[Federal Register Volume 70, Number 141 (Monday, July 25, 2005)]
[Proposed Rules]
[Pages 42674-43011]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-14448]



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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 419 and 485



Medicare Program; Proposed Changes to the Hospital Outpatient 
Prospective Payment System and Calendar Year 2006 Payment Rates; 
Proposed Rule

  Federal Register / Vol. 70, No. 141 / Monday, July 25, 2005 / 
Proposed Rules  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 419 and 485

[CMS-1501-P]
RIN 0938-AN46


Medicare Program; Proposed Changes to the Hospital Outpatient 
Prospective Payment System and Calendar Year 2006 Payment Rates

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

ACTION: Proposed rule.

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SUMMARY: This proposed rule would revise the Medicare hospital 
outpatient prospective payment system to implement applicable statutory 
requirements and changes arising from our continuing experience with 
this system and to implement certain related provisions of the Medicare 
Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. In 
addition, the proposed rule describes proposed changes to the amounts 
and factors used to determine the payment rates for Medicare hospital 
outpatient services paid under the prospective payment system. This 
proposed rule would also change the requirement for physician oversight 
of mid-level practitioners in critical access hospitals (CAHs). These 
changes would be applicable to services furnished on or after January 
1, 2006.

DATES: To be ensured consideration, comments must be received at one of 
the addresses provided in the ADDRESSES section, no later than 5 p.m. 
on September 16, 2005.

ADDRESSES: In commenting, please refer to file code CMS-1501-P. Because 
of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of three ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this proposed rule to http://www.cms.hhs.gov/regulations/ecomments. (Attachments should be in Microsoft Word, WordPerfect, or 
Excel; however, we prefer Microsoft Word).
    2. By regular mail. You may 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-1501-P, P.O. Box 8016, Baltimore, MD 21244-8018.
    3. By express or overnight mail. You may send 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-1501-P, Mail Stop C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses. If you 
intend to deliver your comments to the Baltimore address, please call 
telephone number (410) 786-7195 in advance to schedule your arrival 
with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 
200 Independence Avenue, SW., Washington, DC 20201, or 7500 Security 
Boulevard, Baltimore, MD 21244-1850.

(Because access to the interior of the Hubert H. Humphrey 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 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 received after the comment 
period.
    Submission of Comments on Paperwork Requirements: For comments that 
relate to information collection requirements, mail a copy of comments 
to the following addresses: Centers for Medicare & Medicaid Services, 
Office of Strategic Operations and Regulatory Affairs, Security and 
Standards Group, Office of Issuances, Room C4-24-02, 7500 Security 
Boulevard, Baltimore, MD 21244-1850, Attn: James Wickliffe, CMS-1501-P; 
and, Office of Information and Regulatory Affairs, Office of Management 
and Budget, Room 3001, New Executive Office Building, Washington, DC 
20503, Christopher Martin, CMS Desk Officer, CMS-1501-P.
    Comments submitted to OMB may also be e-mailed to the following 
address: [email protected], or faxed to OMB at (202) 395-
6974.
    Submitting Comments: We welcome comments from the public on all 
issues set forth in this rule to assist us in fully considering issues 
and developing policies. You can assist us by referencing the file code 
CMS-1501-P and the specific ``issue identifier'' that precedes the 
section on which you choose to comment.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. CMS posts all electronic 
comments received before the close of the comment period on its public 
Web site as soon as possible after they have been received. Hard copy 
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, MD 
21244-1850, Monday through Friday of each week from 8:30 a.m. to 4 p.m. 
To schedule an appointment to view public comments, phone 1-800-743-
3951.

FOR FURTHER INFORMATION, CONTACT: Rebecca Kane, (410) 786-0378, 
Outpatient prospective payment issues, and Suzanne Asplen, (410) 786-
4558, Partial hospitalization and community mental health center 
issues.

SUPPLEMENTARY INFORMATION:

Electronic Access

    This Federal Register document is 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.gpoaccess.gov/fr/index.html.

Alphabetical List of Acronyms Appearing in the Proposed Rule

ACEP American College of Emergency Physicians
AHA American Hospital Association
AHIMA American Health Information Management Association
AMA American Medical Association
APC Ambulatory payment classification
AMP Average manufacturer price
ASP Average sales price
ASC Ambulatory surgical center
AWP Average wholesale price
BBA Balanced Budget Act of 1997, Pub. L. 105-33
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection 
Act of 2000, Pub. L. 106-554
BBRA Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 
1999, Pub. L. 106-113
CAH Critical access hospital
CBSA Core-Based Statistical Areas
CCR (Cost center specific) cost-to-charge ratio
CMHC Community mental health center

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CMS Centers for Medicare & Medicaid Services (formerly known as the 
Health Care Financing Administration)
CORF Comprehensive outpatient rehabilitation facility
CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 2005, 
copyrighted by the American Medical Association
CRNA Certified registered nurse anesthetist
CY Calendar year
DMEPOS Durable medical equipment, prosthetics, orthotics, and supplies
DMERC Durable medical equipment regional carrier
DRG Diagnosis-related group
DSH Disproportionate share hospital
EACH Essential Access Community Hospital
E/M Evaluation and management
EPO Erythropoietin
ESRD End-stage renal disease
FACA Federal Advisory Committee Act, Pub. L. 92-463
FDA Food and Drug Administration
FI Fiscal intermediary
FSS Federal Supply Schedule
FY Federal fiscal year
GAO Government Accountability Office
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, Pub. 
L. 104-191
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
MMA Medicare Prescription Drug, Improvement, and Modernization Act of 
2003, Pub. L. 108-173
MSA Metropolitan Statistical Area
NCCI National Correct Coding Initiative
NCD National Coverage Determination
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
PPI Producer Price Index
PPS Prospective payment system
PPV Pneumococcal pneumonia (virus)
PRA Paperwork Reduction Act
QIO Quality Improvement Organization
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 of 1982, Pub. L. 97-248
TOPS Transitional outpatient payments
USPDI United States Pharmacopoeia Drug Information

    To assist readers in referencing sections contained in this 
document, we are providing the following outline of contents:

Outline of Contents

I. Background
    A. Legislative and Regulatory Authority for the Hospital 
Outpatient Prospective Payment System
    B. Excluded OPPS Services and Hospitals
    C. Prior Rulemaking
    D. APC Advisory Panel
    1. Authority for the APC Panel
    2. Establishment of the APC Panel
    3. APC Panel Meetings and Organizational Structure
    E. Provisions of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 To Be Implemented Beginning in CY 2006
    1. Hold Harmless Provisions
    2. Study and Authorization of Adjustment for Rural Hospitals
    3. Payment for ``Specified Covered Outpatient Drugs''
    4. Adjustment in Payment Rates for ``Specified Covered 
Outpatient Drugs'' for Overhead Costs
    5. Budget Neutrality Adjustment
    F. CMS' Commitment to New Technologies
    G. Summary of the Major Content of This Proposed Rule
II. Proposed Updates Affecting Payments for CY 2006
    A. Recalibration of APC Relative Weights for CY 2006
    1. Database Construction
    a. Database Source and Methodology
    b. Proposed Use of Single and Multiple Procedure Claims
    2. Proposed Calculation of Median Costs for CY 2006
    3. Proposed Calculation of Scaled OPPS Payment Weights
    4. Proposed Changes to Packaged Services
    B. Proposed Payment for Partial Hospitalization
    1. Background
    2. Proposed PHP APC Update for CY 2006
    3. Proposed Separate Threshold for Outlier Payments to CMHCs
    C. Proposed Conversion Factor Update for CY 2006
    D. Proposed Wage Index Changes for CY 2006
    E. Proposed Statewide Average Default Cost-to-Charge Ratios
    F. Expiring Hold Harmless Provision for Transitional Corridor 
Payments for certain Rural Hospitals
    G. Proposed Adjustment for Rural Hospitals
    1. Factors Contributing to Unit Cost Differences Between Rural 
Hospitals and Urban Hospitals
    2. Explanatory Variables
    3. Results
    H. Proposed Hospital Outpatient Outlier Payments
    I. Calculation of Proposed National Unadjusted Medicare Payment
    J. Proposed Beneficiary Copayments for CY 2006
    1. Background
    2. Proposed Copayment for CY 2006
    3. Calculation of the Proposed Unadjusted Copayment Amount for 
CY 2006
III. Proposed Ambulatory Payment Classification (APC) Group Policies
    A. Background
    B. Proposed Changes--Variations Within APCs
    1. Application of the 2 Times Rule
    a. APC 0146: Level I Sigmoidoscopy
    b. APC 0342: Level I Pathology
    2. Proposed Exceptions to the 2 Times Rule
    C. New Technology APCs
    1. Background
    2. Proposed Refinement of New Technology Cost Bands
    3. Proposed Requirements for Assigning Services to New 
Technology APCs
    4. Proposed Movement of Procedures from New Technology APCs to 
Clinically Appropriate APCs
    a. Proton Beam Therapy
    b. Stereotactic Radiosurgery
    c. Other Services in New Technology APCs
    D. Proposed APC-Specific Policies
    1. Hyperbaric Oxygen Therapy
    2. Allergy Testing
    3. Stretta Procedure
    4. Vascular Access Procedures
    E. Proposed Addition of New Procedure Codes
IV. Proposed Payment Changes for Devices
    A. Device-Dependent APCs
    B. APC Panel Recommendations Pertaining to APC 0107 and APC 0108
    C. Pass-Through Payments for Devices
    1. Expiration of Transitional Pass-Through Payments for Certain 
Devices
    2. Proposed Policy for CY 2006
    D. Other Policy Issues Relating to Pass-Through Device 
Categories
    1. Provisions for Reducing Transitional Pass-Through Payments to 
Offset Costs Packaged into APC Groups
    a. Background
    b. Proposed Policy for CY 2006
    2. Criteria for Establishing New Pass-Through Device Categories
    a. Surgical Insertion and Implantation Criterion
    b. Public Comments Received and Our Responses
    c. Existing Device Category Criterion
V. Proposed Payment Changes for Drugs, Biologicals, and 
Radiopharmaceutical Agents
    A. Transitional Pass-Through Payment for Additional Costs of 
Drugs and Biologicals

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    1. Background
    2. Expiration in CY 2005 of Pass-Through Status for Drugs and 
Biologicals
    3. Drugs and Biologicals with Proposed Pass-Through Status in CY 
2006
    B. Proposed Payment for Drugs, Biologicals, and 
Radiopharmaceuticals Without Pass-Through Status
    1. Background
    2. Proposed Criteria for Packaging Payment for Drugs, 
Biologicals, and Radiopharmaceuticals
    3. Proposed Payment for Drugs, Biologicals, and 
Radiopharmaceuticals Without Pass-Through Status That Are Not 
Packaged
    a. Proposed Payment for Specified Covered Outpatient Drugs
    (1) Background
    (2) Proposed Changes for CY 2006 Related to Pub. L. 108-173
    (3) Data Sources Available for Setting CY 2006 Payment Rates
    (4) CY 2006 Proposed Payment Policy for Radiopharmaceutical 
Agents
    (5) MedPAC Report on APC Payment Rate Adjustment of Specified 
Covered Outpatient Drugs
    b. Proposed CY 2006 Payment for Nonpass-Through Drugs, 
Biologicals, and Radiopharmaceuticals with HCPCS Codes But Without 
OPPS Hospital Claims Data
    C. Proposed Coding and Billing Changes for Specified Covered 
Outpatient Drugs
    1. Background
    2. Proposed Policy for CY 2006
    D. Proposed Payment for New Drugs, Biologicals, and 
Radiopharmaceuticals Before HCPCS Codes Are Assigned
    1. Background
    2. Proposed Policy for CY 2006
    E. Proposed Payment for Vaccines
    F. Proposed Changes in Payments for Single Indication Orphan 
Drugs
VI. Estimate of Transitional Pass-Through Spending in CY 2006 for 
Drugs, Biologicals, and Devices
    A. Total Allowed Pass-Through Spending
    B. Estimate of Pass-Through Spending for CY 2006
VII. Proposed Brachytherapy Payment Changes
    A. Background
    B. Proposed Changes Related to Pub. L. 108-173
VIII. Proposed Coding and Payment for Drug Administration
    A. Background
    B. Proposed Changes for CY 2006
    C. Proposed Changes to Vaccine Administration
IX. Hospital Coding for Evaluation and Management (E/M) Services
X. Proposed Payment for Blood and Blood Products
    A. Background
    B. Proposed Changes for CY 2006
XI. Proposed Payment for Observation Services
    A. Background
    B. Proposed CY 2006 Coding Changes for Observation Services
    C. Proposed Criteria for Separately Payable Observation Services
    1. Diagnosis Requirements
    2. Observation Time
    3. Additional Hospital Services
    4. Physician Evaluation
    D. Separate Payment for Direct Admission to Observation Care 
(APC 0600)
XII. Procedures That Will Be Paid Only as Inpatient Procedures
    A. Background
    B. Proposed Changes to the Inpatient List
    C. Ancillary Outpatient Services When Patient Expires
XIII. Proposed Indicator Assignments
    A. Proposed Status Indicator Assignments
    B. Proposed Comment Indicators for the CY 2006 OPPS Final Rule
XIV. Proposed Nonrecurring Policy Changes
    A. Proposed Payment for Multiple Diagnostic Imaging Procedures
    B. Interrupted Procedure Payment Policies (Modifiers -52, -73, 
and -74)
XV. OPPS Policy and Payment Recommendations
    A. MedPAC Recommendations
    B. APC Panel Recommendations
    C. GAO Recommendations
XVI. Physician Oversight of Mid-Level Practitioners in Critical 
Access Hospitals
    A. Background
    B. Proposed Policy Change
XVII. Files Available to the Public via the Internet
XVIII. Collection of Information Requirements
XIX. Response to Public Comments
XX. Regulatory Impact Analysis
    A. OPPS: General
    1. Executive Order 12866
    2. Regulatory Flexibility Act (RFA)
    3. Small Rural Hospitals
    4. Unfunded Mandates
    5. Federalism
    B. Impact of Proposed Changes in this Proposed Rule
    C. Alternatives Considered
    1. Option Considered for Proposed Payment Policy for Separately 
Payable Drugs and Biologicals
    2. Payment Adjustment for Rural Sole Community Hospitals
    3. Change in the Percentage of Total OPPS Payments Dedicated to 
Outlier Payments
    D. Limitations of Our Analysis
    E. Estimated Impacts of this Proposed Rule on Hospitals
    F. Estimated Impacts of this Proposed Rule on Beneficiaries

Regulation Text

Addenda

Addendum A--List of Ambulatory Payment Classification (APCs) with 
Status Indicators, Relative Weights, Payment Rates, and Copayment 
Amounts for CY 2006
Addendum B--Payment Status by HCPCS Code and Related Information--CY 
2006
Addendum C--Healthcare Common Procedure Coding System (HCPCS) Codes 
by Ambulatory Payment Classification (APC) (Available only on CMS 
Web site via Internet. Refer to section XVII. of the preamble of 
this proposed rule.)
Addendum D1--Payment Status Indicators for the Hospital Outpatient 
Prospective Payment System
Addendum D2--Comment Indicators
Addendum E--CPT Codes That Are 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 K--Puerto Rico Wage Index by CBSA
Addendum L--Out-Migration Wage Adjustment--CY 2006
Addendum M--Hospital Reclassifications and Redesignations by 
Individual Hospitals and CBSA
Addendum N--Hospital Reclassifications and Redesignations by 
Individual Hospitals under Section 508 of Pub. L. 108-173
Addendum O--Hospitals Redesignated as Rural Under Section 
1886(d)(8)(E) of the Act

I. Background

A. Legislative and Regulatory Authority for the Hospital 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 reasonable 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 Medicare, Medicaid, and SCHIP 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. Section 1833(t) of the Act was also amended by the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(MMA), Pub. L. 108-173, enacted on December 8, 2003. (Discussion of 
provisions related specifically to the CY 2006 OPPS is included in 
sections V. and VII. of this proposed rule.) The OPPS was first 
implemented for services furnished on or after August 1, 2000. 
Implementing regulations for the OPPS are located at 42 CFR part 419.
    Under the OPPS, we pay for hospital outpatient services on a rate-
per-service basis that varies according to the ambulatory payment 
classification (APC) group to which the service is

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assigned. We use Healthcare Common Procedure Coding System (HCPCS) 
codes (which include certain Current Procedural Terminology (CPT) 
codes) and descriptors to identify and group the services within each 
APC group. The OPPS includes payment for most hospital outpatient 
services, except those identified in section I.B. of this proposed 
rule. Section 1833(t)(1)(B)(ii) of the Act provides for Medicare 
payment under the OPPS for certain services designated by the Secretary 
that are furnished to inpatients who have exhausted their Part A 
benefits or who are otherwise not in a covered Part A stay. Section 611 
of Pub. L. 108-173 provided for Medicare coverage of an initial 
preventive physical examination, subject to the applicable deductible 
and coinsurance, as an outpatient department service, payable under the 
OPPS. In addition, the OPPS includes payment for partial 
hospitalization services furnished by community mental health centers 
(CMHCs).
    The OPPS rate is an unadjusted national payment amount that 
includes the Medicare payment and the beneficiary copayment. This rate 
is divided into a labor-related amount and a nonlabor-related amount. 
The labor-related amount is adjusted for area wage differences using 
the inpatient hospital wage index value for the locality in which the 
hospital or CMHC is located.
    All services and items within an APC group are comparable 
clinically and with respect to resource use (section 1833(t)(2)(B) of 
the Act). In accordance with section 1833(t)(2) of the Act, subject to 
certain exceptions, services and items 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 APC group is more than 2 times greater than the 
lowest median cost for an item or service within the same APC group 
(referred to as the ``2 times rule''). In implementing this provision, 
we use the median cost of the item or service assigned to an APC group.
    Special payments under the OPPS may be made for new technology 
items and services in one of two ways. Section 1833(t)(6) of the Act 
provides for temporary additional payments or ``transitional pass-
through payments'' for certain drugs, biological agents, brachytherapy 
devices used for the treatment of cancer, and categories of medical 
devices for at least 2 but not more than 3 years. For new technology 
services that are not eligible for pass-through payments and for which 
we lack sufficient data to appropriately assign them to a clinical APC 
group, we have established special APC groups based on costs, which we 
refer to as ``APC cost bands.'' These cost bands allow us to price 
these new procedures more appropriately and consistently. Similar to 
pass-through payments, these special payments for new technology 
services are also temporary; that is, we retain a service within a new 
technology APC group until we acquire adequate data to assign it to a 
clinically appropriate APC group.

B. Excluded OPPS Services and Hospitals

    Section 1833(t)(1)(B)(i) of the Act authorizes the Secretary to 
designate the hospital outpatient services that are paid under the 
OPPS. While most hospital outpatient services are payable under the 
OPPS, section 1833(t)(1)(B)(iv) of the Act excluded payment for 
ambulance, physical and occupational therapy, and speech-language 
pathology services, for which payment is made under a fee schedule. 
Section 614 of Pub. L. 108-173 amended section 1833(t)(1)(B)(iv) of the 
Act to exclude OPPS payment for screening and diagnostic mammography 
services. The Secretary exercised the broad authority granted under the 
statute to exclude from the OPPS those services that are paid under fee 
schedules or other payment systems. Such excluded services include, for 
example, the professional services of physicians and nonphysician 
practitioners paid under the Medicare Physician Fee Schedule (MPFS); 
laboratory services paid under the clinical diagnostic laboratory fee 
schedule; services for beneficiaries with end-stage renal disease 
(ESRD) that are paid under the ESRD composite rate; and services and 
procedures that require an inpatient stay that are paid under the 
hospital inpatient prospective payment system (IPPS). We set forth the 
services that are excluded from payment under the OPPS in Sec.  419.22 
of the regulations.
    Under Sec.  419.20 of the regulations, we specify the types of 
hospitals and entities that are excluded from payment under the OPPS. 
These excluded entities include Maryland hospitals, but only for 
services that are paid under a cost containment waiver in accordance 
with section 1814(b)(3) of the Act; critical access hospitals (CAHs); 
hospitals located outside of the 50 States, the District of Columbia, 
and Puerto Rico; and Indian Health Service hospitals.

C. Prior Rulemaking

    On April 7, 2000, we published in the Federal Register a final rule 
with comment period (65 FR 18434) to implement a prospective payment 
system for hospital outpatient services. The hospital OPPS was first 
implemented for services furnished on or after August 1, 2000. Section 
1833(t)(9) of the Act requires the Secretary to review certain 
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. Since implementing the OPPS, we have published final rules 
in the Federal Register annually to implement statutory requirements 
and changes arising from our experience with this system. For a full 
discussion of the changes to the OPPS, we refer readers to these 
Federal Register final rules.\1\
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    \1\ Interim final rule with comment period, August 3, 2000 (65 
FR 47670); interim final rule with comment period, November 13, 2000 
(65 FR 67798); final rule and interim final rule with comment 
period, November 2, 2001 (66 FR 55850 and 55857); final rule, 
November 30, 2001 (66 FR 59856); final rule, December 31, 2001 (66 
FR 67494); final rule, March 1, 2002 (67 FR 9556); final rule, 
November 1, 2002 (67 FR 66718); final rule with comment period, 
November 7, 2003 (68 FR 63398); correction of the November 7, 2003 
final rule with comment period, December 31, 2003 (68 FR 75442); 
interim final rule with comment period, January 6, 2004 (69 FR 820); 
and final rule with comment period, November 15, 2004 (69 FR 65681).
---------------------------------------------------------------------------

    On November 15, 2004, we published in the Federal Register a final 
rule with comment period (69 FR 65681) that revised the OPPS to update 
the payment weights and conversion factor for services payable under 
the calendar year (CY) 2005 OPPS on the basis of claims data from 
January 1, 2003 through December 31, 2003, and to implement certain 
provisions of Pub. L. 108-173. In addition, we responded to public 
comments received on the January 6, 2004 interim final rule with 
comment period relating to Pub. L. 108-173 provisions that were 
effective January 1, 2004, and finalized those policies. Further, we 
responded to public comments received on the November 7, 2003 final 
rule with comment period pertaining to the APC assignment of HCPCS 
codes identified in Addendum B of that rule with the new interim (NI) 
comment indicators; and public comments received on the August 16, 2004 
OPPS proposed rule (69 FR 50448).
    Subsequent to publishing the November 15, 2004 final rule with 
comment period, we published a correction of final rule with comment 
period on December 30, 2004 (69 FR 78315). This document corrected 
technical errors that appeared in the November 15, 2004 final rule with

[[Page 42678]]

comment period. It also provided additional information about the CY 
2005 wage indices for the OPPS that was not published in the November 
15, 2004 final rule with comment period.

D. APC Advisory Panel

1. Authority of the APC Panel
    Section 1833(t)(9)(A) of the Act, as amended by section 201(h) of 
the BBRA of 1999, requires that we consult with an outside panel of 
experts to review the clinical integrity of the payment groups and 
weights under the OPPS. The Advisory Panel on Ambulatory Payment 
Classification (APC) Groups (the APC Panel), discussed under section 
I.D.2. of this preamble, fulfills this requirement. The Act further 
specifies that the APC Panel will act in an advisory capacity. This 
expert panel, which is to be composed of 15 representatives of 
providers subject to the OPPS (currently employed full-time, not 
consultants, in their respective areas of expertise), reviews and 
advises us about the clinical integrity of the APC groups and their 
weights. The APC Panel is not restricted to using our data and may use 
data collected or developed by organizations outside the Department in 
conducting its review.
2. Establishment of the APC Panel
    On November 21, 2000, the Secretary originally signed the charter 
establishing the APC Panel. The APC Panel is technical in nature and is 
governed by the provisions of the Federal Advisory Committee Act 
(FACA), as amended (Pub. L. 92-463). Since its initial chartering, the 
Secretary has twice renewed the APC Panel's charter: On November 1, 
2002, and on November 8, 2004. The renewed charter indicates that the 
APC Panel continues to be technical in nature; is governed by the 
provisions of the FACA with a Designated Federal Official (DEO) to 
oversee the day-to-day administration of the FACA requirements and to 
provide to the Committee Management Officer all committee reports for 
forwarding to the Library of Congress; may convene up to three meetings 
per year; and is chaired by a Federal official who also serves as a CMS 
medical officer.
    Originally, in establishing the APC 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 who 
nominated either colleagues or themselves. After carefully reviewing 
the applications, we chose 15 highly qualified individuals to serve on 
the APC Panel. Because of the loss of four APC Panel members due to the 
expiration of terms of office on March 31, 2004, we published a Federal 
Register notice on January 23, 2004 (69 FR 3370) that solicited 
nominations for APC Panel membership. From the 24 nominations that we 
received, we chose four new members. Six members' terms expired on 
March 31, 2005; therefore, a Federal Register notice was published on 
February 25, 2005, requesting nominations to the APC Panel. We received 
only 13 nominations before the nomination period closed on March 15, 
2005. Therefore, we extended the deadline for nominations to May 9, 
2005, and announced the extension in the Federal Register on April 8, 
2005 (70 FR 18028). The entire APC Panel membership and information 
pertaining to it, including Federal Register notices, meeting dates, 
agenda topics, and meeting reports are identified on the CMS Web site: 
http://www.cms.hhs.gov/faca/apc/apcmem.asp.
3. APC Panel Meetings and Organizational Structure
    The APC Panel first met on February 27, February 28, and March 1, 
2001. Since that initial meeting, the APC Panel has held six subsequent 
meetings, with the last meeting taking place on February 23 and 24, 
2005. (The APC Panel did not meet on February 25, 2004, as announced in 
the meeting notice published on December 30, 2004, (69 FR 78464).) 
Prior to each of these biennial meetings, we published a notice in the 
Federal Register to announce each meeting and, when necessary, to 
solicit and announce nominations for APC Panel membership. For a more 
detailed discussion about these announcements, refer to the following 
Federal Register notices: December 5, 2000 (65 FR 75943), December 14, 
2001 (66 FR 64838), December 27, 2002 (67 FR 79107), July 25, 2003 (68 
FR 44089), December 24, 2003 (68 FR 74621), August 5, 2004 (69 FR 
47446), and December 30, 2004 (69 FR 78464).
    During these meetings, the APC Panel established its operational 
structure that, in part, includes the use of three subcommittees to 
facilitate its required APC review process. Currently, the three 
subcommittees are the Data Subcommittee, the Observation Subcommittee, 
and the Packaging Subcommittee. The Data Subcommittee is responsible 
for studying the data issues confronting the APC Panel and for 
recommending viable options for resolving them. This subcommittee was 
initially established on April 23, 2001, as the Research Subcommittee 
and reestablished as the Data Subcommittee on April 13, 2004, and 
February 11, 2005. The Observation Subcommittee, which was established 
on June 24, 2003, and reestablished with new members on March 8, 2004, 
and February 11, 2005, reviews and makes recommendations to the APC 
Panel on all issues pertaining to observation services paid under the 
OPPS, such as coding and operational issues. The Packaging 
Subcommittee, which was established on March 8, 2004 and reestablished 
with new members on February 11, 2005, studies and makes 
recommendations on issues pertaining to services that are not 
separately payable under the OPPS but are bundled or packaged APC 
payments. Each of these subcommittees was established by a majority 
vote of the APC Panel during a scheduled APC Panel meeting. All 
subcommittee recommendations are discussed and voted upon by the full 
APC Panel.
    For a detailed discussion of the APC Panel meetings, refer to the 
hospital OPPS final rules cited in section I.C. of this preamble. Full 
discussion of the recommendations resulting from the APC Panel's 
February 2005 meeting are included in the sections of this preamble 
that are specific to each recommendation.

E. Provisions of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 To Be Implemented Beginning in CY 2006

    On December 8, 2003, the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (MMA), Pub. L. 108-173, was enacted. Pub. 
L. 108-173 made changes to the Act relating to the Medicare OPPS. In 
the January 6, 2004 interim final rule with comment period and the 
November 15, 2004 final rule with comment period, we implemented 
provisions of Pub. L. 108-173 relating to the OPPS that were effective 
for CY 2004 and CY 2005, respectively. Provisions of Pub. L. 108-173 
that were implemented in CY 2004 or CY 2005, and that are continuing in 
CY 2006, are discussed throughout this proposed rule. Moreover, in this 
proposed rule, we are proposing to implement the following provisions 
of Pub. L. 108-173 that affect the OPPS beginning in CY 2006:
1. Hold Harmless Provisions
    Section 411 of Pub. L. 108-173 amended section 1833(t)(7)(D)(i) of 
the Act and extended the hold harmless provision for small rural 
hospitals having 100 or fewer beds through December 31, 2005. Section 
411 of Pub. L. 108-173 further amended section 1833(t)(7) of the Act to 
provide that hold-harmless transitional corridor payments shall apply 
through December

[[Page 42679]]

31, 2005 to sole community hospitals (SCHs) (as defined in section 
1886(d)(5)(D)(iii) of the Act) located in a rural area. In accordance 
with these provisions, effective January 1, 2006, we are proposing to 
discontinue transitional corridor payments for small rural hospitals 
having 100 or fewer beds and for SCHs located in a rural area.
2. Study and Authorization of Adjustment for Rural Hospitals
    Section 411(b) of Pub. L. 108-173 added a new paragraph (13) to 
section 1833(t) of the Act to authorize an ``Adjustment for Rural 
Hospitals''. This provision requires us to conduct a study to determine 
if costs incurred by hospitals located in rural areas by APCs exceed 
those costs incurred by hospitals located in urban areas. This 
provision further requires us to provide for an appropriate adjustment 
by January 1, 2006, if we find that the costs incurred by hospitals 
located in rural areas exceed those costs incurred by hospitals located 
in urban areas.
3. Payment for ``Specified Covered Outpatient Drugs''
    Section 621(a)(1) of Pub. L. 108-173 added section 1833(t)(14) to 
the Act that specifies payments for certain ``specified covered 
outpatient drugs'' beginning in 2006. Specifically, section 
1833(t)(14)(A)(iii)(I) of the Act states that such payment shall be 
equal to what we determine to be the average acquisition cost for the 
drug, taking into account hospital acquisition cost survey data 
furnished by the Government Accountability Office (GAO). Section 
1833(t)(14)(A)(iii)(II) of the Act further notes that if hospital 
acquisition cost data are not available, payment for specified covered 
outpatient drugs shall equal the average price for the drug established 
under section 1842(o), section 1847(A), or section 1847(B) of the Act 
as calculated and adjusted by the Secretary as necessary. Both payment 
approaches are subject to adjustments under section 1833(t)(14)(E) of 
the Act as discussed below.
4. Adjustment in Payment Rates for ``Specified Covered Outpatient 
Drugs'' for Overhead Costs
    Section 621(a)(1) of Pub. L. 108-173 added section 1833(t)(14)(E) 
to the Act. Section 1833(t)(14)(E)(ii) of the Act authorizes us to make 
an adjustment to payments for ``specified covered outpatient drugs'' to 
take into account overhead and related expenses such as pharmacy 
services and handling costs, based on recommendations contained in a 
report prepared by the Medicare Payment Advisory Commission (MedPAC).
5. Budget Neutrality Adjustment
    Section 621(a)(1) of Pub. L. 108-173 amended the Act by adding 
section 1833(t)(14)(H), which requires that additional expenditures 
resulting from adjustments in APC payment rates for specified covered 
outpatient drugs be taken into account beginning in CY 2006 and 
continuing in subsequent years, in establishing the OPPS conversion, 
weighting, and other adjustment factors.

F. CMS' Commitment to New Technologies

(If you choose to comment on issues in this section, please include 
the caption ``Commitment to New Technologies'' at the beginning of 
your comment.)

    CMS is committed to ensuring that Medicare beneficiaries will have 
timely access to new medical treatments and technologies that are well-
evaluated and demonstrated to be effective. We launched the Council on 
Technology and Innovation (CTI) to provide the Agency with improved 
methods for developing practical information about the clinical 
benefits of new medical technologies to result in faster and more 
efficient coverage and payment of these medical technologies. The CTI 
supports CMS efforts to develop better evidence on the safety, 
effectiveness, and cost of new and approved technologies to help 
promote their more effective use.
    We want to provide doctors and patients with better information 
about the benefits of new medical treatments and/or technologies, 
especially compared to other treatment options. We also want 
beneficiaries to have access to valuable new medical innovations as 
quickly and efficiently as possible. We note there are a number of 
payment mechanisms in the OPPS and the IPPS designed to achieve 
appropriate payment of promising new technologies. In the OPPS, 
qualifying new medical devices may be paid on a cost basis by means of 
transitional pass-through payments, in addition to the APC payments for 
the procedures which utilize the devices. In addition, qualifying new 
services may be assigned for payment to New Technology APCs or, if 
appropriate, to regular clinical APCs. In the IPPS, qualifying new 
technologies may receive add-on payments to the standard diagnosis-
related group (DRG) payments. We also note that collaborative efforts 
are underway to facilitate coordination between the Food and Drug 
Administration (FDA) and CMS with regard to streamlining the CMS 
coverage process by which new technologies come to the marketplace.
    To promote timely access to new medical treatments and 
technologies, in this proposed rule we are proposing enhancements to 
both the OPPS pass-through payment criteria for devices as discussed in 
section IV.D.2. of this preamble and the qualifying process for 
assignment of new services to New Technology APCs or regular clinical 
APCs discussed in section III.C.3. of this preamble. We are proposing 
to make device pass-through eligibility available to a broader range of 
qualifying devices. We are also proposing to change the application and 
review process for assignment of new services to New Technology APCs to 
promote thoughtful review of the coding, clinical use and efficacy of 
new services by the wider medical community, encouraging appropriate 
dissemination of new technologies. These enhancements are explained in 
this proposed rule.

G. Summary of the Major Content of This Proposed Rule

    In this proposed rule, we are setting forth proposed changes to the 
Medicare hospital OPPS for CY 2006. These changes would be effective 
for services furnished on or after January 1, 2006. The following is a 
summary of the major changes that we are proposing to make:
1. Proposed Updates to Payments for CY 2006
    In section II. of this preamble, we set forth--
     The methodology used to recalibrate the proposed APC 
relative payment weights and the proposed recalibration of the relative 
payment weights for CY 2006.
     The proposed payment for partial hospitalization, 
including the proposed separate threshold for outlier payments for 
CMCHs.
     The proposed update to the conversion factor used to 
determine payment rates under the OPPS for CY 2006.
     The proposed retention of our current policy to apply the 
IPPS wage indices to wage adjust the APC median costs in determining 
the OPPS payment rate and the copayment standardized amount for CY 
2006.
     The proposed update of statewide average default cost-to-
charge ratios.
     Proposed changes relating to the expiring hold harmless 
payment provision.
     Proposed changes to payment for rural sole community 
hospitals for CY 2006.

[[Page 42680]]

     Proposed changes in the way we calculate hospital 
outpatient outlier payments for CY 2006.
     Calculation of the proposed national unadjusted Medicare 
OPPS payment.
     The proposed beneficiary copayment for OPPS services for 
CY 2006.
2. Proposed Ambulatory Payment Classification (APC) Group Policies
    In section III. of this preamble, we discuss our proposal to 
establish a number of new APCs and to make changes to the assignment of 
HCPCS codes under a number of existing APCs based on our analyses of 
Medicare claims data and recommendations of the APC Panel. We also 
discuss in section III. of this preamble, the application of the 2 
times rule and proposed exceptions to it; proposed changes for specific 
APCs; the proposed refinement of the New Technology cost bands; the 
proposed movement of procedures from the New Technology APCs; and the 
proposed additions of new procedure codes to the APC groups.
3. Proposed Payment Changes for Devices
    In section IV. of this preamble, we discuss proposed changes to the 
device-dependent APCs and to the pass-through payment for three 
categories of devices.
4. Proposed Payment Changes for Drugs, Biologicals, and 
Radiopharmaceutical Agents
    In section V. of this preamble, we discuss proposed changes for 
drugs, biologicals, radiopharmaceutical agents, and vaccines.
5. Estimate of Transitional Pass-Through Spending in CY 2006 for Drugs, 
Biologicals, and Devices
    In section VI. of this preamble, we discuss the proposed 
methodology for estimating total pass-through spending and whether 
there should be a pro rata reduction for transitional pass-through 
drugs, biologicals, radiopharmacials, and categories of devices for CY 
2006.
6. Proposed Brachytherapy Payment Changes
    In section VII. of this preamble, we include a discussion of our 
proposal concerning coding and payment for the sources of 
brachytherapy.
7. Proposed Coding and Payment for Drug Administration
    In section VIII. of this preamble, we discuss our proposed coding 
and payment changes for drug administration services.
8. Hospital Coding for Evaluation and Management (E/M) Services
    In section IX. of this preamble, we include a discussion of our 
proposal for developing the coding guidelines for evaluation and 
management services.
9. Proposed Payment for Blood and Blood Products
    In section X. of this preamble, we discuss our proposed payment 
changes for blood and blood products.
10. Proposed Payment for Observation Services
    In section XI. of this preamble, we discuss our proposed criteria 
and coding changes for separately payable observation services.
11. Procedures That Will Be Paid Only as Inpatient Services
    In section XII. of this preamble, we discuss the procedures that we 
are proposing to remove from the inpatient list and assign to APCs.
12. Proposed Indicator Assignments
    In section XIII. of this preamble, we discuss the proposed changes 
to the list of status indicators assigned to APCs and present our 
proposed comment indicators for the CY 2006 OPPS final rule.
13. Proposed Nonrecurring Policy Changes
    In section XIV. of this preamble, we discuss proposed changes in 
payments for multiple diagnostic imaging procedures and in the 
interrupted procedures payment policies.
14. OPPS Policy and Payment Recommendations
    In section XV. of this preamble, we address recommendations made by 
MedPAC, the APC Panel, and the GAO regarding the OPPS for CY 2006.
15. Physician Oversight in Critical Access Hospitals
    In section XVI. of this preamble, we address physician oversight 
for services provided by nonphysician practitioners such as physician 
assistants, nurse practitioners, and clinical nurse specialists in 
critical access hospitals (CAHs).

II. Proposed Updates Affecting Payments for CY 2006

A. Recalibration of APC Relative Weights for CY 2006

(If you choose to comment on the issues in this section, please 
include the caption ``APC Relative Weights'' at the beginning of 
your comment.)
1. Database Construction
a. Database Source and Methodology
    Section 1833(t)(9)(A) of the Act requires that the Secretary review 
and revise the relative payment weights for APCs at least annually. In 
the April 7, 2000 OPPS 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 
a small number of APC changes, these relative payment weights continued 
to be in effect for CY 2001. This policy is discussed in the November 
13, 2000 interim final rule (65 FR 67824 through 67827).
    We are proposing to use the same basic methodology that we 
described in the April 7, 2000 final rule to recalibrate the APC 
relative payment weights for services furnished on or after January 1, 
2006, and before January 1, 2007. That is, we would recalibrate the 
relative payment weights for each APC based on claims and cost report 
data for outpatient services. We are proposing to use the most recent 
available data to construct the database for calculating APC group 
weights. For the purpose of recalibrating APC relative payment weights 
for CY 2006, we used approximately 127 million final action claims for 
hospital OPD services furnished on or after January 1, 2004, and before 
January 1, 2005. Of the 127 million final action claims for services 
provided in hospital outpatient settings, 102 million claims were of 
the type of bill potentially appropriate for use in setting rates for 
OPPS services (but did not necessarily contain services payable under 
the OPPS). Of the 102 million claims, we were able to use 49 million 
whole claims to set the proposed OPPS APC relative weights for CY 2006 
OPPS. From the 49 million whole claims, we created 81 million single 
records, of which 50 million were ``pseudo'' single claims (created 
from multiple procedure claims using the process we discuss in this 
section).
    The proposed APC relative weights and payments in Addenda A and B 
to this proposed rule were calculated using claims from this period 
that had been processed before January 1, 2005. We selected claims for 
services paid under the OPPS and matched these claims to the most 
recent cost report filed by the individual hospitals represented in our 
claims data. We are proposing that the APC relative payment weights for 
CY 2006 under the OPPS would continue to be based on the median 
hospital costs for services in the APC groups. For the CY 2006 OPPS 
final rule, we are proposing to base APC median costs on

[[Page 42681]]

claims for services furnished in CY 2004 and processed before June 30, 
2005.
b. Proposed Use of Single and Multiple Procedure Claims
    For CY 2006, we are proposing to continue to use single procedure 
claims to set the medians on which the APC relative payment weights 
would be based. As noted in the November 15, 2004 final rule with 
comment period, 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 relative payment 
weights (69 FR 65730 through 65731). Requesters believe that relying 
solely on single procedure claims to recalibrate APC relative payment 
weights fails to take into account data for many frequently performed 
procedures, particularly those commonly performed in combination with 
other procedures. They believe that, by depending upon single procedure 
claims, we base relative payment weights on the least-costly services, 
thereby introducing downward bias to the medians on which the weights 
are based.
    We agree that, optimally, it is desirable to use the data from as 
many claims as possible to recalibrate the APC relative payment 
weights, including those with multiple procedures. We generally use 
single procedure claims to set the median costs for APCs because we 
are, so far, unable to ensure that packaged costs can be appropriately 
allocated across multiple procedures performed on the same date of 
service. However, by bypassing specified codes that we believe do not 
have significant packaged costs, we are able to use more data from 
multiple procedure claims. In many cases this enables us to create 
multiple ``pseudo'' single claims from claims that, as submitted, 
contained multiple separately paid procedures on the same claim. We 
have used the date of service on the claims and a list of codes to be 
bypassed to create ``pseudo'' single claims from multiple procedure 
claims the same as we did in recalibrating the CY 2005 APC relative 
payment weights. We refer to these newly created single procedure 
claims as ``pseudo'' singles because they were submitted by providers 
as multiple procedure claims.
    For CY 2003, we created ``pseudo'' single claims by bypassing HCPCS 
codes 93005 (Electrocardiogram, tracing), 71010 (Chest x-ray), and 
71020 (Chest x-ray) on a submitted claim. However, we did not use 
claims data for the bypassed codes in the creation of the median costs 
for the APCs to which these three codes were assigned because the level 
of packaging that would have remained on the claim after we selected 
the bypass code was not apparent and, therefore, it was difficult to 
determine if the medians for these codes would be correct.
    For CY 2004, we created ``pseudo'' single claims by bypassing these 
three codes and also by bypassing an additional 269 HCPCS codes in 
APCs. We selected these codes based on a clinical review of the 
services and because it was presumed that these codes had only very 
limited packaging and could appropriately be bypassed for the purpose 
of creating ``pseudo'' single claims. The APCs to which these codes 
were assigned were varied and included mammography, cardiac 
rehabilitation, and Level I plain film x-rays. To derive more 
``pseudo'' single claims, we also split the claims where there were 
dates of service for revenue code charges on that claim that could be 
matched to a single procedure code on the claim on the same date.
    As in CY 2003, we did not include the claims data for the bypassed 
codes in the creation of the APCs to which the 269 codes were assigned 
because, again, we had not established that such an approach was 
appropriate and would aid in accurately estimating the median cost for 
that APC. For CY 2004, from about 16.3 million otherwise unusable 
claims, we used about 9.5 million multiple procedure claims to create 
about 27 million ``pseudo'' single claims. For CY 2005, we created 383 
bypass codes and from approximately 24 million otherwise unusable 
claims, we used about 18 million multiple procedure claims to create 
about 52 million ``pseudo'' single claims.
    For CY 2006, we are proposing to continue using date of service 
matching as a tool for creation of ``pseudo'' single claims and to 
continue the use of a bypass list to create ``pseudo'' single claims. 
The process we are proposing for CY 2006 OPPS results in our being able 
to use some part of 90 percent of the total claims that are eligible 
for use in OPPS ratesetting and modeling in developing this proposed 
rule. This process enabled us to use, for CY 2006, 81 million single 
bills for ratesetting: 50 million ``pseudo'' singles and 31 million 
``natural'' single bills (bills that were submitted containing only one 
separately payable major HCPCS code).
    We are proposing to bypass the 404 codes identified in Table 1 to 
create new single claims and to use the line-item costs associated with 
the bypass codes on these claims in the creation of the median costs 
for the APCs into which they are assigned. Of the codes on this list, 
345 were used for bypass in CY 2005. We are proposing to continue the 
use of the codes on the CY 2005 OPPS bypass list and expand it by 
adding 46 codes that, using data presented to the APC Panel at its 
February 2005 meeting, meet the same empirical criteria as those used 
in CY 2005 to create the bypass list. Our examination of the data 
against the criteria for inclusion on the bypass list, as discussed 
below for the addition of new codes, shows that the empirically 
selected codes used for bypass for the CY 2005 OPPS generally continue 
to meet the criteria or come very close to meeting the criteria, and we 
have received no comments against bypassing them.
    To facilitate comment, Table 1 indicates the list of codes we are 
proposing to bypass for creation of ``pseudo'' singles for CY 2006 OPPS 
and indicates those used in the CY 2005 OPPS for bypass and those 
proposed to be added for the CY 2006 OPPS. Bypass codes shown in Table 
1 with an asterisk indicate the HCPCs codes we are proposing to add to 
the list for the CY 2006 OPPS. The criteria we are proposing to use to 
determine the additional codes to add to the CY 2005 OPPS bypass list 
in order to create the bypass list for CY 2006 OPPS are discussed 
below.
    The following empirical criteria were developed by reviewing the 
frequency and magnitude of packaging in the single claims for payable 
codes other than drugs and biologicals. We assumed that the 
representation of packaging on the single claims for any given code is 
comparable to packaging for that code in the multiple claims:
     There were 100 or more single claims for the code. This 
number of single claims ensured that observed outcomes were 
sufficiently representative of packaging that might occur in the 
multiple claims.
     Five percent or fewer of the single claims for the code 
had packaged costs on that single claim for the code. This criterion 
results in limiting the amount of packaging being redistributed to the 
payable procedure remaining on the claim after the bypass code is 
removed and ensures that the costs associated with the bypass code 
represent the cost of the bypassed service.
     The median cost of packaging observed in the single claim 
was equal to or less than $50. This limits the amount of error in 
redistributed costs.
     The code is not a code for an unlisted service.
    We also added to the bypass list three codes (CPT codes 51701, 
51702, and 51703 for bladder catheterization) which do not meet these 
criteria. These

[[Page 42682]]

codes have been packaged and have never been paid separately. For that 
reason, when these were the only services provided to the beneficiary, 
no payment was made to the hospital. The APC Panel's packaging 
subcommittee recommends that we make separate payment when they are the 
only service on the claim. See section II.A.4. of this preamble for 
further discussion of our proposal to pay them separately. We are 
proposing to add them to the bypass list because changing them from 
packaged to separately paid would result in the reduction of the number 
of single bills on which we could base median costs for other major 
separately paid procedures which are billed on the same claim with 
these procedure codes. Single bills which contain other procedures 
would become multiple procedure claims when these bladder 
catheterization codes were converted from packaged to separately paid 
status.
    We examined the packaging on the single procedure claims in the CY 
2004 data used for this proposed rule for these codes. We found that 
none of these codes met the empirical standards for the bypass list. 
However, we believe that when these services are performed on the same 
date as another separately paid procedure, any packaging that appears 
on the claim would appropriately be associated with the other 
procedures and not with these codes. Therefore, we believe that 
bypassing them does not adversely affect the medians for other 
procedures. Moreover, future separate payment for these codes does not 
harm the hospitals that furnish these services, in view of the 
historical absence of separate payment for them under the OPPS in the 
past. Hence, we propose to pay separately for these codes and to add 
them to the bypass list for the CY 2006 OPPS.
    We specifically invite public comment on the ``pseudo'' single 
process, including the bypass list and the criteria.

  Table 1.--Proposed CY 2006 HCPCS Bypass Codes for Creating ``Pseudo''
               Single Claims for Calculating Median Costs
------------------------------------------------------------------------
        HCPCS code \1\            Short description    Status  indicator
------------------------------------------------------------------------
11056*........................  Trim skin lesions, 2  T
                                 to 4.
11057*........................  Trim skin lesions,    T
                                 over 4.
11719.........................  Trim nail(s)........  T
11720.........................  Debride nail, 1-5...  T
11721.........................  Debride nail, 6 or    T
                                 more.
17003*........................  Destroy lesions, 2-   T
                                 14.
31231*........................  Nasal endoscopy, dx.  T
31579.........................  Diagnostic            T
                                 laryngoscopy.
51701*........................  Insert bladder        X
                                 catheter.
51702*........................  Insert temp bladder   X
                                 catheter.
51703*........................  Insert bladder        X
                                 catheter, complex.
51798*........................  Us urine capacity     X
                                 measure.
54240.........................  Penis study.........  T
67820*........................  Revise eyelashes....  S
70030*........................  X-ray eye for         X
                                 foreign body.
70100.........................  X-ray exam of jaw...  X
70110.........................  X-ray exam of jaw...  X
70130.........................  X-ray exam of         X
                                 mastoids.
70140.........................  X-ray exam of facial  X
                                 bones.
70150.........................  X-ray exam of facial  X
                                 bones.
70160.........................  X-ray exam of nasal   X
                                 bones.
70200.........................  X-ray exam of eye     X
                                 sockets.
70210.........................  X-ray exam of         X
                                 sinuses.
70220.........................  X-ray exam of         X
                                 sinuses.
70250.........................  X-ray exam of skull.  X
70260.........................  X-ray exam of skull.  X
70328.........................  X-ray exam of jaw     X
                                 joint.
70330.........................  X-ray exam of jaw     X
                                 joints.
70336*........................  Magnetic image, jaw   S
                                 joint.
70355.........................  Panoramic x-ray of    X
                                 jaws.
70360.........................  X-ray exam of neck..  X
70370*........................  Throat x-ray &        X
                                 fluoroscopy.
70371.........................  Speech evaluation,    X
                                 complex.
70450.........................  Ct head/brain w/o     S
                                 dye.
70480.........................  Ct orbit/ear/fossa w/ S
                                 o dye.
70486.........................  Ct maxillofacial w/o  S
                                 dye.
70544.........................  Mr angiography head   S
                                 w/o dye.
70551*........................  Mri brain w/o dye...  S
71010.........................  Chest x-ray.........  X
71015.........................  Chest x-ray.........  X
71020.........................  Chest x-ray.........  X
71021.........................  Chest x-ray.........  X
71022.........................  Chest x-ray.........  X
71023*........................  Chest x-ray and       X
                                 fluoroscopy.
71030.........................  Chest x-ray.........  X
71034.........................  Chest x-ray and       X
                                 fluoroscopy.
71090.........................  X-ray & pacemaker     X
                                 insertion.
71100.........................  X-ray exam of ribs..  X
71101.........................  X-ray exam of ribs/   X
                                 chest.

[[Page 42683]]

 
71110.........................  X-ray exam of ribs..  X
71111.........................  X-ray exam of ribs/   X
                                 chest.
71120.........................  X-ray exam of         X
                                 breastbone.
71130.........................  X-ray exam of         X
                                 breastbone.
71250.........................  Ct thorax w/o dye...  S
72040.........................  X-ray exam of neck    X
                                 spine.
72050.........................  X-ray exam of neck    X
                                 spine.
72052.........................  X-ray exam of neck    X
                                 spine.
72069*........................  X-ray exam of trunk   X
                                 spine.
72070.........................  X-ray exam of         X
                                 thoracic spine.
72072.........................  X-ray exam of         X
                                 thoracic spine.
72074.........................  X-ray exam of         X
                                 thoracic spine.
72080.........................  X-ray exam of trunk   X
                                 spine.
72090.........................  X-ray exam of trunk   X
                                 spine.
72100.........................  X-ray exam of lower   X
                                 spine.
72110.........................  X-ray exam of lower   X
                                 spine.
72114.........................  X-ray exam of lower   X
                                 spine.
72120.........................  X-ray exam of lower   X
                                 spine.
72125.........................  Ct neck spine w/o     S
                                 dye.
72128*........................  Ct chest spine w/o    S
                                 dye.
72141.........................  Mri neck spine w/o    S
                                 dye.
72146.........................  Mri chest spine w/o   S
                                 dye.
72148.........................  Mri lumbar spine w/o  S
                                 dye.
72170.........................  X-ray exam of pelvis  X
72190.........................  X-ray exam of pelvis  X
72192.........................  Ct pelvis w/o dye...  S
72220.........................  X-ray exam of         X
                                 tailbone.
73000.........................  X-ray exam of collar  X
                                 bone.
73010.........................  X-ray exam of         X
                                 shoulder blade.
73020.........................  X-ray exam of         X
                                 shoulder.
73030.........................  X-ray exam of         X
                                 shoulder.
73050.........................  X-ray exam of         X
                                 shoulders.
73060.........................  X-ray exam of         X
                                 humerus.
73070.........................  X-ray exam of elbow.  X
73080.........................  X-ray exam of elbow.  X
73090.........................  X-ray exam of         X
                                 forearm.
73100.........................  X-ray exam of wrist.  X
73110.........................  X-ray exam of wrist.  X
73120.........................  X-ray exam of hand..  X
73130.........................  X-ray exam of hand..  X
73140.........................  X-ray exam of         X
                                 finger(s).
73218.........................  Mri upper extremity   S
                                 w/o dye.
73221.........................  Mri joint upr extrem  S
                                 w/o dye.
73510.........................  X-ray exam of hip...  X
73520.........................  X-ray exam of hips..  X
73540.........................  X-ray exam of pelvis  X
                                 & hips.
73550.........................  X-ray exam of thigh.  X
73560.........................  X-ray exam of knee,   X
                                 1 or 2.
73562.........................  X-ray exam of knee,   X
                                 3.
73564.........................  X-ray exam, knee, 4   X
                                 or more.
73565.........................  X-ray exam of knees.  X
73590.........................  X-ray exam of lower   X
                                 leg.
73600.........................  X-ray exam of ankle.  X
73610.........................  X-ray exam of ankle.  X
73620.........................  X-ray exam of foot..  X
73630.........................  X-ray exam of foot..  X
73650.........................  X-ray exam of heel..  X
73660.........................  X-ray exam of toe(s)  X
73700.........................  Ct lower extremity w/ S
                                 o dye.
73718*........................  Mri lower extremity   S
                                 w/o dye.
73721.........................  Mri jnt of lwr extre  S
                                 w/o dye.
74000.........................  X-ray exam of         X
                                 abdomen.
74010*........................  X-ray exam of         X
                                 abdomen.
74210.........................  Contrst x-ray exam    S
                                 of throat.
74220.........................  Contrast x-ray,       S
                                 esophagus.
74230.........................  Cine/vid x-ray,       S
                                 throat/esoph.
74235.........................  Remove esophagus      S
                                 obstruction.
74240.........................  X-ray exam, upper gi  S
                                 tract.
74245.........................  X-ray exam, upper gi  S
                                 tract.
74246.........................  Contrst x-ray uppr    S
                                 gi tract.

[[Page 42684]]

 
74247.........................  Contrst x-ray uppr    S
                                 gi tract.
74249.........................  Contrst x-ray uppr    S
                                 gi tract.
74250.........................  X-ray exam of small   S
                                 bowel.
74300.........................  X-ray bile ducts/     X
                                 pancreas.
74301.........................  X-rays at surgery     X
                                 add-on.
74305.........................  X-ray bile ducts/     X
                                 pancreas.
74327.........................  X-ray bile stone      S
                                 removal.
74340.........................  X-ray guide for GI    X
                                 tube.
74350.........................  X-ray guide, stomach  X
                                 tube.
74355.........................  X-ray guide,          X
                                 intestinal tube.
74360.........................  X-ray guide, GI       S
                                 dilation.
74363.........................  X-ray, bile duct      S
                                 dilation.
74475.........................  X-ray control, cath   S
                                 insert.
74480.........................  X-ray control, cath   S
                                 insert.
74485.........................  X-ray guide, GU       S
                                 dilation.
74742.........................  X-ray, fallopian      X
                                 tube.
75894.........................  X-rays, transcath     S
                                 therapy.
75898.........................  Follow-up             X
                                 angiography.
75901.........................  Remove cva device     X
                                 obstruct.
75902.........................  Remove cva lumen      X
                                 obstruct.
75945.........................  Intravascular us....  S
75946.........................  Intravascular us add- S
                                 on.
75960.........................  Transcatheter intro,  S
                                 stent.
75961.........................  Retrieval, broken     S
                                 catheter.
75962.........................  Repair arterial       S
                                 blockage.
75964.........................  Repair artery         S
                                 blockage, each.
75966.........................  Repair arterial       S
                                 blockage.
75968.........................  Repair artery         S
                                 blockage, each.
75970.........................  Vascular biopsy.....  S
75978.........................  Repair venous         S
                                 blockage.
75980.........................  Contrast xray exam    S
                                 bile duct.
75982.........................  Contrast xray exam    S
                                 bile duct.
75984.........................  Xray control          X
                                 catheter change.
75992.........................  Atherectomy, x-ray    S
                                 exam.
75993.........................  Atherectomy, x-ray    S
                                 exam.
75994.........................  Atherectomy, x-ray    S
                                 exam.
75995.........................  Atherectomy, x-ray    S
                                 exam.
75996.........................  Atherectomy, x-ray    S
                                 exam.
76012.........................  Percut                S
                                 vertebroplasty
                                 fluor.
76013.........................  Percut                S
                                 vertebroplasty, ct.
76040.........................  X-rays, bone          X
                                 evaluation.
76061.........................  X-rays, bone survey.  X
76062.........................  X-rays, bone survey.  X
76066.........................  Joint survey, single  X
                                 view.
76070*........................  CT scan, bone         S
                                 density study.
76075.........................  Dexa, axial skeleton  S
                                 study.
76076.........................  Dexa, peripheral      S
                                 study.
76078.........................  Radiographic          X
                                 absorptiometry.
76095.........................  Stereotactic breast   T
                                 biopsy.
76096.........................  X-ray of needle       X
                                 wire, breast.
76100.........................  X-ray exam of body    X
                                 section.
76101.........................  Complex body section  X
                                 x-ray.
76360.........................  Ct scan for needle    S
                                 biopsy.
76380.........................  CAT scan follow-up    S
                                 study.
76393.........................  Mr guidance for       S
                                 needle place.
76511.........................  Echo exam of eye....  S
76512.........................  Echo exam of eye....  S
76516.........................  Echo exam of eye....  S
76519.........................  Echo exam of eye....  S
76536.........................  Us exam of head and   S
                                 neck.
76645.........................  Us exam, breast(s)..  S
76700.........................  Us exam, abdom,       S
                                 complete.
76705.........................  Echo exam of abdomen  S
76770.........................  Us exam abdo back     S
                                 wall, comp.
76775.........................  Us exam abdo back     S
                                 wall, lim.
76778*........................  Us exam kidney        S
                                 transplant.
76801*........................  Ob us < 14 wks,       S
                                 single fetus.
76811*........................  Ob us, detailed,      S
                                 sngl fetus.
76817*........................  Transvaginal us,      S
                                 obstetric.
76830.........................  Transvaginal us, non- S
                                 ob.

[[Page 42685]]

 
76856.........................  Us exam, pelvic,      S
                                 complete.
76857.........................  Us exam, pelvic,      S
                                 limited.
76870.........................  Us exam, scrotum....  S
76880.........................  Us exam, extremity..  S
76941.........................  Echo guide for        S
                                 transfusion.
76945.........................  Echo guide, villus    S
                                 sampling.
76946.........................  Echo guide for        S
                                 amniocentesis.
76948.........................  Echo guide, ova       S
                                 aspiration.
76950*........................  Echo guidance         S
                                 radiotherapy.
76970*........................  Ultrasound exam       S
                                 follow-up.
76977.........................  Us bone density       X
                                 measure.
77280.........................  Set radiation         X
                                 therapy field.
77285.........................  Set radiation         X
                                 therapy field.
77295*........................  Set radiation         X
                                 therapy field.
77300.........................  Radiation therapy     X
                                 dose plan.
77301.........................  Radiotherapy dose     X
                                 plan, imrt.
77315.........................  Teletx isodose plan   X
                                 complex.
77326.........................  Radiation therapy     X
                                 dose plan.
77327.........................  Brachytx isodose      X
                                 calc interm.
77328.........................  Brachytx isodose      X
                                 plan compl.
77331.........................  Special radiation     X
                                 dosimetry.
77332.........................  Radiation treatment   X
                                 aid(s).
77333.........................  Radiation treatment   X
                                 aid(s).
77334.........................  Radiation treatment   X
                                 aid(s).
77336.........................  Radiation physics     X
                                 consult.
77370.........................  Radiation physics     X
                                 consult.
77402*........................  Radiation treatment   S
                                 delivery.
77403.........................  Radiation treatment   S
                                 delivery.
77404*........................  Radiation treatment   S
                                 delivery.
77408*........................  Radiation treatment   S
                                 delivery.
77409.........................  Radiation treatment   S
                                 delivery.
77411.........................  Radiation treatment   S
                                 delivery.
77412.........................  Radiation treatment   S
                                 delivery.
77413.........................  Radiation treatment   S
                                 delivery.
77414.........................  Radiation treatment   S
                                 delivery.
77416.........................  Radiation treatment   S
                                 delivery.
77417.........................  Radiology port        X
                                 film(s).
77418.........................  Radiation tx          S
                                 delivery, imrt.
77470.........................  Special radiation     S
                                 treatment.
78350.........................  Bone mineral, single  X
                                 photon.
80502.........................  Lab pathology         X
                                 consultation.
85060.........................  Blood smear           X
                                 interpretation.
86585.........................  TB tine test........  X
86850.........................  RBC antibody screen.  X
86870.........................  RBC antibody          X
                                 identification.
86880.........................  Coombs test, direct.  X
86885.........................  Coombs test,          X
                                 indirect, qual.
86886.........................  Coombs test,          X
                                 indirect, titer.
86890.........................  Autologous blood      X
                                 process.
86900.........................  Blood typing, ABO...  X
86901.........................  Blood typing, Rh (D)  X
86905.........................  Blood typing, RBC     X
                                 antigens.
86906.........................  Blood typing, Rh      X
                                 phenotype.
86930.........................  Frozen blood prep...  X
86970.........................  RBC pretreatment....  X
88104.........................  Cytopathology,        X
                                 fluids.
88106.........................  Cytopathology,        X
                                 fluids.
88107.........................  Cytopathology,        X
                                 fluids.
88108.........................  Cytopath,             X
                                 concentrate tech.
88160.........................  Cytopath smear,       X
                                 other source.
88161.........................  Cytopath smear,       X
                                 other source.
88172.........................  Cytopathology eval    X
                                 of fna.
88182.........................  Cell marker study...  X
88300.........................  Surgical path, gross  X
88304.........................  Tissue exam by        X
                                 pathologist.
88305.........................  Tissue exam by        X
                                 pathologist.
88311.........................  Decalcify tissue....  X
88312.........................  Special stains......  X
88313.........................  Special stains......  X
88321.........................  Microslide            X
                                 consultation.

[[Page 42686]]

 
88323.........................  Microslide            X
                                 consultation.
88325.........................  Comprehensive review  X
                                 of data.
88331.........................  Path consult          X
                                 intraop, 1 bloc.
88342.........................  Immunohistochemistry  X
88346.........................  Immunofluorescent     X
                                 study.
88347.........................  Immunofluorescent     X
                                 study.
90801.........................  Psy dx interview....  S
90804*........................  Psytx, office, 20-30  S
                                 min.
90805.........................  Psytx, off, 20-30     S
                                 min w/e&m.
90806.........................  Psytx, off, 45-50     S
                                 min.
90807.........................  Psytx, off, 45-50     S
                                 min w/e&m.
90808.........................  Psytx, office, 75-80  S
                                 min.
90809.........................  Psytx, off, 75-80, w/ S
                                 e&m.
90810.........................  Intac psytx, off, 20- S
                                 30 min.
90818.........................  Psytx, hosp, 45-50    S
                                 min.
90826.........................  Intac psytx, hosp,    S
                                 45-50 min.
90845.........................  Psychoanalysis......  S
90846.........................  Family psytx w/o      S
                                 patient.
90847.........................  Family psytx w/       S
                                 patient.
90853.........................  Group psychotherapy.  S
90857.........................  Intac group psytx...  S
90862.........................  Medication            X
                                 management.
92002.........................  Eye exam, new         V
                                 patient.
92004.........................  Eye exam, new         V
                                 patient.
92012.........................  Eye exam established  V
                                 pat.
92014.........................  Eye exam & treatment  V
92020*........................  Special eye           S
                                 evaluation.
92081*........................  Visual field          S
                                 examination(s).
92082.........................  Visual field          S
                                 examination(s).
92083.........................  Visual field          S
                                 examination(s).
92135.........................  Opthalmic dx imaging  S
92136.........................  Ophthalmic biometry.  S
92225.........................  Special eye exam,     S
                                 initial.
92226.........................  Special eye exam,     S
                                 subsequent.
92230.........................  Eye exam with photos  T
92250.........................  Eye exam with photos  S
92275.........................  Electroretinography.  S
92285.........................  Eye photography.....  S
92286.........................  Internal eye          S
                                 photography.
92520.........................  Laryngeal function    X
                                 studies.
92541*........................  Spontaneous           X
                                 nystagmus test.
92546.........................  Sinusoidal            X
                                 rotational test.
92548.........................  Posturography.......  X
92552.........................  Pure tone             X
                                 audiometry, air.
92553.........................  Audiometry, air &     X
                                 bone.
92555.........................  Speech threshold      X
                                 audiometry.
92556.........................  Speech audiometry,    X
                                 complete.
92557*........................  Comprehensive         X
                                 hearing test.
92567.........................  Tympanometry........  X
92582.........................  Conditioning play     X
                                 audiometry.
92585.........................  Auditor evoke         S
                                 potent, compre.
92604*........................  Reprogram cochlear    X
                                 implt 7 >.
93005.........................  Electrocardiogram,    S
                                 tracing.
93225.........................  ECG monitor/record,   X
                                 24 hrs.
93226.........................  ECG monitor/report,   X
                                 24 hrs.
93231.........................  Ecg monitor/record,   X
                                 24 hrs.
93232.........................  ECG monitor/report,   X
                                 24 hrs.
93236.........................  ECG monitor/report,   X
                                 24 hrs.
93270.........................  ECG recording.......  X
93278.........................  ECG/signal-averaged.  S
93303.........................  Echo transthoracic..  S
93307.........................  Echo exam of heart..  S
93320.........................  Doppler echo exam,    S
                                 heart.
93731.........................  Analyze pacemaker     S
                                 system.
93732*........................  Analyze pacemaker     S
                                 system.
93733.........................  Telephone analy,      S
                                 pacemaker.
93734.........................  Analyze pacemaker     S
                                 system.
93735*........................  Analyze pacemaker     S
                                 system.
93736.........................  Telephonic analy,     S
                                 pacemaker.
93741*........................  Analyze ht pace       S
                                 device sngl.

[[Page 42687]]

 
93743.........................  Analyze ht pace       S
                                 device dual.
93797.........................  Cardiac rehab.......  S
93798.........................  Cardiac rehab/        S
                                 monitor.
93875.........................  Extracranial study..  S
93880.........................  Extracranial study..  S
93882.........................  Extracranial study..  S
93886.........................  Intracranial study..  S
93888.........................  Intracranial study..  S
93922.........................  Extremity study.....  S
93923.........................  Extremity study.....  S
93924.........................  Extremity study.....  S
93925.........................  Lower extremity       S
                                 study.
93926.........................  Lower extremity       S
                                 study.
93930*........................  Upper extremity       S
                                 study.
93931.........................  Upper extremity       S
                                 study.
93965.........................  Extremity study.....  S
93970.........................  Extremity study.....  S
93971.........................  Extremity study.....  S
93975.........................  Vascular study......  S
93976.........................  Vascular study......  S
93978.........................  Vascular study......  S
93979.........................  Vascular study......  S
93990.........................  Doppler flow testing  S
94015.........................  Patient recorded      X
                                 spirometry.
95115.........................  Immunotherapy, one    X
                                 injection.
95117*........................  Immunotherapy         X
                                 injections.
95165.........................  Antigen therapy       X
                                 services.
95805.........................  Multiple sleep        S
                                 latency test.
95806*........................  Sleep study,          S
                                 unattended.
95807.........................  Sleep study,          S
                                 attended.
95812.........................  Electroencephalogram  S
                                 (EEG).
95813.........................  Eeg, over 1 hour....  S
95816.........................  Electroencephalogram  S
                                 (EEG).
95819.........................  Electroencephalogram  S
                                 (EEG).
95822.........................  Sleep                 S
                                 electroencephalogra
                                 m.
95864.........................  Muscle test, 4 limbs  S
95867*........................  Muscle test, head or  S
                                 neck.
95872.........................  Muscle test, one      S
                                 fiber.
95900.........................  Motor nerve           S
                                 conduction test.
95921.........................  Autonomic nerv        S
                                 function test.
95925*........................  Somatosensory         S
                                 testing.
95926.........................  Somatosensory         S
                                 testing.
95930.........................  Visual evoked         S
                                 potential test.
95937.........................  Neuromuscular         S
                                 junction test.
95950.........................  Ambulatory eeg        S
                                 monitoring.
95953.........................  EEG monitoring/       S
                                 computer.
95970*........................  Analyze neurostim,    S
                                 no prog.
95972*........................  Analyze neurostim,    S
                                 complex.
95974*........................  Cranial neurostim,    S
                                 complex.
96000.........................  Motion analysis,      S
                                 video/3d.
96100.........................  Psychological         X
                                 testing.
96115.........................  Neurobehavior status  X
                                 exam.
96117*........................  Neuropsych test       X
                                 battery.
96900.........................  Ultraviolet light     S
                                 therapy.
96910.........................  Photochemotherapy     S
                                 with UV-B.
96912.........................  Photochemotherapy     S
                                 with UV-A.
96913.........................  Photochemotherapy,    S
                                 UV-A or B.
98925*........................  Osteopathic           S
                                 manipulation.
98940.........................  Chiropractic          S
                                 manipulation.
99213.........................  Office/outpatient     V
                                 visit, est.
99214.........................  Office/outpatient     V
                                 visit, est.
99241.........................  Office consultation.  V
99242*........................  Office consultation.  V
99243.........................  Office consultation.  V
99244.........................  Office consultation.  V
99245.........................  Office consultation.  V
99273.........................  Confirmatory          V
                                 consultation.
99274.........................  Confirmatory          V
                                 consultation.
99275.........................  Confirmatory          V
                                 consultation.
D0473.........................  Micro exam, prep &    S
                                 report.

[[Page 42688]]

 
G0101.........................  CA screen; pelvic/    V
                                 breast exam.
G0127.........................  Trim nail(s)........  T
G0166.........................  Extrnl counterpulse,  T
                                 per tx.
G0175.........................  OPPS Service, sched   V
                                 team conf.
HCPCS.........................  Descriptor..........  SI
Q0091.........................  Obtaining screen pap  T
                                 smear.
------------------------------------------------------------------------
\1\ HCPCS codes shown with an asterisk are bypass codes we are proposing
  to add to the list for CY 2006.

2. Proposed Calculation of Median Costs for CY 2006
    In this section of the preamble, we discuss the use of claims to 
calculate the proposed OPPS payment rates for CY 2006. The hospital 
outpatient prospective payment page on the CMS Web site on which this 
proposed rule is posted provides an accounting of claims used in the 
development of the proposed rates: http://www.cms.hhs.gov/providers/hopps. The accounting of claims used in the development of the proposed 
rule is included on the Web site under supplemental materials for the 
CY 2006 proposed rule. That accounting provides additional detail 
regarding the number of claims derived at each stage of the process. In 
addition, below we discuss the files of claims that comprise the data 
sets that are available for purchase under a CMS data user contract. 
Our CMS Web site, http://www.cms.hhs.gov/providers/hopps, includes 
information about purchasing the following two OPPS data files: ``OPPS 
Limited Data Set'' and ``OPPS Identifiable Data Set.''
    We are proposing to use the following methodology to establish the 
relative weights to be used in calculating the proposed OPPS payment 
rates for CY 2006 shown in Addenda A and B to this proposed rule. This 
methodology is as follows:
    We used outpatient claims for full CY 2004 to set the proposed 
relative weights for CY 2006. To begin the calculation of the relative 
weights for CY 2006, we pulled all claims for outpatient services 
furnished in CY 2004 from the national claims history file. This is not 
the population of claims paid under the OPPS, but all outpatient claims 
(including, for example, CAH claims, and hospital claims for clinical 
laboratory services for persons who are neither inpatients nor 
outpatients of the hospital).
    We then excluded claims with condition codes 04, 20, 21, and 77. 
These are claims that providers submitted to Medicare knowing that no 
payment will be made. For example, providers submit claims with a 
condition code 21 to elicit an official denial notice from Medicare and 
document that a service is not covered. We then excluded claims for 
services furnished in Maryland, Guam, and the U.S. Virgin Islands 
because hospitals in those geographic areas are not paid under the 
OPPS.
    We divided the remaining claims into the three groups shown below. 
Groups 2 and 3 comprise the 102 million claims that contain hospital 
bill types paid under the OPPS.
    1. Claims that were not bill types 12X, 13X, 14X (hospital bill 
types), or 76X (CMHC bill types). Other bill types, such as ambulatory 
surgical centers (ASCs), bill type 83, are not paid under the OPPS and, 
therefore, these claims were not used to set OPPS payment.
    2. Claims that were bill types 12X, 13X, or 14X (hospital bill 
types). These claims are hospital outpatient claims.
    3. Claims that were bill type 76X (CMHC). (These claims are later 
combined with any claims in item 2 above with a condition code 41 to 
set the per diem partial hospitalization rate determined through a 
separate process.)
    For the cost-to-charge ratio (CCR) calculation process, we used the 
same approach as that used in developing the final APC rates for CY 
2005 (69 FR 65744). That is, we first limited the population of cost 
reports to only those for hospitals that filed outpatient claims in CY 
2004 before determining whether the CCRs for such hospitals were valid. 
This initial limitation changed the distribution of CCRs used during 
the trimming process discussed below.
    We then calculated the CCRs at a departmental level and overall for 
each hospital for which we had claims data. We did this using hospital-
specific data from the Hospital Cost Report Information System (HCRIS). 
We used the most recent available cost report data, in most cases, cost 
reports for CY 2002 or CY 2003. We used the most recent cost report 
available whether submitted or settled. If the most recent available 
cost report was submitted but not settled, we looked at the last 
settled cost report to determine the ratio of submitted to settled 
cost, and we then adjusted the most recent available submitted but not 
settled cost report using that ratio. We propose to use the most 
recently submitted cost reports to calculate the CCRs to be used to 
calculate median costs for the OPPS CY 2006 final rule.
    We then flagged CAHs, which are not paid under the OPPS, and 
hospitals with invalid CCRs. These included claims from hospitals 
without a CCR; those from hospitals paid an all-inclusive rate; those 
from hospitals with obviously erroneous CCRs (greater than 90 or less 
than .0001); and those from hospitals with CCRs that were identified as 
outliers (3 standard deviations from the geometric mean after removing 
error CCRs). In addition, we trimmed the CCRs at the departmental level 
by removing the CCRs for each cost center as outliers if they exceeded 
+/-3 standard deviations of the geometric mean. This is the same 
methodology that we used in developing the final CY 2005 CCRs. For CY 
2006, we are proposing to trim at the departmental CCR level to 
eliminate aberrant CCRs that, if found in high volume hospitals, could 
skew the medians. We used a four-tiered hierarchy of cost center CCRs 
to match a cost center to a revenue code with the top tier being the 
most common cost center and the last tier being the default CCR. If a 
hospital's departmental CCR was deleted by trimming, we set the 
departmental CCR for that cost center to ``missing,'' so that another 
departmental CCR in the revenue center hierarchy could apply. If no 
other departmental CCR could apply to the revenue code on the claim, we 
used the hospital's overall CCR for the revenue code in question. The 
hierarchy of CCRs is available for inspection and comment at the CMS 
Web site: http://www.cms.hhs.gov/providers/hopps/default.asp.
    We then converted the charges on the claim by applying the CCR that 
we believed was best suited to the revenue

[[Page 42689]]

code indicated on the line with the charge. Table 2 below in this 
preamble contains a list of the allowed revenue codes. Revenue codes 
not included in Table 2 are those not allowed under the OPPS because 
their services cannot be paid under the OPPS (for example, inpatient 
room and board charges) and, thus charges with those revenue codes were 
not packaged for creation of the OPPS median costs. If a hospital did 
not have a CCR that was appropriate to the revenue code reported for a 
line-item charge (for example, a visit reported under the clinic 
revenue code, but the hospital did not have a clinic cost center), we 
applied the hospital-specific overall CCR, except as discussed in 
section X. of this preamble, for calculation of costs for blood.
    Thus, we applied CCRs as described above to claims with bill types 
12X, 13X, or 14X, excluding all claims from CAHs and hospitals in 
Maryland, Guam, and the U.S. Virgin Islands, and flagged hospitals with 
invalid CCRs. We excluded claims from all hospitals for which CCRs were 
flagged as invalid.
    We identified claims with condition code 41 as partial 
hospitalization services of CMHCs and moved them to another file. These 
claims were combined with the 76X claims identified previously to 
calculate the proposed partial hospitalization per diem rate.
    We then excluded claims without a HCPCS code. We also moved claims 
for observation services to another file. We moved to another file 
claims that contained nothing but flu and pneumococcal pneumonia 
(``PPV'') vaccine. Influenza and PPV vaccines are paid at reasonable 
cost and, therefore, these claims are not used to set OPPS rates. We 
note that the two above mentioned separate files containing partial 
hospitalization claims and the observation services claims are included 
in the files that are available for purchase as discussed above.
    We next copied line-item costs for drugs, blood, and devices (the 
lines stay on the claim, but are copied off onto another file) to a 
separate file. No claims were deleted when we copied these lines onto 
another file. These line-items are used to calculate the per unit 
median for drugs, radiopharmaceuticals, and blood and blood products. 
The line-item costs were also used to calculate the per administration 
cost of drugs, radiopharmaceuticals, and biologicals (other than blood 
and blood products).
    We then divided the remaining claims into five groups.
    1. Single Major Claims: Claims with a single separately payable 
procedure, all of which would be used in median setting.
    2. Multiple Major Claims: Claims with more than one separately 
payable procedure or multiple units for one payable procedure. As 
discussed below, some of these can be used in median setting.
    3. Single Minor Claims: Claims with a single HCPCS code that is not 
separately payable. These claims may have a single packaged procedure 
or a drug code.
    4. Multiple Minor Claims: Claims with multiple HCPCS codes that are 
not separately payable without examining dates of service. For example, 
pathology codes are not used unless the pathology service is the single 
code on the bill or unless the pathology code is on a separate date of 
service from the other procedure on the claim. The multiple minor file 
has claims with multiple occurrences of pathology codes, with packaged 
costs that cannot be appropriately allocated across the multiple 
pathology codes. However, by matching dates of service for the code and 
the reported costs through the ``pseudo'' single creation process 
discussed earlier, a claim with multiple pathology codes may become 
several ``pseudo'' single claims with a unique pathology code and its 
associated costs on each day. These ``pseudo'' singles for the 
pathology codes would then be considered a separately payable code and 
would be used the same as claims in the single major claim file.
    5. Non-OPPS Claims: Claims that contain no services payable under 
the OPPS. These claims are excluded from the files used for the OPPS. 
Non-OPPS claims have codes paid under other fee schedules, for example, 
durable medical equipment or clinical laboratory.
    We note that the claims listed in numbers 1, 2, and 4 above are 
included in the data files that can be purchased as described above.
    We set aside the single minor claims and the non-OPPS claims 
(numbers 3 and 5 above) because we did not use either in calculating 
median cost. We then examined the multiple major and multiple minor 
claims (numbers 2 and 4 above) to determine if we could convert any of 
them to single major claims using the process described previously. We 
first grouped items on the claims by date of service. If each major 
procedure on the claim had a different date of service and if the line-
items for packaged HCPCS and packaged revenue codes had dates of 
service, we split the claim into multiple ``pseudo'' single claims 
based on the date of service.
    After those single claims were created, we used the list of 
``bypass codes'' in Table 1 of this preamble to remove separately 
payable procedures that we determined contain limited costs or no 
packaged costs from a multiple procedure bill. A discussion of the 
creation of the list of bypass codes used for the creation of 
``pseudo'' single claims is contained in section II.A.1.b. of this 
preamble.
    When one of the two separately payable procedures on a multiple 
procedure claim was on the bypass code list, we split the claim into 
two single procedure claims records. The single procedure claim record 
that contained the bypass code did not retain packaged services. The 
single procedure claim record that contained the other separately 
payable procedure (but no bypass code) retained the packaged revenue 
code charges and the packaged HCPCS charges. This enables us to use a 
claim that would otherwise be a multiple procedure claim and could not 
be used.
    We excluded those claims that we were not able to convert to 
singles even after applying both of the techniques for creation of 
``pseudo'' singles. We then packaged the costs of packaged HCPCS codes 
(codes with status indicator ``N'' listed in Addendum B to this 
proposed rule) and packaged revenue codes into the cost of the single 
major procedure remaining on the claim. The list of packaged revenue 
codes is shown in Table 2 below.
    After removing claims for hospitals with error CCRs, claims without 
HCPCS codes, claims for immunizations not covered under the OPPS, and 
claims for services not paid under the OPPS, 55 million claims were 
left. Of these 55 million claims, we were able to use some portion of 
49 million whole claims (90 percent of the potentially usable claims) 
to create the 81 million single and ``pseudo'' single claims for use in 
the CY 2006 median payment ratesetting.
    We also excluded (1) claims that had zero costs after summing all 
costs on the claim; (2) claims for which CMS lacked an appropriate 
provider wage index; and (3) claims containing token charges (charges 
of less than $1.01) or for which intermediary systems had allocated 
charges as if the charges were submitted on the claim. We are proposing 
to delete claims containing token charges. We do not believe that a 
charge of less than $1.01 would yield a cost that would be valid to set 
weights for a significant separately paid service. Moreover, effective 
for services furnished on or after July 1, 2004, the OCE assigns 
payment flag number 3 to claims on which hospitals submitted token 
charges for a service with status

[[Page 42690]]

indicator ``S'' or ``T'' (a major separately paid service under OPPS) 
for which the intermediary is required to allocate the sum of charges 
for services with a status indicator equaling ``S'' or ``T'' based on 
the weight for the APC to which each code is assigned. We do not 
believe that these charges, which were token charges as submitted by 
the hospital, are valid reflections of hospital resource and that they 
should not be used to set median costs. Therefore, we are proposing to 
delete these claims.
    For the remaining claims, we then wage adjusted 60 percent of the 
cost of the claim (which we have previously determined to be the labor-
related portion), as has been our policy since the initial 
implementation of the OPPS, to adjust for geographic variation in 
labor-related costs. We made this adjustment by determining the wage 
index that applied to the hospital that furnished the service and 
dividing the cost for the separately paid HCPCS code furnished by the 
hospital by that wage index. As has been our policy since the inception 
of the OPPS, we are proposing to use the pre-reclassified wage indices 
for standardization because we believe that they better reflect the 
true costs of items and services in the area in which the hospital is 
located than the post-reclassification wage indices, and would result 
in the most accurate adjusted median costs.
    We then excluded claims that were outside 3 standard deviations 
from the geometric mean cost for each HCPCS code. We used the remaining 
claims to calculate median costs for each separately payable HCPCS 
code; first, to determine the applicability of the ``2 times'' rule, 
and second, to determine APC medians based on the claims containing the 
HCPCS codes assigned to each APC. As stated previously, 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 (``the 2 times rule''). Finally, we 
reviewed the medians and reassigned HCPCS codes to different APCs as 
deemed appropriate. Section III.B. of this preamble includes a 
discussion of the HCPCS code assignment changes that resulted from 
examination of the medians and for other reasons. The APC medians were 
recalculated after we reassigned the affected HCPCS codes.
    A detailed discussion of the medians for blood and blood products 
is included in section X. of this preamble. A discussion of the medians 
for APCs that require one or more devices when the service is performed 
is included in section IV.A. of this preamble. A discussion of the 
median for observation services is included in section XI. of this 
preamble and a discussion of the median for partial hospitalization is 
included below in section II.B. of this preamble.

      Table 2.--CY 2006 Proposed Packaged Services by Revenue Code
------------------------------------------------------------------------
           Revenue code                          Description
------------------------------------------------------------------------
250...............................  PHARMACY.
251...............................  GENERIC.
252...............................  NONGENERIC.
254...............................  PHARMACY INCIDENT TO OTHER
                                     DIAGNOSTIC.
255...............................  PHARMACY INCIDENT TO RADIOLOGY.
257...............................  NONPRESCRIPTION DRUGS.
258...............................  IV SOLUTIONS.
259...............................  OTHER PHARMACY.
260...............................  IV THERAPY, GENERAL CLASS.
262...............................  IV THERAPY/PHARMACY SERVICES.
263...............................  SUPPLY/DELIVERY.
264...............................  IV THERAPY/SUPPLIES.
269...............................  OTHER IV THERAPY.
270...............................  M&S SUPPLIES.
271...............................  NONSTERILE SUPPLIES.
272...............................  STERILE SUPPLIES.
274...............................  PROSTHETIC/ORTHOTIC DEVICES.
275...............................  PACEMAKER DRUG.
276...............................  INTRAOCULAR LENS SOURCE DRUG.
278...............................  OTHER IMPLANTS.
279...............................  OTHER M&S SUPPLIES.
280...............................  ONCOLOGY.
289...............................  OTHER ONCOLOGY.
290...............................  DURABLE MEDICAL EQUIPMENT.
343...............................  DIAGNOSTIC RADIOPHARMS.
344...............................  THERAPEUTIC RADIOPHARMS.
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.
681...............................  TRAUMA RESPONSE, LEVEL I.
682...............................  TRAUMA RESPONSE, LEVEL II.
683...............................  TRAUMA RESPONSE, LEVEL III.
684...............................  TRAUMA RESPONSE, LEVEL IV.
689...............................  TRAUMA RESPONSE, OTHER.
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.
------------------------------------------------------------------------

3. Proposed Calculation of Scaled OPPS Payment Weights
    Using the median APC costs discussed previously, we calculated the 
proposed relative payment weights for each APC for CY 2006 shown in 
Addenda A and B to this proposed rule. 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 CY 2004 data, the median cost for APC 0601 is $60.57 for CY 2006.
    Section 1833(t)(9)(B) of the Act requires that APC reclassification 
and recalibration changes, wage index changes, and other adjustments be 
made in a manner that assures that aggregate payments under the OPPS 
for CY 2006 are neither greater than nor less than the aggregate 
payments that would have been made without the changes. To comply with 
this requirement concerning the APC changes, we compared aggregate 
payments using the CY 2005 relative weights to aggregate payments using 
the CY 2006 proposed relative weights. Based on this comparison, we are 
proposing to make an adjustment to the relative weights for purposes of 
budget neutrality. The unscaled relative payment weights were adjusted 
by .999207669 for budget neutrality. The proposed relative payment 
weights are listed in Addenda A and B to this proposed rule. The 
proposed relative payment weights incorporate the recalibration 
adjustments discussed in sections II.A.1. and 2.

[[Page 42691]]

    Section 1833(t)(14)(H) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, states that ``Additional expenditures resulting from 
this paragraph shall not be taken into account in establishing the 
conversion factor, weighting and other adjustment factors for 2004 and 
2005 under paragraph (9) but shall be taken into account for subsequent 
years.'' Section 1833(t)(14) of the Act provides the payment rates for 
certain ``specified covered outpatient drugs.'' Therefore, the 
incremental cost of those specified covered outpatient drugs (as 
discussed in section V. of this preamble) is included in the budget 
neutrality calculations.
    Under section 1833(t)(16)(C) of the Act, as added by section 
621(b)(1) of Pub. L. 108-173, payment for devices of brachytherapy 
consisting of a seed or seeds (or radioactive source) is to be made at 
charges adjusted to cost for services furnished on or after January 1, 
2004, and before January 1, 2006. As we stated in our January 6, 2004 
interim final rule, charges for the brachytherapy sources will not be 
used in determining outlier payments and payments for these items will 
be excluded from budget neutrality calculations. (We provide a 
discussion of brachytherapy payment issues at section VII. of this 
proposed rule.)
4. Proposed Changes to Packaged Services
    Payments for packaged services under the OPPS are bundled into the 
payments providers receive for separately payable services provided on 
the same day. Packaged services are identified by the status indicator 
``N.'' Hospitals include charges for packaged services on their claims, 
and the costs associated with these packaged services are then bundled 
into the costs for separately payable procedures on the claims for 
purposes of median cost calculations. Hospitals may use CPT codes to 
report any packaged services that were performed, consistent with CPT 
coding guidelines.
    As a result of requests from the public, a Packaging Subcommittee 
to the APC Panel was established to review all the procedural CPT codes 
with a status indicator of ``N.''
    Providers have often suggested that many packaged services could be 
provided alone, without any other separately payable services on the 
claim, and requested that these codes not be assigned status indicator 
``N.'' The Packaging Subcommittee reviewed every code that was packaged 
in the CY 2004 OPPS. Based on comments we have received and their own 
expert judgment, the subcommittee identified a set of packaged codes 
that are often provided separately and subsequently reviewed 
utilization and median cost data for these codes. One of the main 
criteria utilized by the Packaging Subcommittee to determine whether a 
code should become unpackaged was how likely it was for the code to be 
billed without any other separately payable services on the claim. The 
Packaging Subcommittee also examined median costs from hospital claims 
for packaged services that were billed alone.
    The Packaging Subcommittee identified areas for change for some 
packaged CPT codes that they believe could frequently be provided to 
patients as the sole service on a given date and that require 
significant hospital resources as determined from hospital claims data. 
During the February 2005 meeting, the APC Panel accepted the report of 
the Packaging Subcommittee and made the following recommendations:
    (1) That packaged codes be reviewed by the Panel individually.
    (2) That the Packaging Subcommittee continue to meet throughout the 
year to discuss problematic packaged codes.
    (3) That CMS assign a modifier to CPT codes 36540 (Collect blood, 
venous device); 36600 (Withdrawal of arterial blood); and 51701 
(Insertion of non-indwelling bladder catheter), for use when there are 
no other separately payable codes on the claim. The modifier would flag 
the outpatient code editor (OCE) to assign payment to the claim.
    (4) That CMS maintain the current packaged status indicator for CPT 
code 76937 (Ultrasound guidance for vascular access).
    (5) That CMS change the status indicators for CPT immunization 
administration codes 90471 and 90472 to allow separate payment and 
ensure consistency with other injection codes.
    (6) That CMS gather more data on CPT code 94762 (Overnight pulse 
oximetry) to determine how often this code is billed without any other 
separately payable codes and whether it is performed more frequently 
alone in rural settings than other settings.
    (7) No changes to the packaged status of CPT codes 77790 (radiation 
source handling) and 94760 and 94761 (both codes measure blood oxygen 
levels).
    (8) That CMS provide education and consistent guidelines to 
providers and fiscal intermediaries on correct billing procedures for 
packaged codes in general and in particular for CPT codes 36540, 36600, 
and 51701 and the recommended modifier, if approved.
    (9) That the Packaging Subcommittee review CPT codes 42550 
(Injection for salivary x-ray) and 38792 (Sentinel node imaging).
    (10) That CPT code 97602 (Nonselective wound care) be referred to 
the Physician Payment Group within CMS for evaluation of its bundled 
status as it relates to services provided under the OPPS and that the 
Physician Payment Group report its conclusions back to the APC Panel.
    For CY 2006, we are proposing to maintain CPT codes 36540 (Collect 
blood venous device) and 36600 (Withdrawal of arterial blood) as 
packaged services and not adopt the APC Panel's recommendation to add a 
modifier. We note CPT code 36540 is also bundled under the Medicare 
Physician Fee Schedule (MPFS), and our data demonstrate that the 
service is generally billed with other separately payable services. We 
also have relatively few single claims for CPT code 36600, compared to 
the procedure's overall frequency. Both of these codes have relatively 
low resource utilization. As these procedures are almost always 
provided with other separately payable services, hospitals' payments 
for those other services include the costs of CPT codes 36540 and 
36600.
    For CY 2006, we are proposing to pay separately for CPT code 51701 
(Insertion of non-indwelling bladder catheter), and to map it to APC 
0340 (Minor Ancillary Procedures), with status indicator ``X'', and a 
median cost of $38.52. The APC Panel recommended that we pay separately 
for this code only when there are no other separately payable services 
on the claim. However, we are proposing to pay separately for this code 
every time it is billed. We believe that it is more appropriate to make 
payment for each procedure rather than increase hospitals' 
administrative burden by requiring specific coding changes to indicate 
that there are no other separately payable procedures on the claim. 
Based on our review of the data, the cost for this procedure is not 
insignificant, and the volume of single and multiple claims is modest. 
When we reviewed related codes, including CPT code 51702 (Insertion of 
temporary indwelling bladder catheter, simple) and CPT code 51703 
(Insertion of temporary indwelling bladder catheter, complicate), we 
noted that these codes also had substantial median costs and a moderate 
volume of single claims. Therefore, for CY 2006, we are also proposing 
to pay separately for CPT codes 51702 and 51703, mapping them to APC 
0340 with a median cost of $38.52 and APC 0164 (Level I Urinary

[[Page 42692]]

and Anal Procedures) with a median cost of $71.54, respectively. CPT 
codes 51701, 51702, and 51703 will be placed on the bypass list, as 
discussed in section II.A.1.b. of this proposed rule.
    For CY 2006, we are proposing to accept the APC Panel 
recommendation that CPT code 76937 (Ultrasound guidance for vascular 
access) remain packaged. We are concerned that there may be unnecessary 
overuse of this procedure if it is separately payable. In addition, we 
believe that the service would always be provided with another 
separately payable procedure, so its costs would be appropriately 
bundled with the definitive vascular access service. As stated in the 
CY 2005 final rule with comment period (69 FR 65697), CMS and the 
Packaging Subcommittee reviewed CY 2004 claims data for CPT code 76937 
and determined that this code should remain packaged.
    For CY 2006, see section VIII. of this preamble on drug 
administration regarding CPT codes 90471 and 90472.
    For CY 2006, we are proposing to accept the APC Panel 
recommendations that CPT codes 77790 (Radiation handling), 94760 (Pulse 
oximetry for oxygen saturation, single determination), and 94761 (Pulse 
oximetry for oxygen saturation, multiple determinations) remain 
packaged. We believe that CPT code 77790 is integral to the provision 
of brachytherapy and should always be billed on the same day with 
brachytherapy sources and their loading, ensuring that the provider 
would receive appropriate payment for the radiation source handling and 
loading bundled with the payment for the brachytherapy service. The 
small number of single claims for this code in our data verifies that 
this code is rarely billed alone without other payable services on the 
claim, and those few single claims may be miscoded claims. Our data 
review of CPT codes 94760 and 94761 revealed that these codes have low 
resource utilization, and are most frequently provided with other 
services. Similar to CPT code 77790, there are many fewer single claims 
for CPT codes 94760 and 94761 than multiple procedure claims that 
include CPT codes 94760 and 94761. CPT codes 94760 and 94761 describe 
services that are very commonly performed in the hospital outpatient 
setting, and unpackaging these codes would likely significantly 
decrease the number of single claims available for use in calculating 
median costs for other services.
    For CY 2006, we are proposing to accept the APC Panel 
recommendation to gather data and review CPT codes 94762, 42550, and 
38792 with the Packaging Subcommittee. We will analyze single and 
multiple procedure claims' volumes and resource utilization data, and 
review these studies with the Packaging Subcommittee.
    We referred CPT code 97602 (non-selective wound care) for MPFS 
evaluation of its bundled status as CPT code 97602 relates to services 
provided under the OPPS. CPT code 97602 is assigned status indicator 
``A'' in this OPPS proposed rule, meaning that while it is no longer 
payable under the OPPS, it is payable under a fee schedule other than 
OPPS. Under the MPFS, the nonselective wound care services described by 
CPT code 97602 are ``bundled'' into the selective wound care 
debridement codes (CPT codes 97597 and 97598). Under the MPFS, a 
separate payment is never made for ``bundled'' services and, because of 
this designation, the provider does not receive separate payment for 
non-selective wound care described by CPT code 97602. While this code 
now falls under the MPFS rules, payment policy for this ``bundled'' 
service has not changed and separate payment is not made.
    The APC Panel Packaging Subcommittee remains active, and additional 
issues and new data concerning the packaging status of codes will be 
shared for its consideration as information becomes available. We 
continue to encourage submission of common clinical scenarios involving 
currently packaged HCPCS codes to the Packaging Subcommittee for its 
ongoing review. Additional detailed suggestions for the Packaging 
Subcommittee should be submitted to [email protected], with 
``Packaging Subcommittee'' in the subject line.

B. Proposed Payment for Partial Hospitalization

(If you choose to comment on issues in this section, please include 
the caption ``Partial Hospitalization'' at the beginning of your 
comment.)
1. Background
    Partial hospitalization is an intensive outpatient program of 
psychiatric services provided to patients as an alternative to 
inpatient psychiatric care for beneficiaries who have an acute mental 
illness. A partial hospitalization program (PHP) may be provided by a 
hospital to its outpatients or by a Medicare-certified CMHC. Section 
1833(t)(1)(B)(i) of the Act provides the Secretary with the authority 
to designate the hospital outpatient services to be covered under the 
OPPS. Section 419.21(c) of the Medicare regulations that implement this 
provision specifies that payments under the OPPS will be made for 
partial hospitalization services furnished by CMHCs. Section 
1883(t)(2)(C) of the Act requires that we establish relative payment 
weights based on median (or mean, at the election of the Secretary) 
hospital costs determined by 1996 claims data and data from the most 
recent available cost reports. 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. For a detailed discussion, refer 
to the April 7, 2000 OPPS final rule (65 FR 18452).
2. Proposed PHP APC Update for CY 2006
    To calculate the proposed CY 2006 PHP per diem payment, we used the 
same methodology that was used to compute the CY 2005 PHP per diem 
payment. For CY 2005, the per diem amount was based on 12 months of 
hospital and CMHC PHP claims data (for services furnished from January 
1, 2003 through December 31, 2003). We used data from all hospital 
bills reporting condition code 41, which identifies the claim as 
partial hospitalization, and all bills from CMHCs because CMHCs are 
Medicare providers only for the purpose of providing partial 
hospitalization services. We used CCRs from the most recently available 
hospital and CMHC cost reports to convert each provider's line-item 
charges as reported on bills, to estimate the provider's cost for a day 
of PHP services. Per diem costs were then computed by summing the line-
item costs on each bill and dividing by the number of days on the bill.
    In a Program Memorandum issued on January 17, 2003 (Transmittal A-
03-004), we directed fiscal intermediaries to recalculate hospital and 
CMHC CCRs using the most recently settled cost reports by April 30, 
2003. Following the initial update of CCRs, fiscal intermediaries were 
further instructed to continue to update a provider's CCR and enter 
revised CCRs into the outpatient provider specific file. Therefore, for 
CMHCs, we use CCRs from the outpatient provider specific file.
    Historically, the median per diem cost for CMHCs has greatly 
exceeded the median per diem cost for hospital-based PHPs and has 
fluctuated significantly

[[Page 42693]]

from year to year while the median per diem cost for hospital-based 
PHPs has remained relatively constant ($200-$225). Medicare providers 
are required to maintain uniform charges for all payers. We believe 
that hospitals have multiple payers and are far less likely to 
significantly change their charges for PHP from year to year. However, 
many CMHCs have indicated that Medicare is their only payer. As a 
result, we believe that these providers may have increased and 
decreased their charges in response to Medicare payment policies. As 
discussed in more detail in the next section and in the final rule 
establishing the CY 2004 OPPS (68 FR 63470), we believe that some CMHCs 
manipulated their charges in order to inappropriately receive outlier 
payments.
    In the CY 2003 update, the difference in median per diem cost for 
CMHCs and hospital-based PHPs was so great, $685 for CMHCs and $225 for 
hospital-based PHPs, that we applied an adjustment factor of .583 to 
CMHC costs to account for the difference between ``as submitted'' and 
``final settled'' cost reports. By doing so, the CMHC median per diem 
cost was reduced to $384, resulting in a combined hospital-based and 
CMHC PHP median per diem cost of $273. As with all APCs in the OPPS, 
the median cost for each APC was scaled to be relative to the cost of a 
mid-level office visit and the conversion factor was applied. The 
resulting per diem rate for PHP for CY 2003 was $240.03.
    In the CY 2004 OPPS update, the median per diem cost for CMHCs grew 
to $1038, while the median per diem cost for hospital-based PHPs was 
again $225. After applying the .583 adjustment factor to the median 
CMHC per diem cost, the median CMHC per diem cost was $605. As the CMHC 
median per diem cost exceeded the average per diem cost of inpatient 
psychiatric care, we proposed a per diem rate for CY 2004 based solely 
on hospital-based PHP data. The proposed PHP per diem for CY 2004, 
after scaling, was $208.95. However, by the time we published the OPPS 
final rule for CY 2004, we had received updated CCRs for CMHCs. Using 
the updated CCRs significantly lowered the CMHC median per diem cost to 
$440. As a result, we determined that the higher per diem cost for 
CMHCs was not due to the difference between ``as submitted'' and 
``final settled'' cost reports, but were the result of excessive 
increases in charges which may have been done in order to receive 
higher outlier payments. Therefore, in calculating the PHP median per 
diem cost for CY 2004, we did not apply the .583 adjustment factor to 
CMHC costs to compute the PHP APC. Using the updated CCRs for CMHCs, 
the combined hospital-based and CMHC median per diem cost for PHP was 
$303. After scaling, we established the CY 2004 PHP APC of $286.82.
    Then, in the CY 2005 OPPS update, the CMHC median per diem cost was 
$310 and the hospital-based PHP median per diem cost was $215. No 
adjustments were determined to be necessary and, after scaling, the 
combined median per diem cost of $289 was reduced to $281.33. We 
believed that the reduction in the CMHC median per diem cost indicated 
that the use of updated CCRs had accounted for the previous increase in 
CMHC charges, and represented a more accurate estimate of CMHC per diem 
costs for PHP.
    For CY 2006, we analyzed 12 months of data for hospital and CMHC 
PHP claims for services furnished between January 1, 2004, and December 
31, 2004. The data indicated that the median per diem cost for CMHCs 
had dropped to $143, while the median per diem cost for hospital-based 
PHPs was $209. It appears that CMHCs significantly reduced their 
charges in CY 2004. The average charge per day for CMHCs in CY 2003 was 
$1,184 and the average cost per day was $335. In CY 2004, the CMHC 
average charge per day dropped to $765 and the average cost per day was 
$167. We have determined that a combination of lower charges and 
slightly lower CCRs for CMHCs resulted in a significant decline in the 
CMHC median per diem cost.
    Following the methodology used for the CY 2005 OPPS update, the 
combined hospital-based and CMHC median per diem cost would be $149, a 
decrease of 48 percent compared to the CY 2005 combined median per diem 
amount. We believe that after scaling this amount to the cost of a mid-
level office visit, the resulting APC rate would be too low to cover 
the per diem cost for all PHPs.
    We are considering an alternative update methodology for the PHP 
APC for CY 2006 that would mitigate this drastic reduction in payment 
for PHP. One alternative would be to base the PHP APC on hospital-based 
PHP data alone. The median per diem cost of hospital-based PHPs has 
remained in the $200-225 range over the last 5 years, while the median 
per diem cost for CMHC PHPs has fluctuated significantly from a high of 
$1,037 to a low of $143. Under this alternative, we would use $209, the 
median per diem cost for hospital-based PHPs during CY 2004 to 
establish the PHP APC for CY 2006. However, we believe using this 
amount would also result in an unacceptable drop in Medicare payments 
for all PHPs in CY 2006 compared to payments in CY 2005.
    Another alternative we are considering is to apply a different 
trimming methodology to CMHC costs in an effort to eliminate the effect 
of data for those CMHCs that appeared to have excessively increased 
their charges in order to receive outlier payments. We compared CMHC 
per diem costs in CY 2003 to CMHC per diem costs in CY 2004 and 
determined the percentage change. Initially, we trimmed CMHCs claims 
where the CMHC's per diem costs changed by 50 percent or more from CY 
2003 to CY 2004. After combining the remaining CMHC claims with the 
hospital-based PHP claims, we calculated a median per diem cost of 
$160.75. However, this approach did not eliminate the data for all of 
the CMHCs with unreasonable per diem costs. We then analyzed the 
resulting median per diem cost if we trimmed CMHC claims where the 
difference in CMHC per diem costs from 2003 to 2004 was 25 percent. 
This trimming approach resulted in a combined CMHC and hospital-based 
PHP median per diem cost of $176. We also trimmed the CMHC claims from 
the CY 2003 data to see how trimming aberrant data would affect the 
combined hospital/CMHC median per diem cost. We found that trimming the 
claims from the CMHCs with a 25 percent difference in per diem cost 
from CY 2003 to CY 2004 reduced the $289 median per diem cost to $218.
    We believe it is important to eliminate aberrant data and we 
believe trimming certain CMHC data would provide an incentive for CMHCs 
to stabilize their charges so that we could use their data in future 
updates of the PHP APC. However, we believe that the trimming methods 
described above would also result in an unacceptably large decrease in 
payment. In addition, the trimming method we used was based on 
percentage change in cost per day, and may not have identified all the 
CMHCs that may have manipulated their charges in order to receive more 
outlier payments, for example, CMHCs with high charges and no reduction 
in charges compared to CY 2003.
    Although we prefer to use both CMHC and hospital data to establish 
the PHP APC, we continue to be concerned about the volatility of the 
CMHC data. The analyses we have conducted seem to indicate that 
eliminating aberrant CMHC data results in a median per diem cost more 
in line with hospital data. We will continue to analyze the CMHC data 
in developing payment rates, however, if the data continues to

[[Page 42694]]

be unstable, we may use only hospital data in the future.
    We are considering an approach that would lessen the PHP payment 
reduction for CY 2006, yet, ensure an adequate payment amount and 
continue to ensure access to the partial hospitalization benefit for 
Medicare beneficiaries. For CY 2006, we are proposing to apply a 15-
percent reduction in the combined hospital-based and CMHC median per 
diem cost that was used to establish the CY 2005 PHP APC. That amount 
would then be scaled to be relative to the cost of a mid-level office 
visit to establish the PHP APC for CY 2006. We believe a reduction in 
the CY 2005 median per diem cost would strike an appropriate balance 
between using the best available data and providing adequate payment 
for a program that often spans 5-6 hours a day. We believe 15 percent 
is an appropriate reduction because it recognizes decreases in median 
per diem costs in both the hospital data and the CMHC data, and also 
reduces the risk of any adverse impact on access to these services that 
might result from a large single-year rate reduction. However, we would 
propose that the reduction in payments for PHP be a transitional 
measure, and will continue to monitor CMHC costs and charges for these 
services and work with CMHCs to improve their reporting so that 
payments can be calculated based on better empirical data, consistent 
with the approach we have used to calculate payments in other areas of 
the OPPS.
    To apply the methodology, we would reduce $289 (the CY 2005 
combined hospital-based and CMHC median per diem cost) by 15 percent, 
resulting in a combined median per diem cost of $245.65. After scaling, 
we are proposing the resulting APC amount for PHP of $240.51 for CY 
2006, of which $48.10 is the beneficiary's coinsurance. We will 
continue to analyze the data to determine whether there is a more 
targeted approach that would allow use of the CMHC and hospital PHP 
claims data to establish the final PHP rate for CY 2006.
3. Proposed Separate Threshold for Outlier Payments to CMHCs
    In the November 7, 2003 final rule with comment period (68 FR 
63469), we indicated 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. There was a significant 
difference in the amount of outlier payments made to hospitals and 
CMHCs for PHP. Further analysis indicated the use of OPPS outlier 
payments for CMHCs was contrary to the intent of the general OPPS 
outlier policy. Therefore, for CYs 2004 and 2005, we established a 
separate outlier threshold for CMHCs. We designated 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 each of those years, excluding outlier payments.
    As stated in the November 15, 2004 final rule with comment period, 
CMHCs were projected to receive 0.6 percent of the estimated total OPPS 
payments in CY 2005 (69 FR 65848). The CY 2005 CMHC outlier threshold 
is met when the cost of furnishing services by a CMHC exceeds 3.5 times 
the PHP APC payment amount. The current outlier payment percentage is 
50 percent of the amount of costs in excess of the threshold.
    CMS and the Office of the Inspector General are continuing to 
monitor the excessive outlier payments to CMHCs. As previously stated 
in section II.B.2. above, we used CY 2004 claims data to calculate the 
proposed CY 2006 per diem payment. These data show the effect of the 
separate outlier threshold for CMHCs that was effective January 1, 
2004. During CY 2004, the separate outlier threshold for CMHCs resulted 
in $1.8 million in outlier payments to CMHCs, within the 2.0 percent of 
total OPPS payments identified for CMHCs. In CY 2003, more than $30 
million was paid to CMHCs in outlier payments. We believe this 
difference in outlier payments indicates that the separate outlier 
threshold for CMHCs has been successful in keeping outlier payments to 
CMHCs in line with the percentage of OPPS payments made to CMHCs.
    As noted in section II.H. of this preamble, for CY 2006, we are 
proposing to set the target for hospital outpatient outlier payments at 
1.0 percent of total OPPS payments. We are also proposing to allocate a 
portion of that 1.0 percent, 0.006 percent (or 0.006 percent of total 
OPPS payments), to CMHCs for PHP services. As discussed in section 
II.G. below, we are proposing a dollar threshold in addition to an APC 
multiplier threshold for hospital OPPS outlier payments. However, 
because PHP is the only APC for which CMHCs may receive payment under 
the OPPS, we would not expect to redirect outlier payments by imposing 
a dollar threshold. Therefore, we are not proposing a dollar threshold 
for CMHC outliers. We are proposing to set the outlier threshold for 
CMHCs for CY 2006 at 3.45 percent times the APC payment amount and the 
CY 2006 outlier payment percentage applicable to costs in excess of the 
threshold at 50 percent. As we did with the hospital outlier threshold, 
we used hospital charge inflation factor to inflate charges to CY 2006.

C. Proposed Conversion Factor Update for CY 2006

(If you choose to comment on issues in this section, please include 
the caption ``Conversion Factor'' at the beginning of your comment.)

    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 
CY 2006, 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 2006 
published in the IPPS proposed rule on May 4, 2005 is 3.2 percent (70 
FR 23384). To set the OPPS proposed conversion factor for CY 2006, we 
increased the CY 2005 conversion factor of $56.983, as specified in the 
November 15, 2004 final rule with comment period (69 FR 65842), by 3.2 
percent.
    In accordance with section 1833(t)(9)(B) of the Act, we further 
adjusted the conversion factor for CY 2005 to ensure that the revisions 
we are making to our updates by means of the wage index are made on a 
budget-neutral basis. We calculated a proposed budget neutrality factor 
of 1.002015212 for wage index changes by comparing total payments from 
our simulation model using the FY 2006 IPPS proposed wage index values 
to those payments using the current (FY 2005) IPPS wage index values. 
In addition, to accommodate the proposed rural adjustment discussed in 
section II.G. of this preamble, we calculated a proposed budget 
neutrality factor of 0.99652023 by comparing payments with the rural 
adjustment to those without. For CY 2006, allowed pass-through payments 
are estimated to decrease to 0.05 percent of total OPPS payments, down 
from 0.1 percent in CY 2005. The proposed conversion factor is also 
adjusted by the difference in estimated pass-through payments of 0.05 
percent. Finally, decreasing proposed payments for outliers to 1.0 
percent of total payments returned 1.0 percent to the conversion 
factor.
    The proposed market basket increase update factor of 3.2 percent 
for CY 2006, the required wage index budget neutrality adjustment of 
approximately 1.002015212, the return of 1.0 percent

[[Page 42695]]

in total payments from a reduced outlier target, the 0.05 percent 
adjustment to the pass-through estimate, and the adjustment for the 
proposed rural payment adjustment of 0.99652023 result in a proposed 
conversion factor for CY 2006 of $59.350.

D. Proposed Wage Index Changes for CY 2006

(If you choose to comment on issues in this section, please include 
the caption ``Wage Index'' at the beginning of your comment.)

    Section 1833(t)(2)(D) of the Act requires the Secretary to 
determine a wage adjustment factor to adjust, for geographic wage 
differences, the portion of the OPPS payment rate and the copayment 
standardized amount attributable to labor and labor-related cost. This 
adjustment must be made in a budget neutral manner. As we have done in 
prior years, we are proposing to adopt the IPPS wage indices and extend 
these wage indices to TEFRA hospitals that participate in the OPPS but 
not the IPPS.
    As discussed in section II.A. of this preamble, we standardize 60 
percent of estimated costs (labor-related costs) for geographic area 
wage variation using the IPPS wage indices that are calculated prior to 
adjustments for reclassification to remove the effects of differences 
in area wage levels in determining the OPPS payment rate and the 
copayment standardized amount.
    As published in the original OPPS April 7, 2000 final rule (65 FR 
18545), OPPS has consistently adopted the final IPPS wage indices as 
the wage indices for adjusting the OPPS standard payment amounts for 
labor market differences. As initially explained in the September 8, 
1998 OPPS proposed rule, we believed and continue to believe that using 
the IPPS wage index as the source of an adjustment factor for OPPS is 
reasonable and logical, given the inseparable, subordinate status of 
the hospital outpatient within the hospital overall. In accordance with 
section 1886(d)(3)(E) of the Act, the IPPS wage index is updated 
annually. In this proposed rule, we are proposing to use the proposed 
FY 2006 hospital IPPS wage index published in the Federal Register on 
May 4, 2005 (70 FR 23550 through 23581), and as corrected and posted on 
the CMS Web site, to determine the wage adjustments for the OPPS 
payment rate and the copayment standardized amount for CY 2006. In 
accordance with our established policy, we are proposing to use the FY 
2006 final version of these wage indices to determine the wage 
adjustments and copayment standardized amount that we will publish in 
our final rule for CY 2006.
    We note that the FY 2006 IPPS wage indices continue to reflect a 
number of changes implemented in FY 2005 as a result of the new OMB 
standards for defining geographic statistical areas, the implementation 
of an occupational mix adjustment as part of the wage index, and new 
wage adjustments provided for under Pub. L. 108-173. The following is a 
brief summary of the proposed changes in the FY 2005 IPPS wage indices, 
continued for FY 2006, and any adjustments that we are proposing 
applying to the OPPS for CY 2006. We refer the reader to the FY 2006 
IPPS proposed rule (70 FR 23367 through 23384, May 4, 2005) for a 
detailed discussion of the changes to the wage indices.)
    1. The proposed continued use of the new Core Based Statistical 
Areas (CBSAs) issued by the Office of Management and Budget (OMB) as 
revised standards for designating geographical statistical areas based 
on the 2000 Census data, to define labor market areas for hospitals for 
purposes of the IPPS wage index. The OMB revised standards were 
published in the Federal Register on December 27, 2000 (65 FR 82235), 
and OMB announced the new CBSAs on June 6, 2003, through an OMB 
bulletin. In the FY 2005 hospital IPPS final rule, CMS adopted the new 
OMB definitions for wage index purposes. In the FY 2006 IPPS proposed 
rule, we again stated that hospitals located in MSAs would be urban and 
hospitals that are located in Micropolitan Areas or Outside CBSAs would 
be rural. To help alleviate the decreased payments for previously urban 
hospitals that became rural under the new MSA definitions, we allowed 
these hospitals to maintain their assignment to the MSA where they 
previously had been located for the 3-year period from FY 2005 through 
FY 2007. To be consistent with IPPS, we will continue the policy we 
began in CY 2005 of applying the same criterion to TEFRA hospitals paid 
under the OPPS but not under the IPPS and to maintain that MSA 
designation for determining a wage index for the specified period. 
Beginning in FY 2008, these hospitals will receive their statewide 
rural wage index, although those hospitals paid under the IPPS will be 
eligible to apply for reclassification. In addition to this ``hold 
harmless'' provision, the FY 2005 IPPS final rule implemented a one-
year transition for hospitals that experienced a decrease in their FY 
2005 wage index compared to their FY 2004 wage index due solely to the 
changes in labor market definitions. These hospitals received 50 
percent of their wage indices based on the new MSA configurations and 
50 percent based on the FY 2004 labor market areas. In the FY 2006 IPPS 
proposed rule, we discussed the cessation of the one-year transition 
and proposed that hospitals receive 100 percent of their wage index 
based upon the new CBSA configurations beginning in FY 2006. Again, for 
the sake of consistency with IPPS, we also are proposing that TEFRA 
hospitals would receive 100 percent of their wage index based upon the 
new CBSA configurations beginning in FY 2006.
    2. We again proposed to apply the proposed occupational mix 
adjustment for FY 2006 IPPS to 10-percent of the average hourly wage 
and leave 90 percent of the average hourly wage unadjusted for 
occupational mix. As noted in the FY 2006 IPPS proposed rule, we are, 
essentially, using the same CMS Wage Index Occupational Mix Survey and 
Bureau of Labor Statistics data to calculate the adjustment. Because 
there are no significant differences between the FY 2005 and the FY 
2006 occupational mix survey data and results, we believe it is 
appropriate to adopt the IPPS rule and apply the same occupational mix 
adjustment to 10 percent of the proposed FY 2006 wage index.
    3. The reclassifications of hospitals to geographic areas for 
purposes of the wage index. For purposes of the OPPS wage index, we are 
proposing to adopt all of the IPPS reclassifications proposed for FY 
2006, including reclassifications that the Medicare Geographic 
Classification Review Board (MGCRB) approved under the one-time appeal 
process for hospitals under section 508 of Pub. L. 108-173. We note 
that section 508 reclassifications will terminate March 31, 2007.
    4. The proposed continuation of an adjustment to the wage index to 
reflect the ``out-migration'' of hospital employees who reside in one 
county but commute to work in a different county with a higher wage 
index, in accordance with section 505 of Pub. L. 108-173 (FY 2006 IPPS 
proposed rule (70 FR 23381 and 23382, May 4, 2005)). Hospitals paid 
under the IPPS located in the qualifying section 505 ``out-migration'' 
counties receive a wage index increase unless they have already been 
reclassified under section 1886(d)(10) of the Act, redesignated under 
section 1886(d)(8)(B) of the Act, or reclassified under section 508. As 
discussed in the FY 2006 IPPS proposed rule, we proposed that 
reclassified hospitals not receive the out-migration adjustment unless 
they waive their reclassified

[[Page 42696]]

status. For OPPS purposes, we are continuing our policy from CY 2005 to 
apply the same 505 criterion to TEFRA hospitals paid under the OPPS but 
not paid under the IPPS. Because TEFRA hospitals cannot reclassify 
under sections 1886(d)(8) and 1886(d)(10) of the Act or section 508, 
they are eligible for the out-migration adjustment. Therefore, TEFRA 
hospitals located in a qualifying section 505 county will also receive 
an increase to their wage index under OPPS. Addendum L shows the 
hospitals, including TEFRA hospitals, that we currently believe will 
receive the out-migration adjustment. However, because we are proposing 
to adopt the final FY 2006 IPPS wage index, we will adopt any changes 
in a hospital's classification status that would make them either 
eligible or ineligible for the out-migration adjustment.
    The following proposed FY 2006 IPPS wage indices that were 
published in the May 4, 2005 Federal Register (70 FR 23550 through 
2323581) are reprinted as Addenda in this OPPS proposed rule: Addendum 
H--Wage Index for Urban Areas; Addendum I--Wage Index for Rural Areas; 
Addendum J--Wage Index for Hospitals That Are Reclassified; Addendum 
K--Puerto Rico Wage Index by CBSA; Addendum L--Out-Migration Wage 
Adjustment; Addendum M--Hospital Reclassifications and Redesignations 
by Individual Hospital and CBSA; Addendum N--Hospital Reclassifications 
and Redesignations by Individual Hospital under Section 508 of Pub. L. 
108-173; and Addendum O--Hospitals Redesignated as Rural Under Section 
1886(d)(8)(E) of the Act. We are proposing to use these FY 2006 IPPS 
indices, as they are finalized, to adjust the payment rates and 
coinsurance amounts that we will publish in the OPPS final rule for CY 
2006.
    With the exception of reclassifications resulting from the 
implementation of the one-time appeal process under section 508 of Pub. 
L. 108-173, all changes to the wage index resulting from geographic 
labor market area reclassifications or other adjustments must be 
incorporated in a budget neutral manner. Accordingly, in calculating 
the OPPS budget neutrality estimates for CY 2006, we have included the 
wage index changes that result from MGCRB reclassifications, 
implementation of section 505 of Pub. L. 108-173, and other refinements 
made in the FY 2006 IPPS proposed rule, such as the hold harmless 
provision for hospitals changing status from urban to rural under the 
new CBSA geographic statistical area definitions. However, section 508 
set aside $900 million to implement the section 508 reclassifications. 
We considered the increased Medicare payments that the section 508 
reclassifications would create in both the IPPS and OPPS when we 
determined the impact of the one-time appeal process. Because the 
increased OPPS payments already counted against the $900 million limit, 
we did not consider these reclassifications when we calculated the OPPS 
budget neutrality adjustment.

E. Proposed Statewide Average Default Cost-to-Charge Ratios

(If you choose to comment on issues in this section, please include 
the caption ``Cost-to-Charge Ratios'' at the beginning of your 
comment.)

    CMS uses CCRs to determine outlier payments, payments for pass-
through devices, and monthly interim transitional corridor payments 
under the OPPS. Some hospitals do not have a valid CCR. These hospitals 
include, but are not limited to, hospitals that are new and have not 
yet submitted a cost report, hospitals that have a CCR that falls 
outside predetermined floor and ceiling thresholds for a valid CCR, or 
hospitals that have recently given up their all-inclusive rate status. 
Last year we updated the default urban and rural CCRs for CY 2005 in 
our final rule published on November 15, 2004 (69 FR 65821 through 
65825). We are proposing to update the default ratios using the most 
recent cost report data for CY 2006.
    We calculated the proposed statewide default CCRs using the same 
CCRs that we use to adjust charges to costs on claims data. Table 3 
lists the proposed CY 2006 default urban and rural CCRs by State. These 
CCRs are the ratio of total costs to total charges from each provider's 
most recently submitted cost report, for those cost centers relevant to 
outpatient services. We also adjusted these ratios to reflect final 
settled status by applying the differential between settled to 
submitted costs and charges from the most recent pair of settled to 
submitted cost reports.
    The majority of submitted cost reports, 80.79 percent, were for CY 
2003. We only used valid CCRs to calculate these default ratios. That 
is, we removed the CCRs for all-inclusive hospitals, CAHs, and 
hospitals in Guam and the U.S. Virgin Islands because these entities 
are not paid under the OPPS, or in the case of all-inclusive hospitals, 
because their CCRs are suspect. We further identified and removed any 
obvious error CCRs and trimmed any outliers. We limited the hospitals 
used in the calculation of the default CCRs to those hospitals that 
billed for services under the OPPS during CY 2003.
    Finally, we calculated an overall average CCR, weighted by a 
measure of volume, for each State except Maryland. This measure of 
volume is the total lines on claims and is the same one that we use in 
our impact tables. For Maryland, we used an overall weighted average 
CCR for all hospitals in the nation as a substitute for Maryland CCRs, 
which appear in Table 3. Very few providers in Maryland are eligible to 
receive payment under the OPPS, which limits the data available to 
calculate an accurate and representative CCR. The overall decrease in 
default statewide CCRs can be attributed to the general decline in the 
ratio between costs and charges widely observed in the cost report 
data.

                                Table 3.--Statewide Average Cost-to-Charge Ratios
----------------------------------------------------------------------------------------------------------------
                                                                                     Previous
                 State                                 Urban/rural                  default CCR     Default CCR
----------------------------------------------------------------------------------------------------------------
ALABAMA................................  RURAL..................................         0.31552         0.26710
ALABAMA................................  URBAN..................................         0.29860         0.24570
ALASKA.................................  RURAL..................................         0.59388         0.61850
ALASKA.................................  URBAN..................................         0.38555         0.42710
ARIZONA................................  RURAL..................................         0.39748         0.32760
ARIZONA................................  URBAN..................................         0.30922         0.26980
ARKANSAS...............................  RURAL..................................         0.35936         0.31750
ARKANSAS...............................  URBAN..................................         0.38278         0.30470
CALIFORNIA.............................  RURAL..................................         0.40335         0.29310
CALIFORNIA.............................  URBAN..................................         0.32427         0.24210
COLORADO...............................  RURAL..................................         0.51041         0.43060

[[Page 42697]]

 
COLORADO...............................  URBAN..................................         0.41863         0.32170
CONNECTICUT............................  RURAL..................................         0.42702         0.47250
CONNECTICUT............................  URBAN..................................         0.46592         0.44620
DELAWARE...............................  RURAL..................................         0.36289         0.36300
DELAWARE...............................  URBAN..................................         0.45061         0.45940
DISTRICT OF COLUMBIA...................  URBAN..................................         0.38690         0.37510
FLORIDA................................  RURAL..................................         0.31782         0.24300
FLORIDA................................  URBAN..................................         0.28363         0.22400
GEORGIA................................  RURAL..................................         0.39829         0.33820
GEORGIA................................  URBAN..................................         0.40262         0.32100
HAWAII.................................  RURAL..................................         0.44420         0.41020
HAWAII.................................  URBAN..................................         0.34815         0.34470
IDAHO..................................  RURAL..................................         0.49682         0.46450
IDAHO..................................  URBAN..................................         0.51942         0.49170
ILLINOIS...............................  RURAL..................................         0.41825         0.34060
ILLINOIS...............................  URBAN..................................         0.36825         0.29960
INDIANA................................  RURAL..................................         0.44596         0.36860
INDIANA................................  URBAN..................................         0.44205         0.37230
IOWA...................................  RURAL..................................         0.50166         0.41990
IOWA...................................  URBAN..................................         0.46963         0.38780
KANSAS.................................  RURAL..................................         0.48065         0.38970
KANSAS.................................  URBAN..................................         0.34698         0.29270
KENTUCKY...............................  RURAL..................................         0.36987         0.31080
KENTUCKY...............................  URBAN..................................         0.37381         0.32470
LOUISIANA..............................  RURAL..................................         0.34317         0.29910
LOUISIANA..............................  URBAN..................................         0.34357         0.27730
MAINE..................................  RURAL..................................         0.47857         0.38800
MAINE..................................  URBAN..................................         0.54084         0.44890
MARYLAND...............................  RURAL..................................         0.70380         0.36521
MARYLAND...............................  URBAN..................................         0.68104         0.32997
MASSACHUSETTS..........................  URBAN..................................         0.44439         0.38810
MICHIGAN...............................  RURAL..................................         0.44890         0.39410
MICHIGAN...............................  URBAN..................................         0.41143         0.37420
MINNESOTA..............................  RURAL..................................         0.48514         0.47130
MINNESOTA..............................  URBAN..................................         0.45259         0.37410
MISSISSIPPI............................  RURAL..................................         0.34264         0.30290
MISSISSIPPI............................  URBAN..................................         0.37097         0.29320
MISSOURI...............................  RURAL..................................         0.42187         0.34160
MISSOURI...............................  URBAN..................................         0.38128         0.31080
MONTANA................................  RURAL..................................         0.51173         0.47890
MONTANA................................  URBAN..................................         0.49396         0.44810
NEBRASKA...............................  RURAL..................................         0.49386         0.42370
NEBRASKA...............................  URBAN..................................         0.42043         0.33870
NEVADA.................................  RURAL..................................         0.42878         0.50620
NEVADA.................................  URBAN..................................         0.22854         0.22330
NEW HAMPSHIRE..........................  RURAL..................................         0.50083         0.43580
NEW HAMPSHIRE..........................  URBAN..................................         0.39954         0.33220
NEW JERSEY.............................  URBAN..................................         0.49024         0.34030
NEW MEXICO.............................  RURAL..................................         0.44932         0.33890
NEW MEXICO.............................  URBAN..................................         0.50857         0.43310
NEW YORK...............................  RURAL..................................         0.52062         0.43940
NEW YORK...............................  URBAN..................................         0.54625         0.42550
NORTH CAROLINA.........................  RURAL..................................         0.37776         0.35410
NORTH CAROLINA.........................  URBAN..................................         0.42726         0.38110
NORTH DAKOTA...........................  RURAL..................................         0.52829         0.41170
NORTH DAKOTA...........................  URBAN..................................         0.47341         0.36740
OHIO...................................  RURAL..................................         0.42562         0.41160
OHIO...................................  URBAN..................................         0.42718         0.32810
OKLAHOMA...............................  RURAL..................................         0.40628         0.32900
OKLAHOMA...............................  URBAN..................................         0.36264         0.29190
OREGON.................................  RURAL..................................         0.47915         0.42460
OREGON.................................  URBAN..................................         0.49958         0.43760
PENNSYLVANIA...........................  RURAL..................................         0.40582         0.36010
PENNSYLVANIA...........................  URBAN..................................         0.33807         0.28010
PUERTO RICO............................  URBAN..................................         0.42208         0.41370
RHODE ISLAND...........................  URBAN..................................         0.43930         0.35100
SOUTH CAROLINA.........................  RURAL..................................         0.35996         0.29370
SOUTH CAROLINA.........................  URBAN..................................         0.36961         0.29160
SOUTH DAKOTA...........................  RURAL..................................         0.49599         0.39210
SOUTH DAKOTA...........................  URBAN..................................         0.44259         0.33940
TENNESSEE..............................  RURAL..................................         0.36663         0.30290

[[Page 42698]]

 
TENNESSEE..............................  URBAN..................................         0.36464         0.28310
TEXAS..................................  RURAL..................................         0.41763         0.33640
TEXAS..................................  URBAN..................................         0.33611         0.30300
UTAH...................................  RURAL..................................         0.49748         0.47090
UTAH...................................  URBAN..................................         0.46733         0.45230
VERMONT................................  RURAL..................................         0.47278         0.46750
VERMONT................................  URBAN..................................         0.54533         0.44250
VIRGINIA...............................  RURAL..................................         0.39408         0.33500
VIRGINIA...............................  URBAN..................................         0.38604         0.32550
WASHINGTON.............................  RURAL..................................         0.54246         0.43420
WASHINGTON.............................  URBAN..................................         0.54658         0.41360
WEST VIRGINIA..........................  RURAL..................................         0.42671         0.35070
WEST VIRGINIA..........................  URBAN..................................         0.45616         0.40700
WISCONSIN..............................  RURAL..................................         0.50126         0.42300
WISCONSIN..............................  URBAN..................................         0.46268         0.38480
WYOMING................................  RURAL..................................         0.54596         0.51580
WYOMING................................  URBAN..................................         0.41265         0.41080
----------------------------------------------------------------------------------------------------------------

F. Expiring Hold Harmless Provision for Transitional Corridor Payments 
for Certain Rural Hospitals

    When the OPPS was implemented, every provider was eligible to 
receive an additional payment adjustment (transitional corridor 
payment) if the payments it received for covered OPD services under the 
OPPS were less than the payments it would have received for the same 
services under the prior reasonable cost-based system (section 
1833(t)(7) of the Act). Section 1833(t)(7) of the Act provides that the 
transitional corridor payments are temporary payments for most 
providers, with two exceptions, to ease their transition from the prior 
reasonable cost-based payment system to the OPPS system. Cancer 
hospitals and children's hospitals receive the transitional corridor 
payments on a permanent basis. Section 1833(t)(7)(D)(i) of the Act 
originally provided for transitional corridor payments to rural 
hospitals with 100 or fewer beds for covered OPD services furnished 
before January 1, 2004. However, section 411 of Pub. L. 108-173 amended 
section 1833(t)(7)(D)(i) of the Act to extend these payments through 
December 31, 2005, for rural hospitals with 100 or fewer beds. Section 
411 also extended the transitional corridor payments to sole community 
hospitals located in rural areas for services furnished during the 
period that begins with the provider's first cost reporting period 
beginning on or after January 1, 2004, and ends on December 31, 2005. 
Accordingly, the authority for making transitional corridor payments 
under section 1833(t)(7)(D)(i) of the Act, as amended by section 411 of 
Pub . L. 108-173, will expire for rural hospitals having 100 or fewer 
beds and sole community hospitals located in rural areas on December 
31, 2005. For CY 2006, transitional corridor payments will continue to 
be available to cancer and children's hospitals. (We note that the 
succeeding section II.G. of this preamble discusses an additional 
provision of section 411 of Pub. L. 108-173 that related to a study to 
determine appropriate adjustment to payments for rural hospitals under 
the OPPS beginning January 2006.)

G. Proposed Adjustment for Rural Hospitals

(If you choose to comment on issues in this section, please include 
the caption ``Rural Hospital Adjustment'' at the beginning of your 
comment.)

    Section 411 of Pub. L. 108-173 added a new paragraph (13) to 
section 1833(t) of the Act. New section 1833(t)(13)(A) specifically 
instructs the Secretary to conduct a study to determine if rural 
hospital outpatient costs exceed urban hospital outpatient costs. 
Moreover, under new section 1833(t)(13)(B) of the Act, the Secretary is 
given authorization to provide an appropriate adjustment to rural 
hospitals by January 1, 2006, if rural hospital costs are determined to 
be greater than urban hospital costs.
    To conduct the study required under section 1833(t)(13)(A), as 
added by section 411 of Pub. L. 108-173, we believe that a simple 
comparison of unit costs is insufficient because the costs faced by 
hospitals, whether urban or rural, will be a function of many factors. 
These include the local labor supply, and the complexity and volume of 
services provided. Therefore, we used regression analysis to study 
differences in the outpatient cost per unit between rural and urban 
hospitals in order to compare costs after accounting for the influence 
of these other factors.
    Our regression analysis included all 4,077 hospitals billing under 
OPPS for which we could model accurate cost per unit estimates. For 
each hospital, total outpatient costs and descriptive information were 
derived from CY 2004 Medicare claims and the hospital's most recently 
submitted cost report. The description of claims used, our methodology 
for creating costs from charges, and a description of the specific 
hospitals included in our modeling are discussed in section II.A. of 
this preamble. We excluded separately payable drugs and biologicals, 
and clinical laboratory services paid on a fee schedule from our 
analysis. We excluded the 49 hospitals in Puerto Rico because their 
wage indices and unit costs are so different that they would have 
skewed results. Finally, we excluded facilities whose unit outpatient 
costs were outside of 3 standard deviations from the geometric mean 
unit outpatient cost.
    Total unit outpatient cost for each hospital was calculated by 
dividing total outpatient cost by the total number of APC units 
discounted for the joint performance of multiple procedures. (See 
section II.G.2. below for a definition of discounted units.) We modeled 
both explanatory and payment regression models. In an ``explanatory 
model'' approach, all variables that are hypothesized to be important 
determinants of cost are included in the cost regression, whether or 
not they are going to be used as payment adjustments. In a ``payment 
model'' approach, the only independent variables included in the cost 
regression are those variables that are used as payment adjustments. 
The regression

[[Page 42699]]

equations for both models were specified in double logarithmetic form. 
The dependent variable in the explanatory regression equation was unit 
outpatient cost. The dependent variable in the payment regressions was 
standardized unit outpatient costs, that is, unit outpatient costs 
adjusted to reflect payment by dividing through by the provider's 
service-mix index which was adjusted by the provider's wage index. The 
service-mix index is a measure of the resource intensity of services 
provided by each hospital. Both regression equation models included 
quantitative independent variables transformed into natural logarithms 
and categorical independent variables. Categorical independent (dummy) 
variables included hospital characteristics such as rural location or 
type of hospital (short stay or specialty hospital).
1. Factors Contributing to Unit Cost Differences Between Rural 
Hospitals and Urban Hospitals
    In considering potential independent variables that might explain 
differences in unit outpatient costs between urban and rural hospitals, 
we determined that several factors would be important:
     First, unit outpatient costs are expected to vary directly 
with the prices of inputs used to produce outpatient services, 
especially labor. Wage rates tend to be lower in rural areas than in 
urban areas.
     Second, there may be economies of scale in producing 
outpatient services, which imply that unit costs will vary inversely 
with the volume of outpatient services provided.
     Third, independent of the volume of outpatient services, 
hospitals that provide more complex outpatient services are expected to 
have higher unit costs than hospitals with less complex service-mixes. 
Typically, greater complexity involves a combination of higher 
equipment and labor costs. Rural hospitals usually have less volume and 
perform less complex services than urban hospitals.
     Fourth, the size of a hospital may influence the volume 
and service-mix of outpatient services. Large hospitals generally 
provide a wider range of more complex services than do small hospitals. 
Large hospitals may also have larger volumes in ancillary departments 
that are shared between outpatient and inpatient services, and as a 
result, benefit from greater economies of scale than do small 
hospitals. Rural hospitals tend to be smaller than urban hospitals. Our 
primary measure of outpatient volume is units of APCs, which only 
reflects the volume of Medicare services paid under the outpatient PPS. 
This measure does not include the inpatient utilization of shared 
ancillary departments or non-Medicare outpatient services. For all 
these reasons, it seems appropriate to include a broader measure of 
facility size in the explanatory regression model. Therefore, as 
explained below, we used the total number of facility beds to measure 
facility size. Unit outpatient costs may be positively or negatively 
related to facility size depending on whether complexity effects or 
scale economies are more important.
2. Explanatory Variables
    We used the hospital wage index as our measure of labor input 
prices. To reflect the complexity of outpatient services, we used a 
service-mix index defined as the ratio of the number of discounted 
units weighted by APC relative weights divided by the number of 
unweighted discounted units. Discounted units are the total number of 
units after we adjust for the multiple procedure reduction of 50 
percent that applies to payment for surgical services when two surgical 
procedures are performed during the same operative session and for 
selected radiology procedures, as proposed (see section XIV. of the 
preamble). For example, if a procedure is paid at 100 percent of 
payment 1,000 times and the same procedure is paid at 50 percent of 
payment 100 times, the discounted units for that procedure equal 1,050 
units (the sum of 1,000 units at full payment plus 100 units at 50 
percent payment). We then calculate the total weight for that procedure 
by multiplying the discounted units by the full weight for the 
procedure. The service-mix index reflects the average APC weight of 
each facility's outpatient services. Outpatient service volume was 
measured as the total number of unweighted discounted units. We used 
the total number of facility beds as the broader measure of facility 
size. We also included categorical variables to indicate the types of 
specialty hospitals that participate in OPPS, specifically cancer, 
children's, long-term care, rehabilitation, and psychiatric hospitals. 
Finally, we included a categorical variable for rural/urban location to 
capture variation unexplained by the other independent variables in the 
model. For all of the rural dummy variables discussed below, urban 
hospitals are the reference group. Table 4 provides descriptive 
statistics for the dependent variable and key independent variables by 
urban and rural status. Without controlling for the other influences on 
per unit cost, rural hospitals have lower cost per unit than urban 
hospitals. However, when standardized for the service-mix wage indices, 
average unit costs are nearly identical between urban and rural 
hospitals

    Table 4.--Means and Standard Deviations (In Parenthesis) for Key
                    Variables by Urban-Rural Location
------------------------------------------------------------------------
                                         Rural               Urban
------------------------------------------------------------------------
Unit Outpatient Cost............            $163.78             $195.54
                                            ($65.69)            ($93.59)
Standardized Unit Outpatient                 $75.04              $75.15
 Cost...........................
                                            ($26.97)            ($45.00)
Wage Index......................             0.8798              1.0214
                                            (0.0771)            (0.1487)
Service-Mix Index...............             2.4121              2.7741
                                            (0.8915)            (1.4579)
Outpatient Volume...............             18,645              35,744
                                            (19,578)            (42,626)
Beds............................              76.70                 198
                                             (55.82)               (169)
Number of Hospitals.............              1,257               2,820
------------------------------------------------------------------------


[[Page 42700]]

3. Results
    Overall, all rural hospitals give some indication of having higher 
cost per unit, after controlling for labor input prices, service-mix 
complexity, volume, facility size, and type of hospital. In an 
explanatory model regressing unit costs on all independent variables 
discussed above, the coefficient for the rural categorical variable was 
0.024 (p=0.058), which suggests that rural hospitals are approximately 
2.4 percent more costly than urban hospitals after accounting for the 
impact of other explanatory variables. The results of this regression 
appear in Table 5. This regression demonstrated reasonably good 
explanatory power with an adjusted R2 of 0.53 (rounded). Adjusted R2 is 
the percentage of variation in the dependent variable explained by the 
independent variables and is a standard measure of how well the 
regression model fits the data. The regression coefficients of the key 
explanatory variables all move in the expected direction: positive for 
the wage index, indicating that rural hospitals can be expected to have 
lower unit outpatient costs because they tend to be located in areas 
with lower wage rates; positive for the outpatient service-mix index, 
consistent with the hypothesis that rural hospitals' less complex 
outpatient service-mixes result in lower unit costs than those of the 
typical urban hospital; negative for outpatient service volume, 
implying that, on average, rural hospitals' lower service volumes are a 
source of higher unit cost compared to urban hospitals; and positive 
for the facility size variable (beds), suggesting that facility size is 
more reflective of complexity than any economies of scale. The rural 
dummy variable has a coefficient of 0.02414. If the unit costs of rural 
hospitals are the same as the unit costs of urban hospitals, the 
probability of observing a value as extreme as or more extreme than 2.4 
percent would be approximately 6 percent or less. This explanatory 
regression model provides some evidence that outpatient services 
provided by rural hospitals are more costly than outpatient services 
provided by urban hospitals, but the evidence is weak. The payment 
regression that accompanies this explanatory model indicates an 
adjustment for all rural hospitals of 3.7 percent.

                    Table 5.--Regression Results for Unit Outpatient Cost: Rural Versus Urban
----------------------------------------------------------------------------------------------------------------
                                                    Explanatory                            Payment
                                       -------------------------------------------------------------------------
               Variable                  Regression                           Regression
                                        coefficient   t Value 1   p Value 2  coefficient   t Value 1   p Value 2
----------------------------------------------------------------------------------------------------------------
Intercept.............................      4.89665      124.65      <.0001      4.24092     0.00624     <0.0001
Wage Index............................      0.64435       17.96      <.0001  ...........  ..........  ..........
Service-Mix Index.....................      0.75813       58.51      <.0001  ...........  ..........  ..........
Outpatient Volume.....................     -0.06532      -14.40      <.0001  ...........  ..........  ..........
Beds..................................      0.04475        6.17      <.0001  ...........  ..........  ..........
Rural.................................      0.02414        1.89      0.0582      0.03656        3.25      0.0012
Children's Hospital...................      0.06497        1.33      0.1824  ...........  ..........  ..........
Psychiatric Hospital..................     -0.44446      -15.13      <.0001  ...........  ..........  ..........
Long-Term Care Hospital...............     -0.08759       -2.77     .0.0057  ...........  ..........  ..........
Rehabilitation Hospital...............     -0.25295       -7.85      <.0001  ...........  ..........  ..........
Cancer Hospital.......................      0.30897        3.45      0.0006  ...........  ..........  ..........
R2....................................      0.5285   ..........  ..........  ...........  ..........  ..........
----------------------------------------------------------------------------------------------------------------
 Note: Coefficients of all quantitative variables are elasticities since both the dependent variable, unit
  outpatient cost, and all quantitative independent variables were in natural logarithms. To calculate
  percentage differences for categorical variables, their coefficients must be raised to the power, e, the base
  of natural logarithms.
1 A t value is an indicator of our degree of confidence that the regression coefficient is different from zero,
  taking into account the statistical variability of the estimated coefficient.
2 A p value is the probability of observing the specific t value when the estimated coefficient is zero. The t
  values greater than 2 and less than -2 indicate a probability less than 5 percent, p-value<0.05, that the
  estimated coefficient is zero.

    In order to assess whether the small difference in costs was 
uniform across rural hospitals or whether all of the variation was 
attributable to a specific class of rural hospitals, we included more 
specific categories of rural hospitals in our explanatory regression 
analysis. We divided rural hospitals into rural SCHs, rural hospitals 
with less than 100 beds that are not rural sole community hospitals, 
and other rural hospitals. The first two categories of rural hospitals 
are currently eligible for payments under the expiring hold-harmless 
provision. Because it appears that rural SCHs are responsible for the 
variation in rural hospital costs, we then collapsed the last remaining 
categories in an ``all other'' rural hospital category.
    We found that rural SCHs demonstrated significantly higher cost per 
unit than urban hospitals after controlling for labor input prices, 
service-mix complexity, volume, facility size, and type of hospital. 
The results of this regression appear in Table 6. With the exception of 
the new rural variables, the independent variables have the same sign 
and significance as in Table 5. Rural SCHs have a positive and 
significant coefficient; all other rural hospitals do not. The rural 
SCH ``dummy'' variable has an explanatory regression coefficient of 
0.05668 and an observed probability that the coefficient is zero of 
less than 0.001. If the unit costs of rural SCHs are the same as those 
of urban hospitals, the probability of observing a value as extreme or 
more extreme than 5.8 percent would be less than 0.1 percent. 
Accordingly, we have determined that rural SCHs are more costly than 
urban hospitals, holding all other variables constant. Notably, we 
observed no significant difference between all other rural hospitals 
and urban hospitals.

[[Page 42701]]



              Table 6.--Regression Results for Unit Outpatient Cost: Rural Sole Community Hospitals
----------------------------------------------------------------------------------------------------------------
                                                    Explanatory                            Payment
                                       -------------------------------------------------------------------------
               Variable                  Regression    t Value                Regression    t Value
                                        coefficient      \1\     pValue \2\  coefficient      \1\     pValue \2\
----------------------------------------------------------------------------------------------------------------
Intercept.............................      4.89444      124.70      <.0001      4.24474      768.57      <.0001
Wage Index............................      0.64022       17.85      <.0001  ...........  ..........  ..........
Service-Mix Index.....................      0.75798       58.56      <.0001  ...........  ..........  ..........
Outpatient Volume.....................     -0.06538      -14.43      <.0001  ...........  ..........  ..........
Beds..................................      0.04533        6.26      <.0001  ...........  ..........  ..........
Rural SCH.............................      0.05668        3.42      0.0006      0.06354        3.94      <.0001
All Other Rural.......................      0.00415        0.29      0.7715  ...........  ..........  ..........
Children's Hospital...................      0.06475        1.33      0.1835  ...........  ..........  ..........
Psychiatric Hospital..................     -0.44345      -15.11      <.0001  ...........  ..........  ..........
Long-Term Care Hospital...............     -0.08644       -2.73      0.0063  ...........  ..........  ..........
Rehabilitation Hospital...............     -0.25234       -7.83      <.0001  ...........  ..........  ..........
Cancer Hospital.......................      0.30957        3.46      0.0005  ...........  ..........  ..........
R2....................................      0.5295   ..........  ..........  ...........  ..........  ..........
----------------------------------------------------------------------------------------------------------------
Note: Coefficients of all quantitative variables are elasticities since both the dependent variables, unit
  outpatient cost, and all quantitative independent variables were in natural logarithms. To calculate
  percentage differences for categorical variables, their coefficients must be raised to the power, e, the base
  of natural logarithms.
\1\ A t value is an indicator of our degree of confidence that the regression coefficient is different from
  zero, taking into account the statistical variability of the estimated coefficient.
\2\ A p value is the probability of observing the specific t value when the estimated coefficient is zero. The t
  values greater than 2 and less than -2 indicate a probability less than 5 percent, p-value <0.05, that the
  estimated coefficient is zero.

    Based on the above analysis and as noted in the explanatory 
regression in Table 6, we believe that a payment adjustment for rural 
SCHs is warranted. The accompanying payment regression, also appearing 
in Table 6, indicates a cost impact of 6.6 percent. Thus, in accordance 
with the authority provided in section 1833(t)(13)(B) of the Act, as 
added by section 411 of Pub. L. 108-173, we are proposing a 6.6 percent 
payment increase for rural SCHs for CY 2006. This adjustment would 
apply to all services and procedures paid under the OPPS, excluding 
drugs and biologicals. We note that this adjustment would be budget 
neutral, and would be applied before calculating outliers and 
coinsurance. We may revisit this adjustment in the future.
    Additional descriptive statistics are available on the CMS Web 
site.

H. Proposed Hospital Outpatient Outlier Payments

(If you choose to comment on issues in this section, please include 
the caption ``Outlier Payments'' at the beginning of your comment.)

    Currently, the OPPS pays outlier payments on a service-by-service 
basis. For CY 2005, the outlier threshold is met when the cost of 
furnishing a service or procedure by a hospital exceeds 1.75 times the 
APC payment amount and exceeds the APC payment rate plus a $1,175 fixed 
dollar threshold. We introduced a fixed dollar threshold in CY 2005 in 
addition to the traditional multiple threshold to better target 
outliers to those high cost and complex procedures where a very costly 
case could present a hospital with significant financial loss. If a 
provider meets both of these conditions, the multiple threshold and the 
fixed dollar threshold, the outlier payment is calculated as 50 percent 
of the amount by which the cost of furnishing the service exceeds 1.75 
times the APC payment rate. For CMHCs, the outlier threshold is met 
when the cost of furnishing a service or procedure by a CMHC exceeds 
3.5 times the APC payment rate. If a CMHC provider meets this 
condition, the outlier payment is calculated as 50 percent of the 
amount by which the cost exceeds 3.5 times the APC payment rate.
    As explained in our CY 2005 final rule (69 FR 65844), we set our 
projected target for aggregate outlier payments at 2.0 percent of 
aggregate total payments under OPPS. Our outlier thresholds were set so 
that estimated CY 2005 aggregate outlier payments would equal 2.0 
percent of aggregate total payments under OPPS.
    For CY 2006, we are proposing to set our projected target for 
aggregate outlier payments at 1.0 percent of aggregate total payments 
under OPPS. A portion of that 1.0 percent, an amount equal to .006 
percent of aggregate total payments under OPPS, would be allocated to 
CMHCs for partial hospitalization program service outliers. In its 
March 2004 Report, MedPAC recommended that Congress should eliminate 
the outlier policy under the outpatient prospective payment system. 
While this would require a statutory change, many of the reasons cited 
by MedPAC for the elimination of the outlier policy are equally 
applicable to any reduction in the size of the percentage of total 
payments dedicated to outlier payments, including the following: the 
narrow definition of many of the services provided in hospital 
outpatient departments suggests that variability in costs should not be 
great; the distribution of outlier payments benefits some hospital 
groups more than others; the outlier policy is susceptible to 
``gaming'' through charge inflation; and, the OPPS is the only 
ambulatory payment system with an outlier policy.
    In order to ensure that estimated CY 2006 aggregate outlier 
payments would equal 1.0 percent of estimated aggregate total payments 
under OPPS, we are proposing that the outlier threshold be modified so 
that outlier payments are triggered when the cost of furnishing a 
service or procedure by a hospital exceeds 1.75 times the APC payment 
amount and exceeds the APC payment rate plus a $1,575 fixed dollar 
threshold. We choose to modify the fixed dollar threshold to target 1.0 
percent of estimated aggregate total payment under OPPS and not modify 
the current 1.75 multiple to further our policy of targeting outlier 
payments to complex and expensive procedures with sufficient 
variability to pose a financial risk for hospitals. Modifying the 
multiple would do less to target outlier payments to complex and 
expensive procedures. For example, if we were to establish a multiple 
of 2.00 rather than 1.75, then an APC with a payment rate of $20,000 
would see the outlier threshold associated with the multiple increase 
from $35,000 to $40,000. Raising the fixed dollar threshold to

[[Page 42702]]

$1,575 only increases the threshold for expensive procedures by $400. 
For this reason, we believe it is more appropriate to focus the 
modification necessary to target 1.0 percent of aggregate OPPS payments 
on the fixed dollar threshold and increase it from $1,175 in CY 2005 to 
our proposed $1,575 in CY 2006 and have the multiple threshold remain 
at 1.75.
    For CY 2006, the outlier threshold for CMHCs is met when the cost 
of furnishing a service or procedure by a CMHC exceeds 3.45 times the 
APC payment rate. If a CMHC provider meets this condition, the outlier 
payment is calculated as 50 percent of the amount by which the cost 
exceeds 3.45 times the APC payment rate.
    The following is an example of an outlier calculation for CY 2006 
under our proposed policy. A hospital charges $26,000 for a procedure. 
The APC payment for the procedure is $3,000, including a rural 
adjustment, if applicable. Using the provider's cost-to-charge ratio of 
0.30, the estimated cost to the hospital is $7,800. To determine 
whether this provider is eligible for outlier payments for this 
procedure, the provider must determine whether the cost for the service 
exceeds both the APC outlier cost threshold (1.75 x APC payment) and 
the fixed dollar threshold ($1,575 + APC payment). In this example, the 
provider meets both criteria:
    (1) $7,800 exceeds $5,250 (1.75 x $3,000)
    (2) $7,800 exceeds $4,575 ($1,575 + $3,000)
    To calculate the outlier payment, which is 50 percent of the amount 
by which the cost of furnishing the service exceeds 1.75 times the APC 
rate, subtract $5,250 (1.75 x $3,000) from $7,800 (resulting in 
$2,550). The provider is eligible for 50 percent of the difference, in 
this case $1,275 ($2,550/2). The formula is (cost -(1.75 x APC payment 
rate))/2.

I. Calculation of the Proposed National Unadjusted Medicare Payment

(If you choose to comment on issues in this section, please include 
the caption ``Payment Rate for APCs'' at the beginning of your 
comment.)

    The basic methodology for determining prospective payment rates for 
OPD services under the OPPS is set forth in existing regulations at 
Sec.  419.31 and Sec.  419.32. The payment rate for services and 
procedures for which payment is made under the OPPS is the product of 
the conversion factor calculated in accordance with section II.C. of 
this proposed rule, and the relative weight determined under section 
II.A. of this proposed rule. Therefore, the national unadjusted payment 
rate for APCs contained in Addendum A to this proposed rule and for 
payable HCPCS codes in Addendum B to this proposed rule (Addendum B is 
provided as a convenience for readers) was calculated by multiplying 
the proposed CY 2006 scaled weight for the APC by the proposed CY 2006 
conversion factor.
    However, to determine the payment that would be made in a calendar 
year under the OPPS to a specific hospital for an APC for a service 
other than a drug, in a circumstance in which the multiple procedure 
discount does not apply, we take the following steps:
    Step 1. Calculate 60 percent (the labor-related portion) of the 
national unadjusted payment rate. Since initial implementation of the 
OPPS, we have used 60 percent to represent our estimate of that portion 
of costs attributable, on average, to labor. (Refer to the April 7, 
2000 final rule with comment period (65 FR 18496 through 18497), for a 
detailed discussion of how we derived this percentage.)
    Step 2. Determine the wage index area in which the hospital is 
located and identify the wage index level that applies to the specific 
hospital. The wage index values assigned to each area reflect the new 
geographic statistical areas as a result of revised OMB standards 
(urban and rural) to which hospitals would be assigned for FY 2006 
under the IPPS, reclassifications through the Medicare Classification 
Geographic Review Board, section 1866(d)(8)(B) ``Lugar'' hospitals, and 
section 401 of Pub. L. 108-173, and the reclassifications of hospitals 
under the one-time appeals process under section 508 of Pub. L. 108-
173. Assess whether the previous MSA-based wage index is higher than 
the CBSA-based wage index, and, if higher, apply a 50/50 blend. The 
wage index values include the occupational mix adjustment described in 
section II.D. of this proposed rule that was developed for the IPPS.
    Step 3. Adjust the wage index of hospitals located in certain 
qualifying counties that have a relatively high percentage of hospital 
employees who reside in the county, but who work in a different county 
with a higher wage index, in accordance with section 505 of Pub. L. 
108-173. Addendum K contains the qualifying counties and the proposed 
wage index increase developed for the IPPS. This step is to be followed 
only if the hospital has chosen not to accept reclassification under 
Step 2 above.
    Step 4. Multiply the applicable wage index determined under Steps 2 
and 3 by the amount determined under Step 1 that represents the labor-
related portion of the national unadjusted payment rate.
    Step 5. Calculate 40 percent (the nonlabor-related portion) of the 
national unadjusted payment rate and add that amount to the resulting 
product of Step 4. The result is the wage index adjusted payment rate 
for the relevant wage index area.
    Step 6. If a provider is a sole community hospital, as defined in 
Sec.  419.92, and located in a rural area, as defined in Sec.  
412.63(b) or is treated as being located in a rural area under section 
1886(d)(8)(E) of the Act, multiply the wage index adjusted payment rate 
by 1.066 to calculate the total payment.

J. Proposed Beneficiary Copayments for CY 2006

(If you choose to comment on issues in this section, please include 
the caption ``Beneficiary Copayment'' at the beginning of your 
comment.)
1. Background
    Section 1833(t)(3)(B) of the Act requires the Secretary to set 
rules for determining copayment amounts to be paid by beneficiaries for 
covered OPD services. Section 1833(t)(8)(C)(ii) of the Act specifies 
that the Secretary must reduce the national unadjusted copayment amount 
for a covered OPD service (or group of such services) furnished in a 
year in a manner so that the effective copayment rate (determined on a 
national unadjusted basis) for that service in the year does not exceed 
specified percentages. For all services paid under the OPPS in CY 2006, 
and in calendar years thereafter, the specified percentage is 40 
percent of the APC payment rate. Section 1833(t)(3)(B)(ii) of the Act 
provides that, for a covered OPD service (or group of such services) 
furnished in a year, the national unadjusted coinsurance amount cannot 
be less than 20 percent of the OPD fee schedule amount.
2. Proposed Copayment for CY 2006
    For CY 2006, we are proposing to determine copayment amounts for 
new and revised APCs using the same methodology that we implemented for 
CY 2004 (see the November 7, 2003 OPPS final rule with comment period, 
68 FR 63458). The proposed unadjusted copayment amounts for services 
payable under the OPPS that would be effective January 1, 2006, are 
shown in Addendum A and Addendum B of this proposed rule.

[[Page 42703]]

3. Calculation of the Proposed Unadjusted Copayment Amount for CY 2006
    To calculate the unadjusted copayment amount for an APC group, take 
the following steps:
    Step 1. Calculate the beneficiary payment percentage for the APC by 
dividing the APC's national unadjusted copayment by its payment rate. 
For example, using APC 0001, $9.95 is 40 percent of $24.89.
    Step 2. Calculate the wage adjusted payment rate for the APC, for 
the provider in question, as indicated in section II.I. above.
    Step 3. Multiply the percentage calculated in Step 1 by the payment 
rate calculated in Step 2. The result is the wage adjusted copayment 
amount for the APC.

III. Proposed Ambulatory Payment Classification (APC) Group Policies

A. Background

    Section 1833(t)(2)(A) of the Act requires the Secretary to develop 
a classification system for covered hospital outpatient services. 
Section 1833(t)(2)(B) provides that this classification system may be 
composed of groups of services, so that services within each group are 
comparable clinically and with respect to the use of resources. In 
accordance with these provisions, we developed a grouping 
classification system, referred to as the Ambulatory Payment 
Classification Groups (or APCs), as set forth in Sec.  419.31 of the 
regulations. We use Level I and Level II HCPCS codes and descriptors to 
identify and group the services within each APC. The APCs are organized 
such that each group is homogeneous both clinically and in terms of 
resource use. Using this classification system, we have established 
distinct groups of surgical, diagnostic, and partial hospitalization 
services, and medical visits. We also have developed separate APC 
groups for certain medical devices, drugs, biologicals, 
radiopharmaceuticals, and devices of brachytherapy.
    We have packaged into each procedure or service within an APC group 
the cost associated with those items or services that are directly 
related and integral to performing a procedure or furnishing a service. 
Therefore, we do not make separate payment for packaged items or 
services. For example, packaged items and services include: use of an 
operating, treatment, or procedure room; use of a recovery room; use of 
an observation bed; anesthesia; medical/surgical supplies; 
pharmaceuticals (other than those for which separate payment may be 
allowed under the provisions discussed in section V. of this preamble); 
and incidental services such as venipuncture. Our packaging methodology 
is discussed in section II.A. of this proposed rule.
    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 than annually and to revise the 
groups and relative payment weights and make 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, as amended 
by section 201(h) of the BBRA of 1999, also requires the Secretary, 
beginning in CY 2001, to consult with an outside panel of experts to 
review the APC groups and the relative payment weights (the APC Panel 
recommendations for CY 2006 OPPS and our responses to them are 
discussed in sections III.B. and III.C.4. of this preamble).
    Finally, as discussed earlier, 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.

B. Proposed Changes--Variations Within APCs

(If you choose to comment on issues in this section, please include 
the caption ``2 Times Rule'' at the beginning of your comment.)
1. Application of the 2 Times Rule
    In accordance with section 1833(t)(2) of the Act and Sec.  419.31 
of the regulations, we annually review the items and services within an 
APC group to determine with respect to comparability of the use of 
resources if the median of the highest cost item or service within an 
APC group is more than 2 times greater than the median of the lowest 
cost item or service within that same group (``2 times rule''). We make 
exceptions to this limit on the variation of costs within each APC 
group in unusual cases such as low-volume items and services. The 
statute provides no exception in the case of a drug or biological that 
has been designated as an orphan drug under section 526 of the Federal 
Food, Drug, and Cosmetic Act because these drugs are assigned to 
individual APC's.
    During the APC Panel's February 2005 meeting, we presented median 
cost and utilization data for the period of January 1, 2004, through 
September 30, 2004, concerning a number of APCs that violate the 2 
times rule and asked the APC Panel for its recommendation. After 
carefully considering the information and data we presented, the APC 
Panel recommended moving a total of 65 HCPCS codes from their currently 
assigned APC to a different APC to resolve the 2 times rule violations. 
Of the 65 HCPCS code reassignments recommended by the APC Panel, we 
concur with 58 of the recommended reassignments. Therefore, we are 
proposing to reassign these HCPCS codes as shown in Table 7.

   Table 7.--Proposed Movement of HCPCS Codes Among APCs Based on the APC Panel's Recommendations for CY 2006
----------------------------------------------------------------------------------------------------------------
                                                                                                   Proposed  CY
                 HCPCS code                               Description               CY 2005 APC      2006 APC
----------------------------------------------------------------------------------------------------------------
45307.......................................  Proctosigmoidoscopy fb............            0146            0428
45320.......................................  Proctosigmoidoscopy ablate........            0147            0428
45321.......................................  Proctosigmoidoscopy volvul........            0147            0428

[[Page 42704]]

 
45335.......................................  Sigmoidoscopy w/submuc inj........            0147            0146
45337.......................................  Sigmoidoscopy & decompress........            0147            0146
46606.......................................  Anoscopy and biopsy...............            0147            0146
46610.......................................  Anoscopy, remove lesion...........            0147            0428
46612.......................................  Anoscopy, remove lesions..........            0147            0428
46614.......................................  Anoscopy, control bleeding........            0147            0146
46615.......................................  Anoscopy..........................            0147            0428
56405.......................................  I & D of vulva/perineum...........            0192            0189
57155.......................................  Insert uteri tandems/ovoids.......            0193            0192
65265.......................................  Remove foreign body from eye......            0236            0237
65285.......................................  Repair of eye wound...............            0236            0672
66220.......................................  Repair eye lesion.................            0236            0672
67025.......................................  Replace eye fluid.................            0236            0237
67027.......................................  Implant eye drug system...........            0237            0672
67036.......................................  Removal of inner eye fluid........            0237            0672
67038.......................................  Strip retinal membrane............            0237            0672
67039.......................................  Laser treatment of retina.........            0237            0672
67121.......................................  Remove eye implant material.......            0236            0237
75790.......................................  Visualize A-V shunt...............            0281            0279
75820.......................................  Vein x-ray, arm/leg...............            0281            0668
75822.......................................  Vein x-ray, arms/legs.............            0281            0668
75831.......................................  Vein x-ray, kidney................            0287            0279
75840.......................................  Vein x-ray, adrenal gland.........            0287            0280
75842.......................................  Vein x-ray, adrenal glands........            0287            0280
75860.......................................  Vein x-ray, neck..................            0287            0668
75870.......................................  Vein x-ray, skull.................            0287            0668
75872.......................................  Vein x-ray, skull.................            0287            0279
75880.......................................  Vein x-ray, eye socket............            0287            0668
86077.......................................  Physician blood bank service......            0343            0433
86079.......................................  Physician blood bank service......            0343            0433
88104.......................................  Cytopathology, fluids.............            0343            0433
88107.......................................  Cytopathology, fluids.............            0343            0433
88160.......................................  Cytopath smear, other source......            0342            0433
88161.......................................  Cytopath smear, other source......            0343            0433
88162.......................................  Cytopath smear, other source......            0342            0433
88184.......................................  Flowcytometry/tc, 1 marker........            0342            0344
88185.......................................  Flowcytometry/tc, add-on..........            0342            0343
88187.......................................  Flowcytometry/read, 2-8...........            0342            0433
88188.......................................  Flowcytometry/read, 9-15..........            0342            0433
88189.......................................  Flowcytometry/read, 16 & >........            0344            0343
88312.......................................  Special stains....................            0342            0433
88313.......................................  Special stains....................            0342            0433
88318.......................................  Chemical histochemistry...........            0342            0433
88323.......................................  Microslide consultation...........            0344            0343
88329.......................................  Path consult introp...............            0342            0433
88332.......................................  Path consult intraop, add'l.......            0342            0433
88342.......................................  Immunohistochemistry..............            0344            0343
88346.......................................  Immunofluorescent study...........            0344            0343
88347.......................................  Immunofluorescent study...........            0344            0343
88355.......................................  Analysis, skeletal muscle.........            0344            0343
89230.......................................  Collect sweat for test............            0343            0433
92004.......................................  Eye exam, new patient.............            0602            0601
92014.......................................  Eye exam & treatment..............            0602            0601
----------------------------------------------------------------------------------------------------------------

    The seven HCPCS code movements that the APC Panel recommended, but 
upon further review we are proposing not to accept, are discussed 
below. We include in our discussion our proposal specific to each of 
them to resolve the 2 times rule violations.
    a. APC 0146: Level I Sigmoidoscopy, APC 0147: Level II 
Sigmoidoscopy, APC 0428: Level III Sigmoidoscopy.
    APCs 0146 and 0147 were exceptions to the 2 times rule in CY 2005. 
Our analysis of these two APCs based on the most current CY 2004 data 
revealed greater violations of the 2 times rule and changing relative 
frequencies of simple and complex procedures in these two APCs. Thus, 
for CY 2006, the APC Panel assisted us in reconfiguring these two APCs 
into three related APCs to resolve the two times violations and improve 
their clinical and resource homogeneity based on the most current 
hospital claims data and to remove these APCs from the list of 
exceptions. The APC Panel recommended moving CPT codes 45303 
(Proctosigmoidoscopy dilate) and 45305 (Proctosigmoidoscopy w/bx) from 
APC 0147 to APC 0146 because the median cost for these codes appeared 
too high, and was likely based primarily on aberrant CY 2004 claims. In 
addition, the APC Panel recommended that CMS move CPT code 45309 
(Proctosigmoidoscopy removal) from APC 0147 to a new proposed APC 0428.

[[Page 42705]]

Based on the results of our review of several years of claims data and 
our study of hospital resource homogeneity, we disagree that these 
claims data are aberrant. We are proposing to move CPT codes 45303 and 
45305 to APC 0147 and to keep CPT 45309 in APC 0147, to resolve the 2 
times rule violation.
    b. APC 0342: Level I Pathology, APC 0433: Level II Pathology, APC 
0343: Level III Pathology.
    To resolve a 2 times rule violation, the APC Panel recommended 
moving CPT codes 88108 (Cytopath, concentrate tech) and 88112 
(Cytopath, cell enhance tech) from APC 0343 to a proposed new APC 0433. 
The APC Panel also recommended moving CPT codes 88319 (Enzyme 
histochemistry) and 88321 (Microslide consultation) from APC 0342 to a 
proposed new APC 0433. Based on the results of our review of several 
years of claims data and the study of hospital resource homogeneity, we 
are proposing a different way to resolve the 2 times rule violation: We 
are proposing to place CPT codes 88319 and 88112 in APC 0343 and to 
place CPT codes 88108 and 88321 in APC 0433.
2. Proposed Exceptions to the 2 Times Rule
    As discussed earlier, we may make exceptions to the 2 times limit 
on the variation of costs within each APC group in unusual cases such 
as low-volume items and services. Taking into account the APC changes 
that we are proposing for CY 2006 based on the APC Panel 
recommendations discussed in section III.B.1. of this preamble and the 
use of CY 2004 claims data to calculate the median cost of procedures 
classified in the APCs, we reviewed all the APCs to determine which 
APCs would not meet the 2 times limit. We used the following criteria 
to decide whether to propose exceptions to the 2 times rule for 
affected APCs:
     Resource homogeneity
     Clinical homogeneity
     Hospital concentration
     Frequency of service (volume)
     Opportunity for upcoding and code fragments.
    For a detailed discussion of these criteria, refer to the April 7, 
2000 OPPS final rule with comment period (65 FR 18457).
    Table 8 below contains the APCs that we are proposing to exempt 
from the 2 times rule based on the criteria cited above. In cases in 
which a recommendation of the APC Panel appeared to result in or allow 
a violation of the 2 times rule, we generally accepted the APC Panel's 
recommendation because these recommendations were based on explicit 
consideration of resource use, clinical homogeneity, hospital 
specialization, and the quality of the data used to determine the APC 
payment rates that we are proposing for CY 2006. The median cost for 
hospital outpatient services for these and all other APCs can be found 
on the CMS Web site: http//www.cms.hhs.gov.

    Table 8.--Proposed APC Exceptions to the 2 Times Rule For CY 2006
------------------------------------------------------------------------
              APC                           APC description
-----------------------------------------------------------------------
0004...........................  Level I Needle Biopsy/ Aspiration
                                  Except Bone Marrow.
0005...........................  Level II Needle Biopsy/Aspiration
                                  Except Bone Marrow.
0019...........................  Level I Excision/ Biopsy.............
0024...........................  Level I Skin Repair..................
0040...........................  Level I Implantation of
                                  Neurostimulator Electrodes.
0043...........................  Closed Treatment Fracture Finger/Toe/
                                  Trunk.
0046...........................  Open/Percutaneous Treatment Fracture
                                  or Dislocation.
0060...........................  Manipulation Therapy.................
0080...........................  Diagnostic Cardiac Catheterization...
0081...........................  Non-Coronary Angioplasty or
                                  Atherectomy.
0093...........................  Vascular Reconstruction/Fistula
                                  Repair without Device.
0099...........................  Electrocardiograms...................
0105...........................  Revision/Removal of Pacemakers, AICD,
                                  or Vascular.
0120...........................  Infusion Therapy Except Chemotherapy.
0140...........................  Esophageal Dilation without Endoscopy
0141...........................  Level I Upper GI Procedures..........
0148...........................  Level I Anal/Rectal Procedures.......
0164...........................  Level I Urinary and Anal Procedures..
0191...........................  Level I Female Reproductive Proc.....
0204...........................  Level I Nerve Injections.............
0209...........................  Extended EEG Studies and Sleep
                                  Studies, Level II.
0235...........................  Level I Posterior Segment Eye
                                  Procedures.
0251...........................  Level I ENT Procedures...............
0252...........................  Level II ENT Procedures..............
0262...........................  Plain Film of Teeth..................
0274...........................  Myelography..........................
0297...........................  Level II Therapeutic Radiologic
                                  Procedures.
0303...........................  Treatment Device Construction........
0312...........................  Radioelement Applications............
0325...........................  Group Psychotherapy..................
0330...........................  Dental Procedures....................
0341...........................  Skin Tests...........................
0353...........................  Level II Injections..................
0373...........................  Neuropsychological Testing...........
0397...........................  Vascular Imaging.....................
0409...........................  Red Blood Cell Tests.................
0432...........................  Health and Behavior Services.........
0600...........................  Low Level Clinic Visits..............
0688...........................  Revision/Removal of Neurostimulator
                                  Pulse Generator Receiver.
0004...........................  Level I Needle Biopsy/ Aspiration
                                  Except Bone Marrow.
0005...........................  Level II Needle Biopsy/Aspiration
                                  Except Bone Marrow.

[[Page 42706]]

 
0019...........................  Level I Excision/ Biopsy.............
------------------------------------------------------------------------

C. New Technology APCs

(If you choose to comment on issues in this section, please include 
the caption ``New Technology APCs'' at the beginning of your 
comment.)
1. Background
    In the November 30, 2001 final rule (66 FR 59903), we finalized 
changes to the time period a service was eligible for payment under a 
New Technology APC. Beginning in CY 2002, we retain services within New 
Technology APC groups until we gather sufficient claims data to enable 
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. 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.
2. Proposed Refinement of New Technology Cost Bands
    In the November 7, 2003 final rule with comment period, we last 
restructured the New Technology APC groups to make the cost intervals 
more consistent across payment levels (68 FR 63416). We established 
payment levels in $50, $100, and $500 intervals and expanded the number 
of New Technology APCs. We also retained two parallel sets of New 
Technology APCs, one set with a status indicator of ``S'' (Significant 
Procedure, Not Discounted When Multiple) and the other set with a 
status indicator of ``T'' (Significant Procedures, Multiple Reduction 
Applies). We did this restructuring because the number of procedures 
assigned to New Technology APCs had increased, and narrower cost bands 
were necessary to avoid significant payment inaccuracies for New 
Technology services. Therefore, we dedicated two new series of APCs to 
the restructured New Technology APCs, which allowed us to narrow the 
cost bands and afforded us the flexibility to create additional bands 
as future needs dictated.
    As the number of procedures that qualify for placement in the New 
Technology APCs has continued to increase over the past 2 years, the $0 
to $50 cost band represented by ``S'' status APC 1501 (New Technology, 
Level I, $0-$50) and ``T'' status APC 1538 (New Technology, Level I, 
$0-$50) spans too broad of a cost interval to accurately represent the 
lower costs of an ever-increasing number of procedures that qualify for 
New Technology payment. Therefore, we are proposing to refine this cost 
band to five $10 increments, resulting in the creation of an additional 
10 New Technology APCs to accommodate the two parallel sets of New 
Technology APCs, one set with a status indicator of ``S'' and the other 
set with a status indicator of ``T.'' We are also proposing to 
eliminate the two $0 to $50 cost band New Technology APCs 1501 and 
1538, so that the cost bands of all New Technology APCs would continue 
to be mutually exclusive. Table 9 contains a listing of the 10 
additional New Technology APCs that we are proposing for CY 2006.

                               Table 9.--Proposed New Technology APCs for CY 2006
----------------------------------------------------------------------------------------------------------------
                                                                                                    Proposed CY
                APC                             Descriptor                  Status indicator       2006 payment
                                                                                                       rate
----------------------------------------------------------------------------------------------------------------
1491...............................  New Technology--Level IA ($0-     S                                      $5
                                      $10).
1492...............................  New Technology--Level IB ($10-    S                                      15
                                      $20).
1493...............................  New Technology--Level IC ($20-    S                                      25
                                      $30).
1494...............................  New Technology--Level ID ($30-    S                                      35
                                      $40).
1495...............................  New Technology--Level IE ($40-    S                                      45
                                      $50).
1496...............................  New Technology--Level IA ($0-     T                                       5
                                      $10).
1497...............................  New Technology--Level B ($10-     T                                      15
                                      $20).
1498...............................  New Technology--Level IC ($20-    T                                      25
                                      $30).
1499...............................  New Technology--Level D ($30-     T                                      35
                                      $40).
1500...............................  New Technology--Level E ($40-     T                                      45
                                      $50).
----------------------------------------------------------------------------------------------------------------

    As we explained in the November 30, 2001 final rule (66 FR 59897), 
we generally keep a procedure in the New Technology APC to which it is 
initially assigned until we have collected data sufficient to enable us 
to move the procedure to a clinically appropriate APC. However, in 
cases where we find that our original New Technology APC assignment was 
based on inaccurate or inadequate information, or where the New 
Technology APCs are restructured, we may, based on more recent resource 
utilization information (including claims data) or the availability of 
refined New Technology APC bands, reassign the procedure or service to 
a different New Technology APC that most appropriately reflects its 
cost. Therefore, we are proposing to discontinue New Technology APCs 
1501 and 1538, and reassign the procedures currently assigned to them 
to proposed New Technology APCs 1491 through 1500. Table 10 summarizes 
these proposed New Technology APC reassignments.

[[Page 42707]]



 Table 10.--Proposed Movement of HCPCS Codes From New Technology APCS 1501 and 1538 to New Technology APCs 1491
                                            Through 1500 for CY 2006
----------------------------------------------------------------------------------------------------------------
                                                                                                      CY 2006
                                                                                    CY 2005 new    proposed new
              HCPCS/CPT code                             Descriptor               technology APC  technology APC
                                                                                    assignment     reassignment
----------------------------------------------------------------------------------------------------------------
0003T....................................  Cervicography........................            1501            1492
90473....................................  Immunization Admin, one vaccine by                N/A            1491
                                            intranasal or oral.
90474....................................  Immunization Admin, each additional               N/A            1491
                                            vaccine by intranasal or oral.
G0375....................................  Smoking and tobacco-use cessation                1501            1491
                                            counseling visit; intermediate,
                                            greater than 3 minutes up to 10
                                            minutes.
G0376....................................  Smoking and tobacco-use cessation                1501            1492
                                            counseling visit; intensive, greater
                                            than 10 minutes.
----------------------------------------------------------------------------------------------------------------

3. Proposed Requirements for Assigning Services to New Technology APCs
    In the April 7, 2000 final rule (65 FR 18477), we created a set of 
New Technology APCs to pay for certain new technology services under 
the OPPS. We described a group of criteria for use in determining 
whether a service is eligible for assignment to a New Technology APC. 
We subsequently modified this set of criteria in our November 30, 2001 
final rule (66 FR 59897 to 59901), effective January 1, 2002. These 
modifications were based on changes in the data (we were no longer 
required to use 1996 data to set payment rates) and on our continuing 
experience with the assignment of services to New Technology APCs.
    Based on our history of reviewing applications for New Technology 
APC assignments under the OPPS, we have encountered situations where 
there is extremely limited clinical experience with new technology 
services regarding their use and efficacy in the typical Medicare 
population. In some cases, there may be ambiguity regarding how the new 
technology services fit within the standard coding framework for 
established procedures, and there may be no specific coding available 
for the new technology services in other settings or for use by other 
payers. Nevertheless, applicants requesting assignment of services to 
New Technology APCs request that we provide billing and payment 
mechanisms under the OPPS for the new technology services through the 
establishment of codes, descriptors, and payment rates. As stated in 
section I.F. of this preamble, we remain committed to the overarching 
goal of ensuring that Medicare beneficiaries have timely access to the 
most effective new medical treatments and technologies in clinically 
appropriate settings. We believe that our current New Technology APC 
assignment process helps to assure such access, and that an enhancement 
to the New Technology service application process may further encourage 
appropriate dissemination of and Medicare beneficiary access to new 
technology services.
    We are interested in promoting review of the coding, clinical use, 
and efficacy of new technology services by the greater medical 
community through our New Technology service application and review 
process for the OPPS. Therefore, in addition to our current information 
requirements at the time of application, we are proposing to require 
that an application for a code for a new technology service be 
submitted to the American Medical Association's (AMA's) CPT Editorial 
Panel before we accept a New Technology APC application for review. 
This will not change our current criteria for assignment of a service 
to a New Technology APC. This requirement will encourage timely review 
by the wider medical community as CMS is reviewing the service for 
possible new coding and assignment to a New Technology APC under the 
OPPS. There is only one CPT code application that is used by applicants 
requesting consideration for either Category I or III codes. We would 
accept either a Category I or Category III code application to the CPT 
Editorial Panel. The application requests relevant clinical information 
regarding new services, including their appropriate use and the patient 
populations expected to benefit from the services which will provide us 
with useful additional information. CPT code applications are reviewed 
by the CPT Editorial Panel, whose members bring diverse clinical 
expertise to that review. We believe that consideration by the CPT 
Editorial Panel may facilitate appropriate dissemination of the new 
technology services across delivery settings and may bring to light 
other needed coding changes or clarifications. We are further proposing 
that a copy of the submitted CPT application be filed with us as part 
of the application for a New Technology APC assignment under the OPPS, 
along with CPT's letter acknowledging or accepting the coding 
application. We remind the public that we do not consider an 
application complete until all informational requirements are provided. 
In addition, we remind the public that when we assign a new service a 
HCPCS code and provide for payment under the OPPS, these actions do not 
imply coverage by the Medicare program, but indicate only how the 
procedure or service may be paid if covered by the program. Fiscal 
intermediaries must determine whether a service meets all program 
requirements for coverage, for example, that it is reasonable and 
necessary to treat the beneficiary's condition and whether it is 
excluded from payment. CMS may also make National Coverage 
Determinations (NCDs) on new technology procedures.
4. Proposed Movement of Procedures From New Technology APCs to Clinical 
APCs
    The procedures discussed below represent New Technology services 
for which we believe we have sufficient data to reassign to a 
clinically appropriate APC.
a. Proton Beam Therapy
(If you choose to comment on issues in this section, please include 
the caption ``Proton Beam Therapy'' at the beginning of your 
comment.)

    In the August 16, 2004 proposed rule (69 FR 50467), we proposed to 
reassign CPT codes 77523 (Proton treatment delivery, intermediate) and 
77525 (Proton treatment delivery, complex) from New Technology APC 1511 
(New Technology, Level XI, $900-$1,000) to clinical APC 0419 (Proton 
Beam Therapy, Level II). In response to this proposal, we received 
numerous comments urging that we maintain CPT codes 77523 and 77525 in 
New Technology APC 1511 at a payment rate of $950 for CY 2005, arguing 
that the proposed payment rate of $678.31 for

[[Page 42708]]

CY 2005 would halt diffusion of this technology and negatively impact 
patient access to this cancer treatment. Commenters explained that the 
low volume of claims submitted by only two facilities provided volatile 
and insufficient data for movement into the proposed clinical APC 0419. 
They further explained that the extraordinary capital expense of 
between $70 and $125 million and high operating costs of a proton beam 
facility necessitate adequate payment for this service to protect the 
financial viability of this emerging technology.
    In the November 15, 2004 final rule with comment period (69 FR 
65719 through 65720), we considered the concerns expressed by numerous 
commenters that patient access to proton beam therapy might be impeded 
by a significant reduction in OPPS payment. Therefore, we set the CY 
2005 payment rate for CPT codes 77523 and 77525 by calculating a 50/50 
blend of the median cost for intermediate and complex proton beam 
therapies of $690.45 derived from CY 2003 claims and the CY 2004 New 
Technology payment rate of $950. We used the result of this calculation 
($820) to assign intermediate and complex proton beam therapies (CPT 
codes 77523 and 77525) to New Technology APC 1510 (New Technology--
Level X ($800-$900) for a blended payment rate of $850 for CY 2005.
    Our examination of the CY 2004 claims data has revealed a second 
year of a stable, albeit modest, number of claims on which to set the 
CY 2006 payment rates for CPT codes 77523 and 77525. However, unlike 
the median of $690.45 for the CY 2005 Level II proton beam radiation 
therapy clinical APC containing CPT codes 77523 and 77525 derived from 
the CY 2003 claims data, the median for a comparable Level II proton 
beam radiation therapy clinical APC is $934.46 derived from CY 2004 
claims data. This more recent median appears to more accurately reflect 
the significant capital expense and high operating costs of a proton 
beam therapy facility, and supports patient access to proton beam 
therapy. Therefore, we are proposing to move CPT codes 77523 and 77525 
from New Technology APC 1510 to clinical APC 0667 (Level II Proton Beam 
Radiation Therapy) based on a median cost of $934.46 for CY 2006.
b. Stereotactic Radiosurgery

(If you choose to comment on issues in this section, please include 
the caption ``Stereotactic Radiosurgery'' at the beginning of your 
comment.)

    In a correction to the November 7, 2003 final rule with comment 
period, issued on December 31, 2003 (68 FR 75442), we considered a 
commenter's request to combine HCPCS codes G0242 (Cobalt 60-based 
stereotactic radiosurgery planning) and G0243 (Cobalt 60-based 
stereotactic radiosurgery delivery) into a single procedure code in 
order to capture the costs of this treatment in single procedure claims 
because the majority of patients receive the planning and delivery of 
this treatment on the same day. We responded to the commenter's request 
by explaining that several other commenters stated that HCPCS code 
G0242 was being misused to code for the planning phase of linear 
accelerator-based stereotactic radiosurgery planning. Because the 
claims data for HCPCS code G0242 represented costs for linear 
accelerator-based stereotactic radiosurgery planning (due to misuse of 
the code), in addition to Cobalt 60-based stereotactic radiosurgery 
planning, we were uncertain of how to combine these data with HCPCS 
code G0243 to determine an accurate payment rate for a combined code 
for planning and delivery of Cobalt 60-based stereotactic radiosurgery.
    In consideration of the misuse of HCPCS code G0242 and the 
potential for causing greater confusion by combining HCPCS codes G0242 
and G0243 into a single procedure code, for CY 2004 we created a 
planning code for linear accelerator-based stereotactic radiosurgery 
(HCPCS code G0338) to distinguish this service from Cobalt 60-based 
stereotactic radiosurgery planning. We maintained both HCPCS codes 
G0242 and G0243 for the planning and delivery of Cobalt 60-based 
stereotactic radiosurgery, consistent with the use of the two G-codes 
for planning (HCPCS code G0338) and delivery (HCPCS codes G0173, G0251, 
G0339, G0340, as applicable) of each type of linear accelerator-based 
stereotactic radiosurgery (SRS). We indicated that we intended to 
maintain these new codes in their current New Technology APCs until we 
had sufficient hospital claims data reflecting the costs of the 
services to consider moving them to clinical APCs.
    During the February 2005 APC Panel meeting, the APC Panel discussed 
the clinical and resource cost similarities between planning for Cobalt 
60-based and linear accelerator-based SRS. The APC Panel also discussed 
the use of CPT codes instead of specific G-codes to describe the 
services involved in SRS planning, noting the clinical similarities in 
radiation treatment planning regardless of the mode of treatment 
delivery. Acknowledging the possible need for CMS to separately track 
planning for SRS, the APC Panel eventually recommended that we create a 
single HCPCS code to encompass both Cobalt 60-based and linear 
accelerator-based SRS planning. However, a hospital association and 
other presenters at the APC Panel meeting urged that we discontinue the 
use of G-codes for SRS planning, and instead, recognize the current CPT 
codes that describe the specific component services involved in SRS 
planning to reduce the burden on hospitals of maintaining duplicative 
codes for the same services to accommodate different payers. Lastly, 
one presenter urged that we combine HCPCS codes G0242 (Cobalt 60-based 
stereotactic radiosurgery planning) and G0243 (Cobalt 60-based 
stereotactic radiosurgery delivery) into a single procedure code to 
reflect that the majority of patients receive the planning and delivery 
of this treatment on the same day as a single fully integrated service.
    The APC Panel recommended that we make no changes to the coding or 
APC placement of SRS delivery codes G0173, G0243, G0251, G0339, and 
G0340 for CY 2006. We first established the above full group of 
delivery codes in 2004, so we have only one year of hospital claims 
data reflecting costs of the services. In addition, presenters to the 
APC Panel described current ongoing deliberations amongst interested 
professional societies around the descriptions and coding for SRS. The 
APC Panel and presenters suggested that we wait for the outcome of 
these deliberations prior to making any significant changes to SRS 
delivery coding or payment rates.
    In an effort to balance the recommendations of the APC Panel with 
the recommendations of presenters at the APC Panel meeting, in 
accordance with the APC Panel recommendations, we are proposing to make 
no changes to the APC placement of the following SRS treatment delivery 
codes for CY 2006: HCPCS codes G0173, G0243, G0251, G0339, and G0340.
    We recognize concerns expressed by some presenters urging that we 
discontinue the use of the G-codes for SRS planning, and instead, 
recognize the current CPT codes that describe the specific component 
services involved in SRS planning to reduce the burden on hospitals of 
maintaining duplicative codes for the same services to accommodate 
different payers. In addition, we have no need to separately track SRS 
planning services, which share clinical and resource homogeneity with 
other radiation treatment planning

[[Page 42709]]

services described by current CPT codes.
    When HCPCS code G0242 was established for SRS planning, several 
radiology planning services were considered in determining its APC 
placement. In the November 30, 2001 final rule, in which we described 
our determination of the total cost for SRS planning based on our 
claims experience, we added the median costs of the following CPT codes 
that we found to be regularly billed with SRS delivery (CPT code 61793 
in the available hospital data): 77295, 77300, 77370, and 77315. Our 
examination of the costs from the CY 2004 claims data for the above-
mentioned CPT codes closely approximates the CY 2004 median costs 
reported for HCPCS codes G0242 and G0338. The APC median costs for the 
above-mentioned CPT codes based on the CY 2004 claims data total 
$1,297, while the median cost for HCPCS code G0242 is $1,366 and the 
median cost for HCPCS code G0338 is $1,100 based on the CY 2004 claims 
data. In addition, three of the above-mentioned CPT codes are included 
on the proposed bypass list for CY 2006, so we would not anticipate 
that the billing of these codes on the same day as an SRS treatment 
service would cause significant problems with multiple bills for SRS 
services. Therefore, we are proposing to discontinue HCPCS codes G0242 
and G0338 for the reporting of charges for SRS planning under the OPPS, 
and to instruct hospitals to bill charges for SRS planning using all of 
the available CPT codes that most accurately reflect the services 
provided.
    We acknowledge one APC Panel presenter's concern that the coding 
structure of Cobalt 60-based SRS, using either the current SRS planning 
G code or the appropriate CPT codes for planning services as we are 
proposing for CY 2006, may not necessarily reflect the same day, 
integrated Cobalt 60-based SRS service furnished to the majority of 
patients receiving Cobalt 60-based SRS. Thus, we are seeking public 
comment on the clinical, administrative, or other concerns that could 
arise if we were to bundle Cobalt 60-based SRS planning services, 
currently reported using HCPCS code G0242 and proposed for CY 2006 to 
be billed using the appropriate CPT codes for planning services, into 
the Cobalt 60-based SRS treatment service, currently reported under the 
OPPS using HCPCS code G0243. Under such a scenario, the SRS treatment 
service described by HCPCS code G0243 would be placed in a higher 
paying New Technology APC to reflect payment for the costs of the SRS 
planning and delivery as an integrated service. Hospitals would be 
prohibited from billing other radiation planning services along with 
the Cobalt 60-based SRS treatment delivery code. In contrast to Cobalt 
60-based SRS coding, we would not consider bundling the planning for 
linear accelerator-based SRS with the treatment delivery services, 
given the various timeframes for planning that may occur with linear 
accelerator-based SRS.
c. Other Services in New Technology APCs
(If you choose to comment on issues in this section, please include 
the caption ``Other New Technology Services'' at the beginning of 
your comment.)

    Other than proton beam and stereotactic radiosurgery services, 
there are 10 procedures currently assigned to New Technology APCs for 
which we have data adequate to support their assignment to clinical 
APCs. We are proposing to reassign these procedures to clinically 
appropriate APCs, using CY 2004 claims data to establish median costs 
on which payments would be based. These procedures and their proposed 
APC assignments are displayed below in Table 11.

        Table 11.--Proposed APC Reassignment of New Technology Procedures Into Clinical APCs for CY 2006
----------------------------------------------------------------------------------------------------------------
                                                                                                        Proposed
                                          CY 2005      CY 2005      Proposed   Proposed CY   CY 2005    CY 2006
       HCPCS             Descriptor         APC         status      CY 2006    2006 status   payment    payment
                                                      indicator       APC       indicator     amount     amount
----------------------------------------------------------------------------------------------------------------
0027T..............  Endoscopic               1547  T                   0220  T                  $850  $1,025.57
                      epidural lysis.
33225..............  L ventric pacing         1525  S                   0418  T                 3,750   6,457.83
                      lead add-on.
61623..............  Endovasc tempory         1555  T                   0081  T                 1,650   2,035.19
                      vessel occl.
92974..............  Cath place, cardio       1559  T                   0103  T                 2,250     869.34
                      brachytx.
93580..............  Transcath closure        1559  T                   0434  T                 2,250   5,363.85
                      of asd.
93581..............  Transcath closure        1559  T                   0434  T                 2,250   5,363.85
                      of vsd.
95965..............  Meg, spontaneous..       1528  S                   0430  T                 5,250     673.76
95966..............  Meg, evoked,             1516  S                   0430  T                 1,450     673.76
                      single.
95967..............  Meg, evoked, each        1511  S                   0430  T                   950     673.76
                      add'l.
C9713..............  Non-contact laser        1525  S                   0429  T                 3,750   2,500.01
                      vap prosta.
----------------------------------------------------------------------------------------------------------------

    We are proposing to move these 10 procedures to new or established 
clinical APCs that contain services that exhibit clinical and resource 
homogeneity. HCPCS code C9713 (Noncontact laser vaporization of 
prostate, including coagulation control of intraoperative and post-
operative bleeding) is similar to CPT code 52647 (Noncontact laser 
coagulation of prostate, including control of postoperative bleeding, 
complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration 
and/or dilation, and internal urethrotomy are included)) and CPT code 
52648 (Contact laser vaporization with or without transurethral 
resection of prostate, including control of postoperative bleeding, 
complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration 
and/or dilation, and internal urethrotomy are included)) with respect 
to their clinical characteristics and hospital resource utilization. 
However, instead of mapping HCPCS code C9713 to APC 163 (Level IV 
Cystourethroscopy and other Genitourinary Procedures), where CPT codes 
52647 and 52648 are currently mapped for CY 2005, we are proposing to 
create a Level V APC for Cystourethroscopy and Other Genitourinary 
Procedures. These codes are more clinically sound in this new Level V 
APC. We are also proposing to map CPT codes 52647 and 52648 to this new 
Level V APC. In addition, we are proposing to move CPT codes 50080 and 
50081 from APC 0163 to this new Level V APC, since they are similar 
clinically and use similar hospital resources. We believe that this 
configuration would improve homogeneity as well as result in a

[[Page 42710]]

clinically coherent Level V APC, where the procedures utilize similar 
hospital resources.

D. Proposed APC-Specific Policies

1. Hyperbaric Oxygen Therapy (APC 0659)

(If you choose to comment on issues in this section, please include 
the caption ``Hyperbaric Oxygen'' at the beginning of your comment.)

    When hyperbaric oxygen therapy (HBOT) is prescribed for promoting 
the healing of chronic wounds, it typically is prescribed on average 
for 90 minutes, which would be billed using multiple units of HBOT to 
achieve full body hyperbaric oxygen therapy. In addition to the 
therapeutic time spent at full hyperbaric oxygen pressure, treatment 
involves additional time for achieving full pressure (descent), 
providing air breaks to prevent neurological and other complications 
from occurring during the course of treatment, and returning the 
patient to atmospheric pressure (ascent). The OPPS recognizes HCPCS 
code C1300 (Hyperbaric oxygen under pressure, full body chamber, per 30 
minute interval) for HBOT provided in the hospital outpatient setting.
    We explained in the August 16, 2004 proposed rule (69 FR 50495) 
that our CY 2003 claims data revealed that many providers were 
improperly reporting charges for 90 to 120 minutes under only one unit 
rather than three or four units of HBOT. This inaccurate coding 
resulted in an inflated median cost of $177.96 for HBOT, derived using 
single service claims and ``pseudo'' single service claims. Because of 
these single claims coding anomalies, we proposed to calculate a ``per 
unit'' median cost for APC 0659, using only multiple units or multiple 
occurrences of HBOT, excluding claims with only one unit of HBOT and 
excluding packaged costs. To convert HBOT charges to costs, we used the 
CCR from the respiratory therapy cost center when available; otherwise, 
we used the hospital's overall CCR. Using this ``per unit'' 
methodology, we proposed a median cost for APC 0659 of $82.91 for CY 
2005.
    In the November 15, 2004 final rule with comment period (69 FR 
65758), we agreed with commenters that there was sufficient evidence 
that the CCR for HBOT was not reflected solely in the respiratory 
therapy cost center; rather, the CCR for HBOT was reflected in a 
variety of cost centers. Therefore, we calculated a ``per unit'' median 
of $93.26 for HBOT, using only multiple units or multiple occurrences 
of HBOT and each hospital's overall CCR.
    Our examination of the CY 2004 single procedure claims filed for 
HCPCS code C1300 revealed similar coding anomalies to those encountered 
in the CY 2003 single procedure claims data. Therefore, for CY 2006 
ratesetting, we recalculated a ``per unit'' median cost for HCPCS code 
C1300 using only multiple units or multiple occurrences of HBOT and 
each hospital's overall CCR, which is the same methodology we used for 
setting the CY 2005 payment rate for HBOT. Excluding claims with only 
one unit of HBOT, we used a total of 26,556 claims to calculate the 
median for APC 0659 for CY 2006. Applying the methodology described 
above, we are proposing a median cost for APC 0659 of $93.71 for CY 
2006.
2. Allergy Testing (APC 0370)

(If you choose to comment on issues in this section, please include 
the caption ``Allergy Testing'' at the beginning of your comment.)

    A number of providers have expressed confusion related to the 
reporting of units for allergy testing described by CPT codes 95004 
through 95078. Most of the CPT codes in the code range are assigned to 
APC 0370 (Allergy Tests) for the CY 2005 OPPS. Nine of these CPT codes 
assigned to APC 0370 instruct providers to specify the number of tests 
or use the singular word ``test'' in their descriptors, while five of 
these CPT codes assigned to APC 0370 do not contain such an instruction 
or do not contain ``tests'' or ``testing'' in their descriptors. Some 
providers have stated that the lack of clarity related to the reporting 
of units has resulted in erroneous reporting of charges for multiple 
allergy tests under one unit (that is, ``per visit'') for the CPT codes 
that instruct providers to specify the number of tests.
    In light of the variable hospital billing that may be inconsistent 
with the CPT code descriptors, we have examined carefully the CY 2004 
single and multiple procedure claims data for the allergy test codes 
that reside in APC 0370 to set the CY 2006 payment rates. Our 
examination of the CY 2004 claims data revealed that many of the 
services for which providers billed multiple units of an allergy test 
reported a consistent charge for each unit. Conversely, some providers 
that billed only a single unit of an allergy test reported a charge 
many times greater than the ``per test'' charge reported by providers 
billing multiple units of an allergy test.
    Our analysis of the claims data appears to validate reports made by 
a number of providers that the charges reported on many of the single 
procedure claims represent a ``per visit'' charge, rather than a ``per 
test'' charge, including claims for the allergy test codes that 
instruct providers to specify the number of tests. Because the OPPS 
relies only on these single procedure claims in establishing payment 
rates, we believe this inaccurate coding would have resulted in an 
inflated CY 2006 median cost of $66.44 for services that are in the CY 
2005 configuration of APC 0370.
    Therefore, we are proposing to move the allergy test CPT codes that 
instruct providers to specify the number of tests or use the singular 
word ``test'' in their descriptors from APC 0370 (Allergy Tests) to 
proposed APC 0381 (Single Allergy Tests) for CY 2006. We are proposing 
to calculate a ``per unit'' median cost for proposed APC 0381 using a 
total of 306 claims containing multiple units or multiple occurrences 
of a single CPT code. Packaging on the claims was allocated equally to 
each unit of the CPT code. Using this ``per unit'' methodology, we are 
proposing a median cost for APC 0381 of $11.37 for CY 2006. Because we 
believe the single procedure claims for the codes remaining in APC 0370 
reflect accurate coding of these services, we are proposing to use the 
standard OPPS methodology to calculate the median for APC 0370. Table 
12 below lists the proposed assignment of CPT codes to APC 0370 and 
proposed APC 0381 for CY 2006.

Table 12.--Proposed Assignment of CPT Codes to APC 0370 and Proposed APC
                            0381 for CY 2006
------------------------------------------------------------------------
              APC 0370                        Proposed APC 0381
------------------------------------------------------------------------
95056, Photosensitivity tests......  95004, Percut allergy skin tests.
95060, Eye allergy tests...........  95010, Percut allergy titrate test.
95078, Provoactive testing.........  95015, ld allergy titrate-drug/bug.
95180, Rapid desensitization.......  95024, ld allergy test, drug/bug.
95199U, Unlisted allergy/clinical    95027, ld allergy titrate-airborne.
 immunologic service or procedure.
                                     95028, ld allergy test-delayed
                                      type.

[[Page 42711]]

 
                                     95044, Allergy patch tests.
                                     95052, Photo patch test.
                                     95065, Nose allergy test.
------------------------------------------------------------------------

3. Stretta Procedure (APC 0322)

(If you choose to comment on issues in this section, please include 
the caption ``Stretta'' at the beginning of your comment.)

    CPT code 43257, effective January 1, 2005, is used for 
esophagoscopy with delivery of thermal energy to the muscle of the 
lower esophageal sphincter and/or gastric cardia for the treatment of 
gastresophageal reflux disease. This code describes the Stretta 
procedure, including use of the Stretta System and all endoscopies 
associated with the Stretta procedure. Prior to CY 2005, the Stretta 
procedure was recognized under HCPCS code C9701 in the OPPS. For the CY 
2005 OPPS, C9701 was deleted and CPT code 43257 was utilized for the 
Stretta procedure. In CY 2005, the Stretta procedure was transitioned 
from a New Technology APC to clinical APC 0422 (Level II Upper GI 
Procedures) based on several years of hospital cost data. Procedures 
within APC 0422 were similar to the Stretta procedure in terms of 
clinical characteristics and resource use.
    For CY 2006, we are proposing to use both CY 2004 single claims for 
C9701 and multiple procedure claims containing one unit of HCPCS code 
C9701 and one unit of either CPT code 43234 or CPT code 43235 to 
calculate the Stretta procedure's contribution to the median for APC 
0422. Claims reporting one endoscopy code (43234 or 43235) along with 
HCPCS code C9701 are included in the proposed median calculation 
because, in CY 2002, CMS authorized the separate and additional billing 
of a single endoscopy code with HCPCS code C9701, while CPT code 43257 
now includes all endoscopies performed during the procedure.
    Using this proposed methodology, we calculated a median for CPT 
code 43257 (HCPCS code C9701 in the CY 2004 claims data) of $1669.43. 
Using these claims in the calculation of the median cost for APC 0422, 
we calculated a median cost of $1385.77. We are proposing to use this 
methodology, applied to the more complete final rule claims set, to 
calculate the final CY 2006 OPPS median cost for APC 0422.
4. Vascular Access Procedures (APCs 0032, 0109, 0115, 0119, 0124, and 
0187)
(If you choose to comment on issues in this section, please include 
the caption ``Vascular Access Procedures'' at the beginning of your 
comment.)

    Many of the codes that currently describe vascular access 
procedures were new in the 2004 version of CPT and were assigned into 
APC groups by crosswalking the newly created CPT codes to the deleted 
codes' APC assignments. Although the new codes were implemented in 
January 2004, because of the delay between a bill being submitted to 
Medicare and when the bill data are viable for analysis, we did not 
have cost and utilization data for the new codes available for analysis 
until this year in preparation for the CY 2006 OPPS.
    Since those original APC assignments were made, we have received 
requests from the public for specific APC assignment changes. We were 
reluctant to make changes without data to support reassignments and, 
therefore, made few changes to those original APC assignments.
    As an outcome of an analysis of procedure-specific median costs and 
2 times rule violations in preparation for the CY 2006 update of the 
OPPS, we developed a new APC configuration for vascular access 
procedure codes and several other related codes. The proposed new 
assignments are supported by CY 2004 hospital claims data and are based 
on median cost and clinical considerations.
    Thus, for CY 2006, we are proposing to reassign many of the CPT 
codes that are currently in the following APCs:
     APC 0032 (Insertion of Central Venous/Arterial Catheter).
     APC 0109 (Removal of Implanted Devices).
     APC 0115 (Cannula/Access Device Procedures).
     APC 0119 (Implantation of Infusion Pump).
     APC 0124 (Revision of Implanted Infusion Pump).
     APC 0187 (Miscellaneous Placement/Repositioning).
    The configuration that we are proposing places all of the 
procedures currently assigned to APC 0187 into more clinically 
appropriate APCs. We are also proposing to reassign all of the vascular 
access procedure codes currently assigned to any of the identified APCs 
to existing or newly reconfigured clinical APCs to create more clinical 
and median cost homogeneity. As a result of the proposed reassignments, 
those APCs are comprised of a different mix of codes than is currently 
the case for the CY 2005 OPPS. There are no codes assigned to APC 0187 
because the only procedures that remained in APC 0187 after reassigning 
the vascular access procedures as we are proposing were CPT code 75940 
(X-ray placement of vein filter) and CPT code 76095 (Stereotactic 
breast biopsy), which we reassigned to more clinically appropriate 
APCs. We are proposing to reassign CPT code 75940 to APC 0297 (Level II 
Therapeutic Radiologic Procedures) and CPT code 76095 to APC 0264 
(Level II Miscellaneous Radiology Procedures).
    We are proposing to create three new APCs, APC 0621 (Level I 
Vascular Access Codes), APC 0622 (Level II Vascular Access Codes), and 
APC 0623 (Level III Vascular Access Codes) and assign procedures to 
each of these based on median cost and clinical homogeneity. We are 
also proposing to rename APCs 0109 and 0115 as follows: APC 0109 
(Removal of Implanted Devices); and APC 0115 (Cannula/Access Device 
Procedures). Table 13 displays the procedures and their current and the 
CY 2006 proposed APC assignments.

[[Page 42712]]



  Table 13.--Current and Proposed APC Assignments for Vascular Access Procedures and Related Procedures for CY
                                                      2006
----------------------------------------------------------------------------------------------------------------
                                                                                                    Proposed CY
                  CPT code                                Descriptor                CY 2005 APC      2006 APC
----------------------------------------------------------------------------------------------------------------
                                   APC 0621--Level I Vascular Access Procedure
----------------------------------------------------------------------------------------------------------------
 
36555.......................................  Insertion non-tunneled cv cath....            0187            0621
36556.......................................  Insertion non-tunneled cv cath....            0187            0621
36568.......................................  Insert tunneled cv cath...........            0187            0621
36569.......................................  Insert tunneled cv cath...........            0187            0621
36575.......................................  Repair tunneled cv cath...........            0187            0621
36576.......................................  Repair tunneled cv cath...........            0187            0621
36580.......................................  Replace tunneled cv cath..........            0187            0621
36584.......................................  Replace tunneled cv cath..........            0187            0621
36589.......................................  Remove tunneled cv cath...........            0109            0621
36590.......................................  Remove tunneled cv cath...........            0187            0621
36596.......................................  Mech removal tunneled cv cath.....            0187            0621
36597.......................................  Reposition venous catheter........            0187            0621
---------------------------------------------
 
                                  APC 0622--Level II Vascular Access Procedures
----------------------------------------------------------------------------------------------------------------
 
36557.......................................  Insert tunneled cv cath...........            0032            0622
36558.......................................  Insert tunneled cv cath...........            0032            0622
36578.......................................  Replace tunneled cv cath..........            0187            0622
36581.......................................  Replace tunneled cv cath..........            0032            0622
36585.......................................  Replace tunneled cv cath..........            0032            0622
36570.......................................  Insert tunneled cv cath...........            0032            0622
36571.......................................  Insert tunneled cv cath...........            0032            0622
36595.......................................  Mech removal tunneled cv cath.....            0187            0622
36262.......................................  Removal intra-arterial inf. Pump..            0124            0622
---------------------------------------------
 
                                 APC 0623--Level III Vascular Access Procedures
----------------------------------------------------------------------------------------------------------------
 
36560.......................................  Insert tunneled cv cath...........            0115            0623
36561.......................................  Insert tunneled cv cath...........            0115            0623
36563.......................................  Insert tunneled cv cath...........            0119            0623
36565.......................................  Insert tunneled cv cath...........            0115            0623
36582.......................................  Replace tunneled cv cath..........            0115            0623
36583.......................................  Insertion of access device........            0119            0623
36640.......................................  Insertion catheter, artery........            0032            0623
36260.......................................  Insertion of infusion pump........            0119            0623
36261.......................................  Revision of infusion pump.........            0124            0623
---------------------------------------------
 
                                   APC 0115--Cannula/Access Device Procedures
----------------------------------------------------------------------------------------------------------------
 
36835.......................................  Artery to vein shunt..............            0115            0115
35903.......................................  Excision, graft, extremity........            0115            0115
36815.......................................  Insertion of cannula..............            0115            0115
36861.......................................  Cannula declotting................            0115            0115
35761.......................................  Exploration of artery/vein........            0115            0115
49419.......................................  Insert abdominal cath for chemo...            0115            0115
36800.......................................  Insertion of cannula..............            0115            0115
37204.......................................  Transcatheter occlusion...........            0115            0115
36810.......................................  Insertion of cannula..............            0115            0115
---------------------------------------------
 
                                     APC 0109--Removal of Implanted Devices
----------------------------------------------------------------------------------------------------------------
 
33284.......................................  Remove pt-activated heart recorder            0109            0109
63746.......................................  Removal of spinal shunt...........            0109            0109
----------------------------------------------------------------------------------------------------------------

    We presented this proposal to the APC Panel at its February, 2005 
meeting. The APC Panel was supportive of the proposed reassignments and 
recommended that we make these changes. Therefore, for the stated 
reasons, we are proposing the APC modifications for CY 2006 OPPS as 
summarized in Table 13 above.

E. Proposed Addition of New Procedure Codes

(If you choose to comment on issues in this section, please include 
the caption ``New Procedure Codes'' at the beginning of your 
comment.)

    During the second quarter of CY 2005, we created 11 HCPCS codes 
that were not addressed in the November 15, 2004 final rule with 
comment period that updated the CY 2005 OPPS. We have designated the 
payment status of those codes and added them to the April update of the 
CY 2005 OPPS (Transmittal 514). The codes are shown in Table 14 below. 
In this proposed rule, we are soliciting comment on the APC assignment 
of these services.
    Further, consistent with our annual APC updating policy, we are 
proposing to assign the new HCPCS codes for CY 2006 to the appropriate 
APC's and

[[Page 42713]]

would incorporate them into our final rule for CY 2006.

          Table 14.--New HCPCS Codes Implemented in April 2005
------------------------------------------------------------------------
           HCPCS code                           Description
------------------------------------------------------------------------
C9127...........................  Injection, paclitaxel protein-bound
                                   particles, per 1 mg.
C9128...........................  Injection, pegaptamib sodium, per 0.3
                                   mg.
C9223...........................  Injection, adenosine for therapeutic
                                   or diagnostic use, 6 mg (not to be
                                   used to report any adenosine
                                   phosphate compounds, instead use
                                   A9270).
C9440...........................  Vinorelbine tartrate, brand name, per
                                   10 mg.
C9723...........................  Dynamic infrared blood perfusion
                                   imaging (DIRI).
C9724...........................  Endoscopic full-thickness plication in
                                   the gastric cardia using endoscopic
                                   plication system (EPS); includes
                                   endoscopy.
Q4079...........................  Injection, natalizumab, 1 mg.
Q9941...........................  Injection, Immune Globulin,
                                   Intravenous, Lyophilized, 1g.
Q9942...........................  Injection, Immune Globulin,
                                   Intravenous, Lyophilized, 10 mg.
Q9943...........................  Injection, Immune Globulin,
                                   Intravenous, Non-Lyophilized, 1g.
Q9944...........................  Injection, Immune Globulin,
                                   Intravenous, Non-Lyophilized, 10 mg.
------------------------------------------------------------------------

IV. Proposed Payment Changes for Devices

A. Device-Dependent APCs

(If you choose to comment on issues in this section, please include 
the caption ``Device-Dependent APCs'' at the beginning of your 
comment.)

    Device-dependent APCs are populated by HCPCS codes that usually, 
but not always, require that a device be implanted or used to perform 
the procedure. For the CY 2002 OPPS, we used external data, in part, to 
establish the device-dependent APC medians used for weight setting. At 
that time, many devices were eligible for pass-through payment. For the 
CY 2002 OPPS, we estimated that the total amount of pass-through 
payments would far exceed the limit imposed by statute. To reduce the 
amount of a pro rata adjustment to all pass-through items, we packaged 
75 percent of the cost of the devices, using external data furnished by 
commenters on the August 24, 2001 proposed rule and information 
furnished on applications for pass-through payment, into the median 
cost for the device-dependent APCs associated with these pass-through 
devices. The remaining 25 percent of the cost was considered to be 
pass-through payment.
    In the CY 2003 OPPS, we determined APC medians for device-dependent 
APCs using a three pronged approach. First, we used only claims with 
device codes on the claim to set the medians for these APCs. Second, we 
used external data, in part, to set the medians for selected device-
dependent APCs by blending that external data with claims data to 
establish the APC medians. Finally, we also adjusted the median for any 
APC (whether device-dependent or not) that declined more than 15 
percent. In addition, in the CY 2003 OPPS, we deleted the device codes 
(``C'' codes) from the HCPCS file in the belief that hospitals would 
include the charges for the devices on their claims, notwithstanding 
the absence of specific codes for devices used.
    In the CY 2004 OPPS, we used only claims containing device codes to 
set the medians for device-dependent APCs and again used external data 
in a 50-percent blend with claims data to adjust medians for a few 
device-dependent codes when it appeared that the adjustments were 
important to ensure access to care. However, hospital device code 
reporting was optional.
    In the CY 2005 OPPS, which was based on CY 2003 claims data, there 
were no device codes on the claims and, therefore, we could not use 
device-coded claims in median calculations as a proxy for completeness 
of the coding and charges on the claims. For the CY 2005 OPPS, we 
adjusted device-dependent APC medians for those device-dependent APCs 
for which the CY 2005 OPPS payment median was less than 95 percent of 
the CY 2004 OPPS payment median. In these cases, the CY 2005 OPPS 
payment median was adjusted to 95 percent of the CY 2004 OPPS payment 
median. We also reinstated the device codes and made the use of the 
device codes mandatory where an appropriate code exists to describe a 
device utilized in a procedure and also implemented HCPCS code edits to 
facilitate complete reporting of the charges for the devices used in 
the procedures assigned to the device-dependent APCs.
    We are proposing to base the CY 2006 OPPS device-dependent APC 
medians on CY 2004 claims, the most current data available. In CY 2004, 
the use of device codes was optional. Thus, for the CY 2006 OPPS, we 
calculated median costs for these APCs using all single bills without 
regard to whether there was a device code on the claim. We calculated 
median costs for this set of APCs using the standard median calculation 
methodology. This methodology uses single procedure claims to set the 
median costs for the APC. We then compared these unadjusted median 
costs to the adjusted median costs that we used to set the payment 
rates for the CY 2005 OPPS. We found that 21 APCs experienced increases 
in median cost compared to the CY 2005 OPPS adjusted median costs, 1 
APC median was unchanged, 16 APCs experienced decreases in median 
costs, and 8 APCs are proposed to be reconfigured in such a way that no 
valid comparison was possible. Table 15 shows the comparison of these 
median costs.
    As we stated previously, in CY 2004, CMS reissued HCPCS codes for 
devices and asked that hospitals voluntarily code devices utilized to 
provide services. As part of our development of the proposed medians 
for this proposed rule, we examined CY 2004 claims that contained 
device codes that met our device edits, as posted on the OPPS Web site 
at http://www.cms.hhs.gov/providers/hopps/default.asp. We found that, 
in many cases, the number of claims that passed the device edits was 
quite small. To use these claims to set medians for the CY 2006 OPPS 
would mean that the medians for some of these APCs would be set based 
on very small numbers of claims, reflecting the fact that in CY 2004 
when device coding was optional under the OPPS relatively few hospitals 
chose to code for devices. For example, if we used only claims that 
passed the device code edits, the median for APC 0089 (Insertion/
Replacement of Permanent Pacemaker and Electrodes), would be based on 
34 claims that passed the device edits (0.78 percent of all claims), 
rather than on 1,934 single bills out of 4,424 total bills (43.72 
percent of all claims). Median

[[Page 42714]]

costs for insertion/replacement of a permanent pacemaker and electrodes 
developed based upon these 34 claims from a small subset of hospitals 
are unlikely to be representative of the resource costs of most 
hospitals that provided the service. Moreover, there are a few 
procedures for which no device codes are required although the 
procedures require a device to be used. For this set of services, 
subsetting the claims to those that pass the device edits does not 
change the group of single bills available for median calculation. For 
these reasons, we decided not to use only claims that passed the device 
edits to set the median costs for device-dependent APCs for the CY 2006 
OPPS.
    When we considered whether to base the weights for these APCs on 
the unadjusted median costs, we found that for 10 of the 38 APCs for 
which the APC composition is stable, basing the payment weight on the 
unadjusted median cost would result in a reduction of more than 15 
percent in the median cost for the CY 2006 OPPS compared to the CY 2005 
OPPS.
    We fully expect to use the unadjusted median costs for device-
dependent APCs as the basis of their payment weights for the CY 2007 
OPPS because device coding is required for CY 2005 and device editing 
is being implemented in CY 2005, so that all CY 2005 claims should 
reflect the costs of devices used to provide services. Nevertheless we 
recognize that a payment reduction of more than 15 percent from the CY 
2005 OPPS to the CY 2006 OPPS may be problematic for hospitals that 
provide the services contained in these APCs. Therefore, for the CY 
2006 OPPS, as we have consistently done for device-dependent APCs, we 
are proposing to adjust the median costs for the device-dependent APCs 
listed in Table 15 for which comparisons with prior years are valid to 
the higher of the CY 2006 unadjusted APC median or 85 percent of the 
adjusted median on which payment was based for the CY 2005 OPPS. This 
would result in the use of adjusted medians for 10 device-dependent 
APCs. We view this as a transitional step from the adjusted medians of 
past years to the use of unadjusted medians based solely on hospital 
claims data with device codes in future years.
    We expect that this would be the last year in which we would make 
an across the board adjustment to the median costs for these device-
dependent APCs based on comparisons to the prior year's payment 
medians. We believe that mandatory reporting of device codes for 
services furnished in CY 2005, combined with the editing of claims for 
the presence of device codes, where such codes are appropriate, would 
result in claims data that more fully reflect the relative costs of 
these services and that across the board adjustments to median costs 
for these APCs would no longer be appropriate.
    We recognize that the APC Panel recommended that CMS set a corridor 
of median costs for device-dependent APCs at no less than 90 percent of 
the CY 2005 payment median nor more than 110 percent of the CY 2005 
payment median for purposes of setting the payment rate for the CY 2006 
OPPS for these APCs. We do not believe that setting a corridor to 
control both increases and decreases in median costs is consistent with 
the use of adjusted medians as a means of transitioning hospitals to 
the use of the unadjusted claims data. The purpose of the transition is 
to moderate the rate of decline in payments so that hospitals can 
determine how to best adjust to payments based on unadjusted claims 
data. Limiting the rate of increase in payments based on such claims 
data would be inconsistent with that purpose. Therefore, we are 
proposing to adjust median costs to the greater of the median from 
claims data or 85 percent of the CY 2005 median used to set the payment 
rate in CY 2005 and not to impose a limit on the extent to which a 
median cost can increase.

                                    Table 15.--Proposed Median Cost Adjustments for Device-Dependent APCs for CY 2006
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                      Change from
                                                                              Adjusted                  CY 2005                   CY 2006      CY 2006
                                                                              final CY     Proposed   adjusted to  Proposed CY     single       total
           APC                    Description          Status  indicator     2005 OPPS    unadjusted    CY 2006     2006 OPPS    frequency    frequency
                                                                            median cost  CY 2006 APC   unadjusted    adjusted     (CY 2004     (CY 2004
                                                                             (percent)   median cost  median cost  median cost    claims)      claims)
                                                                                                       (percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
0039.....................  Implantation of           S....................   $12,878.01    $9,905.38          -23   $10,946.31          809        1,809
                            Neurostimulator.
0040.....................  Level II Implantation of  S....................     2,885.37     3,338.79           16     3,338.79        2,615       11,986
                            Neurostimulator
                            Electrodes.
0080.....................  Diagnostic Cardiac        T....................     2,123.65     2,240.92            6     2,240.92      267,077      393,166
                            Catheterization.
0081.....................  Non-Coronary Angioplasty  T....................     1,918.04     2,078.67            8     2,078.67        2,046      130,737
                            or Atherectomy.
0082.....................  Coronary Atherectomy....  T....................     6,035.25     4,819.40          -20     5,129.96           27          359
0083.....................  Coronary Angioplasty and  T....................     3,241.85     3,071.03           -5     3,071.03          539        5,492
                            Percutaneous
                            Valvuloplasty.
0085.....................  Level II                  T....................     2,034.82     2,123.46            4     2,123.46        3,088       20,401
                            Electrophysiologic
                            Evaluation.
0086.....................  Ablate Heart Dysrhythm    T....................     2,637.96     2,670.78            1     2,670.78          919        9,160
                            Focus.
0087.....................  Cardiac                   T....................     2,180.19       853.76          -61     1,853.16          330       12,969
                            Electrophysiologic
                            Recording/Mapping.
0089.....................  Insertion/Replacement of  T....................     6,416.90     6,373.13           -1     6,373.13        1,934        4,424
                            Permanent Pacemaker and
                            Electrodes.
0090.....................  Insertion/Replacement of  T....................     5,301.99     5,380.07            1     5,380.07          740        6,412
                            Pacemaker Pulse
                            Generator.

[[Page 42715]]

 
0104.....................  Transcatheter Placement   T....................     4,750.06     4,767.70            0     4,767.70        1,103        8,137
                            of Intracoronary Stents.
0106.....................  Insertion/Replacement/    T....................     3,229.10     1,908.38          -41     2,744.73          489        3,938
                            Repair of Pacemaker and/
                            or Electrodes.
0107.....................  Insertion of              T....................    18,460.10    15,166.64          -18    15,691.08          445        8,073
                            Cardioverter-
                            Defibrillator.
0108.....................  Insertion/Replacement/    T....................    24,788.26    18,165.78          -27    21,070.02          520        6,003
                            Repair of Cardioverter-
                            Defibrillator Leads.
0115.....................  Cannula/device access     T....................     1,502.71     1,899.17           26     1,899.17        3,022       10,115
                            procedures.
0202.....................  Level X Female            T....................     2,322.83     2,437.07            5     2,437.07        7,951       15,303
                            Reproductive Proc.
0222.....................  Implantation of           T....................    12,714.60     9,742.78          -23    10,807.41        1,678        5,629
                            Neurological Device.
0225.....................  Level I Implementation    S....................    12,327.52    14,162.16           15    14,162.16          185          939
                            of Neurostimulator
                            Electrodes.
0227.....................  Implantation of Drug      T....................     8,806.84     8,236.41           -6     8,236.41          442        2,776
                            Infusion Device.
0229.....................  Transcatherter Placement  T....................     3,638.52     3,889.41            7     3,889.41          778       46,625
                            of Intravascular Shunts.
0259.....................  Level VI ENT Procedures.  T....................    26,006.74    21,424.48          -18    22,105.73          554          964
0315.....................  Level II Implantation of  T....................    20,633.70    12,170.26          -41    17,538.65          229          327
                            Neurostimulator.
0384.....................  GI Procedures with        T....................     1,585.92     1,287.07          -19     1,348.03        6,268       20,711
                            Stents.
0385.....................  Level I Prosthetic        S....................     4,080.56     4,564.66           12     4,564.66          553          783
                            Urological Procedures.
0386.....................  Level II Prosthetic       S....................     6,674.53     7,251.44            9     7,251.44        3,213        4,549
                            Urological Procedures.
0418.....................  Left ventricular lead...  T....................     4,363.37     6,595.80           51     6,595.80          202        4,712
0425.....................  Level II Arthroplasty     T....................     5,715.97     6,046.77            6     6,046.77          375          882
                            with prosthesis.
0648.....................  Breast Reconstruction     T....................     2,957.76     3,044.08            3     3,044.08          398        1,320
                            with Prosthesis.
0652.....................  Insertion of              T....................     1,626.29     1,743.61            7     1,743.61        3,067        4,986
                            Intraperitoneal
                            Catheters.
0653.....................  Vascular Reconstruction/  T....................     1,644.53     1,842.52           12     1,842.52          800       28,788
                            Fistula Repair with
                            Device.
0654.....................  Insertion/Replacement of  T....................     6,170.83     6,090.43           -1     6,090.43        1,807       20,809
                            a permanent dual
                            chamber pacemaker.
0655.....................  Insertion/Replacement/    T....................     7,913.85     8,072.56            2     8,072.56        7,353       13,991
                            Conversion of a
                            permanent dual chamber
                            pacemaker.
0656.....................  Transcatheter Placement   T....................     6,156.14     6,633.18            8     6,633.18        2,394       19,898
                            of Intracoronary Drug
                            Eluting Stents.
0670.....................  Intravenous and           S....................     1,779.08     1,533.52          -14     1,533.52          111        7,041
                            Intracardiac Ultrasound.
0674.....................  Prostate Cryoablation...  T....................     6,569.33     5,780.04          -12     5,780.04        1,248        2,080
0680.....................  Insertion of Patient      S....................     3,744.69     3,796.10            1     3,796.10        1,400        2,226
                            Activated Event
                            Recorders.
0681.....................  Knee Arthroplasty.......  T....................     5,374.98     8,276.89           54     8,276.89          492          683
                           No adjustment; major
                            HCPCS migration:
0122.....................  Level II Tube changes     T....................       485.26       420.72  ...........       420.72        5,138       14,701
                            and Repositioning.
0427.....................  Level III Tube changes    T....................  ...........       615.37  ...........       615.37        2,485        5,376
                            and Repositioning (new
                            for 2006).

[[Page 42716]]

 
0166.....................  Level I Urethral          T....................     1,040.53     1,066.53  ...........     1,066.53          778        2,282
                            procedures (contains
                            part of deleted DD APC
                            167).
0167.....................  Urethral procedures       T....................     1,664.80           NA  ...........           NA           NA           NA
                            (deleted APC; codes
                            moved to 167 and 168
                            for '06).
0168.....................  Level II Urethral         T....................     1,801.96     1,705.82  ...........     1,705.82        7,684       10,018
                            procedures (contains
                            part of deleted DD APC
                            167).
0621.....................  Level I VAD.............  T....................    new in 06       500.77  ...........       500.77       60,115      113,720
0622.....................  Level II VAD............  T....................    new in 06     1,283.33  ...........     1,283.33       21,792       54,816
0623.....................  Level III VAD...........  T....................    new in 06     1,635.94  ...........     1,635.94       23,963       62,538
--------------------------------------------------------------------------------------------------------------------------------------------------------

B. APC Panel Recommendations Pertaining to APC 0107 and APC 0108

    The median costs for APC 0107 (Implantation of Cardioverter-
Defibrillator) and APC 0108 (Insertion/Replacement/Repair of 
Cardioverter-Defibrillator Leads and Insertion of Cardioverter-
Defibrillator) have been adjusted each year since CY 2003 when pass-
through payment expired for cardioverter-defibrillators, because the 
unadjusted medians have differed significantly from the prior year's 
payment medians. Moreover, because we use single procedure claims to 
set the median costs, the median costs for these APCs have always been 
set on a relatively small number of claims as compared to the total 
frequency of claims for the services under the OPPS. For example, for 
this CY 2006 OPPS proposed rule, the unadjusted median cost for APC 
0107 was set based on 445 single procedure claims, which is 5.5 percent 
of the 8,073 claims on which a procedure code in the APC was billed. 
Similarly, the unadjusted median cost for APC 0108 was set based on 520 
single procedure claims, which is 8.7 percent of the 6,003 claims on 
which a procedure code in the APC was billed. Commenters have 
frequently told us that using the single procedure median costs for 
these APCs does not accurately reflect the costs of the procedures 
because claims from typical clinical circumstances involving multiple 
procedures are not used to establish the medians.
    At the February 2005 APC Panel meeting, the APC Panel recommended 
that CMS package CPT codes 93640 and 93641 (electrophysiologic 
evaluation at time of initial implantation or replacement of 
cardioverter-defibrillator leads). The APC Panel recommended that we 
always package the costs for these codes because the definitions of the 
codes state that these evaluations are done at the time of lead 
implantation. Therefore, CPT codes 93640 and 93641 would never be 
correctly reported without a code in APC 0107 or APC 0108 also being 
reported. In addition, when a service assigned to APC 0107 or APC 0108 
is provided, we would expect that CPT codes 93640 or 93641 for 
electrophysiologic evaluation and testing would also be performed 
frequently, and CY 2004 claims data for services in APC 0107 and APC 
0108 confirm this. The APC Panel believed that packaging the costs of 
CPT codes 93640 and 93641 would result in more single bills available 
for setting the median costs for APC 0107 and APC 0108, and thus would 
likely yield more appropriate median costs for those APCs. Those 
medians would then include the costs of the electrophysiologic testing 
commonly performed at the time of the implantable cardioverter-
defibrillator (ICD) insertion.
    The APC Panel further recommended that CMS treat CPT code 33241 
(Subcutaneous removal of cardioverter-defibrillator) as a bypass code 
when the code appeared on the same claims with services assigned to APC 
0107 or APC 0108. The APC Panel recommended bypassing charges for this 
code only when it appeared on the same claim with codes in APC 0107 or 
APC 0108, because when a cardioverter defibrillator (ICD) is removed 
and replaced in the same operative session, it is appropriate to 
attribute all of the packaged costs on the claim to the implantation of 
the device rather than to the removal of the device. The line costs for 
CPT code 33241 that are removed from the claims in this case would be 
discarded and would not be used to set the median for APC 0105 (the APC 
in which the code is located).
    We modeled the median costs that would be calculated for APCs 0107 
and 0108, if we were to make the changes recommended by the APC Panel 
for these APCs, under four possible scenarios: (1) The cardioverter-
defibrillator device is inserted without removal or testing; (2) the 
device is inserted and tested with no removal; (3) the device is 
removed and inserted but not tested; and (4) the device is removed, 
inserted, and tested. We then compared the sum of the unadjusted median 
costs, the sum of the proposed adjusted median costs and the sum of the 
costs that we modeled using the APC Panel recommendations. These 
results are shown in Table 16 below.

[[Page 42717]]



                              Table 16.--Total Median Costs for APCs 0107 and 0108
----------------------------------------------------------------------------------------------------------------
                                      APC 0107     APC 0107                  APC 0108     APC 0108
                                       Using        Using       APC 0107      Using        Using       APC 0108
                                     unadjusted    adjusted    With panel   unadjusted    adjusted    With panel
                                    median cost  median cost    changes    median cost  median cost    changes
                                            (1)          (2)          (3)          (4)          (5)          (6)
-----------------------------------
Median for codes in APC...........   $15,166.64   $15,691.08   $15,961.14   $18,165.78   $21,070.02   $21,517.00
50% of median for APC 0105 (CPT          674.90       674.90       674.90       674.90       674.90       674.90
 code 33241; removal); multiple
 procedure discount...............
Proposed median for APC 0084 (CPT        604.67       604.67          (1)       604.67       604.67          (1)
 code 93640/93641; testing).......
(A) Median total if device is         15,166.64    15,691.08    15,961.14    18,165.78    21,070.02    21,517.00
 inserted only (neither removal
 nor testing).....................
(B) Median total if device is         15,771.31    16,295.75    15,961.14    18,770.45    21,674.69    21,517.00
 inserted and tested (no removal).
(C) Median total if device is         15,841.54    16,365.98    16,636.04    18,840.68    21,744.92    22,191.90
 removed and inserted (no testing)
(D) Median total if device is         16,446.21    16,970.65    16,636.04    19,445.35    22,349.59   22,191.90
 removed, inserted and tested.....
----------------------------------------------------------------------------------------------------------------
\1\ NA (testing is packaged).

    We also found that if we were to adopt the APC Panel 
recommendations for APCs 0107 and 0108 for the CY 2006 OPPS, the number 
of single bills that would be available for use in median setting would 
increase significantly, as shown in Table 17.

                                Table 17.--Single Bills for APC 0107 and APC 0108
----------------------------------------------------------------------------------------------------------------
                                                                   Single bills    Single bills
                                                                      without          with            Total
                                                                    recommended     recommended      frequency
                                                                      changes         changes
----------------------------------------------------------------------------------------------------------------
APC 0107........................................................             445            4500            8073
APC 0108........................................................             520            1447            6003
----------------------------------------------------------------------------------------------------------------

    In general, we believe that the recommendations of the APC Panel 
show great potential for providing a far more robust set of single 
bills for use in setting medians for APCs 0107 and 0108 and, therefore, 
for improving the accuracy of the median costs acquired from the claims 
data. However, for the CY 2006 OPPS, adopting the APC Panel 
recommendations would result in higher total payments for services 
related to cardioverter-defibrillator insertion for some possible 
clinical scenarios than under the proposed adjustment methodology but 
would result in lower total payments in other cases. Moreover, the 
effects are not identical for both APCs. Both APCs require the 
insertion of an ICD, but the codes in APC 0108 also require the repair, 
revision or insertion of leads. Because the APCs are so closely related 
clinically and both APCs include payments for expensive implanted 
cardioverter-defibrillators, we are proposing to apply the same payment 
policy to both APC 0107 and APC 0108. We would like to receive input 
from the APC Panel and from the affected parties regarding the results 
of modeling the methodology before we decide whether to implement this 
multiple procedure claim strategy for both of these APCs.
    Specifically, we are proposing to set the medians for these APCs at 
85 percent of their CY 2005 payment medians and have based our modeling 
of the scaler and the impact analysis on that proposal, although we 
believe that the APC Panel recommendations have significant merit, 
particularly when we move to complete reliance on claims data in 
updating the OPPS for CY 2007. Although we are proposing to adjust the 
median costs for these APCs in the same manner as other device-
dependent APCs, we will consider, based on the public comments, whether 
it would be appropriate to apply the multiple procedure claims 
methodology to these APCs for the CY 2006 OPPS. We look forward to 
specifically receiving public comments on the APC Panel recommendations 
regarding packaging and bypassing services frequently performed with 
procedures assigned to APC 0107 and APC 0108, with the goal of 
increasing single bills available for ratesetting in order to improve 
the accuracy of median costs based upon hospital claims.

C. Pass-Through Payments for Devices

(If you choose to comment on issues in this section, please include 
the caption ``Transitional Pass-Through Payments for Devices'' at 
the beginning of your comment.)
1. Expiration of Transitional Pass-Through Payments for Certain Devices
    Section 1833(t)(6)(B)(iii) of the Act requires that, under the 
OPPS, 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. In our 
November 15, 2004 final rule with comment period (69 FR 65773), we 
specified three device categories currently in effect that would cease 
to be eligible for pass-through payment effective January 1, 2006.
    The device category codes became effective April 1, 2001, under the 
provisions of the BIPA. Prior to pass-through device categories, we 
paid for pass-through devices under the OPPS on a brand-specific basis. 
All of the initial 97 category codes that were established as of April 
1, 2001, have

[[Page 42718]]

expired; 95 categories expired after CY 2002 and 2 categories expired 
after CY 2003. All of the categories listed in Table 18, along with 
their expected expiration dates, were created since we published the 
criteria and process for creating additional device categories for 
pass-through payment on November 2, 2001 (66 FR 55850 through 55857). 
We based the expiration dates for the category codes listed in Table 18 
on the date on which a category was first eligible for pass-through 
payment.
    There are three categories for devices that would have been 
eligible for pass-through payments for at least 2 years as of December 
31, 2005. In the November 15, 2004 final rule with comment period, we 
finalized the December 31, 2005 expiration dates for these three 
categories--C1814 (Retinal tamponade device, silicone oil), C1818 
(Integrated keratoprosthesis), and C1819 (Tissue localization excision 
device). Each category includes devices for which pass-through payment 
was first made under the OPPS in CY 2003 or 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). For CY 2003, we packaged the costs of the devices 
no longer eligible for pass-through payments into the costs of the 
procedures with which the devices were billed in CY 2001. There were 
few exceptions to this established policy (brachytherapy sources for 
other than prostate brachytherapy, which is now also separately paid in 
accordance with section 621(b)(2) of Pub. L. 108-173). For CY 2005, we 
continued to apply this policy, the same as we did in CY 2003 and 2004, 
to categories of devices that expired on December 31, 2004.
2. Proposed Policy for CY 2006
    For CY 2006, we are proposing to implement the final decision we 
made in the November 15, 2004 final rule with comment period that 
finalizes the expiration date for pass-through status for device 
categories C1814, C1818, and C1819. Therefore, as of January 1, 2006, 
we will discontinue pass-through payment for C1814, C1818, and C1819. 
In accordance with our established policy, we are proposing to package 
the costs of the devices assigned to these three categories into the 
costs of the procedures with which the devices were billed in CY 2004, 
the year of hospital claims data used for this proposed OPPS update.

                  Table 18.--List of Current Pass-Through Device Categories By Expiration Date
----------------------------------------------------------------------------------------------------------------
                                                                                      Date(s)       Expiration
                 HCPCS codes                       Category long descriptor          populated         date
----------------------------------------------------------------------------------------------------------------
C1814.......................................  Retinal tamponade device, silicone          4/1/03        12/31/05
                                               oil.
C1818.......................................  Integrated keratoprosthesis.......          7/1/03        12/31/05
C1819.......................................  Tissue localization excision                1/1/04        12/31/05
                                               device.
----------------------------------------------------------------------------------------------------------------

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

(If you choose to comment on issues in this section, please include 
the caption ``Pass-Through Device Categories'' at the beginning of 
your comment.)
1. Provisions for Reducing Transitional Pass-Through Payments to Offset 
Costs Packaged Into APC Groups
a. Background
    In the November 30, 2001 final rule, we explained the methodology 
we used to estimate the portion of each APC payment rate that could 
reasonably be attributed to the cost of the associated devices that are 
eligible for pass-through payments (66 FR 59904). Beginning with the 
implementation of the CY 2002 OPPS quarterly update (April 1, 2002), we 
deducted from the pass-through payments for the identified devices an 
amount that reflected the portion of the APC payment amount that we 
determined was associated with the cost of the device, as required by 
section 1833(t)(6)(D)(ii) of the Act. In the November 1, 2002 interim 
final rule with comment period, we published the applicable offset 
amounts for CY 2003 (67 FR 66801).
    For the CY 2002 and CY 2003 OPPS updates, to estimate the portion 
of each APC payment rate that could reasonably be attributed to the 
cost of an associated device eligible for pass-through payment, we used 
claims data from the period used for recalibration of the APC rates. 
That is, for CY 2002 OPPS updating, we used CY 2000 claims data and for 
CY 2003 OPPS updating, we used CY 2001 claims data. For CY 2002, we 
used median cost claims data based on specific revenue centers used for 
device related costs because C-code cost data were not available until 
CY 2003. For CY 2003, 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 the associated device category C-codes that were 
billed with the APC packaged into the median. Comparing the median APC 
cost without device packaging to the median APC cost including device 
packaging enabled us to determine the percentage of the median APC cost 
that is attributable to the associated pass-through devices. By 
applying those percentages to the APC payment rates, we determined the 
applicable amount to be deducted from the pass-through payment, the 
''offset'' amount. We created an offset list comprised of any APC for 
which the device cost was at least 1 percent of the APC's cost.
    The offset list that we have published each year is a list of 
offset amounts associated with those APCs with identified offset 
amounts developed using the methodology described above. As a rule, we 
do not know in advance which procedures residing in certain APCs may be 
billed with new device categories. Therefore, an offset amount is 
applied only when a new device category is billed with a HCPCS 
procedure code that is assigned to an APC appearing on the offset list. 
The list of potential offsets for CY 2005 is currently published on the 
CMS Web site: http://www.cms.hhs.gov, as ``Device-Related Portions of 
Ambulatory Payment Classification Costs for 2005.''
    For CY 2004, we modified our policy for applying offsets to device 
pass-through payments. Specifically, we indicated that we would apply 
an offset to a new device category only when we could determine that an 
APC contains costs associated with the device. We continued our 
existing methodology for determining the offset amount, described 
earlier. We were able to use this methodology to establish the device 
offset amounts for CY 2004 because providers reported device codes (C-
codes) on the CY 2002 claims used for the CY 2004 OPPS update. For the 
CY 2005 update to the OPPS, our data consisted of CY 2003 claims that 
did not contain device codes and, therefore, for CY 2005 we utilized 
the device percentages as developed for CY 2004. In the CY 2004 OPPS 
update, we reviewed the device categories eligible

[[Page 42719]]

for continuing pass-through payment in CY 2004 to determine whether the 
costs associated with the device categories are packaged into the 
existing APCs. Based on our review of the data for the device 
categories existing in CY 2004, we determined that there were no close 
or identifiable costs associated with the devices relating to the 
respective APCs that are normally billed with them. Therefore, for 
those device categories, we set the offset to $0 for CY 2004. We 
continued this policy of setting offsets to $0 for the device 
categories that continued to receive pass-through payment in CY 2005.
    For the CY 2006 OPPS update, CY 2004 hospital claims are available 
for analysis. Hospitals billed device C-codes in CY 2004 on a voluntary 
basis. We have reviewed our CY 2004 data, examining hospital claims for 
services that included device C-codes and utilizing the methodology for 
calculating device offsets noted above. The numbers of claims for 
services in many of the APCs for which we calculated device percentages 
using CY 2004 data were quite small. Many of these APCs already had 
relatively few single claims available for median calculations compared 
with the total bill frequencies because of our inability to use many 
multiple bills in establishing median costs for all APCs, and 
subsetting the single claims to only those including C-codes often 
reduced those single bills by 80 percent or more. Our claims 
demonstrate that relatively few hospitals specifically coded for 
devices utilized in CY 2004. Thus, we do not feel confident that CY 
2004 claims reporting C-codes represent the typical costs of all 
hospitals providing the services. Therefore, we do not propose to use 
CY 2004 claims with device coding to propose CY 2006 device offset 
amounts at this time. In addition, we do not propose to use CY 2005's 
methodology, for which we utilized the device percentages as developed 
for CY 2004. Two years have passed since we developed the device 
offsets for CY 2004, and the device offsets originally calculated from 
CY 2002 hospitals' claims data may not appropriately reflect the 
contributions of device costs to procedural costs in the current 
outpatient hospital environment. In addition, a number of the APCs on 
the CY 2004 and CY 2005 device offset percentage lists are either no 
longer in existence or have been so significantly reconfigured that the 
past device offsets likely do not apply.
b. Proposed Policy for CY 2006
    For CY 2006, we are proposing to continue to review each new device 
category on a case-by-case basis as we have done in CY 2004 and CY 
2005, to determine whether device costs associated with the new 
category are packaged into the existing APC structure. If we do not 
determine that for any new device category that device costs associated 
with the new category are packaged into existing APCs, we are proposing 
to continue our current policy of setting the offset for the new 
category to $0 for CY 2006. There are currently no established 
categories that would continue for pass-through payment in CY 2006. 
However, we may establish new categories in any quarter. If we create a 
new device category and determine that our data contain a sufficient 
number of claims with identifiable costs associated with the devices in 
any APC, we would adjust the APC payment if the offset is greater than 
$0. If we determine that a device offset greater than $0 is appropriate 
for any new category that we create, we are proposing to announce the 
offset amounts in the program transmittal that announces the new 
category.
    For CY 2006, we are proposing to use available partial year or full 
year CY 2005 hospital claims data to calculate device percentages and 
potential offsets for CY 2006 applications for new device categories. 
Effective January 1, 2005, we require hospitals to report device C-
codes and their costs when hospitals bill for services which utilize 
devices described by the existing C-codes. In addition, during CY 2005 
we are implementing device edits for many services which require 
devices and for which appropriate device C-codes exist. Therefore, we 
expect that the number of claims including device codes and their 
respective costs will be much more robust and representative for CY 
2005 than for CY 2004. We also note that offsets would not be used for 
any existing categories at this time. If a new device category is 
created for payment, for CY 2006 we are proposing to examine the 
available CY 2005 claims data, including device costs, to determine 
whether device costs associated with the new category are already 
packaged into the existing APC structure, as indicated earlier. If we 
conclude that some related device costs are packaged into existing 
APCs, we are proposing to utilize the methodology described earlier and 
first used for the CY 2003 OPPS to determine an appropriate device 
offset percentage for those APCs with which the new category would be 
reported.
    Our proposal not to publish a list of APCs with device percentages 
at this time would be a transitional policy for CY 2006 because of the 
previously discussed limitations of the CY 2004 OPPS data with respect 
to device costs associated with procedures. We expect that we will 
reexamine our previous methodology for calculating the device 
percentages and offset amounts for the CY 2007 OPPS update, which will 
be based on CY 2005 hospitals claims data where device C-code reporting 
is required.
2. Criteria for Establishing New Pass-Through Device Categories
a. Surgical Insertion and Implantation Criterion
    One of our criteria, as set forth in Sec.  419.66(b)(3) of the 
regulations, for establishing a new category of devices for pass-
through payment is that the item be surgically inserted or implanted. 
The criterion that a device be surgically inserted or implanted is one 
of our original criteria adopted when we implemented the BBRA 
requirement that we establish pass-through payment for devices. This 
criterion helps us define whether an item is a device, as distinguished 
from other items, such as materials and supplies. We further clarified 
our definition of the surgical insertion and implantation criterion in 
the November 13, 2000 final rule (65 FR 67805). In that rule we stated 
that we consider a device to be surgically inserted or implanted if it 
is introduced into the human body through a surgically created 
incision. We also stated that we do not consider an item used to cut or 
otherwise create a surgical opening to be a device that is surgically 
inserted or implanted.
    In our November 15, 2004 final rule with comment period, we 
responded to comments received on our August 16, 2004 proposed rule, 
which requested that we revisit our surgical insertion and implantation 
criterion for establishing a new device category. The commenters 
specifically requested that CMS eliminate the current requirement that 
items that are included in new pass-through device categories must be 
surgically inserted or implanted through a surgically created incision. 
The commenters expressed concern that the current requirement may 
prevent access to innovative and less invasive technologies, 
particularly in the areas of gynecologic, urologic, colorectal and 
gastrointestinal procedures. These commenters asked that CMS change the 
surgical insertion or implantation criterion to allow pass-through 
payment for potential new device categories that include items 
introduced into the human body through a natural orifice, as well as 
through a surgically created incision. Several of the commenters

[[Page 42720]]

recommended that CMS allow the creation of a new pass-through category 
for items implanted or inserted through a natural orifice, as long as 
the other existing criteria are met.
    In responding to the commenters, we stated in the November 15, 2004 
final rule with comment period (69 FR 65774) that we were also 
interested in hearing the views of other parties and receiving 
additional information on these issues. While we appreciate and welcome 
additional comments on these issues from the medical device makers, we 
were also interested in hearing the views of Medicare beneficiaries, of 
the hospitals that are paid under the OPPS, and of physicians and other 
practitioners who attend to patients in the hospital outpatient 
setting. For that reason, we solicited additional comments on this 
topic within the 60-day comment period for the November 15, 2004 final 
rule with comment period (69 FR 65774 through 65775). In framing their 
comments, we asked that commenters consider the following questions 
specific to devices introduced into the body through natural orifices:
    1. Whether orifices include those that are either naturally or 
surgically created, as in the case of ostomies. If you believe this 
includes only natural orifices, why do you distinguish between natural 
and surgically created orifices?
    2. How would you define ``new,'' with respect to time and to 
predecessor technology? What additional criteria or characteristics do 
you believe distinguish ``new'' devices that are surgically introduced 
through an existing orifice from older technology that also is inserted 
through an orifice?
    3. What characteristics do you consider to distinguish a device 
that might be eligible for a pass-through category even if inserted 
through an existing orifice from materials and supplies such as 
sutures, clips or customized surgical kits that are used incident to a 
service or procedure?
    4. Are there differences with respect to instruments that are seen 
as supplies or equipment for open procedures when those same 
instruments are passed through an orifice using a scope?
b. Public Comments Received and Our Responses
    Below is a summary of the public comments we received on the four 
stated surgical insertion and implantation device criterion questions 
and our response to them.
    Comment: Most commenters generally framed their responses to the 
four questions listed above. Commenters were generally in favor of 
modifying our surgical insertion and implantation criterion so that 
devices that are placed into patients without the need for a surgical 
incision would not be ineligible for pass-through payment, claiming 
that devices that are inserted through a natural orifice offer 
important benefits to Medicare beneficiaries, such as avoidance of more 
costly and more invasive surgery. One commenter stated that procedures 
that could be performed with minimal morbidity and on an outpatient 
basis are the trend for surgery and should be encouraged. Another 
commenter believed that our criterion of surgical insertion or 
implantation through a surgically created incision was ineffective as a 
clear and comprehensive description of surgical procedures, including 
endoscopic and laparoscopic procedures.
    Regarding the first specific question we posed, whether devices 
introduced into the body through natural orifices includes orifices 
that are either naturally or surgically created, commenters generally 
stated we should include devices as potentially eligible for pass-
through categories whether they are introduced through orifices that 
are either naturally or surgically created, as in the case of ostomies, 
if the devices meet other cost and clinical criteria, in order to 
encourage the development of new technologies.
    Regarding the second question restated above, which asked how the 
public would define ``new'' with respect to time and to predecessor 
technology, some commenters stated that they believed the current 
clinical and cost criteria are sufficient and that no additional 
criteria or characteristics are needed. Several commenters indicated 
that the timeframe for what we consider ``new'' could be clarified if 
the device in question was not FDA approved or in use in the OPD during 
the year that hospital claims are used for that calendar year's OPPS 
update, that is, it should be considered ``new.'' Some commenters 
elaborated by example. They stated that if we change the surgical 
insertion or implantation requirement to include devices inserted 
through natural orifices in 2005, devices approved by the FDA and in 
use in the OPD in 2003 or previously would not be eligible, while 
devices approved by FDA in 2004 or later and used in the OPD settings 
would be eligible for pass-through consideration. Another commenter 
stated that the definition of ``new'' device should include those 
devices that require only an FDA investigational device exemption (IDE) 
clearance. The commenter further stated that these devices should be 
granted ``new'' status at the time of FDA release as an IDE. The 
commenter stated that if FDA required a premarket approval (PMA) for 
the device, a determination of newness should be made on a case by case 
basis.
    Regarding the question of what characteristics distinguish a device 
that might be eligible for a pass-through category even if inserted 
through an existing orifice from materials and supplies that are used 
incident to a service or procedure, some commenters generally stated 
their belief that the current clinical and cost criteria are sufficient 
to distinguish devices that might be eligible from materials and 
supplies. Other commenters stated that the device must be an integral 
part of the procedure or that it should include the characteristic of 
having a diagnostic or therapeutic purpose, without which the procedure 
could not be performed. Thus, according to these commenters, the device 
must function for a specific procedure, while supplies may be used for 
many procedures. One commenter pointed out that many devices are now 
implanted through the use of naturally occurring orifices or without 
significant incisions. This commenter indicated that the requirement of 
a ``traditional incision'' no longer serves the purpose of 
distinguishing between devices that are and are not implanted, or 
between devices and supplies and instruments. The commenter stated that 
retaining the requirement of a traditional incision could create 
incentives to use more invasive technology, if that is the technology 
that is eligible for pass-through payments and less invasive technology 
is not. This commenter suggested excluding tools and disposable 
supplies by excluding any item that is used primarily for the purpose 
of cutting or delivering an implantable device. However, the commenter 
recommended not reducing payment when delivery systems are packaged 
with the device. The commenter further recommended that the term 
incision be clearly defined to include all procedures involving the 
cutting, breaking or puncturing of tissue or skin, regardless of how 
small that cut is, provided that the device is attached to or inserted 
into the body via this cut or puncture or break. Another commenter 
stated that there are items included in a surgical kit that have 
significant cost and are single use, for example, guide wires, implying 
that it is sometimes difficult to determine what a supply is.
    Regarding our question about whether there are differences with 
respect to instruments that are seen as supplies or equipment for open 
procedures when those same instruments are passed through an orifice 
using a scope,

[[Page 42721]]

commenters believed that the definitions of supplies and eligible 
devices are independent of the use of a scope during a procedure, and 
stated there were no distinguishing features of supplies or equipment. 
A commenter reiterated that the current clinical and cost criteria are 
sufficient to distinguish eligible devices (that is, those with ``a 
specific therapeutic use'') from materials and supplies. Commenters 
believed that the use of a scope should not be a factor in the 
distinction between devices and supplies.
    One commenter urged us to consider the points that the surgical 
incision requirement is not mandated by statute and that CMS's 
criterion to limit devices to only those that are surgically inserted 
or implanted may have been based upon concern that less restrictive 
criteria would cause spending on pass-though items to exceed the pool 
of money set to fund the pass-though payments. This commenter indicated 
that this concern would no longer be valid, given the relatively few 
items currently paid on a pass-through basis.
    Response: As we stated in the November 15, 2004 final rule, we 
share the view that it is important to ensure access for Medicare 
beneficiaries to new technologies that offer substantial clinical 
improvement in the treatment of their medical conditions. We also 
recognize that since the beginning of the OPPS, there have been 
beneficial advances in technologies and services for many conditions, 
which have both markedly altered the courses of medical care and 
ultimately improved the health outcomes of many beneficiaries.
    We carefully considered the comments and are proposing to maintain 
our current criterion that a device must be surgically inserted or 
implanted, but are also proposing to modify the way we currently 
interpret this criterion under Sec.  419.66(b)(3) of the regulations. 
We are proposing to consider eligible those items that are surgically 
inserted or implanted either through a natural orifice or a surgically 
created orifice (such as through an ostomy), as well as those that are 
inserted or implanted through a surgically created incision. We will 
maintain all of our other criteria in Sec.  419.66 of the regulations, 
as elaborated in our various rules, such as the November 1, 2002 final 
rule (67 FR 66781 through 66787). Specifically, the clarification made 
at the time we clarified the surgically inserted or implanted criterion 
in our August 3, 2000 interim final rule with comment period, namely, 
that we do not consider an item used to cut or otherwise create a 
surgical opening to be a device that is surgically implanted or 
inserted (65 FR 67805).
    With this revision of our definition of devices that are surgically 
inserted or implanted, we remind the public that device category 
eligibility for transitional pass-through payment continues to depend 
on meeting our substantial clinical improvement criterion, where we 
compare the clinical outcomes of treatment options using the device to 
currently available treatments, including treatments using devices in 
existing or previously established pass-through device categories. We 
expect that requested new pass-through device categories that 
successfully demonstrate substantial clinical improvement for Medicare 
beneficiaries would describe new devices, where the additional device 
costs would not be reflected in the hospital claims data providing the 
costs of treatments available during the time period used for the most 
recent OPPS update.
c. Existing Device Category Criterion
    One of our criteria, as set forth in Sec.  419.66(c)(1) of the 
regulations, to establish a new device category for pass-through 
payment, is that the devices that would populate the category not be 
described by any existing or previously existing category. Commenters 
to our various proposed rules, as well as applicants for new device 
categories, have expressed concern that some of our existing and 
previously existing device category descriptors are overly broad, and 
that the category descriptors as they are currently written may 
preclude some new technologies from qualifying for establishment of a 
new device category for pass-through payment. Such parties have 
recommended that we consider modifying the descriptors for existing 
device categories, especially when a device would otherwise meet all 
the other criteria for establishing a new device category to qualify 
for pass-through payment.
    We agree that implementation of the requirement that a new device 
category not be described by an existing or previously existing 
category merits review. Beginning with CY 2006, 3 years will have 
elapsed since 95 of the 97 initial device categories we established on 
April 1, 2001 will have expired: 95 categories expired after December 
31, 2002, and 2 categories expired after December 31, 2003. Several 
additional years will have passed since those categories were first 
populated in CY 2000 or CY 2001. Thus, while some of the initial device 
category descriptors sufficed at the time they were first created, 
further clarification as to the types of devices that they are meant to 
describe is indicated. Therefore, we are proposing to create an 
additional category for devices that meet all of the criteria required 
to establish a new category for pass-through payment in instances where 
we believe that an existing or previously existing category descriptor 
does not appropriately describe the new type of device. This may entail 
the need to clarify or refine the short or long descriptors of the 
previous category. We would evaluate each situation on a case by case 
basis. We are proposing that any such clarification would be made 
prospectively from the date the new category would be made effective.
    We are also proposing to revise Sec.  419.66(c)(1) of the 
regulations, accordingly, to reflect as one of the criteria for 
establishing a device category our determination that a device is not 
appropriately described by any of the existing categories or by any 
category previously in effect. In order to determine if a ``new'' 
device is appropriately described by an existing or previously existing 
category of devices, we are proposing to apply two tests based upon our 
evaluation of information provided to us in the device category 
application. First, we will expect an applicant for a new device 
category to show that their device is not similar to devices (including 
related predicate devices) whose costs are reflected in our OPPS claims 
data in the most recent OPPS update. Second, we will require an 
applicant for a new device category to demonstrate that utilization of 
their device provides a substantial clinical improvement for Medicare 
beneficiaries compared with currently available treatments, including 
procedures utilizing devices in existing or previously existing device 
categories. We would consider a new device that meets both of these 
tests not to be appropriately described by one of the existing or 
previously existing pass-through device categories.

V. Proposed Payment Changes for Drugs, Biologicals, and 
Radiopharmaceutical Agents

A. Transitional Pass-Through Payment for Additional Costs of Drugs and 
Biologicals

(If you choose to comment on issues in this section, please include 
the caption ``Pass-Through'' at the beginning of your comment.)
1. Background
    Section 1833(t)(6) of the Act provides for temporary additional 
payments or ``transitional pass-through payments'' for certain drugs 
and biological agents. As originally enacted by the BBRA, this

[[Page 42722]]

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 and biological agents and brachytherapy used for the treatment of 
cancer; and current radiopharmaceutical drugs and biological products. 
For those drugs and biological agents referred to as ``current,'' the 
transitional pass-through payment began on the first date the hospital 
OPPS was implemented (before enactment of BIPA (Pub. L. 106-554), on 
December 21, 2000).
    Transitional pass-through payments are also required for certain 
``new'' drugs, devices, and biological agents that were not being paid 
for as a hospital OPD 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 drug, device, or 
biological. Under the statute, transitional pass-through payments can 
be made for at least 2 years but not more than 3 years. In Addenda A 
and B to this proposed rule, pass-through drugs and biological agents 
are identified by status indicator ``G.''
    The process to apply for transitional pass-through payment for 
eligible drugs and biological agents can be found on our CMS Web site: 
http://www.cms.hhs.gov. If we revise the application instructions in 
any way, we will post the revisions on our Web site and submit the 
changes to the Office of Management and Budget (OMB) for approval, as 
required under the Paperwork Reduction Act (PRA). Notification of new 
drugs and biologicals application processes is generally posted on the 
OPPS Web site at: http://www.cms.hhs.gov/providers/hopps.
2. Expiration in CY 2005 of Pass-Through Status for Drugs and 
Biologicals
    Section 1833(t)(6)(C)(i) of the Act specifies that the duration of 
transitional pass-through payments for drugs and biologicals must be no 
less than 2 years and no longer than 3 years. The drugs whose pass-
through status will expire on December 31, 2005, meet that criterion. 
Table 19 below lists the 10 drugs and biologicals for which we are 
proposing that pass-through status would expire on December 31, 2005.

Table 19.--Proposed List of Drugs and Biologicals for Which Pass-Through
                    Status Expires December 31, 2005
------------------------------------------------------------------------
            HCPCS                APC            Short descriptor
------------------------------------------------------------------------
C9123........................    9123  Transcyte, per 247 sq cm.
C9205........................    9205  Oxaliplatin.
C9211........................    9211  Inj, alefacept, IV.
C9212........................    9212  Inj, alefacept, IM.
J0180........................    9208  Agalsidase beta injection.
J1931........................    9209  Laronidase injection.
J2469........................    9210  Palonosetron HCl.
J3486........................    9204  Ziprasidone mesylate.
J9041........................    9207  Bortezomib injection.
Q9955........................    9203  Inj perflexane lip micros, ml.
------------------------------------------------------------------------

3. Drugs and Biologicals With Proposed Pass-Through Status in CY 2006
    We are proposing to continue pass-through status in CY 2006 for 14 
drugs and biologicals. These items, which are listed in Table 20 below, 
were given pass-through status as of April 1, 2005. The APCs and HCPCS 
codes for drugs and biologicals that we are proposing to continue with 
pass-through status in CY 2006 are assigned status indicator ``G'' in 
Addendum A and Addendum B of this proposed rule.
    Section 1833(t)(6)(D)(i) of the Act sets the payment rate for pass-
through eligible drugs (assuming that no pro rata reduction in pass-
through payment is necessary) as the amount determined under section 
1842(o) of the Act. We note that this section of the Act also states 
that if a drug or biological is covered under a competitive acquisition 
contract under section 1847(B), then the payment rate be equal to the 
average price for the drug or biological for all competitive 
acquisition areas and year established as calculated and adjusted by 
the Secretary. The competitive acquisition program has not yet been 
implemented as of the development of this proposed rule; therefore, we 
do not have payment rates for certain drugs and biologicals that would 
be covered under this program at this time. Section 1847(A) of the Act, 
as added by section 303(c) of Pub. L. 108-173, establishes the use of 
the average sales price (ASP) methodology as the basis for payment of 
drugs and biologicals described in section 1842(o)(1)(C) of the Act and 
furnished on or after January 1, 2005. This payment methodology is set 
forth in Sec.  419.64 of the regulations. Similar to the payment policy 
established for pass-through drugs and biologicals in CY 2005, we are 
proposing to pay under the OPPS for drugs and biologicals with pass-
through status in CY 2006 consistent with the provisions of section 
1842(o) of the Act, as amended by section 621 of Pub. L. 108-173, at a 
rate that is equivalent to the payment these drugs and biologicals 
would receive in the physician office setting.
    Section 1833(t)(6)(D)(i) of the Act also sets the amount of 
additional payment for pass-through eligible drugs and biologicals (the 
pass-through payment amount). The pass-through payment amount is the 
difference between the amount authorized under section 1842(o) of the 
Act, and the portion of the otherwise applicable fee schedule amount 
(that is, the APC payment rate) that the Secretary determines is 
associated with the drug or biological.
    As we explain in section V.B. of this proposed rule, we are 
proposing to continue to make separate payment in CY 2006 for new drugs 
and biologicals with a HCPCS code consistent with the provisions of 
section 1842(o) of the Act, as amended by section 621 of Pub. L. 108-
173, at a rate that is equivalent to the payment they would receive in 
a physician office setting, whether or not we have received a pass-
through application for the item. Accordingly, in CY 2006, the pass-
through payment amount would equal zero for those new drugs and 
biologicals that we determine have pass-through status. That is, when 
we subtract the amount to be paid for pass-through drugs and 
biologicals under section 1842(o) of the Act, as amended by section 621 
of Pub. L. 108-173, from the portion of the otherwise applicable fee 
schedule amount, or the APC payment rate associated with the drug or 
biological that would be the amount paid for drugs and biologicals 
under section 1842(o) of the Act as amended by section 621 of Pub. L. 
108-173, the resulting difference is equal to zero.
    We are proposing to use payment rates based on the ASP data from 
the fourth quarter of 2004 for budget neutrality estimates, impact 
analyses, and to complete Addenda A and B of this proposed rule because 
these are the most recent numbers available to us during the 
development of this proposed rule. These payment rates were also the 
basis for drug payments in the physician office setting effective April 
1, 2005. To be consistent with the ASP-based payments that would be 
made when these drugs and biologicals are furnished in physician 
offices, we plan to make any appropriate adjustments to the amounts 
shown in Addenda A and B of this proposed rule when we publish our 
final rule and also on a quarterly basis on our Web site during CY 2006 
if later quarter ASP submissions indicate that adjustments to the 
payment rates for these pass-

[[Page 42723]]

through drugs and biologicals are necessary.
    Table 20 lists the drugs and biologicals for which we are proposing 
that pass-through status continue in CY 2006. We assigned pass-through 
status to these drugs and biologicals as of April 1, 2005. We also have 
included in Addenda A and B to this proposed rule the proposed CY 2006 
APC payment rates for these pass-through drugs and biologicals.

   Table 20.--Proposed List of Drugs and Biologicals With Pass-Through
                            Status in CY 2006
------------------------------------------------------------------------
          HCPCS code             APC            Short descriptor
------------------------------------------------------------------------
C9220........................    9220  Sodium hyaluronate.
C9221........................    9221  Graftjacket Reg Matrix.
C9222........................    9222  Graftjacket SftTis.
J0128........................    9216  Abarelix injection.
J0878........................    9124  Daptomycin injection.
J2357........................    9300  Omalizumab injection.
J2783........................    0738  Rasburicase.
J2794........................    9125  Risperidone, long acting.
J7518........................    9219  Mycophenolic acid.
J8501........................    0868  Oral aprepitant.
J9035........................    9214  Bevacizumab injection.
J9055........................    9215  Cetuximab injection.
J9305........................    9213  Pemetrexed injection.
Q4079........................    9126  Injection, Natalizumab, 1 MG.
------------------------------------------------------------------------

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

(If you choose to comment on issues in this section, please include 
the caption ``NonPass-Throughs'' at the beginning of your comment.)
1. Background
    Under the OPPS, we currently pay for drugs, biologicals including 
blood and blood products, and radiopharmaceuticals that do not have 
pass-through status in one of two ways: packaged payment and separate 
payment (individual APCs). We explained in the April 7, 2000 final rule 
(65 FR 18450) that 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 
packaged items and supplies whose costs are recognized and paid for 
within the national OPPS payment rate for the associated procedure or 
service. (Program Memorandum Transmittal A-01-133, issued on November 
20, 2001, explains in greater detail the rules regarding separate 
payment for packaged services.)
    Packaging costs into a single aggregate payment for a service, 
procedure, or episode of care is a fundamental principle that 
distinguishes a prospective payment system from a fee schedule. In 
general, packaging the costs of items and services into the payment for 
the primary procedure or service with which they are associated 
encourages hospital efficiencies and also enables hospitals to manage 
their resources with maximum flexibility. Notwithstanding our 
commitment to package as many costs as possible, we are aware that 
packaging payments for certain drugs, biologicals, and 
radiopharmaceuticals, especially those that are particularly expensive 
or rarely used, might result in insufficient payments to hospitals, 
which could adversely affect beneficiary access to medically necessary 
services.
    Section 1833(t)(16)(B) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, requires that the threshold for establishing separate 
APCs for drugs and biologicals be set at $50 per administration for CYs 
2005 and 2006. For CY 2005, we finalized our policy to continue paying 
separately for drugs, biologicals, and radiopharmaceuticals whose 
median cost per day exceeds $50 and packaging the cost of drugs, 
biologicals, and radiopharmaceuticals whose median cost per day is less 
than $50 into the procedures with which they are billed. For CY 2005, 
we also adopted an exception policy to our packaging rule for one 
particular class of drugs, the oral and injectible 5HT3 forms of anti-
emetic treatments (69 FR 65779 through 65780).
2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and 
Radiopharmaceuticals
    For CY 2006, the threshold for establishing separate APCs for drugs 
and biologicals is required to be set at $50 per administration 
according to section 1833(t)(16)(B) of the Act. Therefore, we are 
proposing to continue our existing policy of paying separately for 
drugs, biologicals, and radiopharmaceuticals whose per day cost exceeds 
$50 and packaging the cost of drugs, biologicals, and 
radiopharmaceuticals whose per day cost is less than $50 into the 
procedures with which they are billed. We are also proposing to 
continue our policy of exempting the oral and injectible 5HT3 anti-
emetic products from our packaging rule (Table 21), thereby making 
separate payment for all of the 5HT3 anti-emetic products. As stated in 
our CY 2005 final rule with comment period (69 FR 65779 through 65780), 
chemotherapy is very difficult for many patients to tolerate as the 
side effects are often debilitating. In order for beneficiaries to 
achieve the maximum therapeutic benefit from chemotherapy and other 
therapies with side effects of nausea and vomiting, anti-emetic use is 
often an integral part of the treatment regimen. We want to continue to 
ensure that our payment rules do not impede a beneficiary's access to 
the particular anti-emetic that is most effective for him or her as 
determined by the beneficiary and his or her physician.

      Table 21.--Proposed Anti-Emetics To Exempt From $50 Packaging
                               Requirement
------------------------------------------------------------------------
             HCPCS code                       Short description
------------------------------------------------------------------------
J2405..............................  Ondansetron HCl injection.
Q0179..............................  Ondansetron HCl 8 mg oral.
Q0180..............................  Dolasetron mesylate oral.
J1260..............................  Dolasetron mesylate.
J1626..............................  Granisetron HCl injection.
Q0166..............................  Granisetron HCl 1 mg oral.
J2469..............................  Palonosetron HCl.
------------------------------------------------------------------------

    For the CY 2006 proposed payment rates, we calculated the per day 
cost of all drugs, biologicals, and radiopharmaceuticals that had a 
HCPCS code in CY 2004 and were paid (via packaged or separate payment) 
under the OPPS using claims data from January 1, 2004, to December 31, 
2004. In CY 2004, multisource drugs and radiopharmaceuticals had two 
HCPCS codes that distinguished the innovator multisource (brand) drug 
or radiopharmaceutical from the noninnovator multisource (generic) drug 
or radiopharmaceutical. We aggregated claims for both the brand and 
generic HCPCS codes in our packaging analysis of these multisource 
products. Items such as single indication orphan drugs, certain 
vaccines, and blood and blood products were excluded from these 
calculations and our treatment of these items is discussed separately 
in sections V.F., E., and I., respectively, of this preamble.
    In order to calculate the per day cost for drugs, biologicals, and 
radiopharmaceuticals to determine their packaging status in CY 2006, we 
are proposing several changes in the methodology that was described in 
detail in the CY 2004 OPPS proposed rule (68 FR 47996 through 47997) 
and finalized in the CY 2004 final rule with comment period (68 FR 
63444 through 63447). For CY 2006, to calculate the per day cost of the 
drugs, biologicals, and radiopharmaceuticals, we took the following 
steps:

[[Page 42724]]

    Step 1. After application of the cost-to-charge ratios, we 
aggregated all line-items for a single date of service on a single 
claim for each product. This resulted in creation of a single line-item 
with the total number of units and the total cost of a drug or 
radiopharmaceutical given to a patient in a single day.
    Step 2. We then created a separate record for each drug or 
radiopharmaceutical by date of service, regardless of the number of 
lines on which the drug or radiopharmaceutical was billed on each 
claim. For example, ``drug X'' is billed on a claim with two different 
dates of service, and for each date of service, the drug is billed on 
two line-items with a cost of $10 and 5 units for each line-item. In 
this case, the computer program would create two records for this drug, 
and each record would have a total cost of $20 and 10 units of the 
product.
    Step 3. We trimmed records with unit counts per day greater or less 
than 3 standard deviations from the geometric mean (This is a new step 
in the methodology we are proposing for CY 2006).
    Step 4. For each remaining record for a drug or 
radiopharmaceutical, we calculated the cost per unit of the drug. If 
the HCPCS descriptor for ``drug X'' is ``per 1 mg'' and one record was 
created for a total of 10 mg (as indicated by the total number of units 
for the drug on the claim for each unique date of service), then the 
computer program divided the total cost for the record by 10 to give a 
per unit cost. We then weighted this unit cost by the total number of 
units in the record. We did this by generating a number of line-items 
equivalent to the number of units in that particular claim. Thus, a 
claim with 100 units of ``drug X'' and a total cost of $200 would be 
given 100 line-items, each with a cost of $2, while a claim of 50 units 
with a cost of $50 would be given 50 line items, each with a cost of 
$1.
    Step 5. We then trimmed the unit records with cost per unit greater 
or less than 3 standard deviations from the geometric mean.
    Step 6. We aggregated the remaining unit records to determine the 
mean cost per unit of the drug or radiopharmaceutical.
    Step 7. Using only the records that remained after records with 
unit counts per day greater or less than 3 standard deviations from the 
geometric mean were trimmed (step 3), the total number of units billed 
for each item and the total number of unique per-day records for each 
item were determined. We divided the count of the total number of units 
by the total number of unique per-day records for each item to 
calculate an average number of units per day.
    Step 8. Instead of using median cost as done in previous years, we 
used the payment rate for each drug and biological effective April 1, 
2005 furnished in the physician office setting, which was calculated 
using the ASP methodology, and multiplied the payment rate by the 
average number of units per day for each drug or biological to arrive 
at its per day cost. For items that did not have an ASP-based payment 
rate, we used their mean unit cost derived from the CY 2004 hospital 
claims data to determine their per day cost. Our reasoning for using 
these cost data is discussed in section V.B.3.a. of this preamble.
    Step 9. We then packaged the items with per day cost based on the 
ASP methodology or mean cost less than $50 and made items with per day 
cost greater than $50 separately payable.
    In the past, many commenters have alleged that hospitals do not 
accurately bill the number of units for drugs and radiopharmaceuticals. 
We have consistently decided not to identify which hospital claims 
contain correctly coded units because we do not believe we should be 
identifying when a dosage is clinically appropriate from hospital 
claims information. Variations among patients with respect to 
appropriate doses, the variety of indications with different dosing 
regimens for some agents, and the possibility of off-label uses make it 
difficult to know when units are incorrect. However, we do believe that 
trimming the units would improve the accuracy of estimates by removing 
those records with the most extreme units, without requiring us to 
speculate about clinically appropriate dosing. Therefore, we believe 
that trimming the records with unit counts greater or less than 3 
standard deviations from the geometric mean will eliminate claims from 
our analysis that may not appropriately represent the actual number of 
units of a drug or radiopharmaceutical furnished by a hospital to a 
patient during a specific clinical encounter. Because it reduces 
extreme variation, trimming on greater or less than 3 standard 
deviations from the geometric mean makes this trim more conservative 
and removes fewer records. This change in methodology gives us even 
greater confidence in the cost estimates we use for our packaging 
decisions. We are seeking comments on the changes that we are proposing 
in our methodology for packaging drugs and radiopharmaceuticals.
    Section 1833(t)(16)(B) of the Act that requires the threshold for 
establishing separate APCs for drugs and biologicals to be set at $50 
per administration will expire at the end of CY 2006. Therefore, we 
will be evaluating other packaging thresholds for these products for 
the CY 2007 OPPS update. We are specifically requesting comments on the 
use of alternative thresholds for packaging drugs and 
radiopharmaceuticals in CY 2007.
3. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals 
Without Pass-Through Status That Are Not Packaged
a. Proposed Payment for Specified Covered Outpatient Drugs
(1) Background
    Section 1833(t)(14) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, requires special classification of certain separately 
paid radiopharmaceutical agents, drugs, and biologicals and mandates 
specific payments for these items. Under section 1833(t)(14)(B)(i) of 
the Act, a ``specified covered outpatient drug'' is a covered 
outpatient drug, as defined in section 1927(k)(2) of the Act, for which 
a separate APC exists and that either is a radiopharmaceutical agent or 
is a drug or biological for which payment was made on a pass-through 
basis on or before December 31, 2002.
    Under section 1833(t)(14)(B)(ii) of the Act, certain drugs and 
biologicals are designated as exceptions and are not included in the 
definition of ``specified covered outpatient drugs.'' These exceptions 
are--
     A drug or biological for which payment is first made on or 
after January 1, 2003, under the transitional pass-through payment 
provision in section 1833(t)(6) of the Act.
     A drug or biological for which a temporary HCPCS code has 
not been assigned.
     During CYs 2004 and 2005, an orphan drug (as designated by 
the Secretary).
    Section 1833(t)(14)(F) of the Act defines the categories of drugs 
based on section 1861(t)(1) and sections 1927(k)(7)(A)(ii), 
(k)(7)(A)(iii), and (k)(7)(A)(iv) of the Act. The categories of drugs 
are ``sole source drugs (includes a biological product or a single 
source drug),'' ``innovator multiple source drugs,'' and ``noninnovator 
multiple source drugs.'' The definitions of these specified categories 
for drugs, biologicals, and radiopharmaceutical agents were discussed 
in the January 6, 2004 OPPS interim final rule with comment period (69 
FR 822), along with our use of the Medicaid average manufacturer price 
database to determine the appropriate classification

[[Page 42725]]

of these products. Because of the many comments received on the January 
6, 2004 interim final rule with comment period, the classification of 
many of the drugs, biologicals, and radiopharmaceuticals changed from 
that initially published. We announced these changes to the public on 
February 27, 2004, Transmittal 112, Change Request 3144. We also 
implemented additional classification changes through Transmittals 132 
(Change Request 3154, released March 30, 2004) and Transmittal 194 
(Change Request 3322, released June 4, 2004).
    Section 1833(t)(14)(A) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, also provides that payment for these specified covered 
outpatient drugs for CYs 2004 and 2005 is to be based on its 
``reference average wholesale price.'' Section 1833(t)(14)(G) of the 
Act) defines reference AWP as the AWP determined under section 1842(o) 
of the Act as of May 1, 2003. Section 1833(t)(14)(A)(ii) of the Act, as 
added by section 621(a) of Pub. L. 108-173 requires that in CY 2005--
     A sole source drug must be paid no less than 83 percent 
and no more than 95 percent of the reference AWP.
     An innovator multiple source drug must be paid no more 
than 68 percent of the reference AWP.
     A noninnovator multiple source drug must be paid no more 
than 46 percent of the reference AWP.
    Section 1833(t)(14)(G) of the Act defines ``reference AWP'' as the 
AWP determined under section 1842(o) the Act as of May 1, 2003. We 
interpreted this to mean the AWP set under the CMS single drug pricer 
(SDP) based on prices published in the Red Book on May 1, 2003.
    For CY 2005, we finalized our policy to determine the payment rates 
for specified covered outpatient drugs under the provisions of Pub. L. 
108-173 by comparing the payment amount calculated under the median 
cost methodology as done for procedural APCs to the AWP percentages 
specified in section 1833(t)(14)(A)(ii) of the Act.
(2) Proposed Changes for CY 2006 Related to Pub. L. 108-173
    Section 1833(t)(14)(A)(iii) of the Act, as added by section 
621(a)(1) of Pub. L. 108-173, requires that payment for specified 
covered outpatient drugs in CY 2006 be equal to the average acquisition 
cost for the drug for that year as determined by the Secretary but 
subject to any adjustment for overhead costs and taking into account 
the hospital acquisition cost survey data collected by the GAO in 2004 
and 2005. If hospital acquisition cost data are not available, then the 
law requires that payment be equal to payment rates established under 
the methodology described in section 1842(o), section 1847(A), or 
section 1847(B) of the Act as calculated and adjusted by the Secretary 
as necessary.
(3) Data Sources Available for Setting CY 2006 Payment Rates
    Section 1833(t)(14)(D) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, outlines the provisions of the hospital outpatient 
drug acquisition cost survey mandated for the GAO. This provision 
directs the GAO to collect data on hospital acquisition costs of 
specified covered outpatient drugs and to provide information based on 
these data that can be taken into consideration for setting CY 2006 
payment rates for these products under the OPPS. Accordingly, the GAO 
conducted a survey of 1,400 acute care, Medicare-certified hospitals 
requesting hospitals to provide purchase prices for specified covered 
outpatient drugs purchased from July 1, 2003 to June 30, 2004. The 
survey yielded a response rate of 83 percent where 1,157 hospitals 
provided usable information. To ensure that its methodology for data 
collection and analysis were sound, the GAO consulted an advisory panel 
of experts in pharmaceutical economics, pharmacy, medicine, survey 
sampling and Medicare payment.
    The GAO reported the average and median purchase prices for 55 
specified covered outpatient drug categories for the period July 1, 
2003 to June 30, 2004. These items represented 86 percent of the 
Medicare spending for specified covered outpatient drugs during the 
first 9 months of 2004. The initial GAO data did not include any 
radiopharmaceuticals. The report noted that the purchase price 
information accounted for volume and other discounts provided at the 
time of purchase, but excluded subsequent rebates from manufacturers 
and payments from group purchasing organizations.
    Another source of drug pricing information that we have is the ASP 
data from the fourth quarter of 2004, which were used to set payment 
rates for drugs and biologicals in the physician office setting 
effective April 1, 2005. We have ASP-based prices for approximately 475 
drugs and biologicals (including contrast agents) payable under the 
OPPS; however, we currently do not have any ASP data on 
radiopharmaceuticals. Payments for most of the drugs and biologicals 
paid in the physician office setting are based on the ASP+6 percent. 
Payments for items with no reported ASP are based on wholesale 
acquisition cost (WAC).
    Lastly, the third source of cost data we have for drugs, 
biologicals, and radiopharmaceuticals are the mean and median costs 
derived from the CY 2004 hospital claims data. In our data analysis, we 
compared the payment rates for drugs and biologicals using data from 
all three sources described above. As section 1833(t)(14)(A)(iii) of 
the Act clearly specifies that payment for specified covered outpatient 
drugs in CY 2006 be equal to the ``average'' acquisition cost for the 
drug, we limited our analysis to the mean costs of drugs determined 
using the GAO acquisition cost survey and the hospital claims data, 
instead of using median costs.
    We estimated aggregate expenditures for all drugs and biologicals 
(excluding radiopharmaceuticals) that would be separately payable in CY 
2006 and for the 55 drugs and biologicals reported by the GAO using 
mean cost from the claims data, the GAO mean purchase price, and the 
ASP-based payment amount (ASP+6 percent in most cases), and then 
calculated the equivalent average ASP-based payment rate under each of 
the three payment methodologies. The results are presented in Table 22 
below.

  Table 22.--Comparison of Relative Pricing for OPPS Drugs and Biologicals Under Various Payment Methodologies
----------------------------------------------------------------------------------------------------------------
                                                                                          ASP equivalent (all
       Type of pricing data             Time period of       ASP equivalent (55 GAO       separately billable
                                         pricing data        drugs only)  (percent)              drugs)
----------------------------------------------------------------------------------------------------------------
GAO mean purchase price...........  12 months ending June  ASP+3                       N/A
                                     2004.
ASP+6%............................  4th quarter of 2004..  ASP+6                       ASP+6%

[[Page 42726]]

 
Mean cost from claims data........  1st 9 months of 2004.  ASP+8                       ASP+8%
----------------------------------------------------------------------------------------------------------------

    Prior to any adjustments for the differing time periods of the 
pricing data, the results indicated that using the GAO mean purchase 
prices as the basis for paying the 55 drugs and biologicals would be 
equivalent to paying for those drugs and biologicals, on average, at 
ASP+3 percent. Additionally, using mean unit cost to set the payment 
rates for the drugs and biologicals that would be separately payable in 
CY 2006 would be equivalent to basing their payment rates, on average, 
at ASP+8 percent.
    In determining the payment rates for drugs and biologicals in CY 
2006, we are not proposing to use the GAO mean purchase prices for the 
55 drugs and biologicals because the GAO data reflect hospital 
acquisition costs from a less recent period of time. The survey was 
conducted from July 1, 2003 to June 30, 2004; thus, the purchase prices 
are generally reflective of the time that is the midpoint of this 
period, which is January 1, 2004. The hospital purchase price data also 
does not fully account for rebates from manufacturers or payments from 
group purchasing organizations made to hospitals. We also note that it 
would be difficult to update the GAO mean purchase prices during CY 
2006 and in future years.
    We are also not proposing, in general, to use mean costs from CY 
2004 hospital claims data to set payment rates for drugs and 
biologicals in CY 2006. In previous OPPS rules, we stated that pharmacy 
overhead costs are captured in the pharmacy revenue cost centers and 
reflected in the median cost of drug administration APCs, and the 
payment rate we established for a drug, biological, or 
radiopharmaceutical APC was intended to pay only for the cost of 
acquiring the item (66 FR 59896 and 67 FR 66769). However, findings 
from a MedPAC survey of hospital charging practices indicated that 
hospitals set charges for drugs, biologicals, and radiopharmaceuticals 
high enough to reflect their handling costs as well as their 
acquisition costs; therefore, the mean costs calculated using charges 
from hospital claims data converted to costs are representative of 
hospital acquisition costs for these products, as well as their 
overhead costs. For CY 2006, the statute specifies that payments for 
specified covered outpatient drugs are required to be equal to the 
``average'' acquisition cost for the drug. Payments based on mean costs 
would represent the products' acquisition costs plus overhead costs, 
instead of acquisition costs only. Therefore, we believe that it is 
appropriate for us to use a source of cost information other than the 
CY 2004 hospital claims data to set the payment rates for most drugs 
and biologicals in CY 2006.
    We are proposing to pay ASP+6 percent for separately payable drugs 
and biologicals in CY 2006. Given the data as described above, we 
believe this is our best estimate of average acquisition costs for CY 
2006. We note that the comparison between the GAO purchase price data 
and the ASP data indicated that the GAO data on average were equivalent 
to ASP+3 percent. However, as noted earlier, this comparison is 
problematic for two reasons. First, there are differences in the time 
periods for two sources of data. The GAO data are from the 12 months 
ending June 2004 and the ASP data are from the fourth quarter of 2004. 
It could be argued that prices increased in the intervening time 
period. However, we do not have a source of reliable information on 
specific price changes for this time period for the drugs studied by 
the GAO. In the future, we will have better information on price trends 
for Medicare Part B drugs as more quarters of pricing information are 
reported under the ASP system.
    We also note the comparison between the GAO data and the ASP data 
is problematic as the ASP data include rebates and other price 
concessions and the GAO data do not. Inclusion of these rebates and 
price concession in the GAO data would decrease the GAO prices relative 
to the ASP prices, suggesting that ASP+6 percent may be an overestimate 
of hospitals' average acquisition costs. Unfornately, we do not have a 
source of information on the magnitude of the rebates and price 
concessions for the specific drugs in the GAO data at this time.
    At the present time, therefore, it is difficult to adjust the GAO 
prices for inflation, rebates, and price concessions to make the 
comparison with ASP more precise. We will continue to examine new data 
to improve our future estimates of acquisition costs. In future years, 
our proposed pricing will be modified as appropriate to reflect the 
most recent data and analyses available. We also note that, in addition 
to the importance of making accurate estimates of acquisition costs for 
drug pricing, there are important implications for prices of other 
services due to the required budget neutrality of the OPPS. For 
example, drugs and biological prices set at ASP+3 percent instead of 
ASP+6 percent would have made available approximately an additional $60 
million for other items and services under the OPPS.
    We note that ASP data are unavailable for some drugs and 
biologicals. For the few drugs and biologicals, other than 
radiopharmaceuticals as discussed later, where ASP data are 
unavailable, we are proposing to use the mean costs from the CY 2004 
hospital claims data to determine their packaging status for 
ratesetting. Until we receive ASP data for these items, payment will be 
based on their mean cost.
    Our proposal uses payment rates based on ASP data from the fourth 
quarter of 2004 because these are the most recent numbers available to 
us during the development of this proposed rule. To be consistent with 
the ASP-based payments that would be made when these drugs and 
biologicals are furnished in physician offices, we plan to make any 
appropriate adjustments to the amounts shown in Addenda A and B to this 
proposed rule for these items based on more recent ASP data from the 
second quarter of 2005, which will be the basis for setting payment 
rates for drugs and biologicals in the physician office setting 
effective October 1, 2005, prior to our publication of the CY 2006 OPPS 
final rule and also on a quarterly basis on our Web site during CY 
2006. We note that we would determine the packaging status of each drug 
or biological only once during the year during the update process; 
however, for the separately payable drugs and biologicals, we would 
update their ASP-based payment rates on a quarterly basis.

[[Page 42727]]

    We intend for the quarterly updates of the ASP-based payment rates 
for separately payable drugs and biologicals to function as future 
surveys of hospital acquisition cost data, as section 
1833(t)(14)(D)(ii) of the Act instructs us to conduct periodic 
subsequent surveys to determine hospital acquisition cost for each 
specified covered outpatient drug.
    We are specifically requesting comments on our proposal to pay for 
drugs and biologicals (including contrast agents) under the OPPS using 
the ASP-based methodology that is also used to set the payment rates 
for drugs and biologicals furnished in physician offices and the 
adequacy of the payment rates to account for acquisition costs of the 
drugs and biologicals.
    In CY 2005, we applied an equitable adjustment to determine the 
payment rate for darbepoetin alfa (Q0137) pursuant to section 
1833(t)(2)(E) of the Act. However, for CY 2006, we are proposing to 
establish the payment rate for this biological using the ASP 
methodology. The ASP data represents market prices for this biological; 
therefore, we believe it is appropriate to use the ASP methodology to 
establish payment rates for darbepoetin alfa because this method will 
permit market forces to determine the appropriate payment for this 
biological. We are seeking comments on the proposed payment policy for 
this biological.
    Effective April 1, 2005, several HCPCS codes were created to 
describe various concentrations of low osmolar contrast material 
(LOCM). These new codes are Q9945 through Q9951. However, in 
Transmittal 514 (April 2005 Update of the OPPS), we instructed 
hospitals to continue reporting LOCM in CY 2005 using the existing 
HCPCS codes A4644, A4645, and A4646 and made Q9945 through Q9951 not 
payable under the OPPS. For CY 2006, we are proposing to activate the 
new Q-codes for hospitals and discontinue the use of HCPCS codes A4644 
through A4646 for billing LOCM products. We have CY 2004 hospital 
claims data for HCPCS codes A4644 through A4646, which show that the 
mean costs per day for these products are greater than $50. Because we 
do not have CY 2004 hospital claims data for HCPCS codes Q9945 through 
Q9951, we crosswalked the cost data for the HCPCS A-codes to the new Q-
codes. There is no predecessor code which crosswalks to HCPCS code 
Q9951 for LOCM with a concentration of 400 or greater mg/ml of iodine. 
Therefore, our general payment policy of paying separately for new 
codes while hospital data are being collected applies to HCPCS code 
Q9951. As our historical hospital mean per day costs for the three A 
codes exceed the packaging threshold and our payment policy for new 
codes without predecessors applies to one of the new codes, we are 
proposing to pay for the HCPCS codes Q9945 through Q9951 separately in 
CY 2006 at payment rates calculated using the ASP methodology. We note 
that because the new Q-codes describing LOCM are more descriptively 
discriminating and have different units than the previous A-codes for 
LOCM as well as widely varying ASPs, we expect that the packaging 
status of these Q-codes may change in future years when we have 
specific OPPS claims data for these new codes. We are seeking comments 
specifically on our proposed policy to pay separately for LOCM 
described by HCPCS codes Q9945 through Q9951 in CY 2006.
(4) CY 2006 Proposed Payment Policy for Radiopharmaceutical Agents
    We do not have ASP data for radiopharmaceuticals. Therefore, for CY 
2006, we are proposing to calculate per day costs of 
radiopharmaceuticals using mean unit cost from the CY 2004 hospital 
claims data to determine the items' packaging status similar to the 
drugs and biologicals with no ASP data. In a separate report, the GAO 
provided CMS with hospital purchase price information for nine 
radiopharmaceutical agents. As part of the GAO survey described 
earlier, the GAO surveyed 1,400 acute-care, Medicare-certified 
hospitals requesting hospitals to provide purchase prices for 
radiopharmaceuticals from July 1, 2003 to June 30, 2004. The 
radiopharmaceutical part of the survey yielded a response rate of 61 
percent, where 808 hospitals provided usable information. The GAO 
reported the average and median purchase prices for nine 
radiopharmaceuticals for the period July 1, 2003 to June 30, 2004. 
These items represented 9 percent of the Medicare spending for 
specified covered outpatient drugs during the first 9 months of 2004. 
The report noted that the purchase price information accounted for 
volume and other discounts provided at the time of purchase, but 
excluded subsequent rebates from manufacturers and payments from group 
purchasing organizations.
    When we examined differences between the CY 2005 payment rates for 
these nine radiopharmaceutical agents and their GAO mean purchase 
prices, we saw that the GAO purchase prices were substantially lower 
for several of these agents. We also saw similar patterns when we 
compared the CY 2005 payment rates for radiopharmaceutical agents with 
their CY 2004 median and mean costs from hospital claims data. Our 
intent is to maintain consistency, whenever possible between the 
payment rates for these agents from CY 2005 to CY 2006, because such 
rapid reductions could adversely affect beneficiary access to services 
utilizing radiopharmaceuticals.
    As we do not have ASPs for radiopharmaceuticals that best represent 
market prices, we are proposing as a temporary 1-year policy for CY 
2006 to pay for radiopharmaceutical agents that are separately payable 
in CY 2006 based on the hospital's charge for each radiopharmaceutical 
agent adjusted to cost. As MedPAC has indicated that hospitals 
currently include the charge for pharmacy overhead costs in their 
charge for the radiopharmaceutical, if we pay for these items using 
charges converted to cost, we believe that payment at cost would be the 
best available proxy for the average acquisition cost of the 
radiopharmaceutical along with its handling cost until we receive ASP 
information and overhead information on these agents. We expect that 
hospitals' different purchasing and preparation and handling practices 
for radiopharmaceuticals would be reflected in their charges, which 
would be converted to costs using hospital-specific cost-to-charge 
ratios. To better identify the separately payable radiopharmaceutical 
agents to which this policy would apply, we propose to assign them to 
status indicator ``H'' in Addendum B of this rule. Should ASP data be 
unavailable for radiopharmaceuticals for CY 2007, it is not apparent to 
us what methodology we could use to establish payment rates for these 
items in CY 2007 other than the hospital CY 2006 claims-based 
methodology. We are seeking comments specifically on the proposed 
payment policy for separately payable radiopharmaceutical agents in CY 
2006.
    Section 303(h) of Pub. L. 108-173 exempted radiopharmaceuticals 
from ASP pricing in the physician office setting where the fewer 
numbers (relative to the hospital outpatient setting) of 
radiopharmaceuticals are priced locally by Medicare contractors. 
However, radiopharmaceuticals are subject to ASP reporting. We 
currently do not require reporting for radiopharmaceuticals because we 
do not pay for any of the radiopharmaceuticals using the ASP 
methodology. However, for CY 2006, we are proposing to begin collecting 
ASP data on all radiopharmaceutical agents for purposes of ASP-based 
payment of

[[Page 42728]]

radiopharmaceuticals beginning in CY 2007.
    We recognize that there are significant complex issues surrounding 
the reporting of ASPs for radiopharmaceutical agents. Most 
radiopharmaceuticals must be compounded from a ``cold kit'' containing 
necessary nonradioactive materials for the final product to which a 
radioisotope is added. There are critical timing issues, given the 
short half-lives of many radioisotopes used for diagnostic or 
therapeutic purposes. Significant variations in practices exist with 
respect to what entity purchases the constituents and who then 
compounds the radiopharmaceutical to develop a final product for 
administration to a patient. For example, manufacturers may sell the 
components of a radiopharmaceutical to independent radiopharmacies. 
These radiopharmacies may then sell unit or multi-doses to many 
hospitals; however, some hospitals also may purchase the components of 
the radiopharmaceutical and prepare the radiopharmaceutical themselves. 
In some cases, hospitals may generate the radioisotope on-site, rather 
than purchasing it. The costs associated with acquiring the 
radiopharmaceutical in these instances may significantly vary. Also, 
there may only be manufacturer pricing for the components; however, the 
price set by the manufacturer for one component of a 
radiopharmaceutical may not directly translate into the acquisition 
cost of the ''complete'' radiopharmaceutical, which may result from the 
combination of several components. In general, for drugs other than 
radiopharmaceuticals, the products sold by manufacturers with National 
Drug Codes (NDCs) correspond directly with the HCPCS codes for the 
products administered to patients so ASPs may be directly calculated 
for the HCPCS codes. In the case of radiopharmaceuticals this 1:1 
relationship may not hold, potentially making the calculation of ASPs 
for radiopharmaceuticals more complex. In addition, some hospitals may 
generate their own radioisotopes, which they then use for 
radiopharmaceutical compounding, and they may sell these complete 
products to other sites. The costs associated with this practice could 
be difficult to capture through ASP reporting. We seek very specific 
comments on these and all other relevant issues surrounding 
implementation of ASP reporting for radiopharmaceuticals. We discuss in 
section V.B.3.a.(5) of this preamble under the MedPAC report on APC 
payment rate adjustments, our CY 2006 proposed payment policies for 
overhead costs of drugs, biologicals, and radiopharmaceuticals.
    In section V.D. of the preamble we discuss the methodology that we 
are proposing to use to determine the CY 2006 payment rates for new 
drugs, biologicals, and radiopharmaceuticals.
    While payments for drugs, biologicals and radiopharmaceuticals are 
taken into account when calculating budget neutrality, we note that we 
are proposing to pay for drugs, biologicals and radiopharmaceuticals 
without scaling these payment amounts. We believe that these payment 
amounts are the best proxies we have for the average acquisition costs 
of drugs, biologicals, and radiopharmaceuticals for CY 2006; therefore, 
Congress would not have intended for us to scale these payment rates. 
In section V.B.3.a.(5) of this preamble, we also discuss that we 
propose to add 2 percent of the ASP to the payment rates for drugs and 
biologicals with rates based on the ASP methodology to provide payment 
to hospitals for pharmacy overhead costs associated with furnishing 
these products. We are proposing to scale these additional payment 
amounts for pharmacy overhead costs. We are seeking comments on whether 
it is appropriate to exempt payment rates for drugs, biologicals, and 
radiopharmaceuticals from scaling and scale the additional payment 
amount for pharmacy overhead costs.
    We note that further discussion of the budget neutrality 
implications of the various drug payment proposals that we considered 
is included in section XIV.C. of this preamble.
(5) MedPAC Report on APC Payment Rate Adjustment of Specified Covered 
Outpatient Drugs
    Section 1833(t)(14)(E) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, requires MedPAC to submit a report to the Secretary, 
not later than July 1, 2005, on adjusting the APC rates for specified 
covered outpatient drugs to take into account overhead and related 
expenses, such as pharmacy services and handling costs. This provision 
also requires that the MedPAC report include the following: A 
description and analysis of the data available for adjusting such 
overhead expenses; recommendation as to whether a payment adjustment 
should be made; and the methodology for adjusting payment, if an 
adjustment is recommended. Section 1833(t)(14)(E)(ii) of the Act, as 
added by section 621(a)(1) of Pub. L. 108-173, authorizes the Secretary 
to adjust the APC weights for specified covered outpatient drugs to 
reflect the MedPAC recommendation.
    The statute mandates MedPAC to report on whether drug APC payments 
under the OPPS should be adjusted to account for pharmacy overhead and 
nuclear medicine handling costs associated with providing specified 
covered outpatient drugs. In creating its framework for analysis, 
MedPAC interviewed stakeholders, analyzed cost report data, conducted 
four individual hospital case studies, and received technical advice on 
grouping items with similar handling costs from a team of experts in 
hospital pharmacy, hospital finance, cost accounting, and nuclear 
medicine.
    MedPAC concluded that the handling costs for drugs, biologicals, 
and radiopharmaceuticals delivered in the hospital outpatient 
department are not insignificant, as medications typically administered 
in outpatient departments generally require greater pharmacy 
preparation time than do those provided to inpatients. MedPAC found 
that little information is currently available about the magnitude of 
these costs. According to the MedPAC analysis, hospitals historically 
set charges for drugs, biologicals, and radiopharmaceuticals at levels 
that reflected their respective handling costs, and payments covered 
both drug acquisition and handling. Moreover, hospitals vary 
considerably in their likelihood of providing services which utilize 
drugs, biologicals, or radiopharmaceuticals with different handling 
costs.
    MedPAC developed seven drug categories for pharmacy and nuclear 
medicine handling costs, according to the level of resources used to 
prepare the products (Table 23). Characteristics associated with the 
level of handling resources required included radioactivity, toxicity, 
mode of administration, and the need for special handling. Groupings 
ranged from dispensing an oral medication on the low end of relative 
cost to providing radiopharmaceuticals on the high end. MedPAC 
collected cost data from four hospitals that were then used to develop 
relative median costs for all categories but radiopharmaceuticals 
(Category 7+). The case study facilities were not able to provide 
sufficient cost information regarding the handling of outpatient 
radiopharmaceuticals to develop a cost relative for Category 7+. The 
MedPAC study classified about 230 different drugs, biologicals, and 
radiopharmaceuticals into the seven categories based on input from 
their expert panel and each case study facility.

[[Page 42729]]



 Table 23.--MedPAC Recommended Drug Categories and Median Cost Relatives
------------------------------------------------------------------------
                                                            Median cost
       Drug category                 Description             relative
------------------------------------------------------------------------
Category 1.................  Orals (oral tablets,                   0.36
                              capsules, solutions).
Category 2.................  Injection/Sterile                      1.00
                              Preparation (draw up a
                              drug for administration).
Category 3.................  Single IV Solution/Sterile             1.28
                              Preparation (adding a drug
                              or drugs to a sterile IV
                              solution) or Controlled
                              Substances.
Category 4.................  Compounded/Reconstituted IV            1.61
                              Preparations (requiring
                              calculations performed
                              correctly and then
                              compounded correctly).
Category 5.................  Specialty IV or Agents                 2.70
                              requiring special handling
                              in order to preserve their
                              therapeutic value or
                              Cytotoxic Agents, oral
                              (chemotherapeutic,
                              teratogenic, or toxic)
                              requiring PPE.
Category 6.................  Cytotoxic Agents                       5.33
                              (chemotherapeutic,
                              teratogenic, or toxic) in
                              all formulations except
                              oral requiring personal
                              protective equipment (PPE).
Category 7+................  Radiopharmaceuticals: Basic          (\1\)
                              and Complex Diagnostic
                              Agents, PET Agents,
                              Therapeutic Agents, and
                              Radioimmunoconjugates.
------------------------------------------------------------------------
\1\ Not available.

    In its report, MedPAC recommended the following:
    (1) Establish separate, budget neutral payments to cover the costs 
hospitals incur for handling separately payable drugs, biologicals, and 
radiopharmaceuticals; and
    (2) Define a set of handling fee APCs that group drugs, 
biologicals, and radiopharmaceuticals based on attributes of the 
products that affect handling costs; instruct hospitals to submit 
charges for these APCs; and base payment rates for the handling fee 
APCs on submitted charges reduced to costs.
    MedPAC found some differences in the categorizations of drug and 
radiopharmaceutical products by different experts and across the case 
study sites. In the majority of cases where groupings disagreed, 
hospitals used different forms of the products which were coded with 
the same HCPCS code. For example, a drug may be purchased as a 
prepackaged liquid or as a powder requiring reconstitution. Such a drug 
would vary in the handling resources required for its preparation and 
would fall into a different drug category depending on its form. In 
addition, the handling cost groupings may vary depending on the 
intended method of drug delivery, such as via intravenous push or 
intravenous infusion. For a number of commonly used drugs, MedPAC 
provided two categories in their final consensus categorizations, with 
the categories 2 and 3 reported as the most frequent combination. For 
example, MedPAC placed HCPCS codes J1260 (Injection, dolasetron 
mesylate, 10 mg) and J2020 (Injection, linezolid, 200 mg) in consensus 
categories 2 and 3, acknowledging that the appropriate categorization 
could vary depending on the clinical preparation and use of the drug. 
We note that we have no information regarding hospitals' frequencies of 
use of various forms of drugs provided in the outpatient department 
under the OPPS, as the case studies only included four facilities and 
the technical advisory committee was similarly small. Thus, in many 
cases it is impossible to exclusively and appropriately assign a drug 
to a certain overhead category that would apply to all hospital 
outpatient uses of the drug because of the different handling resources 
required to prepare different forms of the drugs.
    There are over 100 separately payable drugs, biologicals, and 
radiopharmaceuticals that are separately payable under the OPPS but for 
which MedPAC provided no consensus categorizations in its seven drug 
groups. We independently examined these products and considered the 
handling cost categories that could be appropriately assigned to each 
product as described by an individual HCPCS code. As discussed above, 
many of the drugs had several forms which would place them in different 
handling cost groupings depending on the specific form of the drug 
prepared by the hospital pharmacy for a patient's treatment. 
Additionally, we believe that hospitals may have difficulty 
discriminating among the seven categories for some drugs, because the 
applicability of a given category description to a specific clinical 
situation may be ambiguous. Indeed, in the MedPAC study, initially only 
about 80 percent of the case study pharmacists agreed with the expert 
panel category assignments; however, concurrence increased that 
percentage to almost 90 percent after discussion and review. 
Nevertheless, there remained a number of drugs for which differences in 
categorization by the case study facilities and the expert panel 
persisted.
    In light of our concerns over our ability to appropriately assign 
drugs to the seven MedPAC drug categories so that the categories 
accurately describe the drugs' attributes in all of the OPPS hospitals 
and the MedPAC recommendations, for CY 2006 we are proposing to 
establish three distinct HCPCS C-codes and three corresponding APCs for 
drug handling categories to differentiate overhead costs for drugs and 
biologicals, by combining several of the categories identified in the 
MedPAC report. We collapsed the MedPAC categories 2, 3, and 4 into a 
single category described by HCPCS code CXXXX, and MedPAC categories 5 
and 6 into another category described by HCPCS code CYYYY, while 
maintaining MedPAC category 1 as described by HCPCS code CWWWW. Our 
rationale for not creating an overhead payment category for 
radiopharmaceuticals is discussed below. We believe that merging 
categories in this way generally resolves the categorization dilemmas 
resulting from the most common scenarios where drugs may fall into more 
than one grouping and minimizes the administrative burden on hospitals 
to determine which category applies to the handling of a drug in a 
specific clinical situation. In addition, these broader handling cost 
groupings minimize any undesirable payment policy incentives to utilize 
particular forms of drugs or specific preparation methods. We have only 
collapsed those categories whose MedPAC relative weights differ by less 
than a factor of two, consistent with the principle outlined in section 
1833(t)(2) of the Act that provides that items and services within an 
APC group cannot be considered comparable with respect to the use of 
resources if the median of the highest cost item or service within an 
APC group is more than 2 times greater than the median of the lowest 
cost item or service within that same group.
    As noted previously, we believe that pharmacy overhead costs are 
captured in the pharmacy revenue cost centers and reflected in the 
median cost of drug

[[Page 42730]]

administration APCs, and the payment rate we established for a drug, 
biological, or radiopharmaceutical APC was intended to pay only for the 
cost of acquiring the item (66 FR 59896 and 67 FR 66769). As a MedPAC 
survey of hospital charging practices indicated that hospitals' charges 
for drugs, biologicals, and radiopharmaceuticals reflect their handling 
costs as well as their acquisition costs, we believe pharmacy overhead 
costs would be incorporated into the OPPS payment rates for drugs, 
biologicals, and radiopharmaceuticals if the rates are based on 
hospital claims data. However, in light of our proposal to establish 
three distinct C-codes for drug handling categories, we are proposing 
to instruct hospitals to charge the appropriate pharmacy overhead C-
code for overhead costs associated with each administration of each 
separately payable drug and biological based on the code description 
which best reflects the service the hospital provides to prepare the 
product for administration to a patient. We would then collect hospital 
charges for these C-codes for 2 years, and consider basing payment for 
the corresponding drug handling APCs on the charges reduced to costs in 
CY 2008, similar to the payment methodology for other procedural APCs. 
Median hospital costs for the drug handling APCs should reflect the CY 
2006 practice patterns across all OPPS hospitals of handling drugs 
whose preparation is described by each of the C-codes, reflecting the 
differential utilization of various forms of drugs and alternative 
methods of preparation and delivery through hospitals' billing and 
charges for the C-codes. Table 24 contains the drug handling 
categories, C-codes, and APCs we are proposing for CY 2006.

                     Table 24.--Proposed CY 2006 Drug Handling Categories, C-Codes, and APCs
----------------------------------------------------------------------------------------------------------------
  Drug handling category              C code                 Drug candling APC               Description
----------------------------------------------------------------------------------------------------------------
Category 1................  CWWWW.....................  WWWW......................   Orals (oral
                                                                                     tablets, capsules,
                                                                                     solutions).
Category 2................  CXXXX.....................  XXXX......................   Injection/Sterile
                                                                                     Preparation (draw up a drug
                                                                                     for administration).
                                                                                     Single IV Solution/
                                                                                     Sterile Preparation (adding
                                                                                     a drug or drugs to a
                                                                                     sterile IV solution) or
                                                                                     Controlled Substances.
                                                                                     Compounded/
                                                                                     Reconstituted IV
                                                                                     Preparations (requiring
                                                                                     calculations performed
                                                                                     correctly and then
                                                                                     compounded correctly).
Category 3................  CYYYY.....................  YYYY......................   Specialty IV or
                                                                                     Agents requiring special
                                                                                     handling in order to
                                                                                     preserve their therapeutic
                                                                                     value or Cytotoxic Agents,
                                                                                     oral (chemotherapeutic,
                                                                                     teratogenic, or toxic)
                                                                                     requiring PPE.
                                                                                     Cytotoxic Agents
                                                                                     (chemotherapeutic,
                                                                                     teratogenic, or toxic) in
                                                                                     all formulations except
                                                                                     oral requiring personal
                                                                                     protective equipment (PPE).
----------------------------------------------------------------------------------------------------------------

    We believe that these three categories are sufficiently distinct 
and reflective of the resources necessary for drug handling to permit 
appropriate hospital billing and to capture the varying overhead costs 
of the drugs and biologicals separately payable under the OPPS. We are 
not proposing to adopt the median cost relatives reported for MedPAC's 
six categories (excluding radiopharmaceuticals). It is very difficult 
to accurately crosswalk the cost relatives for the six categories to 
the three categories we are proposing. In addition, we are not 
confident that the cost relatives that were based on cost data from 
four hospitals appropriately reflect the median relative resource costs 
of all hospitals that would bill these drug handling services under the 
OPPS. Instead, we believe it is most appropriate to collect hospital 
charges for the drug handling services based on attributes of the 
products that affect the hospital resources required for their 
handling, and consider making future payments under the OPPS using the 
proposed C-codes based on the medians of charges converted to costs for 
the drug handling APC associated with each administration of a 
separately payable drug or biological.
    For CY 2006, pursuant to section 1833(t)(14)(E)(ii) of the Act, we 
propose an adjustment to cover the costs hospitals incur for handling 
separately payable drugs and biologicals. As we do not currently have 
separate hospital charge data on pharmacy overhead, we are proposing 
for CY 2006 to pay for drug and biological overhead costs based on 2 
percent of the ASP. As described earlier, we estimated aggregate 
expenditure for all separately payable OPPS drugs and biologicals 
(excluding radiopharmaceuticals) using mean costs from the claims data 
and then determined the equivalent average ASP-based rates. Our 
calculations indicated that using mean unit costs to set the payment 
rates for all separately payable drugs and biologicals would be 
equivalent to basing their payment rates on the ASP+8 percent. As noted 
previously, because pharmacy overhead costs are already built into the 
charges for drugs, biologicals, and radiopharmaceuticals as indicated 
by the MedPAC study described above, we believe that payment for drugs 
and biologicals and overhead at a combined ASP+8 percent would serve as 
a proxy for representing both the acquisition cost and overhead cost of 
each of these products. Moreover, as we are proposing to pay for all 
separately payable drugs and biologicals using the ASP methodology, 
where payment rates for most of these items are set at the ASP+6 
percent, we believe that an additional 2 percent of the ASP would 
provide adequate additional payment for the overhead cost of these 
products and be consistent with historical hospital costs for drug 
acquisition and handling. Even though we are not proposing to scale the 
payment rates for drugs and biologicals based on the ASP methodology, 
we are proposing to scale the additional payment amount of 2 percent of 
the ASP for pharmacy overhead costs. Therefore, for CY 2006, we are 
proposing to pay an additional 2 percent of the ASP scaled for budget 
neutrality for overhead costs associated with separately payable drugs 
and biologicals, along with paying ASP+6 percent for the acquisition 
costs of the drugs and biologicals. The payment rate for a separately 
payable drug or biological shown in Addenda A and B to this proposed 
rule represents the payment rate for the drug or biological in addition 
to payment for its overhead costs. We are specifically seeking comments 
on this proposed policy for paying for pharmacy overhead costs in CY 
2006 and on the proposed policy regarding hospital billing of drug 
handling charges associated with each administration of each separately 
payable drug or biological using the proposed C-codes.
    As discussed earlier, we are proposing to pay for separately 
payable radiopharmaceutical agents based on their charges in the claims 
submitted by hospitals converted to costs. MedPAC found that the 
handling resource costs

[[Page 42731]]

associated with radiopharmaceuticals were especially difficult to study 
because of the varying resource requirements for handling them in a 
variety of hospital outpatient settings for different clinical uses. 
These various methods of preparation of radiopharmaceuticals, and the 
individual radiopharmaceuticals themselves, differ significantly in the 
costs of their handling, with substantial variation in such factors as 
site of preparation, personnel time, shielding, transportation, 
equipment, waste disposal, and regulatory compliance requirements. 
However, as MedPAC also found that handling costs for drugs, 
biologicals, and radiopharmaceuticals were built into hospitals' 
charges for the products themselves, we believe that the charges from 
hospital claims converted to costs are representative of hospital 
acquisition costs for these agents, as well as their overhead costs. 
These costs would appropriately reflect each hospital's potentially 
diverse patterns of acquisition or production of radiopharmaceuticals 
for use in the outpatient hospital setting and their related handling 
costs that vary across radiopharmaceutical products and the 
circumstances of their production and use. Therefore, we are not 
proposing to create separate handling categories for 
radiopharmaceutical agents for CY 2006.
    However, because we are proposing to collect ASP information for 
radiopharmaceuticals in CY 2006, we are seeking specific comments on 
appropriate categories for potentially capturing radiopharmaceutical 
handling costs. We believe that these handling costs may vary depending 
on many factors. The handling cost categories should exclude any 
resources covered by specific diagnostic procedures or administration 
codes for patient services that utilize the radiopharmaceuticals. 
However, the handling cost categories should include all aspects of 
radiopharmaceutical handling and preparation, including transportation, 
storage, compounding, required shielding, inventory management, 
revision of dosages based on patient conditions, documentation, 
disposal, and regulatory compliance. The MedPAC study contractor 
suggested a variety of discriminating factors which may be related to 
the magnitude of radiopharmaceutical handling costs, including the 
complexity of the calculations and manipulations involved with 
compounding, the intended use of the product for diagnostic or 
therapeutic purposes, the item's status as a radioimmunoconjugate or 
non-radioimmunoconjugate, short-lived agents produced in-house, and 
preparation of the radiopharmaceutical in-house versus production in a 
commercial radiopharmacy. We are seeking comments on the construction 
of radiopharmaceutical handling cost categories that would meaningfully 
reflect differences in the levels of necessary hospital resources and 
that could easily be understood and applied by hospitals characterizing 
their preparation of radiopharmaceuticals.
b. Proposed CY 2006 Payment for Nonpass-Through Drugs, Biologicals, and 
Radiopharmaceuticals With HCPCS Codes, But Without OPPS Hospital Claims 
Data
    Pub. L. 108-173 does not address the OPPS payment in CY 2005 and 
after for new drugs, biologicals, and radiopharmaceuticals that have 
assigned HCPCS codes, but that do not have a reference AWP or approval 
for payment as pass-through drugs or biologicals. Because there is no 
statutory provision that dictated payment for such drugs and 
biologicals in CY 2005, and because we had no hospital claims data to 
use in establishing a payment rate for them, we investigated several 
payment options for CY 2005 and discussed them in detail in the CY 2005 
OPPS final rule with comment period (69 FR 65797 through 65799).
    For CY 2006, we are proposing to use the same methodology that we 
used in CY 2005. That is, we are proposing to pay for these new drugs 
and biologicals with HCPCS codes but which do not have pass-through 
status at a rate that is equivalent to the payment they would receive 
in the physician office setting, which would be established in 
accordance with the ASP methodology described in the CY 2005 Medicare 
Physician Fee Schedule final rule (69 FR 66299). As discussed in the 
OPPS CY 2005 final rule (69 FR 65797), new drugs, biologicals, and 
radiopharmaceuticals may be expensive and we are concerned that 
packaging these new items may jeopardize beneficiary access to them. In 
addition, we do not want to delay separate payment for these items 
solely because a pass-through application was not submitted. We note 
that this payment methodology is the same as the methodology that would 
be used to calculate the OPPS payment amount that pass-through drugs 
and biologicals would be paid in CY 2006 in accordance with section 
1842(o) of the Act, as amended by section 303(b) of Pub. L. 108-173, 
and section 1847A of the Act. Thus, we are proposing to continue to 
treat new drugs, biologicals, and radiopharmaceuticals with established 
HCPCS codes the same, irrespective of whether pass-through status has 
been determined. We are also proposing to assign status indicator ``K'' 
to HCPCS codes for new drugs and biologicals for which we have not 
received a pass-through application.
    There are several drugs, biologicals, and radiopharmaceuticals that 
were payable during CY 2004 or their HCPCS codes were created effective 
January 1, 2005 for which we do not have any CY 2004 hospital claims 
data. In order to determine the packaging status of these items for CY 
2006, we calculated an estimate of per day cost of each of these items 
by multiplying the payment rate for each product as determined using 
the ASP methodology by an estimated average number of units of each 
product that would be furnished to a patient during one administration. 
We are proposing to package items for which we estimated the per 
administration cost to be less than $50 and pay separately for items 
with estimated per administration cost greater than $50. Payment for 
the separately payable items would be based on rates determined using 
the ASP methodology established in the physician office setting. There 
are two codes 90393 (Vaccina ig, im) and Q9953 (Inj Fe-based MR 
contrast, ml) for which we were not able to determine payment rates 
based on the ASP methodology. Because we are unable to estimate the per 
administration cost of these items, we are proposing to package them in 
CY 2006. We are specifically seeking comments on our proposed policy 
for determining per administration cost of these drugs, biologicals, 
and radiopharmaceuticals that are payable under the OPPS, but do not 
have any CY 2004 claims data.

[[Page 42732]]



 Table 25.--Proposed CY ASP Payment Rate for Drugs, Biologicals, and Radiopharmaceuticals Without CY 2004 Claims
                                                      Data
----------------------------------------------------------------------------------------------------------------
                                                                                  Est. average
                                                                    ASP-based       number of     Proposed 2006
         HCPCS code              Description           APC        payment rate      units per         status
                                                                                 administration     indicator
----------------------------------------------------------------------------------------------------------------
C1093......................  TC99M fanolesomab.            1093       $1,197.00           1      H
C9206......................  Integra, per cm2..            9206            9.06          19      K
J0135......................  Adalimumab                    1083          294.63           2      K
                              injection.
J0288......................  Ampho b                       0735           12.00          35      K
                              cholesteryl
                              sulfate.
J0395......................  Arbutamine HCl                9031          160.00           1      K
                              injection.
J1180......................  Dyphylline                    9166            7.59           8.4    K
                              injection.
J1457......................  Gallium nitrate               1085            1.28         340      K
                              injection.
J3315......................  Triptorelin                   9122          363.24           1      K
                              pamoate.
J7350......................  Injectable human              9055            3.47          33      K
                              tissue.
J9357......................  Valrubicin, 200 mg            9167          369.60           4      K
Q2012......................  Pegademase bovine,            9168          158.05          56      K
                              25 iu.
Q2018......................  Urofollitropin, 75            7037           43.87           2      K
                              iu.
90581......................  Anthrax vaccine,              9169          126.46           1      K
                              sc.
J0200......................  Alatrofloxacin      ..............           14.75           2.5    N
                              mesylate.
J7674......................  Methacholine        ..............            0.40           8.875  N
                              chloride, neb.
J0190......................  Inj biperiden       ..............            3.16           1      N
                              lactate/5 mg.
J3530......................  Nasal vaccine       ..............           15.00           1      N
                              inhalation.
----------------------------------------------------------------------------------------------------------------

C. Proposed Coding and Billing Changes for Specified Covered Outpatient 
Drugs

(If you choose to comment on issues in this section, please include 
the caption ``Drug Coding and Billing'' at the beginning of your 
comment.)
1. Background
    As discussed in the January 6, 2004 interim final rule with comment 
period (69 FR 826), we instructed hospitals to bill for sole source 
drugs using the existing HCPCS codes, which were priced in accordance 
with the provisions of section 1833(t)(14)(A)(i) of the Act, as added 
by Pub. L. 108-173. However, at that time, the existing HCPCS codes did 
not allow us to differentiate payment amounts for innovator multiple 
source and noninnovator multiple source forms of the drug. Therefore, 
effective April 1, 2004, we implemented new HCPCS codes via Program 
Transmittal 112 (Change Request 3144, February 27, 2004) and Program 
Transmittal 132 (Change Request 3154, March 30, 2004) that providers 
were instructed to use to bill for innovator multiple source drugs in 
order to receive appropriate payment in accordance with section 
1833(t)(14)(A)(i)(II) of the Act. We also instructed providers to 
continue to use the existing HCPCS codes to bill for noninnovator 
multiple source drugs to receive payment in accordance with section 
1833(t)(14)(A)(i)(III) of the Act. These coding policies allowed 
hospitals to appropriately code for drugs, biologicals, and 
radiopharmaceuticals based on their classification and to be paid 
accordingly. We continued this coding practice in CY 2005 with payment 
made in accordance with section 1833(t)(14)(A)(ii) of the Act.
2. Proposed Policy for CY 2006
    For CY 2006, we are proposing to base the payment rates for drugs 
and biologicals and their pharmacy overhead costs on the ASP 
methodology that is used to set payment rates for these items in the 
physician office setting. Under this methodology, a single payment rate 
for the drug is calculated by considering the prices for both the 
innovator multiple source (brand) and noninnovator multiple source 
(generic) forms of the drug. Therefore, under the OPPS, we believe that 
there is no longer a need to differentiate between the brand and 
generic forms of a drug. Thus, we are proposing to discontinue use of 
the C-codes that were created to represent the innovator multiple 
source drugs. In CY 2006, hospitals would use the HCPCS codes for 
noninnovator multiple source (generic) drugs to bill for both the brand 
and generic forms of a drug as they did prior to implementation of 
section 1833(t)(14)(A) in Pub. L. 108-173. We are specifically 
requesting comments on this proposed policy.

D. Proposed Payment for New Drugs, Biologicals, and 
Radiopharmaceuticals Before HCPCS Codes Are Assigned

(If you choose to comment on issues in this section, please include 
the caption ``HCPCS Codes'' at the beginning of your comment.)
1. Background
    Historically, hospitals have used a HCPCS code for an unlisted or 
unclassified drug, biological, or radiopharmaceutical or used an 
appropriate revenue code to bill for drugs, biologicals, and 
radiopharmaceuticals furnished in the outpatient department that do not 
have an assigned HCPCS code. The codes for not otherwise classified 
drugs, biologicals, and radiopharmaceuticals are assigned packaged 
status under the OPPS. That is, separate payment is not made for the 
code, but charges for the code would be eligible for an outlier payment 
and, in future OPPS updates, the charges for the code are packaged with 
the separately payable service with which the code is reported for the 
same date of service.
    Drugs and biologicals that are newly approved by the FDA and for 
which a HCPCS code has not yet been assigned by the National HCPCS 
Alpha-Numeric Workgroup could qualify for pass-through payment under 
the OPPS. An application must be submitted to CMS in order for a drug 
or biological to be assigned pass-through status, a temporary C-code 
assigned for billing purposes, and an APC payment amount to be 
determined. Pass-through applications are reviewed on a flow basis, and 
payment for drugs and biologicals approved for pass-through status is 
implemented throughout the year as part of the quarterly updates of the 
OPPS.
2. Proposed Policy for CY 2006
    Section 1833(t)(15) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, provides for payment for new drugs and biologicals 
until HCPCS codes are assigned under the OPPS. Under this provision, we 
are required to make payment for an outpatient drug or

[[Page 42733]]

biological that is furnished as part of the covered OPD services for 
which a HCPCS code has not been assigned in an amount equal to 95 
percent of AWP. This provision applies only to payments made under the 
OPPS on or after January 1, 2004.
    We initially adopted the methodology for determining payment under 
section 1833(t)(15) of the Act on an interim basis on May 28, 2004, via 
Transmittal 188, Change Request 3287, and finalized the methodology for 
CY 2005 in our CY 2005 OPPS final rule with comment period. In that 
final rule with comment period, we also expanded the methodology to 
include payment for new radiopharmaceuticals to which a HCPCS code is 
not assigned (69 FR 65804 through 65807). We instructed hospitals to 
bill for a drug or biological that is newly approved by the FDA by 
reporting the NDC for the product along with a new HCPCS code, C9399 
(Unclassified drug or biological). When HCPCS code C9399 appears on a 
claim, the OCE suspends the claim for manual pricing by the fiscal 
intermediary. The fiscal intermediary prices the claim at 95 percent of 
its AWP using the Red Book or an equivalent recognized compendium, and 
processes the claim for payment. This approach enables hospitals to 
bill and receive payment for a new drug, biological, or 
radiopharmaceutical concurrent with its approval by the FDA. The 
hospital does not have to wait for the next OPPS quarterly release or 
for approval of a product-specific HCPCS code to receive payment for a 
newly approved drug, biological, or radiopharmaceutical. In addition, 
the hospital does not have to resubmit claims for adjustment. Hospitals 
would discontinue billing HCPCS code C9399 and the NDC upon 
implementation of a HCPCS code, status indicator, and appropriate 
payment amount with the next OPPS quarterly update.
    For CY 2006, we are proposing to continue the same methodology for 
paying for new drugs, biologicals, and radiopharmaceuticals without 
HCPCS codes.

E. Proposed Payment for Vaccines

(If you choose to comment on issues in this section, please include 
the caption ``Vaccines'' at the beginning of your comment.)
    Outpatient hospital departments administer large numbers of 
immunizations 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 the 
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 the OPPS rates as a major concern. 
They indicated 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 costs of the flu vaccine. We 
agreed with this concern and decided to pay hospitals for influenza and 
pneumococcal pneumonia vaccines based on a reasonable cost methodology. 
As a result of this change, hospitals, home health agencies (HHAs), and 
hospices, which were paid for these vaccines under the OPPS in CY 2002, 
have been receiving payment at reasonable cost for these vaccines since 
CY 2003.
    Influenza, pneumococcal, and hepatitis B vaccines and their 
administration are specifically covered by Medicare under section 
1861(s)(10) of the Act. We are proposing to continue to pay influenza 
and pneumococcal vaccines at reasonable cost in CY 2006. However, 
hepatitis B vaccines so far have been paid under clinical APCs that 
also include other vaccines. For CY 2006, we are proposing to pay for 
all hepatitis B vaccines at reasonable cost, consistent with the 
payment methodology for influenza and pneumococcal vaccines. Influenza 
and pneumococcal vaccines are exempt from coinsurance and deductible 
payments under sections 1833(a)(3) and 1833(b) of the Act and have been 
assigned to status indicator ``L''. However, hepatitis B vaccines have 
no similar coinsurance or deductible exemption. Therefore, we are 
proposing to assign these items to status indicator ``F''.
    Previously, under the OPPS, separately payable vaccines other than 
influenza and pneumococcal were grouped into clinical APCs 355 and 356 
for payment purposes. Payment rates for these APCs were based on the 
APCs' median costs, calculated from the costs of all of the vaccines 
grouped within the APCs. For CY 2006, we are proposing to pay for each 
separately payable vaccine under its own APC, consistent with our 
policy for separately payable drugs other than vaccines, instead of 
aggregating them into clinical APCs with other vaccines. We believe 
this policy would allow us to more appropriately establish a payment 
rate for each separately payable vaccine based on the ASP methodology. 
We are specifically requesting comments on our proposed vaccine 
policies for CY 2006. Proposed policy changes to coding and payments 
for the administration of these vaccines are discussed in section VIII. 
of this preamble.

F. Proposed Changes in Payment for Single Indication Orphan Drugs

(If you choose to comment on issues in this section, please include 
the caption ``Orphan Drugs'' at the beginning of your comment.)

    Section 1833 (t)(1)((B)(i) of the Act gives the Secretary the 
authority to designate the hospital outpatient services to be covered. 
The Secretary has specified coverage for certain drugs as orphan drugs 
(section 1833(t)(14)(B)(ii)(III) of the Act, as added by section 
621(a)(1) of Pub. L. 108-173). Section 1833 (t)(14)(C) of the Act, as 
added by section 621(a)(1) of Pub. L. 108-173, gives the Secretary the 
authority in CYs 2004 and 2005 to specify the amount of payment for an 
orphan drug that has been designated as such by the Secretary.
    We recognize that orphan drugs that are used solely for an orphan 
condition or conditions are generally expensive and, by definition, are 
rarely used. We believe that if the costs of these drugs were packaged 
into the payment for an associated procedure or visit, the payment for 
the procedure might be insufficient to compensate a hospital for the 
typically high costs of this special type of drug. Therefore, we are 
proposing to continue paying for them separately.
    In the November 1, 2002 final rule (67 FR 66772), we identified 11 
single indication orphan drugs that are used solely for orphan 
conditions by applying the following criteria:
     The drug is designated as an orphan drug by the FDA and 
approved by the FDA for treatment of only one or more orphan 
condition(s).
     The current United States Pharmacopoeia Drug Information 
(USPDI) shows that the drug has neither an approved use nor an off-
label use for other than the orphan condition(s).
    Eleven single indication orphan drugs were identified as having met 
these criteria and payments for these drugs were made outside of the 
OPPS on a reasonable cost basis.
    In the November 7, 2003 final rule with comment period (68 FR 
63452), we discontinued payment for orphan drugs on a reasonable cost 
basis and made separate payments for each single indication orphan drug 
under its own APC. Payments for the orphan drugs were made at 88 
percent of the AWP listed for these drugs in the April 1, 2003 single 
drug pricer, unless we were presented with verifiable information

[[Page 42734]]

that showed that our payment rate did not reflect the price that was 
widely available to the hospital market. For CY 2004, Ceredase 
(alglucerase) and Cerezyme (imiglucerase) were paid at 94 percent of 
the AWP because external data submitted by commenters on the August 12, 
2003 proposed rule caused us to believe that payment at 88 percent of 
the AWP would be insufficient to ensure beneficiaries' access to these 
drugs.
    In the December 31, 2003 correction of the November 7, 2003 final 
rule with comment period (68 FR 75442), we added HCPCS code J9017 
(Arsenic trioxide, 1 mg) to our list of single indication orphan drugs. 
In the November 15, 2004 final rule with comment period (69 FR 65807), 
we retained the same criteria for identifying single indication orphan 
drugs and added two HCPCS codes to our list--C9218 (Injection, 
Azactidine, per 1 mg) and J9010 (Alemtuzumab, 10 mg) (69 FR 65808). As 
of CY 2005, the following are the 14 orphan drugs that we have 
identified as meeting our criteria: C9218 (Injection, Azactidine, per 1 
mg); J0205 (Injection, Alglucerase, per 10 units); J0256 (Injection, 
Alpha 1-proteinase inhibitor, 10 mg); J9300 (Gemtuzumab ozogamicin, 
5mg); J1785 (Injection, Imiglucerase, per unit); J2355 (Injection, 
Oprelvekin, 5 mg); J3240 (Injection, Thyrotropin alpha, 0.9 mg); J7513 
(Daclizumab, parenteral, 25 mg); J9010 (Alemtuzumab, 10 mg); J9015 
(Aldesleukin, per single use vial); J9017 (Arsenic trioxide, 1 mg); 
J9160 (Denileukin diftitox, 300 mcg); J9216 (Interferon, gamma 1-b, 3 
million units); and Q2019 (Injection, Basiliximab, 20 mg).
    In the November 15, 2004 final rule with comment period (69 FR 
65808), we stated that had we not classified these drugs as single 
indication orphan drugs for payment under the OPPS, they would have met 
the definition of single source specified covered outpatient drugs and 
received lower payments, which could have impeded beneficiary access to 
these unique drugs dedicated to the treatment of rare diseases. 
Instead, for CY 2005, under our authority at section 1833(t)(14)(C) of 
the Act, we set payment for all 14 single indication orphan drugs at 
the higher of 88 percent of the AWP or the ASP+6 percent. For CY 2005, 
we also updated on a quarterly basis the payment rates through 
comparison of the most current ASP and AWP information available to us. 
Given that CY 2005 was the first year of mandatory ASP reporting by 
manufacturers, we did not want potential significant fluctuations in 
the ASPs to affect payments to hospitals furnishing these drugs, which 
in turn might cause access problems for beneficiaries. Therefore, in 
the November 15, 2004 final rule, we did not implement the proposed 95 
percent AWP cap on payments for single indication orphan drugs which 
was described in the August 16, 2004 proposed rule (69 FR 50518), as we 
intended to monitor the impact of our payment policy and consider the 
need for a cap in future OPPS updates if appropriate (69 FR 65809).
    As a part of the GAO study on hospital acquisition costs of 
specified covered outpatient drugs, the GAO provided the average 
hospital purchase prices for four orphan drugs: J0256 (Injection, Alpha 
1-proteinase inhibitor, 10 mg), J1785 (Injection, Imiglucerase, per 
unit), J9160 (Denileukin difitox, 300 mcg), and J9010 (Alemtuzumab, 10 
mg).
    For alpha 1-proteinase inhibitor (J0256), the hospitals in the 
study sample represented only about 14 percent of the estimated total 
number of hospitals purchasing the drug. The mean hospital purchase 
price was about 73 percent of the payment rate based on ASP+6 percent 
rate and about 63 percent of the CY 2005 payment rate updated in April 
2005. We believe the GAO acquisition data for alpha 1-proteinase 
inhibitor are likely not representative of hospital acquisition costs 
for the drug because the number of hospitals providing data was so 
small compared to the total number of hospitals expected to utilize the 
drug. Furthermore, we recognize that the GAO data on hospital drug 
acquisition costs do not reflect the current acquisition costs 
experienced by hospitals but instead, rely on past cost data from late 
CY 2003 through early CY 2004. On the other hand, the ASP data are more 
current and thus are likely more reflective of present hospital 
acquisition costs for alpha 1-proteinase inhibitor.
    In contrast to the GAO data for alpha 1-proteinase inhibitor, the 
GAO data for imiglucerase (J1785) reflect hospital purchase prices from 
about 69 percent of the hospitals expected to utilize the drug. For 
this drug, the mean hospital purchase price was about 93 percent of the 
CY 2005 payment rate for imiglucerase updated in April 2005, which was 
based on ASP+6 percent rate. Thus, the ASP-based payment rate also 
would appear to be appropriately reflective of hospital acquisition 
costs for imiglucerase, and to be consistent with the GAO mean purchase 
price.
    For denileukin difitox (J9160) and alemtuzumab (J9010), the GAO 
data for these drugs reflect hospital purchase prices from about 77 
percent and 66 percent of the hospitals expected to acquire these 
drugs, respectively. The mean hospital purchase price for denileukin 
difitox was about 94 percent of the payment rate based on the ASP+6 
percent rate and about 79 percent of the CY 2005 payment rate. As for 
alemtuzumab, the mean hospital purchase price was about 95 percent of 
the payment rate based on the ASP+6 percent rate and about 89 percent 
of the CY 2005 payment rate. For both of these drugs, the ASP-based 
payment rates also appear to be appropriately reflective of their 
hospital acquisition costs, based on confirmation by the GAO average 
purchase price data from over two-thirds of the hospitals expected to 
acquire the drugs.
    During the quarterly updates to payment rates for single indication 
orphan drugs for CY 2005, we observed significant improvement in the 
accuracy and consistency of manufacturers' reporting of the ASPs for 
these orphan drugs. Overall, we found that the ASPs as compared to the 
AWPs were less likely to experience dramatic fluctuations in prices 
from quarter to quarter. We expect that as the ASP system continues to 
mature, manufacturers will further refine their quarterly reporting, 
leading to even greater stability and accuracy in their reporting of 
sales prices. As the ASPs reflect the average sales prices to all 
purchasers, the ASP data also include drug sales to hospitals. Past 
commenters have indicated to us that some orphan drugs are administered 
principally in hospitals, and to the extent that this is true their 
ASPs should predominantly be based upon the sales of drugs used by 
hospitals. For three of the orphan drugs for which the GAO provided 
average purchase prices from a large percentage of hospitals expected 
to acquire the drugs, the GAO data were very consistent with the ASP+6 
percent. For the fourth drug, the GAO mean was significantly lower than 
the ASP+6 percent and the confidence interval around that mean was 
quite tight, although only a small proportion of hospitals expected to 
acquire the drug reported their purchase prices. Thus, we believe that 
proposing to pay for orphan drugs based on an ASP methodology is 
appropriate for the CY 2006 OPPS and should assure patients' continued 
access to these orphan drugs in the hospital outpatient department. 
Therefore, for CY 2006, we are proposing to pay for single indication 
orphan drugs at the ASP+6 percent. We believe that paying for orphan 
drugs using the ASP methodology is consistent with our proposed general 
drug payment policy for other separately payable drugs and

[[Page 42735]]

biologicals in the CY 2006 and reflects our general view that ASP-based 
payment rates serve as the best proxy for the average acquisition cost 
for these items as described in this section V. of the preamble. In 
addition, we are proposing to pay an additional 2 percent of the ASP 
scaled for budget neutrality to cover the handling costs of these 
drugs, also consistent with our proposed general pharmacy overhead 
payment policy for handling costs associated with separately payable 
drugs and biologicals. We believe that the ASPs plus 6 percent for 
orphan drugs will provide appropriate payment for hospital acquisition 
costs for these drugs that are administered by a relatively small 
number of providers, so that patients will continue to have access to 
orphan drugs in the hospital outpatient setting. Hospitals will also 
receive additional payments for costs associated with their storage, 
handling, and preparation of orphan drugs. Payment rates will be 
updated on a quarterly basis to reflect the most current ASPs available 
to us. Appropriate adjustments to the payment amounts shown in Addendum 
A and B would be made if the ASP submissions in a later quarter 
indicate that adjustments to the payment rates are necessary. These 
changes to the Addenda would be announced in our program instructions 
released on a quarterly basis and posted on our Web site at http://www.cms.hhs.gov. We are specifically requesting comments on our 
proposed payment policy for orphan drugs in CY 2006.

VI. Estimate of Transitional Pass-Through Spending in CY 2006 for 
Drugs, Biologicals, and Devices

(If you choose to comment on issues in this section, please include 
the caption ``Estimated Transitional Pass-Through Spending'' at the 
beginning of your comment.)

A. Total Allowed Pass-Through Spending

    Section 1833(t)(6)(E) of the Act limits the total projected amount 
of transitional pass-through payments for drugs, biologicals, 
radiopharmaceuticals, and categories of devices for a given year to an 
``applicable percentage'' of projected total Medicare and beneficiary 
payments under the hospital OPPS. For a year before CY 2004, the 
applicable percentage was 2.5 percent; for CY 2005 and subsequent 
years, we specify the applicable percentage up to 2.0 percent.
    If we estimate before the beginning of the calendar year that the 
total amount of pass-through payments in that year would exceed the 
applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a 
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 payments exceed the applicable percentage, but also to 
determine the appropriate reduction to the conversion factor for the 
projected level of pass-through spending in the following year.
    For devices, making an estimate of pass-through spending in CY 2006 
entails estimating spending for two groups of items. The first group 
consists of those items for which we have claims data for procedures 
that we believe used devices that were eligible for pass-through status 
in CY 2004 and CY 2005 and that would continue to be eligible for pass-
through payment in CY 2006. The second group consists of those items 
for which we have no direct claims data, that is, items that became, or 
would become, eligible in CY 2005 and would retain pass-through status 
in CY 2006, as well as items that would be newly eligible for pass-
through payment beginning in CY 2006.

B. Estimate of Pass-Through Spending for CY 2006

    We are proposing to set the applicable percentage cap at 2.0 
percent of the total OPPS projected payments for CY 2006. As we discuss 
in section IV.C. of this preamble, the three remaining device 
categories receiving pass-through payment in CY 2005 will expire on 
December 31, 2005. Therefore, we estimate pass-through spending 
attributable to the first group of items described above to equal zero.
    To estimate CY 2006 pass-through spending for device categories in 
the second group, that is, items for which we have no direct claims 
data, we are proposing to use the following approach: For additional 
device categories that are approved for pass-through status after July 
1, 2005, but before January 1, 2006, we are proposing to use price 
information from manufacturers and volume estimates based on claims for 
procedures that would most likely use the devices in question because 
we would have no CY 2004 claims data upon which to base a spending 
estimate. We are proposing to project these data forward to CY 2006 
using inflation and utilization factors based on total growth in OPPS 
services as projected by CMS' Office of the Actuary (OACT) to estimate 
CY 2006 pass-through spending for this group of device categories. For 
device categories that become eligible for pass-through status in CY 
2006, we are proposing to use the same methodology. We anticipate that 
any new categories for January 1, 2006, would be announced after the 
publication of this proposed rule, but before publication of the final 
rule. Therefore, the estimate of pass-through spending in the CY 2006 
OPPS final rule would incorporate any pass-through spending for device 
categories made effective January 1, 2006, and during subsequent 
quarters of CY 2006.
    With respect to CY 2006 pass-through spending for drugs and 
biologicals, as we explain in section V.A.3. of this proposed rule, the 
pass-through payment amount for new drugs and biologicals that we 
determine have pass-through status would equal zero. Therefore, our 
estimate of pass-through spending for drugs and biologicals with pass-
through status in CY 2006 equals zero.
    In accordance with the methodology described above and the 
methodology for estimating pass-through spending discussed in the 
August 16, 2004 proposed rule (69 FR 50526), we estimate that total 
pass-through spending for device categories that first become eligible 
for pass-through status after publication of this proposed rule for 
which pass-through payment continues in CY 2006 or become eligible 
during CY 2006 would equal approximately $12.5 million, which 
represents 0.05 percent of total OPPS projected payments for CY 2006. 
This figure includes estimates for the current device categories 
continuing into CY 2006, which equals zero, in addition to projections 
for categories that first become eligible during the second half of CY 
2005 or in CY 2006.
    This estimate of total pass-through spending for CY 2006 is 
significantly lower than previous years' estimates both because of the 
method we are proposing in section V.A.3. of this preamble for 
determining the amount of pass-through payment for drugs and 
biologicals with pass-through status, and the fact that there are no CY 
2005 pass-through device categories that are being carried over to CY 
2006.
    Because we estimate pass-through spending in CY 2006 would not 
amount to 2.0 percent of total projected OPPS CY 2006 spending, we are 
proposing to return 1.95 percent of the pass-through pool to adjust the 
conversion factor, as we discuss in section II.C. of this preamble.

[[Page 42736]]

VII. Proposed Brachytherapy Payment Changes

(If you choose to comment on issues in this section, please include 
the caption ``Brachytherapy'' at the beginning of your comment.)

A. Background

    Section 1833(t)(16)(C) and section 1833(t)(2)(H) of the Act, as 
added by sections 621(b)(1) and (b)(2) of Pub. L. 108-173, 
respectively, establish separate payment for devices of brachytherapy 
consisting of a seed or seeds (or radioactive source) based on a 
hospital's charges for the service, adjusted to cost. Charges for the 
brachytherapy devices may not be used in determining any outlier 
payments under the OPPS. In addition, consistent with our practice 
under the OPPS to exclude items paid at cost from budget neutrality 
consideration, these items must be excluded from budget neutrality as 
well. The period of payment under this provision is for brachytherapy 
sources furnished from January 1, 2004, through December 31, 2006.
    Section 621(b)(3) of Pub. L. 108-173 requires the Government 
Accountability Office (GAO) to conduct a study to determine appropriate 
payment amounts for devices of brachytherapy, and to submit a report on 
its study to the Congress and the Secretary, including recommendations. 
We are awaiting the report and any recommendations on the payment of 
brachytherapy, which would pertain to brachytherapy payments after 
December 31, 2006.
    In the OPPS interim final rule with comment period published on 
January 6, 2004 (69 FR 827), we implemented sections 621(b)(1) and 
(b)(2)(C) of Pub. L. 108-173. In that rule, we stated that we will pay 
for the brachytherapy sources listed in Table 4 of the interim final 
rule with comment period (69 FR 828) on a cost basis, as required by 
the statute. The status indicator for brachytherapy sources was changed 
to ``H.'' The definition of status indicator ``H'' was for pass-through 
payment only for devices, but the brachytherapy sources affected by 
sections 1833(t)(16)(C) and 1833(t)(2)(H) of the Act are not pass-
through device categories. Therefore, we also changed, for CY 2004, the 
definition of payment status indicator ``H'' to include nonpass-through 
brachytherapy sources paid on a cost basis. This use of status 
indicator ``H'' was a pragmatic decision that allowed us to pay for 
brachytherapy sources in accordance with section 1833(t)(16)(C) of the 
Act, effective January 1, 2004, without having to modify our claims 
processing systems. We stated in the January 6, 2004 interim final rule 
with comment period that we would revisit the use and definition of 
status indicator ``H'' for this purpose in the OPPS update for CY 2005. 
In the November 15, 2004 final rule with comment period, we finalized 
this policy for CY 2005 (69 FR 65838).
    As we indicated in the January 6, 2004 interim final rule with 
comment period, we began payment for the brachytherapy source in HCPCS 
code C1717 (Brachytx source, HCR lr-192) based on the hospital's charge 
adjusted to cost beginning January 1, 2004. Prior to enactment of Pub. 
L. 108-173, these sources were paid as packaged services in APC 0313. 
As a result of the requirement under Pub. L. 108-173 to pay for HCPCS 
code C1717 separately, we adjusted the payment rate for APC 0313, 
Brachytherapy, to reflect the unpackaging of the brachytherapy source. 
We finalized this payment methodology in our November 15, 2004 final 
rule with comment period (69 FR 65839).
    Section 1833(t)(2)(H) of the Act, as added by section 621(b)(2)(C) 
of Pub. L. 108-173, mandated the creation of separate groups of covered 
OPD services that classify brachytherapy devices separately from other 
services or groups of services. The additional groups must be created 
in a manner that reflects the number, isotope, and radioactive 
intensity of the devices of brachytherapy furnished, including separate 
groups for Palladium-103 and Iodine-125 devices. At its meetings in 
February 2004, the APC Panel heard from parties that recommended the 
addition of two new codes to describe brachtherapy sources in a manner 
that reflects the number, radioisostope, and radioactive intensity of 
the sources. The presenters recommended two new brachytherapy HCPCS 
codes and APCs for high activity Iodine-125 and high activity 
Palladium-103. The APC Panel, in turn, recommended that CMS establish 
new HCPCS codes and new APCs, on a per source basis, for these two 
brachytherapy sources.
    We considered this recommendation and agreed with the APC Panel. 
Therefore, in the November 15, 2004 final rule with comment period, we 
established the following two new brachytherapy source codes for CY 
2005:
    C2634 Brachytherapy source, High Activity Iodine-125, greater than 
1.01 mCi (NIST), per source
    C2635 Brachytherapy source, High Activity Palladium-103, greater 
than 2.2 mCi (NIST), per source
    In addition, we believed the APC Panel's recommendation to 
establish new HCPCS codes that would distinguish high activity Iodine-
125 from high activity Palladium-103 on a per source basis should have 
been implemented for other brachytherapy code descriptors, as well. 
Therefore, beginning January 1, 2005, we included ``per source'' in the 
HCPCS code descriptors for all those brachytherapy source descriptors 
for which units of payment were not already delineated. Table 40 
published in the November 15, 2004 final rule with comment period 
included a complete listing of the HCPCS codes, long descriptors, APC 
assignments, and status indicators that we used for brachytherapy 
sources paid under the OPPS in CY 2005 (69 FR 65840 through 65841).
    Further, for CY 2005, we added the following code of linear source 
Palladium-103 to be paid at cost: C2636 Brachytherapy linear source, 
Palladium-103, per 1 mm. We had indicated in our August 16, 2004 
proposed rule that we were aware of a new linear source Palladium-103, 
which came to our attention in CY 2003 through an application for a new 
device category for pass-through payment. We stated that, while we 
decided not to create a new category for pass-through payment, we 
believed that the new linear source fell under the provisions of Pub. 
L. 108-173. Therefore, we made final our proposal to add HCPCS code 
C2636 as a new brachytherapy source to be paid at cost in CY 2005.

B. Proposed Changes Related to Pub. L. 108-173

    We have consistently invited the public to submit recommendations 
for new codes to describe brachytherapy sources in a manner reflecting 
the number, radioisotope, and radioactivity intensity of the sources. 
We requested that commenters provide a detailed rationale to support 
recommended new codes and to send recommendations to us. We stated that 
we would endeavor to add new brachytherapy source codes and descriptors 
to our systems for payment on a quarterly basis. We have only very 
recently received one such request for coding and payment of a new 
brachytherapy source since we added separate APC payment beginning in 
CY 2005 for the three brachytherapy sources discussed above. We will 
evaluate this source prior to our final rule for CY 2006. Therefore, we 
are not proposing any coding changes to the sources of brachytherapy 
for CY 2006 at this time. Table 26 below includes a list of the 
separately payable brachytherapy

[[Page 42737]]

sources that we are proposing to continue for CY 2006.

                    Table 26.--Proposed Separately Payable Brachytherapy Sources for CY 2006
----------------------------------------------------------------------------------------------------------------
                                                                                                   New status
            HCPCS                 Long descriptor            APC              APC title             indicator
----------------------------------------------------------------------------------------------------------------
C1716.......................  Brachytherapy source,              1716  Brachytx source, Gold    H
                               Gold 198, per source.                    198.
C1717.......................  Brachytherapy source,              1717  Brachytx source, HDR Ir- H
                               High Dose Rate Iridium                   192.
                               192, per source.
C1718.......................  Brachytherapy source,              1718  Brachytx source, Iodine  H
                               Iodine 125, per source.                  125.
C1719.......................  Brachytherapy source,              1719  Brachytx source, Non-    H
                               Non-High Dose Rate                       HDR Ir-192.
                               Iridium 192, per
                               source.
C1720.......................  Brachytherapy source,              1720  Brachytx source,         H
                               Palladium 103, per                       Palladium 103.
                               source.
C2616.......................  Brachytherapy source,              2616  Brachytx source,         H
                               Yttrium-90, per source.                  Yttrium-90.
C2632.......................  Brachytherapy solution,            2632  Brachytx sol, I-125,     H
                               Iodine 125, per mCi.                     per mCi.
C2633.......................  Brachytherapy source,              2633  Brachytx source, Cesium- H
                               Cesium-131, per source.                  131.
C2634.......................  Brachytherapy source,              2634  Brachytx source, HA, I-  H
                               High Activity, Iodine-                   125.
                               125, greater than 1.01
                               mCi (NIST), per source.
C2635.......................  Brachytherapy source,              2635  Brachytx source, HA, P-  H
                               High Activity,                           103.
                               Palladium-103, greater
                               than 2.2 mCi (NIST),
                               per source.
----------------------------------------------------------------------------------------------------------------

VIII. Proposed Coding and Payment for Drug Administration

(If you choose to comment on issues in this section, please include 
the caption ``Drug Administration'' at the beginning of your 
comment.)

A. Background

    From the start of the OPPS until the end of CY 2004, three HCPCS 
codes were used to bill drug administration services provided in the 
hospital outpatient department:
     Q0081 (Infusion therapy, using other than chemotherapeutic 
drugs, per visit)
     Q0083 (Chemotherapy administration by other than infusion 
technique only, per visit)
     Q0084 (Chemotherapy administration by infusion technique 
only, per visit) A fourth OPPS drug administration HCPCS code, Q0085 
(Administration of chemotherapy by both infusion and another route, per 
visit) was active from the beginning of the OPPS through the end of CY 
2003.
    Each of these four HCPCS codes mapped to an APC (that is, Q0081 
mapped to APC 0120, Q0083 mapped to APC 0116, Q0084 mapped to APC 0117, 
and Q0085 mapped to APC 0118), and APC payment rates for these codes 
were made on a per-visit basis. The per-visit payment included payment 
for all hospital resources (except separately payable drugs) associated 
with the drug administration procedures. For CY 2004, we discontinued 
using HCPCS code Q0085 to identify drug administration services, moving 
to a combination of HCPCS codes Q0083 and Q0084 that allowed more 
accurate calculations when determining OPPS payment rates.
    In response to comments we received concerning the available 
opportunities to gather additional drug administration data (and 
subsequently facilitate development of more accurate payment rates for 
drug administration services in future years) and to reduce hospital 
administrative burden, we proposed for the CY 2005 OPPS to change our 
coding and payment methodologies related to drug administration 
services.
    After examining comments and suggestions, including recommendations 
of the APC Panel, we adopted a crosswalk for the CY 2005 OPPS that 
identified all active CPT drug administration codes and the 
corresponding Q-codes, which hospitals had previously used to report 
their charges for the procedures. Hospitals were instructed to begin 
billing CPT codes for drug administration services in the hospital 
outpatient department effective January 1, 2005.
    Payment rates for CY 2005 drug administration services were set 
using CY 2003 claims data. These data reflected per-visit costs 
associated with the four Q-codes listed above. To allow for the time 
necessary to collect data at the more specific CPT code level and to 
continue accurate payments based on available claims data, we used the 
Q-code crosswalk to map CPT drug administration codes to existing drug 
administration APCs. While hospitals were instructed to bill all 
relevant CPT codes that describe the services provided, the Outpatient 
Code Editor (OCE) collapsed payments for drug administration services 
attributed to the same APC and paid a single APC amount for those 
services for each visit, unless a modifier was used to identify drug 
administration services provided more than once in a separate encounter 
on the same day.

B. Proposed Changes for CY 2006

    In 2004, the CPT Editorial Panel approved several new drug 
administration codes and revised several existing codes for use 
beginning in 2006. For use in the physician office setting in CY 2005, 
we established HCPCS G-codes that correspond with the expected new CPT 
codes that will become active in 2006.
    For CY 2006 OPPS billing purposes, we are proposing to continue our 
policy of using CPT codes to bill for drug administration services 
provided in the hospital outpatient department. We anticipate that the 
current CPT codes will no longer be effective in CY 2006, and, 
therefore, we are proposing a CY 2006 crosswalk that maps current CPT 
codes to the CPT drug administration codes approved by the CPT 
Editorial Panel in 2004, which correspond to the G-codes used in the 
physician office setting for CY 2005 and which we expect to become 
active CPT codes for 2006.
    The OPPS drug administration payment rates that we are proposing 
for CY 2006 are dependent on CY 2004 data

[[Page 42738]]

containing per-visit charges for HCPCS codes Q0081, Q0083, and Q0084. 
While HCPCS code Q0085 was used to inform payment rates for drug 
administration APCs for CY 2005, there are no data from this code to 
develop payment rates for drug administration APCs for CY 2006 because 
this code was not used in CY 2004. We are proposing to map the new CPT 
codes to existing drug administration APC groups (APC 0116, APC 0117, 
and APC 0120) as we did in CY 2005. Again, hospitals would be expected 
to bill all relevant CPT codes for services provided, but payment for 
services within the same APC group would be collapsed by the OCE into a 
single per-visit APC payment, unless a modifier is used to identify 
drug administration services provided more than once in a separate 
encounter on the same day.
    Table 27 shows the crosswalk from the CY 2005 CPT codes to the 
expected CY 2006 CPT codes (indicated by definition and 2005 HCPCS G-
code) and includes the proposed CY 2006 status indicators and APC 
payment groups for these services. At its February 2005 meeting, the 
APC Panel recommended that this crosswalk be used to establish drug 
administration payments for the CY 2006 OPPS. Therefore, we are 
proposing to use the crosswalk as illustrated in Table 27 to assign 
drug administration services to APC payment groups for CY 2006 OPPS.

                      Table 27.--Proposed Crosswalk From Expected CY 2006 Drug Administration CPT Codes to Drug Administration APCs
                                       [Note: G-codes are only for use in the physician office setting in CY 2005]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                    OCE
                                                                                                                                maximum APC      OCE
                                                                                              CY 2006  Proposed                    units     maximum APC
         2005 CPT code                  2005 HCPCS code                Description            status  indicator        APC        without    units  with
                                                                                                                                  modifier     modifier
                                                                                                                                     59           59
--------------------------------------------------------------------------------------------------------------------------------------------------------
90780.........................  G0345.........................  Intravenous Infusion,      S                              0120            1            4
                                                                 Hydration; Initial, up
                                                                 to one hour.
90781.........................  G0346.........................  Intravenous Infusion,      N                       ...........            0            0
                                                                 Hydration; each
                                                                 additional hour, up to
                                                                 eight (8) hours.
90780.........................  G0347.........................  Intravenous Infusion, for  S                              0120            1            4
                                                                 Therapeutic/Diagnostic;
                                                                 Initial, up to one hour.
90781.........................  G0348.........................  Intravenous Infusion, for  N                       ...........            0            0
                                                                 Therapeutic/Diagnostic;
                                                                 each additional hour, up
                                                                 to eight (8) hours.
                                G0349.........................  Intravenous Infusion, for  N                       ...........            0            0
                                                                 Therapeutic/Diagnostic;
                                                                 additional sequential
                                                                 infusion, up to one hour.
                                G0350.........................  Intravenous Infusion, for  N                       ...........            0            0
                                                                 Therapeutic/Diagnostic;
                                                                 concurrent infusion.
90782.........................  G0351.........................  Therapeutic or Diagnostic  X                              0353          N/A          N/A
                                                                 Injection; subcutaneous
                                                                 or intramuscular.
90784.........................  G0353.........................  Intravenous Push; single   X                              0359          N/A          N/A
                                                                 or initial substance/
                                                                 drug.
90784.........................  G0354.........................  Intravenous Push; each     X                              0359          N/A          N/A
                                                                 additional sequential
                                                                 intravenous push.
90783.........................  90783.........................  Injection, ia............  X                              0359          N/A          N/A
90788.........................  90788.........................  Injection of antibiotic..  X                              0359          N/A          N/A
96549.........................  96549.........................  Chemotherapy, unspecified  S                              0116            1            2
96400.........................  G0355.........................  Chemotherapy               S                              0116            1            2
                                                                 Administration,
                                                                 subcutaneous or
                                                                 intramuscular non-
                                                                 hormonal antineoplastic.
96400.........................  G0356.........................  Chemotherapy               S                              0116            1            2
                                                                 Administration,
                                                                 subcutaneous or
                                                                 intramuscular hormonal
                                                                 antineoplastic.
96542.........................  96542.........................  Chemotherapy injection...  S                              0116            1            2
96405.........................  96405.........................  Intralesional chemo admin  S                              0116            1            2
96406.........................  96406.........................  Intralesional chemo admin  S                              0116            1            2
96408.........................  G0357.........................  Intravenous, push          S                              0116            1            2
                                                                 technique, single or
                                                                 initial substance/drug.
96408.........................  G0358.........................  Intravenous, push          S                              0116            1            2
                                                                 technique, each
                                                                 additional substance/
                                                                 drug.
96420.........................  96420.........................  Chemotherapy, push         S                              0116            1            2
                                                                 technique.
96440.........................  96440.........................  Chemotherapy,              S                              0116            1            2
                                                                 intracavitary.
96445.........................  96445.........................  Chemotherapy,              S                              0116            1            2
                                                                 intracavitary.
96450.........................  96450.........................  Chemotherapy, into CNS...  S                              0116            1            2
96410.........................  G0359.........................  Chemotherapy               S                              0117            1            2
                                                                 Administration,
                                                                 Intravenous Infusion
                                                                 Technique; up to one
                                                                 hour, single or initial
                                                                 substance/drug.
96412.........................  G0360.........................  Chemotherapy               N                       ...........            0            0
                                                                 Administration,
                                                                 Intravenous Infusion
                                                                 Technique; Each
                                                                 additional hour, one to
                                                                 eight (8) hours.
                                G0362.........................  Chemotherapy               N                       ...........            0            0
                                                                 Administration,
                                                                 Intravenous Infusion
                                                                 Technique; Each
                                                                 additional sequential
                                                                 infusion (different
                                                                 substance/drug), up to
                                                                 one hour.
96414.........................  G0361.........................  Initiation of prolonged    S                              0117            1            2
                                                                 chemotherapy infusion
                                                                 (more than eight hours),
                                                                 requiring use of a
                                                                 portable or implantable
                                                                 pump.
96422.........................  96422.........................  Chemotherapy, infusion     S                              0117            1            2
                                                                 method.

[[Page 42739]]

 
96423.........................  96423.........................  Chemo, infuse method add-  N                       ...........            0            0
                                                                 on.
96425.........................  96425.........................  Chemotherapy, infusion     S                              0117            1            2
                                                                 method.
                                G0363.........................  Irrigation of Implanted    N                       ...........            0            0
                                                                 Venous Access Device for
                                                                 Drug Delivery Systems.
96520.........................  96520.........................  Port pump refill & main..  T                              0125          N/A          N/A
96530.........................  96530.........................  Syst pump refill & main..  T                              0125          N/A          N/A
--------------------------------------------------------------------------------------------------------------------------------------------------------

C. Proposed Changes to Vaccine Administration

    Hospitals currently use three HCPCS G-codes to indicate the 
administration of the following vaccines that have specific statutory 
coverage:
     G0008--Administration of Influenza Virus Vaccine
     G0009--Administration of Pneumococcal Vaccine
     G0010--Administration of Hepatitis B Vaccine
    HCPCS codes G0008 and G0009 are exempt from beneficiary coinsurance 
and deductible applications and, as such, payment has been made outside 
of the OPPS since CY 2003 based on reasonable cost. We have made 
payment for HCPCS code G0010 through a clinical APC (that is, APC 0355) 
that included vaccines along with this vaccine administration code. 
Additional vaccine administration codes have been packaged or not paid 
under the OPPS.
    We believe that HCPCS codes G0008, G0009 and G0010 are clinically 
similar and comparable in resource use to one another and to the 
administration of other immunizations and other therapeutic, 
prophylactic, or diagnostic injections. The appropriate APC assignment 
for these vaccine administration services is newly reconfigured APC 
0353 (``Injection, Level II''). However, because of their statutory 
exemption regarding beneficiary deductible and coinsurance, for 
operational reasons we are unable to include HCPCS codes G0008 and 
G0009 in an APC with codes that do not share this exemption.
    Therefore, for CY 2006, we are proposing to map HCPCS codes G0008 
and G0009 to new APC 0350 (Administration of flu and PPV vaccines). As 
dictated by statute, HCPCS codes G0008 and G0009 will continue to be 
exempt from beneficiary coinsurance and deductible.
    We are also proposing to change the status indicator for HCPCS code 
G0010 from ``K'' (Separate APC Payment) to ``B'' (Not paid under OPPS; 
Alternate code may be available), and to change the status indicators 
for vaccine administration codes 90471 and 90472 from ``N'' (Packaged) 
to ``X'' (Separate APC Payment), in agreement with the recommendation 
of the APC Panel to unpackage these services. Hospitals would code for 
hepatitis B vaccine administration using codes 96471 or 96472 (as 
appropriate), and payment would be mapped to reconfigured APC 0353 
(``Injection, Level II'') that will include other injection services 
that are clinically similar and comparable in resource use.
    Additionally, in order to pay appropriately for services that we 
believe are clinically similar and comparable in resource use and, 
barring technical restrictions, would otherwise be assigned to the same 
APC, we are proposing to calculate a combined median cost for all 
services assigned to APC 0350 and APC 0353 that would then serve as the 
median cost for both APCs. This combined median would be calculated 
using charges converted to costs from claims for services in both APCs 
and would have the effect of making the OPPS payment rates for APC 0350 
and APC 0353 identical, although beneficiary copayment and deductible 
would not be applied to services in APC 0350.
    In addition, we are proposing to change the status indicators for 
vaccine administration codes 90473 and 90474 from ``E'' (Not paid under 
OPPS) to ``S'' (Paid under OPPS) and make payments for these services 
when they are covered through proposed APC 1491 (New Technology--Level 
IA ($0-$10)). Finally, we are proposing to change the status indicators 
for the four remaining vaccine administration codes involving physician 
counseling (90465, 90466, 90467 and 90468) from ``N'' (Packaged) to 
``B'' (Not paid under OPPS; Alternate code may be available). Hospitals 
providing immunization services with physician counseling would use the 
vaccine administration codes 90471, 90472, 90473, and 90473 to report 
such services, as we do not believe the provision of physician 
counseling significantly affects the hospital resources required for 
administration of immunizations. Table 28 displays the changes that we 
are proposing for CY 2006.

                                      Table 28.--Proposed CY 2006 Vaccine Administration Codes and APC Median Cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                             CY 2005                                           CY 2006
             HCPCS                   Description      --------------------------------------------------------------------------------------------------
                                                                SI                        APC                       SI              APC         Median
--------------------------------------------------------------------------------------------------------------------------------------------------------
G0008.........................  Influenza Vaccine      L                    Reasonable Cost...............  X                          0350       $24.00
                                 Administration.
G0009.........................  Pneumococcal Vaccine   L                    Reasonable Cost...............  X                          0350        24.00
                                 Administration.
G0010.........................  Hepatitis B Vaccine    K                    0355..........................  B                   ...........  ...........
                                 Administration.
90465.........................  Immunization Admin,    N                    ..............................  B                   ...........  ...........
                                 under 8 yrs old,
                                 with counseling;
                                 first injection.
90466.........................  Immunization Admin,    N                    ..............................  B                   ...........  ...........
                                 under 8 yrs old,
                                 with counseling;
                                 each additional
                                 injection.

[[Page 42740]]

 
90467.........................  Immunization Admin,    N                    ..............................  B                   ...........  ...........
                                 under 8 yrs old,
                                 with counseling;
                                 first intranasal or
                                 oral.
90468.........................  Immunization Admin,    N                    ..............................  B                   ...........  ...........
                                 under 8 yrs old,
                                 with counseling;
                                 each additional
                                 intranasal or oral.
90471.........................  Immunization Admin,    N                    ..............................  X                          0353        24.00
                                 one vaccine
                                 injection.
90472.........................  Immunization Admin,    N                    ..............................  X                          0353        24.00
                                 each additional
                                 vaccine injection.
90473.........................  Immunization Admin,    E                    ..............................  S                          1491         5.00
                                 one vaccine by
                                 intranasal or oral.
90474.........................  Immunization Admin,    E                    ..............................  S                          1491         5.00
                                 each additional
                                 vaccine by
                                 intranasal or oral.
--------------------------------------------------------------------------------------------------------------------------------------------------------

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

(If you choose to comment on issues in this section, please include 
the caption ``E/M Services'' at the beginning of your comment.)

    In the November 15, 2004 final rule with comment period (69 FR 
65838), we noted our primary concerns and direction for developing the 
proposed coding guidelines for emergency department and clinic visits. 
We intend to make available for public comment the proposed coding 
guidelines that we are considering through the CMS OPPS Web site as 
soon as we have completed them. We will notify the public through our 
listserve when these proposed guidelines become available. To subscribe 
to this listserve, please go to the following CMS Web site: http://www.cms.hhs.gov/medlearn/listserv.asp and follow the directions to the 
OPPS listserve. We will provide ample opportunity for the public to 
comment on the proposal.
    We will continue to be considerate of the time necessary to educate 
clinicians and coders on the use of the new codes and guidelines and 
for hospitals to modify their systems. We anticipate providing a 
minimum notice of between 6 and 12 months prior to implementation of 
the new evaluation and management codes and guidelines. We will 
continue developing and testing the new codes even though we have not 
yet made plans for their implementation.

X. Proposed Payment for Blood and Blood Products

(If you choose to comment on issues in this section, please include 
the caption ``Blood and Blood Products'' at the beginning of your 
comment.)

A. Background

    Since the implementation of the OPPS in August 2000, separate 
payments have been made for blood and blood products through APCs 
rather than packaging them into payments for the procedures with which 
they were administered. Hospital payments for the costs of blood and 
blood products, as well as the costs of collecting, processing, and 
storing blood and blood products, are made through the OPPS payments 
for specific blood product APCs. On April 12, 2001, CMS issued the 
original billing guidance for blood products to hospitals (Program 
Transmittal A-01-50). In response to requests for clarification of 
these instructions, CMS issued Transmittal 496 on March 4, 2005. The 
comprehensive billing guidelines in the Transmittal also addressed 
specific concerns and issues related to billing for blood-related 
services, which the public had brought to our attention.
    In CY 2000, payments for blood and blood products were established 
based on external data provided by commenters due to limited Medicare 
claims data. From CY 2000 to CY 2002, payment rates for blood and blood 
products were updated for inflation. For CY 2003, as described in the 
November 1, 2002 final rule with comment period (67 FR 66773), we 
applied a special dampening methodology to blood and blood products 
that had significant reductions in payment rates from CY 2002 to CY 
2003, when median costs were first calculated from hospital claims. 
Using the dampening methodology, we limited the decrease in payment 
rates for blood and blood products to approximately 15 percent. For CY 
2004, as recommended by the APC Panel, we froze payment rates for blood 
and blood products at CY 2003 levels as we studied concerns raised by 
commenters and presenters at the August 2003 and February 2004 APC 
Panel meetings.
    For CY 2005, we established new APCs that allowed each blood 
product to be assigned to its own separate APC, as several of the 
previous blood product APCs contained multiple blood products with no 
clinical homogeneity or whose product-specific median costs may not 
have been similar. Some of the blood product HCPCS codes were 
reassigned to the new APCs (Table 34 of the November 15, 2004 final 
rule with comment period (69 FR 65819)).
    We also noted in the November 15, 2004 final rule with comment 
period that public comments to previous OPPS rules had stated that the 
CCRs that were used to adjust charges to costs for blood products in 
past years were too low. Past commenters indicated that this approach 
resulted in an underestimation of the true hospital costs for blood and 
blood products. In response to these comments and APC Panel 
recommendations from their February 2004 and September 2004 meetings, 
we conducted a thorough analysis of the OPPS CY 2003 claims (used to 
calculate the CY 2005 APC payment rates) to compare CCRs between those 
hospitals reporting a blood-specific cost center and those hospitals 
defaulting to the overall hospital CCR in the conversion of their blood 
product charges to costs. As a result of this analysis, we observed a 
significant difference in CCRs utilized for conversion of blood product 
charges to costs for those hospitals with and without blood-specific 
cost centers. The median hospital blood-specific CCRs were almost two 
times the median overall hospital CCR. As discussed in the November 15, 
2004 final rule with comment period, we applied a methodology for 
hospitals not reporting a blood-specific cost center, which simulated a 
blood-specific CCR for each hospital that we then used to convert 
charges to costs for blood products. Thus, we developed simulated 
medians for all blood and blood products based on CY 2003 hospital 
claims data (69 FR 65816).

[[Page 42741]]

    For CY 2005, we also identified a subset of blood products that had 
less than 1,000 units billed in CY 2003. For these low-volume blood 
products, we based the CY 2005 payment rate on a 50/50 blend of CY 2004 
product-specific OPPS median costs and the CY 2005 simulated medians 
based on the application of blood-specific CCRs to all claims. We were 
concerned that, given the low frequency in which these products were 
billed, a few occurrences of coding or billing errors may have led to 
significant variability in the median calculation. The claims data may 
not have captured the complete costs of these products to hospitals as 
fully as possible. This low-volume adjustment methodology also allowed 
us to further study the issues raised by commenters and by presenters 
at the September 2004 APC Panel meeting, without putting beneficiary 
access to these low-volume blood products at risk.

B. Proposed Changes for CY 2006

    For CY 2006, we are proposing to continue to make separate payments 
for blood and blood products under the OPPS through individual APCs for 
each product. We are also proposing to establish payment rates for 
these blood and blood products by using the same simulation methodology 
described in the November 15, 2004 final rule with comment period (69 
FR 65816), which utilized hospital-specific actual or simulated CCRs 
for blood cost centers to convert hospital charges to costs, with an 
adjustment applied to some products. We continue to believe that using 
blood-specific CCRs applied to hospital claims data will result in 
reasonably accurate payments that more fully reflect hospitals' true 
costs of providing blood and blood products than our general 
methodology of defaulting to the overall hospital CCR when more 
specific CCRs are unavailable.
    For blood and blood products whose CY 2006 simulated medians 
experienced a decrease of more than 10 percent in comparison to their 
CY 2005 payment medians, we are proposing to limit the decrease in 
medians to 10 percent. Therefore, overall we are proposing to base 
median costs for blood and blood products in CY 2006 on the greater of: 
(1) Simulated medians calculated using CY 2004 claims data; or (2) 90 
percent of the APC payment median for CY 2005 for such products. We 
recognize that possible errors in hospital billing or coding for blood 
products in CY 2004 may have contributed to these decreases in medians. 
In particular, hospitals may have been uncertain about which of their 
many different costs for providing blood and blood products should be 
captured in their charges for the products, based on variations in the 
specific circumstances of the services they provided. In addition, the 
six products affected by the proposed CY 2006 adjustment policy all 
were relatively low volume with fewer than 7,000 units billed in CY 
2004. Three of these products were affected by the low-volume payment 
adjustment for CY 2005 because there were less than 1,000 units billed, 
and their CY 2005 payment medians would have decreased without the 
adjustment. In the interim, as hospitals become more familiar with the 
comprehensive billing guidelines for blood and blood products that are 
described in Program Transmittal 496, (Change Request 3681 dated March 
4, 2005), we acknowledge the need to protect beneficiaries' access to a 
safe blood supply and are proposing to do so by limiting significant 
decreases in payment rates for blood and blood products from CY 2005 to 
CY 2006. We expect that our billing guidance will assist hospitals in 
more fully including all appropriate costs for providing blood and 
blood products in their charges for those products, so that our data 
for CY 2005, which will be used to set median costs for blood and blood 
products in the CY 2007 OPPS, should more accurately capture the 
hospital costs associated with each different blood product.
    Displayed in Table 29 is the list of blood product HCPCS codes with 
their proposed CY 2006 payment medians. Overall, medians from CY 2005 
and CY 2006 were relatively stable, and we expect that as hospitals 
improve their billing and coding practices, medians based on historical 
hospital claims data should continue to become more consistent and 
reflective of all hospital costs. For blood and blood products whose CY 
2006 simulated median would have experienced a decrease from CY 2005 to 
CY 2006 of greater than 10 percent, the adjusted median is shown.
    Therefore, for CY 2006, we are proposing to establish payment rates 
for blood and blood products under the OPPS by using the same 
simulation methodology described in the November 15, 2004 final rule 
with comment period (69 FR 65816). For blood and blood products whose 
2006 medians would have otherwise experienced a decrease of more than 
10 percent in comparison with their CY 2005 payment rates, we are 
proposing to adjust the simulated medians by limiting their decrease to 
10 percent.

           Table 29.--Proposed CY 2006 Payment Medians for Blood and Blood Products by HCPCS/APC Codes
----------------------------------------------------------------------------------------------------------------
                                                                                                     Proposed CY
                                                                                          CY 2005        2006
              HCPCS                   APC        CY 2004            Description           payment      median,
                                                  units                                    median    (limited if
                                                                                                     applicable)
----------------------------------------------------------------------------------------------------------------
P9016...........................         0954       609026  RBC leukocytes reduced....      $170.28      $165.16
P9021...........................         0959       158964  Red blood cells unit......       116.42       122.50
P9040...........................         0969        46732  RBC leukoreduced                 211.28       219.96
                                                             irradiated.
P9035...........................         9501        37199  Platelet pheres                  486.18       491.77
                                                             leukoreduced.
P9019...........................         0957        37079  Platelets, each unit......        49.50        50.19
P9017...........................         9508        36807  Plasma 1 donor frz w/in 8         65.10        72.64
                                                             hr.
P9031...........................         1013        21899  Platelets leukocytes              88.78        96.69
                                                             reduced.
P9037...........................         1019        13873  Plate pheres leukoredu           603.62       574.05
                                                             irrad.
P9034...........................         9507        10419  Platelets, pheresis.......       449.86       416.30
P9033...........................         0968         6031  Platelets leukoreduced           158.50      *142.65
                                                             irrad.
P9044...........................         1009         5635  Cryoprecipitate reduced           63.20        78.82
                                                             plasma.
P9012...........................         0952         5264  Cryoprecipitate each unit.        49.58       *44.62
P9055...........................         1017         4546  Plt, aph/pher, l/r, cmv-         489.46       518.94
                                                             neg.
P9056...........................         1018         3759  Blood, l/r, irradiated....       187.76      *168.98
P9038...........................         9505         3149  RBC irradiated............       122.09       144.08
P9010...........................         0950         3012  Whole blood for                  115.97       121.43
                                                             transfusion.

[[Page 42742]]

 
P9051...........................         1010         2854  Blood, l/r, cmv-neg.......       172.35       179.17
P9022...........................         0960         2086  Washed red blood cells           199.18      *179.26
                                                             unit.
P9059...........................         0955         1863  Plasma, frz between 8-24          76.28        78.05
                                                             hour.
P9052...........................         1011         1603  Platelets, hla-m, l/r,           583.87       661.91
                                                             unit.
P9036...........................         9502         1166  Platelet pheresis                343.02       313.15
                                                             irradiated.
P9058...........................         1022         1081  RBC, l/r, cmv-neg, irrad..       280.94       258.88
P9032...........................         9500         1080  Platelets, irradiated.....        91.11       *82.00
P9020...........................         0958          944  Plaelet rich plasma unit..       155.53       312.67
P9039...........................         9504          862  RBC deglycerolized........       305.13       388.09
P9050...........................         9506          793  Granulocytes, pheresis         1,046.99      *942.29
                                                             unit.
P9023...........................         0949          776  Frozen plasma, pooled, sd.        80.16       *72.14
P9054...........................         1016          681  Blood, l/r, froz/degly/          275.72       317.59
                                                             wash.
P9053...........................         1020          549  Plt, pher, l/r cmv-neg,          573.06       612.79
                                                             irr.
P9048...........................         0966          524  Plasmaprotein fract, 5%,         332.32      *299.09
                                                             250 ml.
P9060...........................         9503          488  Fr frz plasma donor               76.86        98.00
                                                             retested.
P9043...........................         0956           43  Plasma protein fract, 5%,         68.62        67.74
                                                             50 ml.
P9057...........................         1021           27  RBC, frz/deg/wsh, l/r,           327.11     *294.40
                                                             irrad.
----------------------------------------------------------------------------------------------------------------
* Indicates adjusted median.

    In addition, we are proposing to change the status indicator for 
CPT code 85060 (Blood smear, peripheral, interpretation by physician 
with written report) from ``X'' (separately paid under the OPPS) to 
``B'' (not paid under the OPPS). When a hospital provides a physician 
interpretation of an abnormal peripheral blood smear interpretation for 
a hospital outpatient, the charge for the facility resources associated 
with the interpretation should be bundled into the charge reported for 
the ordered hematology lab service, such as, CPT code 85007 (Blood 
count; blood smear, microscopic examination with manual differential 
WBC count) or CPT code 85008 (Blood count; blood smear, microscopic 
examination without manual differential WBC count), which are paid 
under the Clinical Laboratory Fee Schedule (CLFS). A physician 
interpretation of an abnormal peripheral blood smear is considered a 
routine part of the ordered hematology lab service, such as CPT codes 
85007 and 85008 paid under the CLFS, so hospitals would receive 
duplicate payment for the facility resources associated with a 
physician's blood smear interpretation if we were to continue to pay 
separately for CPT code 85060 under the OPPS for hospital outpatients. 
Therefore, for CY 2006, we are proposing to discontinue payment under 
the OPPS for CPT code 85060 by changing its status indicator from ``X'' 
to ``B.''

XI. Proposed Payment for Observation Services

(If you choose to comment on issues in this section, please include 
the caption ``Observation Services'' at the beginning of your 
comment.)

A. Background

    Observation care is a well-defined set of specific, clinically 
appropriate services, which include ongoing short-term treatment, 
assessment, and reassessment, before a decision can be made regarding 
whether patients will require further treatment as hospital inpatients 
or if they are able to be discharged from the hospital. Observation 
status is commonly assigned to patients with unexpectedly prolonged 
recovery after surgery and to patients who present to the emergency 
department and who then require a significant period of treatment or 
monitoring before a decision is made concerning their next placement. 
For a detailed discussion of the clinical and payment history of 
observation services, refer to the November 1, 2002 final rule with 
comment period (67 FR 66794).
    Before the implementation of the OPPS in CY 2000, payment for 
observation care was made on a reasonable cost basis. With the 
initiation of the OPPS, costs for observation services were packaged 
into payments for the services with which the observation care was 
associated but no separate payment for observation services was 
implemented.
    For CY 2002, we implemented separate payment for observation 
services (APC 0339) under the OPPS for three medical conditions (chest 
pain, congestive heart failure, and asthma). Additional criteria, such 
as the billing of select diagnosis codes, an evaluation and management 
service, a minimum and maximum number of observation hours, and 
provision of certain condition-specific diagnostic tests, along with 
documentation of the physician's determination that the patient would 
benefit from observation care, were also required in order for 
hospitals to receive the separate APC payment (APC 0339) for 
observation services.
    Taking into account numerous comments from providers about the 
increased administrative burden caused by reporting requirements 
associated with payment for APC 0339 and after reviewing comments and 
recommendations by the APC Panel, we removed the mandated diagnostic 
testing requirements beginning in CY 2005 (Transmittal 514, Change 
Request 3756, released March 30, 2005). Hospitals were instructed to 
rely on clinical judgment in combination with internal and external 
quality review processes to ensure that appropriate diagnostic testing 
is provided for patients receiving high quality, medically necessary 
observation care. In an effort to further reduce administrative burden 
related to accurate billing and in response to suggestions from 
hospitals and the APC Panel, effective January 1, 2005, we clarified 
our instructions for counting time in observation care to end at the 
time the outpatient is actually discharged from the hospital or 
admitted as an inpatient. Our expectation was that specific, medically 
necessary observation services were being provided to the patient up 
until

[[Page 42743]]

the time of discharge. However, we did not expect reported observation 
time to include the time patients remain in the observation area after 
treatment is finished for reasons such as waiting for transportation 
home.
    In updating the CY 2005 OPPS, we also looked at CY 2003 claims data 
for all packaged visit-related observation care for all medical 
conditions in order to determine whether or not there were other 
diagnoses that would be candidates for separately payable observation 
services. This year, we again reviewed the most recent claims data (CY 
2004) for packaged and unpackaged observation services to assess the 
current appropriateness of the three medical conditions for separately 
payable observation services and to determine if the list of diagnosis 
codes was complete for those conditions. The APC Panel recommended at 
the February 2005 APC Panel meeting that CMS expand the list of 
diagnoses eligible for separate observation payments.
    The diagnoses currently associated with the three medical 
conditions continue to be frequently reported on OPPS visit-related 
claims with packaged observation services, and there are a large number 
of claims for separately payable observation care for the three medical 
conditions. At this time, our data show almost 80,000 claims from CY 
2004 for separately payable observation services, compared with 67,182 
for CY 2003 hospital claims. We have also explored other diagnoses that 
appeared in hospital claims data with packaged observation services. 
However, the data on packaged observation services continue to be 
incomplete and unreliable, reported using a number of different CPT 
codes with ``per day'' in their code descriptors. Some hospitals appear 
to be reporting observation services per day, while others appear to be 
reporting each hour of observation care as one unit, as we instructed 
them to do when reporting HCPCS code G0244 for separately payable 
observation. As described in section XI.B. of this preamble, we are 
proposing to make changes to hospital coding for all observation 
services for CY 2006, both separately payable and packaged. We are 
currently not convinced that there are other conditions for which there 
is a well-defined set of hospital services that are distinct from the 
services provided during a clinic or emergency visit. Moreover, 
hospital data from CY 2004 do not reflect our CY 2005 changes in 
separately payable observation policy. We also seek to gain additional 
experience with more consistent hospital billing for observation 
services, both packaged and separately payable, to guide our future 
analyses of observation care. Thus, we believe it is premature to 
expand the conditions for which we would separately pay for visit-
related observation services.

B. Proposed CY 2006 Coding Changes for Observation Services

    In response to comments received regarding the continuing 
administrative burden on hospitals when attempting to differentiate 
between packaged and separately payable observation services for 
purposes of billing correctly, and recommendations put forward by the 
APC Panel and participants at the February 2005 APC Panel meeting, we 
are proposing two changes in payment policy for observation services in 
CY 2006. First, we are proposing to discontinue HCPCS codes G0244 
(Observation care by facility to patient), G0263 (Direct admission with 
CHF, CP, asthma), and G0264 (Assessment other than CHF, CP, asthma) and 
to create two new HCPCS codes to be used by hospitals to report all 
observation services whether separately payable or packaged, and direct 
admission for observation care:
     GXXXX--Hospital observation services, per hour
     GYYYY--Direct admission of patient for hospital 
observation care
    Second, we are proposing to shift determination of whether or not 
observation services are separately payable under APC 0339 from the 
hospital billing department to the OPPS claims processing logic. That 
is, hospitals would bill GXXXX when observation services are provided 
to any patient admitted to ``observation status,'' regardless of the 
patient's status as an inpatient or outpatient. Hospitals would 
additionally bill GYYYY when observation services are the result of a 
direct admission to ``observation status'' without an associated 
emergency room visit, hospital outpatient clinic visit, or critical 
care service on the day of or day before the observation services. Both 
of these new HCPCS codes would be assigned a new status indicator that 
would trigger OCE logic during the processing of the claim to determine 
if the observation service is packaged with the other separately 
payable hospital services provided or if a separate APC payment for 
observation services is appropriate in accordance with the criteria 
discussed below in section XI.C. of this preamble. In addition, we are 
proposing to change the status indicator for CPT codes 99217 through 
99220 and 99234 through 99236 from ``N'' (packaged) to ``B'' (code not 
recognized by OPPS). We will expect hospitals to utilize GXXXX to 
accurately report all observation services provided to beneficiaries, 
whether the observation would be packaged or separately payable, to 
assist us in developing consistent and complete hospital claims data 
regarding the utilization and costs of observation services. The units 
of service reported with GXXXX would equal the number of hours the 
patient is in observation status.

C. Proposed Criteria for Separately Payable Observation Services (APC 
0339)

    For CY 2006, we are proposing to continue applying the existing CY 
2005 criteria (69 FR 65830), which determine if hospitals may receive 
separate payment for medically necessary observation care provided to a 
patient with congestive heart failure, chest pain, or asthma. In 
addition, we are proposing to continue our policy of packaging payment 
for all other observation services into the payments for the separately 
payable services with which the observation service is reported. As 
explained previously in section XI.B. of this section, the only changes 
we are proposing are related to the codes hospitals would use to report 
observation services, and the point at which a payment determination is 
made. Rather than requiring the hospital to determine prior to claims 
submission whether patient condition and the services furnished meet 
the criteria for payment of APC 0339, that determination would shift to 
the claims processing modules installed by the fiscal intermediaries to 
process all OPPS bills, thereby reducing the administrative burden on 
hospitals.
    Criteria for separate observation service payments include 
documentation of specific ICD-9-CM diagnostic codes (International 
Classification of Diseases, Ninth Edition, Clinical Modification); the 
length of time a patient is in observation status; hospital services 
provided before, during, and after the patient receives observation 
care; and ongoing physician evaluation of the patient's status.
    As we stated in Transmittal A-02-129, released in January 2003, we 
will continue to update any changes in the list of ICD-9-CM codes 
required for payment of HCPCS code GXXXX resulting from the October 1 
annual update of ICD-9-CM in the October quarterly update of the OPPS. 
In addition, changes to the ICD-9-CM codes, which are listed in Table 
30 below, would be included in the OPPS CY 2006 final rule.

[[Page 42744]]

    Below are the criteria that we are proposing to continue using in 
CY 2006 to determine if hospitals may receive separate OPPS payment for 
medically necessary observation care provided to a patient with 
congestive heart failure, chest pain, or asthma.
1. Diagnosis Requirements
    a. The beneficiary must have one of three medical conditions: 
Congestive heart failure, chest pain, or asthma.
    b. The hospital bill must report as the reason for visit or 
principal diagnosis an appropriate ICD-9-CM code (as shown in Table 30 
below) to reflect the condition.
    c. The qualifying ICD-9-CM diagnosis code must be reported in Form 
Locator (FL) 76, Patient Reason for Visit, or FL 67, principal 
diagnosis, or both, in order for the hospital to receive separate 
payment for APC 0339. If a qualifying ICD-9-CM diagnosis code(s) is 
reported in the secondary diagnosis field but is not reported in either 
the Patient Reason for Visit field (FL 76) or in the principal 
diagnosis field (FL 67), separate payment for APC 0339 will not be 
allowed.

                  Table 30.--CY 2006 Eligible Diagnosis Codes for Billing Observation Services
----------------------------------------------------------------------------------------------------------------
                                                 Eligible ICD-
             Required diagnosis for                9-CM code                     Code descriptor
----------------------------------------------------------------------------------------------------------------
Chest pain.....................................         411.0   Postmyocardial infarction syndrome.
                                                        411.1   Intermediate coronary syndrome.
                                                        411.81  Coronary occlusion without myocardial
                                                                 infarction.
                                                        411.89  Other acute ischemic heart disease.
                                                        413.0   Angina decubitus.
                                                        413.1   Prinzmetal angina.
                                                        413.9   Other and unspecified angina pectoris.
                                                        786.05  Shortness of breath.
                                                        786.50  Chest pain, unspecified.
                                                        786.51  Precordial pain.
                                                        786.52  Painful respiration.
                                                        786.59  Other chest pain.
Asthma.........................................         493.01  Extrinsic asthma with status asthmaticus.
                                                        493.02  Extrinsic asthma with acute exacerbation.
                                                        493.11  Intrinsic asthma with status asthmaticus.
                                                        493.12  Intrinsic asthma with acute exacerbation.
                                                        493.21  Chronic obstructive asthma with status
                                                                 asthmaticus.
                                                        493.22  Chronic obstructive asthma with acute
                                                                 exacerbation.
                                                        493.91  Asthma, unspecified with status asthmaticus.
                                                        493.92  Asthma, unspecified with acute exacerbation.
Heart Failure..................................         391.8   Other acute rheumatic heart disease.
                                                        398.91  Rheumatic heart failure (congestive).
                                                        402.01  Malignant hypertensive heart disease with
                                                                 congestive heart failure.
                                                        402.11  Benign hypertensive heart disease with
                                                                 congestive heart failure.
                                                        402.91  Unspecified hypertensive heart disease with
                                                                 congestive heart failure.
                                                        404.01  Malignant hypertensive heart and renal disease
                                                                 with congestive heart failure.
                                                        404.03  Malignant hypertensive heart and renal disease
                                                                 with congestive heart and renal failure.
                                                        404.11  Benign hypertensive heart and renal disease with
                                                                 congestive heart failure.
                                                        404.13  Benign hypertensive heart and renal disease with
                                                                 congestive heart and renal failure.
                                                        404.91  Unspecified hypertensive heart and renal disease
                                                                 with congestive heart failure.
                                                        404.93  Unspecified hypertensive heart and renal disease
                                                                 with heart and renal failure.
                                                        428.0   Congestive heart failure.
                                                        428.1   Left heart failure.
                                                        428.20  Unspecified systolic heart failure.
                                                        428.21  Acute systolic heart failure.
                                                        428.22  Chronic systolic heart failure.
                                                        428.23  Acute on chronic systolic heart failure.
                                                        428.30  Unspecified diastolic heart failure.
                                                        428.31  Acute diastolic heart failure.
                                                        428.32  Chronic diastolic heart failure.
                                                        428.33  Acute on chronic diastolic heart failure.
                                                        428.40  Unspecified combined systolic and diastolic
                                                                 heart failure.
                                                        428.41  Acute combined systolic and diastolic heart
                                                                 failure.
                                                        428.42  Chronic combined systolic and diastolic heart
                                                                 failure.
                                                        428.43  Acute on chronic combined systolic and diastolic
                                                                 heart failure.
                                                        428.9   Heart failure, unspecified.
----------------------------------------------------------------------------------------------------------------

2. Observation Time
    a. Observation time must be documented in the medical record.
    b. A beneficiary's time in observation (and hospital billing) 
begins with the beneficiary's admission to an observation bed.
    c. A beneficiary's time in observation (and hospital billing) ends 
when all clinical or medical interventions have been completed, 
including followup care furnished by hospital staff and physicians that 
may take place after a physician has ordered the patient be released or 
admitted as an inpatient.
    d. The number of units reported with HCPCS code GXXXX must equal or 
exceed 8 hours.
3. Additional Hospital Services
    a. The hospital must provide on the same day or the day before and 
report on the bill:

[[Page 42745]]

     An emergency department visit (APC 0610, 0611, or 0612),
     A clinic visit (APC 0600, 0601, or 0602), or
     Critical care (APC 0620).
    b. No procedure with a ``T'' status indicator can be reported on 
the same day or day before observation care is provided.
4. Physician Evaluation
    a. The beneficiary must be in the care of a physician during the 
period of observation, as documented in the medical record by 
admission, discharge, and other appropriate progress notes that are 
timed, written, and signed by the physician.
    b. The medical record must include documentation that the physician 
explicitly assessed patient risk to determine that the beneficiary 
would benefit from observation care.

D. Separate Payment for Direct Admission to Observation Care (APC 0600)

    For CY 2006, we are proposing to continue paying for direct 
admission to observation at a rate equal to that of a Level I Clinic 
Visit when a Medicare beneficiary is directly admitted into a hospital 
outpatient department for observation care that does not qualify for 
separate payment under APC 0339. In order to receive separate payment 
for a direct admission into observation (APC 0600), the claim must 
show:
    1. Both HCPCS codes GXXXX (Hourly Observation) and GYYYY (Direct 
Admit to Observation) with the same date of service.
    2. That no services with a status indicator ``T'' or ``V'' were 
provided on the same day of service as HCPCS code GYYYY.

XII. Procedures That Will Be Paid Only as Inpatient Procedures

(If you choose to comment on issues in this section, please include 
the caption ``Inpatient Procedures'' at the beginning of your 
comment.)

A. Background

    Section 1833(t)(B)(i) of the Act gives the Secretary broad 
authority to determine the services to be covered and paid for under 
the OPPS. Before implementation of the OPPS in August 2000, Medicare 
paid reasonable costs for services provided in the outpatient 
department. The claims submitted were subject to medical review by the 
fiscal intermediaries to determine the appropriateness of providing 
certain services in the outpatient setting. We did not specify in 
regulations those services that were appropriate to provide only in the 
inpatient setting and that, therefore, should be payable only when 
provided in that setting.
    In the April 7, 2000 final rule with comment period, 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 because of the 
nature of the procedure, the need for at least 24 hours of 
postoperative recovery time or monitoring before the patient can be 
safely discharged, or the underlying physical condition of the patient. 
As we discussed in the April 7, 2000 final rule with comment period (65 
FR 18455) and the November 30, 2001 final rule (66 FR 59856), we use 
the following criteria when reviewing procedures to determine whether 
or not they should be moved from the inpatient list and assigned to an 
APC group for payment under the OPPS:
     Most outpatient departments are equipped to provide the 
services to the Medicare population.
     The simplest procedure described by the code may be 
performed in most outpatient departments.
     The procedure is related to codes that we have already 
removed from the inpatient list.
    In the November 1, 2002 final rule with comment period (67 FR 
66792), we removed 43 procedures from the inpatient list for payment 
under OPPS. We also 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:
     We have determined that the procedure is being performed 
in multiple hospitals on an outpatient basis; or
     We have determined that the procedure can be appropriately 
and safely performed in an ambulatory surgical center (ASC) and is on 
the list of approved ASC procedures or proposed by us for addition to 
the ASC list.
    We believe that these additional criteria help us to identify 
procedures that are appropriate for removal from the inpatient list.
    In the November 7, 2003 final rule with comment period (68 FR 
63465), no significant changes were made to the inpatient list. In the 
November 15, 2004 final rule 5with comment period (69 FR 65834), we 
removed 22 procedures from the inpatient list, effective for services 
furnished on or after January 1, 2005.

B. Proposed Changes to the Inpatient List

    We used the same methodology as described in the November 15, 2004 
final rule with comment period (69 FR 65837) to identify a subset of 
procedures currently on the inpatient list that were being widely 
performed on an outpatient basis. These procedures were then clinically 
reviewed for possible removal from the inpatient list. We solicited 
input from the APC Panel on the appropriateness of the removal of 26 
procedures from the inpatient list at the February 2005 APC Panel 
meeting. The APC Panel recommended that these 26 procedures be removed 
from the list and further recommended that CMS consider CPT code 37183 
(Remove hepatic shunt (TIPS)) for removal. We agree with the APC 
Panel's recommendation that CPT code 37183 be removed from the 
inpatient list for CY 2006 and we are proposing to remove it from the 
inpatient list.
    However, subsequent to the APC Panel's February 2005 meeting, we 
conducted further clinical evaluations of three procedures (CPT codes 
33420, 65273, and 59856) included among the 26 procedures that the APC 
Panel recommended for removal from the inpatient list. Upon further 
clinical evaluation of CPT code 33420 (Valvotomy, mitral valve; closed 
heart), we believe that the utilization data suggesting that this 
procedure is an office-based procedure were errant. Additional sources 
of utilization data suggest that this procedure is predominately 
performed on an inpatient basis. Concomitant with not meeting our 
criteria of being performed on an outpatient basis in multiple 
hospitals and not appearing on the ASC list of approved procedures, we 
are not compelled to support the removal of this procedure from the 
inpatient list. For this reason, we are proposing to retain CPT code 
33420 on the inpatient list for CY 2006.
    CPT codes 65273 and 59856 were similarly reevaluated because of our 
concern with the HCPCS long descriptors for these two codes. The long 
descriptors for these codes are as follows: CPT code 65273 (Repair of 
laceration; conjunctiva, by mobilization and rearrangement, with 
hospitalization) and CPT code 59856 (Induced abortion, by one or more 
vaginal suppositories (eg, prostaglandin) with or without cervical 
dilation (eg, laminaria), including hospital admission and visits, 
delivery of fetus and secundines; with dilation and

[[Page 42746]]

curettage and/or evacuation). The long descriptors indicate that 
hospital admission or hospitalization is included in the codes for 
these two procedures, which leads us to believe that these two 
procedures do not meet the established criteria for removal from the 
inpatient list. The same code descriptor for CPT code 65273, but 
without hospitalization, is assigned to CPT code 65272, which is 
already separately payable under the OPPS. Therefore, we are proposing 
to retain CPT codes 65273 and 59856 on the inpatient list for CY 2006.
    In addition, we are proposing to remove CPT code 62160 
(Neuroendoscopy) from the inpatient list. Questions about this service 
have been raised to us by the hospital community because CPT code 62160 
is an add-on CPT code (that is, a code that is commonly performed as an 
``additional or supplemental'' procedure to the primary procedure). Two 
of the separately coded services that CPT indicates are to be used with 
the add-on code are currently payable under the OPPS. Further clinical 
evaluation of this add-on procedure and its use in various sites of 
service leads us to believe it is appropriate for removal from the 
inpatient list.
    Therefore, for CY 2006, we are proposing to remove 25 procedures 
from the inpatient list and to assign 23 of these procedures to 
clinically appropriate APCs, as shown below in Table 31. We are not 
proposing to assign two of these procedures to APC groups, that is, CPT 
codes 00634 (Anesthesia for procedures in lumbar region; 
chemonucleoysis) and 01190 (Anesthesia for obturator neurectomy; 
intrapelvic) because they are anesthesia procedures for which a 
separate payment is not made under the OPPS. Payment for these two 
procedures would be packaged into the procedures with which they are 
billed. The proposed changes to the inpatient list would be effective 
for services furnished on or after January 1, 2006.

Table 31.--Proposed Procedure Codes to Remove From Inpatient List and Proposed APC Assignment, Effective January
                                                     1, 2006
----------------------------------------------------------------------------------------------------------------
                                                                        New APC      Old status      New status
          HCPCS                         Long descriptor                assignment     indicator      indicator
----------------------------------------------------------------------------------------------------------------
00634....................  ANESTHESIA FOR PROCEDURES IN LUMBAR                n/a  C               N
                            REGION; CHEMONUCLEOLYSIS.
01190....................  ANESTHESIA FOR OBTURATOR NEURECTOMY;               n/a  C               N
                            INTRAPELVIC.
20662....................  APPLICATION OF HALO, INCLUDING REMOVAL;           0049  C               T
                            PELVIC.
20663....................  APPLICATION OF HALO, INCLUDING REMOVAL;           0049  C               T
                            FEMORAL.
20822....................  REPLANTATION, DIGIT, EXCLUDING THUMB              0054  C               T
                            (INCLUDES DISTAL TIP TO SUBLIMIS TENDON
                            INSERTION), COMPLETE AMPUTATION.
20972....................  FREE OSTEOCUTANEOUS FLAP WITH                     0056  C               T
                            MICROVASCULAR ANASTOMOSIS; METATARSAL.
20973....................  FREE OSTEOCUTANEOUS FLAP WITH                     0056  C               T
                            MICROVASCULAR ANASTOMOSIS; GREAT TOE
                            WITH WEB SPACE.
21150....................  RECONSTRUCTION MIDFACE, LEFORT II;                0256  C               T
                            ANTERIOR INTRUSION (EG, TREACHER-COLLINS
                            SYNDROME).
21175....................  RECONSTRUCTION, BIFRONTAL, SUPERIOR-              0256  C               T
                            LATERAL ORBITAL RIMS AND LOWER FOREHEAD,
                            ADVANCEMENT OR ALTERATION (EG,
                            PLAGIOCEPHALY, TRIGONOCEPHALY,
                            BRACHYCEPHALY), WITH OR WITHOUT GRAFTS
                            (INCLUDES OBTAINING AUTOGRAFTS).
21195....................  RECONSTRUCTION OF MANDIBULAR RAMI AND/OR          0256  C               T
                            BODY, SAGITTAL SPLIT; WITHOUT INTERNAL
                            RIGID FIXATION.
21408....................  OPEN TREATMENT OF FRACTURE OF ORBIT,              0256  C               T
                            EXCEPT BLOWOUT; WITH BONE GRAFTING
                            (INCLUDES OBTAINING GRAFT).
21495....................  OPEN TREATMENT OF HYOID FRACTURE.........         0253  C               T
27475....................  ARREST, EPIPHYSEAL, ANY METHOD (EG,               0050  C               T
                            EPIPHYSIODESIS); DISTAL FEMUR.
31293....................  NASAL/SINUS ENDOSCOPY, SURGICAL; WITH             0075  C               T
                            MEDIAL ORBITAL WALL AND INFERIOR ORBITAL
                            WALL DECOMPRESSION.
31294....................  NASAL/SINUS ENDOSCOPY, SURGICAL; WITH             0075  C               T
                            OPTIC NERVE DECOMPRESSION.
36510....................  CATHETERIZATION OF UMBILICAL VEIN FOR              n/a  C               T
                            DIAGNOSIS OR THERAPY, NEWBORN.
37183....................  REMOVE HEPATIC SHUNT (TIPS)..............         0229  C               T
37195....................  THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS            0676  C               T
                            INFUSION.
54560....................  EXPLORATION FOR UNDESCENDED TESTIS WITH           0183  C               T
                            ABDOMINAL EXPLORATION.
55600....................  VESICULOTOMY.............................         0183  C               T
59100....................  HYSTEROTOMY, ABDOMINAL (EG, FOR                   0195  C               T
                            HYDATIDIFORM MOLE, ABORTION).
61334....................  EXPLORATION OF ORBIT (TRANSCRANIAL                0256  C               T
                            APPROACH); WITH REMOVAL OF FOREIGN BODY.
62160....................  NEUROENDOSCOPY...........................         0122  C               T
64763....................  TRANSECTION OR AVULSION OF OBTURATOR              0220  C               T
                            NERVE, EXTRAPELVIC, WITH OR WITHOUT
                            ADDUCTOR TENOTOMY.
64766....................  TRANSECTION OR AVULSION OF OBTURATOR              0221  C               T
                            NERVE, INTRAPELVIC, WITH OR WITHOUT
                            ADDUCTOR TENOTOMY.
----------------------------------------------------------------------------------------------------------------


[[Page 42747]]

C. Ancillary Outpatient Services When Patient Expires (-CA Modifier)

(If you choose to comment on issues in this section, please include 
the caption ``Ancillary Outpatient Services'' at the beginning of 
your comment.)

In the November 1, 2002 final rule with comment period (67 FR 66798), 
we discussed the creation of a new HCPCS modifier -CA to address 
situations where a procedure on the OPPS inpatient list must be 
performed to resuscitate or stabilize a patient (whose status is that 
of an outpatient) with an emergent, life-threatening condition, and the 
patient dies before being admitted as an inpatient. In Transmittal A-
02-129, issued on January 3, 2003, we instructed hospitals on the use 
of this modifier when submitting a claim on bill type 13x for a 
procedure that is on the inpatient list and assigned the payment status 
indicator (SI) ``C.'' Conditions to be met for hospital payment for a 
claim reporting a service billed with modifier -CA include a patient 
with an emergent, life-threatening condition on whom a procedure on the 
inpatient list is performed on an emergency basis to resuscitate or 
stabilize the patient. For CY 2003, a single payment for otherwise 
payable outpatient services billed on a claim with a procedure appended 
with this new -CA modifier was made under APC 0977 (New Technology 
Level VIII, $1,000-$1,250), due to the lack of available claims data to 
establish a payment rate based on historical hospital costs.
    As discussed in the November 7, 2003 final rule with comment 
period, we created APC 0375 to pay for services furnished on the same 
date as a procedure with SI ``C'' and billed with the modifier -CA (68 
FR 63467) because we were concerned that payment under a New Technology 
APC would not result in an appropriate payment. Payment under a New 
Technology APC is a fixed amount that does not have a relative payment 
weight and, therefore, is not subject to recalibration based on 
hospital costs. In the absence of hospital claims data to determine 
costs, the clinical APC 0375 payment rate for CY 2004 was set at of 
$1,150, which was the payment amount for the newly structured New 
Technology APC that replaced APC 0977.
    For CY 2005, payment for otherwise payable outpatient services 
furnished on the same date of service that a procedure with SI ``C'' 
was performed on an emergent basis on an outpatient who died before 
inpatient admission and where modifier -CA was appended to the 
inpatient procedure continued to be made under APC 0375 (Ancillary 
Outpatient Services When Patient Expires) at a payment rate of 
$3,217.47. As discussed in the November 15, 2004 final rule with 
comment period (69 FR 65841), the payment median was set in accordance 
with the same methodology we followed to set payment rates for the 
other procedural APCs in CY 2005, based on the relative payment weight 
calculated for APC 0375. A review of the 18 hospital claims utilized 
for ratesetting revealed a reasonable mix of outpatient services that a 
hospital could be expected to furnish during an encounter with a 
patient with an emergency condition requiring immediate medical 
intervention, as well as a wide range of costs.
    For CY 2006, we are not proposing any changes to our payment policy 
for services billed on the same date as a ``C'' status procedure 
appended with modifier -CA. We are proposing to continue to make one 
payment under APC 0375 for the services that meet the specific 
conditions discussed in previous rules for using modifier -CA, based on 
calculation of the relative payment weight for APC 0375, using charge 
data from CY 2004 claims for line items with a HCPCS code and status 
indicator ``V,'' ``S,'' ``T,'' ``X,'' ``N,'' ``K,'' ``G,'' and ``H,'' 
in addition to charges for revenue codes without a HCPCS code.
    In accordance with this methodology, for CY 2006, we calculated a 
median cost of $2,528.61 for APC 0375 for the aggregated otherwise 
payable outpatient hospital services based on 300 CY 2004 hospital 
claims reporting modifier -CA with an inpatient procedure. These 300 
claims were billed by 218 different hospital providers, each submitting 
between 1 and 10 claims with modifier -CA appended to a ``C'' status 
procedure. This median cost for APC 0375 is relatively consistent with 
the median calculated for the CY 2005 OPPS update, and, as expected, 
the hospital claims once again show a wide range of costs. 
Nevertheless, we are concerned with the very large increase in the 
volume of hospital claims billed with the -CA modifier from CY 2003 to 
CY 2004, growing from 18 to 300 claims over that 1-year time period. We 
acknowledge that modifier -CA was first introduced quite recently in CY 
2003, and in CY 2003 and CY 2004 hospitals may have been experiencing a 
learning curve with respect to its appropriate use on claims for 
services payable under the OPPS.
    However, our clinical review of the 300 claims reporting modifier -
CA lends some support to our early concerns regarding the increased CY 
2004 modifier volume and hospitals' possible incorrect use of the 
modifier for services that do not meet the payment conditions we 
established. Hospitals should be using this modifier only under 
circumstances described in section VI. of Transmittal A-02-129, which 
provided specific billing guidance for the use of modifier -CA. In 
addition to expected use of the -CA modifier for exploratory 
laparotomies and insertions of intra-aortic balloon assist devices, 
other unanticipated examples of ``C'' status procedures reported with 
the -CA modifier by hospitals in CY 2004 include knee arthroplasty, 
thyroidectomy, repair of nonunion or malunion of the femur, and 
thromboendarterectomy of the carotid, vertebral, or subclavian 
arteries. Moreover, few of the claims also include a clinic or 
emergency room visit on the same date of service as the procedure 
appended with modifier -CA, as might be expected for some patients 
presenting to a hospital with serious medical conditions which require 
urgent interventions with inpatient procedures. We are concerned that 
some procedures reported by hospitals with the -CA modifier in CY 2004 
may not have been provided to patients with emergent, life-threatening 
conditions, where the inpatient procedure was performed on an emergency 
basis to resuscitate or stabilize the patient. Instead, those 
procedures may have been provided to hospital outpatients as scheduled 
inpatient procedures that were not emergency interventions for patients 
in critical or unstable condition and such circumstances would have 
been inconsistent with our billing and payment rules regarding correct 
use of the -CA modifier to receive payment for APC 0375. In light of 
these claims findings and our current analysis, we will continue to 
closely monitor hospital use of modifier -CA, following changes in the 
claims volume, noting inpatient procedures to which the -CA modifier is 
appended, examining other services billed on the same date as the 
inpatient procedure, and analyzing specific hospital patterns of 
billing for services with modifier -CA appended, to assess whether a 
proposal to change our policies regarding payment for APC 0375 would be 
warranted in the future or whether hospitals require further education 
regarding correct use of the modifier -CA.

XIII. Proposed Indicator Assignments

A. Proposed Status Indicator Assignments

(If you choose to comment on issues in the section, please include 
the caption ``Status

[[Page 42748]]

Indicator'' at the beginning of your comment.)

    The payment status indicators (SIs) that we assign to HCPCS codes 
and APCs under the OPPS play an important role in determining payment 
for services under the OPPS because they indicate whether a service 
represented by a HCPCS code is payable under the OPPS or another 
payment system and also whether particular OPPS policies apply to the 
code. For CY 2006, we are providing our proposed status indicator 
assignments for APCs in Addendum A, for the HCPCS codes in Addendum B, 
and the definitions of the status indicators in Addendum D1 to this 
proposed rule.
    Payment under the OPPS is based on HCPCS codes for medical and 
other health services. These codes are used for a wide variety of 
payment systems under Medicare, including, but not limited to, the 
Medicare fee schedule for physician services, the Medicare fee schedule 
for durable medical equipment and prosthetic devices, and the Medicare 
clinical laboratory fee schedule. For purposes of making payment under 
the OPPS, we must be able to signal the claims processing system 
through the OCE software as to HCPCS codes that are paid under the OPPS 
and those codes to which particular OPPS payment policies apply. We 
accomplish this identification in the OPPS through the establishment of 
a system of status indicators with specific meanings. Addendum D1 
contains the proposed definitions of each status indicator for purposes 
of the OPPS for CY 2006.
    We assign one and only one status indicator to each APC and to each 
HCPCS code. Each HCPCS code that is assigned to an APC has the same 
status indicator as the APC to which it is assigned.
    Specifically, for CY 2006, we are proposing to use the following 
status indicators in the specified manner:
     ``A'' to indicate services that are billable to fiscal 
intermediaries but are paid under some payment method other than OPPS, 
such as under the durable medical equipment, prosthetics, orthotics, 
and supplies (DMEPOS) fee schedule or the Medicare Physician Fee 
Schedule. Some, but not all, of these other payment systems are 
identified in Addendum D1 to this proposed rule.
     ``B'' to indicate the services that are billable to fiscal 
intermediaries but are not payable under the OPPS when submitted on an 
outpatient hospital Part B bill type, but that may be payable by fiscal 
intermediaries to other provider types when submitted on an appropriate 
bill type.
     ``C'' to indicate inpatient services that are not payable 
under the OPPS.
     ``D'' to indicate a code that is discontinued, effective 
January 1, 2006.
     ``E'' to indicate items or services that are not covered 
by Medicare or codes that are not recognized by Medicare.
     ``F'' to indicate acquisition of corneal tissue which is 
paid on a reasonable cost basis, certain CRNA services, and hepatitis B 
vaccines that are paid on a reasonable cost basis.
     ``G'' to indicate drugs and biologicals that are paid 
under the OPPS transitional pass-through rules.
     ``H'' to indicate pass-through devices, brachytherapy 
sources, and separately payable radiopharmaceuticals that are paid on a 
cost basis.
     ``K'' to indicate drugs and biologicals (including blood 
and blood products) and radiopharmaceutical agents that are paid in 
separate APCs under the OPPS, but that are not paid under the OPPS 
transitional pass-through rules.
     ``L'' to indicate flu and pneumococcal immunizations that 
are paid at reasonable cost but to which no coinsurance or copayment 
apply.
     ``M'' to indicate services that are only billable to 
carriers and not to fiscal intermediaries and that are not payable 
under the OPPS.
     ``N'' to indicate services that are paid under the OPPS, 
but for which payment is packaged into another service or APC group.
     ``P'' to indicate services that are paid under the OPPS, 
but only in partial hospitalization programs.
     ``Q'' to indicate packaged services subject to separate 
payment under OPPS payment criteria.
     ``S'' to indicate significant services subject to separate 
payment under the OPPS.
     ``T'' to indicate significant services that are paid under 
the OPPS and to which the multiple procedure payment discount under the 
OPPS applies.
     ``V'' to indicate medical visits (including emergency 
department or clinic visits) that are paid under the OPPS.
     ``X'' to indicate ancillary services that are paid under 
the OPPS.
     ``Y'' to indicate nonimplantable durable medical equipment 
that must be billed directly to the durable medical equipment regional 
carrier rather than to the fiscal intermediary.
    We are proposing the payment status indicators identified above, of 
which indicators ``M'' and ``Q'' are new for CY 2006, for each HCPCS 
code and each APC listed in Addenda A and B and are requesting comments 
on the appropriateness of the indicators we have assigned.

B. Proposed Comment Indicators for the CY 2006 OPPS Final Rule

(If you choose to comment on issues in the section, please include 
the caption ``Comment Indicator'' at the beginning of your comment.)

    We are proposing to continue our use of the two comment indicators 
finalized in the November 15, 2004 final rule with comment period (69 
FR 65827 and 65828) to identify in the CY 2006 OPPS final rule the 
assignment status of a specific HCPCS code to an APC and the timeframe 
when comments on the HCPCS APC assignment will be accepted. The two 
comment indicators are listed below, and in Addendum D2 of this 
proposed rule:
     ``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.

XIV. Proposed Nonrecurring Policy Changes

A. Proposed Payments for Multiple Diagnostic Imaging Procedures

(If you choose to comment on issues in this section, please include 
the caption ``Multiple Diagnostic Imaging Procedures'' at the 
beginning of your comment.)

    Currently, under the OPPS, hospitals billing for diagnostic imaging 
procedures receive full APC payments for each service on a claim, 
regardless of how many procedures are performed using a single imaging 
modality and whether or not contiguous areas of the body are studied in 
the same session. In its March 2005 Report to Congress, MedPAC 
recommended that the Secretary should improve Medicare coding edits 
that detect unbundled diagnostic imaging services and reduce the 
technical component payment for multiple imaging services when they are 
performed on contiguous areas of the body (Recommendation 3-B). MedPAC 
pointed out that Medicare's payment rates are based on each service 
being provided independently and that the rates do not account for 
efficiencies that may be gained when multiple studies using the same 
imaging modality are performed in the same session. Those efficiencies 
are especially likely when contiguous body areas are the focus of the 
imaging because the patient and

[[Page 42749]]

equipment have already been prepared for the second and subsequent 
procedures, potentially yielding resource savings in areas such as 
clerical time, technical preparation, and supplies, elements of 
hospital costs for imaging procedures that are reflected in APC payment 
rates under the OPPS.
    Under the OPPS, we have a longstanding policy of reducing payment 
for multiple surgical procedures performed on the same patient in the 
same operative session (Sec.  419.44(a) of the regulations). In such 
cases, full payment is made for the procedure with the highest APC 
payment rate, and each subsequent procedure is paid at 50 percent of 
its respective APC payment rate. We believe that a similar policy for 
payment of diagnostic imaging services would be more appropriate than 
our current policy because it would lead to more appropriate payment 
for multiple imaging procedures of contiguous body areas that are 
performed during the same session.
    In our efforts to determine whether or not such a policy would 
improve the accuracy of OPPS payments, we identified 11 ``families'' of 
imaging procedures by imaging modality (ultrasound, computerized 
tomography (CT) and computerized tomography angiography (CTA), magnetic 
resonance imaging (MRI) and magnetic resonance angiography (MRA)) and 
contiguous body area (for example, CT and CTA of Chest/Thorax/Abdomen/
Pelvis), as displayed in Table 32. Using those Families of procedures, 
we examined OPPS bills for CY 2004 and found that there were numerous 
claims reporting more than one imaging procedure within the same Family 
provided to a beneficiary by a hospital on the same day. For instance, 
of the approximately 2.7 million OPPS claims billed for services within 
Family 2 (CT and CTA of the Chest/Thorax/Abdomen/Pelvis), approximately 
1.1 million were claims for multiple procedures within Family 2. In 
particular, there were 288,200 claims for the combination of CPT codes 
72192 (CT of the pelvis without dye) and 74150 (CT of the abdomen 
without dye).

 Table 32.--Multiple Imaging Procedures Families by Imaging Modality and
                          Contiguous Body Area
------------------------------------------------------------------------
                                           Imaging modality/contiguous
                 Family                             body area
------------------------------------------------------------------------
Family 1--Ultrasound (Chest/Abdomen/
 Pelvis--Non-Obstetrical):
    76604..............................  Us exam, chest, b-scan.
    76645..............................  Us exam, breast(s).
    76700..............................  Us exam, abdom, complete.
    76705..............................  Echo exam of abdomen.
    76770..............................  Us exam abdo back wall, comp.
    76775..............................  Us exam abdo back wall, lim.
    76778..............................  Us exam kidney transplant.
    76830..............................  Transvaginal us, non-ob.
    76831..............................  Echo exam, uterus.
    76856..............................  Us exam, pelvic, complete.
    76857..............................  Us exam, pelvic, limited.
Family 2--CT and CTA (Chest/Thorax/Abd/
 Pelvis):
    71250..............................  Ct thorax w/o dye.
    71260..............................  Ct thorax w/ dye.
    71270..............................  Ct thorax w/o & w/ dye.
    72192..............................  Ct pelvis w/o dye.
    72193..............................  Ct pelvis w/ dye.
    72194..............................  Ct pelvis w/o & w/ dye.
    74150..............................  Ct abdomen w/o dye.
    74160..............................  Ct abdomen w/ dye.
    74170..............................  Ct abdomen w/o & w/ dye.
    71275..............................  Ct angiography, chest.
    72191..............................  Ct angiography, pelv w/o & w/
                                          dye.
    74175..............................  Ct angiography, abdom w/o & w/
                                          dye.
    75635..............................  Ct angio abdominal arteries.
    0067T..............................  Ct colonography; dx.
Family 3--CT and CTA (Head/Brain/Orbit/
 Maxillofacial/Neck):
    70450..............................  Ct head/brain w/o dye.
    70460..............................  Ct head/brain w/ dye.
    70470..............................  Ct head/brain w/o & w/ dye.
    70480..............................  Ct orbit/ear/fossa w/o dye.
    70481..............................  Ct orbit/ear/fossa w/ dye.
    70482..............................  Ct orbit/ear/fossa w/o & w/
                                          dye.
    70486..............................  Ct maxillofacial w/o dye.
    70487..............................  Ct maxillofacial w/ dye.
    70488..............................  Ct maxillofacial w/o & w/ dye.
    70490..............................  Ct soft tissue neck w/o dye.
    70491..............................  Ct soft tissue neck w/ dye.
    70492..............................  Ct soft tissue neck w/o & w/
                                          dye.
    70496..............................  Ct angiography, head.
    70498..............................  Ct angiography, neck.
Family 4--MRI and MRA (Chest/Abd/
 Pelvis):
    71550..............................  Mri chest w/o dye.
    71551..............................  Mri chest w/ dye.
    71552..............................  Mri chest w/o & w/ dye.
    72195..............................  Mri pelvis w/o dye.
    72196..............................  Mri pelvis w/ dye.
    72197..............................  Mri pelvis w/o &w/ dye.
    74181..............................  Mri abdomen w/o dye.

[[Page 42750]]

 
    74182..............................  Mri abdomen w/ dye.
    74183..............................  Mri abdomen w/o and w/ dye.
    C8900..............................  MRA w/contrast, abdomen.
    C8901..............................  MRA w/o contrast, abdomen.
    C8902..............................  MRA w/o fol w/contrast, abd.
    C8903..............................  MRI w/contrast, breast,
                                          unilateral.
    C8904..............................  MRI w/o contrast, breast,
                                          unilateral.
    C8905..............................  MRI w/o fol w/contrast, breast,
                                          uni.
    C8906..............................  MRI w/contrast, breast,
                                          bilateral.
    C8907..............................  MRI w/o contrast, breast,
                                          bilateral.
    C8908..............................  MRI w/o fol w/contrast, breast,
                                          bilat.
    C8909..............................  MRA w/contrast, chest.
    C8910..............................  MRA w/o contrast, chest.
    C8911..............................  MRA w/o fol w/contrast, chest.
    C8918..............................  MRA w/contrast, pelvis.
    C8919..............................  MRA w/o contrast, pelvis.
    C8920..............................  MRA w/o fol w/contrast, pelvis.
Family 5--MRI and MRA (Head/Brain/
 Neck):
    70540..............................  Mri orbit/face/neck w/o dye.
    70542..............................  Mri orbit/face/neck w/ dye.
    70543..............................  Mri orbit/face/neck w/o & w/
                                          dye.
    70551..............................  Mri brain w/o dye.
    70552..............................  Mri brain w/dye.
    70553..............................  Mri brain w/o & w/dye.
    70544..............................  Mr angiography head w/o dye.
    70545..............................  Mr angiography head w/dye.
    70546..............................  Mr angiography head w/o & w/
                                          dye.
    70547..............................  Mr angiography neck w/o dye.
    70548..............................  Mr angiography neck w/dye.
    70549..............................  Mr angiography neck w/o & w/
                                          dye.
Family 6--MRI and MRA (Spine):
    72141..............................  Mri neck spine w/o dye.
    72142..............................  Mri neck spine w/dye.
    72146..............................  Mri chest spine w/o dye.
    72147..............................  Mri chest spine w/dye.
    72148..............................  Mri lumbar spine w/o dye.
    72149..............................  Mri lumbar spine w/dye.
    72156..............................  Mri neck spine w/o & w/dye.
    72157..............................  Mri chest spine w/o & w/dye.
    72158..............................  Mri lumbar spine w/o & w/dye.
Family 7--CT (Spine):
    72125..............................  CT neck spine w/o dye.
    72126..............................  Ct neck spine w/dye.
    72127..............................  Ct neck spine w/o & w/dye.
    72128..............................  Ct chest spine w/o dye.
    72129..............................  Ct chest spine w/dye.
    72130..............................  Ct chest spine w/o & w/dye.
    72131..............................  Ct lumbar spine w/o dye.
    72132..............................  Ct lumbar spine w/dye.
    72133..............................  Ct lumbar spine w/o & w/dye.
Family 8--MRI and MRA (Lower
 Extremities):
    73718..............................  Mri lower extremity w/o dye.
    73719..............................  Mri lower extremity w/dye.
    73720..............................  Mri lower ext w/ & w/o dye.
    73721..............................  Mri joint of lwr extre w/o dye.
    73722..............................  Mri joint of lwr extr w/dye.
    73723..............................  Mri joint of lwr extr w/o & w/
                                          dye.
    C8912..............................  MRA w/contrast, lwr extremity.
    C8913..............................  MRA w/o contrast, lwr
                                          extremity.
    C8914..............................  MRA w/o fol w/contrast, lwr
                                          extremity.
Family 9--CT and CTA (Lower
 Extremities):
    73700..............................  Ct lower extremity w/o dye.
    73701..............................  Ct lower extremity w/dye.
    73702..............................  Ct lower extremity w/o & w/dye.
    73706..............................  Ct angio lower ext w/o & w/dye.
Family 10--Mr and MRI (Upper
 Extremities and Joints):
    73218..............................  Mri upper extr w/o dye.
    73219..............................  Mri upper extr w/dye.
    73220..............................  Mri upper extremity w/o & w/
                                          dye.
    73221..............................  Mri joint upper extr w/o dye.
    73222..............................  Mri joint upper extr w/dye.

[[Page 42751]]

 
    73223..............................  Mri joint upper extr w/o & w/
                                          dye.
Family 11--CT and CTA (Upper
 Extremities):
    73200..............................  Ct upper extremity w/o dye.
    73201..............................  Ct upper extremity w/dye.
    73202..............................  Ct upper extremity w/o & w/dye.
    73206..............................  Ct angio upper extr w/o & w/
                                          dye.
------------------------------------------------------------------------

    The imaging procedures described by CPT codes 72192 and 74150 study 
two adjacent body regions. Appropriate diagnostic evaluation of many 
constellations of patients' signs and symptoms and potentially affected 
organ systems may involve assessment of pathology in both the abdomen 
and pelvis, body areas that are anatomically and functionally closely 
related. Therefore, both studies are frequently performed in the same 
session to provide the necessary clinical information to diagnose and 
treat a patient. Although each procedure, by itself, entails the use of 
hospital resources, including certain staff, equipment, and supplies, 
some of those resource costs are not incurred twice when the procedures 
are performed in the same session and thus, should not be paid as if 
they were. Beginning with the beneficiary's arrival in the outpatient 
department, costs are incurred only once for registering the patient, 
taking the patient to the procedure room, positioning the patient on 
the table for the CT scan, among others. We believe it is clear that 
reducing the payment for the second and subsequent procedures within 
the identified families would result in more accurate payments with 
respect to the hospital resources utilized for multiple imaging 
procedures performed in the same session.
    OPPS bills do not contain detailed information on the hospitals' 
costs that are incurred in furnishing imaging procedures. Much of the 
costs are packaged and included in the overall charges for the 
procedures. Even if bundled costs are reported with charges on separate 
lines either with HCPCS codes or with revenue codes, when there are 
multiple procedures on the claims, it is impossible for us to 
accurately attribute bundled costs to each procedure. However, our 
analysis of CY 2004 hospital claims convinced us that some discounting 
of multiple imaging procedures is warranted. In order to determine the 
level of adjustment that would be appropriate for the second and 
subsequent procedures performed within a family in the same session, we 
used the MPFS methodology and data.
    Under the resource-based practice expense methodology used for 
Medicare payments to physicians, specific practice expense inputs of 
clinical labor, supplies and equipment are used to calculate ``relative 
value units'' on which physician payments are based. When multiple 
images are acquired in a single session, most of the clinical labor 
activities are not performed twice and many of the supplies are not 
furnished twice. Specifically, we consider that the following clinical 
labor activities included in the ``technical component'' (TC) of the 
MPFS are not duplicated for subsequent procedures: Greeting, 
positioning and escorting the patient; providing education and 
obtaining consent; retrieving prior exams; setting up the IV; and 
preparing and cleaning the room. In addition, we consider that 
supplies, with the exception of film, are not duplicated for subsequent 
procedures. Equipment time and indirect costs are allocated based on 
clinical labor time in the physician payment methodology and, 
therefore, these inputs should be reduced accordingly.
    We performed analyses and found that excluding those practice 
expense inputs, along with the corresponding portion of equipment time 
and indirect costs, supports a 50-percent reduction in the payment for 
the TC portion of subsequent procedures. The items and services that 
make up hospitals' facility costs are generally very similar to those 
that are counted in the TC portion of the MPFS for diagnostic imaging 
procedures. We believe that the analytic justification for a 50-percent 
reduction of the TC for the second and subsequent imaging procedures 
using the MPFS input data also provides a basis for a similar relative 
reduction to payments for multiple imaging procedures performed in the 
hospital outpatient department. Therefore, we are proposing to make a 
50-percent reduction in the OPPS payments for some second and 
subsequent imaging procedures performed in the same session, similar to 
our policy of reducing payments for some second and subsequent surgical 
procedures.
    We are proposing to apply the multiple imaging procedure reduction 
only to individual services described by codes within one Family, not 
across Families. Reductions would apply when more than one procedure 
within the Family is performed in the same session. For example, no 
reduction would apply to an MRI of the brain (CPT code 70552) in code 
Family 5, when performed in the same session as an MRI of the spinal 
canal and contents (CPT code 72142) in code Family 6. We are proposing 
to make full payment for the procedure with the highest APC payment 
rate, and payment at 50 percent of the applicable APC payment rate for 
every additional procedure, when performed in the same session.

B. Interrupted Procedure Payment Policies (Modifiers -52, -73, and -74)

(If you choose to comment on issues in this section, please include 
the caption ``Interrupted Procedures'' at the beginning of your 
comment.)

    Since implementation of the OPPS in 2000, we have required 
hospitals to report modifiers -52, -73, and -74 to indicate procedures 
that were terminated before their completion. Modifier -52 indicates 
partial reduction or discontinuation of services that do not require 
anesthesia, while modifiers -73 and -74 are used for procedures 
requiring anesthesia, where the patient was taken to the treatment room 
and the procedure was discontinued before anesthesia administration or 
after anesthesia administration/procedure initiation respectively. The 
elective cancellation of procedures is not reported. Hospitals are paid 
50 percent of the APC payment for services with -73 appended and 100 
percent for procedures with modifier -52 or -74 reported, in accordance 
with Sec.  419.44(b) of the regulations. In January 2005, we clarified 
in Program Transmittal 442 the definition of anesthesia for purposes of 
billing for services furnished in the hospital outpatient department in 
the context of reporting modifiers -73 and -74. The APC Panel 
considered the

[[Page 42752]]

current OPPS payment policies for interrupted procedures at its 
February 2005 meeting and made a number of recommendations that are 
addressed in the following discussion.
    Current OPPS policy requires providers to use modifier -52 to 
indicate that a service that did not require anesthesia was partially 
reduced or discontinued at the physician's discretion. The physician 
may discontinue or cancel a procedure that is not completed in its 
entirety due to a number of circumstances, such as adverse patient 
reaction or medical judgment that completion of the full study is 
unnecessary. Based on an analysis of CY 2004 hospital claims data, in 
the outpatient hospital setting modifier -52 is used infrequently. The 
modifier is reported most often to identify interrupted or reduced 
radiological and imaging procedures, and our current policy is to make 
full payment for procedures with a -52 modifier.
    We are now reconsidering our payment policy for interrupted or 
reduced services not requiring anesthesia and reported with a -52 
modifier. At its February 2005 meeting, the APC Panel recommended 
continuing current OPPS payment policy at 100 percent of the APC 
payment for reduced services reported with modifier -52, although the 
Panel members acknowledged their limited familiarity with the specific 
outpatient hospital services and their clinical circumstances that 
would warrant the reporting of modifier -52. We have examined our data 
to determine the appropriateness of our current policy regarding 
payment for services that are reduced, and although some hospital 
resources are used to provide even an incomplete service, such as a 
radiology service, we are skeptical that it is accurate to pay the full 
rate for a discontinued or reduced radiological service. Compared to 
surgical procedures that require anesthesia, a number of general and 
procedure-specific supplies, and reserved procedure rooms that must be 
cleaned and prepared prior to performance of each specific procedure, 
the costs to the hospital outpatient department for the rooms and 
supplies typically associated with procedures not requiring anesthesia 
are much more limited. For example, the scheduling maintained for 
radiological services not requiring anesthesia generally exhibits 
greater flexibility than that for surgical procedures, and the 
procedure rooms are used for many unscheduled services that are fit in, 
when possible, between those that are scheduled. Consequently, we 
believe that the loss of revenue that may result from a surgical 
procedure being discontinued prior to its initiation in the procedure 
room is usually more substantial than that lost as the result of a 
discontinued service not requiring anesthesia, such as a radiology 
procedure. Nonetheless, under our current policy, Medicare makes the 
full APC payment for discontinued or reduced radiological procedures 
and only 50 percent of the APC payment for surgical procedures that are 
discontinued prior to initiation of the procedure or the administration 
of anesthesia.
    Therefore, we are proposing to pay 50 percent of the APC payment 
amount for a discontinued procedure that does not require anesthesia 
where modifier -52 is reported. We believe that this proposed payment 
would appropriately recognize the hospital's costs involved with the 
delivery of a typical reduced service, similar to our payment policies 
for interrupted procedures that require anesthesia.
    When a procedure requiring anesthesia is discontinued after the 
beneficiary was prepared for the procedure and taken to the room where 
it was to be performed but before the administration of anesthesia, 
hospitals currently report modifier -73 and receive 50 percent of the 
APC payment for the planned service. The APC Panel recommended that we 
make full APC payment for services with modifier -73 reported, because 
significant hospital resources were expended to prepare the patient and 
the treatment room or operating room for the procedure. Although the 
circumstances that require use of modifier -73 occur infrequently, we 
continue to believe that hospitals realize significant savings when 
procedures are discontinued prior to initiation but after the 
beneficiary is taken to the procedure room. We believe savings are 
recognized for treatment/operating room time, single use devices, 
drugs, equipment, supplies, and recovery room time. Thus, we believe 
our policy of paying 50 percent of the procedure's APC payment when 
modifier -73 is reported remains appropriate.
    Further, we are exploring the possibility of applying a payment 
reduction for interrupted procedures in which anesthesia was to be used 
(and may have been administered) and the procedure was initiated. 
Currently, those cases are reported using modifier -74, and we make the 
full APC payment for the planned service. We are now reviewing that 
policy and are soliciting comments that include information regarding 
what costs are incurred by providers in these cases.
    The payment policy for interrupted procedures reported with 
modifier -74 was originally adopted because we believed that the 
facility costs incurred for discontinued procedures that were initiated 
to some degree were as significant to the hospital provider as for a 
completed procedure, including resources for patient preparation, 
operating room use, and recovery room care. However, we have come to 
question that underlying assumption, especially as many surgical 
procedures have come to require specialized and costly devices and 
equipment, and our APC payments include the costs for those devices and 
equipment. We now believe that there are costs that are not incurred in 
the event of a procedure's discontinuation, if a hospital is managing 
its use of devices, supplies, and equipment efficiently and 
conservatively. For example, the patient's recovery time may be less 
than the recovery time would have been for the planned procedure, 
because less extensive surgery was performed or costly devices planned 
for the procedure may not be used.
    The APC Panel recommended that we continue to pay 100 percent of 
the procedural APC payment when modifier -74 is appended to the 
surgical service because, in its opinion, procedures may frequently be 
terminated prior to completion because the patient is experiencing 
adverse effects from the surgical service or the anesthesia. The Panel 
speculated that, in fact, significant additional resources could be 
expended in such a situation to stabilize and treat the patient if a 
procedure were discontinued because of patient complications. However, 
we believe that many of such additional services, including critical 
care, drugs, blood and blood products, and x-rays that may be necessary 
to manage and treat such patients, are separately payable under the 
OPPS and thus the hospital's costs need not be paid through the APC 
payment for the planned procedure. Because the OPPS is paying for the 
time in the operating room, recovery room, outpatient department staff, 
and supplies related to the typical procedure, it would seem that those 
costs may be lower in those infrequent cases when the procedure is 
initiated but not completed. We acknowledge that the costs on claims 
reporting a service with modifier -74 may be particularly diverse, 
depending upon the point in the procedure the service is interrupted. 
Thus, we are seeking comment on the clinical circumstances in which 
modifier -74 is used in the

[[Page 42753]]

hospital outpatient department, and the degree to which hospitals may 
experience cost savings in such situations where procedures are not 
completed. We are specifically interested in comments regarding the 
disposition of devices and specialized equipment that are not used 
because a procedure is discontinued after its initiation. In 
particular, we are interested in obtaining information about when 
during the procedure the decision to discontinue is made.

XV. OPPS Policy and Payment Recommendations

A. MedPAC Recommendations

1. Report to the Congress: Medicare Payment Policy (March 2005)
    The Medicare Payment Advisory Commission (MedPAC) submits reports 
to Congress in March and June that summarize payment policy 
recommendations. The March 2005 MedPAC report included the following 
two recommendations relating specifically to the hospital OPPS:
    a. Recommendation 1: The Congress should increase payment rates for 
the outpatient prospective payment system by the projected increase in 
the hospital market basket index less 0.4 percent for calendar year 
2006. A discussion regarding hospital update payments, and the effect 
of the market basket update in relation to other factors influencing 
OPPS proposed payment rates, is included in section II.C. (``Proposed 
Conversion Factor Update for CY 2006'') of this preamble.
    b. Recommendation 2: The Congress should extend hold-harmless 
payments under the outpatient prospective payment system for rural sole 
community hospitals and other rural hospitals with 100 or fewer beds 
through calendar year 2006. A discussion of the expiration of the hold-
harmless provision is included in section II.F. of this preamble. See 
also section II.G. (``Proposed Adjustment for Rural Hospitals'') of 
this preamble for a discussion of section 411 of Pub. L. 108-173.
2. Report to the Congress: Issues in a Modernized Medicare Program--
Payment for Pharmacy Handling Costs in Hospital Outpatient Departments 
(June 2005)
    A discussion of the MedPAC recommendations relating to pharmacy 
overhead payments in the hospital outpatient department can be found in 
section V. of the preamble of this proposed rule.

B. APC Panel Recommendations

    Recommendations made by the APC Panel are discussed in sections of 
this preamble that correspond to topics addressed by the APC Panel. 
Minutes of the APC Panel's February 2005 meeting are available online 
at http://www.cms.hhs.gov/faca/apc/default.asp.

C. GAO Hospital Outpatient Drug Acquisition Cost Survey

    A discussion of the June 30, 2005 GAO report entitled ``Medicare: 
Drug Purchase Prices for CMS Consideration in Hospital Outpatient Rate-
Setting'' and section 621(a)(1) of the MMA is included in section V. of 
the preamble of this proposed rule.

XVI. Physician Oversight of Mid-Level Practitioners in Critical Access 
Hospitals

(If you choose to comment on issues in this section, please include 
the caption ``Physician Oversight of Nonphysician Practitioners'' at 
the beginning of your comment.)

A. Background

    Section 1820 of the Act, as amended by section 4201 of the Balanced 
Budget Act of 1997, Pub. L. 105-33, provides for the establishment of 
Medicare Rural Hospital Flexibility Programs (MRHFPs), under which 
individual States may designate certain facilities as critical access 
hospitals (CAHs). Facilities that are so designated and meet the CAH 
conditions of participations (COPs) under 42 CFR Part 485, Subpart F, 
will be certified as CAHs by CMS. The MRHFP replaced the Essential 
Access Community Hospital (EACH)/ Rural Primary Care Hospital (RPCH) 
program.

B. Proposed Policy Change

    Under the former EACH/RPCH program, physician oversight was 
required for services provided by nonphysician practitioners such as 
physician assistants (PAs), nurse practitioners (NPs), and clinical 
nurse specialists (CNSs) in a CAH. Under the MRHFP, the statute 
likewise required a physician oversight provision for nonphysician 
practitioners.
    We note that under the EACH/RPCH program, we allowed for situations 
when the RPCH had an unusually high volume of outpatients (100 or more 
during a 2-week period) that were treated by nonphysician 
practitioners. We stated that it would be sufficient for a physician to 
review and sign a 25-percent sample of medical records for patients 
cared for by a mid-level practitioner unless State practice and laws 
require higher standards for physician oversight for mid-level 
practitioners.
    However, the current regulation does not distinguish between 
inpatient and outpatient physician oversight. Although the CAH CoPs at 
Sec.  485.631(b)(iv) provide that a doctor of medicine or osteopathy 
periodically reviews and signs the records of patients cared for by 
NPs, CNSs, or PAs, section 1820(c)(2)(B)(iv)(III) of the Act states 
that CAH inpatient care provided by a PA or NP is subject to the 
oversight of a physician. The review of outpatient records is not 
addressed in the statute. Presently, for patients cared for by 
nonphysician practitioners, the interpretative guidelines set forth in 
Appendix W of the State Operations Manual (CMS Publication 107) set 
parameters for inpatient and outpatient physician reviews. To maintain 
consistency from the EACH/RPCH program to the CAH program, we indicated 
that CAHs with a high volume of outpatients need to have a physician 
review and sign a random sample of 25 percent outpatient medical 
records. Therefore, the interpretative guidelines allow a physician to 
review and sign a 25-percent sample of outpatient records for patients 
under the care of a nonphysician practitioner.
    Nonphysician practitioners recently brought to our attention their 
concerns regarding their ability to practice under their State laws 
governing scope of practice. Particularly, the nonphysician 
practitioners believe the current regulations and guidelines impede 
their ability to practice in CAHs. Certified nurse midwives, NPs, and 
CNSs disagree with the need for a physician to review records of 
patients that have been in their care when State law permits them to 
practice independently.
    MedPAC, in its June 2002 Report to the Congress, stated that 
certified nurse midwives, NPs, CNSs, and PAs are health care 
practitioners who furnish many of the same health care services 
traditionally provided by physicians, such as diagnosing illnesses, 
performing physical examinations, ordering and interpreting laboratory 
tests, and providing preventive health services. In many States, 
advance practice nurses are permitted to practice independently or in 
collaboration with a physician. MedPAC reported that NPs have 
independent practice authority in 21 States, and CNSs have independent 
practice authority in 20 States. PAs, by law, must work under the 
supervision of a physician. Based on the American Medical Association's 
guidelines for PAs, the definition of supervision varies by State. 
Generally, the physician assistant is a representative of the

[[Page 42754]]

physician, treating the patient in the style and manner developed and 
directed by the supervising physician.
    MedPAC further reported that several studies have shown comparable 
patient outcomes for the services provided by physician and 
nonphysician practitioners. MedPAC reported that research conducted by 
Mundinger et al.\2\ in 2000, Brown and Grimes \3\ in 1993, Ryan in 
1993,\4\ and the Office of Technology Assessment \5\ in 1986 has shown 
that nonphysician practitioners can perform about 80 percent of the 
services provided by primary care physicians with comparable quality. A 
randomized trial of physicians and nurse practitioners providing care 
in ambulatory care settings who had the same authority, 
responsibilities, productivity, and administrative requirements were 
shown to have comparable patient outcomes (see pages 5 and 11 of the 
June 2002 MedPAC report). Nonphysician practitioners are trained with 
the expectation that they will exercise a certain degree of autonomy 
when providing patient care. About 90 percent of nurse practitioners 
and 50 percent of physician assistants provide primary care.
---------------------------------------------------------------------------

    \2\ Mundinger, M.O., Kane, R.I., Lenez, E.R., et al., Primary 
Care Outcomes in Patients Treated by Nurse Practitioners or 
Physicians, A Randomized Trial, The Journal of the American Medical 
Association, January 5, 2000, Vol. 283, No. 1, pages 59-68.
    \3\ Brown, S.A. and Grimes, D.E., Nurse Practitioners and 
Certified Nurse Midwives: A Meta Analysis of Studies on Nurses in 
Primary Care Roles, American Nurses Association, Washington, DC, 
March 1993.
    \4\ Ryan, S.A., Nurse Practitioners: Educational Issues, 
Practice Styles, and Service Barriers. In Clawson, D.K., Osterweis, 
M., eds: The Role of Physician Assistants and Nurse Practitioners in 
Primary Health Care, Association of Academic Health Centers, 
Washington, DC, 1993.
    \5\ Office of Technology Assessment, U.S. Congress: Nurse 
Practitioners, Physician Assistants, and Certified Nurse Midwives: A 
Policy Analysis, Health Technology Case Study 37, Washington, DC, 
U.S Government Printing Office, 1986.
---------------------------------------------------------------------------

    We believe sufficient control and oversight of these nonphysician 
practitioners is generated by State laws which allow independent 
practice authority. Moreover, it further appears that quality is not 
impaired by such nonphysician practitioners. We remain concerned, 
however, that in those States without independent practice laws we have 
a responsibility to continue to ensure the safety and quality of 
services provided to Medicare beneficiaries.
    Therefore, we are proposing to revise the regulation at Sec.  
485.631(b)(iv) to defer to State law regarding the review of records 
for outpatients cared for by nonphysician practitioners. We are 
proposing that if State law allows these practitioners to practice 
independently, we would not require physicians to review and sign 
medical records of outpatients cared for by nonphysician practitioners. 
However, for those States that do not allow independent practice of 
nonphysician practitioners, we would continue to maintain that periodic 
review is performed by the physician on outpatient records under the 
care of a nonphysician practitioner. We believe a review of at least 
every 2 weeks provides a sufficient time period without unduly imposing 
an administrative burden on the physician or the CAH. In addition, we 
would allow the CAH to determine the sample size of the reviewed 
records in accordance with current standards of practice to allow the 
CAH flexibility in adapting the review to its particular circumstances. 
Specifically, we are proposing that the physician periodically (that 
is, at least once every 2 weeks) reviews and signs a sample of the 
outpatient records of nonphysician practitioners according to the 
facility policy and current standards of practice. We would still 
require periodic review and oversight of all inpatient records by 
physicians.

XVII. Files Available to the Public Via the Internet

    The data referenced for Addendum C and Addendum P to this proposed 
rule are available on the following CMS Web site via Internet only: 
http://www.cms.hhs.gov/providers/hopps/. We are not republishing the 
data represented in these Addenda to this proposed rule because of 
their volume. For additional assistance, contact Rebecca Kane, at (410) 
786-0378.

Addendum C--Healthcare Common Procedure Coding System (HCPCS) Codes by 
Ambulatory Payment Classification (APC)

    This file contains the HCPCS codes sorted by the APCs into which 
they are assigned for payment under the OPPS. The file also includes 
the APC status indicators, relative weights, and OPPS payment amounts.

XVIII. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995 (PRA), 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 evaluate fairly whether an information collection should be 
approved by OMB, section 35006(c)(2)(A) of the PRA requires that we 
solicit comment on the following issues:
     The need for the information collection and its usefulness 
in carrying out the proper functions of the agency.
     The accuracy of our estimates of the information 
collection burden,
     The quality, utility, and clarity of the information to be 
collected.
     Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    We are soliciting public comments on each of these issues for the 
information requirement discussed below.
    The following information collection requirements in this proposed 
rule and the associated burdens are subject to the PRA:

Proposed Sec.  485.631(b)(1)(iv), (b)(1)(v), and (b)(1)(vi)--Condition 
of Participation: Staffing and Staff Responsibilities

    Existing Sec.  485.631(b)(1)(iv) requires, as a condition of 
participation for a CAH, that a doctor of medicine or osteopathy to 
periodically review and sign the records of patients cared for by nurse 
practitioners, clinical specialists, or physician assistants. This 
proposed rule would amend those requirements to require that a doctor 
of medicine or osteopathy (1) periodically review and sign the records 
of all inpatients cared for by nurse practitioners, clinical nurse 
specialists, certified nurse midwives, or physician assistants; and (2) 
periodically, but not less than every 2 weeks, review and sign a sample 
of outpatient records of patients cared for by nurse practitioners, 
clinical nurse specialists, certified nurse midwives, or physician 
assistants according to the policy and standard practice of the CAH 
when State law does not allow these nonphysician practitioners to 
practice independently. In addition, the proposed rule would provide 
that a doctor of medicine or osteopathy is not required to review and 
sign outpatient records of patients cared for by nurse practitioners, 
clinical nurse specialists, certified nurse midwives, or physician 
assistants when State law allows these nonphysician practitioners to 
practice independently.
    The information collection requirements associated with these 
provisions are subject to the PRA. However, the collection requirement 
is currently approved under OMB control number 0938-0328 with an 
expiration date of January 31, 2008.
    We have submitted a copy of this proposed rule to OMB for its 
review of the information collection requirements described above. 
These requirements are

[[Page 42755]]

not effective until they have been approved by OMB.
    If you comment on any of these information collection and record 
keeping requirements, please mail copies directly to the following:

Centers for Medicare & Medicaid Services, Office of Strategic 
Operations and Regulatory Affairs, Regulations Development and 
Issuances Group, Attn: James Wickliffe, CMS-1501-P, 7500 Security 
Boulevard, Baltimore, MD 21244-1850; and
Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 10235, New Executive Office Building, Washington, DC 
20503, Attn: Christopher Martin, CMS Desk Officer.

    Comments submitted to OMB may also be e-mailed to the following 
address: [email protected], or faxed at (202) 395-6974.

XIX. Response to Comments

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

XX. Regulatory Impact Analysis

(If you choose to comment on issues in this section, please include 
the caption ``Impact'' at the beginning of your comment.)

A. OPPS: General

    We have examined the impacts of this proposed rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 19, 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.
1. Executive Order 12866
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year).
    We estimate the effects of the provisions that would be implemented 
by this proposed rule would result in expenditures exceeding $100 
million in any 1 year. We estimate the total increase (from changes in 
this proposed rule as well as enrollment, utilization, and case-mix 
changes) in expenditures under the OPPS for CY 2006 compared to CY 2005 
to be approximately $1.4 billion. Therefore, this proposed rule is an 
economically significant rule under Executive Order 12866, and a major 
rule under 5 U.S.C. 804(2).
2. Regulatory Flexibility Act (RFA)
    The RFA requires agencies to determine whether a rule would have a 
significant economic impact on a substantial number of small entities. 
For purposes of the RFA, small entities include small businesses, 
nonprofit organizations, and government agencies. Most hospitals and 
most other providers and suppliers are small entities, either by 
nonprofit status or by having revenues of $6 million to $29 million in 
any 1 year (65 FR 69432).
    For purposes of the RFA, we have determined that approximately 37 
percent of hospitals would be considered small entities according to 
the Small Business Administration (SBA) size standards. We do not have 
data available to calculate the percentages of entities in the 
pharmaceutical preparation manufacturing, biological products, or 
medical instrument industries that would be considered to be small 
entities according to the SBA size standards. For the pharmaceutical 
preparation manufacturing industry (NAICS 325412), the size standard is 
750 or fewer employees and $67.6 billion in annual sales (1997 business 
census). For biological products (except diagnostic) (NAICS 325414), 
with $5.7 billion in annual sales, and medical instruments (NAICS 
339112), with $18.5 billion in annual sales, the standard is 50 or 
fewer employees (see the standards Web site at http://www.sba.gov/regulations/siccodes/). Individuals and States are not included in the 
definition of a small entity.
3. Small Rural Hospitals
    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 previously defined a small 
rural hospital as a hospital with fewer than 100 beds that is located 
outside of a Metropolitan Statistical Area (MSA) (or New England County 
Metropolitan Area (NECMA)). However, under the new labor market 
definitions that we are adopted in the November 15, 2004 final rule 
with comment period, for CY 2005, (consistent with the FY 2005 IPPS 
final rule), we no longer employ NECMAs to define urban areas in New 
England. Therefore, we now define a small rural hospital as a hospital 
with fewer than 100 beds that is located outside of an MSA. Section 
601(g) of the Social Security Amendments of 1983 (Pub. L. 98-21) 
designated hospitals in certain New England counties as belonging to 
the adjacent NECMA. Thus, for purposes of the OPPS, we classify these 
hospitals as urban hospitals. We believe that the changes in this 
proposed rule would affect both a substantial number of rural hospitals 
as well as other classes of hospitals and that the effects on some may 
be significant. Therefore, we conclude that this proposed rule would 
have a significant impact on a substantial number of small entities.
4. Unfunded Mandates
    Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 
104-4) also requires that agencies assess anticipated costs and 
benefits before issuing any rule that may result in an expenditure in 
any 1 year by State, local, or tribal governments, in the aggregate, or 
by the private sector, of $110 million. This proposed rule does not 
mandate any requirements for State, local, or tribal governments. This 
proposed rule also does not impose unfunded mandates on the private 
sector of more than $110 million dollars.
5. Federalism
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it publishes any rule (proposed or final rule) 
that imposes substantial direct costs on State and local governments, 
preempts State law, or otherwise has Federalism implications.
    We have examined this proposed rule in accordance with Executive 
Order 13132, Federalism, and have determined that it would not have an 
impact on the rights, roles, and responsibilities of State, local or 
tribal

[[Page 42756]]

governments. The impact analysis (refer to Table 33) shows that 
payments to governmental hospitals (including State, local, and tribal 
governmental hospitals) would increase by 1.8 percent under this 
proposed rule.

B. Impact of Proposed Changes in This Proposed Rule

    We are proposing several changes to the OPPS that are required by 
the statute. We are required under section 1833(t)(3)(C)(ii) of the Act 
to update annually the conversion factor used to determine the APC 
payment rates. We are also required under section 1833(t)(9)(A) of the 
Act to revise, not less often than annually, the wage index and other 
adjustments. In addition, we must review the clinical integrity of 
payment groups and weights at least annually. Accordingly, in this 
proposed rule, we are proposing to update the conversion factor and the 
wage index adjustment for hospital outpatient services furnished 
beginning January 1, 2006, as we discuss in sections II.C. and II.D., 
respectively, of this proposed rule. We also are proposing to revise 
the relative APC payment weights using claims data from January 1, 
2004, through December 31, 2004. In response to a provision in Pub. L. 
108-173 that we analyze the cost of outpatient services in rural 
hospitals relative to urban hospitals, we are proposing to increase 
payments to rural sole community hospitals. Refer to section II.G. of 
the preamble to this proposed rule for greater detail on this 
adjustment. Finally, we are proposing to remove 3 device categories 
from pass-through payment status. In particular, refer to section 
IV.C.1 of the preamble of this proposed rule with regard to the 
expiration of pass-through status for devices.
    Under this proposed rule, the update change to the conversion 
factor as provided by statute would increase total OPPS payments by 3.2 
percent in CY 2006. The inclusion in CY 2006 of payment for specific 
covered outpatient drugs within budget neutrality, and the expiration 
of additional drug payment outside budget neutrality, which were 
authorized by Pub. L. 108-173 result in a net increase of 1.9 percent. 
The changes to the APC weights, the introduction of a multiple 
procedure discount for diagnostic imaging, changes to the wage index, 
and the introduction of a payment adjustment for rural sole community 
hospitals would not increase OPPS payments because these changes to the 
OPPS are budget neutral. However, these updates do change the 
distribution of payments within the budget neutral system as shown in 
Table 33 and described in more detail in this section.

C. Alternatives Considered

    Alternatives to the changes we are making and the reasons that we 
have chosen the options we have are discussed throughout this proposed 
rule. Some of the major issues discussed in this proposed rule and the 
options considered are discussed below.
1. Option Considered for Proposed Payment Policy for Separately Payable 
Drugs and Biologicals
    As discussed in detail in section V.B.3 of the preamble of this 
proposed rule, section 1833(t)(14)(A)(iii) of the Act requires that 
payment for specified covered outpatient drugs in CY 2006, as adjusted 
for pharmacy overhead costs, be equal to the average acquisition cost 
for the drug for that year as determined by the Secretary and taking 
into account the hospital acquisition cost survey data collected by the 
GAO in 2004 and 2005. If hospital acquisition cost data are not 
available, then the law requires that payment be equal to payment rates 
established under the methodology described in section 1842(o), section 
1847(A), or section 1847(B) of the Act as calculated and adjusted by 
the Secretary as necessary.
    The payment policy that we are proposing for CY 2006 is to pay for 
all separately payable drugs and biologicals at the payment rates 
effective in the physician office setting as determined using the 
manufacturer's average sales price (ASP) methodology. Our proposal uses 
payment rates based on ASP data from the fourth quarter of 2004, which 
were used to set payment rates for drugs and biologicals in the 
physician office setting effective April 1, 2005, as these are the most 
recent numbers available to us during the development of this proposed 
rule. For the few drugs and biologicals, other than 
radiopharmaceuticals as discussed earlier, where ASP data are 
unavailable, we are proposing to use the mean costs from the CY 2004 
hospital claims data to determine their packaging status and for 
ratesetting. We believe that the ASP-based payment rates serve as the 
best proxy for the average acquisition cost for the drug or biological 
because the rates calculated using the ASP methodology are based on the 
manufacturers' sales prices from the fourth quarter of 2004 and take 
into consideration information on sales prices to hospitals. 
Furthermore, payments for drugs and biologicals using the ASP 
methodology would allow for consistency of drug pricing between the 
physician offices and hospital outpatient departments.
    An alternative payment option for separately payable drugs and 
biologicals (before payment for pharmacy overhead) we considered was 
using ASP+3 percent based on the average relationship between the GAO 
mean purchase prices and ASP. A second payment option we considered 
using was ASP+8 percent (again before payment for pharmacy overhead) 
based on the average relationship between the mean costs from hospital 
claims data and ASP.
    We are not proposing to set payment rates for separately payable 
drugs and biologcals at ASP+3 percent because the GAO data reflect 
hospital acquisition costs from a less recent period of time as the 
midpoint of the time period when the survey was conducted is January 1, 
2004, and it would be difficult to update the GAO mean purchase prices 
during CY 2006 and in future years. Because the changes in drug 
payments are required to be budget neutral by law, we note that paying 
for separately payable drugs and biologicals at ASP+3 percent relative 
to ASP+6 percent would have made available approximately an additional 
$60 million for other items and services paid under the OPPS.
    We are also not proposing to use ASP+8 percent to set payment rates 
for drugs and biologicals in CY 2006. The statute specifies that CY 
2006 payments for specified covered outpatient drugs are required to be 
equal to the ``average'' acquisition cost for the drug. Payment at 
ASP+8 percent for drugs or biologicals, which represents the average 
relationship between the mean cost from hospital claims data and ASP, 
would reflect the product's acquisition cost plus overhead cost, 
instead of acquisition cost only. Therefore, we believe that it would 
not be appropriate for us to use ASP+8 percent to set the payment rates 
for drugs and biologicals in CY 2006. Using ASP+8 percent to set 
payments for separately payable drugs and biologicals relative to ASP+6 
percent would have reduced payments for other items and services paid 
under the OPPS by approximately $40 million as the law requires that 
changes in drug payments be made in a budget neutral manner.
2. Payment Adjustment for Rural Sole Community Hospitals
    In section II.G. of the preamble of this proposed rule, we propose 
a 6.6 percent payment adjustment increase to rural sole community 
hospitals. Section 1833(t)(13)(A) of the Act instructs the Secretary to 
conduct a study to determine if rural hospital outpatient costs exceed 
urban hospital outpatient

[[Page 42757]]

costs. In addition, under new section 1833(t)(13)(B) of the Act, the 
Secretary is given authorization to provide an appropriate adjustment 
to rural hospitals, by January 1, 2006, if rural hospital costs are 
determined to be greater than urban hospital costs.
    To conduct the study, we believe that a simple comparison of unit 
costs is insufficient because the costs faced by hospitals, whether 
urban or rural, will be a function of many factors. These include the 
local labor supply, and the complexity and volume of services provided. 
(We note that without controlling for the other influences on per unit 
cost, rural hospitals have lower cost per unit than urban hospitals.) 
Therefore, we rejected the option of using a simple comparison of unit 
costs and instead used regression analysis to analyze the differences 
in the outpatient cost per unit between rural and urban hospitals in 
order to compare costs after accounting for the influence of these 
other factors.
    Our initial regression analysis found that all rural hospitals give 
some indication of having higher cost per unit, after controlling for 
labor input prices, service-mix complexity, volume, facility size, and 
type of hospital. Initially, we planned a small adjustment to all rural 
hospitals. However, in order to assess whether the small difference in 
costs was uniform across rural hospitals or whether all of the 
variation was attributable to a specific class of rural hospitals, we 
included more specific categories of rural hospitals in our explanatory 
regression analysis. Further analysis revealed that only rural sole 
community hospitals are more costly than urban hospitals holding all 
other variables constant. Notably, we observed no significant 
difference between all other rural hospitals and urban hospitals. 
Therefore, we propose not to pay a small adjustment increase to all 
rural hospitals, but to instead pay a 6.6 percent payment increase to 
rural sole community hospitals.
3. Change in the Percentage of Total OPPS Payments Dedicated to Outlier 
Payments
    In section II.H. of the preamble of this proposed rule, we are 
proposing to change the percentage of total OPPS payments dedicated to 
outlier payments to 1.0 percent in CY 2006 from the current policy of 
2.0 percent. We also are proposing to continue using a fixed-dollar 
threshold in addition to the threshold based on a multiple of the APC 
amount that we have applied since the beginning of the OPPS. In 
response to findings reported by the MedPAC in their March 2004 Report 
to Congress that the OPPS outlier policy did not provide sufficient 
insurance against large financial loses for certain complex procedures 
that ultimately could impact beneficiary access to services, we 
implemented the fixed-dollar threshold in the CY 2005 OPPS. Our 
decision to reduce the percentage of total payments dedicated to 
outlier payments continues to refine our outlier policy to improve its 
appropriateness for OPPS. Because OPPS pays by service, rather than by 
case, hospitals are already paid for every increased service associated 
with a costly case. A reduction in the size of the outlier pool 
combined with the fixed dollar threshold continues to target outlier 
payments to those services where one costly occurrence could pose a 
financial risk for hospitals, but limits these payments to the most 
complex and costly services. At the same time, reducing the outlier 
pool increases overall payments for all services by 1.0 percent.
    Alternatives to this policy are either to remain at 2.0 percent or 
to increase the percentage of payments dedicated to outliers to the 
statutory limit of 3.0 percent. Increasing the percentage of payments 
dedicated to outliers could target more payment to outliers, but is at 
odds with OPPS payment by service rather than case. It is not possible 
to eliminate outlier payments entirely without a statutory change.

D. Limitations of Our Analysis

    The distributional impacts presented here are the projected effects 
of the policy changes, as well as the statutory changes that would be 
effective for CY 2006, on various hospital groups. We estimate the 
effects of individual policy changes by estimating payments per service 
while holding all other payment policies constant. We use the best data 
available but do not attempt to predict behavioral responses to our 
policy changes. In addition, we are not proposing to make adjustments 
for future changes in variables such as service volume, service-mix, or 
number of encounters. As we have done in previous proposed rules, we 
are soliciting comments and information about the anticipated effects 
of these proposed changes on hospitals and our methodology for 
estimating them.

E. Estimated Impacts of This Proposed Rule on Hospitals

    The estimated increase in the total payments made under OPPS is 
limited by the increase to the conversion factor set under the 
methodology in the statute. The distributional impacts presented do not 
include assumptions about changes in volume and service-mix. However, 
total payments actually made under the system also may be influenced by 
changes in volume and service-mix, which CMS cannot forecast. The 
enactment of Pub. L. 108-173 on December 8, 2003, provided for the 
payment of additional dollars in CY 2004 and CY 2005 to providers of 
OPPS services outside of the budget neutrality requirements for 
specified covered outpatient drugs. These provisions expire CY 2006, as 
noted in this proposed rule. Pub. L. 108-173 also provided for 
additional payment for wage indexes for specific hospitals reclassified 
under section 508 through 2007. Table 33 shows the estimated 
redistribution of hospital payments among providers as a result of a 
new APC structure, multiple procedure discount for diagnostic imaging, 
wage indices, and rural adjustment, which are budget neutral; the 
estimated distribution of increased payments in CY 2006 resulting from 
the combined impact of proposed APC recalibration, proposed wage 
effects, the proposed rural sole community hospital adjustment, and the 
proposed market basket update to the conversion factor; and, finally, 
estimated payments considering all proposed payments for CY 2006 
relative to all payments for CY 2005 including the expiration of the 
provision in Pub. L. 108-173 that required payment for specified 
covered outpatient drugs outside budget neutrality and the proposed 
change in the percentage of total payments dedicated to outlier 
payments. The expiration of the requirement that payment for specified 
covered outpatient drugs need not be budget neutral, leaves most 
classes of hospitals with a positive update that is lower than the 
proposed market basket. We also estimate that a few classes of 
hospitals may receive less payment in CY 2006. Because updates to the 
conversion factor, including the market basket, any reintroduction of 
transitional pass-through dollars, and change in the percentage of 
total payments dedicated to outlier payments are applied uniformly, 
observed redistributions of payments in the impact table largely 
depends on the mix of services furnished by a hospital (for example, 
how the APCs for the hospital's most frequently furnished services 
would change) and the impact of the wage index changes on the hospital. 
However, the extent to which this proposed rule redistributes money 
during implementation would also depend on changes in volume, practice 
patterns, and case-mix of services billed between CY 2005 and CY 2006. 
Overall, the

[[Page 42758]]

proposed OPPS rates for CY 2006 would have a positive effect for all 
hospitals paid under OPPS. Proposed changes would result in a 1.9 
percent increase in Medicare payments to all hospitals, exclusive of 
transitional pass-through payments.
    To illustrate the impact of the proposed CY 2006 changes, our 
analysis begins with a baseline simulation model that uses the final CY 
2005 weights, the FY 2005 final post-reclassification IPPS wage 
indices, as subsequently corrected, without changes in wage indices 
resulting from section 508 reclassifications, and the final CY 2005 
conversion factor. Columns 2, 3, and 4 in Table 33 reflect the 
independent effects of the proposed changes in the APC reclassification 
and recalibration changes, the proposed multiple procedure discount for 
diagnostic imaging, the proposed wage indices, and the proposed 
adjustment for rural sole community hospitals respectively. These 
effects are budget neutral, which is apparent in the overall zero 
impact in payment for all hospitals in the top row. Column 2 shows the 
independent effect of changes resulting from the proposed 
reclassification of HCPCS codes among APC groups and the proposed 
recalibration of APC weights based on a complete year of CY 2004 
hospital OPPS claims data. This column also shows the impact of 
incorporating drug payment at 106 percent of ASP plus overhead and, for 
radiopharmaceuticals, at cost, within budget neutrality. This column 
also includes the impact of a multiple procedure discount for 
diagnostic imaging services. We modeled the independent effect of APC 
recalibration by varying only the weights, the final CY 2005 weights 
versus the proposed CY 2006 weights, in our baseline model, and 
calculating the percent difference in payments. Column 3 shows the 
impact of updating the wage indices used to calculate payment by 
applying the proposed FY 2006 IPPS wage indices. The OPPS wage indices 
used in Column 3 do not include changes to the wage indices for 
hospitals reclassified under section 508 of Pub. L. 108-173. We modeled 
the independent effect of introducing the new wage indices by varying 
only the wage index, using the proposed CY 2006 scaled weights, and a 
CY 2005 conversion factor that included a budget neutrality adjustment 
for changes in wage effects between CY 2005 and CY 2006. Column 4 shows 
the budget neutral impact of adding a proposed 6.6 percent adjustment 
to payment for services other than drugs and biologicals to rural sole 
community hospitals. We modeled the independent effect of the proposed 
payment adjustment for rural sole community hospitals by varying only 
the presence of the rural adjustment, using CY 2006 scaled weights, FY 
2006 wage index, and a CY 2005 conversion factor with the wage and 
rural budget neutrality adjustments.
    Column 5 demonstrates the combined ``budget neutral'' impact of 
proposed APC recalibration and wage index updates on various classes of 
hospitals, as well as the impact of updating the conversion factor with 
the market basket. We modeled the independent effect of proposed budget 
neutrality adjustments and the market basket update by using the 
weights and wage indices for each year to model CY 2006 requirements, 
and using a CY 2005 conversion factor that included a budget neutrality 
adjustment for differences in wages, the proposed adjustment for rural 
sole community hospitals, and the market basket increase.
    Finally, Column 6 depicts the full impact of the proposed CY 2006 
policy on each hospital group by including the effect of all the 
changes for CY 2006 and comparing them to the full effect of all 
payments in CY 2005, including those required by Pub. L. 108-173. 
Column 6 shows the combined budget neutral effects of Columns 2 through 
5, as well as the impact of changing the percentage of total payments 
dedicated to outlier payments to 1.0 percent, changing the percentage 
of total payments dedicated to transitional pass-through payments to 
0.05 percent, the effects of expiring monies added to OPPS in CY 2005 
as a result of Pub. L. 108-173, and the continued presence of payment 
for wage indices reclassified under section 508 of Pub. L. 108-173.
    We modeled the independent effect of all changes in column 6 using 
the final weights for CY 2005 with additional money for drugs required 
by section 621 of Pub. L. 108-173 and the proposed weights for CY 2006. 
The wage indices in each year include wage index increases for 
hospitals eligible for reclassification under section 508 of Pub. L. 
108-173. We used the final conversion factor for CY 2005 and the 
proposed CY 2006 conversion factor of $59.35. Column 6 also contains 
simulated outlier payments for each year. We used the charge inflation 
factor used in the proposed FY 2006 IPPS rule of 8.65 percent to 
increase individual costs on the CY 2004 claims to reflect CY 2005 and 
CY 2006 dollars respectively. Using the CY 2004 claims and an 8.65 
percent charge inflation factor, we currently estimate that actual 
outlier payments for CY 2005, using a multiple threshold of 1.75 and a 
fixed dollar threshold of $1,175 will be 1.0 percent of total payments, 
which is 1.0 percent lower than the 2.0 percent that we projected in 
setting outlier policies for CY 2005. Outlier payments of only 1.0 
percent appear in the CY 2005 comparison in Column 6. We used the same 
set of claims and a charge inflation factor of 18.04 percent to model 
the proposed CY 2006 outliers at 1.0 percent of total payments using a 
multiple threshold of 1.75 and a fixed dollar threshold of $1,575.
Column 1: Total Number of Hospitals
    Column 1 in Table 33 shows the total number of hospital providers 
(4,212) for which we were able to use CY 2004 hospital outpatient 
claims to model CY 2005 and CY 2006 payments by classes of hospitals. 
We excluded all hospitals for which we could not accurately estimate CY 
2005 or CY 2006 payment and entities that are not paid under the OPPS. 
The latter include critical access hospitals, all-inclusive hospitals, 
and hospitals located in Guam, the U.S. Virgin Islands, and the State 
of Maryland. This process is discussed in greater detail in section 
II.A. of this proposed rule. At this time we are unable to calculate a 
disproportionate share (DSH) variable for hospitals not participating 
in the IPPS. Hospitals for whom we do not have a DSH variable are 
grouped separately. Finally, because section 1833(t)(7)(D) of the Act 
permanently holds harmless cancer hospitals and children's hospitals, 
that is, these hospitals cannot receive less payment in CY 2006 than 
they did in the CY 2005, we removed these hospitals from our impact 
analyses.
Column 2: APC Recalibration
    The combined effect of proposed APC reclassification and 
recalibration, including the proposal to pay for drugs and biologicals 
as 106 percent of ASP plus 2 percent of ASP for overhead, and the 
introduction of a proposed multiple procedure discount for diagnostic 
imaging resulted in larger changes in Column 2 than are typically 
observed for APC recalibration. In general, these changes have a 
greater negative impact on some classes of urban hospitals than on 
rural hospitals. APC changes effect the distribution of hospital 
payments by increasing payments to specific subsets of urban hospitals 
while decreasing payments made to large urban hospitals and rural 
hospitals.
    Overall, these changes have no impact on all urban hospitals, which 
show no projected change in payments, although some classes of urban 
hospitals experience large decreases in payments. However, changes to 
the APC structure

[[Page 42759]]

for CY 2006 tend to favor, slightly, urban hospitals that are not 
located in large urban areas. Large urban hospitals experience a 
decline of 0.8 percent, while ``other'' urban hospitals experience an 
increase of 1.0 percent. Urban hospitals with between 100 and 199 beds 
and between 300 and 499 beds experienced decreases, while the largest 
urban hospitals, those with beds greater than 500, and moderately sized 
urban hospitals, those with beds between 200 and 299 beds report 
increases of at least 0.2 percent. The smallest urban hospitals do not 
appear to be impacted by changes to the APC structure. With regard to 
volume, all urban hospitals except those with the highest volume, 
experience a decrease in payments. The lowest volume hospitals 
experience the largest decrease of 5.8 percent. Urban hospitals 
providing the highest volume of services demonstrate a projected 
increase of 0.2 percent as a result of APC recalibration. Decreases for 
urban hospitals are also concentrated in some regions, specifically, 
New England, Pacific, South Atlantic, West South Central, and Mountain, 
with the first two experiencing the largest decreases of 1.2 and 1.8 
percent respectively. On the other hand, a few regions experience 
moderate increases. Hospitals in the East South Central and West North 
Central regions experience increases of 1.5 and 2.6 percent 
respectively.
    Overall, rural hospitals show a modest 0.1 percent decrease as a 
result of changes to the APC structure, and this 0.1 percent decrease 
appears to be concentrated in rural hospitals that are not rural sole 
community hospitals. Notwithstanding a modest overall decline, there is 
substantial variation among classes of rural hospitals. Specifically, 
rural hospitals with less than 100 beds and between 150 and 199 beds 
experience decreases, with hospitals having less than 50 beds 
experiencing the largest decrease of 0.9 percent. Rural hospitals with 
greater than 100 and less than 150 beds experience the largest increase 
of 1.4 percent. With regard to volume, all rural hospitals except those 
with the highest volume, experience a decrease in payments. The lowest 
volume hospitals experience the largest decrease of 2.9 percent. Rural 
hospitals providing the highest volume of services demonstrate a 
projected increase of 0.7 percent as a result of APC recalibration. 
Decreases for rural hospitals occur in every region except West North 
Central and the Middle Atlantic. The largest decreases are observed in 
West South Central and Mountain regions. On the other hand, hospitals 
in the Middle Atlantic and West North Central experience increases of 
1.9 and 1.8 percent respectively.
    Among other classes of hospitals, the largest observed impacts 
resulting from APC recalibration include declines of 0.4 percent for 
non-teaching hospitals and increases of 0.5 percent for major teaching 
hospitals. Hospitals without a valid DSH variable, most of which are 
TEFRA hospitals, experience decreases of 0.9 percent, and of these, 
those in urban areas experience a decline of 1.4 percent. Hospitals 
treating the most low-income patients (high DSH percentage) demonstrate 
declines of 0.3 percent, where as all other hospitals treating DSH 
patients appear to experience slight increases of 0.1 percent. 
Hospitals that are treating DSH patients and are also teaching 
hospitals experience increases of 0.4 percent. Classifying hospitals by 
type of ownership suggests that proprietary hospitals will lose 1.3 
percent and voluntary and government hospitals will gain at least 0.1 
percent.
Column 3: New Wage Index
    Changes introduced by the proposed FY 2006 IPPS wage indices would 
have a modest impact in CY 2006, increasing payments to rural hospitals 
slightly and reducing payments to specific classes of urban hospitals. 
We estimate that rural hospitals, and specifically rural hospitals that 
are not sole community hospitals, will experience an increase in 
payments of 0.1 percent. With respect to facility size, only rural 
hospitals with between 150 and 199 beds experience a decrease in 
payments of 0.2 percent. Similarly, moderate rural volume hospitals 
experience a decrease of 0.1 percent. For both facility size and 
volume, no category of rural hospitals experiences an increase greater 
than 0.2 percent. Examining hospitals by region reveals slightly 
greater variability. We estimate that rural hospitals in several 
regions will experience decreases in payment up to 0.4 percent due to 
wage changes, including the Middle Atlantic, South Atlantic, West North 
Central, West South Central. However, rural hospitals in the remaining 
regions experience increases. We estimate that the Pacific region will 
see the largest increase of 1.8 percent.
    Overall, urban hospitals experience no change in payments as a 
result of the new wage indices. With respect to facility size, we 
estimate that urban hospitals with between 300 and 499 beds will 
experience a decrease in payments of 0.1 percent. Urban hospitals with 
less than 99 beds experience the largest increase of 0.2 percent. When 
categorized by volume, no class of urban hospitals experience a 
decrease in payment as a result of changes to the wage index. We 
estimate that urban hospitals in all but the Pacific and East South 
Central region will experience modest decreases due to wage changes of 
no more than 0.4 percent. Urban hospitals in the Pacific region will 
experience an increase of 1.1 percent, and urban hospitals in the East 
South Central region will experience no change in payments.
    Looking across other categories of hospitals, we estimate that 
updating the wage index will lead major teaching hospitals to lose 0.2 
percent and hospitals without graduate medical education programs are 
estimated to gain 0.1 percent. Hospitals serving between 0.0 and 0.10 
percent of low-income patients and between 0.23 and 0.35 percent of 
low-income patients lose up to 0.2 percent and 0.1 percent 
respectively, whereas hospitals serving other percentages of low-income 
patients gain by up to 0.1 percent or experience no change. Government 
hospitals will experience an increase of 0.1 percent.
Column 4: New Adjustment for Rural Sole Community Hospitals
    As discussed in section II.G. of the preamble of this proposed 
rule, we have proposed to increase payments for all services except 
drugs and biologicals to rural sole community hospitals by 6.6 percent. 
This resulted in an adjustment to the conversion factor of 0.997. 
Targeting payments to these rural hospitals uniformly reduces payments 
to all other hospitals by 0.3 percent. The uniform reduction for all 
urban and other rural hospitals is evident in Column 4. The observed 
increase of 5.2 percent for rural sole community hospitals is lower 
than 6.6 percent because drugs and biologicals do not receive the 
proposed payment adjustment. The remaining classes of rural hospitals 
show variable increases that reflect the distribution of rural sole 
community hospitals. The largest increases are observed among rural 
hospitals with small numbers of beds, with moderate volume, and regions 
in the western half of the country.
Column 5: All Budget Neutrality Changes and Market Basket Update
    With the exception of urban hospitals with the lowest volume of 
services, the addition of the market basket update alleviates any 
negative impacts on payments for CY 2006 created by the budget 
neutrality adjustments made in Columns 2, 3, and 4. In many instances, 
and especially among rural hospitals, the redistribution of payments 
created by proposed APC recalibration offset those introduced by 
updating the wage

[[Page 42760]]

indices. In some instances, especially for urban hospitals, APC 
recalibration changes compound the impact of updating the wage index. 
In addition, all urban and other rural hospitals experience a decrease 
in payment of 0.3 percent as a result of the proposed payment 
adjustment for rural sole community hospitals.
    We estimate that the cumulative impact of proposed budget 
neutrality adjustments and the addition of the market basket would 
result in an increase in payments for urban hospitals of 2.8 percent, 
which is less than the market basket update of 3.2 percent. Large urban 
hospitals would experience an increase of 2.0 percent and other urban 
hospitals would experience an increase of 3.8 percent. This trend of 
updates lower than the market basket holds for most other classes of 
urban hospitals. For example, of all classes of urban hospitals, urban 
hospitals with the lowest volume are the only group to experience a 
negative market basket update, which is largely a function of the 5.8 
percent decrease in payments attributable to proposed changes to the 
APC structure. Urban hospitals with moderate volume would also lose the 
bulk of the market basket update as a result of a -2.8 percent change 
resulting from proposed APC recalibration and the addition of the 
proposed payment adjustment for rural sole community hospitals. The 
same compounding effect holds true for urban hospitals in New England 
as well. Urban hospitals in New England would experience a 1.2 percent 
loss due to changes in APC structure, a 0.1 percent loss for changes to 
the wage index and a 0.3 percent loss for the new rural adjustment, 
reducing their increase to 1.5 percent. Urban hospitals in a few 
regions experience increases in payment for CY 2006 above the market 
basket, including the East South Central, Middle Atlantic, and West 
North Central regions.
    We estimate that the cumulative impact of budget neutrality 
adjustments and the market basket update will result in an overall 
increase for rural hospitals of 5.0 percent, with rural sole community 
hospitals experiencing an update of 8.6 percent and other rural 
hospitals experiencing an update of 2.8 percent. In general, rural 
hospitals with more than 100 beds and high volume rural hospitals 
experience increases of more than 5.0 percent, which generally results 
from the combined impact of increases in payment from APC 
recalibration, wage changes, and the new adjustment for rural sole 
community hospitals. Rural hospitals also demonstrate large increases 
by region, with Middle Atlantic, West North Central, Mountain, and 
Pacific regions experiencing large increases. For these regions, in 
aggregate, the payment adjustment for rural sole community hospitals 
compensates for observed loses in the APC recalibration column.
    The changes across columns for other classes of hospitals are 
fairly moderate and most show updates relatively close to the market 
basket. TEFRA hospitals that are not paid under OPPS show payment 
updates much lower than the market basket as a result of negative 
payment changes for proposed APC recalibration and the proposed 
adjustment for rural sole community hospitals. Proprietary hospitals 
also show an increase much less than the market basket as a result of 
negative payments under APC recalibration.
Column 6: All Proposed Changes for CY 2006
    Column 6 compares all proposed changes for CY 2006 to final payment 
for CY 2005 and includes any additional dollars resulting from 
provisions in Pub. L. 108-173 in both years, changes in outlier payment 
percentages and proposed thresholds, and the difference in pass-through 
estimates. Overall, we estimate that hospitals would gain 1.9 percent 
under this proposed rule in CY 2006 relative to total spending in CY 
2005, which included Pub. L. 108-173 dollars for drugs and wage 
indices. While hospitals receive the 3.2 percent increase due to the 
market basket appearing in Column 5 and the additional 1.0 percent in 
outlier payments that we estimate as not being paid in CY 2005, we 
estimate that hospitals also experience an overall 2.3 percent loss due 
to the expiration of additional payment for drugs in CY 2005. That is, 
without the additional 1.0 percent increase in outlier payments due to 
lower than expected payment for outliers in CY 2005, hospitals would 
receive a positive increase in payments of 0.9 percent. Paying the 
additional 1.0 percent in outlier payments in CY 2006 increases overall 
gains to 1.9 percent, which is lower than the market basket. Overall, 
the change in the outlier thresholds has a minimal redistributive 
impact by class of hospital and the vast majority of redistributive 
impacts observed between Columns 5 and 6 can be attributed to the loss 
of additional payment for drugs outside budget neutrality required by 
Pub. L. 108-173.
    In general, urban hospitals appear to experience the largest 
negative impacts from the loss of additional payments for drugs because 
of the combined effects of decreases in payment from the proposed 
payment adjustment for rural sole community hospitals and, frequently, 
negative changes in payments due to APC recalibration. We estimate that 
hospitals in large urban areas will gain 0.8 percent in CY 2006 and 
hospitals in other urban areas will gain 2.6 percent. We estimate that 
some urban hospitals will experience a decrease in total payments 
between CY 2005 and CY 2006. Specifically, low volume urban hospitals 
will experience a decrease in payments of 2.1 percent, which includes 
the cumulative effect of negative payments from APC recalibration, a 
negative impact of the payment adjustment for rural sole community 
hospitals, and a loss of payments outside budget neutrality for drugs. 
We estimate that urban hospitals in New England would experience a loss 
of 0.2 percent in CY 2006. The reason for this is the same as that for 
low volume urban hospitals, except that the urban hospitals in New 
England also experience a decrease in payments from updating the wage 
index. Other classes of urban hospitals generally show increases 
between 1.0 and 3.0 percent. Urban hospitals in the East South Central 
and West North Central experience the largest increases for urban 
hospitals of 3.4 and 3.7 percent, respectively.
    Overall, rural hospitals experience larger increases than those 
observed for urban hospitals because the proposed payment adjustment 
for rural sole community hospitals tends to buffer the loss of payments 
for drugs from Pub. L. 108-173. However, this adjustment is only for 
rural sole community hospitals. Overall, we estimate that rural 
hospitals will experience an increase in payments of 3.4 percent. But, 
we also estimate that rural sole community hospitals will experience an 
increase of 6.4 percent and that other rural hospitals will only 
experience an increase of 1.6 percent. No rural hospital experiences a 
decrease in payments between CY 2005 and CY 2006 and some classes of 
rural hospitals show increases comparable to the market basket. For 
example rural hospitals with more than 100 beds experience increases of 
at least 3.1 percent. Rural hospitals with moderate to high volume 
experience increases comparable to the market basket. Across the 
regions, rural hospitals in the Middle Atlantic, South Atlantic, West 
North Central, West South Central, Mountain, and Pacific all experience 
increases in payments greater than 3 percent. Low volume rural 
hospitals and rural hospitals in New England experience the lowest 
updates of only 1.0 percent.
    Among other classes of hospitals, we estimate that TEFRA hospitals 
not paid

[[Page 42761]]

under IPPS would experience decreases in payments between CY 2005 and 
CY 2006 of 1.9 percent and that TEFRA hospitals in urban areas will 
experience a decrease in payments between CY 2005 and CY 2006 of 2.6 
percent. Factoring in expiring payments for drugs through Pub. L. 108-
173, we estimate that major teaching hospitals would only experience an 
increase of 0.8 percent.

G. Estimated Impacts of This Proposed Rule on Beneficiaries

    For services for which the beneficiary pays a copayment of 20 
percent of the payment rate, the beneficiary share of payment will 
increase for services for which OPPS payments will rise and will 
decrease for services for which OPPS payments will fall. For example, 
for a mid-level office visit (APC 0601), the minimum unadjusted 
copayment in CY 2005 was $11.22. In this proposed rule, the minimum 
unadjusted copayment for APC 601 is $11.86 because the OPPS payment for 
the service will increase under this proposed rule. In another example, 
for a Level IV Needle Biopsy (APC 0037), the minimum unadjusted 
copayment in CY 2005 was $234.20. In this proposed rule, the minimum 
unadjusted copayment for APC 0037 is $223.91 because the minimum 
unadjusted copayment is limited to 40 percent of the APC payment rate 
for CY 2006, as discussed in section II. of the preamble to this 
proposed rule. However, in all cases, the statute limits beneficiary 
liability for copayment for a service to the inpatient hospital 
deductible for the applicable year.
    In order to better understand the impact of changes in copayment on 
beneficiaries we modeled the percent change in total copayment 
liability using CY 2004 claims. We estimate that total beneficiary 
liability for copayments will decline as an overall percentage of total 
payments from 32 percent in CY 2005 to 30 percent in CY 2006.

Conclusion

    The changes in this proposed rule would affect all classes of 
hospitals. Some hospitals experience significant gains and others less 
significant gains, but all hospitals would experience positive updates 
in OPPS payments in CY 2006. Table 33 demonstrates the estimated 
distributional impact of the OPPS budget neutrality requirements and an 
additional 1.9 percent increase in payments for CY 2006, after 
considering the expiring provision for additional drug payment under 
Pub. L. 108-173 and a change in the percentage of total payments 
dedicated to outliers and transitional pass-through payments, exclusive 
of transitional pass-through payments, across various classes of 
hospitals. The accompanying discussion, in combination with the rest of 
this proposed rule constitutes a regulatory impact analysis.

                            Table 33.--Impact of Proposed Changes for CY 2006 Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                (5)
                                                                                                           (4)  New adj     Cumulative
                    Hospital category                     (1)  Number of     (2)  APC      (3)  New wage  for rural sole   (cols 2,3,4)      (6)  All
                                                             hospitals        changes          index         community      with market       changes
                                                                                                             hospitals     basket update
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL HOSPITALS...........................................            4212             0.0             0.0             0.0             3.2             1.9
URBAN HOSPITALS.........................................            2949             0.0             0.0            -0.3             2.8             1.6
    LARGE URBAN.........................................            1624            -0.8             0.0            -0.3             2.0             0.8
    OTHER URBAN.........................................            1325             1.0             0.0            -0.3             3.8             2.6
RURAL HOSPITALS.........................................            1263            -0.1             0.1             1.8             5.0             3.4
    SOLE COMMUNITY......................................             478             0.0             0.0             5.2             8.6             6.4
    OTHER RURAL.........................................             785            -0.1             0.1            -0.3             2.8             1.6
BEDS (URBAN):
    0-99 BEDS...........................................             917             0.0             0.2            -0.3             3.0             2.1
    100-199 BEDS........................................             964            -0.4             0.0            -0.3             2.4             1.4
    200-299 BEDS........................................             503             0.2             0.1            -0.3             3.1             2.3
    300-499 BEDS........................................             402            -0.1            -0.1            -0.3             2.6             1.5
    500 + BEDS..........................................             163             0.5             0.0            -0.3             3.3             1.2
BEDS (RURAL):
    0--49 BEDS..........................................             551            -0.9             0.2             2.0             4.5             3.0
    50-100 BEDS.........................................             419            -0.8             0.2             2.2             4.8             2.9
    101-149 BEDS........................................             180             1.4             0.0             1.1             5.8             4.7
    150-199 BEDS........................................              62            -0.3            -0.2             1.7             4.5             3.5
    200 + BEDS..........................................              51             0.2             0.0             1.7             5.1             3.1
VOLUME (URBAN):
    LT 5,000 claim lines................................             600            -5.8             0.5            -0.3            -2.7            -2.1
    5,000-10,999........................................             180            -2.8             0.2            -0.3             0.2             0.2
    11,000-20,999.......................................             299            -0.8             0.2            -0.3             2.2             2.3
    21,000-42,999.......................................             575            -0.8             0.1            -0.3             2.2             1.8
    GT 42,999...........................................            1295             0.2             0.0            -0.3             3.0             1.6
VOLUME (RURAL):
    LT 5,000 claim lines................................             119            -2.9             0.0             1.3             1.6             1.3
    5,000--10,999.......................................             195            -2.1             0.0             2.1             3.2             2.2
    11,000--20,999......................................             325            -1.0            -0.1             2.0             4.1             3.3
    21,000--42,999......................................             364            -0.9             0.2             1.9             4.4             2.9
    GT 42,999...........................................             260             0.7             0.0             1.6             5.7             3.8
REGION (URBAN):
    NEW ENGLAND.........................................             166            -1.2            -0.1            -0.3             1.5            -0.2
    MIDDLE ATLANTIC.....................................             393             0.7            -0.1            -0.3             3.5             2.2
    SOUTH ATLANTIC......................................             453            -0.4            -0.4            -0.3             2.0             1.0
    EAST NORTH CENT.....................................             466             0.5            -0.1            -0.3             3.2             1.7
    EAST SOUTH CENT.....................................             197             1.5             0.0            -0.3             4.4             3.4
    WEST NORTH CENT.....................................             184             2.6            -0.3            -0.3             5.2             3.7
    WEST SOUTH CENT.....................................             445            -0.3            -0.1            -0.3             2.4             1.3

[[Page 42762]]

 
    MOUNTAIN............................................             163            -0.1            -0.2            -0.3             2.5             1.3
    PACIFIC.............................................             431            -1.8             1.1            -0.3             2.1             1.3
    PUERTO RICO.........................................              51             0.1            -0.3            -0.3             2.7             1.9
REGION (RURAL):
    NEW ENGLAND.........................................              37            -0.9             0.8             1.2             4.4             1.0
    MIDDLE ATLANTIC.....................................              78             1.9            -0.4             1.4             6.1             4.2
    SOUTH ATLANTIC......................................             189            -0.4            -0.2             1.7             4.3             3.2
    EAST NORTH CENT.....................................             171            -0.5             0.1             1.3             4.1             2.2
    EAST SOUTH CENT.....................................             202            -0.9             0.5             0.5             3.3             2.9
    WEST NORTH CENT.....................................             188             1.8            -0.3             2.5             7.3             4.8
    WEST SOUTH CENT.....................................             242            -1.1            -0.2             2.2             4.1             3.5
    MOUNTAIN............................................              95            -1.0             0.1             4.4             6.8             5.0
    PACIFIC.............................................              61            -0.6             1.8             2.6             7.1             5.2
TEACHING STATUS:
    NON-TEACHING........................................            3115            -0.4             0.1             0.2             3.1             2.2
    MINOR...............................................             769             0.2             0.0            -0.2             3.3             2.2
    MAJOR...............................................             328             0.5            -0.2            -0.3             3.2             0.8
DSH PATIENT PERCENT:
    0...................................................              16             0.0             0.0            -0.3             2.8             2.8
    GT 0-0.10...........................................             386             0.1            -0.2            -0.3             2.7             1.7
    0.10-0.16...........................................             555             0.0             0.1             0.2             3.5             2.4
    0.16-0.23...........................................             802             0.1             0.0             0.1             3.5             2.3
    0.23-0.35...........................................             977             0.1            -0.1             0.0             3.2             1.9
    GE 0.35.............................................             792            -0.3             0.1            -0.1             3.0             1.8
    TEFRA: DSH NOT AVAIL \1\............................             684            -0.9             0.0            -0.3             1.9            -1.9
URBAN TEACHING/DSH:
    TEACHING & DSH......................................             944             0.4            -0.1            -0.3             3.2             1.7
    NO TEACHING/DSH.....................................            1401            -0.4             0.0            -0.3             2.5             1.7
    NO TEACHING/NO DSH..................................              16             0.0             0.0            -0.3             2.8             2.8
    TEFRA: DSH NOT AVAIL \1\............................             588            -1.4             0.1            -0.3             1.5            -2.6
TYPE OF OWNERSHIP:
    VOLUNTARY...........................................            2397             0.2             0.0             0.0             3.3             2.0
    PROPRIETARY.........................................            1091            -1.3             0.0             0.0             1.9             1.4
    GOVERNMENT..........................................             724             0.1             0.1             0.2             3.7            1.8
--------------------------------------------------------------------------------------------------------------------------------------------------------
Col (1) Total hospitals in CY 2006.
Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and from the addition of multiple
  procedure discounting for radiology procedures (budget neutral overall).
Col (3) This column shows the adjustment for updating the wage index (budget neutral overall).
Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall).
Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket update.
Col (6) The column shows the impact of the change in MMA dollars in CY 2006 (drugs and 508) and outlier changes.
\1\ Complete DSH numbers are not available for hospitals that are not paid under IPPS.

    In accordance with the provisions of Executive Order 12866, this 
proposed rule was reviewed by the Office of Management and Budget.

List of Subjects

42 CFR Part 419

    Hospitals, Medicare, Reporting and recordkeeping requirements.

42 CFR Part 485

    Grant program-health, Health facilities, Medicaid, Medicare, 
Reporting and recordkeeping requirements.

    For the reasons stated in the preamble of this proposed rule, the 
Centers for Medicare & Medicaid Services is proposing to amend 42 CFR 
Chapter IV as set forth below:

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

    A. Part 419 is amended as follows:
    1. The authority citation for Part 419 continues to read as 
follows:

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

    2. Section 419.43 is amended by adding a new paragraph (g) to read 
as follows:


Sec.  419.43  Adjustments to national program payment and beneficiary 
copayment amounts.

* * * * *
    (g) Payment adjustment for certain rural hospitals. (1) General 
rule. CMS provides for additional payment for covered hospital 
outpatient service not excluded under paragraph (g)(4) of this section, 
furnished on or after January 1, 2006, if the hospital--
    (i) Is a sole community hospital under Sec.  412.92 of this 
chapter; and
    (ii) Is located in a rural area as defined in Sec.  412.64(b) of 
this chapter or is treated as being located in a rural area under 
section 1886(d)(8)(E) of the Act.
    (2) Amount of adjustment. The amount of the additional payment 
under paragraph (g)(1) of this section is determined by CMS and is 
based on the difference between costs incurred by hospitals that meet 
the criteria in paragraphs (g)(1)(i) and (g)(1)(ii) of this section and 
costs incurred by hospitals located in urban areas.
    (3) Budget neutrality. CMS establishes the payment adjustment under

[[Page 42763]]

paragraph (g)(2) of this section in a budget neutral manner, excluding 
services and groups specified in paragraph (g)(4) of this section.
    (4) Excluded services and groups. Drugs and biologicals that are 
paid under a separate APC and devices of brachytheraphy consisting of a 
seed or seeds (including a radioactive source) are excluded from 
qualification for the payment adjustment in paragraph (g)(2) of this 
section.
    (5) Copayment The payment adjustment in paragraph (g)((2) of this 
section is applied before calculating copayment amounts.
    (6) Outliers: The payment adjustment in paragraph (g) (2) of this 
section is applied before calculating outlier payments.
* * * * *
    3. Section 419.66 is amended by revising paragraph (c)(1) to read 
as follows:


Sec.  419.66  Transitional pass-through payments: Medical devices.

* * * * *
    (c) Criteria for establishing device categories. * * *
    (1) CMS determines that a device to be included in the category is 
not appropriately described by any of the existing categories or by any 
category previously in effect, and was not being paid for as an 
outpatient service as of December 31, 1996.
* * * * *

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

    B. Part 485 is amended as follows:
    1. The authority citation for Part 485 continues to read as 
follows:

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

    2. Section 485.631 is amended by--
    a. Republishing paragraph (b)(1).
    b. Revising paragraph (b)(1)(iv).
    c. Adding new paragraphs (b)(1)(v) and (b)(1)(vi).
    The revision and additions read as follows:


Sec.  485.631  Condition of participation: Staffing and staff 
responsibilities.

* * * * *
    (b) Standard: Responsibilities of the doctor of medicine or 
osteopathy. (1) The doctor of medicine or osteopathy--
* * * * *
    (iv) Periodically reviews and signs the records of all inpatients 
cared for by nurse practitioners, clinical nurse specialists, certified 
nurse midwives, or physician assistants.
    (v) Periodically, but not less than every 2 weeks, reviews and 
signs a sample of outpatient records of patients cared for by nurse 
practitioners, clinical nurse specialists, certified nurse midwives, or 
physician assistants according to the policies of the CAH and according 
to current standards of practice where State law does not allow these 
nonphysician practitioners to practice independently.
    (vi) Is not required to review and sign outpatient records of 
patients cared for by nurse practitioners, clinical nurse specialists, 
certified nurse midwives, or physician assistants where State law 
allows these nonphysician practitioners to practice independently.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: July 8, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: July 13, 2005.
Michael O. Leavitt,
Secretary.

[[Page 42764]]



Addendum A.--List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment
                                 Rates, and Copayment Amounts Calendar Year 2006
----------------------------------------------------------------------------------------------------------------
                                                                                          National     Minimum
      APC               Group title              Status         Relative     Payment     unadjusted   unadjusted
                                                indicator        weight        rate      copayment    copayment
----------------------------------------------------------------------------------------------------------------
0001...........  Level I Photochemotherapy  S...............       0.4194       $24.89        $7.00        $4.98
0002...........  Level I Fine Needle        T...............       0.9515       $56.47  ...........       $11.29
                  Biopsy/Aspiration.
0003...........  Bone Marrow Biopsy/        T...............       2.6410      $156.74  ...........       $31.35
                  Aspiration.
0004...........  Level I Needle Biopsy/     T...............       1.7566      $104.25       $22.36       $20.85
                  Aspiration Except Bone
                  Marrow.
0005...........  Level II Needle Biopsy/    T...............       3.5831      $212.66       $71.45       $42.53
                  Aspiration Except Bone
                  Marrow.
0006...........  Level I Incision &         T...............       1.5430       $91.58       $22.18       $18.32
                  Drainage.
0007...........  Level II Incision &        T...............      11.3983      $676.49  ...........      $135.30
                  Drainage.
0008...........  Level III Incision and     T...............      16.4242      $974.78  ...........      $194.96
                  Drainage.
0009...........  Nail Procedures..........  T...............       0.6650       $39.47        $8.34        $7.89
0010...........  Level I Destruction of     T...............       0.5693       $33.79        $9.63        $6.76
                  Lesion.
0011...........  Level II Destruction of    T...............       2.0745      $123.12       $25.06       $24.62
                  Lesion.
0012...........  Level I Debridement &      T...............       0.8458       $50.20       $11.18       $10.04
                  Destruction.
0013...........  Level II Debridement &     T...............       1.1028       $65.45       $14.20       $13.09
                  Destruction.
0015...........  Level III Debridement &    T...............       1.6439       $97.57       $20.20       $19.51
                  Destruction.
0016...........  Level IV Debridement &     T...............       2.5717      $152.63       $33.42       $30.53
                  Destruction.
0017...........  Level VI Debridement &     T...............      18.3377    $1,088.34      $227.84      $217.67
                  Destruction.
0018...........  Biopsy of Skin/Puncture    T...............       1.1673       $69.28       $16.04       $13.86
                  of Lesion.
0019...........  Level I Excision/Biopsy..  T...............       4.0363      $239.55       $71.87       $47.91
0020...........  Level II Excision/Biopsy.  T...............       6.9118      $410.22      $106.93       $82.04
0021...........  Level III Excision/Biopsy  T...............      14.9098      $884.90      $219.48      $176.98
0022...........  Level IV Excision/Biopsy.  T...............      19.5582    $1,160.78      $354.45      $232.16
0023...........  Exploration Penetrating    T...............       4.7558      $282.26  ...........       $56.45
                  Wound.
0024...........  Level I Skin Repair......  T...............       1.6011       $95.03       $31.11       $19.01
0025...........  Level II Skin Repair.....  T...............       5.4690      $324.59      $101.85       $64.92
0027...........  Level IV Skin Repair.....  T...............      18.3348    $1,088.17      $329.72      $217.63
0028...........  Level I Breast Surgery...  T...............      19.4914    $1,156.81      $303.74      $231.36
0029...........  Level II Breast Surgery..  T...............      31.9024    $1,893.41      $632.64      $378.68
0030...........  Level III Breast Surgery.  T...............      39.9010    $2,368.12      $763.55      $473.62
0033...........  Partial Hospitalization..  P...............       4.0524      $240.51  ...........       $48.10
0035...........  Venous Cutdown...........  T...............       0.7125       $42.29  ...........        $8.46
0036...........  Level II Fine Needle       T...............       2.1675      $128.64  ...........       $25.73
                  Biopsy/Aspiration.
0037...........  Level IV Needle Biopsy/    T...............       9.4322      $559.80      $223.91      $111.96
                  Aspiration Except Bone
                  Marrow.
0039...........  Level I Implantation of    S...............     180.5784   $10,717.33  ...........    $2,143.47
                  Neurostimulator.
0040...........  Level I Implantation of    S...............      55.0791    $3,268.94  ...........      $653.79
                  Neurostimulator
                  Electrodes.
0041...........  Level I Arthroscopy......  T...............      28.0044    $1,662.06  ...........      $332.41
0042...........  Level II Arthroscopy.....  T...............      43.7761    $2,598.11      $804.74      $519.62
0043...........  Closed Treatment Fracture  T...............       1.7614      $104.54  ...........       $20.91
                  Finger/Toe/Trunk.
0045...........  Bone/Joint Manipulation    T...............      14.4289      $856.36      $268.47      $171.27
                  Under Anesthesia.
0046...........  Open/Percutaneous          T...............      37.5315    $2,227.49      $535.76      $445.50
                  Treatment Fracture or
                  Dislocation.
0047...........  Arthroplasty without       T...............      31.4675    $1,867.60      $537.03      $373.52
                  Prosthesis.
0048...........  Level I Arthroplasty with  T...............      42.9335    $2,548.10      $570.30      $509.62
                  Prosthesis.
0049...........  Level I Musculoskeletal    T...............      20.2784    $1,203.52  ...........      $240.70
                  Procedures Except Hand
                  and Foot.
0050...........  Level II Musculoskeletal   T...............      23.7998    $1,412.52  ...........      $282.50
                  Procedures Except Hand
                  and Foot.
0051...........  Level III Musculoskeletal  T...............      36.3617    $2,158.07  ...........      $431.61
                  Procedures Except Hand
                  and Foot.
0052...........  Level IV Musculoskeletal   T...............      43.7388    $2,595.90  ...........      $519.18
                  Procedures Except Hand
                  and Foot.
0053...........  Level I Hand               T...............      15.6085      $926.36      $253.49      $185.27
                  Musculoskeletal
                  Procedures.
0054...........  Level II Hand              T...............      25.2562    $1,498.96  ...........      $299.79
                  Musculoskeletal
                  Procedures.
0055...........  Level I Foot               T...............      19.9783    $1,185.71      $355.34      $237.14
                  Musculoskeletal
                  Procedures.
0056...........  Level II Foot              T...............      40.1132    $2,380.72  ...........      $476.14
                  Musculoskeletal
                  Procedures.
0057...........  Bunion Procedures........  T...............      27.4246    $1,627.65      $475.91      $325.53
0058...........  Level I Strapping and      S...............       1.0884       $64.60  ...........       $12.92
                  Cast Application.
0060...........  Manipulation Therapy.....  S...............       0.4913       $29.16  ...........        $5.83
0068...........  CPAP Initiation..........  S...............       1.2237       $72.63       $29.05       $14.53
0069...........  Thoracoscopy.............  T...............      30.5386    $1,812.47      $591.64      $362.49
0070...........  Thoracentesis/Lavage       T...............       3.1956      $189.66  ...........       $37.93
                  Procedures.
0071...........  Level I Endoscopy Upper    T...............       0.7879       $46.76       $11.31        $9.35
                  Airway.
0072...........  Level II Endoscopy Upper   T...............       1.4296       $84.85       $21.27       $16.97
                  Airway.
0073...........  Level III Endoscopy Upper  T...............       4.1420      $245.83       $73.38       $49.17
                  Airway.
0074...........  Level IV Endoscopy Upper   T...............      15.7042      $932.04      $295.70      $186.41
                  Airway.
0075...........  Level V Endoscopy Upper    T...............      21.2460    $1,260.95      $445.92      $252.19
                  Airway.
0076...........  Level I Endoscopy Lower    T...............       9.4163      $558.86      $189.82      $111.77
                  Airway.
0077...........  Level I Pulmonary          S...............       0.3428       $20.35        $7.74        $4.07
                  Treatment.
0078...........  Level II Pulmonary         S...............       1.0190       $60.48       $14.55       $12.10
                  Treatment.
0079...........  Ventilation Initiation     S...............       2.3375      $138.73  ...........       $27.75
                  and Management.
0080...........  Diagnostic Cardiac         T...............      36.9679    $2,194.04      $838.92      $438.81
                  Catheterization.
0081...........  Non-Coronary Angioplasty   T...............      34.2913    $2,035.19  ...........      $407.04
                  or Atherectomy.
0082...........  Coronary Atherectomy.....  T...............      84.6276    $5,022.65    $1,080.41    $1,004.53
0083...........  Coronary Angioplasty and   T...............      50.6620    $3,006.79  ...........      $601.36
                  Percutaneous
                  Valvuloplasty.
0084...........  Level I                    S...............       9.9751      $592.02  ...........      $118.40
                  Electrophysiologic
                  Evaluation.

[[Page 42765]]

 
0085...........  Level II                   T...............      35.0288    $2,078.96      $426.25      $415.79
                  Electrophysiologic
                  Evaluation.
0086...........  Ablate Heart Dysrhythm     T...............      44.0592    $2,614.91      $833.33      $522.98
                  Focus.
0087...........  Cardiac                    T...............      30.5711    $1,814.39  ...........      $362.88
                  Electrophysiologic
                  Recording/Mapping.
0088...........  Thrombectomy.............  T...............      36.3961    $2,160.11      $655.22      $432.02
0089...........  Insertion/Replacement of   T...............     105.1359    $6,239.82    $1,681.06    $1,247.96
                  Permanent Pacemaker and
                  Electrodes.
0090...........  Insertion/Replacement of   T...............      88.7536    $5,267.53    $1,612.80    $1,053.51
                  Pacemaker Pulse
                  Generator.
0091...........  Level II Vascular          T...............      28.8685    $1,713.35      $348.23      $342.67
                  Ligation.
0092...........  Level I Vascular Ligation  T...............      26.3621    $1,564.59      $505.37      $312.92
0093...........  Vascular Reconstruction/   T...............      23.3454    $1,385.55      $277.34      $277.11
                  Fistula Repair without
                  Device.
0094...........  Level I Resuscitation and  S...............       2.5248      $149.85       $47.41       $29.97
                  Cardioversion.
0095...........  Cardiac Rehabilitation...  S...............       0.5858       $34.77       $13.90        $6.95
0096...........  Non-Invasive Vascular      S...............       1.6233       $96.34       $38.53       $19.27
                  Studies.
0097...........  Cardiac and Ambulatory     X...............       1.0177       $60.40       $23.79       $12.08
                  Blood Pressure
                  Monitoring.
0098...........  Injection of Sclerosing    T...............       1.1295       $67.04  ...........       $13.41
                  Solution.
0099...........  Electrocardiograms.......  S...............       0.3804       $22.58  ...........        $4.52
0100...........  Cardiac Stress Tests.....  X...............       2.4855      $147.51       $41.44       $29.50
0101...........  Tilt Table Evaluation....  S...............       4.2593      $252.79      $101.11       $50.56
0103...........  Miscellaneous Vascular     T...............      14.6476      $869.34      $223.63      $173.87
                  Procedures.
0104...........  Transcatheter Placement    T...............      78.6515    $4,667.97  ...........      $933.59
                  of Intracoronary Stents.
0105...........  Revision/Removal of        T...............      22.2671    $1,321.55      $370.40      $264.31
                  Pacemakers, AICD, or
                  Vascular.
0106...........  Insertion/Replacement/     T...............      45.2791    $2,687.31  ...........      $537.46
                  Repair of Pacemaker and/
                  or Electrodes.
0107...........  Insertion of Cardioverter- T...............     258.8517   $15,362.85    $3,089.53    $3,072.57
                  Defibrillator.
0108...........  Insertion/Replacement/     T...............     347.5867   $20,629.27  ...........    $4,125.85
                  Repair of Cardioverter-
                  Defibrillator Leads.
0109...........  Removal of Implanted       T...............      10.9933      $652.45      $131.49      $130.49
                  Devices.
0110...........  Transfusion..............  S...............       3.6428      $216.20  ...........       $43.24
0111...........  Blood Product Exchange...  S...............      12.3394      $732.34      $200.18      $146.47
0112...........  Apheresis, Photopheresis,  S...............      26.6734    $1,583.07      $437.01      $316.61
                  and Plasmapheresis.
0113...........  Excision Lymphatic System  T...............      21.3681    $1,268.20  ...........      $253.64
0114...........  Thyroid/Lymphadenectomy    T...............      40.5805    $2,408.45      $485.91      $481.69
                  Procedures.
0115...........  Cannula/Access Device      T...............      31.3302    $1,859.45      $459.35      $371.89
                  Procedures.
0116...........  Chemotherapy               S...............       1.1401       $67.66  ...........       $13.53
                  Administration by Other
                  Technique Except
                  Infusion.
0117...........  Chemotherapy               S...............       3.2231      $191.29       $42.54       $38.26
                  Administration by
                  Infusion Only.
0120...........  Infusion Therapy Except    S...............       2.0101      $119.30       $28.21       $23.86
                  Chemotherapy.
0121...........  Level I Tube changes and   T...............       2.2663      $134.50       $43.80       $26.90
                  Repositioning.
0122...........  Level II Tube changes and  T...............       6.9405      $411.92       $84.48       $82.38
                  Repositioning.
0123...........  Bone Marrow Harvesting     S...............      22.8861    $1,358.29  ...........      $271.66
                  and Bone Marrow/Stem
                  Cell Transplant.
0125...........  Refilling of Infusion      T...............       1.9244      $114.21  ...........       $22.84
                  Pump.
0130...........  Level I Laparoscopy......  T...............      31.7825    $1,886.29      $659.53      $377.26
0131...........  Level II Laparoscopy.....  T...............      43.1426    $2,560.51    $1,001.89      $512.10
0132...........  Level III Laparoscopy....  T...............      62.7061    $3,721.61    $1,239.22      $744.32
0140...........  Esophageal Dilation        T...............       5.4489      $323.39       $93.77       $64.68
                  without Endoscopy.
0141...........  Level I Upper GI           T...............       8.1464      $483.49      $143.38       $96.70
                  Procedures.
0142...........  Small Intestine Endoscopy  T...............       9.3063      $552.33      $152.78      $110.47
0143...........  Lower GI Endoscopy.......  T...............       8.6475      $513.23      $186.06      $102.65
0146...........  Level I Sigmoidoscopy and  T...............       4.6164      $273.98       $64.40       $54.80
                  Anoscopy.
0147...........  Level II Sigmoidoscopy     T...............       7.9318      $470.75  ...........       $94.15
                  and Anoscopy.
0148...........  Level I Anal/Rectal        T...............       3.7213      $220.86       $56.96       $44.17
                  Procedures.
0149...........  Level III Anal/Rectal      T...............      17.9907    $1,067.75      $293.06      $213.55
                  Procedures.
0150...........  Level IV Anal/Rectal       T...............      23.7573    $1,410.00      $437.12      $282.00
                  Procedures.
0151...........  Endoscopic Retrograde      T...............      18.6489    $1,106.81      $245.46      $221.36
                  Cholangio-
                  Pancreatography (ERCP).
0152...........  Level I Percutaneous       T...............      12.2277      $725.71  ...........      $145.14
                  Abdominal and Biliary
                  Procedures.
0153...........  Peritoneal and Abdominal   T...............      21.5979    $1,281.84      $381.07      $256.37
                  Procedures.
0154...........  Hernia/Hydrocele           T...............      28.6544    $1,700.64      $464.85      $340.13
                  Procedures.
0155...........  Level II Anal/Rectal       T...............      16.1810      $960.34  ...........      $192.07
                  Procedures.
0156...........  Level II Urinary and Anal  T...............       2.5635      $152.14       $40.52       $30.43
                  Procedures.
0157...........  Colorectal Cancer          S...............       2.2800      $135.32  ...........       $27.06
                  Screening: Barium Enema.
0158...........  Colorectal Cancer          T...............       7.6242      $452.50  ...........      $113.13
                  Screening: Colonoscopy.
0159...........  Colorectal Cancer          S...............       3.1312      $185.84  ...........       $46.46
                  Screening: Flexible
                  Sigmoidoscopy.
0160...........  Level I Cystourethroscopy  T...............       6.6450      $394.38      $105.06       $78.88
                  and other Genitourinary
                  Procedures.
0161...........  Level II                   T...............      18.4736    $1,096.41      $249.36      $219.28
                  Cystourethroscopy and
                  other Genitourinary
                  Procedures.
0162...........  Level III                  T...............      23.2858    $1,382.01  ...........      $276.40
                  Cystourethroscopy and
                  other Genitourinary
                  Procedures.
0163...........  Level IV                   T...............      33.5826    $1,993.13  ...........      $398.63
                  Cystourethroscopy and
                  other Genitourinary
                  Procedures.

[[Page 42766]]

 
0164...........  Level I Urinary and Anal   T...............       1.1802       $70.04       $17.21       $14.01
                  Procedures.
0165...........  Level III Urinary and      T...............      16.5934      $984.82  ...........      $196.96
                  Anal Procedures.
0166...........  Level I Urethral           T...............      17.5942    $1,044.22      $218.73      $208.84
                  Procedures.
0168...........  Level II Urethral          T...............      28.1405    $1,670.14      $386.32      $334.03
                  Procedures.
0169...........  Lithotripsy..............  T...............      42.8184    $2,541.27    $1,016.50      $508.25
0170...........  Dialysis.................  S...............       5.8726      $348.54  ...........       $69.71
0180...........  Circumcision.............  T...............      19.7926    $1,174.69      $304.87      $234.94
0181...........  Penile Procedures........  T...............      30.7265    $1,823.62      $621.82      $364.72
0183...........  Testes/Epididymis          T...............      23.5344    $1,396.77  ...........      $279.35
                  Procedures.
0184...........  Prostate Biopsy..........  T...............       4.3369      $257.40       $96.27       $51.48
0188...........  Level II Female            T...............       1.1348       $67.35  ...........       $13.47
                  Reproductive Proc.
0189...........  Level III Female           T...............       2.3602      $140.08  ...........       $28.02
                  Reproductive Proc.
0190...........  Level I Hysteroscopy.....  T...............      20.9699    $1,244.56      $424.28      $248.91
0191...........  Level I Female             T...............       0.1663        $9.87        $2.77        $1.97
                  Reproductive Proc.
0192...........  Level IV Female            T...............       4.2887      $254.53  ...........       $50.91
                  Reproductive Proc.
0193...........  Level V Female             T...............      14.5183      $861.66  ...........      $172.33
                  Reproductive Proc.
0194...........  Level VIII Female          T...............      20.6585    $1,226.08      $397.84      $245.22
                  Reproductive Proc.
0195...........  Level IX Female            T...............      26.5582    $1,576.23      $483.80      $315.25
                  Reproductive Proc.
0196...........  Dilation and Curettage...  T...............      17.0200    $1,010.14      $338.23      $202.03
0197...........  Infertility Procedures...  T...............       2.3465      $139.26  ...........       $27.85
0198...........  Pregnancy and Neonatal     T...............       1.3621       $80.84       $32.19       $16.17
                  Care Procedures.
0200...........  Level VII Female           T...............      17.7919    $1,055.95      $263.69      $211.19
                  Reproductive Proc.
0201...........  Level VI Female            T...............      17.5250    $1,040.11      $329.65      $208.02
                  Reproductive Proc.
0202...........  Level X Female             T...............      40.2037    $2,386.09      $954.43      $477.22
                  Reproductive Proc.
0203...........  Level IV Nerve Injections  T...............      10.3544      $614.53      $245.81      $122.91
0204...........  Level I Nerve Injections.  T...............       2.1811      $129.45       $40.13       $25.89
0206...........  Level II Nerve Injections  T...............       5.4672      $324.48       $75.55       $64.90
0207...........  Level III Nerve            T...............       5.9837      $355.13       $86.92       $71.03
                  Injections.
0208...........  Laminotomies and           T...............      42.1492    $2,501.56  ...........      $500.31
                  Laminectomies.
0209...........  Extended EEG Studies and   S...............      11.5189      $683.65      $273.46      $136.73
                  Sleep Studies, Level II.
0212...........  Nervous System Injections  T...............       2.9606      $175.71       $70.28       $35.14
0213...........  Extended EEG Studies and   S...............       2.2828      $135.48       $54.19       $27.10
                  Sleep Studies, Level I.
0214...........  Electroencephalogram.....  S...............       1.1302       $67.08       $26.83       $13.42
0215...........  Level I Nerve and Muscle   S...............       0.6087       $36.13       $14.45        $7.23
                  Tests.
0216...........  Level III Nerve and        S...............       2.6599      $157.87  ...........       $31.57
                  Muscle Tests.
0218...........  Level II Nerve and Muscle  S...............       1.1356       $67.40  ...........       $13.48
                  Tests.
0220...........  Level I Nerve Procedures.  T...............      17.2800    $1,025.57  ...........      $205.11
0221...........  Level II Nerve Procedures  T...............      29.7854    $1,767.76      $463.62      $353.55
0222...........  Implantation of            T...............     178.2870   $10,581.33  ...........    $2,116.27
                  Neurological Device.
0223...........  Implantation or Revision   T...............      27.9956    $1,661.54  ...........      $332.31
                  of Pain Management
                  Catheter.
0224...........  Implantation of Reservoir/ T...............      40.4614    $2,401.38  ...........      $480.28
                  Pump/Shunt.
0225...........  Level II Implantation of   S...............     233.6295   $13,865.91  ...........    $2,773.18
                  Neurostimulator
                  Electrodes.
0226...........  Implantation of Drug       T...............     138.2406    $8,204.58  ...........    $1,640.92
                  Infusion Reservoir.
0227...........  Implantation of Drug       T...............     135.8740    $8,064.12  ...........    $1,612.82
                  Infusion Device.
0228...........  Creation of Lumbar         T...............      51.4916    $3,056.03  ...........      $611.21
                  Subarachnoid Shunt.
0229...........  Transcatherter Placement   T...............      64.1626    $3,808.05      $771.23      $761.61
                  of Intravascular Shunts.
0230...........  Level I Eye Tests &        S...............       0.7823       $46.43       $14.97        $9.29
                  Treatments.
0231...........  Level III Eye Tests &      S...............       1.9191      $113.90  ...........       $22.78
                  Treatments.
0232...........  Level I Anterior Segment   T...............       6.6429      $394.26      $103.17       $78.85
                  Eye Procedures.
0233...........  Level II Anterior Segment  T...............      14.8995      $884.29      $266.33      $176.86
                  Eye Procedures.
0234...........  Level III Anterior         T...............      21.8746    $1,298.26      $511.31      $259.65
                  Segment Eye Procedures.
0235...........  Level I Posterior Segment  T...............       4.6382      $275.28       $67.10       $55.06
                  Eye Procedures.
0236...........  Level II Posterior         T...............      16.9458    $1,005.73  ...........      $201.15
                  Segment Eye Procedures.
0237...........  Level III Posterior        T...............      28.8091    $1,709.82  ...........      $341.96
                  Segment Eye Procedures.
0238...........  Level I Repair and         T...............       2.5816      $153.22  ...........       $30.64
                  Plastic Eye Procedures.
0239...........  Level II Repair and        T...............       6.8784      $408.23  ...........       $81.65
                  Plastic Eye Procedures.
0240...........  Level III Repair and       T...............      18.0686    $1,072.37      $315.31      $214.47
                  Plastic Eye Procedures.
0241...........  Level IV Repair and        T...............      23.1980    $1,376.80      $384.47      $275.36
                  Plastic Eye Procedures.
0242...........  Level V Repair and         T...............      30.4081    $1,804.72      $597.36      $360.94
                  Plastic Eye Procedures.
0243...........  Strabismus/Muscle          T...............      22.0667    $1,309.66      $431.39      $261.93
                  Procedures.
0244...........  Corneal Transplant.......  T...............      38.1985    $2,267.08      $803.26      $453.42
0245...........  Level I Cataract           T...............      13.3020      $789.47      $220.91      $157.89
                  Procedures without IOL
                  Insert.
0246...........  Cataract Procedures with   T...............      23.3535    $1,386.03      $495.96      $277.21
                  IOL Insert.
0247...........  Laser Eye Procedures       T...............       5.0102      $297.36      $104.31       $59.47
                  Except Retinal.
0248...........  Laser Retinal Procedures.  T...............       4.6557      $276.32       $93.57       $55.26
0249...........  Level II Cataract          T...............      27.8103    $1,650.54      $524.67      $330.11
                  Procedures without IOL
                  Insert.
0250...........  Nasal Cauterization/       T...............       1.2838       $76.19       $26.67       $15.24
                  Packing.
0251...........  Level I ENT Procedures...  T...............       2.0010      $118.76  ...........       $23.75
0252...........  Level II ENT Procedures..  T...............       7.8317      $464.81      $113.41       $92.96

[[Page 42767]]

 
0253...........  Level III ENT Procedures.  T...............      16.0627      $953.32      $282.29      $190.66
0254...........  Level IV ENT Procedures..  T...............      23.2980    $1,382.74      $321.35      $276.55
0256...........  Level V ENT Procedures...  T...............      37.1513    $2,204.93  ...........      $440.99
0258...........  Tonsil and Adenoid         T...............      22.1458    $1,314.35      $437.25      $262.87
                  Procedures.
0259...........  Level VI ENT Procedures..  T...............     364.6725   $21,643.31    $8,034.61    $4,328.66
0260...........  Level I Plain Film Except  X...............       0.7521       $44.64       $17.85        $8.93
                  Teeth.
0261...........  Level II Plain Film        X...............       1.2843       $76.22  ...........       $15.24
                  Except Teeth Including
                  Bone Density Measurement.
0262...........  Plain Film of Teeth......  X...............       0.9186       $54.52  ...........       $10.90
0263...........  Level I Miscellaneous      X...............       1.7397      $103.25       $24.29       $20.65
                  Radiology Procedures.
0264...........  Level II Miscellaneous     X...............       3.5080      $208.20       $79.41       $41.64
                  Radiology Procedures.
0265...........  Level I Diagnostic         S...............       1.0167       $60.34       $24.13       $12.07
                  Ultrasound.
0266...........  Level II Diagnostic        S...............       1.6319       $96.85       $38.74       $19.37
                  Ultrasound.
0267...........  Level III Diagnostic       S...............       2.6208      $155.54       $62.18       $31.11
                  Ultrasound.
0268...........  Ultrasound Guidance        S...............       1.0562       $62.69  ...........       $12.54
                  Procedures.
0269...........  Level III Echocardiogram   S...............       3.2290      $191.64       $76.65       $38.33
                  Except Transesophageal.
0270...........  Transesophageal            S...............       5.9919      $355.62      $142.24       $71.12
                  Echocardiogram.
0272...........  Level I Fluoroscopy......  X...............       1.3738       $81.54       $32.61       $16.31
0274...........  Myelography..............  S...............       3.0275      $179.68       $71.87       $35.94
0275...........  Arthrography.............  S...............       3.5617      $211.39       $69.09       $42.28
0276...........  Level I Digestive          S...............       1.5250       $90.51       $36.20       $18.10
                  Radiology.
0277...........  Level II Digestive         S...............       2.3744      $140.92       $56.36       $28.18
                  Radiology.
0278...........  Diagnostic Urography.....  S...............       2.6314      $156.17       $62.46       $31.23
0279...........  Level II Angiography and   S...............       8.8914      $527.70      $150.03      $105.54
                  Venography except
                  Extremity.
0280...........  Level III Angiography and  S...............      20.6960    $1,228.31      $353.85      $245.66
                  Venography except
                  Extremity.
0282...........  Miscellaneous              S...............       1.6467       $97.73       $39.09       $19.55
                  Computerized Axial
                  Tomography.
0283...........  Computerized Axial         S...............       4.4053      $261.45      $104.58       $52.29
                  Tomography with Contrast
                  Material.
0284...........  Magnetic Resonance         S...............       6.3910      $379.31      $151.72       $75.86
                  Imaging and Magnetic
                  Resonance Angiography
                  with Contras.
0285...........  Myocardial Positron        S...............      17.1020    $1,015.00      $318.72      $203.00
                  Emission Tomography
                  (PET).
0288...........  Bone Density:Axial         S...............       1.2511       $74.25  ...........       $14.85
                  Skeleton.
0296...........  Level I Therapeutic        S...............       2.2350      $132.65       $53.06       $26.53
                  Radiologic Procedures.
0297...........  Level II Therapeutic       S...............       5.2293      $310.36      $122.13       $62.07
                  Radiologic Procedures.
0299...........  Miscellaneous Radiation    S...............       5.8217      $345.52  ...........       $69.10
                  Treatment.
0300...........  Level I Radiation Therapy  S...............       1.5129       $89.79  ...........       $17.96
0301...........  Level II Radiation         S...............       2.2094      $131.13  ...........       $26.23
                  Therapy.
0302...........  Level III Radiation        S...............       4.5936      $272.63      $103.28       $54.53
                  Therapy.
0303...........  Treatment Device           X...............       2.8228      $167.53       $66.95       $33.51
                  Construction.
0304...........  Level I Therapeutic        X...............       1.7658      $104.80       $41.52       $20.96
                  Radiation Treatment
                  Preparation.
0305...........  Level II Therapeutic       X...............       3.9854      $236.53       $91.38       $47.31
                  Radiation Treatment
                  Preparation.
0310...........  Level III Therapeutic      X...............      13.8858      $824.12      $325.27      $164.82
                  Radiation Treatment
                  Preparation.
0312...........  Radioelement Applications  S...............       4.9806      $295.60  ...........       $59.12
0313...........  Brachytherapy............  S...............      12.8072      $760.11  ...........      $152.02
0314...........  Hyperthermic Therapies...  S...............       5.9674      $354.17       $98.36       $70.83
0315...........  Level II Implantation of   T...............     289.3306   $17,171.77  ...........    $3,434.35
                  Neurostimulator.
0320...........  Electroconvulsive Therapy  S...............       5.3522      $317.65       $80.06       $63.53
0321...........  Biofeedback and Other      S...............       1.3517       $80.22       $21.61       $16.04
                  Training.
0322...........  Brief Individual           S...............       1.2263       $72.78  ...........       $14.56
                  Psychotherapy.
0323...........  Extended Individual        S...............       1.6153       $95.87       $19.99       $19.17
                  Psychotherapy.
0324...........  Family Psychotherapy.....  S...............       2.0901      $124.05  ...........       $24.81
0325...........  Group Psychotherapy......  S...............       1.3130       $77.93       $17.03       $15.59
0330...........  Dental Procedures........  S...............       7.1431      $423.94  ...........       $84.79
0332...........  Computerized Axial         S...............       3.2546      $193.16       $77.26       $38.63
                  Tomography and
                  Computerized Angiography
                  without Contras.
0333...........  Computerized Axial         S...............       5.2596      $312.16      $124.86       $62.43
                  Tomography and
                  Computerized Angio w/o
                  Contrast Material.
0335...........  Magnetic Resonance         S...............       5.1347      $304.74      $121.89       $60.95
                  Imaging, Miscellaneous.
0336...........  Magnetic Resonance         S...............       6.0467      $358.87      $143.54       $71.77
                  Imaging and Magnetic
                  Resonance Angiography
                  without Cont.
0337...........  MRI and Magnetic           S...............       8.7547      $519.59      $207.83      $103.92
                  Resonance Angiography
                  without Contrast
                  Material followed.
0339...........  Observation..............  S...............       7.1080      $421.86  ...........       $84.37
0340...........  Minor Ancillary            X...............       0.6355       $37.72  ...........        $7.54
                  Procedures.
0341...........  Skin Tests...............  X...............       0.1107        $6.57        $2.62        $1.31
0342...........  Level I Pathology........  X...............       0.1553        $9.22        $3.68        $1.84
0343...........  Level III Pathology......  X...............       0.4764       $28.27       $11.10        $5.65
0344...........  Level IV Pathology.......  X...............       0.7960       $47.24       $15.66        $9.45
0345...........  Level I Transfusion        X...............       0.2266       $13.45        $2.99        $2.69
                  Laboratory Procedures.
0346...........  Level II Transfusion       X...............       0.3418       $20.29        $4.52        $4.06
                  Laboratory Procedures.

[[Page 42768]]

 
0347...........  Level III Transfusion      X...............       0.8395       $49.82       $12.30        $9.96
                  Laboratory Procedures.
0348...........  Fertility Laboratory       X...............       0.7891       $46.83  ...........        $9.37
                  Procedures.
0350...........  Administration of flu and  X...............       0.3936       $23.36        $0.00        $0.00
                  PPV vaccines.
0352...........  Level I Injections.......  X...............       0.1407        $8.35  ...........        $1.67
0353...........  Level II Injections......  X...............       0.3936       $23.36  ...........        $4.67
0359...........  Level III Injections.....  X...............       0.8274       $49.11  ...........        $9.82
0360...........  Level I Alimentary Tests.  X...............       1.4672       $87.08       $34.83       $17.42
0361...........  Level II Alimentary Tests  X...............       3.6052      $213.97       $83.23       $42.79
0362...........  Contact Lens and           X...............       2.6486      $157.19  ...........       $31.44
                  Spectacle Services.
0363...........  Level I                    X...............       0.9087       $53.93       $17.44       $10.79
                  Otorhinolaryngologic
                  Function Tests.
0364...........  Level I Audiometry.......  X...............       0.4686       $27.81        $9.06        $5.56
0365...........  Level II Audiometry......  X...............       1.2300       $73.00       $18.95       $14.60
0366...........  Level III Audiometry.....  X...............       1.7663      $104.83       $27.36       $20.97
0367...........  Level I Pulmonary Test...  X...............       0.6629       $39.34       $14.80        $7.87
0368...........  Level II Pulmonary Tests.  X...............       0.9716       $57.66       $23.06       $11.53
0369...........  Level III Pulmonary Tests  X...............       2.7394      $162.58       $44.18       $32.52
0370...........  Allergy Tests............  X...............       1.1181       $66.36  ...........       $13.27
0372...........  Therapeutic Phlebotomy...  X...............       0.5675       $33.68       $10.09        $6.74
0373...........  Neuropsychological         X...............       2.1827      $129.54  ...........       $25.91
                  Testing.
0374...........  Monitoring Psychiatric     X...............       1.0367       $61.53  ...........       $12.31
                  Drugs.
0375...........  Ancillary Outpatient       T...............      42.3971    $2,516.27  ...........      $503.25
                  Services When Patient
                  Expires.
0376...........  Level II Cardiac Imaging.  S...............       5.1740      $307.08      $121.42       $61.42
0377...........  Level III Cardiac Imaging  S...............       6.8034      $403.78      $161.51       $80.76
0378...........  Level II Pulmonary         S...............       5.4748      $324.93      $129.97       $64.99
                  Imaging.
0379...........  Injection adenosine......  K...............  ...........       $33.44  ...........        $6.69
0381...........  Single Allergy Tests.....  X...............       0.1876       $11.13        $2.34        $2.23
0384...........  GI Procedures with Stents  T...............      22.2381    $1,319.83      $286.66      $263.97
0385...........  Level I Prosthetic         S...............      75.3020    $4,469.17  ...........      $893.83
                  Urological Procedures.
0386...........  Level II Prosthetic        S...............     119.6251    $7,099.75  ...........    $1,419.95
                  Urological Procedures.
0387...........  Level II Hysteroscopy....  T...............      32.3971    $1,922.77      $655.55      $384.55
0388...........  Discography..............  S...............      12.2736      $728.44      $291.37      $145.69
0389...........  Non-imaging Nuclear        S...............       1.4908       $88.48       $35.39       $17.70
                  Medicine.
0390...........  Level I Endocrine Imaging  S...............       2.5446      $151.02       $60.40       $30.20
0391...........  Level II Endocrine         S...............       2.8643      $170.00       $68.00       $34.00
                  Imaging.
0393...........  Red Cell/Plasma Studies..  S...............       3.4282      $203.46       $81.38       $40.69
0394...........  Hepatobiliary Imaging....  S...............       4.4428      $263.68      $105.47       $52.74
0395...........  GI Tract Imaging.........  S...............       3.8523      $228.63       $91.45       $45.73
0396...........  Bone Imaging.............  S...............       4.1238      $244.75       $97.90       $48.95
0397...........  Vascular Imaging.........  S...............       2.2543      $133.79       $53.51       $26.76
0398...........  Level I Cardiac Imaging..  S...............       4.2898      $254.60      $101.84       $50.92
0399...........  Nuclear Medicine Add-on    S...............       1.5123       $89.76       $35.90       $17.95
                  Imaging.
0400...........  Hematopoietic Imaging....  S...............       4.1147      $244.21       $97.68       $48.84
0401...........  Level I Pulmonary Imaging  S...............       3.3995      $201.76       $80.70       $40.35
0402...........  Brain Imaging............  S...............       5.1612      $306.32      $122.52       $61.26
0403...........  CSF Imaging..............  S...............       3.5974      $213.51       $85.40       $42.70
0404...........  Renal and Genitourinary    S...............       3.8385      $227.81       $91.12       $45.56
                  Studies Level I.
0405...........  Renal and Genitourinary    S...............       4.2480      $252.12      $100.84       $50.42
                  Studies Level II.
0406...........  Tumor/Infection Imaging..  S...............       4.2840      $254.26      $101.70       $50.85
0407...........  Radionuclide Therapy.....  S...............       3.9659      $235.38       $94.15       $47.08
0409...........  Red Blood Cell Tests.....  X...............       0.1252        $7.43        $2.22        $1.49
0411...........  Respiratory Procedures...  S...............       0.3852       $22.86  ...........        $4.57
0412...........  IMRT Treatment Delivery..  S...............       5.3400      $316.93  ...........       $63.39
0415...........  Level II Endoscopy Lower   T...............      21.9955    $1,305.43      $459.92      $261.09
                  Airway.
0416...........  Level I Intravascular and  S...............      19.4657    $1,155.29  ...........      $231.06
                  Intracardiac Ultrasound
                  and Flow Reserve.
0417...........  Computerized               S...............       4.0566      $240.76  ...........       $48.15
                  Reconstruction.
0418...........  Insertion of Left          T...............     108.8092    $6,457.83  ...........    $1,291.57
                  Ventricular Pacing
                  Elect..
0421...........  Prolonged Physiologic      X...............       1.6525       $98.08  ...........       $19.62
                  Monitoring.
0422...........  Level II Upper GI          T...............      22.8607    $1,356.78      $448.81      $271.36
                  Procedures.
0423...........  Level II Percutaneous      T...............      40.1041    $2,380.18  ...........      $476.04
                  Abdominal and Biliary
                  Procedures.
0425...........  Level II Arthroplasty      T...............      99.7520    $5,920.28    $1,378.01    $1,184.06
                  with Prosthesis.
0426...........  Level II Strapping and     S...............       2.1147      $125.51  ...........       $25.10
                  Cast Application.
0427...........  Level III Tube Changes     T...............      10.1516      $602.50      $123.56      $120.50
                  and Repositioning.
0428...........  Level III Sigmoidoscopy    T...............      19.8121    $1,175.85  ...........      $235.17
                  and Anoscopy.
0429...........  Level V Cystourethroscopy  T...............      42.1231    $2,500.01  ...........      $500.00
                  and other Genitourinary
                  Procedures.
0430...........  Level IV Nerve and Muscle  T...............      11.3524      $673.76  ...........      $134.75
                  Tests.
0432...........  Health and Behavior        S...............       0.6918       $41.06  ...........        $8.21
                  Services.
0433...........  Level II Pathology.......  X...............       0.2569       $15.25        $6.10        $3.05

[[Page 42769]]

 
0434...........  Cardiac Defect Repair....  T...............      90.3765    $5,363.85  ...........    $1,072.77
0600...........  Low Level Clinic Visits..  V...............       0.8649       $51.33  ...........       $10.27
0601...........  Mid Level Clinic Visits..  V...............       0.9992       $59.30  ...........       $11.86
0602...........  High Level Clinic Visits.  V...............       1.4220       $84.40  ...........       $16.88
0610...........  Low Level Emergency        V...............       1.2889       $76.50       $19.40       $15.30
                  Visits.
0611...........  Mid Level Emergency        V...............       2.2615      $134.22       $35.60       $26.84
                  Visits.
0612...........  High Level Emergency       V...............       3.9673      $235.46       $54.12       $47.09
                  Visits.
0620...........  Critical Care............  S...............       8.2620      $490.35      $135.08       $98.07
0621...........  Level I Vascular Access    T...............       8.2610      $490.29  ...........       $98.06
                  Procedures.
0622...........  Level II Vascular Access   T...............      21.1708    $1,256.49  ...........      $251.30
                  Procedures.
0623...........  Level III Vascular Access  T...............      26.9877    $1,601.72  ...........      $320.34
                  Procedures.
0648...........  Breast Reconstruction      T...............      50.2174    $2,980.40  ...........      $596.08
                  with Prosthesis.
0651...........  Complex Interstitial       S...............      12.0898      $717.53  ...........      $143.51
                  Radiation Source
                  Application.
0652...........  Insertion of               T...............      28.7639    $1,707.14  ...........      $341.43
                  Intraperitoneal
                  Catheters.
0653...........  Vascular Reconstruction/   T...............      30.3956    $1,803.98  ...........      $360.80
                  Fistula Repair with
                  Device.
0654...........  Insertion/Replacement of   T...............     100.4722    $5,963.03  ...........    $1,192.61
                  a permanent dual chamber
                  pacemaker.
0655...........  Insertion/Replacement/     T...............     133.1709    $7,903.69  ...........    $1,580.74
                  Conversion of a
                  permanent dual chamber
                  pacemaker.
0656...........  Transcatheter Placement    T...............     109.4258    $6,494.42  ...........    $1,298.88
                  of Intracoronary Drug-
                  Eluting Stents.
0657...........  Placement of Tissue Clips  S...............       1.7015      $100.98  ...........       $20.20
0658...........  Percutaneous Breast        T...............       6.0773      $360.69  ...........       $72.14
                  Biopsies.
0659...........  Hyperbaric Oxygen........  S...............       1.5403       $91.42  ...........       $18.28
0660...........  Level II                   X...............       1.6345       $97.01       $30.60       $19.40
                  Otorhinolaryngologic
                  Function Tests.
0661...........  Level V Pathology........  X...............       3.3622      $199.55       $79.82       $39.91
0662...........  CT Angiography...........  S...............       5.1387      $304.98      $121.99       $61.00
0664...........  Level I Proton Beam        S...............      12.8853      $764.74  ...........      $152.95
                  Radiation Therapy.
0665...........  Bone                       S...............       0.6435       $38.19  ...........        $7.64
                  Density:AppendicularSkel
                  eton.
0667...........  Level II Proton Beam       S...............      15.4156      $914.92  ...........      $182.98
                  Radiation Therapy.
0668...........  Level I Angiography and    S...............       6.4730      $384.17      $114.67       $76.83
                  Venography except
                  Extremity.
0670...........  Level II Intravascular     S...............      25.2980    $1,501.44      $470.38      $300.29
                  and Intracardiac
                  Ultrasound and Flow
                  Reserve.
0671...........  Level II Echocardiogram    S...............       1.6951      $100.60       $40.24       $20.12
                  Except Transesophageal.
0672...........  Level IV Posterior         T...............      36.7611    $2,181.77  ...........      $436.35
                  Segment Eye Procedures.
0673...........  Level IV Anterior Segment  T...............      29.1257    $1,728.61      $649.56      $345.72
                  Eye Procedures.
0674...........  Prostate Cryoablation....  T...............      95.3518    $5,659.13  ...........    $1,131.83
0675...........  Prostatic Thermotherapy..  T...............      43.5348    $2,583.79  ...........      $516.76
0676...........  Thrombolysis and           T...............       2.3996      $142.42  ...........       $28.48
                  Thrombectomy.
0678...........  External Counterpulsation  T...............       1.7197      $102.06  ...........       $20.41
0679...........  Level II Resuscitation     S...............       5.5521      $329.52       $95.30       $65.90
                  and Cardioversion.
0680...........  Insertion of Patient       S...............      62.6232    $3,716.69  ...........      $743.34
                  Activated Event
                  Recorders.
0681...........  Knee Arthroplasty........  T...............     136.5417    $8,103.75    $2,081.48    $1,620.75
0682...........  Level V Debridement &      T...............       6.8794      $408.29      $161.70       $81.66
                  Destruction.
0683...........  Level II                   S...............       1.8920      $112.29       $25.23       $22.46
                  Photochemotherapy.
0685...........  Level III Needle Biopsy/   T...............       5.9902      $355.52      $115.47       $71.10
                  Aspiration Except Bone
                  Marrow.
0686...........  Level III Skin Repair....  T...............      13.7661      $817.02  ...........      $163.40
0687...........  Revision/Removal of        T...............      19.1476    $1,136.41      $454.56      $227.28
                  Neurostimulator
                  Electrodes.
0688...........  Revision/Removal of        T...............      42.8494    $2,543.11    $1,017.24      $508.62
                  Neurostimulator Pulse
                  Generator Receiver.
0689...........  Electronic Analysis of     S...............       0.5709       $33.88  ...........        $6.78
                  Cardioverter-
                  defibrillators.
0690...........  Electronic Analysis of     S...............       0.3738       $22.19        $8.87        $4.44
                  Pacemakers and other
                  Cardiac Devices.
0691...........  Electronic Analysis of     S...............       2.5138      $149.19       $59.67       $29.84
                  Programmable Shunts/
                  Pumps.
0692...........  Electronic Analysis of     S...............       2.0020      $118.82       $30.16       $23.76
                  Neurostimulator Pulse
                  Generators.
0693...........  Level II Breast            T...............      42.0342    $2,494.73      $798.17      $498.95
                  Reconstruction.
0694...........  Mohs Surgery.............  T...............       3.8278      $227.18       $61.59       $45.44
0695...........  Level VII Debridement &    T...............      20.2244    $1,200.32      $266.59      $240.06
                  Destruction.
0697...........  Level I Echocardiogram     S...............       1.5288       $90.73       $36.29       $18.15
                  Except Transesophageal.
0698...........  Level II Eye Tests &       S...............       1.2381       $73.48       $16.48       $14.70
                  Treatments.
0699...........  Level IV Eye Tests &       T...............       9.9723      $591.86  ...........      $118.37
                  Treatments.
0700...........  Antepartum Manipulation..  T...............       5.3371      $316.76  ...........       $63.35
0701...........  SR 89 chloride, per mCi..  H...............  ...........  ...........  ...........  ...........
0702...........  SM 153 lexidronam........  H...............  ...........  ...........  ...........  ...........
0704...........  IN 111 Satumomab           H...............  ...........  ...........  ...........  ...........
                  pendetide per dose.
0705...........  Technetium TC99M           H...............  ...........  ...........  ...........  ...........
                  tetrofosmin.
0726...........  Dexrazoxane hcl injection  K...............  ...........      $216.38  ...........       $43.28
0728...........  Filgrastim injection.....  K...............  ...........      $178.38  ...........       $35.68
0730...........  Pamidronate disodium.....  K...............  ...........       $58.41  ...........       $11.68
0731...........  Sargramostim injection...  K...............  ...........       $21.11  ...........        $4.22
0732...........  Mesna injection..........  K...............  ...........       $13.68  ...........        $2.74

[[Page 42770]]

 
0733...........  Non esrd epoetin alpha     K...............  ...........        $9.99  ...........        $2.00
                  inj.
0734...........  Injection, darbepoetin     K...............  ...........        $3.28  ...........         $.66
                  alfa (for non-ESRD).
0735...........  Ampho b cholesteryl        K...............  ...........       $12.24  ...........        $2.45
                  sulfate.
0736...........  Amphotericin b liposome    K...............  ...........       $21.91  ...........        $4.38
                  inj.
0737...........  Ammonia N-13, per dose...  H...............  ...........  ...........  ...........  ...........
0738...........  Rasburicase..............  G...............  ...........      $109.17  ...........       $21.83
0750...........  Dolasetron mesylate......  K...............  ...........        $6.55  ...........        $1.31
0763...........  Dolasetron mesylate oral.  K...............  ...........       $48.54  ...........        $9.71
0764...........  Granisetron HCl injection  K...............  ...........        $7.24  ...........        $1.45
0765...........  Granisetron HCl oral.....  K...............  ...........       $33.50  ...........        $6.70
0768...........  Ondansetron hcl injection  K...............  ...........        $3.80  ...........         $.76
0769...........  Ondansetron hcl oral.....  K...............  ...........       $32.02  ...........        $6.40
0800...........  Leuprolide acetate.......  K...............  ...........      $441.74  ...........       $88.35
0802...........  Etoposide oral...........  K...............  ...........       $41.12  ...........        $8.22
0807...........  Aldesleukin/single use     K...............  ...........      $701.71  ...........      $140.34
                  vial.
0809...........  Bcg live intravesical vac  K...............  ...........      $121.74  ...........       $24.35
0810...........  Goserelin acetate implant  K...............  ...........      $196.24  ...........       $39.25
0811...........  Carboplatin injection....  K...............  ...........       $77.15  ...........       $15.43
0812...........  Carmus bischl nitro inj..  K...............  ...........      $141.27  ...........       $28.25
0814...........  Asparaginase injection...  K...............  ...........       $55.41  ...........       $11.08
0819...........  Dacarbazine inj..........  K...............  ...........        $6.20  ...........        $1.24
0820...........  Daunorubicin.............  K...............  ...........       $35.28  ...........        $7.06
0821...........  Daunorubicin citrate       K...............  ...........       $57.55  ...........       $11.51
                  liposom.
0823...........  Docetaxel................  K...............  ...........      $301.15  ...........       $60.23
0827...........  Floxuridine injection....  K...............  ...........       $60.16  ...........       $12.03
0828...........  Gemcitabine HCL..........  K...............  ...........      $117.44  ...........       $23.49
0830...........  Irinotecan injection.....  K...............  ...........      $129.07  ...........       $25.81
0831...........  Ifosfomide injection.....  K...............  ...........       $53.53  ...........       $10.71
0832...........  Idarubicin hcl injection.  K...............  ...........      $313.97  ...........       $62.79
0834...........  Interferon alfa-2a inj...  K...............  ...........       $31.75  ...........        $6.35
0835...........  Inj cosyntropin..........  K...............  ...........       $69.27  ...........       $13.85
0836...........  Interferon alfa-2b inj     K...............  ...........       $13.22  ...........        $2.64
                  recombinant, 1 million.
0838...........  Interferon gamma 1-b inj.  K...............  ...........      $277.77  ...........       $55.55
0840...........  Melphalan hydrochl.......  K...............  ...........      $523.18  ...........      $104.64
0842...........  Fludarabine phosphate inj  K...............  ...........      $262.39  ...........       $52.48
0843...........  Pegaspargase.............  K...............  ...........    $1,528.67  ...........      $305.73
0844...........  Pentostatin injection....  K...............  ...........    $1,868.76  ...........      $373.75
0849...........  Rituximab................  K...............  ...........      $447.93  ...........       $89.59
0850...........  Streptozocin injection...  K...............  ...........      $153.31  ...........       $30.66
0851...........  Thiotepa injection.......  K...............  ...........       $44.55  ...........        $8.91
0852...........  Topotecan................  K...............  ...........      $755.44  ...........      $151.09
0855...........  Vinorelbine tartrate.....  K...............  ...........       $62.84  ...........       $12.57
0856...........  Porfimer sodium..........  K...............  ...........    $2,457.78  ...........      $491.56
0857...........  Bleomycin sulfate          K...............  ...........       $54.17  ...........       $10.83
                  injection.
0858...........  Cladribine...............  K...............  ...........       $39.37  ...........        $7.87
0860...........  Plicamycin (mithramycin)   K...............  ...........       $80.54  ...........       $16.11
                  inj.
0861...........  Leuprolide acetate         K...............  ...........       $10.96  ...........        $2.19
                  injection.
0862...........  Mitomycin................  K...............  ...........       $26.36  ...........        $5.27
0863...........  Paclitaxel injection.....  K...............  ...........       $19.11  ...........        $3.82
0864...........  Mitoxantrone hcl.........  K...............  ...........      $329.66  ...........       $65.93
0865...........  Interferon alfa-n3 inj,    K...............  ...........        $8.77  ...........        $1.75
                  human leukocyte derived,
                  2.
0868...........  Oral aprepitant..........  G...............  ...........        $4.75  ...........         $.95
0869...........  IVIG lyophil 1g..........  K...............  ...........       $39.46  ...........        $7.89
0870...........  IVIG lyophil 10 mg.......  K...............  ...........         $.40  ...........         $.08
0871...........  IVIG non-lyophil 1g......  K...............  ...........       $57.26  ...........       $11.45
0872...........  IVIG non-lyophil 10 mg...  K...............  ...........         $.57  ...........         $.11
0876...........  Caffeine citrate           K...............  ...........        $3.34  ...........         $.67
                  injection.
0880...........  Penicillin g benzathine    K...............  ...........       $72.25  ...........       $14.45
                  inj.
0884...........  Rho d immune globulin inj  K...............  ...........      $113.90  ...........       $22.78
0887...........  Azathioprine parenteral..  K...............  ...........       $47.39  ...........        $9.48
0888...........  Cyclosporine oral........  K...............  ...........        $3.94  ...........         $.79
0890...........  Lymphocyte immune          K...............  ...........      $290.28  ...........       $58.06
                  globulin.
0891...........  Tacrolimus oral..........  K...............  ...........        $3.37  ...........         $.67
0892...........  Edetate calcium disodium   K...............  ...........       $40.34  ...........        $8.07
                  inj.
0893...........  Calcitonin salmon          K...............  ...........       $35.68  ...........        $7.14
                  injection.
0895...........  Deferoxamine mesylate inj  K...............  ...........       $14.91  ...........        $2.98
0900...........  Alglucerase injection....  K...............  ...........       $39.94  ...........        $7.99
0901...........  Alpha 1 proteinase         K...............  ...........        $3.30  ...........         $.66
                  inhibitor.
0902...........  Botulinum toxin a, per     K...............  ...........        $4.80  ...........         $.96
                  unit.

[[Page 42771]]

 
0903...........  Cytomegalovirus imm IV/    K...............  ...........      $683.02  ...........      $136.60
                  vial.
0906...........  RSV-ivig.................  K...............  ...........       $15.56  ...........        $3.11
0910...........  Interferon beta-1b.......  K...............  ...........       $81.94  ...........       $16.39
0911...........  Streptokinase............  K...............  ...........       $83.35  ...........       $16.67
0912...........  Interferon alfacon-1.....  K...............  ...........        $3.91  ...........         $.78
0913...........  Ganciclovir long act       K...............  ...........    $4,318.33  ...........      $863.67
                  implant.
0916...........  Injection imiglucerase /   K...............  ...........        $3.98  ...........         $.80
                  unit.
0917...........  Adenosine injection......  K...............  ...........       $71.52  ...........       $14.30
0925...........  Factor viii..............  K...............  ...........         $.51  ...........         $.10
0926...........  Factor VIII (porcine)....  K...............  ...........        $1.75  ...........         $.35
0927...........  Factor viii recombinant..  K...............  ...........         $.94  ...........         $.19
0928...........  Factor ix complex........  K...............  ...........         $.52  ...........         $.10
0929...........  Anti-inhibitor per iu....  K...............  ...........        $1.12  ...........         $.22
0931...........  Factor IX non-recombinant  K...............  ...........         $.75  ...........         $.15
0932...........  Factor IX recombinant....  K...............  ...........         $.86  ...........         $.17
0935...........  Clonidine hydrochloride..  K...............  ...........       $57.46  ...........       $11.49
0949...........  Plasma, Pooled Multiple    K...............       1.1902       $70.64  ...........       $14.13
                  Donor, Solvent/Detergent
                  T.
0950...........  Blood (Whole) For          K...............       2.0032      $118.89  ...........       $23.78
                  Transfusion.
0952...........  Cryoprecipitate..........  K...............       0.7361       $43.69  ...........        $8.74
0954...........  RBC leukocytes reduced...  K...............       2.7246      $161.71  ...........       $32.34
0955...........  Plasma, Fresh Frozen.....  K...............       1.2876       $76.42  ...........       $15.28
0956...........  Plasma Protein Fraction..  K...............       1.1175       $66.32  ...........       $13.26
0957...........  Platelet Concentrate.....  K...............       0.8279       $49.14  ...........        $9.83
0958...........  Platelet Rich Plasma.....  K...............       5.1580      $306.13  ...........       $61.23
0959...........  Red Blood Cells..........  K...............       2.0209      $119.94  ...........       $23.99
0960...........  Washed Red Blood Cells...  K...............       2.9573      $175.52  ...........       $35.10
0961...........  Infusion, Albumin (Human)  K...............       0.5119       $30.38  ...........        $6.08
                  5%, 50 ml.
0963...........  Albumin (human), 5%......  K...............       1.3867       $82.30  ...........       $16.46
0964...........  Albumin (human), 25%.....  K...............       0.4878       $28.95  ...........        $5.79
0965...........  Albumin (human), 25%.....  K...............       1.1115       $65.97  ...........       $13.19
0966...........  Plasmaprotein fract,5%...  K...............       4.9340      $292.83  ...........       $58.57
0967...........  Split unit of blood......  K...............       1.2641       $75.02  ...........       $15.00
0968...........  Platelets leukocyte        K...............       2.3532      $139.66  ...........       $27.93
                  reduced irradiated.
0969...........  Red blood cell leukocyte   K...............       3.6286      $215.36  ...........       $43.07
                  reduced irradiated.
1009...........  Cryoprecip reduced plasma  K...............       1.3003       $77.17  ...........       $15.43
1010...........  Blood, L/R, CMV-neg......  K...............       2.9558      $175.43  ...........       $35.09
1011...........  Platelets, HLA-m, L/R,     K...............      10.9193      $648.06  ...........      $129.61
                  unit.
1013...........  Platelet concentrate, L/   K...............       1.5950       $94.66  ...........       $18.93
                  R, unit.
1016...........  Blood, L/R, froz/          K...............       5.2392      $310.95  ...........       $62.19
                  deglycerol/washed.
1017...........  Platelets, aph/pher, L/R,  K...............       8.5608      $508.08  ...........      $101.62
                  CMV-neg, unit.
1018...........  Blood, L/R, irradiated...  K...............       2.7877      $165.45  ...........       $33.09
1019...........  Platelets, aph/pher, L/R,  K...............       9.4700      $562.04  ...........      $112.41
                  irradiated, unit.
1020...........  Pit, pher,L/R,CMV,irrad..  K...............      10.1091      $599.98  ...........      $120.00
1021...........  RBC, frz/deg/wsh, L/R,     K...............       4.8566      $288.24  ...........       $57.65
                  irrad.
1022...........  RBC, L/R, CMV neg, irrad.  K...............       4.2707      $253.47  ...........       $50.69
1045...........  Iobenguane sulfate I-131.  H...............  ...........  ...........  ...........  ...........
1052...........  Injection, Voriconazole..  K...............  ...........        $4.63  ...........         $.93
1064...........  I-131 sodium iodide        H...............  ...........  ...........  ...........  ...........
                  capsule.
1065...........  I-131 sodium iodide        H...............  ...........  ...........  ...........  ...........
                  solution.
1080...........  I-131 tositumomab, dx....  H...............  ...........  ...........  ...........  ...........
1081...........  I-131 tositumomab, tx....  H...............  ...........  ...........  ...........  ...........
1082...........  Treprostinil.............  K...............  ...........       $55.02  ...........       $11.00
1083...........  Injection, Adalimumab....  K...............  ...........      $300.07  ...........       $60.01
1084...........  Denileukin diftitox......  K...............  ...........    $1,235.23  ...........      $247.05
1085...........  Injection, Gallium         K...............  ...........        $1.30  ...........         $.26
                  Nitrate.
1086...........  Temozolomide,oral........  K...............  ...........        $7.28  ...........        $1.46
1088...........  Dx I131 so iodide cap      H...............  ...........  ...........  ...........  ...........
                  millic.
1091...........  IN 111 Oxyquinoline......  H...............  ...........  ...........  ...........  ...........
1092...........  IN 111 Pentetate.........  H...............  ...........  ...........  ...........  ...........
1093...........  TC99M fanolesomab........  H...............  ...........  ...........  ...........  ...........
1096...........  TC 99M Exametazime, per    H...............  ...........  ...........  ...........  ...........
                  dose.
1150...........  Th I131 so iodide sol      H...............  ...........  ...........  ...........  ...........
                  millic.
1166...........  Cytarabine liposome......  K...............  ...........      $366.40  ...........       $73.28
1167...........  Epirubicin hcl...........  K...............  ...........       $25.15  ...........        $5.03
1178...........  Busulfan IV..............  K...............       0.2851       $16.92  ...........        $3.38
1201...........  TC 99M SUCCIMER, PER Vial  H...............  ...........  ...........  ...........  ...........
1203...........  Verteporfin for injection  K...............  ...........        $9.16  ...........        $1.83
1207...........  Octreotide injection,      K...............  ...........       $87.39  ...........       $17.48
                  depot.
1210...........  Inj dihydroergotamine      K...............  ...........       $27.82  ...........        $5.56
                  mesylt.

[[Page 42772]]

 
1280...........  Corticotropin injection..  K...............  ...........       $95.43  ...........       $19.09
1305...........  Apligraf.................  K...............      12.9206      $766.84  ...........      $153.37
1330...........  Ergonovine maleate         K...............       0.5262       $31.23  ...........        $6.25
                  injection.
1409...........  Factor viia recombinant..  K...............  ...........    $1,080.03  ...........      $216.01
1436...........  Etidronate disodium inj..  K...............  ...........       $68.69  ...........       $13.74
1491...........  New Technology - Level I   S...............  ...........        $5.00  ...........        $1.00
                  ($0-$10).
1492...........  New Technology - Level I   S...............  ...........       $15.00  ...........        $3.00
                  ($10-$20).
1493...........  New Technology - Level I   S...............  ...........       $25.00  ...........        $5.00
                  ($20-$30).
1494...........  New Technology - Level I   S...............  ...........       $35.00  ...........        $7.00
                  ($30-$40).
1495...........  New Technology - Level I   S...............  ...........       $45.00  ...........        $9.00
                  ($40-$50).
1496...........  New Technology - Level I   T...............  ...........        $5.00  ...........        $1.00
                  ($0-$10).
1497...........  New Technology - Level I   T...............  ...........       $15.00  ...........        $3.00
                  ($10-$20).
1498...........  New Technology - Level I   T...............  ...........       $25.00  ...........        $5.00
                  ($20-$30).
1499...........  New Technology - Level I   T...............  ...........       $35.00  ...........        $7.00
                  ($30-$40).
1500...........  New Technology - Level I   T...............  ...........       $45.00  ...........        $9.00
                  ($40-$50).
1502...........  New Technology - Level II  S...............  ...........       $75.00  ...........       $15.00
                  ($50 - $100).
1503...........  New Technology - Level     S...............  ...........      $150.00  ...........       $30.00
                  III ($100 - $200).
1504...........  New Technology - Level IV  S...............  ...........      $250.00  ...........       $50.00
                  ($200 - $300).
1505...........  New Technology - Level V   S...............  ...........      $350.00  ...........       $70.00
                  ($300 - $400).
1506...........  New Technology - Level VI  S...............  ...........      $450.00  ...........       $90.00
                  ($400 - $500).
1507...........  New Technology - Level     S...............  ...........      $550.00  ...........      $110.00
                  VII ($500 - $600).
1508...........  New Technology - Level     S...............  ...........      $650.00  ...........      $130.00
                  VIII ($600 - $700).
1509...........  New Technology - Level IX  S...............  ...........      $750.00  ...........      $150.00
                  ($700 - $800).
1510...........  New Technology - Level X   S...............  ...........      $850.00  ...........      $170.00
                  ($800 - $900).
1511...........  New Technology - Level XI  S...............  ...........      $950.00  ...........      $190.00
                  ($900 - $1000).
1512...........  New Technology - Level     S...............  ...........    $1,050.00  ...........      $210.00
                  XII ($1000 - $1100).
1513...........  New Technology - Level     S...............  ...........    $1,150.00  ...........      $230.00
                  XIII ($1100 - $1200).
1514...........  New Technology-Level XIV   S...............  ...........    $1,250.00  ...........      $250.00
                  ($1200- $1300).
1515...........  New Technology - Level XV  S...............  ...........    $1,350.00  ...........      $270.00
                  ($1300 - $1400).
1516...........  New Technology - Level     S...............  ...........    $1,450.00  ...........      $290.00
                  XVI ($1400 - $1500).
1517...........  New Technology - Level     S...............  ...........    $1,550.00  ...........      $310.00
                  XVII ($1500-$1600).
1518...........  New Technology - Level     S...............  ...........    $1,650.00  ...........      $330.00
                  XVIII ($1600-$1700).
1519...........  New Technology - Level     S...............  ...........    $1,750.00  ...........      $350.00
                  IXX ($1700-$1800).
1520...........  New Technology - Level XX  S...............  ...........    $1,850.00  ...........      $370.00
                  ($1800-$1900).
1521...........  New Technology - Level     S...............  ...........    $1,950.00  ...........      $390.00
                  XXI ($1900-$2000).
1522...........  New Technology - Level     S...............  ...........    $2,250.00  ...........      $450.00
                  XXII ($2000-$2500).
1523...........  New Technology - Level     S...............  ...........    $2,750.00  ...........      $550.00
                  XXIII ($2500-$3000).
1524...........  New Technology - Level     S...............  ...........    $3,250.00  ...........      $650.00
                  XIV ($3000-$3500).
1525...........  New Technology - Level     S...............  ...........    $3,750.00  ...........      $750.00
                  XXV ($3500-$4000).
1526...........  New Technology - Level     S...............  ...........    $4,250.00  ...........      $850.00
                  XXVI ($4000-$4500).
1527...........  New Technology - Level     S...............  ...........    $4,750.00  ...........      $950.00
                  XXVII ($4500-$5000).
1528...........  New Technology - Level     S...............  ...........    $5,250.00  ...........    $1,050.00
                  XXVIII ($5000-$5500).
1529...........  New Technology - Level     S...............  ...........    $5,750.00  ...........    $1,150.00
                  XXIX ($5500-$6000).
1530...........  New Technology - Level     S...............  ...........    $6,250.00  ...........    $1,250.00
                  XXX ($6000-$6500).
1531...........  New Technology - Level     S...............  ...........    $6,750.00  ...........    $1,350.00
                  XXXI ($6500-$7000).
1532...........  New Technology - Level     S...............  ...........    $7,250.00  ...........    $1,450.00
                  XXXII ($7000-$7500).
1533...........  New Technology - Level     S...............  ...........    $7,750.00  ...........    $1,550.00
                  XXXIII ($7500-$8000).
1534...........  New Technology - Level     S...............  ...........    $8,250.00  ...........    $1,650.00
                  XXXIV ($8000-$8500).
1535...........  New Technology - Level     S...............  ...........    $8,750.00  ...........    $1,750.00
                  XXXV ($8500-$9000).
1536...........  New Technology - Level     S...............  ...........    $9,250.00  ...........    $1,850.00
                  XXXVI ($9000-$9500).
1537...........  New Technology - Level     S...............  ...........    $9,750.00  ...........    $1,950.00
                  XXXVII ($9500-$10000).
1539...........  New Technology - Level II  T...............  ...........       $75.00  ...........       $15.00
                  ($50 - $100).
1540...........  New Technology - Level     T...............  ...........      $150.00  ...........       $30.00
                  III ($100 - $200).
1541...........  New Technology - Level IV  T...............  ...........      $250.00  ...........       $50.00
                  ($200 - $300).
1542...........  New Technology - Level V   T...............  ...........      $350.00  ...........       $70.00
                  ($300 - $400).
1543...........  New Technology - Level VI  T...............  ...........      $450.00  ...........       $90.00
                  ($400 - $500).
1544...........  New Technology - Level     T...............  ...........      $550.00  ...........      $110.00
                  VII ($500 - $600).
1545...........  New Technology - Level     T...............  ...........      $650.00  ...........      $130.00
                  VIII ($600 - $700).
1546...........  New Technology - Level IX  T...............  ...........      $750.00  ...........      $150.00
                  ($700 - $800).
1547...........  New Technology - Level X   T...............  ...........      $850.00  ...........      $170.00
                  ($800 - $900).
1548...........  New Technology - Level XI  T...............  ...........      $950.00  ...........      $190.00
                  ($900 - $1000).
1549...........  New Technology - Level     T...............  ...........    $1,050.00  ...........      $210.00
                  XII ($1000 - $1100).
1550...........  New Technology - Level     T...............  ...........    $1,150.00  ...........      $230.00
                  XIII ($1100 - $1200).
1551...........  New Technology-Level XIV   T...............  ...........    $1,250.00  ...........      $250.00
                  ($1200- $1300).
1552...........  New Technology - Level XV  T...............  ...........    $1,350.00  ...........      $270.00
                  ($1300 - $1400).
1553...........  New Technology - Level     T...............  ...........    $1,450.00  ...........      $290.00
                  XVI ($1400 - $1500).
1554...........  New Technology - Level     T...............  ...........    $1,550.00  ...........      $310.00
                  XVII ($1500-$1600).
1555...........  New Technology - Level     T...............  ...........    $1,650.00  ...........      $330.00
                  XVIII ($1600-$1700).
1556...........  New Technology - Level     T...............  ...........    $1,750.00  ...........      $350.00
                  XIX ($1700-$1800).

[[Page 42773]]

 
1557...........  New Technology - Level XX  T...............  ...........    $1,850.00  ...........      $370.00
                  ($1800-$1900).
1558...........  New Technology - Level     T...............  ...........    $1,950.00  ...........      $390.00
                  XXI ($1900-$2000).
1559...........  New Technology - Level     T...............  ...........    $2,250.00  ...........      $450.00
                  XXII ($2000-$2500).
1560...........  New Technology - Level     T...............  ...........    $2,750.00  ...........      $550.00
                  XXIII ($2500-$3000).
1561...........  New Technology - Level     T...............  ...........    $3,250.00  ...........      $650.00
                  XXIV ($3000-$3500).
1562...........  New Technology - Level     T...............  ...........    $3,750.00  ...........      $750.00
                  XXV ($3500-$4000).
1563...........  New Technology - Level     T...............  ...........    $4,250.00  ...........      $850.00
                  XXVI ($4000-$4500).
1564...........  New Technology - Level     T...............  ...........    $4,750.00  ...........      $950.00
                  XXVII ($4500-$5000).
1565...........  New Technology - Level     T...............  ...........    $5,250.00  ...........    $1,050.00
                  XXVIII ($5000-$5500).
1566...........  New Technology - Level     T...............  ...........    $5,750.00  ...........    $1,150.00
                  XXIX ($5500-$6000).
1567...........  New Technology - Level     T...............  ...........    $6,250.00  ...........    $1,250.00
                  XXX ($6000-$6500).
1568...........  New Technology - Level     T...............  ...........    $6,750.00  ...........    $1,350.00
                  XXXI ($6500-$7000).
1569...........  New Technology - Level     T...............  ...........    $7,250.00  ...........    $1,450.00
                  XXXII ($7000-$7500).
1570...........  New Technology - Level     T...............  ...........    $7,750.00  ...........    $1,550.00
                  XXXIII ($7500-$8000).
1571...........  New Technology - Level     T...............  ...........    $8,250.00  ...........    $1,650.00
                  XXXIV ($8000-$8500).
1572...........  New Technology - Level     T...............  ...........    $8,750.00  ...........    $1,750.00
                  XXXV ($8500-$9000).
1573...........  New Technology - Level     T...............  ...........    $9,250.00  ...........    $1,850.00
                  XXXVI ($9000-$9500).
1574...........  New Technology - Level     T...............  ...........    $9,750.00  ...........    $1,950.00
                  XXXVII ($9500-$10000).
1600...........  Technetium TC 99m          H...............  ...........  ...........  ...........  ...........
                  sestamibi.
1603...........  Thallous chloride TL 201.  H...............  ...........  ...........  ...........  ...........
1604...........  IN 111 capromab            H...............  ...........  ...........  ...........  ...........
                  pendetide, per dose.
1605...........  Abciximab injection......  K...............  ...........      $450.56  ...........       $90.11
1607...........  Eptifibatide injection...  K...............  ...........       $12.73  ...........        $2.55
1608...........  Etanercept injection.....  K...............  ...........      $152.10  ...........       $30.42
1609...........  Rho(D) immune globulin h,  K...............  ...........       $12.04  ...........        $2.41
                  sd.
1611...........  Hylan G-F 20 injection...  K...............  ...........      $203.13  ...........       $40.63
1612...........  Daclizumab, parenteral...  K...............  ...........      $381.45  ...........       $76.29
1613...........  Trastuzumab..............  K...............  ...........       $53.97  ...........       $10.79
1615...........  Basiliximab..............  K...............  ...........    $1,473.45  ...........      $294.69
1618...........  Vonwillebrandfactrcmplx,   K...............  ...........         $.74  ...........         $.15
                  per iu.
1619...........  Gallium ga 67............  H...............  ...........  ...........  ...........  ...........
1620...........  Technetium tc99m bicisate  H...............  ...........  ...........  ...........  ...........
1622...........  Technetium tc99m           H...............  ...........  ...........  ...........  ...........
                  mertiatide.
1624...........  Sodium phosphate p32.....  H...............  ...........  ...........  ...........  ...........
1625...........  Indium 111-in              H...............  ...........  ...........  ...........  ...........
                  pentetreotide.
1628...........  Chromic phosphate p32....  H...............  ...........  ...........  ...........  ...........
1655...........  Tinzaparin sodium          K...............  ...........        $2.53  ...........         $.51
                  injection.
1670...........  Tetanus immune globulin    K...............  ...........       $76.89  ...........       $15.38
                  inj.
1716...........  Brachytx source, Gold 198  H...............  ...........  ...........  ...........  ...........
1717...........  Brachytx source, HDR Ir-   H...............  ...........  ...........  ...........  ...........
                  192.
1718...........  Brachytx source, Iodine    H...............  ...........  ...........  ...........  ...........
                  125.
1719...........  Brachytx sour,Non-HDR Ir-  H...............  ...........  ...........  ...........  ...........
                  192.
1720...........  Brachytx sour, Palladium   H...............  ...........  ...........  ...........  ...........
                  103.
1740...........  Diazoxide injection......  K...............  ...........      $113.85  ...........       $22.77
1775...........  FDG, per dose (4-40 mCi/   H...............  ...........  ...........  ...........  ...........
                  ml).
2210...........  Methyldopate hcl           K...............  ...........        $9.58  ...........        $1.92
                  injection.
2616...........  Brachytx source, Yttrium-  H...............  ...........  ...........  ...........  ...........
                  90.
2632...........  Brachytx sol, I-125, per   H...............  ...........  ...........  ...........  ...........
                  mCi.
2633...........  Brachytx source, Cesium-   H...............  ...........  ...........  ...........  ...........
                  131.
2634...........  Brachytx source, HA, I-    H...............  ...........  ...........  ...........  ...........
                  125.
2635...........  Brachytx source, HA, P-    H...............  ...........  ...........  ...........  ...........
                  103.
2636...........  Brachytx linear source, P- H...............  ...........  ...........  ...........  ...........
                  103.
2730...........  Pralidoxime chloride inj.  K...............  ...........       $76.67  ...........       $15.33
2770...........  Quinupristin/dalfopristin  K...............  ...........      $105.48  ...........       $21.10
2940...........  Somatrem injection.......  K...............  ...........       $43.13  ...........        $8.63
3030...........  Sumatriptan succinate....  K...............  ...........       $51.03  ...........       $10.21
7000...........  Amifostine...............  K...............  ...........      $435.98  ...........       $87.20
7005...........  Gonadorelin hydroch......  K...............  ...........      $173.42  ...........       $34.68
7011...........  Oprelvekin injection.....  K...............  ...........      $249.04  ...........       $49.81
7015...........  Busulfan, oral...........  K...............  ...........        $1.98  ...........         $.40
7019...........  Aprotinin................  K...............  ...........        $2.20  ...........         $.44
7024...........  Corticorelin ovine         K...............  ...........      $386.49  ...........       $77.30
                  triflutat.
7025...........  Digoxin immune FAB         K...............  ...........      $552.14  ...........      $110.43
                  (ovine).
7026...........  Ethanolamine oleate......  K...............  ...........       $64.53  ...........       $12.91
7027...........  Fomepizole...............  K...............  ...........       $12.31  ...........        $2.46
7028...........  Fosphenytoin.............  K...............  ...........        $5.19  ...........        $1.04
7030...........  Hemin....................  K...............  ...........        $6.51  ...........        $1.30
7034...........  Somatropin injection.....  K...............  ...........       $42.93  ...........        $8.59
7035...........  Teniposide...............  K...............  ...........      $266.21  ...........       $53.24

[[Page 42774]]

 
7036...........  Urokinase inj............  K...............  ...........      $415.66  ...........       $83.13
7037...........  Urofollitropin...........  K...............  ...........       $44.73  ...........        $8.95
7038...........  Monoclonal antibodies....  K...............  ...........      $885.29  ...........      $177.06
7040...........  Pentastarch 10% solution.  K...............  ...........       $12.45  ...........        $2.49
7041...........  Tirofiban hcl............  K...............  ...........        $7.89  ...........        $1.58
7042...........  Capecitabine, oral.......  K...............  ...........        $3.30  ...........         $.66
7043...........  Infliximab injection.....  K...............  ...........       $54.19  ...........       $10.84
7045...........  Trimetrexate glucoronate.  K...............  ...........      $139.84  ...........       $27.97
7046...........  Doxorubicin hcl liposome   K...............  ...........      $365.61  ...........       $73.12
                  inj.
7048...........  Alteplase recombinant....  K...............  ...........       $30.65  ...........        $6.13
7049...........  Filgrastim injection.....  K...............  ...........      $282.27  ...........       $56.45
7051...........  Leuprolide acetate         K...............  ...........    $2,262.01  ...........      $452.40
                  implant.
7308...........  Aminolevulinic acid hcl    K...............  ...........       $96.79  ...........       $19.36
                  top.
7316...........  Sodium hyaluronate         K...............  ...........      $110.64  ...........       $22.13
                  injection.
7515...........  Cyclosporine oral........  K...............  ...........        $1.00  ...........         $.20
9001...........  Linezolid injection......  K...............  ...........       $24.15  ...........        $4.83
9002...........  Tenecteplase.............  K...............  ...........    $2,052.60  ...........      $410.52
9003...........  Palivizumab..............  K...............       4.1486      $246.22  ...........       $49.24
9004...........  Gemtuzumab ozogamicin....  K...............  ...........    $2,244.86  ...........      $448.97
9005...........  Reteplase injection......  K...............  ...........      $898.74  ...........      $179.75
9006...........  Tacrolimus injection.....  K...............  ...........      $126.61  ...........       $25.32
9008...........  Baclofen Refill Kit-       K...............       0.2447       $14.52  ...........        $2.90
                  500mcg.
9009...........  Baclofen refill kit - per  K...............       0.7208       $42.78  ...........        $8.56
                  2000 mcg.
9012...........  Arsenic Trioxide.........  K...............  ...........       $33.76  ...........        $6.75
9015...........  Mycophenolate mofetil      K...............  ...........        $2.50  ...........         $.50
                  oral.
9018...........  Botulinum toxin B........  K...............  ...........        $7.89  ...........        $1.58
9019...........  Caspofungin acetate......  K...............  ...........       $32.35  ...........        $6.47
9020...........  Sirolimus tablet.........  K...............  ...........        $6.85  ...........        $1.37
9022...........  IM inj interferon beta 1-  K...............  ...........       $89.09  ...........       $17.82
                  a.
9023...........  Rho d immune globulin....  K...............  ...........       $25.08  ...........        $5.02
9024...........  Amphotericin b lipid       K...............  ...........       $11.95  ...........        $2.39
                  complex.
9025...........  Rubidium-Rb-82...........  H...............  ...........  ...........  ...........  ...........
9030...........  Amphotericin B...........  K...............  ...........       $30.70  ...........        $6.14
9031...........  Arbutamine HCl injection.  K...............  ...........      $163.13  ...........       $32.63
9032...........  Baclofen 10 MG injection.  K...............  ...........      $188.00  ...........       $37.60
9033...........  Cidofovir injection......  K...............  ...........      $782.91  ...........      $156.58
9038...........  Inj estrogen conjugate...  K...............  ...........       $57.76  ...........       $11.55
9040...........  Intraocular Fomivirsen na  K...............  ...........      $203.91  ...........       $40.78
9042...........  Glucagon hydrochloride...  K...............  ...........       $62.16  ...........       $12.43
9044...........  Ibutilide fumarate         K...............  ...........      $243.32  ...........       $48.66
                  injection.
9045...........  Iron dextran.............  K...............  ...........       $11.43  ...........        $2.29
9046...........  Iron sucrose injection...  K...............  ...........         $.38  ...........         $.08
9047...........  Itraconazole injection...  K...............  ...........       $36.93  ...........        $7.39
9051...........  Urea injection...........  K...............       1.0453       $62.04  ...........       $12.41
9054...........  Metabolically active       K...............  ...........       $15.69  ...........        $3.14
                  tissue.
9055...........  Injectable human tissue..  K...............  ...........        $3.54  ...........         $.71
9057...........  Lepirudin................  K...............  ...........      $128.16  ...........       $25.63
9100...........  Iodinated I-131            H...............  ...........  ...........  ...........  ...........
                  serumalbumin, per 5uci.
9104...........  Anti-thymocycte globulin   K...............  ...........      $299.45  ...........       $59.89
                  rabbit.
9105...........  Hep B imm glob...........  K...............       1.8810      $111.64  ...........       $22.33
9108...........  Thyrotropin alfa.........  K...............  ...........      $712.52  ...........      $142.50
9110...........  Alemtuzumab injection....  K...............  ...........      $516.83  ...........      $103.37
9112...........  Inj Perflutren lipid       K...............  ...........       $63.50  ...........       $12.70
                  micros, ml.
9114...........  Nesiritide...............  K...............  ...........       $75.18  ...........       $15.04
9115...........  Inj, zoledronic acid.....  K...............  ...........      $202.39  ...........       $40.48
9117...........  Yttrium 90 ibritumomab     H...............  ...........  ...........  ...........  ...........
                  tiuxetan.
9118...........  In-111 ibritumomab         H...............  ...........  ...........  ...........  ...........
                  tiuxetan.
9119...........  Pegfilgrastim............  K...............  ...........    $2,178.11  ...........      $435.62
9120...........  Inj, Fulvestrant.........  K...............  ...........       $82.90  ...........       $16.58
9121...........  Inj, Argatroban..........  K...............       0.1897       $11.26  ...........        $2.25
9122...........  Triptorelin pamoate......  K...............  ...........      $369.95  ...........       $73.99
9123...........  Transcyte................  K...............  ...........      $719.36  ...........      $143.87
9124...........  Injection, daptomycin....  G...............  ...........         $.30  ...........         $.06
9125...........  Risperidone, long acting.  G...............  ...........        $4.71  ...........         $.94
9126...........  Injection, natalizumab...  G...............  ...........        $6.51  ...........        $1.30
9127...........  Paclitaxel protein pr....  K...............  ...........        $8.59  ...........        $1.72
9128...........  Inj pegaptanib sodium....  K...............  ...........    $1,074.18  ...........      $214.84
9130...........  Na chromateCr51, per       H...............  ...........  ...........  ...........  ...........
                  0.25mCi.
9132...........  51 Na Chromate, 50mCi....  H...............  ...........  ...........  ...........  ...........

[[Page 42775]]

 
9133...........  Rabies ig, im/sc.........  K...............  ...........       $64.56  ...........       $12.91
9134...........  Rabies ig, heat treated..  K...............  ...........       $69.78  ...........       $13.96
9135...........  Varicella-zoster ig, im..  K...............  ...........       $96.57  ...........       $19.31
9136...........  Adenovirus vaccine, type   K...............       0.9498       $56.37  ...........       $11.27
                  4.
9137...........  Bcg vaccine, percut......  K...............  ...........      $124.53  ...........       $24.91
9138...........  Hep a/hep b vacc, adult    K...............       0.9673       $57.41  ...........       $11.48
                  im.
9139...........  Rabies vaccine, im.......  K...............  ...........      $128.03  ...........       $25.61
9140...........  Rabies vaccine, id.......  K...............       1.4957       $88.77  ...........       $17.75
9141...........  Measles-rubella vaccine,   K...............       0.9466       $56.18  ...........       $11.24
                  sc.
9142...........  Chicken pox vaccine, sc..  K...............  ...........       $64.29  ...........       $12.86
9143...........  Meningococcal vaccine, sc  K...............  ...........       $56.74  ...........       $11.35
9144...........  Encephalitis vaccine, sc.  K...............  ...........       $67.72  ...........       $13.54
9145...........  Meningococcal vaccine, im  K...............       0.8947       $53.10  ...........       $10.62
9146...........  Technetium TC99m           H...............  ...........  ...........  ...........  ...........
                  Disofenin.
9147...........  Technetium TC 99M          H...............  ...........  ...........  ...........  ...........
                  Depreotide.
9148...........  I-123 sodium iodide        H...............  ...........  ...........  ...........  ...........
                  capsule.
9149...........  Dx I131 so iodide          H...............  ...........  ...........  ...........  ...........
                  microcurie.
9150...........  I-125 serum albumin micro  H...............  ...........  ...........  ...........  ...........
9151...........  Tc 99M ARCITUMOMAB PER     H...............  ...........  ...........  ...........  ...........
                  VIAL.
9152...........  Baclofen Intrathecal kit-  K...............       0.8561       $50.81  ...........       $10.16
                  1am.
9153...........  Na Iothalamate I-125, 10   H...............  ...........  ...........  ...........  ...........
                  uCi.
9154...........  Technetium tc99m           H...............  ...........  ...........  ...........  ...........
                  glucepatate.
9155...........  Technetium                 H...............  ...........  ...........  ...........  ...........
                  tc99mlabeledrbcs.
9156...........  Nonmetabolic active        K...............  ...........       $53.75  ...........       $10.75
                  tissue.
9157...........  LOCM <=149 mg/ml iodine..  K...............  ...........         $.51  ...........         $.10
9158...........  LOCM 150-199mg/ml iodine.  K...............  ...........        $2.00  ...........         $.40
9159...........  LOCM 200-249mg/ml iodine.  K...............  ...........         $.78  ...........         $.16
9160...........  LOCM 250-299mg/ml iodine.  K...............  ...........         $.66  ...........         $.13
9161...........  LOCM 300-349mg/ml iodine.  K...............  ...........         $.41  ...........         $.08
9162...........  LOCM 350-399mg/ml iodine.  K...............  ...........         $.27  ...........         $.05
9163...........  LOCM >= 400 mg/ml iodine.  K...............  ...........         $.20  ...........         $.04
9164...........  Inj Gad-base MR contrast.  K...............  ...........        $3.01  ...........         $.60
9165...........  Oral MR contrast.........  K...............  ...........        $9.01  ...........        $1.80
9166...........  Dyphylline injection.....  K...............  ...........        $7.74  ...........        $1.55
9167...........  Valrubicin...............  K...............  ...........      $376.83  ...........       $75.37
9168...........  Pegademase bovine........  K...............  ...........      $161.15  ...........       $32.23
9169...........  Anthrax vaccine, sc......  K...............  ...........      $128.94  ...........       $25.79
9200...........  Orcel....................  K...............       2.6890      $159.59  ...........       $31.92
9201...........  Dermagraft...............  K...............       6.2059      $368.32  ...........       $73.66
9202...........  Inj Octafluoropropane      K...............  ...........       $41.42  ...........        $8.28
                  mic,ml.
9203...........  Inj Perflexane lipid       K...............  ...........       $13.49  ...........        $2.70
                  micros, ml.
9205...........  Oxaliplatin..............  K...............  ...........       $84.05  ...........       $16.81
9206...........  Integra..................  K...............  ...........        $9.23  ...........        $1.85
9207...........  Injection, bortezomib....  K...............  ...........       $28.90  ...........        $5.78
9208...........  Injection, agalsidase      K...............  ...........      $123.35  ...........       $24.67
                  beta.
9209...........  Injection, laronidase....  K...............  ...........       $23.16  ...........        $4.63
9210...........  Injection, palonosetron    K...............  ...........       $18.42  ...........        $3.68
                  HCL.
9211...........  Inj, alefacept, IV.......  K...............  ...........      $570.97  ...........      $114.19
9212...........  Inj, alefacept, IM.......  K...............  ...........      $401.97  ...........       $80.39
9213...........  Injection, Pemetrexed....  G...............  ...........       $41.29  ...........        $8.26
9214...........  Injection, Bevacizumab...  G...............  ...........       $58.17  ...........       $11.63
9215...........  Injection, Cetuximab.....  G...............  ...........       $50.58  ...........       $10.12
9216...........  Abarelix Injection.......  G...............  ...........       $66.96  ...........       $13.39
9217...........  Leuprolide acetate         K...............  ...........      $230.85  ...........       $46.17
                  suspnsion.
9218...........  Injection, Azacitidine...  K...............  ...........        $4.03  ...........         $.81
9219...........  Mycophenolic Acid........  G...............  ...........        $2.47  ...........         $.49
9220...........  Sodium hyaluronate.......  G...............  ...........      $203.82  ...........       $40.76
9221...........  Graftjacket Reg Matrix...  G...............  ...........    $1,234.26  ...........      $246.85
9222...........  Graftjacket SftTis.......  G...............  ...........      $890.67  ...........      $178.13
9300...........  Injection, Omalizumab....  G...............  ...........       $15.98  ...........        $3.20
9500...........  Platelets, irradiated....  K...............       1.3527       $80.28  ...........       $16.06
9501...........  Platelets, pheresis,       K...............       8.1126      $481.48  ...........       $96.30
                  leukocytes reduced.
9502...........  Platelet pheresis          K...............       5.1660      $306.60  ...........       $61.32
                  irradiated.
9503...........  Fresh frozen plasma, ea    K...............       1.6167       $95.95  ...........       $19.19
                  unit.
9504...........  RBC deglycerolized.......  K...............       6.4022      $379.97  ...........       $75.99
9505...........  RBC irradiated...........  K...............       2.3768      $141.06  ...........       $28.21
9506...........  Granulocytes, pheresis...  K...............      15.5448      $922.58  ...........      $184.52
9507...........  Platelets, pheresis......  K...............       6.8676      $407.59  ...........       $81.52
9508...........  Plasma, frozen w/in 8      K...............       1.1983       $71.12  ...........       $14.22
                  hours.
----------------------------------------------------------------------------------------------------------------



    --------------------
*Code is subject to contiguous body area imaging discount policy 
discussed in Section XIV of this proposed rule.

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 42776]]



                                  Addendum B.--Payment Status by HCPCS Code and Related Information Calendar Year 2006
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                  National     Minimum
       CPT/HCPCS               SI               CI                 Description               APC        Relative     Payment     unadjusted   unadjusted
                                                                                                         weight        rate      copayment    copayment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0003T.................  S..............  ...............  Cervicography................         1492  ...........       $15.00  ...........        $3.00
0008T.................  T..............  ...............  Upper gi endoscopy w/suture..         0422      22.8607    $1,356.78      $448.81      $271.36
00100.................  N..............  ...............  Anesth, salivary gland.......  ...........  ...........  ...........  ...........  ...........
00102.................  N..............  ...............  Anesth, repair of cleft lip..  ...........  ...........  ...........  ...........  ...........
00103.................  N..............  ...............  Anesth, blepharoplasty.......  ...........  ...........  ...........  ...........  ...........
00104.................  N..............  ...............  Anesth, electroshock.........  ...........  ...........  ...........  ...........  ...........
0010T.................  A..............  ...............  Tb test, gamma interferon....  ...........  ...........  ...........  ...........  ...........
00120.................  N..............  ...............  Anesth, ear surgery..........  ...........  ...........  ...........  ...........  ...........
00124.................  N..............  ...............  Anesth, ear exam.............  ...........  ...........  ...........  ...........  ...........
00126.................  N..............  ...............  Anesth, tympanotomy..........  ...........  ...........  ...........  ...........  ...........
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.............  ...........  ...........  ...........  ...........  ...........
00160.................  N..............  ...............  Anesth, nose/sinus surgery...  ...........  ...........  ...........  ...........  ...........
00162.................  N..............  ...............  Anesth, nose/sinus surgery...  ...........  ...........  ...........  ...........  ...........
00164.................  N..............  ...............  Anesth, biopsy of nose.......  ...........  ...........  ...........  ...........  ...........
0016T.................  T..............  ...............  Thermotx choroid vasc lesion.         0235       4.6382      $275.28       $67.10       $55.06
00170.................  N..............  ...............  Anesth, procedure on mouth...  ...........  ...........  ...........  ...........  ...........
00172.................  N..............  ...............  Anesth, cleft palate repair..  ...........  ...........  ...........  ...........  ...........
00174.................  N..............  ...............  Anesth, pharyngeal surgery...  ...........  ...........  ...........  ...........  ...........
00176.................  C..............  ...............  Anesth, pharyngeal surgery...  ...........  ...........  ...........  ...........  ...........
0017T.................  E..............  ...............  Photocoagulat macular drusen.  ...........  ...........  ...........  ...........  ...........
0018T.................  S..............  ...............  Transcranial magnetic stimul.         0215       0.6087       $36.13       $14.45        $7.23
00190.................  N..............  ...............  Anesth, face/skull bone surg.  ...........  ...........  ...........  ...........  ...........
00192.................  C..............  ...............  Anesth, facial bone surgery..  ...........  ...........  ...........  ...........  ...........
0019T.................  E..............  ...............  Extracorp shock wave tx, ms..  ...........  ...........  ...........  ...........  ...........
0020T.................  B..............  ...............  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..  ...........  ...........  ...........  ...........  ...........
0026T.................  A..............  ...............  Measure remnant lipoproteins.  ...........  ...........  ...........  ...........  ...........
0027T.................  T..............  ...............  Endoscopic epidural lysis....         0220      17.2800    $1,025.57  ...........      $205.11
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....  ...........  ...........  ...........  ...........  ...........
00404.................  C..............  ...............  Anesth, surgery of breast....  ...........  ...........  ...........  ...........  ...........
00406.................  C..............  ...............  Anesth, surgery of breast....  ...........  ...........  ...........  ...........  ...........
0040T.................  C..............  ...............  Rad s/i, endovasc taa prosth.  ...........  ...........  ...........  ...........  ...........

[[Page 42777]]

 
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..............  ...............  Whole body photography.......  ...........  ...........  ...........  ...........  ...........
0046T.................  T..............  ...............  Cath lavage, mammary duct(s).         0021      14.9098      $884.90      $219.48      $176.98
00470.................  N..............  ...............  Anesth, removal of rib.......  ...........  ...........  ...........  ...........  ...........
00472.................  N..............  ...............  Anesth, chest wall repair....  ...........  ...........  ...........  ...........  ...........
00474.................  C..............  ...............  Anesth, surgery of rib(s)....  ...........  ...........  ...........  ...........  ...........
0047T.................  T..............  ...............  Cath lavage, mammary duct(s).         0021      14.9098      $884.90      $219.48      $176.98
0048T.................  C..............  ...............  Implant ventricular device...  ...........  ...........  ...........  ...........  ...........
0049T.................  C..............  ...............  External circulation assist..  ...........  ...........  ...........  ...........  ...........
00500.................  N..............  ...............  Anesth, esophageal surgery...  ...........  ...........  ...........  ...........  ...........
0050T.................  C..............  ...............  Removal circulation assist...  ...........  ...........  ...........  ...........  ...........
0051T.................  C..............  ...............  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..............  ...............  Anesth, chest partition view.  ...........  ...........  ...........  ...........  ...........
0052T.................  C..............  ...............  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..............  ...............  Replace component heart syst.  ...........  ...........  ...........  ...........  ...........
00540.................  C..............  ...............  Anesth, chest surgery........  ...........  ...........  ...........  ...........  ...........
00541.................  N..............  ...............  Anesth, one lung ventilation.  ...........  ...........  ...........  ...........  ...........
00542.................  C..............  ...............  Anesth, release of lung......  ...........  ...........  ...........  ...........  ...........
00546.................  C..............  ...............  Anesth, lung,chest wall surg.  ...........  ...........  ...........  ...........  ...........
00548.................  N..............  ...............  Anesth, trachea,bronchi surg.  ...........  ...........  ...........  ...........  ...........
0054T.................  B..............  ...............  Bone surgery using computer..  ...........  ...........  ...........  ...........  ...........
00550.................  N..............  ...............  Anesth, sternal debridement..  ...........  ...........  ...........  ...........  ...........
0055T.................  B..............  ...............  Bone surgery using computer..  ...........  ...........  ...........  ...........  ...........
00560.................  C..............  ...............  Anesth, open heart surgery...  ...........  ...........  ...........  ...........  ...........
00561.................  C..............  ...............  Anesth, heart surg < age 1...  ...........  ...........  ...........  ...........  ...........
00562.................  C..............  ...............  Anesth, open heart surgery...  ...........  ...........  ...........  ...........  ...........
00563.................  N..............  ...............  Anesth, heart proc w/pump....  ...........  ...........  ...........  ...........  ...........
00566.................  N..............  ...............  Anesth, cabg w/o pump........  ...........  ...........  ...........  ...........  ...........
0056T.................  B..............  ...............  Bone surgery using computer..  ...........  ...........  ...........  ...........  ...........
00580.................  C..............  ...............  Anesth, heart/lung transplnt.  ...........  ...........  ...........  ...........  ...........
0058T.................  X..............  ...............  Cryopreservation, ovary tiss.         0348       0.7891       $46.83  ...........        $9.37
0059T.................  X..............  ...............  Cryopreservation, oocyte.....         0348       0.7891       $46.83  ...........        $9.37
00600.................  N..............  ...............  Anesth, spine, cord surgery..  ...........  ...........  ...........  ...........  ...........
00604.................  C..............  ...............  Anesth, sitting procedure....  ...........  ...........  ...........  ...........  ...........
0060T.................  B..............  ...............  Electrical impedance scan....  ...........  ...........  ...........  ...........  ...........
0061T.................  B..............  ...............  Destruction of tumor, breast.  ...........  ...........  ...........  ...........  ...........
00620.................  N..............  ...............  Anesth, spine, cord surgery..  ...........  ...........  ...........  ...........  ...........
00622.................  C..............  ...............  Anesth, removal of nerves....  ...........  ...........  ...........  ...........  ...........
0062T.................  T..............  ...............  Rep intradisc annulus1 lev...         0203      10.3544      $614.53      $245.81      $122.91
00630.................  N..............  ...............  Anesth, spine, cord surgery..  ...........  ...........  ...........  ...........  ...........
00632.................  C..............  ...............  Anesth, removal of nerves....  ...........  ...........  ...........  ...........  ...........
00634.................  N..............  ...............  Anesth for chemonucleolysis..  ...........  ...........  ...........  ...........  ...........
00635.................  N..............  ...............  Anesth, lumbar puncture......  ...........  ...........  ...........  ...........  ...........
0063T.................  T..............  ...............  Rep intradisc annulus>1lev...         0203      10.3544      $614.53      $245.81      $122.91
00640.................  N..............  ...............  Anesth, spine manipulation...  ...........  ...........  ...........  ...........  ...........
0064T.................  A..............  ...............  Spectroscop eval expired gas.  ...........  ...........  ...........  ...........  ...........
0065T.................  A..............  ...............  Ocular photoscreen bilat.....  ...........  ...........  ...........  ...........  ...........
0066T.................  E..............  ...............  Ct colonography screen.......  ...........  ...........  ...........  ...........  ...........
00670.................  C..............  ...............  Anesth, spine, cord surgery..  ...........  ...........  ...........  ...........  ...........
0067T*................  S..............  ...............  Ct colonography dx...........         0333       5.2596      $312.16      $124.86       $62.43

[[Page 42778]]

 
0068T.................  B..............  ...............  Interp/rept heart sound......  ...........  ...........  ...........  ...........  ...........
0069T.................  N..............  ...............  Analysis only heart sound....  ...........  ...........  ...........  ...........  ...........
00700.................  N..............  ...............  Anesth, abdominal wall surg..  ...........  ...........  ...........  ...........  ...........
00702.................  N..............  ...............  Anesth, for liver biopsy.....  ...........  ...........  ...........  ...........  ...........
0070T.................  N..............  ...............  Interp only heart sound......  ...........  ...........  ...........  ...........  ...........
0071T.................  T..............  ...............  U/s leiomyomata ablate <200..         0193      14.5183      $861.66  ...........      $172.33
0072T.................  T..............  ...............  U/s leiomyomata ablate >200..         0193      14.5183      $861.66  ...........      $172.33
00730.................  N..............  ...............  Anesth, abdominal wall surg..  ...........  ...........  ...........  ...........  ...........
0073T.................  S..............  ...............  Delivery, comp imrt..........         0412       5.3400      $316.93  ...........       $63.39
00740.................  N..............  ...............  Anesth, upper gi visualize...  ...........  ...........  ...........  ...........  ...........
0074T.................  E..............  ...............  Online physician e/m.........  ...........  ...........  ...........  ...........  ...........
00750.................  N..............  ...............  Anesth, repair of hernia.....  ...........  ...........  ...........  ...........  ...........
00752.................  N..............  ...............  Anesth, repair of hernia.....  ...........  ...........  ...........  ...........  ...........
00754.................  N..............  ...............  Anesth, repair of hernia.....  ...........  ...........  ...........  ...........  ...........
00756.................  N..............  ...............  Anesth, repair of hernia.....  ...........  ...........  ...........  ...........  ...........
0075T.................  C..............  ...............  Perq stent/chest vert art....  ...........  ...........  ...........  ...........  ...........
0076T.................  C..............  ...............  S&i stent/chest vert art.....  ...........  ...........  ...........  ...........  ...........
00770.................  N..............  ...............  Anesth, blood vessel repair..  ...........  ...........  ...........  ...........  ...........
0077T.................  C..............  ...............  Cereb therm perfusion probe..  ...........  ...........  ...........  ...........  ...........
0078T.................  C..............  ...............  Endovasc aort repr w/device..  ...........  ...........  ...........  ...........  ...........
00790.................  N..............  ...............  Anesth, surg upper abdomen...  ...........  ...........  ...........  ...........  ...........
00792.................  C..............  ...............  Anesth, hemorr/excise liver..  ...........  ...........  ...........  ...........  ...........
00794.................  C..............  ...............  Anesth, pancreas removal.....  ...........  ...........  ...........  ...........  ...........
00796.................  C..............  ...............  Anesth, for liver transplant.  ...........  ...........  ...........  ...........  ...........
00797.................  N..............  ...............  Anesth, surgery for obesity..  ...........  ...........  ...........  ...........  ...........
0079T.................  C..............  ...............  Endovasc visc extnsn repr....  ...........  ...........  ...........  ...........  ...........
00800.................  N..............  ...............  Anesth, abdominal wall surg..  ...........  ...........  ...........  ...........  ...........
00802.................  C..............  ...............  Anesth, fat layer removal....  ...........  ...........  ...........  ...........  ...........
0080T.................  C..............  ...............  Endovasc aort repr rad s&i...  ...........  ...........  ...........  ...........  ...........
00810.................  N..............  ...............  Anesth, low intestine scope..  ...........  ...........  ...........  ...........  ...........
0081T.................  C..............  ...............  Endovasc visc extnsn s&i.....  ...........  ...........  ...........  ...........  ...........
00820.................  N..............  ...............  Anesth, abdominal wall surg..  ...........  ...........  ...........  ...........  ...........
0082T.................  B..............  ...............  Stereotactic rad delivery....  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
0083T.................  N..............  ...............  Stereotactic rad tx mngmt....  ...........  ...........  ...........  ...........  ...........
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....  ...........  ...........  ...........  ...........  ...........
0084T.................  T..............  ...............  Temp prostate urethral stent.         0164       1.1802       $70.04       $17.21       $14.01
00851.................  N..............  ...............  Anesth, tubal ligation.......  ...........  ...........  ...........  ...........  ...........
0085T.................  X..............  ...............  Breath test heart reject.....         0340       0.6355       $37.72  ...........        $7.54
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....  ...........  ...........  ...........  ...........  ...........
0086T.................  N..............  ...............  L ventricle fill pressure....  ...........  ...........  ...........  ...........  ...........
00870.................  N..............  ...............  Anesth, bladder stone surg...  ...........  ...........  ...........  ...........  ...........
00872.................  N..............  ...............  Anesth kidney stone destruct.  ...........  ...........  ...........  ...........  ...........
00873.................  N..............  ...............  Anesth kidney stone destruct.  ...........  ...........  ...........  ...........  ...........
0087T.................  X..............  ...............  Sperm eval hyaluronan........         0348       0.7891       $46.83  ...........        $9.37
00880.................  N..............  ...............  Anesth, abdomen vessel surg..  ...........  ...........  ...........  ...........  ...........
00882.................  C..............  ...............  Anesth, major vein ligation..  ...........  ...........  ...........  ...........  ...........
0088T.................  T..............  ...............  Rf tongue base vol reduxn....         0253      16.0627      $953.32      $282.29      $190.66
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...  ...........  ...........  ...........  ...........  ...........

[[Page 42779]]

 
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.................  N..............  ...............  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..............  ...............  Anesth, fx repair, pelvis....  ...........  ...........  ...........  ...........  ...........
01180.................  N..............  ...............  Anesth, pelvis nerve removal.  ...........  ...........  ...........  ...........  ...........
01190.................  N..............  ...............  Anesth, pelvis nerve removal.  ...........  ...........  ...........  ...........  ...........
01200.................  N..............  ...............  Anesth, hip joint procedure..  ...........  ...........  ...........  ...........  ...........
01202.................  N..............  ...............  Anesth, arthroscopy of hip...  ...........  ...........  ...........  ...........  ...........
01210.................  N..............  ...............  Anesth, hip joint surgery....  ...........  ...........  ...........  ...........  ...........
01212.................  C..............  ...............  Anesth, hip disarticulation..  ...........  ...........  ...........  ...........  ...........
01214.................  C..............  ...............  Anesth, hip arthroplasty.....  ...........  ...........  ...........  ...........  ...........
01215.................  N..............  ...............  Anesth, revise hip repair....  ...........  ...........  ...........  ...........  ...........
01220.................  N..............  ...............  Anesth, procedure on femur...  ...........  ...........  ...........  ...........  ...........
01230.................  N..............  ...............  Anesth, surgery of femur.....  ...........  ...........  ...........  ...........  ...........
01232.................  C..............  ...............  Anesth, amputation of femur..  ...........  ...........  ...........  ...........  ...........
01234.................  C..............  ...............  Anesth, radical femur surg...  ...........  ...........  ...........  ...........  ...........
01250.................  N..............  ...............  Anesth, upper leg surgery....  ...........  ...........  ...........  ...........  ...........
01260.................  N..............  ...............  Anesth, upper leg veins surg.  ...........  ...........  ...........  ...........  ...........
01270.................  N..............  ...............  Anesth, thigh arteries surg..  ...........  ...........  ...........  ...........  ...........
01272.................  C..............  ...............  Anesth, femoral artery surg..  ...........  ...........  ...........  ...........  ...........
01274.................  C..............  ...............  Anesth, femoral embolectomy..  ...........  ...........  ...........  ...........  ...........
01320.................  N..............  ...............  Anesth, knee area surgery....  ...........  ...........  ...........  ...........  ...........
01340.................  N..............  ...............  Anesth, knee area procedure..  ...........  ...........  ...........  ...........  ...........
01360.................  N..............  ...............  Anesth, knee area surgery....  ...........  ...........  ...........  ...........  ...........
01380.................  N..............  ...............  Anesth, knee joint procedure.  ...........  ...........  ...........  ...........  ...........
01382.................  N..............  ...............  Anesth, 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....  ...........  ...........  ...........  ...........  ...........

[[Page 42780]]

 
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..  ...........  ...........  ...........  ...........  ...........
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..............  ...............  Anesth, antepartum manipul...  ...........  ...........  ...........  ...........  ...........

[[Page 42781]]

 
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....  ...........  ...........  ...........  ...........  ...........
0500F.................  E..............  ...............  Initial prenatal care visit..  ...........  ...........  ...........  ...........  ...........
0501F.................  E..............  ...............  Prenatal flow sheet..........  ...........  ...........  ...........  ...........  ...........
0502F.................  E..............  ...............  Subsequent prenatal care.....  ...........  ...........  ...........  ...........  ...........
0503F.................  E..............  ...............  Postpartum care visit........  ...........  ...........  ...........  ...........  ...........
1000F.................  E..............  ...............  Tobacco use, smoking, assess.  ...........  ...........  ...........  ...........  ...........
1001F.................  E..............  ...............  Tobacco use, non-smoking.....  ...........  ...........  ...........  ...........  ...........
10021.................  T..............  ...............  Fna w/o image................         0002       0.9515       $56.47  ...........       $11.29
10022.................  T..............  ...............  Fna w/image..................         0036       2.1675      $128.64  ...........       $25.73
1002F.................  E..............  ...............  Assess anginal symptom/level.  ...........  ...........  ...........  ...........  ...........
10040.................  T..............  ...............  Acne surgery.................         0010       0.5693       $33.79        $9.63        $6.76
10060.................  T..............  ...............  Drainage of skin abscess.....         0006       1.5430       $91.58       $22.18       $18.32
10061.................  T..............  ...............  Drainage of skin abscess.....         0006       1.5430       $91.58       $22.18       $18.32
10080.................  T..............  ...............  Drainage of pilonidal cyst...         0006       1.5430       $91.58       $22.18       $18.32
10081.................  T..............  ...............  Drainage of pilonidal cyst...         0007      11.3983      $676.49  ...........      $135.30
10120.................  T..............  ...............  Remove foreign body..........         0006       1.5430       $91.58       $22.18       $18.32
10121.................  T..............  ...............  Remove foreign body..........         0021      14.9098      $884.90      $219.48      $176.98
10140.................  T..............  ...............  Drainage of hematoma/fluid...         0007      11.3983      $676.49  ...........      $135.30
10160.................  T..............  ...............  Puncture drainage of lesion..         0018       1.1673       $69.28       $16.04       $13.86
10180.................  T..............  ...............  Complex drainage, wound......         0008      16.4242      $974.78  ...........      $194.96
11000.................  T..............  ...............  Debride infected skin........         0015       1.6439       $97.57       $20.20       $19.51
11001.................  T..............  ...............  Debride infected skin add-on.         0012       0.8458       $50.20       $11.18       $10.04
11004.................  C..............  ...............  Debride genitalia & perineum.  ...........  ...........  ...........  ...........  ...........
11005.................  C..............  ...............  Debride abdom wall...........  ...........  ...........  ...........  ...........  ...........
11006.................  C..............  ...............  Debride genit/per/abdom wall.  ...........  ...........  ...........  ...........  ...........
11008.................  C..............  ...............  Remove mesh from abd wall....  ...........  ...........  ...........  ...........  ...........
11010.................  T..............  ...............  Debride skin, fx.............         0019       4.0363      $239.55       $71.87       $47.91
11011.................  T..............  ...............  Debride skin/muscle, fx......         0019       4.0363      $239.55       $71.87       $47.91
11012.................  T..............  ...............  Debride skin/muscle/bone, fx.         0019       4.0363      $239.55       $71.87       $47.91
11040.................  T..............  ...............  Debride skin, partial........         0015       1.6439       $97.57       $20.20       $19.51
11041.................  T..............  ...............  Debride skin, full...........         0015       1.6439       $97.57       $20.20       $19.51
11042.................  T..............  ...............  Debride skin/tissue..........         0016       2.5717      $152.63       $33.42       $30.53
11043.................  T..............  ...............  Debride tissue/muscle........         0016       2.5717      $152.63       $33.42       $30.53
11044.................  T..............  ...............  Debride tissue/muscle/bone...         0682       6.8794      $408.29      $161.70       $81.66
11055.................  T..............  ...............  Trim skin lesion.............         0012       0.8458       $50.20       $11.18       $10.04
11056.................  T..............  ...............  Trim skin lesions, 2 to 4....         0012       0.8458       $50.20       $11.18       $10.04
11057.................  T..............  ...............  Trim skin lesions, over 4....         0013       1.1028       $65.45       $14.20       $13.09
11100.................  T..............  ...............  Biopsy, skin lesion..........         0018       1.1673       $69.28       $16.04       $13.86
11101.................  T..............  ...............  Biopsy, skin add-on..........         0018       1.1673       $69.28       $16.04       $13.86
11200.................  T..............  ...............  Removal of skin tags.........         0013       1.1028       $65.45       $14.20       $13.09
11201.................  T..............  ...............  Remove skin tags add-on......         0015       1.6439       $97.57       $20.20       $19.51
11300.................  T..............  ...............  Shave skin lesion............         0012       0.8458       $50.20       $11.18       $10.04
11301.................  T..............  ...............  Shave skin lesion............         0012       0.8458       $50.20       $11.18       $10.04
11302.................  T..............  ...............  Shave skin lesion............         0013       1.1028       $65.45       $14.20       $13.09
11303.................  T..............  ...............  Shave skin lesion............         0015       1.6439       $97.57       $20.20       $19.51
11305.................  T..............  ...............  Shave skin lesion............         0013       1.1028       $65.45       $14.20       $13.09
11306.................  T..............  ...............  Shave skin lesion............         0013       1.1028       $65.45       $14.20       $13.09
11307.................  T..............  ...............  Shave skin lesion............         0013       1.1028       $65.45       $14.20       $13.09
11308.................  T..............  ...............  Shave skin lesion............         0013       1.1028       $65.45       $14.20       $13.09
11310.................  T..............  ...............  Shave skin lesion............         0013       1.1028       $65.45       $14.20       $13.09
11311.................  T..............  ...............  Shave skin lesion............         0013       1.1028       $65.45       $14.20       $13.09
11312.................  T..............  ...............  Shave skin lesion............         0013       1.1028       $65.45       $14.20       $13.09
11313.................  T..............  ...............  Shave skin lesion............         0016       2.5717      $152.63       $33.42       $30.53

[[Page 42782]]

 
11400.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11401.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11402.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11403.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11404.................  T..............  ...............  Removal of skin lesion.......         0021      14.9098      $884.90      $219.48      $176.98
11406.................  T..............  ...............  Removal of skin lesion.......         0021      14.9098      $884.90      $219.48      $176.98
11420.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11421.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11422.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11423.................  T..............  ...............  Removal of skin lesion.......         0021      14.9098      $884.90      $219.48      $176.98
11424.................  T..............  ...............  Removal of skin lesion.......         0021      14.9098      $884.90      $219.48      $176.98
11426.................  T..............  ...............  Removal of skin lesion.......         0022      19.5582    $1,160.78      $354.45      $232.16
11440.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11441.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11442.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11443.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11444.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11446.................  T..............  ...............  Removal of skin lesion.......         0022      19.5582    $1,160.78      $354.45      $232.16
11450.................  T..............  ...............  Removal, sweat gland lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11451.................  T..............  ...............  Removal, sweat gland lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11462.................  T..............  ...............  Removal, sweat gland lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11463.................  T..............  ...............  Removal, sweat gland lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11470.................  T..............  ...............  Removal, sweat gland lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11471.................  T..............  ...............  Removal, sweat gland lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11600.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11601.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11602.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11603.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11604.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11606.................  T..............  ...............  Removal of skin lesion.......         0021      14.9098      $884.90      $219.48      $176.98
11620.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11621.................  T..............  ...............  Removal of skin lesion.......         0019       4.0363      $239.55       $71.87       $47.91
11622.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11623.................  T..............  ...............  Removal of skin lesion.......         0021      14.9098      $884.90      $219.48      $176.98
11624.................  T..............  ...............  Removal of skin lesion.......         0021      14.9098      $884.90      $219.48      $176.98
11626.................  T..............  ...............  Removal of skin lesion.......         0022      19.5582    $1,160.78      $354.45      $232.16
11640.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11641.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11642.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11643.................  T..............  ...............  Removal of skin lesion.......         0020       6.9118      $410.22      $106.93       $82.04
11644.................  T..............  ...............  Removal of skin lesion.......         0021      14.9098      $884.90      $219.48      $176.98
11646.................  T..............  ...............  Removal of skin lesion.......         0022      19.5582    $1,160.78      $354.45      $232.16
11719.................  T..............  ...............  Trim nail(s).................         0009       0.6650       $39.47        $8.34        $7.89
11720.................  T..............  ...............  Debride nail, 1-5............         0009       0.6650       $39.47        $8.34        $7.89
11721.................  T..............  ...............  Debride nail, 6 or more......         0009       0.6650       $39.47        $8.34        $7.89
11730.................  T..............  ...............  Removal of nail plate........         0013       1.1028       $65.45       $14.20       $13.09
11732.................  T..............  ...............  Remove nail plate, add-on....         0012       0.8458       $50.20       $11.18       $10.04
11740.................  T..............  ...............  Drain blood from under nail..         0009       0.6650       $39.47        $8.34        $7.89
11750.................  T..............  ...............  Removal of nail bed..........         0019       4.0363      $239.55       $71.87       $47.91
11752.................  T..............  ...............  Remove nail bed/finger tip...         0022      19.5582    $1,160.78      $354.45      $232.16
11755.................  T..............  ...............  Biopsy, nail unit............         0019       4.0363      $239.55       $71.87       $47.91
11760.................  T..............  ...............  Repair of nail bed...........         0024       1.6011       $95.03       $31.11       $19.01
11762.................  T..............  ...............  Reconstruction of nail bed...         0024       1.6011       $95.03       $31.11       $19.01
11765.................  T..............  ...............  Excision of nail fold, toe...         0015       1.6439       $97.57       $20.20       $19.51
11770.................  T..............  ...............  Removal of pilonidal lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11771.................  T..............  ...............  Removal of pilonidal lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11772.................  T..............  ...............  Removal of pilonidal lesion..         0022      19.5582    $1,160.78      $354.45      $232.16
11900.................  T..............  ...............  Injection into skin lesions..         0012       0.8458       $50.20       $11.18       $10.04
11901.................  T..............  ...............  Added skin lesions injection.         0012       0.8458       $50.20       $11.18       $10.04
11920.................  T..............  ...............  Correct skin color defects...         0024       1.6011       $95.03       $31.11       $19.01
11921.................  T..............  ...............  Correct skin color defects...         0024       1.6011       $95.03       $31.11       $19.01
11922.................  T..............  ...............  Correct skin color defects...         0024       1.6011       $95.03       $31.11       $19.01
11950.................  T..............  ...............  Therapy for contour defects..         0024       1.6011       $95.03       $31.11       $19.01
11951.................  T..............  ...............  Therapy for contour defects..         0024       1.6011       $95.03       $31.11       $19.01
11952.................  T..............  ...............  Therapy for contour defects..         0024       1.6011       $95.03       $31.11       $19.01
11954.................  T..............  ...............  Therapy for contour defects..         0024       1.6011       $95.03       $31.11       $19.01

[[Page 42783]]

 
11960.................  T..............  ...............  Insert tissue expander(s)....         0027      18.3348    $1,088.17      $329.72      $217.63
11970.................  T..............  ...............  Replace tissue expander......         0027      18.3348    $1,088.17      $329.72      $217.63
11971.................  T..............  ...............  Remove tissue expander(s)....         0022      19.5582    $1,160.78      $354.45      $232.16
11975.................  E..............  ...............  Insert contraceptive cap.....  ...........  ...........  ...........  ...........  ...........
11976.................  T..............  ...............  Removal of contraceptive cap.         0019       4.0363      $239.55       $71.87       $47.91
11977.................  E..............  ...............  Removal/reinsert contra cap..  ...........  ...........  ...........  ...........  ...........
11980.................  X..............  ...............  Implant hormone pellet(s)....         0340       0.6355       $37.72  ...........        $7.54
11981.................  X..............  ...............  Insert drug implant device...         0340       0.6355       $37.72  ...........        $7.54
11982.................  X..............  ...............  Remove drug implant device...         0340       0.6355       $37.72  ...........        $7.54
11983.................  X..............  ...............  Remove/insert drug implant...         0340       0.6355       $37.72  ...........        $7.54
12001.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12002.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12004.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12005.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12006.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12007.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12011.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12013.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12014.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12015.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12016.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12017.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12018.................  T..............  ...............  Repair superficial wound(s)..         0024       1.6011       $95.03       $31.11       $19.01
12020.................  T..............  ...............  Closure of split wound.......         0024       1.6011       $95.03       $31.11       $19.01
12021.................  T..............  ...............  Closure of split wound.......         0024       1.6011       $95.03       $31.11       $19.01
12031.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12032.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12034.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12035.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12036.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12037.................  T..............  ...............  Layer closure of wound(s)....         0025       5.4690      $324.59      $101.85       $64.92
12041.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12042.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12044.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12045.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12046.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12047.................  T..............  ...............  Layer closure of wound(s)....         0025       5.4690      $324.59      $101.85       $64.92
12051.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12052.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12053.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12054.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12055.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12056.................  T..............  ...............  Layer closure of wound(s)....         0024       1.6011       $95.03       $31.11       $19.01
12057.................  T..............  ...............  Layer closure of wound(s)....         0025       5.4690      $324.59      $101.85       $64.92
13100.................  T..............  ...............  Repair of wound or lesion....         0025       5.4690      $324.59      $101.85       $64.92
13101.................  T..............  ...............  Repair of wound or lesion....         0025       5.4690      $324.59      $101.85       $64.92
13102.................  T..............  ...............  Repair wound/lesion add-on...         0024       1.6011       $95.03       $31.11       $19.01
13120.................  T..............  ...............  Repair of wound or lesion....         0024       1.6011       $95.03       $31.11       $19.01
13121.................  T..............  ...............  Repair of wound or lesion....         0024       1.6011       $95.03       $31.11       $19.01
13122.................  T..............  ...............  Repair wound/lesion add-on...         0024       1.6011       $95.03       $31.11       $19.01
13131.................  T..............  ...............  Repair of wound or lesion....         0024       1.6011       $95.03       $31.11       $19.01
13132.................  T..............  ...............  Repair of wound or lesion....         0024       1.6011       $95.03       $31.11       $19.01
13133.................  T..............  ...............  Repair wound/lesion add-on...         0024       1.6011       $95.03       $31.11       $19.01
13150.................  T..............  ...............  Repair of wound or lesion....         0025       5.4690      $324.59      $101.85       $64.92
13151.................  T..............  ...............  Repair of wound or lesion....         0024       1.6011       $95.03       $31.11       $19.01
13152.................  T..............  ...............  Repair of wound or lesion....         0025       5.4690      $324.59      $101.85       $64.92
13153.................  T..............  ...............  Repair wound/lesion add-on...         0024       1.6011       $95.03       $31.11       $19.01
13160.................  T..............  ...............  Late closure of wound........         0027      18.3348    $1,088.17      $329.72      $217.63
14000.................  T..............  ...............  Skin tissue rearrangement....         0686      13.7661      $817.02  ...........      $163.40
14001.................  T..............  ...............  Skin tissue rearrangement....         0027      18.3348    $1,088.17      $329.72      $217.63
14020.................  T..............  ...............  Skin tissue rearrangement....         0686      13.7661      $817.02  ...........      $163.40
14021.................  T..............  ...............  Skin tissue rearrangement....         0027      18.3348    $1,088.17      $329.72      $217.63
14040.................  T..............  ...............  Skin tissue rearrangement....         0686      13.7661      $817.02  ...........      $163.40
14041.................  T..............  ...............  Skin tissue rearrangement....         0027      18.3348    $1,088.17      $329.72      $217.63
14060.................  T..............  ...............  Skin tissue rearrangement....         0027      18.3348    $1,088.17      $329.72      $217.63
14061.................  T..............  ...............  Skin tissue rearrangement....         0686      13.7661      $817.02  ...........      $163.40

[[Page 42784]]

 
14300.................  T..............  ...............  Skin tissue rearrangement....         0027      18.3348    $1,088.17      $329.72      $217.63
14350.................  T..............  ...............  Skin tissue rearrangement....         0027      18.3348    $1,088.17      $329.72      $217.63
15000.................  T..............  ...............  Skin graft...................         0025       5.4690      $324.59      $101.85       $64.92
15001.................  T..............  ...............  Skin graft add-on............         0025       5.4690      $324.59      $101.85       $64.92
15050.................  T..............  ...............  Skin pinch graft.............         0025       5.4690      $324.59      $101.85       $64.92
15100.................  T..............  ...............  Skin split graft.............         0027      18.3348    $1,088.17      $329.72      $217.63
15101.................  T..............  ...............  Skin split graft add-on......         0027      18.3348    $1,088.17      $329.72      $217.63
15120.................  T..............  ...............  Skin split graft.............         0027      18.3348    $1,088.17      $329.72      $217.63
15121.................  T..............  ...............  Skin split graft add-on......         0027      18.3348    $1,088.17      $329.72      $217.63
15200.................  T..............  ...............  Skin full graft..............         0027      18.3348    $1,088.17      $329.72      $217.63
15201.................  T..............  ...............  Skin full graft add-on.......         0025       5.4690      $324.59      $101.85       $64.92
15220.................  T..............  ...............  Skin full graft..............         0027      18.3348    $1,088.17      $329.72      $217.63
15221.................  T..............  ...............  Skin full graft add-on.......         0025       5.4690      $324.59      $101.85       $64.92
15240.................  T..............  ...............  Skin full graft..............         0686      13.7661      $817.02  ...........      $163.40
15241.................  T..............  ...............  Skin full graft add-on.......         0025       5.4690      $324.59      $101.85       $64.92
15260.................  T..............  ...............  Skin full graft..............         0686      13.7661      $817.02  ...........      $163.40
15261.................  T..............  ...............  Skin full graft add-on.......         0025       5.4690      $324.59      $101.85       $64.92
15342.................  T..............  ...............  Cultured skin graft, 25 cm...         0024       1.6011       $95.03       $31.11       $19.01
15343.................  T..............  ...............  Culture skn graft add'l 25 cm         0024       1.6011       $95.03       $31.11       $19.01
15350.................  T..............  ...............  Skin homograft...............         0686      13.7661      $817.02  ...........      $163.40
15351.................  T..............  ...............  Skin homograft add-on........         0686      13.7661      $817.02  ...........      $163.40
15400.................  T..............  ...............  Skin heterograft.............         0025       5.4690      $324.59      $101.85       $64.92
15401.................  T..............  ...............  Skin heterograft add-on......         0025       5.4690      $324.59      $101.85       $64.92
15570.................  T..............  ...............  Form skin pedicle flap.......         0027      18.3348    $1,088.17      $329.72      $217.63
15572.................  T..............  ...............  Form skin pedicle flap.......         0027      18.3348    $1,088.17      $329.72      $217.63
15574.................  T..............  ...............  Form skin pedicle flap.......         0027      18.3348    $1,088.17      $329.72      $217.63
15576.................  T..............  ...............  Form skin pedicle flap.......         0686      13.7661      $817.02  ...........      $163.40
15600.................  T..............  ...............  Skin graft...................         0027      18.3348    $1,088.17      $329.72      $217.63
15610.................  T..............  ...............  Skin graft...................         0027      18.3348    $1,088.17      $329.72      $217.63
15620.................  T..............  ...............  Skin graft...................         0027      18.3348    $1,088.17      $329.72      $217.63
15630.................  T..............  ...............  Skin graft...................         0027      18.3348    $1,088.17      $329.72      $217.63
15650.................  T..............  ...............  Transfer skin pedicle flap...         0027      18.3348    $1,088.17      $329.72      $217.63
15732.................  T..............  ...............  Muscle-skin graft, head/neck.         0027      18.3348    $1,088.17      $329.72      $217.63
15734.................  T..............  ...............  Muscle-skin graft, trunk.....         0027      18.3348    $1,088.17      $329.72      $217.63
15736.................  T..............  ...............  Muscle-skin graft, arm.......         0027      18.3348    $1,088.17      $329.72      $217.63
15738.................  T..............  ...............  Muscle-skin graft, leg.......         0027      18.3348    $1,088.17      $329.72      $217.63
15740.................  T..............  ...............  Island pedicle flap graft....         0686      13.7661      $817.02  ...........      $163.40
15750.................  T..............  ...............  Neurovascular pedicle graft..         0027      18.3348    $1,088.17      $329.72      $217.63
15756.................  C..............  ...............  Free muscle flap, microvasc..  ...........  ...........  ...........  ...........  ...........
15757.................  C..............  ...............  Free skin flap, microvasc....  ...........  ...........  ...........  ...........  ...........
15758.................  C..............  ...............  Free fascial flap, microvasc.  ...........  ...........  ...........  ...........  ...........
15760.................  T..............  ...............  Composite skin graft.........         0027      18.3348    $1,088.17      $329.72      $217.63
15770.................  T..............  ...............  Derma-fat-fascia graft.......         0027      18.3348    $1,088.17      $329.72      $217.63
15775.................  T..............  ...............  Hair transplant punch grafts.         0025       5.4690      $324.59      $101.85       $64.92
15776.................  T..............  ...............  Hair transplant punch grafts.         0025       5.4690      $324.59      $101.85       $64.92
15780.................  T..............  ...............  Abrasion treatment of skin...         0022      19.5582    $1,160.78      $354.45      $232.16
15781.................  T..............  ...............  Abrasion treatment of skin...         0019       4.0363      $239.55       $71.87       $47.91
15782.................  T..............  ...............  Dressing change not for burn.         0019       4.0363      $239.55       $71.87       $47.91
15783.................  T..............  ...............  Abrasion treatment of skin...         0016       2.5717      $152.63       $33.42       $30.53
15786.................  T..............  ...............  Abrasion, lesion, single.....         0013       1.1028       $65.45       $14.20       $13.09
15787.................  T..............  ...............  Abrasion, lesions, add-on....         0013       1.1028       $65.45       $14.20       $13.09
15788.................  T..............  ...............  Chemical peel, face, epiderm.         0012       0.8458       $50.20       $11.18       $10.04
15789.................  T..............  ...............  Chemical peel, face, dermal..         0015       1.6439       $97.57       $20.20       $19.51
15792.................  T..............  ...............  Chemical peel, nonfacial.....         0013       1.1028       $65.45       $14.20       $13.09
15793.................  T..............  ...............  Chemical peel, nonfacial.....         0012       0.8458       $50.20       $11.18       $10.04
15810.................  T..............  ...............  Salabrasion..................         0016       2.5717      $152.63       $33.42       $30.53
15811.................  T..............  ...............  Salabrasion..................         0016       2.5717      $152.63       $33.42       $30.53
15819.................  T..............  ...............  Plastic surgery, neck........         0025       5.4690      $324.59      $101.85       $64.92
15820.................  T..............  ...............  Revision of lower eyelid.....         0027      18.3348    $1,088.17      $329.72      $217.63
15821.................  T..............  ...............  Revision of lower eyelid.....         0027      18.3348    $1,088.17      $329.72      $217.63
15822.................  T..............  ...............  Revision of upper eyelid.....         0027      18.3348    $1,088.17      $329.72      $217.63
15823.................  T..............  ...............  Revision of upper eyelid.....         0027      18.3348    $1,088.17      $329.72      $217.63
15824.................  T..............  ...............  Removal of forehead wrinkles.         0027      18.3348    $1,088.17      $329.72      $217.63
15825.................  T..............  ...............  Removal of neck wrinkles.....         0027      18.3348    $1,088.17      $329.72      $217.63
15826.................  T..............  ...............  Removal of brow wrinkles.....         0027      18.3348    $1,088.17      $329.72      $217.63
15828.................  T..............  ...............  Removal of face wrinkles.....         0027      18.3348    $1,088.17      $329.72      $217.63

[[Page 42785]]

 
15829.................  T..............  ...............  Removal of skin wrinkles.....         0027      18.3348    $1,088.17      $329.72      $217.63
15831.................  T..............  ...............  Excise excessive skin tissue.         0022      19.5582    $1,160.78      $354.45      $232.16
15832.................  T..............  ...............  Excise excessive skin tissue.         0022      19.5582    $1,160.78      $354.45      $232.16
15833.................  T..............  ...............  Excise excessive skin tissue.         0022      19.5582    $1,160.78      $354.45      $232.16
15834.................  T..............  ...............  Excise excessive skin tissue.         0022      19.5582    $1,160.78      $354.45      $232.16
15835.................  T..............  ...............  Excise excessive skin tissue.         0025       5.4690      $324.59      $101.85       $64.92
15836.................  T..............  ...............  Excise excessive skin tissue.         0021      14.9098      $884.90      $219.48      $176.98
15837.................  T..............  ...............  Excise excessive skin tissue.         0021      14.9098      $884.90      $219.48      $176.98
15838.................  T..............  ...............  Excise excessive skin tissue.         0021      14.9098      $884.90      $219.48      $176.98
15839.................  T..............  ...............  Excise excessive skin tissue.         0021      14.9098      $884.90      $219.48      $176.98
15840.................  T..............  ...............  Graft for face nerve palsy...         0027      18.3348    $1,088.17      $329.72      $217.63
15841.................  T..............  ...............  Graft for face nerve palsy...         0027      18.3348    $1,088.17      $329.72      $217.63
15842.................  T..............  ...............  Flap for face nerve palsy....         0027      18.3348    $1,088.17      $329.72      $217.63
15845.................  T..............  ...............  Skin and muscle repair, face.         0027      18.3348    $1,088.17      $329.72      $217.63
15850.................  T..............  ...............  Removal of sutures...........         0016       2.5717      $152.63       $33.42       $30.53
15851.................  T..............  ...............  Removal of sutures...........         0016       2.5717      $152.63       $33.42       $30.53
15852.................  X..............  ...............  Dressing change not for burn.         0340       0.6355       $37.72  ...........        $7.54
15860.................  X..............  ...............  Test for blood flow in graft.         0359       0.8274       $49.11  ...........        $9.82
15876.................  T..............  ...............  Suction assisted lipectomy...         0027      18.3348    $1,088.17      $329.72      $217.63
15877.................  T..............  ...............  Suction assisted lipectomy...         0027      18.3348    $1,088.17      $329.72      $217.63
15878.................  T..............  ...............  Suction assisted lipectomy...         0686      13.7661      $817.02  ...........      $163.40
15879.................  T..............  ...............  Suction assisted lipectomy...         0027      18.3348    $1,088.17      $329.72      $217.63
15920.................  T..............  ...............  Removal of tail bone ulcer...         0019       4.0363      $239.55       $71.87       $47.91
15922.................  T..............  ...............  Removal of tail bone ulcer...         0027      18.3348    $1,088.17      $329.72      $217.63
15931.................  T..............  ...............  Remove sacrum pressure sore..         0022      19.5582    $1,160.78      $354.45      $232.16
15933.................  T..............  ...............  Remove sacrum pressure sore..         0022      19.5582    $1,160.78      $354.45      $232.16
15934.................  T..............  ...............  Remove sacrum pressure sore..         0027      18.3348    $1,088.17      $329.72      $217.63
15935.................  T..............  ...............  Remove sacrum pressure sore..         0027      18.3348    $1,088.17      $329.72      $217.63
15936.................  T..............  ...............  Remove sacrum pressure sore..         0027      18.3348    $1,088.17      $329.72      $217.63
15937.................  T..............  ...............  Remove sacrum pressure sore..         0027      18.3348    $1,088.17      $329.72      $217.63
15940.................  T..............  ...............  Remove hip pressure sore.....         0022      19.5582    $1,160.78      $354.45      $232.16
15941.................  T..............  ...............  Remove hip pressure sore.....         0022      19.5582    $1,160.78      $354.45      $232.16
15944.................  T..............  ...............  Remove hip pressure sore.....         0027      18.3348    $1,088.17      $329.72      $217.63
15945.................  T..............  ...............  Remove hip pressure sore.....         0027      18.3348    $1,088.17      $329.72      $217.63
15946.................  T..............  ...............  Remove hip pressure sore.....         0027      18.3348    $1,088.17      $329.72      $217.63
15950.................  T..............  ...............  Remove thigh pressure sore...         0022      19.5582    $1,160.78      $354.45      $232.16
15951.................  T..............  ...............  Remove thigh pressure sore...         0022      19.5582    $1,160.78      $354.45      $232.16
15952.................  T..............  ...............  Remove thigh pressure sore...         0027      18.3348    $1,088.17      $329.72      $217.63
15953.................  T..............  ...............  Remove thigh pressure sore...         0027      18.3348    $1,088.17      $329.72      $217.63
15956.................  T..............  ...............  Remove thigh pressure sore...         0027      18.3348    $1,088.17      $329.72      $217.63
15958.................  T..............  ...............  Remove thigh pressure sore...         0027      18.3348    $1,088.17      $329.72      $217.63
15999.................  T..............  ...............  Removal of pressure sore.....         0019       4.0363      $239.55       $71.87       $47.91
16000.................  T..............  ...............  Initial treatment of burn(s).         0012       0.8458       $50.20       $11.18       $10.04
16010.................  T..............  ...............  Treatment of burn(s).........         0016       2.5717      $152.63       $33.42       $30.53
16015.................  T..............  ...............  Treatment of burn(s).........         0017      18.3377    $1,088.34      $227.84      $217.67
16020.................  T..............  ...............  Treatment of burn(s).........         0013       1.1028       $65.45       $14.20       $13.09
16025.................  T..............  ...............  Treatment of burn(s).........         0013       1.1028       $65.45       $14.20       $13.09
16030.................  T..............  ...............  Treatment of burn(s).........         0015       1.6439       $97.57       $20.20       $19.51
16035.................  C..............  ...............  Incision of burn scab, initi.  ...........  ...........  ...........  ...........  ...........
16036.................  C..............  ...............  Escharotomy addl incision....  ...........  ...........  ...........  ...........  ...........
17000.................  T..............  ...............  Destroy benign/premlg lesion.         0010       0.5693       $33.79        $9.63        $6.76
17003.................  T..............  ...............  Destroy lesions, 2-14........         0010       0.5693       $33.79        $9.63        $6.76
17004.................  T..............  ...............  Destroy lesions, 15 or more..         0011       2.0745      $123.12       $25.06       $24.62
17106.................  T..............  ...............  Destruction of skin lesions..         0011       2.0745      $123.12       $25.06       $24.62
17107.................  T..............  ...............  Destruction of skin lesions..         0011       2.0745      $123.12       $25.06       $24.62
17108.................  T..............  ...............  Destruction of skin lesions..         0011       2.0745      $123.12       $25.06       $24.62
17110.................  T..............  ...............  Destruct lesion, 1-14........         0010       0.5693       $33.79        $9.63        $6.76
17111.................  T..............  ...............  Destruct lesion, 15 or more..         0010       0.5693       $33.79        $9.63        $6.76
17250.................  T..............  ...............  Chemical cautery, tissue.....         0013       1.1028       $65.45       $14.20       $13.09
17260.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17261.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17262.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17263.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17264.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17266.................  T..............  ...............  Destruction of skin lesions..         0016       2.5717      $152.63       $33.42       $30.53
17270.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51

[[Page 42786]]

 
17271.................  T..............  ...............  Destruction of skin lesions..         0013       1.1028       $65.45       $14.20       $13.09
17272.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17273.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17274.................  T..............  ...............  Destruction of skin lesions..         0016       2.5717      $152.63       $33.42       $30.53
17276.................  T..............  ...............  Destruction of skin lesions..         0016       2.5717      $152.63       $33.42       $30.53
17280.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17281.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17282.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17283.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17284.................  T..............  ...............  Destruction of skin lesions..         0016       2.5717      $152.63       $33.42       $30.53
17286.................  T..............  ...............  Destruction of skin lesions..         0015       1.6439       $97.57       $20.20       $19.51
17304.................  T..............  ...............  Chemosurgery of skin lesion..         0694       3.8278      $227.18       $61.59       $45.44
17305.................  T..............  ...............  2 stage mohs, up to 5 spec...         0694       3.8278      $227.18       $61.59       $45.44
17306.................  T..............  ...............  3 stage mohs, up to 5 spec...         0694       3.8278      $227.18       $61.59       $45.44
17307.................  T..............  ...............  Mohs addl stage up to 5 spec.         0694       3.8278      $227.18       $61.59       $45.44
17310.................  T..............  ...............  Extensive skin chemosurgery..         0694       3.8278      $227.18       $61.59       $45.44
17340.................  T..............  ...............  Cryotherapy of skin..........         0012       0.8458       $50.20       $11.18       $10.04
17360.................  T..............  ...............  Skin peel therapy............         0013       1.1028       $65.45       $14.20       $13.09
17380.................  T..............  ...............  Hair removal by electrolysis.         0013       1.1028       $65.45       $14.20       $13.09
17999.................  T..............  ...............  Skin tissue procedure........         0006       1.5430       $91.58       $22.18       $18.32
19000.................  T..............  ...............  Drainage of breast lesion....         0004       1.7566      $104.25       $22.36       $20.85
19001.................  T..............  ...............  Drain breast lesion add-on...         0004       1.7566      $104.25       $22.36       $20.85
19020.................  T..............  ...............  Incision of breast lesion....         0008      16.4242      $974.78  ...........      $194.96
19030.................  N..............  ...............  Injection for breast x-ray...  ...........  ...........  ...........  ...........  ...........
19100.................  T..............  ...............  Bx breast percut w/o image...         0005       3.5831      $212.66       $71.45       $42.53
19101.................  T..............  ...............  Biopsy of breast, open.......         0028      19.4914    $1,156.81      $303.74      $231.36
19102.................  T..............  ...............  Bx breast percut w/image.....         0005       3.5831      $212.66       $71.45       $42.53
19103.................  T..............  ...............  Bx breast percut w/device....         0658       6.0773      $360.69  ...........       $72.14
19110.................  T..............  ...............  nipple exploration...........         0028      19.4914    $1,156.81      $303.74      $231.36
19112.................  T..............  ...............  Excise breast duct fistula...         0028      19.4914    $1,156.81      $303.74      $231.36
19120.................  T..............  ...............  Removal of breast lesion.....         0028      19.4914    $1,156.81      $303.74      $231.36
19125.................  T..............  ...............  Excision, breast lesion......         0028      19.4914    $1,156.81      $303.74      $231.36
19126.................  T..............  ...............  Excision, addl breast lesion.         0028      19.4914    $1,156.81      $303.74      $231.36
19140.................  T..............  ...............  Removal of breast tissue.....         0028      19.4914    $1,156.81      $303.74      $231.36
19160.................  T..............  ...............  Removal of breast tissue.....         0028      19.4914    $1,156.81      $303.74      $231.36
19162.................  T..............  ...............  Remove breast tissue, nodes..         0693      42.0342    $2,494.73      $798.17      $498.95
19180.................  T..............  ...............  Removal of breast............         0029      31.9024    $1,893.41      $632.64      $378.68
19182.................  T..............  ...............  Removal of breast............         0029      31.9024    $1,893.41      $632.64      $378.68
19200.................  C..............  ...............  Removal of breast............  ...........  ...........  ...........  ...........  ...........
19220.................  C..............  ...............  Removal of breast............  ...........  ...........  ...........  ...........  ...........
19240.................  T..............  ...............  Removal of breast............         0030      39.9010    $2,368.12      $763.55      $473.62
19260.................  T..............  ...............  Removal of chest wall lesion.         0021      14.9098      $884.90      $219.48      $176.98
19271.................  C..............  ...............  Revision of chest wall.......  ...........  ...........  ...........  ...........  ...........
19272.................  C..............  ...............  Extensive chest wall surgery.  ...........  ...........  ...........  ...........  ...........
19290.................  N..............  ...............  Place needle wire, breast....  ...........  ...........  ...........  ...........  ...........
19291.................  N..............  ...............  Place needle wire, breast....  ...........  ...........  ...........  ...........  ...........
19295.................  S..............  ...............  Place breast clip, percut....         0657       1.7015      $100.98  ...........       $20.20
19296.................  S..............  ...............  Place po breast cath for rad.         1524  ...........    $3,250.00  ...........      $650.00
19297.................  S..............  ...............  Place breast cath for rad....         1523  ...........    $2,750.00  ...........      $550.00
19298.................  S..............  ...............  Place breast rad tube/caths..         1524  ...........    $3,250.00  ...........      $650.00
19316.................  T..............  ...............  Suspension of breast.........         0029      31.9024    $1,893.41      $632.64      $378.68
19318.................  T..............  ...............  Reduction of large breast....         0693      42.0342    $2,494.73      $798.17      $498.95
19324.................  T..............  ...............  Enlarge breast...............         0693      42.0342    $2,494.73      $798.17      $498.95
19325.................  T..............  ...............  Enlarge breast with implant..         0648      50.2174    $2,980.40  ...........      $596.08
19328.................  T..............  ...............  Removal of breast implant....         0029      31.9024    $1,893.41      $632.64      $378.68
19330.................  T..............  ...............  Removal of implant material..         0029      31.9024    $1,893.41      $632.64      $378.68
19340.................  T..............  ...............  Immediate breast prosthesis..         0030      39.9010    $2,368.12      $763.55      $473.62
19342.................  T..............  ...............  Delayed breast prosthesis....         0648      50.2174    $2,980.40  ...........      $596.08
19350.................  T..............  ...............  Breast reconstruction........         0028      19.4914    $1,156.81      $303.74      $231.36
19355.................  T..............  ...............  Correct inverted nipple(s)...         0029      31.9024    $1,893.41      $632.64      $378.68
19357.................  T..............  ...............  Breast reconstruction........         0648      50.2174    $2,980.40  ...........      $596.08
19361.................  C..............  ...............  Breast reconstruction........  ...........  ...........  ...........  ...........  ...........
19364.................  C..............  ...............  Breast reconstruction........  ...........  ...........  ...........  ...........  ...........
19366.................  T..............  ...............  Breast reconstruction........         0029      31.9024    $1,893.41      $632.64      $378.68
19367.................  C..............  ...............  Breast reconstruction........  ...........  ...........  ...........  ...........  ...........
19368.................  C..............  ...............  Breast reconstruction........  ...........  ...........  ...........  ...........  ...........

[[Page 42787]]

 
19369.................  C..............  ...............  Breast reconstruction........  ...........  ...........  ...........  ...........  ...........
19370.................  T..............  ...............  Surgery of breast capsule....         0029      31.9024    $1,893.41      $632.64      $378.68
19371.................  T..............  ...............  Removal of breast capsule....         0029      31.9024    $1,893.41      $632.64      $378.68
19380.................  T..............  ...............  Revise breast reconstruction.         0030      39.9010    $2,368.12      $763.55      $473.62
19396.................  T..............  ...............  Design custom breast implant.         0029      31.9024    $1,893.41      $632.64      $378.68
19499.................  T..............  ...............  Breast surgery procedure.....         0028      19.4914    $1,156.81      $303.74      $231.36
20000.................  T..............  ...............  Incision of abscess..........         0006       1.5430       $91.58       $22.18       $18.32
20005.................  T..............  ...............  Incision of deep abscess.....         0049      20.2784    $1,203.52  ...........      $240.70
2000F.................  E..............  ...............  Blood pressure, measured.....  ...........  ...........  ...........  ...........  ...........
20100.................  T..............  ...............  Explore wound, neck..........         0023       4.7558      $282.26  ...........       $56.45
20101.................  T..............  ...............  Explore wound, chest.........         0027      18.3348    $1,088.17      $329.72      $217.63
20102.................  T..............  ...............  Explore wound, abdomen.......         0027      18.3348    $1,088.17      $329.72      $217.63
20103.................  T..............  ...............  Explore wound, extremity.....         0023       4.7558      $282.26  ...........       $56.45
20150.................  T..............  ...............  Excise epiphyseal bar........         0051      36.3617    $2,158.07  ...........      $431.61
20200.................  T..............  ...............  Muscle biopsy................         0021      14.9098      $884.90      $219.48      $176.98
20205.................  T..............  ...............  Deep muscle biopsy...........         0021      14.9098      $884.90      $219.48      $176.98
20206.................  T..............  ...............  Needle biopsy, muscle........         0005       3.5831      $212.66       $71.45       $42.53
20220.................  T..............  ...............  Bone biopsy, trocar/needle...         0019       4.0363      $239.55       $71.87       $47.91
20225.................  T..............  ...............  Bone biopsy, trocar/needle...         0020       6.9118      $410.22      $106.93       $82.04
20240.................  T..............  ...............  Bone biopsy, excisional......         0022      19.5582    $1,160.78      $354.45      $232.16
20245.................  T..............  ...............  Bone biopsy, excisional......         0022      19.5582    $1,160.78      $354.45      $232.16
20250.................  T..............  ...............  Open bone biopsy.............         0049      20.2784    $1,203.52  ...........      $240.70
20251.................  T..............  ...............  Open bone biopsy.............         0049      20.2784    $1,203.52  ...........      $240.70
20500.................  T..............  ...............  Injection of sinus tract.....         0251       2.0010      $118.76  ...........       $23.75
20501.................  N..............  ...............  Inject sinus tract for x-ray.  ...........  ...........  ...........  ...........  ...........
20520.................  T..............  ...............  Removal of foreign body......         0019       4.0363      $239.55       $71.87       $47.91
20525.................  T..............  ...............  Removal of foreign body......         0022      19.5582    $1,160.78      $354.45      $232.16
20526.................  T..............  ...............  Ther injection, carp tunnel..         0204       2.1811      $129.45       $40.13       $25.89
20550.................  T..............  ...............  Inject tendon/ligament/cyst..         0204       2.1811      $129.45       $40.13       $25.89
20551.................  T..............  ...............  Inj tendon origin/insertion..         0204       2.1811      $129.45       $40.13       $25.89
20552.................  T..............  ...............  Inj trigger point, 1/2 muscl.         0204       2.1811      $129.45       $40.13       $25.89
20553.................  T..............  ...............  Inject trigger points, > 3...         0204       2.1811      $129.45       $40.13       $25.89
20600.................  T..............  ...............  Drain/inject, joint/bursa....         0204       2.1811      $129.45       $40.13       $25.89
20605.................  T..............  ...............  Drain/inject, joint/bursa....         0204       2.1811      $129.45       $40.13       $25.89
20610.................  T..............  ...............  Drain/inject, joint/bursa....         0204       2.1811      $129.45       $40.13       $25.89
20612.................  T..............  ...............  Aspirate/inj ganglion cyst...         0204       2.1811      $129.45       $40.13       $25.89
20615.................  T..............  ...............  Treatment of bone cyst.......         0004       1.7566      $104.25       $22.36       $20.85
20650.................  T..............  ...............  Insert and remove bone pin...         0049      20.2784    $1,203.52  ...........      $240.70
20660.................  C..............  ...............  Apply, rem fixation device...  ...........  ...........  ...........  ...........  ...........
20661.................  C..............  ...............  Application of head brace....  ...........  ...........  ...........  ...........  ...........
20662.................  T..............  ...............  Application of pelvis brace..         0049      20.2784    $1,203.52  ...........      $240.70
20663.................  T..............  ...............  Application of thigh brace...         0049      20.2784    $1,203.52  ...........      $240.70
20664.................  C..............  ...............  Halo brace application.......  ...........  ...........  ...........  ...........  ...........
20665.................  X..............  ...............  Removal of fixation device...         0340       0.6355       $37.72  ...........        $7.54
20670.................  T..............  ...............  Removal of support implant...         0021      14.9098      $884.90      $219.48      $176.98
20680.................  T..............  ...............  Removal of support implant...         0022      19.5582    $1,160.78      $354.45      $232.16
20690.................  T..............  ...............  Apply bone fixation device...         0050      23.7998    $1,412.52  ...........      $282.50
20692.................  T..............  ...............  Apply bone fixation device...         0050      23.7998    $1,412.52  ...........      $282.50
20693.................  T..............  ...............  Adjust bone fixation device..         0049      20.2784    $1,203.52  ...........      $240.70
20694.................  T..............  ...............  Remove bone fixation device..         0049      20.2784    $1,203.52  ...........      $240.70
20802.................  C..............  ...............  Replantation, arm, complete..  ...........  ...........  ...........  ...........  ...........
20805.................  C..............  ...............  Replant forearm, complete....  ...........  ...........  ...........  ...........  ...........
20808.................  C..............  ...............  Replantation hand, complete..  ...........  ...........  ...........  ...........  ...........
20816.................  C..............  ...............  Replantation digit, complete.  ...........  ...........  ...........  ...........  ...........
20822.................  T..............  ...............  Replantation digit, complete.         0054      25.2562    $1,498.96  ...........      $299.79
20824.................  C..............  ...............  Replantation thumb, complete.  ...........  ...........  ...........  ...........  ...........
20827.................  C..............  ...............  Replantation thumb, complete.  ...........  ...........  ...........  ...........  ...........
20838.................  C..............  ...............  Replantation foot, complete..  ...........  ...........  ...........  ...........  ...........
20900.................  T..............  ...............  Removal of bone for graft....         0050      23.7998    $1,412.52  ...........      $282.50
20902.................  T..............  ...............  Removal of bone for graft....         0050      23.7998    $1,412.52  ...........      $282.50
20910.................  T..............  ...............  Remove cartilage for graft...         0027      18.3348    $1,088.17      $329.72      $217.63
20912.................  T..............  ...............  Remove cartilage for graft...         0027      18.3348    $1,088.17      $329.72      $217.63
20920.................  T..............  ...............  Removal of fascia for graft..         0686      13.7661      $817.02  ...........      $163.40
20922.................  T..............  ...............  Removal of fascia for graft..         0027      18.3348    $1,088.17      $329.72      $217.63
20924.................  T..............  ...............  Removal of tendon for graft..         0050      23.7998    $1,412.52  ...........      $282.50
20926.................  T..............  ...............  Removal of tissue for graft..         0686      13.7661      $817.02  ...........      $163.40

[[Page 42788]]

 
20930.................  C..............  ...............  Spinal bone allograft........  ...........  ...........  ...........  ...........  ...........
20931.................  C..............  ...............  Spinal bone allograft........  ...........  ...........  ...........  ...........  ...........
20936.................  C..............  ...............  Spinal bone autograft........  ...........  ...........  ...........  ...........  ...........
20937.................  C..............  ...............  Spinal bone autograft........  ...........  ...........  ...........  ...........  ...........
20938.................  C..............  ...............  Spinal bone autograft........  ...........  ...........  ...........  ...........  ...........
20950.................  T..............  ...............  Fluid pressure, muscle.......         0006       1.5430       $91.58       $22.18       $18.32
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.................  T..............  ...............  Bone/skin graft, metatarsal..         0056      40.1132    $2,380.72  ...........      $476.14
20973.................  T..............  ...............  Bone/skin graft, great toe...         0056      40.1132    $2,380.72  ...........      $476.14
20974.................  A..............  ...............  Electrical bone stimulation..  ...........  ...........  ...........  ...........  ...........
20975.................  X..............  ...............  Electrical bone stimulation..         0340       0.6355       $37.72  ...........        $7.54
20979.................  A..............  ...............  Us bone stimulation..........  ...........  ...........  ...........  ...........  ...........
20982.................  T..............  ...............  Ablate, bone tumor(s) perq...         1557  ...........    $1,850.00  ...........      $370.00
20999.................  T..............  ...............  Musculoskeletal surgery......         0049      20.2784    $1,203.52  ...........      $240.70
21010.................  T..............  ...............  Incision of jaw joint........         0254      23.2980    $1,382.74      $321.35      $276.55
21015.................  T..............  ...............  Resection of facial tumor....         0253      16.0627      $953.32      $282.29      $190.66
21025.................  T..............  ...............  Excision of bone, lower jaw..         0256      37.1513    $2,204.93  ...........      $440.99
21026.................  T..............  ...............  Excision of facial bone(s)...         0256      37.1513    $2,204.93  ...........      $440.99
21029.................  T..............  ...............  Contour of face bone lesion..         0256      37.1513    $2,204.93  ...........      $440.99
21030.................  T..............  ...............  Removal of face bone lesion..         0254      23.2980    $1,382.74      $321.35      $276.55
21031.................  T..............  ...............  Remove exostosis, mandible...         0254      23.2980    $1,382.74      $321.35      $276.55
21032.................  T..............  ...............  Remove exostosis, maxilla....         0254      23.2980    $1,382.74      $321.35      $276.55
21034.................  T..............  ...............  Removal of face bone lesion..         0256      37.1513    $2,204.93  ...........      $440.99
21040.................  T..............  ...............  Removal of jaw bone lesion...         0254      23.2980    $1,382.74      $321.35      $276.55
21044.................  T..............  ...............  Removal of jaw bone lesion...         0256      37.1513    $2,204.93  ...........      $440.99
21045.................  C..............  ...............  Extensive jaw surgery........  ...........  ...........  ...........  ...........  ...........
21046.................  T..............  ...............  Remove mandible cyst complex.         0256      37.1513    $2,204.93  ...........      $440.99
21047.................  T..............  ...............  Excise lwr jaw cyst w/repair.         0256      37.1513    $2,204.93  ...........      $440.99
21048.................  T..............  ...............  Remove maxilla cyst complex..         0256      37.1513    $2,204.93  ...........      $440.99
21049.................  T..............  ...............  Excis uppr jaw cyst w/repair.         0256      37.1513    $2,204.93  ...........      $440.99
21050.................  T..............  ...............  Removal of jaw joint.........         0256      37.1513    $2,204.93  ...........      $440.99
21060.................  T..............  ...............  Remove jaw joint cartilage...         0256      37.1513    $2,204.93  ...........      $440.99
21070.................  T..............  ...............  Remove coronoid process......         0256      37.1513    $2,204.93  ...........      $440.99
21076.................  T..............  ...............  Prepare face/oral prosthesis.         0254      23.2980    $1,382.74      $321.35      $276.55
21077.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21079.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21080.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21081.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21082.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21083.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21084.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21085.................  T..............  ...............  Prepare face/oral prosthesis.         0253      16.0627      $953.32      $282.29      $190.66
21086.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21087.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21088.................  T..............  ...............  Prepare face/oral prosthesis.         0256      37.1513    $2,204.93  ...........      $440.99
21089.................  T..............  ...............  Prepare face/oral prosthesis.         0251       2.0010      $118.76  ...........       $23.75
21100.................  T..............  ...............  Maxillofacial fixation.......         0256      37.1513    $2,204.93  ...........      $440.99
21110.................  T..............  ...............  Interdental fixation.........         0252       7.8317      $464.81      $113.41       $92.96
21116.................  N..............  ...............  Injection, jaw joint x-ray...  ...........  ...........  ...........  ...........  ...........
21120.................  T..............  ...............  Reconstruction of chin.......         0254      23.2980    $1,382.74      $321.35      $276.55
21121.................  T..............  ...............  Reconstruction of chin.......         0254      23.2980    $1,382.74      $321.35      $276.55
21122.................  T..............  ...............  Reconstruction of chin.......         0254      23.2980    $1,382.74      $321.35      $276.55
21123.................  T..............  ...............  Reconstruction of chin.......         0254      23.2980    $1,382.74      $321.35      $276.55
21125.................  T..............  ...............  Augmentation, lower jaw bone.         0254      23.2980    $1,382.74      $321.35      $276.55
21127.................  T..............  ...............  Augmentation, lower jaw bone.         0256      37.1513    $2,204.93  ...........      $440.99
21137.................  T..............  ...............  Reduction of forehead........         0254      23.2980    $1,382.74      $321.35      $276.55
21138.................  T..............  ...............  Reduction of forehead........         0256      37.1513    $2,204.93  ...........      $440.99
21139.................  T..............  ...............  Reduction of forehead........         0256      37.1513    $2,204.93  ...........      $440.99
21141.................  C..............  ...............  Reconstruct midface, lefort..  ...........  ...........  ...........  ...........  ...........
21142.................  C..............  ...............  Reconstruct midface, lefort..  ...........  ...........  ...........  ...........  ...........
21143.................  C..............  ...............  Reconstruct midface, lefort..  ...........  ...........  ...........  ...........  ...........

[[Page 42789]]

 
21145.................  C..............  ...............  Reconstruct midface, lefort..  ...........  ...........  ...........  ...........  ...........
21146.................  C..............  ...............  Reconstruct midface, lefort..  ...........  ...........  ...........  ...........  ...........
21147.................  C..............  ...............  Reconstruct midface, lefort..  ...........  ...........  ...........  ...........  ...........
21150.................  T..............  ...............  Reconstruct midface, lefort..         0256      37.1513    $2,204.93  ...........      $440.99
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.................  T..............  ...............  Reconstruct orbit/forehead...         0256      37.1513    $2,204.93  ...........      $440.99
21179.................  C..............  ...............  Reconstruct entire forehead..  ...........  ...........  ...........  ...........  ...........
21180.................  C..............  ...............  Reconstruct entire forehead..  ...........  ...........  ...........  ...........  ...........
21181.................  T..............  ...............  Contour cranial bone lesion..         0254      23.2980    $1,382.74      $321.35      $276.55
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.................  T..............  ...............  Reconst lwr jaw w/o fixation.         0256      37.1513    $2,204.93  ...........      $440.99
21196.................  C..............  ...............  Reconst lwr jaw w/fixation...  ...........  ...........  ...........  ...........  ...........
21198.................  T..............  ...............  Reconstr lwr jaw segment.....         0256      37.1513    $2,204.93  ...........      $440.99
21199.................  T..............  ...............  Reconstr lwr jaw w/advance...         0256      37.1513    $2,204.93  ...........      $440.99
21206.................  T..............  ...............  Reconstruct upper jaw bone...         0256      37.1513    $2,204.93  ...........      $440.99
21208.................  T..............  ...............  Augmentation of facial bones.         0256      37.1513    $2,204.93  ...........      $440.99
21209.................  T..............  ...............  Reduction of facial bones....         0256      37.1513    $2,204.93  ...........      $440.99
21210.................  T..............  ...............  Face bone graft..............         0256      37.1513    $2,204.93  ...........      $440.99
21215.................  T..............  ...............  Lower jaw bone graft.........         0256      37.1513    $2,204.93  ...........      $440.99
21230.................  T..............  ...............  Rib cartilage graft..........         0256      37.1513    $2,204.93  ...........      $440.99
21235.................  T..............  ...............  Ear cartilage graft..........         0254      23.2980    $1,382.74      $321.35      $276.55
21240.................  T..............  ...............  Reconstruction of jaw joint..         0256      37.1513    $2,204.93  ...........      $440.99
21242.................  T..............  ...............  Reconstruction of jaw joint..         0256      37.1513    $2,204.93  ...........      $440.99
21243.................  T..............  ...............  Reconstruction of jaw joint..         0256      37.1513    $2,204.93  ...........      $440.99
21244.................  T..............  ...............  Reconstruction of lower jaw..         0256      37.1513    $2,204.93  ...........      $440.99
21245.................  T..............  ...............  Reconstruction of jaw........         0256      37.1513    $2,204.93  ...........      $440.99
21246.................  T..............  ...............  Reconstruction of jaw........         0256      37.1513    $2,204.93  ...........      $440.99
21247.................  C..............  ...............  Reconstruct lower jaw bone...  ...........  ...........  ...........  ...........  ...........
21248.................  T..............  ...............  Reconstruction of jaw........         0256      37.1513    $2,204.93  ...........      $440.99
21249.................  T..............  ...............  Reconstruction of jaw........         0256      37.1513    $2,204.93  ...........      $440.99
21255.................  C..............  ...............  Reconstruct lower jaw bone...  ...........  ...........  ...........  ...........  ...........
21256.................  C..............  ...............  Reconstruction of orbit......  ...........  ...........  ...........  ...........  ...........
21260.................  T..............  ...............  Revise eye sockets...........         0256      37.1513    $2,204.93  ...........      $440.99
21261.................  T..............  ...............  Revise eye sockets...........         0256      37.1513    $2,204.93  ...........      $440.99
21263.................  T..............  ...............  Revise eye sockets...........         0256      37.1513    $2,204.93  ...........      $440.99
21267.................  T..............  ...............  Revise eye sockets...........         0256      37.1513    $2,204.93  ...........      $440.99
21268.................  C..............  ...............  Revise eye sockets...........  ...........  ...........  ...........  ...........  ...........
21270.................  T..............  ...............  Augmentation, cheek bone.....         0256      37.1513    $2,204.93  ...........      $440.99
21275.................  T..............  ...............  Revision, orbitofacial bones.         0256      37.1513    $2,204.93  ...........      $440.99
21280.................  T..............  ...............  Revision of eyelid...........         0256      37.1513    $2,204.93  ...........      $440.99
21282.................  T..............  ...............  Revision of eyelid...........         0253      16.0627      $953.32      $282.29      $190.66
21295.................  T..............  ...............  Revision of jaw muscle/bone..         0252       7.8317      $464.81      $113.41       $92.96
21296.................  T..............  ...............  Revision of jaw muscle/bone..         0254      23.2980    $1,382.74      $321.35      $276.55
21299.................  T..............  ...............  Cranio/maxillofacial surgery.         0251       2.0010      $118.76  ...........       $23.75
21300.................  T..............  ...............  Treatment of skull fracture..         0253      16.0627      $953.32      $282.29      $190.66
21310.................  T..............  ...............  Treatment of nose fracture...         0251       2.0010      $118.76  ...........       $23.75
21315.................  T..............  ...............  Treatment of nose fracture...         0251       2.0010      $118.76  ...........       $23.75
21320.................  T..............  ...............  Treatment of nose fracture...         0252       7.8317      $464.81      $113.41       $92.96
21325.................  T..............  ...............  Treatment of nose fracture...         0254      23.2980    $1,382.74      $321.35      $276.55
21330.................  T..............  ...............  Treatment of nose fracture...         0254      23.2980    $1,382.74      $321.35      $276.55
21335.................  T..............  ...............  Treatment of nose fracture...         0254      23.2980    $1,382.74      $321.35      $276.55
21336.................  T..............  ...............  Treat nasal septal fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
21337.................  T..............  ...............  Treat nasal septal fracture..         0253      16.0627      $953.32      $282.29      $190.66
21338.................  T..............  ...............  Treat nasoethmoid fracture...         0254      23.2980    $1,382.74      $321.35      $276.55
21339.................  T..............  ...............  Treat nasoethmoid fracture...         0254      23.2980    $1,382.74      $321.35      $276.55
21340.................  T..............  ...............  Treatment of nose fracture...         0256      37.1513    $2,204.93  ...........      $440.99

[[Page 42790]]

 
21343.................  C..............  ...............  Treatment of sinus fracture..  ...........  ...........  ...........  ...........  ...........
21344.................  C..............  ...............  Treatment of sinus fracture..  ...........  ...........  ...........  ...........  ...........
21345.................  T..............  ...............  Treat nose/jaw fracture......         0254      23.2980    $1,382.74      $321.35      $276.55
21346.................  C..............  ...............  Treat nose/jaw fracture......  ...........  ...........  ...........  ...........  ...........
21347.................  C..............  ...............  Treat nose/jaw fracture......  ...........  ...........  ...........  ...........  ...........
21348.................  C..............  ...............  Treat nose/jaw fracture......  ...........  ...........  ...........  ...........  ...........
21355.................  T..............  ...............  Treat cheek bone fracture....         0256      37.1513    $2,204.93  ...........      $440.99
21356.................  T..............  ...............  Treat cheek bone fracture....         0254      23.2980    $1,382.74      $321.35      $276.55
21360.................  C..............  ...............  Treat cheek bone fracture....  ...........  ...........  ...........  ...........  ...........
21365.................  C..............  ...............  Treat cheek bone fracture....  ...........  ...........  ...........  ...........  ...........
21366.................  C..............  ...............  Treat cheek bone fracture....  ...........  ...........  ...........  ...........  ...........
21385.................  C..............  ...............  Treat eye socket fracture....  ...........  ...........  ...........  ...........  ...........
21386.................  C..............  ...............  Treat eye socket fracture....  ...........  ...........  ...........  ...........  ...........
21387.................  C..............  ...............  Treat eye socket fracture....  ...........  ...........  ...........  ...........  ...........
21390.................  T..............  ...............  Treat eye socket fracture....         0256      37.1513    $2,204.93  ...........      $440.99
21395.................  C..............  ...............  Treat eye socket fracture....  ...........  ...........  ...........  ...........  ...........
21400.................  T..............  ...............  Treat eye socket fracture....         0252       7.8317      $464.81      $113.41       $92.96
21401.................  T..............  ...............  Treat eye socket fracture....         0253      16.0627      $953.32      $282.29      $190.66
21406.................  T..............  ...............  Treat eye socket fracture....         0256      37.1513    $2,204.93  ...........      $440.99
21407.................  T..............  ...............  Treat eye socket fracture....         0256      37.1513    $2,204.93  ...........      $440.99
21408.................  T..............  ...............  Treat eye socket fracture....         0256      37.1513    $2,204.93  ...........      $440.99
21421.................  T..............  ...............  Treat mouth roof fracture....         0254      23.2980    $1,382.74      $321.35      $276.55
21422.................  C..............  ...............  Treat mouth roof fracture....  ...........  ...........  ...........  ...........  ...........
21423.................  C..............  ...............  Treat mouth roof fracture....  ...........  ...........  ...........  ...........  ...........
21431.................  C..............  ...............  Treat craniofacial fracture..  ...........  ...........  ...........  ...........  ...........
21432.................  C..............  ...............  Treat craniofacial fracture..  ...........  ...........  ...........  ...........  ...........
21433.................  C..............  ...............  Treat craniofacial fracture..  ...........  ...........  ...........  ...........  ...........
21435.................  C..............  ...............  Treat craniofacial fracture..  ...........  ...........  ...........  ...........  ...........
21436.................  C..............  ...............  Treat craniofacial fracture..  ...........  ...........  ...........  ...........  ...........
21440.................  T..............  ...............  Treat dental ridge fracture..         0254      23.2980    $1,382.74      $321.35      $276.55
21445.................  T..............  ...............  Treat dental ridge fracture..         0254      23.2980    $1,382.74      $321.35      $276.55
21450.................  T..............  ...............  Treat lower jaw fracture.....         0251       2.0010      $118.76  ...........       $23.75
21451.................  T..............  ...............  Treat lower jaw fracture.....         0252       7.8317      $464.81      $113.41       $92.96
21452.................  T..............  ...............  Treat lower jaw fracture.....         0253      16.0627      $953.32      $282.29      $190.66
21453.................  T..............  ...............  Treat lower jaw fracture.....         0256      37.1513    $2,204.93  ...........      $440.99
21454.................  T..............  ...............  Treat lower jaw fracture.....         0254      23.2980    $1,382.74      $321.35      $276.55
21461.................  T..............  ...............  Treat lower jaw fracture.....         0256      37.1513    $2,204.93  ...........      $440.99
21462.................  T..............  ...............  Treat lower jaw fracture.....         0256      37.1513    $2,204.93  ...........      $440.99
21465.................  T..............  ...............  Treat lower jaw fracture.....         0256      37.1513    $2,204.93  ...........      $440.99
21470.................  T..............  ...............  Treat lower jaw fracture.....         0256      37.1513    $2,204.93  ...........      $440.99
21480.................  T..............  ...............  Reset dislocated jaw.........         0251       2.0010      $118.76  ...........       $23.75
21485.................  T..............  ...............  Reset dislocated jaw.........         0253      16.0627      $953.32      $282.29      $190.66
21490.................  T..............  ...............  Repair dislocated jaw........         0256      37.1513    $2,204.93  ...........      $440.99
21493.................  T..............  ...............  Treat hyoid bone fracture....         0252       7.8317      $464.81      $113.41       $92.96
21494.................  T..............  ...............  Treat hyoid bone fracture....         0252       7.8317      $464.81      $113.41       $92.96
21495.................  T..............  ...............  Treat hyoid bone fracture....         0253      16.0627      $953.32      $282.29      $190.66
21497.................  T..............  ...............  Interdental wiring...........         0253      16.0627      $953.32      $282.29      $190.66
21499.................  T..............  ...............  Head surgery procedure.......         0251       2.0010      $118.76  ...........       $23.75
21501.................  T..............  ...............  Drain neck/chest lesion......         0008      16.4242      $974.78  ...........      $194.96
21502.................  T..............  ...............  Drain chest lesion...........         0049      20.2784    $1,203.52  ...........      $240.70
21510.................  C..............  ...............  Drainage of bone lesion......  ...........  ...........  ...........  ...........  ...........
21550.................  T..............  ...............  Biopsy of neck/chest.........         0021      14.9098      $884.90      $219.48      $176.98
21555.................  T..............  ...............  Remove lesion, neck/chest....         0022      19.5582    $1,160.78      $354.45      $232.16
21556.................  T..............  ...............  Remove lesion, neck/chest....         0022      19.5582    $1,160.78      $354.45      $232.16
21557.................  T..............  ...............  Remove tumor, neck/chest.....         0022      19.5582    $1,160.78      $354.45      $232.16
21600.................  T..............  ...............  Partial removal of rib.......         0050      23.7998    $1,412.52  ...........      $282.50
21610.................  T..............  ...............  Partial removal of rib.......         0050      23.7998    $1,412.52  ...........      $282.50
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..............  ...............  Hyoid myotomy & suspension...         0252       7.8317      $464.81      $113.41       $92.96
21700.................  T..............  ...............  Revision of neck muscle......         0049      20.2784    $1,203.52  ...........      $240.70
21705.................  C..............  ...............  Revision of neck muscle/rib..  ...........  ...........  ...........  ...........  ...........

[[Page 42791]]

 
21720.................  T..............  ...............  Revision of neck muscle......         0049      20.2784    $1,203.52  ...........      $240.70
21725.................  T..............  ...............  Revision of neck muscle......         0006       1.5430       $91.58       $22.18       $18.32
21740.................  C..............  ...............  Reconstruction of sternum....  ...........  ...........  ...........  ...........  ...........
21742.................  T..............  ...............  Repair stern/nuss w/o scope..         0051      36.3617    $2,158.07  ...........      $431.61
21743.................  T..............  ...............  Repair sternum/nuss w/scope..         0051      36.3617    $2,158.07  ...........      $431.61
21750.................  C..............  ...............  Repair of sternum separation.  ...........  ...........  ...........  ...........  ...........
21800.................  T..............  ...............  Treatment of rib fracture....         0043       1.7614      $104.54  ...........       $20.91
21805.................  T..............  ...............  Treatment of rib fracture....         0046      37.5315    $2,227.49      $535.76      $445.50
21810.................  C..............  ...............  Treatment of rib fracture(s).  ...........  ...........  ...........  ...........  ...........
21820.................  T..............  ...............  Treat sternum fracture.......         0043       1.7614      $104.54  ...........       $20.91
21825.................  C..............  ...............  Treat sternum fracture.......  ...........  ...........  ...........  ...........  ...........
21899.................  T..............  ...............  Neck/chest surgery procedure.         0251       2.0010      $118.76  ...........       $23.75
21920.................  T..............  ...............  Biopsy soft tissue of back...         0020       6.9118      $410.22      $106.93       $82.04
21925.................  T..............  ...............  Biopsy soft tissue of back...         0022      19.5582    $1,160.78      $354.45      $232.16
21930.................  T..............  ...............  Remove lesion, back or flank.         0022      19.5582    $1,160.78      $354.45      $232.16
21935.................  T..............  ...............  Remove tumor, back...........         0022      19.5582    $1,160.78      $354.45      $232.16
22100.................  T..............  ...............  Remove part of neck vertebra.         0208      42.1492    $2,501.56  ...........      $500.31
22101.................  T..............  ...............  Remove part, thorax vertebra.         0208      42.1492    $2,501.56  ...........      $500.31
22102.................  T..............  ...............  Remove part, lumbar vertebra.         0208      42.1492    $2,501.56  ...........      $500.31
22103.................  T..............  ...............  Remove extra spine segment...         0208      42.1492    $2,501.56  ...........      $500.31
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.................  T..............  ...............  Revision of thorax spine.....         0208      42.1492    $2,501.56  ...........      $500.31
22224.................  C..............  ...............  Revision of lumbar spine.....  ...........  ...........  ...........  ...........  ...........
22226.................  C..............  ...............  Revise, extra spine segment..  ...........  ...........  ...........  ...........  ...........
22305.................  T..............  ...............  Treat spine process fracture.         0043       1.7614      $104.54  ...........       $20.91
22310.................  T..............  ...............  Treat spine fracture.........         0043       1.7614      $104.54  ...........       $20.91
22315.................  T..............  ...............  Treat spine fracture.........         0043       1.7614      $104.54  ...........       $20.91
22318.................  C..............  ...............  Treat odontoid fx w/o graft..  ...........  ...........  ...........  ...........  ...........
22319.................  C..............  ...............  Treat odontoid fx w/graft....  ...........  ...........  ...........  ...........  ...........
22325.................  C..............  ...............  Treat spine fracture.........  ...........  ...........  ...........  ...........  ...........
22326.................  C..............  ...............  Treat neck spine fracture....  ...........  ...........  ...........  ...........  ...........
22327.................  C..............  ...............  Treat thorax spine fracture..  ...........  ...........  ...........  ...........  ...........
22328.................  C..............  ...............  Treat each add spine fx......  ...........  ...........  ...........  ...........  ...........
22505.................  T..............  ...............  Manipulation of spine........         0045      14.4289      $856.36      $268.47      $171.27
22520.................  T..............  ...............  Percut vertebroplasty thor...         0050      23.7998    $1,412.52  ...........      $282.50
22521.................  T..............  ...............  Percut vertebroplasty lumb...         0050      23.7998    $1,412.52  ...........      $282.50
22522.................  T..............  ...............  Percut vertebroplasty add'l..         0050      23.7998    $1,412.52  ...........      $282.50
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..........  ...........  ...........  ...........  ...........  ...........
22612.................  T..............  ...............  Lumbar spine fusion..........         0208      42.1492    $2,501.56  ...........      $500.31
22614.................  T..............  ...............  Spine fusion, extra segment..         0208      42.1492    $2,501.56  ...........      $500.31
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..............  ...........  ...........  ...........  ...........  ...........

[[Page 42792]]

 
22812.................  C..............  ...............  Fusion of spine..............  ...........  ...........  ...........  ...........  ...........
22818.................  C..............  ...............  Kyphectomy, 1-2 segments.....  ...........  ...........  ...........  ...........  ...........
22819.................  C..............  ...............  Kyphectomy, 3 or more........  ...........  ...........  ...........  ...........  ...........
22830.................  C..............  ...............  Exploration of spinal fusion.  ...........  ...........  ...........  ...........  ...........
22840.................  C..............  ...............  Insert spine fixation device.  ...........  ...........  ...........  ...........  ...........
22841.................  C..............  ...............  Insert spine fixation device.  ...........  ...........  ...........  ...........  ...........
22842.................  C..............  ...............  Insert spine fixation device.  ...........  ...........  ...........  ...........  ...........
22843.................  C..............  ...............  Insert spine fixation device.  ...........  ...........  ...........  ...........  ...........
22844.................  C..............  ...............  Insert spine fixation device.  ...........  ...........  ...........  ...........  ...........
22845.................  C..............  ...............  Insert spine fixation device.  ...........  ...........  ...........  ...........  ...........
22846.................  C..............  ...............  Insert spine fixation device.  ...........  ...........  ...........  ...........  ...........
22847.................  C..............  ...............  Insert spine fixation device.  ...........  ...........  ...........  ...........  ...........
22848.................  C..............  ...............  Insert pelv fixation device..  ...........  ...........  ...........  ...........  ...........
22849.................  C..............  ...............  Reinsert spinal fixation.....  ...........  ...........  ...........  ...........  ...........
22850.................  C..............  ...............  Remove spine fixation device.  ...........  ...........  ...........  ...........  ...........
22851.................  C..............  ...............  Apply spine prosth device....  ...........  ...........  ...........  ...........  ...........
22852.................  C..............  ...............  Remove spine fixation device.  ...........  ...........  ...........  ...........  ...........
22855.................  C..............  ...............  Remove spine fixation device.  ...........  ...........  ...........  ...........  ...........
22899.................  T..............  ...............  Spine surgery procedure......         0043       1.7614      $104.54  ...........       $20.91
22900.................  T..............  ...............  Remove abdominal wall lesion.         0022      19.5582    $1,160.78      $354.45      $232.16
22999.................  T..............  ...............  Abdomen surgery procedure....         0019       4.0363      $239.55       $71.87       $47.91
23000.................  T..............  ...............  Removal of calcium deposits..         0021      14.9098      $884.90      $219.48      $176.98
23020.................  T..............  ...............  Release shoulder joint.......         0051      36.3617    $2,158.07  ...........      $431.61
23030.................  T..............  ...............  Drain shoulder lesion........         0008      16.4242      $974.78  ...........      $194.96
23031.................  T..............  ...............  Drain shoulder bursa.........         0008      16.4242      $974.78  ...........      $194.96
23035.................  T..............  ...............  Drain shoulder bone lesion...         0049      20.2784    $1,203.52  ...........      $240.70
23040.................  T..............  ...............  Exploratory shoulder surgery.         0050      23.7998    $1,412.52  ...........      $282.50
23044.................  T..............  ...............  Exploratory shoulder surgery.         0050      23.7998    $1,412.52  ...........      $282.50
23065.................  T..............  ...............  Biopsy shoulder tissues......         0021      14.9098      $884.90      $219.48      $176.98
23066.................  T..............  ...............  Biopsy shoulder tissues......         0022      19.5582    $1,160.78      $354.45      $232.16
23075.................  T..............  ...............  Removal of shoulder lesion...         0021      14.9098      $884.90      $219.48      $176.98
23076.................  T..............  ...............  Removal of shoulder lesion...         0022      19.5582    $1,160.78      $354.45      $232.16
23077.................  T..............  ...............  Remove tumor of shoulder.....         0022      19.5582    $1,160.78      $354.45      $232.16
23100.................  T..............  ...............  Biopsy of shoulder joint.....         0049      20.2784    $1,203.52  ...........      $240.70
23101.................  T..............  ...............  Shoulder joint surgery.......         0050      23.7998    $1,412.52  ...........      $282.50
23105.................  T..............  ...............  Remove shoulder joint lining.         0050      23.7998    $1,412.52  ...........      $282.50
23106.................  T..............  ...............  Incision of collarbone joint.         0050      23.7998    $1,412.52  ...........      $282.50
23107.................  T..............  ...............  Explore treat shoulder joint.         0050      23.7998    $1,412.52  ...........      $282.50
23120.................  T..............  ...............  Partial removal, collar bone.         0051      36.3617    $2,158.07  ...........      $431.61
23125.................  T..............  ...............  Removal of collar bone.......         0051      36.3617    $2,158.07  ...........      $431.61
23130.................  T..............  ...............  Remove shoulder bone, part...         0051      36.3617    $2,158.07  ...........      $431.61
23140.................  T..............  ...............  Removal of bone lesion.......         0049      20.2784    $1,203.52  ...........      $240.70
23145.................  T..............  ...............  Removal of bone lesion.......         0050      23.7998    $1,412.52  ...........      $282.50
23146.................  T..............  ...............  Removal of bone lesion.......         0050      23.7998    $1,412.52  ...........      $282.50
23150.................  T..............  ...............  Removal of humerus lesion....         0050      23.7998    $1,412.52  ...........      $282.50
23155.................  T..............  ...............  Removal of humerus lesion....         0050      23.7998    $1,412.52  ...........      $282.50
23156.................  T..............  ...............  Removal of humerus lesion....         0050      23.7998    $1,412.52  ...........      $282.50
23170.................  T..............  ...............  Remove collar bone lesion....         0050      23.7998    $1,412.52  ...........      $282.50
23172.................  T..............  ...............  Remove shoulder blade lesion.         0050      23.7998    $1,412.52  ...........      $282.50
23174.................  T..............  ...............  Remove humerus lesion........         0050      23.7998    $1,412.52  ...........      $282.50
23180.................  T..............  ...............  Remove collar bone lesion....         0050      23.7998    $1,412.52  ...........      $282.50
23182.................  T..............  ...............  Remove shoulder blade lesion.         0050      23.7998    $1,412.52  ...........      $282.50
23184.................  T..............  ...............  Remove humerus lesion........         0050      23.7998    $1,412.52  ...........      $282.50
23190.................  T..............  ...............  Partial removal of scapula...         0050      23.7998    $1,412.52  ...........      $282.50
23195.................  T..............  ...............  Removal of head of humerus...         0050      23.7998    $1,412.52  ...........      $282.50
23200.................  C..............  ...............  Removal of collar bone.......  ...........  ...........  ...........  ...........  ...........
23210.................  C..............  ...............  Removal of shoulder blade....  ...........  ...........  ...........  ...........  ...........
23220.................  C..............  ...............  Partial removal of humerus...  ...........  ...........  ...........  ...........  ...........
23221.................  C..............  ...............  Partial removal of humerus...  ...........  ...........  ...........  ...........  ...........
23222.................  C..............  ...............  Partial removal of humerus...  ...........  ...........  ...........  ...........  ...........
23330.................  T..............  ...............  Remove shoulder foreign body.         0020       6.9118      $410.22      $106.93       $82.04
23331.................  T..............  ...............  Remove shoulder foreign body.         0022      19.5582    $1,160.78      $354.45      $232.16
23332.................  C..............  ...............  Remove shoulder foreign body.  ...........  ...........  ...........  ...........  ...........
23350.................  N..............  ...............  Injection for shoulder x-ray.  ...........  ...........  ...........  ...........  ...........
23395.................  T..............  ...............  Muscle transfer,shoulder/arm.         0051      36.3617    $2,158.07  ...........      $431.61
23397.................  T..............  ...............  Muscle transfers.............         0052      43.7388    $2,595.90  ...........      $519.18

[[Page 42793]]

 
23400.................  T..............  ...............  Fixation of shoulder blade...         0050      23.7998    $1,412.52  ...........      $282.50
23405.................  T..............  ...............  Incision of tendon & muscle..         0050      23.7998    $1,412.52  ...........      $282.50
23406.................  T..............  ...............  Incise tendon(s) & muscle(s).         0050      23.7998    $1,412.52  ...........      $282.50
23410.................  T..............  ...............  Repair of tendon(s)..........         0052      43.7388    $2,595.90  ...........      $519.18
23412.................  T..............  ...............  Repair rotator cuff, chronic.         0052      43.7388    $2,595.90  ...........      $519.18
23415.................  T..............  ...............  Release of shoulder ligament.         0051      36.3617    $2,158.07  ...........      $431.61
23420.................  T..............  ...............  Repair of shoulder...........         0052      43.7388    $2,595.90  ...........      $519.18
23430.................  T..............  ...............  Repair biceps tendon.........         0052      43.7388    $2,595.90  ...........      $519.18
23440.................  T..............  ...............  Remove/transplant tendon.....         0052      43.7388    $2,595.90  ...........      $519.18
23450.................  T..............  ...............  Repair shoulder capsule......         0052      43.7388    $2,595.90  ...........      $519.18
23455.................  T..............  ...............  Repair shoulder capsule......         0052      43.7388    $2,595.90  ...........      $519.18
23460.................  T..............  ...............  Repair shoulder capsule......         0052      43.7388    $2,595.90  ...........      $519.18
23462.................  T..............  ...............  Repair shoulder capsule......         0052      43.7388    $2,595.90  ...........      $519.18
23465.................  T..............  ...............  Repair shoulder capsule......         0052      43.7388    $2,595.90  ...........      $519.18
23466.................  T..............  ...............  Repair shoulder capsule......         0052      43.7388    $2,595.90  ...........      $519.18
23470.................  T..............  ...............  Reconstruct shoulder joint...         0425      99.7520    $5,920.28    $1,378.01    $1,184.06
23472.................  C..............  ...............  Reconstruct shoulder joint...  ...........  ...........  ...........  ...........  ...........
23480.................  T..............  ...............  Revision of collar bone......         0051      36.3617    $2,158.07  ...........      $431.61
23485.................  T..............  ...............  Revision of collar bone......         0051      36.3617    $2,158.07  ...........      $431.61
23490.................  T..............  ...............  Reinforce clavicle...........         0051      36.3617    $2,158.07  ...........      $431.61
23491.................  T..............  ...............  Reinforce shoulder bones.....         0051      36.3617    $2,158.07  ...........      $431.61
23500.................  T..............  ...............  Treat clavicle fracture......         0043       1.7614      $104.54  ...........       $20.91
23505.................  T..............  ...............  Treat clavicle fracture......         0043       1.7614      $104.54  ...........       $20.91
23515.................  T..............  ...............  Treat clavicle fracture......         0046      37.5315    $2,227.49      $535.76      $445.50
23520.................  T..............  ...............  Treat clavicle dislocation...         0043       1.7614      $104.54  ...........       $20.91
23525.................  T..............  ...............  Treat clavicle dislocation...         0043       1.7614      $104.54  ...........       $20.91
23530.................  T..............  ...............  Treat clavicle dislocation...         0046      37.5315    $2,227.49      $535.76      $445.50
23532.................  T..............  ...............  Treat clavicle dislocation...         0046      37.5315    $2,227.49      $535.76      $445.50
23540.................  T..............  ...............  Treat clavicle dislocation...         0043       1.7614      $104.54  ...........       $20.91
23545.................  T..............  ...............  Treat clavicle dislocation...         0043       1.7614      $104.54  ...........       $20.91
23550.................  T..............  ...............  Treat clavicle dislocation...         0046      37.5315    $2,227.49      $535.76      $445.50
23552.................  T..............  ...............  Treat clavicle dislocation...         0046      37.5315    $2,227.49      $535.76      $445.50
23570.................  T..............  ...............  Treat shoulder blade fx......         0043       1.7614      $104.54  ...........       $20.91
23575.................  T..............  ...............  Treat shoulder blade fx......         0043       1.7614      $104.54  ...........       $20.91
23585.................  T..............  ...............  Treat scapula fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
23600.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
23605.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
23615.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
23616.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
23620.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
23625.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
23630.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
23650.................  T..............  ...............  Treat shoulder dislocation...         0043       1.7614      $104.54  ...........       $20.91
23655.................  T..............  ...............  Treat shoulder dislocation...         0045      14.4289      $856.36      $268.47      $171.27
23660.................  T..............  ...............  Treat shoulder dislocation...         0046      37.5315    $2,227.49      $535.76      $445.50
23665.................  T..............  ...............  Treat dislocation/fracture...         0043       1.7614      $104.54  ...........       $20.91
23670.................  T..............  ...............  Treat dislocation/fracture...         0046      37.5315    $2,227.49      $535.76      $445.50
23675.................  T..............  ...............  Treat dislocation/fracture...         0043       1.7614      $104.54  ...........       $20.91
23680.................  T..............  ...............  Treat dislocation/fracture...         0046      37.5315    $2,227.49      $535.76      $445.50
23700.................  T..............  ...............  Fixation of shoulder.........         0045      14.4289      $856.36      $268.47      $171.27
23800.................  T..............  ...............  Fusion of shoulder joint.....         0051      36.3617    $2,158.07  ...........      $431.61
23802.................  T..............  ...............  Fusion of shoulder joint.....         0051      36.3617    $2,158.07  ...........      $431.61
23900.................  C..............  ...............  Amputation of arm & girdle...  ...........  ...........  ...........  ...........  ...........
23920.................  C..............  ...............  Amputation at shoulder joint.  ...........  ...........  ...........  ...........  ...........
23921.................  T..............  ...............  Amputation follow-up surgery.         0025       5.4690      $324.59      $101.85       $64.92
23929.................  T..............  ...............  Shoulder surgery procedure...         0043       1.7614      $104.54  ...........       $20.91
23930.................  T..............  ...............  Drainage of arm lesion.......         0008      16.4242      $974.78  ...........      $194.96
23931.................  T..............  ...............  Drainage of arm bursa........         0008      16.4242      $974.78  ...........      $194.96
23935.................  T..............  ...............  Drain arm/elbow bone lesion..         0049      20.2784    $1,203.52  ...........      $240.70
24000.................  T..............  ...............  Exploratory elbow surgery....         0050      23.7998    $1,412.52  ...........      $282.50
24006.................  T..............  ...............  Release elbow joint..........         0050      23.7998    $1,412.52  ...........      $282.50
24065.................  T..............  ...............  Biopsy arm/elbow soft tissue.         0021      14.9098      $884.90      $219.48      $176.98
24066.................  T..............  ...............  Biopsy arm/elbow soft tissue.         0021      14.9098      $884.90      $219.48      $176.98
24075.................  T..............  ...............  Remove arm/elbow lesion......         0021      14.9098      $884.90      $219.48      $176.98
24076.................  T..............  ...............  Remove arm/elbow lesion......         0022      19.5582    $1,160.78      $354.45      $232.16
24077.................  T..............  ...............  Remove tumor of arm/elbow....         0022      19.5582    $1,160.78      $354.45      $232.16

[[Page 42794]]

 
24100.................  T..............  ...............  Biopsy elbow joint lining....         0049      20.2784    $1,203.52  ...........      $240.70
24101.................  T..............  ...............  Explore/treat elbow joint....         0050      23.7998    $1,412.52  ...........      $282.50
24102.................  T..............  ...............  Remove elbow joint lining....         0050      23.7998    $1,412.52  ...........      $282.50
24105.................  T..............  ...............  Removal of elbow bursa.......         0049      20.2784    $1,203.52  ...........      $240.70
24110.................  T..............  ...............  Remove humerus lesion........         0049      20.2784    $1,203.52  ...........      $240.70
24115.................  T..............  ...............  Remove/graft bone lesion.....         0050      23.7998    $1,412.52  ...........      $282.50
24116.................  T..............  ...............  Remove/graft bone lesion.....         0050      23.7998    $1,412.52  ...........      $282.50
24120.................  T..............  ...............  Remove elbow lesion..........         0049      20.2784    $1,203.52  ...........      $240.70
24125.................  T..............  ...............  Remove/graft bone lesion.....         0050      23.7998    $1,412.52  ...........      $282.50
24126.................  T..............  ...............  Remove/graft bone lesion.....         0050      23.7998    $1,412.52  ...........      $282.50
24130.................  T..............  ...............  Removal of head of radius....         0050      23.7998    $1,412.52  ...........      $282.50
24134.................  T..............  ...............  Removal of arm bone lesion...         0050      23.7998    $1,412.52  ...........      $282.50
24136.................  T..............  ...............  Remove radius bone lesion....         0050      23.7998    $1,412.52  ...........      $282.50
24138.................  T..............  ...............  Remove elbow bone lesion.....         0050      23.7998    $1,412.52  ...........      $282.50
24140.................  T..............  ...............  Partial removal of arm bone..         0050      23.7998    $1,412.52  ...........      $282.50
24145.................  T..............  ...............  Partial removal of radius....         0050      23.7998    $1,412.52  ...........      $282.50
24147.................  T..............  ...............  Partial removal of elbow.....         0050      23.7998    $1,412.52  ...........      $282.50
24149.................  T..............  ...............  Radical resection of elbow...         0050      23.7998    $1,412.52  ...........      $282.50
24150.................  T..............  ...............  Extensive humerus surgery....         0052      43.7388    $2,595.90  ...........      $519.18
24151.................  T..............  ...............  Extensive humerus surgery....         0052      43.7388    $2,595.90  ...........      $519.18
24152.................  T..............  ...............  Extensive radius surgery.....         0052      43.7388    $2,595.90  ...........      $519.18
24153.................  T..............  ...............  Extensive radius surgery.....         0052      43.7388    $2,595.90  ...........      $519.18
24155.................  T..............  ...............  Removal of elbow joint.......         0051      36.3617    $2,158.07  ...........      $431.61
24160.................  T..............  ...............  Remove elbow joint implant...         0050      23.7998    $1,412.52  ...........      $282.50
24164.................  T..............  ...............  Remove radius head implant...         0050      23.7998    $1,412.52  ...........      $282.50
24200.................  T..............  ...............  Removal of arm foreign body..         0019       4.0363      $239.55       $71.87       $47.91
24201.................  T..............  ...............  Removal of arm foreign body..         0021      14.9098      $884.90      $219.48      $176.98
24220.................  N..............  ...............  Injection for elbow x-ray....  ...........  ...........  ...........  ...........  ...........
24300.................  T..............  ...............  Manipulate elbow w/anesth....         0045      14.4289      $856.36      $268.47      $171.27
24301.................  T..............  ...............  Muscle/tendon transfer.......         0050      23.7998    $1,412.52  ...........      $282.50
24305.................  T..............  ...............  Arm tendon lengthening.......         0050      23.7998    $1,412.52  ...........      $282.50
24310.................  T..............  ...............  Revision of arm tendon.......         0049      20.2784    $1,203.52  ...........      $240.70
24320.................  T..............  ...............  Repair of arm tendon.........         0051      36.3617    $2,158.07  ...........      $431.61
24330.................  T..............  ...............  Revision of arm muscles......         0051      36.3617    $2,158.07  ...........      $431.61
24331.................  T..............  ...............  Revision of arm muscles......         0051      36.3617    $2,158.07  ...........      $431.61
24332.................  T..............  ...............  Tenolysis, triceps...........         0049      20.2784    $1,203.52  ...........      $240.70
24340.................  T..............  ...............  Repair of biceps tendon......         0051      36.3617    $2,158.07  ...........      $431.61
24341.................  T..............  ...............  Repair arm tendon/muscle.....         0051      36.3617    $2,158.07  ...........      $431.61
24342.................  T..............  ...............  Repair of ruptured tendon....         0051      36.3617    $2,158.07  ...........      $431.61
24343.................  T..............  ...............  Repr elbow lat ligmnt w/tiss.         0050      23.7998    $1,412.52  ...........      $282.50
24344.................  T..............  ...............  Reconstruct elbow lat ligmnt.         0051      36.3617    $2,158.07  ...........      $431.61
24345.................  T..............  ...............  Repr elbw med ligmnt w/tissu.         0050      23.7998    $1,412.52  ...........      $282.50
24346.................  T..............  ...............  Reconstruct elbow med ligmnt.         0051      36.3617    $2,158.07  ...........      $431.61
24350.................  T..............  ...............  Repair of tennis elbow.......         0050      23.7998    $1,412.52  ...........      $282.50
24351.................  T..............  ...............  Repair of tennis elbow.......         0050      23.7998    $1,412.52  ...........      $282.50
24352.................  T..............  ...............  Repair of tennis elbow.......         0050      23.7998    $1,412.52  ...........      $282.50
24354.................  T..............  ...............  Repair of tennis elbow.......         0050      23.7998    $1,412.52  ...........      $282.50
24356.................  T..............  ...............  Revision of tennis elbow.....         0050      23.7998    $1,412.52  ...........      $282.50
24360.................  T..............  ...............  Reconstruct elbow joint......         0047      31.4675    $1,867.60      $537.03      $373.52
24361.................  T..............  ...............  Reconstruct elbow joint......         0425      99.7520    $5,920.28    $1,378.01    $1,184.06
24362.................  T..............  ...............  Reconstruct elbow joint......         0048      42.9335    $2,548.10      $570.30      $509.62
24363.................  T..............  ...............  Replace elbow joint..........         0425      99.7520    $5,920.28    $1,378.01    $1,184.06
24365.................  T..............  ...............  Reconstruct head of radius...         0047      31.4675    $1,867.60      $537.03      $373.52
24366.................  T..............  ...............  Reconstruct head of radius...         0425      99.7520    $5,920.28    $1,378.01    $1,184.06
24400.................  T..............  ...............  Revision of humerus..........         0050      23.7998    $1,412.52  ...........      $282.50
24410.................  T..............  ...............  Revision of humerus..........         0050      23.7998    $1,412.52  ...........      $282.50
24420.................  T..............  ...............  Revision of humerus..........         0051      36.3617    $2,158.07  ...........      $431.61
24430.................  T..............  ...............  Repair of humerus............         0051      36.3617    $2,158.07  ...........      $431.61
24435.................  T..............  ...............  Repair humerus with graft....         0051      36.3617    $2,158.07  ...........      $431.61
24470.................  T..............  ...............  Revision of elbow joint......         0051      36.3617    $2,158.07  ...........      $431.61
24495.................  T..............  ...............  Decompression of forearm.....         0050      23.7998    $1,412.52  ...........      $282.50
24498.................  T..............  ...............  Reinforce humerus............         0051      36.3617    $2,158.07  ...........      $431.61
24500.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
24505.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
24515.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
24516.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50

[[Page 42795]]

 
24530.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
24535.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
24538.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
24545.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
24546.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
24560.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
24565.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
24566.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
24575.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
24576.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
24577.................  T..............  ...............  Treat humerus fracture.......         0043       1.7614      $104.54  ...........       $20.91
24579.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
24582.................  T..............  ...............  Treat humerus fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
24586.................  T..............  ...............  Treat elbow fracture.........         0046      37.5315    $2,227.49      $535.76      $445.50
24587.................  T..............  ...............  Treat elbow fracture.........         0046      37.5315    $2,227.49      $535.76      $445.50
24600.................  T..............  ...............  Treat elbow dislocation......         0043       1.7614      $104.54  ...........       $20.91
24605.................  T..............  ...............  Treat elbow dislocation......         0045      14.4289      $856.36      $268.47      $171.27
24615.................  T..............  ...............  Treat elbow dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
24620.................  T..............  ...............  Treat elbow fracture.........         0043       1.7614      $104.54  ...........       $20.91
24635.................  T..............  ...............  Treat elbow fracture.........         0046      37.5315    $2,227.49      $535.76      $445.50
24640.................  T..............  ...............  Treat elbow dislocation......         0043       1.7614      $104.54  ...........       $20.91
24650.................  T..............  ...............  Treat radius fracture........         0043       1.7614      $104.54  ...........       $20.91
24655.................  T..............  ...............  Treat radius fracture........         0043       1.7614      $104.54  ...........       $20.91
24665.................  T..............  ...............  Treat radius fracture........         0046      37.5315    $2,227.49      $535.76      $445.50
24666.................  T..............  ...............  Treat radius fracture........         0046      37.5315    $2,227.49      $535.76      $445.50
24670.................  T..............  ...............  Treat ulnar fracture.........         0043       1.7614      $104.54  ...........       $20.91
24675.................  T..............  ...............  Treat ulnar fracture.........         0043       1.7614      $104.54  ...........       $20.91
24685.................  T..............  ...............  Treat ulnar fracture.........         0046      37.5315    $2,227.49      $535.76      $445.50
24800.................  T..............  ...............  Fusion of elbow joint........         0051      36.3617    $2,158.07  ...........      $431.61
24802.................  T..............  ...............  Fusion/graft of elbow joint..         0051      36.3617    $2,158.07  ...........      $431.61
24900.................  C..............  ...............  Amputation of upper arm......  ...........  ...........  ...........  ...........  ...........
24920.................  C..............  ...............  Amputation of upper arm......  ...........  ...........  ...........  ...........  ...........
24925.................  T..............  ...............  Amputation follow-up surgery.         0049      20.2784    $1,203.52  ...........      $240.70
24930.................  C..............  ...............  Amputation follow-up surgery.  ...........  ...........  ...........  ...........  ...........
24931.................  C..............  ...............  Amputate upper arm & implant.  ...........  ...........  ...........  ...........  ...........
24935.................  T..............  ...............  Revision of amputation.......         0052      43.7388    $2,595.90  ...........      $519.18
24940.................  C..............  ...............  Revision of upper arm........  ...........  ...........  ...........  ...........  ...........
24999.................  T..............  ...............  Upper arm/elbow surgery......         0043       1.7614      $104.54  ...........       $20.91
25000.................  T..............  ...............  Incision of tendon sheath....         0049      20.2784    $1,203.52  ...........      $240.70
25001.................  T..............  ...............  Incise flexor carpi radialis.         0049      20.2784    $1,203.52  ...........      $240.70
25020.................  T..............  ...............  Decompress forearm 1 space...         0049      20.2784    $1,203.52  ...........      $240.70
25023.................  T..............  ...............  Decompress forearm 1 space...         0050      23.7998    $1,412.52  ...........      $282.50
25024.................  T..............  ...............  Decompress forearm 2 spaces..         0050      23.7998    $1,412.52  ...........      $282.50
25025.................  T..............  ...............  Decompress forearm 2 spaces..         0050      23.7998    $1,412.52  ...........      $282.50
25028.................  T..............  ...............  Drainage of forearm lesion...         0049      20.2784    $1,203.52  ...........      $240.70
25031.................  T..............  ...............  Drainage of forearm bursa....         0049      20.2784    $1,203.52  ...........      $240.70
25035.................  T..............  ...............  Treat forearm bone lesion....         0049      20.2784    $1,203.52  ...........      $240.70
25040.................  T..............  ...............  Explore/treat wrist joint....         0050      23.7998    $1,412.52  ...........      $282.50
25065.................  T..............  ...............  Biopsy forearm soft tissues..         0021      14.9098      $884.90      $219.48      $176.98
25066.................  T..............  ...............  Biopsy forearm soft tissues..         0022      19.5582    $1,160.78      $354.45      $232.16
25075.................  T..............  ...............  Removel forearm lesion subcu.         0021      14.9098      $884.90      $219.48      $176.98
25076.................  T..............  ...............  Removel forearm lesion deep..         0022      19.5582    $1,160.78      $354.45      $232.16
25077.................  T..............  ...............  Remove tumor, forearm/wrist..         0022      19.5582    $1,160.78      $354.45      $232.16
25085.................  T..............  ...............  Incision of wrist capsule....         0049      20.2784    $1,203.52  ...........      $240.70
25100.................  T..............  ...............  Biopsy of wrist joint........         0049      20.2784    $1,203.52  ...........      $240.70
25101.................  T..............  ...............  Explore/treat wrist joint....         0050      23.7998    $1,412.52  ...........      $282.50
25105.................  T..............  ...............  Remove wrist joint lining....         0050      23.7998    $1,412.52  ...........      $282.50
25107.................  T..............  ...............  Remove wrist joint cartilage.         0050      23.7998    $1,412.52  ...........      $282.50
25110.................  T..............  ...............  Remove wrist tendon lesion...         0049      20.2784    $1,203.52  ...........      $240.70
25111.................  T..............  ...............  Remove wrist tendon lesion...         0053      15.6085      $926.36      $253.49      $185.27
25112.................  T..............  ...............  Reremove wrist tendon lesion.         0053      15.6085      $926.36      $253.49      $185.27
25115.................  T..............  ...............  Remove wrist/forearm lesion..         0049      20.2784    $1,203.52  ...........      $240.70
25116.................  T..............  ...............  Remove wrist/forearm lesion..         0049      20.2784    $1,203.52  ...........      $240.70
25118.................  T..............  ...............  Excise wrist tendon sheath...         0050      23.7998    $1,412.52  ...........      $282.50
25119.................  T..............  ...............  Partial removal of ulna......         0050      23.7998    $1,412.52  ...........      $282.50
25120.................  T..............  ...............  Removal of forearm lesion....         0050      23.7998    $1,412.52  ...........      $282.50

[[Page 42796]]

 
25125.................  T..............  ...............  Remove/graft forearm lesion..         0050      23.7998    $1,412.52  ...........      $282.50
25126.................  T..............  ...............  Remove/graft forearm lesion..         0050      23.7998    $1,412.52  ...........      $282.50
25130.................  T..............  ...............  Removal of wrist lesion......         0050      23.7998    $1,412.52  ...........      $282.50
25135.................  T..............  ...............  Remove & graft wrist lesion..         0050      23.7998    $1,412.52  ...........      $282.50
25136.................  T..............  ...............  Remove & graft wrist lesion..         0050      23.7998    $1,412.52  ...........      $282.50
25145.................  T..............  ...............  Remove forearm bone lesion...         0050      23.7998    $1,412.52  ...........      $282.50
25150.................  T..............  ...............  Partial removal of ulna......         0050      23.7998    $1,412.52  ...........      $282.50
25151.................  T..............  ...............  Partial removal of radius....         0050      23.7998    $1,412.52  ...........      $282.50
25170.................  T..............  ...............  Extensive forearm surgery....         0052      43.7388    $2,595.90  ...........      $519.18
25210.................  T..............  ...............  Removal of wrist bone........         0054      25.2562    $1,498.96  ...........      $299.79
25215.................  T..............  ...............  Removal of wrist bones.......         0054      25.2562    $1,498.96  ...........      $299.79
25230.................  T..............  ...............  Partial removal of radius....         0050      23.7998    $1,412.52  ...........      $282.50
25240.................  T..............  ...............  Partial removal of ulna......         0050      23.7998    $1,412.52  ...........      $282.50
25246.................  N..............  ...............  Injection for wrist x-ray....  ...........  ...........  ...........  ...........  ...........
25248.................  T..............  ...............  Remove forearm foreign body..         0049      20.2784    $1,203.52  ...........      $240.70
25250.................  T..............  ...............  Removal of wrist prosthesis..         0050      23.7998    $1,412.52  ...........      $282.50
25251.................  T..............  ...............  Removal of wrist prosthesis..         0050      23.7998    $1,412.52  ...........      $282.50
25259.................  T..............  ...............  Manipulate wrist w/anesthes..         0043       1.7614      $104.54  ...........       $20.91
25260.................  T..............  ...............  Repair forearm tendon/muscle.         0050      23.7998    $1,412.52  ...........      $282.50
25263.................  T..............  ...............  Repair forearm tendon/muscle.         0050      23.7998    $1,412.52  ...........      $282.50
25265.................  T..............  ...............  Repair forearm tendon/muscle.         0050      23.7998    $1,412.52  ...........      $282.50
25270.................  T..............  ...............  Repair forearm tendon/muscle.         0050      23.7998    $1,412.52  ...........      $282.50
25272.................  T..............  ...............  Repair forearm tendon/muscle.         0050      23.7998    $1,412.52  ...........      $282.50
25274.................  T..............  ...............  Repair forearm tendon/muscle.         0050      23.7998    $1,412.52  ...........      $282.50
25275.................  T..............  ...............  Repair forearm tendon sheath.         0050      23.7998    $1,412.52  ...........      $282.50
25280.................  T..............  ...............  Revise wrist/forearm tendon..         0050      23.7998    $1,412.52  ...........      $282.50
25290.................  T..............  ...............  Incise wrist/forearm tendon..         0050      23.7998    $1,412.52  ...........      $282.50
25295.................  T..............  ...............  Release wrist/forearm tendon.         0049      20.2784    $1,203.52  ...........      $240.70
25300.................  T..............  ...............  Fusion of tendons at wrist...         0050      23.7998    $1,412.52  ...........      $282.50
25301.................  T..............  ...............  Fusion of tendons at wrist...         0050      23.7998    $1,412.52  ...........      $282.50
25310.................  T..............  ...............  Transplant forearm tendon....         0051      36.3617    $2,158.07  ...........      $431.61
25312.................  T..............  ...............  Transplant forearm tendon....         0051      36.3617    $2,158.07  ...........      $431.61
25315.................  T..............  ...............  Revise palsy hand tendon(s)..         0051      36.3617    $2,158.07  ...........      $431.61
25316.................  T..............  ...............  Revise palsy hand tendon(s)..         0051      36.3617    $2,158.07  ...........      $431.61
25320.................  T..............  ...............  Repair/revise wrist joint....         0051      36.3617    $2,158.07  ...........      $431.61
25332.................  T..............  ...............  Revise wrist joint...........         0047      31.4675    $1,867.60      $537.03      $373.52
25335.................  T..............  ...............  Realignment of hand..........         0051      36.3617    $2,158.07  ...........      $431.61
25337.................  T..............  ...............  Reconstruct ulna/radioulnar..         0051      36.3617    $2,158.07  ...........      $431.61
25350.................  T..............  ...............  Revision of radius...........         0051      36.3617    $2,158.07  ...........      $431.61
25355.................  T..............  ...............  Revision of radius...........         0051      36.3617    $2,158.07  ...........      $431.61
25360.................  T..............  ...............  Revision of ulna.............         0050      23.7998    $1,412.52  ...........      $282.50
25365.................  T..............  ...............  Revise radius & ulna.........         0050      23.7998    $1,412.52  ...........      $282.50
25370.................  T..............  ...............  Revise radius or ulna........         0051      36.3617    $2,158.07  ...........      $431.61
25375.................  T..............  ...............  Revise radius & ulna.........         0051      36.3617    $2,158.07  ...........      $431.61
25390.................  T..............  ...............  Shorten radius or ulna.......         0050      23.7998    $1,412.52  ...........      $282.50
25391.................  T..............  ...............  Lengthen radius or ulna......         0051      36.3617    $2,158.07  ...........      $431.61
25392.................  T..............  ...............  Shorten radius & ulna........         0050      23.7998    $1,412.52  ...........      $282.50
25393.................  T..............  ...............  Lengthen radius & ulna.......         0051      36.3617    $2,158.07  ...........      $431.61
25394.................  T..............  ...............  Repair carpal bone, shorten..         0053      15.6085      $926.36      $253.49      $185.27
25400.................  T..............  ...............  Repair radius or ulna........         0050      23.7998    $1,412.52  ...........      $282.50
25405.................  T..............  ...............  Repair/graft radius or ulna..         0050      23.7998    $1,412.52  ...........      $282.50
25415.................  T..............  ...............  Repair radius & ulna.........         0050      23.7998    $1,412.52  ...........      $282.50
25420.................  T..............  ...............  Repair/graft radius & ulna...         0051      36.3617    $2,158.07  ...........      $431.61
25425.................  T..............  ...............  Repair/graft radius or ulna..         0051      36.3617    $2,158.07  ...........      $431.61
25426.................  T..............  ...............  Repair/graft radius & ulna...         0051      36.3617    $2,158.07  ...........      $431.61
25430.................  T..............  ...............  Vasc graft into carpal bone..         0054      25.2562    $1,498.96  ...........      $299.79
25431.................  T..............  ...............  Repair nonunion carpal bone..         0054      25.2562    $1,498.96  ...........      $299.79
25440.................  T..............  ...............  Repair/graft wrist bone......         0051      36.3617    $2,158.07  ...........      $431.61
25441.................  T..............  ...............  Reconstruct wrist joint......         0425      99.7520    $5,920.28    $1,378.01    $1,184.06
25442.................  T..............  ...............  Reconstruct wrist joint......         0425      99.7520    $5,920.28    $1,378.01    $1,184.06
25443.................  T..............  ...............  Reconstruct wrist joint......         0048      42.9335    $2,548.10      $570.30      $509.62
25444.................  T..............  ...............  Reconstruct wrist joint......         0048      42.9335    $2,548.10      $570.30      $509.62
25445.................  T..............  ...............  Reconstruct wrist joint......         0048      42.9335    $2,548.10      $570.30      $509.62
25446.................  T..............  ...............  Wrist replacement............         0425      99.7520    $5,920.28    $1,378.01    $1,184.06
25447.................  T..............  ...............  Repair wrist joint(s)........         0047      31.4675    $1,867.60      $537.03      $373.52
25449.................  T..............  ...............  Remove wrist joint implant...         0047      31.4675    $1,867.60      $537.03      $373.52

[[Page 42797]]

 
25450.................  T..............  ...............  Revision of wrist joint......         0051      36.3617    $2,158.07  ...........      $431.61
25455.................  T..............  ...............  Revision of wrist joint......         0051      36.3617    $2,158.07  ...........      $431.61
25490.................  T..............  ...............  Reinforce radius.............         0051      36.3617    $2,158.07  ...........      $431.61
25491.................  T..............  ...............  Reinforce ulna...............         0051      36.3617    $2,158.07  ...........      $431.61
25492.................  T..............  ...............  Reinforce radius and ulna....         0051      36.3617    $2,158.07  ...........      $431.61
25500.................  T..............  ...............  Treat fracture of radius.....         0043       1.7614      $104.54  ...........       $20.91
25505.................  T..............  ...............  Treat fracture of radius.....         0043       1.7614      $104.54  ...........       $20.91
25515.................  T..............  ...............  Treat fracture of radius.....         0046      37.5315    $2,227.49      $535.76      $445.50
25520.................  T..............  ...............  Treat fracture of radius.....         0043       1.7614      $104.54  ...........       $20.91
25525.................  T..............  ...............  Treat fracture of radius.....         0046      37.5315    $2,227.49      $535.76      $445.50
25526.................  T..............  ...............  Treat fracture of radius.....         0046      37.5315    $2,227.49      $535.76      $445.50
25530.................  T..............  ...............  Treat fracture of ulna.......         0043       1.7614      $104.54  ...........       $20.91
25535.................  T..............  ...............  Treat fracture of ulna.......         0043       1.7614      $104.54  ...........       $20.91
25545.................  T..............  ...............  Treat fracture of ulna.......         0046      37.5315    $2,227.49      $535.76      $445.50
25560.................  T..............  ...............  Treat fracture radius & ulna.         0043       1.7614      $104.54  ...........       $20.91
25565.................  T..............  ...............  Treat fracture radius & ulna.         0043       1.7614      $104.54  ...........       $20.91
25574.................  T..............  ...............  Treat fracture radius & ulna.         0046      37.5315    $2,227.49      $535.76      $445.50
25575.................  T..............  ...............  Treat fracture radius/ulna...         0046      37.5315    $2,227.49      $535.76      $445.50
25600.................  T..............  ...............  Treat fracture radius/ulna...         0043       1.7614      $104.54  ...........       $20.91
25605.................  T..............  ...............  Treat fracture radius/ulna...         0043       1.7614      $104.54  ...........       $20.91
25611.................  T..............  ...............  Treat fracture radius/ulna...         0046      37.5315    $2,227.49      $535.76      $445.50
25620.................  T..............  ...............  Treat fracture radius/ulna...         0046      37.5315    $2,227.49      $535.76      $445.50
25622.................  T..............  ...............  Treat wrist bone fracture....         0043       1.7614      $104.54  ...........       $20.91
25624.................  T..............  ...............  Treat wrist bone fracture....         0043       1.7614      $104.54  ...........       $20.91
25628.................  T..............  ...............  Treat wrist bone fracture....         0046      37.5315    $2,227.49      $535.76      $445.50
25630.................  T..............  ...............  Treat wrist bone fracture....         0043       1.7614      $104.54  ...........       $20.91
25635.................  T..............  ...............  Treat wrist bone fracture....         0043       1.7614      $104.54  ...........       $20.91
25645.................  T..............  ...............  Treat wrist bone fracture....         0046      37.5315    $2,227.49      $535.76      $445.50
25650.................  T..............  ...............  Treat wrist bone fracture....         0043       1.7614      $104.54  ...........       $20.91
25651.................  T..............  ...............  Pin ulnar styloid fracture...         0046      37.5315    $2,227.49      $535.76      $445.50
25652.................  T..............  ...............  Treat fracture ulnar styloid.         0046      37.5315    $2,227.49      $535.76      $445.50
25660.................  T..............  ...............  Treat wrist dislocation......         0043       1.7614      $104.54  ...........       $20.91
25670.................  T..............  ...............  Treat wrist dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
25671.................  T..............  ...............  Pin radioulnar dislocation...         0046      37.5315    $2,227.49      $535.76      $445.50
25675.................  T..............  ...............  Treat wrist dislocation......         0043       1.7614      $104.54  ...........       $20.91
25676.................  T..............  ...............  Treat wrist dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
25680.................  T..............  ...............  Treat wrist fracture.........         0043       1.7614      $104.54  ...........       $20.91
25685.................  T..............  ...............  Treat wrist fracture.........         0046      37.5315    $2,227.49      $535.76      $445.50
25690.................  T..............  ...............  Treat wrist dislocation......         0043       1.7614      $104.54  ...........       $20.91
25695.................  T..............  ...............  Treat wrist dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
25800.................  T..............  ...............  Fusion of wrist joint........         0051      36.3617    $2,158.07  ...........      $431.61
25805.................  T..............  ...............  Fusion/graft of wrist joint..         0051      36.3617    $2,158.07  ...........      $431.61
25810.................  T..............  ...............  Fusion/graft of wrist joint..         0051      36.3617    $2,158.07  ...........      $431.61
25820.................  T..............  ...............  Fusion of hand bones.........         0053      15.6085      $926.36      $253.49      $185.27
25825.................  T..............  ...............  Fuse hand bones with graft...         0054      25.2562    $1,498.96  ...........      $299.79
25830.................  T..............  ...............  Fusion, radioulnar jnt/ulna..         0051      36.3617    $2,158.07  ...........      $431.61
25900.................  C..............  ...............  Amputation of forearm........  ...........  ...........  ...........  ...........  ...........
25905.................  C..............  ...............  Amputation of forearm........  ...........  ...........  ...........  ...........  ...........
25907.................  T..............  ...............  Amputation follow-up surgery.         0049      20.2784    $1,203.52  ...........      $240.70
25909.................  C..............  ...............  Amputation follow-up surgery.  ...........  ...........  ...........  ...........  ...........
25915.................  C..............  ...............  Amputation of forearm........  ...........  ...........  ...........  ...........  ...........
25920.................  C..............  ...............  Amputate hand at wrist.......  ...........  ...........  ...........  ...........  ...........
25922.................  T..............  ...............  Amputate hand at wrist.......         0049      20.2784    $1,203.52  ...........      $240.70
25924.................  C..............  ...............  Amputation follow-up surgery.  ...........  ...........  ...........  ...........  ...........
25927.................  C..............  ...............  Amputation of hand...........  ...........  ...........  ...........  ...........  ...........
25929.................  T..............  ...............  Amputation follow-up surgery.         0686      13.7661      $817.02  ...........      $163.40
25931.................  C..............  ...............  Amputation follow-up surgery.  ...........  ...........  ...........  ...........  ...........
25999.................  T..............  ...............  Forearm or wrist surgery.....         0043       1.7614      $104.54  ...........       $20.91
26010.................  T..............  ...............  Drainage of finger abscess...         0006       1.5430       $91.58       $22.18       $18.32
26011.................  T..............  ...............  Drainage of finger abscess...         0007      11.3983      $676.49  ...........      $135.30
26020.................  T..............  ...............  Drain hand tendon sheath.....         0053      15.6085      $926.36      $253.49      $185.27
26025.................  T..............  ...............  Drainage of palm bursa.......         0053      15.6085      $926.36      $253.49      $185.27
26030.................  T..............  ...............  Drainage of palm bursa(s)....         0053      15.6085      $926.36      $253.49      $185.27
26034.................  T..............  ...............  Treat hand bone lesion.......         0053      15.6085      $926.36      $253.49      $185.27
26035.................  T..............  ...............  Decompress fingers/hand......         0053      15.6085      $926.36      $253.49      $185.27
26037.................  T..............  ...............  Decompress fingers/hand......         0053      15.6085      $926.36      $253.49      $185.27

[[Page 42798]]

 
26040.................  T..............  ...............  Release palm contracture.....         0054      25.2562    $1,498.96  ...........      $299.79
26045.................  T..............  ...............  Release palm contracture.....         0054      25.2562    $1,498.96  ...........      $299.79
26055.................  T..............  ...............  Incise finger tendon sheath..         0053      15.6085      $926.36      $253.49      $185.27
26060.................  T..............  ...............  Incision of finger tendon....         0053      15.6085      $926.36      $253.49      $185.27
26070.................  T..............  ...............  Explore/treat hand joint.....         0053      15.6085      $926.36      $253.49      $185.27
26075.................  T..............  ...............  Explore/treat finger joint...         0053      15.6085      $926.36      $253.49      $185.27
26080.................  T..............  ...............  Explore/treat finger joint...         0053      15.6085      $926.36      $253.49      $185.27
26100.................  T..............  ...............  Biopsy hand joint lining.....         0053      15.6085      $926.36      $253.49      $185.27
26105.................  T..............  ...............  Biopsy finger joint lining...         0053      15.6085      $926.36      $253.49      $185.27
26110.................  T..............  ...............  Biopsy finger joint lining...         0053      15.6085      $926.36      $253.49      $185.27
26115.................  T..............  ...............  Removel hand lesion subcut...         0022      19.5582    $1,160.78      $354.45      $232.16
26116.................  T..............  ...............  Removel hand lesion, deep....         0022      19.5582    $1,160.78      $354.45      $232.16
26117.................  T..............  ...............  Remove tumor, hand/finger....         0022      19.5582    $1,160.78      $354.45      $232.16
26121.................  T..............  ...............  Release palm contracture.....         0054      25.2562    $1,498.96  ...........      $299.79
26123.................  T..............  ...............  Release palm contracture.....         0054      25.2562    $1,498.96  ...........      $299.79
26125.................  T..............  ...............  Release palm contracture.....         0053      15.6085      $926.36      $253.49      $185.27
26130.................  T..............  ...............  Remove wrist joint lining....         0053      15.6085      $926.36      $253.49      $185.27
26135.................  T..............  ...............  Revise finger joint, each....         0054      25.2562    $1,498.96  ...........      $299.79
26140.................  T..............  ...............  Revise finger joint, each....         0053      15.6085      $926.36      $253.49      $185.27
26145.................  T..............  ...............  Tendon excision, palm/finger.         0053      15.6085      $926.36      $253.49      $185.27
26160.................  T..............  ...............  Remove tendon sheath lesion..         0053      15.6085      $926.36      $253.49      $185.27
26170.................  T..............  ...............  Removal of palm tendon, each.         0053      15.6085      $926.36      $253.49      $185.27
26180.................  T..............  ...............  Removal of finger tendon.....         0053      15.6085      $926.36      $253.49      $185.27
26185.................  T..............  ...............  Remove finger bone...........         0053      15.6085      $926.36      $253.49      $185.27
26200.................  T..............  ...............  Remove hand bone lesion......         0053      15.6085      $926.36      $253.49      $185.27
26205.................  T..............  ...............  Remove/graft bone lesion.....         0054      25.2562    $1,498.96  ...........      $299.79
26210.................  T..............  ...............  Removal of finger lesion.....         0053      15.6085      $926.36      $253.49      $185.27
26215.................  T..............  ...............  Remove/graft finger lesion...         0053      15.6085      $926.36      $253.49      $185.27
26230.................  T..............  ...............  Partial removal of hand bone.         0053      15.6085      $926.36      $253.49      $185.27
26235.................  T..............  ...............  Partial removal, finger bone.         0053      15.6085      $926.36      $253.49      $185.27
26236.................  T..............  ...............  Partial removal, finger bone.         0053      15.6085      $926.36      $253.49      $185.27
26250.................  T..............  ...............  Extensive hand surgery.......         0053      15.6085      $926.36      $253.49      $185.27
26255.................  T..............  ...............  Extensive hand surgery.......         0054      25.2562    $1,498.96  ...........      $299.79
26260.................  T..............  ...............  Extensive finger surgery.....         0053      15.6085      $926.36      $253.49      $185.27
26261.................  T..............  ...............  Extensive finger surgery.....         0053      15.6085      $926.36      $253.49      $185.27
26262.................  T..............  ...............  Partial removal of finger....         0053      15.6085      $926.36      $253.49      $185.27
26320.................  T..............  ...............  Removal of implant from hand.         0021      14.9098      $884.90      $219.48      $176.98
26340.................  T..............  ...............  Manipulate finger w/anesth...         0043       1.7614      $104.54  ...........       $20.91
26350.................  T..............  ...............  Repair finger/hand tendon....         0054      25.2562    $1,498.96  ...........      $299.79
26352.................  T..............  ...............  Repair/graft hand tendon.....         0054      25.2562    $1,498.96  ...........      $299.79
26356.................  T..............  ...............  Repair finger/hand tendon....         0054      25.2562    $1,498.96  ...........      $299.79
26357.................  T..............  ...............  Repair finger/hand tendon....         0054      25.2562    $1,498.96  ...........      $299.79
26358.................  T..............  ...............  Repair/graft hand tendon.....         0054      25.2562    $1,498.96  ...........      $299.79
26370.................  T..............  ...............  Repair finger/hand tendon....         0054      25.2562    $1,498.96  ...........      $299.79
26372.................  T..............  ...............  Repair/graft hand tendon.....         0054      25.2562    $1,498.96  ...........      $299.79
26373.................  T..............  ...............  Repair finger/hand tendon....         0054      25.2562    $1,498.96  ...........      $299.79
26390.................  T..............  ...............  Revise hand/finger tendon....         0054      25.2562    $1,498.96  ...........      $299.79
26392.................  T..............  ...............  Repair/graft hand tendon.....         0054      25.2562    $1,498.96  ...........      $299.79
26410.................  T..............  ...............  Repair hand tendon...........         0053      15.6085      $926.36      $253.49      $185.27
26412.................  T..............  ...............  Repair/graft hand tendon.....         0054      25.2562    $1,498.96  ...........      $299.79
26415.................  T..............  ...............  Excision, hand/finger tendon.         0054      25.2562    $1,498.96  ...........      $299.79
26416.................  T..............  ...............  Graft hand or finger tendon..         0054      25.2562    $1,498.96  ...........      $299.79
26418.................  T..............  ...............  Repair finger tendon.........         0053      15.6085      $926.36      $253.49      $185.27
26420.................  T..............  ...............  Repair/graft finger tendon...         0054      25.2562    $1,498.96  ...........      $299.79
26426.................  T..............  ...............  Repair finger/hand tendon....         0054      25.2562    $1,498.96  ...........      $299.79
26428.................  T..............  ...............  Repair/graft finger tendon...         0054      25.2562    $1,498.96  ...........      $299.79
26432.................  T..............  ...............  Repair finger tendon.........         0053      15.6085      $926.36      $253.49      $185.27
26433.................  T..............  ...............  Repair finger tendon.........         0053      15.6085      $926.36      $253.49      $185.27
26434.................  T..............  ...............  Repair/graft finger tendon...         0054      25.2562    $1,498.96  ...........      $299.79
26437.................  T..............  ...............  Realignment of tendons.......         0053      15.6085      $926.36      $253.49      $185.27
26440.................  T..............  ...............  Release palm/finger tendon...         0053      15.6085      $926.36      $253.49      $185.27
26442.................  T..............  ...............  Release palm & finger tendon.         0054      25.2562    $1,498.96  ...........      $299.79
26445.................  T..............  ...............  Release hand/finger tendon...         0053      15.6085      $926.36      $253.49      $185.27
26449.................  T..............  ...............  Release forearm/hand tendon..         0054      25.2562    $1,498.96  ...........      $299.79
26450.................  T..............  ...............  Incision of palm tendon......         0053      15.6085      $926.36      $253.49      $185.27
26455.................  T..............  ...............  Incision of finger tendon....         0053      15.6085      $926.36      $253.49      $185.27

[[Page 42799]]

 
26460.................  T..............  ...............  Incise hand/finger tendon....         0053      15.6085      $926.36      $253.49      $185.27
26471.................  T..............  ...............  Fusion of finger tendons.....         0053      15.6085      $926.36      $253.49      $185.27
26474.................  T..............  ...............  Fusion of finger tendons.....         0053      15.6085      $926.36      $253.49      $185.27
26476.................  T..............  ...............  Tendon lengthening...........         0053      15.6085      $926.36      $253.49      $185.27
26477.................  T..............  ...............  Tendon shortening............         0053      15.6085      $926.36      $253.49      $185.27
26478.................  T..............  ...............  Lengthening of hand tendon...         0053      15.6085      $926.36      $253.49      $185.27
26479.................  T..............  ...............  Shortening of hand tendon....         0053      15.6085      $926.36      $253.49      $185.27
26480.................  T..............  ...............  Transplant hand tendon.......         0054      25.2562    $1,498.96  ...........      $299.79
26483.................  T..............  ...............  Transplant/graft hand tendon.         0054      25.2562    $1,498.96  ...........      $299.79
26485.................  T..............  ...............  Transplant palm tendon.......         0054      25.2562    $1,498.96  ...........      $299.79
26489.................  T..............  ...............  Transplant/graft palm tendon.         0054      25.2562    $1,498.96  ...........      $299.79
26490.................  T..............  ...............  Revise thumb tendon..........         0054      25.2562    $1,498.96  ...........      $299.79
26492.................  T..............  ...............  Tendon transfer with graft...         0054      25.2562    $1,498.96  ...........      $299.79
26494.................  T..............  ...............  Hand tendon/muscle transfer..         0054      25.2562    $1,498.96  ...........      $299.79
26496.................  T..............  ...............  Revise thumb tendon..........         0054      25.2562    $1,498.96  ...........      $299.79
26497.................  T..............  ...............  Finger tendon transfer.......         0054      25.2562    $1,498.96  ...........      $299.79
26498.................  T..............  ...............  Finger tendon transfer.......         0054      25.2562    $1,498.96  ...........      $299.79
26499.................  T..............  ...............  Revision of finger...........         0054      25.2562    $1,498.96  ...........      $299.79
26500.................  T..............  ...............  Hand tendon reconstruction...         0053      15.6085      $926.36      $253.49      $185.27
26502.................  T..............  ...............  Hand tendon reconstruction...         0054      25.2562    $1,498.96  ...........      $299.79
26504.................  T..............  ...............  Hand tendon reconstruction...         0054      25.2562    $1,498.96  ...........      $299.79
26508.................  T..............  ...............  Release thumb contracture....         0053      15.6085      $926.36      $253.49      $185.27
26510.................  T..............  ...............  Thumb tendon transfer........         0054      25.2562    $1,498.96  ...........      $299.79
26516.................  T..............  ...............  Fusion of knuckle joint......         0054      25.2562    $1,498.96  ...........      $299.79
26517.................  T..............  ...............  Fusion of knuckle joints.....         0054      25.2562    $1,498.96  ...........      $299.79
26518.................  T..............  ...............  Fusion of knuckle joints.....         0054      25.2562    $1,498.96  ...........      $299.79
26520.................  T..............  ...............  Release knuckle contracture..         0053      15.6085      $926.36      $253.49      $185.27
26525.................  T..............  ...............  Release finger contracture...         0053      15.6085      $926.36      $253.49      $185.27
26530.................  T..............  ...............  Revise knuckle joint.........         0047      31.4675    $1,867.60      $537.03      $373.52
26531.................  T..............  ...............  Revise knuckle with implant..         0048      42.9335    $2,548.10      $570.30      $509.62
26535.................  T..............  ...............  Revise finger joint..........         0047      31.4675    $1,867.60      $537.03      $373.52
26536.................  T..............  ...............  Revise/implant finger joint..         0048      42.9335    $2,548.10      $570.30      $509.62
26540.................  T..............  ...............  Repair hand joint............         0053      15.6085      $926.36      $253.49      $185.27
26541.................  T..............  ...............  Repair hand joint with graft.         0054      25.2562    $1,498.96  ...........      $299.79
26542.................  T..............  ...............  Repair hand joint with graft.         0053      15.6085      $926.36      $253.49      $185.27
26545.................  T..............  ...............  Reconstruct finger joint.....         0054      25.2562    $1,498.96  ...........      $299.79
26546.................  T..............  ...............  Repair nonunion hand.........         0054      25.2562    $1,498.96  ...........      $299.79
26548.................  T..............  ...............  Reconstruct finger joint.....         0054      25.2562    $1,498.96  ...........      $299.79
26550.................  T..............  ...............  Construct thumb replacement..         0054      25.2562    $1,498.96  ...........      $299.79
26551.................  C..............  ...............  Great toe-hand transfer......  ...........  ...........  ...........  ...........  ...........
26553.................  C..............  ...............  Single transfer, toe-hand....  ...........  ...........  ...........  ...........  ...........
26554.................  C..............  ...............  Double transfer, toe-hand....  ...........  ...........  ...........  ...........  ...........
26555.................  T..............  ...............  Positional change of finger..         0054      25.2562    $1,498.96  ...........      $299.79
26556.................  C..............  ...............  Toe joint transfer...........  ...........  ...........  ...........  ...........  ...........
26560.................  T..............  ...............  Repair of web finger.........         0053      15.6085      $926.36      $253.49      $185.27
26561.................  T..............  ...............  Repair of web finger.........         0054      25.2562    $1,498.96  ...........      $299.79
26562.................  T..............  ...............  Repair of web finger.........         0054      25.2562    $1,498.96  ...........      $299.79
26565.................  T..............  ...............  Correct metacarpal flaw......         0054      25.2562    $1,498.96  ...........      $299.79
26567.................  T..............  ...............  Correct finger deformity.....         0054      25.2562    $1,498.96  ...........      $299.79
26568.................  T..............  ...............  Lengthen metacarpal/finger...         0054      25.2562    $1,498.96  ...........      $299.79
26580.................  T..............  ...............  Repair hand deformity........         0053      15.6085      $926.36      $253.49      $185.27
26587.................  T..............  ...............  Reconstruct extra finger.....         0053      15.6085      $926.36      $253.49      $185.27
26590.................  T..............  ...............  Repair finger deformity......         0053      15.6085      $926.36      $253.49      $185.27
26591.................  T..............  ...............  Repair muscles of hand.......         0054      25.2562    $1,498.96  ...........      $299.79
26593.................  T..............  ...............  Release muscles of hand......         0053      15.6085      $926.36      $253.49      $185.27
26596.................  T..............  ...............  Excision constricting tissue.         0053      15.6085      $926.36      $253.49      $185.27
26600.................  T..............  ...............  Treat metacarpal fracture....         0043       1.7614      $104.54  ...........       $20.91
26605.................  T..............  ...............  Treat metacarpal fracture....         0043       1.7614      $104.54  ...........       $20.91
26607.................  T..............  ...............  Treat metacarpal fracture....         0043       1.7614      $104.54  ...........       $20.91
26608.................  T..............  ...............  Treat metacarpal fracture....         0046      37.5315    $2,227.49      $535.76      $445.50
26615.................  T..............  ...............  Treat metacarpal fracture....         0046      37.5315    $2,227.49      $535.76      $445.50
26641.................  T..............  ...............  Treat thumb dislocation......         0043       1.7614      $104.54  ...........       $20.91
26645.................  T..............  ...............  Treat thumb fracture.........         0043       1.7614      $104.54  ...........       $20.91
26650.................  T..............  ...............  Treat thumb fracture.........         0046      37.5315    $2,227.49      $535.76      $445.50
26665.................  T..............  ...............  Treat thumb fracture.........         0046      37.5315    $2,227.49      $535.76      $445.50
26670.................  T..............  ...............  Treat hand dislocation.......         0043       1.7614      $104.54  ...........       $20.91

[[Page 42800]]

 
26675.................  T..............  ...............  Treat hand dislocation.......         0043       1.7614      $104.54  ...........       $20.91
26676.................  T..............  ...............  Pin hand dislocation.........         0046      37.5315    $2,227.49      $535.76      $445.50
26685.................  T..............  ...............  Treat hand dislocation.......         0046      37.5315    $2,227.49      $535.76      $445.50
26686.................  T..............  ...............  Treat hand dislocation.......         0046      37.5315    $2,227.49      $535.76      $445.50
26700.................  T..............  ...............  Treat knuckle dislocation....         0043       1.7614      $104.54  ...........       $20.91
26705.................  T..............  ...............  Treat knuckle dislocation....         0043       1.7614      $104.54  ...........       $20.91
26706.................  T..............  ...............  Pin knuckle dislocation......         0043       1.7614      $104.54  ...........       $20.91
26715.................  T..............  ...............  Treat knuckle dislocation....         0046      37.5315    $2,227.49      $535.76      $445.50
26720.................  T..............  ...............  Treat finger fracture, each..         0043       1.7614      $104.54  ...........       $20.91
26725.................  T..............  ...............  Treat finger fracture, each..         0043       1.7614      $104.54  ...........       $20.91
26727.................  T..............  ...............  Treat finger fracture, each..         0046      37.5315    $2,227.49      $535.76      $445.50
26735.................  T..............  ...............  Treat finger fracture, each..         0046      37.5315    $2,227.49      $535.76      $445.50
26740.................  T..............  ...............  Treat finger fracture, each..         0043       1.7614      $104.54  ...........       $20.91
26742.................  T..............  ...............  Treat finger fracture, each..         0043       1.7614      $104.54  ...........       $20.91
26746.................  T..............  ...............  Treat finger fracture, each..         0046      37.5315    $2,227.49      $535.76      $445.50
26750.................  T..............  ...............  Treat finger fracture, each..         0043       1.7614      $104.54  ...........       $20.91
26755.................  T..............  ...............  Treat finger fracture, each..         0043       1.7614      $104.54  ...........       $20.91
26756.................  T..............  ...............  Pin finger fracture, each....         0046      37.5315    $2,227.49      $535.76      $445.50
26765.................  T..............  ...............  Treat finger fracture, each..         0046      37.5315    $2,227.49      $535.76      $445.50
26770.................  T..............  ...............  Treat finger dislocation.....         0043       1.7614      $104.54  ...........       $20.91
26775.................  T..............  ...............  Treat finger dislocation.....         0045      14.4289      $856.36      $268.47      $171.27
26776.................  T..............  ...............  Pin finger dislocation.......         0046      37.5315    $2,227.49      $535.76      $445.50
26785.................  T..............  ...............  Treat finger dislocation.....         0046      37.5315    $2,227.49      $535.76      $445.50
26820.................  T..............  ...............  Thumb fusion with graft......         0054      25.2562    $1,498.96  ...........      $299.79
26841.................  T..............  ...............  Fusion of thumb..............         0054      25.2562    $1,498.96  ...........      $299.79
26842.................  T..............  ...............  Thumb fusion with graft......         0054      25.2562    $1,498.96  ...........      $299.79
26843.................  T..............  ...............  Fusion of hand joint.........         0054      25.2562    $1,498.96  ...........      $299.79
26844.................  T..............  ...............  Fusion/graft of hand joint...         0054      25.2562    $1,498.96  ...........      $299.79
26850.................  T..............  ...............  Fusion of knuckle............         0054      25.2562    $1,498.96  ...........      $299.79
26852.................  T..............  ...............  Fusion of knuckle with graft.         0054      25.2562    $1,498.96  ...........      $299.79
26860.................  T..............  ...............  Fusion of finger joint.......         0054      25.2562    $1,498.96  ...........      $299.79
26861.................  T..............  ...............  Fusion of finger jnt, add-on.         0054      25.2562    $1,498.96  ...........      $299.79
26862.................  T..............  ...............  Fusion/graft of finger joint.         0054      25.2562    $1,498.96  ...........      $299.79
26863.................  T..............  ...............  Fuse/graft added joint.......         0054      25.2562    $1,498.96  ...........      $299.79
26910.................  T..............  ...............  Amputate metacarpal bone.....         0054      25.2562    $1,498.96  ...........      $299.79
26951.................  T..............  ...............  Amputation of finger/thumb...         0053      15.6085      $926.36      $253.49      $185.27
26952.................  T..............  ...............  Amputation of finger/thumb...         0053      15.6085      $926.36      $253.49      $185.27
26989.................  T..............  ...............  Hand/finger surgery..........         0043       1.7614      $104.54  ...........       $20.91
26990.................  T..............  ...............  Drainage of pelvis lesion....         0049      20.2784    $1,203.52  ...........      $240.70
26991.................  T..............  ...............  Drainage of pelvis bursa.....         0049      20.2784    $1,203.52  ...........      $240.70
26992.................  C..............  ...............  Drainage of bone lesion......  ...........  ...........  ...........  ...........  ...........
27000.................  T..............  ...............  Incision of hip tendon.......         0049      20.2784    $1,203.52  ...........      $240.70
27001.................  T..............  ...............  Incision of hip tendon.......         0050      23.7998    $1,412.52  ...........      $282.50
27003.................  T..............  ...............  Incision of hip tendon.......         0050      23.7998    $1,412.52  ...........      $282.50
27005.................  C..............  ...............  Incision of hip tendon.......  ...........  ...........  ...........  ...........  ...........
27006.................  C..............  ...............  Incision of hip tendons......  ...........  ...........  ...........  ...........  ...........
27025.................  C..............  ...............  Incision of hip/thigh fascia.  ...........  ...........  ...........  ...........  ...........
27030.................  C..............  ...............  Drainage of hip joint........  ...........  ...........  ...........  ...........  ...........
27033.................  T..............  ...............  Exploration of hip joint.....         0051      36.3617    $2,158.07  ...........      $431.61
27035.................  T..............  ...............  Denervation of hip joint.....         0052      43.7388    $2,595.90  ...........      $519.18
27036.................  C..............  ...............  Excision of hip joint/muscle.  ...........  ...........  ...........  ...........  ...........
27040.................  T..............  ...............  Biopsy of soft tissues.......         0020       6.9118      $410.22      $106.93       $82.04
27041.................  T..............  ...............  Biopsy of soft tissues.......         0020       6.9118      $410.22      $106.93       $82.04
27047.................  T..............  ...............  Remove hip/pelvis lesion.....         0022      19.5582    $1,160.78      $354.45      $232.16
27048.................  T..............  ...............  Remove hip/pelvis lesion.....         0022      19.5582    $1,160.78      $354.45      $232.16
27049.................  T..............  ...............  Remove tumor, hip/pelvis.....         0022      19.5582    $1,160.78      $354.45      $232.16
27050.................  T..............  ...............  Biopsy of sacroiliac joint...         0049      20.2784    $1,203.52  ...........      $240.70
27052.................  T..............  ...............  Biopsy of hip joint..........         0049      20.2784    $1,203.52  ...........      $240.70
27054.................  C..............  ...............  Removal of hip joint lining..  ...........  ...........  ...........  ...........  ...........
27060.................  T..............  ...............  Removal of ischial bursa.....         0049      20.2784    $1,203.52  ...........      $240.70
27062.................  T..............  ...............  Remove femur lesion/bursa....         0049      20.2784    $1,203.52  ...........      $240.70
27065.................  T..............  ...............  Removal of hip bone lesion...         0049      20.2784    $1,203.52  ...........      $240.70
27066.................  T..............  ...............  Removal of hip bone lesion...         0050      23.7998    $1,412.52  ...........      $282.50
27067.................  T..............  ...............  Remove/graft hip bone lesion.         0050      23.7998    $1,412.52  ...........      $282.50
27070.................  C..............  ...............  Partial removal of hip bone..  ...........  ...........  ...........  ...........  ...........
27071.................  C..............  ...............  Partial removal of hip bone..  ...........  ...........  ...........  ...........  ...........

[[Page 42801]]

 
27075.................  C..............  ...............  Extensive hip surgery........  ...........  ...........  ...........  ...........  ...........
27076.................  C..............  ...............  Extensive hip surgery........  ...........  ...........  ...........  ...........  ...........
27077.................  C..............  ...............  Extensive hip surgery........  ...........  ...........  ...........  ...........  ...........
27078.................  C..............  ...............  Extensive hip surgery........  ...........  ...........  ...........  ...........  ...........
27079.................  C..............  ...............  Extensive hip surgery........  ...........  ...........  ...........  ...........  ...........
27080.................  T..............  ...............  Removal of tail bone.........         0050      23.7998    $1,412.52  ...........      $282.50
27086.................  T..............  ...............  Remove hip foreign body......         0020       6.9118      $410.22      $106.93       $82.04
27087.................  T..............  ...............  Remove hip foreign body......         0049      20.2784    $1,203.52  ...........      $240.70
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 tendon.......         0050      23.7998    $1,412.52  ...........      $282.50
27098.................  T..............  ...............  Transfer tendon to pelvis....         0050      23.7998    $1,412.52  ...........      $282.50
27100.................  T..............  ...............  Transfer of abdominal muscle.         0051      36.3617    $2,158.07  ...........      $431.61
27105.................  T..............  ...............  Transfer of spinal muscle....         0051      36.3617    $2,158.07  ...........      $431.61
27110.................  T..............  ...............  Transfer of iliopsoas muscle.         0051      36.3617    $2,158.07  ...........      $431.61
27111.................  T..............  ...............  Transfer of iliopsoas muscle.         0051      36.3617    $2,158.07  ...........      $431.61
27120.................  C..............  ...............  Reconstruction of hip socket.  ...........  ...........  ...........  ...........  ...........
27122.................  C..............  ...............  Reconstruction of hip socket.  ...........  ...........  ...........  ...........  ...........
27125.................  C..............  ...............  Partial hip replacement......  ...........  ...........  ...........  ...........  ...........
27130.................  C..............  ...............  Total hip arthroplasty.......  ...........  ...........  ...........  ...........  ...........
27132.................  C..............  ...............  Total hip arthroplasty.......  ...........  ...........  ...........  ...........  ...........
27134.................  C..............  ...............  Revise hip joint replacement.  ...........  ...........  ...........  ...........  ...........
27137.................  C..............  ...............  Revise hip joint replacement.  ...........  ...........  ...........  ...........  ...........
27138.................  C..............  ...............  Revise hip joint replacement.  ...........  ...........  ...........  ...........  ...........
27140.................  C..............  ...............  Transplant femur ridge.......  ...........  ...........  ...........  ...........  ...........
27146.................  C..............  ...............  Incision of hip bone.........  ...........  ...........  ...........  ...........  ...........
27147.................  C..............  ...............  Revision of hip bone.........  ...........  ...........  ...........  ...........  ...........
27151.................  C..............  ...............  Incision of hip bones........  ...........  ...........  ...........  ...........  ...........
27156.................  C..............  ...............  Revision of hip bones........  ...........  ...........  ...........  ...........  ...........
27158.................  C..............  ...............  Revision of pelvis...........  ...........  ...........  ...........  ...........  ...........
27161.................  C..............  ...............  Incision of neck of femur....  ...........  ...........  ...........  ...........  ...........
27165.................  C..............  ...............  Incision/fixation of femur...  ...........  ...........  ...........  ...........  ...........
27170.................  C..............  ...............  Repair/graft femur head/neck.  ...........  ...........  ...........  ...........  ...........
27175.................  C..............  ...............  Treat slipped epiphysis......  ...........  ...........  ...........  ...........  ...........
27176.................  C..............  ...............  Treat slipped epiphysis......  ...........  ...........  ...........  ...........  ...........
27177.................  C..............  ...............  Treat slipped epiphysis......  ...........  ...........  ...........  ...........  ...........
27178.................  C..............  ...............  Treat slipped epiphysis......  ...........  ...........  ...........  ...........  ...........
27179.................  C..............  ...............  Revise head/neck of femur....  ...........  ...........  ...........  ...........  ...........
27181.................  C..............  ...............  Treat slipped epiphysis......  ...........  ...........  ...........  ...........  ...........
27185.................  C..............  ...............  Revision of femur epiphysis..  ...........  ...........  ...........  ...........  ...........
27187.................  C..............  ...............  Reinforce hip bones..........  ...........  ...........  ...........  ...........  ...........
27193.................  T..............  ...............  Treat pelvic ring fracture...         0043       1.7614      $104.54  ...........       $20.91
27194.................  T..............  ...............  Treat pelvic ring fracture...         0045      14.4289      $856.36      $268.47      $171.27
27200.................  T..............  ...............  Treat tail bone fracture.....         0043       1.7614      $104.54  ...........       $20.91
27202.................  T..............  ...............  Treat tail bone fracture.....         0046      37.5315    $2,227.49      $535.76      $445.50
27215.................  C..............  ...............  Treat pelvic fracture(s).....  ...........  ...........  ...........  ...........  ...........
27216.................  T..............  ...............  Treat pelvic ring fracture...         0050      23.7998    $1,412.52  ...........      $282.50
27217.................  C..............  ...............  Treat pelvic ring fracture...  ...........  ...........  ...........  ...........  ...........
27218.................  C..............  ...............  Treat pelvic ring fracture...  ...........  ...........  ...........  ...........  ...........
27220.................  T..............  ...............  Treat hip socket fracture....         0043       1.7614      $104.54  ...........       $20.91
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       1.7614      $104.54  ...........       $20.91
27232.................  C..............  ...............  Treat thigh fracture.........  ...........  ...........  ...........  ...........  ...........
27235.................  T..............  ...............  Treat thigh fracture.........         0050      23.7998    $1,412.52  ...........      $282.50
27236.................  C..............  ...............  Treat thigh fracture.........  ...........  ...........  ...........  ...........  ...........
27238.................  T..............  ...............  Treat thigh fracture.........         0043       1.7614      $104.54  ...........       $20.91
27240.................  C..............  ...............  Treat thigh fracture.........  ...........  ...........  ...........  ...........  ...........
27244.................  C..............  ...............  Treat thigh fracture.........  ...........  ...........  ...........  ...........  ...........
27245.................  C..............  ...............  Treat thigh fracture.........  ...........  ...........  ...........  ...........  ...........
27246.................  T..............  ...............  Treat thigh fracture.........         0043       1.7614      $104.54  ...........       $20.91

[[Page 42802]]

 
27248.................  C..............  ...............  Treat thigh fracture.........  ...........  ...........  ...........  ...........  ...........
27250.................  T..............  ...............  Treat hip dislocation........         0043       1.7614      $104.54  ...........       $20.91
27252.................  T..............  ...............  Treat hip dislocation........         0045      14.4289      $856.36      $268.47      $171.27
27253.................  C..............  ...............  Treat hip dislocation........  ...........  ...........  ...........  ...........  ...........
27254.................  C..............  ...............  Treat hip dislocation........  ...........  ...........  ...........  ...........  ...........
27256.................  T..............  ...............  Treat hip dislocation........         0043       1.7614      $104.54  ...........       $20.91
27257.................  T..............  ...............  Treat hip dislocation........         0045      14.4289      $856.36      $268.47      $171.27
27258.................  C..............  ...............  Treat hip dislocation........  ...........  ...........  ...........  ...........  ...........
27259.................  C..............  ...............  Treat hip dislocation........  ...........  ...........  ...........  ...........  ...........
27265.................  T..............  ...............  Treat hip dislocation........         0043       1.7614      $104.54  ...........       $20.91
27266.................  T..............  ...............  Treat hip dislocation........         0045      14.4289      $856.36      $268.47      $171.27
27275.................  T..............  ...............  Manipulation of hip joint....         0045      14.4289      $856.36      $268.47      $171.27
27280.................  C..............  ...............  Fusion of sacroiliac joint...  ...........  ...........  ...........  ...........  ...........
27282.................  C..............  ...............  Fusion of pubic bones........  ...........  ...........  ...........  ...........  ...........
27284.................  C..............  ...............  Fusion of hip joint..........  ...........  ...........  ...........  ...........  ...........
27286.................  C..............  ...............  Fusion of hip joint..........  ...........  ...........  ...........  ...........  ...........
27290.................  C..............  ...............  Amputation of leg at hip.....  ...........  ...........  ...........  ...........  ...........
27295.................  C..............  ...............  Amputation of leg at hip.....  ...........  ...........  ...........  ...........  ...........
27299.................  T..............  ...............  Pelvis/hip joint surgery.....         0043       1.7614      $104.54  ...........       $20.91
27301.................  T..............  ...............  Drain thigh/knee lesion......         0008      16.4242      $974.78  ...........      $194.96
27303.................  C..............  ...............  Drainage of bone lesion......  ...........  ...........  ...........  ...........  ...........
27305.................  T..............  ...............  Incise thigh tendon & fascia.         0049      20.2784    $1,203.52  ...........      $240.70
27306.................  T..............  ...............  Incision of thigh tendon.....         0049      20.2784    $1,203.52  ...........      $240.70
27307.................  T..............  ...............  Incision of thigh tendons....         0049      20.2784    $1,203.52  ...........      $240.70
27310.................  T..............  ...............  Exploration of knee joint....         0050      23.7998    $1,412.52  ...........      $282.50
27315.................  T..............  ...............  Partial removal, thigh nerve.         0220      17.2800    $1,025.57  ...........      $205.11
27320.................  T..............  ...............  Partial removal, thigh nerve.         0220      17.2800    $1,025.57  ...........      $205.11
27323.................  T..............  ...............  Biopsy, thigh soft tissues...         0021      14.9098      $884.90      $219.48      $176.98
27324.................  T..............  ...............  Biopsy, thigh soft tissues...         0022      19.5582    $1,160.78      $354.45      $232.16
27327.................  T..............  ...............  Removal of thigh lesion......         0022      19.5582    $1,160.78      $354.45      $232.16
27328.................  T..............  ...............  Removal of thigh lesion......         0022      19.5582    $1,160.78      $354.45      $232.16
27329.................  T..............  ...............  Remove tumor, thigh/knee.....         0022      19.5582    $1,160.78      $354.45      $232.16
27330.................  T..............  ...............  Biopsy, knee joint lining....         0050      23.7998    $1,412.52  ...........      $282.50
27331.................  T..............  ...............  Explore/treat knee joint.....         0050      23.7998    $1,412.52  ...........      $282.50
27332.................  T..............  ...............  Removal of knee cartilage....         0050      23.7998    $1,412.52  ...........      $282.50
27333.................  T..............  ...............  Removal of knee cartilage....         0050      23.7998    $1,412.52  ...........      $282.50
27334.................  T..............  ...............  Remove knee joint lining.....         0050      23.7998    $1,412.52  ...........      $282.50
27335.................  T..............  ...............  Remove knee joint lining.....         0050      23.7998    $1,412.52  ...........      $282.50
27340.................  T..............  ...............  Removal of kneecap bursa.....         0049      20.2784    $1,203.52  ...........      $240.70
27345.................  T..............  ...............  Removal of knee cyst.........         0049      20.2784    $1,203.52  ...........      $240.70
27347.................  T..............  ...............  Remove knee cyst.............         0049      20.2784    $1,203.52  ...........      $240.70
27350.................  T..............  ...............  Removal of kneecap...........         0050      23.7998    $1,412.52  ...........      $282.50
27355.................  T..............  ...............  Remove femur lesion..........         0050      23.7998    $1,412.52  ...........      $282.50
27356.................  T..............  ...............  Remove femur lesion/graft....         0050      23.7998    $1,412.52  ...........      $282.50
27357.................  T..............  ...............  Remove femur lesion/graft....         0050      23.7998    $1,412.52  ...........      $282.50
27358.................  T..............  ...............  Remove femur lesion/fixation.         0050      23.7998    $1,412.52  ...........      $282.50
27360.................  T..............  ...............  Partial removal, leg bone(s).         0050      23.7998    $1,412.52  ...........      $282.50
27365.................  C..............  ...............  Extensive leg surgery........  ...........  ...........  ...........  ...........  ...........
27370.................  N..............  ...............  Injection for knee x-ray.....  ...........  ...........  ...........  ...........  ...........
27372.................  T..............  ...............  Removal of foreign body......         0022      19.5582    $1,160.78      $354.45      $232.16
27380.................  T..............  ...............  Repair of kneecap tendon.....         0049      20.2784    $1,203.52  ...........      $240.70
27381.................  T..............  ...............  Repair/graft kneecap tendon..         0049      20.2784    $1,203.52  ...........      $240.70
27385.................  T..............  ...............  Repair of thigh muscle.......         0049      20.2784    $1,203.52  ...........      $240.70
27386.................  T..............  ...............  Repair/graft of thigh muscle.         0049      20.2784    $1,203.52  ...........      $240.70
27390.................  T..............  ...............  Incision of thigh tendon.....         0049      20.2784    $1,203.52  ...........      $240.70
27391.................  T..............  ...............  Incision of thigh tendons....         0049      20.2784    $1,203.52  ...........      $240.70
27392.................  T..............  ...............  Incision of thigh tendons....         0049      20.2784    $1,203.52  ...........      $240.70
27393.................  T..............  ...............  Lengthening of thigh tendon..         0050      23.7998    $1,412.52  ...........      $282.50
27394.................  T..............  ...............  Lengthening of thigh tendons.         0050      23.7998    $1,412.52  ...........      $282.50
27395.................  T..............  ...............  Lengthening of thigh tendons.         0051      36.3617    $2,158.07  ...........      $431.61
27396.................  T..............  ...............  Transplant of thigh tendon...         0050      23.7998    $1,412.52  ...........      $282.50
27397.................  T..............  ...............  Transplants of thigh tendons.         0051      36.3617    $2,158.07  ...........      $431.61
27400.................  T..............  ...............  Revise thigh muscles/tendons.         0051      36.3617    $2,158.07  ...........      $431.61
27403.................  T..............  ...............  Repair of knee cartilage.....         0050      23.7998    $1,412.52  ...........      $282.50
27405.................  T..............  ...............  Repair of knee ligament......         0051      36.3617    $2,158.07  ...........      $431.61
27407.................  T..............  ...............  Repair of knee ligament......         0051      36.3617    $2,158.07  ...........      $431.61

[[Page 42803]]

 
27409.................  T..............  ...............  Repair of knee ligaments.....         0051      36.3617    $2,158.07  ...........      $431.61
27412.................  T..............  ...............  Autochondrocyte implant knee.         0042      43.7761    $2,598.11      $804.74      $519.62
27415.................  T..............  ...............  Osteochondral knee allograft.         0042      43.7761    $2,598.11      $804.74      $519.62
27418.................  T..............  ...............  Repair degenerated kneecap...         0051      36.3617    $2,158.07  ...........      $431.61
27420.................  T..............  ...............  Revision of unstable kneecap.         0051      36.3617    $2,158.07  ...........      $431.61
27422.................  T..............  ...............  Revision of unstable kneecap.         0051      36.3617    $2,158.07  ...........      $431.61
27424.................  T..............  ...............  Revision/removal of kneecap..         0051      36.3617    $2,158.07  ...........      $431.61
27425.................  T..............  ...............  Lateral retinacular release..         0050      23.7998    $1,412.52  ...........      $282.50
27427.................  T..............  ...............  Reconstruction, knee.........         0052      43.7388    $2,595.90  ...........      $519.18
27428.................  T..............  ...............  Reconstruction, knee.........         0052      43.7388    $2,595.90  ...........      $519.18
27429.................  T..............  ...............  Reconstruction, knee.........         0052      43.7388    $2,595.90  ...........      $519.18
27430.................  T..............  ...............  Revision of thigh muscles....         0051      36.3617    $2,158.07  ...........      $431.61
27435.................  T..............  ...............  Incision of knee joint.......         0051      36.3617    $2,158.07  ...........      $431.61
27437.................  T..............  ...............  Revise kneecap...............         0047      31.4675    $1,867.60      $537.03      $373.52
27438.................  T..............  ...............  Revise kneecap with implant..         0048      42.9335    $2,548.10      $570.30      $509.62
27440.................  T..............  ...............  Revision of knee joint.......         0047      31.4675    $1,867.60      $537.03      $373.52
27441.................  T..............  ...............  Revision of knee joint.......         0047      31.4675    $1,867.60      $537.03      $373.52
27442.................  T..............  ...............  Revision of knee joint.......         0047      31.4675    $1,867.60      $537.03      $373.52
27443.................  T..............  ...............  Revision of knee joint.......         0047      31.4675    $1,867.60      $537.03      $373.52
27445.................  C..............  ...............  Revision of knee joint.......  ...........  ...........  ...........  ...........  ...........
27446.................  T..............  ...............  Revision of knee joint.......         0681     136.5417    $8,103.75    $2,081.48    $1,620.75
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.................  T..............  ...............  Surgery to stop leg growth...         0050      23.7998    $1,412.52  ...........      $282.50
27477.................  C..............  ...............  Surgery to stop leg growth...  ...........  ...........  ...........  ...........  ...........
27479.................  C..............  ...............  Surgery to stop leg growth...  ...........  ...........  ...........  ...........  ...........
27485.................  C..............  ...............  Surgery to stop leg growth...  ...........  ...........  ...........  ...........  ...........
27486.................  C..............  ...............  Revise/replace knee joint....  ...........  ...........  ...........  ...........  ...........
27487.................  C..............  ...............  Revise/replace knee joint....  ...........  ...........  ...........  ...........  ...........
27488.................  C..............  ...............  Removal of knee prosthesis...  ...........  ...........  ...........  ...........  ...........
27495.................  C..............  ...............  Reinforce thigh..............  ...........  ...........  ...........  ...........  ...........
27496.................  T..............  ...............  Decompression of thigh/knee..         0049      20.2784    $1,203.52  ...........      $240.70
27497.................  T..............  ...............  Decompression of thigh/knee..         0049      20.2784    $1,203.52  ...........      $240.70
27498.................  T..............  ...............  Decompression of thigh/knee..         0049      20.2784    $1,203.52  ...........      $240.70
27499.................  T..............  ...............  Decompression of thigh/knee..         0049      20.2784    $1,203.52  ...........      $240.70
27500.................  T..............  ...............  Treatment of thigh fracture..         0043       1.7614      $104.54  ...........       $20.91
27501.................  T..............  ...............  Treatment of thigh fracture..         0043       1.7614      $104.54  ...........       $20.91
27502.................  T..............  ...............  Treatment of thigh fracture..         0043       1.7614      $104.54  ...........       $20.91
27503.................  T..............  ...............  Treatment of thigh fracture..         0043       1.7614      $104.54  ...........       $20.91
27506.................  C..............  ...............  Treatment of thigh fracture..  ...........  ...........  ...........  ...........  ...........
27507.................  C..............  ...............  Treatment of thigh fracture..  ...........  ...........  ...........  ...........  ...........
27508.................  T..............  ...............  Treatment of thigh fracture..         0043       1.7614      $104.54  ...........       $20.91
27509.................  T..............  ...............  Treatment of thigh fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27510.................  T..............  ...............  Treatment of thigh fracture..         0043       1.7614      $104.54  ...........       $20.91
27511.................  C..............  ...............  Treatment of thigh fracture..  ...........  ...........  ...........  ...........  ...........
27513.................  C..............  ...............  Treatment of thigh fracture..  ...........  ...........  ...........  ...........  ...........
27514.................  C..............  ...............  Treatment of thigh fracture..  ...........  ...........  ...........  ...........  ...........
27516.................  T..............  ...............  Treat thigh fx growth plate..         0043       1.7614      $104.54  ...........       $20.91
27517.................  T..............  ...............  Treat thigh fx growth plate..         0043       1.7614      $104.54  ...........       $20.91
27519.................  C..............  ...............  Treat thigh fx growth plate..  ...........  ...........  ...........  ...........  ...........
27520.................  T..............  ...............  Treat kneecap fracture.......         0043       1.7614      $104.54  ...........       $20.91
27524.................  T..............  ...............  Treat kneecap fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
27530.................  T..............  ...............  Treat knee fracture..........         0043       1.7614      $104.54  ...........       $20.91
27532.................  T..............  ...............  Treat knee fracture..........         0043       1.7614      $104.54  ...........       $20.91
27535.................  C..............  ...............  Treat knee fracture..........  ...........  ...........  ...........  ...........  ...........
27536.................  C..............  ...............  Treat knee fracture..........  ...........  ...........  ...........  ...........  ...........
27538.................  T..............  ...............  Treat knee fracture(s).......         0043       1.7614      $104.54  ...........       $20.91

[[Page 42804]]

 
27540.................  C..............  ...............  Treat knee fracture..........  ...........  ...........  ...........  ...........  ...........
27550.................  T..............  ...............  Treat knee dislocation.......         0043       1.7614      $104.54  ...........       $20.91
27552.................  T..............  ...............  Treat knee dislocation.......         0045      14.4289      $856.36      $268.47      $171.27
27556.................  C..............  ...............  Treat knee dislocation.......  ...........  ...........  ...........  ...........  ...........
27557.................  C..............  ...............  Treat knee dislocation.......  ...........  ...........  ...........  ...........  ...........
27558.................  C..............  ...............  Treat knee dislocation.......  ...........  ...........  ...........  ...........  ...........
27560.................  T..............  ...............  Treat kneecap dislocation....         0043       1.7614      $104.54  ...........       $20.91
27562.................  T..............  ...............  Treat kneecap dislocation....         0045      14.4289      $856.36      $268.47      $171.27
27566.................  T..............  ...............  Treat kneecap dislocation....         0046      37.5315    $2,227.49      $535.76      $445.50
27570.................  T..............  ...............  Fixation of knee joint.......         0045      14.4289      $856.36      $268.47      $171.27
27580.................  C..............  ...............  Fusion of knee...............  ...........  ...........  ...........  ...........  ...........
27590.................  C..............  ...............  Amputate leg at thigh........  ...........  ...........  ...........  ...........  ...........
27591.................  C..............  ...............  Amputate leg at thigh........  ...........  ...........  ...........  ...........  ...........
27592.................  C..............  ...............  Amputate leg at thigh........  ...........  ...........  ...........  ...........  ...........
27594.................  T..............  ...............  Amputation follow-up surgery.         0049      20.2784    $1,203.52  ...........      $240.70
27596.................  C..............  ...............  Amputation follow-up surgery.  ...........  ...........  ...........  ...........  ...........
27598.................  C..............  ...............  Amputate lower leg at knee...  ...........  ...........  ...........  ...........  ...........
27599.................  T..............  ...............  Leg surgery procedure........         0043       1.7614      $104.54  ...........       $20.91
27600.................  T..............  ...............  Decompression of lower leg...         0049      20.2784    $1,203.52  ...........      $240.70
27601.................  T..............  ...............  Decompression of lower leg...         0049      20.2784    $1,203.52  ...........      $240.70
27602.................  T..............  ...............  Decompression of lower leg...         0049      20.2784    $1,203.52  ...........      $240.70
27603.................  T..............  ...............  Drain lower leg lesion.......         0008      16.4242      $974.78  ...........      $194.96
27604.................  T..............  ...............  Drain lower leg bursa........         0049      20.2784    $1,203.52  ...........      $240.70
27605.................  T..............  ...............  Incision of achilles tendon..         0055      19.9783    $1,185.71      $355.34      $237.14
27606.................  T..............  ...............  Incision of achilles tendon..         0049      20.2784    $1,203.52  ...........      $240.70
27607.................  T..............  ...............  Treat lower leg bone lesion..         0049      20.2784    $1,203.52  ...........      $240.70
27610.................  T..............  ...............  Explore/treat ankle joint....         0050      23.7998    $1,412.52  ...........      $282.50
27612.................  T..............  ...............  Exploration of ankle joint...         0050      23.7998    $1,412.52  ...........      $282.50
27613.................  T..............  ...............  Biopsy lower leg soft tissue.         0020       6.9118      $410.22      $106.93       $82.04
27614.................  T..............  ...............  Biopsy lower leg soft tissue.         0022      19.5582    $1,160.78      $354.45      $232.16
27615.................  T..............  ...............  Remove tumor, lower leg......         0046      37.5315    $2,227.49      $535.76      $445.50
27618.................  T..............  ...............  Remove lower leg lesion......         0021      14.9098      $884.90      $219.48      $176.98
27619.................  T..............  ...............  Remove lower leg lesion......         0022      19.5582    $1,160.78      $354.45      $232.16
27620.................  T..............  ...............  Explore/treat ankle joint....         0050      23.7998    $1,412.52  ...........      $282.50
27625.................  T..............  ...............  Remove ankle joint lining....         0050      23.7998    $1,412.52  ...........      $282.50
27626.................  T..............  ...............  Remove ankle joint lining....         0050      23.7998    $1,412.52  ...........      $282.50
27630.................  T..............  ...............  Removal of tendon lesion.....         0049      20.2784    $1,203.52  ...........      $240.70
27635.................  T..............  ...............  Remove lower leg bone lesion.         0050      23.7998    $1,412.52  ...........      $282.50
27637.................  T..............  ...............  Remove/graft leg bone lesion.         0050      23.7998    $1,412.52  ...........      $282.50
27638.................  T..............  ...............  Remove/graft leg bone lesion.         0050      23.7998    $1,412.52  ...........      $282.50
27640.................  T..............  ...............  Partial removal of tibia.....         0051      36.3617    $2,158.07  ...........      $431.61
27641.................  T..............  ...............  Partial removal of fibula....         0050      23.7998    $1,412.52  ...........      $282.50
27645.................  C..............  ...............  Extensive lower leg surgery..  ...........  ...........  ...........  ...........  ...........
27646.................  C..............  ...............  Extensive lower leg surgery..  ...........  ...........  ...........  ...........  ...........
27647.................  T..............  ...............  Extensive ankle/heel surgery.         0051      36.3617    $2,158.07  ...........      $431.61
27648.................  N..............  ...............  Injection for ankle x-ray....  ...........  ...........  ...........  ...........  ...........
27650.................  T..............  ...............  Repair achilles tendon.......         0051      36.3617    $2,158.07  ...........      $431.61
27652.................  T..............  ...............  Repair/graft achilles tendon.         0051      36.3617    $2,158.07  ...........      $431.61
27654.................  T..............  ...............  Repair of achilles tendon....         0051      36.3617    $2,158.07  ...........      $431.61
27656.................  T..............  ...............  Repair leg fascia defect.....         0049      20.2784    $1,203.52  ...........      $240.70
27658.................  T..............  ...............  Repair of leg tendon, each...         0049      20.2784    $1,203.52  ...........      $240.70
27659.................  T..............  ...............  Repair of leg tendon, each...         0049      20.2784    $1,203.52  ...........      $240.70
27664.................  T..............  ...............  Repair of leg tendon, each...         0049      20.2784    $1,203.52  ...........      $240.70
27665.................  T..............  ...............  Repair of leg tendon, each...         0050      23.7998    $1,412.52  ...........      $282.50
27675.................  T..............  ...............  Repair lower leg tendons.....         0049      20.2784    $1,203.52  ...........      $240.70
27676.................  T..............  ...............  Repair lower leg tendons.....         0050      23.7998    $1,412.52  ...........      $282.50
27680.................  T..............  ...............  Release of lower leg tendon..         0050      23.7998    $1,412.52  ...........      $282.50
27681.................  T..............  ...............  Release of lower leg tendons.         0050      23.7998    $1,412.52  ...........      $282.50
27685.................  T..............  ...............  Revision of lower leg tendon.         0050      23.7998    $1,412.52  ...........      $282.50
27686.................  T..............  ...............  Revise lower leg tendons.....         0050      23.7998    $1,412.52  ...........      $282.50
27687.................  T..............  ...............  Revision of calf tendon......         0050      23.7998    $1,412.52  ...........      $282.50
27690.................  T..............  ...............  Revise lower leg tendon......         0051      36.3617    $2,158.07  ...........      $431.61
27691.................  T..............  ...............  Revise lower leg tendon......         0051      36.3617    $2,158.07  ...........      $431.61
27692.................  T..............  ...............  Revise additional leg tendon.         0051      36.3617    $2,158.07  ...........      $431.61
27695.................  T..............  ...............  Repair of ankle ligament.....         0050      23.7998    $1,412.52  ...........      $282.50
27696.................  T..............  ...............  Repair of ankle ligaments....         0050      23.7998    $1,412.52  ...........      $282.50

[[Page 42805]]

 
27698.................  T..............  ...............  Repair of ankle ligament.....         0050      23.7998    $1,412.52  ...........      $282.50
27700.................  T..............  ...............  Revision of ankle joint......         0047      31.4675    $1,867.60      $537.03      $373.52
27702.................  C..............  ...............  Reconstruct ankle joint......  ...........  ...........  ...........  ...........  ...........
27703.................  C..............  ...............  Reconstruction, ankle joint..  ...........  ...........  ...........  ...........  ...........
27704.................  T..............  ...............  Removal of ankle implant.....         0049      20.2784    $1,203.52  ...........      $240.70
27705.................  T..............  ...............  Incision of tibia............         0051      36.3617    $2,158.07  ...........      $431.61
27707.................  T..............  ...............  Incision of fibula...........         0049      20.2784    $1,203.52  ...........      $240.70
27709.................  T..............  ...............  Incision of tibia & fibula...         0050      23.7998    $1,412.52  ...........      $282.50
27712.................  C..............  ...............  Realignment of lower leg.....  ...........  ...........  ...........  ...........  ...........
27715.................  C..............  ...............  Revision of lower leg........  ...........  ...........  ...........  ...........  ...........
27720.................  C..............  ...............  Repair of tibia..............  ...........  ...........  ...........  ...........  ...........
27722.................  C..............  ...............  Repair/graft of tibia........  ...........  ...........  ...........  ...........  ...........
27724.................  C..............  ...............  Repair/graft of tibia........  ...........  ...........  ...........  ...........  ...........
27725.................  C..............  ...............  Repair of lower leg..........  ...........  ...........  ...........  ...........  ...........
27727.................  C..............  ...............  Repair of lower leg..........  ...........  ...........  ...........  ...........  ...........
27730.................  T..............  ...............  Repair of tibia epiphysis....         0050      23.7998    $1,412.52  ...........      $282.50
27732.................  T..............  ...............  Repair of fibula epiphysis...         0050      23.7998    $1,412.52  ...........      $282.50
27734.................  T..............  ...............  Repair lower leg epiphyses...         0050      23.7998    $1,412.52  ...........      $282.50
27740.................  T..............  ...............  Repair of leg epiphyses......         0050      23.7998    $1,412.52  ...........      $282.50
27742.................  T..............  ...............  Repair of leg epiphyses......         0051      36.3617    $2,158.07  ...........      $431.61
27745.................  T..............  ...............  Reinforce tibia..............         0051      36.3617    $2,158.07  ...........      $431.61
27750.................  T..............  ...............  Treatment of tibia fracture..         0043       1.7614      $104.54  ...........       $20.91
27752.................  T..............  ...............  Treatment of tibia fracture..         0043       1.7614      $104.54  ...........       $20.91
27756.................  T..............  ...............  Treatment of tibia fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27758.................  T..............  ...............  Treatment of tibia fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27759.................  T..............  ...............  Treatment of tibia fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27760.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
27762.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
27766.................  T..............  ...............  Treatment of ankle fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27780.................  T..............  ...............  Treatment of fibula fracture.         0043       1.7614      $104.54  ...........       $20.91
27781.................  T..............  ...............  Treatment of fibula fracture.         0043       1.7614      $104.54  ...........       $20.91
27784.................  T..............  ...............  Treatment of fibula fracture.         0046      37.5315    $2,227.49      $535.76      $445.50
27786.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
27788.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
27792.................  T..............  ...............  Treatment of ankle fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27808.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
27810.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
27814.................  T..............  ...............  Treatment of ankle fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27816.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
27818.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
27822.................  T..............  ...............  Treatment of ankle fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27823.................  T..............  ...............  Treatment of ankle fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
27824.................  T..............  ...............  Treat lower leg fracture.....         0043       1.7614      $104.54  ...........       $20.91
27825.................  T..............  ...............  Treat lower leg fracture.....         0043       1.7614      $104.54  ...........       $20.91
27826.................  T..............  ...............  Treat lower leg fracture.....         0046      37.5315    $2,227.49      $535.76      $445.50
27827.................  T..............  ...............  Treat lower leg fracture.....         0046      37.5315    $2,227.49      $535.76      $445.50
27828.................  T..............  ...............  Treat lower leg fracture.....         0046      37.5315    $2,227.49      $535.76      $445.50
27829.................  T..............  ...............  Treat lower leg joint........         0046      37.5315    $2,227.49      $535.76      $445.50
27830.................  T..............  ...............  Treat lower leg dislocation..         0043       1.7614      $104.54  ...........       $20.91
27831.................  T..............  ...............  Treat lower leg dislocation..         0043       1.7614      $104.54  ...........       $20.91
27832.................  T..............  ...............  Treat lower leg dislocation..         0046      37.5315    $2,227.49      $535.76      $445.50
27840.................  T..............  ...............  Treat ankle dislocation......         0043       1.7614      $104.54  ...........       $20.91
27842.................  T..............  ...............  Treat ankle dislocation......         0045      14.4289      $856.36      $268.47      $171.27
27846.................  T..............  ...............  Treat ankle dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
27848.................  T..............  ...............  Treat ankle dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
27860.................  T..............  ...............  Fixation of ankle joint......         0045      14.4289      $856.36      $268.47      $171.27
27870.................  T..............  ...............  Fusion of ankle joint........         0051      36.3617    $2,158.07  ...........      $431.61
27871.................  T..............  ...............  Fusion of tibiofibular joint.         0051      36.3617    $2,158.07  ...........      $431.61
27880.................  C..............  ...............  Amputation of lower leg......  ...........  ...........  ...........  ...........  ...........
27881.................  C..............  ...............  Amputation of lower leg......  ...........  ...........  ...........  ...........  ...........
27882.................  C..............  ...............  Amputation of lower leg......  ...........  ...........  ...........  ...........  ...........
27884.................  T..............  ...............  Amputation follow-up surgery.         0049      20.2784    $1,203.52  ...........      $240.70
27886.................  C..............  ...............  Amputation follow-up surgery.  ...........  ...........  ...........  ...........  ...........
27888.................  C..............  ...............  Amputation of foot at ankle..  ...........  ...........  ...........  ...........  ...........
27889.................  T..............  ...............  Amputation of foot at ankle..         0050      23.7998    $1,412.52  ...........      $282.50
27892.................  T..............  ...............  Decompression of leg.........         0049      20.2784    $1,203.52  ...........      $240.70

[[Page 42806]]

 
27893.................  T..............  ...............  Decompression of leg.........         0049      20.2784    $1,203.52  ...........      $240.70
27894.................  T..............  ...............  Decompression of leg.........         0049      20.2784    $1,203.52  ...........      $240.70
27899.................  T..............  ...............  Leg/ankle surgery procedure..         0043       1.7614      $104.54  ...........       $20.91
28001.................  T..............  ...............  Drainage of bursa of foot....         0007      11.3983      $676.49  ...........      $135.30
28002.................  T..............  ...............  Treatment of foot infection..         0049      20.2784    $1,203.52  ...........      $240.70
28003.................  T..............  ...............  Treatment of foot infection..         0049      20.2784    $1,203.52  ...........      $240.70
28005.................  T..............  ...............  Treat foot bone lesion.......         0055      19.9783    $1,185.71      $355.34      $237.14
28008.................  T..............  ...............  Incision of foot fascia......         0055      19.9783    $1,185.71      $355.34      $237.14
28010.................  T..............  ...............  Incision of toe tendon.......         0055      19.9783    $1,185.71      $355.34      $237.14
28011.................  T..............  ...............  Incision of toe tendons......         0055      19.9783    $1,185.71      $355.34      $237.14
28020.................  T..............  ...............  Exploration of foot joint....         0055      19.9783    $1,185.71      $355.34      $237.14
28022.................  T..............  ...............  Exploration of foot joint....         0055      19.9783    $1,185.71      $355.34      $237.14
28024.................  T..............  ...............  Exploration of toe joint.....         0055      19.9783    $1,185.71      $355.34      $237.14
28030.................  T..............  ...............  Removal of foot nerve........         0220      17.2800    $1,025.57  ...........      $205.11
28035.................  T..............  ...............  Decompression of tibia nerve.         0220      17.2800    $1,025.57  ...........      $205.11
28043.................  T..............  ...............  Excision of foot lesion......         0021      14.9098      $884.90      $219.48      $176.98
28045.................  T..............  ...............  Excision of foot lesion......         0055      19.9783    $1,185.71      $355.34      $237.14
28046.................  T..............  ...............  Resection of tumor, foot.....         0055      19.9783    $1,185.71      $355.34      $237.14
28050.................  T..............  ...............  Biopsy of foot joint lining..         0055      19.9783    $1,185.71      $355.34      $237.14
28052.................  T..............  ...............  Biopsy of foot joint lining..         0055      19.9783    $1,185.71      $355.34      $237.14
28054.................  T..............  ...............  Biopsy of toe joint lining...         0055      19.9783    $1,185.71      $355.34      $237.14
28060.................  T..............  ...............  Partial removal, foot fascia.         0055      19.9783    $1,185.71      $355.34      $237.14
28062.................  T..............  ...............  Removal of foot fascia.......         0055      19.9783    $1,185.71      $355.34      $237.14
28070.................  T..............  ...............  Removal of foot joint lining.         0055      19.9783    $1,185.71      $355.34      $237.14
28072.................  T..............  ...............  Removal of foot joint lining.         0055      19.9783    $1,185.71      $355.34      $237.14
28080.................  T..............  ...............  Removal of foot lesion.......         0055      19.9783    $1,185.71      $355.34      $237.14
28086.................  T..............  ...............  Excise foot tendon sheath....         0055      19.9783    $1,185.71      $355.34      $237.14
28088.................  T..............  ...............  Excise foot tendon sheath....         0055      19.9783    $1,185.71      $355.34      $237.14
28090.................  T..............  ...............  Removal of foot lesion.......         0055      19.9783    $1,185.71      $355.34      $237.14
28092.................  T..............  ...............  Removal of toe lesions.......         0055      19.9783    $1,185.71      $355.34      $237.14
28100.................  T..............  ...............  Removal of ankle/heel lesion.         0055      19.9783    $1,185.71      $355.34      $237.14
28102.................  T..............  ...............  Remove/graft foot lesion.....         0056      40.1132    $2,380.72  ...........      $476.14
28103.................  T..............  ...............  Remove/graft foot lesion.....         0056      40.1132    $2,380.72  ...........      $476.14
28104.................  T..............  ...............  Removal of foot lesion.......         0055      19.9783    $1,185.71      $355.34      $237.14
28106.................  T..............  ...............  Remove/graft foot lesion.....         0056      40.1132    $2,380.72  ...........      $476.14
28107.................  T..............  ...............  Remove/graft foot lesion.....         0056      40.1132    $2,380.72  ...........      $476.14
28108.................  T..............  ...............  Removal of toe lesions.......         0055      19.9783    $1,185.71      $355.34      $237.14
28110.................  T..............  ...............  Part removal of metatarsal...         0055      19.9783    $1,185.71      $355.34      $237.14
28111.................  T..............  ...............  Part removal of metatarsal...         0055      19.9783    $1,185.71      $355.34      $237.14
28112.................  T..............  ...............  Part removal of metatarsal...         0055      19.9783    $1,185.71      $355.34      $237.14
28113.................  T..............  ...............  Part removal of metatarsal...         0055      19.9783    $1,185.71      $355.34      $237.14
28114.................  T..............  ...............  Removal of metatarsal heads..         0055      19.9783    $1,185.71      $355.34      $237.14
28116.................  T..............  ...............  Revision of foot.............         0055      19.9783    $1,185.71      $355.34      $237.14
28118.................  T..............  ...............  Removal of heel bone.........         0055      19.9783    $1,185.71      $355.34      $237.14
28119.................  T..............  ...............  Removal of heel spur.........         0055      19.9783    $1,185.71      $355.34      $237.14
28120.................  T..............  ...............  Part removal of ankle/heel...         0055      19.9783    $1,185.71      $355.34      $237.14
28122.................  T..............  ...............  Partial removal of foot bone.         0055      19.9783    $1,185.71      $355.34      $237.14
28124.................  T..............  ...............  Partial removal of toe.......         0055      19.9783    $1,185.71      $355.34      $237.14
28126.................  T..............  ...............  Partial removal of toe.......         0055      19.9783    $1,185.71      $355.34      $237.14
28130.................  T..............  ...............  Removal of ankle bone........         0055      19.9783    $1,185.71      $355.34      $237.14
28140.................  T..............  ...............  Removal of metatarsal........         0055      19.9783    $1,185.71      $355.34      $237.14
28150.................  T..............  ...............  Removal of toe...............         0055      19.9783    $1,185.71      $355.34      $237.14
28153.................  T..............  ...............  Partial removal of toe.......         0055      19.9783    $1,185.71      $355.34      $237.14
28160.................  T..............  ...............  Partial removal of toe.......         0055      19.9783    $1,185.71      $355.34      $237.14
28171.................  T..............  ...............  Extensive foot surgery.......         0055      19.9783    $1,185.71      $355.34      $237.14
28173.................  T..............  ...............  Extensive foot surgery.......         0055      19.9783    $1,185.71      $355.34      $237.14
28175.................  T..............  ...............  Extensive foot surgery.......         0055      19.9783    $1,185.71      $355.34      $237.14
28190.................  T..............  ...............  Removal of foot foreign body.         0019       4.0363      $239.55       $71.87       $47.91
28192.................  T..............  ...............  Removal of foot foreign body.         0021      14.9098      $884.90      $219.48      $176.98
28193.................  T..............  ...............  Removal of foot foreign body.         0020       6.9118      $410.22      $106.93       $82.04
28200.................  T..............  ...............  Repair of foot tendon........         0055      19.9783    $1,185.71      $355.34      $237.14
28202.................  T..............  ...............  Repair/graft of foot tendon..         0055      19.9783    $1,185.71      $355.34      $237.14
28208.................  T..............  ...............  Repair of foot tendon........         0055      19.9783    $1,185.71      $355.34      $237.14
28210.................  T..............  ...............  Repair/graft of foot tendon..         0056      40.1132    $2,380.72  ...........      $476.14
28220.................  T..............  ...............  Release of foot tendon.......         0055      19.9783    $1,185.71      $355.34      $237.14
28222.................  T..............  ...............  Release of foot tendons......         0055      19.9783    $1,185.71      $355.34      $237.14

[[Page 42807]]

 
28225.................  T..............  ...............  Release of foot tendon.......         0055      19.9783    $1,185.71      $355.34      $237.14
28226.................  T..............  ...............  Release of foot tendons......         0055      19.9783    $1,185.71      $355.34      $237.14
28230.................  T..............  ...............  Incision of foot tendon(s)...         0055      19.9783    $1,185.71      $355.34      $237.14
28232.................  T..............  ...............  Incision of toe tendon.......         0055      19.9783    $1,185.71      $355.34      $237.14
28234.................  T..............  ...............  Incision of foot tendon......         0055      19.9783    $1,185.71      $355.34      $237.14
28238.................  T..............  ...............  Revision of foot tendon......         0056      40.1132    $2,380.72  ...........      $476.14
28240.................  T..............  ...............  Release of big toe...........         0055      19.9783    $1,185.71      $355.34      $237.14
28250.................  T..............  ...............  Revision of foot fascia......         0055      19.9783    $1,185.71      $355.34      $237.14
28260.................  T..............  ...............  Release of midfoot joint.....         0055      19.9783    $1,185.71      $355.34      $237.14
28261.................  T..............  ...............  Revision of foot tendon......         0055      19.9783    $1,185.71      $355.34      $237.14
28262.................  T..............  ...............  Revision of foot and ankle...         0055      19.9783    $1,185.71      $355.34      $237.14
28264.................  T..............  ...............  Release of midfoot joint.....         0056      40.1132    $2,380.72  ...........      $476.14
28270.................  T..............  ...............  Release of foot contracture..         0055      19.9783    $1,185.71      $355.34      $237.14
28272.................  T..............  ...............  Release of toe joint, each...         0055      19.9783    $1,185.71      $355.34      $237.14
28280.................  T..............  ...............  Fusion of toes...............         0055      19.9783    $1,185.71      $355.34      $237.14
28285.................  T..............  ...............  Repair of hammertoe..........         0055      19.9783    $1,185.71      $355.34      $237.14
28286.................  T..............  ...............  Repair of hammertoe..........         0055      19.9783    $1,185.71      $355.34      $237.14
28288.................  T..............  ...............  Partial removal of foot bone.         0055      19.9783    $1,185.71      $355.34      $237.14
28289.................  T..............  ...............  Repair hallux rigidus........         0055      19.9783    $1,185.71      $355.34      $237.14
28290.................  T..............  ...............  Correction of bunion.........         0057      27.4246    $1,627.65      $475.91      $325.53
28292.................  T..............  ...............  Correction of bunion.........         0057      27.4246    $1,627.65      $475.91      $325.53
28293.................  T..............  ...............  Correction of bunion.........         0057      27.4246    $1,627.65      $475.91      $325.53
28294.................  T..............  ...............  Correction of bunion.........         0057      27.4246    $1,627.65      $475.91      $325.53
28296.................  T..............  ...............  Correction of bunion.........         0057      27.4246    $1,627.65      $475.91      $325.53
28297.................  T..............  ...............  Correction of bunion.........         0057      27.4246    $1,627.65      $475.91      $325.53
28298.................  T..............  ...............  Correction of bunion.........         0057      27.4246    $1,627.65      $475.91      $325.53
28299.................  T..............  ...............  Correction of bunion.........         0057      27.4246    $1,627.65      $475.91      $325.53
28300.................  T..............  ...............  Incision of heel bone........         0056      40.1132    $2,380.72  ...........      $476.14
28302.................  T..............  ...............  Incision of ankle bone.......         0055      19.9783    $1,185.71      $355.34      $237.14
28304.................  T..............  ...............  Incision of midfoot bones....         0056      40.1132    $2,380.72  ...........      $476.14
28305.................  T..............  ...............  Incise/graft midfoot bones...         0056      40.1132    $2,380.72  ...........      $476.14
28306.................  T..............  ...............  Incision of metatarsal.......         0055      19.9783    $1,185.71      $355.34      $237.14
28307.................  T..............  ...............  Incision of metatarsal.......         0055      19.9783    $1,185.71      $355.34      $237.14
28308.................  T..............  ...............  Incision of metatarsal.......         0055      19.9783    $1,185.71      $355.34      $237.14
28309.................  T..............  ...............  Incision of metatarsals......         0056      40.1132    $2,380.72  ...........      $476.14
28310.................  T..............  ...............  Revision of big toe..........         0055      19.9783    $1,185.71      $355.34      $237.14
28312.................  T..............  ...............  Revision of toe..............         0055      19.9783    $1,185.71      $355.34      $237.14
28313.................  T..............  ...............  Repair deformity of toe......         0055      19.9783    $1,185.71      $355.34      $237.14
28315.................  T..............  ...............  Removal of sesamoid bone.....         0055      19.9783    $1,185.71      $355.34      $237.14
28320.................  T..............  ...............  Repair of foot bones.........         0056      40.1132    $2,380.72  ...........      $476.14
28322.................  T..............  ...............  Repair of metatarsals........         0056      40.1132    $2,380.72  ...........      $476.14
28340.................  T..............  ...............  Resect enlarged toe tissue...         0055      19.9783    $1,185.71      $355.34      $237.14
28341.................  T..............  ...............  Resect enlarged toe..........         0055      19.9783    $1,185.71      $355.34      $237.14
28344.................  T..............  ...............  Repair extra toe(s)..........         0055      19.9783    $1,185.71      $355.34      $237.14
28345.................  T..............  ...............  Repair webbed toe(s).........         0055      19.9783    $1,185.71      $355.34      $237.14
28360.................  T..............  ...............  Reconstruct cleft foot.......         0056      40.1132    $2,380.72  ...........      $476.14
28400.................  T..............  ...............  Treatment of heel fracture...         0043       1.7614      $104.54  ...........       $20.91
28405.................  T..............  ...............  Treatment of heel fracture...         0043       1.7614      $104.54  ...........       $20.91
28406.................  T..............  ...............  Treatment of heel fracture...         0046      37.5315    $2,227.49      $535.76      $445.50
28415.................  T..............  ...............  Treat heel fracture..........         0046      37.5315    $2,227.49      $535.76      $445.50
28420.................  T..............  ...............  Treat/graft heel fracture....         0046      37.5315    $2,227.49      $535.76      $445.50
28430.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
28435.................  T..............  ...............  Treatment of ankle fracture..         0043       1.7614      $104.54  ...........       $20.91
28436.................  T..............  ...............  Treatment of ankle fracture..         0046      37.5315    $2,227.49      $535.76      $445.50
28445.................  T..............  ...............  Treat ankle fracture.........         0046      37.5315    $2,227.49      $535.76      $445.50
28450.................  T..............  ...............  Treat midfoot fracture, each.         0043       1.7614      $104.54  ...........       $20.91
28455.................  T..............  ...............  Treat midfoot fracture, each.         0043       1.7614      $104.54  ...........       $20.91
28456.................  T..............  ...............  Treat midfoot fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
28465.................  T..............  ...............  Treat midfoot fracture, each.         0046      37.5315    $2,227.49      $535.76      $445.50
28470.................  T..............  ...............  Treat metatarsal fracture....         0043       1.7614      $104.54  ...........       $20.91
28475.................  T..............  ...............  Treat metatarsal fracture....         0043       1.7614      $104.54  ...........       $20.91
28476.................  T..............  ...............  Treat metatarsal fracture....         0046      37.5315    $2,227.49      $535.76      $445.50
28485.................  T..............  ...............  Treat metatarsal fracture....         0046      37.5315    $2,227.49      $535.76      $445.50
28490.................  T..............  ...............  Treat big toe fracture.......         0043       1.7614      $104.54  ...........       $20.91
28495.................  T..............  ...............  Treat big toe fracture.......         0043       1.7614      $104.54  ...........       $20.91
28496.................  T..............  ...............  Treat big toe fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50

[[Page 42808]]

 
28505.................  T..............  ...............  Treat big toe fracture.......         0046      37.5315    $2,227.49      $535.76      $445.50
28510.................  T..............  ...............  Treatment of toe fracture....         0043       1.7614      $104.54  ...........       $20.91
28515.................  T..............  ...............  Treatment of toe fracture....         0043       1.7614      $104.54  ...........       $20.91
28525.................  T..............  ...............  Treat toe fracture...........         0046      37.5315    $2,227.49      $535.76      $445.50
28530.................  T..............  ...............  Treat sesamoid bone fracture.         0043       1.7614      $104.54  ...........       $20.91
28531.................  T..............  ...............  Treat sesamoid bone fracture.         0046      37.5315    $2,227.49      $535.76      $445.50
28540.................  T..............  ...............  Treat foot dislocation.......         0043       1.7614      $104.54  ...........       $20.91
28545.................  T..............  ...............  Treat foot dislocation.......         0045      14.4289      $856.36      $268.47      $171.27
28546.................  T..............  ...............  Treat foot dislocation.......         0046      37.5315    $2,227.49      $535.76      $445.50
28555.................  T..............  ...............  Repair foot dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
28570.................  T..............  ...............  Treat foot dislocation.......         0043       1.7614      $104.54  ...........       $20.91
28575.................  T..............  ...............  Treat foot dislocation.......         0043       1.7614      $104.54  ...........       $20.91
28576.................  T..............  ...............  Treat foot dislocation.......         0046      37.5315    $2,227.49      $535.76      $445.50
28585.................  T..............  ...............  Repair foot dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
28600.................  T..............  ...............  Treat foot dislocation.......         0043       1.7614      $104.54  ...........       $20.91
28605.................  T..............  ...............  Treat foot dislocation.......         0043       1.7614      $104.54  ...........       $20.91
28606.................  T..............  ...............  Treat foot dislocation.......         0046      37.5315    $2,227.49      $535.76      $445.50
28615.................  T..............  ...............  Repair foot dislocation......         0046      37.5315    $2,227.49      $535.76      $445.50
28630.................  T..............  ...............  Treat toe dislocation........         0043       1.7614      $104.54  ...........       $20.91
28635.................  T..............  ...............  Treat toe dislocation........         0045      14.4289      $856.36      $268.47      $171.27
28636.................  T..............  ...............  Treat toe dislocation........         0046      37.5315    $2,227.49      $535.76      $445.50
28645.................  T..............  ...............  Repair toe dislocation.......         0046      37.5315    $2,227.49      $535.76      $445.50
28660.................  T..............  ...............  Treat toe dislocation........         0043       1.7614      $104.54  ...........       $20.91
28665.................  T..............  ...............  Treat toe dislocation........         0045      14.4289      $856.36      $268.47      $171.27
28666.................  T..............  ...............  Treat toe dislocation........         0046      37.5315    $2,227.49      $535.76      $445.50
28675.................  T..............  ...............  Repair of toe dislocation....         0046      37.5315    $2,227.49      $535.76      $445.50
28705.................  T..............  ...............  Fusion of foot bones.........         0056      40.1132    $2,380.72  ...........      $476.14
28715.................  T..............  ...............  Fusion of foot bones.........         0056      40.1132    $2,380.72  ...........      $476.14
28725.................  T..............  ...............  Fusion of foot bones.........         0056      40.1132    $2,380.72  ...........      $476.14
28730.................  T..............  ...............  Fusion of foot bones.........         0056      40.1132    $2,380.72  ...........      $476.14
28735.................  T..............  ...............  Fusion of foot bones.........         0056      40.1132    $2,380.72  ...........      $476.14
28737.................  T..............  ...............  Revision of foot bones.......         0056      40.1132    $2,380.72  ...........      $476.14
28740.................  T..............  ...............  Fusion of foot bones.........         0056      40.1132    $2,380.72  ...........      $476.14
28750.................  T..............  ...............  Fusion of big toe joint......         0056      40.1132    $2,380.72  ...........      $476.14
28755.................  T..............  ...............  Fusion of big toe joint......         0055      19.9783    $1,185.71      $355.34      $237.14
28760.................  T..............  ...............  Fusion of big toe joint......         0056      40.1132    $2,380.72  ...........      $476.14
28800.................  C..............  ...............  Amputation of midfoot........  ...........  ...........  ...........  ...........  ...........
28805.................  C..............  ...............  Amputation thru metatarsal...  ...........  ...........  ...........  ...........  ...........
28810.................  T..............  ...............  Amputation toe & metatarsal..         0055      19.9783    $1,185.71      $355.34      $237.14
28820.................  T..............  ...............  Amputation of toe............         0055      19.9783    $1,185.71      $355.34      $237.14
28825.................  T..............  ...............  Partial amputation of toe....         0055      19.9783    $1,185.71      $355.34      $237.14
28899.................  T..............  ...............  Foot/toes surgery procedure..         0043       1.7614      $104.54  ...........       $20.91
29000.................  S..............  ...............  Application of body cast.....         0058       1.0884       $64.60  ...........       $12.92
29010.................  S..............  ...............  Application of body cast.....         0426       2.1147      $125.51  ...........       $25.10
29015.................  S..............  ...............  Application of body cast.....         0426       2.1147      $125.51  ...........       $25.10
29020.................  S..............  ...............  Application of body cast.....         0058       1.0884       $64.60  ...........       $12.92
29025.................  S..............  ...............  Application of body cast.....         0058       1.0884       $64.60  ...........       $12.92
29035.................  S..............  ...............  Application of body cast.....         0426       2.1147      $125.51  ...........       $25.10
29040.................  S..............  ...............  Application of body cast.....         0058       1.0884       $64.60  ...........       $12.92
29044.................  S..............  ...............  Application of body cast.....         0426       2.1147      $125.51  ...........       $25.10
29046.................  S..............  ...............  Application of body cast.....         0426       2.1147      $125.51  ...........       $25.10
29049.................  S..............  ...............  Application of figure eight..         0058       1.0884       $64.60  ...........       $12.92
29055.................  S..............  ...............  Application of shoulder cast.         0426       2.1147      $125.51  ...........       $25.10
29058.................  S..............  ...............  Application of shoulder cast.         0058       1.0884       $64.60  ...........       $12.92
29065.................  S..............  ...............  Application of long arm cast.         0426       2.1147      $125.51  ...........       $25.10
29075.................  S..............  ...............  Application of forearm cast..         0426       2.1147      $125.51  ...........       $25.10
29085.................  S..............  ...............  Apply hand/wrist cast........         0058       1.0884       $64.60  ...........       $12.92
29086.................  S..............  ...............  Apply finger cast............         0058       1.0884       $64.60  ...........       $12.92
29105.................  S..............  ...............  Apply long arm splint........         0058       1.0884       $64.60  ...........       $12.92
29125.................  S..............  ...............  Apply forearm splint.........         0058       1.0884       $64.60  ...........       $12.92
29126.................  S..............  ...............  Apply forearm splint.........         0058       1.0884       $64.60  ...........       $12.92
29130.................  S..............  ...............  Application of finger splint.         0058       1.0884       $64.60  ...........       $12.92
29131.................  S..............  ...............  Application of finger splint.         0058       1.0884       $64.60  ...........       $12.92
29200.................  S..............  ...............  Strapping of chest...........         0058       1.0884       $64.60  ...........       $12.92
29220.................  S..............  ...............  Strapping of low back........         0058       1.0884       $64.60  ...........       $12.92
29240.................  S..............  ...............  Strapping of shoulder........         0058       1.0884       $64.60  ...........       $12.92

[[Page 42809]]

 
29260.................  S..............  ...............  Strapping of elbow or wrist..         0058       1.0884       $64.60  ...........       $12.92
29280.................  S..............  ...............  Strapping of hand or finger..         0058       1.0884       $64.60  ...........       $12.92
29305.................  S..............  ...............  Application of hip cast......         0426       2.1147      $125.51  ...........       $25.10
29325.................  S..............  ...............  Application of hip casts.....         0426       2.1147      $125.51  ...........       $25.10
29345.................  S..............  ...............  Application of long leg cast.         0426       2.1147      $125.51  ...........       $25.10
29355.................  S..............  ...............  Application of long leg cast.         0426       2.1147      $125.51  ...........       $25.10
29358.................  S..............  ...............  Apply long leg cast brace....         0426       2.1147      $125.51  ...........       $25.10
29365.................  S..............  ...............  Application of long leg cast.         0426       2.1147      $125.51  ...........       $25.10
29405.................  S..............  ...............  Apply short leg cast.........         0426       2.1147      $125.51  ...........       $25.10
29425.................  S..............  ...............  Apply short leg cast.........         0426       2.1147      $125.51  ...........       $25.10
29435.................  S..............  ...............  Apply short leg cast.........         0426       2.1147      $125.51  ...........       $25.10
29440.................  S..............  ...............  Addition of walker to cast...         0058       1.0884       $64.60  ...........       $12.92
29445.................  S..............  ...............  Apply rigid leg cast.........         0426       2.1147      $125.51  ...........       $25.10
29450.................  S..............  ...............  Application of leg cast......         0058       1.0884       $64.60  ...........       $12.92
29505.................  S..............  ...............  Application, long leg splint.         0058       1.0884       $64.60  ...........       $12.92
29515.................  S..............  ...............  Application lower leg splint.         0058       1.0884       $64.60  ...........       $12.92
29520.................  S..............  ...............  Strapping of hip.............         0058       1.0884       $64.60  ...........       $12.92
29530.................  S..............  ...............  Strapping of knee............         0058       1.0884       $64.60  ...........       $12.92
29540.................  S..............  ...............  Strapping of ankle...........         0058       1.0884       $64.60  ...........       $12.92
29550.................  S..............  ...............  Strapping of toes............         0058       1.0884       $64.60  ...........       $12.92
29580.................  S..............  ...............  Application of paste boot....         0058       1.0884       $64.60  ...........       $12.92
29590.................  S..............  ...............  Application of foot splint...         0058       1.0884       $64.60  ...........       $12.92
29700.................  S..............  ...............  Removal/revision of cast.....         0058       1.0884       $64.60  ...........       $12.92
29705.................  S..............  ...............  Removal/revision of cast.....         0058       1.0884       $64.60  ...........       $12.92
29710.................  S..............  ...............  Removal/revision of cast.....         0426       2.1147      $125.51  ...........       $25.10
29715.................  S..............  ...............  Removal/revision of cast.....         0058       1.0884       $64.60  ...........       $12.92
29720.................  S..............  ...............  Repair of body cast..........         0058       1.0884       $64.60  ...........       $12.92
29730.................  S..............  ...............  Windowing of cast............         0058       1.0884       $64.60  ...........       $12.92
29740.................  S..............  ...............  Wedging of cast..............         0058       1.0884       $64.60  ...........       $12.92
29750.................  S..............  ...............  Wedging of clubfoot cast.....         0058       1.0884       $64.60  ...........       $12.92
29799.................  S..............  ...............  Casting/strapping procedure..         0058       1.0884       $64.60  ...........       $12.92
29800.................  T..............  ...............  Jaw arthroscopy/surgery......         0041      28.0044    $1,662.06  ...........      $332.41
29804.................  T..............  ...............  Jaw arthroscopy/surgery......         0041      28.0044    $1,662.06  ...........      $332.41
29805.................  T..............  ...............  Shoulder arthroscopy, dx.....         0041      28.0044    $1,662.06  ...........      $332.41
29806.................  T..............  ...............  Shoulder arthroscopy/surgery.         0042      43.7761    $2,598.11      $804.74      $519.62
29807.................  T..............  ...............  Shoulder arthroscopy/surgery.         0042      43.7761    $2,598.11      $804.74      $519.62
29819.................  T..............  ...............  Shoulder arthroscopy/surgery.         0041      28.0044    $1,662.06  ...........      $332.41
29820.................  T..............  ...............  Shoulder arthroscopy/surgery.         0041      28.0044    $1,662.06  ...........      $332.41
29821.................  T..............  ...............  Shoulder arthroscopy/surgery.         0041      28.0044    $1,662.06  ...........      $332.41
29822.................  T..............  ...............  Shoulder arthroscopy/surgery.         0041      28.0044    $1,662.06  ...........      $332.41
29823.................  T..............  ...............  Shoulder arthroscopy/surgery.         0041      28.0044    $1,662.06  ...........      $332.41
29824.................  T..............  ...............  Shoulder arthroscopy/surgery.         0041      28.0044    $1,662.06  ...........      $332.41
29825.................  T..............  ...............  Shoulder arthroscopy/surgery.         0041      28.0044    $1,662.06  ...........      $332.41
29826.................  T..............  ...............  Shoulder arthroscopy/surgery.         0042      43.7761    $2,598.11      $804.74      $519.62
29827.................  T..............  ...............  Arthroscop rotator cuff repr.         0042      43.7761    $2,598.11      $804.74      $519.62
29830.................  T..............  ...............  Elbow arthroscopy............         0041      28.0044    $1,662.06  ...........      $332.41
29834.................  T..............  ...............  Elbow arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29835.................  T..............  ...............  Elbow arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29836.................  T..............  ...............  Elbow arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29837.................  T..............  ...............  Elbow arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29838.................  T..............  ...............  Elbow arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29840.................  T..............  ...............  Wrist arthroscopy............         0041      28.0044    $1,662.06  ...........      $332.41
29843.................  T..............  ...............  Wrist arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29844.................  T..............  ...............  Wrist arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29845.................  T..............  ...............  Wrist arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29846.................  T..............  ...............  Wrist arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29847.................  T..............  ...............  Wrist arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29848.................  T..............  ...............  Wrist endoscopy/surgery......         0041      28.0044    $1,662.06  ...........      $332.41
29850.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29851.................  T..............  ...............  Knee arthroscopy/surgery.....         0042      43.7761    $2,598.11      $804.74      $519.62
29855.................  T..............  ...............  Tibial arthroscopy/surgery...         0042      43.7761    $2,598.11      $804.74      $519.62
29856.................  T..............  ...............  Tibial arthroscopy/surgery...         0041      28.0044    $1,662.06  ...........      $332.41
29860.................  T..............  ...............  Hip arthroscopy, dx..........         0041      28.0044    $1,662.06  ...........      $332.41
29861.................  T..............  ...............  Hip arthroscopy/surgery......         0041      28.0044    $1,662.06  ...........      $332.41
29862.................  T..............  ...............  Hip arthroscopy/surgery......         0042      43.7761    $2,598.11      $804.74      $519.62
29863.................  T..............  ...............  Hip arthroscopy/surgery......         0042      43.7761    $2,598.11      $804.74      $519.62

[[Page 42810]]

 
29866.................  T..............  ...............  Autgrft implnt, knee w/scope.         0042      43.7761    $2,598.11      $804.74      $519.62
29867.................  T..............  ...............  Allgrft implnt, knee w/scope.         0042      43.7761    $2,598.11      $804.74      $519.62
29868.................  T..............  ...............  Meniscal trnspl, knee w/scpe.         0042      43.7761    $2,598.11      $804.74      $519.62
29870.................  T..............  ...............  Knee arthroscopy, dx.........         0041      28.0044    $1,662.06  ...........      $332.41
29871.................  T..............  ...............  Knee arthroscopy/drainage....         0041      28.0044    $1,662.06  ...........      $332.41
29873.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29874.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29875.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29876.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29877.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29879.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29880.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29881.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29882.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29883.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29884.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29885.................  T..............  ...............  Knee arthroscopy/surgery.....         0042      43.7761    $2,598.11      $804.74      $519.62
29886.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29887.................  T..............  ...............  Knee arthroscopy/surgery.....         0041      28.0044    $1,662.06  ...........      $332.41
29888.................  T..............  ...............  Knee arthroscopy/surgery.....         0042      43.7761    $2,598.11      $804.74      $519.62
29889.................  T..............  ...............  Knee arthroscopy/surgery.....         0042      43.7761    $2,598.11      $804.74      $519.62
29891.................  T..............  ...............  Ankle arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29892.................  T..............  ...............  Ankle arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29893.................  T..............  ...............  Scope, plantar fasciotomy....         0055      19.9783    $1,185.71      $355.34      $237.14
29894.................  T..............  ...............  Ankle arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29895.................  T..............  ...............  Ankle arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29897.................  T..............  ...............  Ankle arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29898.................  T..............  ...............  Ankle arthroscopy/surgery....         0041      28.0044    $1,662.06  ...........      $332.41
29899.................  T..............  ...............  Ankle arthroscopy/surgery....         0042      43.7761    $2,598.11      $804.74      $519.62
29900.................  T..............  ...............  Mcp joint arthroscopy, dx....         0053      15.6085      $926.36      $253.49      $185.27
29901.................  T..............  ...............  Mcp joint arthroscopy, surg..         0053      15.6085      $926.36      $253.49      $185.27
29902.................  T..............  ...............  Mcp joint arthroscopy, surg..         0053      15.6085      $926.36      $253.49      $185.27
29999.................  T..............  ...............  Arthroscopy of joint.........         0041      28.0044    $1,662.06  ...........      $332.41
30000.................  T..............  ...............  Drainage of nose lesion......         0251       2.0010      $118.76  ...........       $23.75
30020.................  T..............  ...............  Drainage of nose lesion......         0251       2.0010      $118.76  ...........       $23.75
30100.................  T..............  ...............  Intranasal biopsy............         0252       7.8317      $464.81      $113.41       $92.96
30110.................  T..............  ...............  Removal of nose polyp(s).....         0253      16.0627      $953.32      $282.29      $190.66
30115.................  T..............  ...............  Removal of nose polyp(s).....         0253      16.0627      $953.32      $282.29      $190.66
30117.................  T..............  ...............  Removal of intranasal lesion.         0253      16.0627      $953.32      $282.29      $190.66
30118.................  T..............  ...............  Removal of intranasal lesion.         0254      23.2980    $1,382.74      $321.35      $276.55
30120.................  T..............  ...............  Revision of nose.............         0253      16.0627      $953.32      $282.29      $190.66
30124.................  T..............  ...............  Removal of nose lesion.......         0252       7.8317      $464.81      $113.41       $92.96
30125.................  T..............  ...............  Removal of nose lesion.......         0256      37.1513    $2,204.93  ...........      $440.99
30130.................  T..............  ...............  Removal of turbinate bones...         0253      16.0627      $953.32      $282.29      $190.66
30140.................  T..............  ...............  Removal of turbinate bones...         0254      23.2980    $1,382.74      $321.35      $276.55
30150.................  T..............  ...............  Partial removal of nose......         0256      37.1513    $2,204.93  ...........      $440.99
30160.................  T..............  ...............  Removal of nose..............         0256      37.1513    $2,204.93  ...........      $440.99
30200.................  T..............  ...............  Injection treatment of nose..         0252       7.8317      $464.81      $113.41       $92.96
30210.................  T..............  ...............  Nasal sinus therapy..........         0252       7.8317      $464.81      $113.41       $92.96
30220.................  T..............  ...............  Insert nasal septal button...         0252       7.8317      $464.81      $113.41       $92.96
30300.................  X..............  ...............  Remove nasal foreign body....         0340       0.6355       $37.72  ...........        $7.54
30310.................  T..............  ...............  Remove nasal foreign body....         0253      16.0627      $953.32      $282.29      $190.66
30320.................  T..............  ...............  Remove nasal foreign body....         0253      16.0627      $953.32      $282.29      $190.66
30400.................  T..............  ...............  Reconstruction of nose.......         0256      37.1513    $2,204.93  ...........      $440.99
30410.................  T..............  ...............  Reconstruction of nose.......         0256      37.1513    $2,204.93  ...........      $440.99
30420.................  T..............  ...............  Reconstruction of nose.......         0256      37.1513    $2,204.93  ...........      $440.99
30430.................  T..............  ...............  Revision of nose.............         0254      23.2980    $1,382.74      $321.35      $276.55
30435.................  T..............  ...............  Revision of nose.............         0256      37.1513    $2,204.93  ...........      $440.99
30450.................  T..............  ...............  Revision of nose.............         0256      37.1513    $2,204.93  ...........      $440.99
30460.................  T..............  ...............  Revision of nose.............         0256      37.1513    $2,204.93  ...........      $440.99
30462.................  T..............  ...............  Revision of nose.............         0256      37.1513    $2,204.93  ...........      $440.99
30465.................  T..............  ...............  Repair nasal stenosis........         0256      37.1513    $2,204.93  ...........      $440.99
30520.................  T..............  ...............  Repair of nasal septum.......         0254      23.2980    $1,382.74      $321.35      $276.55
30540.................  T..............  ...............  Repair nasal defect..........         0256      37.1513    $2,204.93  ...........      $440.99
30545.................  T..............  ...............  Repair nasal defect..........         0256      37.1513    $2,204.93  ...........      $440.99
30560.................  T..............  ...............  Release of nasal adhesions...         0251       2.0010      $118.76  ...........       $23.75

[[Page 42811]]

 
30580.................  T..............  ...............  Repair upper jaw fistula.....         0256      37.1513    $2,204.93  ...........      $440.99
30600.................  T..............  ...............  Repair mouth/nose fistula....         0256      37.1513    $2,204.93  ...........      $440.99
30620.................  T..............  ...............  Intranasal reconstruction....         0256      37.1513    $2,204.93  ...........      $440.99
30630.................  T..............  ...............  Repair nasal septum defect...         0254      23.2980    $1,382.74      $321.35      $276.55
30801.................  T..............  ...............  Cauterization, inner nose....         0252       7.8317      $464.81      $113.41       $92.96
30802.................  T..............  ...............  Cauterization, inner nose....         0252       7.8317      $464.81      $113.41       $92.96
30901.................  T..............  ...............  Control of nosebleed.........         0250       1.2838       $76.19       $26.67       $15.24
30903.................  T..............  ...............  Control of nosebleed.........         0250       1.2838       $76.19       $26.67       $15.24
30905.................  T..............  ...............  Control of nosebleed.........         0250       1.2838       $76.19       $26.67       $15.24
30906.................  T..............  ...............  Repeat control of nosebleed..         0250       1.2838       $76.19       $26.67       $15.24
30915.................  T..............  ...............  Ligation, nasal sinus artery.         0091      28.8685    $1,713.35      $348.23      $342.67
30920.................  T..............  ...............  Ligation, upper jaw artery...         0092      26.3621    $1,564.59      $505.37      $312.92
30930.................  T..............  ...............  Therapy, fracture of nose....         0253      16.0627      $953.32      $282.29      $190.66
30999.................  T..............  ...............  Nasal surgery procedure......         0251       2.0010      $118.76  ...........       $23.75
31000.................  T..............  ...............  Irrigation, maxillary sinus..         0251       2.0010      $118.76  ...........       $23.75
31002.................  T..............  ...............  Irrigation, sphenoid sinus...         0252       7.8317      $464.81      $113.41       $92.96
31020.................  T..............  ...............  Exploration, maxillary sinus.         0254      23.2980    $1,382.74      $321.35      $276.55
31030.................  T..............  ...............  Exploration, maxillary sinus.         0256      37.1513    $2,204.93  ...........      $440.99
31032.................  T..............  ...............  Explore sinus, remove polyps.         0256      37.1513    $2,204.93  ...........      $440.99
31040.................  T..............  ...............  Exploration behind upper jaw.         0254      23.2980    $1,382.74      $321.35      $276.55
31050.................  T..............  ...............  Exploration, sphenoid sinus..         0256      37.1513    $2,204.93  ...........      $440.99
31051.................  T..............  ...............  Sphenoid sinus surgery.......         0256      37.1513    $2,204.93  ...........      $440.99
31070.................  T..............  ...............  Exploration of frontal sinus.         0254      23.2980    $1,382.74      $321.35      $276.55
31075.................  T..............  ...............  Exploration of frontal sinus.         0256      37.1513    $2,204.93  ...........      $440.99
31080.................  T..............  ...............  Removal of frontal sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31081.................  T..............  ...............  Removal of frontal sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31084.................  T..............  ...............  Removal of frontal sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31085.................  T..............  ...............  Removal of frontal sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31086.................  T..............  ...............  Removal of frontal sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31087.................  T..............  ...............  Removal of frontal sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31090.................  T..............  ...............  Exploration of sinuses.......         0256      37.1513    $2,204.93  ...........      $440.99
31200.................  T..............  ...............  Removal of ethmoid sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31201.................  T..............  ...............  Removal of ethmoid sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31205.................  T..............  ...............  Removal of ethmoid sinus.....         0256      37.1513    $2,204.93  ...........      $440.99
31225.................  C..............  ...............  Removal of upper jaw.........  ...........  ...........  ...........  ...........  ...........
31230.................  C..............  ...............  Removal of upper jaw.........  ...........  ...........  ...........  ...........  ...........
31231.................  T..............  ...............  Nasal endoscopy, dx..........         0072       1.4296       $84.85       $21.27       $16.97
31233.................  T..............  ...............  Nasal/sinus endoscopy, dx....         0072       1.4296       $84.85       $21.27       $16.97
31235.................  T..............  ...............  Nasal/sinus endoscopy, dx....         0074      15.7042      $932.04      $295.70      $186.41
31237.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0075      21.2460    $1,260.95      $445.92      $252.19
31238.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0074      15.7042      $932.04      $295.70      $186.41
31239.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0075      21.2460    $1,260.95      $445.92      $252.19
31240.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0074      15.7042      $932.04      $295.70      $186.41
31254.................  T..............  ...............  Revision of ethmoid sinus....         0075      21.2460    $1,260.95      $445.92      $252.19
31255.................  T..............  ...............  Removal of ethmoid sinus.....         0075      21.2460    $1,260.95      $445.92      $252.19
31256.................  T..............  ...............  Exploration maxillary sinus..         0075      21.2460    $1,260.95      $445.92      $252.19
31267.................  T..............  ...............  Endoscopy, maxillary sinus...         0075      21.2460    $1,260.95      $445.92      $252.19
31276.................  T..............  ...............  Sinus endoscopy, surgical....         0075      21.2460    $1,260.95      $445.92      $252.19
31287.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0075      21.2460    $1,260.95      $445.92      $252.19
31288.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0075      21.2460    $1,260.95      $445.92      $252.19
31290.................  C..............  ...............  Nasal/sinus endoscopy, surg..  ...........  ...........  ...........  ...........  ...........
31291.................  C..............  ...............  Nasal/sinus endoscopy, surg..  ...........  ...........  ...........  ...........  ...........
31292.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0075      21.2460    $1,260.95      $445.92      $252.19
31293.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0075      21.2460    $1,260.95      $445.92      $252.19
31294.................  T..............  ...............  Nasal/sinus endoscopy, surg..         0075      21.2460    $1,260.95      $445.92      $252.19
31299.................  T..............  ...............  Sinus surgery procedure......         0251       2.0010      $118.76  ...........       $23.75
31300.................  T..............  ...............  Removal of larynx lesion.....         0254      23.2980    $1,382.74      $321.35      $276.55
31320.................  T..............  ...............  Diagnostic incision, larynx..         0256      37.1513    $2,204.93  ...........      $440.99
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....  ...........  ...........  ...........  ...........  ...........

[[Page 42812]]

 
31390.................  C..............  ...............  Removal of larynx & pharynx..  ...........  ...........  ...........  ...........  ...........
31395.................  C..............  ...............  Reconstruct larynx & pharynx.  ...........  ...........  ...........  ...........  ...........
31400.................  T..............  ...............  Revision of larynx...........         0256      37.1513    $2,204.93  ...........      $440.99
31420.................  T..............  ...............  Removal of epiglottis........         0256      37.1513    $2,204.93  ...........      $440.99
31500.................  S..............  ...............  Insert emergency airway......         0094       2.5248      $149.85       $47.41       $29.97
31502.................  T..............  ...............  Change of windpipe airway....         0121       2.2663      $134.50       $43.80       $26.90
31505.................  T..............  ...............  Diagnostic laryngoscopy......         0071       0.7879       $46.76       $11.31        $9.35
31510.................  T..............  ...............  Laryngoscopy with biopsy.....         0074      15.7042      $932.04      $295.70      $186.41
31511.................  T..............  ...............  Remove foreign body, larynx..         0072       1.4296       $84.85       $21.27       $16.97
31512.................  T..............  ...............  Removal of larynx lesion.....         0074      15.7042      $932.04      $295.70      $186.41
31513.................  T..............  ...............  Injection into vocal cord....         0072       1.4296       $84.85       $21.27       $16.97
31515.................  T..............  ...............  Laryngoscopy for aspiration..         0074      15.7042      $932.04      $295.70      $186.41
31520.................  T..............  ...............  Diagnostic laryngoscopy......         0072       1.4296       $84.85       $21.27       $16.97
31525.................  T..............  ...............  Diagnostic laryngoscopy......         0074      15.7042      $932.04      $295.70      $186.41
31526.................  T..............  ...............  Diagnostic laryngoscopy......         0075      21.2460    $1,260.95      $445.92      $252.19
31527.................  T..............  ...............  Laryngoscopy for treatment...         0075      21.2460    $1,260.95      $445.92      $252.19
31528.................  T..............  ...............  Laryngoscopy and dilation....         0074      15.7042      $932.04      $295.70      $186.41
31529.................  T..............  ...............  Laryngoscopy and dilation....         0074      15.7042      $932.04      $295.70      $186.41
31530.................  T..............  ...............  Operative laryngoscopy.......         0075      21.2460    $1,260.95      $445.92      $252.19
31531.................  T..............  ...............  Operative laryngoscopy.......         0075      21.2460    $1,260.95      $445.92      $252.19
31535.................  T..............  ...............  Operative laryngoscopy.......         0075      21.2460    $1,260.95      $445.92      $252.19
31536.................  T..............  ...............  Operative laryngoscopy.......         0075      21.2460    $1,260.95      $445.92      $252.19
31540.................  T..............  ...............  Operative laryngoscopy.......         0075      21.2460    $1,260.95      $445.92      $252.19
31541.................  T..............  ...............  Operative laryngoscopy.......         0075      21.2460    $1,260.95      $445.92      $252.19
31545.................  T..............  ...............  Remove vc lesion w/scope.....         0075      21.2460    $1,260.95      $445.92      $252.19
31546.................  T..............  ...............  Remove vc lesion scope/graft.         0075      21.2460    $1,260.95      $445.92      $252.19
31560.................  T..............  ...............  Operative laryngoscopy.......         0075      21.2460    $1,260.95      $445.92      $252.19
31561.................  T..............  ...............  Operative laryngoscopy.......         0075      21.2460    $1,260.95      $445.92      $252.19
31570.................  T..............  ...............  Laryngoscopy with injection..         0074      15.7042      $932.04      $295.70      $186.41
31571.................  T..............  ...............  Laryngoscopy with injection..         0075      21.2460    $1,260.95      $445.92      $252.19
31575.................  T..............  ...............  Diagnostic laryngoscopy......         0072       1.4296       $84.85       $21.27       $16.97
31576.................  T..............  ...............  Laryngoscopy with biopsy.....         0075      21.2460    $1,260.95      $445.92      $252.19
31577.................  T..............  ...............  Remove foreign body, larynx..         0073       4.1420      $245.83       $73.38       $49.17
31578.................  T..............  ...............  Removal of larynx lesion.....         0075      21.2460    $1,260.95      $445.92      $252.19
31579.................  T..............  ...............  Diagnostic laryngoscopy......         0073       4.1420      $245.83       $73.38       $49.17
31580.................  T..............  ...............  Revision of larynx...........         0256      37.1513    $2,204.93  ...........      $440.99
31582.................  T..............  ...............  Revision of larynx...........         0256      37.1513    $2,204.93  ...........      $440.99
31584.................  C..............  ...............  Treat larynx fracture........  ...........  ...........  ...........  ...........  ...........
31585.................  T..............  ...............  Treat larynx fracture........         0253      16.0627      $953.32      $282.29      $190.66
31586.................  T..............  ...............  Treat larynx fracture........         0256      37.1513    $2,204.93  ...........      $440.99
31587.................  C..............  ...............  Revision of larynx...........  ...........  ...........  ...........  ...........  ...........
31588.................  T..............  ...............  Revision of larynx...........         0256      37.1513    $2,204.93  ...........      $440.99
31590.................  T..............  ...............  Reinnervate larynx...........         0256      37.1513    $2,204.93  ...........      $440.99
31595.................  T..............  ...............  Larynx nerve surgery.........         0256      37.1513    $2,204.93  ...........      $440.99
31599.................  T..............  ...............  Larynx surgery procedure.....         0251       2.0010      $118.76  ...........       $23.75
31600.................  T..............  ...............  Incision of windpipe.........         0254      23.2980    $1,382.74      $321.35      $276.55
31601.................  T..............  ...............  Incision of windpipe.........         0254      23.2980    $1,382.74      $321.35      $276.55
31603.................  T..............  ...............  Incision of windpipe.........         0252       7.8317      $464.81      $113.41       $92.96
31605.................  T..............  ...............  Incision of windpipe.........         0252       7.8317      $464.81      $113.41       $92.96
31610.................  T..............  ...............  Incision of windpipe.........         0254      23.2980    $1,382.74      $321.35      $276.55
31611.................  T..............  ...............  Surgery/speech prosthesis....         0254      23.2980    $1,382.74      $321.35      $276.55
31612.................  T..............  ...............  Puncture/clear windpipe......         0254      23.2980    $1,382.74      $321.35      $276.55
31613.................  T..............  ...............  Repair windpipe opening......         0254      23.2980    $1,382.74      $321.35      $276.55
31614.................  T..............  ...............  Repair windpipe opening......         0256      37.1513    $2,204.93  ...........      $440.99
31615.................  T..............  ...............  Visualization of windpipe....         0076       9.4163      $558.86      $189.82      $111.77
31620.................  S..............  ...............  Endobronchial us add-on......         0670      25.2980    $1,501.44      $470.38      $300.29
31622.................  T..............  ...............  Dx bronchoscope/wash.........         0076       9.4163      $558.86      $189.82      $111.77
31623.................  T..............  ...............  Dx bronchoscope/brush........         0076       9.4163      $558.86      $189.82      $111.77
31624.................  T..............  ...............  Dx bronchoscope/lavage.......         0076       9.4163      $558.86      $189.82      $111.77
31625.................  T..............  ...............  Bronchoscopy w/biopsy(s).....         0076       9.4163      $558.86      $189.82      $111.77
31628.................  T..............  ...............  Bronchoscopy/lung bx, each...         0076       9.4163      $558.86      $189.82      $111.77
31629.................  T..............  ...............  Bronchoscopy/needle bx, each.         0076       9.4163      $558.86      $189.82      $111.77
31630.................  T..............  ...............  Bronchoscopy dilate/fx repr..         0415      21.9955    $1,305.43      $459.92      $261.09
31631.................  T..............  ...............  Bronchoscopy, dilate w/stent.         0415      21.9955    $1,305.43      $459.92      $261.09
31632.................  T..............  ...............  Bronchoscopy/lung bx, add'l..         0076       9.4163      $558.86      $189.82      $111.77
31633.................  T..............  ...............  Bronchoscopy/needle bx add'l.         0076       9.4163      $558.86      $189.82      $111.77

[[Page 42813]]

 
31635.................  T..............  ...............  Bronchoscopy w/fb removal....         0076       9.4163      $558.86      $189.82      $111.77
31636.................  T..............  ...............  Bronchoscopy, bronch stents..         0415      21.9955    $1,305.43      $459.92      $261.09
31637.................  T..............  ...............  Bronchoscopy, stent add-on...         0076       9.4163      $558.86      $189.82      $111.77
31638.................  T..............  ...............  Bronchoscopy, revise stent...         0415      21.9955    $1,305.43      $459.92      $261.09
31640.................  T..............  ...............  Bronchoscopy w/tumor excise..         0415      21.9955    $1,305.43      $459.92      $261.09
31641.................  T..............  ...............  Bronchoscopy, treat blockage.         0415      21.9955    $1,305.43      $459.92      $261.09
31643.................  T..............  ...............  Diag bronchoscope/catheter...         0076       9.4163      $558.86      $189.82      $111.77
31645.................  T..............  ...............  Bronchoscopy, clear airways..         0076       9.4163      $558.86      $189.82      $111.77
31646.................  T..............  ...............  Bronchoscopy, reclear airway.         0076       9.4163      $558.86      $189.82      $111.77
31656.................  T..............  ...............  Bronchoscopy, inj for x-ray..         0076       9.4163      $558.86      $189.82      $111.77
31700.................  T..............  ...............  Insertion of airway catheter.         0072       1.4296       $84.85       $21.27       $16.97
31708.................  N..............  ...............  Instill airway contrast dye..  ...........  ...........  ...........  ...........  ...........
31710.................  N..............  ...............  Insertion of airway catheter.  ...........  ...........  ...........  ...........  ...........
31715.................  N..............  ...............  Injection for bronchus x-ray.  ...........  ...........  ...........  ...........  ...........
31717.................  T..............  ...............  Bronchial brush biopsy.......         0073       4.1420      $245.83       $73.38       $49.17
31720.................  T..............  ...............  Clearance of airways.........         0071       0.7879       $46.76       $11.31        $9.35
31725.................  C..............  ...............  Clearance of airways.........  ...........  ...........  ...........  ...........  ...........
31730.................  T..............  ...............  Intro, windpipe wire/tube....         0073       4.1420      $245.83       $73.38       $49.17
31750.................  T..............  ...............  Repair of windpipe...........         0256      37.1513    $2,204.93  ...........      $440.99
31755.................  T..............  ...............  Repair of windpipe...........         0256      37.1513    $2,204.93  ...........      $440.99
31760.................  C..............  ...............  Repair of windpipe...........  ...........  ...........  ...........  ...........  ...........
31766.................  C..............  ...............  Reconstruction of windpipe...  ...........  ...........  ...........  ...........  ...........
31770.................  C..............  ...............  Repair/graft of bronchus.....  ...........  ...........  ...........  ...........  ...........
31775.................  C..............  ...............  Reconstruct bronchus.........  ...........  ...........  ...........  ...........  ...........
31780.................  C..............  ...............  Reconstruct windpipe.........  ...........  ...........  ...........  ...........  ...........
31781.................  C..............  ...............  Reconstruct windpipe.........  ...........  ...........  ...........  ...........  ...........
31785.................  T..............  ...............  Remove windpipe lesion.......         0254      23.2980    $1,382.74      $321.35      $276.55
31786.................  C..............  ...............  Remove windpipe lesion.......  ...........  ...........  ...........  ...........  ...........
31800.................  C..............  ...............  Repair of windpipe injury....  ...........  ...........  ...........  ...........  ...........
31805.................  C..............  ...............  Repair of windpipe injury....  ...........  ...........  ...........  ...........  ...........
31820.................  T..............  ...............  Closure of windpipe lesion...         0253      16.0627      $953.32      $282.29      $190.66
31825.................  T..............  ...............  Repair of windpipe defect....         0254      23.2980    $1,382.74      $321.35      $276.55
31830.................  T..............  ...............  Revise windpipe scar.........         0254      23.2980    $1,382.74      $321.35      $276.55
31899.................  T..............  ...............  Airways surgical procedure...         0076       9.4163      $558.86      $189.82      $111.77
32000.................  T..............  ...............  Drainage of chest............         0070       3.1956      $189.66  ...........       $37.93
32002.................  T..............  ...............  Treatment of collapsed lung..         0070       3.1956      $189.66  ...........       $37.93
32005.................  T..............  ...............  Treat lung lining chemically.         0070       3.1956      $189.66  ...........       $37.93
32019.................  T..............  ...............  Insert pleural catheter......         0070       3.1956      $189.66  ...........       $37.93
32020.................  T..............  ...............  Insertion of chest tube......         0070       3.1956      $189.66  ...........       $37.93
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 lesion...         0070       3.1956      $189.66  ...........       $37.93
32215.................  C..............  ...............  Treat chest lining...........  ...........  ...........  ...........  ...........  ...........
32220.................  C..............  ...............  Release of lung..............  ...........  ...........  ...........  ...........  ...........
32225.................  C..............  ...............  Partial release of lung......  ...........  ...........  ...........  ...........  ...........
32310.................  C..............  ...............  Removal of chest lining......  ...........  ...........  ...........  ...........  ...........
32320.................  C..............  ...............  Free/remove chest lining.....  ...........  ...........  ...........  ...........  ...........
32400.................  T..............  ...............  Needle biopsy chest lining...         0685       5.9902      $355.52      $115.47       $71.10
32402.................  C..............  ...............  Open biopsy chest lining.....  ...........  ...........  ...........  ...........  ...........
32405.................  T..............  ...............  Biopsy, lung or mediastinum..         0685       5.9902      $355.52      $115.47       $71.10
32420.................  T..............  ...............  Puncture/clear lung..........         0070       3.1956      $189.66  ...........       $37.93
32440.................  C..............  ...............  Removal of lung..............  ...........  ...........  ...........  ...........  ...........
32442.................  C..............  ...............  Sleeve pneumonectomy.........  ...........  ...........  ...........  ...........  ...........
32445.................  C..............  ...............  Removal of lung..............  ...........  ...........  ...........  ...........  ...........
32480.................  C..............  ...............  Partial removal of lung......  ...........  ...........  ...........  ...........  ...........

[[Page 42814]]

 
32482.................  C..............  ...............  Bilobectomy..................  ...........  ...........  ...........  ...........  ...........
32484.................  C..............  ...............  Segmentectomy................  ...........  ...........  ...........  ...........  ...........
32486.................  C..............  ...............  Sleeve lobectomy.............  ...........  ...........  ...........  ...........  ...........
32488.................  C..............  ...............  Completion pneumonectomy.....  ...........  ...........  ...........  ...........  ...........
32491.................  C..............  ...............  Lung volume reduction........  ...........  ...........  ...........  ...........  ...........
32500.................  C..............  ...............  Partial removal of lung......  ...........  ...........  ...........  ...........  ...........
32501.................  C..............  ...............  Repair bronchus add-on.......  ...........  ...........  ...........  ...........  ...........
32520.................  C..............  ...............  Remove lung & revise chest...  ...........  ...........  ...........  ...........  ...........
32522.................  C..............  ...............  Remove lung & revise chest...  ...........  ...........  ...........  ...........  ...........
32525.................  C..............  ...............  Remove lung & revise chest...  ...........  ...........  ...........  ...........  ...........
32540.................  C..............  ...............  Removal of lung lesion.......  ...........  ...........  ...........  ...........  ...........
32601.................  T..............  ...............  Thoracoscopy, diagnostic.....         0069      30.5386    $1,812.47      $591.64      $362.49
32602.................  T..............  ...............  Thoracoscopy, diagnostic.....         0069      30.5386    $1,812.47      $591.64      $362.49
32603.................  T..............  ...............  Thoracoscopy, diagnostic.....         0069      30.5386    $1,812.47      $591.64      $362.49
32604.................  T..............  ...............  Thoracoscopy, diagnostic.....         0069      30.5386    $1,812.47      $591.64      $362.49
32605.................  T..............  ...............  Thoracoscopy, diagnostic.....         0069      30.5386    $1,812.47      $591.64      $362.49
32606.................  T..............  ...............  Thoracoscopy, diagnostic.....         0069      30.5386    $1,812.47      $591.64      $362.49
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..  ...........  ...........  ...........  ...........  ...........
32855.................  C..............  ...............  Prepare donor lung, single...  ...........  ...........  ...........  ...........  ...........
32856.................  C..............  ...............  Prepare donor lung, double...  ...........  ...........  ...........  ...........  ...........
32900.................  C..............  ...............  Removal of rib(s)............  ...........  ...........  ...........  ...........  ...........
32905.................  C..............  ...............  Revise & repair chest wall...  ...........  ...........  ...........  ...........  ...........
32906.................  C..............  ...............  Revise & repair chest wall...  ...........  ...........  ...........  ...........  ...........
32940.................  C..............  ...............  Revision of lung.............  ...........  ...........  ...........  ...........  ...........
32960.................  T..............  ...............  Therapeutic pneumothorax.....         0070       3.1956      $189.66  ...........       $37.93
32997.................  C..............  ...............  Total lung lavage............  ...........  ...........  ...........  ...........  ...........
32999.................  T..............  ...............  Chest surgery procedure......         0070       3.1956      $189.66  ...........       $37.93
33010.................  T..............  ...............  Drainage of heart sac........         0070       3.1956      $189.66  ...........       $37.93
33011.................  T..............  ...............  Repeat drainage of heart sac.         0070       3.1956      $189.66  ...........       $37.93
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 pacemaker.         0089     105.1359    $6,239.82    $1,681.06    $1,247.96

[[Page 42815]]

 
33207.................  T..............  ...............  Insertion of heart pacemaker.         0089     105.1359    $6,239.82    $1,681.06    $1,247.96
33208.................  T..............  ...............  Insertion of heart pacemaker.         0655     133.1709    $7,903.69  ...........    $1,580.74
33210.................  T..............  ...............  Insertion of heart electrode.         0106      45.2791    $2,687.31  ...........      $537.46
33211.................  T..............  ...............  Insertion of heart electrode.         0106      45.2791    $2,687.31  ...........      $537.46
33212.................  T..............  ...............  Insertion of pulse generator.         0090      88.7536    $5,267.53    $1,612.80    $1,053.51
33213.................  T..............  ...............  Insertion of pulse generator.         0654     100.4722    $5,963.03  ...........    $1,192.61
33214.................  T..............  ...............  Upgrade of pacemaker system..         0655     133.1709    $7,903.69  ...........    $1,580.74
33215.................  T..............  ...............  Reposition pacing-defib lead.         0105      22.2671    $1,321.55      $370.40      $264.31
33216.................  T..............  ...............  Revise eltrd pacing-defib....         0106      45.2791    $2,687.31  ...........      $537.46
33217.................  T..............  ...............  Insert lead pace-defib, dual.         0106      45.2791    $2,687.31  ...........      $537.46
33218.................  T..............  ...............  Repair lead pace-defib, one..         0106      45.2791    $2,687.31  ...........      $537.46
33220.................  T..............  ...............  Repair lead pace-defib, dual.         0106      45.2791    $2,687.31  ...........      $537.46
33222.................  T..............  ...............  Revise pocket, pacemaker.....         0027      18.3348    $1,088.17      $329.72      $217.63
33223.................  T..............  ...............  Revise pocket, pacing-defib..         0027      18.3348    $1,088.17      $329.72      $217.63
33224.................  T..............  ...............  Insert pacing lead & connect.         0418     108.8092    $6,457.83  ...........    $1,291.57
33225.................  T..............  ...............  L ventric pacing lead add-on.         0418     108.8092    $6,457.83  ...........    $1,291.57
33226.................  T..............  ...............  Reposition l ventric lead....         0105      22.2671    $1,321.55      $370.40      $264.31
33233.................  T..............  ...............  Removal of pacemaker system..         0105      22.2671    $1,321.55      $370.40      $264.31
33234.................  T..............  ...............  Removal of pacemaker system..         0105      22.2671    $1,321.55      $370.40      $264.31
33235.................  T..............  ...............  Removal pacemaker electrode..         0105      22.2671    $1,321.55      $370.40      $264.31
33236.................  C..............  ...............  Remove electrode/thoracotomy.  ...........  ...........  ...........  ...........  ...........
33237.................  C..............  ...............  Remove electrode/thoracotomy.  ...........  ...........  ...........  ...........  ...........
33238.................  C..............  ...............  Remove electrode/thoracotomy.  ...........  ...........  ...........  ...........  ...........
33240.................  B..............  ...............  Insert pulse generator.......  ...........  ...........  ...........  ...........  ...........
33241.................  T..............  ...............  Remove pulse generator.......         0105      22.2671    $1,321.55      $370.40      $264.31
33243.................  C..............  ...............  Remove eltrd/thoracotomy.....  ...........  ...........  ...........  ...........  ...........
33244.................  T..............  ...............  Remove eltrd, transven.......         0105      22.2671    $1,321.55      $370.40      $264.31
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 ht record.         0680      62.6232    $3,716.69  ...........      $743.34
33284.................  T..............  ...............  Remove pat-active ht record..         0109      10.9933      $652.45      $131.49      $130.49
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..  ...........  ...........  ...........  ...........  ...........

[[Page 42816]]

 
33460.................  C..............  ...............  Revision of tricuspid valve..  ...........  ...........  ...........  ...........  ...........
33463.................  C..............  ...............  Valvuloplasty, tricuspid.....  ...........  ...........  ...........  ...........  ...........
33464.................  C..............  ...............  Valvuloplasty, tricuspid.....  ...........  ...........  ...........  ...........  ...........
33465.................  C..............  ...............  Replace tricuspid valve......  ...........  ...........  ...........  ...........  ...........
33468.................  C..............  ...............  Revision of tricuspid valve..  ...........  ...........  ...........  ...........  ...........
33470.................  C..............  ...............  Revision of pulmonary valve..  ...........  ...........  ...........  ...........  ...........
33471.................  C..............  ...............  Valvotomy, pulmonary valve...  ...........  ...........  ...........  ...........  ...........
33472.................  C..............  ...............  Revision of pulmonary valve..  ...........  ...........  ...........  ...........  ...........
33474.................  C..............  ...............  Revision of pulmonary valve..  ...........  ...........  ...........  ...........  ...........
33475.................  C..............  ...............  Replacement, pulmonary valve.  ...........  ...........  ...........  ...........  ...........
33476.................  C..............  ...............  Revision of heart chamber....  ...........  ...........  ...........  ...........  ...........
33478.................  C..............  ...............  Revision of heart chamber....  ...........  ...........  ...........  ...........  ...........
33496.................  C..............  ...............  Repair, prosth valve clot....  ...........  ...........  ...........  ...........  ...........
33500.................  C..............  ...............  Repair heart vessel fistula..  ...........  ...........  ...........  ...........  ...........
33501.................  C..............  ...............  Repair heart vessel fistula..  ...........  ...........  ...........  ...........  ...........
33502.................  C..............  ...............  Coronary artery correction...  ...........  ...........  ...........  ...........  ...........
33503.................  C..............  ...............  Coronary artery graft........  ...........  ...........  ...........  ...........  ...........
33504.................  C..............  ...............  Coronary artery graft........  ...........  ...........  ...........  ...........  ...........
33505.................  C..............  ...............  Repair artery w/tunnel.......  ...........  ...........  ...........  ...........  ...........
33506.................  C..............  ...............  Repair artery, translocation.  ...........  ...........  ...........  ...........  ...........
33508.................  N..............  ...............  Endoscopic vein harvest......  ...........  ...........  ...........  ...........  ...........
33510.................  C..............  ...............  CABG, vein, single...........  ...........  ...........  ...........  ...........  ...........
33511.................  C..............  ...............  CABG, vein, two..............  ...........  ...........  ...........  ...........  ...........
33512.................  C..............  ...............  CABG, vein, three............  ...........  ...........  ...........  ...........  ...........
33513.................  C..............  ...............  CABG, vein, four.............  ...........  ...........  ...........  ...........  ...........
33514.................  C..............  ...............  CABG, vein, five.............  ...........  ...........  ...........  ...........  ...........
33516.................  C..............  ...............  Cabg, vein, six or more......  ...........  ...........  ...........  ...........  ...........
33517.................  C..............  ...............  CABG, artery-vein, single....  ...........  ...........  ...........  ...........  ...........
33518.................  C..............  ...............  CABG, artery-vein, two.......  ...........  ...........  ...........  ...........  ...........
33519.................  C..............  ...............  CABG, artery-vein, three.....  ...........  ...........  ...........  ...........  ...........
33521.................  C..............  ...............  CABG, artery-vein, four......  ...........  ...........  ...........  ...........  ...........
33522.................  C..............  ...............  CABG, artery-vein, five......  ...........  ...........  ...........  ...........  ...........
33523.................  C..............  ...............  Cabg, art-vein, six or more..  ...........  ...........  ...........  ...........  ...........
33530.................  C..............  ...............  Coronary artery, bypass/reop.  ...........  ...........  ...........  ...........  ...........
33533.................  C..............  ...............  CABG, arterial, single.......  ...........  ...........  ...........  ...........  ...........
33534.................  C..............  ...............  CABG, arterial, two..........  ...........  ...........  ...........  ...........  ...........
33535.................  C..............  ...............  CABG, arterial, three........  ...........  ...........  ...........  ...........  ...........
33536.................  C..............  ...............  Cabg, arterial, four or more.  ...........  ...........  ...........  ...........  ...........
33542.................  C..............  ...............  Removal of heart lesion......  ...........  ...........  ...........  ...........  ...........
33545.................  C..............  ...............  Repair of heart damage.......  ...........  ...........  ...........  ...........  ...........
33572.................  C..............  ...............  Open coronary endarterectomy.  ...........  ...........  ...........  ...........  ...........
33600.................  C..............  ...............  Closure of valve.............  ...........  ...........  ...........  ...........  ...........
33602.................  C..............  ...............  Closure of valve.............  ...........  ...........  ...........  ...........  ...........
33606.................  C..............  ...............  Anastomosis/artery-aorta.....  ...........  ...........  ...........  ...........  ...........
33608.................  C..............  ...............  Repair anomaly w/conduit.....  ...........  ...........  ...........  ...........  ...........
33610.................  C..............  ...............  Repair by enlargement........  ...........  ...........  ...........  ...........  ...........
33611.................  C..............  ...............  Repair double ventricle......  ...........  ...........  ...........  ...........  ...........
33612.................  C..............  ...............  Repair double ventricle......  ...........  ...........  ...........  ...........  ...........
33615.................  C..............  ...............  Repair, modified fontan......  ...........  ...........  ...........  ...........  ...........
33617.................  C..............  ...............  Repair single ventricle......  ...........  ...........  ...........  ...........  ...........
33619.................  C..............  ...............  Repair single ventricle......  ...........  ...........  ...........  ...........  ...........
33641.................  C..............  ...............  Repair heart septum defect...  ...........  ...........  ...........  ...........  ...........
33645.................  C..............  ...............  Revision of heart veins......  ...........  ...........  ...........  ...........  ...........
33647.................  C..............  ...............  Repair heart septum defects..  ...........  ...........  ...........  ...........  ...........
33660.................  C..............  ...............  Repair of heart defects......  ...........  ...........  ...........  ...........  ...........
33665.................  C..............  ...............  Repair of heart defects......  ...........  ...........  ...........  ...........  ...........
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......  ...........  ...........  ...........  ...........  ...........

[[Page 42817]]

 
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..  ...........  ...........  ...........  ...........  ...........
33933.................  C..............  ...............  Prepare donor heart/lung.....  ...........  ...........  ...........  ...........  ...........
33935.................  C..............  ...............  Transplantation, heart/lung..  ...........  ...........  ...........  ...........  ...........
33940.................  C..............  ...............  Removal of donor heart.......  ...........  ...........  ...........  ...........  ...........
33944.................  C..............  ...............  Prepare 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........  ...........  ...........  ...........  ...........  ...........

[[Page 42818]]

 
33974.................  C..............  ...............  Remove intra-aortic balloon..  ...........  ...........  ...........  ...........  ...........
33975.................  C..............  ...............  Implant ventricular device...  ...........  ...........  ...........  ...........  ...........
33976.................  C..............  ...............  Implant ventricular device...  ...........  ...........  ...........  ...........  ...........
33977.................  C..............  ...............  Remove ventricular device....  ...........  ...........  ...........  ...........  ...........
33978.................  C..............  ...............  Remove ventricular device....  ...........  ...........  ...........  ...........  ...........
33979.................  C..............  ...............  Insert intracorporeal device.  ...........  ...........  ...........  ...........  ...........
33980.................  C..............  ...............  Remove intracorporeal device.  ...........  ...........  ...........  ...........  ...........
33999.................  T..............  ...............  Cardiac surgery procedure....         0070       3.1956      $189.66  ...........       $37.93
34001.................  C..............  ...............  Removal of artery clot.......  ...........  ...........  ...........  ...........  ...........
34051.................  C..............  ...............  Removal of artery clot.......  ...........  ...........  ...........  ...........  ...........
34101.................  T..............  ...............  Removal of artery clot.......         0088      36.3961    $2,160.11      $655.22      $432.02
34111.................  T..............  ...............  Removal of arm artery clot...         0088      36.3961    $2,160.11      $655.22      $432.02
34151.................  C..............  ...............  Removal of artery clot.......  ...........  ...........  ...........  ...........  ...........
34201.................  T..............  ...............  Removal of artery clot.......         0088      36.3961    $2,160.11      $655.22      $432.02
34203.................  T..............  ...............  Removal of leg artery clot...         0088      36.3961    $2,160.11      $655.22      $432.02
34401.................  C..............  ...............  Removal of vein clot.........  ...........  ...........  ...........  ...........  ...........
34421.................  T..............  ...............  Removal of vein clot.........         0088      36.3961    $2,160.11      $655.22      $432.02
34451.................  C..............  ...............  Removal of vein clot.........  ...........  ...........  ...........  ...........  ...........
34471.................  T..............  ...............  Removal of vein clot.........         0088      36.3961    $2,160.11      $655.22      $432.02
34490.................  T..............  ...............  Removal of vein clot.........         0088      36.3961    $2,160.11      $655.22      $432.02
34501.................  T..............  ...............  Repair valve, femoral vein...         0088      36.3961    $2,160.11      $655.22      $432.02
34502.................  C..............  ...............  Reconstruct vena cava........  ...........  ...........  ...........  ...........  ...........
34510.................  T..............  ...............  Transposition of vein valve..         0088      36.3961    $2,160.11      $655.22      $432.02
34520.................  T..............  ...............  Cross-over vein graft........         0088      36.3961    $2,160.11      $655.22      $432.02
34530.................  T..............  ...............  Leg vein fusion..............         0088      36.3961    $2,160.11      $655.22      $432.02
34800.................  C..............  ...............  Endovasc abdo repair w/tube..  ...........  ...........  ...........  ...........  ...........
34802.................  C..............  ...............  Endovasc abdo repr w/device..  ...........  ...........  ...........  ...........  ...........
34803.................  C..............  ...............  Endovas aaa repr w/3-p part..  ...........  ...........  ...........  ...........  ...........
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, 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 artery......         0653      30.3956    $1,803.98  ...........      $360.80
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..  ...........  ...........  ...........  ...........  ...........

[[Page 42819]]

 
35180.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35182.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35184.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35188.................  T..............  ...............  Repair blood vessel lesion...         0088      36.3961    $2,160.11      $655.22      $432.02
35189.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35190.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35201.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35206.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35207.................  T..............  ...............  Repair blood vessel lesion...         0088      36.3961    $2,160.11      $655.22      $432.02
35211.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35216.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35221.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35226.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35231.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35236.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35241.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35246.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35251.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35256.................  T..............  ...............  Repair blood vessel lesion...         0093      23.3454    $1,385.55      $277.34      $277.11
35261.................  T..............  ...............  Repair blood vessel lesion...         0653      30.3956    $1,803.98  ...........      $360.80
35266.................  T..............  ...............  Repair blood vessel lesion...         0653      30.3956    $1,803.98  ...........      $360.80
35271.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35276.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35281.................  C..............  ...............  Repair blood vessel lesion...  ...........  ...........  ...........  ...........  ...........
35286.................  T..............  ...............  Repair blood vessel lesion...         0653      30.3956    $1,803.98  ...........      $360.80
35301.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35311.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35321.................  T..............  ...............  Rechanneling of artery.......         0093      23.3454    $1,385.55      $277.34      $277.11
35331.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35341.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35351.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35355.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35361.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35363.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35371.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35372.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35381.................  C..............  ...............  Rechanneling of artery.......  ...........  ...........  ...........  ...........  ...........
35390.................  C..............  ...............  Reoperation, carotid add-on..  ...........  ...........  ...........  ...........  ...........
35400.................  C..............  ...............  Angioscopy...................  ...........  ...........  ...........  ...........  ...........
35450.................  C..............  ...............  Repair arterial blockage.....  ...........  ...........  ...........  ...........  ...........
35452.................  C..............  ...............  Repair arterial blockage.....  ...........  ...........  ...........  ...........  ...........
35454.................  C..............  ...............  Repair arterial blockage.....  ...........  ...........  ...........  ...........  ...........
35456.................  C..............  ...............  Repair arterial blockage.....  ...........  ...........  ...........  ...........  ...........
35458.................  T..............  ...............  Repair arterial blockage.....         0081      34.2913    $2,035.19  ...........      $407.04
35459.................  T..............  ...............  Repair arterial blockage.....         0081      34.2913    $2,035.19  ...........      $407.04
35460.................  T..............  ...............  Repair venous blockage.......         0081      34.2913    $2,035.19  ...........      $407.04
35470.................  T..............  ...............  Repair arterial blockage.....         0081      34.2913    $2,035.19  ...........      $407.04
35471.................  T..............  ...............  Repair arterial blockage.....         0081      34.2913    $2,035.19  ...........      $407.04
35472.................  T..............  ...............  Repair arterial blockage.....         0081      34.2913    $2,035.19  ...........      $407.04
35473.................  T..............  ...............  Repair arterial blockage.....         0081      34.2913    $2,035.19  ...........      $407.04
35474.................  T..............  ...............  Repair arterial blockage.....         0081      34.2913    $2,035.19  ...........      $407.04
35475.................  T..............  ...............  Repair arterial blockage.....         0081      34.2913    $2,035.19  ...........      $407.04
35476.................  T..............  ...............  Repair venous blockage.......         0081      34.2913    $2,035.19  ...........      $407.04
35480.................  C..............  ...............  Atherectomy, open............  ...........  ...........  ...........  ...........  ...........
35481.................  C..............  ...............  Atherectomy, open............  ...........  ...........  ...........  ...........  ...........
35482.................  C..............  ...............  Atherectomy, open............  ...........  ...........  ...........  ...........  ...........
35483.................  C..............  ...............  Atherectomy, open............  ...........  ...........  ...........  ...........  ...........
35484.................  T..............  ...............  Atherectomy, open............         0081      34.2913    $2,035.19  ...........      $407.04
35485.................  T..............  ...............  Atherectomy, open............         0081      34.2913    $2,035.19  ...........      $407.04
35490.................  T..............  ...............  Atherectomy, percutaneous....         0081      34.2913    $2,035.19  ...........      $407.04
35491.................  T..............  ...............  Atherectomy, percutaneous....         0081      34.2913    $2,035.19  ...........      $407.04
35492.................  T..............  ...............  Atherectomy, percutaneous....         0081      34.2913    $2,035.19  ...........      $407.04
35493.................  T..............  ...............  Atherectomy, percutaneous....         0081      34.2913    $2,035.19  ...........      $407.04
35494.................  T..............  ...............  Atherectomy, percutaneous....         0081      34.2913    $2,035.19  ...........      $407.04
35495.................  T..............  ...............  Atherectomy, percutaneous....         0081      34.2913    $2,035.19  ...........      $407.04
35500.................  T..............  ...............  Harvest vein for bypass......         0081      34.2913    $2,035.19  ...........      $407.04

[[Page 42820]]

 
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..........  ...........  ...........  ...........  ...........  ...........
35572.................  N..............  ...............  Harvest femoropopliteal vein.  ...........  ...........  ...........  ...........  ...........
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/patch...         0093      23.3454    $1,385.55      $277.34      $277.11
35686.................  T..............  ...............  Bypass graft/av fist patency.         0093      23.3454    $1,385.55      $277.34      $277.11
35691.................  C..............  ...............  Arterial transposition.......  ...........  ...........  ...........  ...........  ...........
35693.................  C..............  ...............  Arterial transposition.......  ...........  ...........  ...........  ...........  ...........
35694.................  C..............  ...............  Arterial transposition.......  ...........  ...........  ...........  ...........  ...........

[[Page 42821]]

 
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.  ...........  ...........  ...........  ...........  ...........
35761.................  T..............  ...............  Exploration of artery/vein...         0115      31.3302    $1,859.45      $459.35      $371.89
35800.................  C..............  ...............  Explore neck vessels.........  ...........  ...........  ...........  ...........  ...........
35820.................  C..............  ...............  Explore chest vessels........  ...........  ...........  ...........  ...........  ...........
35840.................  C..............  ...............  Explore abdominal vessels....  ...........  ...........  ...........  ...........  ...........
35860.................  T..............  ...............  Explore limb vessels.........         0093      23.3454    $1,385.55      $277.34      $277.11
35870.................  C..............  ...............  Repair vessel graft defect...  ...........  ...........  ...........  ...........  ...........
35875.................  T..............  ...............  Removal of clot in graft.....         0088      36.3961    $2,160.11      $655.22      $432.02
35876.................  T..............  ...............  Removal of clot in graft.....         0088      36.3961    $2,160.11      $655.22      $432.02
35879.................  T..............  ...............  Revise graft w/vein..........         0088      36.3961    $2,160.11      $655.22      $432.02
35881.................  T..............  ...............  Revise graft w/vein..........         0088      36.3961    $2,160.11      $655.22      $432.02
35901.................  C..............  ...............  Excision, graft, neck........  ...........  ...........  ...........  ...........  ...........
35903.................  T..............  ...............  Excision, graft, extremity...         0115      31.3302    $1,859.45      $459.35      $371.89
35905.................  C..............  ...............  Excision, graft, thorax......  ...........  ...........  ...........  ...........  ...........
35907.................  C..............  ...............  Excision, graft, abdomen.....  ...........  ...........  ...........  ...........  ...........
36000.................  N..............  ...............  Place needle in vein.........  ...........  ...........  ...........  ...........  ...........
36002.................  S..............  ...............  Pseudoaneurysm injection trt.         0267       2.6208      $155.54       $62.18       $31.11
36005.................  N..............  ...............  Injection ext venography.....  ...........  ...........  ...........  ...........  ...........
36010.................  N..............  ...............  Place catheter in vein.......  ...........  ...........  ...........  ...........  ...........
36011.................  N..............  ...............  Place catheter in vein.......  ...........  ...........  ...........  ...........  ...........
36012.................  N..............  ...............  Place catheter in vein.......  ...........  ...........  ...........  ...........  ...........
36013.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36014.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36015.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36100.................  N..............  ...............  Establish access to artery...  ...........  ...........  ...........  ...........  ...........
36120.................  N..............  ...............  Establish access to artery...  ...........  ...........  ...........  ...........  ...........
36140.................  N..............  ...............  Establish access to artery...  ...........  ...........  ...........  ...........  ...........
36145.................  N..............  ...............  Artery to vein shunt.........  ...........  ...........  ...........  ...........  ...........
36160.................  N..............  ...............  Establish access to aorta....  ...........  ...........  ...........  ...........  ...........
36200.................  N..............  ...............  Place catheter in aorta......  ...........  ...........  ...........  ...........  ...........
36215.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36216.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36217.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36218.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36245.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36246.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36247.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36248.................  N..............  ...............  Place catheter in artery.....  ...........  ...........  ...........  ...........  ...........
36260.................  T..............  ...............  Insertion of infusion pump...         0623      26.9877    $1,601.72  ...........      $320.34
36261.................  T..............  ...............  Revision of infusion pump....         0623      26.9877    $1,601.72  ...........      $320.34
36262.................  T..............  ...............  Removal of infusion pump.....         0622      21.1708    $1,256.49  ...........      $251.30
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.................  A..............  ...............  Drawing blood................  ...........  ...........  ...........  ...........  ...........
36416.................  N..............  ...............  Capillary blood draw.........  ...........  ...........  ...........  ...........  ...........
36420.................  T..............  ...............  Vein access cutdown < 1 yr...         0035       0.7125       $42.29  ...........        $8.46
36425.................  T..............  ...............  Vein access cutdown > 1 yr...         0035       0.7125       $42.29  ...........        $8.46
36430.................  S..............  ...............  Blood transfusion service....         0110       3.6428      $216.20  ...........       $43.24
36440.................  S..............  ...............  Bl push transfuse, 2 yr or <.         0110       3.6428      $216.20  ...........       $43.24
36450.................  S..............  ...............  Bl exchange/transfuse, nb....         0110       3.6428      $216.20  ...........       $43.24
36455.................  S..............  ...............  Bl exchange/transfuse non-nb.         0110       3.6428      $216.20  ...........       $43.24
36460.................  S..............  ...............  Transfusion service, fetal...         0110       3.6428      $216.20  ...........       $43.24
36468.................  T..............  ...............  Injection(s), spider veins...         0098       1.1295       $67.04  ...........       $13.41
36469.................  T..............  ...............  Injection(s), spider veins...         0098       1.1295       $67.04  ...........       $13.41
36470.................  T..............  ...............  Injection therapy of vein....         0098       1.1295       $67.04  ...........       $13.41
36471.................  T..............  ...............  Injection therapy of veins...         0098       1.1295       $67.04  ...........       $13.41
36475.................  T..............  ...............  Endovenous rf, 1st vein......         0092      26.3621    $1,564.59      $505.37      $312.92
36476.................  T..............  ...............  Endovenous rf, vein add-on...         0092      26.3621    $1,564.59      $505.37      $312.92

[[Page 42822]]

 
36478.................  T..............  ...............  Endovenous laser, 1st vein...         0092      26.3621    $1,564.59      $505.37      $312.92
36479.................  T..............  ...............  Endovenous laser vein addon..         0092      26.3621    $1,564.59      $505.37      $312.92
36481.................  N..............  ...............  Insertion of catheter, vein..  ...........  ...........  ...........  ...........  ...........
36500.................  N..............  ...............  Insertion of catheter, vein..  ...........  ...........  ...........  ...........  ...........
36510.................  N..............  ...............  Insertion of catheter, vein..  ...........  ...........  ...........  ...........  ...........
36511.................  S..............  ...............  Apheresis wbc................         0111      12.3394      $732.34      $200.18      $146.47
36512.................  S..............  ...............  Apheresis rbc................         0111      12.3394      $732.34      $200.18      $146.47
36513.................  S..............  ...............  Apheresis platelets..........         0111      12.3394      $732.34      $200.18      $146.47
36514.................  S..............  ...............  Apheresis plasma.............         0111      12.3394      $732.34      $200.18      $146.47
36515.................  S..............  ...............  Apheresis, adsorp/reinfuse...         0112      26.6734    $1,583.07      $437.01      $316.61
36516.................  S..............  ...............  Apheresis, selective.........         0112      26.6734    $1,583.07      $437.01      $316.61
36522.................  S..............  ...............  Photopheresis................         0112      26.6734    $1,583.07      $437.01      $316.61
36540.................  N..............  ...............  Collect blood venous device..  ...........  ...........  ...........  ...........  ...........
36550.................  T..............  ...............  Declot vascular device.......         0676       2.3996      $142.42  ...........       $28.48
36555.................  T..............  ...............  Insert non-tunnel cv cath....         0621       8.2610      $490.29  ...........       $98.06
36556.................  T..............  ...............  Insert non-tunnel cv cath....         0621       8.2610      $490.29  ...........       $98.06
36557.................  T..............  ...............  Insert tunneled cv cath......         0622      21.1708    $1,256.49  ...........      $251.30
36558.................  T..............  ...............  Insert tunneled cv cath......         0622      21.1708    $1,256.49  ...........      $251.30
36560.................  T..............  ...............  Insert tunneled cv cath......         0623      26.9877    $1,601.72  ...........      $320.34
36561.................  T..............  ...............  Insert tunneled cv cath......         0623      26.9877    $1,601.72  ...........      $320.34
36563.................  T..............  ...............  Insert tunneled cv cath......         0623      26.9877    $1,601.72  ...........      $320.34
36565.................  T..............  ...............  Insert tunneled cv cath......         0623      26.9877    $1,601.72  ...........      $320.34
36566.................  T..............  ...............  Insert tunneled cv cath......         1564  ...........    $4,750.00  ...........      $950.00
36568.................  T..............  ...............  Insert tunneled cv cath......         0621       8.2610      $490.29  ...........       $98.06
36569.................  T..............  ...............  Insert tunneled cv cath......         0621       8.2610      $490.29  ...........       $98.06
36570.................  T..............  ...............  Insert tunneled cv cath......         0622      21.1708    $1,256.49  ...........      $251.30
36571.................  T..............  ...............  Insert tunneled cv cath......         0622      21.1708    $1,256.49  ...........      $251.30
36575.................  T..............  ...............  Repair tunneled cv cath......         0621       8.2610      $490.29  ...........       $98.06
36576.................  T..............  ...............  Repair tunneled cv cath......         0621       8.2610      $490.29  ...........       $98.06
36578.................  T..............  ...............  Replace tunneled cv cath.....         0622      21.1708    $1,256.49  ...........      $251.30
36580.................  T..............  ...............  Replace tunneled cv cath.....         0621       8.2610      $490.29  ...........       $98.06
36581.................  T..............  ...............  Replace tunneled cv cath.....         0622      21.1708    $1,256.49  ...........      $251.30
36582.................  T..............  ...............  Replace tunneled cv cath.....         0623      26.9877    $1,601.72  ...........      $320.34
36583.................  T..............  ...............  Replace tunneled cv cath.....         0623      26.9877    $1,601.72  ...........      $320.34
36584.................  T..............  ...............  Replace tunneled cv cath.....         0621       8.2610      $490.29  ...........       $98.06
36585.................  T..............  ...............  Replace tunneled cv cath.....         0622      21.1708    $1,256.49  ...........      $251.30
36589.................  T..............  ...............  Removal tunneled cv cath.....         0621       8.2610      $490.29  ...........       $98.06
36590.................  T..............  ...............  Removal tunneled cv cath.....         0621       8.2610      $490.29  ...........       $98.06
36595.................  T..............  ...............  Mech remov tunneled cv cath..         0622      21.1708    $1,256.49  ...........      $251.30
36596.................  T..............  ...............  Mech remov tunneled cv cath..         0621       8.2610      $490.29  ...........       $98.06
36597.................  T..............  ...............  Reposition venous catheter...         0621       8.2610      $490.29  ...........       $98.06
36600.................  N..............  ...............  Withdrawal of arterial blood.  ...........  ...........  ...........  ...........  ...........
36620.................  N..............  ...............  Insertion catheter, artery...  ...........  ...........  ...........  ...........  ...........
36625.................  N..............  ...............  Insertion catheter, artery...  ...........  ...........  ...........  ...........  ...........
36640.................  T..............  ...............  Insertion catheter, artery...         0623      26.9877    $1,601.72  ...........      $320.34
36660.................  C..............  ...............  Insertion catheter, artery...  ...........  ...........  ...........  ...........  ...........
36680.................  T..............  ...............  Insert needle, bone cavity...         0002       0.9515       $56.47  ...........       $11.29
36800.................  T..............  ...............  Insertion of cannula.........         0115      31.3302    $1,859.45      $459.35      $371.89
36810.................  T..............  ...............  Insertion of cannula.........         0115      31.3302    $1,859.45      $459.35      $371.89
36815.................  T..............  ...............  Insertion of cannula.........         0115      31.3302    $1,859.45      $459.35      $371.89
36818.................  T..............  ...............  Av fuse, uppr arm, cephalic..         0088      36.3961    $2,160.11      $655.22      $432.02
36819.................  T..............  ...............  Av fusion/uppr arm vein......         0088      36.3961    $2,160.11      $655.22      $432.02
36820.................  T..............  ...............  Av fusion/forearm vein.......         0088      36.3961    $2,160.11      $655.22      $432.02
36821.................  T..............  ...............  Av fusion direct any site....         0088      36.3961    $2,160.11      $655.22      $432.02
36822.................  C..............  ...............  Insertion of cannula(s)......  ...........  ...........  ...........  ...........  ...........
36823.................  C..............  ...............  Insertion of cannula(s)......  ...........  ...........  ...........  ...........  ...........
36825.................  T..............  ...............  Artery-vein autograft........         0088      36.3961    $2,160.11      $655.22      $432.02
36830.................  T..............  ...............  Artery-vein graft............         0088      36.3961    $2,160.11      $655.22      $432.02
36831.................  T..............  ...............  Open thrombect av fistula....         0088      36.3961    $2,160.11      $655.22      $432.02
36832.................  T..............  ...............  Av fistula revision, open....         0088      36.3961    $2,160.11      $655.22      $432.02
36833.................  T..............  ...............  Av fistula revision..........         0088      36.3961    $2,160.11      $655.22      $432.02
36834.................  T..............  ...............  Repair A-V aneurysm..........         0088      36.3961    $2,160.11      $655.22      $432.02
36835.................  T..............  ...............  Artery to vein shunt.........         0115      31.3302    $1,859.45      $459.35      $371.89
36838.................  T..............  ...............  Dist revas ligation, hemo....         0088      36.3961    $2,160.11      $655.22      $432.02
36860.................  T..............  ...............  External cannula declotting..         0676       2.3996      $142.42  ...........       $28.48
36861.................  T..............  ...............  Cannula declotting...........         0115      31.3302    $1,859.45      $459.35      $371.89

[[Page 42823]]

 
36870.................  T..............  ...............  Percut thrombect av fistula..         0653      30.3956    $1,803.98  ...........      $360.80
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.................  T..............  ...............  Remove hepatic shunt (tips)..         0229      64.1626    $3,808.05      $771.23      $761.61
37195.................  T..............  ...............  Thrombolytic therapy, stroke.         0676       2.3996      $142.42  ...........       $28.48
37200.................  T..............  ...............  Transcatheter biopsy.........         0685       5.9902      $355.52      $115.47       $71.10
37201.................  T..............  ...............  Transcatheter therapy infuse.         0676       2.3996      $142.42  ...........       $28.48
37202.................  T..............  ...............  Transcatheter therapy infuse.         0676       2.3996      $142.42  ...........       $28.48
37203.................  T..............  ...............  Transcatheter retrieval......         0103      14.6476      $869.34      $223.63      $173.87
37204.................  T..............  ...............  Transcatheter occlusion......         0115      31.3302    $1,859.45      $459.35      $371.89
37205.................  T..............  ...............  Transcatheter stent..........         0229      64.1626    $3,808.05      $771.23      $761.61
37206.................  T..............  ...............  Transcatheter stent add-on...         0229      64.1626    $3,808.05      $771.23      $761.61
37207.................  T..............  ...............  Transcatheter stent..........         0229      64.1626    $3,808.05      $771.23      $761.61
37208.................  T..............  ...............  Transcatheter stent add-on...         0229      64.1626    $3,808.05      $771.23      $761.61
37209.................  T..............  ...............  Exchange arterial catheter...         0103      14.6476      $869.34      $223.63      $173.87
37215.................  C..............  ...............  Transcath stent, cca w/eps...  ...........  ...........  ...........  ...........  ...........
37216.................  C..............  ...............  Transcath stent, cca w/o eps.  ...........  ...........  ...........  ...........  ...........
37250.................  S..............  ...............  Iv us first vessel add-on....         0416      19.4657    $1,155.29  ...........      $231.06
37251.................  S..............  ...............  Iv us each add vessel add-on.         0416      19.4657    $1,155.29  ...........      $231.06
37500.................  T..............  ...............  Endoscopy ligate perf veins..         0092      26.3621    $1,564.59      $505.37      $312.92
37501.................  T..............  ...............  Vascular endoscopy procedure.         0092      26.3621    $1,564.59      $505.37      $312.92
37565.................  T..............  ...............  Ligation of neck vein........         0093      23.3454    $1,385.55      $277.34      $277.11
37600.................  T..............  ...............  Ligation of neck artery......         0093      23.3454    $1,385.55      $277.34      $277.11
37605.................  T..............  ...............  Ligation of neck artery......         0091      28.8685    $1,713.35      $348.23      $342.67
37606.................  T..............  ...............  Ligation of neck artery......         0091      28.8685    $1,713.35      $348.23      $342.67
37607.................  T..............  ...............  Ligation of a-v fistula......         0092      26.3621    $1,564.59      $505.37      $312.92
37609.................  T..............  ...............  Temporal artery procedure....         0021      14.9098      $884.90      $219.48      $176.98
37615.................  T..............  ...............  Ligation of neck artery......         0091      28.8685    $1,713.35      $348.23      $342.67
37616.................  C..............  ...............  Ligation of chest artery.....  ...........  ...........  ...........  ...........  ...........
37617.................  C..............  ...............  Ligation of abdomen artery...  ...........  ...........  ...........  ...........  ...........
37618.................  C..............  ...............  Ligation of extremity artery.  ...........  ...........  ...........  ...........  ...........
37620.................  T..............  ...............  Revision of major vein.......         0091      28.8685    $1,713.35      $348.23      $342.67
37650.................  T..............  ...............  Revision of major vein.......         0091      28.8685    $1,713.35      $348.23      $342.67
37660.................  C..............  ...............  Revision of major vein.......  ...........  ...........  ...........  ...........  ...........
37700.................  T..............  ...............  Revise leg vein..............         0091      28.8685    $1,713.35      $348.23      $342.67
37720.................  T..............  ...............  Removal of leg vein..........         0092      26.3621    $1,564.59      $505.37      $312.92
37730.................  T..............  ...............  Removal of leg veins.........         0092      26.3621    $1,564.59      $505.37      $312.92
37735.................  T..............  ...............  Removal of leg veins/lesion..         0092      26.3621    $1,564.59      $505.37      $312.92
37760.................  T..............  ...............  Revision of leg veins........         0091      28.8685    $1,713.35      $348.23      $342.67
37765.................  T..............  ...............  Phleb veins - extrem - to 20.         0091      28.8685    $1,713.35      $348.23      $342.67
37766.................  T..............  ...............  Phleb veins - extrem 20+.....         0091      28.8685    $1,713.35      $348.23      $342.67
37780.................  T..............  ...............  Revision of leg vein.........         0091      28.8685    $1,713.35      $348.23      $342.67
37785.................  T..............  ...............  Ligate/divide/excise vein....         0091      28.8685    $1,713.35      $348.23      $342.67
37788.................  C..............  ...............  Revascularization, penis.....  ...........  ...........  ...........  ...........  ...........
37790.................  T..............  ...............  Penile venous occlusion......         0181      30.7265    $1,823.62      $621.82      $364.72
37799.................  T..............  ...............  Vascular surgery procedure...         0103      14.6476      $869.34      $223.63      $173.87
38100.................  C..............  ...............  Removal of spleen, total.....  ...........  ...........  ...........  ...........  ...........
38101.................  C..............  ...............  Removal of spleen, partial...  ...........  ...........  ...........  ...........  ...........
38102.................  C..............  ...............  Removal of spleen, total.....  ...........  ...........  ...........  ...........  ...........
38115.................  C..............  ...............  Repair of ruptured spleen....  ...........  ...........  ...........  ...........  ...........
38120.................  T..............  ...............  Laparoscopy, splenectomy.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
38129.................  T..............  ...............  Laparoscope proc, spleen.....         0130      31.7825    $1,886.29      $659.53      $377.26
38200.................  N..............  ...............  Injection for spleen x-ray...  ...........  ...........  ...........  ...........  ...........
38204.................  E..............  ...............  Bl donor search management...  ...........  ...........  ...........  ...........  ...........
38205.................  S..............  ...............  Harvest allogenic stem cells.         0111      12.3394      $732.34      $200.18      $146.47
38206.................  S..............  ...............  Harvest auto stem cells......         0111      12.3394      $732.34      $200.18      $146.47
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.....  ...........  ...........  ...........  ...........  ...........

[[Page 42824]]

 
38213.................  E..............  ...............  Platelet deplete of harvest..  ...........  ...........  ...........  ...........  ...........
38214.................  E..............  ...............  Volume deplete of harvest....  ...........  ...........  ...........  ...........  ...........
38215.................  E..............  ...............  Harvest stem cell concentrte.  ...........  ...........  ...........  ...........  ...........
38220.................  T..............  ...............  Bone marrow aspiration.......         0003       2.6410      $156.74  ...........       $31.35
38221.................  T..............  ...............  Bone marrow biopsy...........         0003       2.6410      $156.74  ...........       $31.35
38230.................  S..............  ...............  Bone marrow collection.......         0111      12.3394      $732.34      $200.18      $146.47
38240.................  S..............  ...............  Bone marrow/stem transplant..         0123      22.8861    $1,358.29  ...........      $271.66
38241.................  S..............  ...............  Bone marrow/stem transplant..         0123      22.8861    $1,358.29  ...........      $271.66
38242.................  S..............  ...............  Lymphocyte infuse transplant.         0111      12.3394      $732.34      $200.18      $146.47
38300.................  T..............  ...............  Drainage, lymph node lesion..         0007      11.3983      $676.49  ...........      $135.30
38305.................  T..............  ...............  Drainage, lymph node lesion..         0008      16.4242      $974.78  ...........      $194.96
38308.................  T..............  ...............  Incision of lymph channels...         0113      21.3681    $1,268.20  ...........      $253.64
38380.................  C..............  ...............  Thoracic duct procedure......  ...........  ...........  ...........  ...........  ...........
38381.................  C..............  ...............  Thoracic duct procedure......  ...........  ...........  ...........  ...........  ...........
38382.................  C..............  ...............  Thoracic duct procedure......  ...........  ...........  ...........  ...........  ...........
38500.................  T..............  ...............  Biopsy/removal, lymph nodes..         0113      21.3681    $1,268.20  ...........      $253.64
38505.................  T..............  ...............  Needle biopsy, lymph nodes...         0005       3.5831      $212.66       $71.45       $42.53
38510.................  T..............  ...............  Biopsy/removal, lymph nodes..         0113      21.3681    $1,268.20  ...........      $253.64
38520.................  T..............  ...............  Biopsy/removal, lymph nodes..         0113      21.3681    $1,268.20  ...........      $253.64
38525.................  T..............  ...............  Biopsy/removal, lymph nodes..         0113      21.3681    $1,268.20  ...........      $253.64
38530.................  T..............  ...............  Biopsy/removal, lymph nodes..         0113      21.3681    $1,268.20  ...........      $253.64
38542.................  T..............  ...............  Explore deep node(s), neck...         0114      40.5805    $2,408.45      $485.91      $481.69
38550.................  T..............  ...............  Removal, neck/armpit lesion..         0113      21.3681    $1,268.20  ...........      $253.64
38555.................  T..............  ...............  Removal, neck/armpit lesion..         0113      21.3681    $1,268.20  ...........      $253.64
38562.................  C..............  ...............  Removal, pelvic lymph nodes..  ...........  ...........  ...........  ...........  ...........
38564.................  C..............  ...............  Removal, abdomen lymph nodes.  ...........  ...........  ...........  ...........  ...........
38570.................  T..............  ...............  Laparoscopy, lymph node biop.         0131      43.1426    $2,560.51    $1,001.89      $512.10
38571.................  T..............  ...............  Laparoscopy, lymphadenectomy.         0132      62.7061    $3,721.61    $1,239.22      $744.32
38572.................  T..............  ...............  Laparoscopy, lymphadenectomy.         0131      43.1426    $2,560.51    $1,001.89      $512.10
38589.................  T..............  ...............  Laparoscope proc, lymphatic..         0130      31.7825    $1,886.29      $659.53      $377.26
38700.................  T..............  ...............  Removal of lymph nodes, neck.         0113      21.3681    $1,268.20  ...........      $253.64
38720.................  T..............  ...............  Removal of lymph nodes, neck.         0113      21.3681    $1,268.20  ...........      $253.64
38724.................  C..............  ...............  Removal of lymph nodes, neck.  ...........  ...........  ...........  ...........  ...........
38740.................  T..............  ...............  Remove armpit lymph nodes....         0114      40.5805    $2,408.45      $485.91      $481.69
38745.................  T..............  ...............  Remove armpit lymph nodes....         0114      40.5805    $2,408.45      $485.91      $481.69
38746.................  C..............  ...............  Remove thoracic lymph nodes..  ...........  ...........  ...........  ...........  ...........
38747.................  C..............  ...............  Remove abdominal lymph nodes.  ...........  ...........  ...........  ...........  ...........
38760.................  T..............  ...............  Remove groin lymph nodes.....         0113      21.3681    $1,268.20  ...........      $253.64
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 procedure.         0110       3.6428      $216.20  ...........       $43.24
39000.................  C..............  ...............  Exploration of chest.........  ...........  ...........  ...........  ...........  ...........
39010.................  C..............  ...............  Exploration of chest.........  ...........  ...........  ...........  ...........  ...........
39200.................  C..............  ...............  Removal chest lesion.........  ...........  ...........  ...........  ...........  ...........
39220.................  C..............  ...............  Removal chest lesion.........  ...........  ...........  ...........  ...........  ...........
39400.................  T..............  ...............  Visualization of chest.......         0069      30.5386    $1,812.47      $591.64      $362.49
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..  ...........  ...........  ...........  ...........  ...........
4000F.................  E..............  ...............  Tobacco use txmnt counseling.  ...........  ...........  ...........  ...........  ...........
4001F.................  E..............  ...............  Tobacco use txmnt, pharmacol.  ...........  ...........  ...........  ...........  ...........
4002F.................  E..............  ...............  Statin therapy, rx...........  ...........  ...........  ...........  ...........  ...........

[[Page 42825]]

 
4006F.................  E..............  ...............  Beta-blocker therapy, rx.....  ...........  ...........  ...........  ...........  ...........
4009F.................  E..............  ...............  Ace inhibitor therapy, rx....  ...........  ...........  ...........  ...........  ...........
4011F.................  E..............  ...............  Oral antiplatelet tx, rx.....  ...........  ...........  ...........  ...........  ...........
40490.................  T..............  ...............  Biopsy of lip................         0251       2.0010      $118.76  ...........       $23.75
40500.................  T..............  ...............  Partial excision of lip......         0253      16.0627      $953.32      $282.29      $190.66
40510.................  T..............  ...............  Partial excision of lip......         0254      23.2980    $1,382.74      $321.35      $276.55
40520.................  T..............  ...............  Partial excision of lip......         0253      16.0627      $953.32      $282.29      $190.66
40525.................  T..............  ...............  Reconstruct lip with flap....         0254      23.2980    $1,382.74      $321.35      $276.55
40527.................  T..............  ...............  Reconstruct lip with flap....         0254      23.2980    $1,382.74      $321.35      $276.55
40530.................  T..............  ...............  Partial removal of lip.......         0254      23.2980    $1,382.74      $321.35      $276.55
40650.................  T..............  ...............  Repair lip...................         0252       7.8317      $464.81      $113.41       $92.96
40652.................  T..............  ...............  Repair lip...................         0252       7.8317      $464.81      $113.41       $92.96
40654.................  T..............  ...............  Repair lip...................         0252       7.8317      $464.81      $113.41       $92.96
40700.................  T..............  ...............  Repair cleft lip/nasal.......         0256      37.1513    $2,204.93  ...........      $440.99
40701.................  T..............  ...............  Repair cleft lip/nasal.......         0256      37.1513    $2,204.93  ...........      $440.99
40702.................  T..............  ...............  Repair cleft lip/nasal.......         0256      37.1513    $2,204.93  ...........      $440.99
40720.................  T..............  ...............  Repair cleft lip/nasal.......         0256      37.1513    $2,204.93  ...........      $440.99
40761.................  T..............  ...............  Repair cleft lip/nasal.......         0256      37.1513    $2,204.93  ...........      $440.99
40799.................  T..............  ...............  Lip surgery procedure........         0251       2.0010      $118.76  ...........       $23.75
40800.................  T..............  ...............  Drainage of mouth lesion.....         0251       2.0010      $118.76  ...........       $23.75
40801.................  T..............  ...............  Drainage of mouth lesion.....         0252       7.8317      $464.81      $113.41       $92.96
40804.................  X..............  ...............  Removal, foreign body, mouth.         0340       0.6355       $37.72  ...........        $7.54
40805.................  T..............  ...............  Removal, foreign body, mouth.         0252       7.8317      $464.81      $113.41       $92.96
40806.................  T..............  ...............  Incision of lip fold.........         0251       2.0010      $118.76  ...........       $23.75
40808.................  T..............  ...............  Biopsy of mouth lesion.......         0251       2.0010      $118.76  ...........       $23.75
40810.................  T..............  ...............  Excision of mouth lesion.....         0253      16.0627      $953.32      $282.29      $190.66
40812.................  T..............  ...............  Excise/repair mouth lesion...         0253      16.0627      $953.32      $282.29      $190.66
40814.................  T..............  ...............  Excise/repair mouth lesion...         0253      16.0627      $953.32      $282.29      $190.66
40816.................  T..............  ...............  Excision of mouth lesion.....         0254      23.2980    $1,382.74      $321.35      $276.55
40818.................  T..............  ...............  Excise oral mucosa for graft.         0251       2.0010      $118.76  ...........       $23.75
40819.................  T..............  ...............  Excise lip or cheek fold.....         0252       7.8317      $464.81      $113.41       $92.96
40820.................  T..............  ...............  Treatment of mouth lesion....         0253      16.0627      $953.32      $282.29      $190.66
40830.................  T..............  ...............  Repair mouth laceration......         0251       2.0010      $118.76  ...........       $23.75
40831.................  T..............  ...............  Repair mouth laceration......         0252       7.8317      $464.81      $113.41       $92.96
40840.................  T..............  ...............  Reconstruction of mouth......         0254      23.2980    $1,382.74      $321.35      $276.55
40842.................  T..............  ...............  Reconstruction of mouth......         0254      23.2980    $1,382.74      $321.35      $276.55
40843.................  T..............  ...............  Reconstruction of mouth......         0254      23.2980    $1,382.74      $321.35      $276.55
40844.................  T..............  ...............  Reconstruction of mouth......         0256      37.1513    $2,204.93  ...........      $440.99
40845.................  T..............  ...............  Reconstruction of mouth......         0256      37.1513    $2,204.93  ...........      $440.99
40899.................  T..............  ...............  Mouth surgery procedure......         0251       2.0010      $118.76  ...........       $23.75
41000.................  T..............  ...............  Drainage of mouth lesion.....         0253      16.0627      $953.32      $282.29      $190.66
41005.................  T..............  ...............  Drainage of mouth lesion.....         0251       2.0010      $118.76  ...........       $23.75
41006.................  T..............  ...............  Drainage of mouth lesion.....         0254      23.2980    $1,382.74      $321.35      $276.55
41007.................  T..............  ...............  Drainage of mouth lesion.....         0253      16.0627      $953.32      $282.29      $190.66
41008.................  T..............  ...............  Drainage of mouth lesion.....         0253      16.0627      $953.32      $282.29      $190.66
41009.................  T..............  ...............  Drainage of mouth lesion.....         0251       2.0010      $118.76  ...........       $23.75
41010.................  T..............  ...............  Incision of tongue fold......         0252       7.8317      $464.81      $113.41       $92.96
41015.................  T..............  ...............  Drainage of mouth lesion.....         0251       2.0010      $118.76  ...........       $23.75
41016.................  T..............  ...............  Drainage of mouth lesion.....         0252       7.8317      $464.81      $113.41       $92.96
41017.................  T..............  ...............  Drainage of mouth lesion.....         0252       7.8317      $464.81      $113.41       $92.96
41018.................  T..............  ...............  Drainage of mouth lesion.....         0252       7.8317      $464.81      $113.41       $92.96
41100.................  T..............  ...............  Biopsy of tongue.............         0252       7.8317      $464.81      $113.41       $92.96
41105.................  T..............  ...............  Biopsy of tongue.............         0253      16.0627      $953.32      $282.29      $190.66
41108.................  T..............  ...............  Biopsy of floor of mouth.....         0252       7.8317      $464.81      $113.41       $92.96
41110.................  T..............  ...............  Excision of tongue lesion....         0253      16.0627      $953.32      $282.29      $190.66
41112.................  T..............  ...............  Excision of tongue lesion....         0253      16.0627      $953.32      $282.29      $190.66
41113.................  T..............  ...............  Excision of tongue lesion....         0253      16.0627      $953.32      $282.29      $190.66
41114.................  T..............  ...............  Excision of tongue lesion....         0254      23.2980    $1,382.74      $321.35      $276.55
41115.................  T..............  ...............  Excision of tongue fold......         0252       7.8317      $464.81      $113.41       $92.96
41116.................  T..............  ...............  Excision of mouth lesion.....         0253      16.0627      $953.32      $282.29      $190.66
41120.................  T..............  ...............  Partial removal of tongue....         0254      23.2980    $1,382.74      $321.35      $276.55
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...  ...........  ...........  ...........  ...........  ...........

[[Page 42826]]

 
41153.................  C..............  ...............  Tongue, mouth, neck surgery..  ...........  ...........  ...........  ...........  ...........
41155.................  C..............  ...............  Tongue, jaw, & neck surgery..  ...........  ...........  ...........  ...........  ...........
41250.................  T..............  ...............  Repair tongue laceration.....         0251       2.0010      $118.76  ...........       $23.75
41251.................  T..............  ...............  Repair tongue laceration.....         0251       2.0010      $118.76  ...........       $23.75
41252.................  T..............  ...............  Repair tongue laceration.....         0252       7.8317      $464.81      $113.41       $92.96
41500.................  T..............  ...............  Fixation of tongue...........         0254      23.2980    $1,382.74      $321.35      $276.55
41510.................  T..............  ...............  Tongue to lip surgery........         0253      16.0627      $953.32      $282.29      $190.66
41520.................  T..............  ...............  Reconstruction, tongue fold..         0252       7.8317      $464.81      $113.41       $92.96
41599.................  T..............  ...............  Tongue and mouth surgery.....         0251       2.0010      $118.76  ...........       $23.75
41800.................  T..............  ...............  Drainage of gum lesion.......         0251       2.0010      $118.76  ...........       $23.75
41805.................  T..............  ...............  Removal foreign body, gum....         0254      23.2980    $1,382.74      $321.35      $276.55
41806.................  T..............  ...............  Removal foreign body,jawbone.         0253      16.0627      $953.32      $282.29      $190.66
41820.................  T..............  ...............  Excision, gum, each quadrant.         0252       7.8317      $464.81      $113.41       $92.96
41821.................  T..............  ...............  Excision of gum flap.........         0252       7.8317      $464.81      $113.41       $92.96
41822.................  T..............  ...............  Excision of gum lesion.......         0253      16.0627      $953.32      $282.29      $190.66
41823.................  T..............  ...............  Excision of gum lesion.......         0254      23.2980    $1,382.74      $321.35      $276.55
41825.................  T..............  ...............  Excision of gum lesion.......         0253      16.0627      $953.32      $282.29      $190.66
41826.................  T..............  ...............  Excision of gum lesion.......         0253      16.0627      $953.32      $282.29      $190.66
41827.................  T..............  ...............  Excision of gum lesion.......         0254      23.2980    $1,382.74      $321.35      $276.55
41828.................  T..............  ...............  Excision of gum lesion.......         0253      16.0627      $953.32      $282.29      $190.66
41830.................  T..............  ...............  Removal of gum tissue........         0253      16.0627      $953.32      $282.29      $190.66
41850.................  T..............  ...............  Treatment of gum lesion......         0253      16.0627      $953.32      $282.29      $190.66
41870.................  T..............  ...............  Gum graft....................         0254      23.2980    $1,382.74      $321.35      $276.55
41872.................  T..............  ...............  Repair gum...................         0253      16.0627      $953.32      $282.29      $190.66
41874.................  T..............  ...............  Repair tooth socket..........         0254      23.2980    $1,382.74      $321.35      $276.55
41899.................  T..............  ...............  Dental surgery procedure.....         0251       2.0010      $118.76  ...........       $23.75
42000.................  T..............  ...............  Drainage mouth roof lesion...         0251       2.0010      $118.76  ...........       $23.75
42100.................  T..............  ...............  Biopsy roof of mouth.........         0252       7.8317      $464.81      $113.41       $92.96
42104.................  T..............  ...............  Excision lesion, mouth roof..         0253      16.0627      $953.32      $282.29      $190.66
42106.................  T..............  ...............  Excision lesion, mouth roof..         0253      16.0627      $953.32      $282.29      $190.66
42107.................  T..............  ...............  Excision lesion, mouth roof..         0254      23.2980    $1,382.74      $321.35      $276.55
42120.................  T..............  ...............  Remove palate/lesion.........         0256      37.1513    $2,204.93  ...........      $440.99
42140.................  T..............  ...............  Excision of uvula............         0252       7.8317      $464.81      $113.41       $92.96
42145.................  T..............  ...............  Repair palate, pharynx/uvula.         0254      23.2980    $1,382.74      $321.35      $276.55
42160.................  T..............  ...............  Treatment mouth roof lesion..         0253      16.0627      $953.32      $282.29      $190.66
42180.................  T..............  ...............  Repair palate................         0251       2.0010      $118.76  ...........       $23.75
42182.................  T..............  ...............  Repair palate................         0256      37.1513    $2,204.93  ...........      $440.99
42200.................  T..............  ...............  Reconstruct cleft palate.....         0256      37.1513    $2,204.93  ...........      $440.99
42205.................  T..............  ...............  Reconstruct cleft palate.....         0256      37.1513    $2,204.93  ...........      $440.99
42210.................  T..............  ...............  Reconstruct cleft palate.....         0256      37.1513    $2,204.93  ...........      $440.99
42215.................  T..............  ...............  Reconstruct cleft palate.....         0256      37.1513    $2,204.93  ...........      $440.99
42220.................  T..............  ...............  Reconstruct cleft palate.....         0256      37.1513    $2,204.93  ...........      $440.99
42225.................  T..............  ...............  Reconstruct cleft palate.....         0256      37.1513    $2,204.93  ...........      $440.99
42226.................  T..............  ...............  Lengthening of palate........         0256      37.1513    $2,204.93  ...........      $440.99
42227.................  T..............  ...............  Lengthening of palate........         0256      37.1513    $2,204.93  ...........      $440.99
42235.................  T..............  ...............  Repair palate................         0253      16.0627      $953.32      $282.29      $190.66
42260.................  T..............  ...............  Repair nose to lip fistula...         0254      23.2980    $1,382.74      $321.35      $276.55
42280.................  T..............  ...............  Preparation, palate mold.....         0251       2.0010      $118.76  ...........       $23.75
42281.................  T..............  ...............  Insertion, palate prosthesis.         0253      16.0627      $953.32      $282.29      $190.66
42299.................  T..............  ...............  Palate/uvula surgery.........         0251       2.0010      $118.76  ...........       $23.75
42300.................  T..............  ...............  Drainage of salivary gland...         0253      16.0627      $953.32      $282.29      $190.66
42305.................  T..............  ...............  Drainage of salivary gland...         0253      16.0627      $953.32      $282.29      $190.66
42310.................  T..............  ...............  Drainage of salivary gland...         0251       2.0010      $118.76  ...........       $23.75
42320.................  T..............  ...............  Drainage of salivary gland...         0251       2.0010      $118.76  ...........       $23.75
42325.................  T..............  ...............  Create salivary cyst drain...         0251       2.0010      $118.76  ...........       $23.75
42326.................  T..............  ...............  Create salivary cyst drain...         0252       7.8317      $464.81      $113.41       $92.96
42330.................  T..............  ...............  Removal of salivary stone....         0253      16.0627      $953.32      $282.29      $190.66
42335.................  T..............  ...............  Removal of salivary stone....         0253      16.0627      $953.32      $282.29      $190.66
42340.................  T..............  ...............  Removal of salivary stone....         0253      16.0627      $953.32      $282.29      $190.66
42400.................  T..............  ...............  Biopsy of salivary gland.....         0005       3.5831      $212.66       $71.45       $42.53
42405.................  T..............  ...............  Biopsy of salivary gland.....         0253      16.0627      $953.32      $282.29      $190.66
42408.................  T..............  ...............  Excision of salivary cyst....         0253      16.0627      $953.32      $282.29      $190.66
42409.................  T..............  ...............  Drainage of salivary cyst....         0253      16.0627      $953.32      $282.29      $190.66
42410.................  T..............  ...............  Excise parotid gland/lesion..         0256      37.1513    $2,204.93  ...........      $440.99
42415.................  T..............  ...............  Excise parotid gland/lesion..         0256      37.1513    $2,204.93  ...........      $440.99
42420.................  T..............  ...............  Excise parotid gland/lesion..         0256      37.1513    $2,204.93  ...........      $440.99

[[Page 42827]]

 
42425.................  T..............  ...............  Excise parotid gland/lesion..         0256      37.1513    $2,204.93  ...........      $440.99
42426.................  C..............  ...............  Excise parotid gland/lesion..  ...........  ...........  ...........  ...........  ...........
42440.................  T..............  ...............  Excise submaxillary gland....         0256      37.1513    $2,204.93  ...........      $440.99
42450.................  T..............  ...............  Excise sublingual gland......         0254      23.2980    $1,382.74      $321.35      $276.55
42500.................  T..............  ...............  Repair salivary duct.........         0254      23.2980    $1,382.74      $321.35      $276.55
42505.................  T..............  ...............  Repair salivary duct.........         0256      37.1513    $2,204.93  ...........      $440.99
42507.................  T..............  ...............  Parotid duct diversion.......         0256      37.1513    $2,204.93  ...........      $440.99
42508.................  T..............  ...............  Parotid duct diversion.......         0256      37.1513    $2,204.93  ...........      $440.99
42509.................  T..............  ...............  Parotid duct diversion.......         0256      37.1513    $2,204.93  ...........      $440.99
42510.................  T..............  ...............  Parotid duct diversion.......         0256      37.1513    $2,204.93  ...........      $440.99
42550.................  N..............  ...............  Injection for salivary x-ray.  ...........  ...........  ...........  ...........  ...........
42600.................  T..............  ...............  Closure of salivary fistula..         0253      16.0627      $953.32      $282.29      $190.66
42650.................  T..............  ...............  Dilation of salivary duct....         0252       7.8317      $464.81      $113.41       $92.96
42660.................  T..............  ...............  Dilation of salivary duct....         0251       2.0010      $118.76  ...........       $23.75
42665.................  T..............  ...............  Ligation of salivary duct....         0254      23.2980    $1,382.74      $321.35      $276.55
42699.................  T..............  ...............  Salivary surgery procedure...         0251       2.0010      $118.76  ...........       $23.75
42700.................  T..............  ...............  Drainage of tonsil abscess...         0251       2.0010      $118.76  ...........       $23.75
42720.................  T..............  ...............  Drainage of throat abscess...         0253      16.0627      $953.32      $282.29      $190.66
42725.................  T..............  ...............  Drainage of throat abscess...         0256      37.1513    $2,204.93  ...........      $440.99
42800.................  T..............  ...............  Biopsy of throat.............         0253      16.0627      $953.32      $282.29      $190.66
42802.................  T..............  ...............  Biopsy of throat.............         0253      16.0627      $953.32      $282.29      $190.66
42804.................  T..............  ...............  Biopsy of upper nose/throat..         0253      16.0627      $953.32      $282.29      $190.66
42806.................  T..............  ...............  Biopsy of upper nose/throat..         0254      23.2980    $1,382.74      $321.35      $276.55
42808.................  T..............  ...............  Excise pharynx lesion........         0253      16.0627      $953.32      $282.29      $190.66
42809.................  X..............  ...............  Remove pharynx foreign body..         0340       0.6355       $37.72  ...........        $7.54
42810.................  T..............  ...............  Excision of neck cyst........         0254      23.2980    $1,382.74      $321.35      $276.55
42815.................  T..............  ...............  Excision of neck cyst........         0256      37.1513    $2,204.93  ...........      $440.99
42820.................  T..............  ...............  Remove tonsils and adenoids..         0258      22.1458    $1,314.35      $437.25      $262.87
42821.................  T..............  ...............  Remove tonsils and adenoids..         0258      22.1458    $1,314.35      $437.25      $262.87
42825.................  T..............  ...............  Removal of tonsils...........         0258      22.1458    $1,314.35      $437.25      $262.87
42826.................  T..............  ...............  Removal of tonsils...........         0258      22.1458    $1,314.35      $437.25      $262.87
42830.................  T..............  ...............  Removal of adenoids..........         0258      22.1458    $1,314.35      $437.25      $262.87
42831.................  T..............  ...............  Removal of adenoids..........         0258      22.1458    $1,314.35      $437.25      $262.87
42835.................  T..............  ...............  Removal of adenoids..........         0258      22.1458    $1,314.35      $437.25      $262.87
42836.................  T..............  ...............  Removal of adenoids..........         0258      22.1458    $1,314.35      $437.25      $262.87
42842.................  T..............  ...............  Extensive surgery of throat..         0254      23.2980    $1,382.74      $321.35      $276.55
42844.................  T..............  ...............  Extensive surgery of throat..         0256      37.1513    $2,204.93  ...........      $440.99
42845.................  C..............  ...............  Extensive surgery of throat..  ...........  ...........  ...........  ...........  ...........
42860.................  T..............  ...............  Excision of tonsil tags......         0258      22.1458    $1,314.35      $437.25      $262.87
42870.................  T..............  ...............  Excision of lingual tonsil...         0258      22.1458    $1,314.35      $437.25      $262.87
42890.................  T..............  ...............  Partial removal of pharynx...         0256      37.1513    $2,204.93  ...........      $440.99
42892.................  T..............  ...............  Revision of pharyngeal walls.         0256      37.1513    $2,204.93  ...........      $440.99
42894.................  C..............  ...............  Revision of pharyngeal walls.  ...........  ...........  ...........  ...........  ...........
42900.................  T..............  ...............  Repair throat wound..........         0252       7.8317      $464.81      $113.41       $92.96
42950.................  T..............  ...............  Reconstruction of throat.....         0254      23.2980    $1,382.74      $321.35      $276.55
42953.................  C..............  ...............  Repair throat, esophagus.....  ...........  ...........  ...........  ...........  ...........
42955.................  T..............  ...............  Surgical opening of throat...         0254      23.2980    $1,382.74      $321.35      $276.55
42960.................  T..............  ...............  Control throat bleeding......         0250       1.2838       $76.19       $26.67       $15.24
42961.................  C..............  ...............  Control throat bleeding......  ...........  ...........  ...........  ...........  ...........
42962.................  T..............  ...............  Control throat bleeding......         0256      37.1513    $2,204.93  ...........      $440.99
42970.................  T..............  ...............  Control nose/throat bleeding.         0250       1.2838       $76.19       $26.67       $15.24
42971.................  C..............  ...............  Control nose/throat bleeding.  ...........  ...........  ...........  ...........  ...........
42972.................  T..............  ...............  Control nose/throat bleeding.         0253      16.0627      $953.32      $282.29      $190.66
42999.................  T..............  ...............  Throat surgery procedure.....         0251       2.0010      $118.76  ...........       $23.75
43020.................  T..............  ...............  Incision of esophagus........         0252       7.8317      $464.81      $113.41       $92.96
43030.................  T..............  ...............  Throat muscle surgery........         0253      16.0627      $953.32      $282.29      $190.66
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42828]]

 
43121.................  C..............  ...............  Partial removal of esophagus.  ...........  ...........  ...........  ...........  ...........
43122.................  C..............  ...............  Partial removal of esophagus.  ...........  ...........  ...........  ...........  ...........
43123.................  C..............  ...............  Partial removal of esophagus.  ...........  ...........  ...........  ...........  ...........
43124.................  C..............  ...............  Removal of esophagus.........  ...........  ...........  ...........  ...........  ...........
43130.................  T..............  ...............  Removal of esophagus pouch...         0254      23.2980    $1,382.74      $321.35      $276.55
43135.................  C..............  ...............  Removal of esophagus pouch...  ...........  ...........  ...........  ...........  ...........
43200.................  T..............  ...............  Esophagus endoscopy..........         0141       8.1464      $483.49      $143.38       $96.70
43201.................  T..............  ...............  Esoph scope w/submucous inj..         0141       8.1464      $483.49      $143.38       $96.70
43202.................  T..............  ...............  Esophagus endoscopy, biopsy..         0141       8.1464      $483.49      $143.38       $96.70
43204.................  T..............  ...............  Esoph scope w/sclerosis inj..         0141       8.1464      $483.49      $143.38       $96.70
43205.................  T..............  ...............  Esophagus endoscopy/ligation.         0141       8.1464      $483.49      $143.38       $96.70
43215.................  T..............  ...............  Esophagus endoscopy..........         0141       8.1464      $483.49      $143.38       $96.70
43216.................  T..............  ...............  Esophagus endoscopy/lesion...         0141       8.1464      $483.49      $143.38       $96.70
43217.................  T..............  ...............  Esophagus endoscopy..........         0141       8.1464      $483.49      $143.38       $96.70
43219.................  T..............  ...............  Esophagus endoscopy..........         0384      22.2381    $1,319.83      $286.66      $263.97
43220.................  T..............  ...............  Esoph endoscopy, dilation....         0141       8.1464      $483.49      $143.38       $96.70
43226.................  T..............  ...............  Esoph endoscopy, dilation....         0141       8.1464      $483.49      $143.38       $96.70
43227.................  T..............  ...............  Esoph endoscopy, repair......         0141       8.1464      $483.49      $143.38       $96.70
43228.................  T..............  ...............  Esoph endoscopy, ablation....         0422      22.8607    $1,356.78      $448.81      $271.36
43231.................  T..............  ...............  Esoph endoscopy w/us exam....         0141       8.1464      $483.49      $143.38       $96.70
43232.................  T..............  ...............  Esoph endoscopy w/us fn bx...         0141       8.1464      $483.49      $143.38       $96.70
43234.................  T..............  ...............  Upper GI endoscopy, exam.....         0141       8.1464      $483.49      $143.38       $96.70
43235.................  T..............  ...............  Uppr gi endoscopy, diagnosis.         0141       8.1464      $483.49      $143.38       $96.70
43236.................  T..............  ...............  Uppr gi scope w/submuc inj...         0141       8.1464      $483.49      $143.38       $96.70
43237.................  T..............  ...............  Endoscopic us exam, esoph....         0141       8.1464      $483.49      $143.38       $96.70
43238.................  T..............  ...............  Uppr gi endoscopy w/us fn bx.         0141       8.1464      $483.49      $143.38       $96.70
43239.................  T..............  ...............  Upper GI endoscopy, biopsy...         0141       8.1464      $483.49      $143.38       $96.70
43240.................  T..............  ...............  Esoph endoscope w/drain cyst.         0141       8.1464      $483.49      $143.38       $96.70
43241.................  T..............  ...............  Upper GI endoscopy with tube.         0141       8.1464      $483.49      $143.38       $96.70
43242.................  T..............  ...............  Uppr gi endoscopy w/us fn bx.         0141       8.1464      $483.49      $143.38       $96.70
43243.................  T..............  ...............  Upper gi endoscopy & inject..         0141       8.1464      $483.49      $143.38       $96.70
43244.................  T..............  ...............  Upper GI endoscopy/ligation..         0141       8.1464      $483.49      $143.38       $96.70
43245.................  T..............  ...............  Uppr gi scope dilate strictr.         0141       8.1464      $483.49      $143.38       $96.70
43246.................  T..............  ...............  Place gastrostomy tube.......         0141       8.1464      $483.49      $143.38       $96.70
43247.................  T..............  ...............  Operative upper GI endoscopy.         0141       8.1464      $483.49      $143.38       $96.70
43248.................  T..............  ...............  Uppr gi endoscopy/guide wire.         0141       8.1464      $483.49      $143.38       $96.70
43249.................  T..............  ...............  Esoph endoscopy, dilation....         0141       8.1464      $483.49      $143.38       $96.70
43250.................  T..............  ...............  Upper GI endoscopy/tumor.....         0141       8.1464      $483.49      $143.38       $96.70
43251.................  T..............  ...............  Operative upper GI endoscopy.         0141       8.1464      $483.49      $143.38       $96.70
43255.................  T..............  ...............  Operative upper GI endoscopy.         0141       8.1464      $483.49      $143.38       $96.70
43256.................  T..............  ...............  Uppr gi endoscopy w stent....         0384      22.2381    $1,319.83      $286.66      $263.97
43257.................  T..............  ...............  Uppr gi scope w/thrml txmnt..         0422      22.8607    $1,356.78      $448.81      $271.36
43258.................  T..............  ...............  Operative upper GI endoscopy.         0141       8.1464      $483.49      $143.38       $96.70
43259.................  T..............  ...............  Endoscopic ultrasound exam...         0141       8.1464      $483.49      $143.38       $96.70
43260.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43261.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43262.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43263.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43264.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43265.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43267.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43268.................  T..............  ...............  Endo cholangiopancreatograph.         0384      22.2381    $1,319.83      $286.66      $263.97
43269.................  T..............  ...............  Endo cholangiopancreatograph.         0384      22.2381    $1,319.83      $286.66      $263.97
43271.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43272.................  T..............  ...............  Endo cholangiopancreatograph.         0151      18.6489    $1,106.81      $245.46      $221.36
43280.................  T..............  ...............  Laparoscopy, fundoplasty.....         0132      62.7061    $3,721.61    $1,239.22      $744.32
43289.................  T..............  ...............  Laparoscope proc, esoph......         0130      31.7825    $1,886.29      $659.53      $377.26
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...  ...........  ...........  ...........  ...........  ...........

[[Page 42829]]

 
43326.................  C..............  ...............  Revise esophagus & stomach...  ...........  ...........  ...........  ...........  ...........
43330.................  C..............  ...............  Repair of esophagus..........  ...........  ...........  ...........  ...........  ...........
43331.................  C..............  ...............  Repair of esophagus..........  ...........  ...........  ...........  ...........  ...........
43340.................  C..............  ...............  Fuse esophagus & intestine...  ...........  ...........  ...........  ...........  ...........
43341.................  C..............  ...............  Fuse esophagus & intestine...  ...........  ...........  ...........  ...........  ...........
43350.................  C..............  ...............  Surgical opening, esophagus..  ...........  ...........  ...........  ...........  ...........
43351.................  C..............  ...............  Surgical opening, esophagus..  ...........  ...........  ...........  ...........  ...........
43352.................  C..............  ...............  Surgical opening, esophagus..  ...........  ...........  ...........  ...........  ...........
43360.................  C..............  ...............  Gastrointestinal repair......  ...........  ...........  ...........  ...........  ...........
43361.................  C..............  ...............  Gastrointestinal repair......  ...........  ...........  ...........  ...........  ...........
43400.................  C..............  ...............  Ligate esophagus veins.......  ...........  ...........  ...........  ...........  ...........
43401.................  C..............  ...............  Esophagus surgery for veins..  ...........  ...........  ...........  ...........  ...........
43405.................  C..............  ...............  Ligate/staple esophagus......  ...........  ...........  ...........  ...........  ...........
43410.................  C..............  ...............  Repair esophagus wound.......  ...........  ...........  ...........  ...........  ...........
43415.................  C..............  ...............  Repair esophagus wound.......  ...........  ...........  ...........  ...........  ...........
43420.................  C..............  ...............  Repair esophagus opening.....  ...........  ...........  ...........  ...........  ...........
43425.................  C..............  ...............  Repair esophagus opening.....  ...........  ...........  ...........  ...........  ...........
43450.................  T..............  ...............  Dilate esophagus.............         0140       5.4489      $323.39       $93.77       $64.68
43453.................  T..............  ...............  Dilate esophagus.............         0140       5.4489      $323.39       $93.77       $64.68
43456.................  T..............  ...............  Dilate esophagus.............         0140       5.4489      $323.39       $93.77       $64.68
43458.................  T..............  ...............  Dilate esophagus.............         0140       5.4489      $323.39       $93.77       $64.68
43460.................  C..............  ...............  Pressure treatment esophagus.  ...........  ...........  ...........  ...........  ...........
43496.................  C..............  ...............  Free jejunum flap, microvasc.  ...........  ...........  ...........  ...........  ...........
43499.................  T..............  ...............  Esophagus surgery procedure..         0141       8.1464      $483.49      $143.38       $96.70
43500.................  C..............  ...............  Surgical opening of stomach..  ...........  ...........  ...........  ...........  ...........
43501.................  C..............  ...............  Surgical repair of stomach...  ...........  ...........  ...........  ...........  ...........
43502.................  C..............  ...............  Surgical repair of stomach...  ...........  ...........  ...........  ...........  ...........
43510.................  T..............  ...............  Surgical opening of stomach..         0141       8.1464      $483.49      $143.38       $96.70
43520.................  C..............  ...............  Incision of pyloric muscle...  ...........  ...........  ...........  ...........  ...........
43600.................  T..............  ...............  Biopsy of stomach............         0141       8.1464      $483.49      $143.38       $96.70
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....  ...........  ...........  ...........  ...........  ...........
43644.................  C..............  ...............  Lap gastric bypass/roux-en-y.  ...........  ...........  ...........  ...........  ...........
43645.................  C..............  ...............  Lap gastr bypass incl smll i.  ...........  ...........  ...........  ...........  ...........
43651.................  T..............  ...............  Laparoscopy, vagus nerve.....         0132      62.7061    $3,721.61    $1,239.22      $744.32
43652.................  T..............  ...............  Laparoscopy, vagus nerve.....         0132      62.7061    $3,721.61    $1,239.22      $744.32
43653.................  T..............  ...............  Laparoscopy, gastrostomy.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
43659.................  T..............  ...............  Laparoscope proc, stom.......         0130      31.7825    $1,886.29      $659.53      $377.26
43750.................  T..............  ...............  Place gastrostomy tube.......         0141       8.1464      $483.49      $143.38       $96.70
43752.................  X..............  ...............  Nasal/orogastric w/stent.....         0272       1.3738       $81.54       $32.61       $16.31
43760.................  T..............  ...............  Change gastrostomy tube......         0121       2.2663      $134.50       $43.80       $26.90
43761.................  T..............  ...............  Reposition gastrostomy tube..         0122       6.9405      $411.92       $84.48       $82.38
43800.................  C..............  ...............  Reconstruction of pylorus....  ...........  ...........  ...........  ...........  ...........
43810.................  C..............  ...............  Fusion of stomach and bowel..  ...........  ...........  ...........  ...........  ...........
43820.................  C..............  ...............  Fusion of stomach and bowel..  ...........  ...........  ...........  ...........  ...........
43825.................  C..............  ...............  Fusion of stomach and bowel..  ...........  ...........  ...........  ...........  ...........
43830.................  T..............  ...............  Place gastrostomy tube.......         0422      22.8607    $1,356.78      $448.81      $271.36
43831.................  T..............  ...............  Place gastrostomy tube.......         0141       8.1464      $483.49      $143.38       $96.70
43832.................  C..............  ...............  Place gastrostomy tube.......  ...........  ...........  ...........  ...........  ...........
43840.................  C..............  ...............  Repair of stomach lesion.....  ...........  ...........  ...........  ...........  ...........
43842.................  C..............  ...............  Gastroplasty for obesity.....  ...........  ...........  ...........  ...........  ...........
43843.................  C..............  ...............  Gastroplasty for obesity.....  ...........  ...........  ...........  ...........  ...........
43845.................  C..............  ...............  Gastroplasty duodenal switch.  ...........  ...........  ...........  ...........  ...........

[[Page 42830]]

 
43846.................  C..............  ...............  Gastric bypass for obesity...  ...........  ...........  ...........  ...........  ...........
43847.................  C..............  ...............  Gastric bypass for obesity...  ...........  ...........  ...........  ...........  ...........
43848.................  C..............  ...............  Revision gastroplasty........  ...........  ...........  ...........  ...........  ...........
43850.................  C..............  ...............  Revise stomach-bowel fusion..  ...........  ...........  ...........  ...........  ...........
43855.................  C..............  ...............  Revise stomach-bowel fusion..  ...........  ...........  ...........  ...........  ...........
43860.................  C..............  ...............  Revise stomach-bowel fusion..  ...........  ...........  ...........  ...........  ...........
43865.................  C..............  ...............  Revise stomach-bowel fusion..  ...........  ...........  ...........  ...........  ...........
43870.................  T..............  ...............  Repair stomach opening.......         0141       8.1464      $483.49      $143.38       $96.70
43880.................  C..............  ...............  Repair stomach-bowel fistula.  ...........  ...........  ...........  ...........  ...........
43999.................  T..............  ...............  Stomach surgery procedure....         0141       8.1464      $483.49      $143.38       $96.70
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       8.1464      $483.49      $143.38       $96.70
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...  ...........  ...........  ...........  ...........  ...........
44137.................  C..............  ...............  Remove intestinal allograft..  ...........  ...........  ...........  ...........  ...........
44139.................  C..............  ...............  Mobilization of colon........  ...........  ...........  ...........  ...........  ...........
44140.................  C..............  ...............  Partial removal of colon.....  ...........  ...........  ...........  ...........  ...........
44141.................  C..............  ...............  Partial removal of colon.....  ...........  ...........  ...........  ...........  ...........
44143.................  C..............  ...............  Partial removal of colon.....  ...........  ...........  ...........  ...........  ...........
44144.................  C..............  ...............  Partial removal of colon.....  ...........  ...........  ...........  ...........  ...........
44145.................  C..............  ...............  Partial removal of colon.....  ...........  ...........  ...........  ...........  ...........
44146.................  C..............  ...............  Partial removal of colon.....  ...........  ...........  ...........  ...........  ...........
44147.................  C..............  ...............  Partial removal of colon.....  ...........  ...........  ...........  ...........  ...........
44150.................  C..............  ...............  Removal of colon.............  ...........  ...........  ...........  ...........  ...........
44151.................  C..............  ...............  Removal of colon/ileostomy...  ...........  ...........  ...........  ...........  ...........
44152.................  C..............  ...............  Removal of colon/ileostomy...  ...........  ...........  ...........  ...........  ...........
44153.................  C..............  ...............  Removal of colon/ileostomy...  ...........  ...........  ...........  ...........  ...........
44155.................  C..............  ...............  Removal of colon/ileostomy...  ...........  ...........  ...........  ...........  ...........
44156.................  C..............  ...............  Removal of colon/ileostomy...  ...........  ...........  ...........  ...........  ...........
44160.................  C..............  ...............  Removal of colon.............  ...........  ...........  ...........  ...........  ...........
44200.................  T..............  ...............  Laparoscopy, enterolysis.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
44201.................  T..............  ...............  Laparoscopy, jejunostomy.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
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/stoma...         0132      62.7061    $3,721.61    $1,239.22      $744.32
44207.................  T..............  ...............  L colectomy/coloproctostomy..         0132      62.7061    $3,721.61    $1,239.22      $744.32
44208.................  T..............  ...............  L colectomy/coloproctostomy..         0132      62.7061    $3,721.61    $1,239.22      $744.32
44210.................  C..............  ...............  Laparo total proctocolectomy.  ...........  ...........  ...........  ...........  ...........
44211.................  C..............  ...............  Laparo total proctocolectomy.  ...........  ...........  ...........  ...........  ...........
44212.................  C..............  ...............  Laparo total proctocolectomy.  ...........  ...........  ...........  ...........  ...........
44238.................  T..............  ...............  Laparoscope proc, intestine..         0130      31.7825    $1,886.29      $659.53      $377.26
44239.................  T..............  ...............  Laparoscope proc, rectum.....         0130      31.7825    $1,886.29      $659.53      $377.26
44300.................  C..............  ...............  Open bowel to skin...........  ...........  ...........  ...........  ...........  ...........
44310.................  C..............  ...............  Ileostomy/jejunostomy........  ...........  ...........  ...........  ...........  ...........
44312.................  T..............  ...............  Revision of ileostomy........         0027      18.3348    $1,088.17      $329.72      $217.63
44314.................  C..............  ...............  Revision of ileostomy........  ...........  ...........  ...........  ...........  ...........

[[Page 42831]]

 
44316.................  C..............  ...............  Devise bowel pouch...........  ...........  ...........  ...........  ...........  ...........
44320.................  C..............  ...............  Colostomy....................  ...........  ...........  ...........  ...........  ...........
44322.................  C..............  ...............  Colostomy with biopsies......  ...........  ...........  ...........  ...........  ...........
44340.................  T..............  ...............  Revision of colostomy........         0027      18.3348    $1,088.17      $329.72      $217.63
44345.................  C..............  ...............  Revision of colostomy........  ...........  ...........  ...........  ...........  ...........
44346.................  C..............  ...............  Revision of colostomy........  ...........  ...........  ...........  ...........  ...........
44360.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44361.................  T..............  ...............  Small bowel endoscopy/biopsy.         0142       9.3063      $552.33      $152.78      $110.47
44363.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44364.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44365.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44366.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44369.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44370.................  T..............  ...............  Small bowel endoscopy/stent..         0384      22.2381    $1,319.83      $286.66      $263.97
44372.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44373.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44376.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44377.................  T..............  ...............  Small bowel endoscopy/biopsy.         0142       9.3063      $552.33      $152.78      $110.47
44378.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44379.................  T..............  ...............  S bowel endoscope w/stent....         0384      22.2381    $1,319.83      $286.66      $263.97
44380.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44382.................  T..............  ...............  Small bowel endoscopy........         0142       9.3063      $552.33      $152.78      $110.47
44383.................  T..............  ...............  Ileoscopy w/stent............         0384      22.2381    $1,319.83      $286.66      $263.97
44385.................  T..............  ...............  Endoscopy of bowel pouch.....         0143       8.6475      $513.23      $186.06      $102.65
44386.................  T..............  ...............  Endoscopy, bowel pouch/biop..         0143       8.6475      $513.23      $186.06      $102.65
44388.................  T..............  ...............  Colonoscopy..................         0143       8.6475      $513.23      $186.06      $102.65
44389.................  T..............  ...............  Colonoscopy with biopsy......         0143       8.6475      $513.23      $186.06      $102.65
44390.................  T..............  ...............  Colonoscopy for foreign body.         0143       8.6475      $513.23      $186.06      $102.65
44391.................  T..............  ...............  Colonoscopy for bleeding.....         0143       8.6475      $513.23      $186.06      $102.65
44392.................  T..............  ...............  Colonoscopy & polypectomy....         0143       8.6475      $513.23      $186.06      $102.65
44393.................  T..............  ...............  Colonoscopy, lesion removal..         0143       8.6475      $513.23      $186.06      $102.65
44394.................  T..............  ...............  Colonoscopy w/snare..........         0143       8.6475      $513.23      $186.06      $102.65
44397.................  T..............  ...............  Colonoscopy w/stent..........         0384      22.2381    $1,319.83      $286.66      $263.97
44500.................  T..............  ...............  Intro, gastrointestinal tube.         0121       2.2663      $134.50       $43.80       $26.90
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..  ...........  ...........  ...........  ...........  ...........
44715.................  C..............  ...............  Prepare donor intestine......  ...........  ...........  ...........  ...........  ...........
44720.................  C..............  ...............  Prep donor intestine/venous..  ...........  ...........  ...........  ...........  ...........
44721.................  C..............  ...............  Prep donor intestine/artery..  ...........  ...........  ...........  ...........  ...........
44799.................  T..............  ...............  Unlisted procedure intestine.         0142       9.3063      $552.33      $152.78      $110.47
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.................  T..............  ...............  Drain app abscess, percut....         0037       9.4322      $559.80      $223.91      $111.96
44950.................  C..............  ...............  Appendectomy.................  ...........  ...........  ...........  ...........  ...........
44955.................  C..............  ...............  Appendectomy add-on..........  ...........  ...........  ...........  ...........  ...........
44960.................  C..............  ...............  Appendectomy.................  ...........  ...........  ...........  ...........  ...........
44970.................  T..............  ...............  Laparoscopy, appendectomy....         0131      43.1426    $2,560.51    $1,001.89      $512.10
44979.................  T..............  ...............  Laparoscope proc, app........         0130      31.7825    $1,886.29      $659.53      $377.26
45000.................  T..............  ...............  Drainage of pelvic abscess...         0148       3.7213      $220.86       $56.96       $44.17
45005.................  T..............  ...............  Drainage of rectal abscess...         0155      16.1810      $960.34  ...........      $192.07

[[Page 42832]]

 
45020.................  T..............  ...............  Drainage of rectal abscess...         0155      16.1810      $960.34  ...........      $192.07
45100.................  T..............  ...............  Biopsy of rectum.............         0149      17.9907    $1,067.75      $293.06      $213.55
45108.................  T..............  ...............  Removal of anorectal lesion..         0150      23.7573    $1,410.00      $437.12      $282.00
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 stricture.         0149      17.9907    $1,067.75      $293.06      $213.55
45160.................  T..............  ...............  Excision of rectal lesion....         0150      23.7573    $1,410.00      $437.12      $282.00
45170.................  T..............  ...............  Excision of rectal lesion....         0150      23.7573    $1,410.00      $437.12      $282.00
45190.................  T..............  ...............  Destruction, rectal tumor....         0150      23.7573    $1,410.00      $437.12      $282.00
45300.................  T..............  ...............  Proctosigmoidoscopy dx.......         0146       4.6164      $273.98       $64.40       $54.80
45303.................  T..............  ...............  Proctosigmoidoscopy dilate...         0147       7.9318      $470.75  ...........       $94.15
45305.................  T..............  ...............  Proctosigmoidoscopy w/bx.....         0147       7.9318      $470.75  ...........       $94.15
45307.................  T..............  ...............  Proctosigmoidoscopy fb.......         0428      19.8121    $1,175.85  ...........      $235.17
45308.................  T..............  ...............  Proctosigmoidoscopy removal..         0147       7.9318      $470.75  ...........       $94.15
45309.................  T..............  ...............  Proctosigmoidoscopy removal..         0147       7.9318      $470.75  ...........       $94.15
45315.................  T..............  ...............  Proctosigmoidoscopy removal..         0147       7.9318      $470.75  ...........       $94.15
45317.................  T..............  ...............  Proctosigmoidoscopy bleed....         0147       7.9318      $470.75  ...........       $94.15
45320.................  T..............  ...............  Proctosigmoidoscopy ablate...         0428      19.8121    $1,175.85  ...........      $235.17
45321.................  T..............  ...............  Proctosigmoidoscopy volvul...         0428      19.8121    $1,175.85  ...........      $235.17
45327.................  T..............  ...............  Proctosigmoidoscopy w/stent..         0384      22.2381    $1,319.83      $286.66      $263.97
45330.................  T..............  ...............  Diagnostic sigmoidoscopy.....         0146       4.6164      $273.98       $64.40       $54.80
45331.................  T..............  ...............  Sigmoidoscopy and biopsy.....         0146       4.6164      $273.98       $64.40       $54.80
45332.................  T..............  ...............  Sigmoidoscopy w/fb removal...         0146       4.6164      $273.98       $64.40       $54.80
45333.................  T..............  ...............  Sigmoidoscopy & polypectomy..         0147       7.9318      $470.75  ...........       $94.15
45334.................  T..............  ...............  Sigmoidoscopy for bleeding...         0147       7.9318      $470.75  ...........       $94.15
45335.................  T..............  ...............  Sigmoidoscopy w/submuc inj...         0146       4.6164      $273.98       $64.40       $54.80
45337.................  T..............  ...............  Sigmoidoscopy & decompress...         0146       4.6164      $273.98       $64.40       $54.80
45338.................  T..............  ...............  Sigmoidoscopy w/tumr remove..         0147       7.9318      $470.75  ...........       $94.15
45339.................  T..............  ...............  Sigmoidoscopy w/ablate tumr..         0147       7.9318      $470.75  ...........       $94.15
45340.................  T..............  ...............  Sig w/balloon dilation.......         0147       7.9318      $470.75  ...........       $94.15
45341.................  T..............  ...............  Sigmoidoscopy w/ultrasound...         0147       7.9318      $470.75  ...........       $94.15
45342.................  T..............  ...............  Sigmoidoscopy w/us guide bx..         0147       7.9318      $470.75  ...........       $94.15
45345.................  T..............  ...............  Sigmoidoscopy w/stent........         0384      22.2381    $1,319.83      $286.66      $263.97
45355.................  T..............  ...............  Surgical colonoscopy.........         0143       8.6475      $513.23      $186.06      $102.65
45378.................  T..............  ...............  Diagnostic colonoscopy.......         0143       8.6475      $513.23      $186.06      $102.65
45379.................  T..............  ...............  Colonoscopy w/fb removal.....         0143       8.6475      $513.23      $186.06      $102.65
45380.................  T..............  ...............  Colonoscopy and biopsy.......         0143       8.6475      $513.23      $186.06      $102.65
45381.................  T..............  ...............  Colonoscopy, submucous inj...         0143       8.6475      $513.23      $186.06      $102.65
45382.................  T..............  ...............  Colonoscopy/control bleeding.         0143       8.6475      $513.23      $186.06      $102.65
45383.................  T..............  ...............  Lesion removal colonoscopy...         0143       8.6475      $513.23      $186.06      $102.65
45384.................  T..............  ...............  Lesion remove colonoscopy....         0143       8.6475      $513.23      $186.06      $102.65
45385.................  T..............  ...............  Lesion removal colonoscopy...         0143       8.6475      $513.23      $186.06      $102.65
45386.................  T..............  ...............  Colonoscopy dilate stricture.         0143       8.6475      $513.23      $186.06      $102.65
45387.................  T..............  ...............  Colonoscopy w/stent..........         0384      22.2381    $1,319.83      $286.66      $263.97
45391.................  T..............  ...............  Colonoscopy w/endoscope us...         0143       8.6475      $513.23      $186.06      $102.65
45392.................  T..............  ...............  Colonoscopy w/endoscopic fnb.         0143       8.6475      $513.23      $186.06      $102.65
45500.................  T..............  ...............  Repair of rectum.............         0149      17.9907    $1,067.75      $293.06      $213.55
45505.................  T..............  ...............  Repair of rectum.............         0150      23.7573    $1,410.00      $437.12      $282.00
45520.................  T..............  ...............  Treatment of rectal prolapse.         0098       1.1295       $67.04  ...........       $13.41
45540.................  C..............  ...............  Correct rectal prolapse......  ...........  ...........  ...........  ...........  ...........
45541.................  T..............  ...............  Correct rectal prolapse......         0150      23.7573    $1,410.00      $437.12      $282.00
45550.................  C..............  ...............  Repair rectum/remove sigmoid.  ...........  ...........  ...........  ...........  ...........
45560.................  T..............  ...............  Repair of rectocele..........         0150      23.7573    $1,410.00      $437.12      $282.00
45562.................  C..............  ...............  Exploration/repair of rectum.  ...........  ...........  ...........  ...........  ...........

[[Page 42833]]

 
45563.................  C..............  ...............  Exploration/repair of rectum.  ...........  ...........  ...........  ...........  ...........
45800.................  C..............  ...............  Repair rect/bladder fistula..  ...........  ...........  ...........  ...........  ...........
45805.................  C..............  ...............  Repair fistula w/colostomy...  ...........  ...........  ...........  ...........  ...........
45820.................  C..............  ...............  Repair rectourethral fistula.  ...........  ...........  ...........  ...........  ...........
45825.................  C..............  ...............  Repair fistula w/colostomy...  ...........  ...........  ...........  ...........  ...........
45900.................  T..............  ...............  Reduction of rectal prolapse.         0148       3.7213      $220.86       $56.96       $44.17
45905.................  T..............  ...............  Dilation of anal sphincter...         0149      17.9907    $1,067.75      $293.06      $213.55
45910.................  T..............  ...............  Dilation of rectal narrowing.         0149      17.9907    $1,067.75      $293.06      $213.55
45915.................  T..............  ...............  Remove rectal obstruction....         0148       3.7213      $220.86       $56.96       $44.17
45999.................  T..............  ...............  Rectum surgery procedure.....         0148       3.7213      $220.86       $56.96       $44.17
46020.................  T..............  ...............  Placement of seton...........         0150      23.7573    $1,410.00      $437.12      $282.00
46030.................  T..............  ...............  Removal of rectal marker.....         0148       3.7213      $220.86       $56.96       $44.17
46040.................  T..............  ...............  Incision of rectal abscess...         0149      17.9907    $1,067.75      $293.06      $213.55
46045.................  T..............  ...............  Incision of rectal abscess...         0150      23.7573    $1,410.00      $437.12      $282.00
46050.................  T..............  ...............  Incision of anal abscess.....         0148       3.7213      $220.86       $56.96       $44.17
46060.................  T..............  ...............  Incision of rectal abscess...         0150      23.7573    $1,410.00      $437.12      $282.00
46070.................  T..............  ...............  Incision of anal septum......         0155      16.1810      $960.34  ...........      $192.07
46080.................  T..............  ...............  Incision of anal sphincter...         0149      17.9907    $1,067.75      $293.06      $213.55
46083.................  T..............  ...............  Incise external hemorrhoid...         0148       3.7213      $220.86       $56.96       $44.17
46200.................  T..............  ...............  Removal of anal fissure......         0150      23.7573    $1,410.00      $437.12      $282.00
46210.................  T..............  ...............  Removal of anal crypt........         0149      17.9907    $1,067.75      $293.06      $213.55
46211.................  T..............  ...............  Removal of anal crypts.......         0150      23.7573    $1,410.00      $437.12      $282.00
46220.................  T..............  ...............  Removal of anal tag..........         0149      17.9907    $1,067.75      $293.06      $213.55
46221.................  T..............  ...............  Ligation of hemorrhoid(s)....         0148       3.7213      $220.86       $56.96       $44.17
46230.................  T..............  ...............  Removal of anal tags.........         0149      17.9907    $1,067.75      $293.06      $213.55
46250.................  T..............  ...............  Hemorrhoidectomy.............         0150      23.7573    $1,410.00      $437.12      $282.00
46255.................  T..............  ...............  Hemorrhoidectomy.............         0150      23.7573    $1,410.00      $437.12      $282.00
46257.................  T..............  ...............  Remove hemorrhoids & fissure.         0150      23.7573    $1,410.00      $437.12      $282.00
46258.................  T..............  ...............  Remove hemorrhoids & fistula.         0150      23.7573    $1,410.00      $437.12      $282.00
46260.................  T..............  ...............  Hemorrhoidectomy.............         0150      23.7573    $1,410.00      $437.12      $282.00
46261.................  T..............  ...............  Remove hemorrhoids & fissure.         0150      23.7573    $1,410.00      $437.12      $282.00
46262.................  T..............  ...............  Remove hemorrhoids & fistula.         0150      23.7573    $1,410.00      $437.12      $282.00
46270.................  T..............  ...............  Removal of anal fistula......         0150      23.7573    $1,410.00      $437.12      $282.00
46275.................  T..............  ...............  Removal of anal fistula......         0150      23.7573    $1,410.00      $437.12      $282.00
46280.................  T..............  ...............  Removal of anal fistula......         0150      23.7573    $1,410.00      $437.12      $282.00
46285.................  T..............  ...............  Removal of anal fistula......         0150      23.7573    $1,410.00      $437.12      $282.00
46288.................  T..............  ...............  Repair anal fistula..........         0150      23.7573    $1,410.00      $437.12      $282.00
46320.................  T..............  ...............  Removal of hemorrhoid clot...         0148       3.7213      $220.86       $56.96       $44.17
46500.................  T..............  ...............  Injection into hemorrhoid(s).         0155      16.1810      $960.34  ...........      $192.07
46600.................  X..............  ...............  Diagnostic anoscopy..........         0340       0.6355       $37.72  ...........        $7.54
46604.................  T..............  ...............  Anoscopy and dilation........         0147       7.9318      $470.75  ...........       $94.15
46606.................  T..............  ...............  Anoscopy and biopsy..........         0146       4.6164      $273.98       $64.40       $54.80
46608.................  T..............  ...............  Anoscopy, remove for body....         0147       7.9318      $470.75  ...........       $94.15
46610.................  T..............  ...............  Anoscopy, remove lesion......         0428      19.8121    $1,175.85  ...........      $235.17
46611.................  T..............  ...............  Anoscopy.....................         0147       7.9318      $470.75  ...........       $94.15
46612.................  T..............  ...............  Anoscopy, remove lesions.....         0428      19.8121    $1,175.85  ...........      $235.17
46614.................  T..............  ...............  Anoscopy, control bleeding...         0146       4.6164      $273.98       $64.40       $54.80
46615.................  T..............  ...............  Anoscopy.....................         0428      19.8121    $1,175.85  ...........      $235.17
46700.................  T..............  ...............  Repair of anal stricture.....         0150      23.7573    $1,410.00      $437.12      $282.00
46705.................  C..............  ...............  Repair of anal stricture.....  ...........  ...........  ...........  ...........  ...........
46706.................  T..............  ...............  Repr of anal fistula w/glue..         0150      23.7573    $1,410.00      $437.12      $282.00
46715.................  C..............  ...............  Repair of anovaginal fistula.  ...........  ...........  ...........  ...........  ...........
46716.................  C..............  ...............  Repair of anovaginal fistula.  ...........  ...........  ...........  ...........  ...........
46730.................  C..............  ...............  Construction of absent anus..  ...........  ...........  ...........  ...........  ...........
46735.................  C..............  ...............  Construction of absent anus..  ...........  ...........  ...........  ...........  ...........
46740.................  C..............  ...............  Construction of absent anus..  ...........  ...........  ...........  ...........  ...........
46742.................  C..............  ...............  Repair of imperforated anus..  ...........  ...........  ...........  ...........  ...........
46744.................  C..............  ...............  Repair of cloacal anomaly....  ...........  ...........  ...........  ...........  ...........
46746.................  C..............  ...............  Repair of cloacal anomaly....  ...........  ...........  ...........  ...........  ...........
46748.................  C..............  ...............  Repair of cloacal anomaly....  ...........  ...........  ...........  ...........  ...........
46750.................  T..............  ...............  Repair of anal sphincter.....         0150      23.7573    $1,410.00      $437.12      $282.00
46751.................  C..............  ...............  Repair of anal sphincter.....  ...........  ...........  ...........  ...........  ...........
46753.................  T..............  ...............  Reconstruction of anus.......         0150      23.7573    $1,410.00      $437.12      $282.00
46754.................  T..............  ...............  Removal of suture from anus..         0149      17.9907    $1,067.75      $293.06      $213.55
46760.................  T..............  ...............  Repair of anal sphincter.....         0150      23.7573    $1,410.00      $437.12      $282.00
46761.................  T..............  ...............  Repair of anal sphincter.....         0150      23.7573    $1,410.00      $437.12      $282.00

[[Page 42834]]

 
46762.................  T..............  ...............  Implant artificial sphincter.         0150      23.7573    $1,410.00      $437.12      $282.00
46900.................  T..............  ...............  Destruction, anal lesion(s)..         0016       2.5717      $152.63       $33.42       $30.53
46910.................  T..............  ...............  Destruction, anal lesion(s)..         0017      18.3377    $1,088.34      $227.84      $217.67
46916.................  T..............  ...............  Cryosurgery, anal lesion(s)..         0013       1.1028       $65.45       $14.20       $13.09
46917.................  T..............  ...............  Laser surgery, anal lesions..         0695      20.2244    $1,200.32      $266.59      $240.06
46922.................  T..............  ...............  Excision of anal lesion(s)...         0695      20.2244    $1,200.32      $266.59      $240.06
46924.................  T..............  ...............  Destruction, anal lesion(s)..         0695      20.2244    $1,200.32      $266.59      $240.06
46934.................  T..............  ...............  Destruction of hemorrhoids...         0155      16.1810      $960.34  ...........      $192.07
46935.................  T..............  ...............  Destruction of hemorrhoids...         0155      16.1810      $960.34  ...........      $192.07
46936.................  T..............  ...............  Destruction of hemorrhoids...         0149      17.9907    $1,067.75      $293.06      $213.55
46937.................  T..............  ...............  Cryotherapy of rectal lesion.         0149      17.9907    $1,067.75      $293.06      $213.55
46938.................  T..............  ...............  Cryotherapy of rectal lesion.         0150      23.7573    $1,410.00      $437.12      $282.00
46940.................  T..............  ...............  Treatment of anal fissure....         0149      17.9907    $1,067.75      $293.06      $213.55
46942.................  T..............  ...............  Treatment of anal fissure....         0148       3.7213      $220.86       $56.96       $44.17
46945.................  T..............  ...............  Ligation of hemorrhoids......         0155      16.1810      $960.34  ...........      $192.07
46946.................  T..............  ...............  Ligation of hemorrhoids......         0155      16.1810      $960.34  ...........      $192.07
46947.................  T..............  ...............  Hemorrhoidopexy by stapling..         0150      23.7573    $1,410.00      $437.12      $282.00
46999.................  T..............  ...............  Anus surgery procedure.......         0148       3.7213      $220.86       $56.96       $44.17
47000.................  T..............  ...............  Needle biopsy of liver.......         0685       5.9902      $355.52      $115.47       $71.10
47001.................  N..............  ...............  Needle biopsy, liver add-on..  ...........  ...........  ...........  ...........  ...........
47010.................  C..............  ...............  Open drainage, liver lesion..  ...........  ...........  ...........  ...........  ...........
47011.................  T..............  ...............  Percut drain, liver lesion...         0037       9.4322      $559.80      $223.91      $111.96
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.......  ...........  ...........  ...........  ...........  ...........
47135.................  C..............  ...............  Transplantation of liver.....  ...........  ...........  ...........  ...........  ...........
47136.................  C..............  ...............  Transplantation of liver.....  ...........  ...........  ...........  ...........  ...........
47140.................  C..............  ...............  Partial removal, donor liver.  ...........  ...........  ...........  ...........  ...........
47141.................  C..............  ...............  Partial removal, donor liver.  ...........  ...........  ...........  ...........  ...........
47142.................  C..............  ...............  Partial removal, donor liver.  ...........  ...........  ...........  ...........  ...........
47143.................  C..............  ...............  Prep donor liver, whole......  ...........  ...........  ...........  ...........  ...........
47144.................  C..............  ...............  Prep donor liver, 3-segment..  ...........  ...........  ...........  ...........  ...........
47145.................  C..............  ...............  Prep donor liver, lobe split.  ...........  ...........  ...........  ...........  ...........
47146.................  C..............  ...............  Prep donor liver/venous......  ...........  ...........  ...........  ...........  ...........
47147.................  C..............  ...............  Prep donor liver/arterial....  ...........  ...........  ...........  ...........  ...........
47300.................  C..............  ...............  Surgery for liver lesion.....  ...........  ...........  ...........  ...........  ...........
47350.................  C..............  ...............  Repair liver wound...........  ...........  ...........  ...........  ...........  ...........
47360.................  C..............  ...............  Repair liver wound...........  ...........  ...........  ...........  ...........  ...........
47361.................  C..............  ...............  Repair liver wound...........  ...........  ...........  ...........  ...........  ...........
47362.................  C..............  ...............  Repair liver wound...........  ...........  ...........  ...........  ...........  ...........
47370.................  T..............  ...............  Laparo ablate liver tumor rf.         0131      43.1426    $2,560.51    $1,001.89      $512.10
47371.................  T..............  ...............  Laparo ablate liver cryosurg.         0131      43.1426    $2,560.51    $1,001.89      $512.10
47379.................  T..............  ...............  Laparoscope procedure, liver.         0130      31.7825    $1,886.29      $659.53      $377.26
47380.................  C..............  ...............  Open ablate liver tumor rf...  ...........  ...........  ...........  ...........  ...........
47381.................  C..............  ...............  Open ablate liver tumor cryo.  ...........  ...........  ...........  ...........  ...........
47382.................  T..............  ...............  Percut ablate liver rf.......         0423      40.1041    $2,380.18  ...........      $476.04
47399.................  T..............  ...............  Liver surgery procedure......         0002       0.9515       $56.47  ...........       $11.29
47400.................  C..............  ...............  Incision of liver duct.......  ...........  ...........  ...........  ...........  ...........
47420.................  C..............  ...............  Incision of bile duct........  ...........  ...........  ...........  ...........  ...........
47425.................  C..............  ...............  Incision of bile duct........  ...........  ...........  ...........  ...........  ...........
47460.................  C..............  ...............  Incise bile duct sphincter...  ...........  ...........  ...........  ...........  ...........
47480.................  C..............  ...............  Incision of gallbladder......  ...........  ...........  ...........  ...........  ...........
47490.................  T..............  ...............  Incision of gallbladder......         0152      12.2277      $725.71  ...........      $145.14
47500.................  N..............  ...............  Injection for liver x-rays...  ...........  ...........  ...........  ...........  ...........
47505.................  N..............  ...............  Injection for liver x-rays...  ...........  ...........  ...........  ...........  ...........
47510.................  T..............  ...............  Insert catheter, bile duct...         0152      12.2277      $725.71  ...........      $145.14
47511.................  T..............  ...............  Insert bile duct drain.......         0152      12.2277      $725.71  ...........      $145.14
47525.................  T..............  ...............  Change bile duct catheter....         0427      10.1516      $602.50      $123.56      $120.50
47530.................  T..............  ...............  Revise/reinsert bile tube....         0427      10.1516      $602.50      $123.56      $120.50
47550.................  C..............  ...............  Bile duct endoscopy add-on...  ...........  ...........  ...........  ...........  ...........
47552.................  T..............  ...............  Biliary endoscopy thru skin..         0152      12.2277      $725.71  ...........      $145.14
47553.................  T..............  ...............  Biliary endoscopy thru skin..         0152      12.2277      $725.71  ...........      $145.14

[[Page 42835]]

 
47554.................  T..............  ...............  Biliary endoscopy thru skin..         0152      12.2277      $725.71  ...........      $145.14
47555.................  T..............  ...............  Biliary endoscopy thru skin..         0152      12.2277      $725.71  ...........      $145.14
47556.................  T..............  ...............  Biliary endoscopy thru skin..         0152      12.2277      $725.71  ...........      $145.14
47560.................  T..............  ...............  Laparoscopy w/cholangio......         0130      31.7825    $1,886.29      $659.53      $377.26
47561.................  T..............  ...............  Laparo w/cholangio/biopsy....         0130      31.7825    $1,886.29      $659.53      $377.26
47562.................  T..............  ...............  Laparoscopic cholecystectomy.         0131      43.1426    $2,560.51    $1,001.89      $512.10
47563.................  T..............  ...............  Laparo cholecystectomy/graph.         0131      43.1426    $2,560.51    $1,001.89      $512.10
47564.................  T..............  ...............  Laparo cholecystectomy/explr.         0131      43.1426    $2,560.51    $1,001.89      $512.10
47570.................  C..............  ...............  Laparo cholecystoenterostomy.  ...........  ...........  ...........  ...........  ...........
47579.................  T..............  ...............  Laparoscope proc, biliary....         0130      31.7825    $1,886.29      $659.53      $377.26
47600.................  C..............  ...............  Removal of gallbladder.......  ...........  ...........  ...........  ...........  ...........
47605.................  C..............  ...............  Removal of gallbladder.......  ...........  ...........  ...........  ...........  ...........
47610.................  C..............  ...............  Removal of gallbladder.......  ...........  ...........  ...........  ...........  ...........
47612.................  C..............  ...............  Removal of gallbladder.......  ...........  ...........  ...........  ...........  ...........
47620.................  C..............  ...............  Removal of gallbladder.......  ...........  ...........  ...........  ...........  ...........
47630.................  T..............  ...............  Remove bile duct stone.......         0152      12.2277      $725.71  ...........      $145.14
47700.................  C..............  ...............  Exploration of bile ducts....  ...........  ...........  ...........  ...........  ...........
47701.................  C..............  ...............  Bile duct revision...........  ...........  ...........  ...........  ...........  ...........
47711.................  C..............  ...............  Excision of bile duct tumor..  ...........  ...........  ...........  ...........  ...........
47712.................  C..............  ...............  Excision of bile duct tumor..  ...........  ...........  ...........  ...........  ...........
47715.................  C..............  ...............  Excision of bile duct cyst...  ...........  ...........  ...........  ...........  ...........
47716.................  C..............  ...............  Fusion of bile duct cyst.....  ...........  ...........  ...........  ...........  ...........
47720.................  C..............  ...............  Fuse gallbladder & bowel.....  ...........  ...........  ...........  ...........  ...........
47721.................  C..............  ...............  Fuse upper gi structures.....  ...........  ...........  ...........  ...........  ...........
47740.................  C..............  ...............  Fuse gallbladder & bowel.....  ...........  ...........  ...........  ...........  ...........
47741.................  C..............  ...............  Fuse gallbladder & bowel.....  ...........  ...........  ...........  ...........  ...........
47760.................  C..............  ...............  Fuse bile ducts and bowel....  ...........  ...........  ...........  ...........  ...........
47765.................  C..............  ...............  Fuse liver ducts & bowel.....  ...........  ...........  ...........  ...........  ...........
47780.................  C..............  ...............  Fuse bile ducts and bowel....  ...........  ...........  ...........  ...........  ...........
47785.................  C..............  ...............  Fuse bile ducts and bowel....  ...........  ...........  ...........  ...........  ...........
47800.................  C..............  ...............  Reconstruction of bile ducts.  ...........  ...........  ...........  ...........  ...........
47801.................  C..............  ...............  Placement, bile duct support.  ...........  ...........  ...........  ...........  ...........
47802.................  C..............  ...............  Fuse liver duct & intestine..  ...........  ...........  ...........  ...........  ...........
47900.................  C..............  ...............  Suture bile duct injury......  ...........  ...........  ...........  ...........  ...........
47999.................  T..............  ...............  Bile tract surgery procedure.         0152      12.2277      $725.71  ...........      $145.14
48000.................  C..............  ...............  Drainage of abdomen..........  ...........  ...........  ...........  ...........  ...........
48001.................  C..............  ...............  Placement of drain, pancreas.  ...........  ...........  ...........  ...........  ...........
48005.................  C..............  ...............  Resect/debride pancreas......  ...........  ...........  ...........  ...........  ...........
48020.................  C..............  ...............  Removal of pancreatic stone..  ...........  ...........  ...........  ...........  ...........
48100.................  C..............  ...............  Biopsy of pancreas, open.....  ...........  ...........  ...........  ...........  ...........
48102.................  T..............  ...............  Needle biopsy, pancreas......         0685       5.9902      $355.52      $115.47       $71.10
48120.................  C..............  ...............  Removal of pancreas lesion...  ...........  ...........  ...........  ...........  ...........
48140.................  C..............  ...............  Partial removal of pancreas..  ...........  ...........  ...........  ...........  ...........
48145.................  C..............  ...............  Partial removal of pancreas..  ...........  ...........  ...........  ...........  ...........
48146.................  C..............  ...............  Pancreatectomy...............  ...........  ...........  ...........  ...........  ...........
48148.................  C..............  ...............  Removal of pancreatic duct...  ...........  ...........  ...........  ...........  ...........
48150.................  C..............  ...............  Partial removal of pancreas..  ...........  ...........  ...........  ...........  ...........
48152.................  C..............  ...............  Pancreatectomy...............  ...........  ...........  ...........  ...........  ...........
48153.................  C..............  ...............  Pancreatectomy...............  ...........  ...........  ...........  ...........  ...........
48154.................  C..............  ...............  Pancreatectomy...............  ...........  ...........  ...........  ...........  ...........
48155.................  C..............  ...............  Removal of pancreas..........  ...........  ...........  ...........  ...........  ...........
48160.................  E..............  ...............  Pancreas removal/transplant..  ...........  ...........  ...........  ...........  ...........
48180.................  C..............  ...............  Fuse pancreas and bowel......  ...........  ...........  ...........  ...........  ...........
48400.................  C..............  ...............  Injection, intraop add-on....  ...........  ...........  ...........  ...........  ...........
48500.................  C..............  ...............  Surgery of pancreatic cyst...  ...........  ...........  ...........  ...........  ...........
48510.................  C..............  ...............  Drain pancreatic pseudocyst..  ...........  ...........  ...........  ...........  ...........
48511.................  T..............  ...............  Drain pancreatic pseudocyst..         0037       9.4322      $559.80      $223.91      $111.96
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.........  ...........  ...........  ...........  ...........  ...........
48551.................  C..............  ...............  Prep donor pancreas..........  ...........  ...........  ...........  ...........  ...........
48552.................  C..............  ...............  Prep donor pancreas/venous...  ...........  ...........  ...........  ...........  ...........
48554.................  E..............  ...............  Transpl allograft pancreas...  ...........  ...........  ...........  ...........  ...........
48556.................  C..............  ...............  Removal, allograft pancreas..  ...........  ...........  ...........  ...........  ...........

[[Page 42836]]

 
48999.................  T..............  ...............  Pancreas surgery procedure...         0004       1.7566      $104.25       $22.36       $20.85
49000.................  C..............  ...............  Exploration of abdomen.......  ...........  ...........  ...........  ...........  ...........
49002.................  C..............  ...............  Reopening of abdomen.........  ...........  ...........  ...........  ...........  ...........
49010.................  C..............  ...............  Exploration behind abdomen...  ...........  ...........  ...........  ...........  ...........
49020.................  C..............  ...............  Drain abdominal abscess......  ...........  ...........  ...........  ...........  ...........
49021.................  T..............  ...............  Drain abdominal abscess......         0037       9.4322      $559.80      $223.91      $111.96
49040.................  C..............  ...............  Drain, open, abdom abscess...  ...........  ...........  ...........  ...........  ...........
49041.................  T..............  ...............  Drain, percut, abdom abscess.         0037       9.4322      $559.80      $223.91      $111.96
49060.................  C..............  ...............  Drain, open, retrop abscess..  ...........  ...........  ...........  ...........  ...........
49061.................  T..............  ...............  Drain, percut, retroper absc.         0037       9.4322      $559.80      $223.91      $111.96
49062.................  C..............  ...............  Drain to peritoneal cavity...  ...........  ...........  ...........  ...........  ...........
49080.................  T..............  ...............  Puncture, peritoneal cavity..         0070       3.1956      $189.66  ...........       $37.93
49081.................  T..............  ...............  Removal of abdominal fluid...         0070       3.1956      $189.66  ...........       $37.93
49085.................  T..............  ...............  Remove abdomen foreign body..         0153      21.5979    $1,281.84      $381.07      $256.37
49180.................  T..............  ...............  Biopsy, abdominal mass.......         0685       5.9902      $355.52      $115.47       $71.10
49200.................  T..............  ...............  Removal of abdominal lesion..         0130      31.7825    $1,886.29      $659.53      $377.26
49201.................  C..............  ...............  Remove abdom lesion, complex.  ...........  ...........  ...........  ...........  ...........
49215.................  C..............  ...............  Excise sacral spine tumor....  ...........  ...........  ...........  ...........  ...........
49220.................  C..............  ...............  Multiple surgery, abdomen....  ...........  ...........  ...........  ...........  ...........
49250.................  T..............  ...............  Excision of umbilicus........         0153      21.5979    $1,281.84      $381.07      $256.37
49255.................  C..............  ...............  Removal of omentum...........  ...........  ...........  ...........  ...........  ...........
49320.................  T..............  ...............  Diag laparo separate proc....         0130      31.7825    $1,886.29      $659.53      $377.26
49321.................  T..............  ...............  Laparoscopy, biopsy..........         0130      31.7825    $1,886.29      $659.53      $377.26
49322.................  T..............  ...............  Laparoscopy, aspiration......         0130      31.7825    $1,886.29      $659.53      $377.26
49323.................  T..............  ...............  Laparo drain lymphocele......         0130      31.7825    $1,886.29      $659.53      $377.26
49329.................  T..............  ...............  Laparo proc, abdm/per/oment..         0130      31.7825    $1,886.29      $659.53      $377.26
49400.................  N..............  ...............  Air injection into abdomen...  ...........  ...........  ...........  ...........  ...........
49419.................  T..............  ...............  Insrt abdom cath for chemotx.         0115      31.3302    $1,859.45      $459.35      $371.89
49420.................  T..............  ...............  Insert abdom drain, temp.....         0652      28.7639    $1,707.14  ...........      $341.43
49421.................  T..............  ...............  Insert abdom drain, perm.....         0652      28.7639    $1,707.14  ...........      $341.43
49422.................  T..............  ...............  Remove perm cannula/catheter.         0105      22.2671    $1,321.55      $370.40      $264.31
49423.................  T..............  ...............  Exchange drainage catheter...         0152      12.2277      $725.71  ...........      $145.14
49424.................  N..............  ...............  Assess cyst, contrast inject.  ...........  ...........  ...........  ...........  ...........
49425.................  C..............  ...............  Insert abdomen-venous drain..  ...........  ...........  ...........  ...........  ...........
49426.................  T..............  ...............  Revise abdomen-venous shunt..         0153      21.5979    $1,281.84      $381.07      $256.37
49427.................  N..............  ...............  Injection, abdominal shunt...  ...........  ...........  ...........  ...........  ...........
49428.................  C..............  ...............  Ligation of shunt............  ...........  ...........  ...........  ...........  ...........
49429.................  T..............  ...............  Removal of shunt.............         0105      22.2671    $1,321.55      $370.40      $264.31
49491.................  T..............  ...............  Rpr hern preemie reduc.......         0154      28.6544    $1,700.64      $464.85      $340.13
49492.................  T..............  ...............  Rpr ing hern premie, blocked.         0154      28.6544    $1,700.64      $464.85      $340.13
49495.................  T..............  ...............  Rpr ing hernia baby, reduc...         0154      28.6544    $1,700.64      $464.85      $340.13
49496.................  T..............  ...............  Rpr ing hernia baby, blocked.         0154      28.6544    $1,700.64      $464.85      $340.13
49500.................  T..............  ...............  Rpr ing hernia, init, reduce.         0154      28.6544    $1,700.64      $464.85      $340.13
49501.................  T..............  ...............  Rpr ing hernia, init blocked.         0154      28.6544    $1,700.64      $464.85      $340.13
49505.................  T..............  ...............  Prp i/hern init reduc>5 yr...         0154      28.6544    $1,700.64      $464.85      $340.13
49507.................  T..............  ...............  Prp i/hern init block>5 yr...         0154      28.6544    $1,700.64      $464.85      $340.13
49520.................  T..............  ...............  Rerepair ing hernia, reduce..         0154      28.6544    $1,700.64      $464.85      $340.13
49521.................  T..............  ...............  Rerepair ing hernia, blocked.         0154      28.6544    $1,700.64      $464.85      $340.13
49525.................  T..............  ...............  Repair ing hernia, sliding...         0154      28.6544    $1,700.64      $464.85      $340.13
49540.................  T..............  ...............  Repair lumbar hernia.........         0154      28.6544    $1,700.64      $464.85      $340.13
49550.................  T..............  ...............  Rpr rem hernia, init, reduce.         0154      28.6544    $1,700.64      $464.85      $340.13
49553.................  T..............  ...............  Rpr fem hernia, init blocked.         0154      28.6544    $1,700.64      $464.85      $340.13
49555.................  T..............  ...............  Rerepair fem hernia, reduce..         0154      28.6544    $1,700.64      $464.85      $340.13
49557.................  T..............  ...............  Rerepair fem hernia, blocked.         0154      28.6544    $1,700.64      $464.85      $340.13
49560.................  T..............  ...............  Rpr ventral hern init, reduc.         0154      28.6544    $1,700.64      $464.85      $340.13
49561.................  T..............  ...............  Rpr ventral hern init, block.         0154      28.6544    $1,700.64      $464.85      $340.13
49565.................  T..............  ...............  Rerepair ventrl hern, reduce.         0154      28.6544    $1,700.64      $464.85      $340.13
49566.................  T..............  ...............  Rerepair ventrl hern, block..         0154      28.6544    $1,700.64      $464.85      $340.13
49568.................  T..............  ...............  Hernia repair w/mesh.........         0154      28.6544    $1,700.64      $464.85      $340.13
49570.................  T..............  ...............  Rpr epigastric hern, reduce..         0154      28.6544    $1,700.64      $464.85      $340.13
49572.................  T..............  ...............  Rpr epigastric hern, blocked.         0154      28.6544    $1,700.64      $464.85      $340.13
49580.................  T..............  ...............  Rpr umbil hern, reduc < 5 yr.         0154      28.6544    $1,700.64      $464.85      $340.13
49582.................  T..............  ...............  Rpr umbil hern, block < 5 yr.         0154      28.6544    $1,700.64      $464.85      $340.13
49585.................  T..............  ...............  Rpr umbil hern, reduc > 5 yr.         0154      28.6544    $1,700.64      $464.85      $340.13
49587.................  T..............  ...............  Rpr umbil hern, block > 5 yr.         0154      28.6544    $1,700.64      $464.85      $340.13
49590.................  T..............  ...............  Repair spigilian hernia......         0154      28.6544    $1,700.64      $464.85      $340.13

[[Page 42837]]

 
49600.................  T..............  ...............  Repair umbilical lesion......         0154      28.6544    $1,700.64      $464.85      $340.13
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 initial.         0131      43.1426    $2,560.51    $1,001.89      $512.10
49651.................  T..............  ...............  Laparo hernia repair recur...         0131      43.1426    $2,560.51    $1,001.89      $512.10
49659.................  T..............  ...............  Laparo proc, hernia repair...         0130      31.7825    $1,886.29      $659.53      $377.26
49900.................  C..............  ...............  Repair of abdominal wall.....  ...........  ...........  ...........  ...........  ...........
49904.................  C..............  ...............  Omental flap, extra-abdom....  ...........  ...........  ...........  ...........  ...........
49905.................  C..............  ...............  Omental flap.................  ...........  ...........  ...........  ...........  ...........
49906.................  C..............  ...............  Free omental flap, microvasc.  ...........  ...........  ...........  ...........  ...........
49999.................  T..............  ...............  Abdomen surgery procedure....         0153      21.5979    $1,281.84      $381.07      $256.37
50010.................  C..............  ...............  Exploration of kidney........  ...........  ...........  ...........  ...........  ...........
50020.................  T..............  ...............  Renal abscess, open drain....         0162      23.2858    $1,382.01  ...........      $276.40
50021.................  T..............  ...............  Renal abscess, percut drain..         0037       9.4322      $559.80      $223.91      $111.96
50040.................  C..............  ...............  Drainage of kidney...........  ...........  ...........  ...........  ...........  ...........
50045.................  C..............  ...............  Exploration of kidney........  ...........  ...........  ...........  ...........  ...........
50060.................  C..............  ...............  Removal of kidney stone......  ...........  ...........  ...........  ...........  ...........
50065.................  C..............  ...............  Incision of kidney...........  ...........  ...........  ...........  ...........  ...........
50070.................  C..............  ...............  Incision of kidney...........  ...........  ...........  ...........  ...........  ...........
50075.................  C..............  ...............  Removal of kidney stone......  ...........  ...........  ...........  ...........  ...........
50080.................  T..............  ...............  Removal of kidney stone......         0429      42.1231    $2,500.01  ...........      $500.00
50081.................  T..............  ...............  Removal of kidney stone......         0429      42.1231    $2,500.01  ...........      $500.00
50100.................  C..............  ...............  Revise kidney blood vessels..  ...........  ...........  ...........  ...........  ...........
50120.................  C..............  ...............  Exploration of kidney........  ...........  ...........  ...........  ...........  ...........
50125.................  C..............  ...............  Explore and drain kidney.....  ...........  ...........  ...........  ...........  ...........
50130.................  C..............  ...............  Removal of kidney stone......  ...........  ...........  ...........  ...........  ...........
50135.................  C..............  ...............  Exploration of kidney........  ...........  ...........  ...........  ...........  ...........
50200.................  T..............  ...............  Biopsy of kidney.............         0685       5.9902      $355.52      $115.47       $71.10
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......  ...........  ...........  ...........  ...........  ...........
50323.................  C..............  ...............  Prep cadaver renal allograft.  ...........  ...........  ...........  ...........  ...........
50325.................  C..............  ...............  Prep donor renal graft.......  ...........  ...........  ...........  ...........  ...........
50327.................  C..............  ...............  Prep renal graft/venous......  ...........  ...........  ...........  ...........  ...........
50328.................  C..............  ...............  Prep renal graft/arterial....  ...........  ...........  ...........  ...........  ...........
50329.................  C..............  ...............  Prep renal graft/ureteral....  ...........  ...........  ...........  ...........  ...........
50340.................  C..............  ...............  Removal of kidney............  ...........  ...........  ...........  ...........  ...........
50360.................  C..............  ...............  Transplantation of kidney....  ...........  ...........  ...........  ...........  ...........
50365.................  C..............  ...............  Transplantation of kidney....  ...........  ...........  ...........  ...........  ...........
50370.................  C..............  ...............  Remove transplanted kidney...  ...........  ...........  ...........  ...........  ...........
50380.................  C..............  ...............  Reimplantation of kidney.....  ...........  ...........  ...........  ...........  ...........
50390.................  T..............  ...............  Drainage of kidney lesion....         0685       5.9902      $355.52      $115.47       $71.10
50391.................  T..............  ...............  Instll rx agnt into rnal tub.         0156       2.5635      $152.14       $40.52       $30.43
50392.................  T..............  ...............  Insert kidney drain..........         0161      18.4736    $1,096.41      $249.36      $219.28
50393.................  T..............  ...............  Insert ureteral tube.........         0161      18.4736    $1,096.41      $249.36      $219.28
50394.................  N..............  ...............  Injection for kidney x-ray...  ...........  ...........  ...........  ...........  ...........
50395.................  T..............  ...............  Create passage to kidney.....         0161      18.4736    $1,096.41      $249.36      $219.28
50396.................  T..............  ...............  Measure kidney pressure......         0164       1.1802       $70.04       $17.21       $14.01
50398.................  T..............  ...............  Change kidney tube...........         0122       6.9405      $411.92       $84.48       $82.38
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42838]]

 
50541.................  T..............  ...............  Laparo ablate renal cyst.....         0130      31.7825    $1,886.29      $659.53      $377.26
50542.................  T..............  ...............  Laparo ablate renal mass.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
50543.................  T..............  ...............  Laparo partial nephrectomy...         0131      43.1426    $2,560.51    $1,001.89      $512.10
50544.................  T..............  ...............  Laparoscopy, pyeloplasty.....         0130      31.7825    $1,886.29      $659.53      $377.26
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, renal......         0130      31.7825    $1,886.29      $659.53      $377.26
50551.................  T..............  ...............  Kidney endoscopy.............         0160       6.6450      $394.38      $105.06       $78.88
50553.................  T..............  ...............  Kidney endoscopy.............         0161      18.4736    $1,096.41      $249.36      $219.28
50555.................  T..............  ...............  Kidney endoscopy & biopsy....         0160       6.6450      $394.38      $105.06       $78.88
50557.................  T..............  ...............  Kidney endoscopy & treatment.         0162      23.2858    $1,382.01  ...........      $276.40
50561.................  T..............  ...............  Kidney endoscopy & treatment.         0161      18.4736    $1,096.41      $249.36      $219.28
50562.................  T..............  ...............  Renal scope w/tumor resect...         0160       6.6450      $394.38      $105.06       $78.88
50570.................  T..............  ...............  Kidney endoscopy.............         0160       6.6450      $394.38      $105.06       $78.88
50572.................  T..............  ...............  Kidney endoscopy.............         0160       6.6450      $394.38      $105.06       $78.88
50574.................  T..............  ...............  Kidney endoscopy & biopsy....         0160       6.6450      $394.38      $105.06       $78.88
50575.................  T..............  ...............  Kidney endoscopy.............         0163      33.5826    $1,993.13  ...........      $398.63
50576.................  T..............  ...............  Kidney endoscopy & treatment.         0161      18.4736    $1,096.41      $249.36      $219.28
50580.................  C..............  ...............  Kidney endoscopy & treatment.  ...........  ...........  ...........  ...........  ...........
50590.................  T..............  ...............  Fragmenting of kidney stone..         0169      42.8184    $2,541.27    $1,016.50      $508.25
50600.................  C..............  ...............  Exploration of ureter........  ...........  ...........  ...........  ...........  ...........
50605.................  C..............  ...............  Insert ureteral support......  ...........  ...........  ...........  ...........  ...........
50610.................  C..............  ...............  Removal of ureter stone......  ...........  ...........  ...........  ...........  ...........
50620.................  C..............  ...............  Removal of ureter stone......  ...........  ...........  ...........  ...........  ...........
50630.................  C..............  ...............  Removal of ureter stone......  ...........  ...........  ...........  ...........  ...........
50650.................  C..............  ...............  Removal of ureter............  ...........  ...........  ...........  ...........  ...........
50660.................  C..............  ...............  Removal of ureter............  ...........  ...........  ...........  ...........  ...........
50684.................  N..............  ...............  Injection for ureter x-ray...  ...........  ...........  ...........  ...........  ...........
50686.................  T..............  ...............  Measure ureter pressure......         0164       1.1802       $70.04       $17.21       $14.01
50688.................  T..............  ...............  Change of ureter tube........         0122       6.9405      $411.92       $84.48       $82.38
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 ureterolithotomy.         0131      43.1426    $2,560.51    $1,001.89      $512.10
50947.................  T..............  ...............  Laparo new ureter/bladder....         0131      43.1426    $2,560.51    $1,001.89      $512.10
50948.................  T..............  ...............  Laparo new ureter/bladder....         0131      43.1426    $2,560.51    $1,001.89      $512.10
50949.................  T..............  ...............  Laparoscope proc, ureter.....         0130      31.7825    $1,886.29      $659.53      $377.26
50951.................  T..............  ...............  Endoscopy of ureter..........         0160       6.6450      $394.38      $105.06       $78.88
50953.................  T..............  ...............  Endoscopy of ureter..........         0160       6.6450      $394.38      $105.06       $78.88

[[Page 42839]]

 
50955.................  T..............  ...............  Ureter endoscopy & biopsy....         0161      18.4736    $1,096.41      $249.36      $219.28
50957.................  T..............  ...............  Ureter endoscopy & treatment.         0161      18.4736    $1,096.41      $249.36      $219.28
50961.................  T..............  ...............  Ureter endoscopy & treatment.         0161      18.4736    $1,096.41      $249.36      $219.28
50970.................  T..............  ...............  Ureter endoscopy.............         0160       6.6450      $394.38      $105.06       $78.88
50972.................  T..............  ...............  Ureter endoscopy & catheter..         0160       6.6450      $394.38      $105.06       $78.88
50974.................  T..............  ...............  Ureter endoscopy & biopsy....         0161      18.4736    $1,096.41      $249.36      $219.28
50976.................  T..............  ...............  Ureter endoscopy & treatment.         0161      18.4736    $1,096.41      $249.36      $219.28
50980.................  T..............  ...............  Ureter endoscopy & treatment.         0161      18.4736    $1,096.41      $249.36      $219.28
51000.................  T..............  ...............  Drainage of bladder..........         0164       1.1802       $70.04       $17.21       $14.01
51005.................  T..............  ...............  Drainage of bladder..........         0164       1.1802       $70.04       $17.21       $14.01
51010.................  T..............  ...............  Drainage of bladder..........         0165      16.5934      $984.82  ...........      $196.96
51020.................  T..............  ...............  Incise & treat bladder.......         0162      23.2858    $1,382.01  ...........      $276.40
51030.................  T..............  ...............  Incise & treat bladder.......         0162      23.2858    $1,382.01  ...........      $276.40
51040.................  T..............  ...............  Incise & drain bladder.......         0162      23.2858    $1,382.01  ...........      $276.40
51045.................  T..............  ...............  Incise bladder/drain ureter..         0160       6.6450      $394.38      $105.06       $78.88
51050.................  T..............  ...............  Removal of bladder stone.....         0162      23.2858    $1,382.01  ...........      $276.40
51060.................  C..............  ...............  Removal of ureter stone......  ...........  ...........  ...........  ...........  ...........
51065.................  T..............  ...............  Remove ureter calculus.......         0162      23.2858    $1,382.01  ...........      $276.40
51080.................  T..............  ...............  Drainage of bladder abscess..         0008      16.4242      $974.78  ...........      $194.96
51500.................  T..............  ...............  Removal of bladder cyst......         0154      28.6544    $1,700.64      $464.85      $340.13
51520.................  T..............  ...............  Removal of bladder lesion....         0162      23.2858    $1,382.01  ...........      $276.40
51525.................  C..............  ...............  Removal of bladder lesion....  ...........  ...........  ...........  ...........  ...........
51530.................  C..............  ...............  Removal of bladder lesion....  ...........  ...........  ...........  ...........  ...........
51535.................  C..............  ...............  Repair of ureter lesion......  ...........  ...........  ...........  ...........  ...........
51550.................  C..............  ...............  Partial removal of bladder...  ...........  ...........  ...........  ...........  ...........
51555.................  C..............  ...............  Partial removal of bladder...  ...........  ...........  ...........  ...........  ...........
51565.................  C..............  ...............  Revise bladder & ureter(s)...  ...........  ...........  ...........  ...........  ...........
51570.................  C..............  ...............  Removal of bladder...........  ...........  ...........  ...........  ...........  ...........
51575.................  C..............  ...............  Removal of bladder & nodes...  ...........  ...........  ...........  ...........  ...........
51580.................  C..............  ...............  Remove bladder/revise tract..  ...........  ...........  ...........  ...........  ...........
51585.................  C..............  ...............  Removal of bladder & nodes...  ...........  ...........  ...........  ...........  ...........
51590.................  C..............  ...............  Remove bladder/revise tract..  ...........  ...........  ...........  ...........  ...........
51595.................  C..............  ...............  Remove bladder/revise tract..  ...........  ...........  ...........  ...........  ...........
51596.................  C..............  ...............  Remove bladder/create pouch..  ...........  ...........  ...........  ...........  ...........
51597.................  C..............  ...............  Removal of pelvic structures.  ...........  ...........  ...........  ...........  ...........
51600.................  N..............  ...............  Injection for bladder x-ray..  ...........  ...........  ...........  ...........  ...........
51605.................  N..............  ...............  Preparation for bladder xray.  ...........  ...........  ...........  ...........  ...........
51610.................  N..............  ...............  Injection for bladder x-ray..  ...........  ...........  ...........  ...........  ...........
51700.................  T..............  ...............  Irrigation of bladder........         0164       1.1802       $70.04       $17.21       $14.01
51701.................  X..............  ...............  Insert bladder catheter......         0340       0.6355       $37.72  ...........        $7.54
51702.................  X..............  ...............  Insert temp bladder cath.....         0340       0.6355       $37.72  ...........        $7.54
51703.................  T..............  ...............  Insert bladder cath, complex.         0164       1.1802       $70.04       $17.21       $14.01
51705.................  T..............  ...............  Change of bladder tube.......         0121       2.2663      $134.50       $43.80       $26.90
51710.................  T..............  ...............  Change of bladder tube.......         0122       6.9405      $411.92       $84.48       $82.38
51715.................  T..............  ...............  Endoscopic injection/implant.         0168      28.1405    $1,670.14      $386.32      $334.03
51720.................  T..............  ...............  Treatment of bladder lesion..         0156       2.5635      $152.14       $40.52       $30.43
51725.................  T..............  ...............  Simple cystometrogram........         0156       2.5635      $152.14       $40.52       $30.43
51726.................  T..............  ...............  Complex cystometrogram.......         0156       2.5635      $152.14       $40.52       $30.43
51736.................  T..............  ...............  Urine flow measurement.......         0164       1.1802       $70.04       $17.21       $14.01
51741.................  T..............  ...............  Electro-uroflowmetry, first..         0164       1.1802       $70.04       $17.21       $14.01
51772.................  T..............  ...............  Urethra pressure profile.....         0156       2.5635      $152.14       $40.52       $30.43
51784.................  T..............  ...............  Anal/urinary muscle study....         0164       1.1802       $70.04       $17.21       $14.01
51785.................  T..............  ...............  Anal/urinary muscle study....         0164       1.1802       $70.04       $17.21       $14.01
51792.................  T..............  ...............  Urinary reflex study.........         0164       1.1802       $70.04       $17.21       $14.01
51795.................  T..............  ...............  Urine voiding pressure study.         0164       1.1802       $70.04       $17.21       $14.01
51797.................  T..............  ...............  Intraabdominal pressure test.         0164       1.1802       $70.04       $17.21       $14.01
51798.................  X..............  ...............  Us urine capacity measure....         0340       0.6355       $37.72  ...........        $7.54
51800.................  C..............  ...............  Revision of bladder/urethra..  ...........  ...........  ...........  ...........  ...........
51820.................  C..............  ...............  Revision of urinary tract....  ...........  ...........  ...........  ...........  ...........
51840.................  C..............  ...............  Attach bladder/urethra.......  ...........  ...........  ...........  ...........  ...........
51841.................  C..............  ...............  Attach bladder/urethra.......  ...........  ...........  ...........  ...........  ...........
51845.................  C..............  ...............  Repair bladder neck..........  ...........  ...........  ...........  ...........  ...........
51860.................  C..............  ...............  Repair of bladder wound......  ...........  ...........  ...........  ...........  ...........
51865.................  C..............  ...............  Repair of bladder wound......  ...........  ...........  ...........  ...........  ...........
51880.................  T..............  ...............  Repair of bladder opening....         0162      23.2858    $1,382.01  ...........      $276.40
51900.................  C..............  ...............  Repair bladder/vagina lesion.  ...........  ...........  ...........  ...........  ...........

[[Page 42840]]

 
51920.................  C..............  ...............  Close bladder-uterus fistula.  ...........  ...........  ...........  ...........  ...........
51925.................  C..............  ...............  Hysterectomy/bladder repair..  ...........  ...........  ...........  ...........  ...........
51940.................  C..............  ...............  Correction of bladder defect.  ...........  ...........  ...........  ...........  ...........
51960.................  C..............  ...............  Revision of bladder & bowel..  ...........  ...........  ...........  ...........  ...........
51980.................  C..............  ...............  Construct bladder opening....  ...........  ...........  ...........  ...........  ...........
51990.................  T..............  ...............  Laparo urethral suspension...         0131      43.1426    $2,560.51    $1,001.89      $512.10
51992.................  T..............  ...............  Laparo sling operation.......         0132      62.7061    $3,721.61    $1,239.22      $744.32
52000.................  T..............  ...............  Cystoscopy...................         0160       6.6450      $394.38      $105.06       $78.88
52001.................  T..............  ...............  Cystoscopy, removal of clots.         0160       6.6450      $394.38      $105.06       $78.88
52005.................  T..............  ...............  Cystoscopy & ureter catheter.         0161      18.4736    $1,096.41      $249.36      $219.28
52007.................  T..............  ...............  Cystoscopy and biopsy........         0161      18.4736    $1,096.41      $249.36      $219.28
52010.................  T..............  ...............  Cystoscopy & duct catheter...         0160       6.6450      $394.38      $105.06       $78.88
52204.................  T..............  ...............  Cystoscopy...................         0161      18.4736    $1,096.41      $249.36      $219.28
52214.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52224.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52234.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52235.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52240.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52250.................  T..............  ...............  Cystoscopy and radiotracer...         0162      23.2858    $1,382.01  ...........      $276.40
52260.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52265.................  T..............  ...............  Cystoscopy and treatment.....         0160       6.6450      $394.38      $105.06       $78.88
52270.................  T..............  ...............  Cystoscopy & revise urethra..         0161      18.4736    $1,096.41      $249.36      $219.28
52275.................  T..............  ...............  Cystoscopy & revise urethra..         0161      18.4736    $1,096.41      $249.36      $219.28
52276.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52277.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52281.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52282.................  T..............  ...............  Cystoscopy, implant stent....         0163      33.5826    $1,993.13  ...........      $398.63
52283.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52285.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52290.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52300.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52301.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52305.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52310.................  T..............  ...............  Cystoscopy and treatment.....         0160       6.6450      $394.38      $105.06       $78.88
52315.................  T..............  ...............  Cystoscopy and treatment.....         0161      18.4736    $1,096.41      $249.36      $219.28
52317.................  T..............  ...............  Remove bladder stone.........         0162      23.2858    $1,382.01  ...........      $276.40
52318.................  T..............  ...............  Remove bladder stone.........         0162      23.2858    $1,382.01  ...........      $276.40
52320.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52325.................  T..............  ...............  Cystoscopy, stone removal....         0162      23.2858    $1,382.01  ...........      $276.40
52327.................  T..............  ...............  Cystoscopy, inject material..         0162      23.2858    $1,382.01  ...........      $276.40
52330.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52332.................  T..............  ...............  Cystoscopy and treatment.....         0162      23.2858    $1,382.01  ...........      $276.40
52334.................  T..............  ...............  Create passage to kidney.....         0162      23.2858    $1,382.01  ...........      $276.40
52341.................  T..............  ...............  Cysto w/ureter stricture tx..         0162      23.2858    $1,382.01  ...........      $276.40
52342.................  T..............  ...............  Cysto w/up stricture tx......         0162      23.2858    $1,382.01  ...........      $276.40
52343.................  T..............  ...............  Cysto w/renal stricture tx...         0162      23.2858    $1,382.01  ...........      $276.40
52344.................  T..............  ...............  Cysto/uretero, stone remove..         0162      23.2858    $1,382.01  ...........      $276.40
52345.................  T..............  ...............  Cysto/uretero w/up stricture.         0162      23.2858    $1,382.01  ...........      $276.40
52346.................  T..............  ...............  Cystouretero w/renal strict..         0162      23.2858    $1,382.01  ...........      $276.40
52351.................  T..............  ...............  Cystouretero & or pyeloscope.         0161      18.4736    $1,096.41      $249.36      $219.28
52352.................  T..............  ...............  Cystouretero w/stone remove..         0162      23.2858    $1,382.01  ...........      $276.40
52353.................  T..............  ...............  Cystouretero w/lithotripsy...         0163      33.5826    $1,993.13  ...........      $398.63
52354.................  T..............  ...............  Cystouretero w/biopsy........         0162      23.2858    $1,382.01  ...........      $276.40
52355.................  T..............  ...............  Cystouretero w/excise tumor..         0162      23.2858    $1,382.01  ...........      $276.40
52400.................  T..............  ...............  Cystouretero w/congen repr...         0162      23.2858    $1,382.01  ...........      $276.40
52402.................  T..............  ...............  Cystourethro cut ejacul duct.         0162      23.2858    $1,382.01  ...........      $276.40
52450.................  T..............  ...............  Incision of prostate.........         0162      23.2858    $1,382.01  ...........      $276.40
52500.................  T..............  ...............  Revision of bladder neck.....         0162      23.2858    $1,382.01  ...........      $276.40
52510.................  T..............  ...............  Dilation prostatic urethra...         0161      18.4736    $1,096.41      $249.36      $219.28
52601.................  T..............  ...............  Prostatectomy (TURP).........         0163      33.5826    $1,993.13  ...........      $398.63
52606.................  T..............  ...............  Control postop bleeding......         0162      23.2858    $1,382.01  ...........      $276.40
52612.................  T..............  ...............  Prostatectomy, first stage...         0163      33.5826    $1,993.13  ...........      $398.63
52614.................  T..............  ...............  Prostatectomy, second stage..         0163      33.5826    $1,993.13  ...........      $398.63
52620.................  T..............  ...............  Remove residual prostate.....         0163      33.5826    $1,993.13  ...........      $398.63
52630.................  T..............  ...............  Remove prostate regrowth.....         0163      33.5826    $1,993.13  ...........      $398.63
52640.................  T..............  ...............  Relieve bladder contracture..         0162      23.2858    $1,382.01  ...........      $276.40

[[Page 42841]]

 
52647.................  T..............  ...............  Laser surgery of prostate....         0429      42.1231    $2,500.01  ...........      $500.00
52648.................  T..............  ...............  Laser surgery of prostate....         0429      42.1231    $2,500.01  ...........      $500.00
52700.................  T..............  ...............  Drainage of prostate abscess.         0162      23.2858    $1,382.01  ...........      $276.40
53000.................  T..............  ...............  Incision of urethra..........         0166      17.5942    $1,044.22      $218.73      $208.84
53010.................  T..............  ...............  Incision of urethra..........         0166      17.5942    $1,044.22      $218.73      $208.84
53020.................  T..............  ...............  Incision of urethra..........         0166      17.5942    $1,044.22      $218.73      $208.84
53025.................  T..............  ...............  Incision of urethra..........         0166      17.5942    $1,044.22      $218.73      $208.84
53040.................  T..............  ...............  Drainage of urethra abscess..         0166      17.5942    $1,044.22      $218.73      $208.84
53060.................  T..............  ...............  Drainage of urethra abscess..         0166      17.5942    $1,044.22      $218.73      $208.84
53080.................  T..............  ...............  Drainage of urinary leakage..         0166      17.5942    $1,044.22      $218.73      $208.84
53085.................  T..............  ...............  Drainage of urinary leakage..         0166      17.5942    $1,044.22      $218.73      $208.84
53200.................  T..............  ...............  Biopsy of urethra............         0166      17.5942    $1,044.22      $218.73      $208.84
53210.................  T..............  ...............  Removal of urethra...........         0168      28.1405    $1,670.14      $386.32      $334.03
53215.................  T..............  ...............  Removal of urethra...........         0166      17.5942    $1,044.22      $218.73      $208.84
53220.................  T..............  ...............  Treatment of urethra lesion..         0168      28.1405    $1,670.14      $386.32      $334.03
53230.................  T..............  ...............  Removal of urethra lesion....         0168      28.1405    $1,670.14      $386.32      $334.03
53235.................  T..............  ...............  Removal of urethra lesion....         0166      17.5942    $1,044.22      $218.73      $208.84
53240.................  T..............  ...............  Surgery for urethra pouch....         0168      28.1405    $1,670.14      $386.32      $334.03
53250.................  T..............  ...............  Removal of urethra gland.....         0166      17.5942    $1,044.22      $218.73      $208.84
53260.................  T..............  ...............  Treatment of urethra lesion..         0166      17.5942    $1,044.22      $218.73      $208.84
53265.................  T..............  ...............  Treatment of urethra lesion..         0166      17.5942    $1,044.22      $218.73      $208.84
53270.................  T..............  ...............  Removal of urethra gland.....         0166      17.5942    $1,044.22      $218.73      $208.84
53275.................  T..............  ...............  Repair of urethra defect.....         0166      17.5942    $1,044.22      $218.73      $208.84
53400.................  T..............  ...............  Revise urethra, stage 1......         0168      28.1405    $1,670.14      $386.32      $334.03
53405.................  T..............  ...............  Revise urethra, stage 2......         0168      28.1405    $1,670.14      $386.32      $334.03
53410.................  T..............  ...............  Reconstruction of urethra....         0168      28.1405    $1,670.14      $386.32      $334.03
53415.................  C..............  ...............  Reconstruction of urethra....  ...........  ...........  ...........  ...........  ...........
53420.................  T..............  ...............  Reconstruct urethra, stage 1.         0168      28.1405    $1,670.14      $386.32      $334.03
53425.................  T..............  ...............  Reconstruct urethra, stage 2.         0168      28.1405    $1,670.14      $386.32      $334.03
53430.................  T..............  ...............  Reconstruction of urethra....         0168      28.1405    $1,670.14      $386.32      $334.03
53431.................  T..............  ...............  Reconstruct urethra/bladder..         0168      28.1405    $1,670.14      $386.32      $334.03
53440.................  S..............  ...............  Correct bladder function.....         0385      75.3020    $4,469.17  ...........      $893.83
53442.................  T..............  ...............  Remove perineal prosthesis...         0168      28.1405    $1,670.14      $386.32      $334.03
53444.................  S..............  ...............  Insert tandem cuff...........         0385      75.3020    $4,469.17  ...........      $893.83
53445.................  S..............  ...............  Insert uro/ves nck sphincter.         0386     119.6251    $7,099.75  ...........    $1,419.95
53446.................  T..............  ...............  Remove uro sphincter.........         0168      28.1405    $1,670.14      $386.32      $334.03
53447.................  S..............  ...............  Remove/replace ur sphincter..         0386     119.6251    $7,099.75  ...........    $1,419.95
53448.................  C..............  ...............  Remov/replc ur sphinctr comp.  ...........  ...........  ...........  ...........  ...........
53449.................  T..............  ...............  Repair uro sphincter.........         0168      28.1405    $1,670.14      $386.32      $334.03
53450.................  T..............  ...............  Revision of urethra..........         0168      28.1405    $1,670.14      $386.32      $334.03
53460.................  T..............  ...............  Revision of urethra..........         0166      17.5942    $1,044.22      $218.73      $208.84
53500.................  T..............  ...............  Urethrlys, transvag w/ scope.         0168      28.1405    $1,670.14      $386.32      $334.03
53502.................  T..............  ...............  Repair of urethra injury.....         0166      17.5942    $1,044.22      $218.73      $208.84
53505.................  T..............  ...............  Repair of urethra injury.....         0168      28.1405    $1,670.14      $386.32      $334.03
53510.................  T..............  ...............  Repair of urethra injury.....         0166      17.5942    $1,044.22      $218.73      $208.84
53515.................  T..............  ...............  Repair of urethra injury.....         0168      28.1405    $1,670.14      $386.32      $334.03
53520.................  T..............  ...............  Repair of urethra defect.....         0168      28.1405    $1,670.14      $386.32      $334.03
53600.................  T..............  ...............  Dilate urethra stricture.....         0156       2.5635      $152.14       $40.52       $30.43
53601.................  T..............  ...............  Dilate urethra stricture.....         0164       1.1802       $70.04       $17.21       $14.01
53605.................  T..............  ...............  Dilate urethra stricture.....         0161      18.4736    $1,096.41      $249.36      $219.28
53620.................  T..............  ...............  Dilate urethra stricture.....         0165      16.5934      $984.82  ...........      $196.96
53621.................  T..............  ...............  Dilate urethra stricture.....         0164       1.1802       $70.04       $17.21       $14.01
53660.................  T..............  ...............  Dilation of urethra..........         0164       1.1802       $70.04       $17.21       $14.01
53661.................  T..............  ...............  Dilation of urethra..........         0164       1.1802       $70.04       $17.21       $14.01
53665.................  T..............  ...............  Dilation of urethra..........         0166      17.5942    $1,044.22      $218.73      $208.84
53850.................  T..............  ...............  Prostatic microwave thermotx.         0675      43.5348    $2,583.79  ...........      $516.76
53852.................  T..............  ...............  Prostatic rf thermotx........         0675      43.5348    $2,583.79  ...........      $516.76
53853.................  T..............  ...............  Prostatic water thermother...         0162      23.2858    $1,382.01  ...........      $276.40
53899.................  T..............  ...............  Urology surgery procedure....         0164       1.1802       $70.04       $17.21       $14.01
54000.................  T..............  ...............  Slitting of prepuce..........         0166      17.5942    $1,044.22      $218.73      $208.84
54001.................  T..............  ...............  Slitting of prepuce..........         0166      17.5942    $1,044.22      $218.73      $208.84
54015.................  T..............  ...............  Drain penis lesion...........         0008      16.4242      $974.78  ...........      $194.96
54050.................  T..............  ...............  Destruction, penis lesion(s).         0013       1.1028       $65.45       $14.20       $13.09
54055.................  T..............  ...............  Destruction, penis lesion(s).         0017      18.3377    $1,088.34      $227.84      $217.67
54056.................  T..............  ...............  Cryosurgery, penis lesion(s).         0012       0.8458       $50.20       $11.18       $10.04
54057.................  T..............  ...............  Laser surg, penis lesion(s)..         0017      18.3377    $1,088.34      $227.84      $217.67

[[Page 42842]]

 
54060.................  T..............  ...............  Excision of penis lesion(s)..         0017      18.3377    $1,088.34      $227.84      $217.67
54065.................  T..............  ...............  Destruction, penis lesion(s).         0695      20.2244    $1,200.32      $266.59      $240.06
54100.................  T..............  ...............  Biopsy of penis..............         0021      14.9098      $884.90      $219.48      $176.98
54105.................  T..............  ...............  Biopsy of penis..............         0022      19.5582    $1,160.78      $354.45      $232.16
54110.................  T..............  ...............  Treatment of penis lesion....         0181      30.7265    $1,823.62      $621.82      $364.72
54111.................  T..............  ...............  Treat penis lesion, graft....         0181      30.7265    $1,823.62      $621.82      $364.72
54112.................  T..............  ...............  Treat penis lesion, graft....         0181      30.7265    $1,823.62      $621.82      $364.72
54115.................  T..............  ...............  Treatment of penis lesion....         0008      16.4242      $974.78  ...........      $194.96
54120.................  T..............  ...............  Partial removal of penis.....         0181      30.7265    $1,823.62      $621.82      $364.72
54125.................  C..............  ...............  Removal of penis.............  ...........  ...........  ...........  ...........  ...........
54130.................  C..............  ...............  Remove penis & nodes.........  ...........  ...........  ...........  ...........  ...........
54135.................  C..............  ...............  Remove penis & nodes.........  ...........  ...........  ...........  ...........  ...........
54150.................  T..............  ...............  Circumcision.................         0180      19.7926    $1,174.69      $304.87      $234.94
54152.................  T..............  ...............  Circumcision.................         0180      19.7926    $1,174.69      $304.87      $234.94
54160.................  T..............  ...............  Circumcision.................         0180      19.7926    $1,174.69      $304.87      $234.94
54161.................  T..............  ...............  Circumcision.................         0180      19.7926    $1,174.69      $304.87      $234.94
54162.................  T..............  ...............  Lysis penil circumic lesion..         0180      19.7926    $1,174.69      $304.87      $234.94
54163.................  T..............  ...............  Repair of circumcision.......         0180      19.7926    $1,174.69      $304.87      $234.94
54164.................  T..............  ...............  Frenulotomy of penis.........         0180      19.7926    $1,174.69      $304.87      $234.94
54200.................  T..............  ...............  Treatment of penis lesion....         0156       2.5635      $152.14       $40.52       $30.43
54205.................  T..............  ...............  Treatment of penis lesion....         0181      30.7265    $1,823.62      $621.82      $364.72
54220.................  T..............  ...............  Treatment of penis lesion....         0156       2.5635      $152.14       $40.52       $30.43
54230.................  N..............  ...............  Prepare penis study..........  ...........  ...........  ...........  ...........  ...........
54231.................  T..............  ...............  Dynamic cavernosometry.......         0165      16.5934      $984.82  ...........      $196.96
54235.................  T..............  ...............  Penile injection.............         0164       1.1802       $70.04       $17.21       $14.01
54240.................  T..............  ...............  Penis study..................         0164       1.1802       $70.04       $17.21       $14.01
54250.................  T..............  ...............  Penis study..................         0164       1.1802       $70.04       $17.21       $14.01
54300.................  T..............  ...............  Revision of penis............         0181      30.7265    $1,823.62      $621.82      $364.72
54304.................  T..............  ...............  Revision of penis............         0181      30.7265    $1,823.62      $621.82      $364.72
54308.................  T..............  ...............  Reconstruction of urethra....         0181      30.7265    $1,823.62      $621.82      $364.72
54312.................  T..............  ...............  Reconstruction of urethra....         0181      30.7265    $1,823.62      $621.82      $364.72
54316.................  T..............  ...............  Reconstruction of urethra....         0181      30.7265    $1,823.62      $621.82      $364.72
54318.................  T..............  ...............  Reconstruction of urethra....         0181      30.7265    $1,823.62      $621.82      $364.72
54322.................  T..............  ...............  Reconstruction of urethra....         0181      30.7265    $1,823.62      $621.82      $364.72
54324.................  T..............  ...............  Reconstruction of urethra....         0181      30.7265    $1,823.62      $621.82      $364.72
54326.................  T..............  ...............  Reconstruction of urethra....         0181      30.7265    $1,823.62      $621.82      $364.72
54328.................  T..............  ...............  Revise penis/urethra.........         0181      30.7265    $1,823.62      $621.82      $364.72
54332.................  C..............  ...............  Revise penis/urethra.........  ...........  ...........  ...........  ...........  ...........
54336.................  C..............  ...............  Revise penis/urethra.........  ...........  ...........  ...........  ...........  ...........
54340.................  T..............  ...............  Secondary urethral surgery...         0181      30.7265    $1,823.62      $621.82      $364.72
54344.................  T..............  ...............  Secondary urethral surgery...         0181      30.7265    $1,823.62      $621.82      $364.72
54348.................  T..............  ...............  Secondary urethral surgery...         0181      30.7265    $1,823.62      $621.82      $364.72
54352.................  T..............  ...............  Reconstruct urethra/penis....         0181      30.7265    $1,823.62      $621.82      $364.72
54360.................  T..............  ...............  Penis plastic surgery........         0181      30.7265    $1,823.62      $621.82      $364.72
54380.................  T..............  ...............  Repair penis.................         0181      30.7265    $1,823.62      $621.82      $364.72
54385.................  T..............  ...............  Repair penis.................         0181      30.7265    $1,823.62      $621.82      $364.72
54390.................  C..............  ...............  Repair penis and bladder.....  ...........  ...........  ...........  ...........  ...........
54400.................  S..............  ...............  Insert semi-rigid prosthesis.         0385      75.3020    $4,469.17  ...........      $893.83
54401.................  S..............  ...............  Insert self-contd prosthesis.         0386     119.6251    $7,099.75  ...........    $1,419.95
54405.................  S..............  ...............  Insert multi-comp penis pros.         0386     119.6251    $7,099.75  ...........    $1,419.95
54406.................  T..............  ...............  Remove muti-comp penis pros..         0181      30.7265    $1,823.62      $621.82      $364.72
54408.................  T..............  ...............  Repair multi-comp penis pros.         0181      30.7265    $1,823.62      $621.82      $364.72
54410.................  S..............  ...............  Remove/replace penis prosth..         0386     119.6251    $7,099.75  ...........    $1,419.95
54411.................  C..............  ...............  Remov/replc penis pros, comp.  ...........  ...........  ...........  ...........  ...........
54415.................  T..............  ...............  Remove self-contd penis pros.         0181      30.7265    $1,823.62      $621.82      $364.72
54416.................  S..............  ...............  Remv/repl penis contain pros.         0386     119.6251    $7,099.75  ...........    $1,419.95
54417.................  C..............  ...............  Remv/replc penis pros, compl.  ...........  ...........  ...........  ...........  ...........
54420.................  T..............  ...............  Revision of penis............         0181      30.7265    $1,823.62      $621.82      $364.72
54430.................  C..............  ...............  Revision of penis............  ...........  ...........  ...........  ...........  ...........
54435.................  T..............  ...............  Revision of penis............         0181      30.7265    $1,823.62      $621.82      $364.72
54440.................  T..............  ...............  Repair of penis..............         0181      30.7265    $1,823.62      $621.82      $364.72
54450.................  T..............  ...............  Preputial stretching.........         0156       2.5635      $152.14       $40.52       $30.43
54500.................  T..............  ...............  Biopsy of testis.............         0037       9.4322      $559.80      $223.91      $111.96
54505.................  T..............  ...............  Biopsy of testis.............         0183      23.5344    $1,396.77  ...........      $279.35
54512.................  T..............  ...............  Excise lesion testis.........         0183      23.5344    $1,396.77  ...........      $279.35
54520.................  T..............  ...............  Removal of testis............         0183      23.5344    $1,396.77  ...........      $279.35

[[Page 42843]]

 
54522.................  T..............  ...............  Orchiectomy, partial.........         0183      23.5344    $1,396.77  ...........      $279.35
54530.................  T..............  ...............  Removal of testis............         0154      28.6544    $1,700.64      $464.85      $340.13
54535.................  C..............  ...............  Extensive testis surgery.....  ...........  ...........  ...........  ...........  ...........
54550.................  T..............  ...............  Exploration for testis.......         0154      28.6544    $1,700.64      $464.85      $340.13
54560.................  T..............  ...............  Exploration for testis.......         0183      23.5344    $1,396.77  ...........      $279.35
54600.................  T..............  ...............  Reduce testis torsion........         0183      23.5344    $1,396.77  ...........      $279.35
54620.................  T..............  ...............  Suspension of testis.........         0183      23.5344    $1,396.77  ...........      $279.35
54640.................  T..............  ...............  Suspension of testis.........         0154      28.6544    $1,700.64      $464.85      $340.13
54650.................  C..............  ...............  Orchiopexy (Fowler-Stephens).  ...........  ...........  ...........  ...........  ...........
54660.................  T..............  ...............  Revision of testis...........         0183      23.5344    $1,396.77  ...........      $279.35
54670.................  T..............  ...............  Repair testis injury.........         0183      23.5344    $1,396.77  ...........      $279.35
54680.................  T..............  ...............  Relocation of testis(es).....         0183      23.5344    $1,396.77  ...........      $279.35
54690.................  T..............  ...............  Laparoscopy, orchiectomy.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
54692.................  T..............  ...............  Laparoscopy, orchiopexy......         0132      62.7061    $3,721.61    $1,239.22      $744.32
54699.................  T..............  ...............  Laparoscope proc, testis.....         0130      31.7825    $1,886.29      $659.53      $377.26
54700.................  T..............  ...............  Drainage of scrotum..........         0183      23.5344    $1,396.77  ...........      $279.35
54800.................  T..............  ...............  Biopsy of epididymis.........         0004       1.7566      $104.25       $22.36       $20.85
54820.................  T..............  ...............  Exploration of epididymis....         0183      23.5344    $1,396.77  ...........      $279.35
54830.................  T..............  ...............  Remove epididymis lesion.....         0183      23.5344    $1,396.77  ...........      $279.35
54840.................  T..............  ...............  Remove epididymis lesion.....         0183      23.5344    $1,396.77  ...........      $279.35
54860.................  T..............  ...............  Removal of epididymis........         0183      23.5344    $1,396.77  ...........      $279.35
54861.................  T..............  ...............  Removal of epididymis........         0183      23.5344    $1,396.77  ...........      $279.35
54900.................  T..............  ...............  Fusion of spermatic ducts....         0183      23.5344    $1,396.77  ...........      $279.35
54901.................  T..............  ...............  Fusion of spermatic ducts....         0183      23.5344    $1,396.77  ...........      $279.35
55000.................  T..............  ...............  Drainage of hydrocele........         0004       1.7566      $104.25       $22.36       $20.85
55040.................  T..............  ...............  Removal of hydrocele.........         0154      28.6544    $1,700.64      $464.85      $340.13
55041.................  T..............  ...............  Removal of hydroceles........         0154      28.6544    $1,700.64      $464.85      $340.13
55060.................  T..............  ...............  Repair of hydrocele..........         0183      23.5344    $1,396.77  ...........      $279.35
55100.................  T..............  ...............  Drainage of scrotum abscess..         0008      16.4242      $974.78  ...........      $194.96
55110.................  T..............  ...............  Explore scrotum..............         0183      23.5344    $1,396.77  ...........      $279.35
55120.................  T..............  ...............  Removal of scrotum lesion....         0183      23.5344    $1,396.77  ...........      $279.35
55150.................  T..............  ...............  Removal of scrotum...........         0183      23.5344    $1,396.77  ...........      $279.35
55175.................  T..............  ...............  Revision of scrotum..........         0183      23.5344    $1,396.77  ...........      $279.35
55180.................  T..............  ...............  Revision of scrotum..........         0183      23.5344    $1,396.77  ...........      $279.35
55200.................  T..............  ...............  Incision of sperm duct.......         0183      23.5344    $1,396.77  ...........      $279.35
55250.................  T..............  ...............  Removal of sperm duct(s).....         0183      23.5344    $1,396.77  ...........      $279.35
55300.................  N..............  ...............  Prepare, sperm duct x-ray....  ...........  ...........  ...........  ...........  ...........
55400.................  T..............  ...............  Repair of sperm duct.........         0183      23.5344    $1,396.77  ...........      $279.35
55450.................  T..............  ...............  Ligation of sperm duct.......         0183      23.5344    $1,396.77  ...........      $279.35
55500.................  T..............  ...............  Removal of hydrocele.........         0183      23.5344    $1,396.77  ...........      $279.35
55520.................  T..............  ...............  Removal of sperm cord lesion.         0183      23.5344    $1,396.77  ...........      $279.35
55530.................  T..............  ...............  Revise spermatic cord veins..         0183      23.5344    $1,396.77  ...........      $279.35
55535.................  T..............  ...............  Revise spermatic cord veins..         0154      28.6544    $1,700.64      $464.85      $340.13
55540.................  T..............  ...............  Revise hernia & sperm veins..         0154      28.6544    $1,700.64      $464.85      $340.13
55550.................  T..............  ...............  Laparo ligate spermatic vein.         0131      43.1426    $2,560.51    $1,001.89      $512.10
55559.................  T..............  ...............  Laparo proc, spermatic cord..         0130      31.7825    $1,886.29      $659.53      $377.26
55600.................  T..............  ...............  Incise sperm duct pouch......         0183      23.5344    $1,396.77  ...........      $279.35
55605.................  C..............  ...............  Incise sperm duct pouch......  ...........  ...........  ...........  ...........  ...........
55650.................  C..............  ...............  Remove sperm duct pouch......  ...........  ...........  ...........  ...........  ...........
55680.................  T..............  ...............  Remove sperm pouch lesion....         0183      23.5344    $1,396.77  ...........      $279.35
55700.................  T..............  ...............  Biopsy of prostate...........         0184       4.3369      $257.40       $96.27       $51.48
55705.................  T..............  ...............  Biopsy of prostate...........         0184       4.3369      $257.40       $96.27       $51.48
55720.................  T..............  ...............  Drainage of prostate abscess.         0162      23.2858    $1,382.01  ...........      $276.40
55725.................  T..............  ...............  Drainage of prostate abscess.         0162      23.2858    $1,382.01  ...........      $276.40
55801.................  C..............  ...............  Removal of prostate..........  ...........  ...........  ...........  ...........  ...........
55810.................  C..............  ...............  Extensive prostate surgery...  ...........  ...........  ...........  ...........  ...........
55812.................  C..............  ...............  Extensive prostate surgery...  ...........  ...........  ...........  ...........  ...........
55815.................  C..............  ...............  Extensive prostate surgery...  ...........  ...........  ...........  ...........  ...........
55821.................  C..............  ...............  Removal of prostate..........  ...........  ...........  ...........  ...........  ...........
55831.................  C..............  ...............  Removal of prostate..........  ...........  ...........  ...........  ...........  ...........
55840.................  C..............  ...............  Extensive prostate surgery...  ...........  ...........  ...........  ...........  ...........
55842.................  C..............  ...............  Extensive prostate surgery...  ...........  ...........  ...........  ...........  ...........
55845.................  C..............  ...............  Extensive prostate surgery...  ...........  ...........  ...........  ...........  ...........
55859.................  T..............  ...............  Percut/needle insert, pros...         0163      33.5826    $1,993.13  ...........      $398.63
55860.................  T..............  ...............  Surgical exposure, prostate..         0165      16.5934      $984.82  ...........      $196.96
55862.................  C..............  ...............  Extensive prostate surgery...  ...........  ...........  ...........  ...........  ...........

[[Page 42844]]

 
55865.................  C..............  ...............  Extensive prostate surgery...  ...........  ...........  ...........  ...........  ...........
55866.................  C..............  ...............  Laparo radical prostatectomy.  ...........  ...........  ...........  ...........  ...........
55870.................  T..............  ...............  Electroejaculation...........         0197       2.3465      $139.26  ...........       $27.85
55873.................  T..............  ...............  Cryoablate prostate..........         0674      95.3518    $5,659.13  ...........    $1,131.83
55899.................  T..............  ...............  Genital surgery procedure....         0164       1.1802       $70.04       $17.21       $14.01
55970.................  E..............  ...............  Sex transformation, M to F...  ...........  ...........  ...........  ...........  ...........
55980.................  E..............  ...............  Sex transformation, F to M...  ...........  ...........  ...........  ...........  ...........
56405.................  T..............  ...............  I & D of vulva/perineum......         0189       2.3602      $140.08  ...........       $28.02
56420.................  T..............  ...............  Drainage of gland abscess....         0189       2.3602      $140.08  ...........       $28.02
56440.................  T..............  ...............  Surgery for vulva lesion.....         0194      20.6585    $1,226.08      $397.84      $245.22
56441.................  T..............  ...............  Lysis of labial lesion(s)....         0193      14.5183      $861.66  ...........      $172.33
56501.................  T..............  ...............  Destroy, vulva lesions, sim..         0017      18.3377    $1,088.34      $227.84      $217.67
56515.................  T..............  ...............  Destroy vulva lesion/s compl.         0695      20.2244    $1,200.32      $266.59      $240.06
56605.................  T..............  ...............  Biopsy of vulva/perineum.....         0019       4.0363      $239.55       $71.87       $47.91
56606.................  T..............  ...............  Biopsy of vulva/perineum.....         0019       4.0363      $239.55       $71.87       $47.91
56620.................  T..............  ...............  Partial removal of vulva.....         0195      26.5582    $1,576.23      $483.80      $315.25
56625.................  T..............  ...............  Complete removal of vulva....         0195      26.5582    $1,576.23      $483.80      $315.25
56630.................  C..............  ...............  Extensive vulva surgery......  ...........  ...........  ...........  ...........  ...........
56631.................  C..............  ...............  Extensive vulva surgery......  ...........  ...........  ...........  ...........  ...........
56632.................  C..............  ...............  Extensive vulva surgery......  ...........  ...........  ...........  ...........  ...........
56633.................  C..............  ...............  Extensive vulva surgery......  ...........  ...........  ...........  ...........  ...........
56634.................  C..............  ...............  Extensive vulva surgery......  ...........  ...........  ...........  ...........  ...........
56637.................  C..............  ...............  Extensive vulva surgery......  ...........  ...........  ...........  ...........  ...........
56640.................  C..............  ...............  Extensive vulva surgery......  ...........  ...........  ...........  ...........  ...........
56700.................  T..............  ...............  Partial removal of hymen.....         0194      20.6585    $1,226.08      $397.84      $245.22
56720.................  T..............  ...............  Incision of hymen............         0193      14.5183      $861.66  ...........      $172.33
56740.................  T..............  ...............  Remove vagina gland lesion...         0194      20.6585    $1,226.08      $397.84      $245.22
56800.................  T..............  ...............  Repair of vagina.............         0194      20.6585    $1,226.08      $397.84      $245.22
56805.................  T..............  ...............  Repair clitoris..............         0193      14.5183      $861.66  ...........      $172.33
56810.................  T..............  ...............  Repair of perineum...........         0194      20.6585    $1,226.08      $397.84      $245.22
56820.................  T..............  ...............  Exam of vulva w/scope........         0188       1.1348       $67.35  ...........       $13.47
56821.................  T..............  ...............  Exam/biopsy of vulva w/scope.         0189       2.3602      $140.08  ...........       $28.02
57000.................  T..............  ...............  Exploration of vagina........         0193      14.5183      $861.66  ...........      $172.33
57010.................  T..............  ...............  Drainage of pelvic abscess...         0193      14.5183      $861.66  ...........      $172.33
57020.................  T..............  ...............  Drainage of pelvic fluid.....         0192       4.2887      $254.53  ...........       $50.91
57022.................  T..............  ...............  I & d vaginal hematoma, pp...         0007      11.3983      $676.49  ...........      $135.30
57023.................  T..............  ...............  I & d vag hematoma, non-ob...         0008      16.4242      $974.78  ...........      $194.96
57061.................  T..............  ...............  Destroy vag lesions, simple..         0194      20.6585    $1,226.08      $397.84      $245.22
57065.................  T..............  ...............  Destroy vag lesions, complex.         0194      20.6585    $1,226.08      $397.84      $245.22
57100.................  T..............  ...............  Biopsy of vagina.............         0192       4.2887      $254.53  ...........       $50.91
57105.................  T..............  ...............  Biopsy of vagina.............         0194      20.6585    $1,226.08      $397.84      $245.22
57106.................  T..............  ...............  Remove vagina wall, partial..         0194      20.6585    $1,226.08      $397.84      $245.22
57107.................  T..............  ...............  Remove vagina tissue, part...         0195      26.5582    $1,576.23      $483.80      $315.25
57109.................  T..............  ...............  Vaginectomy partial w/nodes..         0195      26.5582    $1,576.23      $483.80      $315.25
57110.................  C..............  ...............  Remove vagina wall, complete.  ...........  ...........  ...........  ...........  ...........
57111.................  C..............  ...............  Remove vagina tissue, compl..  ...........  ...........  ...........  ...........  ...........
57112.................  C..............  ...............  Vaginectomy w/nodes, compl...  ...........  ...........  ...........  ...........  ...........
57120.................  T..............  ...............  Closure of vagina............         0195      26.5582    $1,576.23      $483.80      $315.25
57130.................  T..............  ...............  Remove vagina lesion.........         0194      20.6585    $1,226.08      $397.84      $245.22
57135.................  T..............  ...............  Remove vagina lesion.........         0194      20.6585    $1,226.08      $397.84      $245.22
57150.................  T..............  ...............  Treat vagina infection.......         0191       0.1663        $9.87        $2.77        $1.97
57155.................  T..............  ...............  Insert uteri tandems/ovoids..         0192       4.2887      $254.53  ...........       $50.91
57160.................  T..............  ...............  Insert pessary/other device..         0188       1.1348       $67.35  ...........       $13.47
57170.................  T..............  ...............  Fitting of diaphragm/cap.....         0191       0.1663        $9.87        $2.77        $1.97
57180.................  T..............  ...............  Treat vaginal bleeding.......         0189       2.3602      $140.08  ...........       $28.02
57200.................  T..............  ...............  Repair of vagina.............         0194      20.6585    $1,226.08      $397.84      $245.22
57210.................  T..............  ...............  Repair vagina/perineum.......         0194      20.6585    $1,226.08      $397.84      $245.22
57220.................  T..............  ...............  Revision of urethra..........         0202      40.2037    $2,386.09      $954.43      $477.22
57230.................  T..............  ...............  Repair of urethral lesion....         0195      26.5582    $1,576.23      $483.80      $315.25
57240.................  T..............  ...............  Repair bladder & vagina......         0195      26.5582    $1,576.23      $483.80      $315.25
57250.................  T..............  ...............  Repair rectum & vagina.......         0195      26.5582    $1,576.23      $483.80      $315.25
57260.................  T..............  ...............  Repair of vagina.............         0195      26.5582    $1,576.23      $483.80      $315.25
57265.................  T..............  ...............  Extensive repair of vagina...         0202      40.2037    $2,386.09      $954.43      $477.22
57267.................  T..............  ...............  Insert mesh/pelvic flr addon.         0154      28.6544    $1,700.64      $464.85      $340.13
57268.................  T..............  ...............  Repair of bowel bulge........         0195      26.5582    $1,576.23      $483.80      $315.25
57270.................  C..............  ...............  Repair of bowel pouch........  ...........  ...........  ...........  ...........  ...........

[[Page 42845]]

 
57280.................  C..............  ...............  Suspension of vagina.........  ...........  ...........  ...........  ...........  ...........
57282.................  C..............  ...............  Repair of vaginal prolapse...  ...........  ...........  ...........  ...........  ...........
57283.................  C..............  ...............  Colpopexy, intraperitoneal...  ...........  ...........  ...........  ...........  ...........
57284.................  T..............  ...............  Repair paravaginal defect....         0202      40.2037    $2,386.09      $954.43      $477.22
57287.................  T..............  ...............  Revise/remove sling repair...         0202      40.2037    $2,386.09      $954.43      $477.22
57288.................  T..............  ...............  Repair bladder defect........         0202      40.2037    $2,386.09      $954.43      $477.22
57289.................  T..............  ...............  Repair bladder & vagina......         0195      26.5582    $1,576.23      $483.80      $315.25
57291.................  T..............  ...............  Construction of vagina.......         0195      26.5582    $1,576.23      $483.80      $315.25
57292.................  C..............  ...............  Construct vagina with graft..  ...........  ...........  ...........  ...........  ...........
57300.................  T..............  ...............  Repair rectum-vagina fistula.         0195      26.5582    $1,576.23      $483.80      $315.25
57305.................  C..............  ...............  Repair rectum-vagina fistula.  ...........  ...........  ...........  ...........  ...........
57307.................  C..............  ...............  Fistula repair & colostomy...  ...........  ...........  ...........  ...........  ...........
57308.................  C..............  ...............  Fistula repair, transperine..  ...........  ...........  ...........  ...........  ...........
57310.................  T..............  ...............  Repair urethrovaginal lesion.         0202      40.2037    $2,386.09      $954.43      $477.22
57311.................  C..............  ...............  Repair urethrovaginal lesion.  ...........  ...........  ...........  ...........  ...........
57320.................  T..............  ...............  Repair bladder-vagina lesion.         0195      26.5582    $1,576.23      $483.80      $315.25
57330.................  T..............  ...............  Repair bladder-vagina lesion.         0195      26.5582    $1,576.23      $483.80      $315.25
57335.................  C..............  ...............  Repair vagina................  ...........  ...........  ...........  ...........  ...........
57400.................  T..............  ...............  Dilation of vagina...........         0194      20.6585    $1,226.08      $397.84      $245.22
57410.................  T..............  ...............  Pelvic examination...........         0193      14.5183      $861.66  ...........      $172.33
57415.................  T..............  ...............  Remove vaginal foreign body..         0194      20.6585    $1,226.08      $397.84      $245.22
57420.................  T..............  ...............  Exam of vagina w/scope.......         0189       2.3602      $140.08  ...........       $28.02
57421.................  T..............  ...............  Exam/biopsy of vag w/scope...         0189       2.3602      $140.08  ...........       $28.02
57425.................  T..............  ...............  Laparoscopy, surg, colpopexy.         0130      31.7825    $1,886.29      $659.53      $377.26
57452.................  T..............  ...............  Examination of vagina........         0189       2.3602      $140.08  ...........       $28.02
57454.................  T..............  ...............  Vagina examination & biopsy..         0189       2.3602      $140.08  ...........       $28.02
57455.................  T..............  ...............  Biopsy of cervix w/scope.....         0189       2.3602      $140.08  ...........       $28.02
57456.................  T..............  ...............  Endocerv curettage w/scope...         0189       2.3602      $140.08  ...........       $28.02
57460.................  T..............  ...............  Cervix excision..............         0193      14.5183      $861.66  ...........      $172.33
57461.................  T..............  ...............  Conz of cervix w/scope, leep.         0194      20.6585    $1,226.08      $397.84      $245.22
57500.................  T..............  ...............  Biopsy of cervix.............         0192       4.2887      $254.53  ...........       $50.91
57505.................  T..............  ...............  Endocervical curettage.......         0189       2.3602      $140.08  ...........       $28.02
57510.................  T..............  ...............  Cauterization of cervix......         0193      14.5183      $861.66  ...........      $172.33
57511.................  T..............  ...............  Cryocautery of cervix........         0189       2.3602      $140.08  ...........       $28.02
57513.................  T..............  ...............  Laser surgery of cervix......         0193      14.5183      $861.66  ...........      $172.33
57520.................  T..............  ...............  Conization of cervix.........         0194      20.6585    $1,226.08      $397.84      $245.22
57522.................  T..............  ...............  Conization of cervix.........         0195      26.5582    $1,576.23      $483.80      $315.25
57530.................  T..............  ...............  Removal of cervix............         0195      26.5582    $1,576.23      $483.80      $315.25
57531.................  C..............  ...............  Removal of cervix, radical...  ...........  ...........  ...........  ...........  ...........
57540.................  C..............  ...............  Removal of residual cervix...  ...........  ...........  ...........  ...........  ...........
57545.................  C..............  ...............  Remove cervix/repair pelvis..  ...........  ...........  ...........  ...........  ...........
57550.................  T..............  ...............  Removal of residual cervix...         0195      26.5582    $1,576.23      $483.80      $315.25
57555.................  T..............  ...............  Remove cervix/repair vagina..         0195      26.5582    $1,576.23      $483.80      $315.25
57556.................  T..............  ...............  Remove cervix, repair bowel..         0202      40.2037    $2,386.09      $954.43      $477.22
57700.................  T..............  ...............  Revision of cervix...........         0194      20.6585    $1,226.08      $397.84      $245.22
57720.................  T..............  ...............  Revision of cervix...........         0194      20.6585    $1,226.08      $397.84      $245.22
57800.................  T..............  ...............  Dilation of cervical canal...         0193      14.5183      $861.66  ...........      $172.33
57820.................  T..............  ...............  D & c of residual cervix.....         0196      17.0200    $1,010.14      $338.23      $202.03
58100.................  T..............  ...............  Biopsy of uterus lining......         0188       1.1348       $67.35  ...........       $13.47
58120.................  T..............  ...............  Dilation and curettage.......         0196      17.0200    $1,010.14      $338.23      $202.03
58140.................  C..............  ...............  Removal of uterus lesion.....  ...........  ...........  ...........  ...........  ...........
58145.................  T..............  ...............  Myomectomy vag method........         0195      26.5582    $1,576.23      $483.80      $315.25
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...  ...........  ...........  ...........  ...........  ...........

[[Page 42846]]

 
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 device...         0189       2.3602      $140.08  ...........       $28.02
58321.................  T..............  ...............  Artificial insemination......         0197       2.3465      $139.26  ...........       $27.85
58322.................  T..............  ...............  Artificial insemination......         0197       2.3465      $139.26  ...........       $27.85
58323.................  T..............  ...............  Sperm washing................         0197       2.3465      $139.26  ...........       $27.85
58340.................  N..............  ...............  Catheter for hysterography...  ...........  ...........  ...........  ...........  ...........
58345.................  T..............  ...............  Reopen fallopian tube........         0193      14.5183      $861.66  ...........      $172.33
58346.................  T..............  ...............  Insert heyman uteri capsule..         0193      14.5183      $861.66  ...........      $172.33
58350.................  T..............  ...............  Reopen fallopian tube........         0195      26.5582    $1,576.23      $483.80      $315.25
58353.................  T..............  ...............  Endometr ablate, thermal.....         0195      26.5582    $1,576.23      $483.80      $315.25
58356.................  T..............  ...............  Endometrial cryoablation.....         0202      40.2037    $2,386.09      $954.43      $477.22
58400.................  C..............  ...............  Suspension of uterus.........  ...........  ...........  ...........  ...........  ...........
58410.................  C..............  ...............  Suspension of uterus.........  ...........  ...........  ...........  ...........  ...........
58520.................  C..............  ...............  Repair of ruptured uterus....  ...........  ...........  ...........  ...........  ...........
58540.................  C..............  ...............  Revision of uterus...........  ...........  ...........  ...........  ...........  ...........
58545.................  T..............  ...............  Laparoscopic myomectomy......         0130      31.7825    $1,886.29      $659.53      $377.26
58546.................  T..............  ...............  Laparo-myomectomy, complex...         0131      43.1426    $2,560.51    $1,001.89      $512.10
58550.................  T..............  ...............  Laparo-asst vag hysterectomy.         0132      62.7061    $3,721.61    $1,239.22      $744.32
58552.................  T..............  ...............  Laparo-vag hyst incl t/o.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
58553.................  T..............  ...............  Laparo-vag hyst, complex.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
58554.................  T..............  ...............  Laparo-vag hyst w/t/o, compl.         0131      43.1426    $2,560.51    $1,001.89      $512.10
58555.................  T..............  ...............  Hysteroscopy, dx, sep proc...         0190      20.9699    $1,244.56      $424.28      $248.91
58558.................  T..............  ...............  Hysteroscopy, biopsy.........         0190      20.9699    $1,244.56      $424.28      $248.91
58559.................  T..............  ...............  Hysteroscopy, lysis..........         0190      20.9699    $1,244.56      $424.28      $248.91
58560.................  T..............  ...............  Hysteroscopy, resect septum..         0387      32.3971    $1,922.77      $655.55      $384.55
58561.................  T..............  ...............  Hysteroscopy, remove myoma...         0387      32.3971    $1,922.77      $655.55      $384.55
58562.................  T..............  ...............  Hysteroscopy, remove fb......         0190      20.9699    $1,244.56      $424.28      $248.91
58563.................  T..............  ...............  Hysteroscopy, ablation.......         0387      32.3971    $1,922.77      $655.55      $384.55
58565.................  T..............  ...............  Hysteroscopy, sterilization..         0202      40.2037    $2,386.09      $954.43      $477.22
58578.................  T..............  ...............  Laparo proc, uterus..........         0130      31.7825    $1,886.29      $659.53      $377.26
58579.................  T..............  ...............  Hysteroscope procedure.......         0190      20.9699    $1,244.56      $424.28      $248.91
58600.................  T..............  ...............  Division of fallopian tube...         0195      26.5582    $1,576.23      $483.80      $315.25
58605.................  C..............  ...............  Division of fallopian tube...  ...........  ...........  ...........  ...........  ...........
58611.................  C..............  ...............  Ligate oviduct(s) add-on.....  ...........  ...........  ...........  ...........  ...........
58615.................  T..............  ...............  Occlude fallopian tube(s)....         0194      20.6585    $1,226.08      $397.84      $245.22
58660.................  T..............  ...............  Laparoscopy, lysis...........         0131      43.1426    $2,560.51    $1,001.89      $512.10
58661.................  T..............  ...............  Laparoscopy, remove adnexa...         0131      43.1426    $2,560.51    $1,001.89      $512.10
58662.................  T..............  ...............  Laparoscopy, excise lesions..         0131      43.1426    $2,560.51    $1,001.89      $512.10
58670.................  T..............  ...............  Laparoscopy, tubal cautery...         0131      43.1426    $2,560.51    $1,001.89      $512.10
58671.................  T..............  ...............  Laparoscopy, tubal block.....         0131      43.1426    $2,560.51    $1,001.89      $512.10
58672.................  T..............  ...............  Laparoscopy, fimbrioplasty...         0131      43.1426    $2,560.51    $1,001.89      $512.10
58673.................  T..............  ...............  Laparoscopy, salpingostomy...         0131      43.1426    $2,560.51    $1,001.89      $512.10
58679.................  T..............  ...............  Laparo proc, oviduct-ovary...         0130      31.7825    $1,886.29      $659.53      $377.26
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.................  T..............  ...............  Create new tubal opening.....         0195      26.5582    $1,576.23      $483.80      $315.25
58800.................  T..............  ...............  Drainage of ovarian cyst(s)..         0193      14.5183      $861.66  ...........      $172.33
58805.................  C..............  ...............  Drainage of ovarian cyst(s)..  ...........  ...........  ...........  ...........  ...........
58820.................  T..............  ...............  Drain ovary abscess, open....         0195      26.5582    $1,576.23      $483.80      $315.25
58822.................  C..............  ...............  Drain ovary abscess, percut..  ...........  ...........  ...........  ...........  ...........
58823.................  T..............  ...............  Drain pelvic abscess, percut.         0193      14.5183      $861.66  ...........      $172.33
58825.................  C..............  ...............  Transposition, ovary(s)......  ...........  ...........  ...........  ...........  ...........
58900.................  T..............  ...............  Biopsy of ovary(s)...........         0193      14.5183      $861.66  ...........      $172.33
58920.................  T..............  ...............  Partial removal of ovary(s)..         0195      26.5582    $1,576.23      $483.80      $315.25
58925.................  T..............  ...............  Removal of ovarian cyst(s)...         0195      26.5582    $1,576.23      $483.80      $315.25
58940.................  C..............  ...............  Removal of ovary(s)..........  ...........  ...........  ...........  ...........  ...........

[[Page 42847]]

 
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..  ...........  ...........  ...........  ...........  ...........
58956.................  C..............  ...............  Bso, omentectomy w/tah.......  ...........  ...........  ...........  ...........  ...........
58960.................  C..............  ...............  Exploration of abdomen.......  ...........  ...........  ...........  ...........  ...........
58970.................  T..............  ...............  Retrieval of oocyte..........         0197       2.3465      $139.26  ...........       $27.85
58974.................  T..............  ...............  Transfer of embryo...........         0197       2.3465      $139.26  ...........       $27.85
58976.................  T..............  ...............  Transfer of embryo...........         0197       2.3465      $139.26  ...........       $27.85
58999.................  T..............  ...............  Genital surgery procedure....         0191       0.1663        $9.87        $2.77        $1.97
59000.................  T..............  ...............  Amniocentesis, diagnostic....         0198       1.3621       $80.84       $32.19       $16.17
59001.................  T..............  ...............  Amniocentesis, therapeutic...         0192       4.2887      $254.53  ...........       $50.91
59012.................  T..............  ...............  Fetal cord puncture,prenatal.         0198       1.3621       $80.84       $32.19       $16.17
59015.................  T..............  ...............  Chorion biopsy...............         0198       1.3621       $80.84       $32.19       $16.17
59020.................  T..............  ...............  Fetal contract stress test...         0192       4.2887      $254.53  ...........       $50.91
59025.................  T..............  ...............  Fetal non-stress test........         0198       1.3621       $80.84       $32.19       $16.17
59030.................  T..............  ...............  Fetal scalp blood sample.....         0198       1.3621       $80.84       $32.19       $16.17
59050.................  E..............  ...............  Fetal monitor w/report.......  ...........  ...........  ...........  ...........  ...........
59051.................  B..............  ...............  Fetal monitor/interpret only.  ...........  ...........  ...........  ...........  ...........
59070.................  T..............  ...............  Transabdom amnioinfus w/ us..         0198       1.3621       $80.84       $32.19       $16.17
59072.................  T..............  ...............  Umbilical cord occlud w/ us..         0198       1.3621       $80.84       $32.19       $16.17
59074.................  T..............  ...............  Fetal fluid drainage w/ us...         0198       1.3621       $80.84       $32.19       $16.17
59076.................  T..............  ...............  Fetal shunt placement, w/ us.         0198       1.3621       $80.84       $32.19       $16.17
59100.................  T..............  ...............  Remove uterus lesion.........         0195      26.5582    $1,576.23      $483.80      $315.25
59120.................  C..............  ...............  Treat ectopic pregnancy......  ...........  ...........  ...........  ...........  ...........
59121.................  C..............  ...............  Treat ectopic pregnancy......  ...........  ...........  ...........  ...........  ...........
59130.................  C..............  ...............  Treat ectopic pregnancy......  ...........  ...........  ...........  ...........  ...........
59135.................  C..............  ...............  Treat ectopic pregnancy......  ...........  ...........  ...........  ...........  ...........
59136.................  C..............  ...............  Treat ectopic pregnancy......  ...........  ...........  ...........  ...........  ...........
59140.................  C..............  ...............  Treat ectopic pregnancy......  ...........  ...........  ...........  ...........  ...........
59150.................  T..............  ...............  Treat ectopic pregnancy......         0131      43.1426    $2,560.51    $1,001.89      $512.10
59151.................  T..............  ...............  Treat ectopic pregnancy......         0131      43.1426    $2,560.51    $1,001.89      $512.10
59160.................  T..............  ...............  D & c after delivery.........         0196      17.0200    $1,010.14      $338.23      $202.03
59200.................  T..............  ...............  Insert cervical dilator......         0189       2.3602      $140.08  ...........       $28.02
59300.................  T..............  ...............  Episiotomy or vaginal repair.         0193      14.5183      $861.66  ...........      $172.33
59320.................  T..............  ...............  Revision of cervix...........         0194      20.6585    $1,226.08      $397.84      $245.22
59325.................  C..............  ...............  Revision of cervix...........  ...........  ...........  ...........  ...........  ...........
59350.................  C..............  ...............  Repair of uterus.............  ...........  ...........  ...........  ...........  ...........
59400.................  B..............  ...............  Obstetrical care.............  ...........  ...........  ...........  ...........  ...........
59409.................  T..............  ...............  Obstetrical care.............         0194      20.6585    $1,226.08      $397.84      $245.22
59410.................  B..............  ...............  Obstetrical care.............  ...........  ...........  ...........  ...........  ...........
59412.................  T..............  ...............  Antepartum manipulation......         0700       5.3371      $316.76  ...........       $63.35
59414.................  T..............  ...............  Deliver placenta.............         0193      14.5183      $861.66  ...........      $172.33
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...........         0194      20.6585    $1,226.08      $397.84      $245.22
59614.................  E..............  ...............  Vbac care after delivery.....  ...........  ...........  ...........  ...........  ...........
59618.................  E..............  ...............  Attempted vbac delivery......  ...........  ...........  ...........  ...........  ...........
59620.................  C..............  ...............  Attempted vbac delivery only.  ...........  ...........  ...........  ...........  ...........
59622.................  E..............  ...............  Attempted vbac after care....  ...........  ...........  ...........  ...........  ...........
59812.................  T..............  ...............  Treatment of miscarriage.....         0201      17.5250    $1,040.11      $329.65      $208.02
59820.................  T..............  ...............  Care of miscarriage..........         0201      17.5250    $1,040.11      $329.65      $208.02
59821.................  T..............  ...............  Treatment of miscarriage.....         0201      17.5250    $1,040.11      $329.65      $208.02
59830.................  C..............  ...............  Treat uterus infection.......  ...........  ...........  ...........  ...........  ...........
59840.................  T..............  ...............  Abortion.....................         0200      17.7919    $1,055.95      $263.69      $211.19
59841.................  T..............  ...............  Abortion.....................         0200      17.7919    $1,055.95      $263.69      $211.19
59850.................  C..............  ...............  Abortion.....................  ...........  ...........  ...........  ...........  ...........
59851.................  C..............  ...............  Abortion.....................  ...........  ...........  ...........  ...........  ...........

[[Page 42848]]

 
59852.................  C..............  ...............  Abortion.....................  ...........  ...........  ...........  ...........  ...........
59855.................  C..............  ...............  Abortion.....................  ...........  ...........  ...........  ...........  ...........
59856.................  C..............  ...............  Abortion.....................  ...........  ...........  ...........  ...........  ...........
59857.................  C..............  ...............  Abortion.....................  ...........  ...........  ...........  ...........  ...........
59866.................  T..............  ...............  Abortion (mpr)...............         0198       1.3621       $80.84       $32.19       $16.17
59870.................  T..............  ...............  Evacuate mole of uterus......         0201      17.5250    $1,040.11      $329.65      $208.02
59871.................  T..............  ...............  Remove cerclage suture.......         0194      20.6585    $1,226.08      $397.84      $245.22
59897.................  T..............  ...............  Fetal invas px w/ us.........         0198       1.3621       $80.84       $32.19       $16.17
59898.................  T..............  ...............  Laparo proc, ob care/deliver.         0130      31.7825    $1,886.29      $659.53      $377.26
59899.................  T..............  ...............  Maternity care procedure.....         0198       1.3621       $80.84       $32.19       $16.17
60000.................  T..............  ...............  Drain thyroid/tongue cyst....         0252       7.8317      $464.81      $113.41       $92.96
60001.................  T..............  ...............  Aspirate/inject thyriod cyst.         0004       1.7566      $104.25       $22.36       $20.85
60100.................  T..............  ...............  Biopsy of thyroid............         0004       1.7566      $104.25       $22.36       $20.85
60200.................  T..............  ...............  Remove thyroid lesion........         0114      40.5805    $2,408.45      $485.91      $481.69
60210.................  T..............  ...............  Partial thyroid excision.....         0114      40.5805    $2,408.45      $485.91      $481.69
60212.................  T..............  ...............  Partial thyroid excision.....         0114      40.5805    $2,408.45      $485.91      $481.69
60220.................  T..............  ...............  Partial removal of thyroid...         0114      40.5805    $2,408.45      $485.91      $481.69
60225.................  T..............  ...............  Partial removal of thyroid...         0114      40.5805    $2,408.45      $485.91      $481.69
60240.................  T..............  ...............  Removal of thyroid...........         0114      40.5805    $2,408.45      $485.91      $481.69
60252.................  T..............  ...............  Removal of thyroid...........         0256      37.1513    $2,204.93  ...........      $440.99
60254.................  C..............  ...............  Extensive thyroid surgery....  ...........  ...........  ...........  ...........  ...........
60260.................  T..............  ...............  Repeat thyroid surgery.......         0256      37.1513    $2,204.93  ...........      $440.99
60270.................  C..............  ...............  Removal of thyroid...........  ...........  ...........  ...........  ...........  ...........
60271.................  C..............  ...............  Removal of thyroid...........  ...........  ...........  ...........  ...........  ...........
60280.................  T..............  ...............  Remove thyroid duct lesion...         0114      40.5805    $2,408.45      $485.91      $481.69
60281.................  T..............  ...............  Remove thyroid duct lesion...         0114      40.5805    $2,408.45      $485.91      $481.69
60500.................  T..............  ...............  Explore parathyroid glands...         0256      37.1513    $2,204.93  ...........      $440.99
60502.................  C..............  ...............  Re-explore parathyroids......  ...........  ...........  ...........  ...........  ...........
60505.................  C..............  ...............  Explore parathyroid glands...  ...........  ...........  ...........  ...........  ...........
60512.................  T..............  ...............  Autotransplant parathyroid...         0022      19.5582    $1,160.78      $354.45      $232.16
60520.................  C..............  ...............  Removal of thymus gland......  ...........  ...........  ...........  ...........  ...........
60521.................  C..............  ...............  Removal of thymus gland......  ...........  ...........  ...........  ...........  ...........
60522.................  C..............  ...............  Removal of thymus gland......  ...........  ...........  ...........  ...........  ...........
60540.................  C..............  ...............  Explore adrenal gland........  ...........  ...........  ...........  ...........  ...........
60545.................  C..............  ...............  Explore adrenal gland........  ...........  ...........  ...........  ...........  ...........
60600.................  C..............  ...............  Remove carotid body lesion...  ...........  ...........  ...........  ...........  ...........
60605.................  C..............  ...............  Remove carotid body lesion...  ...........  ...........  ...........  ...........  ...........
60650.................  C..............  ...............  Laparoscopy adrenalectomy....  ...........  ...........  ...........  ...........  ...........
60659.................  T..............  ...............  Laparo proc, endocrine.......         0130      31.7825    $1,886.29      $659.53      $377.26
60699.................  T..............  ...............  Endocrine surgery procedure..         0114      40.5805    $2,408.45      $485.91      $481.69
61000.................  T..............  ...............  Remove cranial cavity fluid..         0212       2.9606      $175.71       $70.28       $35.14
61001.................  T..............  ...............  Remove cranial cavity fluid..         0212       2.9606      $175.71       $70.28       $35.14
61020.................  T..............  ...............  Remove brain cavity fluid....         0212       2.9606      $175.71       $70.28       $35.14
61026.................  T..............  ...............  Injection into brain canal...         0212       2.9606      $175.71       $70.28       $35.14
61050.................  T..............  ...............  Remove brain canal fluid.....         0212       2.9606      $175.71       $70.28       $35.14
61055.................  T..............  ...............  Injection into brain canal...         0212       2.9606      $175.71       $70.28       $35.14
61070.................  T..............  ...............  Brain canal shunt procedure..         0212       2.9606      $175.71       $70.28       $35.14
61105.................  C..............  ...............  Twist drill hole.............  ...........  ...........  ...........  ...........  ...........
61107.................  C..............  ...............  Drill skull for implantation.  ...........  ...........  ...........  ...........  ...........
61108.................  C..............  ...............  Drill skull for drainage.....  ...........  ...........  ...........  ...........  ...........
61120.................  C..............  ...............  Burr hole for puncture.......  ...........  ...........  ...........  ...........  ...........
61140.................  C..............  ...............  Pierce skull for biopsy......  ...........  ...........  ...........  ...........  ...........
61150.................  C..............  ...............  Pierce skull for drainage....  ...........  ...........  ...........  ...........  ...........
61151.................  C..............  ...............  Pierce skull for drainage....  ...........  ...........  ...........  ...........  ...........
61154.................  C..............  ...............  Pierce skull & remove clot...  ...........  ...........  ...........  ...........  ...........
61156.................  C..............  ...............  Pierce skull for drainage....  ...........  ...........  ...........  ...........  ...........
61210.................  C..............  ...............  Pierce skull, implant device.  ...........  ...........  ...........  ...........  ...........
61215.................  T..............  ...............  Insert brain-fluid device....         0224      40.4614    $2,401.38  ...........      $480.28
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......  ...........  ...........  ...........  ...........  ...........

[[Page 42849]]

 
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 socket........         0256      37.1513    $2,204.93  ...........      $440.99
61332.................  C..............  ...............  Explore/biopsy eye socket....  ...........  ...........  ...........  ...........  ...........
61333.................  C..............  ...............  Explore orbit/remove lesion..  ...........  ...........  ...........  ...........  ...........
61334.................  T..............  ...............  Explore orbit/remove object..         0256      37.1513    $2,204.93  ...........      $440.99
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..............  ...............  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.  ...........  ...........  ...........  ...........  ...........

[[Page 42850]]

 
61582.................  C..............  ...............  Craniofacial approach, skull.  ...........  ...........  ...........  ...........  ...........
61583.................  C..............  ...............  Craniofacial approach, skull.  ...........  ...........  ...........  ...........  ...........
61584.................  C..............  ...............  Orbitocranial approach/skull.  ...........  ...........  ...........  ...........  ...........
61585.................  C..............  ...............  Orbitocranial approach/skull.  ...........  ...........  ...........  ...........  ...........
61586.................  C..............  ...............  Resect nasopharynx, skull....  ...........  ...........  ...........  ...........  ...........
61590.................  C..............  ...............  Infratemporal approach/skull.  ...........  ...........  ...........  ...........  ...........
61591.................  C..............  ...............  Infratemporal approach/skull.  ...........  ...........  ...........  ...........  ...........
61592.................  C..............  ...............  Orbitocranial approach/skull.  ...........  ...........  ...........  ...........  ...........
61595.................  C..............  ...............  Transtemporal approach/skull.  ...........  ...........  ...........  ...........  ...........
61596.................  C..............  ...............  Transcochlear approach/skull.  ...........  ...........  ...........  ...........  ...........
61597.................  C..............  ...............  Transcondylar approach/skull.  ...........  ...........  ...........  ...........  ...........
61598.................  C..............  ...............  Transpetrosal approach/skull.  ...........  ...........  ...........  ...........  ...........
61600.................  C..............  ...............  Resect/excise cranial lesion.  ...........  ...........  ...........  ...........  ...........
61601.................  C..............  ...............  Resect/excise cranial lesion.  ...........  ...........  ...........  ...........  ...........
61605.................  C..............  ...............  Resect/excise cranial lesion.  ...........  ...........  ...........  ...........  ...........
61606.................  C..............  ...............  Resect/excise cranial lesion.  ...........  ...........  ...........  ...........  ...........
61607.................  C..............  ...............  Resect/excise cranial lesion.  ...........  ...........  ...........  ...........  ...........
61608.................  C..............  ...............  Resect/excise cranial lesion.  ...........  ...........  ...........  ...........  ...........
61609.................  C..............  ...............  Transect artery, sinus.......  ...........  ...........  ...........  ...........  ...........
61610.................  C..............  ...............  Transect artery, sinus.......  ...........  ...........  ...........  ...........  ...........
61611.................  C..............  ...............  Transect artery, sinus.......  ...........  ...........  ...........  ...........  ...........
61612.................  C..............  ...............  Transect artery, sinus.......  ...........  ...........  ...........  ...........  ...........
61613.................  C..............  ...............  Remove aneurysm, sinus.......  ...........  ...........  ...........  ...........  ...........
61615.................  C..............  ...............  Resect/excise lesion, skull..  ...........  ...........  ...........  ...........  ...........
61616.................  C..............  ...............  Resect/excise lesion, skull..  ...........  ...........  ...........  ...........  ...........
61618.................  C..............  ...............  Repair dura..................  ...........  ...........  ...........  ...........  ...........
61619.................  C..............  ...............  Repair dura..................  ...........  ...........  ...........  ...........  ...........
61623.................  T..............  ...............  Endovasc tempory vessel occl.         0081      34.2913    $2,035.19  ...........      $407.04
61624.................  C..............  ...............  Occlusion/embolization cath..  ...........  ...........  ...........  ...........  ...........
61626.................  T..............  ...............  Transcath occlusion, non-cns.         0081      34.2913    $2,035.19  ...........      $407.04
61680.................  C..............  ...............  Intracranial vessel surgery..  ...........  ...........  ...........  ...........  ...........
61682.................  C..............  ...............  Intracranial vessel surgery..  ...........  ...........  ...........  ...........  ...........
61684.................  C..............  ...............  Intracranial vessel surgery..  ...........  ...........  ...........  ...........  ...........
61686.................  C..............  ...............  Intracranial vessel surgery..  ...........  ...........  ...........  ...........  ...........
61690.................  C..............  ...............  Intracranial vessel surgery..  ...........  ...........  ...........  ...........  ...........
61692.................  C..............  ...............  Intracranial vessel surgery..  ...........  ...........  ...........  ...........  ...........
61697.................  C..............  ...............  Brain aneurysm repr, complx..  ...........  ...........  ...........  ...........  ...........
61698.................  C..............  ...............  Brain aneurysm repr, complx..  ...........  ...........  ...........  ...........  ...........
61700.................  C..............  ...............  Brain aneurysm repr, simple..  ...........  ...........  ...........  ...........  ...........
61702.................  C..............  ...............  Inner skull vessel surgery...  ...........  ...........  ...........  ...........  ...........
61703.................  C..............  ...............  Clamp neck artery............  ...........  ...........  ...........  ...........  ...........
61705.................  C..............  ...............  Revise circulation to head...  ...........  ...........  ...........  ...........  ...........
61708.................  C..............  ...............  Revise circulation to head...  ...........  ...........  ...........  ...........  ...........
61710.................  C..............  ...............  Revise circulation to head...  ...........  ...........  ...........  ...........  ...........
61711.................  C..............  ...............  Fusion of skull arteries.....  ...........  ...........  ...........  ...........  ...........
61720.................  C..............  ...............  Incise skull/brain surgery...  ...........  ...........  ...........  ...........  ...........
61735.................  C..............  ...............  Incise skull/brain surgery...  ...........  ...........  ...........  ...........  ...........
61750.................  C..............  ...............  Incise skull/brain biopsy....  ...........  ...........  ...........  ...........  ...........
61751.................  C..............  ...............  Brain biopsy w/ ct/mr guide..  ...........  ...........  ...........  ...........  ...........
61760.................  C..............  ...............  Implant brain electrodes.....  ...........  ...........  ...........  ...........  ...........
61770.................  C..............  ...............  Incise skull for treatment...  ...........  ...........  ...........  ...........  ...........
61790.................  T..............  ...............  Treat trigeminal nerve.......         0220      17.2800    $1,025.57  ...........      $205.11
61791.................  T..............  ...............  Treat trigeminal tract.......         0206       5.4672      $324.48       $75.55       $64.90
61793.................  E..............  ...............  Focus radiation beam.........  ...........  ...........  ...........  ...........  ...........
61795.................  S..............  ...............  Brain surgery using computer.         0302       4.5936      $272.63      $103.28       $54.53
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......  ...........  ...........  ...........  ...........  ...........
61880.................  T..............  ...............  Revise/remove neuroelectrode.         0687      19.1476    $1,136.41      $454.56      $227.28
61885.................  S..............  ...............  Implant neurostim one array..         0039     180.5784   $10,717.33  ...........    $2,143.47
61886.................  T..............  ...............  Implant neurostim arrays.....         0315     289.3306   $17,171.77  ...........    $3,434.35

[[Page 42851]]

 
61888.................  T..............  ...............  Revise/remove neuroreceiver..         0688      42.8494    $2,543.11    $1,017.24      $508.62
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.................  T..............  ...............  Neuroendoscopy add-on........         0122       6.9405      $411.92       $84.48       $82.38
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 catheter....         0427      10.1516      $602.50      $123.56      $120.50
62200.................  C..............  ...............  Establish brain cavity shunt.  ...........  ...........  ...........  ...........  ...........
62201.................  C..............  ...............  Establish brain cavity shunt.  ...........  ...........  ...........  ...........  ...........
62220.................  C..............  ...............  Establish brain cavity shunt.  ...........  ...........  ...........  ...........  ...........
62223.................  C..............  ...............  Establish brain cavity shunt.  ...........  ...........  ...........  ...........  ...........
62225.................  T..............  ...............  Replace/irrigate catheter....         0427      10.1516      $602.50      $123.56      $120.50
62230.................  T..............  ...............  Replace/revise brain shunt...         0224      40.4614    $2,401.38  ...........      $480.28
62252.................  S..............  ...............  Csf shunt reprogram..........         0691       2.5138      $149.19       $59.67       $29.84
62256.................  C..............  ...............  Remove brain cavity shunt....  ...........  ...........  ...........  ...........  ...........
62258.................  C..............  ...............  Replace brain cavity shunt...  ...........  ...........  ...........  ...........  ...........
62263.................  T..............  ...............  Lysis epidural adhesions.....         0203      10.3544      $614.53      $245.81      $122.91
62264.................  T..............  ...............  Epidural lysis on single day.         0203      10.3544      $614.53      $245.81      $122.91
62268.................  T..............  ...............  Drain spinal cord cyst.......         0212       2.9606      $175.71       $70.28       $35.14
62269.................  T..............  ...............  Needle biopsy, spinal cord...         0685       5.9902      $355.52      $115.47       $71.10
62270.................  T..............  ...............  Spinal fluid tap, diagnostic.         0204       2.1811      $129.45       $40.13       $25.89
62272.................  T..............  ...............  Drain cerebro spinal fluid...         0204       2.1811      $129.45       $40.13       $25.89
62273.................  T..............  ...............  Treat epidural spine lesion..         0206       5.4672      $324.48       $75.55       $64.90
62280.................  T..............  ...............  Treat spinal cord lesion.....         0207       5.9837      $355.13       $86.92       $71.03
62281.................  T..............  ...............  Treat spinal cord lesion.....         0207       5.9837      $355.13       $86.92       $71.03
62282.................  T..............  ...............  Treat spinal canal lesion....         0207       5.9837      $355.13       $86.92       $71.03
62284.................  N..............  ...............  Injection for myelogram......  ...........  ...........  ...........  ...........  ...........
62287.................  T..............  ...............  Percutaneous diskectomy......         0221      29.7854    $1,767.76      $463.62      $353.55
62290.................  N..............  ...............  Inject for spine disk x-ray..  ...........  ...........  ...........  ...........  ...........
62291.................  N..............  ...............  Inject for spine disk x-ray..  ...........  ...........  ...........  ...........  ...........
62292.................  T..............  ...............  Injection into disk lesion...         0212       2.9606      $175.71       $70.28       $35.14
62294.................  T..............  ...............  Injection into spinal artery.         0212       2.9606      $175.71       $70.28       $35.14
62310.................  T..............  ...............  Inject spine c/t.............         0207       5.9837      $355.13       $86.92       $71.03
62311.................  T..............  ...............  Inject spine l/s (cd)........         0207       5.9837      $355.13       $86.92       $71.03
62318.................  T..............  ...............  Inject spine w/cath, c/t.....         0207       5.9837      $355.13       $86.92       $71.03
62319.................  T..............  ...............  Inject spine w/cath l/s (cd).         0207       5.9837      $355.13       $86.92       $71.03
62350.................  T..............  ...............  Implant spinal canal cath....         0223      27.9956    $1,661.54  ...........      $332.31
62351.................  T..............  ...............  Implant spinal canal cath....         0208      42.1492    $2,501.56  ...........      $500.31
62355.................  T..............  ...............  Remove spinal canal catheter.         0203      10.3544      $614.53      $245.81      $122.91
62360.................  T..............  ...............  Insert spine infusion device.         0226     138.2406    $8,204.58  ...........    $1,640.92
62361.................  T..............  ...............  Implant spine infusion pump..         0227     135.8740    $8,064.12  ...........    $1,612.82
62362.................  T..............  ...............  Implant spine infusion pump..         0227     135.8740    $8,064.12  ...........    $1,612.82
62365.................  T..............  ...............  Remove spine infusion device.         0221      29.7854    $1,767.76      $463.62      $353.55
62367.................  S..............  ...............  Analyze spine infusion pump..         0691       2.5138      $149.19       $59.67       $29.84
62368.................  S..............  ...............  Analyze spine infusion pump..         0691       2.5138      $149.19       $59.67       $29.84

[[Page 42852]]

 
63001.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63003.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63005.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63011.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63012.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63015.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63016.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63017.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63020.................  T..............  ...............  Neck spine disk surgery......         0208      42.1492    $2,501.56  ...........      $500.31
63030.................  T..............  ...............  Low back disk surgery........         0208      42.1492    $2,501.56  ...........      $500.31
63035.................  T..............  ...............  Spinal disk surgery add-on...         0208      42.1492    $2,501.56  ...........      $500.31
63040.................  T..............  ...............  Laminotomy, single cervical..         0208      42.1492    $2,501.56  ...........      $500.31
63042.................  T..............  ...............  Laminotomy, single lumbar....         0208      42.1492    $2,501.56  ...........      $500.31
63043.................  C..............  ...............  Laminotomy, add'l cervical...  ...........  ...........  ...........  ...........  ...........
63044.................  C..............  ...............  Laminotomy, add'l lumbar.....  ...........  ...........  ...........  ...........  ...........
63045.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63046.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63047.................  T..............  ...............  Removal of spinal lamina.....         0208      42.1492    $2,501.56  ...........      $500.31
63048.................  T..............  ...............  Remove spinal lamina add-on..         0208      42.1492    $2,501.56  ...........      $500.31
63050.................  C..............  ...............  Cervical laminoplasty........  ...........  ...........  ...........  ...........  ...........
63051.................  C..............  ...............  C-laminoplasty w/graft/plate.  ...........  ...........  ...........  ...........  ...........
63055.................  T..............  ...............  Decompress spinal cord.......         0208      42.1492    $2,501.56  ...........      $500.31
63056.................  T..............  ...............  Decompress spinal cord.......         0208      42.1492    $2,501.56  ...........      $500.31
63057.................  T..............  ...............  Decompress spine cord add-on.         0208      42.1492    $2,501.56  ...........      $500.31
63064.................  T..............  ...............  Decompress spinal cord.......         0208      42.1492    $2,501.56  ...........      $500.31
63066.................  T..............  ...............  Decompress spine cord add-on.         0208      42.1492    $2,501.56  ...........      $500.31
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..............  ...............  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....  ...........  ...........  ...........  ...........  ...........

[[Page 42853]]

 
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...  ...........  ...........  ...........  ...........  ...........
63295.................  C..............  ...............  Repair of laminectomy defect.  ...........  ...........  ...........  ...........  ...........
63300.................  C..............  ...............  Removal of vertebral body....  ...........  ...........  ...........  ...........  ...........
63301.................  C..............  ...............  Removal of vertebral body....  ...........  ...........  ...........  ...........  ...........
63302.................  C..............  ...............  Removal of vertebral body....  ...........  ...........  ...........  ...........  ...........
63303.................  C..............  ...............  Removal of vertebral body....  ...........  ...........  ...........  ...........  ...........
63304.................  C..............  ...............  Removal of vertebral body....  ...........  ...........  ...........  ...........  ...........
63305.................  C..............  ...............  Removal of vertebral body....  ...........  ...........  ...........  ...........  ...........
63306.................  C..............  ...............  Removal of vertebral body....  ...........  ...........  ...........  ...........  ...........
63307.................  C..............  ...............  Removal of vertebral body....  ...........  ...........  ...........  ...........  ...........
63308.................  C..............  ...............  Remove vertebral body add-on.  ...........  ...........  ...........  ...........  ...........
63600.................  T..............  ...............  Remove spinal cord lesion....         0220      17.2800    $1,025.57  ...........      $205.11
63610.................  T..............  ...............  Stimulation of spinal cord...         0220      17.2800    $1,025.57  ...........      $205.11
63615.................  T..............  ...............  Remove lesion of spinal cord.         0220      17.2800    $1,025.57  ...........      $205.11
63650.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
63655.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
63660.................  T..............  ...............  Revise/remove neuroelectrode.         0687      19.1476    $1,136.41      $454.56      $227.28
63685.................  T..............  ...............  Implant neuroreceiver........         0222     178.2870   $10,581.33  ...........    $2,116.27
63688.................  T..............  ...............  Revise/remove neuroreceiver..         0688      42.8494    $2,543.11    $1,017.24      $508.62
63700.................  C..............  ...............  Repair of spinal herniation..  ...........  ...........  ...........  ...........  ...........
63702.................  C..............  ...............  Repair of spinal herniation..  ...........  ...........  ...........  ...........  ...........
63704.................  C..............  ...............  Repair of spinal herniation..  ...........  ...........  ...........  ...........  ...........
63706.................  C..............  ...............  Repair of spinal herniation..  ...........  ...........  ...........  ...........  ...........
63707.................  C..............  ...............  Repair spinal fluid leakage..  ...........  ...........  ...........  ...........  ...........
63709.................  C..............  ...............  Repair spinal fluid leakage..  ...........  ...........  ...........  ...........  ...........
63710.................  C..............  ...............  Graft repair of spine defect.  ...........  ...........  ...........  ...........  ...........
63740.................  C..............  ...............  Install spinal shunt.........  ...........  ...........  ...........  ...........  ...........
63741.................  T..............  ...............  Install spinal shunt.........         0228      51.4916    $3,056.03  ...........      $611.21
63744.................  T..............  ...............  Revision of spinal shunt.....         0228      51.4916    $3,056.03  ...........      $611.21
63746.................  T..............  ...............  Removal of spinal shunt......         0109      10.9933      $652.45      $131.49      $130.49
64400.................  T..............  ...............  N block inj, trigeminal......         0204       2.1811      $129.45       $40.13       $25.89
64402.................  T..............  ...............  N block inj, facial..........         0204       2.1811      $129.45       $40.13       $25.89
64405.................  T..............  ...............  N block inj, occipital.......         0204       2.1811      $129.45       $40.13       $25.89
64408.................  T..............  ...............  N block inj, vagus...........         0204       2.1811      $129.45       $40.13       $25.89
64410.................  T..............  ...............  N block inj, phrenic.........         0206       5.4672      $324.48       $75.55       $64.90
64412.................  T..............  ...............  N block inj, spinal accessor.         0206       5.4672      $324.48       $75.55       $64.90
64413.................  T..............  ...............  N block inj, cervical plexus.         0204       2.1811      $129.45       $40.13       $25.89
64415.................  T..............  ...............  Injection for nerve block....         0204       2.1811      $129.45       $40.13       $25.89
64416.................  T..............  ...............  N block cont infuse, b plex..         0204       2.1811      $129.45       $40.13       $25.89
64417.................  T..............  ...............  N block inj, axillary........         0204       2.1811      $129.45       $40.13       $25.89
64418.................  T..............  ...............  N block inj, suprascapular...         0204       2.1811      $129.45       $40.13       $25.89
64420.................  T..............  ...............  N block inj, intercost, sng..         0204       2.1811      $129.45       $40.13       $25.89
64421.................  T..............  ...............  N block inj, intercost, mlt..         0206       5.4672      $324.48       $75.55       $64.90
64425.................  T..............  ...............  N block inj ilio-ing/hypogi..         0204       2.1811      $129.45       $40.13       $25.89
64430.................  T..............  ...............  N block inj, pudendal........         0204       2.1811      $129.45       $40.13       $25.89
64435.................  T..............  ...............  N block inj, paracervical....         0204       2.1811      $129.45       $40.13       $25.89
64445.................  T..............  ...............  Injection for nerve block....         0204       2.1811      $129.45       $40.13       $25.89
64446.................  T..............  ...............  N blk inj, sciatic, cont inf.         0206       5.4672      $324.48       $75.55       $64.90
64447.................  T..............  ...............  N block inj fem, single......         0204       2.1811      $129.45       $40.13       $25.89
64448.................  T..............  ...............  N block inj fem, cont inf....         0204       2.1811      $129.45       $40.13       $25.89
64449.................  T..............  ...............  N block inj, lumbar plexus...         0204       2.1811      $129.45       $40.13       $25.89
64450.................  T..............  ...............  N block, other peripheral....         0204       2.1811      $129.45       $40.13       $25.89
64470.................  T..............  ...............  Inj paravertebral c/t........         0207       5.9837      $355.13       $86.92       $71.03
64472.................  T..............  ...............  Inj paravertebral c/t add-on.         0206       5.4672      $324.48       $75.55       $64.90

[[Page 42854]]

 
64475.................  T..............  ...............  Inj paravertebral l/s........         0207       5.9837      $355.13       $86.92       $71.03
64476.................  T..............  ...............  Inj paravertebral l/s add-on.         0206       5.4672      $324.48       $75.55       $64.90
64479.................  T..............  ...............  Inj foramen epidural c/t.....         0207       5.9837      $355.13       $86.92       $71.03
64480.................  T..............  ...............  Inj foramen epidural add-on..         0207       5.9837      $355.13       $86.92       $71.03
64483.................  T..............  ...............  Inj foramen epidural l/s.....         0207       5.9837      $355.13       $86.92       $71.03
64484.................  T..............  ...............  Inj foramen epidural add-on..         0207       5.9837      $355.13       $86.92       $71.03
64505.................  T..............  ...............  N block, spenopalatine gangl.         0204       2.1811      $129.45       $40.13       $25.89
64508.................  T..............  ...............  N block, carotid sinus s/p...         0204       2.1811      $129.45       $40.13       $25.89
64510.................  T..............  ...............  N block, stellate ganglion...         0207       5.9837      $355.13       $86.92       $71.03
64517.................  T..............  ...............  N block inj, hypogas plxs....         0204       2.1811      $129.45       $40.13       $25.89
64520.................  T..............  ...............  N block, lumbar/thoracic.....         0207       5.9837      $355.13       $86.92       $71.03
64530.................  T..............  ...............  N block inj, celiac pelus....         0207       5.9837      $355.13       $86.92       $71.03
64550.................  A..............  ...............  Apply neurostimulator........  ...........  ...........  ...........  ...........  ...........
64553.................  S..............  ...............  Implant neuroelectrodes......         0225     233.6295   $13,865.91  ...........    $2,773.18
64555.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
64560.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
64561.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
64565.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
64573.................  S..............  ...............  Implant neuroelectrodes......         0225     233.6295   $13,865.91  ...........    $2,773.18
64575.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
64577.................  S..............  ...............  Implant neuroelectrodes......         0225     233.6295   $13,865.91  ...........    $2,773.18
64580.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
64581.................  S..............  ...............  Implant neuroelectrodes......         0040      55.0791    $3,268.94  ...........      $653.79
64585.................  T..............  ...............  Revise/remove neuroelectrode.         0687      19.1476    $1,136.41      $454.56      $227.28
64590.................  T..............  ...............  Implant neuroreceiver........         0222     178.2870   $10,581.33  ...........    $2,116.27
64595.................  T..............  ...............  Revise/remove neuroreceiver..         0688      42.8494    $2,543.11    $1,017.24      $508.62
64600.................  T..............  ...............  Injection treatment of nerve.         0203      10.3544      $614.53      $245.81      $122.91
64605.................  T..............  ...............  Injection treatment of nerve.         0203      10.3544      $614.53      $245.81      $122.91
64610.................  T..............  ...............  Injection treatment of nerve.         0203      10.3544      $614.53      $245.81      $122.91
64612.................  T..............  ...............  Destroy nerve, face muscle...         0204       2.1811      $129.45       $40.13       $25.89
64613.................  T..............  ...............  Destroy nerve, spine muscle..         0204       2.1811      $129.45       $40.13       $25.89
64614.................  T..............  ...............  Destroy nerve, extrem musc...         0204       2.1811      $129.45       $40.13       $25.89
64620.................  T..............  ...............  Injection treatment of nerve.         0203      10.3544      $614.53      $245.81      $122.91
64622.................  T..............  ...............  Destr paravertebrl nerve l/s.         0203      10.3544      $614.53      $245.81      $122.91
64623.................  T..............  ...............  Destr paravertebral n add-on.         0207       5.9837      $355.13       $86.92       $71.03
64626.................  T..............  ...............  Destr paravertebrl nerve c/t.         0203      10.3544      $614.53      $245.81      $122.91
64627.................  T..............  ...............  Destr paravertebral n add-on.         0207       5.9837      $355.13       $86.92       $71.03
64630.................  T..............  ...............  Injection treatment of nerve.         0206       5.4672      $324.48       $75.55       $64.90
64640.................  T..............  ...............  Injection treatment of nerve.         0206       5.4672      $324.48       $75.55       $64.90
64680.................  T..............  ...............  Injection treatment of nerve.         0207       5.9837      $355.13       $86.92       $71.03
64681.................  T..............  ...............  Injection treatment of nerve.         0203      10.3544      $614.53      $245.81      $122.91
64702.................  T..............  ...............  Revise finger/toe nerve......         0220      17.2800    $1,025.57  ...........      $205.11
64704.................  T..............  ...............  Revise hand/foot nerve.......         0220      17.2800    $1,025.57  ...........      $205.11
64708.................  T..............  ...............  Revise arm/leg nerve.........         0220      17.2800    $1,025.57  ...........      $205.11
64712.................  T..............  ...............  Revision of sciatic nerve....         0220      17.2800    $1,025.57  ...........      $205.11
64713.................  T..............  ...............  Revision of arm nerve(s).....         0220      17.2800    $1,025.57  ...........      $205.11
64714.................  T..............  ...............  Revise low back nerve(s).....         0220      17.2800    $1,025.57  ...........      $205.11
64716.................  T..............  ...............  Revision of cranial nerve....         0220      17.2800    $1,025.57  ...........      $205.11
64718.................  T..............  ...............  Revise ulnar nerve at elbow..         0220      17.2800    $1,025.57  ...........      $205.11
64719.................  T..............  ...............  Revise ulnar nerve at wrist..         0220      17.2800    $1,025.57  ...........      $205.11
64721.................  T..............  ...............  Carpal tunnel surgery........         0220      17.2800    $1,025.57  ...........      $205.11
64722.................  T..............  ...............  Relieve pressure on nerve(s).         0220      17.2800    $1,025.57  ...........      $205.11
64726.................  T..............  ...............  Release foot/toe nerve.......         0220      17.2800    $1,025.57  ...........      $205.11
64727.................  T..............  ...............  Internal nerve revision......         0220      17.2800    $1,025.57  ...........      $205.11
64732.................  T..............  ...............  Incision of brow nerve.......         0220      17.2800    $1,025.57  ...........      $205.11
64734.................  T..............  ...............  Incision of cheek nerve......         0220      17.2800    $1,025.57  ...........      $205.11
64736.................  T..............  ...............  Incision of chin nerve.......         0220      17.2800    $1,025.57  ...........      $205.11
64738.................  T..............  ...............  Incision of jaw nerve........         0220      17.2800    $1,025.57  ...........      $205.11
64740.................  T..............  ...............  Incision of tongue nerve.....         0220      17.2800    $1,025.57  ...........      $205.11
64742.................  T..............  ...............  Incision of facial nerve.....         0220      17.2800    $1,025.57  ...........      $205.11
64744.................  T..............  ...............  Incise nerve, back of head...         0220      17.2800    $1,025.57  ...........      $205.11
64746.................  T..............  ...............  Incise diaphragm nerve.......         0220      17.2800    $1,025.57  ...........      $205.11
64752.................  C..............  ...............  Incision of vagus nerve......  ...........  ...........  ...........  ...........  ...........
64755.................  C..............  ...............  Incision of stomach nerves...  ...........  ...........  ...........  ...........  ...........
64760.................  C..............  ...............  Incision of vagus nerve......  ...........  ...........  ...........  ...........  ...........
64761.................  T..............  ...............  Incision of pelvis nerve.....         0220      17.2800    $1,025.57  ...........      $205.11

[[Page 42855]]

 
64763.................  T..............  ...............  Incise hip/thigh nerve.......         0220      17.2800    $1,025.57  ...........      $205.11
64766.................  T..............  ...............  Incise hip/thigh nerve.......         0221      29.7854    $1,767.76      $463.62      $353.55
64771.................  T..............  ...............  Sever cranial nerve..........         0220      17.2800    $1,025.57  ...........      $205.11
64772.................  T..............  ...............  Incision of spinal nerve.....         0220      17.2800    $1,025.57  ...........      $205.11
64774.................  T..............  ...............  Remove skin nerve lesion.....         0220      17.2800    $1,025.57  ...........      $205.11
64776.................  T..............  ...............  Remove digit nerve lesion....         0220      17.2800    $1,025.57  ...........      $205.11
64778.................  T..............  ...............  Digit nerve surgery add-on...         0220      17.2800    $1,025.57  ...........      $205.11
64782.................  T..............  ...............  Remove limb nerve lesion.....         0220      17.2800    $1,025.57  ...........      $205.11
64783.................  T..............  ...............  Limb nerve surgery add-on....         0220      17.2800    $1,025.57  ...........      $205.11
64784.................  T..............  ...............  Remove nerve lesion..........         0220      17.2800    $1,025.57  ...........      $205.11
64786.................  T..............  ...............  Remove sciatic nerve lesion..         0221      29.7854    $1,767.76      $463.62      $353.55
64787.................  T..............  ...............  Implant nerve end............         0220      17.2800    $1,025.57  ...........      $205.11
64788.................  T..............  ...............  Remove skin nerve lesion.....         0220      17.2800    $1,025.57  ...........      $205.11
64790.................  T..............  ...............  Removal of nerve lesion......         0220      17.2800    $1,025.57  ...........      $205.11
64792.................  T..............  ...............  Removal of nerve lesion......         0221      29.7854    $1,767.76      $463.62      $353.55
64795.................  T..............  ...............  Biopsy of nerve..............         0220      17.2800    $1,025.57  ...........      $205.11
64802.................  T..............  ...............  Remove sympathetic nerves....         0220      17.2800    $1,025.57  ...........      $205.11
64804.................  C..............  ...............  Remove sympathetic nerves....  ...........  ...........  ...........  ...........  ...........
64809.................  C..............  ...............  Remove sympathetic nerves....  ...........  ...........  ...........  ...........  ...........
64818.................  C..............  ...............  Remove sympathetic nerves....  ...........  ...........  ...........  ...........  ...........
64820.................  T..............  ...............  Remove sympathetic nerves....         0220      17.2800    $1,025.57  ...........      $205.11
64821.................  T..............  ...............  Remove sympathetic nerves....         0054      25.2562    $1,498.96  ...........      $299.79
64822.................  T..............  ...............  Remove sympathetic nerves....         0054      25.2562    $1,498.96  ...........      $299.79
64823.................  T..............  ...............  Remove sympathetic nerves....         0054      25.2562    $1,498.96  ...........      $299.79
64831.................  T..............  ...............  Repair of digit nerve........         0221      29.7854    $1,767.76      $463.62      $353.55
64832.................  T..............  ...............  Repair nerve add-on..........         0221      29.7854    $1,767.76      $463.62      $353.55
64834.................  T..............  ...............  Repair of hand or foot nerve.         0221      29.7854    $1,767.76      $463.62      $353.55
64835.................  T..............  ...............  Repair of hand or foot nerve.         0221      29.7854    $1,767.76      $463.62      $353.55
64836.................  T..............  ...............  Repair of hand or foot nerve.         0221      29.7854    $1,767.76      $463.62      $353.55
64837.................  T..............  ...............  Repair nerve add-on..........         0221      29.7854    $1,767.76      $463.62      $353.55
64840.................  T..............  ...............  Repair of leg nerve..........         0221      29.7854    $1,767.76      $463.62      $353.55
64856.................  T..............  ...............  Repair/transpose nerve.......         0221      29.7854    $1,767.76      $463.62      $353.55
64857.................  T..............  ...............  Repair arm/leg nerve.........         0221      29.7854    $1,767.76      $463.62      $353.55
64858.................  T..............  ...............  Repair sciatic nerve.........         0221      29.7854    $1,767.76      $463.62      $353.55
64859.................  T..............  ...............  Nerve surgery................         0221      29.7854    $1,767.76      $463.62      $353.55
64861.................  T..............  ...............  Repair of arm nerves.........         0221      29.7854    $1,767.76      $463.62      $353.55
64862.................  T..............  ...............  Repair of low back nerves....         0221      29.7854    $1,767.76      $463.62      $353.55
64864.................  T..............  ...............  Repair of facial nerve.......         0221      29.7854    $1,767.76      $463.62      $353.55
64865.................  T..............  ...............  Repair of facial nerve.......         0221      29.7854    $1,767.76      $463.62      $353.55
64866.................  C..............  ...............  Fusion of facial/other nerve.  ...........  ...........  ...........  ...........  ...........
64868.................  C..............  ...............  Fusion of facial/other nerve.  ...........  ...........  ...........  ...........  ...........
64870.................  T..............  ...............  Fusion of facial/other nerve.         0221      29.7854    $1,767.76      $463.62      $353.55
64872.................  T..............  ...............  Subsequent repair of nerve...         0221      29.7854    $1,767.76      $463.62      $353.55
64874.................  T..............  ...............  Repair & revise nerve add-on.         0221      29.7854    $1,767.76      $463.62      $353.55
64876.................  T..............  ...............  Repair nerve/shorten bone....         0221      29.7854    $1,767.76      $463.62      $353.55
64885.................  T..............  ...............  Nerve graft, head or neck....         0221      29.7854    $1,767.76      $463.62      $353.55
64886.................  T..............  ...............  Nerve graft, head or neck....         0221      29.7854    $1,767.76      $463.62      $353.55
64890.................  T..............  ...............  Nerve graft, hand or foot....         0221      29.7854    $1,767.76      $463.62      $353.55
64891.................  T..............  ...............  Nerve graft, hand or foot....         0221      29.7854    $1,767.76      $463.62      $353.55
64892.................  T..............  ...............  Nerve graft, arm or leg......         0221      29.7854    $1,767.76      $463.62      $353.55
64893.................  T..............  ...............  Nerve graft, arm or leg......         0221      29.7854    $1,767.76      $463.62      $353.55
64895.................  T..............  ...............  Nerve graft, hand or foot....         0221      29.7854    $1,767.76      $463.62      $353.55
64896.................  T..............  ...............  Nerve graft, hand or foot....         0221      29.7854    $1,767.76      $463.62      $353.55
64897.................  T..............  ...............  Nerve graft, arm or leg......         0221      29.7854    $1,767.76      $463.62      $353.55
64898.................  T..............  ...............  Nerve graft, arm or leg......         0221      29.7854    $1,767.76      $463.62      $353.55
64901.................  T..............  ...............  Nerve graft add-on...........         0221      29.7854    $1,767.76      $463.62      $353.55
64902.................  T..............  ...............  Nerve graft add-on...........         0221      29.7854    $1,767.76      $463.62      $353.55
64905.................  T..............  ...............  Nerve pedicle transfer.......         0221      29.7854    $1,767.76      $463.62      $353.55
64907.................  T..............  ...............  Nerve pedicle transfer.......         0221      29.7854    $1,767.76      $463.62      $353.55
64999.................  T..............  ...............  Nervous system surgery.......         0204       2.1811      $129.45       $40.13       $25.89
65091.................  T..............  ...............  Revise eye...................         0242      30.4081    $1,804.72      $597.36      $360.94
65093.................  T..............  ...............  Revise eye with implant......         0241      23.1980    $1,376.80      $384.47      $275.36
65101.................  T..............  ...............  Removal of eye...............         0242      30.4081    $1,804.72      $597.36      $360.94
65103.................  T..............  ...............  Remove eye/insert implant....         0242      30.4081    $1,804.72      $597.36      $360.94
65105.................  T..............  ...............  Remove eye/attach implant....         0242      30.4081    $1,804.72      $597.36      $360.94
65110.................  T..............  ...............  Removal of eye...............         0242      30.4081    $1,804.72      $597.36      $360.94

[[Page 42856]]

 
65112.................  T..............  ...............  Remove eye/revise socket.....         0242      30.4081    $1,804.72      $597.36      $360.94
65114.................  T..............  ...............  Remove eye/revise socket.....         0242      30.4081    $1,804.72      $597.36      $360.94
65125.................  T..............  ...............  Revise ocular implant........         0240      18.0686    $1,072.37      $315.31      $214.47
65130.................  T..............  ...............  Insert ocular implant........         0241      23.1980    $1,376.80      $384.47      $275.36
65135.................  T..............  ...............  Insert ocular implant........         0241      23.1980    $1,376.80      $384.47      $275.36
65140.................  T..............  ...............  Attach ocular implant........         0242      30.4081    $1,804.72      $597.36      $360.94
65150.................  T..............  ...............  Revise ocular implant........         0241      23.1980    $1,376.80      $384.47      $275.36
65155.................  T..............  ...............  Reinsert ocular implant......         0242      30.4081    $1,804.72      $597.36      $360.94
65175.................  T..............  ...............  Removal of ocular implant....         0240      18.0686    $1,072.37      $315.31      $214.47
65205.................  S..............  ...............  Remove foreign body from eye.         0698       1.2381       $73.48       $16.48       $14.70
65210.................  S..............  ...............  Remove foreign body from eye.         0698       1.2381       $73.48       $16.48       $14.70
65220.................  S..............  ...............  Remove foreign body from eye.         0698       1.2381       $73.48       $16.48       $14.70
65222.................  S..............  ...............  Remove foreign body from eye.         0698       1.2381       $73.48       $16.48       $14.70
65235.................  T..............  ...............  Remove foreign body from eye.         0233      14.8995      $884.29      $266.33      $176.86
65260.................  T..............  ...............  Remove foreign body from eye.         0236      16.9458    $1,005.73  ...........      $201.15
65265.................  T..............  ...............  Remove foreign body from eye.         0237      28.8091    $1,709.82  ...........      $341.96
65270.................  T..............  ...............  Repair of eye wound..........         0240      18.0686    $1,072.37      $315.31      $214.47
65272.................  T..............  ...............  Repair of eye wound..........         0234      21.8746    $1,298.26      $511.31      $259.65
65273.................  C..............  ...............  Repair of eye wound..........  ...........  ...........  ...........  ...........  ...........
65275.................  T..............  ...............  Repair of eye wound..........         0234      21.8746    $1,298.26      $511.31      $259.65
65280.................  T..............  ...............  Repair of eye wound..........         0236      16.9458    $1,005.73  ...........      $201.15
65285.................  T..............  ...............  Repair of eye wound..........         0672      36.7611    $2,181.77  ...........      $436.35
65286.................  T..............  ...............  Repair of eye wound..........         0232       6.6429      $394.26      $103.17       $78.85
65290.................  T..............  ...............  Repair of eye socket wound...         0243      22.0667    $1,309.66      $431.39      $261.93
65400.................  T..............  ...............  Removal of eye lesion........         0233      14.8995      $884.29      $266.33      $176.86
65410.................  T..............  ...............  Biopsy of cornea.............         0233      14.8995      $884.29      $266.33      $176.86
65420.................  T..............  ...............  Removal of eye lesion........         0233      14.8995      $884.29      $266.33      $176.86
65426.................  T..............  ...............  Removal of eye lesion........         0234      21.8746    $1,298.26      $511.31      $259.65
65430.................  S..............  ...............  Corneal smear................         0698       1.2381       $73.48       $16.48       $14.70
65435.................  T..............  ...............  Curette/treat cornea.........         0239       6.8784      $408.23  ...........       $81.65
65436.................  T..............  ...............  Curette/treat cornea.........         0233      14.8995      $884.29      $266.33      $176.86
65450.................  S..............  ...............  Treatment of corneal lesion..         0231       1.9191      $113.90  ...........       $22.78
65600.................  T..............  ...............  Revision of cornea...........         0240      18.0686    $1,072.37      $315.31      $214.47
65710.................  T..............  ...............  Corneal transplant...........         0244      38.1985    $2,267.08      $803.26      $453.42
65730.................  T..............  ...............  Corneal transplant...........         0244      38.1985    $2,267.08      $803.26      $453.42
65750.................  T..............  ...............  Corneal transplant...........         0244      38.1985    $2,267.08      $803.26      $453.42
65755.................  T..............  ...............  Corneal transplant...........         0244      38.1985    $2,267.08      $803.26      $453.42
65760.................  E..............  ...............  Revision of cornea...........  ...........  ...........  ...........  ...........  ...........
65765.................  E..............  ...............  Revision of cornea...........  ...........  ...........  ...........  ...........  ...........
65767.................  E..............  ...............  Corneal tissue transplant....  ...........  ...........  ...........  ...........  ...........
65770.................  T..............  ...............  Revise cornea with implant...         0244      38.1985    $2,267.08      $803.26      $453.42
65771.................  E..............  ...............  Radial keratotomy............  ...........  ...........  ...........  ...........  ...........
65772.................  T..............  ...............  Correction of astigmatism....         0233      14.8995      $884.29      $266.33      $176.86
65775.................  T..............  ...............  Correction of astigmatism....         0233      14.8995      $884.29      $266.33      $176.86
65780.................  T..............  ...............  Ocular reconst, transplant...         0244      38.1985    $2,267.08      $803.26      $453.42
65781.................  T..............  ...............  Ocular reconst, transplant...         0244      38.1985    $2,267.08      $803.26      $453.42
65782.................  T..............  ...............  Ocular reconst, transplant...         0244      38.1985    $2,267.08      $803.26      $453.42
65800.................  T..............  ...............  Drainage of eye..............         0233      14.8995      $884.29      $266.33      $176.86
65805.................  T..............  ...............  Drainage of eye..............         0233      14.8995      $884.29      $266.33      $176.86
65810.................  T..............  ...............  Drainage of eye..............         0234      21.8746    $1,298.26      $511.31      $259.65
65815.................  T..............  ...............  Drainage of eye..............         0234      21.8746    $1,298.26      $511.31      $259.65
65820.................  T..............  ...............  Relieve inner eye pressure...         0232       6.6429      $394.26      $103.17       $78.85
65850.................  T..............  ...............  Incision of eye..............         0234      21.8746    $1,298.26      $511.31      $259.65
65855.................  T..............  ...............  Laser surgery of eye.........         0247       5.0102      $297.36      $104.31       $59.47
65860.................  T..............  ...............  Incise inner eye adhesions...         0247       5.0102      $297.36      $104.31       $59.47
65865.................  T..............  ...............  Incise inner eye adhesions...         0233      14.8995      $884.29      $266.33      $176.86
65870.................  T..............  ...............  Incise inner eye adhesions...         0234      21.8746    $1,298.26      $511.31      $259.65
65875.................  T..............  ...............  Incise inner eye adhesions...         0234      21.8746    $1,298.26      $511.31      $259.65
65880.................  T..............  ...............  Incise inner eye adhesions...         0233      14.8995      $884.29      $266.33      $176.86
65900.................  T..............  ...............  Remove eye lesion............         0233      14.8995      $884.29      $266.33      $176.86
65920.................  T..............  ...............  Remove implant of eye........         0234      21.8746    $1,298.26      $511.31      $259.65
65930.................  T..............  ...............  Remove blood clot from eye...         0234      21.8746    $1,298.26      $511.31      $259.65
66020.................  T..............  ...............  Injection treatment of eye...         0233      14.8995      $884.29      $266.33      $176.86
66030.................  T..............  ...............  Injection treatment of eye...         0232       6.6429      $394.26      $103.17       $78.85
66130.................  T..............  ...............  Remove eye lesion............         0234      21.8746    $1,298.26      $511.31      $259.65
66150.................  T..............  ...............  Glaucoma surgery.............         0234      21.8746    $1,298.26      $511.31      $259.65

[[Page 42857]]

 
66155.................  T..............  ...............  Glaucoma surgery.............         0234      21.8746    $1,298.26      $511.31      $259.65
66160.................  T..............  ...............  Glaucoma surgery.............         0234      21.8746    $1,298.26      $511.31      $259.65
66165.................  T..............  ...............  Glaucoma surgery.............         0234      21.8746    $1,298.26      $511.31      $259.65
66170.................  T..............  ...............  Glaucoma surgery.............         0234      21.8746    $1,298.26      $511.31      $259.65
66172.................  T..............  ...............  Incision of eye..............         0673      29.1257    $1,728.61      $649.56      $345.72
66180.................  T..............  ...............  Implant eye shunt............         0673      29.1257    $1,728.61      $649.56      $345.72
66185.................  T..............  ...............  Revise eye shunt.............         0673      29.1257    $1,728.61      $649.56      $345.72
66220.................  T..............  ...............  Repair eye lesion............         0672      36.7611    $2,181.77  ...........      $436.35
66225.................  T..............  ...............  Repair/graft eye lesion......         0673      29.1257    $1,728.61      $649.56      $345.72
66250.................  T..............  ...............  Follow-up surgery of eye.....         0233      14.8995      $884.29      $266.33      $176.86
66500.................  T..............  ...............  Incision of iris.............         0232       6.6429      $394.26      $103.17       $78.85
66505.................  T..............  ...............  Incision of iris.............         0232       6.6429      $394.26      $103.17       $78.85
66600.................  T..............  ...............  Remove iris and lesion.......         0234      21.8746    $1,298.26      $511.31      $259.65
66605.................  T..............  ...............  Removal of iris..............         0234      21.8746    $1,298.26      $511.31      $259.65
66625.................  T..............  ...............  Removal of iris..............         0232       6.6429      $394.26      $103.17       $78.85
66630.................  T..............  ...............  Removal of iris..............         0234      21.8746    $1,298.26      $511.31      $259.65
66635.................  T..............  ...............  Removal of iris..............         0234      21.8746    $1,298.26      $511.31      $259.65
66680.................  T..............  ...............  Repair iris & ciliary body...         0234      21.8746    $1,298.26      $511.31      $259.65
66682.................  T..............  ...............  Repair iris & ciliary body...         0234      21.8746    $1,298.26      $511.31      $259.65
66700.................  T..............  ...............  Destruction, ciliary body....         0233      14.8995      $884.29      $266.33      $176.86
66710.................  T..............  ...............  Destruction, ciliary body....         0233      14.8995      $884.29      $266.33      $176.86
66711.................  T..............  ...............  Ciliary endoscopic ablation..         0233      14.8995      $884.29      $266.33      $176.86
66720.................  T..............  ...............  Destruction, ciliary body....         0233      14.8995      $884.29      $266.33      $176.86
66740.................  T..............  ...............  Destruction, ciliary body....         0234      21.8746    $1,298.26      $511.31      $259.65
66761.................  T..............  ...............  Revision of iris.............         0247       5.0102      $297.36      $104.31       $59.47
66762.................  T..............  ...............  Revision of iris.............         0247       5.0102      $297.36      $104.31       $59.47
66770.................  T..............  ...............  Removal of inner eye lesion..         0247       5.0102      $297.36      $104.31       $59.47
66820.................  T..............  ...............  Incision, secondary cataract.         0232       6.6429      $394.26      $103.17       $78.85
66821.................  T..............  ...............  After cataract laser surgery.         0247       5.0102      $297.36      $104.31       $59.47
66825.................  T..............  ...............  Reposition intraocular lens..         0234      21.8746    $1,298.26      $511.31      $259.65
66830.................  T..............  ...............  Removal of lens lesion.......         0232       6.6429      $394.26      $103.17       $78.85
66840.................  T..............  ...............  Removal of lens material.....         0245      13.3020      $789.47      $220.91      $157.89
66850.................  T..............  ...............  Removal of lens material.....         0249      27.8103    $1,650.54      $524.67      $330.11
66852.................  T..............  ...............  Removal of lens material.....         0249      27.8103    $1,650.54      $524.67      $330.11
66920.................  T..............  ...............  Extraction of lens...........         0249      27.8103    $1,650.54      $524.67      $330.11
66930.................  T..............  ...............  Extraction of lens...........         0249      27.8103    $1,650.54      $524.67      $330.11
66940.................  T..............  ...............  Extraction of lens...........         0245      13.3020      $789.47      $220.91      $157.89
66982.................  T..............  ...............  Cataract surgery, complex....         0246      23.3535    $1,386.03      $495.96      $277.21
66983.................  T..............  ...............  Cataract surg w/iol, 1 stage.         0246      23.3535    $1,386.03      $495.96      $277.21
66984.................  T..............  ...............  Cataract surg w/iol, 1 stage.         0246      23.3535    $1,386.03      $495.96      $277.21
66985.................  T..............  ...............  Insert lens prosthesis.......         0246      23.3535    $1,386.03      $495.96      $277.21
66986.................  T..............  ...............  Exchange lens prosthesis.....         0246      23.3535    $1,386.03      $495.96      $277.21
66990.................  N..............  ...............  Ophthalmic endoscope add-on..  ...........  ...........  ...........  ...........  ...........
66999.................  T..............  ...............  Eye surgery procedure........         0232       6.6429      $394.26      $103.17       $78.85
67005.................  T..............  ...............  Partial removal of eye fluid.         0237      28.8091    $1,709.82  ...........      $341.96
67010.................  T..............  ...............  Partial removal of eye fluid.         0237      28.8091    $1,709.82  ...........      $341.96
67015.................  T..............  ...............  Release of eye fluid.........         0237      28.8091    $1,709.82  ...........      $341.96
67025.................  T..............  ...............  Replace eye fluid............         0237      28.8091    $1,709.82  ...........      $341.96
67027.................  T..............  ...............  Implant eye drug system......         0672      36.7611    $2,181.77  ...........      $436.35
67028.................  T..............  ...............  Injection eye drug...........         0235       4.6382      $275.28       $67.10       $55.06
67030.................  T..............  ...............  Incise inner eye strands.....         0236      16.9458    $1,005.73  ...........      $201.15
67031.................  T..............  ...............  Laser surgery, eye strands...         0247       5.0102      $297.36      $104.31       $59.47
67036.................  T..............  ...............  Removal of inner eye fluid...         0672      36.7611    $2,181.77  ...........      $436.35
67038.................  T..............  ...............  Strip retinal membrane.......         0672      36.7611    $2,181.77  ...........      $436.35
67039.................  T..............  ...............  Laser treatment of retina....         0672      36.7611    $2,181.77  ...........      $436.35
67040.................  T..............  ...............  Laser treatment of retina....         0672      36.7611    $2,181.77  ...........      $436.35
67101.................  T..............  ...............  Repair detached retina.......         0236      16.9458    $1,005.73  ...........      $201.15
67105.................  T..............  ...............  Repair detached retina.......         0248       4.6557      $276.32       $93.57       $55.26
67107.................  T..............  ...............  Repair detached retina.......         0672      36.7611    $2,181.77  ...........      $436.35
67108.................  T..............  ...............  Repair detached retina.......         0672      36.7611    $2,181.77  ...........      $436.35
67110.................  T..............  ...............  Repair detached retina.......         0236      16.9458    $1,005.73  ...........      $201.15
67112.................  T..............  ...............  Rerepair detached retina.....         0672      36.7611    $2,181.77  ...........      $436.35
67115.................  T..............  ...............  Release encircling material..         0236      16.9458    $1,005.73  ...........      $201.15
67120.................  T..............  ...............  Remove eye implant material..         0236      16.9458    $1,005.73  ...........      $201.15
67121.................  T..............  ...............  Remove eye implant material..         0237      28.8091    $1,709.82  ...........      $341.96
67141.................  T..............  ...............  Treatment of retina..........         0235       4.6382      $275.28       $67.10       $55.06

[[Page 42858]]

 
67145.................  T..............  ...............  Treatment of retina..........         0248       4.6557      $276.32       $93.57       $55.26
67208.................  T..............  ...............  Treatment of retinal lesion..         0236      16.9458    $1,005.73  ...........      $201.15
67210.................  T..............  ...............  Treatment of retinal lesion..         0248       4.6557      $276.32       $93.57       $55.26
67218.................  T..............  ...............  Treatment of retinal lesion..         0236      16.9458    $1,005.73  ...........      $201.15
67220.................  T..............  ...............  Treatment of choroid lesion..         0235       4.6382      $275.28       $67.10       $55.06
67221.................  T..............  ...............  Ocular photodynamic ther.....         0235       4.6382      $275.28       $67.10       $55.06
67225.................  T..............  ...............  Eye photodynamic ther add-on.         0235       4.6382      $275.28       $67.10       $55.06
67227.................  T..............  ...............  Treatment of retinal lesion..         0236      16.9458    $1,005.73  ...........      $201.15
67228.................  T..............  ...............  Treatment of retinal lesion..         0248       4.6557      $276.32       $93.57       $55.26
67250.................  T..............  ...............  Reinforce eye wall...........         0240      18.0686    $1,072.37      $315.31      $214.47
67255.................  T..............  ...............  Reinforce/graft eye wall.....         0237      28.8091    $1,709.82  ...........      $341.96
67299.................  T..............  ...............  Eye surgery procedure........         0235       4.6382      $275.28       $67.10       $55.06
67311.................  T..............  ...............  Revise eye muscle............         0243      22.0667    $1,309.66      $431.39      $261.93
67312.................  T..............  ...............  Revise two eye muscles.......         0243      22.0667    $1,309.66      $431.39      $261.93
67314.................  T..............  ...............  Revise eye muscle............         0243      22.0667    $1,309.66      $431.39      $261.93
67316.................  T..............  ...............  Revise two eye muscles.......         0243      22.0667    $1,309.66      $431.39      $261.93
67318.................  T..............  ...............  Revise eye muscle(s).........         0243      22.0667    $1,309.66      $431.39      $261.93
67320.................  T..............  ...............  Revise eye muscle(s) add-on..         0243      22.0667    $1,309.66      $431.39      $261.93
67331.................  T..............  ...............  Eye surgery follow-up add-on.         0243      22.0667    $1,309.66      $431.39      $261.93
67332.................  T..............  ...............  Rerevise eye muscles add-on..         0243      22.0667    $1,309.66      $431.39      $261.93
67334.................  T..............  ...............  Revise eye muscle w/suture...         0243      22.0667    $1,309.66      $431.39      $261.93
67335.................  T..............  ...............  Eye suture during surgery....         0243      22.0667    $1,309.66      $431.39      $261.93
67340.................  T..............  ...............  Revise eye muscle add-on.....         0243      22.0667    $1,309.66      $431.39      $261.93
67343.................  T..............  ...............  Release eye tissue...........         0243      22.0667    $1,309.66      $431.39      $261.93
67345.................  T..............  ...............  Destroy nerve of eye muscle..         0238       2.5816      $153.22  ...........       $30.64
67350.................  T..............  ...............  Biopsy eye muscle............         0699       9.9723      $591.86  ...........      $118.37
67399.................  T..............  ...............  Eye muscle surgery procedure.         0243      22.0667    $1,309.66      $431.39      $261.93
67400.................  T..............  ...............  Explore/biopsy eye socket....         0241      23.1980    $1,376.80      $384.47      $275.36
67405.................  T..............  ...............  Explore/drain eye socket.....         0241      23.1980    $1,376.80      $384.47      $275.36
67412.................  T..............  ...............  Explore/treat eye socket.....         0241      23.1980    $1,376.80      $384.47      $275.36
67413.................  T..............  ...............  Explore/treat eye socket.....         0241      23.1980    $1,376.80      $384.47      $275.36
67414.................  T..............  ...............  Explr/decompress eye socket..         0242      30.4081    $1,804.72      $597.36      $360.94
67415.................  T..............  ...............  Aspiration, orbital contents.         0240      18.0686    $1,072.37      $315.31      $214.47
67420.................  T..............  ...............  Explore/treat eye socket.....         0242      30.4081    $1,804.72      $597.36      $360.94
67430.................  T..............  ...............  Explore/treat eye socket.....         0242      30.4081    $1,804.72      $597.36      $360.94
67440.................  T..............  ...............  Explore/drain eye socket.....         0242      30.4081    $1,804.72      $597.36      $360.94
67445.................  T..............  ...............  Explr/decompress eye socket..         0242      30.4081    $1,804.72      $597.36      $360.94
67450.................  T..............  ...............  Explore/biopsy eye socket....         0242      30.4081    $1,804.72      $597.36      $360.94
67500.................  S..............  ...............  Inject/treat eye socket......         0231       1.9191      $113.90  ...........       $22.78
67505.................  T..............  ...............  Inject/treat eye socket......         0238       2.5816      $153.22  ...........       $30.64
67515.................  T..............  ...............  Inject/treat eye socket......         0238       2.5816      $153.22  ...........       $30.64
67550.................  T..............  ...............  Insert eye socket implant....         0242      30.4081    $1,804.72      $597.36      $360.94
67560.................  T..............  ...............  Revise eye socket implant....         0241      23.1980    $1,376.80      $384.47      $275.36
67570.................  T..............  ...............  Decompress optic nerve.......         0242      30.4081    $1,804.72      $597.36      $360.94
67599.................  T..............  ...............  Orbit surgery procedure......         0238       2.5816      $153.22  ...........       $30.64
67700.................  T..............  ...............  Drainage of eyelid abscess...         0238       2.5816      $153.22  ...........       $30.64
67710.................  T..............  ...............  Incision of eyelid...........         0239       6.8784      $408.23  ...........       $81.65
67715.................  T..............  ...............  Incision of eyelid fold......         0240      18.0686    $1,072.37      $315.31      $214.47
67800.................  T..............  ...............  Remove eyelid lesion.........         0238       2.5816      $153.22  ...........       $30.64
67801.................  T..............  ...............  Remove eyelid lesions........         0239       6.8784      $408.23  ...........       $81.65
67805.................  T..............  ...............  Remove eyelid lesions........         0238       2.5816      $153.22  ...........       $30.64
67808.................  T..............  ...............  Remove eyelid lesion(s)......         0240      18.0686    $1,072.37      $315.31      $214.47
67810.................  T..............  ...............  Biopsy of eyelid.............         0238       2.5816      $153.22  ...........       $30.64
67820.................  S..............  ...............  Revise eyelashes.............         0698       1.2381       $73.48       $16.48       $14.70
67825.................  T..............  ...............  Revise eyelashes.............         0238       2.5816      $153.22  ...........       $30.64
67830.................  T..............  ...............  Revise eyelashes.............         0239       6.8784      $408.23  ...........       $81.65
67835.................  T..............  ...............  Revise eyelashes.............         0240      18.0686    $1,072.37      $315.31      $214.47
67840.................  T..............  ...............  Remove eyelid lesion.........         0239       6.8784      $408.23  ...........       $81.65
67850.................  T..............  ...............  Treat eyelid lesion..........         0239       6.8784      $408.23  ...........       $81.65
67875.................  T..............  ...............  Closure of eyelid by suture..         0239       6.8784      $408.23  ...........       $81.65
67880.................  T..............  ...............  Revision of eyelid...........         0233      14.8995      $884.29      $266.33      $176.86
67882.................  T..............  ...............  Revision of eyelid...........         0240      18.0686    $1,072.37      $315.31      $214.47
67900.................  T..............  ...............  Repair brow defect...........         0240      18.0686    $1,072.37      $315.31      $214.47
67901.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67902.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67903.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47

[[Page 42859]]

 
67904.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67906.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67908.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67909.................  T..............  ...............  Revise eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67911.................  T..............  ...............  Revise eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67912.................  T..............  ...............  Correction eyelid w/ implant.         0240      18.0686    $1,072.37      $315.31      $214.47
67914.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67915.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67916.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67917.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67921.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67922.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67923.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67924.................  T..............  ...............  Repair eyelid defect.........         0240      18.0686    $1,072.37      $315.31      $214.47
67930.................  T..............  ...............  Repair eyelid wound..........         0240      18.0686    $1,072.37      $315.31      $214.47
67935.................  T..............  ...............  Repair eyelid wound..........         0240      18.0686    $1,072.37      $315.31      $214.47
67938.................  S..............  ...............  Remove eyelid foreign body...         0698       1.2381       $73.48       $16.48       $14.70
67950.................  T..............  ...............  Revision of eyelid...........         0240      18.0686    $1,072.37      $315.31      $214.47
67961.................  T..............  ...............  Revision of eyelid...........         0240      18.0686    $1,072.37      $315.31      $214.47
67966.................  T..............  ...............  Revision of eyelid...........         0240      18.0686    $1,072.37      $315.31      $214.47
67971.................  T..............  ...............  Reconstruction of eyelid.....         0241      23.1980    $1,376.80      $384.47      $275.36
67973.................  T..............  ...............  Reconstruction of eyelid.....         0241      23.1980    $1,376.80      $384.47      $275.36
67974.................  T..............  ...............  Reconstruction of eyelid.....         0241      23.1980    $1,376.80      $384.47      $275.36
67975.................  T..............  ...............  Reconstruction of eyelid.....         0240      18.0686    $1,072.37      $315.31      $214.47
67999.................  T..............  ...............  Revision of eyelid...........         0238       2.5816      $153.22  ...........       $30.64
68020.................  T..............  ...............  Incise/drain eyelid lining...         0240      18.0686    $1,072.37      $315.31      $214.47
68040.................  S..............  ...............  Treatment of eyelid lesions..         0698       1.2381       $73.48       $16.48       $14.70
68100.................  T..............  ...............  Biopsy of eyelid lining......         0232       6.6429      $394.26      $103.17       $78.85
68110.................  T..............  ...............  Remove eyelid lining lesion..         0699       9.9723      $591.86  ...........      $118.37
68115.................  T..............  ...............  Remove eyelid lining lesion..         0240      18.0686    $1,072.37      $315.31      $214.47
68130.................  T..............  ...............  Remove eyelid lining lesion..         0233      14.8995      $884.29      $266.33      $176.86
68135.................  T..............  ...............  Remove eyelid lining lesion..         0239       6.8784      $408.23  ...........       $81.65
68200.................  S..............  ...............  Treat eyelid by injection....         0230       0.7823       $46.43       $14.97        $9.29
68320.................  T..............  ...............  Revise/graft eyelid lining...         0240      18.0686    $1,072.37      $315.31      $214.47
68325.................  T..............  ...............  Revise/graft eyelid lining...         0242      30.4081    $1,804.72      $597.36      $360.94
68326.................  T..............  ...............  Revise/graft eyelid lining...         0241      23.1980    $1,376.80      $384.47      $275.36
68328.................  T..............  ...............  Revise/graft eyelid lining...         0241      23.1980    $1,376.80      $384.47      $275.36
68330.................  T..............  ...............  Revise eyelid lining.........         0234      21.8746    $1,298.26      $511.31      $259.65
68335.................  T..............  ...............  Revise/graft eyelid lining...         0241      23.1980    $1,376.80      $384.47      $275.36
68340.................  T..............  ...............  Separate eyelid adhesions....         0240      18.0686    $1,072.37      $315.31      $214.47
68360.................  T..............  ...............  Revise eyelid lining.........         0234      21.8746    $1,298.26      $511.31      $259.65
68362.................  T..............  ...............  Revise eyelid lining.........         0234      21.8746    $1,298.26      $511.31      $259.65
68371.................  T..............  ...............  Harvest eye tissue, alograft.         0233      14.8995      $884.29      $266.33      $176.86
68399.................  T..............  ...............  Eyelid lining surgery........         0238       2.5816      $153.22  ...........       $30.64
68400.................  T..............  ...............  Incise/drain tear gland......         0238       2.5816      $153.22  ...........       $30.64
68420.................  T..............  ...............  Incise/drain tear sac........         0240      18.0686    $1,072.37      $315.31      $214.47
68440.................  T..............  ...............  Incise tear duct opening.....         0238       2.5816      $153.22  ...........       $30.64
68500.................  T..............  ...............  Removal of tear gland........         0241      23.1980    $1,376.80      $384.47      $275.36
68505.................  T..............  ...............  Partial removal, tear gland..         0241      23.1980    $1,376.80      $384.47      $275.36
68510.................  T..............  ...............  Biopsy of tear gland.........         0240      18.0686    $1,072.37      $315.31      $214.47
68520.................  T..............  ...............  Removal of tear sac..........         0241      23.1980    $1,376.80      $384.47      $275.36
68525.................  T..............  ...............  Biopsy of tear sac...........         0240      18.0686    $1,072.37      $315.31      $214.47
68530.................  T..............  ...............  Clearance of tear duct.......         0240      18.0686    $1,072.37      $315.31      $214.47
68540.................  T..............  ...............  Remove tear gland lesion.....         0241      23.1980    $1,376.80      $384.47      $275.36
68550.................  T..............  ...............  Remove tear gland lesion.....         0242      30.4081    $1,804.72      $597.36      $360.94
68700.................  T..............  ...............  Repair tear ducts............         0241      23.1980    $1,376.80      $384.47      $275.36
68705.................  T..............  ...............  Revise tear duct opening.....         0238       2.5816      $153.22  ...........       $30.64
68720.................  T..............  ...............  Create tear sac drain........         0242      30.4081    $1,804.72      $597.36      $360.94
68745.................  T..............  ...............  Create tear duct drain.......         0241      23.1980    $1,376.80      $384.47      $275.36
68750.................  T..............  ...............  Create tear duct drain.......         0242      30.4081    $1,804.72      $597.36      $360.94
68760.................  S..............  ...............  Close tear duct opening......         0698       1.2381       $73.48       $16.48       $14.70
68761.................  S..............  ...............  Close tear duct opening......         0231       1.9191      $113.90  ...........       $22.78
68770.................  T..............  ...............  Close tear system fistula....         0240      18.0686    $1,072.37      $315.31      $214.47
68801.................  S..............  ...............  Dilate tear duct opening.....         0698       1.2381       $73.48       $16.48       $14.70
68810.................  S..............  ...............  Probe nasolacrimal duct......         0231       1.9191      $113.90  ...........       $22.78
68811.................  T..............  ...............  Probe nasolacrimal duct......         0240      18.0686    $1,072.37      $315.31      $214.47

[[Page 42860]]

 
68815.................  T..............  ...............  Probe nasolacrimal duct......         0240      18.0686    $1,072.37      $315.31      $214.47
68840.................  S..............  ...............  Explore/irrigate tear ducts..         0231       1.9191      $113.90  ...........       $22.78
68850.................  N..............  ...............  Injection for tear sac x-ray.  ...........  ...........  ...........  ...........  ...........
68899.................  S..............  ...............  Tear duct system surgery.....         0230       0.7823       $46.43       $14.97        $9.29
69000.................  T..............  ...............  Drain external ear lesion....         0006       1.5430       $91.58       $22.18       $18.32
69005.................  T..............  ...............  Drain external ear lesion....         0008      16.4242      $974.78  ...........      $194.96
69020.................  T..............  ...............  Drain outer ear canal lesion.         0006       1.5430       $91.58       $22.18       $18.32
69090.................  E..............  ...............  Pierce earlobes..............  ...........  ...........  ...........  ...........  ...........
69100.................  T..............  ...............  Biopsy of external ear.......         0019       4.0363      $239.55       $71.87       $47.91
69105.................  T..............  ...............  Biopsy of external ear canal.         0253      16.0627      $953.32      $282.29      $190.66
69110.................  T..............  ...............  Remove external ear, partial.         0021      14.9098      $884.90      $219.48      $176.98
69120.................  T..............  ...............  Removal of external ear......         0254      23.2980    $1,382.74      $321.35      $276.55
69140.................  T..............  ...............  Remove ear canal lesion(s)...         0254      23.2980    $1,382.74      $321.35      $276.55
69145.................  T..............  ...............  Remove ear canal lesion(s)...         0021      14.9098      $884.90      $219.48      $176.98
69150.................  T..............  ...............  Extensive ear canal surgery..         0252       7.8317      $464.81      $113.41       $92.96
69155.................  C..............  ...............  Extensive ear/neck surgery...  ...........  ...........  ...........  ...........  ...........
69200.................  X..............  ...............  Clear outer ear canal........         0340       0.6355       $37.72  ...........        $7.54
69205.................  T..............  ...............  Clear outer ear canal........         0022      19.5582    $1,160.78      $354.45      $232.16
69210.................  X..............  ...............  Remove impacted ear wax......         0340       0.6355       $37.72  ...........        $7.54
69220.................  T..............  ...............  Clean out mastoid cavity.....         0012       0.8458       $50.20       $11.18       $10.04
69222.................  T..............  ...............  Clean out mastoid cavity.....         0253      16.0627      $953.32      $282.29      $190.66
69300.................  T..............  ...............  Revise external ear..........         0254      23.2980    $1,382.74      $321.35      $276.55
69310.................  T..............  ...............  Rebuild outer ear canal......         0256      37.1513    $2,204.93  ...........      $440.99
69320.................  T..............  ...............  Rebuild outer ear canal......         0256      37.1513    $2,204.93  ...........      $440.99
69399.................  T..............  ...............  Outer ear surgery procedure..         0251       2.0010      $118.76  ...........       $23.75
69400.................  T..............  ...............  Inflate middle ear canal.....         0251       2.0010      $118.76  ...........       $23.75
69401.................  T..............  ...............  Inflate middle ear canal.....         0251       2.0010      $118.76  ...........       $23.75
69405.................  T..............  ...............  Catheterize middle ear canal.         0252       7.8317      $464.81      $113.41       $92.96
69410.................  T..............  ...............  Inset middle ear (baffle)....         0251       2.0010      $118.76  ...........       $23.75
69420.................  T..............  ...............  Incision of eardrum..........         0251       2.0010      $118.76  ...........       $23.75
69421.................  T..............  ...............  Incision of eardrum..........         0253      16.0627      $953.32      $282.29      $190.66
69424.................  T..............  ...............  Remove ventilating tube......         0252       7.8317      $464.81      $113.41       $92.96
69433.................  T..............  ...............  Create eardrum opening.......         0252       7.8317      $464.81      $113.41       $92.96
69436.................  T..............  ...............  Create eardrum opening.......         0253      16.0627      $953.32      $282.29      $190.66
69440.................  T..............  ...............  Exploration of middle ear....         0254      23.2980    $1,382.74      $321.35      $276.55
69450.................  T..............  ...............  Eardrum revision.............         0256      37.1513    $2,204.93  ...........      $440.99
69501.................  T..............  ...............  Mastoidectomy................         0256      37.1513    $2,204.93  ...........      $440.99
69502.................  T..............  ...............  Mastoidectomy................         0254      23.2980    $1,382.74      $321.35      $276.55
69505.................  T..............  ...............  Remove mastoid structures....         0256      37.1513    $2,204.93  ...........      $440.99
69511.................  T..............  ...............  Extensive mastoid surgery....         0256      37.1513    $2,204.93  ...........      $440.99
69530.................  T..............  ...............  Extensive mastoid surgery....         0256      37.1513    $2,204.93  ...........      $440.99
69535.................  C..............  ...............  Remove part of temporal bone.  ...........  ...........  ...........  ...........  ...........
69540.................  T..............  ...............  Remove ear lesion............         0253      16.0627      $953.32      $282.29      $190.66
69550.................  T..............  ...............  Remove ear lesion............         0256      37.1513    $2,204.93  ...........      $440.99
69552.................  T..............  ...............  Remove ear lesion............         0256      37.1513    $2,204.93  ...........      $440.99
69554.................  C..............  ...............  Remove ear lesion............  ...........  ...........  ...........  ...........  ...........
69601.................  T..............  ...............  Mastoid surgery revision.....         0256      37.1513    $2,204.93  ...........      $440.99
69602.................  T..............  ...............  Mastoid surgery revision.....         0256      37.1513    $2,204.93  ...........      $440.99
69603.................  T..............  ...............  Mastoid surgery revision.....         0256      37.1513    $2,204.93  ...........      $440.99
69604.................  T..............  ...............  Mastoid surgery revision.....         0256      37.1513    $2,204.93  ...........      $440.99
69605.................  T..............  ...............  Mastoid surgery revision.....         0256      37.1513    $2,204.93  ...........      $440.99
69610.................  T..............  ...............  Repair of eardrum............         0254      23.2980    $1,382.74      $321.35      $276.55
69620.................  T..............  ...............  Repair of eardrum............         0254      23.2980    $1,382.74      $321.35      $276.55
69631.................  T..............  ...............  Repair eardrum structures....         0256      37.1513    $2,204.93  ...........      $440.99
69632.................  T..............  ...............  Rebuild eardrum structures...         0256      37.1513    $2,204.93  ...........      $440.99
69633.................  T..............  ...............  Rebuild eardrum structures...         0256      37.1513    $2,204.93  ...........      $440.99
69635.................  T..............  ...............  Repair eardrum structures....         0256      37.1513    $2,204.93  ...........      $440.99
69636.................  T..............  ...............  Rebuild eardrum structures...         0256      37.1513    $2,204.93  ...........      $440.99
69637.................  T..............  ...............  Rebuild eardrum structures...         0256      37.1513    $2,204.93  ...........      $440.99
69641.................  T..............  ...............  Revise middle ear & mastoid..         0256      37.1513    $2,204.93  ...........      $440.99
69642.................  T..............  ...............  Revise middle ear & mastoid..         0256      37.1513    $2,204.93  ...........      $440.99
69643.................  T..............  ...............  Revise middle ear & mastoid..         0256      37.1513    $2,204.93  ...........      $440.99
69644.................  T..............  ...............  Revise middle ear & mastoid..         0256      37.1513    $2,204.93  ...........      $440.99
69645.................  T..............  ...............  Revise middle ear & mastoid..         0256      37.1513    $2,204.93  ...........      $440.99
69646.................  T..............  ...............  Revise middle ear & mastoid..         0256      37.1513    $2,204.93  ...........      $440.99
69650.................  T..............  ...............  Release middle ear bone......         0254      23.2980    $1,382.74      $321.35      $276.55

[[Page 42861]]

 
69660.................  T..............  ...............  Revise middle ear bone.......         0256      37.1513    $2,204.93  ...........      $440.99
69661.................  T..............  ...............  Revise middle ear bone.......         0256      37.1513    $2,204.93  ...........      $440.99
69662.................  T..............  ...............  Revise middle ear bone.......         0256      37.1513    $2,204.93  ...........      $440.99
69666.................  T..............  ...............  Repair middle ear structures.         0256      37.1513    $2,204.93  ...........      $440.99
69667.................  T..............  ...............  Repair middle ear structures.         0256      37.1513    $2,204.93  ...........      $440.99
69670.................  T..............  ...............  Remove mastoid air cells.....         0256      37.1513    $2,204.93  ...........      $440.99
69676.................  T..............  ...............  Remove middle ear nerve......         0256      37.1513    $2,204.93  ...........      $440.99
69700.................  T..............  ...............  Close mastoid fistula........         0256      37.1513    $2,204.93  ...........      $440.99
69710.................  E..............  ...............  Implant/replace hearing aid..  ...........  ...........  ...........  ...........  ...........
69711.................  T..............  ...............  Remove/repair hearing aid....         0256      37.1513    $2,204.93  ...........      $440.99
69714.................  T..............  ...............  Implant temple bone w/stimul.         0256      37.1513    $2,204.93  ...........      $440.99
69715.................  T..............  ...............  Temple bne implnt w/stimulat.         0256      37.1513    $2,204.93  ...........      $440.99
69717.................  T..............  ...............  Temple bone implant revision.         0256      37.1513    $2,204.93  ...........      $440.99
69718.................  T..............  ...............  Revise temple bone implant...         0256      37.1513    $2,204.93  ...........      $440.99
69720.................  T..............  ...............  Release facial nerve.........         0256      37.1513    $2,204.93  ...........      $440.99
69725.................  T..............  ...............  Release facial nerve.........         0256      37.1513    $2,204.93  ...........      $440.99
69740.................  T..............  ...............  Repair facial nerve..........         0256      37.1513    $2,204.93  ...........      $440.99
69745.................  T..............  ...............  Repair facial nerve..........         0256      37.1513    $2,204.93  ...........      $440.99
69799.................  T..............  ...............  Middle ear surgery procedure.         0251       2.0010      $118.76  ...........       $23.75
69801.................  T..............  ...............  Incise inner ear.............         0256      37.1513    $2,204.93  ...........      $440.99
69802.................  T..............  ...............  Incise inner ear.............         0256      37.1513    $2,204.93  ...........      $440.99
69805.................  T..............  ...............  Explore inner ear............         0256      37.1513    $2,204.93  ...........      $440.99
69806.................  T..............  ...............  Explore inner ear............         0256      37.1513    $2,204.93  ...........      $440.99
69820.................  T..............  ...............  Establish inner ear window...         0256      37.1513    $2,204.93  ...........      $440.99
69840.................  T..............  ...............  Revise inner ear window......         0256      37.1513    $2,204.93  ...........      $440.99
69905.................  T..............  ...............  Remove inner ear.............         0256      37.1513    $2,204.93  ...........      $440.99
69910.................  T..............  ...............  Remove inner ear & mastoid...         0256      37.1513    $2,204.93  ...........      $440.99
69915.................  T..............  ...............  Incise inner ear nerve.......         0256      37.1513    $2,204.93  ...........      $440.99
69930.................  T..............  ...............  Implant cochlear device......         0259     364.6725   $21,643.31    $8,034.61    $4,328.66
69949.................  T..............  ...............  Inner ear surgery procedure..         0251       2.0010      $118.76  ...........       $23.75
69950.................  C..............  ...............  Incise inner ear nerve.......  ...........  ...........  ...........  ...........  ...........
69955.................  T..............  ...............  Release facial nerve.........         0256      37.1513    $2,204.93  ...........      $440.99
69960.................  T..............  ...............  Release inner ear canal......         0256      37.1513    $2,204.93  ...........      $440.99
69970.................  C..............  ...............  Remove inner ear lesion......  ...........  ...........  ...........  ...........  ...........
69979.................  T..............  ...............  Temporal bone surgery........         0251       2.0010      $118.76  ...........       $23.75
69990.................  N..............  ...............  Microsurgery add-on..........  ...........  ...........  ...........  ...........  ...........
70010.................  S..............  ...............  Contrast x-ray of brain......         0274       3.0275      $179.68       $71.87       $35.94
70015.................  S..............  ...............  Contrast x-ray of brain......         0274       3.0275      $179.68       $71.87       $35.94
70030.................  X..............  ...............  X-ray eye for foreign body...         0260       0.7521       $44.64       $17.85        $8.93
70100.................  X..............  ...............  X-ray exam of jaw............         0260       0.7521       $44.64       $17.85        $8.93
70110.................  X..............  ...............  X-ray exam of jaw............         0260       0.7521       $44.64       $17.85        $8.93
70120.................  X..............  ...............  X-ray exam of mastoids.......         0260       0.7521       $44.64       $17.85        $8.93
70130.................  X..............  ...............  X-ray exam of mastoids.......         0260       0.7521       $44.64       $17.85        $8.93
70134.................  X..............  ...............  X-ray exam of middle ear.....         0261       1.2843       $76.22  ...........       $15.24
70140.................  X..............  ...............  X-ray exam of facial bones...         0260       0.7521       $44.64       $17.85        $8.93
70150.................  X..............  ...............  X-ray exam of facial bones...         0260       0.7521       $44.64       $17.85        $8.93
70160.................  X..............  ...............  X-ray exam of nasal bones....         0260       0.7521       $44.64       $17.85        $8.93
70170.................  X..............  ...............  X-ray exam of tear duct......         0264       3.5080      $208.20       $79.41       $41.64
70190.................  X..............  ...............  X-ray exam of eye sockets....         0260       0.7521       $44.64       $17.85        $8.93
70200.................  X..............  ...............  X-ray exam of eye sockets....         0260       0.7521       $44.64       $17.85        $8.93
70210.................  X..............  ...............  X-ray exam of sinuses........         0260       0.7521       $44.64       $17.85        $8.93
70220.................  X..............  ...............  X-ray exam of sinuses........         0260       0.7521       $44.64       $17.85        $8.93
70240.................  X..............  ...............  X-ray exam, pituitary saddle.         0260       0.7521       $44.64       $17.85        $8.93
70250.................  X..............  ...............  X-ray exam of skull..........         0260       0.7521       $44.64       $17.85        $8.93
70260.................  X..............  ...............  X-ray exam of skull..........         0261       1.2843       $76.22  ...........       $15.24
70300.................  X..............  ...............  X-ray exam of teeth..........         0262       0.9186       $54.52  ...........       $10.90
70310.................  X..............  ...............  X-ray exam of teeth..........         0262       0.9186       $54.52  ...........       $10.90
70320.................  X..............  ...............  Full mouth x-ray of teeth....         0262       0.9186       $54.52  ...........       $10.90
70328.................  X..............  ...............  X-ray exam of jaw joint......         0260       0.7521       $44.64       $17.85        $8.93
70330.................  X..............  ...............  X-ray exam of jaw joints.....         0260       0.7521       $44.64       $17.85        $8.93
70332.................  S..............  ...............  X-ray exam of jaw joint......         0275       3.5617      $211.39       $69.09       $42.28
70336.................  S..............  ...............  Magnetic image, jaw joint....         0335       5.1347      $304.74      $121.89       $60.95
70350.................  X..............  ...............  X-ray head for orthodontia...         0260       0.7521       $44.64       $17.85        $8.93
70355.................  X..............  ...............  Panoramic x-ray of jaws......         0260       0.7521       $44.64       $17.85        $8.93
70360.................  X..............  ...............  X-ray exam of neck...........         0260       0.7521       $44.64       $17.85        $8.93
70370.................  X..............  ...............  Throat x-ray & fluoroscopy...         0272       1.3738       $81.54       $32.61       $16.31

[[Page 42862]]

 
70371.................  X..............  ...............  Speech evaluation, complex...         0272       1.3738       $81.54       $32.61       $16.31
70373.................  X..............  ...............  Contrast x-ray of larynx.....         0263       1.7397      $103.25       $24.29       $20.65
70380.................  X..............  ...............  X-ray exam of salivary gland.         0260       0.7521       $44.64       $17.85        $8.93
70390.................  X..............  ...............  X-ray exam of salivary duct..         0263       1.7397      $103.25       $24.29       $20.65
70450*................  S..............  ...............  Ct head/brain w/o dye........         0332       3.2546      $193.16       $77.26       $38.63
70460*................  S..............  ...............  Ct head/brain w/dye..........         0283       4.4053      $261.45      $104.58       $52.29
70470*................  S..............  ...............  Ct head/brain w/o & w/ dye...         0333       5.2596      $312.16      $124.86       $62.43
70480*................  S..............  ...............  Ct orbit/ear/fossa w/o dye...         0332       3.2546      $193.16       $77.26       $38.63
70481*................  S..............  ...............  Ct orbit/ear/fossa w/dye.....         0283       4.4053      $261.45      $104.58       $52.29
70482*................  S..............  ...............  Ct orbit/ear/fossa w/o&w dye.         0333       5.2596      $312.16      $124.86       $62.43
70486*................  S..............  ...............  Ct maxillofacial w/o dye.....         0332       3.2546      $193.16       $77.26       $38.63
70487*................  S..............  ...............  Ct maxillofacial w/dye.......         0283       4.4053      $261.45      $104.58       $52.29
70488*................  S..............  ...............  Ct maxillofacial w/o & w dye.         0333       5.2596      $312.16      $124.86       $62.43
70490*................  S..............  ...............  Ct soft tissue neck w/o dye..         0332       3.2546      $193.16       $77.26       $38.63
70491*................  S..............  ...............  Ct soft tissue neck w/dye....         0283       4.4053      $261.45      $104.58       $52.29
70492*................  S..............  ...............  Ct sft tsue nck w/o & w/dye..         0333       5.2596      $312.16      $124.86       $62.43
70496*................  S..............  ...............  Ct angiography, head.........         0662       5.1387      $304.98      $121.99       $61.00
70498*................  S..............  ...............  Ct angiography, neck.........         0662       5.1387      $304.98      $121.99       $61.00
70540*................  S..............  ...............  Mri orbit/face/neck w/o dye..         0336       6.0467      $358.87      $143.54       $71.77
70542*................  S..............  ...............  Mri orbit/face/neck w/dye....         0284       6.3910      $379.31      $151.72       $75.86
70543*................  S..............  ...............  Mri orbt/fac/nck w/o & w dye.         0337       8.7547      $519.59      $207.83      $103.92
70544*................  S..............  ...............  Mr angiography head w/o dye..         0336       6.0467      $358.87      $143.54       $71.77
70545*................  S..............  ...............  Mr angiography head w/dye....         0284       6.3910      $379.31      $151.72       $75.86
70546*................  S..............  ...............  Mr angiograph head w/o&w dye.         0337       8.7547      $519.59      $207.83      $103.92
70547*................  S..............  ...............  Mr angiography neck w/o dye..         0336       6.0467      $358.87      $143.54       $71.77
70548*................  S..............  ...............  Mr angiography neck w/dye....         0284       6.3910      $379.31      $151.72       $75.86
70549*................  S..............  ...............  Mr angiograph neck w/o&w dye.         0337       8.7547      $519.59      $207.83      $103.92
70551*................  S..............  ...............  Mri brain w/o dye............         0336       6.0467      $358.87      $143.54       $71.77
70552*................  S..............  ...............  Mri brain w/ dye.............         0284       6.3910      $379.31      $151.72       $75.86
70553*................  S..............  ...............  Mri brain w/o & w/ dye.......         0337       8.7547      $519.59      $207.83      $103.92
70557.................  S..............  ...............  Mri brain w/o dye............         0336       6.0467      $358.87      $143.54       $71.77
70558.................  S..............  ...............  Mri brain w/ dye.............         0284       6.3910      $379.31      $151.72       $75.86
70559.................  S..............  ...............  Mri brain w/o & w/ dye.......         0337       8.7547      $519.59      $207.83      $103.92
71010.................  X..............  ...............  Chest x-ray..................         0260       0.7521       $44.64       $17.85        $8.93
71015.................  X..............  ...............  Chest x-ray..................         0260       0.7521       $44.64       $17.85        $8.93
71020.................  X..............  ...............  Chest x-ray..................         0260       0.7521       $44.64       $17.85        $8.93
71021.................  X..............  ...............  Chest x-ray..................         0260       0.7521       $44.64       $17.85        $8.93
71022.................  X..............  ...............  Chest x-ray..................         0260       0.7521       $44.64       $17.85        $8.93
71023.................  X..............  ...............  Chest x-ray and fluoroscopy..         0272       1.3738       $81.54       $32.61       $16.31
71030.................  X..............  ...............  Chest x-ray..................         0260       0.7521       $44.64       $17.85        $8.93
71034.................  X..............  ...............  Chest x-ray and fluoroscopy..         0272       1.3738       $81.54       $32.61       $16.31
71035.................  X..............  ...............  Chest x-ray..................         0260       0.7521       $44.64       $17.85        $8.93
71040.................  X..............  ...............  Contrast x-ray of bronchi....         0263       1.7397      $103.25       $24.29       $20.65
71060.................  X..............  ...............  Contrast x-ray of bronchi....         0263       1.7397      $103.25       $24.29       $20.65
71090.................  X..............  ...............  X-ray & pacemaker insertion..         0272       1.3738       $81.54       $32.61       $16.31
71100.................  X..............  ...............  X-ray exam of ribs...........         0260       0.7521       $44.64       $17.85        $8.93
71101.................  X..............  ...............  X-ray exam of ribs/chest.....         0260       0.7521       $44.64       $17.85        $8.93
71110.................  X..............  ...............  X-ray exam of ribs...........         0260       0.7521       $44.64       $17.85        $8.93
71111.................  X..............  ...............  X-ray exam of ribs/ chest....         0261       1.2843       $76.22  ...........       $15.24
71120.................  X..............  ...............  X-ray exam of breastbone.....         0260       0.7521       $44.64       $17.85        $8.93
71130.................  X..............  ...............  X-ray exam of breastbone.....         0260       0.7521       $44.64       $17.85        $8.93
71250*................  S..............  ...............  Ct thorax w/o dye............         0332       3.2546      $193.16       $77.26       $38.63
71260*................  S..............  ...............  Ct thorax w/dye..............         0283       4.4053      $261.45      $104.58       $52.29
71270*................  S..............  ...............  Ct thorax w/o & w/ dye.......         0333       5.2596      $312.16      $124.86       $62.43
71275*................  S..............  ...............  Ct angiography, chest........         0662       5.1387      $304.98      $121.99       $61.00
71550*................  S..............  ...............  Mri chest w/o dye............         0336       6.0467      $358.87      $143.54       $71.77
71551*................  S..............  ...............  Mri chest w/dye..............         0284       6.3910      $379.31      $151.72       $75.86
71552*................  S..............  ...............  Mri chest w/o & w/dye........         0337       8.7547      $519.59      $207.83      $103.92
71555.................  B..............  ...............  Mri angio chest w or w/o dye.  ...........  ...........  ...........  ...........  ...........
72010.................  X..............  ...............  X-ray exam of spine..........         0260       0.7521       $44.64       $17.85        $8.93
72020.................  X..............  ...............  X-ray exam of spine..........         0260       0.7521       $44.64       $17.85        $8.93
72040.................  X..............  ...............  X-ray exam of neck spine.....         0260       0.7521       $44.64       $17.85        $8.93
72050.................  X..............  ...............  X-ray exam of neck spine.....         0261       1.2843       $76.22  ...........       $15.24
72052.................  X..............  ...............  X-ray exam of neck spine.....         0261       1.2843       $76.22  ...........       $15.24
72069.................  X..............  ...............  X-ray exam of trunk spine....         0260       0.7521       $44.64       $17.85        $8.93
72070.................  X..............  ...............  X-ray exam of thoracic spine.         0260       0.7521       $44.64       $17.85        $8.93

[[Page 42863]]

 
72072.................  X..............  ...............  X-ray exam of thoracic spine.         0260       0.7521       $44.64       $17.85        $8.93
72074.................  X..............  ...............  X-ray exam of thoracic spine.         0260       0.7521       $44.64       $17.85        $8.93
72080.................  X..............  ...............  X-ray exam of trunk spine....         0260       0.7521       $44.64       $17.85        $8.93
72090.................  X..............  ...............  X-ray exam of trunk spine....         0261       1.2843       $76.22  ...........       $15.24
72100.................  X..............  ...............  X-ray exam of lower spine....         0260       0.7521       $44.64       $17.85        $8.93
72110.................  X..............  ...............  X-ray exam of lower spine....         0261       1.2843       $76.22  ...........       $15.24
72114.................  X..............  ...............  X-ray exam of lower spine....         0261       1.2843       $76.22  ...........       $15.24
72120.................  X..............  ...............  X-ray exam of lower spine....         0261       1.2843       $76.22  ...........       $15.24
72125*................  S..............  ...............  Ct neck spine w/o dye........         0332       3.2546      $193.16       $77.26       $38.63
72126*................  S..............  ...............  Ct neck spine w/dye..........         0283       4.4053      $261.45      $104.58       $52.29
72127*................  S..............  ...............  Ct neck spine w/o & w/dye....         0333       5.2596      $312.16      $124.86       $62.43
72128*................  S..............  ...............  Ct chest spine w/o dye.......         0332       3.2546      $193.16       $77.26       $38.63
72129*................  S..............  ...............  Ct chest spine w/dye.........         0283       4.4053      $261.45      $104.58       $52.29
72130*................  S..............  ...............  Ct chest spine w/o & w/dye...         0333       5.2596      $312.16      $124.86       $62.43
72131*................  S..............  ...............  Ct lumbar spine w/o dye......         0332       3.2546      $193.16       $77.26       $38.63
72132*................  S..............  ...............  Ct lumbar spine w/dye........         0283       4.4053      $261.45      $104.58       $52.29
72133*................  S..............  ...............  Ct lumbar spine w/o & w/dye..         0333       5.2596      $312.16      $124.86       $62.43
72141*................  S..............  ...............  Mri neck spine w/o dye.......         0336       6.0467      $358.87      $143.54       $71.77
72142*................  S..............  ...............  Mri neck spine w/dye.........         0284       6.3910      $379.31      $151.72       $75.86
72146*................  S..............  ...............  Mri chest spine w/o dye......         0336       6.0467      $358.87      $143.54       $71.77
72147*................  S..............  ...............  Mri chest spine w/dye........         0284       6.3910      $379.31      $151.72       $75.86
72148*................  S..............  ...............  Mri lumbar spine w/o dye.....         0336       6.0467      $358.87      $143.54       $71.77
72149*................  S..............  ...............  Mri lumbar spine w/dye.......         0284       6.3910      $379.31      $151.72       $75.86
72156*................  S..............  ...............  Mri neck spine w/o & w/dye...         0337       8.7547      $519.59      $207.83      $103.92
72157*................  S..............  ...............  Mri chest spine w/o & w/dye..         0337       8.7547      $519.59      $207.83      $103.92
72158*................  S..............  ...............  Mri lumbar spine w/o & w/dye.         0337       8.7547      $519.59      $207.83      $103.92
72159.................  E..............  ...............  Mr angio spine w/o&w/dye.....  ...........  ...........  ...........  ...........  ...........
72170.................  X..............  ...............  X-ray exam of pelvis.........         0260       0.7521       $44.64       $17.85        $8.93
72190.................  X..............  ...............  X-ray exam of pelvis.........         0260       0.7521       $44.64       $17.85        $8.93
72191*................  S..............  ...............  Ct angiograph pelv w/o&w/dye.         0662       5.1387      $304.98      $121.99       $61.00
72192*................  S..............  ...............  Ct pelvis w/o dye............         0332       3.2546      $193.16       $77.26       $38.63
72193*................  S..............  ...............  Ct pelvis w/dye..............         0283       4.4053      $261.45      $104.58       $52.29
72194*................  S..............  ...............  Ct pelvis w/o & w/dye........         0333       5.2596      $312.16      $124.86       $62.43
72195*................  S..............  ...............  Mri pelvis w/o dye...........         0336       6.0467      $358.87      $143.54       $71.77
72196*................  S..............  ...............  Mri pelvis w/dye.............         0284       6.3910      $379.31      $151.72       $75.86
72197*................  S..............  ...............  Mri pelvis w/o & w/dye.......         0337       8.7547      $519.59      $207.83      $103.92
72198.................  B..............  ...............  Mr angio pelvis w/o & w/dye..  ...........  ...........  ...........  ...........  ...........
72200.................  X..............  ...............  X-ray exam sacroiliac joints.         0260       0.7521       $44.64       $17.85        $8.93
72202.................  X..............  ...............  X-ray exam sacroiliac joints.         0260       0.7521       $44.64       $17.85        $8.93
72220.................  X..............  ...............  X-ray exam of tailbone.......         0260       0.7521       $44.64       $17.85        $8.93
72240.................  S..............  ...............  Contrast x-ray of neck spine.         0274       3.0275      $179.68       $71.87       $35.94
72255.................  S..............  ...............  Contrast x-ray, thorax spine.         0274       3.0275      $179.68       $71.87       $35.94
72265.................  S..............  ...............  Contrast x-ray, lower spine..         0274       3.0275      $179.68       $71.87       $35.94
72270.................  S..............  ...............  Contrast x-ray, spine........         0274       3.0275      $179.68       $71.87       $35.94
72275.................  S..............  ...............  Epidurography................         0274       3.0275      $179.68       $71.87       $35.94
72285.................  S..............  ...............  X-ray c/t spine disk.........         0388      12.2736      $728.44      $291.37      $145.69
72295.................  S..............  ...............  X-ray of lower spine disk....         0388      12.2736      $728.44      $291.37      $145.69
73000.................  X..............  ...............  X-ray exam of collar bone....         0260       0.7521       $44.64       $17.85        $8.93
73010.................  X..............  ...............  X-ray exam of shoulder blade.         0260       0.7521       $44.64       $17.85        $8.93
73020.................  X..............  ...............  X-ray exam of shoulder.......         0260       0.7521       $44.64       $17.85        $8.93
73030.................  X..............  ...............  X-ray exam of shoulder.......         0260       0.7521       $44.64       $17.85        $8.93
73040.................  S..............  ...............  Contrast x-ray of shoulder...         0275       3.5617      $211.39       $69.09       $42.28
73050.................  X..............  ...............  X-ray exam of shoulders......         0260       0.7521       $44.64       $17.85        $8.93
73060.................  X..............  ...............  X-ray exam of humerus........         0260       0.7521       $44.64       $17.85        $8.93
73070.................  X..............  ...............  X-ray exam of elbow..........         0260       0.7521       $44.64       $17.85        $8.93
73080.................  X..............  ...............  X-ray exam of elbow..........         0260       0.7521       $44.64       $17.85        $8.93
73085.................  S..............  ...............  Contrast x-ray of elbow......         0275       3.5617      $211.39       $69.09       $42.28
73090.................  X..............  ...............  X-ray exam of forearm........         0260       0.7521       $44.64       $17.85        $8.93
73092.................  X..............  ...............  X-ray exam of arm, infant....         0260       0.7521       $44.64       $17.85        $8.93
73100.................  X..............  ...............  X-ray exam of wrist..........         0260       0.7521       $44.64       $17.85        $8.93
73110.................  X..............  ...............  X-ray exam of wrist..........         0260       0.7521       $44.64       $17.85        $8.93
73115.................  S..............  ...............  Contrast x-ray of wrist......         0275       3.5617      $211.39       $69.09       $42.28
73120.................  X..............  ...............  X-ray exam of hand...........         0260       0.7521       $44.64       $17.85        $8.93
73130.................  X..............  ...............  X-ray exam of hand...........         0260       0.7521       $44.64       $17.85        $8.93
73140.................  X..............  ...............  X-ray exam of finger(s)......         0260       0.7521       $44.64       $17.85        $8.93
73200*................  S..............  ...............  Ct upper extremity w/o dye...         0332       3.2546      $193.16       $77.26       $38.63

[[Page 42864]]

 
73201*................  S..............  ...............  Ct upper extremity w/dye.....         0283       4.4053      $261.45      $104.58       $52.29
73202*................  S..............  ...............  Ct uppr extremity w/o&w/dye..         0333       5.2596      $312.16      $124.86       $62.43
73206*................  S..............  ...............  Ct angio upr extrm w/o&w/dye.         0662       5.1387      $304.98      $121.99       $61.00
73218*................  S..............  ...............  Mri upper extremity w/o dye..         0336       6.0467      $358.87      $143.54       $71.77
73219*................  S..............  ...............  Mri upper extremity w/dye....         0284       6.3910      $379.31      $151.72       $75.86
73220*................  S..............  ...............  Mri uppr extremity w/o&w/dye.         0337       8.7547      $519.59      $207.83      $103.92
73221*................  S..............  ...............  Mri joint upr extrem w/o dye.         0336       6.0467      $358.87      $143.54       $71.77
73222*................  S..............  ...............  Mri joint upr extrem w/dye...         0284       6.3910      $379.31      $151.72       $75.86
73223*................  S..............  ...............  Mri joint upr extr w/o&w/dye.         0337       8.7547      $519.59      $207.83      $103.92
73225.................  E..............  ...............  Mr angio upr extr w/o&w/dye..  ...........  ...........  ...........  ...........  ...........
73500.................  X..............  ...............  X-ray exam of hip............         0260       0.7521       $44.64       $17.85        $8.93
73510.................  X..............  ...............  X-ray exam of hip............         0260       0.7521       $44.64       $17.85        $8.93
73520.................  X..............  ...............  X-ray exam of hips...........         0261       1.2843       $76.22  ...........       $15.24
73525.................  S..............  ...............  Contrast x-ray of hip........         0275       3.5617      $211.39       $69.09       $42.28
73530.................  X..............  ...............  X-ray exam of hip............         0261       1.2843       $76.22  ...........       $15.24
73540.................  X..............  ...............  X-ray exam of pelvis & hips..         0260       0.7521       $44.64       $17.85        $8.93
73542.................  S..............  ...............  X-ray exam, sacroiliac joint.         0275       3.5617      $211.39       $69.09       $42.28
73550.................  X..............  ...............  X-ray exam of thigh..........         0260       0.7521       $44.64       $17.85        $8.93
73560.................  X..............  ...............  X-ray exam of knee, 1 or 2...         0260       0.7521       $44.64       $17.85        $8.93
73562.................  X..............  ...............  X-ray exam of knee, 3........         0260       0.7521       $44.64       $17.85        $8.93
73564.................  X..............  ...............  X-ray exam, knee, 4 or more..         0260       0.7521       $44.64       $17.85        $8.93
73565.................  X..............  ...............  X-ray exam of knees..........         0260       0.7521       $44.64       $17.85        $8.93
73580.................  S..............  ...............  Contrast x-ray of knee joint.         0275       3.5617      $211.39       $69.09       $42.28
73590.................  X..............  ...............  X-ray exam of lower leg......         0260       0.7521       $44.64       $17.85        $8.93
73592.................  X..............  ...............  X-ray exam of leg, infant....         0260       0.7521       $44.64       $17.85        $8.93
73600.................  X..............  ...............  X-ray exam of ankle..........         0260       0.7521       $44.64       $17.85        $8.93
73610.................  X..............  ...............  X-ray exam of ankle..........         0260       0.7521       $44.64       $17.85        $8.93
73615.................  S..............  ...............  Contrast x-ray of ankle......         0275       3.5617      $211.39       $69.09       $42.28
73620.................  X..............  ...............  X-ray exam of foot...........         0260       0.7521       $44.64       $17.85        $8.93
73630.................  X..............  ...............  X-ray exam of foot...........         0260       0.7521       $44.64       $17.85        $8.93
73650.................  X..............  ...............  X-ray exam of heel...........         0260       0.7521       $44.64       $17.85        $8.93
73660.................  X..............  ...............  X-ray exam of toe(s).........         0260       0.7521       $44.64       $17.85        $8.93
73700*................  S..............  ...............  Ct lower extremity w/o dye...         0332       3.2546      $193.16       $77.26       $38.63
73701*................  S..............  ...............  Ct lower extremity w/dye.....         0283       4.4053      $261.45      $104.58       $52.29
73702*................  S..............  ...............  Ct lwr extremity w/o&w/dye...         0333       5.2596      $312.16      $124.86       $62.43
73706*................  S..............  ...............  Ct angio lwr extr w/o&w/dye..         0662       5.1387      $304.98      $121.99       $61.00
73718*................  S..............  ...............  Mri lower extremity w/o dye..         0336       6.0467      $358.87      $143.54       $71.77
73719*................  S..............  ...............  Mri lower extremity w/dye....         0284       6.3910      $379.31      $151.72       $75.86
73720*................  S..............  ...............  Mri lwr extremity w/o&w/dye..         0337       8.7547      $519.59      $207.83      $103.92
73721*................  S..............  ...............  Mri jnt of lwr extre w/o dye.         0336       6.0467      $358.87      $143.54       $71.77
73722*................  S..............  ...............  Mri joint of lwr extr w/dye..         0284       6.3910      $379.31      $151.72       $75.86
73723*................  S..............  ...............  Mri joint lwr extr w/o&w/dye.         0337       8.7547      $519.59      $207.83      $103.92
73725.................  B..............  ...............  Mr ang lwr ext w or w/o dye..  ...........  ...........  ...........  ...........  ...........
74000.................  X..............  ...............  X-ray exam of abdomen........         0260       0.7521       $44.64       $17.85        $8.93
74010.................  X..............  ...............  X-ray exam of abdomen........         0260       0.7521       $44.64       $17.85        $8.93
74020.................  X..............  ...............  X-ray exam of abdomen........         0260       0.7521       $44.64       $17.85        $8.93
74022.................  X..............  ...............  X-ray exam series, abdomen...         0261       1.2843       $76.22  ...........       $15.24
74150*................  S..............  ...............  Ct abdomen w/o dye...........         0332       3.2546      $193.16       $77.26       $38.63
74160*................  S..............  ...............  Ct abdomen w/dye.............         0283       4.4053      $261.45      $104.58       $52.29
74170*................  S..............  ...............  Ct abdomen w/o &w /dye.......         0333       5.2596      $312.16      $124.86       $62.43
74175*................  S..............  ...............  Ct angio abdom w/o & w/dye...         0662       5.1387      $304.98      $121.99       $61.00
74181*................  S..............  ...............  Mri abdomen w/o dye..........         0336       6.0467      $358.87      $143.54       $71.77
74182*................  S..............  ...............  Mri abdomen w/dye............         0284       6.3910      $379.31      $151.72       $75.86
74183*................  S..............  ...............  Mri abdomen w/o & w/dye......         0337       8.7547      $519.59      $207.83      $103.92
74185.................  B..............  ...............  Mri angio, abdom w orw/o dye.  ...........  ...........  ...........  ...........  ...........
74190.................  X..............  ...............  X-ray exam of peritoneum.....         0264       3.5080      $208.20       $79.41       $41.64
74210.................  S..............  ...............  Contrst x-ray exam of throat.         0276       1.5250       $90.51       $36.20       $18.10
74220.................  S..............  ...............  Contrast x-ray, esophagus....         0276       1.5250       $90.51       $36.20       $18.10
74230.................  S..............  ...............  Cine/vid x-ray, throat/esoph.         0276       1.5250       $90.51       $36.20       $18.10
74235.................  S..............  ...............  Remove esophagus obstruction.         0296       2.2350      $132.65       $53.06       $26.53
74240.................  S..............  ...............  X-ray exam, upper gi tract...         0276       1.5250       $90.51       $36.20       $18.10
74241.................  S..............  ...............  X-ray exam, upper gi tract...         0276       1.5250       $90.51       $36.20       $18.10
74245.................  S..............  ...............  X-ray exam, upper gi tract...         0277       2.3744      $140.92       $56.36       $28.18
74246.................  S..............  ...............  Contrst x-ray uppr gi tract..         0276       1.5250       $90.51       $36.20       $18.10
74247.................  S..............  ...............  Contrst x-ray uppr gi tract..         0276       1.5250       $90.51       $36.20       $18.10
74249.................  S..............  ...............  Contrst x-ray uppr gi tract..         0277       2.3744      $140.92       $56.36       $28.18

[[Page 42865]]

 
74250.................  S..............  ...............  X-ray exam of small bowel....         0276       1.5250       $90.51       $36.20       $18.10
74251.................  S..............  ...............  X-ray exam of small bowel....         0277       2.3744      $140.92       $56.36       $28.18
74260.................  S..............  ...............  X-ray exam of small bowel....         0277       2.3744      $140.92       $56.36       $28.18
74270.................  S..............  ...............  Contrast x-ray exam of colon.         0276       1.5250       $90.51       $36.20       $18.10
74280.................  S..............  ...............  Contrast x-ray exam of colon.         0277       2.3744      $140.92       $56.36       $28.18
74283.................  S..............  ...............  Contrast x-ray exam of colon.         0276       1.5250       $90.51       $36.20       $18.10
74290.................  S..............  ...............  Contrast x-ray, gallbladder..         0276       1.5250       $90.51       $36.20       $18.10
74291.................  S..............  ...............  Contrast x-rays, gallbladder.         0276       1.5250       $90.51       $36.20       $18.10
74300.................  X..............  ...............  X-ray bile ducts/pancreas....         0263       1.7397      $103.25       $24.29       $20.65
74301.................  X..............  ...............  X-rays at surgery add-on.....         0263       1.7397      $103.25       $24.29       $20.65
74305.................  X..............  ...............  X-ray bile ducts/pancreas....         0263       1.7397      $103.25       $24.29       $20.65
74320.................  X..............  ...............  Contrast x-ray of bile ducts.         0264       3.5080      $208.20       $79.41       $41.64
74327.................  S..............  ...............  X-ray bile stone removal.....         0296       2.2350      $132.65       $53.06       $26.53
74328.................  N..............  ...............  X-ray bile duct endoscopy....  ...........  ...........  ...........  ...........  ...........
74329.................  N..............  ...............  X-ray for pancreas endoscopy.  ...........  ...........  ...........  ...........  ...........
74330.................  N..............  ...............  X-ray bile/panc endoscopy....  ...........  ...........  ...........  ...........  ...........
74340.................  X..............  ...............  X-ray guide for GI tube......         0272       1.3738       $81.54       $32.61       $16.31
74350.................  X..............  ...............  X-ray guide, stomach tube....         0263       1.7397      $103.25       $24.29       $20.65
74355.................  X..............  ...............  X-ray guide, intestinal tube.         0263       1.7397      $103.25       $24.29       $20.65
74360.................  S..............  ...............  X-ray guide, GI dilation.....         0296       2.2350      $132.65       $53.06       $26.53
74363.................  S..............  ...............  X-ray, bile duct dilation....         0297       5.2293      $310.36      $122.13       $62.07
74400.................  S..............  ...............  Contrst x-ray, urinary tract.         0278       2.6314      $156.17       $62.46       $31.23
74410.................  S..............  ...............  Contrst x-ray, urinary tract.         0278       2.6314      $156.17       $62.46       $31.23
74415.................  S..............  ...............  Contrst x-ray, urinary tract.         0278       2.6314      $156.17       $62.46       $31.23
74420.................  S..............  ...............  Contrst x-ray, urinary tract.         0278       2.6314      $156.17       $62.46       $31.23
74425.................  S..............  ...............  Contrst x-ray, urinary tract.         0278       2.6314      $156.17       $62.46       $31.23
74430.................  S..............  ...............  Contrast x-ray, bladder......         0278       2.6314      $156.17       $62.46       $31.23
74440.................  S..............  ...............  X-ray, male genital tract....         0278       2.6314      $156.17       $62.46       $31.23
74445.................  S..............  ...............  X-ray exam of penis..........         0278       2.6314      $156.17       $62.46       $31.23
74450.................  S..............  ...............  X-ray, urethra/bladder.......         0278       2.6314      $156.17       $62.46       $31.23
74455.................  S..............  ...............  X-ray, urethra/bladder.......         0278       2.6314      $156.17       $62.46       $31.23
74470.................  X..............  ...............  X-ray exam of kidney lesion..         0263       1.7397      $103.25       $24.29       $20.65
74475.................  S..............  ...............  X-ray control, cath insert...         0297       5.2293      $310.36      $122.13       $62.07
74480.................  S..............  ...............  X-ray control, cath insert...         0296       2.2350      $132.65       $53.06       $26.53
74485.................  S..............  ...............  X-ray guide, GU dilation.....         0296       2.2350      $132.65       $53.06       $26.53
74710.................  X..............  ...............  X-ray measurement of pelvis..         0261       1.2843       $76.22  ...........       $15.24
74740.................  X..............  ...............  X-ray, female genital tract..         0264       3.5080      $208.20       $79.41       $41.64
74742.................  X..............  ...............  X-ray, fallopian tube........         0264       3.5080      $208.20       $79.41       $41.64
74775.................  S..............  ...............  X-ray exam of perineum.......         0278       2.6314      $156.17       $62.46       $31.23
75552.................  S..............  ...............  Heart mri for morph w/o dye..         0336       6.0467      $358.87      $143.54       $71.77
75553.................  S..............  ...............  Heart mri for morph w/dye....         0284       6.3910      $379.31      $151.72       $75.86
75554.................  S..............  ...............  Cardiac MRI/function.........         0336       6.0467      $358.87      $143.54       $71.77
75555.................  S..............  ...............  Cardiac MRI/limited study....         0336       6.0467      $358.87      $143.54       $71.77
75556.................  E..............  ...............  Cardiac MRI/flow mapping.....  ...........  ...........  ...........  ...........  ...........
75600.................  S..............  ...............  Contrast x-ray exam of aorta.         0280      20.6960    $1,228.31      $353.85      $245.66
75605.................  S..............  ...............  Contrast x-ray exam of aorta.         0280      20.6960    $1,228.31      $353.85      $245.66
75625.................  S..............  ...............  Contrast x-ray exam of aorta.         0280      20.6960    $1,228.31      $353.85      $245.66
75630.................  S..............  ...............  X-ray aorta, leg arteries....         0280      20.6960    $1,228.31      $353.85      $245.66
75635*................  S..............  ...............  Ct angio abdominal arteries..         0662       5.1387      $304.98      $121.99       $61.00
75650.................  S..............  ...............  Artery x-rays, head & neck...         0280      20.6960    $1,228.31      $353.85      $245.66
75658.................  S..............  ...............  Artery x-rays, arm...........         0279       8.8914      $527.70      $150.03      $105.54
75660.................  S..............  ...............  Artery x-rays, head & neck...         0668       6.4730      $384.17      $114.67       $76.83
75662.................  S..............  ...............  Artery x-rays, head & neck...         0280      20.6960    $1,228.31      $353.85      $245.66
75665.................  S..............  ...............  Artery x-rays, head & neck...         0280      20.6960    $1,228.31      $353.85      $245.66
75671.................  S..............  ...............  Artery x-rays, head & neck...         0280      20.6960    $1,228.31      $353.85      $245.66
75676.................  S..............  ...............  Artery x-rays, neck..........         0280      20.6960    $1,228.31      $353.85      $245.66
75680.................  S..............  ...............  Artery x-rays, neck..........         0280      20.6960    $1,228.31      $353.85      $245.66
75685.................  S..............  ...............  Artery x-rays, spine.........         0280      20.6960    $1,228.31      $353.85      $245.66
75705.................  S..............  ...............  Artery x-rays, spine.........         0668       6.4730      $384.17      $114.67       $76.83
75710.................  S..............  ...............  Artery x-rays, arm/leg.......         0280      20.6960    $1,228.31      $353.85      $245.66
75716.................  S..............  ...............  Artery x-rays, arms/legs.....         0280      20.6960    $1,228.31      $353.85      $245.66
75722.................  S..............  ...............  Artery x-rays, kidney........         0280      20.6960    $1,228.31      $353.85      $245.66
75724.................  S..............  ...............  Artery x-rays, kidneys.......         0280      20.6960    $1,228.31      $353.85      $245.66
75726.................  S..............  ...............  Artery x-rays, abdomen.......         0280      20.6960    $1,228.31      $353.85      $245.66
75731.................  S..............  ...............  Artery x-rays, adrenal gland.         0280      20.6960    $1,228.31      $353.85      $245.66
75733.................  S..............  ...............  Artery x-rays, adrenals......         0668       6.4730      $384.17      $114.67       $76.83

[[Page 42866]]

 
75736.................  S..............  ...............  Artery x-rays, pelvis........         0280      20.6960    $1,228.31      $353.85      $245.66
75741.................  S..............  ...............  Artery x-rays, lung..........         0279       8.8914      $527.70      $150.03      $105.54
75743.................  S..............  ...............  Artery x-rays, lungs.........         0280      20.6960    $1,228.31      $353.85      $245.66
75746.................  S..............  ...............  Artery x-rays, lung..........         0279       8.8914      $527.70      $150.03      $105.54
75756.................  S..............  ...............  Artery x-rays, chest.........         0279       8.8914      $527.70      $150.03      $105.54
75774.................  S..............  ...............  Artery x-ray, each vessel....         0279       8.8914      $527.70      $150.03      $105.54
75790.................  S..............  ...............  Visualize A-V shunt..........         0279       8.8914      $527.70      $150.03      $105.54
75801.................  X..............  ...............  Lymph vessel x-ray, arm/leg..         0264       3.5080      $208.20       $79.41       $41.64
75803.................  X..............  ...............  Lymph vessel x-ray,arms/legs.         0264       3.5080      $208.20       $79.41       $41.64
75805.................  X..............  ...............  Lymph vessel x-ray, trunk....         0264       3.5080      $208.20       $79.41       $41.64
75807.................  X..............  ...............  Lymph vessel x-ray, trunk....         0264       3.5080      $208.20       $79.41       $41.64
75809.................  X..............  ...............  Nonvascular shunt, x-ray.....         0263       1.7397      $103.25       $24.29       $20.65
75810.................  S..............  ...............  Vein x-ray, spleen/liver.....         0279       8.8914      $527.70      $150.03      $105.54
75820.................  S..............  ...............  Vein x-ray, arm/leg..........         0668       6.4730      $384.17      $114.67       $76.83
75822.................  S..............  ...............  Vein x-ray, arms/legs........         0668       6.4730      $384.17      $114.67       $76.83
75825.................  S..............  ...............  Vein x-ray, trunk............         0279       8.8914      $527.70      $150.03      $105.54
75827.................  S..............  ...............  Vein x-ray, chest............         0279       8.8914      $527.70      $150.03      $105.54
75831.................  S..............  ...............  Vein x-ray, kidney...........         0279       8.8914      $527.70      $150.03      $105.54
75833.................  S..............  ...............  Vein x-ray, kidneys..........         0279       8.8914      $527.70      $150.03      $105.54
75840.................  S..............  ...............  Vein x-ray, adrenal gland....         0280      20.6960    $1,228.31      $353.85      $245.66
75842.................  S..............  ...............  Vein x-ray, adrenal glands...         0280      20.6960    $1,228.31      $353.85      $245.66
75860.................  S..............  ...............  Vein x-ray, neck.............         0668       6.4730      $384.17      $114.67       $76.83
75870.................  S..............  ...............  Vein x-ray, skull............         0668       6.4730      $384.17      $114.67       $76.83
75872.................  S..............  ...............  Vein x-ray, skull............         0279       8.8914      $527.70      $150.03      $105.54
75880.................  S..............  ...............  Vein x-ray, eye socket.......         0668       6.4730      $384.17      $114.67       $76.83
75885.................  S..............  ...............  Vein x-ray, liver............         0280      20.6960    $1,228.31      $353.85      $245.66
75887.................  S..............  ...............  Vein x-ray, liver............         0279       8.8914      $527.70      $150.03      $105.54
75889.................  S..............  ...............  Vein x-ray, liver............         0280      20.6960    $1,228.31      $353.85      $245.66
75891.................  S..............  ...............  Vein x-ray, liver............         0279       8.8914      $527.70      $150.03      $105.54
75893.................  N..............  ...............  Venous sampling by catheter..  ...........  ...........  ...........  ...........  ...........
75894.................  S..............  ...............  X-rays, transcath therapy....         0297       5.2293      $310.36      $122.13       $62.07
75896.................  S..............  ...............  X-rays, transcath therapy....         0297       5.2293      $310.36      $122.13       $62.07
75898.................  X..............  ...............  Follow-up angiography........         0263       1.7397      $103.25       $24.29       $20.65
75900.................  C..............  ...............  Arterial catheter exchange...  ...........  ...........  ...........  ...........  ...........
75901.................  X..............  ...............  Remove cva device obstruct...         0263       1.7397      $103.25       $24.29       $20.65
75902.................  X..............  ...............  Remove cva lumen obstruct....         0263       1.7397      $103.25       $24.29       $20.65
75940.................  S..............  ...............  X-ray placement, vein filter.         0297       5.2293      $310.36      $122.13       $62.07
75945.................  S..............  ...............  Intravascular us.............         0267       2.6208      $155.54       $62.18       $31.11
75946.................  S..............  ...............  Intravascular us add-on......         0266       1.6319       $96.85       $38.74       $19.37
75952.................  C..............  ...............  Endovasc repair abdom aorta..  ...........  ...........  ...........  ...........  ...........
75953.................  C..............  ...............  Abdom aneurysm endovas rpr...  ...........  ...........  ...........  ...........  ...........
75954.................  C..............  ...............  Iliac aneurysm endovas rpr...  ...........  ...........  ...........  ...........  ...........
75960.................  S..............  ...............  Transcatheter intro, stent...         0668       6.4730      $384.17      $114.67       $76.83
75961.................  S..............  ...............  Retrieval, broken catheter...         0668       6.4730      $384.17      $114.67       $76.83
75962.................  S..............  ...............  Repair arterial blockage.....         0668       6.4730      $384.17      $114.67       $76.83
75964.................  S..............  ...............  Repair artery blockage, each.         0668       6.4730      $384.17      $114.67       $76.83
75966.................  S..............  ...............  Repair arterial blockage.....         0668       6.4730      $384.17      $114.67       $76.83
75968.................  S..............  ...............  Repair artery blockage, each.         0668       6.4730      $384.17      $114.67       $76.83
75970.................  S..............  ...............  Vascular biopsy..............         0668       6.4730      $384.17      $114.67       $76.83
75978.................  S..............  ...............  Repair venous blockage.......         0668       6.4730      $384.17      $114.67       $76.83
75980.................  S..............  ...............  Contrast xray exam bile duct.         0297       5.2293      $310.36      $122.13       $62.07
75982.................  S..............  ...............  Contrast xray exam bile duct.         0297       5.2293      $310.36      $122.13       $62.07
75984.................  X..............  ...............  Xray control catheter change.         0263       1.7397      $103.25       $24.29       $20.65
75989.................  N..............  ...............  Abscess drainage under x-ray.  ...........  ...........  ...........  ...........  ...........
75992.................  S..............  ...............  Atherectomy, x-ray exam......         0279       8.8914      $527.70      $150.03      $105.54
75993.................  S..............  ...............  Atherectomy, x-ray exam......         0279       8.8914      $527.70      $150.03      $105.54
75994.................  S..............  ...............  Atherectomy, x-ray exam......         0279       8.8914      $527.70      $150.03      $105.54
75995.................  S..............  ...............  Atherectomy, x-ray exam......         0279       8.8914      $527.70      $150.03      $105.54
75996.................  S..............  ...............  Atherectomy, x-ray exam......         0279       8.8914      $527.70      $150.03      $105.54
75998.................  N..............  ...............  Fluoroguide for vein device..  ...........  ...........  ...........  ...........  ...........
76000.................  X..............  ...............  Fluoroscope examination......         0272       1.3738       $81.54       $32.61       $16.31
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       0.7521       $44.64       $17.85        $8.93
76010.................  X..............  ...............  X-ray, nose to rectum........         0260       0.7521       $44.64       $17.85        $8.93

[[Page 42867]]

 
76012.................  S..............  ...............  Percut vertebroplasty fluor..         0274       3.0275      $179.68       $71.87       $35.94
76013.................  S..............  ...............  Percut vertebroplasty, ct....         0274       3.0275      $179.68       $71.87       $35.94
76020.................  X..............  ...............  X-rays for bone age..........         0260       0.7521       $44.64       $17.85        $8.93
76040.................  X..............  ...............  X-rays, bone evaluation......         0261       1.2843       $76.22  ...........       $15.24
76061.................  X..............  ...............  X-rays, bone survey..........         0261       1.2843       $76.22  ...........       $15.24
76062.................  X..............  ...............  X-rays, bone survey..........         0261       1.2843       $76.22  ...........       $15.24
76065.................  X..............  ...............  X-rays, bone evaluation......         0261       1.2843       $76.22  ...........       $15.24
76066.................  X..............  ...............  Joint survey, single view....         0260       0.7521       $44.64       $17.85        $8.93
76070.................  S..............  ...............  CT scan, bone density study..         0288       1.2511       $74.25  ...........       $14.85
76071.................  S..............  ...............  Ct bone density, peripheral..         0282       1.6467       $97.73       $39.09       $19.55
76075.................  S..............  ...............  Dexa, axial skeleton study...         0288       1.2511       $74.25  ...........       $14.85
76076.................  S..............  ...............  Dexa, peripheral study.......         0665       0.6435       $38.19  ...........        $7.64
76077.................  X..............  ...............  Dxa bone density/v-fracture..         0260       0.7521       $44.64       $17.85        $8.93
76078.................  X..............  ...............  Radiographic absorptiometry..         0260       0.7521       $44.64       $17.85        $8.93
76080.................  X..............  ...............  X-ray exam of fistula........         0263       1.7397      $103.25       $24.29       $20.65
76082.................  A..............  ...............  Computer mammogram add-on....  ...........  ...........  ...........  ...........  ...........
76083.................  A..............  ...............  Computer mammogram add-on....  ...........  ...........  ...........  ...........  ...........
76086.................  X..............  ...............  X-ray of mammary duct........         0263       1.7397      $103.25       $24.29       $20.65
76088.................  X..............  ...............  X-ray of mammary ducts.......         0263       1.7397      $103.25       $24.29       $20.65
76090.................  A..............  ...............  Mammogram, one breast........  ...........  ...........  ...........  ...........  ...........
76091.................  A..............  ...............  Mammogram, both breasts......  ...........  ...........  ...........  ...........  ...........
76092.................  A..............  ...............  Mammogram, screening.........  ...........  ...........  ...........  ...........  ...........
76093.................  E..............  ...............  Magnetic image, breast.......  ...........  ...........  ...........  ...........  ...........
76094.................  E..............  ...............  Magnetic image, both breasts.  ...........  ...........  ...........  ...........  ...........
76095.................  X..............  ...............  Stereotactic breast biopsy...         0264       3.5080      $208.20       $79.41       $41.64
76096.................  X..............  ...............  X-ray of needle wire, breast.         0263       1.7397      $103.25       $24.29       $20.65
76098.................  X..............  ...............  X-ray exam, breast specimen..         0260       0.7521       $44.64       $17.85        $8.93
76100.................  X..............  ...............  X-ray exam of body section...         0261       1.2843       $76.22  ...........       $15.24
76101.................  X..............  ...............  Complex body section x-ray...         0263       1.7397      $103.25       $24.29       $20.65
76102.................  X..............  ...............  Complex body section x-rays..         0264       3.5080      $208.20       $79.41       $41.64
76120.................  X..............  ...............  Cine/video x-rays............         0272       1.3738       $81.54       $32.61       $16.31
76125.................  X..............  ...............  Cine/video x-rays add-on.....         0260       0.7521       $44.64       $17.85        $8.93
76140.................  E..............  ...............  X-ray consultation...........  ...........  ...........  ...........  ...........  ...........
76150.................  X..............  ...............  X-ray exam, dry process......         0260       0.7521       $44.64       $17.85        $8.93
76350.................  N..............  ...............  Special x-ray contrast study.  ...........  ...........  ...........  ...........  ...........
76355.................  S..............  ...............  Ct scan for localization.....         0283       4.4053      $261.45      $104.58       $52.29
76360.................  S..............  ...............  Ct scan for needle biopsy....         0283       4.4053      $261.45      $104.58       $52.29
76362.................  S..............  ...............  Ct guide for tissue ablation.         0332       3.2546      $193.16       $77.26       $38.63
76370.................  S..............  ...............  Ct scan for therapy guide....         0282       1.6467       $97.73       $39.09       $19.55
76375.................  S..............  ...............  3d/holograph reconstr add-on.         0282       1.6467       $97.73       $39.09       $19.55
76380.................  S..............  ...............  CAT scan follow-up study.....         0282       1.6467       $97.73       $39.09       $19.55
76390.................  E..............  ...............  Mr spectroscopy..............  ...........  ...........  ...........  ...........  ...........
76393.................  S..............  ...............  Mr guidance for needle place.         0335       5.1347      $304.74      $121.89       $60.95
76394.................  S..............  ...............  Mri for tissue ablation......         0335       5.1347      $304.74      $121.89       $60.95
76400.................  S..............  ...............  Magnetic image, bone marrow..         0335       5.1347      $304.74      $121.89       $60.95
76496.................  X..............  ...............  Fluoroscopic procedure.......         0272       1.3738       $81.54       $32.61       $16.31
76497.................  S..............  ...............  Ct procedure.................         0282       1.6467       $97.73       $39.09       $19.55
76498.................  S..............  ...............  Mri procedure................         0335       5.1347      $304.74      $121.89       $60.95
76499.................  X..............  ...............  Radiographic procedure.......         0260       0.7521       $44.64       $17.85        $8.93
76506.................  S..............  ...............  Echo exam of head............         0265       1.0167       $60.34       $24.13       $12.07
76510.................  S..............  ...............  Ophth us, b & quant a........         0266       1.6319       $96.85       $38.74       $19.37
76511.................  S..............  ...............  Echo exam of eye.............         0266       1.6319       $96.85       $38.74       $19.37
76512.................  S..............  ...............  Echo exam of eye.............         0266       1.6319       $96.85       $38.74       $19.37
76513.................  S..............  ...............  Echo exam of eye, water bath.         0266       1.6319       $96.85       $38.74       $19.37
76514.................  X..............  ...............  Echo exam of eye, thickness..         0340       0.6355       $37.72  ...........        $7.54
76516.................  S..............  ...............  Echo exam of eye.............         0265       1.0167       $60.34       $24.13       $12.07
76519.................  S..............  ...............  Echo exam of eye.............         0266       1.6319       $96.85       $38.74       $19.37
76529.................  S..............  ...............  Echo exam of eye.............         0265       1.0167       $60.34       $24.13       $12.07
76536.................  S..............  ...............  Us exam of head and neck.....         0266       1.6319       $96.85       $38.74       $19.37
76604*................  S..............  ...............  Us exam, chest, b-scan.......         0266       1.6319       $96.85       $38.74       $19.37
76645*................  S..............  ...............  Us exam, breast(s)...........         0265       1.0167       $60.34       $24.13       $12.07
76700*................  S..............  ...............  Us exam, abdom, complete.....         0266       1.6319       $96.85       $38.74       $19.37
76705*................  S..............  ...............  Echo exam of abdomen.........         0266       1.6319       $96.85       $38.74       $19.37
76770*................  S..............  ...............  Us exam abdo back wall, comp.         0266       1.6319       $96.85       $38.74       $19.37
76775*................  S..............  ...............  Us exam abdo back wall, lim..         0266       1.6319       $96.85       $38.74       $19.37
76778*................  S..............  ...............  Us exam kidney transplant....         0266       1.6319       $96.85       $38.74       $19.37

[[Page 42868]]

 
76800.................  S..............  ...............  Us exam, spinal canal........         0266       1.6319       $96.85       $38.74       $19.37
76801.................  S..............  ...............  Ob us < 14 wks, single fetus.         0266       1.6319       $96.85       $38.74       $19.37
76802.................  S..............  ...............  Ob us < 14 wks, add'l fetus..         0265       1.0167       $60.34       $24.13       $12.07
76805.................  S..............  ...............  Us exam, pg uterus, compl....         0266       1.6319       $96.85       $38.74       $19.37
76810.................  S..............  ...............  Us exam, pg uterus, mult.....         0266       1.6319       $96.85       $38.74       $19.37
76811.................  S..............  ...............  Ob us, detailed, sngl fetus..         0267       2.6208      $155.54       $62.18       $31.11
76812.................  S..............  ...............  Ob us, detailed, addl fetus..         0266       1.6319       $96.85       $38.74       $19.37
76815.................  S..............  ...............  Us exam, pg uterus limit.....         0265       1.0167       $60.34       $24.13       $12.07
76816.................  S..............  ...............  Us exam pg uterus repeat.....         0265       1.0167       $60.34       $24.13       $12.07
76817.................  S..............  ...............  Transvaginal us, obstetric...         0266       1.6319       $96.85       $38.74       $19.37
76818.................  S..............  ...............  Fetal biophys profile w/nst..         0266       1.6319       $96.85       $38.74       $19.37
76819.................  S..............  ...............  Fetal biophys profil w/o nst.         0266       1.6319       $96.85       $38.74       $19.37
76820.................  S..............  ...............  Umbilical artery echo........         0096       1.6233       $96.34       $38.53       $19.27
76821.................  S..............  ...............  Middle cerebral artery echo..         0096       1.6233       $96.34       $38.53       $19.27
76825.................  S..............  ...............  Echo exam of fetal heart.....         0671       1.6951      $100.60       $40.24       $20.12
76826.................  S..............  ...............  Echo exam of fetal heart.....         0697       1.5288       $90.73       $36.29       $18.15
76827.................  S..............  ...............  Echo exam of fetal heart.....         0671       1.6951      $100.60       $40.24       $20.12
76828.................  S..............  ...............  Echo exam of fetal heart.....         0697       1.5288       $90.73       $36.29       $18.15
76830*................  S..............  ...............  Transvaginal us, non-ob......         0266       1.6319       $96.85       $38.74       $19.37
76831*................  S..............  ...............  Echo exam, uterus............         0267       2.6208      $155.54       $62.18       $31.11
76856*................  S..............  ...............  Us exam, pelvic, complete....         0266       1.6319       $96.85       $38.74       $19.37
76857*................  S..............  ...............  Us exam, pelvic, limited.....         0265       1.0167       $60.34       $24.13       $12.07
76870.................  S..............  ...............  Us exam, scrotum.............         0266       1.6319       $96.85       $38.74       $19.37
76872.................  S..............  ...............  Us, transrectal..............         0266       1.6319       $96.85       $38.74       $19.37
76873.................  S..............  ...............  Echograp trans r, pros study.         0266       1.6319       $96.85       $38.74       $19.37
76880.................  S..............  ...............  Us exam, extremity...........         0266       1.6319       $96.85       $38.74       $19.37
76885.................  S..............  ...............  Us exam infant hips, dynamic.         0265       1.0167       $60.34       $24.13       $12.07
76886.................  S..............  ...............  Us exam infant hips, static..         0266       1.6319       $96.85       $38.74       $19.37
76930.................  S..............  ...............  Echo guide, cardiocentesis...         0268       1.0562       $62.69  ...........       $12.54
76932.................  S..............  ...............  Echo guide for heart biopsy..         0268       1.0562       $62.69  ...........       $12.54
76936.................  S..............  ...............  Echo guide for artery repair.         0268       1.0562       $62.69  ...........       $12.54
76937.................  N..............  ...............  Us guide, vascular access....  ...........  ...........  ...........  ...........  ...........
76940.................  S..............  ...............  Us guide, tissue ablation....         0268       1.0562       $62.69  ...........       $12.54
76941.................  S..............  ...............  Echo guide for transfusion...         0268       1.0562       $62.69  ...........       $12.54
76942.................  S..............  ...............  Echo guide for biopsy........         0268       1.0562       $62.69  ...........       $12.54
76945.................  S..............  ...............  Echo guide, villus sampling..         0268       1.0562       $62.69  ...........       $12.54
76946.................  S..............  ...............  Echo guide for amniocentesis.         0268       1.0562       $62.69  ...........       $12.54
76948.................  S..............  ...............  Echo guide, ova aspiration...         0268       1.0562       $62.69  ...........       $12.54
76950.................  S..............  ...............  Echo guidance radiotherapy...         0268       1.0562       $62.69  ...........       $12.54
76965.................  S..............  ...............  Echo guidance radiotherapy...         0268       1.0562       $62.69  ...........       $12.54
76970.................  S..............  ...............  Ultrasound exam follow-up....         0265       1.0167       $60.34       $24.13       $12.07
76975.................  S..............  ...............  GI endoscopic ultrasound.....         0266       1.6319       $96.85       $38.74       $19.37
76977.................  X..............  ...............  Us bone density measure......         0340       0.6355       $37.72  ...........        $7.54
76986.................  S..............  ...............  Ultrasound guide intraoper...         0266       1.6319       $96.85       $38.74       $19.37
76999.................  S..............  ...............  Echo examination procedure...         0265       1.0167       $60.34       $24.13       $12.07
77261.................  E..............  ...............  Radiation therapy planning...  ...........  ...........  ...........  ...........  ...........
77262.................  E..............  ...............  Radiation therapy planning...  ...........  ...........  ...........  ...........  ...........
77263.................  E..............  ...............  Radiation therapy planning...  ...........  ...........  ...........  ...........  ...........
77280.................  X..............  ...............  Set radiation therapy field..         0304       1.7658      $104.80       $41.52       $20.96
77285.................  X..............  ...............  Set radiation therapy field..         0305       3.9854      $236.53       $91.38       $47.31
77290.................  X..............  ...............  Set radiation therapy field..         0305       3.9854      $236.53       $91.38       $47.31
77295.................  X..............  ...............  Set radiation therapy field..         0310      13.8858      $824.12      $325.27      $164.82
77299.................  E..............  ...............  Radiation therapy planning...  ...........  ...........  ...........  ...........  ...........
77300.................  X..............  ...............  Radiation therapy dose plan..         0304       1.7658      $104.80       $41.52       $20.96
77301.................  X..............  ...............  Radiotherapy dose plan, imrt.         0310      13.8858      $824.12      $325.27      $164.82
77305.................  X..............  ...............  Teletx isodose plan simple...         0304       1.7658      $104.80       $41.52       $20.96
77310.................  X..............  ...............  Teletx isodose plan intermed.         0305       3.9854      $236.53       $91.38       $47.31
77315.................  X..............  ...............  Teletx isodose plan complex..         0305       3.9854      $236.53       $91.38       $47.31
77321.................  X..............  ...............  Special teletx port plan.....         0305       3.9854      $236.53       $91.38       $47.31
77326.................  X..............  ...............  Radiation therapy dose plan..         0304       1.7658      $104.80       $41.52       $20.96
77327.................  X..............  ...............  Brachytx isodose calc interm.         0305       3.9854      $236.53       $91.38       $47.31
77328.................  X..............  ...............  Brachytx isodose plan compl..         0305       3.9854      $236.53       $91.38       $47.31
77331.................  X..............  ...............  Special radiation dosimetry..         0304       1.7658      $104.80       $41.52       $20.96
77332.................  X..............  ...............  Radiation treatment aid(s)...         0303       2.8228      $167.53       $66.95       $33.51
77333.................  X..............  ...............  Radiation treatment aid(s)...         0303       2.8228      $167.53       $66.95       $33.51
77334.................  X..............  ...............  Radiation treatment aid(s)...         0303       2.8228      $167.53       $66.95       $33.51

[[Page 42869]]

 
77336.................  X..............  ...............  Radiation physics consult....         0304       1.7658      $104.80       $41.52       $20.96
77370.................  X..............  ...............  Radiation physics consult....         0304       1.7658      $104.80       $41.52       $20.96
77399.................  X..............  ...............  External radiation dosimetry.         0304       1.7658      $104.80       $41.52       $20.96
77401.................  S..............  ...............  Radiation treatment delivery.         0300       1.5129       $89.79  ...........       $17.96
77402.................  S..............  ...............  Radiation treatment delivery.         0300       1.5129       $89.79  ...........       $17.96
77403.................  S..............  ...............  Radiation treatment delivery.         0300       1.5129       $89.79  ...........       $17.96
77404.................  S..............  ...............  Radiation treatment delivery.         0300       1.5129       $89.79  ...........       $17.96
77406.................  S..............  ...............  Radiation treatment delivery.         0300       1.5129       $89.79  ...........       $17.96
77407.................  S..............  ...............  Radiation treatment delivery.         0300       1.5129       $89.79  ...........       $17.96
77408.................  S..............  ...............  Radiation treatment delivery.         0300       1.5129       $89.79  ...........       $17.96
77409.................  S..............  ...............  Radiation treatment delivery.         0300       1.5129       $89.79  ...........       $17.96
77411.................  S..............  ...............  Radiation treatment delivery.         0301       2.2094      $131.13  ...........       $26.23
77412.................  S..............  ...............  Radiation treatment delivery.         0301       2.2094      $131.13  ...........       $26.23
77413.................  S..............  ...............  Radiation treatment delivery.         0301       2.2094      $131.13  ...........       $26.23
77414.................  S..............  ...............  Radiation treatment delivery.         0301       2.2094      $131.13  ...........       $26.23
77416.................  S..............  ...............  Radiation treatment delivery.         0301       2.2094      $131.13  ...........       $26.23
77417.................  X..............  ...............  Radiology port film(s).......         0260       0.7521       $44.64       $17.85        $8.93
77418.................  S..............  ...............  Radiation tx delivery, imrt..         0412       5.3400      $316.93  ...........       $63.39
77427.................  E..............  ...............  Radiation tx management, x5..  ...........  ...........  ...........  ...........  ...........
77431.................  E..............  ...............  Radiation therapy management.  ...........  ...........  ...........  ...........  ...........
77432.................  E..............  ...............  Stereotactic radiation trmt..  ...........  ...........  ...........  ...........  ...........
77470.................  S..............  ...............  Special radiation treatment..         0299       5.8217      $345.52  ...........       $69.10
77499.................  E..............  ...............  Radiation therapy management.  ...........  ...........  ...........  ...........  ...........
77520.................  S..............  ...............  Proton trmt, simple w/o comp.         0664      12.8853      $764.74  ...........      $152.95
77522.................  S..............  ...............  Proton trmt, simple w/comp...         0664      12.8853      $764.74  ...........      $152.95
77523.................  S..............  ...............  Proton trmt, intermediate....         0667      15.4156      $914.92  ...........      $182.98
77525.................  S..............  ...............  Proton treatment, complex....         0667      15.4156      $914.92  ...........      $182.98
77600.................  S..............  ...............  Hyperthermia treatment.......         0314       5.9674      $354.17       $98.36       $70.83
77605.................  S..............  ...............  Hyperthermia treatment.......         0314       5.9674      $354.17       $98.36       $70.83
77610.................  S..............  ...............  Hyperthermia treatment.......         0314       5.9674      $354.17       $98.36       $70.83
77615.................  S..............  ...............  Hyperthermia treatment.......         0314       5.9674      $354.17       $98.36       $70.83
77620.................  S..............  ...............  Hyperthermia treatment.......         0314       5.9674      $354.17       $98.36       $70.83
77750.................  S..............  ...............  Infuse radioactive materials.         0301       2.2094      $131.13  ...........       $26.23
77761.................  S..............  ...............  Apply intrcav radiat simple..         0312       4.9806      $295.60  ...........       $59.12
77762.................  S..............  ...............  Apply intrcav radiat interm..         0312       4.9806      $295.60  ...........       $59.12
77763.................  S..............  ...............  Apply intrcav radiat compl...         0312       4.9806      $295.60  ...........       $59.12
77776.................  S..............  ...............  Apply interstit radiat simpl.         0312       4.9806      $295.60  ...........       $59.12
77777.................  S..............  ...............  Apply interstit radiat inter.         0312       4.9806      $295.60  ...........       $59.12
77778.................  S..............  ...............  Apply interstit radiat compl.         0651      12.0898      $717.53  ...........      $143.51
77781.................  S..............  ...............  High intensity brachytherapy.         0313      12.8072      $760.11  ...........      $152.02
77782.................  S..............  ...............  High intensity brachytherapy.         0313      12.8072      $760.11  ...........      $152.02
77783.................  S..............  ...............  High intensity brachytherapy.         0313      12.8072      $760.11  ...........      $152.02
77784.................  S..............  ...............  High intensity brachytherapy.         0313      12.8072      $760.11  ...........      $152.02
77789.................  S..............  ...............  Apply surface radiation......         0300       1.5129       $89.79  ...........       $17.96
77790.................  N..............  ...............  Radiation handling...........  ...........  ...........  ...........  ...........  ...........
77799.................  S..............  ...............  Radium/radioisotope therapy..         0313      12.8072      $760.11  ...........      $152.02
78000.................  S..............  ...............  Thyroid, single uptake.......         0389       1.4908       $88.48       $35.39       $17.70
78001.................  S..............  ...............  Thyroid, multiple uptakes....         0389       1.4908       $88.48       $35.39       $17.70
78003.................  S..............  ...............  Thyroid suppress/stimul......         0389       1.4908       $88.48       $35.39       $17.70
78006.................  S..............  ...............  Thyroid imaging with uptake..         0390       2.5446      $151.02       $60.40       $30.20
78007.................  S..............  ...............  Thyroid image, mult uptakes..         0391       2.8643      $170.00       $68.00       $34.00
78010.................  S..............  ...............  Thyroid imaging..............         0390       2.5446      $151.02       $60.40       $30.20
78011.................  S..............  ...............  Thyroid imaging with flow....         0390       2.5446      $151.02       $60.40       $30.20
78015.................  S..............  ...............  Thyroid met imaging..........         0406       4.2840      $254.26      $101.70       $50.85
78016.................  S..............  ...............  Thyroid met imaging/studies..         0406       4.2840      $254.26      $101.70       $50.85
78018.................  S..............  ...............  Thyroid met imaging, body....         0406       4.2840      $254.26      $101.70       $50.85
78020.................  S..............  ...............  Thyroid met uptake...........         0399       1.5123       $89.76       $35.90       $17.95
78070.................  S..............  ...............  Parathyroid nuclear imaging..         0391       2.8643      $170.00       $68.00       $34.00
78075.................  S..............  ...............  Adrenal nuclear imaging......         0391       2.8643      $170.00       $68.00       $34.00
78099.................  S..............  ...............  Endocrine nuclear procedure..         0390       2.5446      $151.02       $60.40       $30.20
78102.................  S..............  ...............  Bone marrow imaging, ltd.....         0400       4.1147      $244.21       $97.68       $48.84
78103.................  S..............  ...............  Bone marrow imaging, mult....         0400       4.1147      $244.21       $97.68       $48.84
78104.................  S..............  ...............  Bone marrow imaging, body....         0400       4.1147      $244.21       $97.68       $48.84
78110.................  S..............  ...............  Plasma volume, single........         0393       3.4282      $203.46       $81.38       $40.69
78111.................  S..............  ...............  Plasma volume, multiple......         0393       3.4282      $203.46       $81.38       $40.69
78120.................  S..............  ...............  Red cell mass, single........         0393       3.4282      $203.46       $81.38       $40.69

[[Page 42870]]

 
78121.................  S..............  ...............  Red cell mass, multiple......         0393       3.4282      $203.46       $81.38       $40.69
78122.................  S..............  ...............  Blood volume.................         0393       3.4282      $203.46       $81.38       $40.69
78130.................  S..............  ...............  Red cell survival study......         0393       3.4282      $203.46       $81.38       $40.69
78135.................  S..............  ...............  Red cell survival kinetics...         0393       3.4282      $203.46       $81.38       $40.69
78140.................  S..............  ...............  Red cell sequestration.......         0393       3.4282      $203.46       $81.38       $40.69
78160.................  S..............  ...............  Plasma iron turnover.........         0393       3.4282      $203.46       $81.38       $40.69
78162.................  S..............  ...............  Radioiron absorption exam....         0393       3.4282      $203.46       $81.38       $40.69
78170.................  S..............  ...............  Red cell iron utilization....         0393       3.4282      $203.46       $81.38       $40.69
78172.................  S..............  ...............  Total body iron estimation...         0393       3.4282      $203.46       $81.38       $40.69
78185.................  S..............  ...............  Spleen imaging...............         0400       4.1147      $244.21       $97.68       $48.84
78190.................  S..............  ...............  Platelet survival, kinetics..         0389       1.4908       $88.48       $35.39       $17.70
78191.................  S..............  ...............  Platelet survival............         0389       1.4908       $88.48       $35.39       $17.70
78195.................  S..............  ...............  Lymph system imaging.........         0400       4.1147      $244.21       $97.68       $48.84
78199.................  S..............  ...............  Blood/lymph nuclear exam.....         0400       4.1147      $244.21       $97.68       $48.84
78201.................  S..............  ...............  Liver imaging................         0394       4.4428      $263.68      $105.47       $52.74
78202.................  S..............  ...............  Liver imaging with flow......         0394       4.4428      $263.68      $105.47       $52.74
78205.................  S..............  ...............  Liver imaging (3D)...........         0394       4.4428      $263.68      $105.47       $52.74
78206.................  S..............  ...............  Liver image (3d) with flow...         0394       4.4428      $263.68      $105.47       $52.74
78215.................  S..............  ...............  Liver and spleen imaging.....         0394       4.4428      $263.68      $105.47       $52.74
78216.................  S..............  ...............  Liver & spleen image/flow....         0394       4.4428      $263.68      $105.47       $52.74
78220.................  S..............  ...............  Liver function study.........         0394       4.4428      $263.68      $105.47       $52.74
78223.................  S..............  ...............  Hepatobiliary imaging........         0394       4.4428      $263.68      $105.47       $52.74
78230.................  S..............  ...............  Salivary gland imaging.......         0395       3.8523      $228.63       $91.45       $45.73
78231.................  S..............  ...............  Serial salivary imaging......         0395       3.8523      $228.63       $91.45       $45.73
78232.................  S..............  ...............  Salivary gland function exam.         0395       3.8523      $228.63       $91.45       $45.73
78258.................  S..............  ...............  Esophageal motility study....         0395       3.8523      $228.63       $91.45       $45.73
78261.................  S..............  ...............  Gastric mucosa imaging.......         0395       3.8523      $228.63       $91.45       $45.73
78262.................  S..............  ...............  Gastroesophageal reflux exam.         0395       3.8523      $228.63       $91.45       $45.73
78264.................  S..............  ...............  Gastric emptying study.......         0395       3.8523      $228.63       $91.45       $45.73
78267.................  A..............  ...............  Breath tst attain/anal c-14..  ...........  ...........  ...........  ...........  ...........
78268.................  A..............  ...............  Breath test analysis, c-14...  ...........  ...........  ...........  ...........  ...........
78270.................  S..............  ...............  Vit B-12 absorption exam.....         0389       1.4908       $88.48       $35.39       $17.70
78271.................  S..............  ...............  Vit b-12 absrp exam, int fac.         0389       1.4908       $88.48       $35.39       $17.70
78272.................  S..............  ...............  Vit B-12 absorp, combined....         0389       1.4908       $88.48       $35.39       $17.70
78278.................  S..............  ...............  Acute GI blood loss imaging..         0395       3.8523      $228.63       $91.45       $45.73
78282.................  S..............  ...............  GI protein loss exam.........         0395       3.8523      $228.63       $91.45       $45.73
78290.................  S..............  ...............  Meckel?s divert exam.........         0395       3.8523      $228.63       $91.45       $45.73
78291.................  S..............  ...............  Leveen/shunt patency exam....         0395       3.8523      $228.63       $91.45       $45.73
78299.................  S..............  ...............  GI nuclear procedure.........         0395       3.8523      $228.63       $91.45       $45.73
78300.................  S..............  ...............  Bone imaging, limited area...         0396       4.1238      $244.75       $97.90       $48.95
78305.................  S..............  ...............  Bone imaging, multiple areas.         0396       4.1238      $244.75       $97.90       $48.95
78306.................  S..............  ...............  Bone imaging, whole body.....         0396       4.1238      $244.75       $97.90       $48.95
78315.................  S..............  ...............  Bone imaging, 3 phase........         0396       4.1238      $244.75       $97.90       $48.95
78320.................  S..............  ...............  Bone imaging (3D)............         0396       4.1238      $244.75       $97.90       $48.95
78350.................  X..............  ...............  Bone mineral, single photon..         0260       0.7521       $44.64       $17.85        $8.93
78351.................  E..............  ...............  Bone mineral, dual photon....  ...........  ...........  ...........  ...........  ...........
78399.................  S..............  ...............  Musculoskeletal nuclear exam.         0396       4.1238      $244.75       $97.90       $48.95
78414.................  S..............  ...............  Non-imaging heart function...         0398       4.2898      $254.60      $101.84       $50.92
78428.................  S..............  ...............  Cardiac shunt imaging........         0398       4.2898      $254.60      $101.84       $50.92
78445.................  S..............  ...............  Vascular flow imaging........         0397       2.2543      $133.79       $53.51       $26.76
78455.................  S..............  ...............  Venous thrombosis study......         0397       2.2543      $133.79       $53.51       $26.76
78456.................  S..............  ...............  Acute venous thrombus image..         0397       2.2543      $133.79       $53.51       $26.76
78457.................  S..............  ...............  Venous thrombosis imaging....         0397       2.2543      $133.79       $53.51       $26.76
78458.................  S..............  ...............  Ven thrombosis images, bilat.         0397       2.2543      $133.79       $53.51       $26.76
78459.................  S..............  ...............  Heart muscle imaging (PET)...         0285      17.1020    $1,015.00      $318.72      $203.00
78460.................  S..............  ...............  Heart muscle blood, single...         0398       4.2898      $254.60      $101.84       $50.92
78461.................  S..............  ...............  Heart muscle blood, multiple.         0377       6.8034      $403.78      $161.51       $80.76
78464.................  S..............  ...............  Heart image (3d), single.....         0398       4.2898      $254.60      $101.84       $50.92
78465.................  S..............  ...............  Heart image (3d), multiple...         0377       6.8034      $403.78      $161.51       $80.76
78466.................  S..............  ...............  Heart infarct image..........         0398       4.2898      $254.60      $101.84       $50.92
78468.................  S..............  ...............  Heart infarct image (ef).....         0398       4.2898      $254.60      $101.84       $50.92
78469.................  S..............  ...............  Heart infarct image (3D).....         0398       4.2898      $254.60      $101.84       $50.92
78472.................  S..............  ...............  Gated heart, planar, single..         0398       4.2898      $254.60      $101.84       $50.92
78473.................  S..............  ...............  Gated heart, multiple........         0376       5.1740      $307.08      $121.42       $61.42
78478.................  S..............  ...............  Heart wall motion add-on.....         0399       1.5123       $89.76       $35.90       $17.95
78480.................  S..............  ...............  Heart function add-on........         0399       1.5123       $89.76       $35.90       $17.95

[[Page 42871]]

 
78481.................  S..............  ...............  Heart first pass, single.....         0398       4.2898      $254.60      $101.84       $50.92
78483.................  S..............  ...............  Heart first pass, multiple...         0376       5.1740      $307.08      $121.42       $61.42
78491.................  S..............  ...............  Heart image (pet), single....         0285      17.1020    $1,015.00      $318.72      $203.00
78492.................  S..............  ...............  Heart image (pet), multiple..         0285      17.1020    $1,015.00      $318.72      $203.00
78494.................  S..............  ...............  Heart image, spect...........         0398       4.2898      $254.60      $101.84       $50.92
78496.................  S..............  ...............  Heart first pass add-on......         0399       1.5123       $89.76       $35.90       $17.95
78499.................  S..............  ...............  Cardiovascular nuclear exam..         0398       4.2898      $254.60      $101.84       $50.92
78580.................  S..............  ...............  Lung perfusion imaging.......         0401       3.3995      $201.76       $80.70       $40.35
78584.................  S..............  ...............  Lung V/Q image single breath.         0378       5.4748      $324.93      $129.97       $64.99
78585.................  S..............  ...............  Lung V/Q imaging.............         0378       5.4748      $324.93      $129.97       $64.99
78586.................  S..............  ...............  Aerosol lung image, single...         0401       3.3995      $201.76       $80.70       $40.35
78587.................  S..............  ...............  Aerosol lung image, multiple.         0401       3.3995      $201.76       $80.70       $40.35
78588.................  S..............  ...............  Perfusion lung image.........         0378       5.4748      $324.93      $129.97       $64.99
78591.................  S..............  ...............  Vent image, 1 breath, 1 proj.         0401       3.3995      $201.76       $80.70       $40.35
78593.................  S..............  ...............  Vent image, 1 proj, gas......         0401       3.3995      $201.76       $80.70       $40.35
78594.................  S..............  ...............  Vent image, mult proj, gas...         0401       3.3995      $201.76       $80.70       $40.35
78596.................  S..............  ...............  Lung differential function...         0378       5.4748      $324.93      $129.97       $64.99
78599.................  S..............  ...............  Respiratory nuclear exam.....         0401       3.3995      $201.76       $80.70       $40.35
78600.................  S..............  ...............  Brain imaging, ltd static....         0402       5.1612      $306.32      $122.52       $61.26
78601.................  S..............  ...............  Brain imaging, ltd w/flow....         0402       5.1612      $306.32      $122.52       $61.26
78605.................  S..............  ...............  Brain imaging, complete......         0402       5.1612      $306.32      $122.52       $61.26
78606.................  S..............  ...............  Brain imaging, compl w/flow..         0402       5.1612      $306.32      $122.52       $61.26
78607.................  S..............  ...............  Brain imaging (3D)...........         0402       5.1612      $306.32      $122.52       $61.26
78608.................  S..............  ...............  Brain imaging (PET)..........         1513  ...........    $1,150.00  ...........      $230.00
78609.................  S..............  ...............  Brain imaging (PET)..........         1513  ...........    $1,150.00  ...........      $230.00
78610.................  S..............  ...............  Brain flow imaging only......         0402       5.1612      $306.32      $122.52       $61.26
78615.................  S..............  ...............  Cerebral vascular flow image.         0402       5.1612      $306.32      $122.52       $61.26
78630.................  S..............  ...............  Cerebrospinal fluid scan.....         0403       3.5974      $213.51       $85.40       $42.70
78635.................  S..............  ...............  CSF ventriculography.........         0403       3.5974      $213.51       $85.40       $42.70
78645.................  S..............  ...............  CSF shunt evaluation.........         0403       3.5974      $213.51       $85.40       $42.70
78647.................  S..............  ...............  Cerebrospinal fluid scan.....         0403       3.5974      $213.51       $85.40       $42.70
78650.................  S..............  ...............  CSF leakage imaging..........         0403       3.5974      $213.51       $85.40       $42.70
78660.................  S..............  ...............  Nuclear exam of tear flow....         0403       3.5974      $213.51       $85.40       $42.70
78699.................  S..............  ...............  Nervous system nuclear exam..         0402       5.1612      $306.32      $122.52       $61.26
78700.................  S..............  ...............  Kidney imaging, static.......         0267       2.6208      $155.54       $62.18       $31.11
78701.................  S..............  ...............  Kidney imaging with flow.....         0404       3.8385      $227.81       $91.12       $45.56
78704.................  S..............  ...............  Imaging renogram.............         0404       3.8385      $227.81       $91.12       $45.56
78707.................  S..............  ...............  Kidney flow/function image...         0404       3.8385      $227.81       $91.12       $45.56
78708.................  S..............  ...............  Kidney flow/function image...         0405       4.2480      $252.12      $100.84       $50.42
78709.................  S..............  ...............  Kidney flow/function image...         0405       4.2480      $252.12      $100.84       $50.42
78710.................  S..............  ...............  Kidney imaging (3D)..........         0404       3.8385      $227.81       $91.12       $45.56
78715.................  S..............  ...............  Renal vascular flow exam.....         0404       3.8385      $227.81       $91.12       $45.56
78725.................  S..............  ...............  Kidney function study........         0389       1.4908       $88.48       $35.39       $17.70
78730.................  X..............  ...............  Urinary bladder retention....         0340       0.6355       $37.72  ...........        $7.54
78740.................  S..............  ...............  Ureteral reflux study........         0404       3.8385      $227.81       $91.12       $45.56
78760.................  S..............  ...............  Testicular imaging...........         0404       3.8385      $227.81       $91.12       $45.56
78761.................  S..............  ...............  Testicular imaging/flow......         0404       3.8385      $227.81       $91.12       $45.56
78799.................  S..............  ...............  Genitourinary nuclear exam...         0404       3.8385      $227.81       $91.12       $45.56
78800.................  S..............  ...............  Tumor imaging, limited area..         0406       4.2840      $254.26      $101.70       $50.85
78801.................  S..............  ...............  Tumor imaging, mult areas....         0406       4.2840      $254.26      $101.70       $50.85
78802.................  S..............  ...............  Tumor imaging, whole body....         0406       4.2840      $254.26      $101.70       $50.85
78803.................  S..............  ...............  Tumor imaging (3D)...........         0406       4.2840      $254.26      $101.70       $50.85
78804.................  S..............  ...............  Tumor imaging, whole body....         1508  ...........      $650.00  ...........      $130.00
78805.................  S..............  ...............  Abscess imaging, ltd area....         0406       4.2840      $254.26      $101.70       $50.85
78806.................  S..............  ...............  Abscess imaging, whole body..         0406       4.2840      $254.26      $101.70       $50.85
78807.................  S..............  ...............  Nuclear localization/abscess.         0406       4.2840      $254.26      $101.70       $50.85
78811.................  S..............  ...............  Tumor imaging (pet), limited.         1513  ...........    $1,150.00  ...........      $230.00
78812.................  S..............  ...............  Tumor image (pet)/skul-thigh.         1513  ...........    $1,150.00  ...........      $230.00
78813.................  S..............  ...............  Tumor image (pet) full body..         1513  ...........    $1,150.00  ...........      $230.00
78814.................  S..............  ...............  Tumor image pet/ct, limited..         1513  ...........    $1,150.00  ...........      $230.00
78815.................  S..............  ...............  Tumorimage pet/ct skul-thigh.         1513  ...........    $1,150.00  ...........      $230.00
78816.................  S..............  ...............  Tumor image pet/ct full body.         1513  ...........    $1,150.00  ...........      $230.00
78890.................  N..............  ...............  Nuclear medicine data proc...  ...........  ...........  ...........  ...........  ...........
78891.................  N..............  ...............  Nuclear med data proc........  ...........  ...........  ...........  ...........  ...........
78999.................  S..............  ...............  Nuclear diagnostic exam......         0389       1.4908       $88.48       $35.39       $17.70
79005.................  S..............  ...............  Nuclear rx, oral admin.......         0407       3.9659      $235.38       $94.15       $47.08

[[Page 42872]]

 
79101.................  S..............  ...............  Nuclear rx, iv admin.........         0407       3.9659      $235.38       $94.15       $47.08
79200.................  S..............  ...............  Intracavitary nuclear trmt...         0407       3.9659      $235.38       $94.15       $47.08
79300.................  S..............  ...............  Interstitial nuclear therapy.         0407       3.9659      $235.38       $94.15       $47.08
79403.................  S..............  ...............  Hematopoetic nuclear therapy.         1507  ...........      $550.00  ...........      $110.00
79440.................  S..............  ...............  Nuclear joint therapy........         0407       3.9659      $235.38       $94.15       $47.08
79445.................  S..............  ...............  Nuclear rx, intra-arterial...         0407       3.9659      $235.38       $94.15       $47.08
79999.................  S..............  ...............  Nuclear medicine therapy.....         0407       3.9659      $235.38       $94.15       $47.08
80048.................  A..............  ...............  Basic metabolic panel........  ...........  ...........  ...........  ...........  ...........
80050.................  E..............  ...............  General health panel.........  ...........  ...........  ...........  ...........  ...........
80051.................  A..............  ...............  Electrolyte panel............  ...........  ...........  ...........  ...........  ...........
80053.................  A..............  ...............  Comprehen metabolic panel....  ...........  ...........  ...........  ...........  ...........
80055.................  E..............  ...............  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.........  ...........  ...........  ...........  ...........  ...........
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.....  ...........  ...........  ...........  ...........  ...........

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80426.................  A..............  ...............  Gonadotropin hormone panel...  ...........  ...........  ...........  ...........  ...........
80428.................  A..............  ...............  Growth hormone panel.........  ...........  ...........  ...........  ...........  ...........
80430.................  A..............  ...............  Growth hormone panel.........  ...........  ...........  ...........  ...........  ...........
80432.................  A..............  ...............  Insulin suppression panel....  ...........  ...........  ...........  ...........  ...........
80434.................  A..............  ...............  Insulin tolerance panel......  ...........  ...........  ...........  ...........  ...........
80435.................  A..............  ...............  Insulin tolerance panel......  ...........  ...........  ...........  ...........  ...........
80436.................  A..............  ...............  Metyrapone panel.............  ...........  ...........  ...........  ...........  ...........
80438.................  A..............  ...............  TRH stimulation panel........  ...........  ...........  ...........  ...........  ...........
80439.................  A..............  ...............  TRH stimulation panel........  ...........  ...........  ...........  ...........  ...........
80440.................  A..............  ...............  TRH stimulation panel........  ...........  ...........  ...........  ...........  ...........
80500.................  X..............  ...............  Lab pathology consultation...         0433       0.2569       $15.25        $6.10        $3.05
80502.................  X..............  ...............  Lab pathology consultation...         0342       0.1553        $9.22        $3.68        $1.84
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......  ...........  ...........  ...........  ...........  ...........
82045.................  A..............  ...............  Albumin, ischemia modified...  ...........  ...........  ...........  ...........  ...........
82055.................  A..............  ...............  Assay of ethanol.............  ...........  ...........  ...........  ...........  ...........
82075.................  A..............  ...............  Assay of breath ethanol......  ...........  ...........  ...........  ...........  ...........
82085.................  A..............  ...............  Assay of aldolase............  ...........  ...........  ...........  ...........  ...........
82088.................  A..............  ...............  Assay of aldosterone.........  ...........  ...........  ...........  ...........  ...........
82101.................  A..............  ...............  Assay of urine alkaloids.....  ...........  ...........  ...........  ...........  ...........
82103.................  A..............  ...............  Alpha-1-antitrypsin, total...  ...........  ...........  ...........  ...........  ...........
82104.................  A..............  ...............  Alpha-1-antitrypsin, pheno...  ...........  ...........  ...........  ...........  ...........
82105.................  A..............  ...............  Alpha-fetoprotein, serum.....  ...........  ...........  ...........  ...........  ...........
82106.................  A..............  ...............  Alpha-fetoprotein, amniotic..  ...........  ...........  ...........  ...........  ...........
82108.................  A..............  ...............  Assay of aluminum............  ...........  ...........  ...........  ...........  ...........
82120.................  A..............  ...............  Amines, vaginal fluid qual...  ...........  ...........  ...........  ...........  ...........
82127.................  A..............  ...............  Amino acid, single qual......  ...........  ...........  ...........  ...........  ...........
82128.................  A..............  ...............  Amino acids, mult qual.......  ...........  ...........  ...........  ...........  ...........
82131.................  A..............  ...............  Amino acids, single quant....  ...........  ...........  ...........  ...........  ...........
82135.................  A..............  ...............  Assay, aminolevulinic acid...  ...........  ...........  ...........  ...........  ...........
82136.................  A..............  ...............  Amino acids, quant, 2-5......  ...........  ...........  ...........  ...........  ...........
82139.................  A..............  ...............  Amino acids, quan, 6 or more.  ...........  ...........  ...........  ...........  ...........
82140.................  A..............  ...............  Assay of ammonia.............  ...........  ...........  ...........  ...........  ...........
82143.................  A..............  ...............  Amniotic fluid scan..........  ...........  ...........  ...........  ...........  ...........
82145.................  A..............  ...............  Assay of amphetamines........  ...........  ...........  ...........  ...........  ...........
82150.................  A..............  ...............  Assay of amylase.............  ...........  ...........  ...........  ...........  ...........
82154.................  A..............  ...............  Androstanediol glucuronide...  ...........  ...........  ...........  ...........  ...........
82157.................  A..............  ...............  Assay of androstenedione.....  ...........  ...........  ...........  ...........  ...........
82160.................  A..............  ...............  Assay of androsterone........  ...........  ...........  ...........  ...........  ...........
82163.................  A..............  ...............  Assay of angiotensin II......  ...........  ...........  ...........  ...........  ...........
82164.................  A..............  ...............  Angiotensin I enzyme test....  ...........  ...........  ...........  ...........  ...........
82172.................  A..............  ...............  Assay of apolipoprotein......  ...........  ...........  ...........  ...........  ...........
82175.................  A..............  ...............  Assay of arsenic.............  ...........  ...........  ...........  ...........  ...........
82180.................  A..............  ...............  Assay of ascorbic acid.......  ...........  ...........  ...........  ...........  ...........

[[Page 42874]]

 
82190.................  A..............  ...............  Atomic absorption............  ...........  ...........  ...........  ...........  ...........
82205.................  A..............  ...............  Assay of barbiturates........  ...........  ...........  ...........  ...........  ...........
82232.................  A..............  ...............  Assay of beta-2 protein......  ...........  ...........  ...........  ...........  ...........
82239.................  A..............  ...............  Bile acids, total............  ...........  ...........  ...........  ...........  ...........
82240.................  A..............  ...............  Bile acids, cholylglycine....  ...........  ...........  ...........  ...........  ...........
82247.................  A..............  ...............  Bilirubin, total.............  ...........  ...........  ...........  ...........  ...........
82248.................  A..............  ...............  Bilirubin, direct............  ...........  ...........  ...........  ...........  ...........
82252.................  A..............  ...............  Fecal bilirubin test.........  ...........  ...........  ...........  ...........  ...........
82261.................  A..............  ...............  Assay of biotinidase.........  ...........  ...........  ...........  ...........  ...........
82270.................  A..............  ...............  Test for blood, feces........  ...........  ...........  ...........  ...........  ...........
82273.................  A..............  ...............  Test for blood, other source.  ...........  ...........  ...........  ...........  ...........
82274.................  A..............  ...............  Assay test for blood, fecal..  ...........  ...........  ...........  ...........  ...........
82286.................  A..............  ...............  Assay of bradykinin..........  ...........  ...........  ...........  ...........  ...........
82300.................  A..............  ...............  Assay of cadmium.............  ...........  ...........  ...........  ...........  ...........
82306.................  A..............  ...............  Assay of vitamin D...........  ...........  ...........  ...........  ...........  ...........
82307.................  A..............  ...............  Assay of vitamin D...........  ...........  ...........  ...........  ...........  ...........
82308.................  A..............  ...............  Assay of calcitonin..........  ...........  ...........  ...........  ...........  ...........
82310.................  A..............  ...............  Assay of calcium.............  ...........  ...........  ...........  ...........  ...........
82330.................  A..............  ...............  Assay of calcium.............  ...........  ...........  ...........  ...........  ...........
82331.................  A..............  ...............  Calcium infusion test........  ...........  ...........  ...........  ...........  ...........
82340.................  A..............  ...............  Assay of calcium in urine....  ...........  ...........  ...........  ...........  ...........
82355.................  A..............  ...............  Calculus analysis, qual......  ...........  ...........  ...........  ...........  ...........
82360.................  A..............  ...............  Calculus assay, quant........  ...........  ...........  ...........  ...........  ...........
82365.................  A..............  ...............  Calculus spectroscopy........  ...........  ...........  ...........  ...........  ...........
82370.................  A..............  ...............  X-ray assay, calculus........  ...........  ...........  ...........  ...........  ...........
82373.................  A..............  ...............  Assay, c-d transfer measure..  ...........  ...........  ...........  ...........  ...........
82374.................  A..............  ...............  Assay, blood carbon dioxide..  ...........  ...........  ...........  ...........  ...........
82375.................  A..............  ...............  Assay, blood carbon monoxide.  ...........  ...........  ...........  ...........  ...........
82376.................  A..............  ...............  Test for carbon monoxide.....  ...........  ...........  ...........  ...........  ...........
82378.................  A..............  ...............  Carcinoembryonic antigen.....  ...........  ...........  ...........  ...........  ...........
82379.................  A..............  ...............  Assay of carnitine...........  ...........  ...........  ...........  ...........  ...........
82380.................  A..............  ...............  Assay of carotene............  ...........  ...........  ...........  ...........  ...........
82382.................  A..............  ...............  Assay, urine catecholamines..  ...........  ...........  ...........  ...........  ...........
82383.................  A..............  ...............  Assay, blood catecholamines..  ...........  ...........  ...........  ...........  ...........
82384.................  A..............  ...............  Assay, three catecholamines..  ...........  ...........  ...........  ...........  ...........
82387.................  A..............  ...............  Assay of cathepsin-d.........  ...........  ...........  ...........  ...........  ...........
82390.................  A..............  ...............  Assay of ceruloplasmin.......  ...........  ...........  ...........  ...........  ...........
82397.................  A..............  ...............  Chemiluminescent assay.......  ...........  ...........  ...........  ...........  ...........
82415.................  A..............  ...............  Assay of chloramphenicol.....  ...........  ...........  ...........  ...........  ...........
82435.................  A..............  ...............  Assay of blood chloride......  ...........  ...........  ...........  ...........  ...........
82436.................  A..............  ...............  Assay of urine chloride......  ...........  ...........  ...........  ...........  ...........
82438.................  A..............  ...............  Assay, other fluid chlorides.  ...........  ...........  ...........  ...........  ...........
82441.................  A..............  ...............  Test for chlorohydrocarbons..  ...........  ...........  ...........  ...........  ...........
82465.................  A..............  ...............  Assay, bld/serum cholesterol.  ...........  ...........  ...........  ...........  ...........
82480.................  A..............  ...............  Assay, serum cholinesterase..  ...........  ...........  ...........  ...........  ...........
82482.................  A..............  ...............  Assay, rbc cholinesterase....  ...........  ...........  ...........  ...........  ...........
82485.................  A..............  ...............  Assay, chondroitin sulfate...  ...........  ...........  ...........  ...........  ...........
82486.................  A..............  ...............  Gas/liquid chromatography....  ...........  ...........  ...........  ...........  ...........
82487.................  A..............  ...............  Paper chromatography.........  ...........  ...........  ...........  ...........  ...........
82488.................  A..............  ...............  Paper chromatography.........  ...........  ...........  ...........  ...........  ...........
82489.................  A..............  ...............  Thin layer chromatography....  ...........  ...........  ...........  ...........  ...........
82491.................  A..............  ...............  Chromotography, quant, sing..  ...........  ...........  ...........  ...........  ...........
82492.................  A..............  ...............  Chromotography, quant, mult..  ...........  ...........  ...........  ...........  ...........
82495.................  A..............  ...............  Assay of chromium............  ...........  ...........  ...........  ...........  ...........
82507.................  A..............  ...............  Assay of citrate.............  ...........  ...........  ...........  ...........  ...........
82520.................  A..............  ...............  Assay of cocaine.............  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42875]]

 
82550.................  A..............  ...............  Assay of ck (cpk)............  ...........  ...........  ...........  ...........  ...........
82552.................  A..............  ...............  Assay of cpk in blood........  ...........  ...........  ...........  ...........  ...........
82553.................  A..............  ...............  Creatine, MB fraction........  ...........  ...........  ...........  ...........  ...........
82554.................  A..............  ...............  Creatine, isoforms...........  ...........  ...........  ...........  ...........  ...........
82565.................  A..............  ...............  Assay of creatinine..........  ...........  ...........  ...........  ...........  ...........
82570.................  A..............  ...............  Assay of urine creatinine....  ...........  ...........  ...........  ...........  ...........
82575.................  A..............  ...............  Creatinine clearance test....  ...........  ...........  ...........  ...........  ...........
82585.................  A..............  ...............  Assay of cryofibrinogen......  ...........  ...........  ...........  ...........  ...........
82595.................  A..............  ...............  Assay of cryoglobulin........  ...........  ...........  ...........  ...........  ...........
82600.................  A..............  ...............  Assay of cyanide.............  ...........  ...........  ...........  ...........  ...........
82607.................  A..............  ...............  Vitamin B-12.................  ...........  ...........  ...........  ...........  ...........
82608.................  A..............  ...............  B-12 binding capacity........  ...........  ...........  ...........  ...........  ...........
82615.................  A..............  ...............  Test for urine cystines......  ...........  ...........  ...........  ...........  ...........
82626.................  A..............  ...............  Dehydroepiandrosterone.......  ...........  ...........  ...........  ...........  ...........
82627.................  A..............  ...............  Dehydroepiandrosterone.......  ...........  ...........  ...........  ...........  ...........
82633.................  A..............  ...............  Desoxycorticosterone.........  ...........  ...........  ...........  ...........  ...........
82634.................  A..............  ...............  Deoxycortisol................  ...........  ...........  ...........  ...........  ...........
82638.................  A..............  ...............  Assay of dibucaine number....  ...........  ...........  ...........  ...........  ...........
82646.................  A..............  ...............  Assay of dihydrocodeinone....  ...........  ...........  ...........  ...........  ...........
82649.................  A..............  ...............  Assay of dihydromorphinone...  ...........  ...........  ...........  ...........  ...........
82651.................  A..............  ...............  Assay of dihydrotestosterone.  ...........  ...........  ...........  ...........  ...........
82652.................  A..............  ...............  Assay of dihydroxyvitamin d..  ...........  ...........  ...........  ...........  ...........
82654.................  A..............  ...............  Assay of dimethadione........  ...........  ...........  ...........  ...........  ...........
82656.................  A..............  ...............  Pancreatic elastase, fecal...  ...........  ...........  ...........  ...........  ...........
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........  ...........  ...........  ...........  ...........  ...........
82938.................  A..............  ...............  Gastrin test.................  ...........  ...........  ...........  ...........  ...........
82941.................  A..............  ...............  Assay of gastrin.............  ...........  ...........  ...........  ...........  ...........
82943.................  A..............  ...............  Assay of glucagon............  ...........  ...........  ...........  ...........  ...........

[[Page 42876]]

 
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...........  ...........  ...........  ...........  ...........  ...........
83009.................  A..............  ...............  H pylori (c-13), blood.......  ...........  ...........  ...........  ...........  ...........
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..........  ...........  ...........  ...........  ...........  ...........

[[Page 42877]]

 
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.........  ...........  ...........  ...........  ...........  ...........
83630.................  A..............  ...............  Lactoferrin, fecal (qual)....  ...........  ...........  ...........  ...........  ...........
83632.................  A..............  ...............  Placental lactogen...........  ...........  ...........  ...........  ...........  ...........
83633.................  A..............  ...............  Test urine for lactose.......  ...........  ...........  ...........  ...........  ...........
83634.................  A..............  ...............  Assay of urine for lactose...  ...........  ...........  ...........  ...........  ...........
83655.................  A..............  ...............  Assay of lead................  ...........  ...........  ...........  ...........  ...........
83661.................  A..............  ...............  L/s ratio, fetal lung........  ...........  ...........  ...........  ...........  ...........
83662.................  A..............  ...............  Foam stability, fetal lung...  ...........  ...........  ...........  ...........  ...........
83663.................  A..............  ...............  Fluoro polarize, fetal lung..  ...........  ...........  ...........  ...........  ...........
83664.................  A..............  ...............  Lamellar bdy, fetal lung.....  ...........  ...........  ...........  ...........  ...........
83670.................  A..............  ...............  Assay of lap enzyme..........  ...........  ...........  ...........  ...........  ...........
83690.................  A..............  ...............  Assay of lipase..............  ...........  ...........  ...........  ...........  ...........
83715.................  A..............  ...............  Assay of blood lipoproteins..  ...........  ...........  ...........  ...........  ...........
83716.................  A..............  ...............  Assay of blood lipoproteins..  ...........  ...........  ...........  ...........  ...........
83718.................  A..............  ...............  Assay of lipoprotein.........  ...........  ...........  ...........  ...........  ...........
83719.................  A..............  ...............  Assay of blood lipoprotein...  ...........  ...........  ...........  ...........  ...........
83721.................  A..............  ...............  Assay of blood lipoprotein...  ...........  ...........  ...........  ...........  ...........
83727.................  A..............  ...............  Assay of lrh hormone.........  ...........  ...........  ...........  ...........  ...........
83735.................  A..............  ...............  Assay of magnesium...........  ...........  ...........  ...........  ...........  ...........
83775.................  A..............  ...............  Assay of md enzyme...........  ...........  ...........  ...........  ...........  ...........
83785.................  A..............  ...............  Assay of manganese...........  ...........  ...........  ...........  ...........  ...........
83788.................  A..............  ...............  Mass spectrometry qual.......  ...........  ...........  ...........  ...........  ...........
83789.................  A..............  ...............  Mass spectrometry quant......  ...........  ...........  ...........  ...........  ...........
83805.................  A..............  ...............  Assay of meprobamate.........  ...........  ...........  ...........  ...........  ...........
83825.................  A..............  ...............  Assay of mercury.............  ...........  ...........  ...........  ...........  ...........
83835.................  A..............  ...............  Assay of metanephrines.......  ...........  ...........  ...........  ...........  ...........
83840.................  A..............  ...............  Assay of methadone...........  ...........  ...........  ...........  ...........  ...........
83857.................  A..............  ...............  Assay of methemalbumin.......  ...........  ...........  ...........  ...........  ...........
83858.................  A..............  ...............  Assay of methsuximide........  ...........  ...........  ...........  ...........  ...........
83864.................  A..............  ...............  Mucopolysaccharides..........  ...........  ...........  ...........  ...........  ...........
83866.................  A..............  ...............  Mucopolysaccharides screen...  ...........  ...........  ...........  ...........  ...........
83872.................  A..............  ...............  Assay synovial fluid mucin...  ...........  ...........  ...........  ...........  ...........
83873.................  A..............  ...............  Assay of csf protein.........  ...........  ...........  ...........  ...........  ...........
83874.................  A..............  ...............  Assay of myoglobin...........  ...........  ...........  ...........  ...........  ...........
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....  ...........  ...........  ...........  ...........  ...........

[[Page 42878]]

 
83937.................  A..............  ...............  Assay of osteocalcin.........  ...........  ...........  ...........  ...........  ...........
83945.................  A..............  ...............  Assay of oxalate.............  ...........  ...........  ...........  ...........  ...........
83950.................  A..............  ...............  Oncoprotein, her-2/neu.......  ...........  ...........  ...........  ...........  ...........
83970.................  A..............  ...............  Assay of parathormone........  ...........  ...........  ...........  ...........  ...........
83986.................  A..............  ...............  Assay of body fluid acidity..  ...........  ...........  ...........  ...........  ...........
83992.................  A..............  ...............  Assay for phencyclidine......  ...........  ...........  ...........  ...........  ...........
84022.................  A..............  ...............  Assay of phenothiazine.......  ...........  ...........  ...........  ...........  ...........
84030.................  A..............  ...............  Assay of blood pku...........  ...........  ...........  ...........  ...........  ...........
84035.................  A..............  ...............  Assay of phenylketones.......  ...........  ...........  ...........  ...........  ...........
84060.................  A..............  ...............  Assay acid phosphatase.......  ...........  ...........  ...........  ...........  ...........
84061.................  A..............  ...............  Phosphatase, forensic exam...  ...........  ...........  ...........  ...........  ...........
84066.................  A..............  ...............  Assay prostate phosphatase...  ...........  ...........  ...........  ...........  ...........
84075.................  A..............  ...............  Assay alkaline phosphatase...  ...........  ...........  ...........  ...........  ...........
84078.................  A..............  ...............  Assay alkaline phosphatase...  ...........  ...........  ...........  ...........  ...........
84080.................  A..............  ...............  Assay alkaline phosphatases..  ...........  ...........  ...........  ...........  ...........
84081.................  A..............  ...............  Amniotic fluid enzyme test...  ...........  ...........  ...........  ...........  ...........
84085.................  A..............  ...............  Assay of rbc pg6d enzyme.....  ...........  ...........  ...........  ...........  ...........
84087.................  A..............  ...............  Assay phosphohexose enzymes..  ...........  ...........  ...........  ...........  ...........
84100.................  A..............  ...............  Assay of phosphorus..........  ...........  ...........  ...........  ...........  ...........
84105.................  A..............  ...............  Assay of urine phosphorus....  ...........  ...........  ...........  ...........  ...........
84106.................  A..............  ...............  Test for porphobilinogen.....  ...........  ...........  ...........  ...........  ...........
84110.................  A..............  ...............  Assay of porphobilinogen.....  ...........  ...........  ...........  ...........  ...........
84119.................  A..............  ...............  Test urine for porphyrins....  ...........  ...........  ...........  ...........  ...........
84120.................  A..............  ...............  Assay of urine porphyrins....  ...........  ...........  ...........  ...........  ...........
84126.................  A..............  ...............  Assay of feces porphyrins....  ...........  ...........  ...........  ...........  ...........
84127.................  A..............  ...............  Assay of feces porphyrins....  ...........  ...........  ...........  ...........  ...........
84132.................  A..............  ...............  Assay of serum potassium.....  ...........  ...........  ...........  ...........  ...........
84133.................  A..............  ...............  Assay of urine potassium.....  ...........  ...........  ...........  ...........  ...........
84134.................  A..............  ...............  Assay of prealbumin..........  ...........  ...........  ...........  ...........  ...........
84135.................  A..............  ...............  Assay of pregnanediol........  ...........  ...........  ...........  ...........  ...........
84138.................  A..............  ...............  Assay of pregnanetriol.......  ...........  ...........  ...........  ...........  ...........
84140.................  A..............  ...............  Assay of pregnenolone........  ...........  ...........  ...........  ...........  ...........
84143.................  A..............  ...............  Assay of 17-hydroxypregneno..  ...........  ...........  ...........  ...........  ...........
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..............  ...............  Assay of protein, urine......  ...........  ...........  ...........  ...........  ...........
84157.................  A..............  ...............  Assay of protein, other......  ...........  ...........  ...........  ...........  ...........
84160.................  A..............  ...............  Assay of protein, any source.  ...........  ...........  ...........  ...........  ...........
84163.................  A..............  ...............  Pappa, serum.................  ...........  ...........  ...........  ...........  ...........
84165.................  A..............  ...............  Electrophoreisis of proteins.  ...........  ...........  ...........  ...........  ...........
84166.................  A..............  ...............  Protein e-phoresis/urine/csf.  ...........  ...........  ...........  ...........  ...........
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..............  ...........  ...........  ...........  ...........  ...........

[[Page 42879]]

 
84295.................  A..............  ...............  Assay of serum sodium........  ...........  ...........  ...........  ...........  ...........
84300.................  A..............  ...............  Assay of urine sodium........  ...........  ...........  ...........  ...........  ...........
84302.................  A..............  ...............  Assay of sweat sodium........  ...........  ...........  ...........  ...........  ...........
84305.................  A..............  ...............  Assay of somatomedin.........  ...........  ...........  ...........  ...........  ...........
84307.................  A..............  ...............  Assay of somatostatin........  ...........  ...........  ...........  ...........  ...........
84311.................  A..............  ...............  Spectrophotometry............  ...........  ...........  ...........  ...........  ...........
84315.................  A..............  ...............  Body fluid specific gravity..  ...........  ...........  ...........  ...........  ...........
84375.................  A..............  ...............  Chromatogram assay, sugars...  ...........  ...........  ...........  ...........  ...........
84376.................  A..............  ...............  Sugars, single, qual.........  ...........  ...........  ...........  ...........  ...........
84377.................  A..............  ...............  Sugars, multiple, qual.......  ...........  ...........  ...........  ...........  ...........
84378.................  A..............  ...............  Sugars, single, quant........  ...........  ...........  ...........  ...........  ...........
84379.................  A..............  ...............  Sugars multiple quant........  ...........  ...........  ...........  ...........  ...........
84392.................  A..............  ...............  Assay of urine sulfate.......  ...........  ...........  ...........  ...........  ...........
84402.................  A..............  ...............  Assay of testosterone........  ...........  ...........  ...........  ...........  ...........
84403.................  A..............  ...............  Assay of total testosterone..  ...........  ...........  ...........  ...........  ...........
84425.................  A..............  ...............  Assay of vitamin b-1.........  ...........  ...........  ...........  ...........  ...........
84430.................  A..............  ...............  Assay of thiocyanate.........  ...........  ...........  ...........  ...........  ...........
84432.................  A..............  ...............  Assay of thyroglobulin.......  ...........  ...........  ...........  ...........  ...........
84436.................  A..............  ...............  Assay of total thyroxine.....  ...........  ...........  ...........  ...........  ...........
84437.................  A..............  ...............  Assay of neonatal thyroxine..  ...........  ...........  ...........  ...........  ...........
84439.................  A..............  ...............  Assay of free thyroxine......  ...........  ...........  ...........  ...........  ...........
84442.................  A..............  ...............  Assay of thyroid activity....  ...........  ...........  ...........  ...........  ...........
84443.................  A..............  ...............  Assay thyroid stim hormone...  ...........  ...........  ...........  ...........  ...........
84445.................  A..............  ...............  Assay of tsi.................  ...........  ...........  ...........  ...........  ...........
84446.................  A..............  ...............  Assay of vitamin e...........  ...........  ...........  ...........  ...........  ...........
84449.................  A..............  ...............  Assay of transcortin.........  ...........  ...........  ...........  ...........  ...........
84450.................  A..............  ...............  Transferase (AST) (SGOT).....  ...........  ...........  ...........  ...........  ...........
84460.................  A..............  ...............  Alanine amino (ALT) (SGPT)...  ...........  ...........  ...........  ...........  ...........
84466.................  A..............  ...............  Assay of transferrin.........  ...........  ...........  ...........  ...........  ...........
84478.................  A..............  ...............  Assay of triglycerides.......  ...........  ...........  ...........  ...........  ...........
84479.................  A..............  ...............  Assay of thyroid (t3 or t4)..  ...........  ...........  ...........  ...........  ...........
84480.................  A..............  ...............  Assay, triiodothyronine (t3).  ...........  ...........  ...........  ...........  ...........
84481.................  A..............  ...............  Free assay (FT-3)............  ...........  ...........  ...........  ...........  ...........
84482.................  A..............  ...............  T3 reverse...................  ...........  ...........  ...........  ...........  ...........
84484.................  A..............  ...............  Assay of troponin, quant.....  ...........  ...........  ...........  ...........  ...........
84485.................  A..............  ...............  Assay duodenal fluid trypsin.  ...........  ...........  ...........  ...........  ...........
84488.................  A..............  ...............  Test feces for trypsin.......  ...........  ...........  ...........  ...........  ...........
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.....  ...........  ...........  ...........  ...........  ...........

[[Page 42880]]

 
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..............  ...............  Reticulated platelet assay...  ...........  ...........  ...........  ...........  ...........
85060.................  B..............  ...............  Blood smear interpretation...  ...........  ...........  ...........  ...........  ...........
85097.................  X..............  ...............  Bone marrow interpretation...         0343       0.4764       $28.27       $11.10        $5.65
85130.................  A..............  ...............  Chromogenic substrate assay..  ...........  ...........  ...........  ...........  ...........
85170.................  A..............  ...............  Blood clot retraction........  ...........  ...........  ...........  ...........  ...........
85175.................  A..............  ...............  Blood clot lysis time........  ...........  ...........  ...........  ...........  ...........
85210.................  A..............  ...............  Blood clot factor II test....  ...........  ...........  ...........  ...........  ...........
85220.................  A..............  ...............  Blood clot factor V test.....  ...........  ...........  ...........  ...........  ...........
85230.................  A..............  ...............  Blood clot factor VII test...  ...........  ...........  ...........  ...........  ...........
85240.................  A..............  ...............  Blood clot factor VIII test..  ...........  ...........  ...........  ...........  ...........
85244.................  A..............  ...............  Blood clot factor VIII test..  ...........  ...........  ...........  ...........  ...........
85245.................  A..............  ...............  Blood clot factor VIII test..  ...........  ...........  ...........  ...........  ...........
85246.................  A..............  ...............  Blood clot factor VIII test..  ...........  ...........  ...........  ...........  ...........
85247.................  A..............  ...............  Blood clot factor VIII test..  ...........  ...........  ...........  ...........  ...........
85250.................  A..............  ...............  Blood clot factor IX test....  ...........  ...........  ...........  ...........  ...........
85260.................  A..............  ...............  Blood clot factor X test.....  ...........  ...........  ...........  ...........  ...........
85270.................  A..............  ...............  Blood clot factor XI test....  ...........  ...........  ...........  ...........  ...........
85280.................  A..............  ...............  Blood clot factor XII test...  ...........  ...........  ...........  ...........  ...........
85290.................  A..............  ...............  Blood clot factor XIII test..  ...........  ...........  ...........  ...........  ...........
85291.................  A..............  ...............  Blood clot factor XIII test..  ...........  ...........  ...........  ...........  ...........
85292.................  A..............  ...............  Blood clot factor assay......  ...........  ...........  ...........  ...........  ...........
85293.................  A..............  ...............  Blood clot factor assay......  ...........  ...........  ...........  ...........  ...........
85300.................  A..............  ...............  Antithrombin III test........  ...........  ...........  ...........  ...........  ...........
85301.................  A..............  ...............  Antithrombin III test........  ...........  ...........  ...........  ...........  ...........
85302.................  A..............  ...............  Blood clot inhibitor antigen.  ...........  ...........  ...........  ...........  ...........
85303.................  A..............  ...............  Blood clot inhibitor test....  ...........  ...........  ...........  ...........  ...........
85305.................  A..............  ...............  Blood clot inhibitor assay...  ...........  ...........  ...........  ...........  ...........
85306.................  A..............  ...............  Blood clot inhibitor test....  ...........  ...........  ...........  ...........  ...........
85307.................  A..............  ...............  Assay activated protein c....  ...........  ...........  ...........  ...........  ...........
85335.................  A..............  ...............  Factor inhibitor test........  ...........  ...........  ...........  ...........  ...........
85337.................  A..............  ...............  Thrombomodulin...............  ...........  ...........  ...........  ...........  ...........
85345.................  A..............  ...............  Coagulation time.............  ...........  ...........  ...........  ...........  ...........
85347.................  A..............  ...............  Coagulation time.............  ...........  ...........  ...........  ...........  ...........
85348.................  A..............  ...............  Coagulation time.............  ...........  ...........  ...........  ...........  ...........
85360.................  A..............  ...............  Euglobulin lysis.............  ...........  ...........  ...........  ...........  ...........
85362.................  A..............  ...............  Fibrin degradation products..  ...........  ...........  ...........  ...........  ...........
85366.................  A..............  ...............  Fibrinogen test..............  ...........  ...........  ...........  ...........  ...........
85370.................  A..............  ...............  Fibrinogen test..............  ...........  ...........  ...........  ...........  ...........
85378.................  A..............  ...............  Fibrin degradation...........  ...........  ...........  ...........  ...........  ...........
85379.................  A..............  ...............  Fibrin degradation, quant....  ...........  ...........  ...........  ...........  ...........
85380.................  A..............  ...............  Fibrin degradation, vte......  ...........  ...........  ...........  ...........  ...........
85384.................  A..............  ...............  Fibrinogen...................  ...........  ...........  ...........  ...........  ...........
85385.................  A..............  ...............  Fibrinogen...................  ...........  ...........  ...........  ...........  ...........
85390.................  A..............  ...............  Fibrinolysins screen.........  ...........  ...........  ...........  ...........  ...........
85396.................  N..............  ...............  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.........  ...........  ...........  ...........  ...........  ...........

[[Page 42881]]

 
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...  ...........  ...........  ...........  ...........  ...........
86064.................  A..............  ...............  B cells, total count.........  ...........  ...........  ...........  ...........  ...........
86077.................  X..............  ...............  Physician blood bank service.         0433       0.2569       $15.25        $6.10        $3.05
86078.................  X..............  ...............  Physician blood bank service.         0343       0.4764       $28.27       $11.10        $5.65
86079.................  X..............  ...............  Physician blood bank service.         0433       0.2569       $15.25        $6.10        $3.05
86140.................  A..............  ...............  C-reactive protein...........  ...........  ...........  ...........  ...........  ...........
86141.................  A..............  ...............  C-reactive protein, hs.......  ...........  ...........  ...........  ...........  ...........
86146.................  A..............  ...............  Glycoprotein antibody........  ...........  ...........  ...........  ...........  ...........
86147.................  A..............  ...............  Cardiolipin antibody.........  ...........  ...........  ...........  ...........  ...........
86148.................  A..............  ...............  Phospholipid antibody........  ...........  ...........  ...........  ...........  ...........
86155.................  A..............  ...............  Chemotaxis assay.............  ...........  ...........  ...........  ...........  ...........
86156.................  A..............  ...............  Cold agglutinin, screen......  ...........  ...........  ...........  ...........  ...........
86157.................  A..............  ...............  Cold agglutinin, titer.......  ...........  ...........  ...........  ...........  ...........
86160.................  A..............  ...............  Complement, antigen..........  ...........  ...........  ...........  ...........  ...........
86161.................  A..............  ...............  Complement/function activity.  ...........  ...........  ...........  ...........  ...........
86162.................  A..............  ...............  Complement, total (CH50).....  ...........  ...........  ...........  ...........  ...........
86171.................  A..............  ...............  Complement fixation, each....  ...........  ...........  ...........  ...........  ...........
86185.................  A..............  ...............  Counterimmunoelectrophoresis.  ...........  ...........  ...........  ...........  ...........
86215.................  A..............  ...............  Deoxyribonuclease, antibody..  ...........  ...........  ...........  ...........  ...........
86225.................  A..............  ...............  DNA antibody.................  ...........  ...........  ...........  ...........  ...........
86226.................  A..............  ...............  DNA antibody, single strand..  ...........  ...........  ...........  ...........  ...........
86235.................  A..............  ...............  Nuclear antigen antibody.....  ...........  ...........  ...........  ...........  ...........
86243.................  A..............  ...............  Fc receptor..................  ...........  ...........  ...........  ...........  ...........
86255.................  A..............  ...............  Fluorescent antibody, screen.  ...........  ...........  ...........  ...........  ...........
86256.................  A..............  ...............  Fluorescent antibody, titer..  ...........  ...........  ...........  ...........  ...........
86277.................  A..............  ...............  Growth hormone antibody......  ...........  ...........  ...........  ...........  ...........

[[Page 42882]]

 
86280.................  A..............  ...............  Hemagglutination inhibition..  ...........  ...........  ...........  ...........  ...........
86294.................  A..............  ...............  Immunoassay, tumor, qual.....  ...........  ...........  ...........  ...........  ...........
86300.................  A..............  ...............  Immunoassay, tumor, ca 15-3..  ...........  ...........  ...........  ...........  ...........
86301.................  A..............  ...............  Immunoassay, tumor, ca 19-9..  ...........  ...........  ...........  ...........  ...........
86304.................  A..............  ...............  Immunoassay, tumor, ca 125...  ...........  ...........  ...........  ...........  ...........
86308.................  A..............  ...............  Heterophile antibodies.......  ...........  ...........  ...........  ...........  ...........
86309.................  A..............  ...............  Heterophile antibodies.......  ...........  ...........  ...........  ...........  ...........
86310.................  A..............  ...............  Heterophile antibodies.......  ...........  ...........  ...........  ...........  ...........
86316.................  A..............  ...............  Immunoassay, tumor other.....  ...........  ...........  ...........  ...........  ...........
86317.................  A..............  ...............  Immunoassay,infectious agent.  ...........  ...........  ...........  ...........  ...........
86318.................  A..............  ...............  Immunoassay,infectious agent.  ...........  ...........  ...........  ...........  ...........
86320.................  A..............  ...............  Serum immunoelectrophoresis..  ...........  ...........  ...........  ...........  ...........
86325.................  A..............  ...............  Other immunoelectrophoresis..  ...........  ...........  ...........  ...........  ...........
86327.................  A..............  ...............  Immunoelectrophoresis assay..  ...........  ...........  ...........  ...........  ...........
86329.................  A..............  ...............  Immunodiffusion..............  ...........  ...........  ...........  ...........  ...........
86331.................  A..............  ...............  Immunodiffusion ouchterlony..  ...........  ...........  ...........  ...........  ...........
86332.................  A..............  ...............  Immune complex assay.........  ...........  ...........  ...........  ...........  ...........
86334.................  A..............  ...............  Immunofixation procedure.....  ...........  ...........  ...........  ...........  ...........
86335.................  A..............  ...............  Immunfix e-phorsis/urine/csf.  ...........  ...........  ...........  ...........  ...........
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..  ...........  ...........  ...........  ...........  ...........
86379.................  A..............  ...............  Nk cells, total count........  ...........  ...........  ...........  ...........  ...........
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       0.1107        $6.57        $2.62        $1.31
86490.................  X..............  ...............  Coccidioidomycosis skin test.         0341       0.1107        $6.57        $2.62        $1.31
86510.................  X..............  ...............  Histoplasmosis skin test.....         0341       0.1107        $6.57        $2.62        $1.31
86580.................  X..............  ...............  TB intradermal test..........         0341       0.1107        $6.57        $2.62        $1.31
86585.................  X..............  ...............  TB tine test.................         0341       0.1107        $6.57        $2.62        $1.31
86586.................  X..............  ...............  Skin test, unlisted..........         0341       0.1107        $6.57        $2.62        $1.31
86587.................  A..............  ...............  Stem cells, total count......  ...........  ...........  ...........  ...........  ...........
86590.................  A..............  ...............  Streptokinase, antibody......  ...........  ...........  ...........  ...........  ...........
86592.................  A..............  ...............  Blood serology, qualitative..  ...........  ...........  ...........  ...........  ...........
86593.................  A..............  ...............  Blood serology, quantitative.  ...........  ...........  ...........  ...........  ...........
86602.................  A..............  ...............  Antinomyces antibody.........  ...........  ...........  ...........  ...........  ...........
86603.................  A..............  ...............  Adenovirus antibody..........  ...........  ...........  ...........  ...........  ...........
86606.................  A..............  ...............  Aspergillus antibody.........  ...........  ...........  ...........  ...........  ...........
86609.................  A..............  ...............  Bacterium antibody...........  ...........  ...........  ...........  ...........  ...........
86611.................  A..............  ...............  Bartonella antibody..........  ...........  ...........  ...........  ...........  ...........
86612.................  A..............  ...............  Blastomyces antibody.........  ...........  ...........  ...........  ...........  ...........
86615.................  A..............  ...............  Bordetella antibody..........  ...........  ...........  ...........  ...........  ...........
86617.................  A..............  ...............  Lyme disease antibody........  ...........  ...........  ...........  ...........  ...........
86618.................  A..............  ...............  Lyme disease antibody........  ...........  ...........  ...........  ...........  ...........
86619.................  A..............  ...............  Borrelia antibody............  ...........  ...........  ...........  ...........  ...........
86622.................  A..............  ...............  Brucella antibody............  ...........  ...........  ...........  ...........  ...........
86625.................  A..............  ...............  Campylobacter antibody.......  ...........  ...........  ...........  ...........  ...........
86628.................  A..............  ...............  Candida antibody.............  ...........  ...........  ...........  ...........  ...........
86631.................  A..............  ...............  Chlamydia antibody...........  ...........  ...........  ...........  ...........  ...........
86632.................  A..............  ...............  Chlamydia igm antibody.......  ...........  ...........  ...........  ...........  ...........
86635.................  A..............  ...............  Coccidioides antibody........  ...........  ...........  ...........  ...........  ...........
86638.................  A..............  ...............  Q fever antibody.............  ...........  ...........  ...........  ...........  ...........
86641.................  A..............  ...............  Cryptococcus antibody........  ...........  ...........  ...........  ...........  ...........

[[Page 42883]]

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

[[Page 42884]]

 
86803.................  A..............  ...............  Hepatitis c ab test..........  ...........  ...........  ...........  ...........  ...........
86804.................  A..............  ...............  Hep c ab test, confirm.......  ...........  ...........  ...........  ...........  ...........
86805.................  A..............  ...............  Lymphocytotoxicity assay.....  ...........  ...........  ...........  ...........  ...........
86806.................  A..............  ...............  Lymphocytotoxicity assay.....  ...........  ...........  ...........  ...........  ...........
86807.................  A..............  ...............  Cytotoxic antibody screening.  ...........  ...........  ...........  ...........  ...........
86808.................  A..............  ...............  Cytotoxic antibody screening.  ...........  ...........  ...........  ...........  ...........
86812.................  A..............  ...............  HLA typing, A, B, or C.......  ...........  ...........  ...........  ...........  ...........
86813.................  A..............  ...............  HLA typing, A, B, or C.......  ...........  ...........  ...........  ...........  ...........
86816.................  A..............  ...............  HLA typing, DR/DQ............  ...........  ...........  ...........  ...........  ...........
86817.................  A..............  ...............  HLA typing, DR/DQ............  ...........  ...........  ...........  ...........  ...........
86821.................  A..............  ...............  Lymphocyte culture, mixed....  ...........  ...........  ...........  ...........  ...........
86822.................  A..............  ...............  Lymphocyte culture, primed...  ...........  ...........  ...........  ...........  ...........
86849.................  A..............  ...............  Immunology procedure.........  ...........  ...........  ...........  ...........  ...........
86850.................  X..............  ...............  RBC antibody screen..........         0345       0.2266       $13.45        $2.99        $2.69
86860.................  X..............  ...............  RBC antibody elution.........         0346       0.3418       $20.29        $4.52        $4.06
86870.................  X..............  ...............  RBC antibody identification..         0346       0.3418       $20.29        $4.52        $4.06
86880.................  X..............  ...............  Coombs test, direct..........         0409       0.1252        $7.43        $2.22        $1.49
86885.................  X..............  ...............  Coombs test, indirect, qual..         0409       0.1252        $7.43        $2.22        $1.49
86886.................  X..............  ...............  Coombs test, indirect, titer.         0409       0.1252        $7.43        $2.22        $1.49
86890.................  X..............  ...............  Autologous blood process.....         0347       0.8395       $49.82       $12.30        $9.96
86891.................  X..............  ...............  Autologous blood, op salvage.         0346       0.3418       $20.29        $4.52        $4.06
86900.................  X..............  ...............  Blood typing, ABO............         0409       0.1252        $7.43        $2.22        $1.49
86901.................  X..............  ...............  Blood typing, Rh (D).........         0409       0.1252        $7.43        $2.22        $1.49
86903.................  X..............  ...............  Blood typing, antigen screen.         0345       0.2266       $13.45        $2.99        $2.69
86904.................  X..............  ...............  Blood typing, patient serum..         0346       0.3418       $20.29        $4.52        $4.06
86905.................  X..............  ...............  Blood typing, RBC antigens...         0345       0.2266       $13.45        $2.99        $2.69
86906.................  X..............  ...............  Blood typing, Rh phenotype...         0345       0.2266       $13.45        $2.99        $2.69
86910.................  E..............  ...............  Blood typing, paternity test.  ...........  ...........  ...........  ...........  ...........
86911.................  E..............  ...............  Blood typing, antigen system.  ...........  ...........  ...........  ...........  ...........
86920.................  X..............  ...............  Compatibility test...........         0346       0.3418       $20.29        $4.52        $4.06
86921.................  X..............  ...............  Compatibility test...........         0345       0.2266       $13.45        $2.99        $2.69
86922.................  X..............  ...............  Compatibility test...........         0346       0.3418       $20.29        $4.52        $4.06
86927.................  X..............  ...............  Plasma, fresh frozen.........         0345       0.2266       $13.45        $2.99        $2.69
86930.................  X..............  ...............  Frozen blood prep............         0347       0.8395       $49.82       $12.30        $9.96
86931.................  X..............  ...............  Frozen blood thaw............         0347       0.8395       $49.82       $12.30        $9.96
86932.................  X..............  ...............  Frozen blood freeze/thaw.....         0347       0.8395       $49.82       $12.30        $9.96
86940.................  A..............  ...............  Hemolysins/agglutinins, auto.  ...........  ...........  ...........  ...........  ...........
86941.................  A..............  ...............  Hemolysins/agglutinins.......  ...........  ...........  ...........  ...........  ...........
86945.................  X..............  ...............  Blood product/irradiation....         0345       0.2266       $13.45        $2.99        $2.69
86950.................  X..............  ...............  Leukacyte transfusion........         0345       0.2266       $13.45        $2.99        $2.69
86965.................  X..............  ...............  Pooling blood platelets......         0345       0.2266       $13.45        $2.99        $2.69
86970.................  X..............  ...............  RBC pretreatment.............         0345       0.2266       $13.45        $2.99        $2.69
86971.................  X..............  ...............  RBC pretreatment.............         0345       0.2266       $13.45        $2.99        $2.69
86972.................  X..............  ...............  RBC pretreatment.............         0346       0.3418       $20.29        $4.52        $4.06
86975.................  X..............  ...............  RBC pretreatment, serum......         0345       0.2266       $13.45        $2.99        $2.69
86976.................  X..............  ...............  RBC pretreatment, serum......         0345       0.2266       $13.45        $2.99        $2.69
86977.................  X..............  ...............  RBC pretreatment, serum......         0345       0.2266       $13.45        $2.99        $2.69
86978.................  X..............  ...............  RBC pretreatment, serum......         0345       0.2266       $13.45        $2.99        $2.69
86985.................  X..............  ...............  Split blood or products......         0345       0.2266       $13.45        $2.99        $2.69
86999.................  X..............  ...............  Transfusion procedure........         0345       0.2266       $13.45        $2.99        $2.69
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.......  ...........  ...........  ...........  ...........  ...........

[[Page 42885]]

 
87101.................  A..............  ...............  Skin fungi culture...........  ...........  ...........  ...........  ...........  ...........
87102.................  A..............  ...............  Fungus isolation culture.....  ...........  ...........  ...........  ...........  ...........
87103.................  A..............  ...............  Blood fungus culture.........  ...........  ...........  ...........  ...........  ...........
87106.................  A..............  ...............  Fungi identification, yeast..  ...........  ...........  ...........  ...........  ...........
87107.................  A..............  ...............  Fungi identification, mold...  ...........  ...........  ...........  ...........  ...........
87109.................  A..............  ...............  Mycoplasma...................  ...........  ...........  ...........  ...........  ...........
87110.................  A..............  ...............  Chlamydia culture............  ...........  ...........  ...........  ...........  ...........
87116.................  A..............  ...............  Mycobacteria culture.........  ...........  ...........  ...........  ...........  ...........
87118.................  A..............  ...............  Mycobacteric identification..  ...........  ...........  ...........  ...........  ...........
87140.................  A..............  ...............  Culture type immunofluoresc..  ...........  ...........  ...........  ...........  ...........
87143.................  A..............  ...............  Culture typing, glc/hplc.....  ...........  ...........  ...........  ...........  ...........
87147.................  A..............  ...............  Culture type, immunologic....  ...........  ...........  ...........  ...........  ...........
87149.................  A..............  ...............  Culture type, nucleic acid...  ...........  ...........  ...........  ...........  ...........
87152.................  A..............  ...............  Culture type pulse field gel.  ...........  ...........  ...........  ...........  ...........
87158.................  A..............  ...............  Culture typing, added method.  ...........  ...........  ...........  ...........  ...........
87164.................  A..............  ...............  Dark field examination.......  ...........  ...........  ...........  ...........  ...........
87166.................  A..............  ...............  Dark field examination.......  ...........  ...........  ...........  ...........  ...........
87168.................  A..............  ...............  Macroscopic exam arthropod...  ...........  ...........  ...........  ...........  ...........
87169.................  A..............  ...............  Macroscopic exam parasite....  ...........  ...........  ...........  ...........  ...........
87172.................  A..............  ...............  Pinworm exam.................  ...........  ...........  ...........  ...........  ...........
87176.................  A..............  ...............  Tissue homogenization, cultr.  ...........  ...........  ...........  ...........  ...........
87177.................  A..............  ...............  Ova and parasites smears.....  ...........  ...........  ...........  ...........  ...........
87181.................  A..............  ...............  Microbe susceptible, diffuse.  ...........  ...........  ...........  ...........  ...........
87184.................  A..............  ...............  Microbe susceptible, disk....  ...........  ...........  ...........  ...........  ...........
87185.................  A..............  ...............  Microbe susceptible, enzyme..  ...........  ...........  ...........  ...........  ...........
87186.................  A..............  ...............  Microbe susceptible, mic.....  ...........  ...........  ...........  ...........  ...........
87187.................  A..............  ...............  Microbe susceptible, mlc.....  ...........  ...........  ...........  ...........  ...........
87188.................  A..............  ...............  Microbe suscept, macrobroth..  ...........  ...........  ...........  ...........  ...........
87190.................  A..............  ...............  Microbe suscept, mycobacteri.  ...........  ...........  ...........  ...........  ...........
87197.................  A..............  ...............  Bactericidal level, serum....  ...........  ...........  ...........  ...........  ...........
87205.................  A..............  ...............  Smear, gram stain............  ...........  ...........  ...........  ...........  ...........
87206.................  A..............  ...............  Smear, fluorescent/acid stai.  ...........  ...........  ...........  ...........  ...........
87207.................  A..............  ...............  Smear, special stain.........  ...........  ...........  ...........  ...........  ...........
87210.................  A..............  ...............  Smear, wet mount, saline/ink.  ...........  ...........  ...........  ...........  ...........
87220.................  A..............  ...............  Tissue exam for fungi........  ...........  ...........  ...........  ...........  ...........
87230.................  A..............  ...............  Assay, toxin or antitoxin....  ...........  ...........  ...........  ...........  ...........
87250.................  A..............  ...............  Virus inoculate, eggs/animal.  ...........  ...........  ...........  ...........  ...........
87252.................  A..............  ...............  Virus inoculation, tissue....  ...........  ...........  ...........  ...........  ...........
87253.................  A..............  ...............  Virus inoculate tissue, addl.  ...........  ...........  ...........  ...........  ...........
87254.................  A..............  ...............  Virus inoculation, shell via.  ...........  ...........  ...........  ...........  ...........
87255.................  A..............  ...............  Genet virus isolate, hsv.....  ...........  ...........  ...........  ...........  ...........
87260.................  A..............  ...............  Adenovirus ag, if............  ...........  ...........  ...........  ...........  ...........
87265.................  A..............  ...............  Pertussis ag, if.............  ...........  ...........  ...........  ...........  ...........
87267.................  A..............  ...............  Enterovirus antibody, dfa....  ...........  ...........  ...........  ...........  ...........
87269.................  A..............  ...............  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.  ...........  ...........  ...........  ...........  ...........

[[Page 42886]]

 
87328.................  A..............  ...............  Cryptosporidium ag, eia......  ...........  ...........  ...........  ...........  ...........
87329.................  A..............  ...............  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..............  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42887]]

 
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..............  ...............  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.  ...........  ...........  ...........  ...........  ...........
87802.................  A..............  ...............  Strep b assay w/optic........  ...........  ...........  ...........  ...........  ...........
87803.................  A..............  ...............  Clostridium toxin a w/optic..  ...........  ...........  ...........  ...........  ...........
87804.................  A..............  ...............  Influenza assay w/optic......  ...........  ...........  ...........  ...........  ...........
87807.................  A..............  ...............  Rsv assay w/optic............  ...........  ...........  ...........  ...........  ...........
87810.................  A..............  ...............  Chylmd trach assay w/optic...  ...........  ...........  ...........  ...........  ...........
87850.................  A..............  ...............  N. gonorrhoeae assay w/optic.  ...........  ...........  ...........  ...........  ...........
87880.................  A..............  ...............  Strep a assay w/optic........  ...........  ...........  ...........  ...........  ...........
87899.................  A..............  ...............  Agent nos assay w/optic......  ...........  ...........  ...........  ...........  ...........
87901.................  A..............  ...............  Genotype, dna, hiv reverse t.  ...........  ...........  ...........  ...........  ...........
87902.................  A..............  ...............  Genotype, dna, hepatitis C...  ...........  ...........  ...........  ...........  ...........
87903.................  A..............  ...............  Phenotype, dna hiv w/culture.  ...........  ...........  ...........  ...........  ...........
87904.................  A..............  ...............  Phenotype, dna hiv w/clt add.  ...........  ...........  ...........  ...........  ...........
87999.................  A..............  ...............  Microbiology procedure.......  ...........  ...........  ...........  ...........  ...........
88000.................  E..............  ...............  Autopsy (necropsy), gross....  ...........  ...........  ...........  ...........  ...........
88005.................  E..............  ...............  Autopsy (necropsy), gross....  ...........  ...........  ...........  ...........  ...........
88007.................  E..............  ...............  Autopsy (necropsy), gross....  ...........  ...........  ...........  ...........  ...........
88012.................  E..............  ...............  Autopsy (necropsy), gross....  ...........  ...........  ...........  ...........  ...........
88014.................  E..............  ...............  Autopsy (necropsy), gross....  ...........  ...........  ...........  ...........  ...........
88016.................  E..............  ...............  Autopsy (necropsy), gross....  ...........  ...........  ...........  ...........  ...........
88020.................  E..............  ...............  Autopsy (necropsy), complete.  ...........  ...........  ...........  ...........  ...........
88025.................  E..............  ...............  Autopsy (necropsy), complete.  ...........  ...........  ...........  ...........  ...........
88027.................  E..............  ...............  Autopsy (necropsy), complete.  ...........  ...........  ...........  ...........  ...........
88028.................  E..............  ...............  Autopsy (necropsy), complete.  ...........  ...........  ...........  ...........  ...........
88029.................  E..............  ...............  Autopsy (necropsy), complete.  ...........  ...........  ...........  ...........  ...........
88036.................  E..............  ...............  Limited autopsy..............  ...........  ...........  ...........  ...........  ...........
88037.................  E..............  ...............  Limited autopsy..............  ...........  ...........  ...........  ...........  ...........
88040.................  E..............  ...............  Forensic autopsy (necropsy)..  ...........  ...........  ...........  ...........  ...........
88045.................  E..............  ...............  Coroner's autopsy (necropsy).  ...........  ...........  ...........  ...........  ...........
88099.................  E..............  ...............  Necropsy (autopsy) procedure.  ...........  ...........  ...........  ...........  ...........
88104.................  X..............  ...............  Cytopathology, fluids........         0433       0.2569       $15.25        $6.10        $3.05
88106.................  X..............  ...............  Cytopathology, fluids........         0433       0.2569       $15.25        $6.10        $3.05
88107.................  X..............  ...............  Cytopathology, fluids........         0433       0.2569       $15.25        $6.10        $3.05
88108.................  X..............  ...............  Cytopath, concentrate tech...         0433       0.2569       $15.25        $6.10        $3.05
88112.................  X..............  ...............  Cytopath, cell enhance tech..         0343       0.4764       $28.27       $11.10        $5.65
88125.................  X..............  ...............  Forensic cytopathology.......         0342       0.1553        $9.22        $3.68        $1.84
88130.................  A..............  ...............  Sex chromatin identification.  ...........  ...........  ...........  ...........  ...........
88140.................  A..............  ...............  Sex chromatin identification.  ...........  ...........  ...........  ...........  ...........

[[Page 42888]]

 
88141.................  N..............  ...............  Cytopath, c/v, interpret.....  ...........  ...........  ...........  ...........  ...........
88142.................  A..............  ...............  Cytopath, c/v, thin layer....  ...........  ...........  ...........  ...........  ...........
88143.................  A..............  ...............  Cytopath c/v thin layer redo.  ...........  ...........  ...........  ...........  ...........
88147.................  A..............  ...............  Cytopath, c/v, automated.....  ...........  ...........  ...........  ...........  ...........
88148.................  A..............  ...............  Cytopath, c/v, auto rescreen.  ...........  ...........  ...........  ...........  ...........
88150.................  A..............  ...............  Cytopath, c/v, manual........  ...........  ...........  ...........  ...........  ...........
88152.................  A..............  ...............  Cytopath, c/v, auto redo.....  ...........  ...........  ...........  ...........  ...........
88153.................  A..............  ...............  Cytopath, c/v, redo..........  ...........  ...........  ...........  ...........  ...........
88154.................  A..............  ...............  Cytopath, c/v, select........  ...........  ...........  ...........  ...........  ...........
88155.................  A..............  ...............  Cytopath, c/v, index add-on..  ...........  ...........  ...........  ...........  ...........
88160.................  X..............  ...............  Cytopath smear, other source.         0433       0.2569       $15.25        $6.10        $3.05
88161.................  X..............  ...............  Cytopath smear, other source.         0433       0.2569       $15.25        $6.10        $3.05
88162.................  X..............  ...............  Cytopath smear, other source.         0433       0.2569       $15.25        $6.10        $3.05
88164.................  A..............  ...............  Cytopath tbs, c/v, manual....  ...........  ...........  ...........  ...........  ...........
88165.................  A..............  ...............  Cytopath tbs, c/v, redo......  ...........  ...........  ...........  ...........  ...........
88166.................  A..............  ...............  Cytopath tbs, c/v, auto redo.  ...........  ...........  ...........  ...........  ...........
88167.................  A..............  ...............  Cytopath tbs, c/v, select....  ...........  ...........  ...........  ...........  ...........
88172.................  X..............  ...............  Cytopathology eval of fna....         0343       0.4764       $28.27       $11.10        $5.65
88173.................  X..............  ...............  Cytopath eval, fna, report...         0343       0.4764       $28.27       $11.10        $5.65
88174.................  A..............  ...............  Cytopath, c/v auto, in fluid.  ...........  ...........  ...........  ...........  ...........
88175.................  A..............  ...............  Cytopath c/v auto fluid redo.  ...........  ...........  ...........  ...........  ...........
88182.................  X..............  ...............  Cell marker study............         0344       0.7960       $47.24       $15.66        $9.45
88184.................  X..............  ...............  Flowcytometry/ tc, 1 marker..         0344       0.7960       $47.24       $15.66        $9.45
88185.................  X..............  ...............  Flowcytometry/tc, add-on.....         0343       0.4764       $28.27       $11.10        $5.65
88187.................  X..............  ...............  Flowcytometry/read, 2-8......         0433       0.2569       $15.25        $6.10        $3.05
88188.................  X..............  ...............  Flowcytometry/read, 9-15.....         0433       0.2569       $15.25        $6.10        $3.05
88189.................  X..............  ...............  Flowcytometry/read, 16 & >...         0343       0.4764       $28.27       $11.10        $5.65
88199.................  A..............  ...............  Cytopathology procedure......  ...........  ...........  ...........  ...........  ...........
88230.................  A..............  ...............  Tissue culture, lymphocyte...  ...........  ...........  ...........  ...........  ...........
88233.................  A..............  ...............  Tissue culture, skin/biopsy..  ...........  ...........  ...........  ...........  ...........
88235.................  A..............  ...............  Tissue culture, placenta.....  ...........  ...........  ...........  ...........  ...........
88237.................  A..............  ...............  Tissue culture, bone marrow..  ...........  ...........  ...........  ...........  ...........
88239.................  A..............  ...............  Tissue culture, tumor........  ...........  ...........  ...........  ...........  ...........
88240.................  A..............  ...............  Cell cryopreserve/storage....  ...........  ...........  ...........  ...........  ...........
88241.................  A..............  ...............  Frozen cell preparation......  ...........  ...........  ...........  ...........  ...........
88245.................  A..............  ...............  Chromosome analysis, 20-25...  ...........  ...........  ...........  ...........  ...........
88248.................  A..............  ...............  Chromosome analysis, 50-100..  ...........  ...........  ...........  ...........  ...........
88249.................  A..............  ...............  Chromosome analysis, 100.....  ...........  ...........  ...........  ...........  ...........
88261.................  A..............  ...............  Chromosome analysis, 5.......  ...........  ...........  ...........  ...........  ...........
88262.................  A..............  ...............  Chromosome analysis, 15-20...  ...........  ...........  ...........  ...........  ...........
88263.................  A..............  ...............  Chromosome analysis, 45......  ...........  ...........  ...........  ...........  ...........
88264.................  A..............  ...............  Chromosome analysis, 20-25...  ...........  ...........  ...........  ...........  ...........
88267.................  A..............  ...............  Chromosome analys, placenta..  ...........  ...........  ...........  ...........  ...........
88269.................  A..............  ...............  Chromosome analys, amniotic..  ...........  ...........  ...........  ...........  ...........
88271.................  A..............  ...............  Cytogenetics, dna probe......  ...........  ...........  ...........  ...........  ...........
88272.................  A..............  ...............  Cytogenetics, 3-5............  ...........  ...........  ...........  ...........  ...........
88273.................  A..............  ...............  Cytogenetics, 10-30..........  ...........  ...........  ...........  ...........  ...........
88274.................  A..............  ...............  Cytogenetics, 25-99..........  ...........  ...........  ...........  ...........  ...........
88275.................  A..............  ...............  Cytogenetics, 100-300........  ...........  ...........  ...........  ...........  ...........
88280.................  A..............  ...............  Chromosome karyotype study...  ...........  ...........  ...........  ...........  ...........
88283.................  A..............  ...............  Chromosome banding study.....  ...........  ...........  ...........  ...........  ...........
88285.................  A..............  ...............  Chromosome count, additional.  ...........  ...........  ...........  ...........  ...........
88289.................  A..............  ...............  Chromosome study, additional.  ...........  ...........  ...........  ...........  ...........
88291.................  A..............  ...............  Cyto/molecular report........  ...........  ...........  ...........  ...........  ...........
88299.................  X..............  ...............  Cytogenetic study............         0342       0.1553        $9.22        $3.68        $1.84
88300.................  X..............  ...............  Surgical path, gross.........         0433       0.2569       $15.25        $6.10        $3.05
88302.................  X..............  ...............  Tissue exam by pathologist...         0433       0.2569       $15.25        $6.10        $3.05
88304.................  X..............  ...............  Tissue exam by pathologist...         0343       0.4764       $28.27       $11.10        $5.65
88305.................  X..............  ...............  Tissue exam by pathologist...         0343       0.4764       $28.27       $11.10        $5.65
88307.................  X..............  ...............  Tissue exam by pathologist...         0344       0.7960       $47.24       $15.66        $9.45
88309.................  X..............  ...............  Tissue exam by pathologist...         0344       0.7960       $47.24       $15.66        $9.45
88311.................  X..............  ...............  Decalcify tissue.............         0342       0.1553        $9.22        $3.68        $1.84
88312.................  X..............  ...............  Special stains...............         0433       0.2569       $15.25        $6.10        $3.05
88313.................  X..............  ...............  Special stains...............         0433       0.2569       $15.25        $6.10        $3.05
88314.................  X..............  ...............  Histochemical stain..........         0342       0.1553        $9.22        $3.68        $1.84
88318.................  X..............  ...............  Chemical histochemistry......         0433       0.2569       $15.25        $6.10        $3.05

[[Page 42889]]

 
88319.................  X..............  ...............  Enzyme histochemistry........         0343       0.4764       $28.27       $11.10        $5.65
88321.................  X..............  ...............  Microslide consultation......         0433       0.2569       $15.25        $6.10        $3.05
88323.................  X..............  ...............  Microslide consultation......         0343       0.4764       $28.27       $11.10        $5.65
88325.................  X..............  ...............  Comprehensive review of data.         0344       0.7960       $47.24       $15.66        $9.45
88329.................  X..............  ...............  Path consult introp..........         0433       0.2569       $15.25        $6.10        $3.05
88331.................  X..............  ...............  Path consult intraop, 1 bloc.         0343       0.4764       $28.27       $11.10        $5.65
88332.................  X..............  ...............  Path consult intraop, add'l..         0433       0.2569       $15.25        $6.10        $3.05
88342.................  X..............  ...............  Immunohistochemistry.........         0343       0.4764       $28.27       $11.10        $5.65
88346.................  X..............  ...............  Immunofluorescent study......         0343       0.4764       $28.27       $11.10        $5.65
88347.................  X..............  ...............  Immunofluorescent study......         0343       0.4764       $28.27       $11.10        $5.65
88348.................  X..............  ...............  Electron microscopy..........         0661       3.3622      $199.55       $79.82       $39.91
88349.................  X..............  ...............  Scanning electron microscopy.         0661       3.3622      $199.55       $79.82       $39.91
88355.................  X..............  ...............  Analysis, skeletal muscle....         0343       0.4764       $28.27       $11.10        $5.65
88356.................  X..............  ...............  Analysis, nerve..............         0344       0.7960       $47.24       $15.66        $9.45
88358.................  X..............  ...............  Analysis, tumor..............         0344       0.7960       $47.24       $15.66        $9.45
88360.................  X..............  ...............  Tumor immunohistochem/manual.         0344       0.7960       $47.24       $15.66        $9.45
88361.................  X..............  ...............  Immunohistochemistry, tumor..         0344       0.7960       $47.24       $15.66        $9.45
88362.................  X..............  ...............  Nerve teasing preparations...         0344       0.7960       $47.24       $15.66        $9.45
88365.................  X..............  ...............  Tissue hybridization.........         0344       0.7960       $47.24       $15.66        $9.45
88367.................  X..............  ...............  Insitu hybridization, auto...         0344       0.7960       $47.24       $15.66        $9.45
88368.................  X..............  ...............  Insitu hybridization, manual.         0344       0.7960       $47.24       $15.66        $9.45
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 contents...         0360       1.4672       $87.08       $34.83       $17.42
89105.................  X..............  ...............  Sample intestinal contents...         0360       1.4672       $87.08       $34.83       $17.42
89125.................  A..............  ...............  Specimen fat stain...........  ...........  ...........  ...........  ...........  ...........
89130.................  X..............  ...............  Sample stomach contents......         0360       1.4672       $87.08       $34.83       $17.42
89132.................  X..............  ...............  Sample stomach contents......         0360       1.4672       $87.08       $34.83       $17.42
89135.................  X..............  ...............  Sample stomach contents......         0360       1.4672       $87.08       $34.83       $17.42
89136.................  X..............  ...............  Sample stomach contents......         0360       1.4672       $87.08       $34.83       $17.42
89140.................  X..............  ...............  Sample stomach contents......         0360       1.4672       $87.08       $34.83       $17.42
89141.................  X..............  ...............  Sample stomach contents......         0360       1.4672       $87.08       $34.83       $17.42
89160.................  A..............  ...............  Exam feces for meat fibers...  ...........  ...........  ...........  ...........  ...........
89190.................  A..............  ...............  Nasal smear for eosinophils..  ...........  ...........  ...........  ...........  ...........
89220.................  X..............  ...............  Sputum specimen collection...         0343       0.4764       $28.27       $11.10        $5.65
89225.................  A..............  ...............  Starch granules, feces.......  ...........  ...........  ...........  ...........  ...........
89230.................  X..............  ...............  Collect sweat for test.......         0433       0.2569       $15.25        $6.10        $3.05
89235.................  A..............  ...............  Water load test..............  ...........  ...........  ...........  ...........  ...........
89240.................  A..............  ...............  Pathology lab procedure......  ...........  ...........  ...........  ...........  ...........
89250.................  X..............  ...............  Cultr oocyte/embryo <4 days..         0348       0.7891       $46.83  ...........        $9.37
89251.................  X..............  ...............  Cultr oocyte/embryo <4 days..         0348       0.7891       $46.83  ...........        $9.37
89253.................  X..............  ...............  Embryo hatching..............         0348       0.7891       $46.83  ...........        $9.37
89254.................  X..............  ...............  Oocyte identification........         0348       0.7891       $46.83  ...........        $9.37
89255.................  X..............  ...............  Prepare embryo for transfer..         0348       0.7891       $46.83  ...........        $9.37
89257.................  X..............  ...............  Sperm identification.........         0348       0.7891       $46.83  ...........        $9.37
89258.................  X..............  ...............  Cryopreservation embryo(s)...         0348       0.7891       $46.83  ...........        $9.37
89259.................  X..............  ...............  Cryopreservation, sperm......         0348       0.7891       $46.83  ...........        $9.37
89260.................  X..............  ...............  Sperm isolation, simple......         0348       0.7891       $46.83  ...........        $9.37
89261.................  X..............  ...............  Sperm isolation, complex.....         0348       0.7891       $46.83  ...........        $9.37
89264.................  X..............  ...............  Identify sperm tissue........         0348       0.7891       $46.83  ...........        $9.37
89268.................  X..............  ...............  Insemination of oocytes......         0348       0.7891       $46.83  ...........        $9.37
89272.................  X..............  ...............  Extended culture of oocytes..         0348       0.7891       $46.83  ...........        $9.37
89280.................  X..............  ...............  Assist oocyte fertilization..         0348       0.7891       $46.83  ...........        $9.37
89281.................  X..............  ...............  Assist oocyte fertilization..         0348       0.7891       $46.83  ...........        $9.37
89290.................  X..............  ...............  Biopsy, oocyte polar body....         0348       0.7891       $46.83  ...........        $9.37
89291.................  X..............  ...............  Biopsy, oocyte polar body....         0348       0.7891       $46.83  ...........        $9.37
89300.................  A..............  ...............  Semen analysis w/huhner......  ...........  ...........  ...........  ...........  ...........
89310.................  A..............  ...............  Semen analysis...............  ...........  ...........  ...........  ...........  ...........
89320.................  A..............  ...............  Semen analysis, complete.....  ...........  ...........  ...........  ...........  ...........

[[Page 42890]]

 
89321.................  A..............  ...............  Semen analysis & motility....  ...........  ...........  ...........  ...........  ...........
89325.................  A..............  ...............  Sperm antibody test..........  ...........  ...........  ...........  ...........  ...........
89329.................  A..............  ...............  Sperm evaluation test........  ...........  ...........  ...........  ...........  ...........
89330.................  A..............  ...............  Evaluation, cervical mucus...  ...........  ...........  ...........  ...........  ...........
89335.................  X..............  ...............  Cryopreserve testicular tiss.         0348       0.7891       $46.83  ...........        $9.37
89342.................  X..............  ...............  Storage/year embryo(s).......         0348       0.7891       $46.83  ...........        $9.37
89343.................  X..............  ...............  Storage/year sperm/semen.....         0348       0.7891       $46.83  ...........        $9.37
89344.................  X..............  ...............  Storage/year reprod tissue...         0348       0.7891       $46.83  ...........        $9.37
89346.................  X..............  ...............  Storage/year oocyte..........         0348       0.7891       $46.83  ...........        $9.37
89352.................  X..............  ...............  Thawing cryopresrved embryo..         0348       0.7891       $46.83  ...........        $9.37
89353.................  X..............  ...............  Thawing cryopresrved sperm...         0348       0.7891       $46.83  ...........        $9.37
89354.................  X..............  ...............  Thaw cryoprsvrd reprod tiss..         0348       0.7891       $46.83  ...........        $9.37
89356.................  X..............  ...............  Thawing cryopresrved oocyte..         0348       0.7891       $46.83  ...........        $9.37
90281.................  E..............  ...............  Human ig, im.................  ...........  ...........  ...........  ...........  ...........
90283.................  E..............  ...............  Human ig, iv.................  ...........  ...........  ...........  ...........  ...........
90287.................  E..............  ...............  Botulinum antitoxin..........  ...........  ...........  ...........  ...........  ...........
90288.................  E..............  ...............  Botulism ig, iv..............  ...........  ...........  ...........  ...........  ...........
90291.................  E..............  ...............  Cmv ig, iv...................  ...........  ...........  ...........  ...........  ...........
90296.................  N..............  ...............  Diphtheria antitoxin.........  ...........  ...........  ...........  ...........  ...........
90371.................  E..............  ...............  Hep b ig, im.................  ...........  ...........  ...........  ...........  ...........
90375.................  K..............  ...............  Rabies ig, im/sc.............         9133  ...........       $64.56  ...........       $12.91
90376.................  K..............  ...............  Rabies ig, heat treated......         9134  ...........       $69.78  ...........       $13.96
90378.................  E..............  ...............  Rsv ig, im, 50mg.............  ...........  ...........  ...........  ...........  ...........
90379.................  E..............  ...............  Rsv ig, iv...................  ...........  ...........  ...........  ...........  ...........
90384.................  E..............  ...............  Rh ig, full-dose, im.........  ...........  ...........  ...........  ...........  ...........
90385.................  N..............  ...............  Rh ig, minidose, im..........  ...........  ...........  ...........  ...........  ...........
90386.................  E..............  ...............  Rh ig, iv....................  ...........  ...........  ...........  ...........  ...........
90389.................  E..............  ...............  Tetanus ig, im...............  ...........  ...........  ...........  ...........  ...........
90393.................  N..............  ...............  Vaccina ig, im...............  ...........  ...........  ...........  ...........  ...........
90396.................  K..............  ...............  Varicella-zoster ig, im......         9135  ...........       $96.57  ...........       $19.31
90399.................  E..............  ...............  Immune globulin..............  ...........  ...........  ...........  ...........  ...........
90465.................  B..............  ...............  Immune admin 1 inj, < 8 yrs..  ...........  ...........  ...........  ...........  ...........
90466.................  B..............  ...............  Immune admin addl inj, < 8 y.  ...........  ...........  ...........  ...........  ...........
90467.................  B..............  ...............  Immune admin o or n, < 8 yrs.  ...........  ...........  ...........  ...........  ...........
90468.................  B..............  ...............  Immune admin o/n, addl < 8 y.  ...........  ...........  ...........  ...........  ...........
90471.................  X..............  ...............  Immunization admin...........         0353       0.3936       $23.36  ...........        $4.67
90472.................  X..............  ...............  Immunization admin, each add.         0353       0.3936       $23.36  ...........        $4.67
90473.................  S..............  ...............  Immune admin oral/nasal......         1491  ...........        $5.00  ...........        $1.00
90474.................  S..............  ...............  Immune admin oral/nasal addl.         1491  ...........        $5.00  ...........        $1.00
90476.................  K..............  ...............  Adenovirus vaccine, type 4...         9136       0.9498       $56.37  ...........       $11.27
90477.................  N..............  ...............  Adenovirus vaccine, type 7...  ...........  ...........  ...........  ...........  ...........
90581.................  K..............  ...............  Anthrax vaccine, sc..........         9169  ...........      $128.94  ...........       $25.79
90585.................  K..............  ...............  Bcg vaccine, percut..........         9137  ...........      $124.53  ...........       $24.91
90586.................  B..............  ...............  Bcg vaccine, intravesical....  ...........  ...........  ...........  ...........  ...........
90632.................  N..............  ...............  Hep a vaccine, adult im......  ...........  ...........  ...........  ...........  ...........
90633.................  N..............  ...............  Hep a vacc, ped/adol, 2 dose.  ...........  ...........  ...........  ...........  ...........
90634.................  N..............  ...............  Hep a vacc, ped/adol, 3 dose.  ...........  ...........  ...........  ...........  ...........
90636.................  K..............  ...............  Hep a/hep b vacc, adult im...         9138       0.9673       $57.41  ...........       $11.48
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..............  ...............  Flu vaccine, 6-35 mo, im.....  ...........  ...........  ...........  ...........  ...........
90656.................  L..............  ...............  Flu vaccine no preserv 3 & >.  ...........  ...........  ...........  ...........  ...........
90657.................  L..............  ...............  Flu vaccine, 6-35 mo, im.....  ...........  ...........  ...........  ...........  ...........
90658.................  L..............  ...............  Flu vaccine, 3 yrs, im.......  ...........  ...........  ...........  ...........  ...........
90660.................  E..............  ...............  Flu vaccine, nasal...........  ...........  ...........  ...........  ...........  ...........
90665.................  N..............  ...............  Lyme disease vaccine, im.....  ...........  ...........  ...........  ...........  ...........
90669.................  E..............  ...............  Pneumococcal vacc, ped <5....  ...........  ...........  ...........  ...........  ...........
90675.................  K..............  ...............  Rabies vaccine, im...........         9139  ...........      $128.03  ...........       $25.61
90676.................  K..............  ...............  Rabies vaccine, id...........         9140       1.4957       $88.77  ...........       $17.75
90680.................  N..............  ...............  Rotovirus vaccine, oral......  ...........  ...........  ...........  ...........  ...........
90690.................  N..............  ...............  Typhoid vaccine, oral........  ...........  ...........  ...........  ...........  ...........
90691.................  N..............  ...............  Typhoid vaccine, im..........  ...........  ...........  ...........  ...........  ...........
90692.................  N..............  ...............  Typhoid vaccine, h-p, sc/id..  ...........  ...........  ...........  ...........  ...........
90693.................  N..............  ...............  Typhoid vaccine, akd, sc.....  ...........  ...........  ...........  ...........  ...........

[[Page 42891]]

 
90698.................  N..............  ...............  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.................  K..............  ...............  Measles-rubella vaccine, sc..         9141       0.9466       $56.18  ...........       $11.24
90710.................  N..............  ...............  Mmrv vaccine, sc.............  ...........  ...........  ...........  ...........  ...........
90712.................  N..............  ...............  Oral poliovirus vaccine......  ...........  ...........  ...........  ...........  ...........
90713.................  N..............  ...............  Poliovirus, ipv, sc..........  ...........  ...........  ...........  ...........  ...........
90715.................  N..............  ...............  Tdap vaccine >7 im...........  ...........  ...........  ...........  ...........  ...........
90716.................  K..............  ...............  Chicken pox vaccine, sc......         9142  ...........       $64.29  ...........       $12.86
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.................  E..............  ...............  Dtap-hep b-ipv vaccine, im...  ...........  ...........  ...........  ...........  ...........
90725.................  N..............  ...............  Cholera vaccine, injectable..  ...........  ...........  ...........  ...........  ...........
90727.................  N..............  ...............  Plague vaccine, im...........  ...........  ...........  ...........  ...........  ...........
90732.................  L..............  ...............  Pneumococcal vaccine.........  ...........  ...........  ...........  ...........  ...........
90733.................  K..............  ...............  Meningococcal vaccine, sc....         9143  ...........       $56.74  ...........       $11.35
90734.................  K..............  ...............  Meningococcal vaccine, im....         9145       0.8947       $53.10  ...........       $10.62
90735.................  K..............  ...............  Encephalitis vaccine, sc.....         9144  ...........       $67.72  ...........       $13.54
90740.................  F..............  ...............  Hepb vacc, ill pat 3 dose im.  ...........  ...........  ...........  ...........  ...........
90743.................  F..............  ...............  Hep b vacc, adol, 2 dose, im.  ...........  ...........  ...........  ...........  ...........
90744.................  F..............  ...............  Hepb vacc ped/adol 3 dose im.  ...........  ...........  ...........  ...........  ...........
90746.................  F..............  ...............  Hep b vaccine, adult, im.....  ...........  ...........  ...........  ...........  ...........
90747.................  F..............  ...............  Hepb vacc, ill pat 4 dose im.  ...........  ...........  ...........  ...........  ...........
90748.................  E..............  ...............  Hep b/hib vaccine, im........  ...........  ...........  ...........  ...........  ...........
90749.................  N..............  ...............  Vaccine toxoid...............  ...........  ...........  ...........  ...........  ...........
90780.................  S..............  ...............  IV infusion therapy, 1 hour..         0120       2.0101      $119.30       $28.21       $23.86
90781.................  N..............  ...............  IV infusion, additional hour.  ...........  ...........  ...........  ...........  ...........
90782.................  X..............  ...............  Injection, sc/im.............         0353       0.3936       $23.36  ...........        $4.67
90783.................  X..............  ...............  Injection, ia................         0359       0.8274       $49.11  ...........        $9.82
90784.................  X..............  ...............  Injection, iv................         0359       0.8274       $49.11  ...........        $9.82
90788.................  X..............  ...............  Injection of antibiotic......         0359       0.8274       $49.11  ...........        $9.82
90799.................  X..............  ...............  Ther/prophylactic/dx inject..         0352       0.1407        $8.35  ...........        $1.67
90801.................  S..............  ...............  Psy dx interview.............         0323       1.6153       $95.87       $19.99       $19.17
90802.................  S..............  ...............  Intac psy dx interview.......         0323       1.6153       $95.87       $19.99       $19.17
90804.................  S..............  ...............  Psytx, office, 20-30 min.....         0322       1.2263       $72.78  ...........       $14.56
90805.................  S..............  ...............  Psytx, off, 20-30 min w/e&m..         0322       1.2263       $72.78  ...........       $14.56
90806.................  S..............  ...............  Psytx, off, 45-50 min........         0323       1.6153       $95.87       $19.99       $19.17
90807.................  S..............  ...............  Psytx, off, 45-50 min w/e&m..         0323       1.6153       $95.87       $19.99       $19.17
90808.................  S..............  ...............  Psytx, office, 75-80 min.....         0323       1.6153       $95.87       $19.99       $19.17
90809.................  S..............  ...............  Psytx, off, 75-80, w/e&m.....         0323       1.6153       $95.87       $19.99       $19.17
90810.................  S..............  ...............  Intac psytx, off, 20-30 min..         0322       1.2263       $72.78  ...........       $14.56
90811.................  S..............  ...............  Intac psytx, 20-30, w/e&m....         0322       1.2263       $72.78  ...........       $14.56
90812.................  S..............  ...............  Intac psytx, off, 45-50 min..         0323       1.6153       $95.87       $19.99       $19.17
90813.................  S..............  ...............  Intac psytx, 45-50 min w/e&m.         0323       1.6153       $95.87       $19.99       $19.17
90814.................  S..............  ...............  Intac psytx, off, 75-80 min..         0323       1.6153       $95.87       $19.99       $19.17
90815.................  S..............  ...............  Intac psytx, 75-80 w/e&m.....         0323       1.6153       $95.87       $19.99       $19.17
90816.................  S..............  ...............  Psytx, hosp, 20-30 min.......         0322       1.2263       $72.78  ...........       $14.56
90817.................  S..............  ...............  Psytx, hosp, 20-30 min w/e&m.         0322       1.2263       $72.78  ...........       $14.56
90818.................  S..............  ...............  Psytx, hosp, 45-50 min.......         0323       1.6153       $95.87       $19.99       $19.17
90819.................  S..............  ...............  Psytx, hosp, 45-50 min w/e&m.         0323       1.6153       $95.87       $19.99       $19.17
90821.................  S..............  ...............  Psytx, hosp, 75-80 min.......         0323       1.6153       $95.87       $19.99       $19.17
90822.................  S..............  ...............  Psytx, hosp, 75-80 min w/e&m.         0323       1.6153       $95.87       $19.99       $19.17
90823.................  S..............  ...............  Intac psytx, hosp, 20-30 min.         0322       1.2263       $72.78  ...........       $14.56
90824.................  S..............  ...............  Intac psytx, hsp 20-30 w/e&m.         0322       1.2263       $72.78  ...........       $14.56
90826.................  S..............  ...............  Intac psytx, hosp, 45-50 min.         0323       1.6153       $95.87       $19.99       $19.17
90827.................  S..............  ...............  Intac psytx, hsp 45-50 w/e&m.         0323       1.6153       $95.87       $19.99       $19.17
90828.................  S..............  ...............  Intac psytx, hosp, 75-80 min.         0323       1.6153       $95.87       $19.99       $19.17

[[Page 42892]]

 
90829.................  S..............  ...............  Intac psytx, hsp 75-80 w/e&m.         0323       1.6153       $95.87       $19.99       $19.17
90845.................  S..............  ...............  Psychoanalysis...............         0323       1.6153       $95.87       $19.99       $19.17
90846.................  S..............  ...............  Family psytx w/o patient.....         0324       2.0901      $124.05  ...........       $24.81
90847.................  S..............  ...............  Family psytx w/patient.......         0324       2.0901      $124.05  ...........       $24.81
90849.................  S..............  ...............  Multiple family group psytx..         0325       1.3130       $77.93       $17.03       $15.59
90853.................  S..............  ...............  Group psychotherapy..........         0325       1.3130       $77.93       $17.03       $15.59
90857.................  S..............  ...............  Intac group psytx............         0325       1.3130       $77.93       $17.03       $15.59
90862.................  X..............  ...............  Medication management........         0374       1.0367       $61.53  ...........       $12.31
90865.................  S..............  ...............  Narcosynthesis...............         0323       1.6153       $95.87       $19.99       $19.17
90870.................  S..............  ...............  Electroconvulsive therapy....         0320       5.3522      $317.65       $80.06       $63.53
90871.................  E..............  ...............  Electroconvulsive therapy....  ...........  ...........  ...........  ...........  ...........
90875.................  E..............  ...............  Psychophysiological therapy..  ...........  ...........  ...........  ...........  ...........
90876.................  E..............  ...............  Psychophysiological therapy..  ...........  ...........  ...........  ...........  ...........
90880.................  S..............  ...............  Hypnotherapy.................         0323       1.6153       $95.87       $19.99       $19.17
90882.................  E..............  ...............  Environmental manipulation...  ...........  ...........  ...........  ...........  ...........
90885.................  N..............  ...............  Psy evaluation of records....  ...........  ...........  ...........  ...........  ...........
90887.................  N..............  ...............  Consultation with family.....  ...........  ...........  ...........  ...........  ...........
90889.................  N..............  ...............  Preparation of report........  ...........  ...........  ...........  ...........  ...........
90899.................  S..............  ...............  Psychiatric service/therapy..         0322       1.2263       $72.78  ...........       $14.56
90901.................  A..............  ...............  Biofeedback train, any meth..  ...........  ...........  ...........  ...........  ...........
90911.................  S..............  ...............  Biofeedback peri/uro/rectal..         0321       1.3517       $80.22       $21.61       $16.04
90918.................  E..............  ...............  ESRD related services, month.  ...........  ...........  ...........  ...........  ...........
90919.................  E..............  ...............  ESRD related services, month.  ...........  ...........  ...........  ...........  ...........
90920.................  E..............  ...............  ESRD related services, month.  ...........  ...........  ...........  ...........  ...........
90921.................  E..............  ...............  ESRD related services, month.  ...........  ...........  ...........  ...........  ...........
90922.................  E..............  ...............  ESRD related services, day...  ...........  ...........  ...........  ...........  ...........
90923.................  E..............  ...............  Esrd related services, day...  ...........  ...........  ...........  ...........  ...........
90924.................  E..............  ...............  Esrd related services, day...  ...........  ...........  ...........  ...........  ...........
90925.................  E..............  ...............  Esrd related services, day...  ...........  ...........  ...........  ...........  ...........
90935.................  S..............  ...............  Hemodialysis, one evaluation.         0170       5.8726      $348.54  ...........       $69.71
90937.................  E..............  ...............  Hemodialysis, repeated eval..  ...........  ...........  ...........  ...........  ...........
90939.................  N..............  ...............  Hemodialysis study, transcut.  ...........  ...........  ...........  ...........  ...........
90940.................  N..............  ...............  Hemodialysis access study....  ...........  ...........  ...........  ...........  ...........
90945.................  S..............  ...............  Dialysis, one evaluation.....         0170       5.8726      $348.54  ...........       $69.71
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 intubation........         0361       3.6052      $213.97       $83.23       $42.79
91010.................  X..............  ...............  Esophagus motility study.....         0361       3.6052      $213.97       $83.23       $42.79
91011.................  X..............  ...............  Esophagus motility study.....         0361       3.6052      $213.97       $83.23       $42.79
91012.................  X..............  ...............  Esophagus motility study.....         0361       3.6052      $213.97       $83.23       $42.79
91020.................  X..............  ...............  Gastric motility.............         0361       3.6052      $213.97       $83.23       $42.79
91030.................  X..............  ...............  Acid perfusion of esophagus..         0361       3.6052      $213.97       $83.23       $42.79
91034.................  X..............  ...............  Gastroesophageal reflux test.         0361       3.6052      $213.97       $83.23       $42.79
91035.................  X..............  ...............  G-esoph reflx tst w/electrod.         0361       3.6052      $213.97       $83.23       $42.79
91037.................  X..............  ...............  Esoph imped function test....         0361       3.6052      $213.97       $83.23       $42.79
91038.................  X..............  ...............  Esoph imped funct test > 1h..         0361       3.6052      $213.97       $83.23       $42.79
91040.................  X..............  ...............  Esoph balloon distension tst.         0360       1.4672       $87.08       $34.83       $17.42
91052.................  X..............  ...............  Gastric analysis test........         0361       3.6052      $213.97       $83.23       $42.79
91055.................  X..............  ...............  Gastric intubation for smear.         0360       1.4672       $87.08       $34.83       $17.42
91060.................  X..............  ...............  Gastric saline load test.....         0360       1.4672       $87.08       $34.83       $17.42
91065.................  X..............  ...............  Breath hydrogen test.........         0360       1.4672       $87.08       $34.83       $17.42
91100.................  X..............  ...............  Pass intestine bleeding tube.         0360       1.4672       $87.08       $34.83       $17.42
91105.................  X..............  ...............  Gastric intubation treatment.         0360       1.4672       $87.08       $34.83       $17.42
91110.................  T..............  ...............  Gi tract capsule endoscopy...         0142       9.3063      $552.33      $152.78      $110.47
91120.................  T..............  ...............  Rectal sensation test........         0156       2.5635      $152.14       $40.52       $30.43
91122.................  T..............  ...............  Anal pressure record.........         0156       2.5635      $152.14       $40.52       $30.43
91123.................  N..............  ...............  Irrigate fecal impaction.....  ...........  ...........  ...........  ...........  ...........
91132.................  X..............  ...............  Electrogastrography..........         0360       1.4672       $87.08       $34.83       $17.42
91133.................  X..............  ...............  Electrogastrography w/test...         0360       1.4672       $87.08       $34.83       $17.42
91299.................  X..............  ...............  Gastroenterology procedure...         0360       1.4672       $87.08       $34.83       $17.42
92002.................  V..............  ...............  Eye exam, new patient........         0601       0.9992       $59.30  ...........       $11.86
92004.................  V..............  ...............  Eye exam, new patient........         0601       0.9992       $59.30  ...........       $11.86
92012.................  V..............  ...............  Eye exam established pat.....         0600       0.8649       $51.33  ...........       $10.27

[[Page 42893]]

 
92014.................  V..............  ...............  Eye exam & treatment.........         0601       0.9992       $59.30  ...........       $11.86
92015.................  E..............  ...............  Refraction...................  ...........  ...........  ...........  ...........  ...........
92018.................  T..............  ...............  New eye exam & treatment.....         0699       9.9723      $591.86  ...........      $118.37
92019.................  T..............  ...............  Eye exam & treatment.........         0699       9.9723      $591.86  ...........      $118.37
92020.................  S..............  ...............  Special eye evaluation.......         0230       0.7823       $46.43       $14.97        $9.29
92060.................  S..............  ...............  Special eye evaluation.......         0230       0.7823       $46.43       $14.97        $9.29
92065.................  S..............  ...............  Orthoptic/pleoptic training..         0698       1.2381       $73.48       $16.48       $14.70
92070.................  N..............  ...............  Fitting of contact lens......  ...........  ...........  ...........  ...........  ...........
92081.................  S..............  ...............  Visual field examination(s)..         0230       0.7823       $46.43       $14.97        $9.29
92082.................  S..............  ...............  Visual field examination(s)..         0230       0.7823       $46.43       $14.97        $9.29
92083.................  S..............  ...............  Visual field examination(s)..         0230       0.7823       $46.43       $14.97        $9.29
92100.................  N..............  ...............  Serial tonometry exam(s).....  ...........  ...........  ...........  ...........  ...........
92120.................  S..............  ...............  Tonography & eye evaluation..         0230       0.7823       $46.43       $14.97        $9.29
92130.................  S..............  ...............  Water provocation tonography.         0230       0.7823       $46.43       $14.97        $9.29
92135.................  S..............  ...............  Opthalmic dx imaging.........         0230       0.7823       $46.43       $14.97        $9.29
92136.................  S..............  ...............  Ophthalmic biometry..........         0698       1.2381       $73.48       $16.48       $14.70
92140.................  S..............  ...............  Glaucoma provocative tests...         0698       1.2381       $73.48       $16.48       $14.70
92225.................  S..............  ...............  Special eye exam, initial....         0230       0.7823       $46.43       $14.97        $9.29
92226.................  S..............  ...............  Special eye exam, subsequent.         0230       0.7823       $46.43       $14.97        $9.29
92230.................  T..............  ...............  Eye exam with photos.........         0699       9.9723      $591.86  ...........      $118.37
92235.................  S..............  ...............  Eye exam with photos.........         0231       1.9191      $113.90  ...........       $22.78
92240.................  S..............  ...............  Icg angiography..............         0231       1.9191      $113.90  ...........       $22.78
92250.................  S..............  ...............  Eye exam with photos.........         0230       0.7823       $46.43       $14.97        $9.29
92260.................  S..............  ...............  Ophthalmoscopy/dynamometry...         0698       1.2381       $73.48       $16.48       $14.70
92265.................  S..............  ...............  Eye muscle evaluation........         0230       0.7823       $46.43       $14.97        $9.29
92270.................  S..............  ...............  Electro-oculography..........         0230       0.7823       $46.43       $14.97        $9.29
92275.................  S..............  ...............  Electroretinography..........         0231       1.9191      $113.90  ...........       $22.78
92283.................  S..............  ...............  Color vision examination.....         0230       0.7823       $46.43       $14.97        $9.29
92284.................  S..............  ...............  Dark adaptation eye exam.....         0698       1.2381       $73.48       $16.48       $14.70
92285.................  S..............  ...............  Eye photography..............         0230       0.7823       $46.43       $14.97        $9.29
92286.................  S..............  ...............  Internal eye photography.....         0698       1.2381       $73.48       $16.48       $14.70
92287.................  S..............  ...............  Internal eye photography.....         0698       1.2381       $73.48       $16.48       $14.70
92310.................  E..............  ...............  Contact lens fitting.........  ...........  ...........  ...........  ...........  ...........
92311.................  X..............  ...............  Contact lens fitting.........         0362       2.6486      $157.19  ...........       $31.44
92312.................  X..............  ...............  Contact lens fitting.........         0362       2.6486      $157.19  ...........       $31.44
92313.................  X..............  ...............  Contact lens fitting.........         0362       2.6486      $157.19  ...........       $31.44
92314.................  E..............  ...............  Prescription of contact lens.  ...........  ...........  ...........  ...........  ...........
92315.................  X..............  ...............  Prescription of contact lens.         0362       2.6486      $157.19  ...........       $31.44
92316.................  X..............  ...............  Prescription of contact lens.         0362       2.6486      $157.19  ...........       $31.44
92317.................  X..............  ...............  Prescription of contact lens.         0362       2.6486      $157.19  ...........       $31.44
92325.................  X..............  ...............  Modification of contact lens.         0362       2.6486      $157.19  ...........       $31.44
92326.................  X..............  ...............  Replacement of contact lens..         0362       2.6486      $157.19  ...........       $31.44
92330.................  S..............  ...............  Fitting of artificial eye....         0230       0.7823       $46.43       $14.97        $9.29
92335.................  N..............  ...............  Fitting of artificial eye....  ...........  ...........  ...........  ...........  ...........
92340.................  E..............  ...............  Fitting of spectacles........  ...........  ...........  ...........  ...........  ...........
92341.................  E..............  ...............  Fitting of spectacles........  ...........  ...........  ...........  ...........  ...........
92342.................  E..............  ...............  Fitting of spectacles........  ...........  ...........  ...........  ...........  ...........
92352.................  X..............  ...............  Special spectacles fitting...         0362       2.6486      $157.19  ...........       $31.44
92353.................  X..............  ...............  Special spectacles fitting...         0362       2.6486      $157.19  ...........       $31.44
92354.................  X..............  ...............  Special spectacles fitting...         0362       2.6486      $157.19  ...........       $31.44
92355.................  X..............  ...............  Special spectacles fitting...         0362       2.6486      $157.19  ...........       $31.44
92358.................  X..............  ...............  Eye prosthesis service.......         0362       2.6486      $157.19  ...........       $31.44
92370.................  E..............  ...............  Repair & adjust spectacles...  ...........  ...........  ...........  ...........  ...........
92371.................  X..............  ...............  Repair & adjust spectacles...         0362       2.6486      $157.19  ...........       $31.44
92390.................  E..............  ...............  Supply of spectacles.........  ...........  ...........  ...........  ...........  ...........
92391.................  E..............  ...............  Supply of contact lenses.....  ...........  ...........  ...........  ...........  ...........
92392.................  E..............  ...............  Supply of low vision aids....  ...........  ...........  ...........  ...........  ...........
92393.................  E..............  ...............  Supply of artificial eye.....  ...........  ...........  ...........  ...........  ...........
92395.................  E..............  ...............  Supply of spectacles.........  ...........  ...........  ...........  ...........  ...........
92396.................  E..............  ...............  Supply of contact lenses.....  ...........  ...........  ...........  ...........  ...........
92499.................  S..............  ...............  Eye service or procedure.....         0230       0.7823       $46.43       $14.97        $9.29
92502.................  T..............  ...............  Ear and throat examination...         0251       2.0010      $118.76  ...........       $23.75
92504.................  N..............  ...............  Ear microscopy examination...  ...........  ...........  ...........  ...........  ...........
92506.................  A..............  ...............  Speech/hearing evaluation....  ...........  ...........  ...........  ...........  ...........
92507.................  A..............  ...............  Speech/hearing therapy.......  ...........  ...........  ...........  ...........  ...........
92508.................  A..............  ...............  Speech/hearing therapy.......  ...........  ...........  ...........  ...........  ...........

[[Page 42894]]

 
92510.................  E..............  ...............  Rehab for ear implant........  ...........  ...........  ...........  ...........  ...........
92511.................  T..............  ...............  Nasopharyngoscopy............         0071       0.7879       $46.76       $11.31        $9.35
92512.................  X..............  ...............  Nasal function studies.......         0363       0.9087       $53.93       $17.44       $10.79
92516.................  X..............  ...............  Facial nerve function test...         0660       1.6345       $97.01       $30.60       $19.40
92520.................  X..............  ...............  Laryngeal function studies...         0660       1.6345       $97.01       $30.60       $19.40
92526.................  A..............  ...............  Oral function therapy........  ...........  ...........  ...........  ...........  ...........
92531.................  N..............  ...............  Spontaneous nystagmus study..  ...........  ...........  ...........  ...........  ...........
92532.................  N..............  ...............  Positional nystagmus test....  ...........  ...........  ...........  ...........  ...........
92533.................  N..............  ...............  Caloric vestibular test......  ...........  ...........  ...........  ...........  ...........
92534.................  N..............  ...............  Optokinetic nystagmus test...  ...........  ...........  ...........  ...........  ...........
92541.................  X..............  ...............  Spontaneous nystagmus test...         0363       0.9087       $53.93       $17.44       $10.79
92542.................  X..............  ...............  Positional nystagmus test....         0363       0.9087       $53.93       $17.44       $10.79
92543.................  X..............  ...............  Caloric vestibular test......         0660       1.6345       $97.01       $30.60       $19.40
92544.................  X..............  ...............  Optokinetic nystagmus test...         0363       0.9087       $53.93       $17.44       $10.79
92545.................  X..............  ...............  Oscillating tracking test....         0363       0.9087       $53.93       $17.44       $10.79
92546.................  X..............  ...............  Sinusoidal rotational test...         0660       1.6345       $97.01       $30.60       $19.40
92547.................  X..............  ...............  Supplemental electrical test.         0363       0.9087       $53.93       $17.44       $10.79
92548.................  X..............  ...............  Posturography................         0660       1.6345       $97.01       $30.60       $19.40
92551.................  E..............  ...............  Pure tone hearing test, air..  ...........  ...........  ...........  ...........  ...........
92552.................  X..............  ...............  Pure tone audiometry, air....         0364       0.4686       $27.81        $9.06        $5.56
92553.................  X..............  ...............  Audiometry, air & bone.......         0365       1.2300       $73.00       $18.95       $14.60
92555.................  X..............  ...............  Speech threshold audiometry..         0364       0.4686       $27.81        $9.06        $5.56
92556.................  X..............  ...............  Speech audiometry, complete..         0364       0.4686       $27.81        $9.06        $5.56
92557.................  X..............  ...............  Comprehensive hearing test...         0365       1.2300       $73.00       $18.95       $14.60
92559.................  E..............  ...............  Group audiometric testing....  ...........  ...........  ...........  ...........  ...........
92560.................  E..............  ...............  Bekesy audiometry, screen....  ...........  ...........  ...........  ...........  ...........
92561.................  X..............  ...............  Bekesy audiometry, diagnosis.         0364       0.4686       $27.81        $9.06        $5.56
92562.................  X..............  ...............  Loudness balance test........         0364       0.4686       $27.81        $9.06        $5.56
92563.................  X..............  ...............  Tone decay hearing test......         0364       0.4686       $27.81        $9.06        $5.56
92564.................  X..............  ...............  Sisi hearing test............         0364       0.4686       $27.81        $9.06        $5.56
92565.................  X..............  ...............  Stenger test, pure tone......         0364       0.4686       $27.81        $9.06        $5.56
92567.................  X..............  ...............  Tympanometry.................         0364       0.4686       $27.81        $9.06        $5.56
92568.................  X..............  ...............  Acoustic reflex testing......         0364       0.4686       $27.81        $9.06        $5.56
92569.................  X..............  ...............  Acoustic reflex decay test...         0364       0.4686       $27.81        $9.06        $5.56
92571.................  X..............  ...............  Filtered speech hearing test.         0364       0.4686       $27.81        $9.06        $5.56
92572.................  X..............  ...............  Staggered spondaic word test.         0365       1.2300       $73.00       $18.95       $14.60
92573.................  X..............  ...............  Lombard test.................         0364       0.4686       $27.81        $9.06        $5.56
92575.................  X..............  ...............  Sensorineural acuity test....         0364       0.4686       $27.81        $9.06        $5.56
92576.................  X..............  ...............  Synthetic sentence test......         0364       0.4686       $27.81        $9.06        $5.56
92577.................  X..............  ...............  Stenger test, speech.........         0366       1.7663      $104.83       $27.36       $20.97
92579.................  X..............  ...............  Visual audiometry (vra)......         0365       1.2300       $73.00       $18.95       $14.60
92582.................  X..............  ...............  Conditioning play audiometry.         0365       1.2300       $73.00       $18.95       $14.60
92583.................  X..............  ...............  Select picture audiometry....         0364       0.4686       $27.81        $9.06        $5.56
92584.................  X..............  ...............  Electrocochleography.........         0660       1.6345       $97.01       $30.60       $19.40
92585.................  S..............  ...............  Auditor evoke potent, compre.         0216       2.6599      $157.87  ...........       $31.57
92586.................  S..............  ...............  Auditor evoke potent, limit..         0218       1.1356       $67.40  ...........       $13.48
92587.................  X..............  ...............  Evoked auditory test.........         0363       0.9087       $53.93       $17.44       $10.79
92588.................  X..............  ...............  Evoked auditory test.........         0363       0.9087       $53.93       $17.44       $10.79
92590.................  E..............  ...............  Hearing aid exam, one ear....  ...........  ...........  ...........  ...........  ...........
92591.................  E..............  ...............  Hearing aid exam, both ears..  ...........  ...........  ...........  ...........  ...........
92592.................  E..............  ...............  Hearing aid check, one ear...  ...........  ...........  ...........  ...........  ...........
92593.................  E..............  ...............  Hearing aid check, both ears.  ...........  ...........  ...........  ...........  ...........
92594.................  E..............  ...............  Electro hearng aid test, one.  ...........  ...........  ...........  ...........  ...........
92595.................  E..............  ...............  Electro hearng aid tst, both.  ...........  ...........  ...........  ...........  ...........
92596.................  X..............  ...............  Ear protector evaluation.....         0364       0.4686       $27.81        $9.06        $5.56
92597.................  A..............  ...............  Voice Prosthetic Evaluation..  ...........  ...........  ...........  ...........  ...........
92601.................  X..............  ...............  Cochlear implt f/up exam < 7.         0366       1.7663      $104.83       $27.36       $20.97
92602.................  X..............  ...............  Reprogram cochlear implt < 7.         0366       1.7663      $104.83       $27.36       $20.97
92603.................  X..............  ...............  Cochlear implt f/up exam 7 >.         0366       1.7663      $104.83       $27.36       $20.97
92604.................  X..............  ...............  Reprogram cochlear implt 7 >.         0366       1.7663      $104.83       $27.36       $20.97
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42895]]

 
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.  ...........  ...........  ...........  ...........  ...........
92620.................  X..............  ...............  Auditory function, 60 min....         0364       0.4686       $27.81        $9.06        $5.56
92621.................  N..............  ...............  Auditory function, + 15 min..  ...........  ...........  ...........  ...........  ...........
92625.................  X..............  ...............  Tinnitus assessment..........         0364       0.4686       $27.81        $9.06        $5.56
92700.................  X..............  ...............  Ent procedure/service........         0364       0.4686       $27.81        $9.06        $5.56
92950.................  S..............  ...............  Heart/lung resuscitation cpr.         0094       2.5248      $149.85       $47.41       $29.97
92953.................  S..............  ...............  Temporary external pacing....         0094       2.5248      $149.85       $47.41       $29.97
92960.................  S..............  ...............  Cardioversion electric, ext..         0679       5.5521      $329.52       $95.30       $65.90
92961.................  S..............  ...............  Cardioversion, electric, int.         0679       5.5521      $329.52       $95.30       $65.90
92970.................  C..............  ...............  Cardioassist, internal.......  ...........  ...........  ...........  ...........  ...........
92971.................  C..............  ...............  Cardioassist, external.......  ...........  ...........  ...........  ...........  ...........
92973.................  T..............  ...............  Percut coronary thrombectomy.         0676       2.3996      $142.42  ...........       $28.48
92974.................  T..............  ...............  Cath place, cardio brachytx..         0103      14.6476      $869.34      $223.63      $173.87
92975.................  C..............  ...............  Dissolve clot, heart vessel..  ...........  ...........  ...........  ...........  ...........
92977.................  T..............  ...............  Dissolve clot, heart vessel..         0676       2.3996      $142.42  ...........       $28.48
92978.................  S..............  ...............  Intravasc us, heart add-on...         0670      25.2980    $1,501.44      $470.38      $300.29
92979.................  S..............  ...............  Intravasc us, heart add-on...         0416      19.4657    $1,155.29  ...........      $231.06
92980.................  T..............  ...............  Insert intracoronary stent...         0104      78.6515    $4,667.97  ...........      $933.59
92981.................  T..............  ...............  Insert intracoronary stent...         0104      78.6515    $4,667.97  ...........      $933.59
92982.................  T..............  ...............  Coronary artery dilation.....         0083      50.6620    $3,006.79  ...........      $601.36
92984.................  T..............  ...............  Coronary artery dilation.....         0083      50.6620    $3,006.79  ...........      $601.36
92986.................  T..............  ...............  Revision of aortic valve.....         0083      50.6620    $3,006.79  ...........      $601.36
92987.................  T..............  ...............  Revision of mitral valve.....         0083      50.6620    $3,006.79  ...........      $601.36
92990.................  T..............  ...............  Revision of pulmonary valve..         0083      50.6620    $3,006.79  ...........      $601.36
92992.................  C..............  ...............  Revision of heart chamber....  ...........  ...........  ...........  ...........  ...........
92993.................  C..............  ...............  Revision of heart chamber....  ...........  ...........  ...........  ...........  ...........
92995.................  T..............  ...............  Coronary atherectomy.........         0082      84.6276    $5,022.65    $1,080.41    $1,004.53
92996.................  T..............  ...............  Coronary atherectomy add-on..         0082      84.6276    $5,022.65    $1,080.41    $1,004.53
92997.................  T..............  ...............  Pul art balloon repr, percut.         0081      34.2913    $2,035.19  ...........      $407.04
92998.................  T..............  ...............  Pul art balloon repr, percut.         0081      34.2913    $2,035.19  ...........      $407.04
93000.................  B..............  ...............  Electrocardiogram, complete..  ...........  ...........  ...........  ...........  ...........
93005.................  S..............  ...............  Electrocardiogram, tracing...         0099       0.3804       $22.58  ...........        $4.52
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 stress test...         0100       2.4855      $147.51       $41.44       $29.50
93018.................  B..............  ...............  Cardiovascular stress test...  ...........  ...........  ...........  ...........  ...........
93024.................  X..............  ...............  Cardiac drug stress test.....         0100       2.4855      $147.51       $41.44       $29.50
93025.................  X..............  ...............  Microvolt t-wave assess......         0100       2.4855      $147.51       $41.44       $29.50
93040.................  B..............  ...............  Rhythm ECG with report.......  ...........  ...........  ...........  ...........  ...........
93041.................  S..............  ...............  Rhythm ECG, tracing..........         0099       0.3804       $22.58  ...........        $4.52
93042.................  B..............  ...............  Rhythm ECG, report...........  ...........  ...........  ...........  ...........  ...........
93224.................  B..............  ...............  ECG monitor/report, 24 hrs...  ...........  ...........  ...........  ...........  ...........
93225.................  X..............  ...............  ECG monitor/record, 24 hrs...         0097       1.0177       $60.40       $23.79       $12.08
93226.................  X..............  ...............  ECG monitor/report, 24 hrs...         0097       1.0177       $60.40       $23.79       $12.08
93227.................  B..............  ...............  ECG monitor/review, 24 hrs...  ...........  ...........  ...........  ...........  ...........
93230.................  B..............  ...............  ECG monitor/report, 24 hrs...  ...........  ...........  ...........  ...........  ...........
93231.................  X..............  ...............  Ecg monitor/record, 24 hrs...         0097       1.0177       $60.40       $23.79       $12.08
93232.................  X..............  ...............  ECG monitor/report, 24 hrs...         0097       1.0177       $60.40       $23.79       $12.08
93233.................  B..............  ...............  ECG monitor/review, 24 hrs...  ...........  ...........  ...........  ...........  ...........
93235.................  B..............  ...............  ECG monitor/report, 24 hrs...  ...........  ...........  ...........  ...........  ...........
93236.................  X..............  ...............  ECG monitor/report, 24 hrs...         0097       1.0177       $60.40       $23.79       $12.08
93237.................  B..............  ...............  ECG monitor/review, 24 hrs...  ...........  ...........  ...........  ...........  ...........
93268.................  B..............  ...............  ECG record/review............  ...........  ...........  ...........  ...........  ...........
93270.................  X..............  ...............  ECG recording................         0097       1.0177       $60.40       $23.79       $12.08
93271.................  X..............  ...............  Ecg/monitoring and analysis..         0097       1.0177       $60.40       $23.79       $12.08
93272.................  B..............  ...............  Ecg/review, interpret only...  ...........  ...........  ...........  ...........  ...........
93278.................  S..............  ...............  ECG/signal-averaged..........         0099       0.3804       $22.58  ...........        $4.52

[[Page 42896]]

 
93303.................  S..............  ...............  Echo transthoracic...........         0269       3.2290      $191.64       $76.65       $38.33
93304.................  S..............  ...............  Echo transthoracic...........         0697       1.5288       $90.73       $36.29       $18.15
93307.................  S..............  ...............  Echo exam of heart...........         0269       3.2290      $191.64       $76.65       $38.33
93308.................  S..............  ...............  Echo exam of heart...........         0697       1.5288       $90.73       $36.29       $18.15
93312.................  S..............  ...............  Echo transesophageal.........         0270       5.9919      $355.62      $142.24       $71.12
93313.................  S..............  ...............  Echo transesophageal.........         0270       5.9919      $355.62      $142.24       $71.12
93314.................  N..............  ...............  Echo transesophageal.........  ...........  ...........  ...........  ...........  ...........
93315.................  S..............  ...............  Echo transesophageal.........         0270       5.9919      $355.62      $142.24       $71.12
93316.................  S..............  ...............  Echo transesophageal.........         0270       5.9919      $355.62      $142.24       $71.12
93317.................  N..............  ...............  Echo transesophageal.........  ...........  ...........  ...........  ...........  ...........
93318.................  S..............  ...............  Echo transesophageal intraop.         0270       5.9919      $355.62      $142.24       $71.12
93320.................  S..............  ...............  Doppler echo exam, heart.....         0671       1.6951      $100.60       $40.24       $20.12
93321.................  S..............  ...............  Doppler echo exam, heart.....         0697       1.5288       $90.73       $36.29       $18.15
93325.................  S..............  ...............  Doppler color flow add-on....         0697       1.5288       $90.73       $36.29       $18.15
93350.................  S..............  ...............  Echo transthoracic...........         0269       3.2290      $191.64       $76.65       $38.33
93501.................  T..............  ...............  Right heart catheterization..         0080      36.9679    $2,194.04      $838.92      $438.81
93503.................  T..............  ...............  Insert/place heart catheter..         0103      14.6476      $869.34      $223.63      $173.87
93505.................  T..............  ...............  Biopsy of heart lining.......         0103      14.6476      $869.34      $223.63      $173.87
93508.................  T..............  ...............  Cath placement, angiography..         0080      36.9679    $2,194.04      $838.92      $438.81
93510.................  T..............  ...............  Left heart catheterization...         0080      36.9679    $2,194.04      $838.92      $438.81
93511.................  T..............  ...............  Left heart catheterization...         0080      36.9679    $2,194.04      $838.92      $438.81
93514.................  T..............  ...............  Left heart catheterization...         0080      36.9679    $2,194.04      $838.92      $438.81
93524.................  T..............  ...............  Left heart catheterization...         0080      36.9679    $2,194.04      $838.92      $438.81
93526.................  T..............  ...............  Rt & Lt heart catheters......         0080      36.9679    $2,194.04      $838.92      $438.81
93527.................  T..............  ...............  Rt & Lt heart catheters......         0080      36.9679    $2,194.04      $838.92      $438.81
93528.................  T..............  ...............  Rt & Lt heart catheters......         0080      36.9679    $2,194.04      $838.92      $438.81
93529.................  T..............  ...............  Rt, lt heart catheterization.         0080      36.9679    $2,194.04      $838.92      $438.81
93530.................  T..............  ...............  Rt heart cath, congenital....         0080      36.9679    $2,194.04      $838.92      $438.81
93531.................  T..............  ...............  R & l heart cath, congenital.         0080      36.9679    $2,194.04      $838.92      $438.81
93532.................  T..............  ...............  R & l heart cath, congenital.         0080      36.9679    $2,194.04      $838.92      $438.81
93533.................  T..............  ...............  R & l heart cath, congenital.         0080      36.9679    $2,194.04      $838.92      $438.81
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.................  S..............  ...............  Heart flow reserve measure...         0670      25.2980    $1,501.44      $470.38      $300.29
93572.................  S..............  ...............  Heart flow reserve measure...         0416      19.4657    $1,155.29  ...........      $231.06
93580.................  T..............  ...............  Transcath closure of asd.....         0434      90.3765    $5,363.85  ...........    $1,072.77
93581.................  T..............  ...............  Transcath closure of vsd.....         0434      90.3765    $5,363.85  ...........    $1,072.77
93600.................  T..............  ...............  Bundle of His recording......         0087      30.5711    $1,814.39  ...........      $362.88
93602.................  T..............  ...............  Intra-atrial recording.......         0087      30.5711    $1,814.39  ...........      $362.88
93603.................  T..............  ...............  Right ventricular recording..         0087      30.5711    $1,814.39  ...........      $362.88
93609.................  T..............  ...............  Map tachycardia, add-on......         0087      30.5711    $1,814.39  ...........      $362.88
93610.................  T..............  ...............  Intra-atrial pacing..........         0087      30.5711    $1,814.39  ...........      $362.88
93612.................  T..............  ...............  Intraventricular pacing......         0087      30.5711    $1,814.39  ...........      $362.88
93613.................  T..............  ...............  Electrophys map 3d, add-on...         0087      30.5711    $1,814.39  ...........      $362.88
93615.................  T..............  ...............  Esophageal recording.........         0087      30.5711    $1,814.39  ...........      $362.88
93616.................  T..............  ...............  Esophageal recording.........         0087      30.5711    $1,814.39  ...........      $362.88
93618.................  T..............  ...............  Heart rhythm pacing..........         0087      30.5711    $1,814.39  ...........      $362.88
93619.................  T..............  ...............  Electrophysiology evaluation.         0085      35.0288    $2,078.96      $426.25      $415.79
93620.................  T..............  ...............  Electrophysiology evaluation.         0085      35.0288    $2,078.96      $426.25      $415.79
93621.................  T..............  ...............  Electrophysiology evaluation.         0085      35.0288    $2,078.96      $426.25      $415.79
93622.................  T..............  ...............  Electrophysiology evaluation.         0085      35.0288    $2,078.96      $426.25      $415.79
93623.................  T..............  ...............  Stimulation, pacing heart....         0087      30.5711    $1,814.39  ...........      $362.88
93624.................  T..............  ...............  Electrophysiologic study.....         0085      35.0288    $2,078.96      $426.25      $415.79
93631.................  T..............  ...............  Heart pacing, mapping........         0087      30.5711    $1,814.39  ...........      $362.88
93640.................  S..............  ...............  Evaluation heart device......         0084       9.9751      $592.02  ...........      $118.40
93641.................  S..............  ...............  Electrophysiology evaluation.         0084       9.9751      $592.02  ...........      $118.40
93642.................  S..............  ...............  Electrophysiology evaluation.         0084       9.9751      $592.02  ...........      $118.40

[[Page 42897]]

 
93650.................  T..............  ...............  Ablate heart dysrhythm focus.         0086      44.0592    $2,614.91      $833.33      $522.98
93651.................  T..............  ...............  Ablate heart dysrhythm focus.         0086      44.0592    $2,614.91      $833.33      $522.98
93652.................  T..............  ...............  Ablate heart dysrhythm focus.         0086      44.0592    $2,614.91      $833.33      $522.98
93660.................  S..............  ...............  Tilt table evaluation........         0101       4.2593      $252.79      $101.11       $50.56
93662.................  S..............  ...............  Intracardiac ecg (ice).......         0670      25.2980    $1,501.44      $470.38      $300.29
93668.................  E..............  ...............  Peripheral vascular rehab....  ...........  ...........  ...........  ...........  ...........
93701.................  S..............  ...............  Bioimpedance, thoracic.......         0099       0.3804       $22.58  ...........        $4.52
93720.................  B..............  ...............  Total body plethysmography...  ...........  ...........  ...........  ...........  ...........
93721.................  X..............  ...............  Plethysmography tracing......         0368       0.9716       $57.66       $23.06       $11.53
93722.................  B..............  ...............  Plethysmography report.......  ...........  ...........  ...........  ...........  ...........
93724.................  S..............  ...............  Analyze pacemaker system.....         0690       0.3738       $22.19        $8.87        $4.44
93727.................  S..............  ...............  Analyze ilr system...........         0690       0.3738       $22.19        $8.87        $4.44
93731.................  S..............  ...............  Analyze pacemaker system.....         0690       0.3738       $22.19        $8.87        $4.44
93732.................  S..............  ...............  Analyze pacemaker system.....         0690       0.3738       $22.19        $8.87        $4.44
93733.................  S..............  ...............  Telephone analy, pacemaker...         0690       0.3738       $22.19        $8.87        $4.44
93734.................  S..............  ...............  Analyze pacemaker system.....         0690       0.3738       $22.19        $8.87        $4.44
93735.................  S..............  ...............  Analyze pacemaker system.....         0690       0.3738       $22.19        $8.87        $4.44
93736.................  S..............  ...............  Telephonic analy, pacemaker..         0690       0.3738       $22.19        $8.87        $4.44
93740.................  X..............  ...............  Temperature gradient studies.         0368       0.9716       $57.66       $23.06       $11.53
93741.................  S..............  ...............  Analyze ht pace device sngl..         0689       0.5709       $33.88  ...........        $6.78
93742.................  S..............  ...............  Analyze ht pace device sngl..         0689       0.5709       $33.88  ...........        $6.78
93743.................  S..............  ...............  Analyze ht pace device dual..         0689       0.5709       $33.88  ...........        $6.78
93744.................  S..............  ...............  Analyze ht pace device dual..         0689       0.5709       $33.88  ...........        $6.78
93745.................  S..............  ...............  Set-up cardiovert-defibrill..         0689       0.5709       $33.88  ...........        $6.78
93760.................  E..............  ...............  Cephalic thermogram..........  ...........  ...........  ...........  ...........  ...........
93762.................  E..............  ...............  Peripheral thermogram........  ...........  ...........  ...........  ...........  ...........
93770.................  N..............  ...............  Measure venous pressure......  ...........  ...........  ...........  ...........  ...........
93784.................  E..............  ...............  Ambulatory BP monitoring.....  ...........  ...........  ...........  ...........  ...........
93786.................  X..............  ...............  Ambulatory BP recording......         0097       1.0177       $60.40       $23.79       $12.08
93788.................  X..............  ...............  Ambulatory BP analysis.......         0097       1.0177       $60.40       $23.79       $12.08
93790.................  B..............  ...............  Review/report BP recording...  ...........  ...........  ...........  ...........  ...........
93797.................  S..............  ...............  Cardiac rehab................         0095       0.5858       $34.77       $13.90        $6.95
93798.................  S..............  ...............  Cardiac rehab/monitor........         0095       0.5858       $34.77       $13.90        $6.95
93799.................  S..............  ...............  Cardiovascular procedure.....         0096       1.6233       $96.34       $38.53       $19.27
93875.................  S..............  ...............  Extracranial study...........         0096       1.6233       $96.34       $38.53       $19.27
93880.................  S..............  ...............  Extracranial study...........         0267       2.6208      $155.54       $62.18       $31.11
93882.................  S..............  ...............  Extracranial study...........         0267       2.6208      $155.54       $62.18       $31.11
93886.................  S..............  ...............  Intracranial study...........         0267       2.6208      $155.54       $62.18       $31.11
93888.................  S..............  ...............  Intracranial study...........         0266       1.6319       $96.85       $38.74       $19.37
93890.................  S..............  ...............  Tcd, vasoreactivity study....         0266       1.6319       $96.85       $38.74       $19.37
93892.................  S..............  ...............  Tcd, emboli detect w/o inj...         0266       1.6319       $96.85       $38.74       $19.37
93893.................  S..............  ...............  Tcd, emboli detect w/inj.....         0266       1.6319       $96.85       $38.74       $19.37
93922.................  S..............  ...............  Extremity study..............         0096       1.6233       $96.34       $38.53       $19.27
93923.................  S..............  ...............  Extremity study..............         0096       1.6233       $96.34       $38.53       $19.27
93924.................  S..............  ...............  Extremity study..............         0096       1.6233       $96.34       $38.53       $19.27
93925.................  S..............  ...............  Lower extremity study........         0267       2.6208      $155.54       $62.18       $31.11
93926.................  S..............  ...............  Lower extremity study........         0266       1.6319       $96.85       $38.74       $19.37
93930.................  S..............  ...............  Upper extremity study........         0267       2.6208      $155.54       $62.18       $31.11
93931.................  S..............  ...............  Upper extremity study........         0266       1.6319       $96.85       $38.74       $19.37
93965.................  S..............  ...............  Extremity study..............         0096       1.6233       $96.34       $38.53       $19.27
93970.................  S..............  ...............  Extremity study..............         0267       2.6208      $155.54       $62.18       $31.11
93971.................  S..............  ...............  Extremity study..............         0266       1.6319       $96.85       $38.74       $19.37
93975.................  S..............  ...............  Vascular study...............         0267       2.6208      $155.54       $62.18       $31.11
93976.................  S..............  ...............  Vascular study...............         0267       2.6208      $155.54       $62.18       $31.11
93978.................  S..............  ...............  Vascular study...............         0266       1.6319       $96.85       $38.74       $19.37
93979.................  S..............  ...............  Vascular study...............         0266       1.6319       $96.85       $38.74       $19.37
93980.................  S..............  ...............  Penile vascular study........         0267       2.6208      $155.54       $62.18       $31.11
93981.................  S..............  ...............  Penile vascular study........         0266       1.6319       $96.85       $38.74       $19.37
93990.................  S..............  ...............  Doppler flow testing.........         0266       1.6319       $96.85       $38.74       $19.37
94010.................  X..............  ...............  Breathing capacity test......         0368       0.9716       $57.66       $23.06       $11.53
94014.................  X..............  ...............  Patient recorded spirometry..         0367       0.6629       $39.34       $14.80        $7.87
94015.................  X..............  ...............  Patient recorded spirometry..         0367       0.6629       $39.34       $14.80        $7.87
94016.................  A..............  ...............  Review patient spirometry....  ...........  ...........  ...........  ...........  ...........
94060.................  X..............  ...............  Evaluation of wheezing.......         0368       0.9716       $57.66       $23.06       $11.53
94070.................  X..............  ...............  Evaluation of wheezing.......         0369       2.7394      $162.58       $44.18       $32.52
94150.................  X..............  ...............  Vital capacity test..........         0367       0.6629       $39.34       $14.80        $7.87

[[Page 42898]]

 
94200.................  X..............  ...............  Lung function test (MBC/MVV).         0367       0.6629       $39.34       $14.80        $7.87
94240.................  X..............  ...............  Residual lung capacity.......         0368       0.9716       $57.66       $23.06       $11.53
94250.................  X..............  ...............  Expired gas collection.......         0367       0.6629       $39.34       $14.80        $7.87
94260.................  X..............  ...............  Thoracic gas volume..........         0367       0.6629       $39.34       $14.80        $7.87
94350.................  X..............  ...............  Lung nitrogen washout curve..         0367       0.6629       $39.34       $14.80        $7.87
94360.................  X..............  ...............  Measure airflow resistance...         0367       0.6629       $39.34       $14.80        $7.87
94370.................  X..............  ...............  Breath airway closing volume.         0367       0.6629       $39.34       $14.80        $7.87
94375.................  X..............  ...............  Respiratory flow volume loop.         0367       0.6629       $39.34       $14.80        $7.87
94400.................  X..............  ...............  CO2 breathing response curve.         0367       0.6629       $39.34       $14.80        $7.87
94450.................  X..............  ...............  Hypoxia response curve.......         0368       0.9716       $57.66       $23.06       $11.53
94452.................  X..............  ...............  Hast w/report................         0368       0.9716       $57.66       $23.06       $11.53
94453.................  X..............  ...............  Hast w/oxygen titrate........         0368       0.9716       $57.66       $23.06       $11.53
94620.................  X..............  ...............  Pulmonary stress test/simple.         0368       0.9716       $57.66       $23.06       $11.53
94621.................  X..............  ...............  Pulm stress test/complex.....         0369       2.7394      $162.58       $44.18       $32.52
94640.................  S..............  ...............  Airway inhalation treatment..         0077       0.3428       $20.35        $7.74        $4.07
94642.................  S..............  ...............  Aerosol inhalation treatment.         0078       1.0190       $60.48       $14.55       $12.10
94656.................  S..............  ...............  Initial ventilator mgmt......         0079       2.3375      $138.73  ...........       $27.75
94657.................  S..............  ...............  Continued ventilator mgmt....         0079       2.3375      $138.73  ...........       $27.75
94660.................  S..............  ...............  Pos airway pressure, CPAP....         0068       1.2237       $72.63       $29.05       $14.53
94662.................  S..............  ...............  Neg press ventilation, cnp...         0079       2.3375      $138.73  ...........       $27.75
94664.................  S..............  ...............  Aerosol or vapor inhalations.         0077       0.3428       $20.35        $7.74        $4.07
94667.................  S..............  ...............  Chest wall manipulation......         0077       0.3428       $20.35        $7.74        $4.07
94668.................  S..............  ...............  Chest wall manipulation......         0077       0.3428       $20.35        $7.74        $4.07
94680.................  X..............  ...............  Exhaled air analysis, o2.....         0367       0.6629       $39.34       $14.80        $7.87
94681.................  X..............  ...............  Exhaled air analysis, o2/co2.         0368       0.9716       $57.66       $23.06       $11.53
94690.................  X..............  ...............  Exhaled air analysis.........         0368       0.9716       $57.66       $23.06       $11.53
94720.................  X..............  ...............  Monoxide diffusing capacity..         0368       0.9716       $57.66       $23.06       $11.53
94725.................  X..............  ...............  Membrane diffusion capacity..         0368       0.9716       $57.66       $23.06       $11.53
94750.................  X..............  ...............  Pulmonary compliance study...         0368       0.9716       $57.66       $23.06       $11.53
94760.................  N..............  ...............  Measure blood oxygen level...  ...........  ...........  ...........  ...........  ...........
94761.................  N..............  ...............  Measure blood oxygen level...  ...........  ...........  ...........  ...........  ...........
94762.................  N..............  ...............  Measure blood oxygen level...  ...........  ...........  ...........  ...........  ...........
94770.................  X..............  ...............  Exhaled carbon dioxide test..         0367       0.6629       $39.34       $14.80        $7.87
94772.................  X..............  ...............  Breath recording, infant.....         0369       2.7394      $162.58       $44.18       $32.52
94799.................  X..............  ...............  Pulmonary service/procedure..         0367       0.6629       $39.34       $14.80        $7.87
95004.................  X..............  ...............  Percut allergy skin tests....         0381       0.1876       $11.13        $2.34        $2.23
95010.................  X..............  ...............  Percut allergy titrate test..         0381       0.1876       $11.13        $2.34        $2.23
95015.................  X..............  ...............  Id allergy titrate-drug/bug..         0381       0.1876       $11.13        $2.34        $2.23
95024.................  X..............  ...............  Id allergy test, drug/bug....         0381       0.1876       $11.13        $2.34        $2.23
95027.................  X..............  ...............  Skin end point titration.....         0381       0.1876       $11.13        $2.34        $2.23
95028.................  X..............  ...............  Id allergy test-delayed type.         0381       0.1876       $11.13        $2.34        $2.23
95044.................  X..............  ...............  Allergy patch tests..........         0381       0.1876       $11.13        $2.34        $2.23
95052.................  X..............  ...............  Photo patch test.............         0381       0.1876       $11.13        $2.34        $2.23
95056.................  X..............  ...............  Photosensitivity tests.......         0370       1.1181       $66.36  ...........       $13.27
95060.................  X..............  ...............  Eye allergy tests............         0370       1.1181       $66.36  ...........       $13.27
95065.................  X..............  ...............  Nose allergy test............         0381       0.1876       $11.13        $2.34        $2.23
95070.................  X..............  ...............  Bronchial allergy tests......         0369       2.7394      $162.58       $44.18       $32.52
95071.................  X..............  ...............  Bronchial allergy tests......         0369       2.7394      $162.58       $44.18       $32.52
95075.................  X..............  ...............  Ingestion challenge test.....         0361       3.6052      $213.97       $83.23       $42.79
95078.................  X..............  ...............  Provocative testing..........         0370       1.1181       $66.36  ...........       $13.27
95115.................  X..............  ...............  Immunotherapy, one injection.         0352       0.1407        $8.35  ...........        $1.67
95117.................  X..............  ...............  Immunotherapy injections.....         0353       0.3936       $23.36  ...........        $4.67
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 services.....         0353       0.3936       $23.36  ...........        $4.67
95145.................  X..............  ...............  Antigen therapy services.....         0353       0.3936       $23.36  ...........        $4.67
95146.................  X..............  ...............  Antigen therapy services.....         0359       0.8274       $49.11  ...........        $9.82
95147.................  X..............  ...............  Antigen therapy services.....         0359       0.8274       $49.11  ...........        $9.82
95148.................  X..............  ...............  Antigen therapy services.....         0353       0.3936       $23.36  ...........        $4.67
95149.................  X..............  ...............  Antigen therapy services.....         0352       0.1407        $8.35  ...........        $1.67
95165.................  X..............  ...............  Antigen therapy services.....         0353       0.3936       $23.36  ...........        $4.67

[[Page 42899]]

 
95170.................  X..............  ...............  Antigen therapy services.....         0352       0.1407        $8.35  ...........        $1.67
95180.................  X..............  ...............  Rapid desensitization........         0370       1.1181       $66.36  ...........       $13.27
95199.................  X..............  ...............  Allergy immunology services..         0370       1.1181       $66.36  ...........       $13.27
95250.................  X..............  ...............  Glucose monitoring, cont.....         0421       1.6525       $98.08  ...........       $19.62
95805.................  S..............  ...............  Multiple sleep latency test..         0209      11.5189      $683.65      $273.46      $136.73
95806.................  S..............  ...............  Sleep study, unattended......         0213       2.2828      $135.48       $54.19       $27.10
95807.................  S..............  ...............  Sleep study, attended........         0209      11.5189      $683.65      $273.46      $136.73
95808.................  S..............  ...............  Polysomnography, 1-3.........         0209      11.5189      $683.65      $273.46      $136.73
95810.................  S..............  ...............  Polysomnography, 4 or more...         0209      11.5189      $683.65      $273.46      $136.73
95811.................  S..............  ...............  Polysomnography w/cpap.......         0209      11.5189      $683.65      $273.46      $136.73
95812.................  S..............  ...............  Electroencephalogram (EEG)...         0213       2.2828      $135.48       $54.19       $27.10
95813.................  S..............  ...............  Eeg, over 1 hour.............         0213       2.2828      $135.48       $54.19       $27.10
95816.................  S..............  ...............  Electroencephalogram (EEG)...         0213       2.2828      $135.48       $54.19       $27.10
95819.................  S..............  ...............  Electroencephalogram (EEG)...         0213       2.2828      $135.48       $54.19       $27.10
95822.................  S..............  ...............  Sleep electroencephalogram...         0213       2.2828      $135.48       $54.19       $27.10
95824.................  S..............  ...............  Eeg, cerebral death only.....         0214       1.1302       $67.08       $26.83       $13.42
95827.................  S..............  ...............  night electroencephalogram...         0213       2.2828      $135.48       $54.19       $27.10
95829.................  S..............  ...............  Surgery electrocorticogram...         0214       1.1302       $67.08       $26.83       $13.42
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       1.1356       $67.40  ...........       $13.48
95858.................  S..............  ...............  Tensilon test & myogram......         0215       0.6087       $36.13       $14.45        $7.23
95860.................  S..............  ...............  Muscle test, one limb........         0218       1.1356       $67.40  ...........       $13.48
95861.................  S..............  ...............  Muscle test, 2 limbs.........         0218       1.1356       $67.40  ...........       $13.48
95863.................  S..............  ...............  Muscle test, 3 limbs.........         0218       1.1356       $67.40  ...........       $13.48
95864.................  S..............  ...............  Muscle test, 4 limbs.........         0218       1.1356       $67.40  ...........       $13.48
95867.................  S..............  ...............  Muscle test, head or neck....         0218       1.1356       $67.40  ...........       $13.48
95868.................  S..............  ...............  Muscle test cran nerve bilat.         0218       1.1356       $67.40  ...........       $13.48
95869.................  S..............  ...............  Muscle test, thor paraspinal.         0215       0.6087       $36.13       $14.45        $7.23
95870.................  S..............  ...............  Muscle test, nonparaspinal...         0215       0.6087       $36.13       $14.45        $7.23
95872.................  S..............  ...............  Muscle test, one fiber.......         0218       1.1356       $67.40  ...........       $13.48
95875.................  S..............  ...............  Limb exercise test...........         0215       0.6087       $36.13       $14.45        $7.23
95900.................  S..............  ...............  Motor nerve conduction test..         0215       0.6087       $36.13       $14.45        $7.23
95903.................  S..............  ...............  Motor nerve conduction test..         0215       0.6087       $36.13       $14.45        $7.23
95904.................  S..............  ...............  Sense nerve conduction test..         0215       0.6087       $36.13       $14.45        $7.23
95920.................  S..............  ...............  Intraop nerve test add-on....         0216       2.6599      $157.87  ...........       $31.57
95921.................  S..............  ...............  Autonomic nerv function test.         0218       1.1356       $67.40  ...........       $13.48
95922.................  S..............  ...............  Autonomic nerv function test.         0218       1.1356       $67.40  ...........       $13.48
95923.................  S..............  ...............  Autonomic nerv function test.         0218       1.1356       $67.40  ...........       $13.48
95925.................  S..............  ...............  Somatosensory testing........         0216       2.6599      $157.87  ...........       $31.57
95926.................  S..............  ...............  Somatosensory testing........         0216       2.6599      $157.87  ...........       $31.57
95927.................  S..............  ...............  Somatosensory testing........         0216       2.6599      $157.87  ...........       $31.57
95928.................  S..............  ...............  C motor evoked, uppr limbs...         0218       1.1356       $67.40  ...........       $13.48
95929.................  S..............  ...............  C motor evoked, lwr limbs....         0218       1.1356       $67.40  ...........       $13.48
95930.................  S..............  ...............  Visual evoked potential test.         0216       2.6599      $157.87  ...........       $31.57
95933.................  S..............  ...............  Blink reflex test............         0215       0.6087       $36.13       $14.45        $7.23
95934.................  S..............  ...............  H-reflex test................         0215       0.6087       $36.13       $14.45        $7.23
95936.................  S..............  ...............  H-reflex test................         0215       0.6087       $36.13       $14.45        $7.23
95937.................  S..............  ...............  Neuromuscular junction test..         0218       1.1356       $67.40  ...........       $13.48
95950.................  S..............  ...............  Ambulatory eeg monitoring....         0213       2.2828      $135.48       $54.19       $27.10
95951.................  S..............  ...............  EEG monitoring/videorecord...         0209      11.5189      $683.65      $273.46      $136.73
95953.................  S..............  ...............  EEG monitoring/computer......         0209      11.5189      $683.65      $273.46      $136.73
95954.................  S..............  ...............  EEG monitoring/giving drugs..         0214       1.1302       $67.08       $26.83       $13.42
95955.................  S..............  ...............  EEG during surgery...........         0213       2.2828      $135.48       $54.19       $27.10
95956.................  S..............  ...............  Eeg monitoring, cable/radio..         0209      11.5189      $683.65      $273.46      $136.73
95957.................  S..............  ...............  EEG digital analysis.........         0214       1.1302       $67.08       $26.83       $13.42
95958.................  S..............  ...............  EEG monitoring/function test.         0213       2.2828      $135.48       $54.19       $27.10
95961.................  S..............  ...............  Electrode stimulation, brain.         0216       2.6599      $157.87  ...........       $31.57
95962.................  S..............  ...............  Electrode stim, brain add-on.         0216       2.6599      $157.87  ...........       $31.57
95965.................  T..............  ...............  Meg, spontaneous.............         0430      11.3524      $673.76  ...........      $134.75
95966.................  T..............  ...............  Meg, evoked, single..........         0430      11.3524      $673.76  ...........      $134.75

[[Page 42900]]

 
95967.................  T..............  ...............  Meg, evoked, each add'l......         0430      11.3524      $673.76  ...........      $134.75
95970.................  S..............  ...............  Analyze neurostim, no prog...         0218       1.1356       $67.40  ...........       $13.48
95971.................  S..............  ...............  Analyze neurostim, simple....         0692       2.0020      $118.82       $30.16       $23.76
95972.................  S..............  ...............  Analyze neurostim, complex...         0692       2.0020      $118.82       $30.16       $23.76
95973.................  S..............  ...............  Analyze neurostim, complex...         0692       2.0020      $118.82       $30.16       $23.76
95974.................  S..............  ...............  Cranial neurostim, complex...         0692       2.0020      $118.82       $30.16       $23.76
95975.................  S..............  ...............  Cranial neurostim, complex...         0692       2.0020      $118.82       $30.16       $23.76
95978.................  S..............  ...............  Analyze neurostim brain/1h...         0692       2.0020      $118.82       $30.16       $23.76
95979.................  S..............  ...............  Analyz neurostim brain addon.         0692       2.0020      $118.82       $30.16       $23.76
95990.................  T..............  ...............  Spin/brain pump refil & main.         0125       1.9244      $114.21  ...........       $22.84
95991.................  T..............  ...............  Spin/brain pump refil & main.         0125       1.9244      $114.21  ...........       $22.84
95999.................  S..............  ...............  Neurological procedure.......         0215       0.6087       $36.13       $14.45        $7.23
96000.................  S..............  ...............  Motion analysis, video/3d....         0216       2.6599      $157.87  ...........       $31.57
96001.................  S..............  ...............  Motion test w/ft press meas..         0216       2.6599      $157.87  ...........       $31.57
96002.................  S..............  ...............  Dynamic surface emg..........         0218       1.1356       $67.40  ...........       $13.48
96003.................  S..............  ...............  Dynamic fine wire emg........         0215       0.6087       $36.13       $14.45        $7.23
96004.................  E..............  ...............  Phys review of motion tests..  ...........  ...........  ...........  ...........  ...........
96100.................  X..............  ...............  Psychological testing........         0373       2.1827      $129.54  ...........       $25.91
96105.................  A..............  ...............  Assessment of aphasia........  ...........  ...........  ...........  ...........  ...........
96110.................  X..............  ...............  Developmental test, lim......         0373       2.1827      $129.54  ...........       $25.91
96111.................  X..............  ...............  Developmental test, extend...         0373       2.1827      $129.54  ...........       $25.91
96115.................  X..............  ...............  Neurobehavior status exam....         0373       2.1827      $129.54  ...........       $25.91
96117.................  X..............  ...............  Neuropsych test battery......         0373       2.1827      $129.54  ...........       $25.91
96150.................  S..............  ...............  Assess lth/behave, init......         0432       0.6918       $41.06  ...........        $8.21
96151.................  S..............  ...............  Assess hlth/behave, subseq...         0432       0.6918       $41.06  ...........        $8.21
96152.................  S..............  ...............  Intervene hlth/behave, indiv.         0432       0.6918       $41.06  ...........        $8.21
96153.................  S..............  ...............  Intervene hlth/behave, group.         0432       0.6918       $41.06  ...........        $8.21
96154.................  S..............  ...............  Interv hlth/behav, fam w/pt..         0432       0.6918       $41.06  ...........        $8.21
96155.................  E..............  ...............  Interv hlth/behav fam no pt..  ...........  ...........  ...........  ...........  ...........
96400.................  S..............  ...............  Chemotherapy, sc/im..........         0116       1.1401       $67.66  ...........       $13.53
96405.................  S..............  ...............  Intralesional chemo admin....         0116       1.1401       $67.66  ...........       $13.53
96406.................  S..............  ...............  Intralesional chemo admin....         0116       1.1401       $67.66  ...........       $13.53
96408.................  S..............  ...............  Chemotherapy, push technique.         0116       1.1401       $67.66  ...........       $13.53
96410.................  S..............  ...............  Chemotherapy,infusion method.         0117       3.2231      $191.29       $42.54       $38.26
96412.................  N..............  ...............  Chemo, infuse method add-on..  ...........  ...........  ...........  ...........  ...........
96414.................  S..............  ...............  Chemo, infuse method add-on..         0117       3.2231      $191.29       $42.54       $38.26
96420.................  S..............  ...............  Chemotherapy, push technique.         0116       1.1401       $67.66  ...........       $13.53
96422.................  S..............  ...............  Chemotherapy,infusion method.         0117       3.2231      $191.29       $42.54       $38.26
96423.................  N..............  ...............  Chemo, infuse method add-on..  ...........  ...........  ...........  ...........  ...........
96425.................  S..............  ...............  Chemotherapy,infusion method.         0117       3.2231      $191.29       $42.54       $38.26
96440.................  S..............  ...............  Chemotherapy, intracavitary..         0116       1.1401       $67.66  ...........       $13.53
96445.................  S..............  ...............  Chemotherapy, intracavitary..         0116       1.1401       $67.66  ...........       $13.53
96450.................  S..............  ...............  Chemotherapy, into CNS.......         0116       1.1401       $67.66  ...........       $13.53
96520.................  T..............  ...............  Port pump refill & main......         0125       1.9244      $114.21  ...........       $22.84
96530.................  T..............  ...............  Pump refilling, maintenance..         0125       1.9244      $114.21  ...........       $22.84
96542.................  S..............  ...............  Chemotherapy injection.......         0116       1.1401       $67.66  ...........       $13.53
96545.................  N..............  ...............  Provide chemotherapy agent...  ...........  ...........  ...........  ...........  ...........
96549.................  S..............  ...............  Chemotherapy, unspecified....         0116       1.1401       $67.66  ...........       $13.53
96567.................  T..............  ...............  Photodynamic tx, skin........         0016       2.5717      $152.63       $33.42       $30.53
96570.................  T..............  ...............  Photodynamic tx, 30 min......         0015       1.6439       $97.57       $20.20       $19.51
96571.................  T..............  ...............  Photodynamic tx, addl 15 min.         0015       1.6439       $97.57       $20.20       $19.51
96900.................  S..............  ...............  Ultraviolet light therapy....         0001       0.4194       $24.89        $7.00        $4.98
96902.................  N..............  ...............  Trichogram...................  ...........  ...........  ...........  ...........  ...........
96910.................  S..............  ...............  Photochemotherapy with UV-B..         0001       0.4194       $24.89        $7.00        $4.98
96912.................  S..............  ...............  Photochemotherapy with UV-A..         0001       0.4194       $24.89        $7.00        $4.98
96913.................  S..............  ...............  Photochemotherapy, UV-A or B.         0683       1.8920      $112.29       $25.23       $22.46
96920.................  T..............  ...............  Laser tx, skin < 250 sq cm...         0013       1.1028       $65.45       $14.20       $13.09
96921.................  T..............  ...............  Laser tx, skin 250-500 sq cm.         0013       1.1028       $65.45       $14.20       $13.09
96922.................  T..............  ...............  Laser tx, skin > 500 sq cm...         0013       1.1028       $65.45       $14.20       $13.09
96999.................  T..............  ...............  Dermatological procedure.....         0010       0.5693       $33.79        $9.63        $6.76
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........  ...........  ...........  ...........  ...........  ...........

[[Page 42901]]

 
97010.................  A..............  ...............  Hot or cold packs therapy....  ...........  ...........  ...........  ...........  ...........
97012.................  A..............  ...............  Mechanical traction therapy..  ...........  ...........  ...........  ...........  ...........
97014.................  E..............  ...............  Electric stimulation therapy.  ...........  ...........  ...........  ...........  ...........
97016.................  A..............  ...............  Vasopneumatic device therapy.  ...........  ...........  ...........  ...........  ...........
97018.................  A..............  ...............  Paraffin bath therapy........  ...........  ...........  ...........  ...........  ...........
97020.................  A..............  ...............  Microwave therapy............  ...........  ...........  ...........  ...........  ...........
97022.................  A..............  ...............  Whirlpool therapy............  ...........  ...........  ...........  ...........  ...........
97024.................  A..............  ...............  Diathermy treatment..........  ...........  ...........  ...........  ...........  ...........
97026.................  A..............  ...............  Infrared therapy.............  ...........  ...........  ...........  ...........  ...........
97028.................  A..............  ...............  Ultraviolet therapy..........  ...........  ...........  ...........  ...........  ...........
97032.................  A..............  ...............  Electrical stimulation.......  ...........  ...........  ...........  ...........  ...........
97033.................  A..............  ...............  Electric current therapy.....  ...........  ...........  ...........  ...........  ...........
97034.................  A..............  ...............  Contrast bath therapy........  ...........  ...........  ...........  ...........  ...........
97035.................  A..............  ...............  Ultrasound therapy...........  ...........  ...........  ...........  ...........  ...........
97036.................  A..............  ...............  Hydrotherapy.................  ...........  ...........  ...........  ...........  ...........
97039.................  A..............  ...............  Physical therapy treatment...  ...........  ...........  ...........  ...........  ...........
97110.................  A..............  ...............  Therapeutic exercises........  ...........  ...........  ...........  ...........  ...........
97112.................  A..............  ...............  Neuromuscular reeducation....  ...........  ...........  ...........  ...........  ...........
97113.................  A..............  ...............  Aquatic therapy/exercises....  ...........  ...........  ...........  ...........  ...........
97116.................  A..............  ...............  Gait training therapy........  ...........  ...........  ...........  ...........  ...........
97124.................  A..............  ...............  Massage therapy..............  ...........  ...........  ...........  ...........  ...........
97139.................  A..............  ...............  Physical medicine procedure..  ...........  ...........  ...........  ...........  ...........
97140.................  A..............  ...............  Manual therapy...............  ...........  ...........  ...........  ...........  ...........
97150.................  A..............  ...............  Group therapeutic procedures.  ...........  ...........  ...........  ...........  ...........
97504.................  A..............  ...............  Orthotic training............  ...........  ...........  ...........  ...........  ...........
97520.................  A..............  ...............  Prosthetic training..........  ...........  ...........  ...........  ...........  ...........
97530.................  A..............  ...............  Therapeutic activities.......  ...........  ...........  ...........  ...........  ...........
97532.................  A..............  ...............  Cognitive skills development.  ...........  ...........  ...........  ...........  ...........
97533.................  A..............  ...............  Sensory integration..........  ...........  ...........  ...........  ...........  ...........
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........  ...........  ...........  ...........  ...........  ...........
97597.................  A..............  ...............  Active wound care/20 cm or <.  ...........  ...........  ...........  ...........  ...........
97598.................  A..............  ...............  Active wound care > 20 cm....  ...........  ...........  ...........  ...........  ...........
97602.................  A..............  ...............  Wound(s) care non-selective..  ...........  ...........  ...........  ...........  ...........
97605.................  A..............  ...............  Neg press wound tx, < 50 cm..  ...........  ...........  ...........  ...........  ...........
97606.................  A..............  ...............  Neg press wound tx, > 50 cm..  ...........  ...........  ...........  ...........  ...........
97703.................  A..............  ...............  Prosthetic checkout..........  ...........  ...........  ...........  ...........  ...........
97750.................  A..............  ...............  Physical performance test....  ...........  ...........  ...........  ...........  ...........
97755.................  A..............  ...............  Assistive technology assess..  ...........  ...........  ...........  ...........  ...........
97799.................  A..............  ...............  Physical medicine procedure..  ...........  ...........  ...........  ...........  ...........
97802.................  A..............  ...............  Medical nutrition, indiv, in.  ...........  ...........  ...........  ...........  ...........
97803.................  A..............  ...............  Med nutrition, indiv, subseq.  ...........  ...........  ...........  ...........  ...........
97804.................  A..............  ...............  Medical nutrition, group.....  ...........  ...........  ...........  ...........  ...........
97810.................  E..............  ...............  Acupunct w/o stimul 15 min...  ...........  ...........  ...........  ...........  ...........
97811.................  E..............  ...............  Acupunct w/o stimul addl 15m.  ...........  ...........  ...........  ...........  ...........
97813.................  E..............  ...............  Acupunct w/stimul 15 min.....  ...........  ...........  ...........  ...........  ...........
97814.................  E..............  ...............  Acupunct w/stimul addl 15m...  ...........  ...........  ...........  ...........  ...........
98925.................  S..............  ...............  Osteopathic manipulation.....         0060       0.4913       $29.16  ...........        $5.83
98926.................  S..............  ...............  Osteopathic manipulation.....         0060       0.4913       $29.16  ...........        $5.83
98927.................  S..............  ...............  Osteopathic manipulation.....         0060       0.4913       $29.16  ...........        $5.83
98928.................  S..............  ...............  Osteopathic manipulation.....         0060       0.4913       $29.16  ...........        $5.83
98929.................  S..............  ...............  Osteopathic manipulation.....         0060       0.4913       $29.16  ...........        $5.83
98940.................  S..............  ...............  Chiropractic manipulation....         0060       0.4913       $29.16  ...........        $5.83
98941.................  S..............  ...............  Chiropractic manipulation....         0060       0.4913       $29.16  ...........        $5.83
98942.................  S..............  ...............  Chiropractic manipulation....         0060       0.4913       $29.16  ...........        $5.83
98943.................  E..............  ...............  Chiropractic manipulation....  ...........  ...........  ...........  ...........  ...........
99000.................  B..............  ...............  Specimen handling............  ...........  ...........  ...........  ...........  ...........
99001.................  B..............  ...............  Specimen handling............  ...........  ...........  ...........  ...........  ...........
99002.................  B..............  ...............  Device handling..............  ...........  ...........  ...........  ...........  ...........
99024.................  B..............  ...............  Postop follow-up visit.......  ...........  ...........  ...........  ...........  ...........
99026.................  E..............  ...............  In-hospital on call service..  ...........  ...........  ...........  ...........  ...........
99027.................  E..............  ...............  Out-of-hosp on call service..  ...........  ...........  ...........  ...........  ...........
99050.................  B..............  ...............  Medical services after hrs...  ...........  ...........  ...........  ...........  ...........

[[Page 42902]]

 
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.................  B..............  ...............  Emergency anesthesia.........  ...........  ...........  ...........  ...........  ...........
99141.................  N..............  ...............  Sedation, iv/im or inhalant..  ...........  ...........  ...........  ...........  ...........
99142.................  N..............  ...............  Sedation, oral/rectal/nasal..  ...........  ...........  ...........  ...........  ...........
99170.................  T..............  ...............  Anogenital exam, child.......         0191       0.1663        $9.87        $2.77        $1.97
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       0.5675       $33.68       $10.09        $6.74
99199.................  B..............  ...............  Special service/proc/report..  ...........  ...........  ...........  ...........  ...........
99201.................  V..............  ...............  Office/outpatient visit, new.         0600       0.8649       $51.33  ...........       $10.27
99202.................  V..............  ...............  Office/outpatient visit, new.         0600       0.8649       $51.33  ...........       $10.27
99203.................  V..............  ...............  Office/outpatient visit, new.         0601       0.9992       $59.30  ...........       $11.86
99204.................  V..............  ...............  Office/outpatient visit, new.         0602       1.4220       $84.40  ...........       $16.88
99205.................  V..............  ...............  Office/outpatient visit, new.         0602       1.4220       $84.40  ...........       $16.88
99211.................  V..............  ...............  Office/outpatient visit, est.         0600       0.8649       $51.33  ...........       $10.27
99212.................  V..............  ...............  Office/outpatient visit, est.         0600       0.8649       $51.33  ...........       $10.27
99213.................  V..............  ...............  Office/outpatient visit, est.         0601       0.9992       $59.30  ...........       $11.86
99214.................  V..............  ...............  Office/outpatient visit, est.         0602       1.4220       $84.40  ...........       $16.88
99215.................  V..............  ...............  Office/outpatient visit, est.         0602       1.4220       $84.40  ...........       $16.88
99217.................  B..............  ...............  Observation care discharge...  ...........  ...........  ...........  ...........  ...........
99218.................  B..............  ...............  Observation care.............  ...........  ...........  ...........  ...........  ...........
99219.................  B..............  ...............  Observation care.............  ...........  ...........  ...........  ...........  ...........
99220.................  B..............  ...............  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.................  B..............  ...............  Observ/hosp same date........  ...........  ...........  ...........  ...........  ...........
99235.................  B..............  ...............  Observ/hosp same date........  ...........  ...........  ...........  ...........  ...........
99236.................  B..............  ...............  Observ/hosp same date........  ...........  ...........  ...........  ...........  ...........
99238.................  E..............  ...............  Hospital discharge day.......  ...........  ...........  ...........  ...........  ...........
99239.................  E..............  ...............  Hospital discharge day.......  ...........  ...........  ...........  ...........  ...........
99241.................  V..............  ...............  Office consultation..........         0600       0.8649       $51.33  ...........       $10.27
99242.................  V..............  ...............  Office consultation..........         0600       0.8649       $51.33  ...........       $10.27
99243.................  V..............  ...............  Office consultation..........         0601       0.9992       $59.30  ...........       $11.86
99244.................  V..............  ...............  Office consultation..........         0602       1.4220       $84.40  ...........       $16.88
99245.................  V..............  ...............  Office consultation..........         0602       1.4220       $84.40  ...........       $16.88
99251.................  C..............  ...............  Initial inpatient consult....  ...........  ...........  ...........  ...........  ...........
99252.................  C..............  ...............  Initial inpatient consult....  ...........  ...........  ...........  ...........  ...........
99253.................  C..............  ...............  Initial inpatient consult....  ...........  ...........  ...........  ...........  ...........
99254.................  C..............  ...............  Initial inpatient consult....  ...........  ...........  ...........  ...........  ...........
99255.................  C..............  ...............  Initial inpatient consult....  ...........  ...........  ...........  ...........  ...........
99261.................  C..............  ...............  Follow-up inpatient consult..  ...........  ...........  ...........  ...........  ...........

[[Page 42903]]

 
99262.................  C..............  ...............  Follow-up inpatient consult..  ...........  ...........  ...........  ...........  ...........
99263.................  C..............  ...............  Follow-up inpatient consult..  ...........  ...........  ...........  ...........  ...........
99271.................  V..............  ...............  Confirmatory consultation....         0600       0.8649       $51.33  ...........       $10.27
99272.................  V..............  ...............  Confirmatory consultation....         0600       0.8649       $51.33  ...........       $10.27
99273.................  V..............  ...............  Confirmatory consultation....         0601       0.9992       $59.30  ...........       $11.86
99274.................  V..............  ...............  Confirmatory consultation....         0602       1.4220       $84.40  ...........       $16.88
99275.................  V..............  ...............  Confirmatory consultation....         0602       1.4220       $84.40  ...........       $16.88
99281.................  V..............  ...............  Emergency dept visit.........         0610       1.2889       $76.50       $19.40       $15.30
99282.................  V..............  ...............  Emergency dept visit.........         0610       1.2889       $76.50       $19.40       $15.30
99283.................  V..............  ...............  Emergency dept visit.........         0611       2.2615      $134.22       $35.60       $26.84
99284.................  V..............  ...............  Emergency dept visit.........         0612       3.9673      $235.46       $54.12       $47.09
99285.................  V..............  ...............  Emergency dept visit.........         0612       3.9673      $235.46       $54.12       $47.09
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 hour....         0620       8.2620      $490.35      $135.08       $98.07
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....  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
99375.................  E..............  ...............  Home health care supervision.  ...........  ...........  ...........  ...........  ...........
99377.................  B..............  ...............  Hospice care supervision.....  ...........  ...........  ...........  ...........  ...........
99378.................  E..............  ...............  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.....  ...........  ...........  ...........  ...........  ...........

[[Page 42904]]

 
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 newborn.         0600       0.8649       $51.33  ...........       $10.27
99432.................  N..............  ...............  Newborn care, not in hosp....  ...........  ...........  ...........  ...........  ...........
99433.................  C..............  ...............  Normal newborn care/hospital.  ...........  ...........  ...........  ...........  ...........
99435.................  E..............  ...............  Newborn discharge day hosp...  ...........  ...........  ...........  ...........  ...........
99436.................  N..............  ...............  Attendance, birth............  ...........  ...........  ...........  ...........  ...........
99440.................  S..............  ...............  Newborn resuscitation........         0094       2.5248      $149.85       $47.41       $29.97
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..  ...........  ...........  ...........  ...........  ...........
99600.................  E..............  ...............  Home visit nos...............  ...........  ...........  ...........  ...........  ...........
99601.................  E..............  ...............  Home infusion/visit, 2 hrs...  ...........  ...........  ...........  ...........  ...........
99602.................  E..............  ...............  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.  ...........  ...........  ...........  ...........  ...........

[[Page 42905]]

 
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.................  B..............  ...............  Amb trans 7pm-7am............  ...........  ...........  ...........  ...........  ...........
A0888.................  E..............  ...............  Noncovered ambulance mileage.  ...........  ...........  ...........  ...........  ...........
A0999.................  A..............  ...............  Unlisted ambulance service...  ...........  ...........  ...........  ...........  ...........
A4206.................  E..............  ...............  1 CC sterile syringe&needle..  ...........  ...........  ...........  ...........  ...........
A4207.................  E..............  ...............  2 CC sterile syringe&needle..  ...........  ...........  ...........  ...........  ...........
A4208.................  E..............  ...............  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..........  ...........  ...........  ...........  ...........  ...........
A4215.................  E..............  ...............  Sterile needle...............  ...........  ...........  ...........  ...........  ...........
A4216.................  A..............  ...............  Sterile water/saline, 10 ml..  ...........  ...........  ...........  ...........  ...........
A4217.................  A..............  ...............  Sterile water/saline, 500 ml.  ...........  ...........  ...........  ...........  ...........
A4220.................  N..............  ...............  Infusion pump refill kit.....  ...........  ...........  ...........  ...........  ...........
A4221.................  Y..............  ...............  Maint drug infus cath per wk.  ...........  ...........  ...........  ...........  ...........
A4222.................  Y..............  ...............  Drug infusion pump supplies..  ...........  ...........  ...........  ...........  ...........
A4223.................  E..............  ...............  Infusion supplies w/o pump...  ...........  ...........  ...........  ...........  ...........
A4230.................  Y..............  ...............  Infus insulin pump non needl.  ...........  ...........  ...........  ...........  ...........
A4231.................  Y..............  ...............  Infusion insulin pump needle.  ...........  ...........  ...........  ...........  ...........
A4232.................  Y..............  ...............  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.................  Y..............  ...............  Blood glucose/reagent strips.  ...........  ...........  ...........  ...........  ...........
A4254.................  Y..............  ...............  Battery for glucose monitor..  ...........  ...........  ...........  ...........  ...........
A4255.................  Y..............  ...............  Glucose monitor platforms....  ...........  ...........  ...........  ...........  ...........
A4256.................  Y..............  ...............  Calibrator solution/chips....  ...........  ...........  ...........  ...........  ...........
A4257.................  Y..............  ...............  Replace Lensshield Cartridge.  ...........  ...........  ...........  ...........  ...........
A4258.................  Y..............  ...............  Lancet device each...........  ...........  ...........  ...........  ...........  ...........
A4259.................  Y..............  ...............  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.................  Y..............  ...............  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..  ...........  ...........  ...........  ...........  ...........

[[Page 42906]]

 
A4285.................  E..............  ...............  Replcmnt breast pump bottle..  ...........  ...........  ...........  ...........  ...........
A4286.................  E..............  ...............  Replcmnt breastpump lok ring.  ...........  ...........  ...........  ...........  ...........
A4290.................  B..............  ...............  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........  ...........  ...........  ...........  ...........  ...........
A4320.................  A..............  ...............  Irrigation tray..............  ...........  ...........  ...........  ...........  ...........
A4321.................  A..............  ...............  Cath therapeutic irrig agent.  ...........  ...........  ...........  ...........  ...........
A4322.................  A..............  ...............  Irrigation syringe...........  ...........  ...........  ...........  ...........  ...........
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........  ...........  ...........  ...........  ...........  ...........
A4348.................  A..............  ...............  Male ext cath extended wear..  ...........  ...........  ...........  ...........  ...........
A4349.................  A..............  ...............  Disposable male external cat.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42907]]

 
A4390.................  A..............  ...............  Drainable pch ex wear convex.  ...........  ...........  ...........  ...........  ...........
A4391.................  A..............  ...............  Urinary pouch w ex wear barr.  ...........  ...........  ...........  ...........  ...........
A4392.................  A..............  ...............  Urinary pouch w st wear barr.  ...........  ...........  ...........  ...........  ...........
A4393.................  A..............  ...............  Urine pch w ex wear bar conv.  ...........  ...........  ...........  ...........  ...........
A4394.................  A..............  ...............  Ostomy pouch liq deodorant...  ...........  ...........  ...........  ...........  ...........
A4395.................  A..............  ...............  Ostomy pouch solid deodorant.  ...........  ...........  ...........  ...........  ...........
A4396.................  A..............  ...............  Peristomal hernia supprt blt.  ...........  ...........  ...........  ...........  ...........
A4397.................  A..............  ...............  Irrigation supply sleeve.....  ...........  ...........  ...........  ...........  ...........
A4398.................  A..............  ...............  Ostomy irrigation bag........  ...........  ...........  ...........  ...........  ...........
A4399.................  A..............  ...............  Ostomy irrig cone/cath w brs.  ...........  ...........  ...........  ...........  ...........
A4400.................  A..............  ...............  Ostomy irrigation set........  ...........  ...........  ...........  ...........  ...........
A4402.................  A..............  ...............  Lubricant per ounce..........  ...........  ...........  ...........  ...........  ...........
A4404.................  A..............  ...............  Ostomy ring each.............  ...........  ...........  ...........  ...........  ...........
A4405.................  A..............  ...............  Nonpectin based ostomy paste.  ...........  ...........  ...........  ...........  ...........
A4406.................  A..............  ...............  Pectin based ostomy paste....  ...........  ...........  ...........  ...........  ...........
A4407.................  A..............  ...............  Ext wear ost skn barr <=4sq''  ...........  ...........  ...........  ...........  ...........
A4408.................  A..............  ...............  Ext wear ost skn barr >4sq''.  ...........  ...........  ...........  ...........  ...........
A4409.................  A..............  ...............  Ost skn barr w flng <=4 sq''.  ...........  ...........  ...........  ...........  ...........
A4410.................  A..............  ...............  Ost skn barr w flng >4sq''...  ...........  ...........  ...........  ...........  ...........
A4413.................  A..............  ...............  2 pc drainable ost pouch.....  ...........  ...........  ...........  ...........  ...........
A4414.................  A..............  ...............  Ostomy sknbarr w flng <=4sq''  ...........  ...........  ...........  ...........  ...........
A4415.................  A..............  ...............  Ostomy skn barr w flng >4sq''  ...........  ...........  ...........  ...........  ...........
A4416.................  A..............  ...............  Ost pch clsd w barrier/filtr.  ...........  ...........  ...........  ...........  ...........
A4417.................  A..............  ...............  Ost pch w bar/bltinconv/fltr.  ...........  ...........  ...........  ...........  ...........
A4418.................  A..............  ...............  Ost pch clsd w/o bar w filtr.  ...........  ...........  ...........  ...........  ...........
A4419.................  A..............  ...............  Ost pch for bar w flange/flt.  ...........  ...........  ...........  ...........  ...........
A4420.................  A..............  ...............  Ost pch clsd for bar w lk fl.  ...........  ...........  ...........  ...........  ...........
A4421.................  E..............  ...............  Ostomy supply misc...........  ...........  ...........  ...........  ...........  ...........
A4422.................  A..............  ...............  Ost pouch absorbent material.  ...........  ...........  ...........  ...........  ...........
A4423.................  A..............  ...............  Ost pch for bar w lk fl/fltr.  ...........  ...........  ...........  ...........  ...........
A4424.................  A..............  ...............  Ost pch drain w bar & filter.  ...........  ...........  ...........  ...........  ...........
A4425.................  A..............  ...............  Ost pch drain for barrier fl.  ...........  ...........  ...........  ...........  ...........
A4426.................  A..............  ...............  Ost pch drain 2 piece system.  ...........  ...........  ...........  ...........  ...........
A4427.................  A..............  ...............  Ost pch drain/barr lk flng/f.  ...........  ...........  ...........  ...........  ...........
A4428.................  A..............  ...............  Urine ost pouch w faucet/tap.  ...........  ...........  ...........  ...........  ...........
A4429.................  A..............  ...............  Urine ost pch bar w lock fln.  ...........  ...........  ...........  ...........  ...........
A4430.................  A..............  ...............  Ost pch urine w lock flng/ft.  ...........  ...........  ...........  ...........  ...........
A4431.................  A..............  ...............  Urine ost pch bar w lock fln.  ...........  ...........  ...........  ...........  ...........
A4432.................  A..............  ...............  Ost pch urine w lock flng/ft.  ...........  ...........  ...........  ...........  ...........
A4433.................  A..............  ...............  Urine ost pch bar w lock fln.  ...........  ...........  ...........  ...........  ...........
A4434.................  A..............  ...............  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....  ...........  ...........  ...........  ...........  ...........
A4520.................  E..............  ...............  Incontinence garment anytype.  ...........  ...........  ...........  ...........  ...........
A4550.................  B..............  ...............  Surgical trays...............  ...........  ...........  ...........  ...........  ...........
A4554.................  E..............  ...............  Disposable underpads.........  ...........  ...........  ...........  ...........  ...........
A4555.................  E..............  ...............  Disposable underpad small....  ...........  ...........  ...........  ...........  ...........
A4556.................  Y..............  ...............  Electrodes, pair.............  ...........  ...........  ...........  ...........  ...........
A4557.................  Y..............  ...............  Lead wires, pair.............  ...........  ...........  ...........  ...........  ...........
A4558.................  Y..............  ...............  Conductive paste or gel......  ...........  ...........  ...........  ...........  ...........
A4561.................  N..............  ...............  Pessary rubber, any type.....  ...........  ...........  ...........  ...........  ...........
A4562.................  N..............  ...............  Pessary, non rubber,any type.  ...........  ...........  ...........  ...........  ...........
A4565.................  A..............  ...............  Slings.......................  ...........  ...........  ...........  ...........  ...........
A4570.................  E..............  ...............  Splint.......................  ...........  ...........  ...........  ...........  ...........

[[Page 42908]]

 
A4575.................  E..............  ...............  Hyperbaric o2 chamber disps..  ...........  ...........  ...........  ...........  ...........
A4580.................  E..............  ...............  Cast supplies (plaster)......  ...........  ...........  ...........  ...........  ...........
A4590.................  E..............  ...............  Special casting material.....  ...........  ...........  ...........  ...........  ...........
A4595.................  Y..............  ...............  TENS suppl 2 lead per month..  ...........  ...........  ...........  ...........  ...........
A4605.................  Y..............  ...............  Trach suction cath close sys.  ...........  ...........  ...........  ...........  ...........
A4606.................  A..............  ...............  Oxygen probe used w oximeter.  ...........  ...........  ...........  ...........  ...........
A4608.................  Y..............  ...............  Transtracheal oxygen cath....  ...........  ...........  ...........  ...........  ...........
A4611.................  Y..............  ...............  Heavy duty battery...........  ...........  ...........  ...........  ...........  ...........
A4612.................  Y..............  ...............  Battery cables...............  ...........  ...........  ...........  ...........  ...........
A4613.................  Y..............  ...............  Battery charger..............  ...........  ...........  ...........  ...........  ...........
A4614.................  A..............  ...............  Hand-held PEFR meter.........  ...........  ...........  ...........  ...........  ...........
A4615.................  Y..............  ...............  Cannula nasal................  ...........  ...........  ...........  ...........  ...........
A4616.................  Y..............  ...............  Tubing (oxygen) per foot.....  ...........  ...........  ...........  ...........  ...........
A4617.................  Y..............  ...............  Mouth piece..................  ...........  ...........  ...........  ...........  ...........
A4618.................  Y..............  ...............  Breathing circuits...........  ...........  ...........  ...........  ...........  ...........
A4619.................  Y..............  ...............  Face tent....................  ...........  ...........  ...........  ...........  ...........
A4620.................  Y..............  ...............  Variable concentration mask..  ...........  ...........  ...........  ...........  ...........
A4623.................  A..............  ...............  Tracheostomy inner cannula...  ...........  ...........  ...........  ...........  ...........
A4624.................  Y..............  ...............  Tracheal suction tube........  ...........  ...........  ...........  ...........  ...........
A4625.................  A..............  ...............  Trach care kit for new trach.  ...........  ...........  ...........  ...........  ...........
A4626.................  A..............  ...............  Tracheostomy cleaning brush..  ...........  ...........  ...........  ...........  ...........
A4627.................  E..............  ...............  Spacer bag/reservoir.........  ...........  ...........  ...........  ...........  ...........
A4628.................  Y..............  ...............  Oropharyngeal suction cath...  ...........  ...........  ...........  ...........  ...........
A4629.................  A..............  ...............  Tracheostomy care kit........  ...........  ...........  ...........  ...........  ...........
A4630.................  Y..............  ...............  Repl bat t.e.n.s. own by pt..  ...........  ...........  ...........  ...........  ...........
A4632.................  Y..............  ...............  Infus pump rplcemnt battery..  ...........  ...........  ...........  ...........  ...........
A4633.................  Y..............  ...............  Uvl replacement bulb.........  ...........  ...........  ...........  ...........  ...........
A4634.................  A..............  ...............  Replacement bulb th lightbox.  ...........  ...........  ...........  ...........  ...........
A4635.................  Y..............  ...............  Underarm crutch pad..........  ...........  ...........  ...........  ...........  ...........
A4636.................  Y..............  ...............  Handgrip for cane etc........  ...........  ...........  ...........  ...........  ...........
A4637.................  Y..............  ...............  Repl tip cane/crutch/walker..  ...........  ...........  ...........  ...........  ...........
A4638.................  Y..............  ...............  Repl batt pulse gen sys......  ...........  ...........  ...........  ...........  ...........
A4639.................  Y..............  ...............  Infrared ht sys replcmnt pad.  ...........  ...........  ...........  ...........  ...........
A4640.................  Y..............  ...............  Alternating pressure pad.....  ...........  ...........  ...........  ...........  ...........
A4641.................  N..............  ...............  Diagnostic imaging agent.....  ...........  ...........  ...........  ...........  ...........
A4642.................  H..............  ...............  Satumomab pendetide per dose.         0704  ...........  ...........  ...........  ...........
A4643.................  B..............  ...............  High dose contrast MRI.......  ...........  ...........  ...........  ...........  ...........
A4644.................  B..............  ...............  Contrast 100-199 MGs iodine..  ...........  ...........  ...........  ...........  ...........
A4645.................  B..............  ...............  Contrast 200-299 MGs iodine..  ...........  ...........  ...........  ...........  ...........
A4646.................  B..............  ...............  Contrast 300-399 MGs iodine..  ...........  ...........  ...........  ...........  ...........
A4647.................  B..............  ...............  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.................  B..............  ...............  Disposable cycler set........  ...........  ...........  ...........  ...........  ...........
A4672.................  B..............  ...............  Drainage ext line, dialysis..  ...........  ...........  ...........  ...........  ...........
A4673.................  B..............  ...............  Ext line w easy lock connect.  ...........  ...........  ...........  ...........  ...........
A4674.................  B..............  ...............  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.....  ...........  ...........  ...........  ...........  ...........
A4714.................  A..............  ...............  Treated water per gallon.....  ...........  ...........  ...........  ...........  ...........
A4719.................  A..............  ...............  ``Y set'' tubing.............  ...........  ...........  ...........  ...........  ...........
A4720.................  A..............  ...............  Dialysat sol fld vol > 249cc.  ...........  ...........  ...........  ...........  ...........
A4721.................  A..............  ...............  Dialysat sol fld vol > 999cc.  ...........  ...........  ...........  ...........  ...........
A4722.................  A..............  ...............  Dialys sol fld vol > 1999cc..  ...........  ...........  ...........  ...........  ...........
A4723.................  A..............  ...............  Dialys sol fld vol > 2999cc..  ...........  ...........  ...........  ...........  ...........

[[Page 42909]]

 
A4724.................  A..............  ...............  Dialys sol fld vol > 3999cc..  ...........  ...........  ...........  ...........  ...........
A4725.................  A..............  ...............  Dialys sol fld vol > 4999cc..  ...........  ...........  ...........  ...........  ...........
A4726.................  A..............  ...............  Dialys sol fld vol > 5999cc..  ...........  ...........  ...........  ...........  ...........
A4728.................  B..............  ...............  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.................  Y..............  ...............  Diab shoe for density insert.  ...........  ...........  ...........  ...........  ...........
A5501.................  Y..............  ...............  Diabetic custom molded shoe..  ...........  ...........  ...........  ...........  ...........
A5503.................  Y..............  ...............  Diabetic shoe w/roller/rockr.  ...........  ...........  ...........  ...........  ...........
A5504.................  Y..............  ...............  Diabetic shoe with wedge.....  ...........  ...........  ...........  ...........  ...........
A5505.................  Y..............  ...............  Diab shoe w/metatarsal bar...  ...........  ...........  ...........  ...........  ...........
A5506.................  Y..............  ...............  Diabetic shoe w/off set heel.  ...........  ...........  ...........  ...........  ...........
A5507.................  Y..............  ...............  Modification diabetic shoe...  ...........  ...........  ...........  ...........  ...........
A5508.................  Y..............  ...............  Diabetic deluxe shoe.........  ...........  ...........  ...........  ...........  ...........
A5509.................  E..............  ...............  Direct heat form shoe insert.  ...........  ...........  ...........  ...........  ...........
A5510.................  E..............  ...............  Compression form shoe insert.  ...........  ...........  ...........  ...........  ...........

[[Page 42910]]

 
A5511.................  E..............  ...............  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 drsg>6<=48 sq in....  ...........  ...........  ...........  ...........  ...........
A6023.................  A..............  ...............  Collagen dressing >48 sq in..  ...........  ...........  ...........  ...........  ...........
A6024.................  A..............  ...............  Collagen dsg wound filler....  ...........  ...........  ...........  ...........  ...........
A6025.................  E..............  ...............  Silicone gel sheet, each.....  ...........  ...........  ...........  ...........  ...........
A6154.................  A..............  ...............  Wound pouch each.............  ...........  ...........  ...........  ...........  ...........
A6196.................  A..............  ...............  Alginate dressing <=16 sq in.  ...........  ...........  ...........  ...........  ...........
A6197.................  A..............  ...............  Alginate drsg >16 <=48 sq in.  ...........  ...........  ...........  ...........  ...........
A6198.................  A..............  ...............  alginate dressing > 48 sq in.  ...........  ...........  ...........  ...........  ...........
A6199.................  A..............  ...............  Alginate drsg wound filler...  ...........  ...........  ...........  ...........  ...........
A6200.................  A..............  ...............  Compos drsg <=16 no border...  ...........  ...........  ...........  ...........  ...........
A6201.................  A..............  ...............  Compos drsg >16<=48 no bdr...  ...........  ...........  ...........  ...........  ...........
A6202.................  A..............  ...............  Compos drsg >48 no border....  ...........  ...........  ...........  ...........  ...........
A6203.................  A..............  ...............  Composite drsg <= 16 sq in...  ...........  ...........  ...........  ...........  ...........
A6204.................  A..............  ...............  Composite drsg >16<=48 sq in.  ...........  ...........  ...........  ...........  ...........
A6205.................  A..............  ...............  Composite drsg > 48 sq in....  ...........  ...........  ...........  ...........  ...........
A6206.................  A..............  ...............  Contact layer <= 16 sq in....  ...........  ...........  ...........  ...........  ...........
A6207.................  A..............  ...............  Contact layer >16<= 48 sq in.  ...........  ...........  ...........  ...........  ...........
A6208.................  A..............  ...............  Contact layer > 48 sq in.....  ...........  ...........  ...........  ...........  ...........
A6209.................  A..............  ...............  Foam drsg <=16 sq in w/o bdr.  ...........  ...........  ...........  ...........  ...........
A6210.................  A..............  ...............  Foam drg >16<=48 sq in w/o b.  ...........  ...........  ...........  ...........  ...........
A6211.................  A..............  ...............  Foam drg > 48 sq in w/o brdr.  ...........  ...........  ...........  ...........  ...........
A6212.................  A..............  ...............  Foam drg <=16 sq in w/border.  ...........  ...........  ...........  ...........  ...........
A6213.................  A..............  ...............  Foam drg >16<=48 sq in w/bdr.  ...........  ...........  ...........  ...........  ...........
A6214.................  A..............  ...............  Foam drg > 48 sq in w/border.  ...........  ...........  ...........  ...........  ...........
A6215.................  A..............  ...............  Foam dressing wound filler...  ...........  ...........  ...........  ...........  ...........
A6216.................  A..............  ...............  Non-sterile gauze<=16 sq in..  ...........  ...........  ...........  ...........  ...........
A6217.................  A..............  ...............  Non-sterile gauze>16<=48 sq..  ...........  ...........  ...........  ...........  ...........
A6218.................  A..............  ...............  Non-sterile gauze > 48 sq in.  ...........  ...........  ...........  ...........  ...........
A6219.................  A..............  ...............  Gauze <= 16 sq in w/border...  ...........  ...........  ...........  ...........  ...........
A6220.................  A..............  ...............  Gauze >16 <=48 sq in w/bordr.  ...........  ...........  ...........  ...........  ...........
A6221.................  A..............  ...............  Gauze > 48 sq in w/border....  ...........  ...........  ...........  ...........  ...........
A6222.................  A..............  ...............  Gauze <=16 in no w/sal w/o b.  ...........  ...........  ...........  ...........  ...........
A6223.................  A..............  ...............  Gauze >16<=48 no w/sal w/o b.  ...........  ...........  ...........  ...........  ...........
A6224.................  A..............  ...............  Gauze > 48 in no w/sal w/o b.  ...........  ...........  ...........  ...........  ...........
A6228.................  A..............  ...............  Gauze <= 16 sq in water/sal..  ...........  ...........  ...........  ...........  ...........
A6229.................  A..............  ...............  Gauze >16<=48 sq in watr/sal.  ...........  ...........  ...........  ...........  ...........
A6230.................  A..............  ...............  Gauze > 48 sq in water/salne.  ...........  ...........  ...........  ...........  ...........
A6231.................  A..............  ...............  Hydrogel dsg<=16 sq in.......  ...........  ...........  ...........  ...........  ...........
A6232.................  A..............  ...............  Hydrogel dsg>16<=48 sq in....  ...........  ...........  ...........  ...........  ...........
A6233.................  A..............  ...............  Hydrogel dressing >48 sq in..  ...........  ...........  ...........  ...........  ...........
A6234.................  A..............  ...............  Hydrocolld drg <=16 w/o bdr..  ...........  ...........  ...........  ...........  ...........
A6235.................  A..............  ...............  Hydrocolld drg >16<=48 w/o b.  ...........  ...........  ...........  ...........  ...........
A6236.................  A..............  ...............  Hydrocolld drg > 48 in w/o b.  ...........  ...........  ...........  ...........  ...........
A6237.................  A..............  ...............  Hydrocolld drg <=16 in w/bdr.  ...........  ...........  ...........  ...........  ...........
A6238.................  A..............  ...............  Hydrocolld drg >16<=48 w/bdr.  ...........  ...........  ...........  ...........  ...........
A6239.................  A..............  ...............  Hydrocolld drg > 48 in w/bdr.  ...........  ...........  ...........  ...........  ...........
A6240.................  A..............  ...............  Hydrocolld drg filler paste..  ...........  ...........  ...........  ...........  ...........
A6241.................  A..............  ...............  Hydrocolloid drg filler dry..  ...........  ...........  ...........  ...........  ...........
A6242.................  A..............  ...............  Hydrogel drg <=16 in w/o bdr.  ...........  ...........  ...........  ...........  ...........
A6243.................  A..............  ...............  Hydrogel drg >16<=48 w/o bdr.  ...........  ...........  ...........  ...........  ...........
A6244.................  A..............  ...............  Hydrogel drg >48 in w/o bdr..  ...........  ...........  ...........  ...........  ...........
A6245.................  A..............  ...............  Hydrogel drg <= 16 in w/bdr..  ...........  ...........  ...........  ...........  ...........
A6246.................  A..............  ...............  Hydrogel drg >16<=48 in w/b..  ...........  ...........  ...........  ...........  ...........
A6247.................  A..............  ...............  Hydrogel drg > 48 sq in w/b..  ...........  ...........  ...........  ...........  ...........
A6248.................  A..............  ...............  Hydrogel drsg gel filler.....  ...........  ...........  ...........  ...........  ...........
A6250.................  A..............  ...............  Skin seal protect moisturizr.  ...........  ...........  ...........  ...........  ...........
A6251.................  A..............  ...............  Absorpt drg <=16 sq in w/o b.  ...........  ...........  ...........  ...........  ...........
A6252.................  A..............  ...............  Absorpt drg >16 <=48 w/o bdr.  ...........  ...........  ...........  ...........  ...........
A6253.................  A..............  ...............  Absorpt drg > 48 sq in w/o b.  ...........  ...........  ...........  ...........  ...........
A6254.................  A..............  ...............  Absorpt drg <=16 sq in w/bdr.  ...........  ...........  ...........  ...........  ...........
A6255.................  A..............  ...............  Absorpt drg >16<=48 in w/bdr.  ...........  ...........  ...........  ...........  ...........

[[Page 42911]]

 
A6256.................  A..............  ...............  Absorpt drg > 48 sq in w/bdr.  ...........  ...........  ...........  ...........  ...........
A6257.................  A..............  ...............  Transparent film <= 16 sq in.  ...........  ...........  ...........  ...........  ...........
A6258.................  A..............  ...............  Transparent film >16<=48 in..  ...........  ...........  ...........  ...........  ...........
A6259.................  A..............  ...............  Transparent film > 48 sq in..  ...........  ...........  ...........  ...........  ...........
A6260.................  A..............  ...............  Wound cleanser any type/size.  ...........  ...........  ...........  ...........  ...........
A6261.................  A..............  ...............  Wound filler gel/paste /oz...  ...........  ...........  ...........  ...........  ...........
A6262.................  A..............  ...............  Wound filler dry form / gram.  ...........  ...........  ...........  ...........  ...........
A6266.................  A..............  ...............  Impreg gauze no h20/sal/yard.  ...........  ...........  ...........  ...........  ...........
A6402.................  A..............  ...............  Sterile gauze <= 16 sq in....  ...........  ...........  ...........  ...........  ...........
A6403.................  A..............  ...............  Sterile gauze>16 <= 48 sq in.  ...........  ...........  ...........  ...........  ...........
A6404.................  A..............  ...............  Sterile gauze > 48 sq in.....  ...........  ...........  ...........  ...........  ...........
A6407.................  A..............  ...............  Packing strips, non-impreg...  ...........  ...........  ...........  ...........  ...........
A6410.................  A..............  ...............  Sterile eye pad..............  ...........  ...........  ...........  ...........  ...........
A6411.................  A..............  ...............  Non-sterile eye pad..........  ...........  ...........  ...........  ...........  ...........
A6412.................  E..............  ...............  Occlusive eye patch..........  ...........  ...........  ...........  ...........  ...........
A6441.................  A..............  ...............  Pad band w>=3'' <5''/yd......  ...........  ...........  ...........  ...........  ...........
A6442.................  A..............  ...............  Conform band n/s w<3''/yd....  ...........  ...........  ...........  ...........  ...........
A6443.................  A..............  ...............  Conform band n/s w>=3''<5''/   ...........  ...........  ...........  ...........  ...........
                                                           yd.
A6444.................  A..............  ...............  Conform band n/s w>=5''/yd...  ...........  ...........  ...........  ...........  ...........
A6445.................  A..............  ...............  Conform band s w <3''/yd.....  ...........  ...........  ...........  ...........  ...........
A6446.................  A..............  ...............  Conform band s w>=3'' <5''/yd  ...........  ...........  ...........  ...........  ...........
A6447.................  A..............  ...............  Conform band s w >=5''/yd....  ...........  ...........  ...........  ...........  ...........
A6448.................  A..............  ...............  Lt compres band <3''/yd......  ...........  ...........  ...........  ...........  ...........
A6449.................  A..............  ...............  Lt compres band >=3'' <5''/yd  ...........  ...........  ...........  ...........  ...........
A6450.................  A..............  ...............  Lt compres band >=5''/yd.....  ...........  ...........  ...........  ...........  ...........
A6451.................  A..............  ...............  Mod compres band w>=3''<5''/   ...........  ...........  ...........  ...........  ...........
                                                           yd.
A6452.................  A..............  ...............  High compres band              ...........  ...........  ...........  ...........  ...........
                                                           w>=3''<5''yd.
A6453.................  A..............  ...............  Self-adher band w <3''/yd....  ...........  ...........  ...........  ...........  ...........
A6454.................  A..............  ...............  Self-adher band w>=3'' <5''/   ...........  ...........  ...........  ...........  ...........
                                                           yd.
A6455.................  A..............  ...............  Self-adher band >=5''/yd.....  ...........  ...........  ...........  ...........  ...........
A6456.................  A..............  ...............  Zinc paste band w >=3''<5''/   ...........  ...........  ...........  ...........  ...........
                                                           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..............  ...............  Neg pres wound ther drsg set.  ...........  ...........  ...........  ...........  ...........
A6551.................  Y..............  ...............  Neg press wound ther canistr.  ...........  ...........  ...........  ...........  ...........
A7000.................  Y..............  ...............  Disposable canister for pump.  ...........  ...........  ...........  ...........  ...........
A7001.................  Y..............  ...............  Nondisposable pump canister..  ...........  ...........  ...........  ...........  ...........
A7002.................  Y..............  ...............  Tubing used w suction pump...  ...........  ...........  ...........  ...........  ...........
A7003.................  Y..............  ...............  Nebulizer administration set.  ...........  ...........  ...........  ...........  ...........
A7004.................  Y..............  ...............  Disposable nebulizer sml vol.  ...........  ...........  ...........  ...........  ...........
A7005.................  Y..............  ...............  Nondisposable nebulizer set..  ...........  ...........  ...........  ...........  ...........
A7006.................  Y..............  ...............  Filtered nebulizer admin set.  ...........  ...........  ...........  ...........  ...........
A7007.................  Y..............  ...............  Lg vol nebulizer disposable..  ...........  ...........  ...........  ...........  ...........
A7008.................  Y..............  ...............  Disposable nebulizer prefill.  ...........  ...........  ...........  ...........  ...........
A7009.................  Y..............  ...............  Nebulizer reservoir bottle...  ...........  ...........  ...........  ...........  ...........
A7010.................  Y..............  ...............  Disposable corrugated tubing.  ...........  ...........  ...........  ...........  ...........
A7011.................  Y..............  ...............  Nondispos corrugated tubing..  ...........  ...........  ...........  ...........  ...........
A7012.................  Y..............  ...............  Nebulizer water collec devic.  ...........  ...........  ...........  ...........  ...........
A7013.................  Y..............  ...............  Disposable compressor filter.  ...........  ...........  ...........  ...........  ...........
A7014.................  Y..............  ...............  Compressor nondispos filter..  ...........  ...........  ...........  ...........  ...........
A7015.................  Y..............  ...............  Aerosol mask used w nebulize.  ...........  ...........  ...........  ...........  ...........
A7016.................  Y..............  ...............  Nebulizer dome & mouthpiece..  ...........  ...........  ...........  ...........  ...........
A7017.................  Y..............  ...............  Nebulizer not used w oxygen..  ...........  ...........  ...........  ...........  ...........
A7018.................  Y..............  ...............  Water distilled w/nebulizer..  ...........  ...........  ...........  ...........  ...........
A7025.................  Y..............  ...............  Replace chest compress vest..  ...........  ...........  ...........  ...........  ...........
A7026.................  Y..............  ...............  Replace chst cmprss sys hose.  ...........  ...........  ...........  ...........  ...........

[[Page 42912]]

 
A7030.................  Y..............  ...............  CPAP full face mask..........  ...........  ...........  ...........  ...........  ...........
A7031.................  Y..............  ...............  Replacement facemask interfa.  ...........  ...........  ...........  ...........  ...........
A7032.................  Y..............  ...............  Replacement nasal cushion....  ...........  ...........  ...........  ...........  ...........
A7033.................  Y..............  ...............  Replacement nasal pillows....  ...........  ...........  ...........  ...........  ...........
A7034.................  Y..............  ...............  Nasal application device.....  ...........  ...........  ...........  ...........  ...........
A7035.................  Y..............  ...............  Pos airway press headgear....  ...........  ...........  ...........  ...........  ...........
A7036.................  Y..............  ...............  Pos airway press chinstrap...  ...........  ...........  ...........  ...........  ...........
A7037.................  Y..............  ...............  Pos airway pressure tubing...  ...........  ...........  ...........  ...........  ...........
A7038.................  Y..............  ...............  Pos airway pressure filter...  ...........  ...........  ...........  ...........  ...........
A7039.................  Y..............  ...............  Filter, non disposable w pap.  ...........  ...........  ...........  ...........  ...........
A7040.................  A..............  ...............  One way chest drain valve....  ...........  ...........  ...........  ...........  ...........
A7041.................  A..............  ...............  Water seal drain container...  ...........  ...........  ...........  ...........  ...........
A7042.................  A..............  ...............  Implanted pleural catheter...  ...........  ...........  ...........  ...........  ...........
A7043.................  A..............  ...............  Vacuum drainagebottle/tubing.  ...........  ...........  ...........  ...........  ...........
A7044.................  Y..............  ...............  PAP oral interface...........  ...........  ...........  ...........  ...........  ...........
A7045.................  Y..............  ...............  Repl exhalation port for PAP.  ...........  ...........  ...........  ...........  ...........
A7046.................  Y..............  ...............  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..............  ...............  Trach/laryn tube non-cuffed..  ...........  ...........  ...........  ...........  ...........
A7521.................  A..............  ...............  Trach/laryn tube cuffed......  ...........  ...........  ...........  ...........  ...........
A7522.................  A..............  ...............  Trach/laryn tube stainless...  ...........  ...........  ...........  ...........  ...........
A7523.................  A..............  ...............  Tracheostomy shower protect..  ...........  ...........  ...........  ...........  ...........
A7524.................  A..............  ...............  Tracheostoma stent/stud/bttn.  ...........  ...........  ...........  ...........  ...........
A7525.................  A..............  ...............  Tracheostomy mask............  ...........  ...........  ...........  ...........  ...........
A7526.................  A..............  ...............  Tracheostomy tube collar.....  ...........  ...........  ...........  ...........  ...........
A7527.................  A..............  ...............  Trach/laryn tube plug/stop...  ...........  ...........  ...........  ...........  ...........
A9150.................  B..............  ...............  Misc/exper non-prescript dru.  ...........  ...........  ...........  ...........  ...........
A9152.................  E..............  ...............  Single vitamin nos...........  ...........  ...........  ...........  ...........  ...........
A9153.................  E..............  ...............  Multi-vitamin nos............  ...........  ...........  ...........  ...........  ...........
A9180.................  E..............  ...............  Lice treatment, topical......  ...........  ...........  ...........  ...........  ...........
A9270.................  E..............  ...............  Non-covered item or service..  ...........  ...........  ...........  ...........  ...........
A9280.................  E..............  ...............  Alert device, noc............  ...........  ...........  ...........  ...........  ...........
A9300.................  E..............  ...............  Exercise equipment...........  ...........  ...........  ...........  ...........  ...........
A9500.................  H..............  ...............  Technetium TC 99m sestamibi..         1600  ...........  ...........  ...........  ...........
A9502.................  H..............  ...............  Technetium TC99M tetrofosmin.         0705  ...........  ...........  ...........  ...........
A9503.................  N..............  ...............  Technetium TC 99m medronate..  ...........  ...........  ...........  ...........  ...........
A9504.................  N..............  ...............  Technetium tc 99m apcitide...  ...........  ...........  ...........  ...........  ...........
A9505.................  H..............  ...............  Thallous chloride TL 201/mci.         1603  ...........  ...........  ...........  ...........
A9507.................  H..............  ...............  Indium/111 capromab pendetid.         1604  ...........  ...........  ...........  ...........
A9508.................  H..............  ...............  Iobenguane sulfate I-131, pe.         1045  ...........  ...........  ...........  ...........
A9510.................  H..............  ...............  Technetium TC99m Disofenin...         9146  ...........  ...........  ...........  ...........
A9511.................  H..............  ...............  Technetium TC 99m depreotide.         9147  ...........  ...........  ...........  ...........
A9512.................  N..............  ...............  Technetiumtc99mpertechnetate.  ...........  ...........  ...........  ...........  ...........
A9513.................  N..............  ...............  Technetium tc-99m mebrofenin.  ...........  ...........  ...........  ...........  ...........
A9514.................  N..............  ...............  Technetiumtc99mpyrophosphate.  ...........  ...........  ...........  ...........  ...........
A9515.................  N..............  ...............  Technetium tc-99m pentetate..  ...........  ...........  ...........  ...........  ...........
A9516.................  H..............  ...............  I-123 sodium iodide capsule..         9148  ...........  ...........  ...........  ...........
A9517.................  H..............  ...............  Th I131 so iodide cap millic.         1064  ...........  ...........  ...........  ...........
A9519.................  N..............  ...............  Technetiumtc-99mmacroag albu.  ...........  ...........  ...........  ...........  ...........
A9520.................  N..............  ...............  Technetiumtc-99m sulfur clld.  ...........  ...........  ...........  ...........  ...........
A9521.................  H..............  ...............  Technetiumtc-99m exametazine.         1096  ...........  ...........  ...........  ...........
A9522.................  B..............  ...............  Indium111ibritumomabtiuxetan.  ...........  ...........  ...........  ...........  ...........
A9523.................  B..............  ...............  Yttrium90ibritumomabtiuxetan.  ...........  ...........  ...........  ...........  ...........
A9524.................  H..............  ...............  Iodinated I-131 serumalbumin.         9100  ...........  ...........  ...........  ...........
A9525.................  E..............  ...............  Low/iso-osmolar contrast mat.  ...........  ...........  ...........  ...........  ...........
A9526.................  H..............  ...............  Ammonia N-13, per dose.......         0737  ...........  ...........  ...........  ...........
A9528.................  H..............  ...............  Dx I131 so iodide cap millic.         1088  ...........  ...........  ...........  ...........
A9529.................  H..............  ...............  Dx I131 so iodide sol millic.         1065  ...........  ...........  ...........  ...........

[[Page 42913]]

 
A9530.................  H..............  ...............  Th I131 so iodide sol millic.         1150  ...........  ...........  ...........  ...........
A9531.................  H..............  ...............  Dx I131 so iodide microcurie.         9149  ...........  ...........  ...........  ...........
A9532.................  H..............  ...............  I-125 serum albumin micro....         9150  ...........  ...........  ...........  ...........
A9533.................  B..............  ...............  I-131 tositumomab diagnostic.  ...........  ...........  ...........  ...........  ...........
A9534.................  B..............  ...............  I-131 tositumomab therapeut..  ...........  ...........  ...........  ...........  ...........
A9600.................  H..............  ...............  Strontium-89 chloride........         0701  ...........  ...........  ...........  ...........
A9605.................  H..............  ...............  Samarium sm153 lexidronamm...         0702  ...........  ...........  ...........  ...........
A9699.................  N..............  ...............  Noc therapeutic radiopharm...  ...........  ...........  ...........  ...........  ...........
A9700.................  B..............  ...............  Echocardiography Contrast....  ...........  ...........  ...........  ...........  ...........
A9900.................  A..............  ...............  Supply/accessory/service.....  ...........  ...........  ...........  ...........  ...........
A9901.................  A..............  ...............  Delivery/set up/dispensing...  ...........  ...........  ...........  ...........  ...........
A9999.................  Y..............  ...............  DME supply or accessory, nos.  ...........  ...........  ...........  ...........  ...........
B4034.................  A..............  ...............  Enter feed supkit syr by day.  ...........  ...........  ...........  ...........  ...........
B4035.................  A..............  ...............  Enteral feed supp pump per d.  ...........  ...........  ...........  ...........  ...........
B4036.................  A..............  ...............  Enteral feed sup kit grav by.  ...........  ...........  ...........  ...........  ...........
B4081.................  A..............  ...............  Enteral ng tubing w/ stylet..  ...........  ...........  ...........  ...........  ...........
B4082.................  A..............  ...............  Enteral ng tubing w/o stylet.  ...........  ...........  ...........  ...........  ...........
B4083.................  A..............  ...............  Enteral stomach tube levine..  ...........  ...........  ...........  ...........  ...........
B4086.................  A..............  ...............  Gastrostomy/jejunostomy tube.  ...........  ...........  ...........  ...........  ...........
B4100.................  E..............  ...............  Food thickener oral..........  ...........  ...........  ...........  ...........  ...........
B4102.................  Y..............  ...............  EF adult fluids and electro..  ...........  ...........  ...........  ...........  ...........
B4103.................  Y..............  ...............  EF ped fluid and electrolyte.  ...........  ...........  ...........  ...........  ...........
B4104.................  E..............  ...............  Additive for enteral formula.  ...........  ...........  ...........  ...........  ...........
B4149.................  Y..............  ...............  EF blenderized foods.........  ...........  ...........  ...........  ...........  ...........
B4150.................  A..............  ...............  Enteral formulae category i..  ...........  ...........  ...........  ...........  ...........
B4152.................  A..............  ...............  Enteral formulae category ii.  ...........  ...........  ...........  ...........  ...........
B4153.................  A..............  ...............  Enteral formulae categoryIII.  ...........  ...........  ...........  ...........  ...........
B4154.................  A..............  ...............  Enteral formulae category IV.  ...........  ...........  ...........  ...........  ...........
B4155.................  A..............  ...............  Enteral formulae category v..  ...........  ...........  ...........  ...........  ...........
B4157.................  Y..............  ...............  EF special metabolic inherit.  ...........  ...........  ...........  ...........  ...........
B4158.................  Y..............  ...............  EF ped complete intact nut...  ...........  ...........  ...........  ...........  ...........
B4159.................  Y..............  ...............  EF ped complete soy based....  ...........  ...........  ...........  ...........  ...........
B4160.................  Y..............  ...............  EF ped calorie dense>/=0.7kc.  ...........  ...........  ...........  ...........  ...........
B4161.................  Y..............  ...............  EF ped hydrolyzed/amino acid.  ...........  ...........  ...........  ...........  ...........
B4162.................  Y..............  ...............  EF ped specmetabolic inherit.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
C1079.................  N..............  ...............  CO 57/58 per 0.5 uCi.........  ...........  ...........  ...........  ...........  ...........
C1080.................  H..............  ...............  I-131 tositumomab, dx........         1080  ...........  ...........  ...........  ...........
C1081.................  H..............  ...............  I-131 tositumomab, tx........         1081  ...........  ...........  ...........  ...........
C1082.................  H..............  ...............  In-111 ibritumomab tiuxetan..         9118  ...........  ...........  ...........  ...........
C1083.................  H..............  ...............  Yttrium 90 ibritumomab tiuxe.         9117  ...........  ...........  ...........  ...........
C1091.................  H..............  ...............  IN111 oxyquinoline,per0.5mCi.         1091  ...........  ...........  ...........  ...........

[[Page 42914]]

 
C1092.................  H..............  ...............  IN 111 pentetate per 0.5 mCi.         1092  ...........  ...........  ...........  ...........
C1093.................  H..............  ...............  TC99M fanolesomab............         1093  ...........  ...........  ...........  ...........
C1122.................  H..............  ...............  Tc 99M ARCITUMOMAB PER VIAL..         9151  ...........  ...........  ...........  ...........
C1178.................  K..............  ...............  BUSULFAN IV, 6 Mg............         1178       0.2851       $16.92  ...........        $3.38
C1200.................  N..............  ...............  TC 99M Sodium Glucoheptonat..  ...........  ...........  ...........  ...........  ...........
C1201.................  H..............  ...............  TC 99M SUCCIMER, PER Vial....         1201  ...........  ...........  ...........  ...........
C1300.................  S..............  ...............  HYPERBARIC Oxygen............         0659       1.5403       $91.42  ...........       $18.28
C1305.................  K..............  ...............  Apligraf, 44cm2..............         1305      12.9206      $766.84  ...........      $153.37
C1713.................  N..............  ...............  Anchor/screw bn/bn,tis/bn....  ...........  ...........  ...........  ...........  ...........
C1714.................  N..............  ...............  Cath, trans atherectomy, dir.  ...........  ...........  ...........  ...........  ...........
C1715.................  N..............  ...............  Brachytherapy needle.........  ...........  ...........  ...........  ...........  ...........
C1716.................  H..............  ...............  Brachytx source, Gold 198....         1716  ...........  ...........  ...........  ...........
C1717.................  H..............  ...............  Brachytx source, HDR Ir-192..         1717  ...........  ...........  ...........  ...........
C1718.................  H..............  ...............  Brachytx source, Iodine 125..         1718  ...........  ...........  ...........  ...........
C1719.................  H..............  ...............  Brachytx sour,Non-HDR Ir-192.         1719  ...........  ...........  ...........  ...........
C1720.................  H..............  ...............  Brachytx sour, Palladium 103.         1720  ...........  ...........  ...........  ...........
C1721.................  N..............  ...............  AICD, dual chamber...........  ...........  ...........  ...........  ...........  ...........
C1722.................  N..............  ...............  AICD, single chamber.........  ...........  ...........  ...........  ...........  ...........
C1724.................  N..............  ...............  Cath, trans atherec,rotation.  ...........  ...........  ...........  ...........  ...........
C1725.................  N..............  ...............  Cath, translumin non-laser...  ...........  ...........  ...........  ...........  ...........
C1726.................  N..............  ...............  Cath, bal dil, non-vascular..  ...........  ...........  ...........  ...........  ...........
C1727.................  N..............  ...............  Cath, bal tis dis, non-vas...  ...........  ...........  ...........  ...........  ...........
C1728.................  N..............  ...............  Cath, brachytx seed adm......  ...........  ...........  ...........  ...........  ...........
C1729.................  N..............  ...............  Cath, drainage...............  ...........  ...........  ...........  ...........  ...........
C1730.................  N..............  ...............  Cath, EP, 19 or few elect....  ...........  ...........  ...........  ...........  ...........
C1731.................  N..............  ...............  Cath, EP, 20 or more elec....  ...........  ...........  ...........  ...........  ...........
C1732.................  N..............  ...............  Cath, EP, diag/abl, 3D/vect..  ...........  ...........  ...........  ...........  ...........
C1733.................  N..............  ...............  Cath, EP, othr than cool-tip.  ...........  ...........  ...........  ...........  ...........
C1750.................  N..............  ...............  Cath, hemodialysis,long-term.  ...........  ...........  ...........  ...........  ...........
C1751.................  N..............  ...............  Cath, inf, per/cent/midline..  ...........  ...........  ...........  ...........  ...........
C1752.................  N..............  ...............  Cath,hemodialysis,short-term.  ...........  ...........  ...........  ...........  ...........
C1753.................  N..............  ...............  Cath, intravas ultrasound....  ...........  ...........  ...........  ...........  ...........
C1754.................  N..............  ...............  Catheter, intradiscal........  ...........  ...........  ...........  ...........  ...........
C1755.................  N..............  ...............  Catheter, intraspinal........  ...........  ...........  ...........  ...........  ...........
C1756.................  N..............  ...............  Cath, pacing, transesoph.....  ...........  ...........  ...........  ...........  ...........
C1757.................  N..............  ...............  Cath, thrombectomy/embolect..  ...........  ...........  ...........  ...........  ...........
C1758.................  N..............  ...............  Catheter, ureteral...........  ...........  ...........  ...........  ...........  ...........
C1759.................  N..............  ...............  Cath, intra echocardiography.  ...........  ...........  ...........  ...........  ...........
C1760.................  N..............  ...............  Closure dev, vasc............  ...........  ...........  ...........  ...........  ...........
C1762.................  N..............  ...............  Conn tiss, human(inc fascia).  ...........  ...........  ...........  ...........  ...........
C1763.................  N..............  ...............  Conn tiss, non-human.........  ...........  ...........  ...........  ...........  ...........
C1764.................  N..............  ...............  Event recorder, cardiac......  ...........  ...........  ...........  ...........  ...........
C1765.................  N..............  ...............  Adhesion barrier.............  ...........  ...........  ...........  ...........  ...........
C1766.................  N..............  ...............  Intro/sheath,strble,non-peel.  ...........  ...........  ...........  ...........  ...........
C1767.................  N..............  ...............  Generator, neurostim, imp....  ...........  ...........  ...........  ...........  ...........
C1768.................  N..............  ...............  Graft, vascular..............  ...........  ...........  ...........  ...........  ...........
C1769.................  N..............  ...............  Guide wire...................  ...........  ...........  ...........  ...........  ...........
C1770.................  N..............  ...............  Imaging coil, MR, insertable.  ...........  ...........  ...........  ...........  ...........
C1771.................  N..............  ...............  Rep dev, urinary, w/sling....  ...........  ...........  ...........  ...........  ...........
C1772.................  N..............  ...............  Infusion pump, programmable..  ...........  ...........  ...........  ...........  ...........
C1773.................  N..............  ...............  Ret dev, insertable..........  ...........  ...........  ...........  ...........  ...........
C1775.................  H..............  ...............  FDG, per dose (4-40 mCi/ml)..         1775  ...........  ...........  ...........  ...........
C1776.................  N..............  ...............  Joint device (implantable)...  ...........  ...........  ...........  ...........  ...........
C1777.................  N..............  ...............  Lead, AICD, endo single coil.  ...........  ...........  ...........  ...........  ...........
C1778.................  N..............  ...............  Lead, neurostimulator........  ...........  ...........  ...........  ...........  ...........
C1779.................  N..............  ...............  Lead, pmkr, transvenous VDD..  ...........  ...........  ...........  ...........  ...........
C1780.................  N..............  ...............  Lens, intraocular (new tech).  ...........  ...........  ...........  ...........  ...........
C1781.................  N..............  ...............  Mesh (implantable)...........  ...........  ...........  ...........  ...........  ...........
C1782.................  N..............  ...............  Morcellator..................  ...........  ...........  ...........  ...........  ...........
C1783.................  N..............  ...............  Ocular imp, aqueous drain de.  ...........  ...........  ...........  ...........  ...........
C1784.................  N..............  ...............  Ocular dev, intraop, det ret.  ...........  ...........  ...........  ...........  ...........
C1785.................  N..............  ...............  Pmkr, dual, rate-resp........  ...........  ...........  ...........  ...........  ...........
C1786.................  N..............  ...............  Pmkr, single, rate-resp......  ...........  ...........  ...........  ...........  ...........
C1787.................  N..............  ...............  Patient progr, neurostim.....  ...........  ...........  ...........  ...........  ...........
C1788.................  N..............  ...............  Port, indwelling, imp........  ...........  ...........  ...........  ...........  ...........
C1789.................  N..............  ...............  Prosthesis, breast, imp......  ...........  ...........  ...........  ...........  ...........

[[Page 42915]]

 
C1813.................  N..............  ...............  Prosthesis, penile, inflatab.  ...........  ...........  ...........  ...........  ...........
C1814.................  N..............  ...............  Retinal tamp, silicone oil...  ...........  ...........  ...........  ...........  ...........
C1815.................  N..............  ...............  Pros, urinary sph, imp.......  ...........  ...........  ...........  ...........  ...........
C1816.................  N..............  ...............  Receiver/transmitter, neuro..  ...........  ...........  ...........  ...........  ...........
C1817.................  N..............  ...............  Septal defect imp sys........  ...........  ...........  ...........  ...........  ...........
C1818.................  N..............  ...............  Integrated keratoprosthesis..  ...........  ...........  ...........  ...........  ...........
C1819.................  N..............  ...............  Tissue local excision........  ...........  ...........  ...........  ...........  ...........
C1874.................  N..............  ...............  Stent, coated/cov w/del sys..  ...........  ...........  ...........  ...........  ...........
C1875.................  N..............  ...............  Stent, coated/cov w/o del sy.  ...........  ...........  ...........  ...........  ...........
C1876.................  N..............  ...............  Stent, non-coa/non-cov w/del.  ...........  ...........  ...........  ...........  ...........
C1877.................  N..............  ...............  Stent, non-coat/cov w/o del..  ...........  ...........  ...........  ...........  ...........
C1878.................  N..............  ...............  Matrl for vocal cord.........  ...........  ...........  ...........  ...........  ...........
C1879.................  N..............  ...............  Tissue marker, implantable...  ...........  ...........  ...........  ...........  ...........
C1880.................  N..............  ...............  Vena cava filter.............  ...........  ...........  ...........  ...........  ...........
C1881.................  N..............  ...............  Dialysis access system.......  ...........  ...........  ...........  ...........  ...........
C1882.................  N..............  ...............  AICD, other than sing/dual...  ...........  ...........  ...........  ...........  ...........
C1883.................  N..............  ...............  Adapt/ext, pacing/neuro lead.  ...........  ...........  ...........  ...........  ...........
C1884.................  N..............  ...............  Embolization Protect syst....  ...........  ...........  ...........  ...........  ...........
C1885.................  N..............  ...............  Cath, translumin angio laser.  ...........  ...........  ...........  ...........  ...........
C1887.................  N..............  ...............  Catheter, guiding............  ...........  ...........  ...........  ...........  ...........
C1888.................  N..............  ...............  Endovas non-cardiac abl cath.  ...........  ...........  ...........  ...........  ...........
C1891.................  N..............  ...............  Infusion pump,non-prog, perm.  ...........  ...........  ...........  ...........  ...........
C1892.................  N..............  ...............  Intro/sheath,fixed,peel-away.  ...........  ...........  ...........  ...........  ...........
C1893.................  N..............  ...............  Intro/sheath, fixed,non-peel.  ...........  ...........  ...........  ...........  ...........
C1894.................  N..............  ...............  Intro/sheath, non-laser......  ...........  ...........  ...........  ...........  ...........
C1895.................  N..............  ...............  Lead, AICD, endo dual coil...  ...........  ...........  ...........  ...........  ...........
C1896.................  N..............  ...............  Lead, AICD, non sing/dual....  ...........  ...........  ...........  ...........  ...........
C1897.................  N..............  ...............  Lead, neurostim test kit.....  ...........  ...........  ...........  ...........  ...........
C1898.................  N..............  ...............  Lead, pmkr, other than trans.  ...........  ...........  ...........  ...........  ...........
C1899.................  N..............  ...............  Lead, pmkr/AICD combination..  ...........  ...........  ...........  ...........  ...........
C1900.................  N..............  ...............  Lead coronary venous.........  ...........  ...........  ...........  ...........  ...........
C2614.................  N..............  ...............  Probe, perc lumb disc........  ...........  ...........  ...........  ...........  ...........
C2615.................  N..............  ...............  Sealant, pulmonary, liquid...  ...........  ...........  ...........  ...........  ...........
C2616.................  H..............  ...............  Brachytx source, Yttrium-90..         2616  ...........  ...........  ...........  ...........
C2617.................  N..............  ...............  Stent, non-cor, tem w/o del..  ...........  ...........  ...........  ...........  ...........
C2618.................  N..............  ...............  Probe, cryoablation..........  ...........  ...........  ...........  ...........  ...........
C2619.................  N..............  ...............  Pmkr, dual, non rate-resp....  ...........  ...........  ...........  ...........  ...........
C2620.................  N..............  ...............  Pmkr, single, non rate-resp..  ...........  ...........  ...........  ...........  ...........
C2621.................  N..............  ...............  Pmkr, other than sing/dual...  ...........  ...........  ...........  ...........  ...........
C2622.................  N..............  ...............  Prosthesis, penile, non-inf..  ...........  ...........  ...........  ...........  ...........
C2625.................  N..............  ...............  Stent, non-cor, tem w/del sy.  ...........  ...........  ...........  ...........  ...........
C2626.................  N..............  ...............  Infusion pump, non-prog,temp.  ...........  ...........  ...........  ...........  ...........
C2627.................  N..............  ...............  Cath, suprapubic/cystoscopic.  ...........  ...........  ...........  ...........  ...........
C2628.................  N..............  ...............  Catheter, occlusion..........  ...........  ...........  ...........  ...........  ...........
C2629.................  N..............  ...............  Intro/sheath, laser..........  ...........  ...........  ...........  ...........  ...........
C2630.................  N..............  ...............  Cath, EP, cool-tip...........  ...........  ...........  ...........  ...........  ...........
C2631.................  N..............  ...............  Rep dev, urinary, w/o sling..  ...........  ...........  ...........  ...........  ...........
C2632.................  H..............  ...............  Brachytx sol, I-125, per mCi.         2632  ...........  ...........  ...........  ...........
C2633.................  H..............  ...............  Brachytx source, Cesium-131..         2633  ...........  ...........  ...........  ...........
C2634.................  H..............  ...............  Brachytx source, HA, I-125...         2634  ...........  ...........  ...........  ...........
C2635.................  H..............  ...............  Brachytx source, HA, P-103...         2635  ...........  ...........  ...........  ...........
C2636.................  H..............  ...............  Brachytx linear source, P-10.         2636  ...........  ...........  ...........  ...........
C8900*................  S..............  ...............  MRA w/cont, abd..............         0284       6.3910      $379.31      $151.72       $75.86
C8901*................  S..............  ...............  MRA w/o cont, abd............         0336       6.0467      $358.87      $143.54       $71.77
C8902*................  S..............  ...............  MRA w/o fol w/cont, abd......         0337       8.7547      $519.59      $207.83      $103.92
C8903*................  S..............  ...............  MRI w/cont, breast, uni......         0284       6.3910      $379.31      $151.72       $75.86
C8904*................  S..............  ...............  MRI w/o cont, breast, uni....         0336       6.0467      $358.87      $143.54       $71.77
C8905*................  S..............  ...............  MRI w/o fol w/cont, brst, un.         0337       8.7547      $519.59      $207.83      $103.92
C8906*................  S..............  ...............  MRI w/cont, breast, bi.......         0284       6.3910      $379.31      $151.72       $75.86
C8907*................  S..............  ...............  MRI w/o cont, breast, bi.....         0336       6.0467      $358.87      $143.54       $71.77
C8908*................  S..............  ...............  MRI w/o fol w/cont, breast,..         0337       8.7547      $519.59      $207.83      $103.92
C8909*................  S..............  ...............  MRA w/cont, chest............         0284       6.3910      $379.31      $151.72       $75.86
C8910*................  S..............  ...............  MRA w/o cont, chest..........         0336       6.0467      $358.87      $143.54       $71.77
C8911*................  S..............  ...............  MRA w/o fol w/cont, chest....         0337       8.7547      $519.59      $207.83      $103.92
C8912*................  S..............  ...............  MRA w/cont, lwr ext..........         0284       6.3910      $379.31      $151.72       $75.86
C8913*................  S..............  ...............  MRA w/o cont, lwr ext........         0336       6.0467      $358.87      $143.54       $71.77

[[Page 42916]]

 
C8914*................  S..............  ...............  MRA w/o fol w/cont, lwr ext..         0337       8.7547      $519.59      $207.83      $103.92
C8918*................  S..............  ...............  MRA w/cont, pelvis...........         0284       6.3910      $379.31      $151.72       $75.86
C8919*................  S..............  ...............  MRA w/o cont, pelvis.........         0336       6.0467      $358.87      $143.54       $71.77
C8920*................  S..............  ...............  MRA w/o fol w/cont, pelvis...         0337       8.7547      $519.59      $207.83      $103.92
C9000.................  H..............  ...............  Na chromateCr51, per 0.25mCi.         9130  ...........  ...........  ...........  ...........
C9003.................  K..............  ...............  Palivizumab, per 50 mg.......         9003       4.1486      $246.22  ...........       $49.24
C9007.................  K..............  ...............  Baclofen Intrathecal kit-1am.         9152       0.8561       $50.81  ...........       $10.16
C9008.................  K..............  ...............  Baclofen Refill Kit-500mcg...         9008       0.2447       $14.52  ...........        $2.90
C9009.................  K..............  ...............  Baclofen Refill Kit-2000mcg..         9009       0.7208       $42.78  ...........        $8.56
C9013.................  N..............  ...............  Co 57 cobaltous chloride.....  ...........  ...........  ...........  ...........  ...........
C9102.................  H..............  ...............  51 Na Chromate, 50mCi........         9132  ...........  ...........  ...........  ...........
C9103.................  H..............  ...............  Na Iothalamate I-125, 10 uCi.         9153  ...........  ...........  ...........  ...........
C9105.................  K..............  ...............  Hep B imm glob, per 1 ml.....         9105       1.8810      $111.64  ...........       $22.33
C9112.................  D..............  ...............  Perflutren lipid micro, 2ml..  ...........  ...........  ...........  ...........  ...........
C9113.................  N..............  ...............  Inj pantoprazole sodium, via.  ...........  ...........  ...........  ...........  ...........
C9121.................  K..............  ...............  Injection, argatroban........         9121       0.1897       $11.26  ...........        $2.25
C9123.................  K..............  ...............  Transcyte, 247cm2............         9123  ...........      $719.36  ...........      $143.87
C9127.................  K..............  ...............  Paclitaxel protein pr........         9127  ...........        $8.59  ...........        $1.72
C9128.................  K..............  ...............  Inj pegaptanib sodium........         9128  ...........    $1,074.18  ...........      $214.84
C9200.................  K..............  ...............  Orcel, 36 cm2................         9200       2.6890      $159.59  ...........       $31.92
C9201.................  K..............  ...............  Dermagraft, 37.5cm2..........         9201       6.2059      $368.32  ...........       $73.66
C9202.................  D..............  ...............  Octafluoropropane............  ...........  ...........  ...........  ...........  ...........
C9203.................  D..............  ...............  Perflexane lipid micro.......  ...........  ...........  ...........  ...........  ...........
C9205.................  K..............  ...............  Oxaliplatin..................         9205  ...........       $84.05  ...........       $16.81
C9206.................  K..............  ...............  Integra, per cm2.............         9206  ...........        $9.23  ...........        $1.85
C9211.................  K..............  ...............  Inj, alefacept, IV...........         9211  ...........      $570.97  ...........      $114.19
C9212.................  K..............  ...............  Inj, alefacept, IM...........         9212  ...........      $401.97  ...........       $80.39
C9218.................  K..............  ...............  Injection, Azacitidine.......         9218  ...........        $4.03  ...........         $.81
C9220.................  G..............  ...............  Sodium hyaluronate...........         9220  ...........      $203.82  ...........       $40.76
C9221.................  G..............  ...............  Graftjacket Reg Matrix.......         9221  ...........    $1,234.26  ...........      $246.85
C9222.................  G..............  ...............  Graftjacket SftTis...........         9222  ...........      $890.67  ...........      $178.13
C9223.................  D..............  ...............  Inj adenosine, tx dx.........  ...........  ...........  ...........  ...........  ...........
C9399.................  A..............  ...............  Unclass drugs/biologicals....  ...........  ...........  ...........  ...........  ...........
C9400.................  D..............  ...............  Thallous chloride, brand.....  ...........  ...........  ...........  ...........  ...........
C9401.................  D..............  ...............  Strontium-89 chloride, brand.  ...........  ...........  ...........  ...........  ...........
C9402.................  D..............  ...............  Th I131 so iodide cap, brand.  ...........  ...........  ...........  ...........  ...........
C9403.................  D..............  ...............  Dx I131 so iodide cap, brand.  ...........  ...........  ...........  ...........  ...........
C9404.................  D..............  ...............  Dx I131 so iodide sol, brand.  ...........  ...........  ...........  ...........  ...........
C9405.................  D..............  ...............  Th I131 so iodide sol, brand.  ...........  ...........  ...........  ...........  ...........
C9410.................  D..............  ...............  Dexrazoxane HCl inj, brand...  ...........  ...........  ...........  ...........  ...........
C9411.................  D..............  ...............  Pamidronate disodium, brand..  ...........  ...........  ...........  ...........  ...........
C9413.................  D..............  ...............  Na hyaluronate bran..........  ...........  ...........  ...........  ...........  ...........
C9414.................  D..............  ...............  Etoposide oral, brand........  ...........  ...........  ...........  ...........  ...........
C9415.................  D..............  ...............  Doxorubic hcl chemo, brand...  ...........  ...........  ...........  ...........  ...........
C9417.................  D..............  ...............  Bleomycin sulfate inj, brand.  ...........  ...........  ...........  ...........  ...........
C9418.................  D..............  ...............  Cisplatin inj, brand.........  ...........  ...........  ...........  ...........  ...........
C9419.................  D..............  ...............  Inj cladribine, brand........  ...........  ...........  ...........  ...........  ...........
C9420.................  D..............  ...............  Cyclophosphamide inj, brand..  ...........  ...........  ...........  ...........  ...........
C9421.................  D..............  ...............  Cyclophosphamide lyo, brand..  ...........  ...........  ...........  ...........  ...........
C9422.................  D..............  ...............  Cytarabine hcl inj, brand....  ...........  ...........  ...........  ...........  ...........
C9423.................  D..............  ...............  Dacarbazine inj, brand.......  ...........  ...........  ...........  ...........  ...........
C9424.................  D..............  ...............  Daunorubicin, brand..........  ...........  ...........  ...........  ...........  ...........
C9425.................  D..............  ...............  Etoposide inj, brand.........  ...........  ...........  ...........  ...........  ...........
C9426.................  D..............  ...............  Floxuridine inj, brand.......  ...........  ...........  ...........  ...........  ...........
C9427.................  D..............  ...............  Ifosfomide inj, brand........  ...........  ...........  ...........  ...........  ...........
C9428.................  D..............  ...............  Mesna injection, brand.......  ...........  ...........  ...........  ...........  ...........
C9429.................  D..............  ...............  Idarubicin hcl inj, brand....  ...........  ...........  ...........  ...........  ...........
C9430.................  D..............  ...............  Leuprolide acetate bran......  ...........  ...........  ...........  ...........  ...........
C9431.................  D..............  ...............  Paclitaxel inj, brand........  ...........  ...........  ...........  ...........  ...........
C9432.................  D..............  ...............  Mitomycin inj, brand.........  ...........  ...........  ...........  ...........  ...........
C9433.................  D..............  ...............  Thiotepa inj, brand..........  ...........  ...........  ...........  ...........  ...........
C9435.................  D..............  ...............  Gonadorelin hydroch, brand...  ...........  ...........  ...........  ...........  ...........
C9436.................  D..............  ...............  Azathioprine parenteral,brnd.  ...........  ...........  ...........  ...........  ...........
C9437.................  D..............  ...............  Carmus bischl nitro inj......  ...........  ...........  ...........  ...........  ...........
C9438.................  D..............  ...............  Cyclosporine oral, brand.....  ...........  ...........  ...........  ...........  ...........
C9439.................  D..............  ...............  Diethylstilbestrol injection.  ...........  ...........  ...........  ...........  ...........

[[Page 42917]]

 
C9440.................  D..............  ...............  Vinorelbine tar,brand........  ...........  ...........  ...........  ...........  ...........
C9704.................  T..............  ...............  Inj inert subs upper GI......         1556  ...........    $1,750.00  ...........      $350.00
C9713.................  T..............  ...............  Non-contact laser vap prosta.         0429      42.1231    $2,500.01  ...........      $500.00
C9716.................  S..............  ...............  RF Energy to Anus............         1519  ...........    $1,750.00  ...........      $350.00
C9718.................  T..............  ...............  Kyphoplasty, first vertebra..         0051      36.3617    $2,158.07  ...........      $431.61
C9719.................  T..............  ...............  Kyphoplasty, each addl.......         0051      36.3617    $2,158.07  ...........      $431.61
C9720.................  T..............  ...............  HE ESW tx, tennis elbow......         1547  ...........      $850.00  ...........      $170.00
C9721.................  T..............  ...............  HE ESW tx, plantar fasciitis.         1547  ...........      $850.00  ...........      $170.00
C9722.................  S..............  ...............  KV imaging w/IR tracking.....         1502  ...........       $75.00  ...........       $15.00
C9723.................  S..............  ...............  Dyn IR Perf Img..............         1502  ...........       $75.00  ...........       $15.00
C9724.................  T..............  ...............  EPS gast cardia plic.........         0422      22.8607    $1,356.78      $448.81      $271.36
D0120.................  E..............  ...............  Periodic oral evaluation.....  ...........  ...........  ...........  ...........  ...........
D0140.................  E..............  ...............  Limit oral eval problm focus.  ...........  ...........  ...........  ...........  ...........
D0150.................  S..............  ...............  Comprehensve oral evaluation.         0330       7.1431      $423.94  ...........       $84.79
D0160.................  E..............  ...............  Extensv oral eval prob focus.  ...........  ...........  ...........  ...........  ...........
D0170.................  E..............  ...............  Re-eval,est pt,problem focus.  ...........  ...........  ...........  ...........  ...........
D0180.................  E..............  ...............  Comp periodontal evaluation..  ...........  ...........  ...........  ...........  ...........
D0210.................  E..............  ...............  Intraor complete film series.  ...........  ...........  ...........  ...........  ...........
D0220.................  E..............  ...............  Intraoral periapical first f.  ...........  ...........  ...........  ...........  ...........
D0230.................  E..............  ...............  Intraoral periapical ea add..  ...........  ...........  ...........  ...........  ...........
D0240.................  S..............  ...............  Intraoral occlusal film......         0330       7.1431      $423.94  ...........       $84.79
D0250.................  S..............  ...............  Extraoral first film.........         0330       7.1431      $423.94  ...........       $84.79
D0260.................  S..............  ...............  Extraoral ea additional film.         0330       7.1431      $423.94  ...........       $84.79
D0270.................  S..............  ...............  Dental bitewing single film..         0330       7.1431      $423.94  ...........       $84.79
D0272.................  S..............  ...............  Dental bitewings two films...         0330       7.1431      $423.94  ...........       $84.79
D0274.................  S..............  ...............  Dental bitewings four films..         0330       7.1431      $423.94  ...........       $84.79
D0277.................  S..............  ...............  Vert bitewings-sev to eight..         0330       7.1431      $423.94  ...........       $84.79
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..........  ...........  ...........  ...........  ...........  ...........
D0416.................  B..............  ...............  Viral culture................  ...........  ...........  ...........  ...........  ...........
D0421.................  B..............  ...............  Gen tst suscept oral disease.  ...........  ...........  ...........  ...........  ...........
D0425.................  E..............  ...............  Caries susceptibility test...  ...........  ...........  ...........  ...........  ...........
D0431.................  B..............  ...............  Diag tst detect mucos abnorm.  ...........  ...........  ...........  ...........  ...........
D0460.................  S..............  ...............  Pulp vitality test...........         0330       7.1431      $423.94  ...........       $84.79
D0470.................  E..............  ...............  Diagnostic casts.............  ...........  ...........  ...........  ...........  ...........
D0472.................  B..............  ...............  Gross exam, prep & report....  ...........  ...........  ...........  ...........  ...........
D0473.................  B..............  ...............  Micro exam, prep & report....  ...........  ...........  ...........  ...........  ...........
D0474.................  B..............  ...............  Micro w exam of surg margins.  ...........  ...........  ...........  ...........  ...........
D0475.................  B..............  ...............  Decalcification procedure....  ...........  ...........  ...........  ...........  ...........
D0476.................  B..............  ...............  Spec stains for microorganis.  ...........  ...........  ...........  ...........  ...........
D0477.................  B..............  ...............  Spec stains not for microorg.  ...........  ...........  ...........  ...........  ...........
D0478.................  B..............  ...............  Immunohistochemical stains...  ...........  ...........  ...........  ...........  ...........
D0479.................  B..............  ...............  Tissue in-situ hybridization.  ...........  ...........  ...........  ...........  ...........
D0480.................  B..............  ...............  Cytopath smear prep & report.  ...........  ...........  ...........  ...........  ...........
D0481.................  B..............  ...............  Electron microscopy diagnost.  ...........  ...........  ...........  ...........  ...........
D0482.................  B..............  ...............  Direct immunofluorescence....  ...........  ...........  ...........  ...........  ...........
D0483.................  B..............  ...............  Indirect immunofluorescence..  ...........  ...........  ...........  ...........  ...........
D0484.................  B..............  ...............  Consult slides prep elsewher.  ...........  ...........  ...........  ...........  ...........
D0485.................  B..............  ...............  Consult inc prep of slides...  ...........  ...........  ...........  ...........  ...........
D0502.................  B..............  ...............  Other oral pathology procedu.  ...........  ...........  ...........  ...........  ...........
D0999.................  B..............  ...............  Unspecified 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...........  ...........  ...........  ...........  ...........  ...........

[[Page 42918]]

 
D1330.................  E..............  ...............  Oral hygiene instruction.....  ...........  ...........  ...........  ...........  ...........
D1351.................  E..............  ...............  Dental sealant per tooth.....  ...........  ...........  ...........  ...........  ...........
D1510.................  S..............  ...............  Space maintainer fxd unilat..         0330       7.1431      $423.94  ...........       $84.79
D1515.................  S..............  ...............  Fixed bilat space maintainer.         0330       7.1431      $423.94  ...........       $84.79
D1520.................  S..............  ...............  Remove unilat space maintain.         0330       7.1431      $423.94  ...........       $84.79
D1525.................  S..............  ...............  Remove bilat space maintain..         0330       7.1431      $423.94  ...........       $84.79
D1550.................  S..............  ...............  Recement space maintainer....         0330       7.1431      $423.94  ...........       $84.79
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.  ...........  ...........  ...........  ...........  ...........
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.......  ...........  ...........  ...........  ...........  ...........
D2712.................  E..............  ...............  Crown 3/4 resin-based compos.  ...........  ...........  ...........  ...........  ...........
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..  ...........  ...........  ...........  ...........  ...........
D2794.................  E..............  ...............  Crown-titanium...............  ...........  ...........  ...........  ...........  ...........
D2799.................  E..............  ...............  Provisional crown............  ...........  ...........  ...........  ...........  ...........
D2910.................  E..............  ...............  Dental recement inlay........  ...........  ...........  ...........  ...........  ...........
D2915.................  E..............  ...............  Recement cast or prefab post.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

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D2934.................  E..............  ...............  Prefab steel crown primary...  ...........  ...........  ...........  ...........  ...........
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..  ...........  ...........  ...........  ...........  ...........
D2971.................  E..............  ...............  Add proc construct new crown.  ...........  ...........  ...........  ...........  ...........
D2975.................  E..............  ...............  Coping.......................  ...........  ...........  ...........  ...........  ...........
D2980.................  E..............  ...............  Crown repair.................  ...........  ...........  ...........  ...........  ...........
D2999.................  S..............  ...............  Dental unspec restorative pr.         0330       7.1431      $423.94  ...........       $84.79
D3110.................  E..............  ...............  Pulp cap direct..............  ...........  ...........  ...........  ...........  ...........
D3120.................  E..............  ...............  Pulp cap indirect............  ...........  ...........  ...........  ...........  ...........
D3220.................  E..............  ...............  Therapeutic pulpotomy........  ...........  ...........  ...........  ...........  ...........
D3221.................  E..............  ...............  Gross pulpal debridement.....  ...........  ...........  ...........  ...........  ...........
D3230.................  E..............  ...............  Pulpal therapy anterior prim.  ...........  ...........  ...........  ...........  ...........
D3240.................  E..............  ...............  Pulpal therapy posterior pri.  ...........  ...........  ...........  ...........  ...........
D3310.................  E..............  ...............  Anterior.....................  ...........  ...........  ...........  ...........  ...........
D3320.................  E..............  ...............  Root canal therapy 2 canals..  ...........  ...........  ...........  ...........  ...........
D3330.................  E..............  ...............  Root canal therapy 3 canals..  ...........  ...........  ...........  ...........  ...........
D3331.................  E..............  ...............  Non-surg tx root canal obs...  ...........  ...........  ...........  ...........  ...........
D3332.................  E..............  ...............  Incomplete endodontic tx.....  ...........  ...........  ...........  ...........  ...........
D3333.................  E..............  ...............  Internal root repair.........  ...........  ...........  ...........  ...........  ...........
D3346.................  E..............  ...............  Retreat root canal anterior..  ...........  ...........  ...........  ...........  ...........
D3347.................  E..............  ...............  Retreat root canal bicuspid..  ...........  ...........  ...........  ...........  ...........
D3348.................  E..............  ...............  Retreat root canal molar.....  ...........  ...........  ...........  ...........  ...........
D3351.................  E..............  ...............  Apexification/recalc initial.  ...........  ...........  ...........  ...........  ...........
D3352.................  E..............  ...............  Apexification/recalc interim.  ...........  ...........  ...........  ...........  ...........
D3353.................  E..............  ...............  Apexification/recalc final...  ...........  ...........  ...........  ...........  ...........
D3410.................  E..............  ...............  Apicoect/perirad surg anter..  ...........  ...........  ...........  ...........  ...........
D3421.................  E..............  ...............  Root surgery bicuspid........  ...........  ...........  ...........  ...........  ...........
D3425.................  E..............  ...............  Root surgery molar...........  ...........  ...........  ...........  ...........  ...........
D3426.................  E..............  ...............  Root surgery ea add root.....  ...........  ...........  ...........  ...........  ...........
D3430.................  E..............  ...............  Retrograde filling...........  ...........  ...........  ...........  ...........  ...........
D3450.................  E..............  ...............  Root amputation..............  ...........  ...........  ...........  ...........  ...........
D3460.................  S..............  ...............  Endodontic endosseous implan.         0330       7.1431      $423.94  ...........       $84.79
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       7.1431      $423.94  ...........       $84.79
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 quadrant.         0330       7.1431      $423.94  ...........       $84.79
D4261.................  E..............  ...............  Osseous surgl-3teethperquad..  ...........  ...........  ...........  ...........  ...........
D4263.................  S..............  ...............  Bone replce graft first site.         0330       7.1431      $423.94  ...........       $84.79
D4264.................  S..............  ...............  Bone replce graft each add...         0330       7.1431      $423.94  ...........       $84.79
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 procedure..         0330       7.1431      $423.94  ...........       $84.79
D4270.................  S..............  ...............  Pedicle soft tissue graft pr.         0330       7.1431      $423.94  ...........       $84.79
D4271.................  S..............  ...............  Free soft tissue graft proc..         0330       7.1431      $423.94  ...........       $84.79
D4273.................  S..............  ...............  Subepithelial tissue graft...         0330       7.1431      $423.94  ...........       $84.79
D4274.................  E..............  ...............  Distal/proximal wedge proc...  ...........  ...........  ...........  ...........  ...........
D4275.................  E..............  ...............  Soft tissue allograft........  ...........  ...........  ...........  ...........  ...........
D4276.................  E..............  ...............  Con tissue w dble ped graft..  ...........  ...........  ...........  ...........  ...........

[[Page 42920]]

 
D4320.................  E..............  ...............  Provision splnt intracoronal.  ...........  ...........  ...........  ...........  ...........
D4321.................  E..............  ...............  Provisional splint extracoro.  ...........  ...........  ...........  ...........  ...........
D4341.................  E..............  ...............  Periodontal scaling & root...  ...........  ...........  ...........  ...........  ...........
D4342.................  E..............  ...............  Periodontal scaling 1-3teeth.  ...........  ...........  ...........  ...........  ...........
D4355.................  S..............  ...............  Full mouth debridement.......         0330       7.1431      $423.94  ...........       $84.79
D4381.................  S..............  ...............  Localized chemo delivery.....         0330       7.1431      $423.94  ...........       $84.79
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..  ...........  ...........  ...........  ...........  ...........
D5225.................  E..............  ...............  Maxillary part denture flex..  ...........  ...........  ...........  ...........  ...........
D5226.................  E..............  ...............  Mandibular part denture flex.  ...........  ...........  ...........  ...........  ...........
D5281.................  E..............  ...............  Removable partial denture....  ...........  ...........  ...........  ...........  ...........
D5410.................  E..............  ...............  Dentures adjust cmplt maxil..  ...........  ...........  ...........  ...........  ...........
D5411.................  E..............  ...............  Dentures adjust cmplt mand...  ...........  ...........  ...........  ...........  ...........
D5421.................  E..............  ...............  Dentures adjust part maxill..  ...........  ...........  ...........  ...........  ...........
D5422.................  E..............  ...............  Dentures adjust part mandbl..  ...........  ...........  ...........  ...........  ...........
D5510.................  E..............  ...............  Dentur repr broken compl bas.  ...........  ...........  ...........  ...........  ...........
D5520.................  E..............  ...............  Replace denture teeth complt.  ...........  ...........  ...........  ...........  ...........
D5610.................  E..............  ...............  Dentures repair resin base...  ...........  ...........  ...........  ...........  ...........
D5620.................  E..............  ...............  Rep part denture cast frame..  ...........  ...........  ...........  ...........  ...........
D5630.................  E..............  ...............  Rep partial denture clasp....  ...........  ...........  ...........  ...........  ...........
D5640.................  E..............  ...............  Replace part denture teeth...  ...........  ...........  ...........  ...........  ...........
D5650.................  E..............  ...............  Add tooth to partial denture.  ...........  ...........  ...........  ...........  ...........
D5660.................  E..............  ...............  Add clasp to partial denture.  ...........  ...........  ...........  ...........  ...........
D5670.................  E..............  ...............  Replc tth&acrlc on mtl frmwk.  ...........  ...........  ...........  ...........  ...........
D5671.................  E..............  ...............  Replc tth&acrlc mandibular...  ...........  ...........  ...........  ...........  ...........
D5710.................  E..............  ...............  Dentures rebase cmplt maxil..  ...........  ...........  ...........  ...........  ...........
D5711.................  E..............  ...............  Dentures rebase cmplt mand...  ...........  ...........  ...........  ...........  ...........
D5720.................  E..............  ...............  Dentures rebase part maxill..  ...........  ...........  ...........  ...........  ...........
D5721.................  E..............  ...............  Dentures rebase part mandbl..  ...........  ...........  ...........  ...........  ...........
D5730.................  E..............  ...............  Denture reln cmplt maxil ch..  ...........  ...........  ...........  ...........  ...........
D5731.................  E..............  ...............  Denture reln cmplt mand chr..  ...........  ...........  ...........  ...........  ...........
D5740.................  E..............  ...............  Denture reln part maxil chr..  ...........  ...........  ...........  ...........  ...........
D5741.................  E..............  ...............  Denture reln part mand chr...  ...........  ...........  ...........  ...........  ...........
D5750.................  E..............  ...............  Denture reln cmplt max lab...  ...........  ...........  ...........  ...........  ...........
D5751.................  E..............  ...............  Denture reln cmplt mand lab..  ...........  ...........  ...........  ...........  ...........
D5760.................  E..............  ...............  Denture reln part maxil lab..  ...........  ...........  ...........  ...........  ...........
D5761.................  E..............  ...............  Denture reln part mand lab...  ...........  ...........  ...........  ...........  ...........
D5810.................  E..............  ...............  Denture interm cmplt maxill..  ...........  ...........  ...........  ...........  ...........
D5811.................  E..............  ...............  Denture interm cmplt mandbl..  ...........  ...........  ...........  ...........  ...........
D5820.................  E..............  ...............  Denture interm part maxill...  ...........  ...........  ...........  ...........  ...........
D5821.................  E..............  ...............  Denture interm part mandbl...  ...........  ...........  ...........  ...........  ...........
D5850.................  E..............  ...............  Denture tiss conditn maxill..  ...........  ...........  ...........  ...........  ...........
D5851.................  E..............  ...............  Denture tiss condtin mandbl..  ...........  ...........  ...........  ...........  ...........
D5860.................  E..............  ...............  Overdenture complete.........  ...........  ...........  ...........  ...........  ...........
D5861.................  E..............  ...............  Overdenture partial..........  ...........  ...........  ...........  ...........  ...........
D5862.................  E..............  ...............  Precision attachment.........  ...........  ...........  ...........  ...........  ...........
D5867.................  E..............  ...............  Replacement of precision att.  ...........  ...........  ...........  ...........  ...........
D5875.................  E..............  ...............  Prosthesis modification......  ...........  ...........  ...........  ...........  ...........
D5899.................  E..............  ...............  Removable prosthodontic proc.  ...........  ...........  ...........  ...........  ...........
D5911.................  S..............  ...............  Facial moulage sectional.....         0330       7.1431      $423.94  ...........       $84.79
D5912.................  S..............  ...............  Facial moulage complete......         0330       7.1431      $423.94  ...........       $84.79
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......  ...........  ...........  ...........  ...........  ...........

[[Page 42921]]

 
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       7.1431      $423.94  ...........       $84.79
D5984.................  S..............  ...............  Radiation shield.............         0330       7.1431      $423.94  ...........       $84.79
D5985.................  S..............  ...............  Radiation cone locator.......         0330       7.1431      $423.94  ...........       $84.79
D5986.................  E..............  ...............  Fluoride applicator..........  ...........  ...........  ...........  ...........  ...........
D5987.................  S..............  ...............  Commissure splint............         0330       7.1431      $423.94  ...........       $84.79
D5988.................  E..............  ...............  Surgical splint..............  ...........  ...........  ...........  ...........  ...........
D5999.................  E..............  ...............  Maxillofacial prosthesis.....  ...........  ...........  ...........  ...........  ...........
D6010.................  E..............  ...............  Odontics endosteal implant...  ...........  ...........  ...........  ...........  ...........
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...............  ...........  ...........  ...........  ...........  ...........
D6094.................  E..............  ...............  Abut support crown titanium..  ...........  ...........  ...........  ...........  ...........
D6095.................  E..............  ...............  Odontics repr abutment.......  ...........  ...........  ...........  ...........  ...........
D6100.................  E..............  ...............  Removal of implant...........  ...........  ...........  ...........  ...........  ...........
D6190.................  E..............  ...............  Radio/surgical implant index.  ...........  ...........  ...........  ...........  ...........

[[Page 42922]]

 
D6194.................  E..............  ...............  Abut support retainer titani.  ...........  ...........  ...........  ...........  ...........
D6199.................  E..............  ...............  Implant procedure............  ...........  ...........  ...........  ...........  ...........
D6205.................  E..............  ...............  Pontic-indirect resin based..  ...........  ...........  ...........  ...........  ...........
D6210.................  E..............  ...............  Prosthodont high noble metal.  ...........  ...........  ...........  ...........  ...........
D6211.................  E..............  ...............  Bridge base metal cast.......  ...........  ...........  ...........  ...........  ...........
D6212.................  E..............  ...............  Bridge noble metal cast......  ...........  ...........  ...........  ...........  ...........
D6214.................  E..............  ...............  Pontic titanium..............  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
D6624.................  E..............  ...............  Inlay titanium...............  ...........  ...........  ...........  ...........  ...........
D6634.................  E..............  ...............  Onlay titanium...............  ...........  ...........  ...........  ...........  ...........
D6710.................  E..............  ...............  Crown-indirect resin based...  ...........  ...........  ...........  ...........  ...........
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...  ...........  ...........  ...........  ...........  ...........
D6794.................  E..............  ...............  Crown titanium...............  ...........  ...........  ...........  ...........  ...........
D6920.................  S..............  ...............  Dental connector bar.........         0330       7.1431      $423.94  ...........       $84.79
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.....  ...........  ...........  ...........  ...........  ...........

[[Page 42923]]

 
D7111.................  S..............  ...............  Coronal remnants deciduous t.         0330       7.1431      $423.94  ...........       $84.79
D7140.................  S..............  ...............  Extraction erupted tooth/exr.         0330       7.1431      $423.94  ...........       $84.79
D7210.................  S..............  ...............  Rem imp tooth w mucoper flp..         0330       7.1431      $423.94  ...........       $84.79
D7220.................  S..............  ...............  Impact tooth remov soft tiss.         0330       7.1431      $423.94  ...........       $84.79
D7230.................  S..............  ...............  Impact tooth remov part bony.         0330       7.1431      $423.94  ...........       $84.79
D7240.................  S..............  ...............  Impact tooth remov comp bony.         0330       7.1431      $423.94  ...........       $84.79
D7241.................  S..............  ...............  Impact tooth rem bony w/comp.         0330       7.1431      $423.94  ...........       $84.79
D7250.................  S..............  ...............  Tooth root removal...........         0330       7.1431      $423.94  ...........       $84.79
D7260.................  S..............  ...............  Oral antral fistula closure..         0330       7.1431      $423.94  ...........       $84.79
D7261.................  S..............  ...............  Primary closure sinus perf...         0330       7.1431      $423.94  ...........       $84.79
D7270.................  E..............  ...............  Tooth reimplantation.........  ...........  ...........  ...........  ...........  ...........
D7272.................  E..............  ...............  Tooth transplantation........  ...........  ...........  ...........  ...........  ...........
D7280.................  E..............  ...............  Exposure impact tooth orthod.  ...........  ...........  ...........  ...........  ...........
D7282.................  E..............  ...............  Mobilize erupted/malpos toot.  ...........  ...........  ...........  ...........  ...........
D7283.................  B..............  ...............  Place device impacted tooth..  ...........  ...........  ...........  ...........  ...........
D7285.................  E..............  ...............  Biopsy of oral tissue hard...  ...........  ...........  ...........  ...........  ...........
D7286.................  E..............  ...............  Biopsy of oral tissue soft...  ...........  ...........  ...........  ...........  ...........
D7287.................  E..............  ...............  Cytology sample collection...  ...........  ...........  ...........  ...........  ...........
D7288.................  B..............  ...............  Brush biopsy.................  ...........  ...........  ...........  ...........  ...........
D7290.................  E..............  ...............  Repositioning of teeth.......  ...........  ...........  ...........  ...........  ...........
D7291.................  S..............  ...............  Transseptal fiberotomy.......         0330       7.1431      $423.94  ...........       $84.79
D7310.................  E..............  ...............  Alveoplasty w/ extraction....  ...........  ...........  ...........  ...........  ...........
D7311.................  E..............  ...............  Alveoloplasty w/extract 1-3..  ...........  ...........  ...........  ...........  ...........
D7320.................  E..............  ...............  Alveoplasty w/o extraction...  ...........  ...........  ...........  ...........  ...........
D7321.................  B..............  ...............  Alveoloplasty not w/extracts.  ...........  ...........  ...........  ...........  ...........
D7340.................  E..............  ...............  Vestibuloplasty ridge extens.  ...........  ...........  ...........  ...........  ...........
D7350.................  E..............  ...............  Vestibuloplasty exten graft..  ...........  ...........  ...........  ...........  ...........
D7410.................  E..............  ...............  Rad exc lesion up to 1.25 cm.  ...........  ...........  ...........  ...........  ...........
D7411.................  E..............  ...............  Excision benign lesion>1.25c.  ...........  ...........  ...........  ...........  ...........
D7412.................  E..............  ...............  Excision benign lesion compl.  ...........  ...........  ...........  ...........  ...........
D7413.................  E..............  ...............  Excision malig lesion<=1.25c.  ...........  ...........  ...........  ...........  ...........
D7414.................  E..............  ...............  Excision malig lesion>1.25cm.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
D7511.................  B..............  ...............  Incision/drain abscess intra.  ...........  ...........  ...........  ...........  ...........
D7520.................  E..............  ...............  I&d abscess extraoral........  ...........  ...........  ...........  ...........  ...........
D7521.................  B..............  ...............  Incision/drain abscess extra.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42924]]

 
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 orthognathic..         0330       7.1431      $423.94  ...........       $84.79
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...............  ...........  ...........  ...........  ...........  ...........
D7953.................  E..............  ...............  Bone replacement graft.......  ...........  ...........  ...........  ...........  ...........
D7955.................  E..............  ...............  Repair maxillofacial defects.  ...........  ...........  ...........  ...........  ...........
D7960.................  E..............  ...............  Frenulectomy/frenulotomy.....  ...........  ...........  ...........  ...........  ...........
D7963.................  E..............  ...............  Frenuloplasty................  ...........  ...........  ...........  ...........  ...........
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.......  ...........  ...........  ...........  ...........  ...........

[[Page 42925]]

 
D8210.................  E..............  ...............  Orthodontic rem appliance tx.  ...........  ...........  ...........  ...........  ...........
D8220.................  E..............  ...............  Fixed appliance therapy habt.  ...........  ...........  ...........  ...........  ...........
D8660.................  E..............  ...............  Preorthodontic tx visit......  ...........  ...........  ...........  ...........  ...........
D8670.................  E..............  ...............  Periodic orthodontc tx visit.  ...........  ...........  ...........  ...........  ...........
D8680.................  E..............  ...............  Orthodontic retention........  ...........  ...........  ...........  ...........  ...........
D8690.................  E..............  ...............  Orthodontic treatment........  ...........  ...........  ...........  ...........  ...........
D8691.................  E..............  ...............  Repair ortho appliance.......  ...........  ...........  ...........  ...........  ...........
D8692.................  E..............  ...............  Replacement retainer.........  ...........  ...........  ...........  ...........  ...........
D8999.................  E..............  ...............  Orthodontic procedure........  ...........  ...........  ...........  ...........  ...........
D9110.................  N..............  ...............  Tx dental pain minor proc....  ...........  ...........  ...........  ...........  ...........
D9210.................  E..............  ...............  Dent anesthesia w/o surgery..  ...........  ...........  ...........  ...........  ...........
D9211.................  E..............  ...............  Regional block anesthesia....  ...........  ...........  ...........  ...........  ...........
D9212.................  E..............  ...............  Trigeminal block anesthesia..  ...........  ...........  ...........  ...........  ...........
D9215.................  E..............  ...............  Local anesthesia.............  ...........  ...........  ...........  ...........  ...........
D9220.................  E..............  ...............  General anesthesia...........  ...........  ...........  ...........  ...........  ...........
D9221.................  E..............  ...............  General anesthesia ea ad 15m.  ...........  ...........  ...........  ...........  ...........
D9230.................  N..............  ...............  Analgesia....................  ...........  ...........  ...........  ...........  ...........
D9241.................  E..............  ...............  Intravenous sedation.........  ...........  ...........  ...........  ...........  ...........
D9242.................  E..............  ...............  IV sedation ea ad 30 m.......  ...........  ...........  ...........  ...........  ...........
D9248.................  N..............  ...............  Sedation (non-iv)............  ...........  ...........  ...........  ...........  ...........
D9310.................  E..............  ...............  Dental consultation..........  ...........  ...........  ...........  ...........  ...........
D9410.................  E..............  ...............  Dental house call............  ...........  ...........  ...........  ...........  ...........
D9420.................  E..............  ...............  Hospital call................  ...........  ...........  ...........  ...........  ...........
D9430.................  E..............  ...............  Office visit during hours....  ...........  ...........  ...........  ...........  ...........
D9440.................  E..............  ...............  Office visit after hours.....  ...........  ...........  ...........  ...........  ...........
D9450.................  E..............  ...............  Case presentation tx plan....  ...........  ...........  ...........  ...........  ...........
D9610.................  E..............  ...............  Dent therapeutic drug inject.  ...........  ...........  ...........  ...........  ...........
D9630.................  S..............  ...............  Other drugs/medicaments......         0330       7.1431      $423.94  ...........       $84.79
D9910.................  E..............  ...............  Dent appl desensitizing med..  ...........  ...........  ...........  ...........  ...........
D9911.................  E..............  ...............  Appl desensitizing resin.....  ...........  ...........  ...........  ...........  ...........
D9920.................  E..............  ...............  Behavior management..........  ...........  ...........  ...........  ...........  ...........
D9930.................  S..............  ...............  Treatment of complications...         0330       7.1431      $423.94  ...........       $84.79
D9940.................  S..............  ...............  Dental occlusal guard........         0330       7.1431      $423.94  ...........       $84.79
D9941.................  E..............  ...............  Fabrication athletic guard...  ...........  ...........  ...........  ...........  ...........
D9942.................  E..............  ...............  Repair/reline occlusal guard.  ...........  ...........  ...........  ...........  ...........
D9950.................  S..............  ...............  Occlusion analysis...........         0330       7.1431      $423.94  ...........       $84.79
D9951.................  S..............  ...............  Limited occlusal adjustment..         0330       7.1431      $423.94  ...........       $84.79
D9952.................  S..............  ...............  Complete occlusal adjustment.         0330       7.1431      $423.94  ...........       $84.79
D9970.................  E..............  ...............  Enamel microabrasion.........  ...........  ...........  ...........  ...........  ...........
D9971.................  E..............  ...............  Odontoplasty 1-2 teeth.......  ...........  ...........  ...........  ...........  ...........
D9972.................  E..............  ...............  Extrnl bleaching per arch....  ...........  ...........  ...........  ...........  ...........
D9973.................  E..............  ...............  Extrnl bleaching per tooth...  ...........  ...........  ...........  ...........  ...........
D9974.................  E..............  ...............  Intrnl bleaching per tooth...  ...........  ...........  ...........  ...........  ...........
D9999.................  E..............  ...............  Adjunctive procedure.........  ...........  ...........  ...........  ...........  ...........
E0100.................  Y..............  ...............  Cane adjust/fixed with tip...  ...........  ...........  ...........  ...........  ...........
E0105.................  Y..............  ...............  Cane adjust/fixed quad/3 pro.  ...........  ...........  ...........  ...........  ...........
E0110.................  Y..............  ...............  Crutch forearm pair..........  ...........  ...........  ...........  ...........  ...........
E0111.................  Y..............  ...............  Crutch forearm each..........  ...........  ...........  ...........  ...........  ...........
E0112.................  Y..............  ...............  Crutch underarm pair wood....  ...........  ...........  ...........  ...........  ...........
E0113.................  Y..............  ...............  Crutch underarm each wood....  ...........  ...........  ...........  ...........  ...........
E0114.................  Y..............  ...............  Crutch underarm pair no wood.  ...........  ...........  ...........  ...........  ...........
E0116.................  Y..............  ...............  Crutch underarm each no wood.  ...........  ...........  ...........  ...........  ...........
E0117.................  Y..............  ...............  Underarm springassist crutch.  ...........  ...........  ...........  ...........  ...........
E0118.................  E..............  ...............  Crutch substitute............  ...........  ...........  ...........  ...........  ...........
E0130.................  Y..............  ...............  Walker rigid adjust/fixed ht.  ...........  ...........  ...........  ...........  ...........
E0135.................  Y..............  ...............  Walker folding adjust/fixed..  ...........  ...........  ...........  ...........  ...........
E0140.................  Y..............  ...............  Walker w trunk support.......  ...........  ...........  ...........  ...........  ...........
E0141.................  Y..............  ...............  Rigid wheeled walker adj/fix.  ...........  ...........  ...........  ...........  ...........
E0143.................  Y..............  ...............  Walker folding wheeled w/o s.  ...........  ...........  ...........  ...........  ...........
E0144.................  Y..............  ...............  Enclosed walker w rear seat..  ...........  ...........  ...........  ...........  ...........
E0147.................  Y..............  ...............  Walker variable wheel resist.  ...........  ...........  ...........  ...........  ...........
E0148.................  Y..............  ...............  Heavyduty walker no wheels...  ...........  ...........  ...........  ...........  ...........
E0149.................  Y..............  ...............  Heavy duty wheeled walker....  ...........  ...........  ...........  ...........  ...........
E0153.................  Y..............  ...............  Forearm crutch platform atta.  ...........  ...........  ...........  ...........  ...........
E0154.................  Y..............  ...............  Walker platform attachment...  ...........  ...........  ...........  ...........  ...........
E0155.................  Y..............  ...............  Walker wheel attachment,pair.  ...........  ...........  ...........  ...........  ...........

[[Page 42926]]

 
E0156.................  Y..............  ...............  Walker seat attachment.......  ...........  ...........  ...........  ...........  ...........
E0157.................  Y..............  ...............  Walker crutch attachment.....  ...........  ...........  ...........  ...........  ...........
E0158.................  Y..............  ...............  Walker leg extenders set of4.  ...........  ...........  ...........  ...........  ...........
E0159.................  Y..............  ...............  Brake for wheeled walker.....  ...........  ...........  ...........  ...........  ...........
E0160.................  Y..............  ...............  Sitz type bath or equipment..  ...........  ...........  ...........  ...........  ...........
E0161.................  Y..............  ...............  Sitz bath/equipment w/faucet.  ...........  ...........  ...........  ...........  ...........
E0162.................  Y..............  ...............  Sitz bath chair..............  ...........  ...........  ...........  ...........  ...........
E0163.................  Y..............  ...............  Commode chair stationry fxd..  ...........  ...........  ...........  ...........  ...........
E0164.................  Y..............  ...............  Commode chair mobile fixed a.  ...........  ...........  ...........  ...........  ...........
E0166.................  Y..............  ...............  Commode chair mobile detach..  ...........  ...........  ...........  ...........  ...........
E0167.................  Y..............  ...............  Commode chair pail or pan....  ...........  ...........  ...........  ...........  ...........
E0168.................  Y..............  ...............  Heavyduty/wide commode chair.  ...........  ...........  ...........  ...........  ...........
E0169.................  Y..............  ...............  Seatlift incorp commodechair.  ...........  ...........  ...........  ...........  ...........
E0175.................  Y..............  ...............  Commode chair foot rest......  ...........  ...........  ...........  ...........  ...........
E0180.................  Y..............  ...............  Press pad alternating w pump.  ...........  ...........  ...........  ...........  ...........
E0181.................  Y..............  ...............  Press pad alternating w/ pum.  ...........  ...........  ...........  ...........  ...........
E0182.................  Y..............  ...............  Pressure pad alternating pum.  ...........  ...........  ...........  ...........  ...........
E0184.................  Y..............  ...............  Dry pressure mattress........  ...........  ...........  ...........  ...........  ...........
E0185.................  Y..............  ...............  Gel pressure mattress pad....  ...........  ...........  ...........  ...........  ...........
E0186.................  Y..............  ...............  Air pressure mattress........  ...........  ...........  ...........  ...........  ...........
E0187.................  Y..............  ...............  Water pressure mattress......  ...........  ...........  ...........  ...........  ...........
E0188.................  Y..............  ...............  Synthetic sheepskin pad......  ...........  ...........  ...........  ...........  ...........
E0189.................  Y..............  ...............  Lambswool sheepskin pad......  ...........  ...........  ...........  ...........  ...........
E0190.................  E..............  ...............  Positioning cushion..........  ...........  ...........  ...........  ...........  ...........
E0191.................  Y..............  ...............  Protector heel or elbow......  ...........  ...........  ...........  ...........  ...........
E0193.................  Y..............  ...............  Powered air flotation bed....  ...........  ...........  ...........  ...........  ...........
E0194.................  Y..............  ...............  Air fluidized bed............  ...........  ...........  ...........  ...........  ...........
E0196.................  Y..............  ...............  Gel pressure mattress........  ...........  ...........  ...........  ...........  ...........
E0197.................  Y..............  ...............  Air pressure pad for mattres.  ...........  ...........  ...........  ...........  ...........
E0198.................  Y..............  ...............  Water pressure pad for mattr.  ...........  ...........  ...........  ...........  ...........
E0199.................  Y..............  ...............  Dry pressure pad for mattres.  ...........  ...........  ...........  ...........  ...........
E0200.................  Y..............  ...............  Heat lamp without stand......  ...........  ...........  ...........  ...........  ...........
E0202.................  Y..............  ...............  Phototherapy light w/ photom.  ...........  ...........  ...........  ...........  ...........
E0203.................  E..............  ...............  Therapeutic lightbox tabletp.  ...........  ...........  ...........  ...........  ...........
E0205.................  Y..............  ...............  Heat lamp with stand.........  ...........  ...........  ...........  ...........  ...........
E0210.................  Y..............  ...............  Electric heat pad standard...  ...........  ...........  ...........  ...........  ...........
E0215.................  Y..............  ...............  Electric heat pad moist......  ...........  ...........  ...........  ...........  ...........
E0217.................  Y..............  ...............  Water circ heat pad w pump...  ...........  ...........  ...........  ...........  ...........
E0218.................  Y..............  ...............  Water circ cold pad w pump...  ...........  ...........  ...........  ...........  ...........
E0220.................  Y..............  ...............  Hot water bottle.............  ...........  ...........  ...........  ...........  ...........
E0221.................  E..............  ...............  Infrared heating pad system..  ...........  ...........  ...........  ...........  ...........
E0225.................  Y..............  ...............  Hydrocollator unit...........  ...........  ...........  ...........  ...........  ...........
E0230.................  Y..............  ...............  Ice cap or collar............  ...........  ...........  ...........  ...........  ...........
E0231.................  E..............  ...............  Wound warming device.........  ...........  ...........  ...........  ...........  ...........
E0232.................  E..............  ...............  Warming card for NWT.........  ...........  ...........  ...........  ...........  ...........
E0235.................  Y..............  ...............  Paraffin bath unit portable..  ...........  ...........  ...........  ...........  ...........
E0236.................  Y..............  ...............  Pump for water circulating p.  ...........  ...........  ...........  ...........  ...........
E0238.................  Y..............  ...............  Heat pad non-electric moist..  ...........  ...........  ...........  ...........  ...........
E0239.................  Y..............  ...............  Hydrocollator unit portable..  ...........  ...........  ...........  ...........  ...........
E0240.................  E..............  ...............  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..............  ...............  Trans bench w/wo comm open...  ...........  ...........  ...........  ...........  ...........
E0248.................  E..............  ...............  HDtrans bench w/wo comm open.  ...........  ...........  ...........  ...........  ...........
E0249.................  Y..............  ...............  Pad water circulating heat u.  ...........  ...........  ...........  ...........  ...........
E0250.................  Y..............  ...............  Hosp bed fixed ht w/ mattres.  ...........  ...........  ...........  ...........  ...........
E0251.................  Y..............  ...............  Hosp bed fixd ht w/o mattres.  ...........  ...........  ...........  ...........  ...........
E0255.................  Y..............  ...............  Hospital bed var ht w/ mattr.  ...........  ...........  ...........  ...........  ...........
E0256.................  Y..............  ...............  Hospital bed var ht w/o matt.  ...........  ...........  ...........  ...........  ...........
E0260.................  Y..............  ...............  Hosp bed semi-electr w/ matt.  ...........  ...........  ...........  ...........  ...........
E0261.................  Y..............  ...............  Hosp bed semi-electr w/o mat.  ...........  ...........  ...........  ...........  ...........
E0265.................  Y..............  ...............  Hosp bed total electr w/ mat.  ...........  ...........  ...........  ...........  ...........

[[Page 42927]]

 
E0266.................  Y..............  ...............  Hosp bed total elec w/o matt.  ...........  ...........  ...........  ...........  ...........
E0270.................  E..............  ...............  Hospital bed institutional t.  ...........  ...........  ...........  ...........  ...........
E0271.................  Y..............  ...............  Mattress innerspring.........  ...........  ...........  ...........  ...........  ...........
E0272.................  Y..............  ...............  Mattress foam rubber.........  ...........  ...........  ...........  ...........  ...........
E0273.................  E..............  ...............  Bed board....................  ...........  ...........  ...........  ...........  ...........
E0274.................  E..............  ...............  Over-bed table...............  ...........  ...........  ...........  ...........  ...........
E0275.................  Y..............  ...............  Bed pan standard.............  ...........  ...........  ...........  ...........  ...........
E0276.................  Y..............  ...............  Bed pan fracture.............  ...........  ...........  ...........  ...........  ...........
E0277.................  Y..............  ...............  Powered pres-redu air mattrs.  ...........  ...........  ...........  ...........  ...........
E0280.................  Y..............  ...............  Bed cradle...................  ...........  ...........  ...........  ...........  ...........
E0290.................  Y..............  ...............  Hosp bed fx ht w/o rails w/m.  ...........  ...........  ...........  ...........  ...........
E0291.................  Y..............  ...............  Hosp bed fx ht w/o rail w/o..  ...........  ...........  ...........  ...........  ...........
E0292.................  Y..............  ...............  Hosp bed var ht w/o rail w/o.  ...........  ...........  ...........  ...........  ...........
E0293.................  Y..............  ...............  Hosp bed var ht w/o rail w/..  ...........  ...........  ...........  ...........  ...........
E0294.................  Y..............  ...............  Hosp bed semi-elect w/ mattr.  ...........  ...........  ...........  ...........  ...........
E0295.................  Y..............  ...............  Hosp bed semi-elect w/o matt.  ...........  ...........  ...........  ...........  ...........
E0296.................  Y..............  ...............  Hosp bed total elect w/ matt.  ...........  ...........  ...........  ...........  ...........
E0297.................  Y..............  ...............  Hosp bed total elect w/o mat.  ...........  ...........  ...........  ...........  ...........
E0300.................  Y..............  ...............  Enclosed ped crib hosp grade.  ...........  ...........  ...........  ...........  ...........
E0301.................  Y..............  ...............  HD hosp bed, 350-600 lbs.....  ...........  ...........  ...........  ...........  ...........
E0302.................  Y..............  ...............  Ex hd hosp bed > 600 lbs.....  ...........  ...........  ...........  ...........  ...........
E0303.................  Y..............  ...............  Hosp bed hvy dty xtra wide...  ...........  ...........  ...........  ...........  ...........
E0304.................  Y..............  ...............  Hosp bed xtra hvy dty x wide.  ...........  ...........  ...........  ...........  ...........
E0305.................  Y..............  ...............  Rails bed side half length...  ...........  ...........  ...........  ...........  ...........
E0310.................  Y..............  ...............  Rails bed side full length...  ...........  ...........  ...........  ...........  ...........
E0315.................  E..............  ...............  Bed accessory brd/tbl/supprt.  ...........  ...........  ...........  ...........  ...........
E0316.................  Y..............  ...............  Bed safety enclosure.........  ...........  ...........  ...........  ...........  ...........
E0325.................  Y..............  ...............  Urinal male jug-type.........  ...........  ...........  ...........  ...........  ...........
E0326.................  Y..............  ...............  Urinal female jug-type.......  ...........  ...........  ...........  ...........  ...........
E0350.................  E..............  ...............  Control unit bowel system....  ...........  ...........  ...........  ...........  ...........
E0352.................  E..............  ...............  Disposable pack w/bowel syst.  ...........  ...........  ...........  ...........  ...........
E0370.................  E..............  ...............  Air elevator for heel........  ...........  ...........  ...........  ...........  ...........
E0371.................  Y..............  ...............  Nonpower mattress overlay....  ...........  ...........  ...........  ...........  ...........
E0372.................  Y..............  ...............  Powered air mattress overlay.  ...........  ...........  ...........  ...........  ...........
E0373.................  Y..............  ...............  Nonpowered pressure mattress.  ...........  ...........  ...........  ...........  ...........
E0424.................  Y..............  ...............  Stationary compressed gas 02.  ...........  ...........  ...........  ...........  ...........
E0425.................  E..............  ...............  Gas system stationary compre.  ...........  ...........  ...........  ...........  ...........
E0430.................  E..............  ...............  Oxygen system gas portable...  ...........  ...........  ...........  ...........  ...........
E0431.................  Y..............  ...............  Portable gaseous 02..........  ...........  ...........  ...........  ...........  ...........
E0434.................  Y..............  ...............  Portable liquid 02...........  ...........  ...........  ...........  ...........  ...........
E0435.................  E..............  ...............  Oxygen system liquid portabl.  ...........  ...........  ...........  ...........  ...........
E0439.................  Y..............  ...............  Stationary liquid 02.........  ...........  ...........  ...........  ...........  ...........
E0440.................  E..............  ...............  Oxygen system liquid station.  ...........  ...........  ...........  ...........  ...........
E0441.................  Y..............  ...............  Oxygen contents, gaseous.....  ...........  ...........  ...........  ...........  ...........
E0442.................  Y..............  ...............  Oxygen contents, liquid......  ...........  ...........  ...........  ...........  ...........
E0443.................  Y..............  ...............  Portable 02 contents, gas....  ...........  ...........  ...........  ...........  ...........
E0444.................  Y..............  ...............  Portable 02 contents, liquid.  ...........  ...........  ...........  ...........  ...........
E0445.................  A..............  ...............  Oximeter non-invasive........  ...........  ...........  ...........  ...........  ...........
E0450.................  Y..............  ...............  Volume vent stationary/porta.  ...........  ...........  ...........  ...........  ...........
E0455.................  Y..............  ...............  Oxygen tent excl croup/ped t.  ...........  ...........  ...........  ...........  ...........
E0457.................  Y..............  ...............  Chest shell..................  ...........  ...........  ...........  ...........  ...........
E0459.................  Y..............  ...............  Chest wrap...................  ...........  ...........  ...........  ...........  ...........
E0460.................  Y..............  ...............  Neg press vent portabl/statn.  ...........  ...........  ...........  ...........  ...........
E0461.................  Y..............  ...............  Vol vent noninvasive interfa.  ...........  ...........  ...........  ...........  ...........
E0462.................  Y..............  ...............  Rocking bed w/ or w/o side r.  ...........  ...........  ...........  ...........  ...........
E0463.................  Y..............  ...............  Press supp vent invasive int.  ...........  ...........  ...........  ...........  ...........
E0464.................  Y..............  ...............  Press supp vent noninv int...  ...........  ...........  ...........  ...........  ...........
E0470.................  Y..............  ...............  RAD w/o backup non-inv intfc.  ...........  ...........  ...........  ...........  ...........
E0471.................  Y..............  ...............  RAD w/backup non inv intrfc..  ...........  ...........  ...........  ...........  ...........
E0472.................  Y..............  ...............  RAD w backup invasive intrfc.  ...........  ...........  ...........  ...........  ...........
E0480.................  Y..............  ...............  Percussor elect/pneum home m.  ...........  ...........  ...........  ...........  ...........
E0481.................  E..............  ...............  Intrpulmnry percuss vent sys.  ...........  ...........  ...........  ...........  ...........
E0482.................  Y..............  ...............  Cough stimulating device.....  ...........  ...........  ...........  ...........  ...........
E0483.................  Y..............  ...............  Chest compression gen system.  ...........  ...........  ...........  ...........  ...........
E0484.................  Y..............  ...............  Non-elec oscillatory pep dvc.  ...........  ...........  ...........  ...........  ...........
E0500.................  Y..............  ...............  Ippb all types...............  ...........  ...........  ...........  ...........  ...........

[[Page 42928]]

 
E0550.................  Y..............  ...............  Humidif extens supple w ippb.  ...........  ...........  ...........  ...........  ...........
E0555.................  Y..............  ...............  Humidifier for use w/ regula.  ...........  ...........  ...........  ...........  ...........
E0560.................  Y..............  ...............  Humidifier supplemental w/ i.  ...........  ...........  ...........  ...........  ...........
E0561.................  Y..............  ...............  Humidifier nonheated w PAP...  ...........  ...........  ...........  ...........  ...........
E0562.................  Y..............  ...............  Humidifier heated used w PAP.  ...........  ...........  ...........  ...........  ...........
E0565.................  Y..............  ...............  Compressor air power source..  ...........  ...........  ...........  ...........  ...........
E0570.................  Y..............  ...............  Nebulizer with compression...  ...........  ...........  ...........  ...........  ...........
E0571.................  Y..............  ...............  Aerosol compressor for svneb.  ...........  ...........  ...........  ...........  ...........
E0572.................  Y..............  ...............  Aerosol compressor adjust pr.  ...........  ...........  ...........  ...........  ...........
E0574.................  Y..............  ...............  Ultrasonic generator w svneb.  ...........  ...........  ...........  ...........  ...........
E0575.................  Y..............  ...............  Nebulizer ultrasonic.........  ...........  ...........  ...........  ...........  ...........
E0580.................  Y..............  ...............  Nebulizer for use w/ regulat.  ...........  ...........  ...........  ...........  ...........
E0585.................  Y..............  ...............  Nebulizer w/ compressor & he.  ...........  ...........  ...........  ...........  ...........
E0590.................  Y..............  ...............  Dispensing fee dme neb drug..  ...........  ...........  ...........  ...........  ...........
E0600.................  Y..............  ...............  Suction pump portab hom modl.  ...........  ...........  ...........  ...........  ...........
E0601.................  Y..............  ...............  Cont airway pressure device..  ...........  ...........  ...........  ...........  ...........
E0602.................  Y..............  ...............  Manual breast pump...........  ...........  ...........  ...........  ...........  ...........
E0603.................  A..............  ...............  Electric breast pump.........  ...........  ...........  ...........  ...........  ...........
E0604.................  A..............  ...............  Hosp grade elec breast pump..  ...........  ...........  ...........  ...........  ...........
E0605.................  Y..............  ...............  Vaporizer room type..........  ...........  ...........  ...........  ...........  ...........
E0606.................  Y..............  ...............  Drainage board postural......  ...........  ...........  ...........  ...........  ...........
E0607.................  Y..............  ...............  Blood glucose monitor home...  ...........  ...........  ...........  ...........  ...........
E0610.................  Y..............  ...............  Pacemaker monitr audible/vis.  ...........  ...........  ...........  ...........  ...........
E0615.................  Y..............  ...............  Pacemaker monitr digital/vis.  ...........  ...........  ...........  ...........  ...........
E0616.................  N..............  ...............  Cardiac event recorder.......  ...........  ...........  ...........  ...........  ...........
E0617.................  Y..............  ...............  Automatic ext defibrillator..  ...........  ...........  ...........  ...........  ...........
E0618.................  A..............  ...............  Apnea monitor................  ...........  ...........  ...........  ...........  ...........
E0619.................  A..............  ...............  Apnea monitor w recorder.....  ...........  ...........  ...........  ...........  ...........
E0620.................  Y..............  ...............  Cap bld skin piercing laser..  ...........  ...........  ...........  ...........  ...........
E0621.................  Y..............  ...............  Patient lift sling or seat...  ...........  ...........  ...........  ...........  ...........
E0625.................  E..............  ...............  Patient lift bathroom or toi.  ...........  ...........  ...........  ...........  ...........
E0627.................  Y..............  ...............  Seat lift incorp lift-chair..  ...........  ...........  ...........  ...........  ...........
E0628.................  Y..............  ...............  Seat lift for pt furn-electr.  ...........  ...........  ...........  ...........  ...........
E0629.................  Y..............  ...............  Seat lift for pt furn-non-el.  ...........  ...........  ...........  ...........  ...........
E0630.................  Y..............  ...............  Patient lift hydraulic.......  ...........  ...........  ...........  ...........  ...........
E0635.................  Y..............  ...............  Patient lift electric........  ...........  ...........  ...........  ...........  ...........
E0636.................  Y..............  ...............  PT support & positioning sys.  ...........  ...........  ...........  ...........  ...........
E0637.................  E..............  ...............  Sit-stand w seatlift wheeled.  ...........  ...........  ...........  ...........  ...........
E0638.................  E..............  ...............  Standing frame sys wheeled...  ...........  ...........  ...........  ...........  ...........
E0639.................  E..............  ...............  Moveable patient lift system.  ...........  ...........  ...........  ...........  ...........
E0640.................  E..............  ...............  Fixed patient lift system....  ...........  ...........  ...........  ...........  ...........
E0650.................  Y..............  ...............  Pneuma compresor non-segment.  ...........  ...........  ...........  ...........  ...........
E0651.................  Y..............  ...............  Pneum compressor segmental...  ...........  ...........  ...........  ...........  ...........
E0652.................  Y..............  ...............  Pneum compres w/cal pressure.  ...........  ...........  ...........  ...........  ...........
E0655.................  Y..............  ...............  Pneumatic appliance half arm.  ...........  ...........  ...........  ...........  ...........
E0660.................  Y..............  ...............  Pneumatic appliance full leg.  ...........  ...........  ...........  ...........  ...........
E0665.................  Y..............  ...............  Pneumatic appliance full arm.  ...........  ...........  ...........  ...........  ...........
E0666.................  Y..............  ...............  Pneumatic appliance half leg.  ...........  ...........  ...........  ...........  ...........
E0667.................  Y..............  ...............  Seg pneumatic appl full leg..  ...........  ...........  ...........  ...........  ...........
E0668.................  Y..............  ...............  Seg pneumatic appl full arm..  ...........  ...........  ...........  ...........  ...........
E0669.................  Y..............  ...............  Seg pneumatic appli half leg.  ...........  ...........  ...........  ...........  ...........
E0671.................  Y..............  ...............  Pressure pneum appl full leg.  ...........  ...........  ...........  ...........  ...........
E0672.................  Y..............  ...............  Pressure pneum appl full arm.  ...........  ...........  ...........  ...........  ...........
E0673.................  Y..............  ...............  Pressure pneum appl half leg.  ...........  ...........  ...........  ...........  ...........
E0675.................  Y..............  ...............  Pneumatic compression device.  ...........  ...........  ...........  ...........  ...........
E0691.................  Y..............  ...............  Uvl pnl 2 sq ft or less......  ...........  ...........  ...........  ...........  ...........
E0692.................  Y..............  ...............  Uvl sys panel 4 ft...........  ...........  ...........  ...........  ...........  ...........
E0693.................  Y..............  ...............  Uvl sys panel 6 ft...........  ...........  ...........  ...........  ...........  ...........
E0694.................  Y..............  ...............  Uvl md cabinet sys 6 ft......  ...........  ...........  ...........  ...........  ...........
E0700.................  E..............  ...............  Safety equipment.............  ...........  ...........  ...........  ...........  ...........
E0701.................  Y..............  ...............  Helmet w face guard prefab...  ...........  ...........  ...........  ...........  ...........
E0710.................  E..............  ...............  Restraints any type..........  ...........  ...........  ...........  ...........  ...........
E0720.................  Y..............  ...............  Tens two lead................  ...........  ...........  ...........  ...........  ...........
E0730.................  Y..............  ...............  Tens four lead...............  ...........  ...........  ...........  ...........  ...........
E0731.................  Y..............  ...............  Conductive garment for tens/.  ...........  ...........  ...........  ...........  ...........
E0740.................  Y..............  ...............  Incontinence treatment systm.  ...........  ...........  ...........  ...........  ...........

[[Page 42929]]

 
E0744.................  Y..............  ...............  Neuromuscular stim for scoli.  ...........  ...........  ...........  ...........  ...........
E0745.................  Y..............  ...............  Neuromuscular stim for shock.  ...........  ...........  ...........  ...........  ...........
E0746.................  E..............  ...............  Electromyograph biofeedback..  ...........  ...........  ...........  ...........  ...........
E0747.................  Y..............  ...............  Elec osteogen stim not spine.  ...........  ...........  ...........  ...........  ...........
E0748.................  Y..............  ...............  Elec osteogen stim spinal....  ...........  ...........  ...........  ...........  ...........
E0749.................  N..............  ...............  Elec osteogen stim implanted.  ...........  ...........  ...........  ...........  ...........
E0752.................  B..............  ...............  Neurostimulator electrode....  ...........  ...........  ...........  ...........  ...........
E0754.................  A..............  ...............  Pulsegenerator pt programmer.  ...........  ...........  ...........  ...........  ...........
E0755.................  E..............  ...............  Electronic salivary reflex s.  ...........  ...........  ...........  ...........  ...........
E0756.................  B..............  ...............  Implantable pulse generator..  ...........  ...........  ...........  ...........  ...........
E0757.................  N..............  ...............  Implantable RF receiver......  ...........  ...........  ...........  ...........  ...........
E0758.................  A..............  ...............  External RF transmitter......  ...........  ...........  ...........  ...........  ...........
E0759.................  A..............  ...............  Replace rdfrquncy transmittr.  ...........  ...........  ...........  ...........  ...........
E0760.................  Y..............  ...............  Osteogen ultrasound stimltor.  ...........  ...........  ...........  ...........  ...........
E0761.................  E..............  ...............  Nontherm electromgntc device.  ...........  ...........  ...........  ...........  ...........
E0765.................  Y..............  ...............  Nerve stimulator for tx n&v..  ...........  ...........  ...........  ...........  ...........
E0769.................  B..............  ...............  Electric wound treatment dev.  ...........  ...........  ...........  ...........  ...........
E0776.................  Y..............  ...............  Iv pole......................  ...........  ...........  ...........  ...........  ...........
E0779.................  Y..............  ...............  Amb infusion pump mechanical.  ...........  ...........  ...........  ...........  ...........
E0780.................  Y..............  ...............  Mech amb infusion pump <8hrs.  ...........  ...........  ...........  ...........  ...........
E0781.................  Y..............  ...............  External ambulatory infus pu.  ...........  ...........  ...........  ...........  ...........
E0782.................  N..............  ...............  Non-programble infusion pump.  ...........  ...........  ...........  ...........  ...........
E0783.................  N..............  ...............  Programmable infusion pump...  ...........  ...........  ...........  ...........  ...........
E0784.................  Y..............  ...............  Ext amb infusn pump insulin..  ...........  ...........  ...........  ...........  ...........
E0785.................  N..............  ...............  Replacement impl pump cathet.  ...........  ...........  ...........  ...........  ...........
E0786.................  N..............  ...............  Implantable pump replacement.  ...........  ...........  ...........  ...........  ...........
E0791.................  Y..............  ...............  Parenteral infusion pump sta.  ...........  ...........  ...........  ...........  ...........
E0830.................  N..............  ...............  Ambulatory traction device...  ...........  ...........  ...........  ...........  ...........
E0840.................  Y..............  ...............  Tract frame attach headboard.  ...........  ...........  ...........  ...........  ...........
E0849.................  Y..............  ...............  Cervical pneum trac equip....  ...........  ...........  ...........  ...........  ...........
E0850.................  Y..............  ...............  Traction stand free standing.  ...........  ...........  ...........  ...........  ...........
E0855.................  Y..............  ...............  Cervical traction equipment..  ...........  ...........  ...........  ...........  ...........
E0860.................  Y..............  ...............  Tract equip cervical tract...  ...........  ...........  ...........  ...........  ...........
E0870.................  Y..............  ...............  Tract frame attach footboard.  ...........  ...........  ...........  ...........  ...........
E0880.................  Y..............  ...............  Trac stand free stand extrem.  ...........  ...........  ...........  ...........  ...........
E0890.................  Y..............  ...............  Traction frame attach pelvic.  ...........  ...........  ...........  ...........  ...........
E0900.................  Y..............  ...............  Trac stand free stand pelvic.  ...........  ...........  ...........  ...........  ...........
E0910.................  Y..............  ...............  Trapeze bar attached to bed..  ...........  ...........  ...........  ...........  ...........
E0920.................  Y..............  ...............  Fracture frame attached to b.  ...........  ...........  ...........  ...........  ...........
E0930.................  Y..............  ...............  Fracture frame free standing.  ...........  ...........  ...........  ...........  ...........
E0935.................  Y..............  ...............  Exercise device passive moti.  ...........  ...........  ...........  ...........  ...........
E0940.................  Y..............  ...............  Trapeze bar free standing....  ...........  ...........  ...........  ...........  ...........
E0941.................  Y..............  ...............  Gravity assisted traction de.  ...........  ...........  ...........  ...........  ...........
E0942.................  Y..............  ...............  Cervical head harness/halter.  ...........  ...........  ...........  ...........  ...........
E0944.................  Y..............  ...............  Pelvic belt/harness/boot.....  ...........  ...........  ...........  ...........  ...........
E0945.................  Y..............  ...............  Belt/harness extremity.......  ...........  ...........  ...........  ...........  ...........
E0946.................  Y..............  ...............  Fracture frame dual w cross..  ...........  ...........  ...........  ...........  ...........
E0947.................  Y..............  ...............  Fracture frame attachmnts pe.  ...........  ...........  ...........  ...........  ...........
E0948.................  Y..............  ...............  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..............  ...............  Cushioned headrest...........  ...........  ...........  ...........  ...........  ...........
E0956.................  Y..............  ...............  W/c lateral trunk/hip suppor.  ...........  ...........  ...........  ...........  ...........
E0957.................  Y..............  ...............  W/c medial thigh support.....  ...........  ...........  ...........  ...........  ...........
E0958.................  A..............  ...............  Whlchr att- conv 1 arm drive.  ...........  ...........  ...........  ...........  ...........
E0959.................  B..............  ...............  Amputee adapter..............  ...........  ...........  ...........  ...........  ...........
E0960.................  Y..............  ...............  W/c shoulder harness/straps..  ...........  ...........  ...........  ...........  ...........
E0961.................  B..............  ...............  Wheelchair brake extension...  ...........  ...........  ...........  ...........  ...........
E0966.................  B..............  ...............  Wheelchair head rest extensi.  ...........  ...........  ...........  ...........  ...........
E0967.................  Y..............  ...............  Wheelchair hand rims.........  ...........  ...........  ...........  ...........  ...........
E0968.................  Y..............  ...............  Wheelchair commode seat......  ...........  ...........  ...........  ...........  ...........
E0969.................  Y..............  ...............  Wheelchair narrowing device..  ...........  ...........  ...........  ...........  ...........
E0970.................  B..............  ...............  Wheelchair no. 2 footplates..  ...........  ...........  ...........  ...........  ...........

[[Page 42930]]

 
E0971.................  B..............  ...............  Wheelchair anti-tipping devi.  ...........  ...........  ...........  ...........  ...........
E0972.................  A..............  ...............  Transfer board or device.....  ...........  ...........  ...........  ...........  ...........
E0973.................  B..............  ...............  W/Ch access det adj armrest..  ...........  ...........  ...........  ...........  ...........
E0974.................  B..............  ...............  W/Ch access anti-rollback....  ...........  ...........  ...........  ...........  ...........
E0977.................  Y..............  ...............  Wheelchair wedge cushion.....  ...........  ...........  ...........  ...........  ...........
E0978.................  B..............  ...............  W/C acc,saf belt pelv strap..  ...........  ...........  ...........  ...........  ...........
E0980.................  Y..............  ...............  Wheelchair safety vest.......  ...........  ...........  ...........  ...........  ...........
E0981.................  Y..............  ...............  Seat upholstery, replacement.  ...........  ...........  ...........  ...........  ...........
E0982.................  Y..............  ...............  Back upholstery, replacement.  ...........  ...........  ...........  ...........  ...........
E0983.................  Y..............  ...............  Add pwr joystick.............  ...........  ...........  ...........  ...........  ...........
E0984.................  Y..............  ...............  Add pwr tiller...............  ...........  ...........  ...........  ...........  ...........
E0985.................  Y..............  ...............  W/c seat lift mechanism......  ...........  ...........  ...........  ...........  ...........
E0986.................  Y..............  ...............  Man w/c push-rim pow assist..  ...........  ...........  ...........  ...........  ...........
E0990.................  B..............  ...............  Whellchair elevating leg res.  ...........  ...........  ...........  ...........  ...........
E0992.................  B..............  ...............  Wheelchair solid seat insert.  ...........  ...........  ...........  ...........  ...........
E0994.................  Y..............  ...............  Wheelchair arm rest..........  ...........  ...........  ...........  ...........  ...........
E0995.................  B..............  ...............  Wheelchair calf rest.........  ...........  ...........  ...........  ...........  ...........
E0996.................  B..............  ...............  Wheelchair tire solid........  ...........  ...........  ...........  ...........  ...........
E0997.................  Y..............  ...............  Wheelchair caster w/ a fork..  ...........  ...........  ...........  ...........  ...........
E0998.................  Y..............  ...............  Wheelchair caster w/o a fork.  ...........  ...........  ...........  ...........  ...........
E0999.................  Y..............  ...............  Wheelchr pneumatic tire w/wh.  ...........  ...........  ...........  ...........  ...........
E1000.................  B..............  ...............  Wheelchair tire pneumatic ca.  ...........  ...........  ...........  ...........  ...........
E1001.................  Y..............  ...............  Wheelchair wheel.............  ...........  ...........  ...........  ...........  ...........
E1002.................  Y..............  ...............  Pwr seat tilt................  ...........  ...........  ...........  ...........  ...........
E1003.................  Y..............  ...............  Pwr seat recline.............  ...........  ...........  ...........  ...........  ...........
E1004.................  Y..............  ...............  Pwr seat recline mech........  ...........  ...........  ...........  ...........  ...........
E1005.................  Y..............  ...............  Pwr seat recline pwr.........  ...........  ...........  ...........  ...........  ...........
E1006.................  Y..............  ...............  Pwr seat combo w/o shear.....  ...........  ...........  ...........  ...........  ...........
E1007.................  Y..............  ...............  Pwr seat combo w/shear.......  ...........  ...........  ...........  ...........  ...........
E1008.................  Y..............  ...............  Pwr seat combo pwr shear.....  ...........  ...........  ...........  ...........  ...........
E1009.................  Y..............  ...............  Add mech leg elevation.......  ...........  ...........  ...........  ...........  ...........
E1010.................  Y..............  ...............  Add pwr leg elevation........  ...........  ...........  ...........  ...........  ...........
E1011.................  Y..............  ...............  Ped wc modify width adjustm..  ...........  ...........  ...........  ...........  ...........
E1014.................  Y..............  ...............  Reclining back add ped w/c...  ...........  ...........  ...........  ...........  ...........
E1015.................  Y..............  ...............  Shock absorber for man w/c...  ...........  ...........  ...........  ...........  ...........
E1016.................  Y..............  ...............  Shock absorber for power w/c.  ...........  ...........  ...........  ...........  ...........
E1017.................  Y..............  ...............  HD shck absrbr for hd man wc.  ...........  ...........  ...........  ...........  ...........
E1018.................  Y..............  ...............  HD shck absrber for hd powwc.  ...........  ...........  ...........  ...........  ...........
E1019.................  E..............  ...............  HD feature power seat........  ...........  ...........  ...........  ...........  ...........
E1020.................  Y..............  ...............  Residual limb support system.  ...........  ...........  ...........  ...........  ...........
E1021.................  E..............  ...............  Ex hd feature power seat.....  ...........  ...........  ...........  ...........  ...........
E1025.................  E..............  ...............  Pedwc lat/thor sup nocontour.  ...........  ...........  ...........  ...........  ...........
E1026.................  E..............  ...............  Pedwc contoured lat/thor sup.  ...........  ...........  ...........  ...........  ...........
E1027.................  E..............  ...............  Ped wc lat/ant support.......  ...........  ...........  ...........  ...........  ...........
E1028.................  Y..............  ...............  W/c manual swingaway.........  ...........  ...........  ...........  ...........  ...........
E1029.................  Y..............  ...............  W/c vent tray fixed..........  ...........  ...........  ...........  ...........  ...........
E1030.................  Y..............  ...............  W/c vent tray gimbaled.......  ...........  ...........  ...........  ...........  ...........
E1031.................  Y..............  ...............  Rollabout chair with casters.  ...........  ...........  ...........  ...........  ...........
E1035.................  Y..............  ...............  Patient transfer system......  ...........  ...........  ...........  ...........  ...........
E1037.................  Y..............  ...............  Transport chair, ped size....  ...........  ...........  ...........  ...........  ...........
E1038.................  Y..............  ...............  Transport chair, adult size..  ...........  ...........  ...........  ...........  ...........
E1039.................  Y..............  ...............  Transport chair pt wt>=250lb.  ...........  ...........  ...........  ...........  ...........
E1050.................  A..............  ...............  Whelchr fxd full length arms.  ...........  ...........  ...........  ...........  ...........
E1060.................  A..............  ...............  Wheelchair detachable arms...  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
E1092.................  A..............  ...............  Wheelchair wide w/ leg rests.  ...........  ...........  ...........  ...........  ...........
E1093.................  A..............  ...............  Wheelchair wide w/ foot rest.  ...........  ...........  ...........  ...........  ...........
E1100.................  A..............  ...............  Whchr s-recl fxd arm leg res.  ...........  ...........  ...........  ...........  ...........

[[Page 42931]]

 
E1110.................  A..............  ...............  Wheelchair semi-recl detach..  ...........  ...........  ...........  ...........  ...........
E1130.................  A..............  ...............  Whlchr stand fxd arm ft rest.  ...........  ...........  ...........  ...........  ...........
E1140.................  A..............  ...............  Wheelchair standard detach a.  ...........  ...........  ...........  ...........  ...........
E1150.................  Y..............  ...............  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.................  Y..............  ...............  Whlchr moto ful arm leg rest.  ...........  ...........  ...........  ...........  ...........
E1211.................  Y..............  ...............  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.................  Y..............  ...............  Wheelchair spec sz semi-recl.  ...........  ...........  ...........  ...........  ...........
E1226.................  B..............  ...............  W/C access fully reclineback.  ...........  ...........  ...........  ...........  ...........
E1227.................  Y..............  ...............  Wheelchair spec sz spec ht a.  ...........  ...........  ...........  ...........  ...........
E1228.................  Y..............  ...............  Wheelchair spec sz spec ht b.  ...........  ...........  ...........  ...........  ...........
E1229.................  Y..............  ...............  Pediatric wheelchair NOS.....  ...........  ...........  ...........  ...........  ...........
E1230.................  Y..............  ...............  Power operated vehicle.......  ...........  ...........  ...........  ...........  ...........
E1231.................  Y..............  ...............  Rigid ped w/c tilt-in-space..  ...........  ...........  ...........  ...........  ...........
E1232.................  Y..............  ...............  Folding ped wc tilt-in-space.  ...........  ...........  ...........  ...........  ...........
E1233.................  Y..............  ...............  Rig ped wc tltnspc w/o seat..  ...........  ...........  ...........  ...........  ...........
E1234.................  Y..............  ...............  Fld ped wc tltnspc w/o seat..  ...........  ...........  ...........  ...........  ...........
E1235.................  Y..............  ...............  Rigid ped wc adjustable......  ...........  ...........  ...........  ...........  ...........
E1236.................  Y..............  ...............  Folding ped wc adjustable....  ...........  ...........  ...........  ...........  ...........
E1237.................  Y..............  ...............  Rgd ped wc adjstabl w/o seat.  ...........  ...........  ...........  ...........  ...........
E1238.................  Y..............  ...............  Fld ped wc adjstabl w/o seat.  ...........  ...........  ...........  ...........  ...........
E1239.................  Y..............  ...............  Ped power wheelchair NOS.....  ...........  ...........  ...........  ...........  ...........
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.................  Y..............  ...............  Wheelchair special seat heig.  ...........  ...........  ...........  ...........  ...........
E1297.................  Y..............  ...............  Wheelchair special seat dept.  ...........  ...........  ...........  ...........  ...........
E1298.................  Y..............  ...............  Wheelchair spec seat depth/w.  ...........  ...........  ...........  ...........  ...........
E1300.................  E..............  ...............  Whirlpool portable...........  ...........  ...........  ...........  ...........  ...........
E1310.................  Y..............  ...............  Whirlpool non-portable.......  ...........  ...........  ...........  ...........  ...........
E1340.................  Y..............  ...............  Repair for DME, per 15 min...  ...........  ...........  ...........  ...........  ...........
E1353.................  Y..............  ...............  Oxygen supplies regulator....  ...........  ...........  ...........  ...........  ...........
E1355.................  Y..............  ...............  Oxygen supplies stand/rack...  ...........  ...........  ...........  ...........  ...........
E1372.................  Y..............  ...............  Oxy suppl heater for nebuliz.  ...........  ...........  ...........  ...........  ...........
E1390.................  Y..............  ...............  Oxygen concentrator..........  ...........  ...........  ...........  ...........  ...........
E1391.................  Y..............  ...............  Oxygen concentrator, dual....  ...........  ...........  ...........  ...........  ...........
E1399.................  N..............  ...............  Durable medical equipment mi.  ...........  ...........  ...........  ...........  ...........
E1405.................  Y..............  ...............  O2/water vapor enrich w/heat.  ...........  ...........  ...........  ...........  ...........
E1406.................  Y..............  ...............  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..  ...........  ...........  ...........  ...........  ...........

[[Page 42932]]

 
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.................  B..............  ...............  Peritoneal dialysis clamp....  ...........  ...........  ...........  ...........  ...........
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.................  Y..............  ...............  Jaw motion rehab system......  ...........  ...........  ...........  ...........  ...........
E1701.................  Y..............  ...............  Repl cushions for jaw motion.  ...........  ...........  ...........  ...........  ...........
E1702.................  Y..............  ...............  Repl measr scales jaw motion.  ...........  ...........  ...........  ...........  ...........
E1800.................  Y..............  ...............  Adjust elbow ext/flex device.  ...........  ...........  ...........  ...........  ...........
E1801.................  Y..............  ...............  SPS elbow device.............  ...........  ...........  ...........  ...........  ...........
E1802.................  Y..............  ...............  Adjst forearm pro/sup device.  ...........  ...........  ...........  ...........  ...........
E1805.................  Y..............  ...............  Adjust wrist ext/flex device.  ...........  ...........  ...........  ...........  ...........
E1806.................  Y..............  ...............  SPS wrist device.............  ...........  ...........  ...........  ...........  ...........
E1810.................  Y..............  ...............  Adjust knee ext/flex device..  ...........  ...........  ...........  ...........  ...........
E1811.................  Y..............  ...............  SPS knee device..............  ...........  ...........  ...........  ...........  ...........
E1815.................  Y..............  ...............  Adjust ankle ext/flex device.  ...........  ...........  ...........  ...........  ...........
E1816.................  Y..............  ...............  SPS ankle device.............  ...........  ...........  ...........  ...........  ...........
E1818.................  Y..............  ...............  SPS forearm device...........  ...........  ...........  ...........  ...........  ...........
E1820.................  Y..............  ...............  Soft interface material......  ...........  ...........  ...........  ...........  ...........
E1821.................  Y..............  ...............  Replacement interface SPSD...  ...........  ...........  ...........  ...........  ...........
E1825.................  Y..............  ...............  Adjust finger ext/flex devc..  ...........  ...........  ...........  ...........  ...........
E1830.................  Y..............  ...............  Adjust toe ext/flex device...  ...........  ...........  ...........  ...........  ...........
E1840.................  Y..............  ...............  Adj shoulder ext/flex device.  ...........  ...........  ...........  ...........  ...........
E1841.................  Y..............  ...............  Static str shldr dev rom adj.  ...........  ...........  ...........  ...........  ...........
E1902.................  A..............  ...............  AAC non-electronic board.....  ...........  ...........  ...........  ...........  ...........
E2000.................  Y..............  ...............  Gastric suction pump hme mdl.  ...........  ...........  ...........  ...........  ...........
E2100.................  Y..............  ...............  Bld glucose monitor w voice..  ...........  ...........  ...........  ...........  ...........
E2101.................  Y..............  ...............  Bld glucose monitor w lance..  ...........  ...........  ...........  ...........  ...........
E2120.................  Y..............  ...............  Pulse gen sys tx endolymp fl.  ...........  ...........  ...........  ...........  ...........
E2201.................  Y..............  ...............  Man w/ch acc seat              ...........  ...........  ...........  ...........  ...........
                                                           w>=20''<24''.
E2202.................  Y..............  ...............  Seat width 24-27 in..........  ...........  ...........  ...........  ...........  ...........
E2203.................  Y..............  ...............  Frame depth less than 22 in..  ...........  ...........  ...........  ...........  ...........
E2204.................  Y..............  ...............  Frame depth 22 to 25 in......  ...........  ...........  ...........  ...........  ...........
E2205.................  Y..............  ...............  Manual wc accessory, handrim.  ...........  ...........  ...........  ...........  ...........
E2206.................  Y..............  ...............  Complete wheel lock assembly.  ...........  ...........  ...........  ...........  ...........
E2291.................  E..............  ...............  Planar back for ped size wc..  ...........  ...........  ...........  ...........  ...........
E2292.................  E..............  ...............  Planar seat for ped size wc..  ...........  ...........  ...........  ...........  ...........
E2293.................  E..............  ...............  Contour back for ped size wc.  ...........  ...........  ...........  ...........  ...........
E2294.................  E..............  ...............  Contour seat for ped size wc.  ...........  ...........  ...........  ...........  ...........
E2300.................  Y..............  ...............  Pwr seat elevation sys.......  ...........  ...........  ...........  ...........  ...........
E2301.................  Y..............  ...............  Pwr standing.................  ...........  ...........  ...........  ...........  ...........
E2310.................  Y..............  ...............  Electro connect btw control..  ...........  ...........  ...........  ...........  ...........
E2311.................  Y..............  ...............  Electro connect btw 2 sys....  ...........  ...........  ...........  ...........  ...........
E2320.................  Y..............  ...............  Hand chin control............  ...........  ...........  ...........  ...........  ...........
E2321.................  Y..............  ...............  Hand interface joystick......  ...........  ...........  ...........  ...........  ...........
E2322.................  Y..............  ...............  Mult mech switches...........  ...........  ...........  ...........  ...........  ...........
E2323.................  Y..............  ...............  Special joystick handle......  ...........  ...........  ...........  ...........  ...........
E2324.................  Y..............  ...............  Chin cup interface...........  ...........  ...........  ...........  ...........  ...........
E2325.................  Y..............  ...............  Sip and puff interface.......  ...........  ...........  ...........  ...........  ...........
E2326.................  Y..............  ...............  Breath tube kit..............  ...........  ...........  ...........  ...........  ...........
E2327.................  Y..............  ...............  Head control interface mech..  ...........  ...........  ...........  ...........  ...........
E2328.................  Y..............  ...............  Head/extremity control inter.  ...........  ...........  ...........  ...........  ...........

[[Page 42933]]

 
E2329.................  Y..............  ...............  Head control nonproportional.  ...........  ...........  ...........  ...........  ...........
E2330.................  Y..............  ...............  Head control proximity switc.  ...........  ...........  ...........  ...........  ...........
E2331.................  Y..............  ...............  Attendant control............  ...........  ...........  ...........  ...........  ...........
E2340.................  Y..............  ...............  W/c wdth 20-23 in seat frame.  ...........  ...........  ...........  ...........  ...........
E2341.................  Y..............  ...............  W/c wdth 24-27 in seat frame.  ...........  ...........  ...........  ...........  ...........
E2342.................  Y..............  ...............  W/c dpth 20-21 in seat frame.  ...........  ...........  ...........  ...........  ...........
E2343.................  Y..............  ...............  W/c dpth 22-25 in seat frame.  ...........  ...........  ...........  ...........  ...........
E2351.................  Y..............  ...............  Electronic SGD interface.....  ...........  ...........  ...........  ...........  ...........
E2360.................  Y..............  ...............  22nf nonsealed leadacid......  ...........  ...........  ...........  ...........  ...........
E2361.................  Y..............  ...............  22nf sealed leadacid battery.  ...........  ...........  ...........  ...........  ...........
E2362.................  Y..............  ...............  Gr24 nonsealed leadacid......  ...........  ...........  ...........  ...........  ...........
E2363.................  Y..............  ...............  Gr24 sealed leadacid battery.  ...........  ...........  ...........  ...........  ...........
E2364.................  Y..............  ...............  U1nonsealed leadacid battery.  ...........  ...........  ...........  ...........  ...........
E2365.................  Y..............  ...............  U1 sealed leadacid battery...  ...........  ...........  ...........  ...........  ...........
E2366.................  Y..............  ...............  Battery charger, single mode.  ...........  ...........  ...........  ...........  ...........
E2367.................  Y..............  ...............  Battery charger, dual mode...  ...........  ...........  ...........  ...........  ...........
E2368.................  Y..............  ...............  Power wc motor replacement...  ...........  ...........  ...........  ...........  ...........
E2369.................  Y..............  ...............  Pwr wc gear box replacement..  ...........  ...........  ...........  ...........  ...........
E2370.................  Y..............  ...............  Pwr wc motor/gear box combo..  ...........  ...........  ...........  ...........  ...........
E2399.................  Y..............  ...............  Noc interface................  ...........  ...........  ...........  ...........  ...........
E2402.................  Y..............  ...............  Neg press wound therapy pump.  ...........  ...........  ...........  ...........  ...........
E2500.................  Y..............  ...............  SGD digitized pre-rec <=8min.  ...........  ...........  ...........  ...........  ...........
E2502.................  Y..............  ...............  SGD prerec msg >8min <=20min.  ...........  ...........  ...........  ...........  ...........
E2504.................  Y..............  ...............  SGD prerec msg>20min <=40min.  ...........  ...........  ...........  ...........  ...........
E2506.................  Y..............  ...............  SGD prerec msg > 40 min......  ...........  ...........  ...........  ...........  ...........
E2508.................  Y..............  ...............  SGD spelling phys contact....  ...........  ...........  ...........  ...........  ...........
E2510.................  Y..............  ...............  SGD w multi methods msg/accs.  ...........  ...........  ...........  ...........  ...........
E2511.................  Y..............  ...............  SGD sftwre prgrm for PC/PDA..  ...........  ...........  ...........  ...........  ...........
E2512.................  Y..............  ...............  SGD accessory, mounting sys..  ...........  ...........  ...........  ...........  ...........
E2599.................  Y..............  ...............  SGD accessory noc............  ...........  ...........  ...........  ...........  ...........
E2601.................  Y..............  ...............  Gen w/c cushion wdth < 22 in.  ...........  ...........  ...........  ...........  ...........
E2602.................  Y..............  ...............  Gen w/c cushion wdth >=22 in.  ...........  ...........  ...........  ...........  ...........
E2603.................  Y..............  ...............  Skin protect wc cus wd <22in.  ...........  ...........  ...........  ...........  ...........
E2604.................  Y..............  ...............  Skin protect wc cus wd>=22in.  ...........  ...........  ...........  ...........  ...........
E2605.................  Y..............  ...............  Position wc cush wdth <22 in.  ...........  ...........  ...........  ...........  ...........
E2606.................  Y..............  ...............  Position wc cush wdth>=22 in.  ...........  ...........  ...........  ...........  ...........
E2607.................  Y..............  ...............  Skin pro/pos wc cus wd <22in.  ...........  ...........  ...........  ...........  ...........
E2608.................  Y..............  ...............  Skin pro/pos wc cus wd>=22in.  ...........  ...........  ...........  ...........  ...........
E2609.................  Y..............  ...............  Custom fabricate w/c cushion.  ...........  ...........  ...........  ...........  ...........
E2610.................  B..............  ...............  Powered w/c cushion..........  ...........  ...........  ...........  ...........  ...........
E2611.................  Y..............  ...............  Gen use back cush wdth <22in.  ...........  ...........  ...........  ...........  ...........
E2612.................  Y..............  ...............  Gen use back cush wdth>=22in.  ...........  ...........  ...........  ...........  ...........
E2613.................  Y..............  ...............  Position back cush wd <22in..  ...........  ...........  ...........  ...........  ...........
E2614.................  Y..............  ...............  Position back cush wd>=22in..  ...........  ...........  ...........  ...........  ...........
E2615.................  Y..............  ...............  Pos back post/lat wdth <22in.  ...........  ...........  ...........  ...........  ...........
E2616.................  Y..............  ...............  Pos back post/lat wdth>=22in.  ...........  ...........  ...........  ...........  ...........
E2617.................  Y..............  ...............  Custom fab w/c back cushion..  ...........  ...........  ...........  ...........  ...........
E2618.................  Y..............  ...............  Wc acc solid seat supp base..  ...........  ...........  ...........  ...........  ...........
E2619.................  Y..............  ...............  Replace cover w/c seat cush..  ...........  ...........  ...........  ...........  ...........
E2620.................  Y..............  ...............  WC planar back cush wd <22in.  ...........  ...........  ...........  ...........  ...........
E2621.................  Y..............  ...............  WC planar back cush wd>=22in.  ...........  ...........  ...........  ...........  ...........
E8000.................  E..............  ...............  Posterior gait trainer.......  ...........  ...........  ...........  ...........  ...........
E8001.................  E..............  ...............  Upright gait trainer.........  ...........  ...........  ...........  ...........  ...........
E8002.................  E..............  ...............  Anterior gait trainer........  ...........  ...........  ...........  ...........  ...........
G0008.................  X..............  ...............  Admin influenza virus vac....         0350       0.3936       $23.36         $.00         $.00
G0009.................  X..............  ...............  Admin pneumococcal vaccine...         0350       0.3936       $23.36         $.00         $.00
G0010.................  B..............  ...............  Admin hepatitis b vaccine....  ...........  ...........  ...........  ...........  ...........
G0027.................  A..............  ...............  Semen analysis...............  ...........  ...........  ...........  ...........  ...........
G0101.................  V..............  ...............  CA screen pelvic/breast exam.         0600       0.8649       $51.33  ...........       $10.27
G0102.................  N..............  ...............  Prostate ca screening dre....  ...........  ...........  ...........  ...........  ...........
G0103.................  A..............  ...............  Psa, total screening.........  ...........  ...........  ...........  ...........  ...........
G0104.................  S..............  ...............  CA screen flexi sigmoidscope.         0159       3.1312      $185.84  ...........       $46.46
G0105.................  T..............  ...............  Colorectal scrn hi risk ind..         0158       7.6242      $452.50  ...........      $113.13
G0106.................  S..............  ...............  Colon CA screen barium enema.         0157       2.2800      $135.32  ...........       $27.06
G0107.................  A..............  ...............  CA screen fecal blood test...  ...........  ...........  ...........  ...........  ...........
G0108.................  A..............  ...............  Diab manage trn per indiv....  ...........  ...........  ...........  ...........  ...........

[[Page 42934]]

 
G0109.................  A..............  ...............  Diab manage trn ind/group....  ...........  ...........  ...........  ...........  ...........
G0110.................  A..............  ...............  Nett pulm-rehab educ ind.....  ...........  ...........  ...........  ...........  ...........
G0111.................  A..............  ...............  Nett pulm-rehab educ group...  ...........  ...........  ...........  ...........  ...........
G0112.................  A..............  ...............  Nett nutrition guid, initial.  ...........  ...........  ...........  ...........  ...........
G0113.................  A..............  ...............  Nett nutrition guid,subseqnt.  ...........  ...........  ...........  ...........  ...........
G0114.................  A..............  ...............  Nett psychosocial consult....  ...........  ...........  ...........  ...........  ...........
G0115.................  A..............  ...............  Nett psychological testing...  ...........  ...........  ...........  ...........  ...........
G0116.................  A..............  ...............  Nett psychosocial counsel....  ...........  ...........  ...........  ...........  ...........
G0117.................  S..............  ...............  Glaucoma scrn hgh risk direc.         0230       0.7823       $46.43       $14.97        $9.29
G0118.................  S..............  ...............  Glaucoma scrn hgh risk direc.         0230       0.7823       $46.43       $14.97        $9.29
G0120.................  S..............  ...............  Colon ca scrn barium enema...         0157       2.2800      $135.32  ...........       $27.06
G0121.................  T..............  ...............  Colon ca scrn not hi rsk ind.         0158       7.6242      $452.50  ...........      $113.13
G0122.................  E..............  ...............  Colon ca scrn barium enema...  ...........  ...........  ...........  ...........  ...........
G0123.................  A..............  ...............  Screen cerv/vag thin layer...  ...........  ...........  ...........  ...........  ...........
G0124.................  A..............  ...............  Screen c/v thin layer by MD..  ...........  ...........  ...........  ...........  ...........
G0127.................  T..............  ...............  Trim nail(s).................         0009       0.6650       $39.47        $8.34        $7.89
G0128.................  B..............  ...............  CORF skilled nursing service.  ...........  ...........  ...........  ...........  ...........
G0129.................  P..............  ...............  Partial hosp prog service....         0033       4.0524      $240.51  ...........       $48.10
G0130.................  X..............  ...............  Single energy x-ray study....         0260       0.7521       $44.64       $17.85        $8.93
G0141.................  E..............  ...............  Scr c/v cyto,autosys and md..  ...........  ...........  ...........  ...........  ...........
G0143.................  A..............  ...............  Scr c/v cyto,thinlayer,rescr.  ...........  ...........  ...........  ...........  ...........
G0144.................  A..............  ...............  Scr c/v cyto,thinlayer,rescr.  ...........  ...........  ...........  ...........  ...........
G0145.................  A..............  ...............  Scr c/v cyto,thinlayer,rescr.  ...........  ...........  ...........  ...........  ...........
G0147.................  A..............  ...............  Scr c/v cyto, automated sys..  ...........  ...........  ...........  ...........  ...........
G0148.................  A..............  ...............  Scr c/v cyto, autosys, rescr.  ...........  ...........  ...........  ...........  ...........
G0151.................  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, per tx..         0678       1.7197      $102.06  ...........       $20.41
G0168.................  N..............  ...............  Wound closure by adhesive....  ...........  ...........  ...........  ...........  ...........
G0173.................  S..............  ...............  Linear acc stereo radsur com.         1528  ...........    $5,250.00  ...........    $1,050.00
G0175.................  V..............  ...............  OPPS Service,sched team conf.         0602       1.4220       $84.40  ...........       $16.88
G0176.................  P..............  ...............  OPPS/PHP activity therapy....         0033       4.0524      $240.51  ...........       $48.10
G0177.................  P..............  ...............  OPPS/PHP train & educ serv...         0033       4.0524      $240.51  ...........       $48.10
G0179.................  E..............  ...............  MD recertification HHA PT....  ...........  ...........  ...........  ...........  ...........
G0180.................  E..............  ...............  MD certification HHA patient.  ...........  ...........  ...........  ...........  ...........
G0181.................  E..............  ...............  Home health care supervision.  ...........  ...........  ...........  ...........  ...........
G0182.................  E..............  ...............  Hospice care supervision.....  ...........  ...........  ...........  ...........  ...........
G0186.................  T..............  ...............  Dstry eye lesn,fdr vssl tech.         0235       4.6382      $275.28       $67.10       $55.06
G0202.................  A..............  ...............  Screeningmammographydigital..  ...........  ...........  ...........  ...........  ...........
G0204.................  A..............  ...............  Diagnosticmammographydigital.  ...........  ...........  ...........  ...........  ...........
G0206.................  A..............  ...............  Diagnosticmammographydigital.  ...........  ...........  ...........  ...........  ...........
G0219.................  E..............  ...............  PET img whbd ring noncov ind.  ...........  ...........  ...........  ...........  ...........
G0235.................  E..............  ...............  PET not otherwise specified..  ...........  ...........  ...........  ...........  ...........
G0237.................  S..............  ...............  Therapeutic procd strg endur.         0411       0.3852       $22.86  ...........        $4.57
G0238.................  S..............  ...............  Oth resp proc, indiv.........         0411       0.3852       $22.86  ...........        $4.57
G0239.................  S..............  ...............  Oth resp proc, group.........         0411       0.3852       $22.86  ...........        $4.57
G0243.................  S..............  ...............  Multisour photon stero treat.         1528  ...........    $5,250.00  ...........    $1,050.00
G0244.................  B..............  ...............  Observ care by facility topt.  ...........  ...........  ...........  ...........  ...........
G0245.................  V..............  ...............  Initial Foot Exam PTLOPS.....         0600       0.8649       $51.33  ...........       $10.27
G0246.................  V..............  ...............  Followup eval of foot pt lop.         0600       0.8649       $51.33  ...........       $10.27
G0247.................  T..............  ...............  Routine footcare pt w lops...         0009       0.6650       $39.47        $8.34        $7.89
G0248.................  S..............  ...............  Demonstrate use home inr mon.         1503  ...........      $150.00  ...........       $30.00
G0249.................  S..............  ...............  Provide test material,equipm.         1503  ...........      $150.00  ...........       $30.00
G0250.................  E..............  ...............  MD review interpret of test..  ...........  ...........  ...........  ...........  ...........
G0251.................  S..............  ...............  Linear acc based stero radio.         1513  ...........    $1,150.00  ...........      $230.00
G0252.................  E..............  ...............  PET imaging initial dx.......  ...........  ...........  ...........  ...........  ...........
G0255.................  E..............  ...............  Current percep threshold tst.  ...........  ...........  ...........  ...........  ...........
G0257.................  S..............  ...............  Unsched dialysis ESRD pt hos.         0170       5.8726      $348.54  ...........       $69.71
G0258.................  X..............  ...............  IV infusion during obs stay..         0340       0.6355       $37.72  ...........        $7.54
G0259.................  N..............  ...............  Inject for sacroiliac joint..  ...........  ...........  ...........  ...........  ...........
G0260.................  T..............  ...............  Inj for sacroiliac jt anesth.         0206       5.4672      $324.48       $75.55       $64.90
G0263.................  B..............  ...............  Adm with CHF, CP, asthma.....  ...........  ...........  ...........  ...........  ...........

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G0264.................  B..............  ...............  Assmt otr CHF, CP, asthma....  ...........  ...........  ...........  ...........  ...........
G0265.................  A..............  ...............  Cryopresevation Freeze+stora.  ...........  ...........  ...........  ...........  ...........
G0266.................  A..............  ...............  Thawing + expansion froz cel.  ...........  ...........  ...........  ...........  ...........
G0267.................  S..............  ...............  Bone marrow or psc harvest...         0110       3.6428      $216.20  ...........       $43.24
G0268.................  X..............  ...............  Removal of impacted wax md...         0340       0.6355       $37.72  ...........        $7.54
G0269.................  N..............  ...............  Occlusive device in vein art.  ...........  ...........  ...........  ...........  ...........
G0270.................  A..............  ...............  MNT subs tx for change dx....  ...........  ...........  ...........  ...........  ...........
G0271.................  A..............  ...............  Group MNT 2 or more 30 mins..  ...........  ...........  ...........  ...........  ...........
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.................  E..............  ...............  Elect stim wound care not pd.  ...........  ...........  ...........  ...........  ...........
G0283.................  A..............  ...............  Elec stim other than wound...  ...........  ...........  ...........  ...........  ...........
G0288.................  S..............  ...............  Recon, CTA for pre & post su.         0417       4.0566      $240.76  ...........       $48.15
G0289.................  N..............  ...............  Arthro, loose body + chondro.  ...........  ...........  ...........  ...........  ...........
G0290.................  T..............  ...............  Drug-eluting stents, single..         0656     109.4258    $6,494.42  ...........    $1,298.88
G0291.................  T..............  ...............  Drug-eluting stents,each add.         0656     109.4258    $6,494.42  ...........    $1,298.88
G0293.................  S..............  ...............  Non-cov surg proc,clin trial.         1505  ...........      $350.00  ...........       $70.00
G0294.................  S..............  ...............  Non-cov proc, clinical trial.         1502  ...........       $75.00  ...........       $15.00
G0295.................  E..............  ...............  Electromagnetic therapy onc..  ...........  ...........  ...........  ...........  ...........
G0297.................  T..............  ...............  Insert single chamber/cd.....         0107     258.8517   $15,362.85    $3,089.53    $3,072.57
G0298.................  T..............  ...............  Insert dual chamber/cd.......         0107     258.8517   $15,362.85    $3,089.53    $3,072.57
G0299.................  T..............  ...............  Inser/repos single icd+leads.         0108     347.5867   $20,629.27  ...........    $4,125.85
G0300.................  T..............  ...............  Insert reposit lead dual+gen.         0108     347.5867   $20,629.27  ...........    $4,125.85
G0302.................  S..............  ...............  Pre-op service LVRS complete.         1509  ...........      $750.00  ...........      $150.00
G0303.................  S..............  ...............  Pre-op service LVRS 10-15dos.         1507  ...........      $550.00  ...........      $110.00
G0304.................  S..............  ...............  Pre-op service LVRS 1-9 dos..         1504  ...........      $250.00  ...........       $50.00
G0305.................  S..............  ...............  Post op service LVRS min 6...         1504  ...........      $250.00  ...........       $50.00
G0306.................  A..............  ...............  CBC/diffwbc w/o platelet.....  ...........  ...........  ...........  ...........  ...........
G0307.................  A..............  ...............  CBC without platelet.........  ...........  ...........  ...........  ...........  ...........
G0308.................  A..............  ...............  ESRD related svc 4+mo<2yrs...  ...........  ...........  ...........  ...........  ...........
G0309.................  A..............  ...............  ESRD related svc 2-3mo<2yrs..  ...........  ...........  ...........  ...........  ...........
G0310.................  A..............  ...............  ESRD related svc 1vst<2yr....  ...........  ...........  ...........  ...........  ...........
G0311.................  A..............  ...............  ESRD related svs 4+mo 2-11yr.  ...........  ...........  ...........  ...........  ...........
G0312.................  A..............  ...............  ESRD relate svs 2-3 mo 2-11y.  ...........  ...........  ...........  ...........  ...........
G0313.................  A..............  ...............  ESRD related svs 1 mon 2-11y.  ...........  ...........  ...........  ...........  ...........
G0314.................  A..............  ...............  ESRD relate svs 4+mo 12-19...  ...........  ...........  ...........  ...........  ...........
G0315.................  A..............  ...............  ESRD related svs 2-3 mo 12-1.  ...........  ...........  ...........  ...........  ...........
G0316.................  A..............  ...............  ESRD related svs 1 vis/12-19.  ...........  ...........  ...........  ...........  ...........
G0317.................  A..............  ...............  ESRD related svs 4+mo 20+yrs.  ...........  ...........  ...........  ...........  ...........
G0318.................  A..............  ...............  ESRD related svs 2-3 mo 20+y.  ...........  ...........  ...........  ...........  ...........
G0319.................  A..............  ...............  ESRD related svs 1visit 20+y.  ...........  ...........  ...........  ...........  ...........
G0320.................  A..............  ...............  ESRD related svs home under..  ...........  ...........  ...........  ...........  ...........
G0321.................  A..............  ...............  ESRDrelatedsvs home mo 2-11y.  ...........  ...........  ...........  ...........  ...........
G0322.................  A..............  ...............  ESRD related svs home mo12-1.  ...........  ...........  ...........  ...........  ...........
G0323.................  A..............  ...............  ESRD related svs home mo 20+.  ...........  ...........  ...........  ...........  ...........
G0324.................  A..............  ...............  ESRD related svs home/dy/2y..  ...........  ...........  ...........  ...........  ...........
G0325.................  A..............  ...............  ESRD relate home/dy 2-11yr...  ...........  ...........  ...........  ...........  ...........
G0326.................  A..............  ...............  ESRD relate home/dy 12-19y...  ...........  ...........  ...........  ...........  ...........
G0327.................  A..............  ...............  ESRD relate home/dy 20+yrs...  ...........  ...........  ...........  ...........  ...........
G0328.................  A..............  ...............  Fecal blood scrn immunoassay.  ...........  ...........  ...........  ...........  ...........
G0329.................  A..............  ...............  Electromagntic tx for ulcers.  ...........  ...........  ...........  ...........  ...........
G0337.................  A..............  ...............  Hospice evaluation preelecti.  ...........  ...........  ...........  ...........  ...........
G0339.................  S..............  ...............  Robot lin-radsurg com, first.         1528  ...........    $5,250.00  ...........    $1,050.00
G0340.................  S..............  ...............  Robt lin-radsurg fractx 2-5..         1525  ...........    $3,750.00  ...........      $750.00
G0341.................  C..............  ...............  Percutaneous islet celltrans.  ...........  ...........  ...........  ...........  ...........
G0342.................  C..............  ...............  Laparoscopy Islet cell Trans.  ...........  ...........  ...........  ...........  ...........
G0343.................  C..............  ...............  Laparotomy Islet cell tranp..  ...........  ...........  ...........  ...........  ...........
G0344.................  V..............  ...............  Initial preventive exam......         0601       0.9992       $59.30  ...........       $11.86
G0345.................  M..............  ...............  IV infuse hydration initial..  ...........  ...........  ...........  ...........  ...........
G0346.................  M..............  ...............  Each additional infuse hours.  ...........  ...........  ...........  ...........  ...........
G0347.................  M..............  ...............  IV infusion therapy/diagnost.  ...........  ...........  ...........  ...........  ...........
G0348.................  M..............  ...............  each additional hr up to 8hr.  ...........  ...........  ...........  ...........  ...........
G0349.................  M..............  ...............  additional sequential infuse.  ...........  ...........  ...........  ...........  ...........

[[Page 42936]]

 
G0350.................  M..............  ...............  concurrent infusion..........  ...........  ...........  ...........  ...........  ...........
G0351.................  M..............  ...............  therapeutic/diagnostic injec.  ...........  ...........  ...........  ...........  ...........
G0353.................  M..............  ...............  IV push,single orinitial dru.  ...........  ...........  ...........  ...........  ...........
G0354.................  M..............  ...............  each addition sequential IV..  ...........  ...........  ...........  ...........  ...........
G0355.................  M..............  ...............  chemo administrate subcut/IM.  ...........  ...........  ...........  ...........  ...........
G0356.................  M..............  ...............  hormonal anti-neoplastic.....  ...........  ...........  ...........  ...........  ...........
G0357.................  M..............  ...............  IV push single/initial subst.  ...........  ...........  ...........  ...........  ...........
G0358.................  M..............  ...............  IV push each additional drug.  ...........  ...........  ...........  ...........  ...........
G0359.................  M..............  ...............  chemotherapy IV one hr initi.  ...........  ...........  ...........  ...........  ...........
G0360.................  M..............  ...............  each additional hr 1-8 hrs...  ...........  ...........  ...........  ...........  ...........
G0361.................  M..............  ...............  prolong chemo Infuse>8hrs pu.  ...........  ...........  ...........  ...........  ...........
G0362.................  M..............  ...............  each add sequential infusion.  ...........  ...........  ...........  ...........  ...........
G0363.................  M..............  ...............  irrigate implanted venous de.  ...........  ...........  ...........  ...........  ...........
G0364.................  X..............  ...............  Bone marrow aspirate & biops.         0342       0.1553        $9.22        $3.68        $1.84
G0365.................  S..............  ...............  Vessel mapping hemo access...         0267       2.6208      $155.54       $62.18       $31.11
G0366.................  B..............  ...............  EKG for initial prevent exam.  ...........  ...........  ...........  ...........  ...........
G0367.................  S..............  ...............  EKG tracing for initial prev.         0099       0.3804       $22.58  ...........        $4.52
G0368.................  M..............  ...............  EKG interpret & report preve.  ...........  ...........  ...........  ...........  ...........
G0369.................  M..............  ...............  Pharm fee 1st month transpla.  ...........  ...........  ...........  ...........  ...........
G0370.................  M..............  ...............  Pharmacy fee oral cancer etc.  ...........  ...........  ...........  ...........  ...........
G0371.................  M..............  ...............  Pharm dispense inhalation 30.  ...........  ...........  ...........  ...........  ...........
G0374.................  M..............  ...............  Pharm dispense inhalation 90.  ...........  ...........  ...........  ...........  ...........
G0375.................  S..............  ...............  Smoke/Tobacco counseling 3-1.         1491  ...........        $5.00  ...........        $1.00
G0376.................  S..............  ...............  Smoke/Tobacco counseling >10.         1491  ...........        $5.00  ...........        $1.00
G3001.................  S..............  ...............  Admin + supply, tositumomab..         1522  ...........    $2,250.00  ...........      $450.00
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....  ...........  ...........  ...........  ...........  ...........
G9013.................  E..............  ...............  ESRD demo bundle level I.....  ...........  ...........  ...........  ...........  ...........
G9014.................  E..............  ...............  ESRD demo bundle-level II....  ...........  ...........  ...........  ...........  ...........
G9016.................  E..............  ...............  Demo-smoking cessation coun..  ...........  ...........  ...........  ...........  ...........
G9017.................  A..............  ...............  Amantadine HCL,oral..........  ...........  ...........  ...........  ...........  ...........
G9018.................  A..............  ...............  Zanamivir, inh pwdr..........  ...........  ...........  ...........  ...........  ...........
G9019.................  A..............  ...............  Oseltamivir phosp............  ...........  ...........  ...........  ...........  ...........
G9020.................  A..............  ...............  Rimantadine HCL..............  ...........  ...........  ...........  ...........  ...........
G9021.................  M..............  ...............  Chemo assess nausea vomit L1.  ...........  ...........  ...........  ...........  ...........
G9022.................  M..............  ...............  Chemo assess nausea vomit L2.  ...........  ...........  ...........  ...........  ...........
G9023.................  M..............  ...............  Chemo assess nausea vomit L3.  ...........  ...........  ...........  ...........  ...........
G9024.................  M..............  ...............  Chemo assess nausea vomit L4.  ...........  ...........  ...........  ...........  ...........
G9025.................  M..............  ...............  Chemo assessment pain level1.  ...........  ...........  ...........  ...........  ...........
G9026.................  M..............  ...............  Chemo assessment pain level2.  ...........  ...........  ...........  ...........  ...........
G9027.................  M..............  ...............  Chemo assessment pain level3.  ...........  ...........  ...........  ...........  ...........
G9028.................  M..............  ...............  Chemo assessment pain level4.  ...........  ...........  ...........  ...........  ...........
G9029.................  M..............  ...............  Chemo assess for fatigue L1..  ...........  ...........  ...........  ...........  ...........
G9030.................  M..............  ...............  Chemo assess for fatigue L2..  ...........  ...........  ...........  ...........  ...........
G9031.................  M..............  ...............  Chemo assess for fatigue L3..  ...........  ...........  ...........  ...........  ...........
G9032.................  M..............  ...............  Chemo assess for fatigue L4..  ...........  ...........  ...........  ...........  ...........
G9033.................  A..............  ...............  Amantadine HCL, oral, brand..  ...........  ...........  ...........  ...........  ...........
G9034.................  A..............  ...............  Zanamivir, inh pwdr, brand...  ...........  ...........  ...........  ...........  ...........
G9035.................  A..............  ...............  Oseltamivir phosp, brand.....  ...........  ...........  ...........  ...........  ...........
G9036.................  A..............  ...............  Rimantadine HCL, brand.......  ...........  ...........  ...........  ...........  ...........
G9041.................  A..............  ...............  Low vision serv occupational.  ...........  ...........  ...........  ...........  ...........
G9042.................  A..............  ...............  Low vision orient/mobility...  ...........  ...........  ...........  ...........  ...........
G9043.................  A..............  ...............  Low vision rehab therapist...  ...........  ...........  ...........  ...........  ...........
G9044.................  A..............  ...............  Low vision rehab teacher.....  ...........  ...........  ...........  ...........  ...........
J0120.................  N..............  ...............  Tetracyclin injection........  ...........  ...........  ...........  ...........  ...........
J0128.................  G..............  ...............  Abarelix injection...........         9216  ...........       $66.96  ...........       $13.39

[[Page 42937]]

 
J0130.................  K..............  ...............  Abciximab injection..........         1605  ...........      $450.56  ...........       $90.11
J0135.................  K..............  ...............  Adalimumab injection.........         1083  ...........      $300.07  ...........       $60.01
J0150.................  K..............  ...............  Injection adenosine 6 MG.....         0379  ...........       $33.44  ...........        $6.69
J0152.................  K..............  ...............  Adenosine injection..........         0917  ...........       $71.52  ...........       $14.30
J0170.................  N..............  ...............  Adrenalin epinephrin inject..  ...........  ...........  ...........  ...........  ...........
J0180.................  K..............  ...............  Agalsidase beta injection....         9208  ...........      $123.35  ...........       $24.67
J0190.................  N..............  ...............  Inj biperiden lactate/5 mg...  ...........  ...........  ...........  ...........  ...........
J0200.................  N..............  ...............  Alatrofloxacin mesylate......  ...........  ...........  ...........  ...........  ...........
J0205.................  K..............  ...............  Alglucerase injection........         0900  ...........       $39.94  ...........        $7.99
J0207.................  K..............  ...............  Amifostine...................         7000  ...........      $435.98  ...........       $87.20
J0210.................  K..............  ...............  Methyldopate hcl injection...         2210  ...........        $9.58  ...........        $1.92
J0215.................  B..............  ...............  Alefacept....................  ...........  ...........  ...........  ...........  ...........
J0256.................  K..............  ...............  Alpha 1 proteinase inhibitor.         0901  ...........        $3.30  ...........         $.66
J0270.................  B..............  ...............  Alprostadil for injection....  ...........  ...........  ...........  ...........  ...........
J0275.................  B..............  ...............  Alprostadil urethral suppos..  ...........  ...........  ...........  ...........  ...........
J0280.................  N..............  ...............  Aminophyllin 250 MG inj......  ...........  ...........  ...........  ...........  ...........
J0282.................  N..............  ...............  Amiodarone HCl...............  ...........  ...........  ...........  ...........  ...........
J0285.................  K..............  ...............  Amphotericin B...............         9030  ...........       $30.70  ...........        $6.14
J0287.................  K..............  ...............  Amphotericin b lipid complex.         9024  ...........       $11.95  ...........        $2.39
J0288.................  K..............  ...............  Ampho b cholesteryl sulfate..         0735  ...........       $12.24  ...........        $2.45
J0289.................  K..............  ...............  Amphotericin b liposome inj..         0736  ...........       $21.91  ...........        $4.38
J0290.................  N..............  ...............  Ampicillin 500 MG inj........  ...........  ...........  ...........  ...........  ...........
J0295.................  N..............  ...............  Ampicillin sodium per 1.5 gm.  ...........  ...........  ...........  ...........  ...........
J0300.................  N..............  ...............  Amobarbital 125 MG inj.......  ...........  ...........  ...........  ...........  ...........
J0330.................  N..............  ...............  Succinycholine chloride inj..  ...........  ...........  ...........  ...........  ...........
J0350.................  N..............  ...............  Injection anistreplase 30 u..  ...........  ...........  ...........  ...........  ...........
J0360.................  N..............  ...............  Hydralazine hcl injection....  ...........  ...........  ...........  ...........  ...........
J0380.................  N..............  ...............  Inj metaraminol bitartrate...  ...........  ...........  ...........  ...........  ...........
J0390.................  N..............  ...............  Chloroquine injection........  ...........  ...........  ...........  ...........  ...........
J0395.................  K..............  ...............  Arbutamine HCl injection.....         9031  ...........      $163.13  ...........       $32.63
J0456.................  N..............  ...............  Azithromycin.................  ...........  ...........  ...........  ...........  ...........
J0460.................  N..............  ...............  Atropine sulfate injection...  ...........  ...........  ...........  ...........  ...........
J0470.................  N..............  ...............  Dimecaprol injection.........  ...........  ...........  ...........  ...........  ...........
J0475.................  K..............  ...............  Baclofen 10 MG injection.....         9032  ...........      $188.00  ...........       $37.60
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..  ...........  ...........  ...........  ...........  ...........
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.................  K..............  ...............  Penicillin g benzathine inj..         0880  ...........       $72.25  ...........       $14.45
J0583.................  N..............  ...............  Bivalirudin..................  ...........  ...........  ...........  ...........  ...........
J0585.................  K..............  ...............  Botulinum toxin a per unit...         0902  ...........        $4.80  ...........         $.96
J0587.................  K..............  ...............  Botulinum toxin type B.......         9018  ...........        $7.89  ...........        $1.58
J0592.................  N..............  ...............  Buprenorphine hydrochloride..  ...........  ...........  ...........  ...........  ...........
J0595.................  N..............  ...............  Butorphanol tartrate 1 mg....  ...........  ...........  ...........  ...........  ...........
J0600.................  K..............  ...............  Edetate calcium disodium inj.         0892  ...........       $40.34  ...........        $8.07
J0610.................  N..............  ...............  Calcium gluconate injection..  ...........  ...........  ...........  ...........  ...........
J0620.................  N..............  ...............  Calcium glycer & lact/10 ML..  ...........  ...........  ...........  ...........  ...........
J0630.................  K..............  ...............  Calcitonin salmon injection..         0893  ...........       $35.68  ...........        $7.14
J0636.................  N..............  ...............  Inj calcitriol per 0.1 mcg...  ...........  ...........  ...........  ...........  ...........
J0637.................  K..............  ...............  Caspofungin acetate..........         9019  ...........       $32.35  ...........        $6.47
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.................  K..............  ...............  Caffeine citrate injection...         0876  ...........        $3.34  ...........         $.67

[[Page 42938]]

 
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.................  K..............  ...............  Clonidine hydrochloride......         0935  ...........       $57.46  ...........       $11.49
J0740.................  K..............  ...............  Cidofovir injection..........         9033  ...........      $782.91  ...........      $156.58
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.................  K..............  ...............  Corticotropin injection......         1280  ...........       $95.43  ...........       $19.09
J0835.................  K..............  ...............  Inj cosyntropin per 0.25 MG..         0835  ...........       $69.27  ...........       $13.85
J0850.................  K..............  ...............  Cytomegalovirus imm IV /vial.         0903  ...........      $683.02  ...........      $136.60
J0878.................  G..............  ...............  Daptomycin injection.........         9124  ...........         $.30  ...........         $.06
J0880.................  E..............  ...............  Darbepoetin alfa injection...  ...........  ...........  ...........  ...........  ...........
J0895.................  K..............  ...............  Deferoxamine mesylate inj....         0895  ...........       $14.91  ...........        $2.98
J0900.................  N..............  ...............  Testosterone enanthate inj...  ...........  ...........  ...........  ...........  ...........
J0945.................  N..............  ...............  Brompheniramine maleate inj..  ...........  ...........  ...........  ...........  ...........
J0970.................  N..............  ...............  Estradiol valerate injection.  ...........  ...........  ...........  ...........  ...........
J1000.................  N..............  ...............  Depo-estradiol cypionate inj.  ...........  ...........  ...........  ...........  ...........
J1020.................  N..............  ...............  Methylprednisolone 20 MG inj.  ...........  ...........  ...........  ...........  ...........
J1030.................  N..............  ...............  Methylprednisolone 40 MG inj.  ...........  ...........  ...........  ...........  ...........
J1040.................  N..............  ...............  Methylprednisolone 80 MG inj.  ...........  ...........  ...........  ...........  ...........
J1051.................  N..............  ...............  Medroxyprogesterone inj......  ...........  ...........  ...........  ...........  ...........
J1055.................  E..............  ...............  Medrxyprogester acetate inj..  ...........  ...........  ...........  ...........  ...........
J1056.................  E..............  ...............  MA/EC contraceptiveinjection.  ...........  ...........  ...........  ...........  ...........
J1060.................  N..............  ...............  Testosterone cypionate 1 ML..  ...........  ...........  ...........  ...........  ...........
J1070.................  N..............  ...............  Testosterone cypionat 100 MG.  ...........  ...........  ...........  ...........  ...........
J1080.................  N..............  ...............  Testosterone cypionat 200 MG.  ...........  ...........  ...........  ...........  ...........
J1094.................  N..............  ...............  Inj dexamethasone acetate....  ...........  ...........  ...........  ...........  ...........
J1100.................  N..............  ...............  Dexamethasone sodium phos....  ...........  ...........  ...........  ...........  ...........
J1110.................  K..............  ...............  Inj dihydroergotamine mesylt.         1210  ...........       $27.82  ...........        $5.56
J1120.................  N..............  ...............  Acetazolamid sodium injectio.  ...........  ...........  ...........  ...........  ...........
J1160.................  N..............  ...............  Digoxin injection............  ...........  ...........  ...........  ...........  ...........
J1165.................  N..............  ...............  Phenytoin sodium injection...  ...........  ...........  ...........  ...........  ...........
J1170.................  N..............  ...............  Hydromorphone injection......  ...........  ...........  ...........  ...........  ...........
J1180.................  K..............  ...............  Dyphylline injection.........         9166  ...........        $7.74  ...........        $1.55
J1190.................  K..............  ...............  Dexrazoxane HCl injection....         0726  ...........      $216.38  ...........       $43.28
J1200.................  N..............  ...............  Diphenhydramine hcl injectio.  ...........  ...........  ...........  ...........  ...........
J1205.................  N..............  ...............  Chlorothiazide sodium inj....  ...........  ...........  ...........  ...........  ...........
J1212.................  N..............  ...............  Dimethyl sulfoxide 50% 50 ML.  ...........  ...........  ...........  ...........  ...........
J1230.................  N..............  ...............  Methadone injection..........  ...........  ...........  ...........  ...........  ...........
J1240.................  N..............  ...............  Dimenhydrinate injection.....  ...........  ...........  ...........  ...........  ...........
J1245.................  N..............  ...............  Dipyridamole injection.......  ...........  ...........  ...........  ...........  ...........
J1250.................  N..............  ...............  Inj dobutamine HCL/250 mg....  ...........  ...........  ...........  ...........  ...........
J1260.................  K..............  ...............  Dolasetron mesylate..........         0750  ...........        $6.55  ...........        $1.31
J1270.................  N..............  ...............  Injection, doxercalciferol...  ...........  ...........  ...........  ...........  ...........
J1320.................  N..............  ...............  Amitriptyline injection......  ...........  ...........  ...........  ...........  ...........
J1325.................  N..............  ...............  Epoprostenol injection.......  ...........  ...........  ...........  ...........  ...........
J1327.................  K..............  ...............  Eptifibatide injection.......         1607  ...........       $12.73  ...........        $2.55
J1330.................  K..............  ...............  Ergonovine maleate injection.         1330       0.5262       $31.23  ...........        $6.25
J1335.................  N..............  ...............  Ertapenem injection..........  ...........  ...........  ...........  ...........  ...........
J1364.................  N..............  ...............  Erythro lactobionate /500 MG.  ...........  ...........  ...........  ...........  ...........
J1380.................  N..............  ...............  Estradiol valerate 10 MG inj.  ...........  ...........  ...........  ...........  ...........
J1390.................  N..............  ...............  Estradiol valerate 20 MG inj.  ...........  ...........  ...........  ...........  ...........
J1410.................  K..............  ...............  Inj estrogen conjugate 25 MG.         9038  ...........       $57.76  ...........       $11.55
J1435.................  N..............  ...............  Injection estrone per 1 MG...  ...........  ...........  ...........  ...........  ...........
J1436.................  K..............  ...............  Etidronate disodium inj......         1436  ...........       $68.69  ...........       $13.74
J1438.................  K..............  ...............  Etanercept injection.........         1608  ...........      $152.10  ...........       $30.42
J1440.................  K..............  ...............  Filgrastim 300 mcg injection.         0728  ...........      $178.38  ...........       $35.68
J1441.................  K..............  ...............  Filgrastim 480 mcg injection.         7049  ...........      $282.27  ...........       $56.45
J1450.................  N..............  ...............  Fluconazole..................  ...........  ...........  ...........  ...........  ...........
J1452.................  K..............  ...............  Intraocular Fomivirsen na....         9040  ...........      $203.91  ...........       $40.78

[[Page 42939]]

 
J1455.................  N..............  ...............  Foscarnet sodium injection...  ...........  ...........  ...........  ...........  ...........
J1457.................  K..............  ...............  Gallium nitrate injection....         1085  ...........        $1.30  ...........         $.26
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.................  E..............  ...............  IV immune globulin...........  ...........  ...........  ...........  ...........  ...........
J1564.................  E..............  ...............  Immune globulin 10 mg........  ...........  ...........  ...........  ...........  ...........
J1565.................  K..............  ...............  RSV-ivig.....................         0906  ...........       $15.56  ...........        $3.11
J1570.................  N..............  ...............  Ganciclovir sodium injection.  ...........  ...........  ...........  ...........  ...........
J1580.................  N..............  ...............  Garamycin gentamicin inj.....  ...........  ...........  ...........  ...........  ...........
J1590.................  N..............  ...............  Gatifloxacin injection.......  ...........  ...........  ...........  ...........  ...........
J1595.................  N..............  ...............  Injection glatiramer acetate.  ...........  ...........  ...........  ...........  ...........
J1600.................  N..............  ...............  Gold sodium thiomaleate inj..  ...........  ...........  ...........  ...........  ...........
J1610.................  K..............  ...............  Glucagon hydrochloride/1 MG..         9042  ...........       $62.16  ...........       $12.43
J1620.................  K..............  ...............  Gonadorelin hydroch/ 100 mcg.         7005  ...........      $173.42  ...........       $34.68
J1626.................  K..............  ...............  Granisetron HCl injection....         0764  ...........        $7.24  ...........        $1.45
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.................  K..............  ...............  Tinzaparin sodium injection..         1655  ...........        $2.53  ...........         $.51
J1670.................  K..............  ...............  Tetanus immune globulin inj..         1670  ...........       $76.89  ...........       $15.38
J1700.................  N..............  ...............  Hydrocortisone acetate inj...  ...........  ...........  ...........  ...........  ...........
J1710.................  N..............  ...............  Hydrocortisone sodium ph inj.  ...........  ...........  ...........  ...........  ...........
J1720.................  N..............  ...............  Hydrocortisone sodium succ i.  ...........  ...........  ...........  ...........  ...........
J1730.................  K..............  ...............  Diazoxide injection..........         1740  ...........      $113.85  ...........       $22.77
J1742.................  K..............  ...............  Ibutilide fumarate injection.         9044  ...........      $243.32  ...........       $48.66
J1745.................  K..............  ...............  Infliximab injection.........         7043  ...........       $54.19  ...........       $10.84
J1750.................  K..............  ...............  Iron dextran.................         9045  ...........       $11.43  ...........        $2.29
J1756.................  K..............  ...............  Iron sucrose injection.......         9046  ...........         $.38  ...........         $.08
J1785.................  K..............  ...............  Injection imiglucerase /unit.         0916  ...........        $3.98  ...........         $.80
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.................  E..............  ...............  Interferon beta-1a...........  ...........  ...........  ...........  ...........  ...........
J1830.................  K..............  ...............  Interferon beta-1b / .25 MG..         0910  ...........       $81.94  ...........       $16.39
J1835.................  K..............  ...............  Itraconazole injection.......         9047  ...........       $36.93  ...........        $7.39
J1840.................  N..............  ...............  Kanamycin sulfate 500 MG inj.  ...........  ...........  ...........  ...........  ...........
J1850.................  N..............  ...............  Kanamycin sulfate 75 MG inj..  ...........  ...........  ...........  ...........  ...........
J1885.................  N..............  ...............  Ketorolac tromethamine inj...  ...........  ...........  ...........  ...........  ...........
J1890.................  N..............  ...............  Cephalothin sodium injection.  ...........  ...........  ...........  ...........  ...........
J1931.................  K..............  ...............  Laronidase injection.........         9209  ...........       $23.16  ...........        $4.63
J1940.................  N..............  ...............  Furosemide injection.........  ...........  ...........  ...........  ...........  ...........
J1950.................  K..............  ...............  Leuprolide acetate /3.75 MG..         0800  ...........      $441.74  ...........       $88.35
J1955.................  B..............  ...............  Inj levocarnitine per 1 gm...  ...........  ...........  ...........  ...........  ...........
J1956.................  N..............  ...............  Levofloxacin injection.......  ...........  ...........  ...........  ...........  ...........
J1960.................  N..............  ...............  Levorphanol tartrate inj.....  ...........  ...........  ...........  ...........  ...........
J1980.................  N..............  ...............  Hyoscyamine sulfate inj......  ...........  ...........  ...........  ...........  ...........
J1990.................  N..............  ...............  Chlordiazepoxide injection...  ...........  ...........  ...........  ...........  ...........
J2001.................  N..............  ...............  Lidocaine injection..........  ...........  ...........  ...........  ...........  ...........
J2010.................  N..............  ...............  Lincomycin injection.........  ...........  ...........  ...........  ...........  ...........
J2020.................  K..............  ...............  Linezolid injection..........         9001  ...........       $24.15  ...........        $4.83
J2060.................  N..............  ...............  Lorazepam injection..........  ...........  ...........  ...........  ...........  ...........

[[Page 42940]]

 
J2150.................  N..............  ...............  Mannitol injection...........  ...........  ...........  ...........  ...........  ...........
J2175.................  N..............  ...............  Meperidine hydrochl /100 MG..  ...........  ...........  ...........  ...........  ...........
J2180.................  N..............  ...............  Meperidine/promethazine inj..  ...........  ...........  ...........  ...........  ...........
J2185.................  N..............  ...............  Meropenem....................  ...........  ...........  ...........  ...........  ...........
J2210.................  N..............  ...............  Methylergonovin maleate inj..  ...........  ...........  ...........  ...........  ...........
J2250.................  N..............  ...............  Inj midazolam hydrochloride..  ...........  ...........  ...........  ...........  ...........
J2260.................  N..............  ...............  Inj milrinone lactate / 5 MG.  ...........  ...........  ...........  ...........  ...........
J2270.................  N..............  ...............  Morphine sulfate injection...  ...........  ...........  ...........  ...........  ...........
J2271.................  N..............  ...............  Morphine so4 injection 100mg.  ...........  ...........  ...........  ...........  ...........
J2275.................  N..............  ...............  Morphine sulfate injection...  ...........  ...........  ...........  ...........  ...........
J2280.................  N..............  ...............  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.................  K..............  ...............  Nesiritide...................         9114  ...........       $75.18  ...........       $15.04
J2353.................  K..............  ...............  Octreotide injection, depot..         1207  ...........       $87.39  ...........       $17.48
J2354.................  N..............  ...............  Octreotide inj, non-depot....  ...........  ...........  ...........  ...........  ...........
J2355.................  K..............  ...............  Oprelvekin injection.........         7011  ...........      $249.04  ...........       $49.81
J2357.................  G..............  ...............  Omalizumab injection.........         9300  ...........       $15.98  ...........        $3.20
J2360.................  N..............  ...............  Orphenadrine injection.......  ...........  ...........  ...........  ...........  ...........
J2370.................  N..............  ...............  Phenylephrine hcl injection..  ...........  ...........  ...........  ...........  ...........
J2400.................  N..............  ...............  Chloroprocaine hcl injection.  ...........  ...........  ...........  ...........  ...........
J2405.................  K..............  ...............  Ondansetron hcl injection....         0768  ...........        $3.80  ...........         $.76
J2410.................  N..............  ...............  Oxymorphone hcl injection....  ...........  ...........  ...........  ...........  ...........
J2430.................  K..............  ...............  Pamidronate disodium /30 MG..         0730  ...........       $58.41  ...........       $11.68
J2440.................  N..............  ...............  Papaverin hcl injection......  ...........  ...........  ...........  ...........  ...........
J2460.................  N..............  ...............  Oxytetracycline injection....  ...........  ...........  ...........  ...........  ...........
J2469.................  K..............  ...............  Palonosetron HCl.............         9210  ...........       $18.42  ...........        $3.68
J2501.................  N..............  ...............  Paricalcitol.................  ...........  ...........  ...........  ...........  ...........
J2505.................  K..............  ...............  Injection, pegfilgrastim 6mg.         9119  ...........    $2,178.11  ...........      $435.62
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.................  K..............  ...............  Pralidoxime chloride inj.....         2730  ...........       $76.67  ...........       $15.33
J2760.................  N..............  ...............  Phentolaine mesylate inj.....  ...........  ...........  ...........  ...........  ...........
J2765.................  N..............  ...............  Metoclopramide hcl injection.  ...........  ...........  ...........  ...........  ...........
J2770.................  K..............  ...............  Quinupristin/dalfopristin....         2770  ...........      $105.48  ...........       $21.10
J2780.................  N..............  ...............  Ranitidine hydrochloride inj.  ...........  ...........  ...........  ...........  ...........
J2783.................  G..............  ...............  Rasburicase..................         0738  ...........      $109.17  ...........       $21.83
J2788.................  K..............  ...............  Rho d immune globulin 50 mcg.         9023  ...........       $25.08  ...........        $5.02
J2790.................  K..............  ...............  Rho d immune globulin inj....         0884  ...........      $113.90  ...........       $22.78
J2792.................  K..............  ...............  Rho(D) immune globulin h, sd.         1609  ...........       $12.04  ...........        $2.41
J2794.................  G..............  ...............  Risperidone, long acting.....         9125  ...........        $4.71  ...........         $.94
J2795.................  N..............  ...............  Ropivacaine HCl injection....  ...........  ...........  ...........  ...........  ...........
J2800.................  N..............  ...............  Methocarbamol injection......  ...........  ...........  ...........  ...........  ...........
J2810.................  N..............  ...............  Inj theophylline per 40 MG...  ...........  ...........  ...........  ...........  ...........
J2820.................  K..............  ...............  Sargramostim injection.......         0731  ...........       $21.11  ...........        $4.22
J2910.................  N..............  ...............  Aurothioglucose injeciton....  ...........  ...........  ...........  ...........  ...........
J2912.................  N..............  ...............  Sodium chloride injection....  ...........  ...........  ...........  ...........  ...........

[[Page 42941]]

 
J2916.................  N..............  ...............  Na ferric gluconate complex..  ...........  ...........  ...........  ...........  ...........
J2920.................  N..............  ...............  Methylprednisolone injection.  ...........  ...........  ...........  ...........  ...........
J2930.................  N..............  ...............  Methylprednisolone injection.  ...........  ...........  ...........  ...........  ...........
J2940.................  K..............  ...............  Somatrem injection...........         2940  ...........       $43.13  ...........        $8.63
J2941.................  K..............  ...............  Somatropin injection.........         7034  ...........       $42.93  ...........        $8.59
J2950.................  N..............  ...............  Promazine hcl injection......  ...........  ...........  ...........  ...........  ...........
J2993.................  K..............  ...............  Reteplase injection..........         9005  ...........      $898.74  ...........      $179.75
J2995.................  K..............  ...............  Inj streptokinase /250000 IU.         0911  ...........       $83.35  ...........       $16.67
J2997.................  K..............  ...............  Alteplase recombinant........         7048  ...........       $30.65  ...........        $6.13
J3000.................  N..............  ...............  Streptomycin injection.......  ...........  ...........  ...........  ...........  ...........
J3010.................  N..............  ...............  Fentanyl citrate injeciton...  ...........  ...........  ...........  ...........  ...........
J3030.................  K..............  ...............  Sumatriptan succinate / 6 MG.         3030  ...........       $51.03  ...........       $10.21
J3070.................  N..............  ...............  Pentazocine hcl injection....  ...........  ...........  ...........  ...........  ...........
J3100.................  K..............  ...............  Tenecteplase injection.......         9002  ...........    $2,052.60  ...........      $410.52
J3105.................  N..............  ...............  Terbutaline sulfate inj......  ...........  ...........  ...........  ...........  ...........
J3110.................  B..............  ...............  Teriparatide injection.......  ...........  ...........  ...........  ...........  ...........
J3120.................  N..............  ...............  Testosterone enanthate inj...  ...........  ...........  ...........  ...........  ...........
J3130.................  N..............  ...............  Testosterone enanthate inj...  ...........  ...........  ...........  ...........  ...........
J3140.................  N..............  ...............  Testosterone suspension inj..  ...........  ...........  ...........  ...........  ...........
J3150.................  N..............  ...............  Testosteron propionate inj...  ...........  ...........  ...........  ...........  ...........
J3230.................  N..............  ...............  Chlorpromazine hcl injection.  ...........  ...........  ...........  ...........  ...........
J3240.................  K..............  ...............  Thyrotropin injection........         9108  ...........      $712.52  ...........      $142.50
J3246.................  K..............  ...............  Tirofiban HCl................         7041  ...........        $7.89  ...........        $1.58
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 glucoronate.         7045  ...........      $139.84  ...........       $27.97
J3310.................  N..............  ...............  Perphenazine injeciton.......  ...........  ...........  ...........  ...........  ...........
J3315.................  K..............  ...............  Triptorelin pamoate..........         9122  ...........      $369.95  ...........       $73.99
J3320.................  N..............  ...............  Spectinomycn di-hcl inj......  ...........  ...........  ...........  ...........  ...........
J3350.................  K..............  ...............  Urea injection...............         9051       1.0453       $62.04  ...........       $12.41
J3360.................  N..............  ...............  Diazepam injection...........  ...........  ...........  ...........  ...........  ...........
J3364.................  N..............  ...............  Urokinase 5000 IU injection..  ...........  ...........  ...........  ...........  ...........
J3365.................  K..............  ...............  Urokinase 250,000 IU inj.....         7036  ...........      $415.66  ...........       $83.13
J3370.................  N..............  ...............  Vancomycin hcl injection.....  ...........  ...........  ...........  ...........  ...........
J3396.................  K..............  ...............  Verteporfin injection........         1203  ...........        $9.16  ...........        $1.83
J3400.................  N..............  ...............  Triflupromazine hcl inj......  ...........  ...........  ...........  ...........  ...........
J3410.................  N..............  ...............  Hydroxyzine hcl injection....  ...........  ...........  ...........  ...........  ...........
J3411.................  N..............  ...............  Thiamine hcl 100 mg..........  ...........  ...........  ...........  ...........  ...........
J3415.................  N..............  ...............  Pyridoxine hcl 100 mg........  ...........  ...........  ...........  ...........  ...........
J3420.................  N..............  ...............  Vitamin b12 injection........  ...........  ...........  ...........  ...........  ...........
J3430.................  N..............  ...............  Vitamin k phytonadione inj...  ...........  ...........  ...........  ...........  ...........
J3465.................  K..............  ...............  Injection, voriconazole......         1052  ...........        $4.63  ...........         $.93
J3470.................  N..............  ...............  Hyaluronidase injection......  ...........  ...........  ...........  ...........  ...........
J3475.................  N..............  ...............  Inj magnesium sulfate........  ...........  ...........  ...........  ...........  ...........
J3480.................  N..............  ...............  Inj potassium chloride.......  ...........  ...........  ...........  ...........  ...........
J3485.................  N..............  ...............  Zidovudine...................  ...........  ...........  ...........  ...........  ...........
J3486.................  N..............  ...............  Ziprasidone mesylate.........  ...........  ...........  ...........  ...........  ...........
J3487.................  K..............  ...............  Zoledronic acid..............         9115  ...........      $202.39  ...........       $40.48
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.................  ...........  ...........  ...........  ...........  ...........

[[Page 42942]]

 
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  ...........         $.51  ...........         $.10
J7191.................  K..............  ...............  Factor VIII (porcine)........         0926  ...........        $1.75  ...........         $.35
J7192.................  K..............  ...............  Factor viii recombinant......         0927  ...........         $.94  ...........         $.19
J7193.................  K..............  ...............  Factor IX non-recombinant....         0931  ...........         $.75  ...........         $.15
J7194.................  K..............  ...............  Factor ix complex............         0928  ...........         $.52  ...........         $.10
J7195.................  K..............  ...............  Factor IX recombinant........         0932  ...........         $.86  ...........         $.17
J7197.................  N..............  ...............  Antithrombin iii injection...  ...........  ...........  ...........  ...........  ...........
J7198.................  K..............  ...............  Anti-inhibitor...............         0929  ...........        $1.12  ...........         $.22
J7199.................  B..............  ...............  Hemophilia clot factor noc...  ...........  ...........  ...........  ...........  ...........
J7300.................  E..............  ...............  Intraut copper contraceptive.  ...........  ...........  ...........  ...........  ...........
J7302.................  E..............  ...............  Levonorgestrel iu contracept.  ...........  ...........  ...........  ...........  ...........
J7303.................  E..............  ...............  Contraceptive vaginal ring...  ...........  ...........  ...........  ...........  ...........
J7304.................  E..............  ...............  Contraceptive hormone patch..  ...........  ...........  ...........  ...........  ...........
J7308.................  K..............  ...............  Aminolevulinic acid hcl top..         7308  ...........       $96.79  ...........       $19.36
J7310.................  K..............  ...............  Ganciclovir long act implant.         0913  ...........    $4,318.33  ...........      $863.67
J7317.................  K..............  ...............  Sodium hyaluronate injection.         7316  ...........      $110.64  ...........       $22.13
J7320.................  K..............  ...............  Hylan G-F 20 injection.......         1611  ...........      $203.13  ...........       $40.63
J7330.................  B..............  ...............  Cultured chondrocytes implnt.  ...........  ...........  ...........  ...........  ...........
J7340.................  E..............  ...............  Metabolic active D/E tissue..  ...........  ...........  ...........  ...........  ...........
J7342.................  K..............  ...............  Metabolically active tissue..         9054  ...........       $15.69  ...........        $3.14
J7343.................  B..............  ...............  Nonmetabolic act d/e tissue..  ...........  ...........  ...........  ...........  ...........
J7344.................  K..............  ...............  Nonmetabolic active tissue...         9156  ...........       $53.75  ...........       $10.75
J7350.................  K..............  ...............  Injectable human tissue......         9055  ...........        $3.54  ...........         $.71
J7500.................  N..............  ...............  Azathioprine oral 50mg.......  ...........  ...........  ...........  ...........  ...........
J7501.................  K..............  ...............  Azathioprine parenteral......         0887  ...........       $47.39  ...........        $9.48
J7502.................  K..............  ...............  Cyclosporine oral 100 mg.....         0888  ...........        $3.94  ...........         $.79
J7504.................  K..............  ...............  Lymphocyte immune globulin...         0890  ...........      $290.28  ...........       $58.06
J7505.................  K..............  ...............  Monoclonal antibodies........         7038  ...........      $885.29  ...........      $177.06
J7506.................  N..............  ...............  Prednisone oral..............  ...........  ...........  ...........  ...........  ...........
J7507.................  K..............  ...............  Tacrolimus oral per 1 MG.....         0891  ...........        $3.37  ...........         $.67
J7509.................  N..............  ...............  Methylprednisolone oral......  ...........  ...........  ...........  ...........  ...........
J7510.................  N..............  ...............  Prednisolone oral per 5 mg...  ...........  ...........  ...........  ...........  ...........
J7511.................  K..............  ...............  Antithymocyte globuln rabbit.         9104  ...........      $299.45  ...........       $59.89
J7513.................  K..............  ...............  Daclizumab, parenteral.......         1612  ...........      $381.45  ...........       $76.29
J7515.................  K..............  ...............  Cyclosporine oral 25 mg......         7515  ...........        $1.00  ...........         $.20
J7516.................  N..............  ...............  Cyclosporin parenteral 250mg.  ...........  ...........  ...........  ...........  ...........
J7517.................  K..............  ...............  Mycophenolate mofetil oral...         9015  ...........        $2.50  ...........         $.50
J7518.................  G..............  ...............  Mycophenolic acid............         9219  ...........        $2.47  ...........         $.49
J7520.................  K..............  ...............  Sirolimus, oral..............         9020  ...........        $6.85  ...........        $1.37
J7525.................  K..............  ...............  Tacrolimus injection.........         9006  ...........      $126.61  ...........       $25.32
J7599.................  N..............  ...............  Immunosuppressive drug noc...  ...........  ...........  ...........  ...........  ...........
J7608.................  Y..............  ...............  Acetylcysteine inh sol u d...  ...........  ...........  ...........  ...........  ...........
J7611.................  Y..............  ...............  Albuterol concentrated form..  ...........  ...........  ...........  ...........  ...........
J7612.................  Y..............  ...............  Levalbuterol concentrated....  ...........  ...........  ...........  ...........  ...........
J7613.................  Y..............  ...............  Albuterol unit dose..........  ...........  ...........  ...........  ...........  ...........
J7614.................  Y..............  ...............  Levalbuterol unit dose.......  ...........  ...........  ...........  ...........  ...........
J7616.................  Y..............  ...............  Albuterol compound solution..  ...........  ...........  ...........  ...........  ...........
J7617.................  Y..............  ...............  Levalbuterol compounded sol..  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42943]]

 
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...  ...........  ...........  ...........  ...........  ...........
J7674.................  N..............  ...............  Methacholine chloride, neb...  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
J8501.................  G..............  ...............  Oral aprepitant..............         0868  ...........        $4.75  ...........         $.95
J8510.................  K..............  ...............  Oral busulfan................         7015  ...........        $1.98  ...........         $.40
J8520.................  K..............  ...............  Capecitabine, oral, 150 mg...         7042  ...........        $3.30  ...........         $.66
J8521.................  E..............  ...............  Capecitabine, oral, 500 mg...  ...........  ...........  ...........  ...........  ...........
J8530.................  N..............  ...............  Cyclophosphamide oral 25 MG..  ...........  ...........  ...........  ...........  ...........
J8560.................  K..............  ...............  Etoposide oral 50 MG.........         0802  ...........       $41.12  ...........        $8.22
J8565.................  E..............  ...............  Gefitinib oral...............  ...........  ...........  ...........  ...........  ...........
J8600.................  N..............  ...............  Melphalan oral 2 MG..........  ...........  ...........  ...........  ...........  ...........
J8610.................  N..............  ...............  Methotrexate oral 2.5 MG.....  ...........  ...........  ...........  ...........  ...........
J8700.................  K..............  ...............  Temozolomide.................         1086  ...........        $7.28  ...........        $1.46
J8999.................  B..............  ...............  Oral prescription drug chemo.  ...........  ...........  ...........  ...........  ...........
J9000.................  N..............  ...............  Doxorubic hcl 10 MG vl chemo.  ...........  ...........  ...........  ...........  ...........
J9001.................  K..............  ...............  Doxorubicin hcl liposome inj.         7046  ...........      $365.61  ...........       $73.12
J9010.................  K..............  ...............  Alemtuzumab injection........         9110  ...........      $516.83  ...........      $103.37
J9015.................  K..............  ...............  Aldesleukin/single use vial..         0807  ...........      $701.71  ...........      $140.34
J9017.................  K..............  ...............  Arsenic trioxide.............         9012  ...........       $33.76  ...........        $6.75
J9020.................  K..............  ...............  Asparaginase injection.......         0814  ...........       $55.41  ...........       $11.08
J9031.................  K..............  ...............  Bcg live intravesical vac....         0809  ...........      $121.74  ...........       $24.35
J9035.................  G..............  ...............  Bevacizumab injection........         9214  ...........       $58.17  ...........       $11.63
J9040.................  K..............  ...............  Bleomycin sulfate injection..         0857  ...........       $54.17  ...........       $10.83
J9041.................  K..............  ...............  Bortezomib injection.........         9207  ...........       $28.90  ...........        $5.78
J9045.................  K..............  ...............  Carboplatin injection........         0811  ...........       $77.15  ...........       $15.43
J9050.................  K..............  ...............  Carmus bischl nitro inj......         0812  ...........      $141.27  ...........       $28.25
J9055.................  G..............  ...............  Cetuximab injection..........         9215  ...........       $50.58  ...........       $10.12
J9060.................  N..............  ...............  Cisplatin 10 MG injection....  ...........  ...........  ...........  ...........  ...........
J9062.................  B..............  ...............  Cisplatin 50 MG injection....  ...........  ...........  ...........  ...........  ...........
J9065.................  K..............  ...............  Inj cladribine per 1 MG......         0858  ...........       $39.37  ...........        $7.87
J9070.................  N..............  ...............  Cyclophosphamide 100 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.................  N..............  ...............  Cyclophosphamide lyophilized.  ...........  ...........  ...........  ...........  ...........
J9094.................  B..............  ...............  Cyclophosphamide lyophilized.  ...........  ...........  ...........  ...........  ...........
J9095.................  B..............  ...............  Cyclophosphamide lyophilized.  ...........  ...........  ...........  ...........  ...........
J9096.................  B..............  ...............  Cyclophosphamide lyophilized.  ...........  ...........  ...........  ...........  ...........
J9097.................  B..............  ...............  Cyclophosphamide lyophilized.  ...........  ...........  ...........  ...........  ...........
J9098.................  K..............  ...............  Cytarabine liposome..........         1166  ...........      $366.40  ...........       $73.28
J9100.................  N..............  ...............  Cytarabine hcl 100 MG inj....  ...........  ...........  ...........  ...........  ...........
J9110.................  B..............  ...............  Cytarabine hcl 500 MG inj....  ...........  ...........  ...........  ...........  ...........
J9120.................  N..............  ...............  Dactinomycin actinomycin d...  ...........  ...........  ...........  ...........  ...........
J9130.................  K..............  ...............  Dacarbazine 100 mg inj.......         0819  ...........        $6.20  ...........        $1.24
J9140.................  B..............  ...............  Dacarbazine 200 MG inj.......  ...........  ...........  ...........  ...........  ...........
J9150.................  K..............  ...............  Daunorubicin.................         0820  ...........       $35.28  ...........        $7.06
J9151.................  K..............  ...............  Daunorubicin citrate liposom.         0821  ...........       $57.55  ...........       $11.51
J9160.................  K..............  ...............  Denileukin diftitox, 300 mcg.         1084  ...........    $1,235.23  ...........      $247.05
J9165.................  N..............  ...............  Diethylstilbestrol injection.  ...........  ...........  ...........  ...........  ...........
J9170.................  K..............  ...............  Docetaxel....................         0823  ...........      $301.15  ...........       $60.23
J9178.................  K..............  ...............  Inj, epirubicin hcl, 2 mg....         1167  ...........       $25.15  ...........        $5.03

[[Page 42944]]

 
J9181.................  N..............  ...............  Etoposide 10 MG inj..........  ...........  ...........  ...........  ...........  ...........
J9182.................  B..............  ...............  Etoposide 100 MG inj.........  ...........  ...........  ...........  ...........  ...........
J9185.................  K..............  ...............  Fludarabine phosphate inj....         0842  ...........      $262.39  ...........       $52.48
J9190.................  N..............  ...............  Fluorouracil injection.......  ...........  ...........  ...........  ...........  ...........
J9200.................  K..............  ...............  Floxuridine injection........         0827  ...........       $60.16  ...........       $12.03
J9201.................  K..............  ...............  Gemcitabine HCl..............         0828  ...........      $117.44  ...........       $23.49
J9202.................  K..............  ...............  Goserelin acetate implant....         0810  ...........      $196.24  ...........       $39.25
J9206.................  K..............  ...............  Irinotecan injection.........         0830  ...........      $129.07  ...........       $25.81
J9208.................  K..............  ...............  Ifosfomide injection.........         0831  ...........       $53.53  ...........       $10.71
J9209.................  K..............  ...............  Mesna injection..............         0732  ...........       $13.68  ...........        $2.74
J9211.................  K..............  ...............  Idarubicin hcl injection.....         0832  ...........      $313.97  ...........       $62.79
J9212.................  K..............  ...............  Interferon alfacon-1.........         0912  ...........        $3.91  ...........         $.78
J9213.................  K..............  ...............  Interferon alfa-2a inj.......         0834  ...........       $31.75  ...........        $6.35
J9214.................  K..............  ...............  Interferon alfa-2b inj.......         0836  ...........       $13.22  ...........        $2.64
J9215.................  K..............  ...............  Interferon alfa-n3 inj.......         0865  ...........        $8.77  ...........        $1.75
J9216.................  K..............  ...............  Interferon gamma 1-b inj.....         0838  ...........      $277.77  ...........       $55.55
J9217.................  K..............  ...............  Leuprolide acetate suspnsion.         9217  ...........      $230.85  ...........       $46.17
J9218.................  K..............  ...............  Leuprolide acetate injeciton.         0861  ...........       $10.96  ...........        $2.19
J9219.................  K..............  ...............  Leuprolide acetate implant...         7051  ...........    $2,262.01  ...........      $452.40
J9230.................  N..............  ...............  Mechlorethamine hcl inj......  ...........  ...........  ...........  ...........  ...........
J9245.................  K..............  ...............  Inj melphalan hydrochl 50 MG.         0840  ...........      $523.18  ...........      $104.64
J9250.................  N..............  ...............  Methotrexate sodium inj......  ...........  ...........  ...........  ...........  ...........
J9260.................  B..............  ...............  Methotrexate sodium inj......  ...........  ...........  ...........  ...........  ...........
J9263.................  B..............  ...............  Oxaliplatin..................  ...........  ...........  ...........  ...........  ...........
J9265.................  K..............  ...............  Paclitaxel injection.........         0863  ...........       $19.11  ...........        $3.82
J9266.................  K..............  ...............  Pegaspargase/singl dose vial.         0843  ...........    $1,528.67  ...........      $305.73
J9268.................  K..............  ...............  Pentostatin injection........         0844  ...........    $1,868.76  ...........      $373.75
J9270.................  K..............  ...............  Plicamycin (mithramycin) inj.         0860  ...........       $80.54  ...........       $16.11
J9280.................  K..............  ...............  Mitomycin 5 MG inj...........         0862  ...........       $26.36  ...........        $5.27
J9290.................  B..............  ...............  Mitomycin 20 MG inj..........  ...........  ...........  ...........  ...........  ...........
J9291.................  B..............  ...............  Mitomycin 40 MG inj..........  ...........  ...........  ...........  ...........  ...........
J9293.................  K..............  ...............  Mitoxantrone hydrochl / 5 MG.         0864  ...........      $329.66  ...........       $65.93
J9300.................  K..............  ...............  Gemtuzumab ozogamicin........         9004  ...........    $2,244.86  ...........      $448.97
J9305.................  G..............  ...............  Pemetrexed injection.........         9213  ...........       $41.29  ...........        $8.26
J9310.................  K..............  ...............  Rituximab cancer treatment...         0849  ...........      $447.93  ...........       $89.59
J9320.................  K..............  ...............  Streptozocin injection.......         0850  ...........      $153.31  ...........       $30.66
J9340.................  K..............  ...............  Thiotepa injection...........         0851  ...........       $44.55  ...........        $8.91
J9350.................  K..............  ...............  Topotecan....................         0852  ...........      $755.44  ...........      $151.09
J9355.................  K..............  ...............  Trastuzumab..................         1613  ...........       $53.97  ...........       $10.79
J9357.................  K..............  ...............  Valrubicin, 200 mg...........         9167  ...........      $376.83  ...........       $75.37
J9360.................  N..............  ...............  Vinblastine sulfate inj......  ...........  ...........  ...........  ...........  ...........
J9370.................  N..............  ...............  Vincristine sulfate 1 MG inj.  ...........  ...........  ...........  ...........  ...........
J9375.................  B..............  ...............  Vincristine sulfate 2 MG inj.  ...........  ...........  ...........  ...........  ...........
J9380.................  B..............  ...............  Vincristine sulfate 5 MG inj.  ...........  ...........  ...........  ...........  ...........
J9390.................  K..............  ...............  Vinorelbine tartrate/10 mg...         0855  ...........       $62.84  ...........       $12.57
J9395.................  K..............  ...............  Injection, Fulvestrant.......         9120  ...........       $82.90  ...........       $16.58
J9600.................  K..............  ...............  Porfimer sodium..............         0856  ...........    $2,457.78  ...........      $491.56
J9999.................  N..............  ...............  Chemotherapy drug............  ...........  ...........  ...........  ...........  ...........
K0001.................  Y..............  ...............  Standard wheelchair..........  ...........  ...........  ...........  ...........  ...........
K0002.................  Y..............  ...............  Stnd hemi (low seat) whlchr..  ...........  ...........  ...........  ...........  ...........
K0003.................  Y..............  ...............  Lightweight wheelchair.......  ...........  ...........  ...........  ...........  ...........
K0004.................  Y..............  ...............  High strength ltwt whlchr....  ...........  ...........  ...........  ...........  ...........
K0005.................  Y..............  ...............  Ultralightweight wheelchair..  ...........  ...........  ...........  ...........  ...........
K0006.................  Y..............  ...............  Heavy duty wheelchair........  ...........  ...........  ...........  ...........  ...........
K0007.................  Y..............  ...............  Extra heavy duty wheelchair..  ...........  ...........  ...........  ...........  ...........
K0009.................  Y..............  ...............  Other manual wheelchair/base.  ...........  ...........  ...........  ...........  ...........
K0010.................  Y..............  ...............  Stnd wt frame power whlchr...  ...........  ...........  ...........  ...........  ...........
K0011.................  Y..............  ...............  Stnd wt pwr whlchr w control.  ...........  ...........  ...........  ...........  ...........
K0012.................  Y..............  ...............  Ltwt portbl power whlchr.....  ...........  ...........  ...........  ...........  ...........
K0014.................  Y..............  ...............  Other power whlchr base......  ...........  ...........  ...........  ...........  ...........
K0015.................  Y..............  ...............  Detach non-adjus hght armrst.  ...........  ...........  ...........  ...........  ...........
K0017.................  Y..............  ...............  Detach adjust armrest base...  ...........  ...........  ...........  ...........  ...........
K0018.................  Y..............  ...............  Detach adjust armrst upper...  ...........  ...........  ...........  ...........  ...........
K0019.................  Y..............  ...............  Arm pad each.................  ...........  ...........  ...........  ...........  ...........
K0020.................  Y..............  ...............  Fixed adjust armrest pair....  ...........  ...........  ...........  ...........  ...........
K0037.................  Y..............  ...............  High mount flip-up footrest..  ...........  ...........  ...........  ...........  ...........

[[Page 42945]]

 
K0038.................  Y..............  ...............  Leg strap each...............  ...........  ...........  ...........  ...........  ...........
K0039.................  Y..............  ...............  Leg strap h style each.......  ...........  ...........  ...........  ...........  ...........
K0040.................  Y..............  ...............  Adjustable angle footplate...  ...........  ...........  ...........  ...........  ...........
K0041.................  Y..............  ...............  Large size footplate each....  ...........  ...........  ...........  ...........  ...........
K0042.................  Y..............  ...............  Standard size footplate each.  ...........  ...........  ...........  ...........  ...........
K0043.................  Y..............  ...............  Ftrst lower extension tube...  ...........  ...........  ...........  ...........  ...........
K0044.................  Y..............  ...............  Ftrst upper hanger bracket...  ...........  ...........  ...........  ...........  ...........
K0045.................  Y..............  ...............  Footrest complete assembly...  ...........  ...........  ...........  ...........  ...........
K0046.................  Y..............  ...............  Elevat legrst low extension..  ...........  ...........  ...........  ...........  ...........
K0047.................  Y..............  ...............  Elevat legrst up hangr brack.  ...........  ...........  ...........  ...........  ...........
K0050.................  Y..............  ...............  Ratchet assembly.............  ...........  ...........  ...........  ...........  ...........
K0051.................  Y..............  ...............  Cam relese assem ftrst/lgrst.  ...........  ...........  ...........  ...........  ...........
K0052.................  Y..............  ...............  Swingaway detach footrest....  ...........  ...........  ...........  ...........  ...........
K0053.................  Y..............  ...............  Elevate footrest articulate..  ...........  ...........  ...........  ...........  ...........
K0056.................  Y..............  ...............  Seat ht >17 or <=21 ltwt wc..  ...........  ...........  ...........  ...........  ...........
K0064.................  Y..............  ...............  Zero pressure tube flat free.  ...........  ...........  ...........  ...........  ...........
K0065.................  Y..............  ...............  Spoke protectors.............  ...........  ...........  ...........  ...........  ...........
K0066.................  Y..............  ...............  Solid tire any size each.....  ...........  ...........  ...........  ...........  ...........
K0067.................  Y..............  ...............  Pneumatic tire any size each.  ...........  ...........  ...........  ...........  ...........
K0068.................  Y..............  ...............  Pneumatic tire tube each.....  ...........  ...........  ...........  ...........  ...........
K0069.................  Y..............  ...............  Rear whl complete solid tire.  ...........  ...........  ...........  ...........  ...........
K0070.................  Y..............  ...............  Rear whl compl pneum tire....  ...........  ...........  ...........  ...........  ...........
K0071.................  Y..............  ...............  Front castr compl pneum tire.  ...........  ...........  ...........  ...........  ...........
K0072.................  Y..............  ...............  Frnt cstr cmpl sem-pneum tir.  ...........  ...........  ...........  ...........  ...........
K0073.................  Y..............  ...............  Caster pin lock each.........  ...........  ...........  ...........  ...........  ...........
K0074.................  Y..............  ...............  Pneumatic caster tire each...  ...........  ...........  ...........  ...........  ...........
K0075.................  Y..............  ...............  Semi-pneumatic caster tire...  ...........  ...........  ...........  ...........  ...........
K0076.................  Y..............  ...............  Solid caster tire each.......  ...........  ...........  ...........  ...........  ...........
K0077.................  Y..............  ...............  Front caster assem complete..  ...........  ...........  ...........  ...........  ...........
K0078.................  Y..............  ...............  Pneumatic caster tire tube...  ...........  ...........  ...........  ...........  ...........
K0090.................  Y..............  ...............  Rear tire power wheelchair...  ...........  ...........  ...........  ...........  ...........
K0091.................  Y..............  ...............  Rear tire tube power whlchr..  ...........  ...........  ...........  ...........  ...........
K0092.................  Y..............  ...............  Rear assem cmplt powr whlchr.  ...........  ...........  ...........  ...........  ...........
K0093.................  Y..............  ...............  Rear zero pressure tire tube.  ...........  ...........  ...........  ...........  ...........
K0094.................  Y..............  ...............  Wheel tire for power base....  ...........  ...........  ...........  ...........  ...........
K0095.................  Y..............  ...............  Wheel tire tube each base....  ...........  ...........  ...........  ...........  ...........
K0096.................  Y..............  ...............  Wheel assem powr base complt.  ...........  ...........  ...........  ...........  ...........
K0097.................  Y..............  ...............  Wheel zero presure tire tube.  ...........  ...........  ...........  ...........  ...........
K0098.................  Y..............  ...............  Drive belt power wheelchair..  ...........  ...........  ...........  ...........  ...........
K0099.................  Y..............  ...............  Pwr wheelchair front caster..  ...........  ...........  ...........  ...........  ...........
K0102.................  Y..............  ...............  Crutch and cane holder.......  ...........  ...........  ...........  ...........  ...........
K0104.................  Y..............  ...............  Cylinder tank carrier........  ...........  ...........  ...........  ...........  ...........
K0105.................  Y..............  ...............  Iv hanger....................  ...........  ...........  ...........  ...........  ...........
K0106.................  Y..............  ...............  Arm trough each..............  ...........  ...........  ...........  ...........  ...........
K0108.................  Y..............  ...............  W/c component-accessory NOS..  ...........  ...........  ...........  ...........  ...........
K0195.................  Y..............  ...............  Elevating whlchair leg rests.  ...........  ...........  ...........  ...........  ...........
K0415.................  B..............  ...............  RX antiemetic drg, oral NOS..  ...........  ...........  ...........  ...........  ...........
K0416.................  B..............  ...............  Rx antiemetic drg,rectal NOS.  ...........  ...........  ...........  ...........  ...........
K0452.................  Y..............  ...............  Wheelchair bearings..........  ...........  ...........  ...........  ...........  ...........
K0455.................  Y..............  ...............  Pump uninterrupted infusion..  ...........  ...........  ...........  ...........  ...........
K0462.................  Y..............  ...............  Temporary replacement eqpmnt.  ...........  ...........  ...........  ...........  ...........
K0552.................  Y..............  ...............  Supply/Ext inf pump syr type.  ...........  ...........  ...........  ...........  ...........
K0600.................  Y..............  ...............  Functional neuromuscularstim.  ...........  ...........  ...........  ...........  ...........
K0601.................  Y..............  ...............  Repl batt silver oxide 1.5 v.  ...........  ...........  ...........  ...........  ...........
K0602.................  Y..............  ...............  Repl batt silver oxide 3 v...  ...........  ...........  ...........  ...........  ...........
K0603.................  Y..............  ...............  Repl batt alkaline 1.5 v.....  ...........  ...........  ...........  ...........  ...........
K0604.................  Y..............  ...............  Repl batt lithium 3.6 v......  ...........  ...........  ...........  ...........  ...........
K0605.................  Y..............  ...............  Repl batt lithium 4.5 v......  ...........  ...........  ...........  ...........  ...........
K0606.................  Y..............  ...............  AED garment w/elec analysis..  ...........  ...........  ...........  ...........  ...........
K0607.................  Y..............  ...............  Repl batt for AED............  ...........  ...........  ...........  ...........  ...........
K0608.................  Y..............  ...............  Repl garment for AED.........  ...........  ...........  ...........  ...........  ...........
K0609.................  Y..............  ...............  Repl electrode for AED.......  ...........  ...........  ...........  ...........  ...........
K0618.................  A..............  ...............  TLSO 2 piece rigid shell.....  ...........  ...........  ...........  ...........  ...........
K0619.................  A..............  ...............  TLSO 3 piece rigid shell.....  ...........  ...........  ...........  ...........  ...........
K0620.................  A..............  ...............  Tubular elastic dressing.....  ...........  ...........  ...........  ...........  ...........
K0628.................  Y..............  ...............  Mult dens insert direct form.  ...........  ...........  ...........  ...........  ...........

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K0629.................  Y..............  ...............  Mult dens insert custom mold.  ...........  ...........  ...........  ...........  ...........
K0630.................  Y..............  ...............  SIO flex pelvisacral prefab..  ...........  ...........  ...........  ...........  ...........
K0631.................  Y..............  ...............  SIO flex pelvisacral custom..  ...........  ...........  ...........  ...........  ...........
K0632.................  Y..............  ...............  SIO panel prefab.............  ...........  ...........  ...........  ...........  ...........
K0633.................  Y..............  ...............  SIO panel custom.............  ...........  ...........  ...........  ...........  ...........
K0634.................  Y..............  ...............  LO flexibl L1 - below L5 pre.  ...........  ...........  ...........  ...........  ...........
K0635.................  Y..............  ...............  LO sag stays/panels pre-fab..  ...........  ...........  ...........  ...........  ...........
K0636.................  Y..............  ...............  LO sagitt rigid panel prefab.  ...........  ...........  ...........  ...........  ...........
K0637.................  Y..............  ...............  LO flex w/o rigid stays pre..  ...........  ...........  ...........  ...........  ...........
K0638.................  Y..............  ...............  LSO flex w/rigid stays cust..  ...........  ...........  ...........  ...........  ...........
K0639.................  Y..............  ...............  LSO post rigid panel pre.....  ...........  ...........  ...........  ...........  ...........
K0640.................  Y..............  ...............  LSO sag-coro rigid frame pre.  ...........  ...........  ...........  ...........  ...........
K0641.................  Y..............  ...............  LSO sag-cor rigid frame cust.  ...........  ...........  ...........  ...........  ...........
K0642.................  Y..............  ...............  LSO flexion control prefab...  ...........  ...........  ...........  ...........  ...........
K0643.................  Y..............  ...............  LSO flexion control custom...  ...........  ...........  ...........  ...........  ...........
K0644.................  Y..............  ...............  LSO sagit rigid panel prefab.  ...........  ...........  ...........  ...........  ...........
K0645.................  Y..............  ...............  LSO sagittal rigid panel cus.  ...........  ...........  ...........  ...........  ...........
K0646.................  Y..............  ...............  LSO sag-coronal panel prefab.  ...........  ...........  ...........  ...........  ...........
K0647.................  Y..............  ...............  LSO sag-coronal panel custom.  ...........  ...........  ...........  ...........  ...........
K0648.................  Y..............  ...............  LSO s/c shell/panel prefab...  ...........  ...........  ...........  ...........  ...........
K0649.................  Y..............  ...............  LSO s/c shell/panel custom...  ...........  ...........  ...........  ...........  ...........
K0669.................  Y..............  ...............  W/c seat/back no CVR SADMERC.  ...........  ...........  ...........  ...........  ...........
K0670.................  A..............  ...............  Stance phase only............  ...........  ...........  ...........  ...........  ...........
K0671.................  Y..............  ...............  Portable oxygen concentrator.  ...........  ...........  ...........  ...........  ...........
L0100.................  A..............  ...............  Cranial orthosis/helmet mold.  ...........  ...........  ...........  ...........  ...........
L0110.................  A..............  ...............  Cranial orthosis/helmet nonm.  ...........  ...........  ...........  ...........  ...........
L0112.................  A..............  ...............  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.  ...........  ...........  ...........  ...........  ...........
L0430.................  A..............  ...............  Dewall posture protector.....  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
L0480.................  A..............  ...............  TLSO rigid plastic custom fa.  ...........  ...........  ...........  ...........  ...........
L0482.................  A..............  ...............  TLSO rigid lined custom fab..  ...........  ...........  ...........  ...........  ...........
L0484.................  A..............  ...............  TLSO rigid plastic cust fab..  ...........  ...........  ...........  ...........  ...........
L0486.................  A..............  ...............  TLSO rigidlined cust fab two.  ...........  ...........  ...........  ...........  ...........
L0488.................  A..............  ...............  TLSO rigid lined pre one pie.  ...........  ...........  ...........  ...........  ...........
L0490.................  A..............  ...............  TLSO rigid plastic pre one...  ...........  ...........  ...........  ...........  ...........
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..............  ...............  Halo repl liner/interface....  ...........  ...........  ...........  ...........  ...........

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L0960.................  E..............  ...............  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.....  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

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L1831.................  A..............  ...............  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.  ...........  ...........  ...........  ...........  ...........
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..............  ...............  AFO supramalleolar custom....  ...........  ...........  ...........  ...........  ...........
L1910.................  A..............  ...............  Afo sing bar clasp attach sh.  ...........  ...........  ...........  ...........  ...........
L1920.................  A..............  ...............  Afo sing upright w/ adjust s.  ...........  ...........  ...........  ...........  ...........
L1930.................  A..............  ...............  Afo plastic..................  ...........  ...........  ...........  ...........  ...........
L1932.................  A..............  ...............  Afo rig ant tib prefab TCF/=.  ...........  ...........  ...........  ...........  ...........
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..............  ...............  AFO spiral prefabricated.....  ...........  ...........  ...........  ...........  ...........
L1960.................  A..............  ...............  Afo pos solid ank plastic mo.  ...........  ...........  ...........  ...........  ...........
L1970.................  A..............  ...............  Afo plastic molded w/ankle j.  ...........  ...........  ...........  ...........  ...........
L1971.................  A..............  ...............  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.  ...........  ...........  ...........  ...........  ...........
L2005.................  A..............  ...............  KAFO sng/dbl mechanical act..  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
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....  ...........  ...........  ...........  ...........  ...........
L2126.................  A..............  ...............  Kafo fem fx cast thermoplas..  ...........  ...........  ...........  ...........  ...........
L2128.................  A..............  ...............  Kafo fem fx cast molded to p.  ...........  ...........  ...........  ...........  ...........
L2132.................  A..............  ...............  Kafo femoral fx cast soft....  ...........  ...........  ...........  ...........  ...........
L2134.................  A..............  ...............  Kafo fem fx cast semi-rigid..  ...........  ...........  ...........  ...........  ...........
L2136.................  A..............  ...............  Kafo femoral fx cast rigid...  ...........  ...........  ...........  ...........  ...........
L2180.................  A..............  ...............  Plas shoe insert w ank joint.  ...........  ...........  ...........  ...........  ...........
L2182.................  A..............  ...............  Drop lock knee...............  ...........  ...........  ...........  ...........  ...........
L2184.................  A..............  ...............  Limited motion knee joint....  ...........  ...........  ...........  ...........  ...........
L2186.................  A..............  ...............  Adj motion knee jnt lerman t.  ...........  ...........  ...........  ...........  ...........
L2188.................  A..............  ...............  Quadrilateral brim...........  ...........  ...........  ...........  ...........  ...........

[[Page 42949]]

 
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.  ...........  ...........  ...........  ...........  ...........
L2232.................  A..............  ...............  Rocker bottom, contact AFO...  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
L2492.................  A..............  ...............  Knee lift loop drop lock rin.  ...........  ...........  ...........  ...........  ...........
L2500.................  A..............  ...............  Thi/glut/ischia wgt bearing..  ...........  ...........  ...........  ...........  ...........
L2510.................  A..............  ...............  Th/wght bear quad-lat brim m.  ...........  ...........  ...........  ...........  ...........
L2520.................  A..............  ...............  Th/wght bear quad-lat brim c.  ...........  ...........  ...........  ...........  ...........
L2525.................  A..............  ...............  Th/wght bear nar m-l brim mo.  ...........  ...........  ...........  ...........  ...........
L2526.................  A..............  ...............  Th/wght bear nar m-l brim cu.  ...........  ...........  ...........  ...........  ...........
L2530.................  A..............  ...............  Thigh/wght bear lacer non-mo.  ...........  ...........  ...........  ...........  ...........
L2540.................  A..............  ...............  Thigh/wght bear lacer molded.  ...........  ...........  ...........  ...........  ...........
L2550.................  A..............  ...............  Thigh/wght bear high roll cu.  ...........  ...........  ...........  ...........  ...........
L2570.................  A..............  ...............  Hip clevis type 2 posit jnt..  ...........  ...........  ...........  ...........  ...........
L2580.................  A..............  ...............  Pelvic control pelvic sling..  ...........  ...........  ...........  ...........  ...........
L2600.................  A..............  ...............  Hip clevis/thrust bearing fr.  ...........  ...........  ...........  ...........  ...........
L2610.................  A..............  ...............  Hip clevis/thrust bearing lo.  ...........  ...........  ...........  ...........  ...........
L2620.................  A..............  ...............  Pelvic control hip heavy dut.  ...........  ...........  ...........  ...........  ...........
L2622.................  A..............  ...............  Hip joint adjustable flexion.  ...........  ...........  ...........  ...........  ...........
L2624.................  A..............  ...............  Hip adj flex ext abduct cont.  ...........  ...........  ...........  ...........  ...........
L2627.................  A..............  ...............  Plastic mold recipro hip & c.  ...........  ...........  ...........  ...........  ...........
L2628.................  A..............  ...............  Metal frame recipro hip & ca.  ...........  ...........  ...........  ...........  ...........
L2630.................  A..............  ...............  Pelvic control band & belt u.  ...........  ...........  ...........  ...........  ...........
L2640.................  A..............  ...............  Pelvic control band & belt b.  ...........  ...........  ...........  ...........  ...........
L2650.................  A..............  ...............  Pelv & thor control gluteal..  ...........  ...........  ...........  ...........  ...........
L2660.................  A..............  ...............  Thoracic control thoracic ba.  ...........  ...........  ...........  ...........  ...........
L2670.................  A..............  ...............  Thorac cont paraspinal uprig.  ...........  ...........  ...........  ...........  ...........
L2680.................  A..............  ...............  Thorac cont lat support upri.  ...........  ...........  ...........  ...........  ...........
L2750.................  A..............  ...............  Plating chrome/nickel pr bar.  ...........  ...........  ...........  ...........  ...........
L2755.................  A..............  ...............  Carbon graphite lamination...  ...........  ...........  ...........  ...........  ...........
L2760.................  A..............  ...............  Extension per extension per..  ...........  ...........  ...........  ...........  ...........
L2768.................  A..............  ...............  Ortho sidebar disconnect.....  ...........  ...........  ...........  ...........  ...........
L2770.................  A..............  ...............  Low ext orthosis per bar/jnt.  ...........  ...........  ...........  ...........  ...........
L2780.................  A..............  ...............  Non-corrosive finish.........  ...........  ...........  ...........  ...........  ...........
L2785.................  A..............  ...............  Drop lock retainer each......  ...........  ...........  ...........  ...........  ...........
L2795.................  A..............  ...............  Knee control full kneecap....  ...........  ...........  ...........  ...........  ...........
L2800.................  A..............  ...............  Knee cap medial or lateral p.  ...........  ...........  ...........  ...........  ...........

[[Page 42950]]

 
L2810.................  A..............  ...............  Knee control condylar pad....  ...........  ...........  ...........  ...........  ...........
L2820.................  A..............  ...............  Soft interface below knee se.  ...........  ...........  ...........  ...........  ...........
L2830.................  A..............  ...............  Soft interface above knee se.  ...........  ...........  ...........  ...........  ...........
L2840.................  A..............  ...............  Tibial length sock fx or equ.  ...........  ...........  ...........  ...........  ...........
L2850.................  A..............  ...............  Femoral lgth sock fx or equa.  ...........  ...........  ...........  ...........  ...........
L2860.................  A..............  ...............  Torsion mechanism knee/ankle.  ...........  ...........  ...........  ...........  ...........
L2999.................  A..............  ...............  Lower extremity orthosis NOS.  ...........  ...........  ...........  ...........  ...........
L3000.................  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..............  ...............  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..............  ...............  Womans shoe oxford brace.....  ...........  ...........  ...........  ...........  ...........
L3225.................  A..............  ...............  Mans 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.................  B..............  ...............  Shoe heel wedge..............  ...........  ...........  ...........  ...........  ...........
L3360.................  B..............  ...............  Shoe sole wedge outside sole.  ...........  ...........  ...........  ...........  ...........
L3370.................  B..............  ...............  Shoe sole wedge between sole.  ...........  ...........  ...........  ...........  ...........

[[Page 42951]]

 
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.  ...........  ...........  ...........  ...........  ...........
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.................  E..............  ...............  Whfo ext power compress gas..  ...........  ...........  ...........  ...........  ...........
L3904.................  A..............  ...............  Whfo electric custom fitted..  ...........  ...........  ...........  ...........  ...........
L3906.................  A..............  ...............  Wrist gauntlet molded to pt..  ...........  ...........  ...........  ...........  ...........

[[Page 42952]]

 
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..............  ...............  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.................  ...........  ...........  ...........  ...........  ...........
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.................  Y..............  ...............  Seo mobile arm sup att to wc.  ...........  ...........  ...........  ...........  ...........
L3965.................  Y..............  ...............  Arm supp att to wc rancho ty.  ...........  ...........  ...........  ...........  ...........
L3966.................  Y..............  ...............  Mobile arm supports reclinin.  ...........  ...........  ...........  ...........  ...........
L3968.................  Y..............  ...............  Friction dampening arm supp..  ...........  ...........  ...........  ...........  ...........
L3969.................  Y..............  ...............  Monosuspension arm/hand supp.  ...........  ...........  ...........  ...........  ...........
L3970.................  Y..............  ...............  Elevat proximal arm support..  ...........  ...........  ...........  ...........  ...........
L3972.................  Y..............  ...............  Offset/lat rocker arm w/ ela.  ...........  ...........  ...........  ...........  ...........
L3974.................  Y..............  ...............  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...  ...........  ...........  ...........  ...........  ...........
L4002.................  A..............  ...............  Replace strap, any orthosis..  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42953]]

 
L4350.................  A..............  ...............  Ankle control orthosi prefab.  ...........  ...........  ...........  ...........  ...........
L4360.................  A..............  ...............  Pneumati walking boot prefab.  ...........  ...........  ...........  ...........  ...........
L4370.................  A..............  ...............  Pneumatic full leg splint....  ...........  ...........  ...........  ...........  ...........
L4380.................  A..............  ...............  Pneumatic knee splint........  ...........  ...........  ...........  ...........  ...........
L4386.................  A..............  ...............  Non-pneum walk boot prefab...  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42954]]

 
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 cushion socket....  ...........  ...........  ...........  ...........  ...........
L5647.................  A..............  ...............  Below knee suction socket....  ...........  ...........  ...........  ...........  ...........
L5648.................  A..............  ...............  Above knee cushion socket....  ...........  ...........  ...........  ...........  ...........
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..............  ...............  Socket insert w lock mech....  ...........  ...........  ...........  ...........  ...........
L5676.................  A..............  ...............  Bk knee joints single axis p.  ...........  ...........  ...........  ...........  ...........
L5677.................  A..............  ...............  Bk knee joints polycentric p.  ...........  ...........  ...........  ...........  ...........
L5678.................  A..............  ...............  Bk joint covers pair.........  ...........  ...........  ...........  ...........  ...........
L5679.................  A..............  ...............  Socket insert w/o lock mech..  ...........  ...........  ...........  ...........  ...........
L5680.................  A..............  ...............  Bk thigh lacer non-molded....  ...........  ...........  ...........  ...........  ...........
L5681.................  A..............  ...............  Intl custm cong/latyp insert.  ...........  ...........  ...........  ...........  ...........
L5682.................  A..............  ...............  Bk thigh lacer glut/ischia m.  ...........  ...........  ...........  ...........  ...........
L5683.................  A..............  ...............  Initial custom socket insert.  ...........  ...........  ...........  ...........  ...........
L5684.................  A..............  ...............  Bk fork strap................  ...........  ...........  ...........  ...........  ...........
L5685.................  A..............  ...............  Below knee sus/seal sleeve...  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42955]]

 
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.  ...........  ...........  ...........  ...........  ...........
L5848.................  A..............  ...............  Knee-shin sys hydraul stance.  ...........  ...........  ...........  ...........  ...........
L5850.................  A..............  ...............  Endo ak/hip knee extens assi.  ...........  ...........  ...........  ...........  ...........
L5855.................  A..............  ...............  Mech hip extension assist....  ...........  ...........  ...........  ...........  ...........
L5856.................  A..............  ...............  Elec knee-shin swing/stance..  ...........  ...........  ...........  ...........  ...........
L5857.................  A..............  ...............  Elec knee-shin swing only....  ...........  ...........  ...........  ...........  ...........
L5910.................  A..............  ...............  Endo below knee alignable sy.  ...........  ...........  ...........  ...........  ...........
L5920.................  A..............  ...............  Endo ak/hip alignable system.  ...........  ...........  ...........  ...........  ...........
L5925.................  A..............  ...............  Above knee manual lock.......  ...........  ...........  ...........  ...........  ...........
L5930.................  A..............  ...............  High activity knee frame.....  ...........  ...........  ...........  ...........  ...........
L5940.................  A..............  ...............  Endo bk ultra-light material.  ...........  ...........  ...........  ...........  ...........
L5950.................  A..............  ...............  Endo ak ultra-light material.  ...........  ...........  ...........  ...........  ...........
L5960.................  A..............  ...............  Endo hip ultra-light materia.  ...........  ...........  ...........  ...........  ...........
L5962.................  A..............  ...............  Below knee flex cover system.  ...........  ...........  ...........  ...........  ...........
L5964.................  A..............  ...............  Above knee flex cover system.  ...........  ...........  ...........  ...........  ...........
L5966.................  A..............  ...............  Hip flexible cover system....  ...........  ...........  ...........  ...........  ...........
L5968.................  A..............  ...............  Multiaxial ankle w dorsiflex.  ...........  ...........  ...........  ...........  ...........
L5970.................  A..............  ...............  Foot external keel sach foot.  ...........  ...........  ...........  ...........  ...........
L5972.................  A..............  ...............  Flexible keel foot...........  ...........  ...........  ...........  ...........  ...........
L5974.................  A..............  ...............  Foot single axis ankle/foot..  ...........  ...........  ...........  ...........  ...........
L5975.................  A..............  ...............  Combo ankle/foot prosthesis..  ...........  ...........  ...........  ...........  ...........
L5976.................  A..............  ...............  Energy storing foot..........  ...........  ...........  ...........  ...........  ...........
L5978.................  A..............  ...............  Ft prosth multiaxial ankl/ft.  ...........  ...........  ...........  ...........  ...........
L5979.................  A..............  ...............  Multi-axial ankle/ft prosth..  ...........  ...........  ...........  ...........  ...........
L5980.................  A..............  ...............  Flex foot system.............  ...........  ...........  ...........  ...........  ...........
L5981.................  A..............  ...............  Flex-walk sys low ext prosth.  ...........  ...........  ...........  ...........  ...........
L5982.................  A..............  ...............  Exoskeletal axial rotation u.  ...........  ...........  ...........  ...........  ...........
L5984.................  A..............  ...............  Endoskeletal axial rotation..  ...........  ...........  ...........  ...........  ...........
L5985.................  A..............  ...............  Lwr ext dynamic prosth pylon.  ...........  ...........  ...........  ...........  ...........
L5986.................  A..............  ...............  Multi-axial rotation unit....  ...........  ...........  ...........  ...........  ...........
L5987.................  A..............  ...............  Shank ft w vert load pylon...  ...........  ...........  ...........  ...........  ...........
L5988.................  A..............  ...............  Vertical shock reducing pylo.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 42956]]

 
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.  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........
L6694.................  A..............  ...............  Elbow socket ins use w/lock..  ...........  ...........  ...........  ...........  ...........
L6695.................  A..............  ...............  Elbow socket ins use w/o lck.  ...........  ...........  ...........  ...........  ...........

[[Page 42957]]

 
L6696.................  A..............  ...............  Cus elbo skt in for con/atyp.  ...........  ...........  ...........  ...........  ...........
L6697.................  A..............  ...............  Cus elbo skt in not con/atyp.  ...........  ...........  ...........  ...........  ...........
L6698.................  A..............  ...............  Below/above elbow lock mech..  ...........  ...........  ...........  ...........  ...........
L6700.................  A..............  ...............  Terminal device model 3.
L6705.................  A..............  ...............  Terminal device model 5.
L6710.................  A..............  ...............  Terminal device model 5x.
L6715.................  A..............  ...............  Terminal device model 5xa.
L6720.................  A..............  ...............  Terminal device model 6.
L6725.................  A..............  ...............  Terminal device model 7.
L6730.................  A..............  ...............  Terminal device model 7lo.
L6735.................  A..............  ...............  Terminal device model 8.
L6740.................  A..............  ...............  Terminal device model 8x.
L6745.................  A..............  ...............  Terminal device model 88x.
L6750.................  A..............  ...............  Terminal device model 10p.
L6755.................  A..............  ...............  Terminal device model 10x.
L6765.................  A..............  ...............  Terminal device model 12p.
L6770.................  A..............  ...............  Terminal device model 99x.
L6775.................  A..............  ...............  Terminal device model 555.
L6780.................  A..............  ...............  Terminal device model ss555.
L6790.................  A..............  ...............  Hooks-accu hook or equal.....  ...........  ...........  ...........  ...........  ...........
L6795.................  A..............  ...............  Hooks-2 load or equal........  ...........  ...........  ...........  ...........  ...........
L6800.................  A..............  ...............  Hooks-aprl vc or equal.......  ...........  ...........  ...........  ...........  ...........
L6805.................  A..............  ...............  Modifier wrist flexion unit..  ...........  ...........  ...........  ...........  ...........
L6806.................  A..............  ...............  Trs grip vc or equal.........  ...........  ...........  ...........  ...........  ...........
L6807.................  A..............  ...............  Term device grip1/2 or equal.  ...........  ...........  ...........  ...........  ...........
L6808.................  A..............  ...............  Term device infant or child..  ...........  ...........  ...........  ...........  ...........
L6809.................  A..............  ...............  Trs super sport passive......  ...........  ...........  ...........  ...........  ...........
L6810.................  A..............  ...............  Pincher tool otto bock or eq.  ...........  ...........  ...........  ...........  ...........
L6825.................  A..............  ...............  Hands dorrance vo............  ...........  ...........  ...........  ...........  ...........
L6830.................  A..............  ...............  Hand aprl vc.................  ...........  ...........  ...........  ...........  ...........
L6835.................  A..............  ...............  Hand sierra vo...............  ...........  ...........  ...........  ...........  ...........
L6840.................  A..............  ...............  Hand becker imperial.........  ...........  ...........  ...........  ...........  ...........
L6845.................  A..............  ...............  Hand becker lock grip........  ...........  ...........  ...........  ...........  ...........
L6850.................  A..............  ...............  Term dvc-hand becker plylite.  ...........  ...........  ...........  ...........  ...........
L6855.................  A..............  ...............  Hand robin-aids vo...........  ...........  ...........  ...........  ...........  ...........
L6860.................  A..............  ...............  Hand robin-aids vo soft......  ...........  ...........  ...........  ...........  ...........
L6865.................  A..............  ...............  Hand passive hand............  ...........  ...........  ...........  ...........  ...........
L6867.................  A..............  ...............  Hand detroit infant hand.....  ...........  ...........  ...........  ...........  ...........
L6868.................  A..............  ...............  Passive inf hand steeper/hos.  ...........  ...........  ...........  ...........  ...........
L6870.................  A..............  ...............  Hand child mitt..............  ...........  ...........  ...........  ...........  ...........
L6872.................  A..............  ...............  Hand nyu child hand..........  ...........  ...........  ...........  ...........  ...........
L6873.................  A..............  ...............  Hand mech inf steeper or equ.  ...........  ...........  ...........  ...........  ...........
L6875.................  A..............  ...............  Hand bock vc.................  ...........  ...........  ...........  ...........  ...........
L6880.................  A..............  ...............  Hand bock vo.................  ...........  ...........  ...........  ...........  ...........
L6881.................  A..............  ...............  Autograsp feature ul term dv.  ...........  ...........  ...........  ...........  ...........
L6882.................  A..............  ...............  Microprocessor control uplmb.  ...........  ...........  ...........  ...........  ...........
L6890.................  A..............  ...............  Production glove.............  ...........  ...........  ...........  ...........  ...........
L6895.................  A..............  ...............  Custom glove.................  ...........  ...........  ...........  ...........  ...........
L6900.................  A..............  ...............  Hand restorat thumb/1 finger.  ...........  ...........  ...........  ...........  ...........
L6905.................  A..............  ...............  Hand restoration multiple fi.  ...........  ...........  ...........  ...........  ...........
L6910.................  A..............  ...............  Hand restoration no fingers..  ...........  ...........  ...........  ...........  ...........
L6915.................  A..............  ...............  Hand restoration replacmnt g.  ...........  ...........  ...........  ...........  ...........
L6920.................  A..............  ...............  Wrist disarticul switch ctrl.  ...........  ...........  ...........  ...........  ...........
L6925.................  A..............  ...............  Wrist disart myoelectronic c.  ...........  ...........  ...........  ...........  ...........
L6930.................  A..............  ...............  Below elbow switch control...  ...........  ...........  ...........  ...........  ...........
L6935.................  A..............  ...............  Below elbow myoelectronic ct.  ...........  ...........  ...........  ...........  ...........
L6940.................  A..............  ...............  Elbow disarticulation switch.  ...........  ...........  ...........  ...........  ...........
L6945.................  A..............  ...............  Elbow disart myoelectronic c.  ...........  ...........  ...........  ...........  ...........
L6950.................  A..............  ...............  Above elbow switch control...  ...........  ...........  ...........  ...........  ...........
L6955.................  A..............  ...............  Above elbow myoelectronic ct.  ...........  ...........  ...........  ...........  ...........
L6960.................  A..............  ...............  Shldr disartic switch contro.  ...........  ...........  ...........  ...........  ...........
L6965.................  A..............  ...............  Shldr disartic myoelectronic.  ...........  ...........  ...........  ...........  ...........
L6970.................  A..............  ...............  Interscapular-thor switch ct.  ...........  ...........  ...........  ...........  ...........
L6975.................  A..............  ...............  Interscap-thor myoelectronic.  ...........  ...........  ...........  ...........  ...........
L7010.................  A..............  ...............  Hand otto back steeper/eq sw.  ...........  ...........  ...........  ...........  ...........
L7015.................  A..............  ...............  Hand sys teknik village swit.  ...........  ...........  ...........  ...........  ...........

[[Page 42958]]

 
L7020.................  A..............  ...............  Electronic greifer switch ct.  ...........  ...........  ...........  ...........  ...........
L7025.................  A..............  ...............  Electron hand myoelectronic..  ...........  ...........  ...........  ...........  ...........
L7030.................  A..............  ...............  Hand sys teknik vill myoelec.  ...........  ...........  ...........  ...........  ...........
L7035.................  A..............  ...............  Electron greifer myoelectro..  ...........  ...........  ...........  ...........  ...........
L7040.................  A..............  ...............  Prehensile actuator hosmer s.  ...........  ...........  ...........  ...........  ...........
L7045.................  A..............  ...............  Electron hook child michigan.  ...........  ...........  ...........  ...........  ...........
L7170.................  A..............  ...............  Electronic elbow hosmer swit.  ...........  ...........  ...........  ...........  ...........
L7180.................  A..............  ...............  Electronic elbow utah myoele.  ...........  ...........  ...........  ...........  ...........
L7181.................  A..............  ...............  Electronic elbo simultaneous.  ...........  ...........  ...........  ...........  ...........
L7185.................  A..............  ...............  Electron elbow adolescent sw.  ...........  ...........  ...........  ...........  ...........
L7186.................  A..............  ...............  Electron elbow child switch..  ...........  ...........  ...........  ...........  ...........
L7190.................  A..............  ...............  Elbow adolescent myoelectron.  ...........  ...........  ...........  ...........  ...........
L7191.................  A..............  ...............  Elbow child myoelectronic ct.  ...........  ...........  ...........  ...........  ...........
L7260.................  A..............  ...............  Electron wrist rotator otto..  ...........  ...........  ...........  ...........  ...........
L7261.................  A..............  ...............  Electron wrist rotator utah..  ...........  ...........  ...........  ...........  ...........
L7266.................  A..............  ...............  Servo control steeper or equ.  ...........  ...........  ...........  ...........  ...........
L7272.................  A..............  ...............  Analogue control unb or equa.  ...........  ...........  ...........  ...........  ...........
L7274.................  A..............  ...............  Proportional ctl 12 volt uta.  ...........  ...........  ...........  ...........  ...........
L7360.................  A..............  ...............  Six volt bat otto bock/eq ea.  ...........  ...........  ...........  ...........  ...........
L7362.................  A..............  ...............  Battery chrgr six volt otto..  ...........  ...........  ...........  ...........  ...........
L7364.................  A..............  ...............  Twelve volt battery utah/equ.  ...........  ...........  ...........  ...........  ...........
L7366.................  A..............  ...............  Battery chrgr 12 volt utah/e.  ...........  ...........  ...........  ...........  ...........
L7367.................  A..............  ...............  Replacemnt lithium ionbatter.  ...........  ...........  ...........  ...........  ...........
L7368.................  A..............  ...............  Lithium ion battery charger..  ...........  ...........  ...........  ...........  ...........
L7499.................  A..............  ...............  Upper extremity prosthes NOS.  ...........  ...........  ...........  ...........  ...........
L7500.................  A..............  ...............  Prosthetic dvc repair hourly.  ...........  ...........  ...........  ...........  ...........
L7510.................  A..............  ...............  Prosthetic device repair rep.  ...........  ...........  ...........  ...........  ...........
L7520.................  A..............  ...............  Repair prosthesis per 15 min.  ...........  ...........  ...........  ...........  ...........
L7900.................  A..............  ...............  Male vacuum erection system..  ...........  ...........  ...........  ...........  ...........
L8000.................  A..............  ...............  Mastectomy bra...............  ...........  ...........  ...........  ...........  ...........
L8001.................  A..............  ...............  Breast prosthesis bra & form.  ...........  ...........  ...........  ...........  ...........
L8002.................  A..............  ...............  Brst prsth bra & bilat form..  ...........  ...........  ...........  ...........  ...........
L8010.................  A..............  ...............  Mastectomy sleeve............  ...........  ...........  ...........  ...........  ...........
L8015.................  A..............  ...............  Ext breastprosthesis garment.  ...........  ...........  ...........  ...........  ...........
L8020.................  A..............  ...............  Mastectomy form..............  ...........  ...........  ...........  ...........  ...........
L8030.................  A..............  ...............  Breast prosthesis silicone/e.  ...........  ...........  ...........  ...........  ...........
L8035.................  A..............  ...............  Custom breast prosthesis.....  ...........  ...........  ...........  ...........  ...........
L8039.................  A..............  ...............  Breast prosthesis NOS........  ...........  ...........  ...........  ...........  ...........
L8040.................  A..............  ...............  Nasal prosthesis.............  ...........  ...........  ...........  ...........  ...........
L8041.................  A..............  ...............  Midfacial prosthesis.........  ...........  ...........  ...........  ...........  ...........
L8042.................  A..............  ...............  Orbital prosthesis...........  ...........  ...........  ...........  ...........  ...........
L8043.................  A..............  ...............  Upper facial prosthesis......  ...........  ...........  ...........  ...........  ...........
L8044.................  A..............  ...............  Hemi-facial prosthesis.......  ...........  ...........  ...........  ...........  ...........
L8045.................  A..............  ...............  Auricular prosthesis.........  ...........  ...........  ...........  ...........  ...........
L8046.................  A..............  ...............  Partial facial prosthesis....  ...........  ...........  ...........  ...........  ...........
L8047.................  A..............  ...............  Nasal septal prosthesis......  ...........  ...........  ...........  ...........  ...........
L8048.................  A..............  ...............  Unspec maxillofacial prosth..  ...........  ...........  ...........  ...........  ...........
L8049.................  A..............  ...............  Repair maxillofacial prosth..  ...........  ...........  ...........  ...........  ...........
L8100.................  E..............  ...............  Compression stocking BK18-30.  ...........  ...........  ...........  ...........  ...........
L8110.................  A..............  ...............  Compression stocking BK30-40.  ...........  ...........  ...........  ...........  ...........
L8120.................  A..............  ...............  Compression stocking BK40-50.  ...........  ...........  ...........  ...........  ...........
L8130.................  E..............  ...............  Gc stocking thighlngth 18-30.  ...........  ...........  ...........  ...........  ...........
L8140.................  E..............  ...............  Gc stocking thighlngth 30-40.  ...........  ...........  ...........  ...........  ...........
L8150.................  E..............  ...............  Gc stocking thighlngth 40-50.  ...........  ...........  ...........  ...........  ...........
L8160.................  E..............  ...............  Gc stocking full lngth 18-30.  ...........  ...........  ...........  ...........  ...........
L8170.................  E..............  ...............  Gc stocking full lngth 30-40.  ...........  ...........  ...........  ...........  ...........
L8180.................  E..............  ...............  Gc stocking full lngth 40-50.  ...........  ...........  ...........  ...........  ...........
L8190.................  E..............  ...............  Gc stocking waistlngth 18-30.  ...........  ...........  ...........  ...........  ...........
L8195.................  E..............  ...............  Gc stocking waistlngth 30-40.  ...........  ...........  ...........  ...........  ...........
L8200.................  E..............  ...............  Gc stocking waistlngth 40-50.  ...........  ...........  ...........  ...........  ...........
L8210.................  E..............  ...............  Gc stocking custom made......  ...........  ...........  ...........  ...........  ...........
L8220.................  E..............  ...............  Gc stocking lymphedema.......  ...........  ...........  ...........  ...........  ...........
L8230.................  E..............  ...............  Gc stocking garter belt......  ...........  ...........  ...........  ...........  ...........
L8239.................  E..............  ...............  G compression stocking NOS...  ...........  ...........  ...........  ...........  ...........
L8300.................  A..............  ...............  Truss single w/ standard pad.  ...........  ...........  ...........  ...........  ...........
L8310.................  A..............  ...............  Truss double w/ standard pad.  ...........  ...........  ...........  ...........  ...........

[[Page 42959]]

 
L8320.................  A..............  ...............  Truss addition to std pad wa.  ...........  ...........  ...........  ...........  ...........
L8330.................  A..............  ...............  Truss add to std pad scrotal.  ...........  ...........  ...........  ...........  ...........
L8400.................  A..............  ...............  Sheath below knee............  ...........  ...........  ...........  ...........  ...........
L8410.................  A..............  ...............  Sheath above knee............  ...........  ...........  ...........  ...........  ...........
L8415.................  A..............  ...............  Sheath upper limb............  ...........  ...........  ...........  ...........  ...........
L8417.................  A..............  ...............  Pros sheath/sock w gel cushn.  ...........  ...........  ...........  ...........  ...........
L8420.................  A..............  ...............  Prosthetic sock multi ply BK.  ...........  ...........  ...........  ...........  ...........
L8430.................  A..............  ...............  Prosthetic sock multi ply AK.  ...........  ...........  ...........  ...........  ...........
L8435.................  A..............  ...............  Pros sock multi ply upper lm.  ...........  ...........  ...........  ...........  ...........
L8440.................  A..............  ...............  Shrinker below knee..........  ...........  ...........  ...........  ...........  ...........
L8460.................  A..............  ...............  Shrinker above knee..........  ...........  ...........  ...........  ...........  ...........
L8465.................  A..............  ...............  Shrinker upper limb..........  ...........  ...........  ...........  ...........  ...........
L8470.................  A..............  ...............  Pros sock single ply BK......  ...........  ...........  ...........  ...........  ...........
L8480.................  A..............  ...............  Pros sock single ply AK......  ...........  ...........  ...........  ...........  ...........
L8485.................  A..............  ...............  Pros sock single ply upper l.  ...........  ...........  ...........  ...........  ...........
L8499.................  A..............  ...............  Unlisted misc prosthetic ser.  ...........  ...........  ...........  ...........  ...........
L8500.................  A..............  ...............  Artificial larynx............  ...........  ...........  ...........  ...........  ...........
L8501.................  A..............  ...............  Tracheostomy speaking valve..  ...........  ...........  ...........  ...........  ...........
L8505.................  A..............  ...............  Artificial larynx, accessory.  ...........  ...........  ...........  ...........  ...........
L8507.................  A..............  ...............  Trach-esoph voice pros pt in.  ...........  ...........  ...........  ...........  ...........
L8509.................  A..............  ...............  Trach-esoph voice pros md in.  ...........  ...........  ...........  ...........  ...........
L8510.................  A..............  ...............  Voice amplifier..............  ...........  ...........  ...........  ...........  ...........
L8511.................  A..............  ...............  Indwelling trach insert......  ...........  ...........  ...........  ...........  ...........
L8512.................  A..............  ...............  Gel cap for trach voice pros.  ...........  ...........  ...........  ...........  ...........
L8513.................  A..............  ...............  Trach pros cleaning device...  ...........  ...........  ...........  ...........  ...........
L8514.................  A..............  ...............  Repl trach puncture dilator..  ...........  ...........  ...........  ...........  ...........
L8515.................  A..............  ...............  Gel cap app device for trach.  ...........  ...........  ...........  ...........  ...........
L8600.................  N..............  ...............  Implant breast silicone/eq...  ...........  ...........  ...........  ...........  ...........
L8603.................  N..............  ...............  Collagen imp urinary 2.5 ml..  ...........  ...........  ...........  ...........  ...........
L8606.................  N..............  ...............  Synthetic implnt urinary 1ml.  ...........  ...........  ...........  ...........  ...........
L8610.................  N..............  ...............  Ocular implant...............  ...........  ...........  ...........  ...........  ...........
L8612.................  N..............  ...............  Aqueous shunt prosthesis.....  ...........  ...........  ...........  ...........  ...........
L8613.................  N..............  ...............  Ossicular implant............  ...........  ...........  ...........  ...........  ...........
L8614.................  N..............  ...............  Cochlear device/system.......  ...........  ...........  ...........  ...........  ...........
L8615.................  A..............  ...............  Coch implant headset replace.  ...........  ...........  ...........  ...........  ...........
L8616.................  A..............  ...............  Coch implant microphone repl.  ...........  ...........  ...........  ...........  ...........
L8617.................  A..............  ...............  Coch implant trans coil repl.  ...........  ...........  ...........  ...........  ...........
L8618.................  A..............  ...............  Coch implant tran cable repl.  ...........  ...........  ...........  ...........  ...........
L8619.................  A..............  ...............  Replace cochlear processor...  ...........  ...........  ...........  ...........  ...........
L8620.................  A..............  ...............  Repl lithium ion battery.....  ...........  ...........  ...........  ...........  ...........
L8621.................  A..............  ...............  Repl zinc air battery........  ...........  ...........  ...........  ...........  ...........
L8622.................  A..............  ...............  Repl alkaline battery........  ...........  ...........  ...........  ...........  ...........
L8630.................  N..............  ...............  Metacarpophalangeal implant..  ...........  ...........  ...........  ...........  ...........
L8631.................  N..............  ...............  MCP joint repl 2 pc or more..  ...........  ...........  ...........  ...........  ...........
L8641.................  N..............  ...............  Metatarsal joint implant.....  ...........  ...........  ...........  ...........  ...........
L8642.................  N..............  ...............  Hallux implant...............  ...........  ...........  ...........  ...........  ...........
L8658.................  N..............  ...............  Interphalangeal joint spacer.  ...........  ...........  ...........  ...........  ...........
L8659.................  N..............  ...............  Interphalangeal joint repl...  ...........  ...........  ...........  ...........  ...........
L8670.................  N..............  ...............  Vascular graft, synthetic....  ...........  ...........  ...........  ...........  ...........
L8699.................  N..............  ...............  Prosthetic implant NOS.......  ...........  ...........  ...........  ...........  ...........
L9900.................  A..............  ...............  O&P supply/accessory/service.  ...........  ...........  ...........  ...........  ...........
M0064.................  X..............  ...............  Visit for drug monitoring....         0374       1.0367       $61.53  ...........       $12.31
M0075.................  E..............  ...............  Cellular therapy.............  ...........  ...........  ...........  ...........  ...........
M0076.................  E..............  ...............  Prolotherapy.................  ...........  ...........  ...........  ...........  ...........
M0100.................  E..............  ...............  Intragastric hypothermia.....  ...........  ...........  ...........  ...........  ...........
M0300.................  E..............  ...............  IV chelationtherapy..........  ...........  ...........  ...........  ...........  ...........
M0301.................  E..............  ...............  Fabric wrapping of aneurysm..  ...........  ...........  ...........  ...........  ...........
P2028.................  A..............  ...............  Cephalin floculation test....  ...........  ...........  ...........  ...........  ...........
P2029.................  A..............  ...............  Congo red blood test.........  ...........  ...........  ...........  ...........  ...........
P2031.................  E..............  ...............  Hair analysis................  ...........  ...........  ...........  ...........  ...........
P2033.................  A..............  ...............  Blood thymol turbidity.......  ...........  ...........  ...........  ...........  ...........
P2038.................  A..............  ...............  Blood mucoprotein............  ...........  ...........  ...........  ...........  ...........
P3000.................  A..............  ...............  Screen pap by tech w md supv.  ...........  ...........  ...........  ...........  ...........
P3001.................  B..............  ...............  Screening pap smear by phys..  ...........  ...........  ...........  ...........  ...........
P7001.................  E..............  ...............  Culture bacterial urine......  ...........  ...........  ...........  ...........  ...........
P9010.................  K..............  ...............  Whole blood for transfusion..         0950       2.0032      $118.89  ...........       $23.78

[[Page 42960]]

 
P9011.................  K..............  ...............  Blood split unit.............         0967       1.2641       $75.02  ...........       $15.00
P9012.................  K..............  ...............  Cryoprecipitate each unit....         0952       0.7361       $43.69  ...........        $8.74
P9016.................  K..............  ...............  RBC leukocytes reduced.......         0954       2.7246      $161.71  ...........       $32.34
P9017.................  K..............  ...............  Plasma 1 donor frz w/in 8 hr.         9508       1.1983       $71.12  ...........       $14.22
P9019.................  K..............  ...............  Platelets, each unit.........         0957       0.8279       $49.14  ...........        $9.83
P9020.................  K..............  ...............  Plaelet rich plasma unit.....         0958       5.1580      $306.13  ...........       $61.23
P9021.................  K..............  ...............  Red blood cells unit.........         0959       2.0209      $119.94  ...........       $23.99
P9022.................  K..............  ...............  Washed red blood cells unit..         0960       2.9573      $175.52  ...........       $35.10
P9023.................  K..............  ...............  Frozen plasma, pooled, sd....         0949       1.1902       $70.64  ...........       $14.13
P9031.................  K..............  ...............  Platelets leukocytes reduced.         1013       1.5950       $94.66  ...........       $18.93
P9032.................  K..............  ...............  Platelets, irradiated........         9500       1.3527       $80.28  ...........       $16.06
P9033.................  K..............  ...............  Platelets leukoreduced irrad.         0968       2.3532      $139.66  ...........       $27.93
P9034.................  K..............  ...............  Platelets, pheresis..........         9507       6.8676      $407.59  ...........       $81.52
P9035.................  K..............  ...............  Platelet pheres leukoreduced.         9501       8.1126      $481.48  ...........       $96.30
P9036.................  K..............  ...............  Platelet pheresis irradiated.         9502       5.1660      $306.60  ...........       $61.32
P9037.................  K..............  ...............  Plate pheres leukoredu irrad.         1019       9.4700      $562.04  ...........      $112.41
P9038.................  K..............  ...............  RBC irradiated...............         9505       2.3768      $141.06  ...........       $28.21
P9039.................  K..............  ...............  RBC deglycerolized...........         9504       6.4022      $379.97  ...........       $75.99
P9040.................  K..............  ...............  RBC leukoreduced irradiated..         0969       3.6286      $215.36  ...........       $43.07
P9041.................  K..............  ...............  Albumin (human),5%, 50ml.....         0961       0.5119       $30.38  ...........        $6.08
P9043.................  K..............  ...............  Plasma protein fract,5%,50ml.         0956       1.1175       $66.32  ...........       $13.26
P9044.................  K..............  ...............  Cryoprecipitatereducedplasma.         1009       1.3003       $77.17  ...........       $15.43
P9045.................  K..............  ...............  Albumin (human), 5%, 250 ml..         0963       1.3867       $82.30  ...........       $16.46
P9046.................  K..............  ...............  Albumin (human), 25%, 20 ml..         0964       0.4878       $28.95  ...........        $5.79
P9047.................  K..............  ...............  Albumin (human), 25%, 50ml...         0965       1.1115       $65.97  ...........       $13.19
P9048.................  K..............  ...............  Plasmaprotein fract,5%,250ml.         0966       4.9340      $292.83  ...........       $58.57
P9050.................  K..............  ...............  Granulocytes, pheresis unit..         9506      15.5448      $922.58  ...........      $184.52
P9051.................  K..............  ...............  Blood, l/r, cmv-neg..........         1010       2.9558      $175.43  ...........       $35.09
P9052.................  K..............  ...............  Platelets, hla-m, l/r, unit..         1011      10.9193      $648.06  ...........      $129.61
P9053.................  K..............  ...............  Plt, pher, l/r cmv-neg, irr..         1020      10.1091      $599.98  ...........      $120.00
P9054.................  K..............  ...............  Blood, l/r, froz/degly/wash..         1016       5.2392      $310.95  ...........       $62.19
P9055.................  K..............  ...............  Plt, aph/pher, l/r, cmv-neg..         1017       8.5608      $508.08  ...........      $101.62
P9056.................  K..............  ...............  Blood, l/r, irradiated.......         1018       2.7877      $165.45  ...........       $33.09
P9057.................  K..............  ...............  RBC, frz/deg/wsh, l/r, irrad.         1021       4.8566      $288.24  ...........       $57.65
P9058.................  K..............  ...............  RBC, l/r, cmv-neg, irrad.....         1022       4.2707      $253.47  ...........       $50.69
P9059.................  K..............  ...............  Plasma, frz between 8-24hour.         0955       1.2876       $76.42  ...........       $15.28
P9060.................  K..............  ...............  Fr frz plasma donor retested.         9503       1.6167       $95.95  ...........       $19.19
P9603.................  A..............  ...............  One-way allow prorated miles.  ...........  ...........  ...........  ...........  ...........
P9604.................  A..............  ...............  One-way allow prorated trip..  ...........  ...........  ...........  ...........  ...........
P9612.................  N..............  ...............  Catheterize for urine spec...  ...........  ...........  ...........  ...........  ...........
P9615.................  N..............  ...............  Urine specimen collect mult..  ...........  ...........  ...........  ...........  ...........
Q0035.................  X..............  ...............  Cardiokymography.............         0100       2.4855      $147.51       $41.44       $29.50
Q0081.................  B..............  ...............  Infusion ther other than che.  ...........  ...........  ...........  ...........  ...........
Q0083.................  B..............  ...............  Chemo by other than infusion.  ...........  ...........  ...........  ...........  ...........
Q0084.................  B..............  ...............  Chemotherapy by infusion.....  ...........  ...........  ...........  ...........  ...........
Q0085.................  B..............  ...............  Chemo by both infusion and o.  ...........  ...........  ...........  ...........  ...........
Q0091.................  T..............  ...............  Obtaining screen pap smear...         0191       0.1663        $9.87        $2.77        $1.97
Q0092.................  N..............  ...............  Set up port xray equipment...  ...........  ...........  ...........  ...........  ...........
Q0111.................  A..............  ...............  Wet mounts/ w preparations...  ...........  ...........  ...........  ...........  ...........
Q0112.................  A..............  ...............  Potassium hydroxide preps....  ...........  ...........  ...........  ...........  ...........
Q0113.................  A..............  ...............  Pinworm examinations.........  ...........  ...........  ...........  ...........  ...........
Q0114.................  A..............  ...............  Fern test....................  ...........  ...........  ...........  ...........  ...........
Q0115.................  A..............  ...............  Post-coital mucous exam......  ...........  ...........  ...........  ...........  ...........
Q0136.................  K..............  ...............  Non esrd epoetin alpha inj...         0733  ...........        $9.99  ...........        $2.00
Q0137.................  K..............  ...............  Darbepoetin alfa, non esrd...         0734  ...........        $3.28  ...........         $.66
Q0144.................  E..............  ...............  Azithromycin dihydrate, oral.  ...........  ...........  ...........  ...........  ...........
Q0163.................  N..............  ...............  Diphenhydramine HCl 50mg.....  ...........  ...........  ...........  ...........  ...........
Q0164.................  N..............  ...............  Prochlorperazine maleate 5mg.  ...........  ...........  ...........  ...........  ...........
Q0165.................  B..............  ...............  Prochlorperazine maleate10mg.  ...........  ...........  ...........  ...........  ...........
Q0166.................  K..............  ...............  Granisetron HCl 1 mg oral....         0765  ...........       $33.50  ...........        $6.70
Q0167.................  N..............  ...............  Dronabinol 2.5mg oral........  ...........  ...........  ...........  ...........  ...........
Q0168.................  B..............  ...............  Dronabinol 5mg oral..........  ...........  ...........  ...........  ...........  ...........
Q0169.................  N..............  ...............  Promethazine HCl 12.5mg oral.  ...........  ...........  ...........  ...........  ...........
Q0170.................  B..............  ...............  Promethazine HCl 25 mg oral..  ...........  ...........  ...........  ...........  ...........
Q0171.................  N..............  ...............  Chlorpromazine HCl 10mg oral.  ...........  ...........  ...........  ...........  ...........
Q0172.................  B..............  ...............  Chlorpromazine HCl 25mg oral.  ...........  ...........  ...........  ...........  ...........

[[Page 42961]]

 
Q0173.................  N..............  ...............  Trimethobenzamide HCl 250mg..  ...........  ...........  ...........  ...........  ...........
Q0174.................  N..............  ...............  Thiethylperazine maleate10mg.  ...........  ...........  ...........  ...........  ...........
Q0175.................  N..............  ...............  Perphenazine 4mg oral........  ...........  ...........  ...........  ...........  ...........
Q0176.................  B..............  ...............  Perphenazine 8mg oral........  ...........  ...........  ...........  ...........  ...........
Q0177.................  N..............  ...............  Hydroxyzine pamoate 25mg.....  ...........  ...........  ...........  ...........  ...........
Q0178.................  B..............  ...............  Hydroxyzine pamoate 50mg.....  ...........  ...........  ...........  ...........  ...........
Q0179.................  K..............  ...............  Ondansetron HCl 8mg oral.....         0769  ...........       $32.02  ...........        $6.40
Q0180.................  K..............  ...............  Dolasetron mesylate oral.....         0763  ...........       $48.54  ...........        $9.71
Q0181.................  E..............  ...............  Unspecified oral anti-emetic.  ...........  ...........  ...........  ...........  ...........
Q0187.................  K..............  ...............  Factor viia recombinant......         1409  ...........    $1,080.03  ...........      $216.01
Q1001.................  N..............  ...............  Ntiol category 1.............  ...........  ...........  ...........  ...........  ...........
Q1002.................  N..............  ...............  Ntiol category 2.............  ...........  ...........  ...........  ...........  ...........
Q1003.................  N..............  ...............  Ntiol category 3.............  ...........  ...........  ...........  ...........  ...........
Q1004.................  N..............  ...............  Ntiol category 4.............  ...........  ...........  ...........  ...........  ...........
Q1005.................  N..............  ...............  Ntiol category 5.............  ...........  ...........  ...........  ...........  ...........
Q2001.................  E..............  ...............  Oral cabergoline 0.5 mg......  ...........  ...........  ...........  ...........  ...........
Q2002.................  N..............  ...............  Elliotts b solution per ml...  ...........  ...........  ...........  ...........  ...........
Q2003.................  K..............  ...............  Aprotinin, 10,000 kiu........         7019  ...........        $2.20  ...........         $.44
Q2004.................  N..............  ...............  Bladder calculi irrig sol....  ...........  ...........  ...........  ...........  ...........
Q2005.................  K..............  ...............  Corticorelin ovine triflutat.         7024  ...........      $386.49  ...........       $77.30
Q2006.................  K..............  ...............  Digoxin immune fab (ovine)...         7025  ...........      $552.14  ...........      $110.43
Q2007.................  K..............  ...............  Ethanolamine oleate 100 mg...         7026  ...........       $64.53  ...........       $12.91
Q2008.................  K..............  ...............  Fomepizole, 15 mg............         7027  ...........       $12.31  ...........        $2.46
Q2009.................  K..............  ...............  Fosphenytoin, 50 mg..........         7028  ...........        $5.19  ...........        $1.04
Q2011.................  K..............  ...............  Hemin, per 1 mg..............         7030  ...........        $6.51  ...........        $1.30
Q2012.................  K..............  ...............  Pegademase bovine, 25 iu.....         9168  ...........      $161.15  ...........       $32.23
Q2013.................  K..............  ...............  Pentastarch 10% solution.....         7040  ...........       $12.45  ...........        $2.49
Q2014.................  N..............  ...............  Sermorelin acetate, 0.5 mg...  ...........  ...........  ...........  ...........  ...........
Q2017.................  K..............  ...............  Teniposide, 50 mg............         7035  ...........      $266.21  ...........       $53.24
Q2018.................  K..............  ...............  Urofollitropin, 75 iu........         7037  ...........       $44.73  ...........        $8.95
Q2019.................  K..............  ...............  Basiliximab..................         1615  ...........    $1,473.45  ...........      $294.69
Q2020.................  E..............  ...............  Histrelin acetate............  ...........  ...........  ...........  ...........  ...........
Q2021.................  K..............  ...............  Lepirudin....................         9057  ...........      $128.16  ...........       $25.63
Q2022.................  K..............  ...............  VonWillebrandFactrCmplxperIU.         1618  ...........         $.74  ...........         $.15
Q3000.................  H..............  ...............  Rubidium-Rb-82...............         9025  ...........  ...........  ...........  ...........
Q3001.................  B..............  ...............  Brachytherapy Radioelements..  ...........  ...........  ...........  ...........  ...........
Q3002.................  H..............  ...............  Gallium ga 67................         1619  ...........  ...........  ...........  ...........
Q3003.................  H..............  ...............  Technetium tc99m bicisate....         1620  ...........  ...........  ...........  ...........
Q3004.................  N..............  ...............  Xenon xe 133.................  ...........  ...........  ...........  ...........  ...........
Q3005.................  H..............  ...............  Technetium tc99m ertiatide...         1622  ...........  ...........  ...........  ...........
Q3006.................  H..............  ...............  Technetium tc99m glucepatate.         9154  ...........  ...........  ...........  ...........
Q3007.................  H..............  ...............  Sodium phosphate p32.........         1624  ...........  ...........  ...........  ...........
Q3008.................  H..............  ...............  Indium 111-in pentetreotide..         1625  ...........  ...........  ...........  ...........
Q3009.................  N..............  ...............  Technetium tc99m oxidronate..  ...........  ...........  ...........  ...........  ...........
Q3010.................  H..............  ...............  Technetium tc99mlabeledrbcs..         9155  ...........  ...........  ...........  ...........
Q3011.................  H..............  ...............  Chromic phosphate p32........         1628  ...........  ...........  ...........  ...........
Q3012.................  N..............  ...............  Cyanocobalamin cobalt co57...  ...........  ...........  ...........  ...........  ...........
Q3014.................  A..............  ...............  Telehealth facility fee......  ...........  ...........  ...........  ...........  ...........
Q3019.................  A..............  ...............  ALS emer trans no ALS serv...  ...........  ...........  ...........  ...........  ...........
Q3020.................  A..............  ...............  ALS nonemer trans no ALS se..  ...........  ...........  ...........  ...........  ...........
Q3025.................  K..............  ...............  IM inj interferon beta 1-a...         9022  ...........       $89.09  ...........       $17.82
Q3026.................  E..............  ...............  Subc inj interferon beta-1a..  ...........  ...........  ...........  ...........  ...........
Q3031.................  N..............  ...............  Collagen skin test...........  ...........  ...........  ...........  ...........  ...........
Q4001.................  B..............  ...............  Cast sup body cast plaster...  ...........  ...........  ...........  ...........  ...........
Q4002.................  B..............  ...............  Cast sup body cast fiberglas.  ...........  ...........  ...........  ...........  ...........
Q4003.................  B..............  ...............  Cast sup shoulder cast plstr.  ...........  ...........  ...........  ...........  ...........
Q4004.................  B..............  ...............  Cast sup shoulder cast fbrgl.  ...........  ...........  ...........  ...........  ...........
Q4005.................  B..............  ...............  Cast sup long arm adult plst.  ...........  ...........  ...........  ...........  ...........
Q4006.................  B..............  ...............  Cast sup long arm adult fbrg.  ...........  ...........  ...........  ...........  ...........
Q4007.................  B..............  ...............  Cast sup long arm ped plster.  ...........  ...........  ...........  ...........  ...........
Q4008.................  B..............  ...............  Cast sup long arm ped fbrgls.  ...........  ...........  ...........  ...........  ...........
Q4009.................  B..............  ...............  Cast sup sht arm adult plstr.  ...........  ...........  ...........  ...........  ...........
Q4010.................  B..............  ...............  Cast sup sht arm adult fbrgl.  ...........  ...........  ...........  ...........  ...........
Q4011.................  B..............  ...............  Cast sup sht arm ped plaster.  ...........  ...........  ...........  ...........  ...........
Q4012.................  B..............  ...............  Cast sup sht arm ped fbrglas.  ...........  ...........  ...........  ...........  ...........
Q4013.................  B..............  ...............  Cast sup gauntlet plaster....  ...........  ...........  ...........  ...........  ...........

[[Page 42962]]

 
Q4014.................  B..............  ...............  Cast sup gauntlet fiberglass.  ...........  ...........  ...........  ...........  ...........
Q4015.................  B..............  ...............  Cast sup gauntlet ped plster.  ...........  ...........  ...........  ...........  ...........
Q4016.................  B..............  ...............  Cast sup gauntlet ped fbrgls.  ...........  ...........  ...........  ...........  ...........
Q4017.................  B..............  ...............  Cast sup lng arm splint plst.  ...........  ...........  ...........  ...........  ...........
Q4018.................  B..............  ...............  Cast sup lng arm splint fbrg.  ...........  ...........  ...........  ...........  ...........
Q4019.................  B..............  ...............  Cast sup lng arm splnt ped p.  ...........  ...........  ...........  ...........  ...........
Q4020.................  B..............  ...............  Cast sup lng arm splnt ped f.  ...........  ...........  ...........  ...........  ...........
Q4021.................  B..............  ...............  Cast sup sht arm splint plst.  ...........  ...........  ...........  ...........  ...........
Q4022.................  B..............  ...............  Cast sup sht arm splint fbrg.  ...........  ...........  ...........  ...........  ...........
Q4023.................  B..............  ...............  Cast sup sht arm splnt ped p.  ...........  ...........  ...........  ...........  ...........
Q4024.................  B..............  ...............  Cast sup sht arm splnt ped f.  ...........  ...........  ...........  ...........  ...........
Q4025.................  B..............  ...............  Cast sup hip spica plaster...  ...........  ...........  ...........  ...........  ...........
Q4026.................  B..............  ...............  Cast sup hip spica fiberglas.  ...........  ...........  ...........  ...........  ...........
Q4027.................  B..............  ...............  Cast sup hip spica ped plstr.  ...........  ...........  ...........  ...........  ...........
Q4028.................  B..............  ...............  Cast sup hip spica ped fbrgl.  ...........  ...........  ...........  ...........  ...........
Q4029.................  B..............  ...............  Cast sup long leg plaster....  ...........  ...........  ...........  ...........  ...........
Q4030.................  B..............  ...............  Cast sup long leg fiberglass.  ...........  ...........  ...........  ...........  ...........
Q4031.................  B..............  ...............  Cast sup lng leg ped plaster.  ...........  ...........  ...........  ...........  ...........
Q4032.................  B..............  ...............  Cast sup lng leg ped fbrgls..  ...........  ...........  ...........  ...........  ...........
Q4033.................  B..............  ...............  Cast sup lng leg cylinder pl.  ...........  ...........  ...........  ...........  ...........
Q4034.................  B..............  ...............  Cast sup lng leg cylinder fb.  ...........  ...........  ...........  ...........  ...........
Q4035.................  B..............  ...............  Cast sup lngleg cylndr ped p.  ...........  ...........  ...........  ...........  ...........
Q4036.................  B..............  ...............  Cast sup lngleg cylndr ped f.  ...........  ...........  ...........  ...........  ...........
Q4037.................  B..............  ...............  Cast sup shrt leg plaster....  ...........  ...........  ...........  ...........  ...........
Q4038.................  B..............  ...............  Cast sup shrt leg fiberglass.  ...........  ...........  ...........  ...........  ...........
Q4039.................  B..............  ...............  Cast sup shrt leg ped plster.  ...........  ...........  ...........  ...........  ...........
Q4040.................  B..............  ...............  Cast sup shrt leg ped fbrgls.  ...........  ...........  ...........  ...........  ...........
Q4041.................  B..............  ...............  Cast sup lng leg splnt plstr.  ...........  ...........  ...........  ...........  ...........
Q4042.................  B..............  ...............  Cast sup lng leg splnt fbrgl.  ...........  ...........  ...........  ...........  ...........
Q4043.................  B..............  ...............  Cast sup lng leg splnt ped p.  ...........  ...........  ...........  ...........  ...........
Q4044.................  B..............  ...............  Cast sup lng leg splnt ped f.  ...........  ...........  ...........  ...........  ...........
Q4045.................  B..............  ...............  Cast sup sht leg splnt plstr.  ...........  ...........  ...........  ...........  ...........
Q4046.................  B..............  ...............  Cast sup sht leg splnt fbrgl.  ...........  ...........  ...........  ...........  ...........
Q4047.................  B..............  ...............  Cast sup sht leg splnt ped p.  ...........  ...........  ...........  ...........  ...........
Q4048.................  B..............  ...............  Cast sup sht leg splnt ped f.  ...........  ...........  ...........  ...........  ...........
Q4049.................  B..............  ...............  Finger splint, static........  ...........  ...........  ...........  ...........  ...........
Q4050.................  B..............  ...............  Cast supplies unlisted.......  ...........  ...........  ...........  ...........  ...........
Q4051.................  B..............  ...............  Splint supplies misc.........  ...........  ...........  ...........  ...........  ...........
Q4054.................  A..............  ...............  Darbepoetin alfa, esrd use...  ...........  ...........  ...........  ...........  ...........
Q4055.................  A..............  ...............  Epoetin alfa, esrd use.......  ...........  ...........  ...........  ...........  ...........
Q4075.................  N..............  ...............  Acyclovir, 5 mg..............  ...........  ...........  ...........  ...........  ...........
Q4076.................  N..............  ...............  Dopamine hcl, 40 mg..........  ...........  ...........  ...........  ...........  ...........
Q4077.................  K..............  ...............  Treprostinil, 1 mg...........         1082  ...........       $55.02  ...........       $11.00
Q4079.................  G..............  ...............  Injection, natalizumab.......         9126  ...........        $6.51  ...........        $1.30
Q9941.................  K..............  ...............  IVIG lyophil 1g..............         0869  ...........       $39.46  ...........        $7.89
Q9942.................  K..............  ...............  IVIG lyophil 10 mg...........         0870  ...........         $.40  ...........         $.08
Q9943.................  K..............  ...............  IVIG non-lyophil 1g..........         0871  ...........       $57.26  ...........       $11.45
Q9944.................  K..............  ...............  IVIG non-lyophil 10 mg.......         0872  ...........         $.57  ...........         $.11
Q9945.................  K..............  ...............  LOCM <=149 mg/ml iodine, 1ml.         9157  ...........         $.51  ...........         $.10
Q9946.................  K..............  ...............  LOCM 150-199mg/ml iodine,1ml.         9158  ...........        $2.00  ...........         $.40
Q9947.................  K..............  ...............  LOCM 200-249mg/ml iodine,1ml.         9159  ...........         $.78  ...........         $.16
Q9948.................  K..............  ...............  LOCM 250-299mg/ml iodine,1ml.         9160  ...........         $.66  ...........         $.13
Q9949.................  K..............  ...............  LOCM 300-349mg/ml iodine,1ml.         9161  ...........         $.41  ...........         $.08
Q9950.................  K..............  ...............  LOCM 350-399mg/ml iodine,1ml.         9162  ...........         $.27  ...........         $.05
Q9951.................  K..............  ...............  LOCM >= 400 mg/ml iodine,1ml.         9163  ...........         $.20  ...........         $.04
Q9952.................  K..............  ...............  Inj Gad-base MR contrast, ml.         9164  ...........        $3.01  ...........         $.60
Q9953.................  N..............  ...............  Inj Fe-based MR contrast, ml.  ...........  ...........  ...........  ...........  ...........
Q9954.................  K..............  ...............  Oral MR contrast, 100 ml.....         9165  ...........        $9.01  ...........        $1.80
Q9955.................  K..............  ...............  Inj perflexane lip micros, m.         9203  ...........       $13.49  ...........        $2.70
Q9956.................  K..............  ...............  Inj octafluoropropane mic,ml.         9202  ...........       $41.42  ...........        $8.28
Q9957.................  K..............  ...............  Inj perflutren lip micros, m.         9112  ...........       $63.50  ...........       $12.70
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......  ...........  ...........  ...........  ...........  ...........

[[Page 42963]]

 
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......  ...........  ...........  ...........  ...........  ...........
V2118.................  A..............  ...............  Lens aniseikonic single......  ...........  ...........  ...........  ...........  ...........
V2121.................  A..............  ...............  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......  ...........  ...........  ...........  ...........  ...........
V2218.................  A..............  ...............  Lens aniseikonic bifocal.....  ...........  ...........  ...........  ...........  ...........
V2219.................  A..............  ...............  Lens bifocal seg width over..  ...........  ...........  ...........  ...........  ...........
V2220.................  A..............  ...............  Lens bifocal add over 3.25d..  ...........  ...........  ...........  ...........  ...........
V2221.................  A..............  ...............  Lenticular lens, bifocal.....  ...........  ...........  ...........  ...........  ...........
V2299.................  A..............  ...............  Lens bifocal speciality......  ...........  ...........  ...........  ...........  ...........
V2300.................  A..............  ...............  Lens sphere trifocal 4.00d...  ...........  ...........  ...........  ...........  ...........
V2301.................  A..............  ...............  Lens sphere trifocal 4.12-7..  ...........  ...........  ...........  ...........  ...........
V2302.................  A..............  ...............  Lens sphere trifocal 7.12-20.  ...........  ...........  ...........  ...........  ...........
V2303.................  A..............  ...............  Lens sphcy trifocal 4.0/.12-.  ...........  ...........  ...........  ...........  ...........
V2304.................  A..............  ...............  Lens sphcy trifocal 4.0/2.25.  ...........  ...........  ...........  ...........  ...........
V2305.................  A..............  ...............  Lens sphcy trifocal 4.0/4.25.  ...........  ...........  ...........  ...........  ...........
V2306.................  A..............  ...............  Lens sphcyl trifocal 4.00/>6.  ...........  ...........  ...........  ...........  ...........
V2307.................  A..............  ...............  Lens sphcy trifocal 4.25-7/..  ...........  ...........  ...........  ...........  ...........
V2308.................  A..............  ...............  Lens sphc trifocal 4.25-7/2..  ...........  ...........  ...........  ...........  ...........
V2309.................  A..............  ...............  Lens sphc trifocal 4.25-7/4..  ...........  ...........  ...........  ...........  ...........
V2310.................  A..............  ...............  Lens sphc trifocal 4.25-7/>6.  ...........  ...........  ...........  ...........  ...........
V2311.................  A..............  ...............  Lens sphc trifo 7.25-12/.25-.  ...........  ...........  ...........  ...........  ...........
V2312.................  A..............  ...............  Lens sphc trifo 7.25-12/2.25.  ...........  ...........  ...........  ...........  ...........
V2313.................  A..............  ...............  Lens sphc trifo 7.25-12/4.25.  ...........  ...........  ...........  ...........  ...........
V2314.................  A..............  ...............  Lens sphcyl trifocal over 12.  ...........  ...........  ...........  ...........  ...........
V2315.................  A..............  ...............  Lens lenticular trifocal.....  ...........  ...........  ...........  ...........  ...........
V2318.................  A..............  ...............  Lens aniseikonic trifocal....  ...........  ...........  ...........  ...........  ...........
V2319.................  A..............  ...............  Lens trifocal seg width > 28.  ...........  ...........  ...........  ...........  ...........
V2320.................  A..............  ...............  Lens trifocal add over 3.25d.  ...........  ...........  ...........  ...........  ...........
V2321.................  A..............  ...............  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..  ...........  ...........  ...........  ...........  ...........

[[Page 42964]]

 
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.................  ...........  ...........  ...........  ...........  ...........
V2702.................  E..............  ...............  Deluxe lens feature..........  ...........  ...........  ...........  ...........  ...........
V2710.................  A..............  ...............  Glass/plastic slab off prism.  ...........  ...........  ...........  ...........  ...........
V2715.................  A..............  ...............  Prism lens/es................  ...........  ...........  ...........  ...........  ...........
V2718.................  A..............  ...............  Fresnell prism press-on lens.  ...........  ...........  ...........  ...........  ...........
V2730.................  A..............  ...............  Special base curve...........  ...........  ...........  ...........  ...........  ...........
V2744.................  A..............  ...............  Tint photochromatic lens/es..  ...........  ...........  ...........  ...........  ...........
V2745.................  A..............  ...............  Tint, any color/solid/grad...  ...........  ...........  ...........  ...........  ...........
V2750.................  A..............  ...............  Anti-reflective coating......  ...........  ...........  ...........  ...........  ...........
V2755.................  A..............  ...............  UV lens/es...................  ...........  ...........  ...........  ...........  ...........
V2756.................  E..............  ...............  Eye glass case...............  ...........  ...........  ...........  ...........  ...........
V2760.................  A..............  ...............  Scratch resistant coating....  ...........  ...........  ...........  ...........  ...........
V2761.................  B..............  ...............  Mirror coating...............  ...........  ...........  ...........  ...........  ...........
V2762.................  A..............  ...............  Polarization, any lens.......  ...........  ...........  ...........  ...........  ...........
V2770.................  A..............  ...............  Occluder lens/es.............  ...........  ...........  ...........  ...........  ...........
V2780.................  A..............  ...............  Oversize lens/es.............  ...........  ...........  ...........  ...........  ...........
V2781.................  B..............  ...............  Progressive lens per lens....  ...........  ...........  ...........  ...........  ...........
V2782.................  A..............  ...............  Lens, 1.54-1.65 p/1.60-1.79g.  ...........  ...........  ...........  ...........  ...........
V2783.................  A..............  ...............  Lens, >= 1.66 p/>=1.80 g.....  ...........  ...........  ...........  ...........  ...........
V2784.................  A..............  ...............  Lens polycarb or equal.......  ...........  ...........  ...........  ...........  ...........
V2785.................  F..............  ...............  Corneal tissue processing....  ...........  ...........  ...........  ...........  ...........
V2786.................  A..............  ...............  Occupational multifocal lens.  ...........  ...........  ...........  ...........  ...........
V2790.................  N..............  ...............  Amniotic membrane............  ...........  ...........  ...........  ...........  ...........
V2797.................  A..............  ...............  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...  ...........  ...........  ...........  ...........  ...........

[[Page 42965]]

 
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...........  ...........  ...........  ...........  ...........  ...........
V5364.................  E..............  ...............  Dysphagia screening..........  ...........  ...........  ...........  ...........  ...........
--------------------------------------------------------------------------------------------------------------------------------------------------------
*Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule.
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. 70, No. 141 / Monday, July 25, 2005 / 
Proposed Rules  

[[Page 42966]]



         Addendum D1.--Payment Status Indicators for the Hospital Outpatient Prospective Payment System
----------------------------------------------------------------------------------------------------------------
     Indicator                    Item/code/service                             OPPS payment status
----------------------------------------------------------------------------------------------------------------
A.................  Services furnished to a hospital outpatient    Not paid under OPPS. Paid by fiscal
                     that are paid under a fee schedule or          intermediaries under a fee schedule or
                     payment system other than OPPS, for example:   payment system other than OPPS.
                     Ambulance Services..................
                     Clinical Diagnostic Laboratory
                     Services.
                     Non-Implantable Prosthetic and
                     Orthotic Devices.
                     EPO for ESRD Patients...............
                     Physical, Occupational, and Speech
                     Therapy.
                     Routine Dialysis Services for ESRD
                     Patients Provided in a Certified Dialysis
                     Unit of a Hospital.
                     Diagnostic Mammography..............
                     Screening Mammography...............
B.................  Codes that are not recognized by OPPS when     Not paid under OPPS
                     submitted on an outpatient hospital Part B     May be paid by intermediaries when
                     bill type (12x,13x, and 14x).                  submitted on a different bill type, for
                                                                    example, 75x (CORF), but not paid under
                                                                    OPPS.
                                                                    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.................  Discontinued Codes...........................  Not paid under OPPS.
E.................  Items, Codes, and Services:                    Not paid under OPPS.
                     That are not covered by Medicare
                     based on statutory exclusion.
                     That are not covered by Medicare for
                     reasons other than statutory exclusion.
                     That are not recognized by Medicare
                     but for which an alternate code for the same
                     item or service may be available.
                     For which separate payment is not
                     provided by Medicare.
F.................  Corneal Tissue Acquisition; Certain CRNA       Not paid under OPPS. Paid at reasonable cost.
                     Services and Hepatitis B Vaccines.
G.................  Pass-Through Drugs and Biologicals...........  Paid under OPPS; Separate APC payment
                                                                    includes pass[pi]through amount.
H.................  (1) Pass-Through Device Categories...........  Paid under OPPS;
                    (2) Brachytherapy Sources....................  (1) Separate cost-based pass-through payment.
                    (3) Radiopharmaceutical Agents...............  (2) Separate cost-based non-pass-through
                                                                    payment.
                                                                   (3) Separate cost-based non-pass-through
                                                                    payment.
K.................  Non-Pass-Through Drugs, Biologicals, and       Paid under OPPS; Separate APC payment.
                     Radiopharmaceuticals Agents.
L.................  Influenza Vaccine; Pneumococcal Pneumonia      Not paid under OPPS. Paid at reasonable cost;
                     Vaccine.                                       Not subject to deductible or coinsurance.
M.................  Items and Services Not Billable to the Fiscal  Not paid under OPPS.
                     Intermediary.
N.................  Items and Services Packaged into APC Rates...  Paid under OPPS; 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.
Q.................  Packaged Services Subject to Separate Payment  Paid under OPPS;
                     Based on Criteria.                            (1) Separate APC payment based on criteria.
                                                                   (2) If criteria are not met, payment is
                                                                    packaged into payment for other services,
                                                                    including outliers. Therefore, there is no
                                                                    separate APC payment.
S.................  Significant Service, Separately Payable......  Paid under OPPS; Separate APC payment.
T.................  Significant Procedure, Multiple Reduction      Paid under OPPS; Separate APC payment.
                     Applies.
V.................  Clinic or Emergency Department Visit.........  Paid under OPPS; Separate APC payment.
Y.................  Non-Implantable Durable Medical Equipment....  Not paid under OPPS. All institutional
                                                                    providers other than home health agencies
                                                                    bill to DMERC.
X.................  Ancillary Services...........................  Paid under OPPS; Separate APC payment.
----------------------------------------------------------------------------------------------------------------


                    Addendum D2.--Comment Indicators
------------------------------------------------------------------------
  Comment  indicator                       Descriptor
------------------------------------------------------------------------
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.
------------------------------------------------------------------------


[[Page 42967]]


    Addendum E.--CPT Codes That Are Paid Only as Inpatient Procedures
------------------------------------------------------------------------
                          Proposed  CY 2006
     CPT/  HCPCS          status  indicator           Description
------------------------------------------------------------------------
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
00546................  C.....................  Anesth, lung,chest wall
                                                surg
00560................  C.....................  Anesth, open heart
                                                surgery
00561................  C.....................  Anesth, heart surg < age
                                                1
00562................  C.....................  Anesth, open heart
                                                surgery
00580................  C.....................  Anesth, heart/lung
                                                transplnt
00604................  C.....................  Anesth, sitting procedure
00622................  C.....................  Anesth, removal of nerves
00632................  C.....................  Anesth, removal of nerves
00670................  C.....................  Anesth, spine, cord
                                                surgery
0075T................  C.....................  Perq stent/chest vert art
0076T................  C.....................  S&i stent/chest vert art
0077T................  C.....................  Cereb therm perfusion
                                                probe
0078T................  C.....................  Endovasc aort repr w/
                                                device
0079T................  C.....................  Endovasc visc extnsn repr
00792................  C.....................  Anesth, hemorr/excise
                                                liver
00794................  C.....................  Anesth, pancreas removal
00796................  C.....................  Anesth, for liver
                                                transplant
0080T................  C.....................  Endovasc aort repr rad
                                                s&i
00802................  C.....................  Anesth, fat layer removal
0081T................  C.....................  Endovasc visc extnsn s&i
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
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
01212................  C.....................  Anesth, hip
                                                disarticulation
01214................  C.....................  Anesth, hip arthroplasty
01232................  C.....................  Anesth, amputation of
                                                femur
01234................  C.....................  Anesth, radical femur
                                                surg
01272................  C.....................  Anesth, femoral artery
                                                surg
01274................  C.....................  Anesth, femoral
                                                embolectomy
01402................  C.....................  Anesth, knee arthroplasty
01404................  C.....................  Anesth, amputation at
                                                knee
01442................  C.....................  Anesth, knee artery surg
01444................  C.....................  Anesth, knee artery
                                                repair
01486................  C.....................  Anesth, ankle replacement
01502................  C.....................  Anesth, lwr leg
                                                embolectomy
01632................  C.....................  Anesth, surgery of
                                                shoulder
01634................  C.....................  Anesth, shoulder joint
                                                amput
01636................  C.....................  Anesth, forequarter amput
01638................  C.....................  Anesth, shoulder
                                                replacement
01652................  C.....................  Anesth, shoulder vessel
                                                surg
01654................  C.....................  Anesth, shoulder vessel
                                                surg
01656................  C.....................  Anesth, arm-leg vessel
                                                surg
01756................  C.....................  Anesth, radical humerus
                                                surg
01990................  C.....................  Support for organ donor
11004................  C.....................  Debride genitalia &
                                                perineum
11005................  C.....................  Debride abdom wall
11006................  C.....................  Debride genit/per/abdom
                                                wall
11008................  C.....................  Remove mesh from abd wall
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.....................  Escharotomy addl incision
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
20664................  C.....................  Halo brace application
20802................  C.....................  Replantation, arm,
                                                complete
20805................  C.....................  Replant forearm, complete
20808................  C.....................  Replantation hand,
                                                complete

[[Page 42968]]

 
20816................  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
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
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
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
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
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
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
21510................  C.....................  Drainage of bone lesion
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
22224................  C.....................  Revision of lumbar spine
22226................  C.....................  Revise, extra spine
                                                segment
22318................  C.....................  Treat odontoid fx w/o
                                                graft
22319................  C.....................  Treat odontoid fx w/graft
22325................  C.....................  Treat spine fracture
22326................  C.....................  Treat neck spine fracture
22327................  C.....................  Treat thorax spine
                                                fracture
22328................  C.....................  Treat each add spine fx
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

[[Page 42969]]

 
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
24900................  C.....................  Amputation of upper arm
24920................  C.....................  Amputation of upper arm
24930................  C.....................  Amputation follow-up
                                                surgery
24931................  C.....................  Amputate upper arm &
                                                implant
24940................  C.....................  Revision of upper arm
25900................  C.....................  Amputation of forearm
25905................  C.....................  Amputation of forearm
25909................  C.....................  Amputation follow-up
                                                surgery
25915................  C.....................  Amputation of forearm
25920................  C.....................  Amputate hand at wrist
25924................  C.....................  Amputation follow-up
                                                surgery
25927................  C.....................  Amputation of hand
25931................  C.....................  Amputation follow-up
                                                surgery
26551................  C.....................  Great toe-hand transfer
26553................  C.....................  Single transfer, toe-hand
26554................  C.....................  Double transfer, toe-hand
26556................  C.....................  Toe joint transfer
26992................  C.....................  Drainage of bone lesion
27005................  C.....................  Incision of hip tendon
27006................  C.....................  Incision of hip tendons
27025................  C.....................  Incision of hip/thigh
                                                fascia
27030................  C.....................  Drainage of hip joint
27036................  C.....................  Excision of hip joint/
                                                muscle
27054................  C.....................  Removal of hip joint
                                                lining
27070................  C.....................  Partial removal of hip
                                                bone
27071................  C.....................  Partial removal of hip
                                                bone
27075................  C.....................  Extensive hip surgery
27076................  C.....................  Extensive hip surgery
27077................  C.....................  Extensive hip surgery
27078................  C.....................  Extensive hip surgery
27079................  C.....................  Extensive hip surgery
27090................  C.....................  Removal of hip prosthesis
27091................  C.....................  Removal of hip prosthesis
27120................  C.....................  Reconstruction of hip
                                                socket
27122................  C.....................  Reconstruction of hip
                                                socket
27125................  C.....................  Partial hip replacement
27130................  C.....................  Total hip arthroplasty
27132................  C.....................  Total hip arthroplasty
27134................  C.....................  Revise hip joint
                                                replacement
27137................  C.....................  Revise hip joint
                                                replacement
27138................  C.....................  Revise hip joint
                                                replacement
27140................  C.....................  Transplant femur ridge
27146................  C.....................  Incision of hip bone
27147................  C.....................  Revision of hip bone
27151................  C.....................  Incision of hip bones
27156................  C.....................  Revision of hip bones
27158................  C.....................  Revision of pelvis
27161................  C.....................  Incision of neck of femur
27165................  C.....................  Incision/fixation of
                                                femur
27170................  C.....................  Repair/graft femur head/
                                                neck
27175................  C.....................  Treat slipped epiphysis
27176................  C.....................  Treat slipped epiphysis
27177................  C.....................  Treat slipped epiphysis
27178................  C.....................  Treat slipped epiphysis
27179................  C.....................  Revise head/neck of femur
27181................  C.....................  Treat slipped epiphysis
27185................  C.....................  Revision of femur
                                                epiphysis
27187................  C.....................  Reinforce hip bones
27215................  C.....................  Treat pelvic fracture(s)
27217................  C.....................  Treat pelvic ring
                                                fracture
27218................  C.....................  Treat pelvic ring
                                                fracture
27222................  C.....................  Treat hip socket fracture
27226................  C.....................  Treat hip wall fracture
27227................  C.....................  Treat hip fracture(s)
27228................  C.....................  Treat hip fracture(s)
27232................  C.....................  Treat thigh fracture
27236................  C.....................  Treat thigh fracture
27240................  C.....................  Treat thigh fracture
27244................  C.....................  Treat thigh fracture
27245................  C.....................  Treat thigh fracture
27248................  C.....................  Treat thigh fracture
27253................  C.....................  Treat hip dislocation
27254................  C.....................  Treat hip dislocation
27258................  C.....................  Treat hip dislocation
27259................  C.....................  Treat hip dislocation
27280................  C.....................  Fusion of sacroiliac
                                                joint
27282................  C.....................  Fusion of pubic bones
27284................  C.....................  Fusion of hip joint
27286................  C.....................  Fusion of hip joint
27290................  C.....................  Amputation of leg at hip
27295................  C.....................  Amputation of leg at hip
27303................  C.....................  Drainage of bone lesion
27365................  C.....................  Extensive leg surgery
27445................  C.....................  Revision of knee joint
27447................  C.....................  Total knee arthroplasty
27448................  C.....................  Incision of thigh
27450................  C.....................  Incision of thigh
27454................  C.....................  Realignment of thigh bone
27455................  C.....................  Realignment of knee
27457................  C.....................  Realignment of knee
27465................  C.....................  Shortening of thigh bone
27466................  C.....................  Lengthening of thigh bone
27468................  C.....................  Shorten/lengthen thighs
27470................  C.....................  Repair of thigh
27472................  C.....................  Repair/graft of thigh
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

[[Page 42970]]

 
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
31360................  C.....................  Removal of larynx
31365................  C.....................  Removal of larynx
31367................  C.....................  Partial removal of larynx
31368................  C.....................  Partial removal of larynx
31370................  C.....................  Partial removal of larynx
31375................  C.....................  Partial removal of larynx
31380................  C.....................  Partial removal of larynx
31382................  C.....................  Partial removal of larynx
31390................  C.....................  Removal of larynx &
                                                pharynx
31395................  C.....................  Reconstruct larynx &
                                                pharynx
31584................  C.....................  Treat larynx fracture
31587................  C.....................  Revision of larynx
31725................  C.....................  Clearance of airways
31760................  C.....................  Repair of windpipe
31766................  C.....................  Reconstruction of
                                                windpipe
31770................  C.....................  Repair/graft of bronchus
31775................  C.....................  Reconstruct bronchus
31780................  C.....................  Reconstruct windpipe
31781................  C.....................  Reconstruct windpipe
31786................  C.....................  Remove windpipe lesion
31800................  C.....................  Repair of windpipe injury
31805................  C.....................  Repair of windpipe injury
32035................  C.....................  Exploration of chest
32036................  C.....................  Exploration of chest
32095................  C.....................  Biopsy through chest wall
32100................  C.....................  Exploration/biopsy of
                                                chest
32110................  C.....................  Explore/repair chest
32120................  C.....................  Re-exploration of chest
32124................  C.....................  Explore chest free
                                                adhesions
32140................  C.....................  Removal of lung lesion(s)
32141................  C.....................  Remove/treat lung lesions
32150................  C.....................  Removal of lung lesion(s)
32151................  C.....................  Remove lung foreign body
32160................  C.....................  Open chest heart massage
32200................  C.....................  Drain, open, lung lesion
32215................  C.....................  Treat chest lining
32220................  C.....................  Release of lung
32225................  C.....................  Partial release of lung
32310................  C.....................  Removal of chest lining
32320................  C.....................  Free/remove chest lining
32402................  C.....................  Open biopsy chest lining
32440................  C.....................  Removal of lung
32442................  C.....................  Sleeve pneumonectomy
32445................  C.....................  Removal of lung
32480................  C.....................  Partial removal of lung
32482................  C.....................  Bilobectomy
32484................  C.....................  Segmentectomy
32486................  C.....................  Sleeve lobectomy
32488................  C.....................  Completion pneumonectomy
32491................  C.....................  Lung volume reduction
32500................  C.....................  Partial removal of lung
32501................  C.....................  Repair bronchus add-on
32520................  C.....................  Remove lung & revise
                                                chest
32522................  C.....................  Remove lung & revise
                                                chest
32525................  C.....................  Remove lung & revise
                                                chest
32540................  C.....................  Removal of lung lesion
32650................  C.....................  Thoracoscopy, surgical
32651................  C.....................  Thoracoscopy, surgical
32652................  C.....................  Thoracoscopy, surgical
32653................  C.....................  Thoracoscopy, surgical
32654................  C.....................  Thoracoscopy, surgical
32655................  C.....................  Thoracoscopy, surgical
32656................  C.....................  Thoracoscopy, surgical
32657................  C.....................  Thoracoscopy, surgical
32658................  C.....................  Thoracoscopy, surgical
32659................  C.....................  Thoracoscopy, surgical
32660................  C.....................  Thoracoscopy, surgical
32661................  C.....................  Thoracoscopy, surgical
32662................  C.....................  Thoracoscopy, surgical
32663................  C.....................  Thoracoscopy, surgical
32664................  C.....................  Thoracoscopy, surgical
32665................  C.....................  Thoracoscopy, surgical
32800................  C.....................  Repair lung hernia
32810................  C.....................  Close chest after
                                                drainage
32815................  C.....................  Close bronchial fistula
32820................  C.....................  Reconstruct injured chest
32850................  C.....................  Donor pneumonectomy
32851................  C.....................  Lung transplant, single
32852................  C.....................  Lung transplant with
                                                bypass
32853................  C.....................  Lung transplant, double
32854................  C.....................  Lung transplant with
                                                bypass
32855................  C.....................  Prepare donor lung,
                                                single
32856................  C.....................  Prepare donor lung,
                                                double
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

[[Page 42971]]

 
33245................  C.....................  Insert epic eltrd pace-
                                                defib
33246................  C.....................  Insert epic eltrd/
                                                generator
33250................  C.....................  Ablate heart dysrhythm
                                                focus
33251................  C.....................  Ablate heart dysrhythm
                                                focus
33253................  C.....................  Reconstruct atria
33261................  C.....................  Ablate heart dysrhythm
                                                focus
33300................  C.....................  Repair of heart wound
33305................  C.....................  Repair of heart wound
33310................  C.....................  Exploratory heart surgery
33315................  C.....................  Exploratory heart surgery
33320................  C.....................  Repair major blood
                                                vessel(s)
33321................  C.....................  Repair major vessel
33322................  C.....................  Repair major blood
                                                vessel(s)
33330................  C.....................  Insert major vessel graft
33332................  C.....................  Insert major vessel graft
33335................  C.....................  Insert major vessel graft
33400................  C.....................  Repair of aortic valve
33401................  C.....................  Valvuloplasty, open
33403................  C.....................  Valvuloplasty, w/cp
                                                bypass
33404................  C.....................  Prepare heart-aorta
                                                conduit
33405................  C.....................  Replacement of aortic
                                                valve
33406................  C.....................  Replacement of aortic
                                                valve
33410................  C.....................  Replacement of aortic
                                                valve
33411................  C.....................  Replacement of aortic
                                                valve
33412................  C.....................  Replacement of aortic
                                                valve
33413................  C.....................  Replacement of aortic
                                                valve
33414................  C.....................  Repair of aortic valve
33415................  C.....................  Revision, subvalvular
                                                tissue
33416................  C.....................  Revise ventricle muscle
33417................  C.....................  Repair of aortic valve
33420................  C.....................  Revision of mitral valve
33422................  C.....................  Revision of mitral valve
33425................  C.....................  Repair of mitral valve
33426................  C.....................  Repair of mitral valve
33427................  C.....................  Repair of mitral valve
33430................  C.....................  Replacement of mitral
                                                valve
33460................  C.....................  Revision of tricuspid
                                                valve
33463................  C.....................  Valvuloplasty, tricuspid
33464................  C.....................  Valvuloplasty, tricuspid
33465................  C.....................  Replace tricuspid valve
33468................  C.....................  Revision of tricuspid
                                                valve
33470................  C.....................  Revision of pulmonary
                                                valve
33471................  C.....................  Valvotomy, pulmonary
                                                valve
33472................  C.....................  Revision of pulmonary
                                                valve
33474................  C.....................  Revision of pulmonary
                                                valve
33475................  C.....................  Replacement, pulmonary
                                                valve
33476................  C.....................  Revision of heart chamber
33478................  C.....................  Revision of heart chamber
33496................  C.....................  Repair, prosth valve clot
33500................  C.....................  Repair heart vessel
                                                fistula
33501................  C.....................  Repair heart vessel
                                                fistula
33502................  C.....................  Coronary artery
                                                correction
33503................  C.....................  Coronary artery graft
33504................  C.....................  Coronary artery graft
33505................  C.....................  Repair artery w/tunnel
33506................  C.....................  Repair artery,
                                                translocation
33510................  C.....................  CABG, vein, single
33511................  C.....................  CABG, vein, two
33512................  C.....................  CABG, vein, three
33513................  C.....................  CABG, vein, four
33514................  C.....................  CABG, vein, five
33516................  C.....................  Cabg, vein, six or more
33517................  C.....................  CABG, artery-vein, single
33518................  C.....................  CABG, artery-vein, two
33519................  C.....................  CABG, artery-vein, three
33521................  C.....................  CABG, artery-vein, four
33522................  C.....................  CABG, artery-vein, five
33523................  C.....................  Cabg, art-vein, six or
                                                more
33530................  C.....................  Coronary artery, bypass/
                                                reop
33533................  C.....................  CABG, arterial, single
33534................  C.....................  CABG, arterial, two
33535................  C.....................  CABG, arterial, three
33536................  C.....................  Cabg, arterial, four or
                                                more
33542................  C.....................  Removal of heart lesion
33545................  C.....................  Repair of heart damage
33572................  C.....................  Open coronary
                                                endarterectomy
33600................  C.....................  Closure of valve
33602................  C.....................  Closure of valve
33606................  C.....................  Anastomosis/artery-aorta
33608................  C.....................  Repair anomaly w/conduit
33610................  C.....................  Repair by enlargement
33611................  C.....................  Repair double ventricle
33612................  C.....................  Repair double ventricle
33615................  C.....................  Repair, modified fontan
33617................  C.....................  Repair single ventricle
33619................  C.....................  Repair single ventricle
33641................  C.....................  Repair heart septum
                                                defect
33645................  C.....................  Revision of heart veins
33647................  C.....................  Repair heart septum
                                                defects
33660................  C.....................  Repair of heart defects
33665................  C.....................  Repair of heart defects
33670................  C.....................  Repair of heart chambers
33681................  C.....................  Repair heart septum
                                                defect
33684................  C.....................  Repair heart septum
                                                defect
33688................  C.....................  Repair heart septum
                                                defect
33690................  C.....................  Reinforce pulmonary
                                                artery
33692................  C.....................  Repair of heart defects
33694................  C.....................  Repair of heart defects
33697................  C.....................  Repair of heart defects
33702................  C.....................  Repair of heart defects
33710................  C.....................  Repair of heart defects
33720................  C.....................  Repair of heart defect
33722................  C.....................  Repair of heart defect
33730................  C.....................  Repair heart-vein
                                                defect(s)
33732................  C.....................  Repair heart-vein defect
33735................  C.....................  Revision of heart chamber
33736................  C.....................  Revision of heart chamber
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

[[Page 42972]]

 
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
33933................  C.....................  Prepare donor heart/lung
33935................  C.....................  Transplantation, heart/
                                                lung
33940................  C.....................  Removal of donor heart
33944................  C.....................  Prepare donor heart
33945................  C.....................  Transplantation of heart
33960................  C.....................  External circulation
                                                assist
33961................  C.....................  External circulation
                                                assist
33967................  C.....................  Insert ia percut device
33968................  C.....................  Remove aortic assist
                                                device
33970................  C.....................  Aortic circulation assist
33971................  C.....................  Aortic circulation assist
33973................  C.....................  Insert balloon device
33974................  C.....................  Remove intra-aortic
                                                balloon
33975................  C.....................  Implant ventricular
                                                device
33976................  C.....................  Implant ventricular
                                                device
33977................  C.....................  Remove ventricular device
33978................  C.....................  Remove ventricular device
33979................  C.....................  Insert intracorporeal
                                                device
33980................  C.....................  Remove intracorporeal
                                                device
34001................  C.....................  Removal of artery clot
34051................  C.....................  Removal of artery clot
34151................  C.....................  Removal of artery clot
34401................  C.....................  Removal of vein clot
34451................  C.....................  Removal of vein clot
34502................  C.....................  Reconstruct vena cava
34800................  C.....................  Endovasc abdo repair w/
                                                tube
34802................  C.....................  Endovasc abdo repr w/
                                                device
34803................  C.....................  Endovas aaa repr w/3-p
                                                part
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,
                                                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
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
35182................  C.....................  Repair blood vessel
                                                lesion
35189................  C.....................  Repair blood vessel
                                                lesion
35211................  C.....................  Repair blood vessel
                                                lesion
35216................  C.....................  Repair blood vessel
                                                lesion
35221................  C.....................  Repair blood vessel
                                                lesion
35241................  C.....................  Repair blood vessel
                                                lesion
35246................  C.....................  Repair blood vessel
                                                lesion
35251................  C.....................  Repair blood vessel
                                                lesion
35271................  C.....................  Repair blood vessel
                                                lesion
35276................  C.....................  Repair blood vessel
                                                lesion
35281................  C.....................  Repair blood vessel
                                                lesion
35301................  C.....................  Rechanneling of artery
35311................  C.....................  Rechanneling of artery
35331................  C.....................  Rechanneling of artery
35341................  C.....................  Rechanneling of artery
35351................  C.....................  Rechanneling of artery
35355................  C.....................  Rechanneling of artery
35361................  C.....................  Rechanneling of artery
35363................  C.....................  Rechanneling of artery
35371................  C.....................  Rechanneling of artery
35372................  C.....................  Rechanneling of artery
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

[[Page 42973]]

 
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
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
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
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)
37215................  C.....................  Transcath stent, cca w/
                                                eps
37216................  C.....................  Transcath stent, cca w/o
                                                eps
37616................  C.....................  Ligation of chest artery
37617................  C.....................  Ligation of abdomen
                                                artery
37618................  C.....................  Ligation of extremity
                                                artery
37660................  C.....................  Revision of major vein
37788................  C.....................  Revascularization, penis
38100................  C.....................  Removal of spleen, total
38101................  C.....................  Removal of spleen,
                                                partial
38102................  C.....................  Removal of spleen, total
38115................  C.....................  Repair of ruptured spleen
38380................  C.....................  Thoracic duct procedure
38381................  C.....................  Thoracic duct procedure
38382................  C.....................  Thoracic duct procedure
38562................  C.....................  Removal, pelvic lymph
                                                nodes
38564................  C.....................  Removal, abdomen lymph
                                                nodes
38724................  C.....................  Removal of lymph nodes,
                                                neck
38746................  C.....................  Remove thoracic lymph
                                                nodes
38747................  C.....................  Remove abdominal lymph
                                                nodes
38765................  C.....................  Remove groin lymph nodes
38770................  C.....................  Remove pelvis lymph nodes
38780................  C.....................  Remove abdomen lymph
                                                nodes
39000................  C.....................  Exploration of chest
39010................  C.....................  Exploration of chest
39200................  C.....................  Removal chest lesion
39220................  C.....................  Removal chest lesion
39499................  C.....................  Chest procedure
39501................  C.....................  Repair diaphragm
                                                laceration
39502................  C.....................  Repair paraesophageal
                                                hernia
39503................  C.....................  Repair of diaphragm
                                                hernia
39520................  C.....................  Repair of diaphragm
                                                hernia
39530................  C.....................  Repair of diaphragm
                                                hernia
39531................  C.....................  Repair of diaphragm
                                                hernia
39540................  C.....................  Repair of diaphragm
                                                hernia
39541................  C.....................  Repair of diaphragm
                                                hernia
39545................  C.....................  Revision of diaphragm
39560................  C.....................  Resect diaphragm, simple
39561................  C.....................  Resect diaphragm, complex
39599................  C.....................  Diaphragm surgery
                                                procedure
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

[[Page 42974]]

 
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
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
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
43644................  C.....................  Lap gastric bypass/roux-
                                                en-y
43645................  C.....................  Lap gastr bypass incl
                                                smll i
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
43845................  C.....................  Gastroplasty duodenal
                                                switch
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
44137................  C.....................  Remove intestinal
                                                allograft
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

[[Page 42975]]

 
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
44715................  C.....................  Prepare donor intestine
44720................  C.....................  Prep donor intestine/
                                                venous
44721................  C.....................  Prep donor intestine/
                                                artery
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
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
45550................  C.....................  Repair rectum/remove
                                                sigmoid
45562................  C.....................  Exploration/repair of
                                                rectum
45563................  C.....................  Exploration/repair of
                                                rectum
45800................  C.....................  Repair rect/bladder
                                                fistula
45805................  C.....................  Repair fistula w/
                                                colostomy
45820................  C.....................  Repair rectourethral
                                                fistula
45825................  C.....................  Repair fistula w/
                                                colostomy
46705................  C.....................  Repair of anal stricture
46715................  C.....................  Repair of anovaginal
                                                fistula
46716................  C.....................  Repair of anovaginal
                                                fistula
46730................  C.....................  Construction of absent
                                                anus
46735................  C.....................  Construction of absent
                                                anus
46740................  C.....................  Construction of absent
                                                anus
46742................  C.....................  Repair of imperforated
                                                anus
46744................  C.....................  Repair of cloacal anomaly
46746................  C.....................  Repair of cloacal anomaly
46748................  C.....................  Repair of cloacal anomaly
46751................  C.....................  Repair of anal sphincter
47010................  C.....................  Open drainage, liver
                                                lesion
47015................  C.....................  Inject/aspirate liver
                                                cyst
47100................  C.....................  Wedge biopsy of liver
47120................  C.....................  Partial removal of liver
47122................  C.....................  Extensive removal of
                                                liver
47125................  C.....................  Partial removal of liver
47130................  C.....................  Partial removal of liver
47133................  C.....................  Removal of donor liver
47135................  C.....................  Transplantation of liver
47136................  C.....................  Transplantation of liver
47140................  C.....................  Partial removal, donor
                                                liver
47141................  C.....................  Partial removal, donor
                                                liver
47142................  C.....................  Partial removal, donor
                                                liver
47143................  C.....................  Prep donor liver, whole
47144................  C.....................  Prep donor liver, 3-
                                                segment
47145................  C.....................  Prep donor liver, lobe
                                                split
47146................  C.....................  Prep donor liver/venous
47147................  C.....................  Prep donor liver/arterial
47300................  C.....................  Surgery for liver lesion
47350................  C.....................  Repair liver wound
47360................  C.....................  Repair liver wound
47361................  C.....................  Repair liver wound
47362................  C.....................  Repair liver wound
47380................  C.....................  Open ablate liver tumor
                                                rf
47381................  C.....................  Open ablate liver tumor
                                                cryo
47400................  C.....................  Incision of liver duct
47420................  C.....................  Incision of bile duct
47425................  C.....................  Incision of bile duct
47460................  C.....................  Incise bile duct
                                                sphincter
47480................  C.....................  Incision of gallbladder
47550................  C.....................  Bile duct endoscopy add-
                                                on
47570................  C.....................  Laparo
                                                cholecystoenterostomy
47600................  C.....................  Removal of gallbladder
47605................  C.....................  Removal of gallbladder
47610................  C.....................  Removal of gallbladder
47612................  C.....................  Removal of gallbladder
47620................  C.....................  Removal of gallbladder
47700................  C.....................  Exploration of bile ducts
47701................  C.....................  Bile duct revision
47711................  C.....................  Excision of bile duct
                                                tumor
47712................  C.....................  Excision of bile duct
                                                tumor
47715................  C.....................  Excision of bile duct
                                                cyst
47716................  C.....................  Fusion of bile duct cyst
47720................  C.....................  Fuse gallbladder & bowel
47721................  C.....................  Fuse upper gi structures
47740................  C.....................  Fuse gallbladder & bowel
47741................  C.....................  Fuse gallbladder & bowel
47760................  C.....................  Fuse bile ducts and bowel
47765................  C.....................  Fuse liver ducts & bowel

[[Page 42976]]

 
47780................  C.....................  Fuse bile ducts and bowel
47785................  C.....................  Fuse bile ducts and bowel
47800................  C.....................  Reconstruction of bile
                                                ducts
47801................  C.....................  Placement, bile duct
                                                support
47802................  C.....................  Fuse liver duct &
                                                intestine
47900................  C.....................  Suture bile duct injury
48000................  C.....................  Drainage of abdomen
48001................  C.....................  Placement of drain,
                                                pancreas
48005................  C.....................  Resect/debride pancreas
48020................  C.....................  Removal of pancreatic
                                                stone
48100................  C.....................  Biopsy of pancreas, open
48120................  C.....................  Removal of pancreas
                                                lesion
48140................  C.....................  Partial removal of
                                                pancreas
48145................  C.....................  Partial removal of
                                                pancreas
48146................  C.....................  Pancreatectomy
48148................  C.....................  Removal of pancreatic
                                                duct
48150................  C.....................  Partial removal of
                                                pancreas
48152................  C.....................  Pancreatectomy
48153................  C.....................  Pancreatectomy
48154................  C.....................  Pancreatectomy
48155................  C.....................  Removal of pancreas
48180................  C.....................  Fuse pancreas and bowel
48400................  C.....................  Injection, intraop add-on
48500................  C.....................  Surgery of pancreatic
                                                cyst
48510................  C.....................  Drain pancreatic
                                                pseudocyst
48520................  C.....................  Fuse pancreas cyst and
                                                bowel
48540................  C.....................  Fuse pancreas cyst and
                                                bowel
48545................  C.....................  Pancreatorrhaphy
48547................  C.....................  Duodenal exclusion
48551................  C.....................  Prep donor pancreas
48552................  C.....................  Prep donor pancreas/
                                                venous
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
49040................  C.....................  Drain, open, abdom
                                                abscess
49060................  C.....................  Drain, open, retrop
                                                abscess
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
50040................  C.....................  Drainage of kidney
50045................  C.....................  Exploration of kidney
50060................  C.....................  Removal of kidney stone
50065................  C.....................  Incision of kidney
50070................  C.....................  Incision of kidney
50075................  C.....................  Removal of kidney stone
50100................  C.....................  Revise kidney blood
                                                vessels
50120................  C.....................  Exploration of kidney
50125................  C.....................  Explore and drain kidney
50130................  C.....................  Removal of kidney stone
50135................  C.....................  Exploration of kidney
50205................  C.....................  Biopsy of kidney
50220................  C.....................  Remove kidney, open
50225................  C.....................  Removal kidney open,
                                                complex
50230................  C.....................  Removal kidney open,
                                                radical
50234................  C.....................  Removal of kidney &
                                                ureter
50236................  C.....................  Removal of kidney &
                                                ureter
50240................  C.....................  Partial removal of kidney
50280................  C.....................  Removal of kidney lesion
50290................  C.....................  Removal of kidney lesion
50300................  C.....................  Removal of donor kidney
50320................  C.....................  Removal of donor kidney
50323................  C.....................  Prep cadaver renal
                                                allograft
50325................  C.....................  Prep donor renal graft
50327................  C.....................  Prep renal graft/venous
50328................  C.....................  Prep renal graft/arterial
50329................  C.....................  Prep renal graft/ureteral
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 w/ ureter
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

[[Page 42977]]

 
50810................  C.....................  Fusion of ureter & bowel
50815................  C.....................  Urine shunt to intestine
50820................  C.....................  Construct bowel bladder
50825................  C.....................  Construct bowel bladder
50830................  C.....................  Revise urine flow
50840................  C.....................  Replace ureter by bowel
50845................  C.....................  Appendico-vesicostomy
50860................  C.....................  Transplant ureter to skin
50900................  C.....................  Repair of ureter
50920................  C.....................  Closure ureter/skin
                                                fistula
50930................  C.....................  Closure ureter/bowel
                                                fistula
50940................  C.....................  Release of ureter
51060................  C.....................  Removal of ureter stone
51525................  C.....................  Removal of bladder lesion
51530................  C.....................  Removal of bladder lesion
51535................  C.....................  Repair of ureter lesion
51550................  C.....................  Partial removal of
                                                bladder
51555................  C.....................  Partial removal of
                                                bladder
51565................  C.....................  Revise bladder &
                                                ureter(s)
51570................  C.....................  Removal of bladder
51575................  C.....................  Removal of bladder &
                                                nodes
51580................  C.....................  Remove bladder/revise
                                                tract
51585................  C.....................  Removal of bladder &
                                                nodes
51590................  C.....................  Remove bladder/revise
                                                tract
51595................  C.....................  Remove bladder/revise
                                                tract
51596................  C.....................  Remove bladder/create
                                                pouch
51597................  C.....................  Removal of pelvic
                                                structures
51800................  C.....................  Revision of bladder/
                                                urethra
51820................  C.....................  Revision of urinary tract
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
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
54650................  C.....................  Orchiopexy (Fowler-
                                                Stephens)
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
57283................  C.....................  Colpopexy,
                                                intraperitoneal
57292................  C.....................  Construct vagina with
                                                graft
57305................  C.....................  Repair rectum-vagina
                                                fistula
57307................  C.....................  Fistula repair &
                                                colostomy
57308................  C.....................  Fistula repair,
                                                transperine
57311................  C.....................  Repair urethrovaginal
                                                lesion
57335................  C.....................  Repair vagina
57531................  C.....................  Removal of cervix,
                                                radical
57540................  C.....................  Removal of residual
                                                cervix
57545................  C.....................  Remove cervix/repair
                                                pelvis
58140................  C.....................  Removal of uterus lesion
58146................  C.....................  Myomectomy abdom complex
58150................  C.....................  Total hysterectomy
58152................  C.....................  Total hysterectomy
58180................  C.....................  Partial hysterectomy
58200................  C.....................  Extensive hysterectomy
58210................  C.....................  Extensive hysterectomy
58240................  C.....................  Removal of pelvis
                                                contents
58260................  C.....................  Vaginal hysterectomy
58262................  C.....................  Vag hyst including t/o
58263................  C.....................  Vag hyst w/t/o & vag
                                                repair
58267................  C.....................  Vag hyst w/urinary repair
58270................  C.....................  Vag hyst w/enterocele
                                                repair
58275................  C.....................  Hysterectomy/revise
                                                vagina
58280................  C.....................  Hysterectomy/revise
                                                vagina
58285................  C.....................  Extensive hysterectomy
58290................  C.....................  Vag hyst complex
58291................  C.....................  Vag hyst incl t/o,
                                                complex
58292................  C.....................  Vag hyst t/o & repair,
                                                compl
58293................  C.....................  Vag hyst w/uro repair,
                                                compl
58294................  C.....................  Vag hyst w/enterocele,
                                                compl
58400................  C.....................  Suspension of uterus
58410................  C.....................  Suspension of uterus
58520................  C.....................  Repair of ruptured uterus

[[Page 42978]]

 
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
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
58956................  C.....................  Bso, omentectomy w/tah
58960................  C.....................  Exploration of abdomen
59120................  C.....................  Treat ectopic pregnancy
59121................  C.....................  Treat ectopic pregnancy
59130................  C.....................  Treat ectopic pregnancy
59135................  C.....................  Treat ectopic pregnancy
59136................  C.....................  Treat ectopic pregnancy
59140................  C.....................  Treat ectopic pregnancy
59325................  C.....................  Revision of cervix
59350................  C.....................  Repair of uterus
59514................  C.....................  Cesarean delivery only
59525................  C.....................  Remove uterus after
                                                cesarean
59620................  C.....................  Attempted vbac delivery
                                                only
59830................  C.....................  Treat uterus infection
59850................  C.....................  Abortion
59851................  C.....................  Abortion
59852................  C.....................  Abortion
59855................  C.....................  Abortion
59856................  C.....................  Abortion
59857................  C.....................  Abortion
60254................  C.....................  Extensive thyroid surgery
60270................  C.....................  Removal of thyroid
60271................  C.....................  Removal of thyroid
60502................  C.....................  Re-explore parathyroids
60505................  C.....................  Explore parathyroid
                                                glands
60520................  C.....................  Removal of thymus gland
60521................  C.....................  Removal of thymus gland
60522................  C.....................  Removal of thymus gland
60540................  C.....................  Explore adrenal gland
60545................  C.....................  Explore adrenal gland
60600................  C.....................  Remove carotid body
                                                lesion
60605................  C.....................  Remove carotid body
                                                lesion
60650................  C.....................  Laparoscopy adrenalectomy
61105................  C.....................  Twist drill hole
61107................  C.....................  Drill skull for
                                                implantation
61108................  C.....................  Drill skull for drainage
61120................  C.....................  Burr hole for puncture
61140................  C.....................  Pierce skull for biopsy
61150................  C.....................  Pierce skull for drainage
61151................  C.....................  Pierce skull for drainage
61154................  C.....................  Pierce skull & remove
                                                clot
61156................  C.....................  Pierce skull for drainage
61210................  C.....................  Pierce skull, implant
                                                device
61250................  C.....................  Pierce skull & explore
61253................  C.....................  Pierce skull & explore
61304................  C.....................  Open skull for
                                                exploration
61305................  C.....................  Open skull for
                                                exploration
61312................  C.....................  Open skull for drainage
61313................  C.....................  Open skull for drainage
61314................  C.....................  Open skull for drainage
61315................  C.....................  Open skull for drainage
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
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.....................  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

[[Page 42979]]

 
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
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, add'l
                                                cervical
63044................  C.....................  Laminotomy, add'l lumbar
63050................  C.....................  Cervical laminoplasty
63051................  C.....................  C-laminoplasty w/graft/
                                                plate
63075................  C.....................  Neck spine disk surgery
63076................  C.....................  Neck spine disk surgery
63077................  C.....................  Spine disk surgery,
                                                thorax

[[Page 42980]]

 
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.....................  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
63295................  C.....................  Repair of laminectomy
                                                defect
63300................  C.....................  Removal of vertebral body
63301................  C.....................  Removal of vertebral body
63302................  C.....................  Removal of vertebral body
63303................  C.....................  Removal of vertebral body
63304................  C.....................  Removal of vertebral body
63305................  C.....................  Removal of vertebral body
63306................  C.....................  Removal of vertebral body
63307................  C.....................  Removal of vertebral body
63308................  C.....................  Remove vertebral body add-
                                                on
63700................  C.....................  Repair of spinal
                                                herniation
63702................  C.....................  Repair of spinal
                                                herniation
63704................  C.....................  Repair of spinal
                                                herniation
63706................  C.....................  Repair of spinal
                                                herniation
63707................  C.....................  Repair spinal fluid
                                                leakage
63709................  C.....................  Repair spinal fluid
                                                leakage
63710................  C.....................  Graft repair of spine
                                                defect
63740................  C.....................  Install spinal shunt
64752................  C.....................  Incision of vagus nerve
64755................  C.....................  Incision of stomach
                                                nerves
64760................  C.....................  Incision of vagus nerve
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

[[Page 42981]]

 
G0341................  C.....................  Percutaneous islet cell
                                                trans
G0342................  C.....................  Laparoscopy Islet cell
                                                Trans
G0343................  C.....................  Laparotomy Islet cell
                                                tranp
------------------------------------------------------------------------


                                 Addendum H.--Wage Index for Urban Areas by CBSA
----------------------------------------------------------------------------------------------------------------
                                                                                                          Wage
                  CBSA code                              Urban area (constituent counties)               index
----------------------------------------------------------------------------------------------------------------
10180.......................................  \2\ Abilene, TX........................................     0.8038
                                              Callahan County, TX
                                              Jones County, TX
                                              Taylor County, TX
10380.......................................  Aguadilla-Isabela-San Sebastian, PR....................     0.4736
                                              Aguada Municipio, PR
                                              Aguadilla Municipio, PR
                                              Anasco Municipio, PR
                                              Isabela Municipio, PR
                                              Lares Municipio, PR
                                              Moca Municipio, PR
                                              Rincon Municipio, PR
                                              San Sebastian Municipio, PR
10420.......................................  Akron, OH..............................................     0.8979
                                              Portage County, OH
                                              Summit County, OH
10500.......................................  Albany, GA.............................................     0.8645
                                              Baker County, GA
                                              Dougherty County, GA
                                              Lee County, GA
                                              Terrell County, GA
                                              Worth County, GA
10580.......................................  Albany-Schenectady-Troy, NY............................     0.8565
                                              Albany County, NY
                                              Rensselaer County, NY
                                              Saratoga County, NY
                                              Schenectady County, NY
                                              Schoharie County, NY
10740.......................................  Albuquerque, NM........................................     0.9696
                                              Bernalillo County, NM
                                              Sandoval County, NM
                                              Torrance County, NM
                                              Valencia County, NM
10780.......................................  Alexandria, LA.........................................     0.8048
                                              Grant Parish, LA
                                              Rapides Parish, LA
10900.......................................  Allentown-Bethlehem-Easton, PA-NJ (PA Hospitals).......     0.9844
                                              Warren County, NJ
                                              Carbon County, PA
                                              Lehigh County, PA
                                              Northampton County, PA
10900.......................................  \2\ Allentown-Bethlehem-Easton, PA-NJ (NJ Hospitals)...     1.1253
                                              Warren County, NJ
                                              Carbon County, PA
                                              Lehigh County, PA
                                              Northampton County, PA
11020.......................................  Altoona, PA............................................     0.8942
                                              Blair County, PA
11100.......................................  Amarillo, TX...........................................     0.9165
                                              Armstrong County, TX
                                              Carson County, TX
                                              Potter County, TX
                                              Randall County, TX
11180.......................................  Ames, IA...............................................     0.9546
                                              Story County, IA
11260.......................................  Anchorage, AK..........................................     1.2110
                                              Anchorage Municipality, AK
                                              Matanuska-Susitna Borough, AK

[[Page 42982]]

 
11300.......................................  Anderson, IN...........................................     0.8634
                                              Madison County, IN
11340.......................................  Anderson, SC...........................................     0.8887
                                              Anderson County, SC
11460.......................................  Ann Arbor, MI..........................................     1.0885
                                              Washtenaw County, MI
11500.......................................  Anniston-Oxford, AL....................................     0.7702
                                              Calhoun County, AL
11540.......................................  \2\ Appleton, WI.......................................     0.9478
                                              Calumet County, WI
                                              Outagamie County, WI
11700.......................................  Asheville, NC..........................................     0.9312
                                              Buncombe County, NC
                                              Haywood County, NC
                                              Henderson County, NC
                                              Madison County, NC
12020.......................................  Athens-Clarke County, GA...............................     0.9813
                                              Clarke County, GA
                                              Madison County, GA
                                              Oconee County, GA
                                              Oglethorpe County, GA
12060.......................................  \1\ Atlanta-Sandy Springs-Marietta, GA.................     0.9637
                                              Barrow County, GA
                                              Bartow County, GA
                                              Butts County, GA
                                              Carroll County, GA
                                              Cherokee County, GA
                                              Clayton County, GA
                                              Cobb County, GA
                                              Coweta County, GA
                                              Dawson County, GA
                                              DeKalb County, GA
                                              Douglas County, GA
                                              Fayette County, GA
                                              Forsyth County, GA
                                              Fulton County, GA
                                              Gwinnett County, GA
                                              Haralson County, GA
                                              Heard County, GA
                                              Henry County, GA
                                              Jasper County, GA
                                              Lamar County, GA
                                              Meriwether County, GA
                                              Newton County, GA
                                              Paulding County, GA
                                              Pickens County, GA
                                              Pike County, GA
                                              Rockdale County, GA
                                              Spalding County, GA
                                              Walton County, GA
12100.......................................  Atlantic City, NJ......................................     1.1618
                                              Atlantic County, NJ
12220.......................................  Auburn-Opelika, AL.....................................     0.8113
                                              Lee County, AL
12260.......................................  Augusta-Richmond County, GA-SC.........................     0.9567
                                              Burke County, GA
                                              Columbia County, GA
                                              McDuffie County, GA
                                              Richmond County, GA
                                              Aiken County, SC
                                              Edgefield County, SC
12420.......................................  \1\ Austin-Round Rock, TX..............................     0.9451
                                              Bastrop County, TX
                                              Caldwell County, TX
                                              Hays County, TX
                                              Travis County, TX
                                              Williamson County, TX
12540.......................................  \1\ Bakersfield, CA....................................     1.0848
                                              Kern County, CA
12580.......................................  \1\ Baltimore-Towson, MD...............................     0.9892
                                              Anne Arundel County, MD

[[Page 42983]]

 
                                              Baltimore County, MD
                                              Carroll County, MD
                                              Harford County, MD
                                              Howard County, MD
                                              Queen Anne's County, MD
                                              Baltimore City, MD
12620.......................................  Bangor, ME.............................................     0.9985
                                              Penobscot County, ME
12700.......................................  Barnstable Town, MA....................................     1.2518
                                              Barnstable County, MA
12940.......................................  Baton Rouge, LA........................................     0.8605
                                              Ascension Parish, LA
                                              East Baton Rouge Parish, LA
                                              East Feliciana Parish, LA
                                              Iberville Parish, LA
                                              Livingston Parish, LA
                                              Pointe Coupee Parish, LA
                                              St. Helena Parish, LA
                                              West Baton Rouge Parish, LA
                                              West Feliciana Parish, LA
12980.......................................  Battle Creek, MI.......................................     0.9492
                                              Calhoun County, MI
13020.......................................  Bay City, MI...........................................     0.9535
                                              Bay County, MI
13140.......................................  Beaumont-Port Arthur, TX...............................     0.8422
                                              Hardin County, TX
                                              Jefferson County, TX
                                              Orange County, TX
13380.......................................  Bellingham, WA.........................................     1.1705
                                              Whatcom County, WA
13460.......................................  Bend, OR...............................................     1.0783
                                              Deschutes County, OR
13644.......................................  \1\ Bethesda-Gaithersburg-Frederick, MD................     1.1471
                                              Frederick County, MD
                                              Montgomery County, MD
13740.......................................  Billings, MT...........................................     0.8855
                                              Carbon County, MT
                                              Yellowstone County, MT
13780.......................................  Binghamton, NY.........................................     0.8588
                                              Broome County, NY
                                              Tioga County, NY
13820.......................................  \1\ Birmingham-Hoover, AL..............................     0.8979
                                              Bibb County, AL
                                              Blount County, AL
                                              Chilton County, AL
                                              Jefferson County, AL
                                              St. Clair County, AL
                                              Shelby County, AL
                                              Walker County, AL
13900.......................................  Bismarck, ND...........................................     0.7519
                                              Burleigh County, ND
                                              Morton County, ND
13980.......................................  \2\ Blacksburg-Christiansburg-Radford, VA..............     0.8024
                                              Giles County, VA
                                              Montgomery County, VA
                                              Pulaski County, VA
                                              Radford City, VA
14020.......................................  \2\ Bloomington, IN....................................     0.8632
                                              Greene County, IN
                                              Monroe County, IN
                                              Owen County, IN
14060.......................................  Bloomington-Normal, IL.................................     0.9083
                                              McLean County, IL
14260.......................................  Boise City-Nampa, ID...................................     0.9048
                                              Ada County, ID
                                              Boise County, ID
                                              Canyon County, ID
                                              Gem County, ID
                                              Owyhee County, ID
14484.......................................  \1\ Boston-Quincy, MA..................................     1.1537
                                              Norfolk County, MA

[[Page 42984]]

 
                                              Plymouth County, MA
                                              Suffolk County, MA
14500.......................................  Boulder, CO............................................     0.9743
                                              Boulder County, CO
14540.......................................  Bowling Green, KY......................................     0.8222
                                              Edmonson County, KY
                                              Warren County, KY
14740.......................................  Bremerton-Silverdale, WA...............................     1.0681
                                              Kitsap County, WA
14860.......................................  Bridgeport-Stamford-Norwalk, CT........................     1.2607
                                              Fairfield County, CT
15180.......................................  Brownsville-Harlingen, TX..............................     0.9853
                                              Cameron County, TX
15260.......................................  Brunswick, GA..........................................     0.9341
                                              Brantley County, GA
                                              Glynn County, GA
                                              McIntosh County, GA
15380.......................................  \1\ Buffalo-Niagara Falls, NY..........................     0.8888
                                              Erie County, NY
                                              Niagara County, NY
15500.......................................  Burlington, NC.........................................     0.8902
                                              Alamance County, NC
15540.......................................  \2\ Burlington-South Burlington, VT....................     1.0199
                                              Chittenden County, VT
                                              Franklin County, VT
                                              Grand Isle County, VT
15764.......................................  \1\ Cambridge-Newton-Framingham, MA....................     1.1078
                                              Middlesex County, MA
15804.......................................  1, 2 Camden, NJ........................................     1.1253
                                              Burlington County, NJ
                                              Camden County, NJ
                                              Gloucester County, NJ
15940.......................................  Canton-Massillon, OH...................................     0.8957
                                              Carroll County, OH
                                              Stark County, OH
15980.......................................  Cape Coral-Fort Myers, FL..............................     0.9333
                                              Lee County, FL
16180.......................................  Carson City, NV........................................     1.0229
                                              Carson City, NV
16220.......................................  \2\ Casper, WY.........................................     0.9207
                                              Natrona County, WY
16300.......................................  Cedar Rapids, IA.......................................     0.8605
                                              Benton County, IA
                                              Jones County, IA
                                              Linn County, IA
16580.......................................  Champaign-Urbana, IL...................................     0.9591
                                              Champaign County, IL
                                              Ford County, IL
                                              Piatt County, IL
16620.......................................  Charleston, WV.........................................     0.8429
                                              Boone County, WV
                                              Clay County, WV
                                              Kanawha County, WV
                                              Lincoln County, WV
                                              Putnam County, WV
16700.......................................  Charleston-North Charleston, SC........................     0.9433
                                              Berkeley County, SC
                                              Charleston County, SC
                                              Dorchester County, SC
16740.......................................  \1\ Charlotte-Gastonia-Concord, NC-SC..................     0.9717
                                              Anson County, NC
                                              Cabarrus County, NC
                                              Gaston County, NC
                                              Mecklenburg County, NC
                                              Union County, NC
                                              York County, SC
16820.......................................  Charlottesville, VA....................................     1.0230
                                              Albemarle County, VA
                                              Fluvanna County, VA
                                              Greene County, VA
                                              Nelson County, VA

[[Page 42985]]

 
                                              Charlottesville City, VA
16860.......................................  Chattanooga, TN-GA.....................................     0.9099
                                              Catoosa County, GA
                                              Dade County, GA
                                              Walker County, GA
                                              Hamilton County, TN
                                              Marion County, TN
                                              Sequatchie County, TN
16940.......................................  \2\ Cheyenne, WY.......................................     0.9207
                                              Laramie County, WY
16974.......................................  \1\ Chicago-Naperville-Joliet, IL......................     1.0846
                                              Cook County, IL
                                              DeKalb County, IL
                                              DuPage County, IL
                                              Grundy County, IL
                                              Kane County, IL
                                              Kendall County, IL
                                              McHenry County, IL
                                              Will County, IL
17020.......................................  \2\ Chico, CA..........................................     1.0848
                                              Butte County, CA
17140.......................................  \1\ Cincinnati-Middletown, OH-KY-IN....................     0.9604
                                              Dearborn County, IN
                                              Franklin County, IN
                                              Ohio County, IN
                                              Boone County, KY
                                              Bracken County, KY
                                              Campbell County, KY
                                              Gallatin County, KY
                                              Grant County, KY
                                              Kenton County, KY
                                              Pendleton County, KY
                                              Brown County, OH
                                              Butler County, OH
                                              Clermont County, OH
                                              Hamilton County, OH
                                              Warren County, OH
17300.......................................  Clarksville, TN-KY.....................................     0.8272
                                              Christian County, KY
                                              Trigg County, KY
                                              Montgomery County, TN
                                              Stewart County, TN
17420.......................................  Cleveland, TN..........................................     0.8160
                                              Bradley County, TN
                                              Polk County, TN
17460.......................................  \1\ Cleveland-Elyria-Mentor, OH........................     0.9197
                                              Cuyahoga County, OH
                                              Geauga County, OH
                                              Lake County, OH
                                              Lorain County, OH
                                              Medina County, OH
17660.......................................  Coeur d'Alene, ID......................................     0.9642
                                              Kootenai County, ID
17780.......................................  College Station-Bryan, TX..............................     0.8911
                                              Brazos County, TX
                                              Burleson County, TX
                                              Robertson County, TX
17820.......................................  Colorado Springs, CO...................................     0.9457
                                              El Paso County, CO
                                              Teller County, CO
17860.......................................  Columbia, MO...........................................     0.8346
                                              Boone County, MO
                                              Howard County, MO
17900.......................................  Columbia, SC...........................................     0.9057
                                              Calhoun County, SC
                                              Fairfield County, SC
                                              Kershaw County, SC
                                              Lexington County, SC
                                              Richland County, SC
                                              Saluda County, SC
17980.......................................  Columbus, GA-AL........................................     0.8570

[[Page 42986]]

 
                                              Russell County, AL
                                              Chattahoochee County, GA
                                              Harris County, GA
                                              Marion County, GA
                                              Muscogee County, GA
18020.......................................  Columbus, IN...........................................     0.9596
                                              Bartholomew County, IN
18140.......................................  \1\ Columbus, OH.......................................     0.9848
                                              Delaware County, OH
                                              Fairfield County, OH
                                              Franklin County, OH
                                              Licking County, OH
                                              Madison County, OH
                                              Morrow County, OH
                                              Pickaway County, OH
                                              Union County, OH
18580.......................................  Corpus Christi, TX.....................................     0.8557
                                              Aransas County, TX
                                              Nueces County, TX
                                              San Patricio County, TX
18700.......................................  Corvallis, OR..........................................     1.0711
                                              Benton County, OR
19060.......................................  Cumberland, MD-WV......................................     0.9310
                                              Allegany County, MD
                                              Mineral County, WV
19124.......................................  \1\ Dallas-Plano-Irving, TX............................     1.0226
                                              Collin County, TX
                                              Dallas County, TX
                                              Delta County, TX
                                              Denton County, TX
                                              Ellis County, TX
                                              Hunt County, TX
                                              Kaufman County, TX
                                              Rockwall County, TX
19140.......................................  Dalton, GA.............................................     0.9033
                                              Murray County, GA
                                              Whitfield County, GA
19180.......................................  Danville, IL...........................................     0.9048
                                              Vermilion County, IL
19260.......................................  Danville, VA...........................................     0.8514
                                              Pittsylvania County, VA
                                              Danville City, VA
19340.......................................  Davenport-Moline-Rock Island, IA-IL....................     0.8716
                                              Henry County, IL
                                              Mercer County, IL
                                              Rock Island County, IL
                                              Scott County, IA
19380.......................................  Dayton, OH.............................................     0.9069
                                              Greene County, OH
                                              Miami County, OH
                                              Montgomery County, OH
                                              Preble County, OH
19460.......................................  Decatur, AL............................................     0.8517
                                              Lawrence County, AL
                                              Morgan County, AL
19500.......................................  \2\ Decatur, IL........................................     0.8285
                                              Macon County, IL
19660.......................................  Deltona-Daytona Beach-Ormond Beach, FL.................     0.9307
                                              Volusia County, FL
19740.......................................  \1\ Denver-Aurora, CO..................................     1.0710
                                              Adams County, CO
                                              Arapahoe County, CO
                                              Broomfield County, CO
                                              Clear Creek County, CO
                                              Denver County, CO
                                              Douglas County, CO
                                              Elbert County, CO
                                              Gilpin County, CO
                                              Jefferson County, CO
                                              Park County, CO
19780.......................................  Des Moines, IA.........................................     0.9650

[[Page 42987]]

 
                                              Dallas County, IA
                                              Guthrie County, IA
                                              Madison County, IA
                                              Polk County, IA
                                              Warren County, IA
19804.......................................  \1\ Detroit-Livonia-Dearborn, MI.......................     1.0453
                                              Wayne County, MI
20020.......................................  Dothan, AL.............................................     0.7743
                                              Geneva County, AL
                                              Henry County, AL
                                              Houston County, AL
20100.......................................  Dover, DE..............................................     0.9821
                                              Kent County, DE
20220.......................................  Dubuque, IA............................................     0.9116
                                              Dubuque County, IA
20260.......................................  Duluth, MN-WI..........................................     1.0224
                                              Carlton County, MN
                                              St. Louis County, MN
                                              Douglas County, WI
20500.......................................  Durham, NC.............................................     1.0260
                                              Chatham County, NC
                                              Durham County, NC
                                              Orange County, NC
                                              Person County, NC
20740.......................................  \2\ Eau Claire, WI.....................................     0.9478
                                              Chippewa County, WI
                                              Eau Claire County, WI
20764.......................................  \1\ Edison, NJ.........................................     1.1301
                                              Middlesex County, NJ
                                              Monmouth County, NJ
                                              Ocean County, NJ
                                              Somerset County, NJ
20940.......................................  \2\ El Centro, CA......................................     1.0848
                                              Imperial County, CA
21060.......................................  Elizabethtown, KY......................................     0.8816
                                              Hardin County, KY
                                              Larue County, KY
21140.......................................  Elkhart-Goshen, IN.....................................     0.9616
                                              Elkhart County, IN
21300.......................................  Elmira, NY.............................................     0.8276
                                              Chemung County, NY
21340.......................................  El Paso, TX............................................     0.8954
                                              El Paso County, TX
21500.......................................  Erie, PA...............................................     0.8746
                                              Erie County, PA
21604.......................................  Essex County, MA.......................................     1.0679
                                              Essex County, MA
21660.......................................  Eugene-Springfield, OR.................................     1.0810
                                              Lane County, OR
21780.......................................  Evansville, IN-KY......................................     0.8735
                                              Gibson County, IN
                                              Posey County, IN
                                              Vanderburgh County, IN
                                              Warrick County, IN
                                              Henderson County, KY
                                              Webster County, KY
21820.......................................  \2\ Fairbanks, AK......................................     1.1977
                                              Fairbanks North Star Borough, AK
21940.......................................  Fajardo, PR............................................     0.4160
                                              Ceiba Municipio, PR
                                              Fajardo Municipio, PR
                                              Luquillo Municipio, PR
22020.......................................  Fargo, ND-MN (ND Hospitals)............................     0.8778
                                              Clay County, MN
                                              Cass County, ND
22020.......................................  \2\ Fargo, ND-MN (MN Hospitals)........................     0.9183
                                              Clay County, MN
                                              Cass County, ND
22140.......................................  \2\ Farmington, NM.....................................     0.8649
                                              San Juan County, NM
22180.......................................  Fayetteville, NC.......................................     0.9426

[[Page 42988]]

 
                                              Cumberland County, NC
                                              Hoke County, NC
22220.......................................  Fayetteville-Springdale-Rogers, AR-MO..................     0.8615
                                              Benton County, AR
                                              Madison County, AR
                                              Washington County, AR
                                              McDonald County, MO
22380.......................................  Flagstaff, AZ..........................................     1.2094
                                              Coconino County, AZ
22420.......................................  Flint, MI..............................................
                                              Genesee County, MI                                          1.0654
22500.......................................  Florence, SC...........................................     0.8988
                                              Darlington County, SC
                                              Florence County, SC
22520.......................................  Florence-Muscle Shoals, AL.............................     0.8305
                                              Colbert County, AL
                                              Lauderdale County, AL
22540.......................................  Fond du Lac, WI........................................     0.9649
                                              Fond du Lac County, WI
22660.......................................  Fort Collins-Loveland, CO..............................     1.0146
                                              Larimer County, CO
22744.......................................  \1\ Fort Lauderdale-Pompano Beach-Deerfield Beach, FL..     1.0508
                                              Broward County, FL
22900.......................................  Fort Smith, AR-OK......................................     0.8231
                                              Crawford County, AR
                                              Franklin County, AR
                                              Sebastian County, AR
                                              Le Flore County, OK
                                              Sequoyah County, OK
23020.......................................  Fort Walton Beach-Crestview-Destin, FL.................     0.8877
                                              Okaloosa County, FL
23060.......................................  Fort Wayne, IN.........................................     0.9797
                                              Allen County, IN
                                              Wells County, IN
                                              Whitley County, IN
23104.......................................  \1\ Fort Worth-Arlington, TX...........................     0.9514
                                              Johnson County, TX
                                              Parker County, TX
                                              Tarrant County, TX
                                              Wise County, TX
23420.......................................  \2\ Fresno, CA.........................................     1.0848
                                              Fresno County, CA
23460.......................................  Gadsden, AL............................................     0.7974
                                              Etowah County, AL
23540.......................................  Gainesville, FL........................................     0.9461
                                              Alachua County, FL
                                              Gilchrist County, FL
23580.......................................  Gainesville, GA........................................     0.8897
                                              Hall County, GA
23844.......................................  Gary, IN...............................................     0.9366
                                              Jasper County, IN
                                              Lake County, IN
                                              Newton County, IN
                                              Porter County, IN
24020.......................................  Glens Falls, NY........................................     0.8587
                                              Warren County, NY
                                              Washington County, NY
24140.......................................  Goldsboro, NC..........................................     0.8781
                                              Wayne County, NC
24220.......................................  Grand Forks, ND-MN.....................................     1.1521
                                              Polk County, MN
                                              Grand Forks County, ND
24300.......................................  Grand Junction, CO.....................................     0.9590
                                              Mesa County, CO
24340.......................................  Grand Rapids-Wyoming, MI...............................     0.9398
                                              Barry County, MI
                                              Ionia County, MI
                                              Kent County, MI
                                              Newaygo County, MI
24500.......................................  Great Falls, MT........................................     0.9074
                                              Cascade County, MT

[[Page 42989]]

 
24540.......................................  Greeley, CO............................................     0.9597
                                              Weld County, CO
24580.......................................  \2\ Green Bay, WI......................................     0.9478
                                              Brown County, WI
                                              Kewaunee County, WI
                                              Oconto County, WI
24660.......................................  Greensboro-High Point, NC..............................     0.9133
                                              Guilford County, NC
                                              Randolph County, NC
                                              Rockingham County, NC
24780.......................................  Greenville, NC.........................................     0.9414
                                              Greene County, NC
                                              Pitt County, NC
24860.......................................  Greenville, SC.........................................     1.0138
                                              Greenville County, SC
                                              Laurens County, SC
                                              Pickens County, SC
25020.......................................  Guayama, PR............................................     0.3186
                                              Arroyo Municipio, PR
                                              Guayama Municipio, PR
                                              Patillas Municipio, PR
25060.......................................  Gulfport-Biloxi, MS....................................     0.8922
                                              Hancock County, MS
                                              Harrison County, MS
                                              Stone County, MS
25180.......................................  Hagerstown-Martinsburg, MD-WV..........................     0.9528
                                              Washington County, MD
                                              Berkeley County, WV
                                              Morgan County, WV
25260.......................................  \2\ Hanford-Corcoran, CA...............................     1.0848
                                              Kings County, CA
25420.......................................  Harrisburg-Carlisle, PA................................     0.9317
                                              Cumberland County, PA
                                              Dauphin County, PA
                                              Perry County, PA
25500.......................................  Harrisonburg, VA.......................................     0.9101
                                              Rockingham County, VA
                                              Harrisonburg City, VA
25540.......................................  1, 2 Hartford-West Hartford-East Hartford, CT..........     1.1790
                                              Hartford County, CT
                                              Litchfield County, CT
                                              Middlesex County, CT
                                              Tolland County, CT
25620.......................................  \2\ Hattiesburg, MS....................................     0.7685
                                              Forrest County, MS
                                              Lamar County, MS
                                              Perry County, MS
25860.......................................  Hickory-Lenoir-Morganton, NC...........................     0.8931
                                              Alexander County, NC
                                              Burke County, NC
                                              Caldwell County, NC
                                              Catawba County, NC
25980.......................................  Hinesville-Fort Stewart, GA............................     0.7684
                                              Liberty County, GA
                                              Long County, GA
26100.......................................  Holland-Grand Haven, MI................................     0.9133
                                              Ottawa County, MI
26180.......................................  Honolulu, HI...........................................     1.1206
                                              Honolulu County, HI
26300.......................................  Hot Springs, AR........................................     0.9066
                                              Garland County, AR
26380.......................................  Houma-Bayou Cane-Thibodaux, LA.........................     0.7903
                                              Lafourche Parish, LA
                                              Terrebonne Parish, LA
26420.......................................  \1\ Houston-Sugar Land-Baytown, TX.....................     1.0008
                                              Austin County, TX
                                              Brazoria County, TX
                                              Chambers County, TX
                                              Fort Bend County, TX
                                              Galveston County, TX
                                              Harris County, TX

[[Page 42990]]

 
                                              Liberty County, TX
                                              Montgomery County, TX
                                              San Jacinto County, TX
                                              Waller County, TX
26580.......................................  Huntington-Ashland, WV-KY-OH...........................     0.9482
                                              Boyd County, KY
                                              Greenup County, KY
                                              Lawrence County, OH
                                              Cabell County, WV
                                              Wayne County, WV
26620.......................................  Huntsville, AL.........................................     0.9124
                                              Limestone County, AL
                                              Madison County, AL
26820.......................................  Idaho Falls, ID........................................     0.9409
                                              Bonneville County, ID
                                              Jefferson County, ID
26900.......................................  \1\ Indianapolis, IN...................................     0.9922
                                              Boone County, IN
                                              Brown County, IN
                                              Hamilton County, IN
                                              Hancock County, IN
                                              Hendricks County, IN
                                              Johnson County, IN
                                              Marion County, IN
                                              Morgan County, IN
                                              Putnam County, IN
                                              Shelby County, IN
26980.......................................  Iowa City, IA..........................................     0.9751
                                              Johnson County, IA
                                              Washington County, IA
27060.......................................  Ithaca, NY.............................................     0.9855
                                              Tompkins County, NY
27100.......................................  Jackson, MI............................................     0.9300
                                              Jackson County, MI
27140.......................................  Jackson, MS............................................     0.8313
                                              Copiah County, MS
                                              Hinds County, MS
                                              Madison County, MS
                                              Rankin County, MS
                                              Simpson County, MS
27180.......................................  Jackson, TN............................................     0.8964
                                              Chester County, TN
                                              Madison County, TN
27260.......................................  \1\ Jacksonville, FL...................................     0.9303
                                              Baker County, FL
                                              Clay County, FL
                                              Duval County, FL
                                              Nassau County, FL
                                              St. Johns County, FL
27340.......................................  \2\ Jacksonville, NC...................................     0.8570
                                              Onslow County, NC
27500.......................................  Janesville, WI.........................................     0.9561
                                              Rock County, WI
27620.......................................  Jefferson City, MO.....................................     0.8389
                                              Callaway County, MO
                                              Cole County, MO
                                              Moniteau County, MO
                                              Osage County, MO
27740.......................................  Johnson City, TN.......................................     0.7958
                                              Carter County, TN
                                              Unicoi County, TN
                                              Washington County, TN
27780.......................................  Johnstown, PA..........................................     0.8348
                                              Cambria County, PA
27860.......................................  Jonesboro, AR..........................................     0.7968
                                              Craighead County, AR
                                              Poinsett County, AR
27900.......................................  Joplin, MO.............................................     0.8594
                                              Jasper County, MO
                                              Newton County, MO
28020.......................................  Kalamazoo-Portage, MI..................................

[[Page 42991]]

 
                                              Kalamazoo County, MI
                                              Van Buren County, MI                                        1.0403
28100.......................................  Kankakee-Bradley, IL...................................     1.0991
                                              Kankakee County, IL
28140.......................................  \1\Kansas City, MO-KS..................................     0.9454
                                              Franklin County, KS
                                              Johnson County, KS
                                              Leavenworth County, KS
                                              Linn County, KS
                                              Miami County, KS
                                              Wyandotte County, KS
                                              Bates County, MO
                                              Caldwell County, MO
                                              Cass County, MO
                                              Clay County, MO
                                              Clinton County, MO
                                              Jackson County, MO
                                              Lafayette County, MO
                                              Platte County, MO
                                              Ray County, MO
28420.......................................  Kennewick-Richland-Pasco, WA...........................     1.0619
                                              Benton County, WA
                                              Franklin County, WA
28660.......................................  Killeen-Temple-Fort Hood, TX...........................     0.8566
                                              Bell County, TX
                                              Coryell County, TX
                                              Lampasas County, TX
28700.......................................  Kingsport-Bristol-Bristol, TN-VA.......................     0.8095
                                              Hawkins County, TN
                                              Sullivan County, TN
                                              Bristol City, VA
                                              Scott County, VA
                                              Washington County, VA
28740.......................................  Kingston, NY...........................................     0.9260
                                              Ulster County, NY
28940.......................................  Knoxville, TN..........................................     0.8470
                                              Anderson County, TN
                                              Blount County, TN
                                              Knox County, TN
                                              Loudon County, TN
                                              Union County, TN
29020.......................................  Kokomo, IN.............................................     0.9555
                                              Howard County, IN
                                              Tipton County, IN
29100.......................................  La Crosse, WI-MN.......................................     0.9557
                                              Houston County, MN
                                              La Crosse County, WI
29140.......................................  Lafayette, IN..........................................     0.8730
                                              Benton County, IN
                                              Carroll County, IN
                                              Tippecanoe County, IN
29180.......................................  Lafayette, LA..........................................     0.8429
                                              Lafayette Parish, LA
                                              St. Martin Parish, LA
29340.......................................  Lake Charles, LA.......................................     0.7847
                                              Calcasieu Parish, LA
                                              Cameron Parish, LA
29404.......................................  Lake County-Kenosha County, IL-WI......................     1.0444
                                              Lake County, IL
                                              Kenosha County, WI
29460.......................................  Lakeland, FL...........................................     0.8934
                                              Polk County, FL
29540.......................................  Lancaster, PA..........................................     0.9716
                                              Lancaster County, PA
29620.......................................  Lansing-East Lansing, MI...............................     0.9786
                                              Clinton County, MI
                                              Eaton County, MI
                                              Ingham County, MI
29700.......................................  Laredo, TX.............................................     0.8101
                                              Webb County, TX
29740.......................................  \2\ Las Cruces, NM.....................................     0.8649

[[Page 42992]]

 
                                              Dona Ana County, NM
29820.......................................  \1\ Las Vegas-Paradise, NV.............................     1.1416
                                              Clark County, NV
29940.......................................  Lawrence, KS...........................................     0.8538
                                              Douglas County, KS
30020.......................................  Lawton, OK.............................................     0.7916
                                              Comanche County, OK
30140.......................................  Lebanon, PA............................................     0.8654
                                              Lebanon County, PA
30300.......................................  Lewiston, ID-WA (ID Hospitals).........................     0.9878
                                              Nez Perce County, ID
                                              Asotin County, WA
30300.......................................  \2\ Lewiston, ID-WA (WA Hospitals).....................     1.0459
                                              Nez Perce County, ID
                                              Asotin County, WA
30340.......................................  Lewiston-Auburn, ME....................................     0.9332
                                              Androscoggin County, ME
30460.......................................  Lexington-Fayette, KY..................................     0.9060
                                              Bourbon County, KY
                                              Clark County, KY
                                              Fayette County, KY
                                              Jessamine County, KY
                                              Scott County, KY
                                              Woodford County, KY
30620.......................................  Lima, OH...............................................     0.9263
                                              Allen County, OH
30700.......................................  Lincoln, NE............................................     1.0197
                                              Lancaster County, NE
                                              Seward County, NE
30780.......................................  Little Rock-North Little Rock, AR......................     0.8768
                                              Faulkner County, AR
                                              Grant County, AR
                                              Lonoke County, AR
                                              Perry County, AR
                                              Pulaski County, AR
                                              Saline County, AR
30860.......................................  Logan, UT-ID...........................................     0.9183
                                              Franklin County, ID
                                              Cache County, UT
30980.......................................  Longview, TX...........................................     0.8741
                                              Gregg County, TX
                                              Rusk County, TX
                                              Upshur County, TX
31020.......................................  \2\ Longview, WA.......................................     1.0459
                                              Cowlitz County, WA
31084.......................................  \1\ Los Angeles-Long Beach-Glendale, CA................     1.1762
                                              Los Angeles County, CA
31140.......................................  \1\ Louisville, KY-IN..................................     0.9264
                                              Clark County, IN
                                              Floyd County, IN
                                              Harrison County, IN
                                              Washington County, IN
                                              Bullitt County, KY
                                              Henry County, KY
                                              Jefferson County, KY
                                              Meade County, KY
                                              Nelson County, KY
                                              Oldham County, KY
                                              Shelby County, KY
                                              Spencer County, KY
                                              Trimble County, KY
31180.......................................  Lubbock, TX............................................     0.8790
                                              Crosby County, TX
                                              Lubbock County, TX
31340.......................................  Lynchburg, VA..........................................     0.8706
                                              Amherst County, VA
                                              Appomattox County, VA
                                              Bedford County, VA
                                              Campbell County, VA
                                              Bedford City, VA
                                              Lynchburg City, VA

[[Page 42993]]

 
31420.......................................  Macon, GA..............................................     0.9485
                                              Bibb County, GA
                                              Crawford County, GA
                                              Jones County, GA
                                              Monroe County, GA
                                              Twiggs County, GA
31460.......................................  \2\ Madera, CA.........................................     1.0848
                                              Madera County, CA
31540.......................................  Madison, WI............................................     1.0629
                                              Columbia County, WI
                                              Dane County, WI
                                              Iowa County, WI
31700.......................................  \2\ Manchester-Nashua, NH..............................     1.0668
                                              Hillsborough County, NH
                                              Merrimack County, NH
31900.......................................  Mansfield, OH..........................................     0.8788
                                              Richland County, OH
32420.......................................  Mayaguez, PR...........................................     0.4016
                                              Hormigueros Municipio, PR
                                              Mayag[uuml]ez Municipio, PR
32580.......................................  McAllen-Edinburg-Mission, TX...........................     0.8945
                                              Hidalgo County, TX
32780.......................................  \2\ Medford, OR........................................     1.0284
                                              Jackson County, OR
32820.......................................  \1\ Memphis, TN-MS-AR..................................     0.9346
                                              Crittenden County, AR
                                              DeSoto County, MS
                                              Marshall County, MS
                                              Tate County, MS
                                              Tunica County, MS
                                              Fayette County, TN
                                              Shelby County, TN
                                              Tipton County, TN
32900.......................................  Merced, CA.............................................     1.1123
                                              Merced County, CA
33124.......................................  \1\ Miami-Miami Beach-Kendall, FL......................     0.9757
                                              Miami-Dade County, FL
33140.......................................  Michigan City-La Porte, IN.............................     0.9409
                                              LaPorte County, IN
33260.......................................  Midland, TX............................................     0.9522
                                              Midland County, TX
33340.......................................  \1\ Milwaukee-Waukesha-West Allis, WI..................     1.0111
                                              Milwaukee County, WI
                                              Ozaukee County, WI
                                              Washington County, WI
                                              Waukesha County, WI
33460.......................................  \1\ Minneapolis-St. Paul-Bloomington, MN-WI............     1.1055
                                              Anoka County, MN
                                              Carver County, MN
                                              Chisago County, MN
                                              Dakota County, MN
                                              Hennepin County, MN
                                              Isanti County, MN
                                              Ramsey County, MN
                                              Scott County, MN
                                              Sherburne County, MN
                                              Washington County, MN
                                              Wright County, MN
                                              Pierce County, WI
                                              St. Croix County, WI
33540.......................................  Missoula, MT...........................................     0.9535
                                              Missoula County, MT
33660.......................................  Mobile, AL.............................................     0.7902
                                              Mobile County, AL
33700.......................................  Modesto, CA............................................     1.1885
                                              Stanislaus County, CA
33740.......................................  Monroe, LA.............................................     0.8044
                                              Ouachita Parish, LA
                                              Union Parish, LA
33780.......................................  Monroe, MI.............................................     0.9468
                                              Monroe County, MI

[[Page 42994]]

 
33860.......................................  Montgomery, AL.........................................     0.8600
                                              Autauga County, AL
                                              Elmore County, AL
                                              Lowndes County, AL
                                              Montgomery County, AL
34060.......................................  Morgantown, WV.........................................     0.8439
                                              Monongalia County, WV
                                              Preston County, WV
34100.......................................  Morristown, TN.........................................     0.8758
                                              Grainger County, TN
                                              Hamblen County, TN
                                              Jefferson County, TN
34580.......................................  \2\ Mount Vernon-Anacortes, WA.........................     1.0459
                                              Skagit County, WA
34620.......................................  Muncie, IN.............................................     0.8952
                                              Delaware County, IN
34740.......................................  Muskegon-Norton Shores, MI.............................     0.9677
                                              Muskegon County, MI
34820.......................................  Myrtle Beach-Conway-North Myrtle Beach, SC.............     0.8869
                                              Horry County, SC
34900.......................................  Napa, CA...............................................     1.2643
                                              Napa County, CA
34940.......................................  Naples-Marco Island, FL................................     1.0115
                                              Collier County, FL
34980.......................................  \1\ Nashville-Davidson--Murfreesboro, TN...............     0.9757
                                              Cannon County, TN
                                              Cheatham County, TN
                                              Davidson County, TN
                                              Dickson County, TN
                                              Hickman County, TN
                                              Macon County, TN
                                              Robertson County, TN
                                              Rutherford County, TN
                                              Smith County, TN
                                              Sumner County, TN
                                              Trousdale County, TN
                                              Williamson County, TN
                                              Wilson County, TN
35004.......................................  \1\ Nassau-Suffolk, NY.................................     1.2781
                                              Nassau County, NY
                                              Suffolk County, NY
35084.......................................  \1\ Newark-Union, NJ-PA................................     1.2192
                                              Essex County, NJ
                                              Hunterdon County, NJ
                                              Morris County, NJ
                                              Sussex County, NJ
                                              Union County, NJ
                                              Pike County, PA
35300.......................................  \2\ New Haven-Milford, CT..............................     1.1790
                                              New Haven County, CT
35380.......................................  \1\ New Orleans-Metairie-Kenner, LA....................     0.9003
                                              Jefferson Parish, LA
                                              Orleans Parish, LA
                                              Plaquemines Parish, LA
                                              St. Bernard Parish, LA
                                              St. Charles Parish, LA
                                              St. John the Baptist Parish, LA
                                              St. Tammany Parish, LA
35644.......................................  \1\ New York-White Plains-Wayne, NY-NJ.................     1.3191
                                              Bergen County, NJ
                                              Hudson County, NJ
                                              Passaic County, NJ
                                              Bronx County, NY
                                              Kings County, NY
                                              New York County, NY
                                              Putnam County, NY
                                              Queens County, NY
                                              Richmond County, NY
                                              Rockland County, NY
                                              Westchester County, NY
35660.......................................  \2\ Niles-Benton Harbor, MI............................     0.8923

[[Page 42995]]

 
                                              Berrien County, MI
35980.......................................  \2\ Norwich-New London, CT.............................     1.1790
                                              New London County, CT
36084.......................................  \1\ Oakland-Fremont-Hayward, CA........................     1.5474
                                              Alameda County, CA
                                              Contra Costa County, CA
36100.......................................  Ocala, FL..............................................     0.8955
                                              Marion County, FL
36140.......................................  Ocean City, NJ.........................................     1.1253
                                              Cape May County, NJ
36220.......................................  Odessa, TX.............................................     0.9893
                                              Ector County, TX
36260.......................................  Ogden-Clearfield, UT...................................     0.9048
                                              Davis County, UT
                                              Morgan County, UT
                                              Weber County, UT
36420.......................................  \1\ Oklahoma City, OK..................................     0.9043
                                              Canadian County, OK
                                              Cleveland County, OK
                                              Grady County, OK
                                              Lincoln County, OK
                                              Logan County, OK
                                              McClain County, OK
                                              Oklahoma County, OK
36500.......................................  Olympia, WA............................................     1.0970
                                              Thurston County, WA
36540.......................................  Omaha-Council Bluffs, NE-IA............................     0.9555
                                              Harrison County, IA
                                              Mills County, IA
                                              Pottawattamie County, IA
                                              Cass County, NE
                                              Douglas County, NE
                                              Sarpy County, NE
                                              Saunders County, NE
                                              Washington County, NE
36740.......................................  \1\ Orlando-Kissimmee, FL..............................     0.9446
                                              Lake County, FL
                                              Orange County, FL
                                              Osceola County, FL
                                              Seminole County, FL
36780.......................................  \2\ Oshkosh-Neenah, WI.................................     0.9478
                                              Winnebago County, WI
36980.......................................  Owensboro, KY..........................................     0.8806
                                              Daviess County, KY
                                              Hancock County, KY
                                              McLean County, KY
37100.......................................  Oxnard-Thousand Oaks-Ventura, CA.......................     1.1604
                                              Ventura County, CA
37340.......................................  Palm Bay-Melbourne-Titusville, FL......................     0.9826
                                              Brevard County, FL
37460.......................................  \2\ Panama City-Lynn Haven, FL.........................     0.8613
                                              Bay County, FL
37620.......................................  Parkersburg-Marietta-Vienna, WV-OH (WV Hospitals)......     0.8303
                                              Washington County, OH
                                              Pleasants County, WV
                                              Wirt County, WV
                                              Wood County, WV
37620.......................................  \2\ Parkersburg-Marietta-Vienna, WV-OH (OH Hospitals)..     0.8788
                                              Washington County, OH
                                              Pleasants County, WV
                                              Wirt County, WV
                                              Wood County, WV
37700.......................................  Pascagoula, MS.........................................     0.8164
                                              George County, MS
                                              Jackson County, MS
37860.......................................  \2\ Pensacola-Ferry Pass-Brent, FL.....................     0.8613
                                              Escambia County, FL
                                              Santa Rosa County, FL
37900.......................................  Peoria, IL.............................................     0.8844
                                              Marshall County, IL
                                              Peoria County, IL

[[Page 42996]]

 
                                              Stark County, IL
                                              Tazewell County, IL
                                              Woodford County, IL
37964.......................................  \1\ Philadelphia, PA...................................     1.1030
                                              Bucks County, PA
                                              Chester County, PA
                                              Delaware County, PA
                                              Montgomery County, PA
                                              Philadelphia County, PA
38060.......................................  \1\ Phoenix-Mesa-Scottsdale, AZ........................     1.0139
                                              Maricopa County, AZ
                                              Pinal County, AZ
38220.......................................  Pine Bluff, AR.........................................     0.8716
                                              Cleveland County, AR
                                              Jefferson County, AR
                                              Lincoln County, AR
38300.......................................  \1\ Pittsburgh, PA.....................................     0.8840
                                              Allegheny County, PA
                                              Armstrong County, PA
                                              Beaver County, PA
                                              Butler County, PA
                                              Fayette County, PA
                                              Washington County, PA
                                              Westmoreland County, PA
38340.......................................  Pittsfield, MA.........................................     1.0679
                                              Berkshire County, MA
38540.......................................  Pocatello, ID..........................................     0.9348
                                              Bannock County, ID
                                              Power County, ID
38660.......................................  Ponce, PR..............................................     0.5178
                                              Juana Diaz Municipio, PR
                                              Ponce Municipio, PR
                                              Villalba Municipio, PR
38860.......................................  Portland-South Portland-Biddeford, ME..................     1.0382
                                              Cumberland County, ME
                                              Sagadahoc County, ME
                                              York County, ME
38900.......................................  \1\ Portland-Vancouver-Beaverton, OR-WA................     1.1229
                                              Clackamas County, OR
                                              Columbia County, OR
                                              Multnomah County, OR
                                              Washington County, OR
                                              Yamhill County, OR
                                              Clark County, WA
                                              Skamania County, WA
38940.......................................  Port St. Lucie-Fort Pierce, FL.........................     1.0162
                                              Martin County, FL
                                              St. Lucie County, FL
39100.......................................  Poughkeepsie-Newburgh-Middletown, NY...................     1.0767
                                              Dutchess County, NY
                                              Orange County, NY
39140.......................................  Prescott, AZ...........................................     0.9884
                                              Yavapai County, AZ
39300.......................................  \1\ Providence-New Bedford-Fall River, RI-MA...........     1.0952
                                              Bristol County, MA
                                              Bristol County, RI
                                              Kent County, RI
                                              Newport County, RI
                                              Providence County, RI
                                              Washington County, RI
39340.......................................  Provo-Orem, UT.........................................     0.9578
                                              Juab County, UT
                                              Utah County, UT
39380.......................................  \2\ Pueblo, CO.........................................     0.9379
                                              Pueblo County, CO
39460.......................................  Punta Gorda, FL........................................     0.9274
                                              Charlotte County, FL
39540.......................................  \2\ Racine, WI.........................................     0.9478
                                              Racine County, WI
39580.......................................  Raleigh-Cary, NC.......................................     0.9709
                                              Franklin County, NC

[[Page 42997]]

 
                                              Johnston County, NC
                                              Wake County, NC
39660.......................................  Rapid City, SD.........................................     0.9027
                                              Meade County, SD
                                              Pennington County, SD
39740.......................................  Reading, PA............................................     0.9698
                                              Berks County, PA
39820.......................................  Redding, CA............................................     1.2207
                                              Shasta County, CA
39900.......................................  Reno-Sparks, NV........................................     1.0984
                                              Storey County, NV
                                              Washoe County, NV
40060.......................................  \1\ Richmond, VA.......................................     0.9319
                                              Amelia County, VA
                                              Caroline County, VA
                                              Charles City County, VA
                                              Chesterfield County, VA
                                              Cumberland County, VA
                                              Dinwiddie County, VA
                                              Goochland County, VA
                                              Hanover County, VA
                                              Henrico County, VA
                                              King and Queen County, VA
                                              King William County, VA
                                              Louisa County, VA
                                              New Kent County, VA
                                              Powhatan County, VA
                                              Prince George County, VA
                                              Sussex County, VA
                                              Colonial Heights City, VA
                                              Hopewell City, VA
                                              Petersburg City, VA
                                              Richmond City, VA
40140.......................................  \1\ Riverside-San Bernardino-Ontario, CA...............     1.1021
                                              Riverside County, CA
                                              San Bernardino County, CA
40220.......................................  Roanoke, VA............................................     0.8450
                                              Botetourt County, VA
                                              Craig County, VA
                                              Franklin County, VA
                                              Roanoke County, VA
                                              Roanoke City, VA
                                              Salem City, VA
40340.......................................  Rochester, MN..........................................     1.1128
                                              Dodge County, MN
                                              Olmsted County, MN
                                              Wabasha County, MN
40380.......................................  \1\ Rochester, NY......................................     0.9117
                                              Livingston County, NY
                                              Monroe County, NY
                                              Ontario County, NY
                                              Orleans County, NY
                                              Wayne County, NY
40420.......................................  Rockford, IL...........................................     0.9975
                                              Boone County, IL
                                              Winnebago County, IL
40484.......................................  \2\ Rockingham County-Strafford County, NH.............     1.0668
                                              Rockingham County, NH
                                              Strafford County, NH
40580.......................................  Rocky Mount, NC........................................     0.8924
                                              Edgecombe County, NC
                                              Nash County, NC
40660.......................................  Rome, GA...............................................     0.9414
                                              Floyd County, GA
40900.......................................  \1\ Sacramento--Arden-Arcade--Roseville, CA............     1.2953
                                              El Dorado County, CA
                                              Placer County, CA
                                              Sacramento County, CA
                                              Yolo County, CA
40980.......................................  Saginaw-Saginaw Township North, MI.....................     0.9474
                                              Saginaw County, MI

[[Page 42998]]

 
41060.......................................  St. Cloud, MN..........................................     1.0030
                                              Benton County, MN
                                              Stearns County, MN
41100.......................................  St. George, UT.........................................     0.9416
                                              Washington County, UT
41140.......................................  St. Joseph, MO-KS......................................     0.9565
                                              Doniphan County, KS
                                              Andrew County, MO
                                              Buchanan County, MO
                                              DeKalb County, MO
41180.......................................  St. Louis, MO-IL.......................................     0.8953
                                              Bond County, IL
                                              Calhoun County, IL
                                              Clinton County, IL
                                              Jersey County, IL
                                              Macoupin County, IL
                                              Madison County, IL
                                              Monroe County, IL
                                              St. Clair County, IL
                                              Crawford County, MO
                                              Franklin County, MO
                                              Jefferson County, MO
                                              Lincoln County, MO
                                              St. Charles County, MO
                                              St. Louis County, MO
                                              Warren County, MO
                                              Washington County, MO
                                              St. Louis City, MO
41420.......................................  Salem, OR..............................................     1.0445
                                              Marion County, OR
                                              Polk County, OR
41500.......................................  Salinas, CA............................................     1.4140
                                              Monterey County, CA
41540.......................................  \2\ Salisbury, MD......................................     0.9099
                                              Somerset County, MD
                                              Wicomico County, MD
41620.......................................  Salt Lake City, UT.....................................     0.9436
                                              Salt Lake County, UT
                                              Summit County, UT
                                              Tooele County, UT
41660.......................................  San Angelo, TX.........................................     0.8287
                                              Irion County, TX
                                              Tom Green County, TX
41700.......................................  \1\ San Antonio, TX....................................     0.8987
                                              Atascosa County, TX
                                              Bandera County, TX
                                              Bexar County, TX
                                              Comal County, TX
                                              Guadalupe County, TX
                                              Kendall County, TX
                                              Medina County, TX
                                              Wilson County, TX
41740.......................................  \1\ San Diego-Carlsbad-San Marcos, CA..................     1.1417
                                              San Diego County, CA
41780.......................................  Sandusky, OH...........................................     0.9033
                                              Erie County, OH
41884.......................................  \1\ San Francisco-San Mateo-Redwood City, CA...........     1.4970
                                              Marin County, CA
                                              San Francisco County, CA
                                              San Mateo County, CA
41900.......................................  San German-Cabo Rojo, PR...............................     0.4646
                                              Cabo Rojo Municipio, PR
                                              Lajas Municipio, PR
                                              Sabana Grande Municipio, PR
                                              San German Municipio, PR
41940.......................................  \1\ San Jose-Sunnyvale-Santa Clara, CA.................     1.5114
                                              San Benito County, CA
                                              Santa Clara County, CA
41980.......................................  \1\ San Juan-Caguas-Guaynabo, PR.......................     0.4686
                                              Aguas Buenas Municipio, PR
                                              Aibonito Municipio, PR

[[Page 42999]]

 
                                              Arecibo Municipio, PR
                                              Barceloneta Municipio, PR
                                              Barranquitas Municipio, PR
                                              Bayamon Municipio, PR
                                              Caguas Municipio, PR
                                              Camuy Municipio, PR
                                              Canovanas Municipio, PR
                                              Carolina Municipio, PR
                                              Catano Municipio, PR
                                              Cayey Municipio, PR
                                              Ciales Municipio, PR
                                              Cidra Municipio, PR
                                              Comerio Municipio, PR
                                              Corozal Municipio, PR
                                              Dorado Municipio, PR
                                              Florida Municipio, PR
                                              Guaynabo Municipio, PR
                                              Gurabo Municipio, PR
                                              Hatillo Municipio, PR
                                              Humacao Municipio, PR
                                              Juncos Municipio, PR
                                              Las Piedras Municipio, PR
                                              Loiza Municipio, PR
                                              Manati Municipio, PR
                                              Maunabo Municipio, PR
                                              Morovis Municipio, PR
                                              Naguabo Municipio, PR
                                              Naranjito Municipio, PR
                                              Orocovis Municipio, PR
                                              Quebradillas Municipio, PR
                                              Rio Grande Municipio, PR
                                              San Juan Municipio, PR
                                              San Lorenzo Municipio, PR
                                              Toa Alta Municipio, PR
                                              Toa Baja Municipio, PR
                                              Trujillo Alto Municipio, PR
                                              Vega Alta Municipio, PR
                                              Vega Baja Municipio, PR
                                              Yabucoa Municipio, PR
42020.......................................  San Luis Obispo-Paso Robles, CA........................     1.1357
                                              San Luis Obispo County, CA
42044.......................................  \1\ Santa Ana-Anaheim-Irvine, CA.......................     1.1564
                                              Orange County, CA
42060.......................................  Santa Barbara-Santa Maria, CA..........................     1.1525
                                              Santa Barbara County, CA
42100.......................................  Santa Cruz-Watsonville, CA.............................     1.5159
                                              Santa Cruz County, CA
42140.......................................  Santa Fe, NM...........................................     1.0908
                                              Santa Fe County, NM
42220.......................................  Santa Rosa-Petaluma, CA................................     1.3480
                                              Sonoma County, CA
42260.......................................  Sarasota-Bradenton-Venice, FL..........................     0.9554
                                              Manatee County, FL
                                              Sarasota County, FL
42340.......................................  Savannah, GA...........................................     0.9483
                                              Bryan County, GA
                                              Chatham County, GA
                                              Effingham County, GA
42540.......................................  Scranton--Wilkes-Barre, PA.............................     0.8530
                                              Lackawanna County, PA
                                              Luzerne County, PA
                                              Wyoming County, PA
42644.......................................  \1\ Seattle-Bellevue-Everett, WA.......................     1.1573
                                              King County, WA
                                              Snohomish County, WA
43100.......................................  \2\ Sheboygan, WI......................................     0.9478
                                              Sheboygan County, WI
43300.......................................  Sherman-Denison, TX....................................     0.9518
                                              Grayson County, TX
43340.......................................  Shreveport-Bossier City, LA............................     0.8767
                                              Bossier Parish, LA

[[Page 43000]]

 
                                              Caddo Parish, LA
                                              De Soto Parish, LA
43580.......................................  Sioux City, IA-NE-SD...................................     0.9360
                                              Woodbury County, IA
                                              Dakota County, NE
                                              Dixon County, NE
                                              Union County, SD
43620.......................................  Sioux Falls, SD........................................     0.9616
                                              Lincoln County, SD
                                              McCook County, SD
                                              Minnehaha County, SD
                                              Turner County, SD
43780.......................................  South Bend-Mishawaka, IN-MI............................     0.9785
                                              St. Joseph County, IN
                                              Cass County, MI
43900.......................................  Spartanburg, SC........................................     0.9183
                                              Spartanburg County, SC
44060.......................................  Spokane, WA............................................     1.0898
                                              Spokane County, WA
44100.......................................  Springfield, IL........................................     0.8879
                                              Menard County, IL
                                              Sangamon County, IL
44140.......................................  Springfield, MA........................................     1.0679
                                              Franklin County, MA
                                              Hampden County, MA
                                              Hampshire County, MA
44180.......................................  Springfield, MO........................................     0.8251
                                              Christian County, MO
                                              Dallas County, MO
                                              Greene County, MO
                                              Polk County, MO
                                              Webster County, MO
44220.......................................  \2\ Springfield, OH....................................     0.8788
                                              Clark County, OH
44300.......................................  State College, PA......................................     0.8368
                                              Centre County, PA
44700.......................................  Stockton, CA...........................................     1.1333
                                              San Joaquin County, CA
44940.......................................  \2\ Sumter, SC.........................................     0.8663
                                              Sumter County, SC
45060.......................................  Syracuse, NY...........................................     0.9595
                                              Madison County, NY
                                              Onondaga County, NY
                                              Oswego County, NY
45104.......................................  Tacoma, WA.............................................     1.0794
                                              Pierce County, WA
45220.......................................  Tallahassee, FL........................................     0.8712
                                              Gadsden County, FL
                                              Jefferson County, FL
                                              Leon County, FL
                                              Wakulla County, FL
45300.......................................  \1\ Tampa-St. Petersburg-Clearwater, FL................     0.9292
                                              Hernando County, FL
                                              Hillsborough County, FL
                                              Pasco County, FL
                                              Pinellas County, FL
45460.......................................  \2\ Terre Haute, IN....................................     0.8632
                                              Clay County, IN
                                              Sullivan County, IN
                                              Vermillion County, IN
                                              Vigo County, IN
45500.......................................  Texarkana, TX-Texarkana, AR............................     0.8293
                                              Miller County, AR
                                              Bowie County, TX
45780.......................................  Toledo, OH.............................................     0.9573
                                              Fulton County, OH
                                              Lucas County, OH
                                              Ottawa County, OH
                                              Wood County, OH
45820.......................................  Topeka, KS.............................................     0.8921
                                              Jackson County, KS

[[Page 43001]]

 
                                              Jefferson County, KS
                                              Osage County, KS
                                              Shawnee County, KS
                                              Wabaunsee County, KS
45940.......................................  Trenton-Ewing, NJ......................................     1.1253
                                              Mercer County, NJ
46060.......................................  Tucson, AZ.............................................     0.9007
                                              Pima County, AZ
46140.......................................  Tulsa, OK..............................................     0.8313
                                              Creek County, OK
                                              Okmulgee County, OK
                                              Osage County, OK
                                              Pawnee County, OK
                                              Rogers County, OK
                                              Tulsa County, OK
                                              Wagoner County, OK
46220.......................................  Tuscaloosa, AL.........................................     0.8724
                                              Greene County, AL
                                              Hale County, AL
                                              Tuscaloosa County, AL
46340.......................................  Tyler, TX..............................................     0.9322
                                              Smith County, TX
46540.......................................  Utica-Rome, NY.........................................     0.8313
                                              Herkimer County, NY
                                              Oneida County, NY
46660.......................................  Valdosta, GA...........................................     0.8873
                                              Brooks County, GA
                                              Echols County, GA
                                              Lanier County, GA
                                              Lowndes County, GA
46700.......................................  Vallejo-Fairfield, CA..................................     1.4888
                                              Solano County, CA
46940.......................................  Vero Beach, FL.........................................     0.9458
                                              Indian River County, FL
47020.......................................  Victoria, TX...........................................     0.8148
                                              Calhoun County, TX
                                              Goliad County, TX
                                              Victoria County, TX
47220.......................................  \2\ Vineland-Millville-Bridgeton, NJ...................     1.1253
                                              Cumberland County, NJ
47260.......................................  \1\ Virginia Beach-Norfolk-Newport News, VA-NC.........     0.8841
                                              Currituck County, NC
                                              Gloucester County, VA
                                              Isle of Wight County, VA
                                              James City County, VA
                                              Mathews County, VA
                                              Surry County, VA
                                              York County, VA
                                              Chesapeake City, VA
                                              Hampton City, VA
                                              Newport News City, VA
                                              Norfolk City, VA
                                              Poquoson City, VA
                                              Portsmouth City, VA
                                              Suffolk City, VA
                                              Virginia Beach City, VA
                                              Williamsburg City, VA
47300.......................................  \2\ Visalia-Porterville, CA............................     1.0848
                                              Tulare County, CA
47380.......................................  Waco, TX...............................................     0.8532
                                              McLennan County, TX
47580.......................................  Warner Robins, GA......................................     0.8662
                                              Houston County, GA
47644.......................................  \1\ Warren-Farmington Hills-Troy, MI...................     0.9858
                                              Lapeer County, MI
                                              Livingston County, MI
                                              Macomb County, MI
                                              Oakland County, MI
                                              St. Clair County, MI
47894.......................................  \1\ Washington-Arlington-Alexandria, DC-VA-MD-WV.......     1.0935
                                              District of Columbia, DC

[[Page 43002]]

 
                                              Calvert County, MD
                                              Charles County, MD
                                              Prince George's County, MD
                                              Arlington County, VA
                                              Clarke County, VA
                                              Fairfax County, VA
                                              Fauquier County, VA
                                              Loudoun County, VA
                                              Prince William County, VA
                                              Spotsylvania County, VA
                                              Stafford County, VA
                                              Warren County, VA
                                              Alexandria City, VA
                                              Fairfax City, VA
                                              Falls Church City, VA
                                              Fredericksburg City, VA
                                              Manassas City, VA
                                              Manassas Park City, VA
                                              Jefferson County, WV
47940.......................................  Waterloo-Cedar Falls, IA...............................     0.8564
                                              Black Hawk County, IA
                                              Bremer County, IA
                                              Grundy County, IA
48140.......................................  Wausau, WI.............................................     0.9964
                                              Marathon County, WI
48260.......................................  Weirton-Steubenville, WV-OH (WV Hospitals).............     0.7821
                                              Jefferson County, OH
                                              Brooke County, WV
                                              Hancock County, WV
48260.......................................  \2\ Weirton-Steubenville, WV-OH (OH Hospitals).........     0.8788
                                              Jefferson County, OH
                                              Brooke County, WV
                                              Hancock County, WV
48300.......................................  \2\ Wenatchee, WA......................................     1.0459
                                              Chelan County, WA
                                              Douglas County, WA
48424.......................................  \1\ West Palm Beach-Boca Raton-Boynton Beach, FL.......     1.0061
                                              Palm Beach County, FL
48540.......................................  \2\ Wheeling, WV-OH (WV Hospitals).....................     0.7742
                                              Belmont County, OH
                                              Marshall County, WV
                                              Ohio County, WV
48540.......................................  \2\ Wheeling, WV-OH (OH Hospitals).....................     0.8788
                                              Belmont County, OH
                                              Marshall County, WV
                                              Ohio County, WV
48620.......................................  Wichita, KS............................................     0.9156
                                              Butler County, KS
                                              Harvey County, KS
                                              Sedgwick County, KS
                                              Sumner County, KS
48660.......................................  Wichita Falls, TX......................................     0.8327
                                              Archer County, TX
                                              Clay County, TX
                                              Wichita County, TX
48700.......................................  Williamsport, PA.......................................     0.8368
                                              Lycoming County, PA
48864.......................................  Wilmington, DE-MD-NJ...................................     1.0652
                                              New Castle County, DE
                                              Cecil County, MD
                                              Salem County, NJ
48864.......................................  Wilmington, DE-MD-NJ (NJ Hospitals)....................     1.1253
48900.......................................  Wilmington, NC.........................................     0.9580
                                              Brunswick County, NC
                                              New Hanover County, NC
                                              Pender County, NC
49020.......................................  Winchester, VA-WV......................................     1.0214
                                              Frederick County, VA
                                              Winchester City, VA
                                              Hampshire County, WV
49180.......................................  Winston-Salem, NC......................................     0.9020

[[Page 43003]]

 
                                              Davie County, NC
                                              Forsyth County, NC
                                              Stokes County, NC
                                              Yadkin County, NC
49340.......................................  Worcester, MA..........................................     1.1044
                                              Worcester County, MA
49420.......................................  \2\ Yakima, WA.........................................     1.0459
                                              Yakima County, WA
49500.......................................  Yauco, PR..............................................     0.4413
                                              Guanica Municipio, PR
                                              Guayanilla Municipio, PR
                                              Penuelas Municipio, PR
                                              Yauco Municipio, PR
49620.......................................  York-Hanover, PA.......................................     0.9422
                                              York County, PA
49660.......................................  \2\ Youngstown-Warren-Boardman, OH-PA (OH Hospitals)...     0.8788
                                              Mahoning County, OH
                                              Trumbull County, OH
                                              Mercer County, PA
49660.......................................  Youngstown-Warren-Boardman, OH-PA (PA Hospitals).......     0.8609
                                              Mahoning County, OH
                                              Trumbull County, OH
                                              Mercer County, PA
49700.......................................  Yuba City, CA..........................................     1.0951
                                              Sutter County, CA
                                              Yuba County, CA
49740.......................................  Yuma, AZ...............................................     0.9188
                                              Yuma County, AZ
----------------------------------------------------------------------------------------------------------------
\1\ Large urban area.
\2\ Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2006.


             Addendum I.--Wage Index for Rural Areas by CBSA
------------------------------------------------------------------------
                                                                  Wage
         CBSA  code                     Rural area               index
------------------------------------------------------------------------
01.........................  Alabama.........................     0.7495
02.........................  Alaska..........................     1.1977
03.........................  Arizona.........................     0.8991
04.........................  Arkansas........................     0.7478
05.........................  California......................     1.0848
06.........................  Colorado........................     0.9379
07.........................  Connecticut.....................     1.1790
08.........................  Delaware........................     0.9606
10.........................  Florida.........................     0.8613
11.........................  Georgia.........................     0.7684
12.........................  Hawaii..........................     1.0598
13.........................  Idaho...........................     0.8810
14.........................  Illinois........................     0.8285
15.........................  Indiana.........................     0.8632
16.........................  Iowa............................     0.8563
17.........................  Kansas..........................     0.8032
18.........................  Kentucky........................     0.7788
19.........................  Louisiana.......................     0.7445
20.........................  Maine...........................     0.8840
21.........................  Maryland........................     0.9099
22.........................  Massachusetts\1\................     1.0679
23.........................  Michigan........................     0.8923
24.........................  Minnesota.......................     0.9183
25.........................  Mississippi.....................     0.7685
26.........................  Missouri........................     0.7927
27.........................  Montana.........................     0.8822
28.........................  Nebraska........................     0.8666
29.........................  Nevada..........................     0.9079
30.........................  New Hampshire...................     1.0668
31.........................  New Jersey\1\...................     1.1253
32.........................  New Mexico......................     0.8649
33.........................  New York........................     0.8220
34.........................  North Carolina..................     0.8570
35.........................  North Dakota....................     0.7278
36.........................  Ohio............................     0.8788
37.........................  Oklahoma........................     0.7615
38.........................  Oregon..........................     1.0284
39.........................  Pennsylvania....................     0.8300
40.........................  Puerto Rico\1\..................  .........
41.........................  Rhode Island\1\.................     1.0952
42.........................  South Carolina..................     0.8663
43.........................  South Dakota....................     0.8475
44.........................  Tennessee.......................     0.7915
45.........................  Texas...........................     0.8038
46.........................  Utah............................     0.8134
47.........................  Vermont.........................     1.0199
49.........................  Virginia........................     0.8024
50.........................  Washington......................     1.0459
51.........................  West Virginia...................     0.7742
52.........................  Wisconsin.......................     0.9478
53.........................  Wyoming.........................    0.9207
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban, with the
  exception of Massachusetts. Massachusetts has area(s) designated as
  rural. However, no short-term, acute care hospitals are located in the
  area(s) for FY 2006. Massachusetts, New Jersey, and Rhode Island rural
  floors are imputed.


   Addendum J.--Wage Index for Hospitals That Are Reclassified by CBSA
------------------------------------------------------------------------
                                                                   Wage
         CBSA  code                          Area                 index
------------------------------------------------------------------------
10180.......................  Abilene, TX......................   0.8038
10420.......................  Akron, OH........................   0.8979
10580.......................  Albany-Schenectady-Troy, NY......   0.8565
10740.......................  Albuquerque, NM..................   0.9558
10780.......................  Alexandria, LA...................   0.8048
10900.......................  Allentown-Bethlehem-Easton, PA-NJ   0.9844
11020.......................  Altoona, PA......................   0.8942
11100.......................  Amarillo, TX.....................   0.9165
11180.......................  Ames, IA.........................   0.9231
11460.......................  Ann Arbor, MI....................   1.0628
11500.......................  Anniston-Oxford, AL..............   0.7702
11700.......................  Asheville, NC....................   0.9312
12020.......................  Athens-Clarke County, GA.........   0.9684
12060.......................  Atlanta-Sandy Springs-Marietta,     0.9637
                               GA.
12420.......................  Austin-Round Rock, TX............   0.9451
12620.......................  Bangor, ME.......................   0.9985
12700.......................  Barnstable Town, MA..............   1.2254
12940.......................  Baton Rouge, LA..................   0.8470
13020.......................  Bay City, MI.....................   0.9535
13780.......................  Binghamton, NY...................   0.8471
13820.......................  Birmingham-Hoover, AL............   0.8872
14260.......................  Boise City-Nampa, ID.............   0.9048
14484.......................  Boston-Quincy, MA................   1.1233
14540.......................  Bowling Green, KY................   0.8222
15380.......................  Buffalo-Niagara Falls, NY........   0.8888
15540.......................  Burlington-South Burlington, VT..   0.9306

[[Page 43004]]

 
15764.......................  Cambridge-Newton-Framingham, MA..   1.0903
16180.......................  Carson City, NV..................   0.9786
16220.......................  Casper, WY.......................   0.9207
16580.......................  Champaign-Urbana, IL.............   0.9335
16620.......................  Charleston, WV (WV Hospitals)....   0.8274
16620.......................  Charleston, WV(OH Hospitals).....   0.8788
16700.......................  Charleston-North Charleston, SC..   0.9317
16740.......................  Charlotte-Gastonia-Concord, NC-SC   0.9585
16820.......................  Charlottesville, VA..............   0.9806
16860.......................  Chattanooga, TN-GA...............   0.9099
16974.......................  Chicago-Naperville-Joliet, IL....   1.0698
17140.......................  Cincinnati-Middletown, OH-KY-IN..   0.9604
17300.......................  Clarksville, TN-KY...............   0.8092
17460.......................  Cleveland-Elyria-Mentor, OH......   0.9197
17780.......................  College Station-Bryan, TX........   0.8911
17860.......................  Columbia, MO.....................   0.8346
17900.......................  Columbia, SC.....................   0.9057
17980.......................  Columbus, GA-AL..................   0.8402
18140.......................  Columbus, OH.....................   0.9848
18700.......................  Corvallis, OR....................   1.0328
19124.......................  Dallas-Plano-Irving, TX..........   0.9955
19380.......................  Dayton, OH.......................   0.9069
19460.......................  Decatur, AL......................   0.8517
19740.......................  Denver-Aurora, CO................   1.0517
19780.......................  Des Moines, IA...................   0.9413
19804.......................  Detroit-Livonia-Dearborn, MI.....   1.0453
20260.......................  Duluth, MN-WI....................   1.0224
20500.......................  Durham, NC.......................   0.9993
20764.......................  Edison, NJ.......................   1.1301
20940.......................  El Centro, CA....................   0.9102
21060.......................  Elizabethtown, KY................   0.8286
21500.......................  Erie, PA.........................   0.8424
21604.......................  Essex County, MA.................   1.0668
21660.......................  Eugene-Springfield, OR...........   1.0492
21780.......................  Evansville, IN-KY................   0.8508
22020.......................  Fargo, ND-MN (ND, SD Hospitals)..   0.8778
22020.......................  Fargo, ND-MN (MN Hospitals)......   0.9183
22180.......................  Fayetteville, NC.................   0.9193
22220.......................  Fayetteville-Springdale-Rogers,     0.8615
                               AR-MO.
22380.......................  Flagstaff, AZ....................   1.1713
22420.......................  Flint, MI........................   1.0654
22540.......................  Fond du Lac, WI..................   0.9478
22660.......................  Fort Collins-Loveland, CO........   1.0146
22744.......................  Ft Lauderdale-Pompano Beach-        1.0508
                               Deerfield Beach, FL.
22900.......................  Fort Smith, AR-OK................   0.7986
23020.......................  Fort Walton Beach-Crestview-        0.8672
                               Destin, FL.
23060.......................  Fort Wayne, IN...................   0.9797
23104.......................  Fort Worth-Arlington, TX.........   0.9514
23540.......................  Gainesville, FL..................   0.9461
23844.......................  Gary, IN.........................   0.9366
24340.......................  Grand Rapids-Wyoming, MI.........   0.9398
24500.......................  Great Falls, MT..................   0.9074
24540.......................  Greeley, CO......................   0.9597
24580.......................  Green Bay, WI (MI Hospitals).....   0.9439
24580.......................  Green Bay, WI (WI Hospitals).....   0.9478
24780.......................  Greenville, NC...................   0.9414
24860.......................  Greenville, SC...................   0.9807
25060.......................  Gulfport-Biloxi, MS..............   0.8612
25420.......................  Harrisburg-Carlisle, PA..........   0.9145
25500.......................  Harrisonburg, VA.................   0.8998
25540.......................  Hartford-West Hartford-East         1.1085
                               Hartford, CT (MA Hospitals).
25540.......................  Hartford-West Hartford-East         1.1790
                               Hartford, CT (CT Hospitals).
25860.......................  Hickory-Lenoir-Morganton, NC.....   0.8931
26100.......................  Holland-Grand Haven, MI..........   0.9133
26180.......................  Honolulu, HI.....................   1.1206
26420.......................  Houston-Sugar Land-Baytown, TX...   1.0008
26580.......................  Huntington-Ashland, WV-KY-OH.....   0.9119
26620.......................  Huntsville, AL...................   0.9124
26900.......................  Indianapolis, IN.................   0.9776
26980.......................  Iowa City, IA....................   0.9574
27060.......................  Ithaca, NY.......................   0.9204
27140.......................  Jackson, MS......................   0.8182
27180.......................  Jackson, TN......................   0.8799
27260.......................  Jacksonville, FL.................   0.9303
27860.......................  Jonesboro, AR....................   0.7793
27900.......................  Joplin, MO.......................   0.8458
28020.......................  Kalamazoo-Portage, MI............   1.0403
28100.......................  Kankakee-Bradley, IL.............   1.0991
28140.......................  Kansas City, MO-KS...............   0.9454
28420.......................  Kennewick-Richland-Pasco, WA.....   1.0459
28700.......................  Kingsport-Bristol-Bristol, TN-VA.   0.8095
28740.......................  Kingston, NY.....................   0.8904
28940.......................  Knoxville, TN....................   0.8470
29180.......................  Lafayette, LA....................   0.8429
29404.......................  Lake County-Kenosha County, IL-WI   1.0444
29460.......................  Lakeland, FL.....................   0.8934
29620.......................  Lansing-East Lansing, MI.........   0.9786
29740.......................  Las Cruces, NM...................   0.8649
29820.......................  Las Vegas-Paradise, NV...........   1.1249
30020.......................  Lawton, OK.......................   0.7673
30460.......................  Lexington-Fayette, KY............   0.8830
30620.......................  Lima, OH.........................   0.9263
30700.......................  Lincoln, NE......................   0.9666
30780.......................  Little Rock-North Little Rock, AR   0.8552
30980.......................  Longview, TX.....................   0.8621
31084.......................  Los Angeles-Long Beach-Santa Ana,   1.1660
                               CA.
31140.......................  Louisville, KY-IN................   0.9264
31180.......................  Lubbock, TX......................   0.8790
31340.......................  Lynchburg, VA....................   0.8596
31420.......................  Macon, GA........................   0.9087
31540.......................  Madison, WI......................   1.0416
31700.......................  Manchester-Nashua, NH............   1.0668
32780.......................  Medford, OR......................   1.0284
32820.......................  Memphis, TN-MS-AR................   0.9108
33124.......................  Miami-Miami Beach-Kendall, FL....   0.9757
33260.......................  Midland, TX......................   0.9317
33340.......................  Milwaukee-Waukesha-West Allis, WI   0.9957
33460.......................  Minneapolis-St. Paul-Bloomington,   1.0905
                               MN-WI.
33540.......................  Missoula, MT.....................   0.9535
33660.......................  Mobile, AL.......................   0.7902
33700.......................  Modesto, CA......................   1.1885
33860.......................  Montgomery, AL...................   0.8276
34060.......................  Morgantown, WV...................   0.8332
34980.......................  Nashville-Davidson--Murfreesboro,   0.9492
                               TN.
35084.......................  Newark-Union, NJ-PA..............   1.2192
35380.......................  New Orleans-Metairie-Kenner, LA..   0.9003
35644.......................  New York-White Plains-Wayne, NY-    1.3191
                               NJ.
36084.......................  Oakland-Fremont-Hayward, CA......   1.5474
36100.......................  Ocala, FL........................   0.8955
36140.......................  Ocean City, NJ...................   1.0289
36220.......................  Odessa, TX.......................   0.9593
36260.......................  Ogden-Clearfield, UT.............   0.9048
36420.......................  Oklahoma City, OK................   0.9043
36500.......................  Olympia, WA......................   1.0970
36540.......................  Omaha-Council Bluffs, NE-IA......   0.9555
36740.......................  Orlando-Kissimmee, FL............   0.9446
37860.......................  Pensacola-Ferry Pass-Brent, FL...   0.8089
37900.......................  Peoria, IL.......................   0.8844
37964.......................  Philadelphia, PA.................   1.1030
38220.......................  Pine Bluff, AR...................   0.8099
38300.......................  Pittsburgh, PA...................   0.8840
38340.......................  Pittsfield, MA...................   1.0199
38860.......................  Portland-South Portland-            0.9884
                               Biddeford, ME.
38900.......................  Portland-Vancouver-Beaverton, OR-   1.1229
                               WA.
38940.......................  Port St. Lucie-Fort Pierce, FL...   1.0162
39100.......................  Poughkeepsie-Newburgh-Middletown,   1.0576
                               NY.
39340.......................  Provo-Orem, UT...................   0.9578
39580.......................  Raleigh-Cary, NC.................   0.9476
39740.......................  Reading, PA......................   0.9500
39820.......................  Redding, CA......................   1.1909
39900.......................  Reno-Sparks, NV (NV Hospitals)...   1.0805
39900.......................  Reno-Sparks, NV (CA Hospitals)...   1.0848
40060.......................  Richmond, VA.....................   0.9319
40220.......................  Roanoke, VA......................   0.8450
40340.......................  Rochester, MN....................   1.1128
40380.......................  Rochester, NY....................   0.9117
40420.......................  Rockford, IL.....................   0.9667
40484.......................  Rockingham County, NH............   1.0503
40660.......................  Rome, GA.........................   0.9414
40900.......................  Sacramento--Arden-Arcade--          1.2953
                               Roseville, CA.
40980.......................  Saginaw-Saginaw Township North,     0.9090
                               MI.
41060.......................  St. Cloud, MN....................   0.9785
41100.......................  St. George, UT...................   0.9416
41180.......................  St. Louis, MO-IL.................   0.8953
41620.......................  Salt Lake City, UT...............   0.9436
41700.......................  San Antonio, TX..................   0.8987

[[Page 43005]]

 
41884.......................  San Francisco-San Mateo-Redwood     1.4739
                               City,CA.
41980.......................  San Juan-Caguas-Guaynabo, PR.....   0.4686
42044.......................  Santa Ana-Anaheim-Irvine, CA.....   1.1297
42140.......................  Santa Fe, NM.....................   1.0163
42220.......................  Santa Rosa-Petaluma, CA..........   1.3480
42260.......................  Sarasota-Bradenton-Venice, FL....   0.9554
42340.......................  Savannah, GA.....................   0.9316
42644.......................  Seattle-Bellevue-Everett, WA.....   1.1573
43300.......................  Sherman-Denison, TX..............   0.8971
43340.......................  Shreveport-Bossier City, LA......   0.8767
43620.......................  Sioux Falls, SD..................   0.9616
43780.......................  South Bend-Mishawaka, IN-MI......   0.9785
43900.......................  Spartanburg, SC..................   0.9183
44060.......................  Spokane, WA......................   1.0722
44180.......................  Springfield, MO..................   0.8251
44300.......................  State College, PA................  0.8300]
44940.......................  Sumter, SC.......................   0.8663
45060.......................  Syracuse, NY.....................   0.9315
45104.......................  Tacoma, WA.......................   1.0794
45220.......................  Tallahassee, FL..................   0.8420
45300.......................  Tampa-St. Petersburg-Clearwater,    0.9292
                               FL.
45500.......................  Texarkana, TX-Texarkana, AR......   0.8293
45820.......................  Topeka, KS.......................   0.8785
46140.......................  Tulsa, OK........................   0.8313
46220.......................  Tuscaloosa, AL...................   0.8614
46340.......................  Tyler, TX........................   0.9164
46660.......................  Valdosta, GA.....................   0.8710
46700.......................  Vallejo-Fairfield, CA............   1.3955
47260.......................  Virginia Beach-Norfolk-Newport      0.8841
                               News, VA.
47380.......................  Waco, TX.........................   0.8532
47894.......................  Washington-Arlington-Alexandria     1.0813
                               DC-VA.
48140.......................  Wausau, WI.......................   0.9964
48620.......................  Wichita, KS......................   0.8946
48700.......................  Williamsport, PA.................   0.8300
48864.......................  Wilmington, DE-MD-NJ.............   1.0652
48864.......................  Wilmington, DE-MD-NJ (NJ            1.1253
                               Hospitals).
48900.......................  Wilmington, NC...................   0.9394
49020.......................  Winchester, VA-WV................   1.0214
49180.......................  Winston-Salem, NC................   0.9020
49660.......................  Youngstown-Warren-Boardman, OH-PA   0.8446
                               (PA Hospitals).
49660.......................  Youngstown-Warren-Boardman, OH-PA   0.8788
                               (OH Hospitals).
03..........................  Rural Arizona....................   0.8991
04..........................  Rural Arkansas...................   0.7478
05..........................  Rural California.................   1.0848
07..........................  Rural Connecticut................   1.0448
10..........................  Rural Florida....................   0.8613
13..........................  Rural Idaho......................   0.8810
14..........................  Rural Illinois...................   0.8285
15..........................  Rural Indiana....................   0.8632
16..........................  Rural Iowa.......................   0.8563
17..........................  Rural Kansas.....................   0.8032
19..........................  Rural Louisiana..................   0.7445
23..........................  Rural Michigan...................   0.8923
24..........................  Rural Minnesota..................   0.9183
26..........................  Rural Missouri...................   0.7927
30..........................  Rural New Hampshire..............   1.0668
37..........................  Rural Oklahoma...................   0.7615
38..........................  Rural Oregon.....................   1.0284
45..........................  Rural Texas......................   0.8038
50..........................  Rural Washington (ID Hospitals)..   1.0061
50..........................  Rural Washington (WA Hospitals)..   1.0459
53..........................  Rural Wyoming....................   0.9207
------------------------------------------------------------------------


               Addendum K.--Puerto Rico Wage Index by CBSA
------------------------------------------------------------------------
                                                            Wage index-
       CBSA code              Area          Wage  index    reclassified
                                                             hospitals
------------------------------------------------------------------------
10380.................  Aguadilla-                1.0196  ..............
                         Isabela-San
                         Sebastian, PR.
21940.................  Fajardo, PR.....          0.8956  ..............
25020.................  Guayama, PR.....          0.6858  ..............
32420.................  Mayaguez, PR....          0.8647  ..............
38660.................  Ponce, PR.......          1.1147  ..............
41900.................  San German-Cabo           1.0002  ..............
                         Rojo, PR.
41980.................  San                       1.0087          1.0087
                         JuanCaguasGuayn
                         abo, PR.
49500.................  Yauco, PR.......          0.9500  ..............
------------------------------------------------------------------------


         Addendum L.--Out-Migration Wage Adjustment--FY 2006 \1\
------------------------------------------------------------------------
                                  Out-
        Provider  No.          migration       Qualifying county name
                               adjustment
------------------------------------------------------------------------
010009......................       0.0092  MORGAN
010010......................       0.0259  MARSHALL
010038......................       0.0062  CALHOUN
010047......................       0.0155  BUTLER
010054......................       0.0092  MORGAN
010061......................       0.0506  JACKSON
010078......................       0.0062  CALHOUN
010085......................       0.0092  MORGAN
010109......................       0.0464  PICKENS
010115......................       0.0093  FRANKLIN
010129......................       0.0121  BALDWIN
010146......................       0.0062  CALHOUN
040066......................       0.0382  CLARK
040070......................       0.0140  MISSISSIPPI
040143......................       0.0026  JEFFERSON
050008......................       0.0028  SAN FRANCISCO
050016......................       0.0087  SAN LUIS OBISPO
050047......................       0.0028  SAN FRANCISCO
050055......................       0.0028  SAN FRANCISCO
050084......................       0.0555  SAN JOAQUIN
050088......................       0.0087  SAN LUIS OBISPO
050101......................       0.0269  SOLANO
050117......................       0.0463  MERCED
050122......................       0.0555  SAN JOAQUIN
050133......................       0.0170  YUBA
050152......................       0.0028  SAN FRANCISCO
050167......................       0.0555  SAN JOAQUIN
050232......................       0.0087  SAN LUIS OBISPO
050253......................       0.0029  ORANGE
050313......................       0.0555  SAN JOAQUIN
050325......................       0.0176  TUOLUMNE
050335......................       0.0176  TUOLUMNE
050336......................       0.0555  SAN JOAQUIN
050367......................       0.0269  SOLANO
050407......................       0.0028  SAN FRANCISCO
050444......................       0.0463  MERCED
050454......................       0.0028  SAN FRANCISCO
050457......................       0.0028  SAN FRANCISCO
050476......................       0.0257  LAKE
050491......................       0.0029  ORANGE

[[Page 43006]]

 
050506......................       0.0087  SAN LUIS OBISPO
050539......................       0.0257  LAKE
050568......................       0.0062  MADERA
050633......................       0.0087  SAN LUIS OBISPO
050680......................       0.0269  SOLANO
050695......................       0.0555  SAN JOAQUIN
070020......................       0.0073  MIDDLESEX
080001......................       0.0062  NEW CASTLE
080003......................       0.0062  NEW CASTLE
100014......................       0.0118  VOLUSIA
100017......................       0.0118  VOLUSIA
100047......................       0.0021  CHARLOTTE
100062......................       0.0060  MARION
100068......................       0.0118  VOLUSIA
100072......................       0.0118  VOLUSIA
100077......................       0.0021  CHARLOTTE
100102......................       0.0133  COLUMBIA
100156......................       0.0133  COLUMBIA
100175......................       0.0231  DE SOTO
100212......................       0.0060  MARION
100236......................       0.0021  CHARLOTTE
100290......................       0.0558  SUMTER
110027......................       0.0387  FRANKLIN
110063......................       0.0290  LIBERTY
110120......................       0.0873  POLK
110124......................       0.0428  WAYNE
110136......................       0.0261  BALDWIN
110190......................       0.0182  MACON
130011......................       0.0218  LATAH
130024......................       0.0275  BONNER
140026......................       0.0346  LA SALLE
140033......................       0.0147  LAKE
140084......................       0.0147  LAKE
140100......................       0.0147  LAKE
140129......................       0.0096  WABASH
140130......................       0.0147  LAKE
140173......................       0.0046  WHITESIDE
140202......................       0.0147  LAKE
140205......................       0.0163  BOONE
150022......................       0.0249  MONTGOMERY
150035......................       0.0083  PORTER
150045......................       0.0416  DE KALB
150060......................       0.0052  VERMILLION
150062......................       0.0153  DECATUR
150091......................       0.0573  HUNTINGTON
150122......................       0.0199  RIPLEY
160013......................       0.0218  MUSCATINE
160030......................       0.0032  STORY
160032......................       0.0272  JASPER
160140......................       0.0364  PLYMOUTH
180128......................       0.0282  LAWRENCE
190010......................       0.0401  TANGIPAHOA
190017......................       0.0235  ST. LANDRY
190049......................       0.0645  WASHINGTON
190054......................       0.0107  IBERIA
190078......................       0.0235  ST. LANDRY
190088......................       0.0705  WEBSTER
190133......................       0.0238  ALLEN
190144......................       0.0705  WEBSTER
190147......................       0.0401  TANGIPAHOA
190148......................       0.0390  AVOYELLES
190184......................       0.0161  CALDWELL
190190......................       0.0161  CALDWELL
190246......................       0.0161  CALDWELL
200013......................       0.0186  WALDO
200032......................       0.0460  OXFORD
210001......................       0.0129  WASHINGTON
210004......................       0.0040  MONTGOMERY
210016......................       0.0040  MONTGOMERY
210018......................       0.0040  MONTGOMERY
210022......................       0.0040  MONTGOMERY
210023......................       0.0209  ANNE ARUNDEL
210028......................       0.0512  ST. MARYS
210043......................       0.0209  ANNE ARUNDEL
210048......................       0.0287  HOWARD
210057......................       0.0040  MONTGOMERY
220006......................       0.0306  ESSEX
220076......................       0.0249  MIDDLESEX
230015......................       0.0359  ST. JOSEPH
230021......................       0.0136  BERRIEN
230041......................       0.0099  BAY
230075......................       0.0145  CALHOUN
230184......................       0.0389  JACKSON
230222......................       0.0228  MIDLAND
240011......................       0.0506  MC LEOD
240014......................       0.0454  RICE
240021......................       0.0897  LE SUEUR
240044......................       0.0868  WINONA
240089......................       0.1196  GOODHUE
240133......................       0.0319  MEEKER
240154......................       0.0138  ITASCA
240205......................       0.0138  ITASCA
250030......................       0.0318  LEAKE
250045......................       0.0042  HANCOCK
250088......................       0.0122  WILKINSON
250154......................       0.0318  LEAKE
260097......................       0.0425  JOHNSON
260127......................       0.0158  PIKE
280054......................       0.0137  GAGE
280123......................       0.0137  GAGE
310010......................       0.0097  MERCER
310011......................       0.0113  CAPE MAY
310039......................       0.0350  MIDDLESEX
310044......................       0.0097  MERCER
310092......................       0.0097  MERCER
310108......................       0.0350  MIDDLESEX
310110......................       0.0097  MERCER
320003......................       0.0630  SAN MIGUEL
320011......................       0.0442  RIO ARRIBA
320018......................       0.0063  DONA ANA
320085......................       0.0063  DONA ANA
330167......................       0.0137  NASSAU
330198......................       0.0137  NASSAU
330209......................       0.0560  ORANGE
330222......................       0.0003  SARATOGA
330224......................       0.0959  ULSTER
330225......................       0.0137  NASSAU
330259......................       0.0137  NASSAU
330276......................       0.0063  FULTON
330331......................       0.0137  NASSAU
330332......................       0.0137  NASSAU
330333......................       0.0137  NASSAU
330372......................       0.0137  NASSAU
330402......................       0.0959  ULSTER
340015......................       0.0267  ROWAN
340020......................       0.0207  LEE
340037......................       0.0216  CLEVELAND
340070......................       0.0448  ALAMANCE
340085......................       0.0377  DAVIDSON
340088......................       0.0115  TRANSYLVANIA
340096......................       0.0377  DAVIDSON
340104......................       0.0216  CLEVELAND
340126......................       0.0161  WILSON
340133......................       0.0302  MARTIN
360034......................       0.0263  WAYNE
360070......................       0.0028  STARK
360084......................       0.0028  STARK
360093......................       0.0120  DEFIANCE
360095......................       0.0087  HANCOCK
360099......................       0.0087  HANCOCK
360100......................       0.0028  STARK
360131......................       0.0028  STARK
360151......................       0.0028  STARK
360156......................       0.0213  SANDUSKY
370023......................       0.0084  STEPHENS
370043......................       0.0294  MARSHALL
370065......................       0.0121  CRAIG
370149......................       0.0356  POTTAWATOMIE
380002......................       0.0130  JOSEPHINE
380029......................       0.0073  MARION
380051......................       0.0073  MARION
380056......................       0.0073  MARION
390011......................       0.0012  CAMBRIA
390044......................       0.0200  BERKS
390046......................       0.0098  YORK
390056......................       0.0042  HUNTINGDON
390096......................       0.0200  BERKS
390101......................       0.0098  YORK
390130......................       0.0012  CAMBRIA
390146......................       0.0053  WARREN
390162......................       0.0207  NORTHAMPTON
390233......................       0.0098  YORK
420007......................       0.0001  SPARTANBURG
420027......................       0.0210  ANDERSON
420043......................       0.0177  CHEROKEE
420083......................       0.0001  SPARTANBURG
420093......................       0.0001  SPARTANBURG
420098......................       0.0035  GEORGETOWN
440024......................       0.0387  BRADLEY
440047......................       0.0499  GIBSON
440056......................       0.0321  JEFFERSON
440063......................       0.0011  WASHINGTON
440105......................       0.0011  WASHINGTON
440114......................       0.0523  LAUDERDALE
440115......................       0.0499  GIBSON
440143......................       0.0448  MARSHALL
440153......................       0.0145  COCKE
440174......................       0.0372  HAYWOOD
440181......................       0.0407  HARDEMAN
440184......................       0.0011  WASHINGTON
450050......................       0.0750  WARD
450113......................       0.0195  ANDERSON
450163......................       0.0134  KLEBERG
450362......................       0.0486  BURNET
450370......................       0.0258  COLORADO
450395......................       0.0484  POLK
450465......................       0.0435  MATAGORDA
450596......................       0.0808  HOOD
450597......................       0.0077  DE WITT
450626......................       0.0294  JACKSON
450763......................       0.0236  HUTCHINSON
450813......................       0.0195  ANDERSON
460017......................       0.0392  BOX ELDER
470018......................       0.0287  WINDSOR
470023......................       0.0118  CALEDONIA
490019......................       0.1240  CULPEPER
490038......................       0.0022  SMYTH
490084......................       0.0167  ESSEX
490110......................       0.0082  MONTGOMERY
500007......................       0.0208  SKAGIT
500019......................       0.0213  LEWIS
500021......................       0.0055  PIERCE
500079......................       0.0055  PIERCE
500108......................       0.0055  PIERCE
500118......................       0.0548  MASON

[[Page 43007]]

 
500129......................       0.0055  PIERCE
510039......................       0.0112  OHIO
510050......................       0.0112  OHIO
510088......................       0.0141  FAYETTE
520035......................       0.0077  SHEBOYGAN
520042......................       0.0118  SAUK
520044......................       0.0077  SHEBOYGAN
520057......................       0.0118  SAUK
520132......................       0.0077  SHEBOYGAN
------------------------------------------------------------------------
\1\ The above table lists all hospitals that we anticipate will have
  their wage index increased by the out-migration adjustment. This list
  includes hospitals designated in Table 4J of FY 2006 hospital IPPS
  proposed rule (May 5, 2005) as NOT reclassified under section
  1886(d)(10) of the Act or redesignated under section 1886(d)(8)(B) of
  the Act, as well as TEFRA hospitals falling in a designated out-
  migration county. In the IPPS proposed rule we asked hospitals to
  notify us if they wish to withdraw their reclassification/
  redesignation request and receive the out-migration adjustment.
  Because we are proposing to adopt the final IPPS wage indices for
  OPPS, we will adopt any changes in eligibility for the out-migration
  adjustment resulting from requests to waive reclassification


     Addendum M.--Hospitals Reclassifications and Redesignations by
                 Individual Hospitals and CBSA--CY 2006
------------------------------------------------------------------------
                      Geographic  Reclassified
    Provider No.         CBSA         CBSA                Lugar
------------------------------------------------------------------------
010005..............         01        13820
010008..............         01        33860
010012..............         01        16860
010022..............         01        40660    LUGAR
010025..............         01        17980
010029..............      12220        17980
010035..............         01        13820
010044..............         01        13820
010045..............         01        13820
010065..............         01        33860
010072..............         01        11500    LUGAR
010083..............         01        37860
010100..............         01        37860
010101..............         01        11500    LUGAR
010118..............         01        33860
010120..............         01        33660
010126..............         01        33860
010143..............         01        13820
010158..............         01        19460
030013..............      49740        20940
030033..............         03        22380
040014..............         04        30780
040017..............         04        44180
040019..............         04        32820
040020..............      27860        32820
040027..............         04        44180
040039..............         04        27860
040041..............         04        30780
040047..............         04        27860
040069..............         04        32820
040071..............      38220        30780
040072..............         04        30780
040076..............         04        30780
040078..............      26300        30780
040080..............         04        27860
040088..............         04        43340
040091..............         04        45500
040100..............         04        30780
040119..............         04        30780
050006..............         05        39820
050009..............      34900        46700
050013..............      34900        46700
050014..............         05        40900
050022..............      40140        42044
050042..............         05        39820
050046..............      37100        31084
050054..............      40140        42044
050065..............      42044        31084
050069..............      42044        31084
050071..............      41940        36084
050073..............      46700        36084
050076..............      41884        36084
050082..............      37100        31084
050089..............      40140        31084
050090..............      42220        41884
050099..............      40140        31084
050102..............      40140        42044
050118..............      44700        33700
050129..............      40140        31084
050136..............      42220        41884
050140..............      40140        31084
050150..............         05        40900
050159..............      37100        31084
050168..............      42044        31084
050173..............      42044        31084
050174..............      42220        41884
050177..............      37100        31084
050193..............      42044        31084
050224..............      42044        31084
050226..............      42044        31084
050228..............      41884        36084
050230..............      42044        31084
050236..............      37100        31084
050243..............      40140        42044
050245..............      40140        31084
050251..............         05        39900
050272..............      40140        31084
050279..............      40140        31084
050291..............      42220        41884
050292..............      40140        42044
050298..............      40140        31084
050300..............      40140        31084
050327..............      40140        31084
050329..............      40140        42044
050331..............      42220        41884
050348..............      42044        31084
050385..............      42220        41884
050390..............      40140        42044
050394..............      37100        31084
050419..............         05        39820
050423..............      40140        42044
050426..............      42044        31084
050430..............         05        39900
050510..............      41884        36084
050517..............      40140        31084
050526..............      42044        31084
050534..............      40140        42044
050535..............      42044        31084
050541..............      41884        36084
050543..............      42044        31084
050547..............      42220        41884
050548..............      42044        31084
050550..............      42044        31084
050551..............      42044        31084
050567..............      42044        31084
050569..............         05        42220
050570..............      42044        31084
050573..............      40140        42044
050580..............      42044        31084
050584..............      40140        31084
050585..............      42044        31084
050586..............      40140        31084
050589..............      42044        31084
050592..............      42044        31084
050594..............      42044        31084
050603..............      42044        31084
050609..............      42044        31084
050616..............      37100        31084
050667..............      34900        46700
050668..............      41884        36084
050678..............      42044        31084
050684..............      40140        42044
050686..............      40140        42044
050690..............      42220        41884
050693..............      42044        31084
050694..............      40140        42044
050701..............      40140        42044
050709..............      40140        31084
050718..............      40140        42044
050720..............      42044        31084
050728..............      42220        41884
060001..............      24540        19740
060003..............      14500        19740
060023..............      24300        39340
060027..............      14500        19740
060044..............         06        19740
060049..............         06        22660
060096..............         06        19740
060103..............      14500        19740
070003..............         07        25540    LUGAR
070021..............         07        25540    LUGAR
070033..............      14860        35644
080004..............      20100        48864
080007..............         08        36140
100022..............      33124        22744
100023..............         10        36740
100024..............         10        33124
100045..............      19660        36740
100049..............         10        29460
100081..............         10        23020    LUGAR
100109..............         10        36740
100118..............         10        27260
100139..............         10        23540    LUGAR
100150..............         10        33124
100157..............      29460        45300
100176..............      48424        38940
100217..............      46940        38940
100232..............         10        27260
100239..............      45300        42260
100249..............         10        36100
100252..............         10        38940
100292..............         10        23020    LUGAR
110001..............      19140        12060
110002..............         11        12060
110003..............         11        27260
110023..............         11        12060

[[Page 43008]]

 
110025..............      15260        27260
110029..............      23580        12060
110038..............         11        45220
110040..............         11        12060    LUGAR
110041..............         11        12020
110052..............         11        16860    LUGAR
110054..............      40660        12060
110069..............      47580        31420
110075..............         11        42340
110088..............         11        12060    LUGAR
110095..............         11        46660
110117..............         11        12060    LUGAR
110122..............      46660        45220
110125..............         11        31420
110128..............         11        42340
110150..............         11        31420
110153..............      47580        31420
110168..............      40660        12060
110187..............         11        12060    LUGAR
110189..............         11        12060
110205..............         11        12060
120028..............         12        26180
130002..............         13        14260
130003..............      30300           50
130049..............      17660        44060
140012..............         14        16974
140015..............         14        41180
140032..............         14        41180
140034..............         14        41180
140040..............         14        37900
140043..............         14        40420
140046..............         14        41180
140058..............         14        41180
140061..............         14        41180
140064..............         14        37900
140110..............         14        16974
140143..............         14        37900
140160..............         14        40420
140161..............         14        16974
140164..............         14        41180
140189..............         14        16580
140233..............      40420        16974
140234..............         14        37900
140236..............         14        28100    LUGAR
140291..............      29404        16974
150002..............      23844        16974
150004..............      23844        16974
150006..............      33140        43780
150008..............      23844        16974
150011..............         15        26900
150015..............      33140        16974
150030..............         15        26900    LUGAR
150048..............         15        17140
150065..............         15        26900
150069..............         15        17140
150076..............         15        43780
150088..............      11300        26900
150090..............      23844        16974
150102..............         15        23844    LUGAR
150112..............      18020        26900
150113..............      11300        26900
150125..............      23844        16974
150126..............      23844        16974
150132..............      23844        16974
150133..............         15        23060
150146..............         15        23060
150147..............      23844        16974
160001..............         16        11180
160016..............         16        19780
160026..............         16        11180    LUGAR
160057..............         16        26980
160080..............         16        40420
160089..............         16        19780
160147..............         16        11180
170006..............         17        27900
170010..............         17        46140
170012..............         17        48620
170013..............         17        48620
170020..............         17        48620
170022..............         17        28140
170023..............         17        48620
170033..............         17        48620
170058..............         17        28140
170068..............         17        11100
170120..............         17        27900
170142..............         17        45820
170175..............         17        48620
180005..............         18        26580
180011..............         18        30460
180012..............      21060        31140
180013..............      14540        34980
180017..............         18        21060
180018..............         18        30460
180019..............         18        17140
180024..............         18        31140
180027..............         18        17300
180028..............         18        26580
180029..............         18        28700
180044..............         18        26580
180048..............         18        31140
180066..............         18        34980
180069..............         18        26580
180075..............         18        14540    LUGAR
180078..............         18        26580
180080..............         18        28940
180093..............         18        21780
180102..............         18        17300
180104..............         18        17300
180116..............         18           14
180124..............      14540        34980
180127..............         18        31140
180132..............         18        30460
180139..............         18        30460
190001..............         19        35380
190003..............         19        29180
190015..............         19        35380
190086..............         19        43340
190099..............         19        12940
190106..............         19        10780
190131..............      12940        35380
190155..............         19        12940    LUGAR
190164..............         19        10780
190191..............         19        12940
190223..............         19        12940    LUGAR
200002..............         20        38860
200020..............      38860        40484
200024..............      30340        38860
200034..............      30340        38860
200039..............         20        38860
200050..............         20        12620
200063..............         20        38860
220001..............      49340        14484
220002..............      15764        14484
220003..............      49340        14484
220010..............      21604        14484
220011..............      15764        14484
220019..............      49340        14484
220025..............      49340        14484
220028..............      49340        14484
220029..............      21604        14484
220033..............      21604        14484
220035..............      21604        14484
220049..............      15764        14484
220058..............      49340        14484
220060..............      14484        12700
220062..............      49340        14484
220063..............      15764        14484
220070..............      15764        14484
220077..............      44140        25540
220080..............      21604        14484
220082..............      15764        14484
220084..............      15764        14484
220089..............      15764        14484
220090..............      49340        14484
220095..............      49340        14484
220098..............      15764        14484
220101..............      15764        14484
220105..............      15764        14484
220133..............      15764        14484
220163..............      49340        14484
220171..............      15764        14484
220174..............      21604        14484
230022..............         23        11460
230030..............         23        40980
230035..............         23        24340    LUGAR
230037..............         23        11460
230042..............         23        26100    LUGAR
230047..............      47644        19804
230054..............         23        24580
230069..............      47644        22420
230077..............      40980        22420
230080..............         23        40980
230093..............         23        24340
230096..............         23        28020
230099..............      33780        11460
230105..............         23        13020
230121..............         23        29620    LUGAR
230134..............         23        26100    LUGAR
230195..............      47644        19804
230204..............      47644        19804
230208..............         23        24340    LUGAR
230217..............      12980        29620
230227..............      47644        19804
230235..............         23        40980    LUGAR
230257..............      47644        19804
230264..............      47644        19804
230279..............      47644        22420
230295..............         23        26100    LUGAR
240013..............         24        33460
240018..............         24        33460
240030..............         24        41060
240031..............      41060        33460
240036..............      41060        33460
240052..............         24        22020
240064..............         24        20260
240069..............         24        40340
240071..............         24        40340
240075..............         24        41060
240088..............         24        41060
240093..............         24        33460
240105..............         24        40340    LUGAR

[[Page 43009]]

 
240150..............         24        40340    LUGAR
240152..............         24        33460
240187..............         24        33460
240211..............         24        33460
250004..............         25        32820
250006..............         25        32820
250009..............         25        27180
250023..............         25        25060    LUGAR
250031..............         25        27140
250034..............         25        32820
250040..............      37700        25060
250042..............         25        32820
250069..............         25        46220
250079..............         25        27140
250081..............         25        27140
250082..............         25        38220
250094..............      25620        25060
250097..............         25        12940
250099..............         25        27140
250100..............         25        46220
250104..............         25        27140
250117..............         25        25060    LUGAR
260009..............         26        28140
260011..............      27620        17860
260017..............         26        41180
260022..............         26           16
260025..............         26        41180
260047..............      27620        17860
260049..............         26        44180    LUGAR
260064..............         26        17860
260074..............         26        17860
260094..............         26        44180
260110..............         26        41180
260113..............         26           14
260116..............         26           14
260183..............         26        41180
260186..............         26        17860
270003..............         27        24500
270011..............         27        24500
270017..............         27        33540
270051..............         27        33540
280009..............         28        30700
280023..............         28        30700
280032..............         28        30700
280057..............         28        30700
280061..............         28           53
280065..............         28        24540
280077..............         28        36540
290002..............         29        16180    LUGAR
290006..............         29        39900
290008..............         29        29820
290019..............      16180        39900
300003..............         30        31700
300005..............         30        31700
300007..............      31700        15764
300011..............      31700        15764
300012..............      31700        15764
300014..............      40484        31700
300017..............      40484        21604
300018..............      40484        31700
300019..............         30        15764
300020..............      31700        15764
300023..............      40484        21604
300029..............      40484        21604
300034..............      31700        15764
310002..............      35084        35644
310009..............      35084        35644
310013..............      35084        35644
310015..............      35084        35644
310018..............      35084        35644
310031..............      15804        20764
310032..............      47220        48864
310038..............      20764        35644
310048..............      20764        35084
310054..............      35084        35644
310070..............      20764        35644
310076..............      35084        35644
310078..............      35084        35644
310083..............      35084        35644
310093..............      35084        35644
310096..............      35084        35644
310119..............      35084        35644
320005..............      22140        10740
320006..............         32        42140
320013..............         32        42140
320014..............         32        29740
320033..............         32        42140    LUGAR
320063..............         32        36220
320065..............         32        36220
330001..............      39100        35644
330004..............      28740        39100
330008..............         33        15380    LUGAR
330027..............      35004        35644
330038..............         33        40380    LUGAR
330062..............         33        27060    LUGAR
330073..............         33        40380    LUGAR
330085..............         33        45060
330094..............         33        28740
330136..............         33        45060
330157..............         33        45060
330181..............      35004        35644
330182..............      35004        35644
330191..............      24020        10580
330229..............      27460        21500
330235..............         33        45060    LUGAR
330239..............      27460        21500
330250..............         33        15540
330277..............         33        27060
330359..............         33        39100    LUGAR
330386..............         33        39100    LUGAR
340004..............      24660        49180
340008..............         34        16740
340010..............      24140        39580
340013..............         34        16740
340018..............         34        43900    LUGAR
340021..............         34        16740
340023..............      11700        24860
340027..............         34        24780
340039..............         34        16740
340050..............         34        22180
340051..............         34        25860
340068..............         34        48900
340069..............      39580        20500
340071..............         34        39580    LUGAR
340073..............      39580        20500
340091..............      24660        49180
340109..............         34        47260
340114..............      39580        20500
340115..............         34        20500
340124..............         34        39580    LUGAR
340127..............         34        20500    LUGAR
340129..............         34        16740
340131..............         34        24780
340136..............         34        20500    LUGAR
340138..............      39580        20500
340144..............         34        16740
340145..............         34        16740    LUGAR
340147..............      40580        39580
340173..............      39580        20500
350009..............         35        22020
360008..............         36        26580
360010..............         36        10420
360011..............         36        18140
360013..............         36        30620
360014..............         36        18140
360019..............      10420        17460
360020..............      10420        17460
360025..............      41780        17460
360027..............      10420        17460
360036..............         36        17460
360039..............         36        18140
360054..............         36        16620
360065..............         36        17460
360078..............      10420        17460
360079..............      19380        17140
360086..............      44220        19380
360096..............         36        49660    LUGAR
360107..............         36        17460
360112..............      45780        11460
360125..............         36        17460    LUGAR
360150..............      10420        17460
360159..............         36        18140
360175..............         36        18140
360185..............         36        49660    LUGAR
360187..............      44220        19380
360197..............         36        18140
360211..............      48260        38300
360238..............         36        49660    LUGAR
360241..............      10420        17460
360245..............         36        17460    LUGAR
370004..............         37        27900
370014..............         37        43300
370015..............         37        46140
370018..............         37        46140
370022..............         37        30020
370025..............         37        46140
370034..............         37        22900
370047..............         37        43300
370049..............         37        36420
370099..............         37        46140
370103..............         37           45
370113..............         37        22220
370179..............         37        46140
380001..............         38        38900
380008..............         38        18700    LUGAR
380022..............         38        18700    LUGAR
380027..............         38        21660
380047..............      13460        21660
380050..............         38        32780
380070..............         38        38900
390006..............         39        25420
390013..............         39        25420
390016..............         39        49660
390030..............         39        10900
390031..............         39        39740    LUGAR
390048..............         39        25420
390052..............         39        11020
390065..............         39        47894
390066..............      30140        25420
390071..............         39        48700    LUGAR
390079..............         39        13780

[[Page 43010]]

 
390081..............      37964        48864
390086..............         39        44300
390091..............         39        49660
390093..............         39        49660
390110..............      27780        38300
390113..............         39        49660
390133..............      10900        37964
390138..............         39        47894
390150..............         39        38300    LUGAR
390151..............         39        47894
390156..............      37964        48864
390180..............      37964        48864
390222..............      37964        48864
390224..............         39        13780    LUGAR
390244..............         39        48700    LUGAR
390246..............         39        48700
390249..............         39        13780    LUGAR
400048..............      25020        41980
410001..............      39300        14484
410004..............      39300        14484
410005..............      39300        14484
410006..............      39300        14484
410007..............      39300        14484
410008..............      39300        14484
410009..............      39300        14484
410011..............      39300        14484
410012..............      39300        14484
410013..............      39300        14484
420009..............         42        24860    LUGAR
420020..............         42        16700
420028..............         42        44940    LUGAR
420030..............         42        16700
420036..............         42        16740
420039..............         42        43900    LUGAR
420067..............         42        42340
420068..............         42        16700
420069..............         42        44940    LUGAR
420070..............      44940        17900
420071..............         42        24860
420080..............         42        42340
420085..............      34820        48900
430012..............         43        43620
430014..............         43        22020
430094..............         43           53
440008..............         44        21780
440020..............         44        26620
440035..............      17300        34980
440050..............         44        11700
440058..............         44        16860
440059..............         44        34980
440060..............         44        27180
440067..............      34100        28940
440068..............         44        16860
440072..............         44        32820
440073..............         44        34980
440148..............         44        34980
440151..............         44        34980
440175..............         44        34980
440180..............         44        28940
440185..............      17420        16860
440192..............         44        34980
450007..............         45        41700
450032..............         45        43340
450039..............      23104        19124
450059..............      41700        12420
450064..............      23104        19124
450073..............         45        10180
450080..............         45        30980
450087..............      23104        19124
450098..............         45        30980
450099..............         45        11100
450121..............      23104        19124
450135..............      23104        19124
450137..............      23104        19124
450144..............         45        36220
450148..............      23104        19124
450187..............         45        26420
450192..............         45        19124
450194..............         45        19124
450196..............         45        19124
450211..............         45        26420
450214..............         45        26420
450224..............         45        46340
450283..............         45        19124    LUGAR
450286..............         45        17780    LUGAR
450347..............         45        26420
450351..............         45        23104
450389..............         45        19124    LUGAR
450400..............         45        47380
450419..............      23104        19124
450438..............         45        26420
450447..............         45        19124
450451..............         45        23104
450484..............         45        26420
450508..............         45        46340
450547..............         45        19124
450563..............      23104        19124
450623..............         45        19124    LUGAR
450639..............      23104        19124
450653..............         45        33260
450656..............         45        46340
450672..............      23104        19124
450675..............      23104        19124
450677..............      23104        19124
450694..............         45        26420
450747..............         45        19124
450755..............         45        31180
450770..............         45        12420    LUGAR
450779..............      23104        19124
450830..............         45        36220
450839..............         45        43340
450858..............      23104        19124
450872..............      23104        19124
450880..............      23104        19124
460004..............      36260        41620
460005..............      36260        41620
460007..............         46        41100
460011..............         46        39340
460021..............      41100        29820
460036..............         46        39340
460039..............         46        36260
460041..............      36260        41620
460042..............      36260        41620
470001..............         47           30
470011..............         47        15764
470012..............         47        38340
490004..............      25500        16820
490005..............      49020        47894
490006..............         49        49020    LUGAR
490013..............         49        31340
490018..............         49        16820
490047..............         49        25500    LUGAR
490079..............         49        49180
490092..............         49        40060
490105..............         49        28700
490106..............         49        16820
490109..............      47260        40060
500002..............         50        28420
500003..............      34580        42644
500016..............      48300        42644
500024..............      36500        45104
500031..............         50        36500
500039..............      14740        42644
500041..............      31020        38900
500072..............         50        42644
500139..............      36500        45104
500143..............      36500        45104
510001..............      34060        38300
510002..............         51        40220
510006..............         51        38300
510018..............         51        16620    LUGAR
510024..............      34060        38300
510028..............         51        16620
510030..............         51        34060
510046..............         51        16620
510047..............         51        38300
510070..............         51        16620
510071..............         51        16620
510077..............         51        26580
520002..............         52        48140
520021..............      29404        16974
520028..............         52        31540    LUGAR
520037..............         52        48140
520059..............      39540        29404
520060..............         52        22540    LUGAR
520066..............      27500        31540
520071..............         52        33340    LUGAR
520076..............         52        31540
520088..............      22540        33340
520094..............      39540        33340
520095..............         52        31540
520096..............      39540        33340
520102..............         52        33340    LUGAR
520107..............         52        24580
520113..............         52        24580
520116..............         52        33340    LUGAR
520152..............         52        24580
520173..............         52        20260
520189..............      29404        16974
530002..............         53        16220
530025..............         53        22660
------------------------------------------------------------------------


Addendum N.--Hospital Reclassifications and Redesignations by Individual
              Hospital Under Section 508 of Pub. L. 108-173
------------------------------------------------------------------------
                                               Wage index  CBSA    Own
           Provider No.            Geographic         508          wage
                                      CBSA     reclassification   index
------------------------------------------------------------------------
010150...........................         01          17980      .......
020008...........................         02   ................   1.2841
050494...........................         05          42220      .......
050549...........................      37100          42220      .......
060057...........................         06          19740      .......
060075...........................         06   ................   1.1709

[[Page 43011]]

 
070001...........................      35300          35004      .......
070005...........................      35300          35004      .......
070010...........................      14860          35644      .......
070016...........................      35300          35004      .......
070017...........................      35300          35004      .......
070019...........................      35300          35004      .......
070022...........................      35300          35004      .......
070028...........................      14860          35644      .......
070031...........................      35300          35004      .......
070036...........................      25540   ................   1.2926
070039...........................      35300          35004      .......
120025...........................         12          26180      .......
150034...........................      23844          16974      .......
160040...........................      47940          16300      .......
160064...........................         16   ................   1.0228
160067...........................      47940          16300      .......
160110...........................      47940          16300      .......
190218...........................         19          43340      .......
220046...........................      38340          14484      .......
230003...........................      26100          28020      .......
230004...........................      34740          28020      .......
230013...........................      47644          22420      .......
230019...........................      47644          22420      .......
230020...........................      19804          11460      .......
230024...........................      19804          11460      .......
230029...........................      47644          22420      .......
230036...........................         23          22420      .......
230038...........................      24340          28020      .......
230053...........................      19804          11460      .......
230059...........................      24340          28020      .......
230066...........................      34740          28020      .......
230071...........................      47644          22420      .......
230072...........................      26100          28020      .......
230089...........................      19804          11460      .......
230092...........................      27100          24340      .......
230097...........................         23          28020      .......
230104...........................      19804          11460      .......
230106...........................      24340          28020      .......
230119...........................      19804          11460      .......
230130...........................      47644          22420      .......
230135...........................      19804          11460      .......
230146...........................      19804          11460      .......
230151...........................      47644          22420      .......
230165...........................      19804          11460      .......
230174...........................      26100          28020      .......
230176...........................      19804          11460      .......
230207...........................      47644          22420      .......
230223...........................      47644          22420      .......
230236...........................      24340          28020      .......
230254...........................      47644          22420      .......
230269...........................      47644          22420      .......
230270...........................      19804          11460      .......
230273...........................      19804          11460      .......
230277...........................      47644          22420      .......
250002...........................         25          25060      .......
250122...........................         25          25060      .......
270021...........................         27          13740      .......
270023...........................      33540          13740      .......
270032...........................         27          13740      .......
270050...........................         27          13740      .......
270057...........................         27          13740      .......
310021...........................      45940          35644      .......
310028...........................      35084          35644      .......
310050...........................      35084          35644      .......
310051...........................      35084          35644      .......
310060...........................      10900          35644      .......
310115...........................      10900          35644      .......
310120...........................      35084          35644      .......
330049...........................      39100          35644      .......
330067...........................      39100          35300      .......
330106...........................      35004   ................   1.4734
330126...........................      39100          35644      .......
330135...........................      39100          35644      .......
330205...........................      39100          35644      .......
330264...........................      39100          35004      .......
340002...........................      11700          16740      .......
350002...........................      13900          22020      .......
350003...........................         35          22020      .......
350006...........................         35          22020      .......
350010...........................         35          22020      .......
350014...........................         35          22020      .......
350015...........................      13900          22020      .......
350017...........................         35          22020      .......
350030...........................         35          22020      .......
350061...........................         35          22020      .......
380090...........................         38   ................   1.2316
390001...........................      42540          10900      .......
390003...........................         39          10900      .......
390054...........................      42540          29540      .......
390072...........................         39          10900      .......
390095...........................      42540          10900      .......
390109...........................      42540          10900      .......
390119...........................      42540          10900      .......
390137...........................      42540          10900      .......
390169...........................      42540          10900      .......
390185...........................      42540          29540      .......
390192...........................      42540          10900      .......
390237...........................      42540          10900      .......
390270...........................      42540          29540      .......
410010...........................      39300   ................   1.1746
430005...........................         43          39660      .......
430015...........................         43          43620      .......
430048...........................         43          43620      .......
430060...........................         43          43620      .......
430064...........................         43          43620      .......
430077...........................      39660          43620      .......
430091...........................      39660          43620      .......
450010...........................      48660          32580      .......
450072...........................      26420          26420      .......
450591...........................      26420          26420      .......
470003...........................      15540          14484      .......
490001...........................         49          31340      .......
490024...........................      40220          19260      .......
530015...........................         53   ................   0.9897
070006*..........................      14860          35644      .......
070018*..........................      14860          35644      .......
070034*..........................      14860          35644      .......
140155*..........................      28100          16974      .......
140186*..........................      28100          16974      .......
250078*..........................      25620          25060      .......
270002*..........................         27          33540      .......
270012*..........................      24500          33540      .......
270084*..........................         27          33540      .......
330023*..........................      39100          35644      .......
330067*..........................      39100          35644      .......
350019*..........................      24220          22020      .......
430008*..........................         43          43620      .......
430013*..........................         43          43620      .......
430031*..........................         43          43620      .......
530008*..........................         53          16220      .......
530010*..........................         53          16220      .......
------------------------------------------------------------------------
* These hospitals are assigned a wage index value under a special
  exceptions policy (FY 2005 IPPS final rule, 69 FR 49105).


Addendum O.--Hospitals Redesignated as Rural Under Section 1886(d)(8)(E)
                               of the Act
------------------------------------------------------------------------
                                            Geographic     Redesignated
              Provider No.                     CBSA         rural area
------------------------------------------------------------------------
030007..................................           39140              03
040075..................................           22220              04
050192..................................           23420              05
050469..................................           40140              05
050528..................................           32900              05
050618..................................           40140              05
070004..................................           25540              07
100048..................................           37860              10
100134..................................           27260              10
130018..................................           26820              13
140167..................................              14              14
150051..................................           14020              15
150078..................................           23844              15
170137..................................           29940              17
190048..................................           26380              19
230078..................................           35660              23
240037..................................           33460              24
260006..................................           41140              26
300009..................................           31700              30
370054..................................           36420              37
380040..................................           13460              38
380084..................................           41420              38
390181..................................              39              39
390183..................................              39              39
390201..................................              39              39
450052..................................              45              45
450078..................................           10180              45
450243..................................           10180              45
450276..................................           48660              45
450348..................................              45              45
500023..................................           28420              50
500037..................................           49420              50
500122..................................              50              50
500147..................................           42644              50
500148..................................           48300              50
------------------------------------------------------------------------

[FR Doc. 05-14448 Filed 7-18-05; 4:10 pm]
BILLING CODE 4120-01-P