[Federal Register Volume 71, Number 163 (Wednesday, August 23, 2006)]
[Proposed Rules]
[Pages 49506-49977]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-6846]



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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 410, 414, et al. Medicare: Hospital Outpatient Prospective 
Payment System and CY 2007 Payment Rates; Proposed Rule

  Federal Register / Vol. 71 , No. 163 / Wednesday, August 23, 2006 / 
Proposed Rules  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410, 414, 416, 419, 421, 485, and 488

[CMS-1506-P; CMS-4125-P]
RIN 0938-AO15


Medicare Program; Hospital Outpatient Prospective Payment System 
and CY 2007 Payment Rates; CY 2007 Update to the Ambulatory Surgical 
Center Covered Procedures List; Ambulatory Surgical Center Payment 
System and CY 2008 Payment Rates; Medicare Administrative Contractors; 
and Reporting Hospital Quality Data for FY 2008 Inpatient Prospective 
Payment System Annual Payment Update Program--HCAHPS[supreg] Survey, 
SCIP, and Mortality

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, and the Deficit Reduction Act (DRA) of 2005. 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. These changes would be applicable to 
services furnished on or after January 1, 2007.
    In addition, this proposed rule would revise the current list of 
procedures that are approved when furnished in a Medicare-approved 
ambulatory surgical center (ASC), which would be applicable to services 
furnished on or after January 1, 2007. Further, this proposed rule 
would revise the ASC facility payment system to implement provisions of 
the MMA and other applicable statutory requirements, and update the ASC 
payment rates. Changes to the ASC facility payment system and the 
payment rates would be applicable to services furnished on or after 
January 1, 2008.
    This proposed rule would revise the emergency medical screening 
requirements for critical access hospitals (CAHs).
    In addition, this proposed rule would support implementation of a 
restructuring of the contracting entities responsibilities and 
functions that support the adjudication of Medicare fee-for-service 
(FFS) claims. This restructuring is directed by section 1874A of the 
Act, as added by section 911 of the MMA. The prior separate Medicare 
intermediary and Medicare carrier contracting authorities under Title 
XVIII of the Act have been replaced with the Medicare Administrative 
Contractor (MAC) authority.
    This proposed rule would also continue to implement the 
requirements of the DRA that require that we expand the ``starter set'' 
of 10 quality measures that we used in FY 2005 and FY 2006 for the 
hospital Inpatient Prospective Payment System (IPPS) Reporting Hospital 
Quality Data for the Annual Payment Update (RHQDAPU) program. We began 
to adopt expanded measures effective for payments beginning in FY 2007. 
We are proposing to add additional quality measures to the expanded set 
of measures for FY 2008 payment purposes. These measures include the 
HCAHPS[supreg] survey, as well as Surgical Care Improvement Project 
(SCIP, formerly Surgical Infection Prevention (SIP)), and Mortality 
quality measures.

DATES: To be assured consideration, comments on all sections of the 
preamble of this proposed rule, except section XVIII. and section 
XXIII., must be received at one of the addresses provided in the 
ADDRESSES section, no later than 5 p.m. October 10, 2006.
    To be assured consideration, comments on section XVIII. of this 
preamble relating to the proposed revised ASC payment system and the 
related regulation changes for implementation January 1, 2008, must be 
received at one of the addresses provided in the ADDRESSES section, no 
later than 5 p.m. on November 6, 2006.

ADDRESSES: In commenting on all provisions except those found in 
section XXIII. of the preamble, please refer to file code CMS-1506-P. 
In commenting on the provisions found in section XXIII. of the preamble 
for the FY 2008 IPPS RHQDAPU program, please refer to file code CMS-
4125-P. Because of staff and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission.
    You may submit comments in one of four ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.cms.hhs.gov/eRulemaking. Click 
on the link ``Submit electronic comments on CMS regulations with an 
open comment period.'' (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-1506-P, or CMS-4125-P, P.O. Box 8011, Baltimore, MD 21244-1850.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    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-1506-P, or CMS-4125-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: Room 
445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-
1850.
    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.
    (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. You may submit 
comments on this document's paperwork requirements by mailing your 
comments to the addresses provided at the end of the ``Collection of 
Information Requirements'' section in this document.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT:


[[Page 49507]]


Alberta Dwivedi, (410) 786-0378, Hospital outpatient prospective 
payment issues.
Dana Burley, (410) 786-0378, Ambulatory surgery center issues.
Suzanne Asplen, (410) 786-4558, Partial hospitalization and community 
mental health centers issues.
Mary Collins, (410) 786-3189, Critical access hospital emergency 
medical planning issues.
Sandra M. Clarke, (410) 786-6975, Medicare Administrative Contractors 
issues.
Mark Zobel, (410) 786-6905, Medicare Administrative Contractors issues.
Liz Goldstein, (410) 786-6665, FY 2008 IPPS RHQDAPU HCAHPS[supreg] 
issues.
Bill Lehrman, (410) 786-1037, FY 2008 IPPS RHQDAPU HCAHPS[supreg] 
issues.
Sheila Blackstock, (410) 786-3506, FY 2008 IPPS RHQDAPU SCIP and 
mortality issues.

SUPPLEMENTARY INFORMATION:


     Submitting Comments We welcome comments from the public on all 
issues set forth in this proposed rule to assist us in fully 
considering issues and developing policies. You can assist us by 
referencing the file code CMS-1506-P or file code CMS-4125-P for FY 
2008 RHQDAPU program issues, 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. We post all comments received before the close 
of the comment period on the following Web site as soon as possible 
after they have been received: http://www.cms.hhs.gov/eRulemaking. 
Click on the link ``Electronic Comments on CMS Regulations'' on that 
Web site to view public comments.
    Comments received timely will also 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, on 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.

Electronic Access

    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. Free public access is available on a Wide 
Area Information Server (WAIS) through the Internet and via 
asynchronous dial-in. Internet users can access the database by using 
the World Wide Web; the Superintendent of Documents' home page address 
is http://www.gpoaccess.gov/index.html, by using local WAIS client 
software, or by telnet to swais.access.gpo.gov, then login as guest (no 
password required). Dial-in users should use communications software 
and modem to call (202) 512-1661; type swais, then login as guest (no 
password required).

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
ASC Ambulatory Surgical Center
ASP Average sales price
AWP Average wholesale price
BBA Balanced Budget Act of 1997, Pub. L. 105-33
BBRA Medicare, Medicaid, and SCHIP [State Children's Health 
Insurance Program] Balanced Budget Refinement Act of 1999, Pub. L. 
106-113
BCA Blue Cross Association
BCBSA Blue Cross and Blue Shield Association
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act of 2000, Pub. L. 106-554
CAH Critical access hospital
CBSA Core-Based Statistical Area
CCR Cost-to-charge ratio
CMHC Community mental health center
CMS Centers for Medicare & Medicaid Services
CNS Clinical nurse specialist
CORF Comprehensive outpatient rehabilitation facility
CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 
2006, 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
DRA Deficit Reduction Act of 2005, Pub. L. 109-171
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
FAR Federal Acquisition Regulations
FDA Food and Drug Administration
FFS Fee-for-service
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
IDE Investigational device exemption
IPPS [Hospital] Inpatient prospective payment system
IVIG Intravenous immune globulin
MAC Medicare Administrative Contractors
MedPAC Medicare Payment Advisory Commission
MDH Medicare-dependent, small rural hospital
MMA Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003, Pub. L. 108-173
MPFS Medicare Physician Fee Schedule
MSA Metropolitan Statistical Area
NCCI National Correct Coding Initiative
NCD National Coverage Determination
NTIOL New technology intraocular lens
OCE Outpatient Code Editor
OMB Office of Management and Budget
OPD [Hospital] Outpatient department
OPPS [Hospital] Outpatient prospective payment system
PA Physician assistant
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
RHQDAPU Reporting hospital quality data for annual payment update
RHHI Regional home health intermediary
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

    In this document, we address three payment systems under the 
Medicare program: the hospital outpatient prospective payment system 
(OPPS), the hospital inpatient prospective payment system (IPPS), and 
the ambulatory surgical center (ASC) payment system. The provisions 
relating to the OPPS are included in sections I. through XIII., XV., 
XVI., XX., XXIV., XXVI., and XXVII. of the preamble and in Addenda A, 
B, C (available on the Internet only; see section XXIV. of the preamble 
of this proposed rule), D1, D2, and E of this proposed rule. The 
provisions related to IPPS are included in sections XXIII., XXV. 
through XXVII. of the preamble. The provisions related to ASCs are

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included in sections XVII,. XVIII., and XXIV. through XXVII. of the 
preamble and in Addenda AA, BB, and CC of the proposed rule.
    In addition, in this document, we address our proposed 
implementation of the Medicare contracting reform provisions of the MMA 
that replace the prior Medicare intermediary and carrier authorities 
formerly found in sections 1816 and 1842 of the Act with Medicare 
administrative contractor (MAC) authority under a new section 1874A of 
the Act. The provisions relating to MACs are included in sections XIX., 
XXVI., and XXVII.E. of this preamble. To assist readers in referencing 
sections contained in this document, we are providing the following 
table of contents:

Table of Contents

I. Background for the OPPS
    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 of 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
    1. Reduction in Threshold for Separate APCs for Drugs
    2. Special Payment for Brachytherapy
    F. Provisions of the Deficit Reduction Act of 2005
    1. 3-Year Transition of Hold Harmless Payments
    2. Medicare Coverage of Ultrasound Screening for Abdominal 
Aortic Aneurysms
    G. Summary of the Major Contents of This Proposed Rule
    1. Proposed Updates Affecting Payment for CY 2007
    2. Proposed Ambulatory Payment Classification (APC) Group 
Policies
    3. Proposed Payment Changes for Devices
    4. Proposed Payment Changes for Drugs, Biologicals, and 
Radiopharmaceuticals
    5. Estimate of Transitional Pass-Through Spending in CY 2007 for 
Drugs, Biologicals, and Radiopharmaceuticals
    6. Proposed Brachytherapy Payment Changes
    7. Proposed Coding and Payment for Drug and Vaccine 
Administration
    8. Proposed Hospital Coding for Evaluation and Management (E/M) 
Services
    9. Proposed Payment for Blood and Blood Products
    10. Proposed Payment for Observation Services
    11. Procedures That Will Be Paid Only as Inpatient Services
    12. Proposed Nonrecurring Policy Changes
    13. Emergency Medical Screening in Critical Access Hospitals 
(CAHs)
    14. Proposed OPPS Payment Status and Comment Indicator
    15. OPPS Policy and Payment Recommendations
    16. Proposed Policies Affecting Ambulatory Surgical Centers 
(ASCs) for CY 2007
    17. Proposed Revised Ambulatory Surgical Center (ASC) Payment 
System for Implementation January 1, 2008
    18. Medicare Provider Contractor Reform Mandate
    19. Reporting Quality Data for Improved Quality and Costs under 
the OPPS
    20. Promoting Effective Use of Health Information Technology
    21. Health Care Information Transparency Initiative
    22. Reporting Hospital Quality Data for Annual Payment Update 
under the IPPS
    23. Impact Analysis
II. Proposed Updates Affecting OPPS Payments for CY 2007
    A. Proposed Recalibration of APC Relative Weights for CY 2007
    1. Database Construction
    a. Database Source and Methodology
    b. Proposed Use of Single and Multiple Procedure Claims
    c. Proposed Revision to the Overall Cost-to-Charge Ratio (CCR) 
Calculation
    2. Proposed Calculation of Median Costs for CY 2007
    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 2007
    3. Proposed Separate Threshold for Outlier Payments to CMHCs
    C. Proposed Conversion Factor Update for CY 2007
    D. Proposed Wage Index Changes for CY 2007
    E. Proposed Statewide Average Default CCRs
    F. OPPS Payments to Certain Rural Hospitals
    1. Hold Harmless Transitional Payment Changes Made by Pub. L. 
109-171 (DRA)
    2. Proposed Adjustment for Rural SCHs Implemented in CY 2006 
Related to Pub. L. 108-173 (MMA)
    G. Proposed CY 2007 Hospital Outpatient Outlier Payments
    H. Calculation of the Proposed OPPS National Unadjusted Medicare 
Payment
    I. Proposed Beneficiary Copayments for CY 2007
    1. Background
    2. Proposed Copayment for CY 2007
    3. Calculation of a Proposed Adjusted Copayment Amount for an 
APC Group for CY 2007
III. Proposed OPPS Ambulatory Payment Classification (APC) Group 
Policies
    A. Proposed Treatment of New HCPCS and CPT Codes
    1. Proposed Treatment of New HCPCS Codes Included in the Second 
and Third Quarterly OPPS Updates for CY 2006
    2. Proposed Treatment of New CY 2007 Category I and III CPT 
Codes and Level II HCPCS Codes
    3. Proposed Treatment of New Mid-Year CPT Codes
    B. Proposed Changes--Variations Within APCs
    1. Background
    2. Application of the 2 Times Rule
    3. Exceptions to the 2 Times Rule
    C. New Technology APCs
    1. Introduction
    2. Proposed Movement of Procedures from New Technology APCs to 
Clinical APCs
    a. Nonmyocardial Positron Emission Tomography (PET) Scans
    b. PET/Computed Tomography (CT) Scans
    c. Stereotactic Radiosurgery (SRS) Treatment Delivery Services
    d. Magnetoencephalography (MEG) Services
    e. Other Services in New Technology APCs
    D. Proposed APC-Specific Policies
    1. Skin Replacement Surgery and Skin Substitutes (APCs 0024, 
0025 and 0027)
    2. Treatment of Fracture/Dislocation (APC 0046)
    3. Electrophysiologic Recording/Mapping (APC 0087)
    4. Insertion of Mesh or Other Prosthesis (APC 0154)
    5. Percutaneous Renal Cryoablation (APC 0163)
    6. Keratoprosthesis (APC 0244)
    7. Medication Therapy Management Services
    8. Complex Interstitial Radiation Source Application (APC 0651)
    9. Single Allergy Tests (APC 0381)
    10. Hyperbaric Oxygen Therapy (APC 0659)
    11. Myocardial Positron Emission Tomography (PET) Scans (APCs 
0306, 0307)
    12. Radiology Procedures (APCs 0333, 0662, and Other Imaging 
APCs)
IV. Proposed OPPS Payment Changes for Devices
    A. Proposed Treatment of Device-Dependent APCs
    1. Background
    2. Proposed CY 2007 Payment Policy
    3. Devices Billed in the Absence of an Appropriate Procedure 
Code
    4. Proposed Payment Policy When Devices are Replaced Without 
Cost or Where Credit for a Replaced Device is Furnished to the 
Hospital
    B. Proposed Pass-Through Payments for Devices
    1. Expiration of Transitional Pass-Through Payments for Certain 
Devices
    a. Background
    b. Proposed Policy for CY 2007
    2. Provisions for Reducing Transitional Pass-Through Payments to 
Offset Costs Packaged Into APC Groups
    a. Background
    b. Proposed Policy for CY 2007
V. Proposed OPPS Payment Changes for Drugs, Biologicals, and 
Radiopharmaceuticals
    A. Proposed Transitional Pass-Through Payment for Additional 
Costs of Drugs and Biologicals
    1. Background
    2. Expiration in CY 2006 of Pass-Through Status for Drugs and 
Biologicals
    3. Drugs and Biologicals With Proposed Pass-Through Status in CY 
2007

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    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
    b. Proposed CY 2007 Payment for Nonpass-Through Drugs, 
Biologicals, Radiopharmaceuticals With HCPCS Codes, But Without OPPS 
Hospital Claims Data
VI. Proposed Estimate of OPPS Transitional Pass-Through Spending in 
CY 2007 for Drugs, Biologicals, Radiopharmaceuticals, and Devices
    A. Total Allowed Pass-Through Spending
    B. Proposed Estimate of Pass-Through Spending for CY 2007
VII. Proposed Brachytherapy Source Payment Changes
    A. Background
    B. Proposed Payments for Brachytherapy Sources in CY 2007
VIII. Proposed Changes to OPPS Drug Administration Coding and 
Payment for CY 2007
    A. Background
    B. Proposed CY 2007 Drug Administration Coding Changes
    C. Proposed CY 2007 Drug Administration Payment Changes
IX. Proposed Hospital Coding and Payment for Visits
    A. Background
    1. Guidelines Based on the Number or Type of Staff Interventions
    2. Guidelines Based on the Time Staff Spent With the Patient
    3. Guidelines Based on a Point System Where a Certain Number of 
Points Are Assigned to Each Staff Intervention Based on the Time, 
Intensity, and Staff Type Required for the Intervention
    4. Guidelines Based on Patient Complexity
    B. CY 2007 Proposed Coding
    1. Clinic Visits
    2. Emergency Department Visits
    3. Critical Care Services
    C. CY 2007 Proposed Payment Policy
    D. CY 2007 Proposed Treatment of Guidelines
    1. Background
    2. Outstanding Concerns With the AHA/AHIMA Guidelines
    a. Three Versus Five Levels of Codes
    b. Lack of Clarity for Some Interventions
    c. Treatment of Separately Payable Services
    d. Some Interventions Appear Overvalued
    e. Concerns of Specialty Clinics
    f. American with Disabilities Act
    g. Differentiation Between New and Established Patients, and 
Between Standard Visits and Consultations
    h. Distinction Between Type A and Type B Emergency Departments
X. Proposed Payment for Blood and Blood Products
    A. Background
    B. Proposed Policy Changes for CY 2007
XI. Proposed OPPS Payment for Observation Services
XII. Proposed Procedures That Will Be Paid Only as Inpatient 
Procedures
    A. Background
    B. Proposed Changes to the Inpatient Only List
    C. Proposed CY 2007 Payment for Ancillary Outpatient Services 
When Patient Expires (-CA Modifier)
    1. Background
    2. Proposed Policy for CY 2007
XIII. Proposed OPPS Nonrecurring Policy Changes
    A. Removal of Comprehensive Outpatient Rehabilitation Facility 
(CORF) Services from the List of Services Paid under the OPPS
    B. Addition of Ultrasound Screening for Abdominal Aortic 
Aneurysms (AAAs) (Section 5112 of Pub. L. 109-171 (DRA))
    1. Background
    2. Proposed Assignment of New HCPCS Code for Payment of 
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) (Section 
5112)
    3. Handling of Comments Received in Response to This Proposal
XIV. Emergency Medical Screening in Critical Access Hospitals (CAHs)
    A. Background
    B. Proposed Policy Change
XV. Proposed OPPS Payment Status and Comment Indicators
    A. Proposed CY 2007 Status Indicator Definitions
    1. Proposed Payment Status Indicators to Designate Services That 
Are Paid Under the OPPS
    2. Proposed Payment Status Indicators to Designate Services That 
Are Paid Under a Payment System Other Than the OPPS
    3. Proposed Payment Status Indicators to Designate Services That 
Are Not Recognized Under the OPPS But That May Be Recognized by 
Other Institutional Providers
    4. Proposed Payment Status Indicators to Designate Services That 
Are Not Payable by Medicare
    B. Proposed CY 2007 Comment Indicator Definitions
XVI. OPPS Policy and Payment Recommendations
    A. MedPAC Recommendations
    B. APC Panel Recommendations
    C. GAO Recommendations
XVII. Proposed Policies Affecting Ambulatory Surgical Centers (ASCs) 
for CY 2007
    A. ASC Background
    1. Legislative History
    2. Current Payment Method
    3. Published Changes to the ASC List
    B. Proposed ASC List Update Effective for Services Furnished on 
or After January 1, 2007
    1. Criteria for Additions to or Deletions from the ASC List
    2. Response to Comments to the May 4, 2005 Interim Final Rule 
for the ASC Update
    3. Procedures Proposed for Additions to the ASC List
    4. Suggested Additions Not Accepted
    5. Rationale for Payment Assignment
    6. Other Comments on the May 4, 2005 Interim Final Rule
    C. Proposed Regulatory Changes for CY 2007
    D. Implementation of Section 5103 of Pub. L. 109-171 (DRA)
    E. Proposal to Modify the Current ASC Process for Adjusting 
Payment for New Technology Intraocular Lenses (NTIOLs)
    1. Background
    a. Current ASC Payment for Insertion of IOLs
    b. Classes of NTIOLs Approved for Payment Adjustment
    2. Proposed Changes
    a. Process for Recognizing IOLs as Belonging to an Active IOL 
Class
    b. Public Notice and Comment Regarding Adjustments of NTIOL 
Payment Amounts
    c. Factors CMS Considers in Determining Whether a Payment 
Adjustment for Insertion of a New Class of IOL is Appropriate
    d. Proposal to Revise Content of a Request to Review
    e. Notice of CMS Determination
    f. Proposed Payment Adjustment
XVIII. Proposed Revised ASC Payment System for Implementation 
January 1, 2008
    A. Background
    1. Provisions of Pub. L. 108-173
    2. Other Factors Considered
    B. Procedures Proposed for Medicare Payment in ASCs Effective 
for Services Furnished on or After January 1, 2008
    1. Proposed Payable Procedures
    a. Proposed Definition of Surgical Procedure
    b. Procedures Proposed for Exclusion from Payment Under the 
Revised ASC System
    2. Proposed Treatment of Unlisted Procedure Codes and Procedures 
That Are Not Paid Separately Under the OPPS
    3. Proposed Treatment of Office-Based Procedures
    4. Listing of Surgical Procedures Proposed for Exclusion from 
Payment of an ASC Facility Fee Under the Revised Payment System
    C. Proposed Ratesetting Method
    1. Overview of Current ASC Payment System
    2. Proposal to Base ASC Relative Payment Weights on APC Groups 
and Relative Payment Weights Established Under the OPPS
    3. Proposed Packaging Policy
    4. Payment for Corneal Tissue Under the Revised ASC Payment 
System
    5. Proposed Payment for Office-Based Procedures
    6. Payment Policy for Multiple Procedure Discounting
    7. Proposed Geographic Adjustment
    8. Proposed Adjustment for Inflation
    9. Proposed Beneficiary Coinsurance
    10. Proposed to Phase in Implementation of Payment Rates 
Calculated Under the CY 2008 Revised ASC Payment System
    11. Proposed Calculation of ASC Conversion Factor and Payment 
Rates for CY 2008
    a. Overview
    b. Budget Neutrality Requirement

[[Page 49510]]

    c. Proposed Calculation of the ASC Payment Rates for CY 2008
    d. Proposed Calculation of the ASC Payment Rates for CY 2009 and 
Future Years
    e. Alternative Option for Calculating the Budget Neutrality 
Adjustment Considered
    12. Proposed Annual Updates
    D. Information in Addenda Related to the Revised CY 2008 ASC 
Payment System
    E. Technical Changes to 42 CFR Parts 414 and 416
XIX. Medicare Contracting Reform Mandate
    A. Background
    B. CMS's Vision for Medicare Fee-for-Service and MACs
    C. Provider Nomination and the Former Medicare Acquisition 
Authorities
    D. Summary of Changes Made to Sections 1816 of the Act
    E. Provisions of the Proposed Regulations
    1. Definitions
    2. Assignments of Providers and Suppliers to MACs
    3. Other Proposed Technical and Conforming Changes
    a. Definition of ``Intermediary''
    b. Intermediary Functions
    c. Options Available to Providers and CMS
    d. Nomination for Intermediary
    e. Notification of Actions on Nominations, Changes to Another 
Intermediary or to Director Payment, and Requirements for Approval 
of an Agreement
    f. Considerations Relating to the Effective and Efficient 
Administration of the Medicare Program
    g. Assignment and Reassignment of Providers by CMS
    h. Designation of National or Regional Intermediaries and 
Designation of Regional and Alternative Designated Regional 
Intermediaries for Home Health Agencies and Hospices
    i. Awarding of Experimental Contracts
XX. Reporting Quality Data for Improved Quality and Costs under the 
OPPS
XXI. Promoting Effective Use of Health Care Technology
XXII. Health Care Information Transparency Initiative
XXIII. Additional Quality Measures and Procedures for Hospital 
Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update
    A. Background
    B. Proposed Additional Quality Measures for FY 2008
    1. Introduction
    2. HCAHPS[supreg] Survey and the Hospital Quality Initiative
    3. Surgical Care Improvement Project (SCIP) Quality Measures
    4. Mortality Outcome Measures
    C. General Procedures and Participation Requirements for the FY 
2008 IPPS RHQDAPU Program
    D. HCAHPS[supreg] Procedures and Participation Requirements for 
the FY 2008 IPPS RHQDAPU Program
    1. Introduction
    2. HCAHPS[supreg] Hospital Pledge and Beginning Date for Data 
Collection
    3. HCAHPS[supreg] Dry Run
    4. HCAHPS[supreg] Data Collection Requirements
    5. HCAHPS[supreg] Registration Requirements
    6. HCAHPS[supreg] Additional Steps
    7. HCAHPS[supreg] Survey Completion Requirements
    8. HCAHPS[supreg] Public Reporting
    9. Reporting HCAHPS[supreg] Results for Multi-Campus Hospitals
    E. SCIP & Mortality Measure Requirements for the FY 2008 RHQDAPU 
Program
    F. Conclusion
XXIV. Files Available to the Public Via the Internet
XXV. Collection of Information Requirements
XXVI. Response to Comments
XXVII. Regulatory Impact Analysis
    A. Overall Impact
    1. Executive Order 12866
    2. Regulatory Flexibility Act (RFA)
    3. Small Rural Hospitals
    4. Unfunded Mandates
    5. Federalism
    B. Effects of Proposed OPPS Changes in This Proposed Rule
    1. Alternatives Considered
    a. Alternatives Considered for CPT Coding and Payment Policy for 
Evaluation and Management Codes
    b. Options Considered for Brachytherapy Source Payments
    c. Options Considered for Payment of Radiopharmaceuticals
    2. Limitation of Our Analysis
    3. Estimated Impact of This Proposed Rule on Hospitals
    4. Estimated Effect of This Proposed Rule on Beneficiaries
    5. Accounting Statement
    6. Conclusion
    C. Effects of Proposed Changes to the ASC Payment System for CY 
2007
    1. Alternatives Considered
    2. Limitations on Our Analysis
    3. Estimated Effects of This Proposed Rule on ASCs
    4. Estimated Effects of This Proposed Rule on Beneficiaries
    5. Conclusion
    6. Accounting Statement
    D. Effects of the Proposed Revisions to the ASC Payment System 
for CY 2008
    1. Alternatives Considered
    2. Limitations on Our Analysis
    3. Estimated Effects of This Proposed Rule on ASCs
    4. Estimated Effects of This Proposed Rule on Beneficiaries
    5. Conclusion
    E. Effects of the Medicare Contractor Reform Mandate
    F. Effects of Proposed Additional Quality Measures and 
Procedures for Hospital Reporting of Quality Data for IPPS FY 2008
    1. Alternatives Considered
    2. Estimated Effects of This Proposed Rule
    a. Effects on Hospitals
    b. Effects on Other Providers
    c. Effects on the Medicare and Medicaid Program
    G. Executive Order 12866

Regulation Text

Addenda

Addendum A--OPPS Proposed List of Ambulatory Payment Classification 
(APCs) With Status Indicators (SI), Relative Weights, Payment Rates, 
and Copayment Amounts-- CY 2007
Addendum AA--Proposed List of Medicare Approved ASC Procedures for 
CY 2007 With Additions and Payment Rates; Including Rates That 
Result From Implementation of Section 5103 of the DRA
Addendum B--OPPS Proposed Payment Status by HCPCS Code and Related 
Information Calendar Year 2007
Addendum BB--Proposed List of Medicare Approved ASC Procedures for 
CY 2008 With Additions and Payment Rates
Addendum CC--Proposed List of Procedures for CY 2008 Subject to 
Payment Limitation at the Medicare Physician Fee Schedule (MPFS) 
Nonfacility Amount
Addendum D1--Proposed Payment Status Indicators
Addendum D2--Proposed Comment Indicators
Addendum E--Proposed CPT Codes That Are Paid Only as Inpatient 
Procedures

I. Background for the OPPS

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 (BBA) of 1997 (Pub. L. 105-33), added section 
1833(t) to the Social Security Act (the Act) authorizing implementation 
of a PPS for hospital outpatient services (OPPS).
    The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act 
(BBRA) of 1999 (Pub. L. 106-113), made major changes in the hospital 
OPPS. The Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act (BIPA) of 2000 (Pub. L. 106-554), made further changes 
in the OPPS. Section 1833(t) of the Act was also amended by the 
Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 
2003 (Pub. L. 108-173). The Deficit Reduction Act (DRA) of 2005 (Pub. 
L. 109-171), enacted on February 8, 2006, made additional changes in 
the OPPS. A discussion of the provisions contained in Pub. L. 109-171 
that are specific to the calendar year (CY) 2007 OPPS is included in 
section II.F. of this preamble.
    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

[[Page 49511]]

basis that varies according to the ambulatory payment classification 
(APC) group to which the service is 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 preamble. Section 1833(t)(1)(B)(ii) of the Act provides 
for Medicare payment under the OPPS for hospital outpatient services 
designated by the Secretary (which includes partial hospitalization 
services furnished by community mental health centers (CMHCs)) and 
hospital outpatient services 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 added provisions 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.
    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 which we refer to as 
``transitional pass-through payments'' for at least 2 but not more than 
3 years for certain drugs, biological agents, brachytherapy devices 
used for the treatment of cancer, and categories of other medical 
devices. For new technology services that are not eligible for 
transitional 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 new 
technology APCs. These new technology APCs are designated by cost bands 
which allow us to provide appropriate and consistent payment for 
designated new procedures that are not yet reflected in our claims 
data. Similar to pass-through payments, an assignment to a new 
technology APC is temporary; that is, we retain a service within a new 
technology APC until we acquire sufficient 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 excludes 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 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(b) 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 initially 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. 
We last published such a document on November 10, 2005 (70 FR 68516). 
In that final rule with comment period, we revised the OPPS to update 
the payment weights and conversion factor for services payable under 
the CY 2006 OPPS on the basis of claims data from January 1, 2004, 
through December 31, 2004, and to implement certain provisions of Pub. 
L. 108-173. In addition, we responded to public comments received on 
the provisions of November 15, 2004 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 July 25, 2005 OPPS proposed rule for CY 2006 
(70 FR 42674).
    We published a correction of the November 10, 2005 final rule with 
comment period on December 23, 2005 (70 FR 76176). This correction 
document corrected a number of technical errors that appeared in the 
November 10, 2005 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, requires that we consult with an outside panel of experts to 
review the clinical integrity of the payment groups and their weights 
under the OPPS. The Act further specifies that the panel will act in an 
advisory capacity. The Advisory Panel on Ambulatory Payment

[[Page 49512]]

Classification (APC) Groups (the APC Panel), discussed under section 
I.D.2. of this preamble, fulfills these requirements. The APC Panel is 
not restricted to using data compiled by CMS 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 signed the initial charter 
establishing the APC Panel. This expert panel, which may be composed of 
up to 15 representatives of providers subject to the OPPS (currently 
employed full-time, not as consultants, in their respective areas of 
expertise), reviews and advises CMS about the clinical integrity of the 
APC groups and their weights. For purposes of this Panel, consultants 
or independent contractors are not considered to be full-time 
employees. The APC Panel is technical in nature and is governed by the 
provisions of the Federal Advisory Committee Act (FACA). Since its 
initial chartering, the Secretary has twice renewed the APC Panel's 
charter: on November 1, 2002, and on November 1, 2004. The current 
charter indicates, among other requirements, that the APC Panel 
continues to be technical in nature; is governed by the provisions of 
the FACA; may convene up to three meetings per year; has a Designated 
Federal Officer (DFO); and is chaired by a Federal official who also 
serves as a CMS medical officer.
    The current APC Panel membership and other information pertaining 
to the Panel, including its charter, Federal Register notices, meeting 
dates, agenda topics, and meeting reports can be viewed on the CMS Web 
site at http://new.cms.hhs.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassificationGroups.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 nine 
subsequent meetings, with the last meeting taking place on March 1 and 
2, 2006. (The APC Panel did not meet on March 3, 2006, as announced in 
the meeting notice published on December 23, 2005 (70 FR 76313).) Prior 
to each meeting, we publish a notice in the Federal Register to 
announce the meeting and, when necessary, to solicit and announce 
nominations for APC Panel membership.
    The APC Panel has established an operational structure that, in 
part, includes the use of three subcommittees to facilitate its 
required APC review process. The three current 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 options for 
resolving them. The Observation Subcommittee 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 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.
    Discussions of the recommendations resulting from the APC Panel's 
March 2006 meeting are included in the sections of this preamble that 
are specific to each recommendation. For discussions of earlier APC 
Panel meetings and recommendations, we reference previous hospital OPPS 
final rules or the Web site mentioned earlier in this section.

E. Provisions of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003

    The Medicare Prescription Drug, Improvement, and Modernization Act 
(MMA) of 2003, 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 services provided in CY 2004 and CY 2005, 
respectively. In the November 10, 2005 final rule with comment period, 
we implemented provisions of Pub. L. 108-173 relating to the OPPS that 
went into effect for services provided in CY 2006 (70 FR 68521). We 
note below those provisions of Pub. L. 108-173 that will expire at the 
end of CY 2006.
1. Reduction in Threshold for Separate APCs for Drugs
    Section 621(a)(2) of Pub. L. 108-173 amended section 1833(t)(16) of 
the Act to set a $50 per administration threshold for the establishment 
of separate APCs for drugs and biologicals furnished from January 1, 
2005, through December 31, 2006. Because this statutory provision will 
no longer be in effect for CY 2007, we have included a discussion of 
the proposed methodology that we would use for the drug administration 
threshold for CY 2007 in section V. of this preamble.
2. Special Payment for Brachytherapy
    Section 621(b)(1) of Pub. L. 108-173 amended section 1833(t)(16) of 
the Act to require that payment for brachytherapy devices consisting of 
a seed or seeds (or radioactive source) furnished on or after January 
1, 2004, and before January 1, 2007, be paid based on the hospital's 
charge for each device furnished, adjusted to cost. Because this 
statutory provision will no longer be in effect for CY 2007, we discuss 
our proposed methodology for payment for brachytherapy devices for CY 
2007 in section VII.B. of this preamble.

F. Provisions of the Deficit Reduction Act of 2005

    The Deficit Reduction Act (DRA) of 2005, Pub. L. 109-171, enacted 
on February 8, 2006, included three provisions affecting the OPPS, as 
discussed below.
1. 3-Year Transition of Hold Harmless Payments
    Section 5105 of Pub. L. 109-171 provides a 3-year transition of 
hold harmless OPPS payments for hospitals located in a rural area with 
not more than 100 beds that are not defined as sole community hospitals 
(SCHs). This provision provides an increased payment for such hospitals 
for covered OPD services furnished on or after January 1, 2006, and 
before January 1, 2009, if the OPPS payment they receive is less than 
the pre-BBA payment amount that they would have received for the same 
covered OPD services. This provision specifies that, in such cases, the 
amount of payment to the specified hospitals shall be increased by the 
applicable percentage of such difference. Section 5105 specifies the 
applicable percentage as 95 percent for CY 2006, 90 percent for CY 
2007, and 85 percent for CY 2008.
2. Medicare Coverage of Ultrasound Screening for Abdominal Aortic 
Aneurysms
    Section 5112 of Pub. L. 109-171 amended section 1861 of the Act to 
include coverage of ultrasound screening for abdominal aortic aneurysms 
for certain individuals on or after January 1, 2007. The provision will 
apply to individuals (a) Who receive a referral for such an ultrasound 
screening as a result of an initial preventive physical examination; 
(b) who have not

[[Page 49513]]

been previously furnished with an ultrasound screening under Medicare; 
and (c) who have a family history of abdominal aortic aneurysm or 
manifest risk factors included in a beneficiary category recommended 
for screening (as determined by the United States Preventive Services 
Task Force). Ultrasound screening for abdominal aortic aneurysm will be 
included in the initial preventive physical examination. Section 5112 
also added ultrasound screening for abdominal aortic aneurysm to the 
list of services for which the beneficiary deductible does not apply. 
These amendments apply to services furnished on or after January 1, 
2007.

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 2007. These changes would be effective 
for services furnished on or after January 1, 2007. We are setting 
forth proposed changes to the Medicare ASC program for CY 2007 and CY 
2008. We are setting forth proposed changes to the way we process FFS 
claims under Medicare Part A and Part B. Some of these changes were 
effective on October 1, 2005 and all of the changes are to be fully 
implemented by October 1, 2011. Finally, we are setting forth a notice 
seeking comments on the RHQDAPU program under the Medicare hospital 
IPPS for FY 2008. These changes would be effective for payments 
beginning with FY 2008. The following is a summary of the major changes 
that we are proposing to make:
1. Proposed Updates Affecting Payments for CY 2007
    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 2007.
     The proposed payment for partial hospitalization, 
including the proposed separate threshold for outlier payments for 
CMHCs.
     The proposed update to the conversion factor used to 
determine payment rates under the OPPS for CY 2007.
     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 
2007.
     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 2007.
     Proposed changes in the way we calculate hospital 
outpatient outlier payments for CY 2007.
     Calculation of the proposed national unadjusted Medicare 
OPPS payment.
     The proposed beneficiary copayment for OPPS services for 
CY 2007.
2. Proposed Ambulatory Payment Classification (APC) Group Policies
    In section III. of this preamble, we discuss the proposed additions 
of new procedure codes to the APCs; our proposal to establish a number 
of new APCs; and our proposal 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 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; and the proposed movement of procedures from 
the New Technology APCs.
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 categories 
of devices.
4. Proposed Payment Changes for Drugs, Biologicals, and 
Radiopharmaceuticals
    In section V. of this preamble, we discuss proposed changes for 
drugs, biologicals, and radiopharmaceuticals.
5. Estimate of Transitional Pass-Through Spending in CY 2007 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, radiopharmaceuticals, and categories of devices for 
CY 2007.
6. Proposed Brachytherapy Payment Changes
    In section VII. of this preamble, we discuss our proposal 
concerning coding and payment for the sources of brachytherapy.
7. Proposed Coding and Payment for Drug and Vaccine Administration
    In section VIII. of this preamble, we discuss our proposed coding 
and payment changes for drug and vaccine administration services.
8. Proposed Hospital Coding for Evaluation and Management (E/M) 
Services
    In section IX. of this preamble, we discuss 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 
propose to remove from the inpatient list and assign to APCs.
12. Proposed Nonrecurring Policy Changes
    In section XIII. of this preamble, we discuss proposed changes to 
certain comprehensive outpatient rehabilitation facility (CORF) 
services paid under the OPPS. In this section, we also discuss proposed 
payment for ultrasound screening for abdominal aortic aneurysms (AAAs).
13. Emergency Medical Screening in Critical Access Hospitals (CAHs)
    In section XIV. of this preamble, we discuss proposed changes to a 
regulation governing emergency medical screening in critical access 
hospitals (CAHs).
14. Proposed OPPS Payment Status and Comment Indicator
    In section XV. of this preamble, we discuss proposed changes to the 
list of status indicators assigned to APCs and present our proposed 
comment indicators for the CY 2007 OPPS final rule.
15. OPPS Policy and Payment Recommendations
    In section XVI. of this preamble, we address recommendations made 
by MedPAC and the APC Panel regarding the OPPS for CY 2007.

[[Page 49514]]

16. Proposed Policies Affecting Ambulatory Surgical Centers (ASCs) for 
CY 2007
    In section XVII. of this preamble we discuss proposed payment 
changes affecting ASCs in CY 2007, the proposed list of updated ASC 
procedures, and proposed modification of the ASC payment adjustment 
process for new technology intraocular lenses (NTIOLs).
17. Proposed Revised Ambulatory Surgical Center (ASC) Payment System 
for Implementation January 1, 2008
    In section XVIII. of this preamble, we discuss our proposal to 
implement a new ASC payment system for services furnished on or after 
January 1, 2008, and the regulatory changes related to the proposed new 
system.
18. Medicare Provider Contractor Reform Mandate
    In section XIX. of this preamble, we discuss proposed changes to 
the regulations under 42 CFR Part 421, Subpart B to conform them to the 
statutory changes required by section 911 of Public Law 108-173 related 
to Medicare contracting reform.
19. Reporting Quality Data for Improved Quality and Costs Under the 
OPPS
    In section XX. of this preamble, we discuss the expenditure growth 
in outpatient hospital services, invite comment on value-based 
purchasing specifically related to hospital outpatient departments, and 
discuss a value-based purchasing program proposal for the CY 2007 OPPS.
20. Promoting Effective Use of Health Information Technology
    In section XXI. of this preamble, we invite comments on promoting 
hospitals' effective use of health information technology.
21. Health Care Information Transparency Initiative
    In section XXII. of this preamble, we discuss HHS' major health 
information transparency initiative which we are launching in 2006.
22. Reporting Hospital Quality Data for Annual Payment Update Under the 
IPPS
    In section XXIII. of this preamble, we invite comment on our 
proposal for the FY 2008 IPPS annual payment update to add the 
HCAHPS[supreg] survey, measures from the Surgical Care Improvement 
Project (SCIP), and Mortality measures to the quality of care measures 
to be used in FY 2007 for purposes of the IPPS annual payment update.
23. Impact Analysis
    In section XXVII. of this preamble, we set forth an analysis of the 
impact that the proposed changes will have on affected entities and 
beneficiaries.

II. Proposed Updates Affecting OPPS Payments for CY 2007

A. Proposed Recalibration of APC Relative Weights for CY 2007

    (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 with comment period (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 with comment period to 
recalibrate the APC relative payment weights for services furnished on 
or after January 1, 2007, and before January 1, 2008. 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 in this proposed rule for CY 2007, we used 
approximately 131.9 million final action claims for hospital OPD 
services furnished on or after January 1, 2005, and before January 1, 
2006. Of the 131.9 million final action claims for services provided in 
hospital outpatient settings, 102.9 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 102.9 million claims, approximately 48.5 million were not for 
services paid under the OPPS or were excluded as not appropriate for 
use (for example, erroneous cost-to-charge ratios or no HCPCS codes 
reported on the claim). We were able to use 50.7 million whole claims 
of the remaining 54.4 million claims to set the proposed OPPS APC 
relative weights for CY 2007 OPPS. From the 50.7 million whole claims, 
we created 91.4 million single records, of which 62.8 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 for CY 2007 in 
Addenda A and B to this proposed rule were calculated using claims from 
this period that had been processed before January 1, 2006. 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 weights for 
CY 2007 continue to be based on the median hospital costs for services 
in the APC groups. For the CY 2007 OPPS final rule, we are proposing to 
base APC median costs on claims for services furnished in CY 2005 and 
processed before June 30, 2006.
b. Proposed Use of Single and Multiple Procedure Claims
    For CY 2007, we are proposing to continue to use single procedure 
claims to set the medians on which the APC relative payment weights 
would be based. 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. 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

[[Page 49515]]

multiple separately paid procedures on the same claim. For the CY 2007 
OPPS, we are proposing to use the date of service on the claims and a 
list of codes to be bypassed to create ``pseudo'' single claims from 
multiple procedure claims, as we did in recalibrating the CY 2006 APC 
relative payment weights. We refer to these newly created single 
procedure claims as ``pseudo'' single claims 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.
    For the CY 2004 OPPS, 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 costs for those APCs. For CY 2004, from approximately 16.3 
million otherwise unusable claims, we used approximately 9.5 million 
multiple procedure claims to create approximately 27 million ``pseudo'' 
single claims. For CY 2005, we identified 383 bypass codes and from 
approximately 24 million otherwise unusable claims, we used 
approximately 18 million multiple procedure claims to create 
approximately 52 million ``pseudo'' single claims. For CY 2005, we used 
the claims data for the bypass codes combined with the single procedure 
claims to set the median costs for the bypass codes.
    For CY 2006, we continued using the codes on the CY 2005 OPPS 
bypass list and expanded it to include 404 bypass codes, including 3 
bladder catheterization codes (CPT codes 51701, 51702, and 51703), 
which did not meet the empirical criteria discussed below for the 
selection of bypass codes. We added these three codes to the CY 2006 
bypass list because a decision to change their payment status from 
packaged to separately paid would have resulted in a reduction of the 
number of single bills on which we could base median costs for other 
major separately paid procedures that were billed on the same claim 
with these three procedure codes. That is, single bills which contained 
other procedures would have become multiple procedure claims when these 
bladder catheterization codes were converted to separately paid status. 
We believed and continue to believe that bypassing these three codes 
does not adversely affect the medians for other procedures because we 
believe that when these services are performed on the same day as 
another separately paid service, any packaging that appears on the 
claim would be appropriately associated with the other procedure and 
not with these codes.
    Consequently, for CY 2006, we identified 404 bypass codes for use 
in creating ``pseudo'' single claims and used some part of 90 percent 
of the total claims that were eligible for use in OPPS ratesetting and 
modeling in developing the final rule with comment period. This process 
enabled us to use, for CY 2006 OPPS, 88 million single bills for 
ratesetting: 55 million ``pseudo'' singles and 34 million ``natural'' 
single bills (bills that were submitted containing only one separately 
payable major HCPCS code). (These numbers do not sum to 88 million 
because more than 800,000 single bills were removed when we trimmed at 
the HCPCS level at +/-3 standard deviations from the geometric mean.)
    For CY 2007, 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 2007 OPPS results in our being able 
to use some part of 94.8 percent of the total claims that are eligible 
for use in the OPPS ratesetting and modeling in developing this 
proposed rule. This process enabled us to use, for CY 2007, 62.8 
million ``pseudo'' singles and 29.6 million ``natural'' single bills.
    We are proposing to bypass the 454 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, together with the single procedure 
claims, in the creation of the median costs for the APCS into which 
they are assigned. Of the codes on this list, 404 codes were used for 
bypass in CY 2006. We are proposing to continue the use of the codes on 
the CY 2006 OPPS bypass list and to expand it by adding codes that, 
using data presented to the APC Panel at its March 2006 meeting, meet 
the same empirical criteria as those used in CY 2006 to create the 
bypass list, or which our clinicians believe would contain minimal 
packaging if the services were correctly coded (for example, ultrasound 
guidance). 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 2006 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 2007 
OPPS. Bypass codes shown in Table 1 with an asterisk indicate the HCPCS 
codes we are proposing to add to the CY 2006 OPPS listed codes for 
bypass in CY 2007. The criteria we are proposing to use to determine 
the additional codes to add to the CY 2006 OPPS bypass list in order to 
create the bypass list for CY 2007 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.

[[Page 49516]]

     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.
    In addition, we are proposing to add to the bypass list codes that 
our clinicians believe contain minimal packaging and codes for 
specified drug administration for which hospitals have requested 
separate payment but for which it is not possible to acquire median 
costs unless we add these codes to the bypass list. A more complete 
discussion of the effects of adding these drug administration codes to 
the bypass list is contained in the discussion of drug administration 
in section VIII.C. of this preamble.
    We specifically invite public comment on the ``pseudo'' single 
process, including the bypass list and the criteria.

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[[Page 49528]]

c. Proposed Revision to the Overall Cost-to-Charge Ratio (CCR) 
Calculation
    We calculate both an overall CCR and cost center-specific cost-to-
charge ratios (CCRs) for each hospital. For CY 2007 OPPS, we are 
proposing to change the methodology for calculating the overall CCR. 
The overall CCR is used in many components of the OPPS. We use the 
overall CCR to estimate costs from charges on a claim when we do not 
have an accurate cost center CCR. This does not happen very often. For 
the vast majority of services, we are able to use a cost center CCR to 
estimate costs from charges. However, we also use the overall CCR to 
identify the outlier threshold, to model payments for services that are 
paid at charges reduced to cost, and, during implementation, to 
determine outlier payments and payments for other services.
    We have discovered that the calculation of the overall CCR that the 
fiscal intermediaries are using to determine outlier payment and 
payment for services paid at charges reduced to cost differs from the 
overall CCR that we use to model the OPPS. In Program Transmittal A-03-
04 on ``Calculating Provider-Specific Outpatient Cost-to-Charge Ratios 
(CCRs) and Instructions on Cost Report Treatment of Hospital Outpatient 
Services Paid on a Reasonable Cost Basis'' (January 17, 2003), we 
revised the overall CCR calculation that the fiscal intermediaries use 
in determining outlier and other cost payments. Until this point, each 
fiscal intermediary had used an overall CCR provided by CMS, or 
calculated an updated CCR at the provider's request using the same 
calculation. The calculation in Program Transmittal A-03-04, that is, 
the fiscal intermediary calculation, diverged from the ``traditional'' 
overall CCR that we used for modeling. It should be noted that the 
fiscal intermediary overall CCR calculation noted in Program 
Transmittal A-03-04 was created with feedback and input from the fiscal 
intermediaries.
    CMS' ``traditional'' calculation consists of summing the total 
costs from Worksheet B, Part I (Column 27), after removing the costs 
for nursing and paramedical education (Columns 21 and 24), for those 
ancillary cost centers that we believe contain most OPPS services, 
summing the total charges from Worksheet C, Part I (Columns 6 and 7) 
for the same set of ancillary cost centers, and dividing the former by 
the later. We exclude selected ancillary cost centers from our overall 
CCR calculation, such as 5700 Renal Dialysis, because we believe that 
the costs and charges in these cost centers are largely paid for under 
other payment systems. The specific list of ancillary cost centers, 
both standard and nonstandard, included in our overall CCR calculation 
is available on our Web site in the revenue center-to-cost center 
crosswalk workbook: http://www.cms.hhs.gov/HospitalOutpatientPPS.
    The overall CCR calculation provided in Program Transmittal A-03-
04, on the other hand, takes the CCRs from Worksheet C, Part I, Column 
9, for each specified ancillary cost center; multiplies them by the 
Medicare Part B outpatient specific charges in each corresponding 
ancillary cost center from Worksheet D, Parts V and VI (Columns 2, 3, 
4, and 5 and subscripts thereof); and then divides the sum of these 
costs by the sum of charges for the specified ancillary cost centers 
from Worksheet D, Parts V and VI (Columns 2, 3, 4, and 5 and subscripts 
thereof). Compared with our ``traditional'' overall CCR calculation 
that has been used for modeling OPPS and to calculate the median costs, 
this fiscal intermediary calculation of overall CCR fails to remove 
allied health costs and adds weighting by Medicare Part B charges.
    In comparing these two calculations, we discovered that, on 
average, the overall CCR calculation being used by the fiscal 
intermediary resulted in higher overall CCRs than under our 
``traditional'' calculation. Using the most recent cost report data 
available for every provider with valid claims for CY 2004 as of 
November 2005, we estimated the median overall CCR using the 
traditional calculation to be 0.3040 (mean 0.3223) and the median 
overall CCR using the fiscal intermediary calculation to be 0.3309 
(mean 0.3742). There also was much greater variability in the fiscal 
intermediary calculation of the overall CCR. The standard deviation 
under the ``traditional'' calculation was 0.1318, while the standard 
deviation using the fiscal intermediary's calculation was 0.2143. In 
part, the higher median estimate for the fiscal intermediary 
calculation is attributable to the inclusion of allied health costs for 
the over 700 hospitals with allied health programs. It is inappropriate 
to include these costs in the overall CCR calculation, because CMS 
already reimburses hospitals for the costs of these programs through 
cost report settlement. The higher median estimate and greater 
variability also is a function of the weighting by Medicare Part B 
charges. Because the fiscal intermediary overall CCR calculation is 
higher, on average, CMS has underestimated the outlier payment 
thresholds and, therefore, overpaid outlier payments. We also have 
underestimated spending for services paid at charges reduced to cost in 
our budget neutrality estimates.
    In examining the two different calculations, we decided that 
elements of each methodology had merit. Clearly, as noted above, allied 
health costs should not be included in an overall CCR calculation. 
However, weighting by Medicare Part B charges from Worksheet D, Parts V 
and VI, makes the overall CCR calculation more specific to OPPS. 
Therefore, we are proposing to adopt a single overall CCR calculation 
that incorporates weighting by Medicare Part B charges but excludes 
allied health costs for modeling and payment. Specifically, the 
proposed calculation removes allied health costs from cost center CCR 
calculations for specified ancillary cost centers, as discussed above, 
multiplies them by the Medicare Part B charges on Worksheet D, Parts V 
and VI, and sums these estimated Medicare costs. This sum is then 
divided by the sum of the same Medicare Part B charges for the same 
specified set of ancillary cost centers.
    Using the same cost report data, we estimated a median overall CCR 
for the proposed calculation of 0.3081 (mean 0.3389) with a standard 
deviation of 0.1583. The similarity to the median and standard 
deviation of the ``traditional'' overall CCR calculation noted above 
(median 0.3040 and standard deviation of 0.1318) masks some sizeable 
changes in overall CCR calculations for specific hospitals due largely 
to the inclusion of Medicare Part B weighting.
    In order to isolate the overall impact of adopting this methodology 
on APC medians, we used the first 9 months of CY 2005 claims data to 
estimate APC median costs varying only the two methods of determining 
overall CCR. We expected the impact to be limited because the majority 
of costs are estimated using a cost center-specific CCR and not the 
overall. As predicted, we observed minor changes in APC median costs 
from the adoption of the proposed overall CCR calculation. We largely 
observed differences of no more than 5 percent in either direction. The 
median overall percent change in APC cost estimates was -0.3 percent. 
We typically observe comparable changes in APC medians when we update 
our cost report data. The impact of the proposed CCR calculation on the 
outlier threshold is discussed further in section II. G. of this 
preamble. Using updated cost report data for the calculations in this 
proposed rule, we estimate a median overall CCR across all hospitals of 
0.2999 using the proposed overall CCR calculation.

[[Page 49529]]

    We believe that a single overall CCR calculation should be used for 
all components of the OPPS for both modeling and payment. Therefore, we 
are proposing to use the modified overall CCR calculation as discussed 
above when the hospital-specific overall CCR is used for any of the 
following calculations--in the CMS calculation of median costs for OPPS 
ratesetting, in the CMS calculation of the outlier threshold, in the 
fiscal intermediary calculation of outlier payments, in the CMS 
calculation of statewide CCRs, in the fiscal intermediary calculation 
of pass-through payments for devices, and for any other fiscal 
intermediary payment calculation in which the current hospital-specific 
overall CCR may be used now or in the future. If this proposal is 
finalized, we would issue a Medicare program instruction to fiscal 
intermediaries that would instruct them to recalculate and use the 
hospital-specific overall CCR as we are proposing for these purposes.
2. Proposed Calculation of Median Costs for CY 2007
    In this section of the preamble, we discuss the use of claims to 
calculate the proposed OPPS payment rates for CY 2007. 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/HospitalOutpatientPPS. The accounting of claims used in the development 
of this proposed rule is included on the Web site under supplemental 
materials for the CY 2007 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/HospitalOutpatientPPS, 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 2007 shown in Addenda A and B to this proposed rule. This 
methodology is as follows:
    We used outpatient claims for the full CY 2005, processed before 
January 1, 2006, to set the relative weights for this proposed rule for 
CY 2007. To begin the calculation of the relative weights for CY 2007, 
we pulled all claims for outpatient services furnished in CY 2005 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 103 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 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 CCR calculation process, we used the same general approach 
as we used in developing the final APC rates for CY 2006 (70 FR 68537), 
with a change to the development of the overall CCR as discussed above. 
That is, we first limited the population of cost reports to only those 
for hospitals that filed outpatient claims in CY 2005 before 
determining whether the CCRs for such hospitals were valid.
    We then calculated the CCRs at a cost center level and overall for 
each hospital for which we had claims data. We did this using hospital-
specific data from the Healthcare Cost Report Information System 
(HCRIS). We used the most recent available cost report data, in most 
cases, cost reports for CY 2004. For this proposed rule, 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 using the overall CCR, and we then adjusted 
the most recent available submitted but not settled cost report using 
that ratio. We are proposing to use the most recently submitted cost 
reports to calculate the CCRs to be used to calculate median costs for 
the OPPS CY 2007 final rule. We calculated both an overall CCR and cost 
center-specific CCRs for each hospital. We used the proposed overall 
CCR calculation discussed in II.A.1.c. of this preamble for all 
purposes.
    We then flagged CAH claims, which are not paid under the OPPS, and 
claims from hospitals with invalid CCRs. The latter 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 cost center level by removing the CCRs for each cost center 
as outliers if they exceeded +/-3 standard deviations from the 
geometric mean. This is the same methodology that we used in developing 
the final CY 2006 CCRs. For CY 2007, 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 every possible 
revenue code appearing in the outpatient claims, with the top tier 
being the most common cost center and the last tier being the default 
CCR. If a hospital's cost center CCR was deleted by trimming, we set 
the CCR for that cost center to ``missing,'' so that another cost 
center 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. For 
example, a visit reported under the clinic revenue code, but the 
hospital did not have a clinic cost center, we mapped the hospital-
specific overall CCR to the clinic revenue code. The hierarchy of CCRs 
is available for inspection and comment at the CMS Web site: http://www.cms.hhs.gov/HospitalOutpatientPPS.
    We then converted the charges to costs on each claim by applying 
the CCR that we believed was best suited to the revenue code indicated 
on the line with the charge. Table 2 below contains a list of the 
allowed revenue codes. Revenue codes not included in Table 2 are those

[[Page 49530]]

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. One exception is the calculation of median blood 
costs, as discussed in section X. of this preamble.
    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 claims from all 
hospitals for which CCRs were flagged as invalid.
    We identified claims with condition code 41 as partial 
hospitalization services of hospitals and moved them to another file. 
These claims were combined with the 76X claims identified previously to 
calculate the 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 a per unit mean 
and median and a per administration mean and median for drugs, 
radiopharmaceutical agents, blood and blood products, and devices, 
including but not limited to brachytherapy sources, as well as other 
information used to set payment rates, including a unit to day ratio 
for drugs.
    We then divided the remaining claims into the following five 
groups:
    1. Single Major Claims: Claims with a single separately payable 
procedure (that is, status indicator S, T, V, or X), all of which would 
be used in median setting.
    2. Multiple Major Claims: Claims with more than one separately 
payable procedure (that is, status indicator S, T, V, or X), 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 
packaged (that is, status indicator N) and not separately payable.
    4. Multiple Minor Claims: Claims with multiple HCPCS codes that are 
packaged (that is, status indicator N) and not separately payable.
    5. Non-OPPS Claims: Claims that contain no services payable under 
the OPPS (that is, all status indicators other than S, T, V, X, or N). 
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, and do not contain either a 
code for a separately paid service or a code for a packaged service.
    In previous years, we made a determination of whether each HCPCS 
code was a major code, or a minor code, or a code other than a major or 
minor code. We used those code specific determinations to sort claims 
into these five identified groups. For CY 2007 OPPS, we are proposing 
to use status indicators, as described above, to sort the claims into 
these groups. We believe that using status indicators is an appropriate 
way to sort the claims into these groups and also to make our process 
more transparent to the public. We further believe that this proposed 
method of sorting claims will enhance the public's ability to derive 
useful information and become a more informed commenter on this 
proposed rule.
    We note that the claims listed in numbers 1, 2, 3, and 4 above are 
included in the data files that can be purchased as described above.
    We set aside the single minor, multiple minor claims and the non-
OPPS claims (numbers 3, 4, and 5 above) because we did not use these 
claims in calculating median cost. We then examined the multiple major 
claims for date of service to determine if we could break them into 
single procedure claims using the dates of service on all lines on the 
claim. If we could create claims with single major procedures by using 
date of service, we created a single procedure claim record for each 
separately paid procedure on a different date of service (that is, a 
``pseudo'' single).
    We then used the ``bypass codes'' listed in Table 1 of this 
preamble and discussed in section II.A.1.b. to remove separately 
payable procedures that we determined contain limited costs or no 
packaged costs, or were otherwise suitable for inclusion on the bypass 
list, from a multiple procedure bill. 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.
    We also removed lines that contained multiple units of codes on the 
bypass list and treated them as ``pseudo'' single claims by dividing 
the cost for the multiple units by the number of units on the line. 
Where one unit of a single separately paid procedure code remained on 
the claim after removal of the multiple units of the bypass code, we 
created a ``pseudo'' single claim from that residual claim record, 
which retained the costs of packaged revenue codes and packaged HCPCS 
codes. This enables us to use claims that would otherwise be multiple 
procedure claims and could not be used. We excluded those claims that 
we were not able to convert to singles even after applying all 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 
below in Table 2.
    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, 97.5 million claims were 
left. Of these 97.5 million claims, we were able to use some portion of 
50.7 million whole claims (93.2 percent of the 54.4 million potentially 
usable claims) to create the 91.4 million single and ``pseudo'' single 
claims for use in the CY 2007 median payment ratesetting. Approximately 
43 million claims were for services not paid under the OPPS.
    We also excluded (1) Claims that had zero costs after summing all 
costs on the claim and (2) claims containing payment flag 3. Effective 
for services furnished on or after July 1, 2004, the Outpatient Code 
Editor (OCE) assigns payment flag number 3 to claims on which hospitals 
submitted token charges for a service with status indicator ``S'' or 
``T'' (a major separately paid service under OPPS) for which the fiscal 
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

[[Page 49531]]

hospital, are valid reflections of hospital resources. Therefore, we 
are proposing to delete these claims. We also deleted claims for which 
the charges equal the revenue center payment (that is, the Medicare 
payment) on the assumption that where the charge equals the payment, to 
apply a CCR to the charge would not yield a valid estimate of relative 
provider cost.
    For the remaining claims, we then standardized 60 percent of the 
costs of the claim (which we have previously determined to be the 
labor-related portion) for geographic differences in labor input 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 also excluded claims that were outside 3 standard deviations 
from the geometric mean of units for each HCPCS code on the bypass list 
(because, as discussed above, we used claims that contain multiple 
units of the bypass codes). We then deleted 299,022 single bills 
reported with modifier 50 that were assigned to APCs that contained 
HCPCS codes that are considered to be conditional or independent 
bilateral procedures under the OPPS and that are subject to special 
payment provisions implemented through the OCE. Modifier 50 signifies 
that the procedure was performed bilaterally. Although these are 
apparently single claims for a separately payable service and although 
there is only one unit of the code reported on the claim, the presence 
of modifier 50 signifies that two services were furnished. Therefore, 
costs reported on these claims are for two procedures and not for a 
single procedure. Hence, we deleted these multiple procedure records, 
which we would have treated as single procedure claims in prior OPPS 
updates. We are seeking comments on the relative benefits of deleting 
these claims versus dividing the costs for the two procedures by two to 
create two ``pseudo'' single claims.
    We used the remaining claims to calculate median costs for each 
separately payable HCPCS code and each APC. The comparison of HCPCS and 
APC medians determines the applicability of the ``2 times'' rule. 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. Both the HCPCS medians and the APC medians were weighted 
to account for the inclusion of multiple units of the bypass codes in 
the creation of pseudo single bills.
    A detailed discussion of the proposed medians for blood and blood 
products is included in section X. of this preamble. A discussion of 
the proposed 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 proposed median for observation services is included 
in section XI. of this preamble and a discussion of the proposed median 
for partial hospitalization is included below in section II.B. of this 
preamble.

BILLING CODE 4120-01-P

[[Page 49532]]

[GRAPHIC] [TIFF OMITTED] TP23AU06.011

BILLING CODE 4120-01-C

[[Page 49533]]

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 2007 shown in 
Addenda A and B of this proposed rule. 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.
    For CY 2007 OPPS, we are proposing to scale all of the relative 
payment weights to APC 0606 (Level III Clinic Visits) because we are 
proposing to delete APC 0601 as part of the reconfiguration of the 
visit APCs. We chose APC 0606 as the scaling base because under our 
proposal to reconfigure the APCs where clinic visits are assigned for 
CY 2007, APC 0606 is the middle level clinic visit APC (that is, Level 
III of five levels). We have historically used the median cost of the 
middle level clinic visit APC (that is APC 0601 through CY 2006) to 
calculate unscaled weights because mid-level clinic visits are among 
the most frequently performed services in the hospital outpatient 
setting. Therefore, to maintain consistency in using as a median the 
most frequently used services, we are proposing to continue to use the 
median cost of the middle clinic level, proposed ASC 0606, to calculate 
unscaled weights. Following our standard methodology, but using the 
proposed CY 2007 median for APC 0606, we assigned APC 0606 a relative 
payment weight of 1.00 and divided the median cost of each APC by the 
median cost for APC 0606 to derive the unscaled relative payment weight 
for each APC. The choice of the APC on which to base the relative 
weights for all other APCs does not affect the payments made under the 
OPPS because we scale the weights for budget neutrality.
    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 2007 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 2006 relative weights to aggregate payments using 
the CY 2007 proposed relative payment weights. Based on this 
comparison, we adjusted the relative weights for purposes of budget 
neutrality. The unscaled relative payment weights were adjusted by 
1.354626473 for budget neutrality. We recognize the scaler, or weight 
scaling factor, for budget neutrality that we are proposing for CY 2007 
is higher than any previous OPPS weight scaler as a result of our 
proposal to use APC 0606 as the base for calculation of relative 
weights. Our proposed use of the median cost for APC 0606 of $83.67 
causes the unscaled weights to be lower than they would have been if we 
had chosen APC 0605 (Level 2 Clinic Visits; median $62.12) as the 
scaling base. The CY 2007 median cost of APC 0606 is significantly 
higher than the CY 2006 median cost of APC 0601 for mid-level clinic 
visits, which was used in CY 2006 and earlier years to calculate 
unscaled weights. Historically, the median cost for APC 0601 has been 
similar to the CY 2007 proposed median cost for APC 0605. In order to 
appropriately scale the total weight estimated for OPPS in CY 2007 to 
be similar to the total weight in OPPS for CY 2006, we calculated a 
scaler of 1.354626473, which is higher using APC 0606 as the base than 
it would be if we used APC 0605 as the base. In addition to adjusting 
for increases and decreases in weight due the recalibration of APC 
medians, the scaler also accounts for any change in the base.
    The proposed relative payment weights listed in Addenda A and B of 
this proposed rule incorporate the recalibration adjustments discussed 
in sections II.A.1. and 2. of this preamble.
    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 cost of 
those specified covered outpatient drugs (as discussed in section V. of 
this preamble) is now included in the budget neutrality calculations 
for CY 2007 OPPS.
    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, 2007. As we stated in our January 6, 2004 
interim final rule, charges for the brachytherapy sources were not used 
in determining outlier payments, and payments for these items were 
excluded from budget neutrality calculations for the CY 2006 OPPS. We 
excluded these payments from budget neutrality calculations, in part, 
because of the challenge posed by estimating hospital-specific cost 
payment. For CY 2007, we are proposing a specific payment rate for 
brachytherapy sources, which will be subject to scaling for budget 
neutrality. (We provide a discussion of brachytherapy payment issues, 
including their continued exclusion from outlier payments, under 
section VII. of this preamble.) Therefore, the costs of brachytherapy 
sources are accounted for in the scaler of 1.354626473.
4. Proposed Changes to Packaged Services
    (If you choose to comment on the issues in this section, please 
include the caption ``Packaged Services'' at the beginning of your 
comment.)
    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 those same claims 
in establishing payment rates for the separately payable services. This 
is consistent with the principles of a prospective payment system based 
upon groupings of services and in contrast to a fee schedule that 
provides individual payment for each service billed. 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.'' In deciding whether to 
package a service or pay for a code separately, we consider a variety 
of factors, including whether the service is normally provided 
separately or in conjunction with other services; how likely it is for 
the costs of the packaged code to be appropriately mapped to the 
separately payable codes

[[Page 49534]]

with which it was performed; and whether the expected cost of the 
service is relatively low.
    The Packaging Subcommittee identified areas for change for some 
packaged CPT codes that it believed could frequently be provided to 
patients as the sole service on a given date and that required 
significant hospital resources as determined from hospital claims data.
    Based on the comments received, additional issues, and new data 
that we shared with the Packaging Subcommittee concerning the packaging 
status of codes for CY 2007, the Packaging Subcommittee reviewed the 
packaging status of numerous HCPCS codes and reported its findings to 
the APC Panel at its March 2006 meeting. The APC Panel accepted the 
report of the Packaging Subcommittee, heard several presentations on 
certain packaged services, discussed the deliberations of the Packaging 
Subcommittee, and recommended that--
     CMS pay separately for HCPCS code 0069T (Acoustic heart 
sound recording and computer analysis only).
     CMS maintain the packaged status of HCPCS code 0152T 
(Computer aided detection with further physician review for 
interpretation, with or without digitization of films radiographic 
images; chest radiograph(s)).
     CMS maintain the packaged status of CPT code 36500 (venous 
catheterization for selective blood organ sampling).
     CMS pay separately for CPT code 36540 (Collect blood, 
venous access device) if there are no separately payable OPPS services 
on the claim.
     CMS pay separately for CPT code 36600 (Arterial puncture; 
withdrawal of blood for diagnosis) if there are no separately payable 
OPPS services on the claim.
     CMS pay separately for CPT code 38792 (Sentinel node 
identification) if there are no separately payable OPPS services on the 
claim.
     CMS maintain the packaged status of CPT codes 74328 
(Endoscopic catheterization of the biliary ductal system, radiological 
supervision and interpretation), 74329 (Endoscopic catheterization of 
the pancreatic ductal system, radiological supervision and 
interpretation), and 74330 (Combined endoscopic catheterization of the 
biliary and pancreatic ductal systems, radiological supervision and 
interpretation).
     CMS pay separately for CPT code 75893 (Venous sampling 
through catheter, with or without angiography, radiological supervision 
and interpretation) if there are no separately payable OPPS services on 
the claim.
     CMS continue to separately pay for CPT code 76000 
(Fluoroscopy, up to one hour physician time).
     CMS maintain the packaged status of CPT codes 76001 
(Fluoroscopy, physician time more than one hour), 76003 ((Fluoroscopic 
guidance for needle placement), and 76005 (Fluoroscopic guidance and 
localization of needle or catheter tip).
     CMS maintain the packaged status of CPT codes 76937 
(Ultrasound guidance for vascular access) and 75998 (Fluoroscopic 
guidance for central venous access device placement, replacement, or 
removal).
     CMS provide separate payment for CPT codes 94760 
(Noninvasive ear or pulse oximetry for oxygen saturation; single 
determination), 94761 (Noninvasive ear or pulse oximetry for oxygen 
saturation; multiple determinations), and 94762 (Noninvasive ear or 
pulse oximetry for oxygen saturation by continuous overnight 
monitoring) if there are no separately payable OPPS services on the 
claim.
     CMS pay separately for CPT code 96523 (Irrigation of 
implanted venous access device) if there are no separately payable OPPS 
services on the claim.
     CMS maintain the packaged status of HCPCS code G0269 
(Placement of occlusive device into either a venous or arterial access 
site).
     CMS pay separately for HCPCS code P9612 (Catheterization 
for collection of specimen, single patient) if there are no separately 
payable OPPS services on the claim.
     CMS bring data to the next APC Panel meeting that show the 
following: (a) how the costs of packaged items and services are 
incorporated into the median costs of APCs and (b) how the costs of 
these packaged items and services influence payments for associated 
procedures.
     The Packaging Subcommittee continue until the next APC 
Panel meeting.
    For CY 2007, we are proposing to maintain CPT code 0069T as a 
packaged service and not adopt the APC Panel's recommendation to pay 
separately for this code. The service uses signal processing technology 
to detect, interpret, and document acoustical activities of the heart 
through special sensors applied to a patient's chest. This code was a 
new Category III CPT code implemented in the CY 2005 OPPS and assigned 
a new interim status indicator of ``N'' in the CY 2005 OPPS final rule. 
The APC Panel recommended packaging CPT code 0069T for CY 2006, and we 
accepted that recommendation when we finalized the status indicator 
``N'' assignment to 0069T for CY 2006. This code is indicated as an 
add-on code to an electrocardiography service, according to the AMA's 
CY 2006 CPT book. In its presentation to the APC Panel, the 
manufacturer requested that we pay separately for CPT code 0069T and 
assign it to APC 0099 (Electrocardiograms), based on its estimated cost 
and clinical characteristics.
    At the APC Panel meeting, the manufacturer stated that the acoustic 
heart sounds recording and analysis service may be provided with or 
without a separately reportable electrocardiogram. Members of the APC 
Panel engaged in extensive discussion of clinical scenarios as they 
considered whether CPT code 0069T could or could not be appropriately 
reported alone or in conjunction with several different procedure 
codes. We note that the parenthetical information following the AMA's 
code descriptor indicates that CPT code 0069T is to be reported in 
conjunction with CPT code 93005 (Electrocardiogram, routine ECG with at 
least 12 leads; tracing only, without interpretation and report). In 
addition, we do not believe that, based on its expected clinical uses 
as described by the manufacturer, CPT code 0069T would ever be 
performed as a sole service without other separately payable OPPS 
services and payment for CPT code 0069T could always be packaged into 
payments for those other services. Therefore, we believe that CPT code 
0069T is appropriately packaged because it is closely linked to the 
performance of an ECG, should never be reported alone, and is estimated 
to require only modest hospital resources. Using CY 2005 claims, we had 
only 9 single claims for CPT code 0069T, with a median line-item cost 
of $1.93, consistent with its low expected cost. Packaging payment for 
CPT code 0069T is consistent with the principles of a prospective 
payment system that provides payments for groups of services. To the 
extent that the acoustic heart sounding recording service may be more 
frequently provided in the future in association with ECGs or other 
OPPS services as its clinical indications evolve, we expect that its 
cost would also be increasingly reflected in the median costs for those 
other services, particularly ECG procedures.
    For CY 2007, we are proposing to accept the APC Panel's 
recommendation to maintain the packaged status of CPT code 0152T. The 
service involves the application of computer algorithms and 
classification technologies to chest x-ray

[[Page 49535]]

images to acquire and display information regarding chest x-ray regions 
that may contain indications of cancer. This code was a new Category 
III CPT code implemented in the CY 2006 OPPS and assigned a new interim 
status indicator of ``N'' in the CY 2006 OPPS final rule with comment 
period. The code is indicated as an add-on code to chest x-ray CPT 
codes, according to the AMA's CY 2006 CPT book. In its presentation to 
the APC Panel, the manufacturer requested that we pay separately for 
this service and assign it to a New Technology APC with a payment rate 
of $15, based on its estimated cost, clinical considerations, and 
similarity to other image post-processing services that are paid 
separately.
    Under the OPPS we make payment for medically necessary services 
either separately or packaged into our payments for other services. We 
agree with the APC Panel that packaged payment for diagnostic chest x-
ray computer-aided detection (CAD) under a prospective payment 
methodology for outpatient hospital services is appropriate because of 
the close relationship of chest x-ray CAD to chest x-ray services and 
its projected modest cost. Because 0152T is a new CPT code for CY 2006, 
we have no CY 2005 hospital claims data available for analysis. To the 
extent that CAD may be more frequently provided in the future to aid in 
the review of diagnostic chest x-rays as its clinical indications 
evolve, we expect that its cost would also be increasingly reflected in 
the median costs for chest x-ray procedures.
    For CY 2007, we are proposing to accept the recommendation of the 
APC Panel and maintain the packaged status of CPT code 36500. We note 
that several providers have commented that CPT code 36500 is sometimes 
billed only with its corresponding radiological supervision and 
interpretation code, 75893, but with no other separately payable OPPS 
services. In those cases, the provider would not receive any payment. 
For CY 2006, we accepted the APC Panel's recommendation to package both 
CPT codes 36500 and 75893 and to examine claims data. Our initial 
review of several clinical scenarios submitted by the public seemed to 
suggest that other separately payable procedures, such as venography, 
would likely be billed on the same claim. Our claims data indicate that 
there are usually separately payable codes that are billed on claims 
with CPT codes 36500 and 75893. However, we acknowledge that these two 
codes may occasionally be provided without any separately payable 
procedures. In these uncommon instances, the provider historically has 
not received any payment under the OPPS. We also understand that there 
is a cost associated with registering a patient and providing these 
services. For CY 2006, we have approximately 160 single claims for CPT 
code 75893, with a median cost of $269. Based on the proposal described 
below for ``special'' packaged codes, for CY 2007, when CPT codes 36500 
and 75893 are billed on a claim with no separately payable OPPS 
services, CPT code 75893 would become separately payable and would 
receive payment for APC 0668. In this circumstance, payment for CPT 
code 36500 would be packaged into the separate payment for CPT code 
75893.
    For CY 2007, we are proposing to accept the APC Panel's 
recommendation and pay separately for CPT codes 36540, 36600, 38792, 
75893, 94762, and 96523 when any of these codes appear on a claim with 
no separately payable OPPS services also reported for the same date of 
service. We will refer to this subset of codes as ``special'' packaged 
codes. We acknowledge that there is a cost to the hospital associated 
with registering and treating a patient, regardless of whether the 
specific service provided requires minimal or significant hospital 
resources. While we continue to believe that these ``special'' packaged 
codes are almost always provided along with a separately payable 
service, our claims analyses indicate that there are rare instances 
when one of these services is provided without another separately 
payable OPPS service on the claim for the same date of service. In 
these instances, providers do not currently receive any payment. 
Therefore, we are proposing to provide payment for the ``special'' 
packaged codes listed above when they are billed on a claim without 
another separately payable OPPS service on the same date. When any of 
the ``special'' packaged codes are billed with other codes that are 
separately payable under the OPPS on the same date of service, the 
``special'' packaged code would be treated as a packaged code, and the 
cost of the packaged code would be bundled into the costs of the other 
separately payable services on the claim. The payments that the 
provider receives for the separately payable services would include the 
bundled payment for the packaged code(s).
    We have heard concerns from the public stating that they are unable 
to submit claims to CMS that report only packaged codes. We note that 
although these claims are processed by the OCE and are ultimately 
rejected for payment, they are received by CMS, and we have cost data 
for packaged services based upon these claims. However, we recognize 
that the data used in our analyses to assess the frequencies with which 
packaged services are provided alone and their median costs are 
somewhat limited. It is possible that an unknown number of hospitals 
chose not to submit claims to CMS when a packaged code(s) was provided 
without other separately payable services on their claims, realizing 
that they would not receive payment for those claims. While we have 
been told that some hospitals may bill for a low-level visit if a 
packaged service only is provided so that they receive some payment for 
the encounter, we note that providers should bill a low-level visit 
code in such circumstances only if the hospital provides a significant, 
separately identifiable low-level visit in association with the 
packaged service.
    Through OCE logic, the PRICER would automatically assign payment 
for a ``special'' packaged service reported on a claim if there are no 
other services separately payable under the OPPS on the claim for the 
same date of service. In all other circumstances, the ``special'' 
packaged codes would be treated as packaged services. We are proposing 
to assign status indicator ``Q'' to these ``special'' packaged codes to 
indicate that they are usually packaged, except for special 
circumstances when they are separately payable. Through OCE logic, the 
status indicator of a ``special'' packaged code would be changed either 
to ``N'' or to the status indicator of the APC to which the code is 
assigned for separate payment, depending upon the presence or absence 
of other OPPS services also reported on the claim for the same date. 
Table 3 below lists the proposed status indicators and APC assignments 
for these ``special'' packaged codes when they are separately payable. 
We note that the payment for these ``special'' packaged codes is 
intended to make payment for all of the hospital costs, which may 
include patient registration and establishment of a medical record, in 
an outpatient hospital setting even when no separately payable services 
are provided to the patient on that day.

[[Page 49536]]



           Table 3.--Proposed Status Indicators and APC Assignments for ``Special'' Packaged CPT Codes
----------------------------------------------------------------------------------------------------------------
                                                                                                    Proposed CY
            CPT code                     Descriptor           Proposed CY      Proposed status       2007 APC
                                                               2007 APC           indicator           median
----------------------------------------------------------------------------------------------------------------
36540...........................  Collect blood, venous               0624  S...................          $32.96
                                   access device.
36600...........................  Arterial puncture;                  0035  T...................           12.45
                                   withdrawal of blood for
                                   diagnosis.
38792...........................  Sentinel node                       0389  S...................           86.92
                                   identification.
75893...........................  Venous sampling through             0668  S...................          393.35
                                   catheter, with or
                                   without angiography,
                                   radiological
                                   supervision and
                                   interpretation.
94762...........................  Noninvasive ear or pulse            0443  X...................           61.39
                                   oximetry for oxygen
                                   saturation by
                                   continuous overnight
                                   monitoring.
96523...........................  Irrigation of implanted             0624  S...................           32.96
                                   venous access device.
----------------------------------------------------------------------------------------------------------------

    In the case of a claim with two or more ``special'' packaged codes 
only reported on a single date of service, the PRICER would assign 
separate payment only to the ``special'' packaged code that would 
receive the highest payment. The other ``special'' codes would remain 
packaged and would not receive separate payment.
    We will monitor and analyze the claims frequency and claims detail 
for situations in which these codes are billed alone and then 
separately paid. This will allow us to determine both which providers 
are billing these codes most often and under what circumstances these 
codes are billed. We expect that hospitals scheduling and providing 
services efficiently to Medicare beneficiaries will continue to 
generally provide these minor services in conjunction with other 
medically necessary services.
    For CY 2007, we are proposing to accept the APC Panel's 
recommendation and maintain the packaged status of CPT codes 74328, 
74329, and 74330. The AMA notes that these radiological supervision and 
interpretation codes should be reported with procedure codes 43260-
43272. In fact, our data indicate that these supervision and 
interpretation codes are billed with 43260-43272 more than 90 percent 
of the time, indicating their routine use. We believe that some 
providers may be concerned that although the payment for the endoscopic 
procedure includes the bundled payment for the supervision and 
interpretation performed by the radiology department, the payment for 
the comprehensive service may be directed to the hospital department 
that performed the endoscopic procedure, rather than to the radiology 
department. While we understand this concern, the OPPS pays hospital 
for services provided, and we believe that hospitals are responsible 
for attributing payments to hospital departments as they believe 
appropriate. We do not believe that packaging these radiological 
supervision and interpretation codes leads to inaccurate payments for 
the full hospital resources associated with endoscopic retrograde 
cholangiopancreatography procedures.
    For CY 2007, we are proposing to accept the APC Panel's 
recommendation to continue to package CPT codes 76001, 76003, and 76005 
and to continue to pay separately for CPT code 76000. We received a 
comment which stated that it was inconsistent to pay separately for CPT 
code 76000 (Fluoroscopy (separate procedure), up to one hour physician 
time) but to package CPT code 76001 (Fluoroscopy, physician time more 
than one hour) when CPT code 76001 appears to be a similar code, except 
that it is for a longer period of physician time. The Packaging 
Subcommittee believed that many of the claims that listed CPT code 
76001 were erroneously billed, as many of the procedure codes that were 
billed with CPT code 76001 included fluoroscopy as an integral part of 
the procedure. In other cases, the Packaging Subcommittee noted that a 
procedure-specific fluoroscopy code should probably have been billed, 
instead of CPT code 76001. The Packaging Subcommittee believed that CPT 
code 76000 could often be provided as a sole service, with no other 
separately payable procedures. The Packaging Subcommittee recommended 
that CMS continue to pay separately for CPT code 76000, consistent with 
the AMA's definition of this code, which specifies that it is a 
separate procedure, and to continue to package CPT codes 76001, 76003, 
and 76005.
    For CY 2007, we are proposing to accept the APC Panel's 
recommendation to continue to package CPT codes 76937 and 75998. In the 
CY 2006 OPPS final rule with comment period (70 FR 68544 and 68545), we 
reviewed in detail the data related to these two codes and promised to 
share CY 2004 and early CY 2005 data with the Packaging Subcommittee. 
We reviewed current data with the Packaging Subcommittee, and it 
recommended that we continue to package these codes. In summary, we 
believe that these services would always be provided with another 
separately payable procedure, so their costs would be appropriately 
bundled with the definitive vascular access device procedures. The 
costs for these guidance procedures are relatively low compared to the 
CY 2007 proposed payment rates for the separately payable services they 
most frequently accompany. If we were to unpackage CPT codes 76937 and 
75998, the single bills available to develop median costs for vascular 
access device insertion services would be significantly reduced. 
Therefore, we are proposing to continue to package both CPT codes 76937 
and 75998 for CY 2007.
    For CY 2007, we are proposing to accept the APC Panel's 
recommendation to continue to package HCPCS code G0269. This code 
should never be billed without another separately payable procedure. 
Recent data indicate that 94 percent of the time HCPCS code G0269 was 
billed with either CPT code 93510 or 93526. In addition, the median 
cost of G0269 is low compared to the costs of the procedures with which 
it is typically associated.
    For CY 2007, we are proposing to continue packaging CPT codes 94760 
(Noninvasive ear or pulse oximetry for oxygen saturation; single 
determination) and 94761 (Noninvasive ear or pulse oximetry for oxygen 
saturation; multiple determinations) and not adopt the APC Panel's 
recommendation to provide separate payment for these services if there 
are no other separately payable OPPS services on the claim for the same 
date of service. Our data review revealed that these services are very 
frequently provided in the OPPS, with over 1 million claims in CY 2005 
for the single pulse oximetry determination service and over 400,000 
claims for the multiple determinations service. These high frequencies 
may actually be understated as both of these services are packaged 
codes, and we have been told that some hospitals may not report the

[[Page 49537]]

HCPCS codes for services for which they receive no separate payments. 
Single and multiple pulse oximetry determinations are almost always 
provided in association with other services that are separately payable 
under the OPPS, into which their costs may be appropriately packaged. 
Specifically, OPPS hospital claims data revealed that out of the total 
instances of CPT code 94760 appearing on claims used for setting 
payment rates for this CY 2007 OPPS proposed rule, CPT code 94760 was 
billed only 4 percent of the time in association with no other 
separately payable OPPS services, with a median cost of $14. Using the 
same data, CPT code 94761 was billed only 7 percent of the time in 
association with no other separately payable OPPS services, with a 
median cost of $36. These pulse oximetry services have a relatively low 
cost compared with the OPPS services they frequently accompany. If we 
were to provide separate payment for these pulse oximetry 
determinations when performed as stand alone procedures by hospitals, 
we are concerned that hospitals would lose their incentive to provide 
these basic, low cost, and brief services as efficiently as possible, 
generally during the same encounters where they are providing other 
services to the same patients. We believe their appropriate provision 
as single services should be very rare. Therefore, for CY 2007 we are 
proposing not to include these codes on the list of ``special'' 
packaged codes, so their payment would remain packaged in all 
circumstances.
    For CY 2007, we are proposing to assign status indicator ``A'' to 
HCPCS code P9612 and reject the APC Panel's recommendation to pay 
separately under the OPPS for this code when it is billed without any 
separately payable OPPS services. This code is currently payable on the 
clinical lab fee schedule. Its status indicator of ``A'' would provide 
payment for the service whenever it is billed, regardless of the 
presence or absence of other reported services. In addition, for 
consistency we are proposing to assign status indicator ``A'' to HCPCS 
code P9615 as it is also payable on the clinical lab fee schedule. In 
general, when a code is payable on the clinical lab fee schedule, we 
defer to that fee schedule and do not assign payment under the OPPS.
    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 community mental 
health center (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. The Medicare regulations at 42 
CFR 419.21(c) that implement this provision specify 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, we refer readers to the April 7, 2000 OPPS final rule with 
comment period (65 FR 18452).
    Historically, the median per diem cost for CMHCs has greatly 
exceeded the median per diem cost for hospital-based PHPs and has 
fluctuated significantly from year to year while the median per diem 
cost for hospital-based PHPs has remained relatively constant ($200-
$225). We believe that CMHCs may have increased and decreased their 
charges in response to Medicare payment policies. As discussed in more 
detail in section II.B.2. of the preamble of this proposed rule and in 
the CY 2004 OPPS final rule with comment period (68 FR 63470), we 
believe that some CMHCs manipulated their charges in order to 
inappropriately receive outlier payments.
    In the CY 2003 OPPS 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 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 $1,038, while the median per diem cost for hospital-based PHPs was 
again $225. After applying the .583 adjustment factor in the CY 2004 
proposed rule to the median CMHC per diem cost, the median CMHC per 
diem cost was $605. Because 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 with comment period 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 was 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.
    For CY 2005, the PHP 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

[[Page 49538]]

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 by April 30, 2003, using the most recently settled cost 
reports. 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 used CCRs from the outpatient provider 
specific file.
    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 the CY 2006 OPPS final rule with comment period, we analyzed 12 
months of the most current claims data available for hospital and CMHC 
PHP services furnished between January 1, 2004, and December 31, 2004. 
We also used the most currently available CCRs to estimate costs. The 
median per diem cost for CMHCs was $154, while the median per diem cost 
for hospital-based PHPs was $201. Based on the CY 2004 claims data, the 
average charge per day for CMHCs was $760, considerably greater than 
hospital-based per day costs but significantly lower than what it was 
in CY 2003 ($1,184). We believed that a combination of reduced charges 
and slightly lower CCRs for CMHCs resulted in a significant decline in 
the CMHC median per diem cost between CY 2003 and CY 2004.
    Following the methodology used for the CY 2005 OPPS update, the CY 
2006 OPPS update combined hospital-based and CMHC median per diem cost 
was $161, a decrease of 44 percent compared to the CY 2005 combined 
median per diem amount. We believed that this amount was too low to 
cover the cost for all PHPs.
    Therefore, as stated in the CY 2006 OPPS final rule with comment 
period (70 FR 68548 and 68549), we considered the following three 
alternatives to our update methodology for the PHP APC for CY 2006 to 
mitigate this drastic reduction in payment for PHP services: (1) Base 
the PHP APC on hospital-based PHP data alone; (2) 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; and (3) apply a 15 
percent reduction to the combined hospital-based and CMHC median per 
diem cost that was used to establish the CY 2005 PHP APC. (We refer 
readers to the CY 2006 OPPS final rule with comment period for a full 
discussion of the three alternatives (70 FR 68548).) After carefully 
considering these three alternatives and all comments received on them, 
we adopted the third alternative for CY 2006. We adopted this 
alternative because we believed and continue to believe that 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 that 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 adopted this policy as a transitional 
measure, and stated in the CY 2006 OPPS final rule with comment period 
that we would 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 (70 FR 68548).
    To apply this methodology for CY 2006, we reduced $289 (the CY 2005 
combined unscaled hospital-based and CMHC median per diem cost) by 15 
percent, resulting in a combined median per diem cost of $245.65 for CY 
2006.
2. Proposed PHP APC Update for CY 2007
    For CY 2007, we are proposing to calculate the CY 2007 PHP per diem 
payment rate using the same update methodology that we adopted in CY 
2006. That is, we are proposing to apply an additional 15-percent 
reduction to the combined hospital-based and CMHC median per diem cost 
that was used to establish the CY 2006 per diem PHP payment.
    For CY 2007, we analyzed 12 months of data for hospital and CMHC 
PHP claims for services furnished between January 1, 2005 and December 
31, 2005. We also used the most currently available CCRs to estimate 
costs. Using these CY 2005 claims data, the median per diem cost for 
CMHCs was $165 and the median per diem cost for hospital-based PHPs was 
$209. Following the methodology used for the CY 2005 update, the CY 
2007 combined hospital-based and CMHC median per diem cost is $172.
    While the combined hospital-based and CMHC median per diem cost is 
about $10 higher using the CY 2005 data compared to the CY 2004 data 
($172 compared to $161), we believe this amount is still too low to 
cover the cost for PHPs. We continue to believe that the policy we 
adopted for CY 2006--a 15-percent reduction applied to the current 
median cost--provides an appropriate decrease in median per diem costs 
for both the hospital and CMHC data. Therefore, for CY 2007, we are 
proposing an additional 15 percent reduction to the combined hospital-
based and CMHC median per diem cost. We will continue to monitor and 
work with CMHCs to improve their reporting. If CMHC data continues to 
be a problem, we would consider using data from hospital-based PHPs 
only.
    To calculate the CY 2007 APC PHP per diem cost, we reduced $245.65 
(the CY 2005 combined hospital-based and CMHC median per diem cost of 
$289 reduced by 15 percent) by 15 percent, which resulted in a combined 
median per diem cost of $208.80.
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. In addition, further analysis indicated that using the 
same OPPS outlier threshold for both hospitals and CMHCs did not limit 
outlier payments to high cost cases and resulted in excessive outlier 
payments to CMHCs. Therefore, for CYs 2004, 2005, and 2006, we 
established a separate outlier threshold for CMHCs. For CYs 2004 and 
2005, we designated a portion of the

[[Page 49539]]

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. For CY 2006, 
we set the estimated outlier target at 1.0 percent and allocated a 
portion of that 1.0 percent, 0.6 percent (or 0.006 percent of total 
OPPS payments), to CMHCs for PHP services. The CY 2006 CMHC outlier 
threshold is met when the cost of furnishing services by a CMHC exceeds 
3.40 times the PHP APC payment amount. The CY 2006 OPPS outlier payment 
percentage is 50 percent of the amount of costs in excess of the 
threshold.
    The separate outlier threshold for CMHCs became effective January 
1, 2004, and has resulted in more commensurate outlier payments. In CY 
2004, the separate outlier threshold for CMHCs resulted in $1.8 million 
in outlier payments to CMHCs. In CY 2005, the separate outlier 
threshold for CMHCs resulted in $0.5 million in outlier payments to 
CMHCs. In contrast, 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 discussed in section II.B.2. of this preamble, the CY 2005 CMHC 
data produce median per diem costs too low to use for the CY 2007 
partial hospitalization payment rate. Due to the continued volatility 
of the CMHC charge data, we are proposing to maintain the existing 
outlier threshold for CMHCs for CY 2007 at 3.40 times the APC payment 
amount and the CY 2007 outlier payment percentage applicable to costs 
in excess of the threshold at 50 percent.
    As noted in section II.G. of this preamble, for CY 2007, we are 
proposing to continue our policy of setting aside 1.0 percent of the 
aggregate total payments under the OPPS for outlier payments. We are 
proposing that a portion of that 1.0 percent, an amount equal to 0.25 
percent of outlier payments and 0.0025 percent of total OPPS payments 
would be allocated to CMHCs for PHP service outliers. As discussed in 
section II.G. of this preamble, we again are proposing to set a dollar 
threshold in addition to an APC multiplier threshold for OPPS outlier 
payments. However, because the 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 to set a dollar threshold for CMHC outliers. As noted above, 
we are proposing to set the outlier threshold for CMHCs for CY 2007 at 
3.40 percent times the APC payment amount and the CY 2007 outlier 
payment percentage applicable to costs in excess of the threshold at 50 
percent.
    CMS and the Office of the Inspector General are continuing to 
monitor the excessive outlier payments to CMHCs.

C. Proposed Conversion Factor Update for CY 2007

    (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 2007, 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 2007 
published in the IPPS proposed rule on April 25, 2006 is 3.4 percent 
(71 FR 24148). To set the OPPS proposed conversion factor for CY 2007, 
we increased the CY 2006 conversion factor of $59.511, as specified in 
the November 10, 2005 final rule with comment period (70 FR 68551), by 
3.4 percent.
    In accordance with section 1833(t)(9)(B) of the Act, we further 
adjusted the conversion factor for CY 2006 to ensure that the revisions 
we are making to our updates for a revised wage index and expanded 
rural adjustment are made on a budget neutral basis. We calculated a 
budget neutrality factor of 0.999908021 for wage index changes by 
comparing total payments from our simulation model using the FY 2007 
IPPS proposed wage index values to those payments using the current (FY 
2006) IPPS wage index values. To reflect the inclusion of essential 
access community hospitals (EACHs) as rural SCHs (discussed in section 
II.F. of this preamble), we calculated an additional budget neutrality 
factor of 0.999883468 for the rural adjustment, including EACHs. For CY 
2007, we estimate that allowed pass-through spending would equal 
approximately $43.2 million, which represents 0.13 percent of total 
OPPS projected spending for CY 2007. The proposed conversion factor 
also is adjusted by the difference between the 0.17 percent pass-
through dollars set-aside in CY 2006 and the 0.13 percent estimate for 
CY 2007 pass-through spending. Finally, proposed payments for outliers 
remain at 1.0 percent of total payments for CY 2007.
    The proposed market basket increase update factor of 3.4 percent 
for CY 2007, the required wage index budget neutrality adjustment of 
approximately 0.999908021, the return of 0.04 percent for the 
difference in the pass-through set-aside, and the proposed adjustment 
for the rural payment adjustment for rural SCHs, including rural EACHs, 
of 0.999883468 result in a proposed conversion factor for CY 2007 of 
$61.551.

D. Proposed Wage Index Changes for CY 2007

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Wage Indices'' 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 hospitals that participate in the OPPS but not 
the IPPS (referred to in this section as ``non-IPPS'' hospitals).
    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 with 
comment period (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. Thus, the wage index that 
applies to a particular hospital under the IPPS will also apply to that 
hospital under the OPPS. 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 using the

[[Page 49540]]

proposed FY 2007 hospital IPPS wage indices published in the Federal 
Register on April 25, 2006, which include the wage indices proposed to 
be in effect through March 31, 2007, and those proposed to be in effect 
on or after April 1, 2007, to accommodate the expiring reclassification 
provisions under section 508 of Pub. L. 108-173, to determine the wage 
adjustments for the OPPS payment rate and the copayment standardized 
amount for CY 2007. However, in accordance with our established policy, 
we are proposing to use the FY 2007 final version of these wage indices 
to determine the wage adjustments for the OPPS payment rate and 
copayment standardized amount that we will publish in our final rule 
for CY 2007.
    On May 17, 2006 (71 FR 28644), in response to a court order in 
Bellevue Hosp. Ctr. v. Leavitt, we published a second IPPS proposed 
rule that would revise the methodology for calculating the occupational 
mix adjustment for FY 2007. We proposed to replace in full the 
descriptions of the data and methodology that would be used in 
calculating the occupational mix adjustment discussed in the first FY 
2007 IPPS proposed rule. The second proposed rule also states that, 
because of the collection of new occupational mix data, we would 
publish the FY 2007 occupational mix adjusted wage index tables and 
related impacts on the CMS Web site shortly after we publish the FY 
2007 IPPS final rule, and in advance of October 1, 2006. The weights 
and factors would also be published on the CMS Web site after the FY 
2007 IPPS final rule, but in advance of October 1, 2006. (71 FR 28650). 
Thus, for purposes of determining OPPS wage indices, readers are also 
directed to refer to the wage index tables that are published after the 
FY 2007 IPPS final rule.
    We note that the FY 2007 IPPS wage indices continue to reflect a 
number of changes implemented in FY 2005 as a result of the revised 
Office of Management and Budget (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 2007, and 
any adjustments that we are applying to the OPPS for CY 2007. We refer 
the reader to the FY 2007 IPPS proposed rule (71 FR 24074 through 
24091) for a detailed discussion of the proposed changes to the wage 
indices. Readers should refer to our proposed rule published May 17, 
2006, for proposed changes to the occupational mix adjustment and 
related issues (71 FR 28644-28653). In this proposed rule, we are not 
reprinting the proposed FY 2007 IPPS wage indices. We also refer 
readers to the CMS Web site for the OPPS at http://www.cms.hhs.gov/providers/hopps. At this Web site, the reader will find a link to the 
proposed FY 2007 IPPS wage indices tables. (However, as noted above, 
these tables may change as a result of the May 17, 2006 occupational 
mix proposed rule discussed above.)
    1. The proposed continued use of the Core Based Statistical Areas 
(CBSAs) issued by the 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 IPPS final rule, 
CMS adopted the new OMB definitions for wage index purposes. In the FY 
2007 IPPS proposed rule, we again stated that hospitals located in MSAs 
will be urban and hospitals that are located in Micropolitan Areas or 
outside CBSAs will be rural. To help alleviate the decreased payments 
for previously urban hospitals that became rural under the new 
geographical definitions, we allowed these hospitals to maintain for 
the 3-year period from FY 2005 through FY 2007, the wage index of the 
MSA where they previously had been located. To be consistent with the 
IPPS, we will continue the policy we began in CY 2005 of applying the 
same urban-to-rural transition to non-IPPS hospitals paid under the 
OPPS. That is, we would maintain the wage index of the MSA where the 
hospital was previously located for purposes of determining a wage 
index for CY 2007. Beginning in FY 2008, the 3-year transition will end 
and these hospitals will receive their statewide rural wage index. 
However, hospitals paid under the IPPS will be eligible to apply for 
reclassification.
    For the occupational mix adjustment, we refer readers to CMS's May 
17, 2006 occupational mix proposed rule discussed above. Under this 
proposed rule, wage indices would be adjusted 100 percent for 
occupational mix. In addition, as stated above, CMS plans that wage 
index tables and other adjustment factors would be published after 
publication of the FY 2007 IPPS final rule, but prior to October 1, 
2006.
    As noted above, for purposes of estimating an adjustment for the 
OPPS payment rates to accommodate geographic differences in labor costs 
in this proposed rule, we have used the wage indices identified in the 
FY 2007 IPPS proposed rule. For the CY 2007 OPPS final rule, we plan to 
use the revised FY 2007 IPPS wage indices that will be fully adjusted 
for differences in occupational mix using the new survey data and 
available after October 1, 2006. In all cases, we will use the final FY 
2007 IPPS wage indices, which include the wage indices to be in effect 
through March 31, 2007, and those to be in effect on or after April 1, 
2007, with any subsequent corrections, for calculating OPPS payment in 
CY 2007.
    2. 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 for FY 2007, 
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, and that this 
expiration, along with the calendar year operating period of OPPS, 
impacts the calculation of the OPPS payment and the budget neutrality 
adjustment for the wage index. In the FY 2007 IPPS proposed rule (71 FR 
24085 through 24087), we proposed procedural rules for hospitals that 
wished to reclassify for the second half of FY 2007 (April 1, 2007, 
through September 30, 2007) under section 1886(d)(10) of the Act. These 
rules essentially provided procedures for some hospitals to retain 
section 508 reclassifications for the first half of FY 2007 and also be 
eligible to maintain an approved reclassification under section 
1886(d)(10) for the second half of FY 2007. Rather than calculating one 
wage index that reflected all final reclassification adjustments, we 
proposed two separate wage indices for FY 2007, one to be in effect 
October 1 through March 31, 2007, and one to be in effect April 1 
through September 30, 2007.
    These procedural rules also impact a hospital's eligibility to 
receive the out-migration wage adjustment, discussed in greater detail 
in section III.I. of the FY 2007 IPPS proposed rule (71 FR 24087) and 
under section II.D.4. of this preamble. A hospital cannot receive an 
out-migration wage adjustment if it is reclassified under section 
1886(d)(10) of the Act. Hospitals declining reclassification status for 
any part of the year become eligible to receive the out-migration wage 
adjustment if they are located in an adjustment county.

[[Page 49541]]

Because the OPPS operates on a calendar year (January 1 through 
December 31) and not a fiscal year, the expiring reclassification 
status under section 508 of Pub. L. 108-173 results in different wage 
indices for OPPS for the first quarter of CY 2007 (January 1, 2007, 
through March 31, 2007) and the last three quarters of CY 2007 (April 
1, 2007, through December 31, 2007).
    3. The out-migration wage adjustment to the wage index. In FY 2007 
IPPS proposed rule (71 FR 24087), we discussed the out-migration 
adjustment under section 505 of Pub. L. 109-173 for counties under this 
adjustment. Hospitals paid under the IPPS located in the qualifying 
section 505 ``out-migration'' counties receive a wage index increase 
unless they have already been otherwise reclassified. (See the IPPS FY 
2007 proposed rule for further information on out-migration.) For OPPS 
purposes, we propose to continue our policy from CY 2006 to allow non-
IPPS hospitals paid under the OPPS to qualify for out-migration 
adjustment if they are located in a section 505 out-migration county. 
Because non-IPPS hospitals cannot reclassify, they are eligible for the 
out-migration wage adjustment. Tables identifying counties eligible for 
the out-migration adjustment will be published after the FY 2007 IPPS 
final rule and CMS plans to publish them in advance of October 1, 2006. 
These tables will reflect updated county listing to reflect changes to 
the occupation mix adjustment made in response to Bellevue court case 
discussed above. Because we are proposing to adopt the final FY 2007 
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 wage adjustment both through March 31, 
2007, and on or after April 1, 2007.
    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 2007, in this proposed 
rule, we have included the wage index changes that would result from 
MGCRB reclassifications, implementation of section 505 of Pub. L. 108-
173, and other refinements made in the FY 2007 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 sets 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 count against the $900 
million limit, we did not consider these reclassifications when we 
calculated the proposed OPPS budget neutrality adjustment.
    Under the procedural rules described under section II.D.3. of this 
proposed rule above and in section III.H.5. of the FY 2007 IPPS 
proposed rule (71 FR 24085) regarding expiring section 508 
reclassifications, different wage indices may be in effect for the 
first quarter of the calendar year and the last three quarters of the 
calendar year. These rules have implications for budget neutrality 
adjustments. Any additional payment attributable to reclassifications 
due to section 508 between January 1 and April 1, 2007, must be 
excluded from a budget neutrality adjustment, and all other adjustments 
to the wage index are subject to budget neutrality. Rather than 
calculating two different conversion factors, with different budget 
neutrality adjustments, we are proposing to calculate one budget 
neutrality adjustment that reflects the combined adjustments required 
for the first quarter and last three quarters of the calendar year, 
respectively. We followed the same approach in the FY 2007 IPPS 
proposed rule (71 FR 24087).

E. Proposed Statewide Average Default CCRs

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: 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 2006 in 
our final rule, published on November 10, 2005 (70 FR 68553 through 
68555). In this proposed rule, we are proposing to update the default 
ratios for CY 2007 using the most recent cost report data.
    We calculated the statewide default CCRs using the same overall 
CCRs that we use to adjust charges to costs on claims data. Please 
refer to section II.A.1.c. of this preamble for a discussion of our 
proposed revision to the overall CCR calculation. Table 4 lists the 
proposed CY 2007 default urban and rural CCRs by State and compares 
them to last year's default CCRs. 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 
weighted by Medicare Part B charges. 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.
    For this proposed rule, 81.79 percent of the submitted cost reports 
represented data for CY 2004. 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 2004.
    Finally, we calculated an overall average CCR, weighted by a 
measure of volume for CY 2004, 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 4. 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 observed 
differences between last year's default statewide CCRs and the proposed 
CCRs are a combination of the general decline in the ratio between 
costs and charges widely observed in the cost report data and the 
change in the proposed overall CCR calculation.

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    As stated above, CMS uses default statewide CCRs for several groups 
of hospitals, including, but 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, and hospitals that have recently given up their all-inclusive rate 
status. Current OPPS policy also requires hospitals that experience a 
change of ownership, but that do not accept assignment of the previous 
hospital's provider agreement, to use the previous provider's CCR.
    For CY 2007, we are proposing to apply this treatment of using the 
default statewide CCR to include an entity that has not accepted 
assignment of an existing hospital's provider agreement in accordance 
with 42 CFR 489.18, and that has not yet submitted its first Medicare 
cost report. We are proposing that this policy be effective for 
hospitals experiencing a change of ownership on or after January 1, 
2007. We believe that a hospital that has not accepted assignment of an 
existing hospital's provider agreement is similar to a new hospital 
that will establish its own costs and charges. We believe that the 
hospital that has chosen not to accept assignment may have different 
costs and charges than the existing hospital. Furthermore, we believe 
that the hospital should be provided time to establish its own costs 
and charges. Therefore, we are proposing to use the default statewide 
CCR to determine cost-based payments until the hospital has submitted 
its first Medicare cost report.

F. OPPS Payments to Certain Rural Hospitals

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Rural Hospitals Hold Harmless Transitional 
Payments'' at the beginning of your comment.)
1. Hold Harmless Transitional Payment Changes Made by Pub. L. 109-171 
(DRA)
    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 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 (SCHs) 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, expired for rural 
hospitals having 100 or fewer beds and SCHs located in rural areas on 
December 31, 2005.
    Section 5105 of Pub. L. 109-171 reinstituted the hold harmless 
transitional outpatient payments (TOPs) for covered OPD services 
furnished on or after January 1, 2006, and before January 1, 2009, for 
rural hospitals having 100 or fewer beds that are not SCHs. When the 
OPPS payment is less than the payment the provider would have received 
under the previous reasonable cost-based system, the amount of payment 
is increased by 95 percent of the amount of the difference between 
those two payment systems for CY 2006, by 90 percent of the amount of 
that difference for CY 2007, and by 85 percent of the amount of that 
difference for CY 2008.
    For CY 2006, we have implemented section 5106 of Pub. L. 109-171 
through Transmittal 877, issued on February 24, 2006. We did not 
specifically address whether TOPs payments apply to EACHs, which are 
considered to be SCHs under section 1886(d)(5)(D)(iii)(III) of the Act. 
Accordingly, under the statute, EACHs are treated as SCHs. Therefore, 
we believe that EACHs are not eligible for TOPs payment under Pub. L. 
109-171. We are proposing to update Sec.  419.70(d)

[[Page 49546]]

to reflect the requirements of Pub. L. 109-171.
2. Proposed Adjustment for Rural SCHs Implemented in CY 2006 Related to 
Pub. L. 108-173 (MMA)
    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Rural SCH Payments'' at the beginning of your 
comment.)
    In the CY 2006 OPPS final rule with comment period (70 FR 68556), 
we finalized a payment increase for rural SCHs of 7.1 percent for all 
services and procedures paid under the OPPS, excluding drugs, 
biologicals, brachytherapy seeds, and services paid under pass-through 
payment policy in accordance with section 1833(t)(13)(B) of the Act, as 
added by section 411 of Pub. L. 108-173. Section 411 gave the Secretary 
the authority to make an adjustment to OPPS payments for rural 
hospitals effective January 1, 2006 if justified by a study of the 
difference in costs by APC between hospitals in rural and urban areas. 
Our analysis showed a difference in costs only for rural SCHs and we 
implemented a payment adjustment for those hospitals beginning January 
1, 2006.
    We recently became aware that we did not specifically address 
whether the adjustment applies to EACHs, which are considered to be 
SCHs pursuant to section 1886(d)(5)(D)(iii)(III) of the Act. Thus, 
under the statute, EACHs are treated as SCHs. Currently, fewer than 10 
hospitals are classified as EACHs. As of CY 1998, under section 4201(c) 
of Pub. L. 105-33, a hospital can no longer become newly classified as 
an EACH. Therefore, for purposes of receiving this rural adjustment, we 
are clarifying that EACHs are treated as SCHs for purposes of receiving 
this adjustment, assuming these entities otherwise meet the rural 
adjustment criteria.
    This adjustment is budget neutral and applied before calculating 
outliers and coinsurance. We also stated that we would not reestablish 
the adjustment amount on an annual basis, but that we might review the 
adjustment in the future and, if appropriate, would revise the 
adjustment. For CY 2007, we are proposing to continue our current 
policy of a budget neutral 7.1 percent payment increase for rural SCHs 
for specified services.

G. Proposed CY 2007 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 2006, 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 $1,250 
fixed-dollar threshold. We introduced a fixed-dollar threshold in CY 
2005 in addition to the traditional multiple threshold in order to 
better target outliers to those high cost and complex procedures where 
a very costly service 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 a 
discussion on CMHC outliers, see section II.B.3. of the preamble to 
this proposed rule.
    As explained in our CY 2006 OPPS final rule with comment period (70 
FR 68561), we set our projected target for aggregate outlier payments 
at 1.0 percent of aggregate total payments under the OPPS. Our outlier 
thresholds were set so that estimated CY 2006 aggregate outlier 
payments would equal 1.0 percent of aggregate total payments under the 
OPPS. In our CY 2006 OPPS final rule with comment period (70 FR 68563), 
we also published total outlier payments as a percent of total 
expenditures for past years. At this time, we do not have a complete 
set of CY 2005 claims in order to produce this number for CY 2005. We 
will report on CY 2005 outlier payments in our CY 2007 OPPS final rule.
    For CY 2007, we are proposing to continue our policy of setting 
aside 1.0 percent of aggregate total payments under the OPPS for 
outlier payments. A portion of that 1.0, an amount equal to 0.25 
percent of outlier payments and 0.0025 percent of total OPPS payments 
would be allocated to CMHCs for partial hospitalization program service 
outliers.
    In order to ensure that estimated CY 2007 aggregate outlier 
payments would equal 1.0 percent of estimated aggregate total payments 
under the OPPS, we are proposing that the outlier threshold be set 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 $1,825 fixed-dollar 
threshold.
    We calculated the fixed-dollar threshold for this proposed rule 
using the same methodology as we did in CY 2006 except we used the 
revised overall CCR calculation discussed in section II.A.1.c. of this 
preamble. As discussed in section II.A.1.c. of this preamble, we 
discovered that the calculation of the overall CCR that the fiscal 
intermediaries are using to determine outlier payment and payment for 
services paid at charges reduced to cost differs from the overall CCR 
that we traditionally use to model the outlier thresholds. We 
discovered this during our calculations of the outlier threshold for 
our CY 2006 final rule with comment period, and we indicated in our 
preamble discussion for that rule, that we may revisit the threshold 
estimate in light of identified differences in the overall CCR 
calculation. Because, on average, the overall CCR calculation used by 
the fiscal intermediaries results in higher CCRs than those estimated 
using our ``traditional'' CCR sets, the outlier threshold is too low. 
The OPPS impact table in section XXVII. of this preamble demonstrates 
an estimated payment differential of 0.25 percent of total spending for 
hospital outlier payments in CY 2006 because of the differences in 
overall CCR calculations. The revised overall CCR calculation that we 
are proposing for CY 2007 aligns the two CCR calculations by removing 
allied and nursing health costs for those hospitals with paramedical 
education programs from the fiscal intermediary's CCR calculation and 
weighting our ``traditional'' calculation by total Medicare Part B 
charges. We expected this proposed change in the overall CCR 
calculation to raise the outlier threshold.
    The claims that we use to model each OPPS lag by 2 years. For this 
proposed rule, we used CY 2005 claims to model the CY 2007 OPPS. In 
order to estimate CY 2007 outlier payments for this proposed rule, we 
inflated the charges on the CY 2005 claims using the same inflation 
factor of 1.1515 that we used to estimate the IPPS fixed-dollar outlier 
threshold for the IPPS FY 2007 proposed rule. For 1 year, the inflation 
factor is 1.0757. The methodology for determining this charge inflation 
factor was discussed in the FY 2007 IPPS proposed rule (71 FR 24150). 
As we stated in our CY 2005 final rule with comment period, we believe 
that the use of this charge inflation factor is appropriate for OPPS 
because, with the exception of the routine service cost centers, 
hospitals use the same cost centers to capture costs and charges across 
inpatient and outpatient services (69 FR 65845, November 15, 2004). As 
also noted in the FY 2006 IPPS final rule, we believe that a charge 
inflation factor is more appropriate than an adjustment to costs 
because this methodology closely captures how

[[Page 49547]]

actual outlier payments are made and calculated (70 FR 47495, August 
12, 2005). We then applied the revised overall CCR that we calculated 
from each hospital's most recent cost report (CMS-2552-96) and, if the 
cost report was not settled, we adjusted it by a settled-to-submitted 
ratio. We simulated aggregated outlier payments using these costs for 
several different fixed-dollar thresholds holding the 1.75 multiple 
constant until the total outlier payments equaled 1.0 percent of 
aggregated total OPPS payments. We estimate that a threshold of $1,825 
combined with the multiple threshold of 1.75 times the APC payment rate 
would allocate 1.0 percent of aggregated total OPPS payments to outlier 
payments.
    For CMHCs, in CY 2007 we project the outlier threshold is met when 
the cost of furnishing a service or procedure by a CMHC exceeds 3.40 
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 3.40 times the APC payment rate. We are proposing to 
continue the same threshold policy for CY 2007 as we have established 
for CY 2006. An explanation for this proposed policy is discussed in 
section II.B.3. the preamble of this proposed rule.
    The following is an example of an outlier calculation for CY 2007 
under our proposed policy. A hospital charges $20,000 for a procedure. 
The wage adjusted, and rural adjusted, if applicable, APC payment for 
the procedure is $3,500. Using the provider's CCR of 0.35, the 
estimated cost to the hospital is $7,000 (0.35 x $20,000). 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 ($1,825 + APC payment). In this example, the 
provider meets both criteria:
    (1) $7,000 exceeds $6,125 (1.75 x $3,500)
    (2) $7,000 exceeds $5,325 ($3,500 + $1,825)
    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 $6,125 (1.75 x $3,500) from $7,000 (resulting in $825). 
The provider is eligible for 50 percent of the difference, in this case 
$437.50 ($825/2). The formula is (cost - (1.75 x APC payment rate))/2.

H. Calculation of the Proposed OPPS National Unadjusted Medicare 
Payment

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: National Unadjusted Medicare Payment'' 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 
HCPCS codes to which payment under the OPPS has been assigned in 
Addendum B to this proposed rule (Addendum B is provided as a 
convenience for readers) was calculated by multiplying the proposed CY 
2007 scaled weight for the APC by the proposed CY 2007 conversion 
factor.
    However, to determine the payment that will 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 the 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 are assigned for FY 2007 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. The 
wage index values include the occupational mix adjustment described in 
section II.D. of this proposed rule that was developed for the proposed 
FY 2007 IPPS payment rates. We note that the original proposal for 
calculating the FY 2007 IPPS wage index has been recently changed. 
(Refer to the May 17, 2006 FY 2007 IPPS proposed rule, 71 FR 28644).) 
Final FY 2007 IPPS wage indices will be adjusted 100 percent for 
differences in occupational mix. Although we have not incorporated 
those changes in this proposed rule due to the availability of new 
survey data, as is our practice, we propose to adopt changes made to 
the FY 2007 IPPS wage index values after they have been finalized.
    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 L contains the qualifying counties and the proposed 
wage index increase developed for the FY 2007 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 SCH, 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 Sec.  412.103 of the Act, 
multiply the wage index adjusted payment rate by 1.071 to calculate the 
total payment.

I. Proposed Beneficiary Copayments for CY 2007

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Beneficiary Copayments'' 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

[[Page 49548]]

(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 2007, and in calendar years thereafter, the specified 
percentage is 40 percent of the APC payment rate (section 
1833(t)(8)(C)(ii)(V) of the Act). 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 2007
    For CY 2007, we are proposing to determine copayment amounts for 
new and revised APCs using the same methodology that we implemented for 
CY 2004 (Refer to 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, 
2007, are shown in Addendum A and Addendum B of this proposed rule.
3. Calculation of a Proposed Adjusted Copayment Amount for an APC Group 
for CY 2007
    To calculate the OPPS adjusted 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, $7.00 is 23 percent of $30.14.
    Step 2. Calculate the wage adjusted payment rate for the APC, for 
the provider in question, as indicated in section II.H. of this 
preamble. Calculate the rural adjustment for eligible providers as 
indicated in section II.H. of this preamble.
    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 OPPS Ambulatory Payment Classification (APC) Group 
Policies

A. Proposed Treatment of New HCPCS and CPT Codes

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: New HCPCS and CPT Codes'' at the beginning of your 
comment.)
1. Proposed Treatment of New HCPCS Codes Included in the Second and 
Third Quarterly OPPS Updates for CY 2006
    During the second and third quarters of CY 2006, we created a total 
of four new Level II HCPCS codes that were not addressed in the 
November 10, 2005 final rule with comment period that updated the CY 
2006 OPPS. We have designated the payment status of those codes and 
added them either through the April update (Transmittal 896, dated 
March 24, 2006) or the July update of the CY 2006 OPPS (Transmittal 
970, dated May 30, 2006). In this proposed rule, we are soliciting 
public comments on the status indicators and APC assignments of these 
services, which are listed in Table 5. Because of the timing of this 
proposed rule, those codes implemented through the July 2006 OPPS 
update are not included in Addendum B of this proposed rule, while 
those codes based upon the April 2006 OPPS update are included in 
Addendum B. We intend to finalize the assignments for all of these 
services in the OPPS CY 2007 final rule.

                           Table 5.--New HCPCS Codes Implemented in April or July 2006
----------------------------------------------------------------------------------------------------------------
                                                          Assigned status
          HCPCS code                  Description            indicator       Assigned APC    Implementation date
----------------------------------------------------------------------------------------------------------------
C9227.........................  Injection, micafungin   G                             9227  April 1, 2006.
                                 sodium, per 1 mg.
C9228.........................  Injection,              G                             9228  April 1, 2006.
                                 tigecycline, per 1 mg.
C9229.........................  Injection ibandronate   G                             9229  July 1, 2006.
                                 sodium.
C9230.........................  Injection, abatacept..  G                             9230  July 1, 2006.
----------------------------------------------------------------------------------------------------------------

2. Proposed Treatment of New CY 2007 Category I and III CPT Codes and 
Level II HCPCS Codes
    As has been our practice in the past, we implement new Category I 
and III CPT codes and new Level II HCPCS codes, which are released in 
the fall of each year for annual updating, effective January 1 in the 
final rule updating the OPPS for the following calendar year. These 
codes are flagged with Comment Indicator ``NI'' in Addendum B of the 
OPPS final rule to indicate that we are assigning them an interim 
payment status which is subject to public comment following publication 
of the final rule that implements the annual OPPS update. (See the 
discussion immediately below concerning our modified policy for 
implementing new Category I and III mid-year CPT codes.) We are 
proposing to continue this recognition and process for CY 2007. New 
Category I and III CPT codes and new Level II HCPCS codes, effective 
January 1, 2007, will be designated in Addendum B of the CY 2007 OPPS 
final rule with Comment Indicator ``NI.'' The status indicator, the APC 
assignment, or both for all such codes flagged with Comment Indicator 
``NI,'' will be open to public comment. We will respond to all comments 
received in a subsequent final rule.
3. Proposed Treatment of New Mid-Year CPT Codes
    Twice each year, the AMA issues Category III CPT codes, which the 
AMA defines as temporary codes for emerging technology, services, and 
procedures. (In addition, AMA issues mid-year Category I CPT codes for 
vaccines for which FDA approval is imminent, to ensure timely 
availability of a code.) The AMA establishes these codes to allow 
collection of data specific to the service described by the code, as 
these services could otherwise only be reported using a Category I CPT 
unlisted code. The AMA releases Category III CPT codes in January, for 
implementation beginning the following July, and in July, for 
implementation beginning the following January. Prior to CY 2006, we 
treated new Category III CPT codes implemented in July of the previous 
year or January of the OPPS update year in the same manner that new 
Category I CPT codes and new Level II HCPCS codes implemented in 
January of the OPPS update year are treated; that is, we provided APC 
and status indicator assignments or both in the final rule updating the 
OPPS for the following calendar year. New Category I and Category III 
CPT codes, as well as new Level II HCPCS codes, were flagged with 
Comment Indicator ``NI'' in Addendum B of the final rule to indicate 
that we were assigning them an

[[Page 49549]]

interim payment status which was subject to public comment following 
publication of the final rule that implemented the annual OPPS update.
    As stated in the CY 2006 OPPS final rule with comment period (70 FR 
68567), we modified our process for implementing the Category III codes 
that the AMA releases each January for implementation in July to ensure 
timely collection of data pertinent to the services described by the 
codes; to ensure patient access to the services the codes describe; and 
to eliminate potential redundancy between Category III CPT codes and 
some of the C-codes, which are payable under the OPPS and created by us 
in response to applications for new technology services. Therefore, 
beginning on July 1, 2006, we implemented in the OPPS seven Category 
III CPT codes that the AMA released in January 2006 for implementation 
in July 2006. The codes are shown in Table 6. These codes are not 
included in Addendum B of this proposed rule, which is based upon the 
April 2006 OPPS update. In this proposed rule, we are soliciting public 
comments on the status indicators and, if applicable, the APC 
assignments of these services. We intend to finalize the assignments of 
these Category III CPT codes implemented in July 2006 in the CY 2007 
OPPS final rule.

                            Table 6.--Category III CPT Codes Implemented in July 2006
----------------------------------------------------------------------------------------------------------------
              HCPCS code                       Long descriptor              Status indicator            APC
----------------------------------------------------------------------------------------------------------------
0155T.................................  Laparoscopy, surgical,         T                                    0130
                                         implantation or replacement
                                         of gastric stimulation
                                         electrodes, lesser curvature
                                         (i.e., morbid obesity).
0156T.................................  Laparoscopy, surgical,         T                                    0130
                                         revision or removal of
                                         gastric stimulation
                                         electrodes, lesser curvature
                                         (i.e., morbid obesity).
0157T.................................  Laparotomy, implantation or    C                          ..............
                                         replacement of gastric
                                         stimulation electrodes,
                                         lesser curvature (i.e.,
                                         morbid obesity).
0158T.................................  Laparotomy, revision or        C                          ..............
                                         removal of gastric
                                         stimulation electrodes,
                                         lesser curvature (i.e.,
                                         morbid obesity).
0159T.................................  Computer aided detection,      N                          ..............
                                         including computer algorithm
                                         analysis of MRI image data
                                         for lesion detection/
                                         characterization,
                                         pharmacokinetic analysis,
                                         with further physician
                                         review for interpretation,
                                         breast MRI.
0160T.................................  Therapeutic repetitive         X                                    0340
                                         transcranial magnetic
                                         stimulation treatment
                                         planning.
0161T.................................  Therapeutic repetitive         X                                    0340
                                         transcranial magnetic
                                         stimulation treatment
                                         delivery and management, per
                                         session.
----------------------------------------------------------------------------------------------------------------

    Some of the new Category III CPT codes describe services that we 
have determined to be similar in clinical characteristics and resource 
use to HCPCS codes in an existing APC. In these instances, we may 
assign the Category III CPT code to the appropriate clinical APC. Other 
Category III CPT codes describe services that we have determined are 
not compatible with an existing clinical APC, yet are appropriately 
provided in the hospital outpatient setting. In these cases, we may 
assign the Category III CPT code to what we estimate is an 
appropriately priced New Technology APC. In other cases, we may assign 
a Category III CPT code one of several nonseparately payable status 
indicators, including N, C, B, or E, which we believe is appropriate 
for the specific code. We expect that we will have received 
applications for new technology status for some of the services 
described by new Category III CPT codes, which may assist us in 
determining appropriate APC assignments. If the AMA establishes a 
Category III CPT code for a service for which an application has been 
submitted to CMS for new technology status, CMS may not have to issue a 
temporary Level II HCPCS code to describe the service, as has often 
been the case in the past when Category III CPT codes were only 
recognized by the OPPS on an annual basis.
    Therefore, for CY 2007, we are proposing to include in Addendum B 
of the OPPS CY 2007 final rule the new Category III CPT codes and the 
new Category I CPT codes for vaccines released in January 2006 for 
implementation on July 1, 2006 (through the OPPS quarterly update 
process) and the Category III and vaccine Category I CPT codes released 
in July 2006 for implementation on January 1, 2007. However, only those 
new Category III codes and the new vaccine codes implemented effective 
January 1, 2007, will be flagged with Comment Indicator ``NI'' in 
Addendum B of the CY 2007 final rule to indicate that we are assigning 
them an interim payment status which is subject to public comment. As 
discussed earlier, Category III codes and Category I vaccine codes 
implemented in July 2006, which are listed in Table 6, are subject to 
comment through this proposed rule and their status will be made final 
in the CY 2007 OPPS final rule.

B. Proposed Changes--Variations Within APCs

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: 2 Times Rule'' at the beginning of your comment.)
1. 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) of the Act 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, as well as medical visits. We also have developed separate 
APC groups for certain medical devices, drugs, biologicals, 
radiopharmaceuticals, and brachytherapy devices.
    We have packaged into each procedure or service within an APC group 
the costs associated with those items or services that are directly 
related and integral to performing a procedure

[[Page 49550]]

or furnishing a service. Therefore, we do not make separate payment for 
packaged items or services. For example, packaged items and services 
include: (1) Use of an operating, treatment, or procedure room; (2) use 
of a recovery room; (3) most observation services; (4) anesthesia; (5) 
medical/surgical supplies; (6) pharmaceuticals (other than those for 
which separate payment may be allowed under the provisions discussed in 
section V of this preamble); and (7) 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 hospital median 
cost of the services included in that APC relative to the hospital 
median cost of the services included in APC 0606. The APC weights are 
scaled to APC 0606 because we are proposing it to be the middle level 
clinic visit APC (that is, where the Level III Clinic Visit HCPCS code 
of five proposed levels of clinic visits is assigned), and because 
middle level clinic visits are among the most frequently furnished 
services in the outpatient hospital setting. See section II.A.3. of 
this preamble for a complete discussion of the reasons for choosing APC 
0606 as the basis for scaling the APC relative weights.
    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 specific services for CY 2007 OPPS and our 
responses to them are discussed in section III.D. 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.
2. 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.
    During the APC Panel's March 1-2, 2006 meeting, we presented median 
cost and utilization data for services furnished during the period of 
January 1, 2005, through September 30, 2005, about which we had 
concerns or about which the public had raised concerns regarding their 
APC assignments, status indicator assignments, or payment rates. The 
discussions of service-specific issues, the APC Panel recommendations 
if any, and our proposals for CY 2007 are contained in section III.D. 
of this preamble.
    In addition to the assignment of specific services to APCs which we 
discussed with the APC Panel, we also identified APCs with 2 times 
violations that were not specifically discussed with the APC Panel but 
for which we are proposing changes to their HCPCS codes' APC 
assignments in Addendum B of this proposed rule. In these cases, to 
eliminate a 2 times violation, we reassigned the codes to APCs that 
contained services that were similar with regard to both resource use 
and clinical homogeneity. We also are proposing changes to the status 
indicators for some codes that are not specifically and separately 
discussed in this proposed rule. In these cases, we changed the status 
indicators for some codes because we thought that another status 
indicator more accurately describes their payment status from an OPPS 
perspective based on our CY 2007 proposed policies.
    Addendum B of this proposed rule identifies with a comment 
indicator ``CH'' those HCPCS codes for which we are proposing a change 
to the APC assignment or status indicator as assigned in the January 
2006 Addendum B. These proposed reassignments of APC or status 
indicator are subject to public comment under this proposed rule.
3. 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 2007 based on the APC Panel 
recommendations discussed in section III.D. of this preamble, the 
proposed changes to status indicators and APC assignments as identified 
in Addendum B, and the use of CY 2005 claims data to calculate the 
median costs of procedures classified in the APCs, we reviewed all the 
APCs to determine which APCs would not satisfy the 2 times rule. 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 7 lists the APCs that we are proposing to exempt from the 2 
times rule based on the criteria cited above. For cases in which a 
recommendation by 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 those 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 2007. The median costs for 
hospital outpatient services for these and all other APCs which were 
used in development of this proposed rule can be found on the CMS Web 
site: http://www.cms.hhs.gov.

[[Page 49551]]



    Table 7.--Proposed APC Exceptions to the 2 Times Rule for CY 2007
------------------------------------------------------------------------
                APC                            APC description
------------------------------------------------------------------------
0007..............................  Level II Incision & Drainage.
0010..............................  Level I Destruction of Lesion.
0019..............................  Level I Excision/Biopsy.
0024..............................  Level I Skin Repair.
0031..............................  Smoking Cessation Services.
0040..............................  Percutaneous Implantation of
                                     Neurostimulator Electrodes,
                                     Excluding Cranial Nerve.
0043..............................  Closed Treatment Fracture Finger/Toe/
                                     Trunk.
0058..............................  Level I Strapping and Cast
                                     Application.
0060..............................  Manipulation Therapy.
0081..............................  Non-Coronary Angioplasty or
                                     Atherectomy.
0085..............................  Level II Electrophysiologic
                                     Evaluation.
0093..............................  Vascular Reconstruction/Fistula
                                     Repair without Device.
0105..............................  Revision/Removal of Pacemakers,
                                     AICD, or Vascular.
0111..............................  Blood Product Exchange.
0112..............................  Apheresis, Photopheresis, and
                                     Plasmapheresis.
0204..............................  Level I Nerve Injections.
0235..............................  Level I Posterior Segment Eye
                                     Procedures.
0245..............................  Level I Cataract Procedures without
                                     IOL Insert.
0251..............................  Level I ENT Procedures.
0252..............................  Level II ENT Procedures.
0274..............................  Myelography.
0303..............................  Treatment Device Construction.
0307..............................  Myocardial Positron Emission
                                     Tomography (PET) Imaging.
0312..............................  Radioelement Applications.
0323..............................  Extended Individual Psychotherapy.
0330..............................  Dental Procedures.
0409..............................  Red Blood Cell Tests.
0418..............................  Insertion of Left Ventricular Pacing
                                     Elect.
0432..............................  Health and Behavior Services.
0437..............................  Level II Drug Administration.
0604..............................  Level I Clinic Visits.
0664..............................  Level I Proton Beam Radiation
                                     Therapy.
------------------------------------------------------------------------

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. Introduction
    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. We note that the cost bands for new technology APCs range 
from $0 to $50 in increments of $10, from $50 to $100 in an increment 
of $50, from $100 through $2,000 in intervals of $100, and from $2,000 
through $6,000 in intervals of $500. These intervals, which are in two 
parallel sets of New Technology APCs, one with status indicator ``S'' 
and the other with status indicator ``T,'' allow us to price new 
technology services more appropriately and consistently.
    Every year we receive many requests for higher payment amounts for 
specific procedures under the OPPS because they require the use of 
expensive equipment. We are taking this opportunity to reiterate our 
response in general to the issue of hospitals' capital expenditures as 
they relate to the OPPS and Medicare.
    Under the OPPS, one of our goals is to make payments that are 
appropriate for the services that are necessary for treatment of 
Medicare beneficiaries. The OPPS like other Medicare payment systems is 
budget neutral and so, although we do not pay full hospital costs for 
procedures, we believe that our payment rates generally reflect the 
costs that are associated with providing care to Medicare beneficiaries 
in cost-efficient settings. Further, we believe that our rates are 
adequate to assure access to services for most beneficiaries.
    For many emerging technologies there is a transitional period 
during which utilization may be low, often because providers are first 
learning about the techniques and their clinical utility. Quite often, 
the requests for higher payment amounts are for new procedures in that 
transitional phase. These requests, and their accompanying estimates 
for expected Medicare beneficiary or total patient utilization, often 
reflect very low rates of patient use, resulting in high per use costs 
for which requesters believe Medicare should make full payment. 
Medicare does not, and we believe should not, assume responsibility for 
more than its share of the costs of procedures based on Medicare 
beneficiary projected utilization and does not set its payment rates 
based on initial projections of low utilization for services that 
require expensive capital equipment. For the OPPS, we rely on hospitals 
to make their business decisions regarding acquisition of high cost 
capital equipment taking into consideration their knowledge about their 
entire patient base (Medicare beneficiaries included) and an 
understanding of Medicare's and other payers' payment policies.
    We note that in a budget neutral environment, payments may not 
fully cover hospitals' costs, including those for the purchase and 
maintenance of capital equipment. We rely on providers to make their 
decisions regarding the acquisition of high cost equipment with the 
understanding that the Medicare

[[Page 49552]]

program must be careful to establish its initial payment rates for new 
services that lack hospital claims data based on realistic utilization 
projections for all such services delivered in cost-efficient hospital 
outpatient settings. As the OPPS acquires claims data regarding 
hospital costs associated with new procedures, we will regularly 
examine the claims data and any available new information regarding the 
clinical aspects of new procedures to confirm that our OPPS payments 
remain appropriate for procedures as they transition into mainstream 
medical practice.
2. Proposed Movement of Procedures From New Technology APCs to Clinical 
APCs
    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.
    The procedures presented below represent services assigned to New 
Technology APCs for CY 2006 for which we believe we have sufficient 
data to reassign them to clinically appropriate APCs for CY 2007. 
Therefore, we are proposing to reassign them to clinically appropriate 
APCs as indicated specifically in our discussion and in Table 10.
a. Nonmyocardial Positron Emission Tomography (PET) Scans
    Positron emission tomography (PET) is a noninvasive diagnostic 
imaging procedure that assesses the level of metabolic activity and 
perfusion in various organ systems of the human body. PET serves an 
important role in the clinical care of many Medicare beneficiaries. We 
recognize that PET is a useful technology in many instances and want to 
ensure that the technology remains available to Medicare beneficiaries 
when medically necessary. Since August 2000, nonmyocardial PET 
procedures have been assigned to a New Technology APC in the OPPS. As a 
result of our collection of 5 full years worth of hospital claims data, 
we believe that we have sufficient data to assign nonmyocardial PET 
scans to a clinically appropriate APC for CY 2007. Note that we assign 
a service to a New Technology APC only when we do not have adequate 
claims data upon which to determine the median cost of performing the 
procedure, and we expect that the service's clinical or resource 
characteristics will differ from all other procedures already assigned 
to clinical APCs. Each New Technology APC represents a particular cost 
band (for example, $1,400-1,500), and we assign procedures to these 
APCs based on our analysis of the procedures' costs. Payment for items 
assigned to a New Technology APC is the midpoint of the band (for 
example, $1,450). We move a service from a New Technology APC to a 
clinical APC when we have adequate claims data upon which to base its 
future payment rate. In the case of nonmyocardial PET services, we 
believe that we now have sufficient data to assign them to a clinically 
appropriate APC.
    We last proposed changes in payments for nonmyocardial PET 
procedures for CY 2005. At that time, while we had large numbers of 
single claims reflecting that the median cost of PET procedures was 
substantially lower than their CY 2004 payment rate of $1,450, we had 
some concerns that abruptly lowering the payment rate for nonmyocardial 
PET scans could hinder access to this technology. Therefore, we 
proposed three options to develop the CY 2005 payment rate for these 
procedures in the August 16, 2004 proposed rule (69 FR 50468). 
Specifically, we proposed the following options and invited comments on 
each of the options.
     Option 1: Continue in CY 2005 the CY 2004 assignment of 
the scans to New Technology APC 1516 prior to assigning to a clinical 
APC.
     Option 2: Assign the PET scans to a clinically appropriate 
APC priced according to the median cost of the scans based on CY 2003 
claims data. Under this option, we would assign PET scans to APC 0420, 
PET imaging.
     Option 3: Transition assignment to a clinical APC in CY 
2006 by setting payment in CY 2005 based on a 50/50 blend of the median 
cost of PET scans and their CY 2004 New Technology payment rate. We 
would assign the scans to New Technology APC 1513 for a blended 
transition payment.
    Based on comments received, we decided to set the CY 2005 payment 
rate for nonmyocardial PET scans based on option 3 at $1,150. We 
further stated in the November 15, 2004 final rule with comment period 
(69 FR 65716) that we believed there were sufficient claims data to 
assign nonmyocardial PET scans to a single clinical APC. However, to 
minimize any potential impact that a payment reduction resulting from 
this move might have had on beneficiary access to this technology, we 
set the CY 2005 OPPS payment rate for nonmyocardial PET scans based on 
a 50/50 blend of their median cost based on CY 2003 claims data and the 
payment rate of the CY 2004 New Technology APC to which they were 
assigned. Therefore, nonmyocardial PET scans were assigned to New 
Technology APC 1513 (New Technology--Level XIV ($1,000-$1,200) for a 
blended payment rate of $1,150 in CY 2005. In CY 2005, in the context 
of an expansion in Medicare coverage for PET procedures, we also 
simplified coding for PET services by instructing hospitals to bill 
several more general CPT codes in place of numerous disease-specific G-
codes. We continued with these coding and payment methodologies in CY 
2006.
    For CY 2007, we are proposing the assignment of nonmyocardial PET 
procedures to a clinically appropriate APC as we have several years of 
robust and stable claims data upon which to determine the median cost 
of performing these procedures. Based on analysis of our claims data, 
the median costs for nonmyocardial PET scans have ranged between 
approximately $852 and $924 for claims submitted from CY 2002 through 
CY 2005, yet our payment rates have been significantly higher than the 
median costs throughout this same time period. We have observed 
significant growth in the number of nonmyocardial PET scans performed 
on Medicare beneficiaries, from about 48,000 in CY 2002, to 68,000 in 
CY 2003, and once again to 121,000 in CY 2004, the year when we first 
reduced the OPPS nonmyocardial PET scan payment rates from $1,450 to 
$1,150. For the CY 2007 proposed rule, we have about 45,000 single PET 
claims from CY 2005, yielding a stable median cost for PET procedures 
of about $867. Although the CY 2005 claims data are not yet complete, 
the apparent decline in numbers of claims for nonmyocardial PET scans 
alone in the CY 2005 claims data is likely related to the large number 
of claims for PET/CT scans now observed in CY 2005, when codes for that 
combined service were first available for billing. In fact, the total 
number of PET scans provided to Medicare beneficiaries in CY 2005, 
defined as PET scans and PET/CT scans, continued to climb to almost 
128,000 based upon the CY 2005 claims data available for this proposed 
rule, in

[[Page 49553]]

comparison to final claims for CY 2004 of approximately 121,000 for PET 
scans.
    Therefore, we are proposing to assign nonmyocardial PET scans, in 
particular, CPT codes 78608, 78811, 78812, and 78813, to new APC 0308 
(Nonmyocardial PET Imaging) with a median cost of $865.30 for CY 2007. 
We are confident, in the face of our stable median costs for 
nonmyocardial PET scans over the past 4 years, that their additional 2-
year period of receiving New Technology APC payments at the blended 
rate of $1,150 for CY 2005 and CY 2006 as we transitioned the services 
to a clinical APC should ensure continued availability of this 
technology now that its services will be paid through a clinical APC 
for CY 2007, like most other OPPS services.
b. PET/Computed Tomography (CT) Scans
    Since August 2000, we have paid separately for PET and CT scans. In 
CY 2004, the payment rate for nonmyocardial PET scans was $1,450, while 
it was $193 for typical diagnostic CT scans. Prior to CY 2005, 
nonmyocardial PET and the PET portion of PET/CT scans were described by 
G-codes for billing to Medicare. Several commenters to the November 15, 
2004 final rule with comment period (69 FR 65682) urged that we replace 
the G-codes for nonmyocardial PET and PET/CT scan procedures with the 
established CPT codes. These commenters stated that movement to the 
established CPT codes would greatly reduce the burden on hospitals of 
tracking and billing the G-codes which are not recognized by other 
payers and would allow for more uniform hospital billing of these 
scans. We agreed with the commenters that movement from the G-codes to 
the established CPT codes for nonmyocardial PET and PET/CT scans would 
allow for more uniform billing of these scans. As a result of a 
Medicare national coverage determination (Publication 100-3, Medicare 
Claims Processing Manual section 220.6) that was made effective January 
28, 2005, we discontinued numerous G-codes that described myocardial 
PET and nonmyocardial PET procedures and replaced them with the 
established CPT codes. The CY 2005 payment rate for concurrent PET/CT 
scans using the CPT codes 78814, 78815, and 78816 was $1,250, which was 
$100 higher than the payment rate for PET scans alone. These PET/CT CPT 
codes were placed in New Technology APC 1514 (New Technology--Level 
XIV, $1,200-$1,300) for CY 2005. We continued with these coding and 
payment methodologies in CY 2006.
    For CY 2007, we are proposing the assignment of concurrent PET/CT 
scans, specifically CPT codes 78814, 78815, and 78816, to a clinically 
appropriate APC because we believe we have adequate claims data from CY 
2005 upon which to determine the median cost of performing these 
procedures. Based on our analysis of CY 2005 single claims, the median 
cost of PET/CT scans is $865 from over almost 64,000 single claims. 
Comparison of the median cost of nonmyocardial PET procedures of $867 
with the median cost of concurrent PET/CT scans demonstrates that the 
median costs of PET scans with or without concurrent CT scans for 
attenuation correction and anatomical localization are about the same. 
This result is not unexpected because many newer PET scanners also have 
the capability of rapidly acquiring CT images for attenuation 
correction and anatomical localization, sometimes with simultaneous 
image acquisition.
    To explore the possibility that the similarity in median costs for 
PET and PET/CT procedures could be related to different groups of 
hospitals billing the two types of PET services based on their 
available equipment, rather than the true comparability of hospital 
resources required for the two types of services, we analyzed claims 
from a subset of hospitals billing both PET and PET/CT scans in CY 
2005. This analysis looked at 362 providers who billed a PET HCPCS code 
and a PET/CT CPT code at least one time each during CY 2005. The median 
cost from this subset of claims for nonmyocardial PET scans was $890, 
in comparison with $863 for the PET/CT scans. Thus, we observed the 
same close relationship between median costs of PET and PET/CT 
procedures from hospitals billing both sets of services as we did for 
all OPPS CY 2005 claims available for this proposed rule for these 
scans. We believe that our claims data accurately reflect the 
comparable hospital resources required to provide PET and PET/CT 
procedures, and the scans have obvious clinical similarity as well. 
Therefore, for CY 2007 we are proposing to assign the CPT codes for 
PET/CT scans, along with the CPT codes for PET scans, to the same new 
APC 0308 (Nonmyocardial PET Imaging) with a median cost of $865.30.
    We note that we have been paying separately for fluorodeoxyglucose 
(FDG), the radiopharmaceutical described by HCPCS code A9552 (F18 fdg), 
that is commonly administered during nonmyocardial PET and PET/CT 
procedures. For CY 2007, we are proposing to continue paying separately 
for FDG, according to the methodology described in section V. (Proposed 
OPPS Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals) 
of the preamble of this proposed rule.
c. Stereotactic Radiosurgery (SRS) Treatment Delivery Services
    For the past several years, we have collected hospital costs 
associated with the planning and delivery of stereotactic radiosurgery 
services (hereafter referred to as SRS). As new technology emerged in 
the field of SRS, public commenters urged us to recognize cost 
differences associated with the various methods of SRS planning and 
delivery. Beginning in CY 2001, we established G-codes to capture any 
such cost variations associated with the various methods of planning 
and delivery of SRS. For CY 2004, based on comments received regarding 
the G-codes used for SRS, we made some modifications to the coding (68 
FR 63431 and 63432). First, we received comments regarding the 
descriptors for HCPCS codes G0173 and G0251, indicating that these 
codes did not distinguish image-guided robotic SRS systems from other 
forms of linear accelerator-based SRS systems to account for the cost 
variation in delivering these services. In response, for CY 2004 we 
created two new G-codes (G0339 and G0340) to describe complete and 
fractionated image-guided robotic linear accelerator-based SRS 
treatment. We placed HCPCS code G0339 in APC 1528 at a payment rate of 
$5,250, and HCPCS code G0340 in APC 1525 at a payment rate of $3,750. 
Second, we received comments on HCPCS code G0242 which requested that 
we modify the code descriptor to avoid confusion and misuse of the 
code, and also to appropriately describe treatment planning for both 
linear accelerator-based and Cobalt 60-based SRS treatments. In 
response, for CY 2004, we created HCPCS code G0338 to distinguish 
linear accelerator-based SRS treatment planning from Cobalt 60-based 
SRS treatment planning. We placed HCPCS code G0338 in APC 1516 at a 
payment rate of $1,450.
    In CY 2005, there were no changes to the coding or New Technology 
APC payment rates for the SRS planning or treatment delivery codes from 
CY 2004. We stated in the CY 2005 OPPS final rule with comment period 
(69 FR 65711) that any SRS code changes would be premature without cost 
data to support a code restructuring. Therefore, we maintained HCPCS 
codes G0173, G0242, G0243, G0251, G0338, G0339, and G0340 in their 
respective New Technology APCs for CY 2005. We further stated that 
until we had completed an analysis of claims for these procedure codes, 
we would

[[Page 49554]]

continue to maintain HCPCS codes G0173, G0242, G0243, G0251, G0338, 
G0339, and G0340 in their respective New Technology APCs for CY 2005 as 
we considered the adoption of CPT codes to describe all SRS procedures 
for CY 2006.
    At its February 2005 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. Given 
the APC Panel's thoughts about 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. Because we had no programmatic need to 
separately track SRS planning services, in the CY 2006 OPPS final rule 
with comment period (70 FR 68585) we discontinued HCPCS codes G0242 and 
G0338 for the reporting of charges for SRS planning and instructed 
hospitals to bill charges for SRS planning, regardless of the mode of 
treatment delivery, using all of the available CPT codes that most 
accurately reflect the services provided.
    Furthermore, the APC Panel recommended that we make no changes to 
the coding or APC placement of SRS treatment delivery HCPCS codes 
G0173, G0243, G0251, G0339, and G0340 for CY 2006. In addition, 
presenters to the APC Panel described ongoing deliberations among 
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 before making any significant changes to 
SRS delivery coding or payment rates. To date, we have received no 
report from participating professional societies as to the outcome of 
such deliberations.
    In response to comments for CY 2006 regarding the mature technology 
and stable median costs associated with Cobalt 60-based SRS treatment 
delivery described by G0243, we reassigned G0243 from a New Technology 
APC to new clinical APC 0127 (Stereotactic Radiosurgery) with a payment 
rate of $7,305 established based on the CY 2004 median cost of G0243. 
We made no changes for CY 2006 to the New Technology APC assignments of 
the other four SRS treatment codes, specifically, G0173, G0251, G0339, 
and G0340.
    Since we first established the full group of SRS treatment delivery 
codes in CY 2004, we now have 2 years of hospital claims data 
reflecting the costs of each of these services. Based on analysis of 
our claims data from CY 2004 and CY 2005, the median costs for linear 
accelerator-based SRS treatment delivery procedures as described by 
HCPCS codes G0173, G0251, G0339, and G0340 have been stable and 
generally lower than our New Technology APC payment rates in effect 
from CY 2004 through CY 2006. Specifically, the payment rate for HCPCS 
code G0173, a complete course of non-image guided, non-robotic linear 
accelerator-based SRS treatment, has been set at $5,250, yet our claims 
data indicate a median cost of $2,802 from CY 2004 claims and $3,665 
from CY 2005 claims, based upon hundreds of single claims from each 
year. For HCPCS code G0251, fractionated non-image guided, non-robotic 
linear accelerator-based SRS treatment, the corresponding median costs 
have been $1,028 and $1,386 based upon over 1,000 single claims from 
each year, and relatively consistent with the procedure's New 
Technology APC payment of $1,150. With respect to the complete course 
of therapy in one session or first fraction of image-guided, robotic 
linear accelerator-based SRS, described by HCPCS code G0339, its median 
costs have been $4,917 and $4,809 for CY 2004 and CY 2005 respectively, 
based upon over 500 single bills in each year, in comparison with the 
procedure's payment rate of $5,250 for those years. Lastly, the median 
costs of HCPCS code G0340, the second through fifth sessions of image-
guided, robotic linear accelerator-based SRS treatment, have been 
$2,502 for CY 2004 and $2,917 for CY 2005 as determined by over 1,000 
single bills during each year, significantly lower than its payment 
rate of $3,750. Unquestionably, the claims data from CY 2004 and CY 
2005 for linear accelerator-based SRS treatment delivery services 
reveal highly stable median costs from year to year based on 
significant claims volume.
    Based on the above findings, we believe that we have adequate 
claims data to assign the SRS treatment delivery procedures to 
clinically appropriate APCs, and we believe that such movement is 
appropriate. For CY 2007, we are proposing to create several new SRS 
clinical APCs of different levels to assign the HCPCS codes describing 
linear accelerator-based SRS treatment, G0173, G0251, G0339, and G0340, 
based on their clinical and hospital resource similarities and 
differences. In particular, we are proposing to assign HCPCS codes 
G0339 and G0173 to the same Level III SRS APC, because we believe these 
codes that describe the complete or first fraction of all types of 
linear accelerator-based SRS treatments have substantial hospital 
resource and clinical similarity, as observed in their median costs and 
recognized previously in their equivalent New Technology APC payments. 
The codes describing subsequent fractions of image-guided, robotic and 
non-image guided, non-robotic linear accelerator-based SRS treatments 
will each be assigned to their own clinical APCs, as they demonstrate 
significant differences in resource utilization as reflected in their 
median costs. Their previous assignments to different New Technology 
APCs anticipated these resource distinctions. We are proposing to 
continue our assignment of HCPCS code G0243 for Cobalt 60-based SRS 
treatment delivery to clinical APC 0127, renamed Level IV Stereotactic 
Radiosurgery. Our proposed reassignments of SRS services from New 
Technology APCs to clinical APCs are listed in Table 8 below.

                                   Table 8.--Proposed APC Reassignment for SRS Treatment Delivery Services for CY 2007
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                        CY 2006                                             Proposed CY
     HCPCS code           Short descriptor            CY 2006 SI         CY 2006 APC    payment       Proposed CY 2007 SI    Proposed CY     2007 APC
                                                                                          rate                                 2007 APC     median cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
G0173...............  Linear acc stereo        S                                1528    $5,250.00  S                                0067       $4,059.61
                       radsur com.
G0251...............  Linear acc based stereo  S                                1513     1,150.00  S                                0065        1,386.20
                       radio.
G0339...............  Robot lin-radsurg com,   S                                1528     5,250.00  S                                0067        4,059.61
                       first.
G0340...............  Robot lin-radsurg        S                                1525     3,750.00  S                                0066        2,916.68
                       fractx 2-5.
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 49555]]

 d. Magnetoencephalography (MEG) Services
    Magnetoencephalography (MEG) is a non-invasive diagnostic tool that 
assists surgeons presurgery by measuring and mapping brain activity. It 
may be used for epilepsy and brain tumor patients. Since CY 2002, the 
MEG procedures described by CPT codes 95965 (Meg, spontaneous), 95966 
(Meg, evoked, single), and 95967 (Meg, evoked, each additional) have 
been assigned to New Technology APCs. In the July 25, 2005 proposed 
rule (70 FR 42709), we proposed to reassign MEG procedures to clinical 
APC 0430 using CY 2004 claims data to establish median costs on which 
the CY 2006 payment rates would be based. This proposal involved the 
reassignment of the three MEG procedures, specifically CPT codes 95965, 
95966, and 95967, from three separate New Technology APCs into one new 
clinical APC with a status indicator of ``T.'' Commenters to this 
proposal believed that their assignment to clinical APC 0430 would be 
inappropriate because the proposed payment level of $674 was inadequate 
to cover the costs of the procedures, and because the procedures should 
not be assigned to only one level as their required hospital resources 
differ significantly. They further stated that our data did not 
represent the true costs of the procedures because MEG procedures are 
performed on very few Medicare patients.
    Analysis of our hospital data for claims submitted from CY 2002 
through CY 2005 indicates that these procedures are rarely performed on 
Medicare beneficiaries. For claims submitted from CY 2002 through CY 
2005, our single claims data show that there were annually only between 
2 and 23 claims submitted for CPT code 95965, 3 and 7 claims for CPT 
code 95966, and only 1 for CPT code 95967. Additionally, the hospital 
claims median costs for these codes have varied widely, perhaps due to 
our small volume of claims. The median cost for CPT code 95965 has 
ranged from $332 using CY 2002 claims to $3,166 based upon CY 2005 
claims. The median cost for CPT code 95966 has varied widely from CY 
2002 to CY 2005. For single claims submitted during CY 2002, the median 
cost was $1,949, while it was $507 for CY 2003, $1,435 for CY 2004, and 
$701 from 3 single claims for CY 2005. The median cost for CPT code 
95967 based upon 1 single claim from CY 2005 claims is $217. We have no 
hospital median cost data for CPT code 95967 prior to CY 2005.
    In the November 10, 2005 final rule with comment period (70 FR 
68579), we stated that we carefully considered our claims data, 
information provided by the commenters, and the APC Panel 
recommendation for CY 2006 that we retain the MEG procedures in New 
Technology APCs. As a result of this analysis, we determined that using 
a 50/50 blend of the code specific median costs from our most recent CY 
2004 hospital claims data and the CY 2005 New Technology APC code-
specific payments amounts as the basis for assignment of the procedures 
for CY 2006 would be an appropriate way to recognize both the current 
payment rates for the procedures, which were originally based on the 
theoretical costs to hospitals of providing MEG services, and the 
median costs based upon our hospital claims data regarding actual MEG 
services provided to Medicare beneficiaries by hospitals. Therefore, 
CPT codes 95965, 95966, and 95967 were assigned to different New 
Technology APCs for CY 2006 based on this blended methodology, with 
payment rates of $2,750, $1,250, and $850 respectively.
    At the March 2006 APC Panel meeting, the Panel recommended that CMS 
move CPT codes 95965 (MEG, spontaneous), 95966 (MEG, evoked, single), 
and 95967 (MEG, evoked, each additional) from their CY 2006 New 
Technology APCs which were assigned based on the blended methodology 
described above to clinical APC(s) for CY 2007. Following that meeting, 
interested parties have provided us with CY 2005 charge and cost 
information from six hospitals that provided MEG services. These 
external data show wide variation in hospitals' costs and charges for 
MEG procedures, with generally higher values for CPT code 95965 and 
lower values for CPT codes 95966 and 95967 but no consistent 
proportionate relationship among those costs and charges. In some 
cases, the charges and costs for CPT codes 95966 and 95967 are quite 
similar for the two related services, one of which describes MEG for a 
single modality of evoked magnetic fields and the other that describes 
MEG for each additional modality of evoked magnetic fields. The 
individual hospital cost and charge data for specific services 
demonstrate significant variations of up to six fold across the 
hospitals, with an apparent inverse relationship between the numbers of 
services provided and the costs of the procedures. This finding is not 
unexpected, given the dependence of MEG procedures on the use of 
expensive capital equipment. As we have previously stated, our OPPS 
payment rates generally reflect the costs that are associated with 
providing care to Medicare beneficiaries in cost-efficient settings. 
For emerging technologies, we establish payment rates for new services 
that lack hospital claims data based on realistic utilization 
projections for all such services delivered in cost-efficient hospital 
outpatient settings. Given that we now have 4 years of hospital claims 
data for MEG procedures, because MEG is no longer a new technology, we 
do not believe these external data from 6 hospitals that performed MEG 
services in CY 2005 provide a better estimate of the hospital resources 
used in MEG procedures during the care of Medicare beneficiaries than 
our standard OPPS historical claims methodology.
    We agree with the APC Panel and are proposing to accept their 
recommendation to move the MEG CPT codes into clinical APCs for CY 
2007. While the volumes for the MEG procedures are low, almost all 
procedures, including those with very low Medicare volume, are assigned 
to clinical APCs under the OPPS, with their payment rates based on the 
median costs of their assigned APCs. Therefore, we are proposing to 
assign CPT code 95965 to new clinical APC 0038 (Spontaneous MEG) with a 
proposed median cost of $3,166.30 and to assign both CPT codes 95966 
and 95967 to APC 0209 (Level II MEG, Extended EEG Studies, and Sleep 
Studies) with a proposed median cost of $709.36. We believe that the 
assignment of CPT codes 95966 and 95967 to APC 0209 is appropriate 
because MEG studies are similar to EEGs and sleep studies in measuring 
activity of the brain over a significant time period, and our hospital 
claims data show that their hospital resources are also relatively 
comparable. MEG procedures and their CY 2007 proposed APC assignments 
are displayed in Table 9.

[[Page 49556]]



                                                    Table 9.--Proposed CY 2007 APC Assignment for MEG
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                        CY 2006                                             Proposed CY
     HCPCS Code           Short descriptor            CY 2006 SI         CY 2006 APC    payment       Proposed CY 2007 SI    Proposed CY     2007 APC
                                                                                          rate                                 2007 APC     median cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
95965...............  Meg, spontaneous.......  S.......................         1523    $2,750.00  S.......................         0038       $3,166.30
95966...............  Meg, evoked, single....  S.......................         1514     1,250.00  S.......................         0209          709.36
95967...............  Meg, evoked, each        S.......................         1510       850.00  S.......................         0209          709.36
                       additional.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    As these procedures are performed on very few Medicare patients, we 
expect to continue to have small Medicare claims volumes for MEG 
services each year. However, we are confident that over time our claims 
data for these procedures will become more consistent and reflective of 
the full hospital resources used in MEG services, especially because 
only a small subset of hospitals provide MEG services. We have been 
told that hospitals performing MEG procedure recently have been paying 
increased attention to accurately reporting charges for all necessary 
hospital resources on their claims. We are optimistic that both 
increased public awareness of Medicare coding for these procedures and 
improved understanding of the standard OPPS methodology for 
establishing APC payment rates should result in improved claims data in 
the future that more accurately reflect the required hospital 
resources.
e. 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 the PET, PET/CT, and SRS new technology services 
discussed above, there are 23 procedures currently assigned to New 
Technology APCs for which we believe we also have data adequate to 
support their assignment to clinical APCs. For CY 2007, we are 
proposing to reassign these procedures to clinically appropriate APCs, 
applying their CY 2005 claims data to develop their clinical APC median 
costs on which payments would be based. These procedures and their 
proposed APC assignments are displayed in Table10.

                          Table 10.--Proposed APC Reassignment of Other New Technology Procedures to Clinical APCs for CY 2007
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                        CY 2006                                             Proposed CY
     HCPCS Code           Short descriptor            CY 2006 SI         CY 2006 APC    payment       Proposed CY 2007 SI    Proposed CY     2007 APC
                                                                                          rate                                 2007 APC     median cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
0003T...............  Cervicography..........  S.......................         1492       $15.00  T.......................         0191           $9.22
0101T...............  Extracorp shockwv tx,hi  T.......................         1547       850.00  T.......................         0050        1,548.05
                       enrg.
0102T...............  Extracorp shockwv        T.......................         1547       850.00  T.......................         0050        1,548.05
                       tx,anesth.
0133T...............  Esophageal implant       T.......................         1556     1,750.00  T.......................         0422        1,704.85
                       injexn.
19296...............  Place po breast cath     S.......................         1524     3,250.00  T.......................         0030        2,533.62
                       for rad.
19297...............  Place breast cath for    S.......................         1523     2,750.00  T.......................         0029        1,822.38
                       rad.
20982...............  Ablate, bone tumor(s)    T.......................         1557     1,850.00  T.......................         0050        1,548.05
                       perq.
28890...............  High energy eswt,        T.......................         1547       850.00  T.......................         0050        1,548.05
                       plantar f.
36566...............  Insert tunneled cv cath  T.......................         1564     4,750.00  T.......................         0623        1,703.97
77421...............  Stereoscopic x-ray       S.......................         1502        75.00  S.......................         0257           88.39
                       guidance.
78804...............  Tumor imaging, whole     S.......................         1508       650.00  S.......................         0408          308.82
                       body.
79403...............  Hematopoietic nuclear    S.......................         1507       550.00  S.......................         0413          315.17
                       tx.
90473...............  Immune admin oral/nasal  S.......................         1491         5.00  S.......................         0436           10.71
90474...............  Immune admin oral/nasal  S.......................         1491         5.00  S.......................         0436           10.71
                       addl.
91035...............  G-esoph reflx tst w/     S.......................         1506       450.00  X.......................         0361          242.86
                       electrod.
C9716...............  Radiofrequency energy    S.......................         1519     1,750.00  T.......................         0150        1,818.31
                       to anu.
G0248...............  Demonstrate use home     S.......................         1503       150.00  V.......................         0604           49.45
                       inr mon.
G0249...............  Provide test             S.......................         1503       150.00  V.......................         0604           49.45
                       material,equipm.
G0293...............  Non-cov surg proc,clin   S.......................         1505       350.00  X.......................         0340           38.52
                       trial.
G0294...............  Non-cov proc, clinical   S.......................         1502        75.00  X.......................         0340           38.52
                       trial.
G0375...............  Smoke/tobacco            S.......................         1491         5.00  X.......................         0031           10.60
                       counseling 3-10.
G0376...............  Smoke/tobacco            S.......................         1491         5.00  X.......................         0031           10.60
                       counseling >10.
G3001...............  Admin + supply,          S.......................         1522     2,250.00  S.......................         0442        1,515.80
                       tositumomab.
--------------------------------------------------------------------------------------------------------------------------------------------------------

D. Proposed APC-Specific Policies

    1. Skin Replacement Surgery and Skin Substitutes (APCs 0024, 0025, 
0027)
    (If you choose to comment on issues in this section, please include 
the caption ``Skin Replacement Surgery and Skin Substitutes'' at the 
beginning of your comment.)
    For CY 2006, the American Medical Association (AMA) made 
comprehensive changes, including code additions, deletions, and 
revisions, accompanied by new and revised introductory language, 
parenthetical notes, subheadings and cross-references, to the 
Integumentary, Repair (Closure) subsection of surgery in the CPT book 
to facilitate more accurate reporting of skin grafts, skin 
replacements, skin substitutes, and local wound care. In particular, 
the section of the CPT book previously titled ``Free Skin Grafts'' and 
containing codes for skin replacement and skin substitute procedures 
was renamed, reorganized, and expanded. New and existing CPT codes 
related to skin replacement surgery and skin substitutes were organized 
into five subsections: Surgical Preparation, Autograft/Tissue Cultured 
Autograft, Acellular Dermal Replacement, Allograft/Tissue Cultured 
Allogeneic Skin Substitute, and Xenograft.

[[Page 49557]]

    As part of the CY 2006 CPT code update in the newly named ``Skin 
Replacement Surgery and Skin Substitutes'' section, certain codes were 
deleted that previously described skin allograft and tissue cultured 
and acellular skin substitute procedures, including CPT 15342 
(Application of bilaminate skin substitute/neodermis; 25 sq cm); CPT 
15343 (Application of bilaminate skin substitute/neodermis; each 
additional 25 sq cm); CPT 15350 (Application of allograft, skin; 100 sq 
cm or less), and CPT 15351 (Application of allograft, skin; each 
additional 100 sq cm). Thirty-seven new CPT codes were created in the 
``Skin Replacement Surgery and Skin Substitutes'' section, and these 
codes received interim final status indicators and APC assignments in 
the CY 2006 final rule with comment period and were subject to comment.
    At its March 2006 meeting, the APC Panel heard several 
presentations on some of the new CY 2006 CPT codes for skin replacement 
and skin substitute procedures, and CMS has received additional 
information from the public regarding a number of these services. In 
particular, 18 new CPT codes that were created to more specifically 
describe skin allograft, skin replacement, and skin substitute 
procedures were the subject of the APC Panel discussion and 
recommendations. These codes are as follows:
     CPT 15170 (Acellular dermal replacement, trunk, arms, 
legs; first 100 sq cm or less, or one percent of body area of infants 
and children)
     CPT 15171 (Acellular dermal replacement, trunk, arms, 
legs; each additional 100 sq cm, or each additional one percent of body 
area of infants and children, or part thereof)
     CPT 15175 (Acellular dermal replacement, face, scalp, 
eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or 
multiple digits; first 100 sq cm or less, or one percent of body area 
of infants and children)
     CPT 15176 (Acellular dermal replacement, face, scalp, 
eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or 
multiple digits; each additional 100 sq cm, or each additional one 
percent of body area of infants and children, or part thereof)
     CPT 15300 (Allograft skin for temporary wound closure, 
trunk, arms, legs; first 100 sq cm or less, or one percent of body area 
of infants and children)
     CPT 15301 (Allograft skin for temporary wound closure; 
trunk, arms, legs; each additional 100 sq cm, or each additional one 
percent of body area of infants and children, or part thereof)
     CPT 15320 (Allograft skin for temporary wound closure, 
face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet 
and/or multiple digits; first 100 sq cm or less, or one percent of body 
area of infants and children)
     CPT 15321 (Allograft skin for temporary wound closure, 
face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet 
and/or multiple digits; each additional 100 sq cm, or each additional 
one percent of body area of infants and children, or part thereof)
     CPT 15340 (Tissue cultured allogeneic skin substitute; 
first 25 sq cm or less)
     CPT 15341 (Tissue cultured allogeneic skin substitute; 
each additional 25 sq cm)
     CPT 15360 (Tissue cultured allogeneic dermal substitute; 
trunk, arms, legs; first 100 sq cm or less, or one percent of body area 
of infants and children)
     CPT 15361 (Tissue cultured allogeneic dermal substitute; 
trunk, arms, legs; each additional 100 sq cm, or each additional one 
percent of body area of infants and children, or part thereof)
     CPT 15365 (Tissue cultured allogeneic dermal substitute, 
face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet 
and/or multiple digits; first 100 sq cm or less, or one percent of body 
area of infants and children)
     CPT 15366 (Tissue cultured allogeneic dermal substitute, 
face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet 
and/or multiple digits; first 100 sq cm or less, or one percent of body 
area of infants and children)
     CPT 15420 (Xenograft skin (dermal), for temporary wound 
closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, 
hands, feet and/or multiple digits; first 100 sq cm or less, or one 
percent of body area of infants and children)
     CPT 15421 (Xenograft skin (dermal), for temporary wound 
closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, 
hands, feet and/or multiple digits; each additional 100 sq cm, or each 
additional one percent of body area of infants and children, or part 
thereof)
     CPT 15430 (Acellular xenograft implant; first 100 sq cm or 
less, or one percent of body area of infants and children)
     CPT 15431 (Acellular xenograft implant; each additional 
100 sq cm, or each additional one percent of body area of infants and 
children, or part thereof).
    The CY 2006 interim final APC assignments of these codes, the 
recommendations made by the APC Panel at its March 2006 meeting, and 
our proposed placement of the codes for CY 2007 are listed in Table 11 
below. Note that in general, biological skin substitutes and 
replacements used in procedures described by these CPT codes are 
proposed for separate payment under the OPPS for CY 2007, according to 
the methodology outlined in section V. of the preamble of this proposed 
rule.

           Table 11.--CY 2007 Proposed Assignments of Skin Substitute and Skin Replacement Procedures
----------------------------------------------------------------------------------------------------------------
                                        CY 2006 assignment                          CY 2007 proposed assignment
                                 -------------------------------     APC panel    ------------------------------
   CPT code     Short descriptor                         APC      recommendation                          APC
                                    APC        SI       median                       APC        SI       median
----------------------------------------------------------------------------------------------------------------
15170.........  Cell graft trunk/      24  T             $92.22                27       25  T            $314.58
                 arm/legs.
15171.........  Cell graft t/arm/      24  T              92.22                25       25  T             314.58
                 leg add-on.
15175.........  Acellular graft,       24  T              92.22                27       25  T             314.58
                 f/n/hf/g.
15176.........  Acell graft, f/n/      24  T              92.22                25       25  T             314.58
                 hf/g/add-on.
15300.........  Apply skin             27  T            1081.66               N/A       25  T             314.58
                 allograft, t/
                 arm/lg.
15301.........  Apply                  25  T             315.37               N/A       25  T             314.58
                 sknallograft t/
                 a/l addl.
15320.........  Apply skin             25  T             315.37                27       25  T             314.58
                 allogrft f/n/hf/
                 g.
15321.........  Apply                  25  T             315.37                25       25  T             314.58
                 sknallogrft f/n/
                 hfg add.
15340.........  Apply cult skin        24  T              92.22                27       25  T             314.58
                 substitute.
15341.........  Apply cult skin        24  T              92.22                25       25  T             314.58
                 sub add-on.
15360.........  Apply cult derm        24  T              92.22                27       25  T             314.58
                 sub, t/a/l.

[[Page 49558]]

 
15361.........  Aply cult derm         24  T              92.22                25       25  T             314.58
                 sub t/a/l/ add-
                 on.
15365.........  Apply cult derm        24  T              92.22                27       25  T             314.58
                 sub f/n/hf/g.
15366.........  Apply cult derm        24  T              92.22                25       25  T             314.58
                 f/hf/g add.
15420.........  Apply skin             25  T             315.37                27       25  T             314.58
                 xgraft, f/n/hf/
                 g.
15421.........  Apply skn              25  T             315.37                25       25  T             314.58
                 xgraft, f/n/hf/
                 g add.
15430.........  Apply acellular        25  T             315.37                27       25  T             314.58
                 xenograft.
15431.........  Apply acellular        25  T             315.37                25       25  T             314.58
                 xgraft add.
----------------------------------------------------------------------------------------------------------------

    We reviewed the presentations to the APC Panel; the APC Panel's 
recommendations; the CPT code descriptors, introductory explanations, 
cross-references, and parenthetical notes; the clinical characteristic 
of the procedures; and the code-specific median costs for all related 
CPT codes available from our CY 2005 claims data. While we agree with 
the APC Panel that the codes currently placed in APC 0024 (Level I Skin 
Repair) should be assigned to an APC with a higher median cost for CY 
2007, we disagree that these procedures should be placed in APC 0027 
(Level IV Skin Repair). APC Panel presenters reasoned that some of the 
codes (CPTs 15170, 15175, 15320, 15340, 15360, 15365, 15420, and 15430) 
for the first increment of body surface area treated should be placed 
in APC 0027 because they are similar to CPT code 15300 (Allograft skin 
for temporary wound closure, trunk, arms, legs; first 100 sq cm or 
less, or one percent of body area of infants and children). Upon 
further review of the clinical and expected hospital resource 
characteristics of CPT code 15300, we believe that this procedure is 
not appropriately placed in APC 0027. Split-thickness and full 
thickness skin autograft procedures currently assigned to APC 0027 are 
likely to require greater hospital resources, including additional 
operating room time and special equipment, in comparison to application 
of a separately paid allograft skin product. Instead, for CY 2007 we 
are proposing to reassign CPT code 15300 to APC 0025 (Level II Skin 
Repair), with an APC median cost of $314.58. We agree, in principle, 
that other CPT codes for the first increment of body surface area 
treated with a skin replacement or skin substitute are similar 
clinically and from a hospital resource perspective to CPT code 15300 
and are, therefore, proposing to assign these procedures to APC 0025 as 
well for CY 2007.
    Similarly, presenters reasoned that the related add-on codes (CPTs 
15171, 15176, 15321, 15342, 15361, 15366, 15421, and 15431) for 
procedures to treat additional body surface areas are similar to CPT 
code 15301 (Allograft skin for temporary wound closure, trunk, arms, 
legs; each additional 100 sq cm, or each additional one percent of body 
area of infants and children, or part thereof) in terms of required 
hospital resources. CPT code 15301 is assigned to APC 0025 for CY 2006. 
We are proposing to maintain the assignment of CPT code 15301 to APC 
0025 for CY 2007 and to reassign the other add-on codes to this APC. 
Note that APC 0025 has a status indicator of ``T,'' so that the add-on 
codes will experience the standard OPPS multiple surgical procedure 
reduction when properly billed with the first body surface area 
treatment codes that are assigned to the same clinical APC. We believe 
that this reduction in payment for the procedural resources associated 
with the add-on services is appropriate.
2. Treatment of Fracture/Dislocation (APC 0046)
    (If you choose to comment on issues in this section, please include 
the caption ``Treatment of Fracture/Dislocation'' at the beginning of 
your comment.)
    APC 0046 is a large clinical APC to which many procedures related 
to the percutaneous or open treatment of fractures and dislocations are 
assigned for CY 2006. Most of the approximately 100 procedures in the 
APC are relatively low volume, with even fewer single bills available 
for ratesetting. The median costs of the significant procedures in this 
APC as configured for CY 2006 range from a low of about $1,415 to a 
high of about $3,893. We received comments to the CY 2006 proposed rule 
(70 FR 42674) requesting that we distinguish procedures containing 
``with or without external fixation'' in their descriptors to provide 
greater payments when external fixation is used to treat fractures. The 
commenters explained that when external fixation devices are used, the 
costs of the procedures increase, and, therefore, the current APC 
placement significantly underpays those procedures in those instances. 
In the CY 2006 final rule with comment period (70 FR 68607), we 
declined to reassign procedures that could include external fixation at 
that time but we acknowledged that we had treated APC 0046 as an 
exception to the 2 times rule for several years. For CY 2006, we again 
treated APC 0046 as an exception to the 2 times rule, but noted we 
would ask the APC Panel to consider whether this APC could be 
reconfigured to improve its clinical and resource homogeneity.
    At the March 2006 meeting of the APC Panel, we asked the Panel to 
consider a possible reconfiguration of APC 0046 based on partial year 
CY 2005 claims data. The reconfiguration would create three new APCs 
and would divide the codes in APC 0046 among them. The APC Panel 
recommended that CMS continue to evaluate the refinement of APC 0046 
(Open/Percutaneous Treatment Fracture or Dislocation) into at least 
three APC levels, with consideration of a fourth level should data 
support this additional level. We are accepting the APC Panel's 
recommendation and are proposing for CY 2007 to split APC 0046 into 
three new APCs: APC 0062 (Level I Treatment Fracture/Dislocation); APC 
0063 (Level II Treatment Fracture/Dislocation); and APC 0064 (Level III 
Treatment Fracture/Dislocation). To ensure clinical and resource 
homogeneity in the new APCs, their proposed configurations are based on 
the procedure code descriptors, clinical considerations specific to 
each procedure, and service-specific hospital resource utilization as 
shown in the claims data from CY 2005. Restructuring APC 0046 into 
these three new APCs eliminates 2 times rule violations in the 
Fracture/Dislocation series.

[[Page 49559]]

    We are not currently proposing a fourth APC level in the Fracture/
Dislocation series because we do not believe our claims data are 
sufficiently robust and consistent from year to year to support 
differential payment for another service level. One code, CPT 27615 
(Radical resection of tumor (e.g., malignant neoplasm), soft tissue of 
leg or ankle area), is not clinically coherent with the other 
procedures in APC 0046, and we are proposing to reassign this procedure 
outside of the Fracture/Dislocation series to APC 0050 (Level II 
Musculoskeletal Procedures Except Hand and Foot) for CY 2007.

BILLING CODE 4120-01-P
[GRAPHIC] [TIFF OMITTED] TP23AU06.016


[[Page 49560]]


[GRAPHIC] [TIFF OMITTED] TP23AU06.017


[[Page 49561]]


[GRAPHIC] [TIFF OMITTED] TP23AU06.018

BILLING CODE 4120-01-C
3. Electrophysiologic Recording/Mapping (APC 0087)
    (If you choose to comment on issues in this section, please include 
the caption ``Electrophysiologic Recording/Mapping'' at the beginning 
of your comment.)
    At its March 2006 meeting, the APC Panel heard testimony from a 
presenter who asked that the Panel recommend that CPT codes 93609 
(intraventricular and/or intra-atrial mapping of tachycardia, add-on), 
93613 (intracardiac electrophysiologic 3-D mapping), and 93631 (intra-
operative epicardial & endocardial pacing and mapping to localize zone 
of slow conduction for surgical correction) be removed from APC 0087. 
The presenter asked the APC Panel to recommend that these codes be 
placed in APC 0086 for improved clinical and resource alignment. The 
presenter indicated that the median costs for these CPT codes were more 
than two times the median cost of the least costly HCPCS code in APC 
0087 and, therefore, constituted a 2 times violation. The presenter 
also indicated that the median cost of APC 0087 had declined in recent 
years, and argued that the payment rate for APC 0087 was too low to 
adequately compensate providers for these services.
    The APC Panel did not recommend that CMS move these codes from APC 
0087 to APC 0086, but instead recommended that CMS maintain the three 
codes in APC 0087 for CY 2007. The APC Panel noted that, due to the low 
volume of these and other services assigned to APC 0087, under the CMS' 
rules there was no 2 times violation in APC 0087. Moreover, the APC 
Panel found that the services under discussion were cardiac 
electrophysiologic mapping services, like other procedures also 
assigned to APC 0087, and were, therefore, clinically coherent with 
other services in APC 0087. The APC Panel did not believe that these 
three cardiac electrophysiologic mapping procedures were similar 
clinically or from a resource perspective to the intracardiac catheter 
ablation procedures residing in APC 0086. We agree with the APC Panel's 
assessment and are accepting this APC Panel recommendation. Therefore, 
we are proposing that CPT codes 93609, 93613, and 93631 remain assigned 
to APC 0087 for CY 2007.
4. Insertion of Mesh or Other Prosthesis (APC 0154)
    (If you choose to comment on issues in this section, please include 
the caption ``Insertion of Mesh or Other Prosthesis'' at the beginning 
of your comment.)
    During the March 2006 APC Panel meeting, a presenter requested that 
we

[[Page 49562]]

reassign CPT code 57267 (Insertion of mesh or other prosthesis for 
repair of pelvic floor defect, each site (anterior, posterior 
compartment), vaginal approach) to a more clinically and resource-
appropriate APC than its CY 2006 assignment to APC 0154 (Hernia/
Hydrocele Procedures). The presenter expressed concern that the 
procedure is currently assigned to an APC with a ``T'' status indicator 
and stated that payment would be more accurate if it were assigned to 
an APC that has an ``S'' status indicator. The mesh insertion procedure 
is a CPT add-on code and is, by definition, performed at the same time 
as certain other procedures and will, therefore, be discounted every 
time it is performed. The presenter objected to our assignment of CPT 
code 57267 to an APC that is subject to the multiple procedure discount 
because it is always a secondary procedure, and the discounted payment 
amount is not adequate to pay even for the cost of the implantable 
mesh. The presenter also believed that its assignment to an APC where 
hernia and hydrocele procedures were also assigned was clinically 
inappropriate.
    The APC Panel recommended that CMS reassign CPT code 57267 to a 
more clinically and resource-appropriate APC.
    In the CY 2005 claims data, the median cost for CPT code 57267 is 
$529.14, the lowest by far for procedures in APC 0154, which has an APC 
median cost of $1,821 for CY 2007. However, the median cost of CPT code 
57267 is based on only 6 single claims of the total 1,038 submitted for 
the service. Because the procedure always is performed in addition to 
other related procedures, we expect that claims for this service will 
be multiple claims. Therefore, we are not confident that the 
procedure's median cost based upon the six single claims is accurate.
    Therefore, in order to obtain more information about the cost of 
the procedure, we performed additional analyses of CY 2005 claims data 
in an attempt to specifically explore the cost of the mesh implant 
packaged into the payment for CPT code 57267. We believe that a 
significant portion of the procedural cost should be related to the 
cost of the mesh, based on information presented at the March 2006 APC 
Panel meeting. We looked at all claims that included charges for the 
HCPCS code for implantable mesh (C1781) and either CPT code 57267 or 
49568 (Implantation of mesh or other prosthesis for incisional or 
ventral hernia repair). We examined the bills for CPT code 49568 in 
addition to those for CPT code 57267 because it is a high volume 
procedure that also uses implantable mesh, and we expected that the 
extra volume would improve our chances of identifying meaningful charge 
data.
    We found 210 claims with charges reported for both CPT code 57267 
and HCPCS code C1781 on the same day and 6,345 claims with reported 
charges for both CPT code 49568 and HCPCS code C1781 on the same day. 
Costs developed from these two claims subsets included the cost of the 
implanted mesh device that was used in performing the procedure. Table 
13 below displays the median costs from those claims. The costs shown 
in the column titled ``Line-item Median Cost'' are those we obtained by 
looking at all CY 2005 OPPS claims on which charges for both the 
procedure code (either CPT code 57267 or 49568) and the code for the 
implantable mesh (HCPCS code C1781) were reported. The costs shown in 
the column titled ``Single Claims Median Cost'' are the median costs 
calculated using only single procedure claims for the specific 
procedure that also included the C-code for the mesh.
    Our additional data analysis supports the APC Panel presenter's 
assertion that the cost of the mesh is greater than 50 percent of the 
total cost of CPT code 57267, but it also indicates that the mesh cost 
is far less than 50 percent of the payment amount for APC 0154. In CY 
2006 the payment rate for APC 0154 is $1,704.59, and the payment when 
the multiple procedure discount is taken is $852.30, which is much 
greater than both the line-item median cost of the mesh and the median 
single claims cost of CPT code 57267 (which explicitly includes the 
implantable mesh) reflected in our claims data.

                      Table 13.--Median Costs of HCPCS Code C1781 and Associated Procedures
----------------------------------------------------------------------------------------------------------------
                                                                                                    CY 2006 APC
                                                                     Line-item     Single claims   0154 payment
              HCPCS code                    Short descriptor        median cost     median cost      amount (T
                                                                                                      status)
----------------------------------------------------------------------------------------------------------------
57267.................................  Insert mesh/pelvic flr           $423.28         $529.14       $1,704.59
                                         add-on.
C1781 (billed with 57267).............  Mesh (implantable)......          383.35             N/A             N/A
49568.................................  Hernia repair w/mesh....          363.41        1,323.29        1,704.59
C1781 (billed with 49568).............  Mesh (implantable)......          242.20             N/A             N/A
----------------------------------------------------------------------------------------------------------------

    We agree with the APC Panel that the procedure should be assigned 
to a more clinically appropriate APC, and therefore, we are proposing 
to accept its recommendation and reassign CPT code 57267 to APC 0195 
(Level IX Female Reproductive Procedures), with status indicator ``T'' 
for CY 2007. The proposed median cost of APC 0195 is $1,777 for CY 
2007, very comparable to the CY 2006 median cost of APC 0154, where CPT 
code 57267 is currently assigned. The median cost for the procedure 
remains very low in comparison with other procedures assigned to APC 
0195, so that payment for the service when the multiple procedure 
reduction is applied should be appropriate. While not affecting the 
procedure's payment significantly, this reassignment improves the 
clinical homogeneity of APCs 0154 and 0195.
5. Percutaneous Renal Cryoablation (APC 0163)
    (If you choose to comment on issues in this section, please include 
the caption ``Percutaneous Renal Cryoablation'' at the beginning of 
your comment.)
    During the March 2006 APC Panel meeting, a presenter requested that 
we reassign CPT code 0135T (Ablation renal tumor(s), unilateral, 
percutaneous, cryotherapy) to APC 0423 (Level II Percutaneous Abdominal 
and Biliary Procedures). The presenter provided information about the 
costs of performing these procedures and compared the resource 
requirements for the procedures to those for CPT code 47382 (Ablation, 
one or more liver tumor(s), percutaneous, radiofrequency), which is 
currently assigned to APC 0423. The presenter proposed reassignment of 
CPT code 0135T to APC 0423 because that is where CPT code 47382 is 
assigned, and stated that the costs of the two procedures are very 
similar.

[[Page 49563]]

    The APC Panel recommended that we assign CPT code 0135T to APC 0423 
for CY 2007.
    CPT code 0135T is new for CY 2006 and therefore, we have no claims 
data on which to base our APC assignment decision. The procedure 
currently has an interim assignment to APC 0163 (Level IV 
Cystourethroscopy and Other Genitourinary Procedures), with a CY 2006 
payment amount of $1,999.35.
    We are proposing to accept the APC Panel's recommendation to 
reassign CPT code 0135T to APC 0423 for CY 2007. We believe that 
assignment of CPT code 0135T to APC 0423 is clinically appropriate, and 
that the CY 2007 median cost of APC 0423 of $2,410 is reasonably close 
to our expectations regarding the resource requirements for the renal 
cryoablation procedure.
6. Keratoprosthesis (APC 0244)
    (If you choose to comment on issues in this section, please include 
the caption ``Keratophrosthesis'' at the beginning of your comment.)
    CPT code 65770 is a surgical procedure for implantation of a 
keratoprosthesis, an artificial cornea. The keratoprosthesis device 
that is required for the implantation is described by HCPCS code C1818 
(Integrated keratoprosthesis), a device category that received 
transitional pass-through payment under the OPPS from July 2003 through 
December 2005. When the device came off pass-through status for CY 2006 
and its costs were packaged into the implantation procedure, CPT code 
65770 continued to be assigned to APC 0244 (Corneal Transplant), with a 
payment rate of about $2,275, despite an increase in the median cost of 
the implantation procedure of about $1,200 associated with the 
packaging of the device. There is no 2 times violation in APC 0244 for 
CY 2006.
    At the March 2006 meeting of the APC Panel, following a 
presentation regarding the procedure to implant a keratoprosthesis that 
described the clinical and hospital resource characteristics of CPT 
code 65770, the Panel recommended moving CPT code 65770 to a more 
appropriate APC in order to make appropriate payment. We agree with the 
recommendation of the APC Panel. Claims data from CY 2005 demonstrate 
that the median cost for implantation of a keratoprosthesis of 
$3,127.51 remains significantly higher than the median costs of other 
procedures assigned to APC 0244, although there is no 2 times 
violation. In addition, CPT code 65770 contributes less than 1 percent 
of the single claims in the APC available for ratesetting, and it is 
likely to continue to be an uncommon procedure among Medicare 
beneficiaries, resulting in its persistent small contribution to the 
median cost of APC 0244. Therefore, for CY 2007 we are proposing to 
create a new APC 0293 (Level V Anterior Segment Eye Procedures) with a 
median cost of $3,127.51 and to move CPT code 65770 into that APC in 
order to more appropriately pay for the procedure and the related 
device.
7. Medication Therapy Management Services
    (If you choose to comment on issues in this section, please include 
the caption ``Medication Therapy Management Services'' at the beginning 
of your comment.)
    Following a presentation at its March 2006 meeting, the APC Panel 
made two recommendations regarding Category III CPT codes for 
pharmacist medication therapy management services that were new for CY 
2006. These services include CPT codes 0115T (medication therapy 
management services provided by a pharmacist, individual, face-to-face 
with patient, initial 15 min., w/assessment and intervention if 
provided; initial encounter), 0116T (medication therapy management; 
subsequent encounter), and 0117T (medication therapy management; 
additional 15 min.). These codes were assigned status indicator ``B'' 
in the CY 2006 OPPS final rule with comment period, indicating that 
they are not recognized by the OPPS when submitted on an outpatient 
hospital Part B bill type, with comment indicator ``NI'' to identify 
them as subject to comment. The APC Panel recommended that we create a 
new APC, with a nominal payment, to which we would assign these codes; 
implement the assignment in July 2006, if possible, or otherwise in CY 
2007; and provide guidance to hospitals on how and when these codes 
should be reported. We are not accepting the APC Panel's 
recommendations. Rather, we are proposing to continue to assign status 
indicator ``B'' to CPT codes 0115T, 0116T, and 0117T for CY 2007.
    According to the AMA, the purpose of Category III CPT codes is to 
facilitate data collection on and assessment of new services and 
procedures. Medication therapy management services are not new services 
in the OPPS, as they have been provided to patients by hospitals in the 
past as components of a wide variety of services provided by hospitals, 
including clinic and emergency room visits, procedures, and diagnostic 
tests. As such, we believe their associated hospital resource costs are 
already incorporated into the OPPS payments for these other services 
that are based on historical hospital claims data. The three Category 
III CPT codes specifically describe medication therapy management 
services provided by a pharmacist. We have no need to distinguish 
medication therapy management services provided by a pharmacist in a 
hospital from medication therapy management services provided by other 
hospital staff, as the OPPS only makes payments for services provided 
incident to physicians' services. Hospitals providing medication 
therapy management services incident to physicians' services may choose 
a variety of staffing configurations to provide those services, taking 
into account other relevant factors such as State and local laws and 
hospital policies.
    In general, we do not establish new clinical APCs for new codes and 
set payment rates for those APCs when we have no cost data for any 
services populating the APCs. New codes where we believe that there are 
no existing clinical APCs compatible with their expected clinical and 
hospital resource characteristics are often assigned to New Technology 
APCs until we have sufficient cost data to determine appropriate 
clinical APC assignments. However, these medication therapy management 
codes would not be eligible to map to New Technology APCs because they 
are not new services which are unrepresented in historical hospital 
claims data. As stated earlier, because we believe the costs of 
medication therapy management services are imbedded as a component 
within our claims data, we are confident that our claims data reflect 
the costs of pharmacist medication management services provided to 
hospital outpatients who are receiving hospital services.
8. Complex Interstitial Radiation Source Application (APC 0651)
    (If you choose to comment on issues in this section, please include 
the caption ``Complex Interstitial Radiation Source Application'' at 
the beginning of your comment.)
    APC 0651 (Complex Interstitial Radiation Source Application), 
contains only one code, CPT code 77778 (Complex interstitial 
application of brachytherapy sources). The coding, APC assignment, 
median cost, and resulting payment rate for CPT code 77778 have not 
been stable since the inception of the OPPS, and that instability has 
been a source of concern to hospitals that furnish the service and to 
specialty societies. The vast majority

[[Page 49564]]

of claims for interstitial brachytherapy are for the treatment of 
patients with a diagnosis of prostate cancer. The historical coding, 
APC assignments, and payment rates for CPT code 77778 and the related 
service CPT code 55859 (Transperitoneal placement of needles or 
catheters into the prostate for application of brachytherapy sources), 
are shown in Table 14.

                            Table 14.--Historical Payment Rates for Complex Interstitial Application of Brachytherapy Sources
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               CPT code                           CPT code
              OPPS CY                    Combination APC        77778         APC for 77778        55859         APC for 55859             Source
--------------------------------------------------------------------------------------------------------------------------------------------------------
2000...............................  N/A...................      $198.31  APC 312.............      $848.04  APC 162.............  Pass-through.
2001...............................  N/A...................      205.495  APC 312.............       878.72  APC 162.............  Pass-through.
2002...............................  N/A...................      6344.67  APC 312.............      2068.23  APC 163.............  Pass-through with pro
                                                                                                                                    rata reduction.
2003 (if prostate brachytherapy      G0261, APC 648,                 N/A  N/A.................          N/A  N/A.................  Packaged.
 with iodine sources).                $5154.34.
2003 (if prostate brachytherapy      G0256, APC 649,                 N/A  N/A.................          N/A  N/A.................  Packaged.
 with palladium sources).             $5998.24.
2003 (if not prostate                N/A...................      2853.58  APC 651.............      1479.60  APC 163.............  Separate payment
 brachytherapy, not including                                                                                                       based on scaled
 sources).                                                                                                                          median cost per
                                                                                                                                    source.
2004...............................  N/A...................       558.24  APC 651.............      1848.55  APC 163.............  Cost.
2005...............................  N/A...................      1248.93  APC 651.............      2055.63  APC 163.............  Cost.
2006...............................  N/A...................       666.21  APC 651.............      1993.35  APC 163.............  Cost.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    We have frequently been told by the public that the instability in 
our payment rates for APC 0651 creates difficulty in planning and 
budgeting for hospitals. Moreover, we have been told that in this case 
reliance on single procedure claims results in use of only incorrectly 
coded claims for prostate brachytherapy because, for application to the 
prostate, which is estimated to be 85 percent of all occurrences of CPT 
code 77778, a correctly coded claim is a multiple procedure claim. 
Specifically, we are told that a correctly coded claim for prostate 
brachytherapy should include, for the same date of service, both CPT 
codes 55859 and 77778, brachytherapy sources reported with C-codes, and 
typically separately coded imaging and radiation therapy planning 
services. We are further advised that in the cases of complex 
interstitial brachytherapy where sources are placed in sites other than 
the prostate, the charges for both placing the needles or catheters and 
for applying the sources may be reported by CPT code 77778 alone 
because there are no other specific CPT codes for placement of needles 
or catheters in those sites. In other cases, the placement of needles 
or catheters may be reported with not otherwise classified codes 
specific to the treated body area.
    At the March 2006 APC Panel meeting, presenters urged the Panel to 
recommend that CMS use only single procedure claims that contain 
charges for brachytherapy sources on the same claim with CPT code 77778 
to set the median cost for APC 0651. Presenters also urged that CMS 
adopt a process for using multiple procedure claims to set the median 
for APC 0651 that would sum the costs on multiple procedure claims 
containing CPT codes 77778 and 55859 (and no other separately payable 
services not on the bypass list) and, excluding the costs of sources, 
split the resulting aggregate median cost on the multiple procedure 
claim according to a preestablished attribution ratio between CPT codes 
77778 and 55859. Presenters also urged that we provide hospital 
education on correct coding of brachytherapy services and devices of 
brachytherapy required to perform brachytherapy procedures. They 
indicated that any claim for a brachytherapy service that did not also 
report a brachytherapy source should be considered to be incorrectly 
coded and thus not reflective of the hospital resources required for 
the interstitial source application procedure. They believed that these 
claims should be excluded from use in establishing the median cost for 
APC 0651. They believed that hospitals which report the brachytherapy 
sources on their claims are more likely to report complete charges for 
the associated brachytherapy procedure than hospitals that do not 
report the separately payable brachytherapy sources.
    The APC Panel recommended that CMS reevaluate the proposed payment 
for brachytherapy services in APC 0651 for CY 2007. The APC Panel also 
recommended that CMS formally work with the Coalition for the 
Advancement of Brachytherapy, American Brachytherapy Society, and the 
American Society for Therapeutic Radiology and Oncology to evaluate the 
methodology for setting brachytherapy service payment rates in APC 
0651.
    In response to the APC Panel recommendations, we are explicitly 
analyzing the standard OPPS methodology that we used in determining our 
proposed payment rate for APC 0651 in this proposed rule in the context 
of alternative multiple bill methodologies. In addition, we note that 
we routinely accept requests from interested organizations to discuss 
their views about OPPS payment policy issues.
    The organizations that the APC Panel asked us to work with have 
frequently brought their concerns to our attention through the 
rulemaking process and otherwise. We will consider the input of any 
individual or organization to the extent allowed by Federal law 
including the Administrative Procedure Act (APA) and the Federal 
Advisory Committee Act (FACA). We establish the OPPS rates through 
regulations. We are required to consider the timely comments of 
interested organizations, establish the payment policies for the 
forthcoming year, and respond to the timely comments of all public 
commenters in the final rule in which we establish the payments for the 
forthcoming year.
    For this proposed rule, we developed a median cost for APC 0651 
using single procedure claims using the general OPPS process, but we 
also looked at multiple procedure claims that contain the most common 
combinations of codes used with APC 0651. Our single procedure claims 
process results in using 1,123 claims to calculate a median cost of 
$1028.93 for APC 0651. We have added CPT code 76965, a CPT code for 
ultrasound guidance that commonly appears on claims for complex

[[Page 49565]]

interstitial brachytherapy, to the bypass list for CY 2007 after close 
clinical review because we believe that it would typically have little 
associated packaging. We believe that this change, along with 
maintenance of CPT code 77290 for complex therapeutic radiology 
simulation-aided field setting on the bypass list, is responsible for 
the growth in single procedure claims from the 381 single bills on 
which the APC 0651 median cost was calculated for the CY 2006 OPPS 
final rule with comment period. However, only 6 of these 1,123 single 
and ``pseudo'' single claims also included brachytherapy sources used 
in complex interstitial brachytherapy source application, and the 
median cost for these 6 claims at $600.68 is significantly less than 
the median cost for all single claims. It is unclear why so many of 
these claims do not contain brachytherapy sources, which were 
separately paid at cost in CY 2005. Because we are proposing to pay 
separately for brachytherapy sources again for CY 2007, we see no 
reason to believe that these few claims for brachytherapy services that 
included sources, which also do not report CPT code 55859 for placement 
of needles or catheters into the prostate, are more correctly coded 
than those claims which do not separately report brachytherapy sources. 
We believe it is possible that hospitals billing CPT code 77778 and not 
the associated brachytherapy sources may have bundled their charges for 
the brachytherapy sources into their charge for CPT code 77778.
    We also identified multiple procedure claims that contained both 
CPT codes 77778 and 55859 and also included any one or more of the 
following procedure codes, which have repeatedly appeared as common 
procedures that are reported on the same claim with CPT codes 55859 and 
77778: 76000, 76965, or 77290. We then calculated median costs for 
interstitial prostate brachytherapy in two different ways: (1) 
Bypassing the line item charges for these three ancillary codes; and 
(2) packaging the costs of these three ancillary codes. We applied this 
methodology both (1) to all claims that met these criteria with and 
without sources and (2) to claims that met the criteria and also 
separately reported brachytherapy sources that would be expected to be 
reported with CPT code 77778. See Tables 15 and 16 below for the 
results of this investigation.
    We found 10,571 multiple procedure claims with CPT codes 55859 and 
77778 reported on the claim, including those both with and without 
separately reported sources. We found that 7,181 of the 10,571 claims 
contained any combination of the 3 ancillary codes (76000, 76965, or 
77290). Table 15 shows the results of bypassing and packaging the line-
item costs of the 3 ancillary procedures.

                    Table 15.--Multiple Procedure Claims Including CPT Codes 55859 and 77778
----------------------------------------------------------------------------------------------------------------
                                                                Minimum      Maximum
                                                  Frequency       cost         cost      Mean cost   Median cost
----------------------------------------------------------------------------------------------------------------
Ancillary Codes Packaged.......................       * 7180      $828.46   $11,202.81    $3,326.50    $3,062.99
Ancillary Codes Bypassed.......................         7181       811.95    11,203.81     3,300.16    3,030.01
----------------------------------------------------------------------------------------------------------------
* 1 lost to trimming.

    We found 9,791 multiple procedure claims with CPT codes 55859 and 
77778 reported on the claim that also included brachytherapy sources 
that would be used with CPT code 77778. We found that 6,748 of the 
9,791 claims contained any combination of the 3 ancillary codes. Table 
16 shows the results of bypassing and packaging the line-item costs of 
the 3 ancillary procedures.

 Table 16.--Multiple Procedure Claims Including CPT Codes 55859 and 77778 and One or More Brachytherapy Sources
----------------------------------------------------------------------------------------------------------------
                                                                Minimum      Maximum
                                                  Frequency       cost         cost      Mean cost   Median cost
----------------------------------------------------------------------------------------------------------------
Ancillary Codes Packaged.......................         6748      $890.56   $10,224.17    $3,240.13    $3,026.62
Ancillary Codes Bypassed.......................         6748       912.81    10,307.37     3,215.75     2,992.60
----------------------------------------------------------------------------------------------------------------

    The claims containing CPT codes 55859 and 77778 and any combination 
of the three identified ancillary codes have mean and median costs that 
are very close to one another, regardless of whether the hospital 
billed separately for the brachytherapy sources on the claim with the 
procedure codes. Moreover, most of the multiple procedure claims we 
identified contained sources. This leads us to conclude that the 
presence of sources on the claim does not make a significant difference 
in the median cost of the combined service.
    Moreover, when we calculate the total median cost from single bills 
for the APCs for the two major procedures codes without regard to the 
separate payments that would be made for CPT codes 76000, 76965, and 
77290, the sum of the CY 2007 proposed medians for APC 0651 and APC 
0163 is $3,197.07, which is greater than the combination medians, even 
when the three ancillary services are packaged into the combination 
median. Under our proposed policies for CY 2007, hospitals would also 
be paid separately for brachytherapy sources, guidance services, and 
radiation therapy planning services that may be provided in support of 
services reported with CPT codes 55859 and 77778.
    Therefore, we believe that the summed median cost for APC 0651 and 
APC 0163 results in an appropriate level of full payment for the 
dominant type of service provided under APC 0651, interstitial prostate 
brachytherapy. We are proposing to use the median cost of $1,028.93, as 
derived from all single bills for APC 0651 according to our standard 
OPPS methodology, to establish the median for that APC.
    We recognize that prostate brachytherapy is not the sole use of CPT 
code 77778, although it is the predominant use. Costs attributable to 
the placement of needles and catheters and to the interstitial 
application of brachytherapy sources to sites other than the prostate 
may also be reported on claims whose data map to APC 0651.

[[Page 49566]]

This clinically driven variability in the claims data is difficult to 
assess without adding additional levels of complexity to the issue by 
considering diagnoses in establishing payments rates. However, 
recognizing that a PPS is a system based on averages and, to the extent 
that claims for all types of complex interstitial brachytherapy source 
application are included in the body of claims used to set the median 
cost for APC 0651, we believe that the payment for these services is 
appropriate.
9. Single Allergy Tests (APC 0381)
    (If you choose to comment on issues in this section, please include 
the caption ``Allergy Testing'' at the beginning of your comment.)
    We are proposing to continue with our methodology of 
differentiating single allergy tests (``per test'') from multiple 
allergy tests (``per visit'') by assigning these services to two 
different APCs to provide accurate payments for these tests in CY 2007. 
Multiple allergy tests are assigned to APC 0370, with a median cost 
calculated based on the standard OPPS methodology. We provided billing 
guidance in CY 2006 in Transmittal 804 (issued on January 3, 2006) 
specifically clarifying that hospitals should report charges for the 
CPT codes that describe single allergy tests to reflect charges ``per 
test'' rather than ``per visit'' and should bill the appropriate number 
of units of these CPT codes to describe all of the tests provided. 
However, our CY 2005 claims data available for the CY 2007 proposed 
rule do not yet reflect the improved and more consistent hospital 
billing practices of ``per test'' ``for single allergy tests. Some 
claims for single allergy tests still appear to provide charges that 
represent a ``per visit'' charge, rather than a ``per test'' charge. 
Therefore, consistent with our payment policy for CY 2006, we are 
proposing to calculate a ``per unit'' median cost for APC 0381, based 
upon 349 claims containing multiple units or multiple occurrences of a 
single CPT code, where packaging on the claims is allocated equally to 
each unit of the CPT code. Using this methodology, we are proposing a 
median cost of $13.29 for APC 0381 for CY 2007. We are hopeful that the 
better and more accurate hospital reporting and charging practices for 
these single allergy test CPT codes beginning in CY 2006 will allow us 
to calculate the median cost of APC 0381 using the standard OPPS 
process in future OPPS updates.
10. Hyperbaric Oxygen Therapy (APC 0659)
    (If you choose to comment on issues in this section, please include 
the caption ``Hyperbaric Oxygen Therapy'' at the beginning of your 
comment.)
    When hyperbaric oxygen therapy (HBOT) is prescribed for promoting 
the healing of chronic wounds, it typically is prescribed for 90 
minutes and billed using multiple units of HBOT on a single line or 
multiple occurrences of HBOT on a claim. 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.
    In the CY 2005 final rule with comment period (69 FR 65758 through 
65759), we finalized a ``per unit'' median cost calculation for HBOT 
using only claims with multiple units or multiple occurrences of HCPCS 
code C1300 because delivery of a typical HBOT service requires more 
than 30 minutes. We observed that claims with only a single occurrence 
of the code were anomalies, either because they reflected terminated 
sessions or because they were incorrectly coded with a single unit. In 
the same rule, we also established that HBOT would not generally be 
furnished with additional services that might be packaged under the 
standard OPPS APC median cost methodology. This enabled us to use 
claims with multiple units or multiple occurrences. Finally, we also 
used each hospital's overall cost-to-charge ratio (CCR) to estimate 
costs for HCPCS code C1300 from billed charges rather than the CCR for 
the respiratory therapy cost center. Comments on the CY 2005 proposed 
rule effectively demonstrated that hospitals report the costs and 
charges for HBOT in a wide variety of cost centers. We used this 
methodology to estimate payment for HBOT in CYs 2005 and 2006. For CY 
2007, we are proposing to continue using the same methodology to 
estimate a ``per unit'' median cost for HCPCS code C1300. Using 50,311 
claims with multiple units or multiple occurrences, we estimate a 
median cost of $98.36.
11. Myocardial Positron Emission Tomography (PET) Scans (APCs 0306, 
0307)
    (If you choose to comment on issues in this section, please include 
the caption ``Myocardial PET Scans'' at the beginning of your comment.)
    From August 2000 to December 31, 2005, under the OPPS we assigned 
to one clinical APC all myocardial positron emission tomography (PET) 
scan procedures, which were reported with multiple G-codes through 
March 31, 2005. Effective April 1, 2005, myocardial PET scans were 
reported with three CPT codes, specifically CPT codes 78459, 78491, and 
78492, under the OPPS. Public comments to the CY 2006 OPPS proposed 
rule suggested that the HCPCS codes describing multiple myocardial PET 
scans should be assigned to a separate APC from single study codes 
because their hospital resource costs are significantly higher than 
single scans. Review of the CY 2004 claims data for myocardial PET 
scans revealed a median cost of $2,482 for the 9 G-codes that describe 
multiple myocardial PET scans, based upon 978 single claims of 2,001 
total claims for multiple scan procedures. The CY 2004 claims data 
showed a median cost of $800 for the 6 G-codes describing single PET 
studies, based on 391 single claims of 575 total claims. A review of CY 
2003 claims data showed a similar pattern of significantly higher 
hospital costs for multiple myocardial PET studies in comparison with 
single studies, although there were fewer claims for the procedures in 
CY 2003 in comparison with CY 2004. In response to the comments 
received and based on this claims information, myocardial PET services 
were assigned to two clinical APCs for the CY 2006 OPPS. HCPCS codes 
for single scans were assigned to APC 0306 with a payment rate of 
$800.55, and HCPCS codes for the multiple scan procedures were assigned 
to APC 0307 with a payment rate of $2,484.88.
    Analysis of the latest CY 2005 claims data for myocardial PET scans 
reveals that the APC median costs for the single and multiple 
myocardial PET codes are $836 and $680 respectively, based on 296 
single claims for single studies and 1,150 single claims for multiple 
scan procedures. Despite more CY 2005 single claims for multiple scan 
procedures, the median cost of these procedures declined significantly 
from CY 2004 to CY 2005, dropping below the median cost of single 
studies. As indicated earlier, there was a significant coding change 
for myocardial PET services in CY 2005, with the reporting

[[Page 49567]]

of a single CPT code for multiple studies (CPT code 78492) for most of 
CY 2005, in comparison with nine G-codes in CY 2004. We examined the 
single bills for multiple scan procedures from CY 2004 and noted 17 
hospitals were represented, with the majority of those claims from a 
single hospital. In contrast, in the CY 2005 claims, 25 hospitals were 
represented in the single bills for multiple scan procedures, and no 
single hospital contributed a majority of claims to the median cost 
calculation. We also examined differences in charges associated with G-
codes versus the CPT code to determine if hospitals had adjusted the 
charge for the CPT code to reflect the termination of the multiple 
study G-codes. However, the individual charging practices of hospitals 
did not appear to vary with the use of a G-code versus the CPT code in 
either the CY 2004 or the CY 2005 claims. Greater volume of claims and 
consistent charging for both the G-codes and CPT code by hospitals 
suggest that the median appropriately captures the greater variability 
in relative hospital costs for multiple myocardial PET studies in the 
CY 2005 claims data.
    Based on our claims data, the use of myocardial PET scan technology 
has become more widely prevalent in hospitals, and as a result, we now 
have more data to support our proposed payment rates. We believe that 
the median costs from our CY 2005 claims data for myocardial PET scan 
services, calculated based upon our standard OPPS methodology and based 
on almost 1,500 single claims, for both the single and multiple scans, 
should be reflective of the hospital resources required to provide the 
services to Medicare beneficiaries in the outpatient hospital setting. 
Based on these data, the differential median costs of the single and 
multiple study procedures do not support the present two-level APC 
payment structure. Although we acknowledge that some people may believe 
that multiple scan procedures should require increased resources at 
some hospitals in comparison with single scans, particularly because of 
the longer scan times required for multiple studies, our data do not 
support a resource differential that would necessitate the placement of 
these single and multiple scan procedures into two separate APCs. As 
myocardial PET scans are being provided more frequently at a greater 
number of hospitals than in the past, it is possible that most 
hospitals performing multiple PET scans are particularly efficient in 
their delivery of higher volumes of these services and, therefore, 
incur hospital costs that are similar to those of single scans, which 
are provided less commonly.
    When all myocardial PET scan procedure codes are combined into a 
single clinical APC, as they were prior to CY 2006, the APC median cost 
for myocardial PET services is about $721, very similar to the $703 
median cost of their single CY 2005 clinical APC. Therefore, for CY 
2007, we are proposing to assign CPT codes 78459, 78491, and 78492 to a 
single APC, specifically, APC 0307 titled Myocardial Positron Emission 
Tomography (PET) Imaging, with a proposed median cost of $721. We 
believe that the assignment of these three CPT codes to APC 0307 is 
appropriate as the CY 2005 claims data reveal that more hospitals are 
providing multiple myocardial PET scan services, most myocardial PET 
scans are multiple studies, and the hospital resource costs of single 
and multiple studies are similar. We believe that the proposed median 
cost appropriately reflects the hospital resources associated with 
providing myocardial PET scans to Medicare beneficiaries in cost-
efficient settings. Further, we believe that the proposed rates are 
adequate to ensure appropriate access to these services for Medicare 
beneficiaries. We are seeking comments on our proposal to provide a 
single payment rate for all myocardial PET scans in CY 2007. The 
myocardial PET scan CPT codes and their CY 2007 proposed APC 
assignments are displayed in Table 17.

                                              Table 17.--Proposed CY 2007 APC Assignment for Myocardial PET
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                        CY 2006                                             Proposed CY
     HCPCS code           Short descriptor            CY 2006 SI         CY 2006 APC    payment       Proposed CY 2007 SI    Proposed CY     2007 APC
                                                                                          rate                                 2007 APC     median cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
78459...............  Heart muscle imaging     S.......................         0306      $800.55  S.......................         0307         $721.26
                       (PET).
78491...............  Heart image (PET),       S.......................         0306       800.55  S.......................         0307          721.26
                       single.
78492...............  Heart image (PET),       S.......................         0307     2,484.88  S.......................         0307          721.26
                       multiple.
--------------------------------------------------------------------------------------------------------------------------------------------------------

12. Radiology Procedures (APCs 0333, 0662, and Other Imaging APCs)
    (If you choose to comment on issues in this section, please include 
the caption ``Radiology Procedures'' at the beginning of your comment.)
    At its March 2006 meeting, the APC Panel made three recommendations 
regarding radiology services. These include the following:
     Reaffirming the CY 2005 recommendation that CMS postpone 
implementation of the multiple procedure reduction policy for imaging 
services as included in the CY 2006 OPPS proposed rule for CY 2007, to 
allow CMS to gather more data on the efficiencies associated with 
multiple imaging procedures that may already be reflected in OPPS 
payment rates for imaging services.
     Recommending that CMS review payment rates for computed 
tomography (CT) and computed tomographic angiography (CTA) procedures 
to ensure that their payment rates are comparatively consistent and 
that they accurately reflect resource use.
     Recommending that CMS invite comments on ways that 
hospitals can uniformly and consistently report charges and costs 
related to radiology services.
    In the CY 2006 OPPS final rule with comment period (70 FR 68707), 
we indicated that based on the APC Panel's recommendations and public 
comments received, we decided not to finalize our CY 2006 proposal to 
reduce OPPS payments for some second and subsequent diagnostic imaging 
procedures performed in the same session. Our analyses did not disprove 
the commenters' contentions that there are efficiencies already 
reflected in their hospital costs, and, therefore, their CCRs and the 
median costs for the procedures. Over the past 7 months, we have 
conducted additional studies of our hospital claims data for single and 
multiple diagnostic imaging procedures, and our analyses to date 
support continued deferral for CY 2007 of implementation of a multiple 
imaging procedure payment reduction policy in the OPPS. Therefore, we 
are accepting the APC Panel's recommendation to not adopt such a policy 
for CY 2007 pending the results of further analyses. Depending upon the 
findings from such studies, in a future rulemaking we may propose 
revisions to the structure of our

[[Page 49568]]

rates to further refine these rates in the context of additional study 
findings.
    We also are accepting the APC Panel's recommendation to review the 
CY 2007 proposed payment rates for CT and CTA procedures to ensure that 
their rates are comparatively consistent and accurately reflective of 
hospitals' resource costs. Presenters at the March 2006 APC Panel 
meeting indicated to the Panel that hospital resources for CTA 
procedures are similar to those for CT procedures that include scans 
without contrast followed by scans with contrast, but additional 
resources are required for the 3-dimensional reconstruction that is 
part of the CTA procedures. As a result of this image postprocessing, 
CTA scans display the vasculature in a 3-dimensional format rather than 
in the 2-dimensional cross-sectional images of conventional CT scans. 
Based upon CY 2005 claims data, the CY 2007 proposed median cost for 
APC 0333 for CT procedures that include scans without contrast 
material, followed by contrast scans to complete the studies is $309, 
and the CY 2007 proposed median cost for APC 0662 for CTA procedures is 
$304. As has been the case for the past several years, the median costs 
associated with these two APCs are virtually identical to one another 
and are also quite consistent with their historical costs from prior 
years of claims data. The CY 2007 proposed median costs for APCs 0333 
and 0662 are based on about 500,000 and 150,000 single claims, 
respectively. The stability of these APC median costs, based on large 
numbers of single claims, is consistent with our belief that the median 
costs of these APCs accurately reflect hospitals' resource use. From CY 
2004 to CY 2005 the number of CTA procedures performed in the 
outpatient department increased by 50 percent, whereas the number of CT 
procedures that included a scan without contrast followed by a scan 
with contrast to complete each full study increased by only about 1 
percent. The large annual increases in the OPPS frequencies of CTA 
procedures through CY 2005 provide no evidence that Medicare 
beneficiaries are experiencing difficulty accessing these services in 
the hospital outpatient setting. CTA procedures are being more commonly 
performed for various clinical indications, likely resulting in more 
consistent and efficient use of the associated image postprocessing 
technology. Accordingly, it is not surprising that the hospital costs 
of typical CTA procedures in contemporary medical practice are very 
similar to the hospital costs of the more involved and resource-
intensive complex CT services that, like CTA procedures, include scans 
without contrast material, followed by scans with contrast. Thus, we 
believe that our CY 2007 proposed payment rates for CT and CTA 
procedures are generally consistent with one another and accurately 
reflective of hospitals' resource costs.
    With respect to the APC Panel's recommendation regarding the 
reporting of costs and charges for radiology services, CMS requires 
hospitals to report their costs and charges through the cost report 
with sufficient specificity to support CMS' use of cost report data for 
monitoring and payment. Within generally accepted principles of cost 
accounting, we allow providers flexibility to accommodate the unique 
attributes of each institution's accounting systems. For example, 
providers must match the generally intended meaning of the line-item 
cost centers, both standard and nonstandard, to the unique 
configuration of department and service categories used by each 
hospital's accounting system. Also, while the cost report provides 
recommended bases of allocation for the general services cost centers, 
a provider is permitted, within specified guidelines, to use an 
alternative basis for a general service cost if it can justify to its 
fiscal intermediary that the alternative is more accurate than the 
recommended basis. This approach creates internal consistency between a 
hospital's accounting system and the cost report, but cannot guarantee 
the precise comparability of costs and charges for individual cost 
centers across institutions.
    However, we believe that achieving greater uniformity by, for 
example, specifying the exact components of individual cost centers, 
would be very burdensome for hospitals and auditors. Hospitals would 
need to tailor their internal accounting systems to reflect a national 
definition of a cost center. It is not clear that the marginal 
improvement in precision created by such a requirement would justify 
the additional administrative burden. The current hospital practice of 
matching costs to the general intended meaning of a cost center ensures 
that most services in the cost center will be comparable across 
providers, even if the precise composition of a cost center among 
hospitals differs. Further, every hospital provides a different mix of 
services. Even if CMS specified the components of each cost center, 
costs and charges on the cost report would continue to reflect each 
individual hospital's mix of services. At the same time, internal 
consistency is very important to the OPPS. Costs are estimated on 
claims by matching cost-to-charge ratios for a given hospital to their 
own claims data through a cost center-to-revenue code crosswalk. OPPS 
relative weights are based on the median cost for all services in an 
APC. The components resulting in CCRs for a given revenue code would 
have to be dramatically different for the providers contributing the 
majority of claims used to calculate an APC's median cost in order to 
impact relative weights.
    We are accepting the APC Panel's recommendation and specifically 
inviting comments on ways that hospitals can uniformly and consistently 
report charges and costs related to all cost centers, not just 
radiology, that also acknowledge the ubiquitous tradeoff between 
greater precision in developing CCRs and administrative burden 
associated with reduced flexibility in hospital accounting practices.

IV. Proposed OPPS Payment Changes for Devices

A. Proposed Treatment of 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.)
1. Background
    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 
costs 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

[[Page 49569]]

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 50/50 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. We 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.
    In the CY 2006 OPPS, which was based on CY 2004 claims data, we set 
the median costs for device-dependent APCs for CY 2006 at the highest 
of: (1) The median cost of all single bills; (2) the median cost 
calculated using only claims that contained pertinent device codes and 
for which the device cost is greater than $1; or (3) 90 percent of the 
payment median that was used to set the CY 2005 payment rates. We set 
90 percent of the CY 2005 payment median as a floor rather than 85 
percent as proposed, in consideration of public comments that stated 
that a 15-percent reduction from the CY 2005 payment median was too 
large of a transitional step. We noted in our CY 2006 proposed rule 
that we viewed our proposed 85-percent payment adjustment 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 (70 FR 42714). We also incorporated, as part of 
our CY 2006 methodology, the recommendation to base payment on medians 
that were calculated using only claims that passed the device edits. As 
stated in the CY 2006 OPPS final rule with comment period (70 FR 
68620), we believed that this policy provided a reasonable transition 
to full use of claims data in CY 2007, which would include device 
coding and device editing, while better moderating the amount of 
decline from the CY 2005 OPPS payment rates.
2. Proposed CY 2007 Payment Policy
    For CY 2007, we are proposing to base the device-dependent APC 
medians on CY 2005 claims, the most current data available. As stated 
earlier, in CY 2005 we reinstated the use of device codes and made the 
reporting of device codes mandatory where an appropriate code exists to 
describe a device utilized. In CY 2005, we 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 
implemented the first set of device edits on April 1, 2005, for those 
APCs for which the CY 2005 payment rate was based on an adjusted median 
cost. We continued to take public comment on the remaining device edits 
after April 1, 2005, and implemented device edits for the remaining 
device-dependent APCs on October 1, 2005. Subsequent to the 
implementation of the device edits, we received public comments that 
caused us to remove the requirement for edits for several APCs on the 
basis that the services in them do not always require the use of a 
device or there may be no suitable device codes available for reporting 
all devices that may be used to perform the procedures.
    For example, we removed the requirement for device codes for APC 
0080 (Diagnostic Cardiac Catheterization) based on the information 
provided by hospitals that the codes assigned to this APC do not always 
require a device for which there is an appropriate HCPCS code. 
Therefore, we no longer consider this APC to be device dependent and 
have removed it from the list of device-dependent APCs. In the case of 
some procedures assigned to other device-dependent APCs, where we 
determined that no device was required to provide a particular service 
or where there were no HCPCS codes that described all devices that 
could be used to furnish the service, we removed the requirement for a 
device code for the individual procedure code but retained the device 
requirement for other procedure codes assigned to that device-dependent 
APC.
    In its February 2005 meeting, the APC Panel recommended that we 
consider calculating the median costs for APCs 0107 (Insertion of 
Cardioverter Defibrillator) and 0108 (Insertion/Replacement/Repair of 
Cardioverter-Defibrillator Leads) by bypassing the line-item costs of 
CPT code 33241 (Subcutaneous removal of single or dual chamber pacing 
cardioverter-defibrillator pulse generator) and packaging the line 
item-costs of CPT codes 93640 (Electrophysiological evaluation of 
single or dual chamber pacing cardioverter-defibrillator leads 
including defibrillation threshold evaluation (induction of arrhythmia, 
evaluation of sensing and pacing for arrhythmia termination) at time of 
initial implantation or replacement) and 93641 (Electrophysiological 
evaluation of single or dual chamber pacing cardioverter-defibrillator 
leads including defibrillation threshold evaluation (induction of 
arrhythmia, evaluation of sensing and pacing for arrhythmia 
termination) at time of initial implantation or replacement; with 
testing of single or dual chamber pacing cardioverter-defibrillator) 
when these codes, separately or in combination, are reported on the 
same claim with HCPCS codes G0297 (Insertion of single chamber pacing 
cardioverter defibrillator pulse generator), G0298 (Insertion of dual 
chamber pacing cardioverter defibrillator pulse generator), G0299 
(Insertion or repositioning of electrode lead for single chamber pacing 
cardioverter defibrillator and insertion of pulse generator) and G0300 
(Insertion or repositioning of electrode lead(s) for dual chamber 
pacing cardioverter defibrillator and insertion of pulse generator), 
which are assigned to APCs 0107 and 0108. The APC Panel recommended 
bypassing the line-item costs for CPT code 33241 because members 
believed that when a pacing cardioverter-defibrillator (ICD) pulse 
generator removal is performed in the same operative session as the 
insertion of a new pulse generator described by a procedure code 
assigned to APC 0107 or 0108, the packaging on the claim is 
appropriately assigned to the procedure code in APC 0107 or 0108. 
Moreover, CPT codes 93640 and 93641 may only be correctly coded when 
the electrophysiologic evaluation of ICD leads is performed at the time 
of initial implantation or replacement of an ICD

[[Page 49570]]

pulse generator and/or leads, with or without testing of the pulse 
generator. Thus, the APC Panel expected that the costs of the 
evaluations of the ICD leads (CPT codes 93640 and 93641) could be 
appropriately packaged with the procedure codes that describe the 
insertion of ICD generators, which are assigned to APCs 0107 and 0108, 
or the insertion of ICD leads assigned to APCs 0106 (Insertion/
Replacement/Repair of Pacemaker and/or Electrodes), 0108, and 0418 
(Insertion of Left Ventricular Pacing Elect). Because APCs 0107 and 
0108 have typically had very few single bills on which the medians have 
been based, and because the APC Panel indicated that it believed that 
we could use many more claims if we bypassed CPT code 33241 and 
packaged CPT codes 93640 and 93641, we calculated median costs for APCs 
0107 and 0108 using these rules. We excluded claims that did not meet 
the device edits, and we also excluded token claims.
    The effect of packaging CPT codes 93640 and 93641 into claims that 
both pass the device edits and also contain no token charges for 
devices are shown in Table 19 below. This affected APCs 0106, 0107, 
0108, and 0418. Bypassing the line-item cost of CPT code 33241 could 
not be done for all claims on which this CPT code was reported because 
there are clinical circumstances in which the ICD pulse generator is 
removed and no new device is implanted. Therefore, the APC assignment 
for CPT code 33241 and the payment for that code need to reflect the 
packaging associated with the procedure when it is performed alone. 
Because of this problem with assigning packaging in all the 
circumstances in which the procedure may be reported, we decided 
against proposing to bypass CPT code 33241, either in general for all 
procedures or selectively, when it is reported with the procedures in 
APCs 0107 and 0108.
    However, CPT codes 93640 and 93641 are always performed during an 
operative procedure for ICD initial implantation or replacement or with 
implantation, revision or replacement of leads, and, therefore, it 
would be appropriate to package them into the surgical procedure with 
which they are performed. Moreover, as a result of the descriptors of 
the lead evaluation CPT codes, they should never be billed as single 
procedure claims and packaging them would also resolve the problem of 
setting their payment rates in part on the basis of claims that reflect 
erroneous coding. Packaging the costs of the intraoperative 
electrophysiologic testing of the ICD leads yields many more single 
bills on which to set median costs and also increases the median costs 
for APCs 0106, 0107, 0108, and 0418. Therefore, we are proposing to 
package CPT codes 93640 and 93641 for CY 2007.
    We calculated the median cost for device-dependent APCs using two 
different sets of claims. We first calculated a median cost using all 
single procedure claims for the procedure codes in those APCs. We also 
calculated a second median cost using only claims that contain allowed 
device codes and also for which charges for all device codes were in 
excess of $1.00 (nontoken charge device claims). We excluded claims for 
which the charge for a device was less than $1.01, in part, to 
recognize hospital charging practices due to a recall of cardioverter 
defibrillator and pacemaker pulse generators in CY 2005 for which the 
manufacturers provided replacement devices without cost to the 
beneficiary or hospital. We also found that there are other devices for 
which the charge was less than $1.01, and we removed those claims also.
    As expected, the median costs calculated using all single procedure 
bills, including both bills that lack appropriate device codes (where 
there are edits) and bills with token charges for devices, are, in many 
cases, less than the medians calculated using only claims that contain 
appropriate device codes and that have no token charges for devices. In 
some cases the medians are significantly different when claims either 
without device codes or which have only token device charges are 
removed. We believe that the claims that reflect the best estimated 
costs for these APCs, including the costs of the devices, are those 
claims that contain appropriate devices and which also have no token 
charges for devices. (See section IV.A.4. below for our discussion of 
payments when the hospital incurs no cost for the principal device 
required for the service.)
    When we compare the proposed median costs calculated using only CY 
2005 claims that contain correct device codes and which do not contain 
token charges for devices to the unadjusted median costs that were 
derived from CY 2004 claims data, we find that the medians for only 2 
APCs decline (6.3 percent for APC 0061 (Laminectomy or Incision for 
Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve) 
and 2.78 percent for APC 0115 (Cannula/Access Device Procedures)). When 
we compared the proposed CY 2007 medians to the adjusted medians used 
to set the payment rates for CY 2006, only 6 APCs would decline more 
than 10 percent in median cost. This compares favorably to the data for 
the CY 2006 OPPS final rule with comment period in which 12 APCs 
declined more than 10 percent when the unadjusted median cost from the 
data for the CY 2006 OPPS final rule with comment period were compared 
to the adjusted median cost on which the CY 2005 OPPS payments were 
based. Some APC cost variation from year to year, whether increasing or 
decreasing, is to be expected.
    Therefore, we are proposing to base the payment rates for CY 2007 
for these device-dependent APCs on median costs calculated using claims 
with appropriate device codes and which have no token charges for 
devices reported on the claim. We do not believe that adjustment of 
these median costs is necessary to provide adequate payment for these 
services, and, therefore, we are not proposing to adjust the median 
costs for these APCs to moderate any decreases in medians from CY 2006 
to CY 2007. We recognize that, notwithstanding the device edits, it may 
continue to be necessary for purposes of median cost calculations to 
remove claims that do not contain devices because it is likely that 
there would be incidental occurrences of interrupted procedures in 
which a device is not used and does not appear on the claim. (The 
interrupted procedure modifier nullifies the device edit.) Moreover, 
there are likely to continue to be incidental occurrences of token 
charges for devices as a result of devices that are replaced without 
cost by the manufacturer. However, each of these circumstances could 
cause the procedure code median cost to underrepresent the cost of the 
complete procedure, including the device cost, where the hospital 
purchases the device.
    Hence, we believe that use of claims that meet the device edits and 
which do not contain token charges for devices are the appropriate 
claims to use to set the median costs for the device-dependent APCs, 
ensuring that the costs of the principal devices are included in the 
APC medians. In addition, we believe that, with our proposed changes to 
the OPPS packaging status of two codes for electrophysiologic 
evaluation of ICD leads, no special payment policies are needed to 
establish payment rates that correctly reflect the relative costs of 
these procedures to other procedures paid under the OPPS.

BILLING CODE 4120-01-P

[[Page 49571]]

[GRAPHIC] [TIFF OMITTED] TP23AU06.019


[[Page 49572]]


[GRAPHIC] [TIFF OMITTED] TP23AU06.020


[[Page 49573]]


[GRAPHIC] [TIFF OMITTED] TP23AU06.021

BILLING CODE 4120-01-C

                                      Table 19.--Effect of Packaging CPT Codes 93640 and 93641 on All Single Bills
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                            Proposed CY     Proposed CY     Proposed CY     Proposed CY
                                                                             Post cost      2007 single     2007 single     2007 single     2007 single
                APC                       SI           APC group title         total      bill frequency    bill median   bill frequency    bill median
                                                                             frequency      93640/93641     93640/93641     93640/93641     93640/93641
                                                                                           not packaged    not packaged      packaged        packaged
--------------------------------------------------------------------------------------------------------------------------------------------------------
0106..............................         T        Insertion/                      3819             457       $2,459.08             494       $2,549.70
                                                     Replacement/Repair
                                                     of Pacemaker and/or
                                                     Electrodes.
0107..............................         T        Insertion of                   16276             481        9,669.32             886       11,215.82
                                                     Cardioverter-
                                                     Defibrillator.
0108..............................         T        Insertion/                      9075             929       18,030.96            2950       22,362.68
                                                     Replacement/Repair
                                                     of Cardioverter-
                                                     Defibrillator Leads.
0418..............................         T        Insertion of Left               4824             142        5,098.03             225        9,696.51
                                                     Ventricular Pacing
                                                     Elect.
--------------------------------------------------------------------------------------------------------------------------------------------------------

3. Devices Billed in the Absence of an Appropriate Procedure Code
    In the course of examining claims data for creation of the payment 
rates for this proposed rule, we identified circumstances in which 
hospitals billed a device code but failed to also bill any procedure 
code with which the device could be used correctly. These errors in 
billing lead to the costs of the device being packaged with an 
incorrect procedure code and also cause the hospital to be paid 
incorrectly for the service furnished if the device was appropriately 
reported. We discussed the billing of devices with incorrect procedure 
codes with the APC Panel at its March 2006 meeting, and the APC Panel 
recommended that we explore the extent to which it would be appropriate 
to establish edits for HCPCS device codes to ensure that hospitals also 
bill procedures in which the devices would be used on the same claim.
    We examined our CY 2005 claims data and found that incorrect 
billing occurs more often with some devices than with others. We are 
taking this opportunity to inform the public that we expect to 
implement device to procedure code edits for the specified devices and 
their associated procedures, which we believe must be reported on a 
claim with the specified device for the claim to be correctly coded and 
the device costs properly attributed to procedures with which they are 
used. The devices for which we expect to implement edits are shown 
below in Table 20 and are posted on the CMS outpatient hospital Web 
site, along with our initial draft of all the procedures with which 
they could be appropriately used and thus reported. We believe the 
establishment of claims edits reflects merely operational and 
administrative practice. However, as the public may assist in 
establishing appropriate edits, we, therefore, are asking that comments 
regarding the specific associations of device codes and procedure codes 
be provided to the following e-mail address: [email protected]. 
This is the same e-mail address to which comments on the existing 
procedure to device edits should be directed.
    Comments submitted on this issue to this mail box are not comments 
on this proposed rule and we will not respond to them in the CY 2007 
OPPS final rule.

 Table 20.--Devices Which Must Be Billed With Associated Procedure Codes
------------------------------------------------------------------------
                  Device                             Description
------------------------------------------------------------------------
C1721.....................................  AICD, dual chamber.
C1722.....................................  AICD, single chamber.
C1767.....................................  Generator, neuro non-
                                             recharg.
C1777.....................................  Lead, AICD, endo single
                                             coil.
C1778.....................................  Lead, neurostimulator.

[[Page 49574]]

 
C1779.....................................  Lead, pmkr, transvenous VDD.
C1785.....................................  Pmkr, dual, rate-resp.
C1786.....................................  Pmkr, single, rate-resp.
C1820.....................................  Generator, neuro rechg bat
                                             sys.
C1882.....................................  AICD, other than sing/dual.
C1895.....................................  Lead, AICD, endo dual coil.
C1896.....................................  Lead, AICD, non sing/dual.
C1897.....................................  Lead, neurostim test kit.
C1898.....................................  Lead, pmkr, other than
                                             trans.
C1899.....................................  Lead, pmkr/AICD combination.
C1900.....................................  Lead, coronary venous.
C2619.....................................  Pmkr, dual, non rate-resp.
C2620.....................................  Pmkr, single, non rate-resp.
C2621.....................................  Pmkr, other than sing/dual.
------------------------------------------------------------------------

4. Proposed Payment Policy When Devices are Replaced Without Cost or 
Where Credit for a Replaced Device Is Furnished to the Hospital
    As we discuss above in the context of the calculation of median 
costs for ICDs and pacemakers, in recent years there have been several 
field actions and recalls with regard to failure of these devices. In 
many of these cases, the manufacturers have offered replacement devices 
without cost to the hospital or credit for the device being replaced if 
the patient required a more expensive device. In some circumstances 
manufacturers have also offered, through a warranty package, to pay 
specified amounts for unreimbursed expenses to persons who had 
replacement devices implanted. In addition, we believe that incidental 
device failures that are covered by manufacturer warranties occur 
routinely. While we understand that some device malfunctions may be 
inevitable as medical technology grows increasingly sophisticated, we 
believe that early recognition of problems would reduce the number of 
people with the potential to be adversely affected by these device 
problems. The medical community needs heightened and early awareness of 
patterns of device failures, voluntary field actions, and recalls so 
that they can take appropriate action to care for our beneficiaries. 
Systematic efforts must be undertaken by all interested and involved 
parties, including manufacturers, insurers, and the medical community, 
to ensure that device problems are recognized and addressed as early as 
possible so that people's health is protected and high quality medical 
care is provided. We are taking several steps to assist in the early 
recognition and analysis of patterns of device problems to minimize the 
potential for harmful device-related effects on the health of Medicare 
beneficiaries and the public in general.
    In recent years, CMS has recognized the importance of data 
collection as a condition of Medicare coverage for selected services. 
In 2005, CMS issued a National Coverage Determination (NCD) that 
expanded coverage of ICDs and required registry participation when the 
devices were implanted for certain clinical indications. The NCD 
included this requirement in order to ensure that the care received by 
Medicare beneficiaries was reasonable and necessary and, therefore, 
appropriately reimbursed. Presently, the American College of 
Cardiology--National Cardiovascular Data Registry (ACC--NCDR) collects 
these data and maintains the registry.
    In addition to ensuring appropriate payment of claims, collection, 
and ongoing analysis of ICD implantation, data can speed public health 
action in the event of future device recalls. The systematic recording 
of device manufacturer and model number can enhance patient and 
provider notification. Analysis of registry data may uncover patterns 
in complication rates (for example, device malfunction, device-related 
infection, and early battery depletion) associated with particular 
devices that signify the need for a more specific investigation. 
Patterns found in registry data may identify problems earlier than the 
currently available mechanisms, which do not systematically collect 
such detailed information surrounding procedures.
    We encourage the medical community to work to develop additional 
registries for implantable devices, so that timely and comprehensive 
information is available regarding devices, recipients of those 
devices, and their health status and outcomes. While participation in 
an ICD registry is required as a condition of coverage for ICD 
implantation for certain clinical conditions, we believe that the 
potential benefits of registries extend well beyond their application 
in Medicare's specific national coverage determinations. As medical 
technology continues to swiftly advance, data collection regarding the 
short and long term outcomes of new technologies, and especially 
concerning implanted devices that may remain in the bodies of patients 
for their lifetimes, will be essential to the timely recognition of 
specific problems and patterns of complications. This information will 
facilitate early interventions to mitigate harm and improve the quality 
and efficiency of health care services.
    Moreover, data from registries may help further the development of 
high quality, evidence-based clinical practice guidelines for the care 
of patients who may receive device-intensive procedures. In turn, 
widespread use of evidence-based guidelines may reduce variation in 
medical practice, leading to improved personal and public health. 
Registry information may also contribute to the development of more 
comprehensive and refined quality metrics that may be used to 
systematically assess and then improve the safety and quality of health 
care. Such improvements in the quality of care that result in better 
personal health will require the sustained commitment of industry, 
payers, health care providers, and others towards that goal, along with 
excellent and open communication and rapid system-wide responses in a 
comprehensive effort to protect and enhance the health of the public. 
We look forward to further discussions with the public about new 
strategies to recognize device problems early and how to definitively 
address them, in order to minimize both the harmful health effects and 
increased health care costs that may result.
    In addition, we believe that the routine identification of Medicare 
claims where hospitals identify and then appropriately report selected 
services performed under the OPPS when devices are replaced without 
cost to the hospital or with full credit to the hospital for the cost 
of the replaced device, should provide comprehensive information 
regarding the outpatient hospital experiences of Medicare beneficiaries 
with certain devices that are being replaced. Because Medicare 
beneficiaries are common recipients of implanted devices, this claims 
information may be particularly helpful in identifying patterns of 
device problems early in their natural history so that appropriate 
strategies to reduce future problems may be developed.
    In addition to our concern for the public health, we also have a 
fiduciary responsibility to the Medicare trust fund to ensure that 
Medicare pays only for covered services. Therefore, we are proposing, 
effective for services furnished on or after January 1, 2007, to reduce 
the APC payment and beneficiary copayment for selected APCs in cases in 
which an implanted

[[Page 49575]]

device is replaced without cost to the hospital or with full credit for 
the removed device. Specifically, we are proposing to revise the 
existing regulations by adding new Sec.  419.45, Payment and copayment 
reduction for replaced devices. This regulation is intended to cover 
certain devices for which credit for the replaced device is given or 
which are replaced as a result of or pursuant to a warranty, field 
action, voluntary recall, involuntary recall, and certain devices which 
are provided free of charge. It would provide for a reduction in the 
APC payment rate when we determine that the device is replaced without 
cost to the provider or beneficiary or when the provider receives full 
credit for the cost of a replaced device. The amount of the reduction 
to the APC payment rate would be calculated in the same manner as the 
offset amount that would be applied if the implanted device assigned to 
the APC had pass-through status as defined under Sec.  419.66. The 
beneficiary's copayment amount would be calculated based on the reduced 
APC payment rate.
    We believe that this is appropriate because in these cases the full 
cost of the replaced device is not incurred and, therefore, we believe 
that an adjustment to the APC payment is necessary to remove the cost 
of the device. We believe that the averaging nature of the calculation 
of the amount of the adjustment causes it to be appropriately applied 
to cases of credit for the replaced device, regardless of whether there 
is a residual cost due to the implantation of a more expensive device.
    We also believe that the proposed adjustment is consistent with 
section 1862(a)(2) of the Act, which excludes from Medicare coverage an 
item or service for which neither the beneficiary nor anyone on his or 
her behalf has an obligation to pay. Payment of the full APC payment 
rate in these cases in which the device was replaced under warranty or 
in which there was a full credit for the price of the recalled or 
failed device effectively results in Medicare payment for a noncovered 
item. Moreover, it results in creation of a beneficiary liability for 
the copayment associated with the device for which the beneficiary has 
no liability. Therefore, we are proposing to adjust the APC payment 
rate in these circumstances under the authority of section 
1833(t)(2)(E) of the Act, which permits us to make equitable 
adjustments to the OPPS payment rates.
    We recognize that in many cases, the packaged cost of the device is 
a relatively modest part of the APC payment for the procedure into 
which the device cost is packaged. In the case of devices of modest 
cost, we believe that the averaging nature of payments under the OPPS 
based on the conversion of charges to costs with CCRs would incorporate 
any significant savings from a warranty replacement, field action, or 
recall into the payment rate for the associated procedural APC and that 
no specific adjustment would be necessary or appropriate. However, in 
other cases, such as implantation of an ICD, the cost of the device is 
the majority of the cost of the APC and payment at the full payment 
rate for the procedural APC would pay the hospital much in excess of 
its incurred cost of the service.
    As we discuss above, we are proposing to set the APC payment rates 
for device-dependent APCs for the CY 2007 OPPS using only claims that 
contain appropriate devices to ensure that we make appropriate full 
payment when the hospital initially incurs the full cost of the device. 
Beginning in CY 2005, we required that device codes be billed for 
devices used and specifically required that hospitals bill certain 
device codes for some services. We are using the CY 2005 claims to set 
the payment rates for the CY 2007 OPPS. Currently, where the device is 
furnished without cost to the hospital, we have authorized hospitals to 
charge less than $1.01, although Medicare's longstanding policy has 
been that, in these cases, providers may not charge for the device 
furnished to them without cost. (See the Medicare Internet Only Manual, 
Medicare Benefit Policy Manual, Publication 100-02 Chapter 16, section 
40.4.)
    We authorized this charge because the CMS device edits require that 
the hospital must report an appropriate device if they bill for certain 
codes that cannot be performed without a device or the claim will be 
returned. Moreover, the Fiscal Intermediary Standard System will not 
accept the claim unless there is a charge for each HCPCS code billed. 
In addition, we were seeking a means of identifying these recall cases 
in the data. Therefore, by authorizing hospitals to charge less than 
$1.01 for the device we enabled the claim to be paid and also provided 
a mechanism for identifying devices for which the hospital incurred no 
expense.
    Where we set the payment rates for these device-dependent APCs 
using only claims that contain the full costs of devices when they are 
purchased by hospitals and exclude claims for which there is no 
appropriate device code or a charge for the device of less than $1.01, 
the proposed APC payments into which the full costs of the devices have 
been packaged would result in excessive program payments and 
beneficiary copayments for the services being furnished if the devices 
were provided without cost to hospitals. To avoid excessive payments in 
these circumstances, as noted previously we are proposing to adjust the 
APC payment rates when implanted devices have been replaced without 
cost to the hospital or beneficiary or where full credit for such a 
device has been given because the replacement device is of greater cost 
than the originally implanted device.
    We are proposing that the adjustment would be limited to the APCs 
listed in Table 21, but only when the purpose of the procedure is to 
replace a device that is reported by a HCPCS code in Table 22 which was 
furnished without cost or at full credit by the manufacturer. We are 
proposing that the following three criteria must each be met for an APC 
to be subject to the adjustment. We selected the APCs in Table 21 on 
the basis of these three criteria.
    The first criterion is that all procedures assigned to the selected 
APCs must require implantable devices that would be reported if device 
replacement procedures were performed. Therefore, the device being 
replaced must be necessary for the service to be furnished and without 
the devices, the services assigned to the APCs could not be performed. 
For services, and, therefore, their assigned APCs, where a device is 
not needed or where it may or may not be needed to perform a procedure, 
we do not believe that reducing the payment for the APCs would be 
appropriate because the charges for the devices are unlikely to be a 
significant factor in establishing the rates for the APCs.
    The second criterion is that the required devices must be 
surgically inserted or implanted devices that remain in the patient's 
body after the conclusion of the procedures, at least temporarily. We 
believe this is necessary to establish that the replacement device is a 
direct replacement for the device being removed. In cases of failures 
of devices that are surgically inserted or implanted but do not remain 
in the patient's body after the conclusion of procedures, we believe 
that it is highly likely that the replacement device is not 
specifically used to care for the patient on whom the original 
defective device was used and that, where a defective device of this 
type is used, there is no savings to the hospital. For example, if a 
vascular catheter fails during a procedure, we believe that the 
physician will probably

[[Page 49576]]

use another similar catheter to finish the procedure. In these cases 
the hospital would correctly charge for the catheter that was used, and 
there would be no savings to the hospital from that procedure. The 
hospital would likely charge for both the defective device and the 
device used to complete the procedure because both catheters were used 
to provide the full service. We believe that if a replacement catheter 
is furnished to the hospital under warranty from the manufacturer, it 
would be used at a much later date on a different patient, it would 
most likely be charged to that patient account, and it would be 
unlikely to be specifically identified as being furnished without cost 
to the hospital. In these cases, we expect that any cost savings from 
the replacement devices such as these (for example, catheters) that are 
furnished without cost would be incorporated into the median costs for 
the procedures in the normal course of the data process through 
application of the CCRs generated from the cost reports.
    The third criterion is that the offset percent for the APC (that 
is, the median cost of the APC without device costs divided by the 
median cost of the APC with devices) must be significant. For this 
purpose, we are defining a significant offset percent as exceeding 40 
percent. We believe that this percent is appropriate because our 
studies have shown that approximately 60 percent of the cost of OPPS 
services is wage-related, and that approximately 40 percent of the cost 
of OPPS services is not wage related. This is why we wage adjust 60 
percent of the APC payment rates for all APCs, including APCs for which 
a greater percentage of the APC payment is for the cost of a device.
    We believe that once the device share of an APC exceeds the 40 
percent we attribute to costs other than wage costs (for example, 
device costs, capital costs, plant costs, and supplies other than 
devices), the device cost is a significant part of the APC cost. 
Therefore, where the device costs in an APC exceed 40 percent, which is 
the average of all types of nonwage-related costs across all APCs, we 
are proposing to define the device costs as ``significant'' for 
purposes of this proposed policy.
    We recognize that it may be appropriate to define ``significant'' 
for this purpose at a different percentage of the APC cost because 
there are costs other than device costs (for example, capital costs and 
other supply costs) in the 40 percent of service costs to which the 
wage adjustment does not apply. We would reassess for future years 
whether it is appropriate to define ``significant'' for this purpose at 
a level other than 40 percent.
    For purposes of making the proposed adjustment, we would adapt the 
methodology that we have employed to establish an offset for the device 
costs incorporated into APCs in cases where a pass-through device is 
also being billed. We currently calculate the offset amount by first 
calculating a median including the device costs and then calculating a 
median excluding device costs using single bills that contain devices. 
We then divide the ``without device'' median by the ``with device'' 
median and subtract the percent from 100 to acquire the percent of cost 
attributable to devices in the APC. We apply this percent to the 
payment rate of the APC to determine the offset amount. For example, 
this is the methodology we used to calculate the offset amount for APC 
0222 when current pass-through device C1820 (Generator, neuro rechg bat 
sys) is billed on the same claim. We believe that it is appropriate to 
apply this same methodology in circumstances when we need to remove the 
cost of the device from the APC payment, not because the device is 
being paid under pass-through but because the hospital is either not 
incurring the cost for the replaced device or has been given full 
credit for the replaced device. In both cases, the intent is to remove 
the cost of the device from the APC payment rate.
    Using this methodology, we calculated the proposed offset amounts 
in Table 21 by first calculating an APC median cost including device 
costs and then calculating a median cost excluding device costs, using 
only single bills that meet our device edits and do not have token 
charges for devices. We then divided the ``without device'' median cost 
by the ``with device'' median cost and subtracted the percent from 100 
to acquire the percent of cost attributable to devices in the APC. We 
next applied this percent to the payment rate for the APC to determine 
the offset amount.
    The following is an example of the payment reduction in the case of 
replacement of an ICD under warranty. Where the cardioverter 
defibrillator pulse generator described by HCPCS code C1721 (AICD, dual 
chamber) is replaced under warranty during a procedure described by 
HCPCS code G0298 (Insertion of dual chamber pacing cardioverter 
defibrillator pulse generator), the hospital would report HCPCS code 
G0298 with a specified modifier and would also report HCPCS code C1721 
with a token charge for the device. Assuming the hospital had a wage 
index of 1, the payment rate for APC 0107 after adjustment would be 
$1862.27. That is, the adjusted payment rate would equal the unadjusted 
payment rate for APC 0107 ($17,185.34) less the warranty reduction 
percentage in Table 21 of 89.13 percent ($15,317.29). Because the 
adjustment amount is set for the APC, the same adjustment amount would 
be removed if devices reported under HCPCS code C1722 or C1882 were 
reported with HCPCS code G0297. This is identical to the amount of 
adjustment that would apply to the payment for a pass-through device if 
there were, hypothetically, a new ICD to which we had given pass-
through status (no ICD currently has pass-through status).
    We are proposing to both adjust the APC payment to remove payment 
for the device furnished without cost to the hospital or beneficiary 
and also to decrease the beneficiary copayment in proportion to the 
reduced APC payment so that the beneficiary would, in many but not all 
cases, share in the cost savings attributable to the provision of the 
device without cost by the manufacturer. We are proposing that when a 
device is replaced without cost to the hospital under warranty or 
recall or a credit is provided for the cost of a failed or recalled 
device (unlike cases of offset for a pass-through device), the 
beneficiary's copayment would be calculated based on the reduced APC 
payment rate, maintaining the same percentage copayment as applies to 
the unadjusted APC payment if the inpatient deductible is not exceeded. 
We believe that it is appropriate to reduce the beneficiary copayment 
in these cases because the device is being furnished or credited by the 
manufacturer without obligation on the part of the beneficiary. We 
note, however, that in the case of some high cost APCs, making the 
payment adjustment in a recall or warranty situation may not result in 
reduction of the copayment because the copayment, although based on the 
reduced payment rate, may continue to exceed the inpatient deductible 
and, therefore, would continue to be set at the inpatient deductible.
    In contrast, in the case of pass-through devices, the beneficiary 
is liable for the copayment on the full APC amount (which, in the case 
of high cost APCs, is limited to the Medicare inpatient deductible) but 
pays no copayment for the incremental cost of the pass-through device. 
This is appropriate in the case of payment for pass-through devices 
because the hospital incurs costs for both the service and the device, 
and Medicare pays for both the service through the full APC

[[Page 49577]]

payment and for the incremental cost of the pass-through device above 
the costs of associated devices already reflected in the APC payment at 
charges reduced to cost by a CCR. The pass-through payment amount is 
reduced only to prevent the program from making duplicate payment for a 
portion of the device, once as part of the APC payment and once through 
the pass-through payment.
    We are proposing to implement the adjustment through the use of an 
appropriate modifier specific to a device replacement without cost or 
crediting of the cost of a device by the manufacturer. Hospitals would 
be required to report the modifier appended to a specific procedure on 
claims for services when two conditions are met. The first condition is 
that the procedure is assigned to one of the APCs in Table 21. We have 
discussed above the criteria that we employed for selecting the APCs in 
Table 21. The second condition is that the device for which the 
manufacturer furnished a replacement device (or provided credit for the 
device being replaced) is one of the devices included in Table 22. We 
are restricting the devices to which the adjustment would apply to 
those included in Table 22 in order to ensure that the adjustment is 
not triggered by the replacement of an inexpensive device whose cost 
does not constitute a significant proportion of the total payment rate 
for an APC.
    The presence of the modifier would trigger the adjustment in 
payment for the APCs in Table 21. While we recognize that this creates 
a reporting burden for hospitals, we believe the reporting requirement 
is unavoidable. Only hospitals can report whether the circumstances for 
reduced payment as described above are met and, therefore, we see no 
option other than to have hospitals report this information to us. We 
recognize that the current FB modifier (``Item furnished without cost 
to provider, supplier or practitioner'') may not be appropriate in 
cases in which the replacement device is a more expensive device than 
the device being removed and may need to be changed to expand its use 
for all potential APC payment adjustment scenarios.
    Our proposed policy would accomplish three important goals. First 
and foremost, it would advise us of the extent to which devices are 
being replaced due to device failures so that, if patterns are 
identified, we can explore them to see if there are systemic problems 
with certain devices. The reporting of a specific modifier with certain 
procedure codes would allow us to examine patterns of delivery of 
specific hospital services when implanted devices are replaced without 
cost or with full credit for the cost of a device by the manufacturer, 
in comparison with publicly available information about problematic 
devices. Analysis of outpatient hospital claims would serve as an 
additional source of information to the medical community about 
patterns of device failures, voluntary field actions, and recalls, 
contributing to improved awareness and understanding of problems.
    Secondly, it would ensure equitable adjustment to the payments for 
surgical procedures to replace problematic devices by providing 
payments to hospitals only for the nondevice related procedural costs 
when a device is replaced without cost to the hospital for the device 
or with full credit for the removed device. Thirdly, it would also 
identify those claims that contain reduced device charges due to the 
full credit provided by the manufacturer for a replaced device so that 
in the future we can assess the impact of these claims on median costs 
for the services into which the device costs are packaged.
    This proposed policy would be effective for services furnished on 
or after January 1, 2007. We believe that this proposed policy is 
necessary to enable us to secure claims data that may be used to 
identify trends in device problems that lead to device replacements. It 
is also necessary to fulfill our fiduciary responsibility to the 
Medicare program by not providing payments for items that are excluded 
from coverage under Medicare law because neither the beneficiary nor 
any party on his or her behalf has an obligation to pay.

  Table 21.--Proposed Adjustment to APCs in Cases of Replacement of or
                Full Credit for Failed or Recalled Device
------------------------------------------------------------------------
                                                               CY 2007
                                                               proposed
       APC               SI            APC group title          offset
                                                               percent
------------------------------------------------------------------------
0039.............  S              Level I Implantation of         78.51%
                                   Neurostimulator.
0040.............  S              Percutaneous Implantation       54.66%
                                   of Neurostimulator
                                   Electrodes, Excluding
                                   Cranial Nerve.
0061.............  S              Laminectomy or Incision         60.59%
                                   for Implantation of
                                   Neurostimulator
                                   Electrodes, Excludin.
0089.............  T              Insertion/Replacement of        77.14%
                                   Permanent Pacemaker and
                                   Electrodes.
0090.............  T              Insertion/Replacement of        74.56%
                                   Pacemaker Pulse
                                   Generator.
0106.............  T              Insertion/Replacement/          41.04%
                                   Repair of Pacemaker and/
                                   or Electrodes.
0107.............  T              Insertion of Cardioverter-      89.13%
                                   Defibrillator.
0108.............  T              Insertion/Replacement/          89.15%
                                   Repair of Cardioverter-
                                   Defibrillator Leads.
0222.............  T              Implantation of                 78.10%
                                   Neurological Device.
0225.............  S              Implantation of                 80.62%
                                   Neurostimulator
                                   Electrodes, Cranial
                                   Nerve.
0226.............  T              Implantation of Drug            62.21%
                                   Infusion Reservoir.
0227.............  T              Implantation of Drug            81.50%
                                   Infusion Device.
0229.............  T              Transcatherter Placement        42.32%
                                   of Intravascular Shunts.
0259.............  T              Level VI ENT Procedures..       84.03%
0315.............  T              Level II Implantation of        83.52%
                                   Neurostimulator.
0385.............  S              Level I Prosthetic              46.88%
                                   Urological Procedures.
0386.............  S              Level II Prosthetic             61.32%
                                   Urological Procedures.
0418.............  T              Insertion of Left               86.11%
                                   Ventricular Pacing Elect.
0654.............  T              Insertion/Replacement of        76.73%
                                   a permanent dual chamber
                                   pacemaker.
0655.............  T              Insertion/Replacement/          76.89%
                                   Conversion of a
                                   permanent dual chamber
                                   pacemaker.
0680.............  S              Insertion of Patient            77.03%
                                   Activated Event
                                   Recorders.
0681.............  T              Knee Arthroplasty........       73.26%
------------------------------------------------------------------------


[[Page 49578]]


Table 22.--Devices for Which the Proposed Modifier Must Be Reported With
 the Procedure Code When Furnished Without Cost or at Full Credit for a
                             Replaced Device
------------------------------------------------------------------------
              Device                             Description
------------------------------------------------------------------------
C1721.............................  AICD, dual chamber.
C1722.............................  AICD, single chamber.
C1764.............................  Event recorder, cardiac.
C1767.............................  Generator, neurostim, imp.
C1771.............................  Rep dev, urinary, w/sling.
C1772.............................  Infusion pump, programmable.
C1776.............................  Joint device (implantable).
C1777.............................  Lead, AICD, endo single coil.
C1778.............................  Lead, neurostimulator.
C1779.............................  Lead, pmkr, transvenous VDD.
C1785.............................  Pmkr, dual, rate-resp.
C1786.............................  Pmkr, single, rate-resp.
C1813.............................  Prosthesis, penile, inflatab.
C1815.............................  Pros, urinary sph, imp.
C1820.............................  Generator, neuro rechg bat sys.
C1882.............................  AICD, other than sing/dual.
C1891.............................  Infusion pump, non-prog, perm.
C1895.............................  Lead, AICD, endo dual coil.
C1896.............................  Lead, AICD, non sing/dual.
C1897.............................  Lead, neurostim, test kit.
C1898.............................  Lead, pmkr, other than trans.
C1899.............................  Lead, pmkr/AICD combination.
C1900.............................  Lead coronary venous.
C2619.............................  Pmkr, dual, non rate-resp.
C2620.............................  Pmkr, single, non rate-resp.
C2621.............................  Pmkr, other than sing/dual.
C2622.............................  Prosthesis, penile, non-inf.
C2626.............................  Infusion pump, non-prog, temp.
C2631.............................  Rep dev, urinary, w/o sling.
L8614.............................  Cochlear device/system.
------------------------------------------------------------------------

B. Proposed Pass-Through Payments for Devices

    (If you choose to comment on issues in this section, please include 
the caption ``Pass-Through Devices'' at the beginning of your comment.)
1. Expiration of Transitional Pass-Through Payments for Certain Devices
a. Background
    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. The 
device category codes became effective April 1, 2001, under the 
provisions of the BIPA. Prior to pass-through device categories, 
Medicare payments for pass-through devices under the OPPS were made on 
a brand-specific basis. All of the initial 97 category codes that were 
established as of April 1, 2001, have expired; 95 categories expired 
after CY 2002, and 2 categories expired after CY 2003. In addition, 
nine new categories have expired since their creation. We currently 
have no category codes for pass-through devices that will expire 
January 1, 2007. We created one new category effective January 1, 2006, 
for C1820 (Generator, neurostimulator (implantable), with rechargeable 
battery and charging system), which we are proposing to continue to pay 
under the pass-through provision in CY 2007 under the OPPS. This 
category was created after we published modifications to our criteria 
in the CY 2006 OPPS final rule with comment period on November 10, 2005 
(70 FR 68628 through 68631) allowing CMS to refine previous pass-
through category descriptions that would have prevented us from making 
pass-through payments for a new technology that otherwise met our 
criteria. These modifications amended the original criteria and process 
for creating additional device categories for pass-through payment that 
we published on November 2, 2001 (66 FR 55850 through 55857). Under our 
established policy, we base the expiration dates for the category codes 
on the date on which a category was first eligible for pass-through 
payment.
    In the November 1, 2002 OPPS 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 through CY 2006, 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 the 
claims data used to set the payment rates for those years. 
Brachytherapy sources, which are now separately paid in accordance with 
section 1833(t)(2)(H) of the Act, are an exception to this established 
policy (with the exception of brachytherapy sources for prostate 
brachytherapy, which were packaged in the CY 2003 OPPS only).
b. Proposed Policy for CY 2007
    As we stated earlier, currently we have one effective device 
category for pass-through payment, C1820, which we created for pass-
through payment effective January 1, 2006. We are proposing to continue 
to make payment under the pass-through provisions for category C1820 
for CY 2007. We are proposing that this category would expire from 
pass-through payment after December 31, 2007. This would provide the 
category transitional pass-through payment status for a 2-year period, 
in accordance with the statutory requirement that no category be paid 
as a pass-through device for less than 2 years, nor more than 3 years.
2. Provisions for Reducing Transitional Pass-Through Payments To Offset 
Costs Packaged Into APC Groups
a. Background
    In the November 30, 2001 OPPS 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 published for CY 2002 through CY 2004 was 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

[[Page 49579]]

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.
    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 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 amount to $0 for CY 2004. We continued this policy of 
setting the offset amount 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 were available 
for analysis. Hospitals billed device C-codes in CY 2004 on a voluntary 
basis. We reviewed our CY 2004 data and found that the numbers of 
claims for services in many of the APCs for which we calculated device 
percentages using CY 2004 data were quite small. We also found that 
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. In addition, we found that our claims 
demonstrated that relatively few hospitals specifically coded for 
devices utilized in CY 2004. Thus, we were not confident that CY 2004 
claims reporting C-codes represented the typical costs of all hospitals 
providing the services. Therefore, we did not use CY 2004 claims with 
device coding to calculate CY 2006 device offset amounts. In addition, 
we did not use the CY 2005 methodology, for which we utilized the 
device percentages as developed for CY 2004. Two years had passed since 
we developed the device offsets for CY 2004, and the device offsets 
originally calculated from CY 2002 hospitals' claims data may either 
have overestimated or underestimated the contributions of device costs 
to total procedural costs in the outpatient hospital environment of CY 
2004. In addition, a number of the APCs on the CY 2004 and CY 2005 
device offset percentage lists were either no longer in existence or 
were so significantly reconfigured that the past device offsets likely 
did not apply.
    For CY 2006, we reviewed the single new device category established 
thus far, C1820, to determine whether device costs associated with the 
new category are packaged into the existing APC structure. Under our 
established policy, if we determine that the device costs associated 
with the new category are closely identifiable to device costs packaged 
into existing APCs, we set the offset amount for the new category to an 
amount greater than $0. Our review of the service indicated that the 
median costs for the applicable APC 0222 (Implantation of Neurological 
Device) contained costs for neurostimulators similar to the costs of 
the new device category C1820. Therefore, we determined that a device 
offset would be appropriate. We announced an offset amount for that 
category in Program Transmittal No. 804, dated January 3, 2006.
    For CY 2006, we are using available partial 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 that utilize devices described by the 
existing C-codes. In addition, during CY 2005, we implemented device 
edits for many services that require devices and for which appropriate 
device C-codes exist. Therefore, we expected that the number of claims 
that include device codes and their respective costs to be much more 
robust and representative for CY 2005 than for CY 2004. We believe that 
use of the most current claims data to establish offset amounts when 
they are needed to ensure appropriate payment is consistent with our 
stated policy; therefore, we are proposing to continue to do so for the 
CY 2007 OPPS. Specifically, if we create a new device category for 
payment in CY 2007, to calculate potential offsets we are proposing to 
examine the most current available 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 use 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.
    We did not publish a list of APCs with device percentages as 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 stated in the CY 2006 final rule with 
comment period (70 FR 68628) that we expected to reexamine our previous 
methodology for calculating the device percentages and offset amounts 
for the CY 2007 OPPS update, which would be based on CY 2005 hospital 
claims data where device C-code reporting is required.
b. Proposed Policy for CY 2007
    For CY 2007, we are proposing to continue to review each new device 
category on a case-by-case basis as we have done in CY 2004, CY 2005, 
and CY 2006, to determine whether device costs associated with the new 
category are packaged into the existing APC structure. If we determine 
that, for any new device category, no device costs associated with the 
new category are packaged into existing APCs, we are proposing to 
continue our current policy of setting the offset amount for the new 
category to $0 for CY 2007. There is currently one new device category 
that would continue for pass-through payment in CY 2007. This category, 
described by HCPCS code C1820, currently has an offset amount of 
$8,647.81, which is applied to APC 0222. We are proposing to update 
this offset for CY 2007 based on the full year of claims data for CY 
2005, the claims data year for our CY 2007 rate update. We are 
proposing an offset amount for C1820 of 78.1 percent of the proposed CY 
2007 payment rate for APC 0222 based on the CY 2005 data used to 
calculate the proposed payment amount in this proposed rule. (See 
Addendum A of this proposed rule for a listing of the proposed CY 2007 
APC payment rates.)
    We are proposing to continue our existing policy to establish new

[[Page 49580]]

categories in any quarter when we determine that the criteria for 
granting pass-through status for a device category are met. If we 
create a new device category and determine that our data contain a 
sufficient number of claims with identifiable costs associated with the 
new category of devices in any APC, we are proposing to adjust the APC 
payment if the offset amount 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 amount in the 
program transmittal that announces the new category.
    In summary, for CY 2007, we are proposing to use CY 2005 hospital 
claims data to calculate device percentages and potential offsets for 
CY 2007 applications for new device categories. We are proposing to 
publish, through program transmittals, any new or updated offsets that 
we calculate for CY 2007, corresponding to newly created categories or 
existing categories, respectively.

V. Proposed OPPS Payment Changes for Drugs, Biologicals, and 
Radiopharmaceuticals

A. Proposed 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 Drugs'' 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 Medicare, Medicaid, 
and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 (Pub. L. 106-
113), this provision requires 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 sources 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 the 
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act 
BIPA of 2000 (Pub. L. 106-554), on December 21, 2000).
    Transitional pass-through payments are also required for certain 
``new'' drugs and biological agents that were not being paid for as a 
hospital outpatient department service as of December 31, 1996, and 
whose cost is ``not insignificant'' in relation to the OPPS payments 
for the procedures or services associated with the new drug 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 of this proposed rule, proposed CY 2007 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 2006 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 12 drugs and 
biologicals listed in Table 23, whose pass-through status will expire 
on December 31, 2006, meet that criterion. For all drugs and 
biologicals with pass-through status expiring on December 31, 2006, 
that are currently assigned temporary C-codes, if there is a permanent 
HCPCS code available for CY 2007 that describes the product, then we 
are proposing to delete the C-code and use the permanent HCPCS code for 
purposes of OPPS billing and payment for the product in CY 2007. Based 
on our review of the existing permanent HCPCS codes available at the 
time of this proposed rule, we have determined that HCPCS code J7344 
(Nonmetabolic active tissue) appropriately describes the product 
reported under HCPCS code C9221 in the CY 2006 OPPS; therefore, we 
propose to delete C9221 and pay for this product using J7344 in CY 
2007. The coding changes for the other products will depend on what the 
final HCPCS codes are for CY 2007, which will be included in the CY 
2007 OPPS final rule. We specifically request comments on this proposed 
policy for CY 2007.

Table 23.--Proposed List of Drugs and Biologicals for Which Pass-Through
                    Status Expires December 31, 2006
------------------------------------------------------------------------
        HCPCS                   APC                Short descriptor
------------------------------------------------------------------------
C9220................  9220.................  Sodium hyaluronate.
C9221................  9221.................  Graftjacket Reg Matrix.
C9222................  9222.................  Graftjacket Sft Tis.
J0128................  9216.................  Abarelix injection.
J0878................  9124.................  Daptomycin injection.
J2357................  9300.................  Omalizumab injection.
J2783................  0738.................  Rasburicase.
J2794................  9125.................  Risperidone, long acting.
J7518................  9219.................  Mycophenolic acid.
J9035................  9214.................  Bevacizumab injection.
J9055................  9215.................  Cetuximab injection.
J9305................  9213.................  Pemetrexed injection.
------------------------------------------------------------------------

3. Drugs and Biologicals With Proposed Pass-Through Status in CY 2007
    We are proposing to continue pass-through status in CY 2007 for 
nine drugs and biologicals. These items, which are listed in Table 24 
below, were given pass-through status as of April 1, 2006. The APCs and 
HCPCS codes for drugs and biologicals that we are proposing to continue 
with pass-through status in CY 2007 are assigned status indicator ``G'' 
in Addenda A and 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 1847B of the Act, the payment rate is equal to 
the average price for the drug or biological for all competitive 
acquisition areas and the year established as calculated and adjusted 
by the Secretary.
    Section 1847A 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. Section 1847B of the Act, as added by section 303(d) of 
Pub. L. 108-173, establishes the payment methodology for drugs and 
biologicals under the competitive acquisition program. The competitive 
acquisition program was implemented as of July 1, 2006. The list of 
drugs and biologicals covered under this program can be found on http://www.cms.hhs.gov/CompetitiveAcquisforBios, along with

[[Page 49581]]

their payment rates and information on the program's methodology.
    Section 1833(t)(6)(D)(i) of the Act sets the payment rate for pass-
through eligible drugs as the amount determined under section 1842(o) 
of the Act, or if a drug or biological is covered under a competitive 
acquisition contract under section 1847B of the Act, the payment rate 
is equal to the average price for the drug or biological for all 
competitive acquisition areas and the year established as calculated 
and adjusted by the Secretary. For CY 2007, under the OPPS we are 
proposing payment for drugs and biologicals with pass-through status 
that will also be covered under the competitive acquisition program to 
be based on the competitive acquisition program methodology. Similar to 
the payment policy established for pass-through drugs and biologicals 
in CY 2006, we are proposing to pay under the OPPS for all other drugs 
and biologicals with pass-through status in CY 2007 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.
    Table 24 lists the drugs and biologicals for which we are proposing 
that pass-through status continue in CY 2007. Of these nine drugs and 
biologicals, only HCPCS codes J2503 (Pegaptanib sodium injection) and 
J9264 (Paclitaxel injection) are covered under the competitive 
acquisition program at the time of the development of this proposed 
rule. Therefore, in CY 2007, we are proposing to set payment for HCPCS 
codes J2503 and J9264 at the amounts determined under the competitive 
acquisition program, which will be a rate slightly different than the 
rate determined under the ASP methodology. Payment for all other drugs 
and biologicals would be equivalent to the payment these drugs and 
biologicals would receive in the physician office setting in CY 2007, 
where payment will be determined by the methodology described in Sec.  
419.904 and generally be equal to ASP+6 percent. In accordance with the 
ASP methodology, in the absence of ASP data, we are continuing the 
policy we implemented during CYs 2005 and 2006 of using the wholesale 
acquisition cost (WAC) for the product to establish the initial payment 
rate. We note, however, that if the WAC is also unavailable, then we 
would make payment at 95 percent of the product's most recent AWP. We 
adopted this interim payment methodology in order to be consistent with 
how we pay for new drugs, biologicals, and radiopharmaceuticals without 
HCPCS codes, as discussed in the CY 2006 OPPS final rule with comment 
period (70 FR 68669). We further note that with respect to items for 
which we currently do not have ASP data, once their ASP data become 
available in later quarter submissions, their payment rates under OPPS 
will be adjusted so that the rates are based on the ASP methodology and 
set to ASP+6 percent.
    Currently, there are no radiopharmaceuticals that would have pass-
through status in CY 2007. In the event that a new radiopharmaceutical 
agent receives pass-through status in CY 2007, we propose to base its 
payment on the WAC for the product as ASP data for radiopharmaceuticals 
are not available. We note, however, that if the WAC is also 
unavailable, then we would calculate payment for the 
radiopharmaceutical at 95 percent of its most recent AWP. We are 
proposing to adopt this interim payment methodology in order to be 
consistent with how we pay for new drugs, biologicals, and 
radiopharmaceuticals without HCPCS codes, as discussed in the CY 2006 
OPPS final rule with comment period (70 FR 68669).
    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 (or under section 1847B of the Act, if the drug or biological is 
covered under a competitive acquisition contract), 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.
    We discuss in section V.B.3.b. of the preamble that we are 
proposing to make separate payment in CY 2007 for new drugs and 
biologicals with a HCPCS code, consistent with the provisions of 
section 1842(o) of the Act at a rate that is equivalent to the payment 
they would receive in a physician office setting (or under section 
1847B of the Act, if the drug or biological is covered under a 
competitive acquisition contract), whether or not we have received a 
pass-through application for the item. Accordingly, in CY 2007 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 (or section 1847B of the 
Act, if the drug or biological is covered under a competitive 
acquisition contract), 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 (or section 1847B of the Act, if the 
drug or biological is covered under a competitive acquisition 
contract), the resulting difference is equal to zero.
    We are proposing to use payment rates based on the ASP data from 
the fourth quarter of CY 2005 for budget neutrality estimates, impact 
analyses, and to complete Addenda A and B of this proposed rule because 
these are the most recent data available to us at this time. These 
payment rates are also the basis for drug payments in the physician 
office setting effective April 1, 2006. To be consistent with the ASP-
based payments that would be made when these drugs and biologicals are 
furnished in physician offices, we are proposing to make any 
appropriate adjustments to the amounts shown in Addenda A and B of this 
proposed rule when we publish our CY 2007 OPPS final rule and also on a 
quarterly basis on our Web site during CY 2007 if later quarter ASP 
submissions (or more recent WACs or AWPs) indicate that adjustments to 
the payment rates for these pass-through drugs and biologicals are 
necessary. The payment rate for a radiopharmaceutical with pass-through 
status would also be adjusted accordingly. We also are proposing to 
make appropriate adjustments to the payment rates for these drugs and 
biologicals in the event that they become covered under the competitive 
acquisition program in the future. For drugs and biologicals that are 
currently covered under the competitive acquisition program, we are 
proposing to use the payment rates calculated under this program that 
are in effect as of July 1, 2006. We are proposing to update these 
payment rates if the rates change in the future.
    Table 24 lists the drugs and biologicals for which we are proposing 
that pass-through status continue in CY 2007. We assigned pass-through 
status to these drugs and biologicals as of April 1, 2006. We also have 
included in Addenda A and B of this proposed rule, the proposed CY 2007 
APC payment rates for all pass-through drugs and biologicals, based on 
ASP data from the fourth quarter of CY 2005 (or if applicable, payment 
rates calculated under the competitive acquisition program) as 
described above.

[[Page 49582]]



   Table 24.--Proposed List of Drugs and Biologicals With Pass-Through
                            Status in CY 2007
------------------------------------------------------------------------
        HCPCS                   APC                Short descriptor
------------------------------------------------------------------------
C9225................  9225.................  Fluocinolone acetonide.
C9227................  9227.................  Injection, micafungin
                                               sodium.
C9228................  9228.................  Injection, tigecycline.
J2278................  1694.................  Ziconotide injection.
J2503................  1697.................  Pegaptanib sodium
                                               injection.
J8501................  0868.................  Oral aprepitant.
J9027................  1710.................  Clofarabine injection.
J9264................  1712.................  Paclitaxel injection.
Q4079................  9126.................  Natalizumab injection.
------------------------------------------------------------------------

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 ``OPPS: Nonpass-Through Drugs, Biologicals, and 
Radiopharmaceuticals'' at the beginning of your comment.)
1. Background
    Under the CY 2006 OPPS, we currently pay for drugs, biologicals, 
and radiopharmaceuticals that do not have pass-through status in one of 
two ways: packaged payment within the payment for the associated 
service or separate payment (individual APCs). We explained in the 
April 7, 2000 OPPS final rule with comment period (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 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)(2) 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. However, this requirement for establishing the packaging 
threshold will expire at the end of CY 2006. For CY 2006, we finalized 
our policy to continue paying separately for drugs, biologicals, and 
radiopharmaceuticals whose per day cost exceeds $50 and packaging the 
costs of drugs, biologicals, and radiopharmaceuticals whose per day 
cost is less than $50 into the procedures with which they are billed. 
For CY 2006, we also continued an exception policy to our packaging 
rule for one particular class of drugs, the oral and injectable 5HT3 
forms of anti-emetic treatments (70 FR 68635 through 68638).
2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and 
Radiopharmaceuticals
    During the March 2006 meeting of the APC Panel, the Panel 
recommended that CMS maintain the $50 packaging threshold or if the 
threshold is reevaluated, that CMS provide the Panel with data that 
indicate the costs of packaged drugs that are incorporated into drug 
administration payment rates.
    As indicated above, in accordance with section 1833(t)(16)(B) of 
the Act, the threshold for establishing separate APCs for drugs and 
biologicals was set to $50 per administration during CYs 2005 and 2006. 
Because this packaging threshold will expire at the end of CY 2006, we 
evaluated four options for packaging levels so that we could determine 
what the appropriate packaging threshold proposal for drugs, 
biologicals, and radiopharmaceuticals would be for the CY 2007 OPPS 
update.
    One of the packaging options we considered for the CY 2007 OPPS 
update was to pay separately for all drugs, biologicals, and 
radiopharmaceuticals with a HCPCS code. This would be a straightforward 
policy that would speed the creation of procedural APC medians. 
However, this policy would be inconsistent with OPPS packaging 
principles, reduce hospitals' incentives for economy and efficiency, 
and increase hospitals' administrative burden related to separate 
billing for more drugs, biologicals, and radiopharmaceuticals.
    The second option we considered for CY 2007 was to increase the 
packaging threshold to a level much higher than the current $50 
threshold. This option would result in the packaging of more drugs, 
biologicals, and radiopharmaceuticals and would be more consistent with 
OPPS packaging principles. This option would also provide greater 
administrative simplicity for hospitals. However, implementation of 
this option might result, in some cases, in the drug administration 
payments being less than the cost of the packaged drugs. Relatively 
expensive drugs, biologicals, and radiopharmaceuticals could also be 
packaged under this option.
    The third packaging threshold option we evaluated was to maintain 
the packaging threshold at $50. We believe that this is a reasonable 
policy option that would provide stability to the payment system, as 
the packaging threshold has been set at $50 since CY 2004. This policy 
option would also be consistent with the APC Panel recommendation to 
maintain the packaging threshold at $50 in CY 2007; however, this 
policy would not take into account price inflation in determining the 
drug packaging threshold since the $50 threshold was initially 
established.
    Consequently, the fourth option we considered and are proposing for 
CY 2007 and subsequent years is to update the packaging threshold for 
inflation using an inflation adjustment factor based on the Producer 
Price Index (PPI) for prescription preparations. In order to update the 
packaging threshold for CY 2007 under this proposal, we used the four 
quarter moving average PPI levels for prescription preparations to 
trend the $50 threshold forward from the third quarter of CY 2005 (when 
the Pub. L. 108-173-mandated threshold became effective) to the third 
quarter of CY 2007. We are proposing that for each year beginning with 
CY 2007, we would adjust the packaging threshold by the PPI for 
prescription drugs, and the adjusted dollar amount would be rounded to 
the nearest $5 increment in order to determine the new threshold. The 
adjusted amount for CY 2007 was calculated to be $55.99, which we are 
rounding to $55. Therefore, for CY 2007, we are proposing to pay 
separately for drugs, biologicals, and radiopharmaceuticals whose per 
day cost exceeds $55 and packaging the costs of drugs, biologicals, and 
radiopharmaceuticals whose per day cost is less than or equal to $55 
into the procedures with which they are billed.

[[Page 49583]]

    This proposed policy is consistent with the principle employed in 
many health care payment policy areas (and many other areas of 
government policy) of acknowledging the real costs by using an 
inflation adjustment instead of static dollar values. We believe that 
our proposed policy is consistent with the APC Panel's recommendation 
because we would be maintaining the $50 threshold in terms of its real 
value during the calendar year in which it would be in effect. Also, in 
the absence of a mechanism to update the threshold, we believe that 
current relatively inexpensive drugs would begin to receive separate 
payment over time. The PPI for prescription preparations reflects price 
changes at the wholesale or manufacturer stage. Because OPPS payment 
rates for drugs and biologicals are generally based on average sales 
price (ASP) data that are reported by their manufacturers, we believe 
that the PPI for prescription preparations would be an appropriate 
price index to use to update the packaging threshold for CY 2007 and 
beyond.
    For CY 2007, we are also proposing to continue our policy of 
exempting the oral and injectable 5HT3 anti-emetic products from our 
packaging rule (Table 25), thereby making separate payment for all of 
the 5HT3 anti-emetic products. As stated in the CY 2005 OPPS 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 Medicare 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 believe that we should 
continue to ensure that Medicare 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. We solicit comments on these packaging proposals.

 Table 25.--Proposed Anti-Emetics To Exempt From Proposed $55 Packaging
                               Requirement
------------------------------------------------------------------------
            HCPCS code                        Short description
------------------------------------------------------------------------
J1260.............................  Dolasetron mesylate.
J1626.............................  Granisetron HCl injection.
J2405.............................  Ondansetron HCl injection.
J2469.............................  Palonosetron HCl.
Q0166.............................  Granisetron HCl 1 mg oral.
Q0179.............................  Ondansetron HCl 8 mg oral.
Q0180.............................  Dolasetron mesylate oral.
------------------------------------------------------------------------

    To determine their CY 2007 proposed packaging status, we calculated 
the per day cost of all drugs, biologicals, and radiopharmaceuticals 
that had a HCPCS code in CY 2005 and were paid (via packaged or 
separate payment) under the OPPS using claims data from January 1, 
2005, to December 31, 2005. In CY 2005, 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. In order to calculate 
the per day cost for drugs, biologicals, and radiopharmaceuticals to 
determine their packaging status in CY 2007, we are proposing to use 
the methodology that was described in detail in the CY 2006 OPPS 
proposed rule (70 FR 42723 through 42724) and finalized in the CY 2006 
OPPS final rule with comment period (70 FR 68636 through 68638). 
However, in our calculation of per day costs for this proposed rule for 
the CY 2007 OPPS update, we used the payment rate for each drug and 
biological at its ASP+5 percent which was based on manufacturer-
submitted ASP data from the fourth quarter of CY 2005. The ASP data 
from this period were also the basis for determining payments for drugs 
and biologicals in the physician office setting, effective April 1, 
2006. The rationale for using ASP+5 percent as the payment for drugs 
and biologicals is described in section V.B.3.a.2. of this preamble. 
For items that did not have an ASP-based payment rate, we used their 
mean unit cost derived from the CY 2005 hospital claims data to 
determine their per day cost. We packaged the items with per day cost 
less than or equal to $55 and made items with per day cost greater than 
$55 separately payable. We are requesting comments on the methodology 
we are proposing to use to determine the per day cost of drugs, 
biologicals, and radiopharmaceuticals under the CY 2007 OPPS update.
    Our policy during previous cycles of the OPPS has been to use 
updated data for the final rules. For the CY 2007 OPPS final rule, we 
are proposing to use the ASP data from the first quarter of CY 2006, 
which would be the basis for calculating payment rates for drugs and 
biologicals in the physician office setting using the ASP methodology 
effective July 1, 2006, along with updated hospital claims data from CY 
2005 to determine the final per day costs of drugs, biologicals, and 
radiopharmaceuticals and their packaging status in CY 2007. 
Subsequently, payment rates for CY 2007 separately payable drugs and 
biologicals will be updated to reflect applicable ASP-based rates 
effective in the physician office setting for services effective 
January 1, 2007.
    Because, for the CY 2007 OPPS final rule, we are proposing to use 
ASP data from the first quarter of CY 2006, which would be the basis 
for calculating payment rates for drugs and biologicals in the 
physician office setting using the ASP methodology, effective July 1, 
2006, along with updated hospital claims data from CY 2005 to determine 
the final per day costs of drugs, biologicals, and 
radiopharmaceuticals, the packaging status of these items using the 
updated data may be different from their packaging status determined 
based on the data we are using for this proposed rule. Under such 
circumstances, we are proposing to apply the following policies to 
these drugs, biologicals, and radiopharmaceuticals whose relationship 
to the $55 threshold changes based on the final updated data:
     Drugs, biologicals, and radiopharmaceuticals that were 
paid separately in CY 2006 (which are proposed for separate payment in 
CY 2007), and then have per day costs less than $55 based on the 
updated ASPs and hospital claims data that would be used for the CY 
2007 final rule with comment period, would continue to receive separate 
payment in CY 2007.
     Drugs, biologicals, and radiopharmaceuticals that were 
packaged in CY 2006, (which are proposed for separate payment in CY 
2007), and then have per day costs less than $55 based on the updated 
ASPs and hospital claims data that would be used for the CY 2007 final 
rule with comment period, would remain packaged in CY 2007.
     Drugs, biologicals, and radiopharmaceuticals for which we 
propose packaged payment in CY 2007 but then have per day costs greater 
than $55 based on the updated ASPs and hospital claims data that would 
be used for the CY 2007 final rule with comment period, would receive 
separate payment in CY 2007.
    We are requesting specific comments on these proposed policies for 
CY 2007.

[[Page 49584]]

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 
Public Law 108-173, requires special classification of certain 
separately paid radiopharmaceuticals, 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)(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 and subsequent years be equal to 
the average acquisition cost for the drug for that year as determined 
by the Secretary subject to any adjustment for overhead costs and 
taking into account the hospital acquisition cost survey data collected 
by the Government Accountability Office (GAO) in CYs 2004 and 2005. If 
hospital acquisition cost data are not available, the law requires that 
payment be equal to payment rates established under the methodology 
described in section 1842(o), section 1847A, or section 1847B of the 
Act as calculated and adjusted by the Secretary as necessary.
    For CY 2006, we adopted a policy of paying for the acquisition and 
overhead costs of separately paid drugs and biologicals at a combined 
rate of ASP+6 percent. To calculate the ASP+6 percent payment rate, we 
evaluated the three data sources that were available to us for setting 
the CY 2006 payment rates for drugs and biologicals. As described in 
the CY 2006 OPPS final rule with comment period (70 FR 68639 through 
68644), these data sources were the GAO reported average purchase 
prices for 55 specified covered outpatient drug categories for the 
period July 1, 2003 to June 30, 2004 collected via a survey of 1,400 
acute care Medicare-certified hospitals; ASP data; and mean costs 
derived from CY 2004 hospital claims data used in developing the CY 
2006 final rule with comment period. For the CY 2006 final rule with 
comment period, we used ASP data from the second quarter of CY 2005, 
which were used to set payment rates for drugs and biologicals in the 
physician office setting effective October 1, 2005. We also used 
updated claims data, reflecting all of the hospital claims data from CY 
2004 and updated CCRs.
    In our data analysis for the CY 2006 OPPS final rule with comment 
period, we compared the payment rates for drugs and biologicals using 
data from all three sources described above. 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 costs 
from the claims data, the GAO mean purchase prices, and the ASP-based 
payment amounts (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 based on updated ASP and claims data 
were published in Table 24 of the CY 2006 OPPS final rule with comment 
period. For a full discussion of our reasons for using these data, 
refer to section V.B.3.a. of the CY 2006 OPPS final rule with comment 
period (70 FR 68639 through 68644).
    As noted in the CY 2006 OPPS final rule with comment period, 
findings from a MedPAC survey of hospital charging practices indicated 
that hospitals set charges for drugs, biologicals, and 
radiopharmaceuticals high enough to reflect their pharmacy handling 
costs as well as their acquisition costs. Therefore, we believe the 
MedPAC survey indicated that payment for drugs and biologicals and 
pharmacy overhead at a combined ASP+6 percent rate would serve as the 
best proxy for the combined acquisition and overhead costs of each of 
these products.
(2) Proposed Payment Policy for CY 2007
    The provision in section 1833(t)(14)(A)(iii) of the Act, as 
described above, continues to be applicable to determining payments for 
specified covered outpatient drugs for CY 2007. Similar to CY 2006, 
this provision requires that in CY 2007 payment for specified covered 
outpatient drugs be equal to the average acquisition cost for the drug 
for that year as determined by the Secretary subject to any adjustment 
for overhead costs and taking into account the hospital acquisition 
cost survey data collected by the Government Accountability Office 
(GAO) in CYs 2004 and 2005. If hospital acquisition cost data are not 
available, the law requires that payment be equal to payment rates 
established under the methodology described in section 1842(o), section 
1847A, or section 1847B of the Act as calculated and adjusted by the 
Secretary as necessary. Additionally, section 1833(t)(14)(E)(ii) 
authorizes the Secretary to adjust APC weights for specified covered 
outpatient drugs to take into account the MedPAC report relating to 
overhead and related expenses, such as pharmacy services and handling 
costs.
    For the CY 2007 proposed rule, we evaluated two data sources that 
we have available to us for setting the CY 2007 payment rates for drugs 
and biologicals. The first source of drug pricing information that we 
have is the ASP data from the fourth quarter of CY 2005, which were 
used to set payment rates for drugs and biologicals in the physician 
office setting effective April 1, 2006. We have ASP-based prices for 
approximately 500 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 ASP+6 percent, and 
payments for items with no reported ASP are based on wholesale 
acquisition cost (WAC).
    The second source of cost data that we have for drugs, biologicals, 
and radiopharmaceuticals are the mean and median costs derived from the 
CY 2005 hospital claims data. As section 1833(t)(14)(A)(iii) of the Act 
clearly specifies that payment for specified covered outpatient drugs 
in CY 2007 be equal to the ``average'' acquisition cost for the drug, 
we limited our analysis to the mean costs of drugs determined using the 
hospital claims data, instead of using median costs.

[[Page 49585]]

    In our data analysis, we compared the payment rates for drugs and 
biologicals using data from both sources described above. We estimated 
aggregate expenditures for all drugs and biologicals (excluding 
radiopharmaceuticals) that would be separately payable in CY 2007 using 
mean costs from the hospital claims data and the ASP-based payment 
amounts (ASP+6 percent in most cases), and calculated the equivalent 
average ASP-based payment rate under both payment methodologies.
    The results of our data analysis indicate that using mean unit cost 
to set the payment rates for the drugs and biologicals that would be 
separately payable in CY 2007 would be equivalent to basing their 
payment rates, on average, at ASP+5 percent. As noted in the CY 2006 
proposed and final rules, findings from a MedPAC survey of hospital 
charging practices indicated that hospitals set charges for drugs, 
biologicals, and radiopharmaceuticals high enough to reflect their 
pharmacy 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 related pharmacy overhead costs. Our 
calculations indicate 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+5 percent, on 
average. Because pharmacy overhead costs are already built into the 
charges for drugs, biologicals, and radiopharmaceuticals, our current 
data therefore indicate that payment for drugs and biologicals and 
pharmacy overhead at a combined ASP+5 percent rate would serve as the 
best proxy for the combined acquisition and overhead costs of each of 
these products. Therefore, for CY 2007, we are proposing a policy of 
paying for the acquisition and overhead costs of separately paid drugs 
and biologicals at a combined rate of ASP+5 percent.
    In its final report on the hospital acquisition cost survey of 
specified covered outpatient drugs titled ``Medicare Hospital 
Pharmaceuticals: Survey Shows Price Variation and Highlights Data 
Collection Lessons and Outpatient Rate-setting Challenges for CMS'', 
the GAO recommended that Secretary validate, on an occasional basis, 
manufacturers' reported drug ASPs as a measure of hospitals' 
acquisition costs using a survey of hospitals or other method that CMS 
determines to be similarly accurate and efficient. As we indicated in 
our written comments to the GAO on its draft report, we will continue 
to consider the best approach for setting payment rates for drugs and 
biologicals in light of this recommendation. We also indicated that we 
will continue to analyze the adequacy of ASP-based pricing in light of 
our hospital claims data, which for this CY 2007 OPPS proposed rule 
indicates that ASP+5 percent would be the best available proxy for 
hospitals' average acquisition and handling costs of drugs and 
biologicals in CY 2007.
    We note that ASP data are unavailable for some drugs and 
biologicals. For these few drugs and biologicals, we are proposing to 
use the mean costs from the CY 2005 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 calculated from 
CY 2005 hospital claims data. The payment rates for separately payable 
drugs and biologicals shown in Addenda A and B to this proposed rule 
represent payments for their acquisition and overhead costs.
    Our proposal uses payment rates based on ASP data from the fourth 
quarter of 2005 because these are the most recent numbers available to 
us at this time. To be consistent with the ASP data that would be used 
to determine payments for these drugs and biologicals when furnished in 
physician offices, we propose to make any appropriate adjustments to 
the amounts shown in Addenda A and B to this proposed rule for those 
items on a quarterly basis as more recent ASP data become available and 
post the payment rate changes on our Web site during each quarter of CY 
2007. 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.
    During the March 2006 meeting of the APC Panel, the Panel 
recommended that CMS examine pharmacy overhead costs issues and work 
with appropriate associations to study how to measure pharmacy overhead 
costs. The Panel also recommended that CMS solicit feedback on how 
pharmacy overhead costs should be reimbursed in the future.
    In response to the APC Panel recommendations, we will continue to 
work on issues related to pharmacy overhead costs and request comments 
on other proposals that we can consider when establishing a future 
pharmacy overhead cost methodology. In addition, we note that we 
routinely accept requests from interested organizations to discuss 
their views about OPPS payment policy issues. We will consider the 
input of any individual or organization to the extent allowed by 
Federal law, including the Administrative Procedure Act (APA) and the 
Federal Advisory Committee Act (FACA). We establish the OPPS rates 
through regulations. We are required to consider the timely comments of 
interested organizations, establish the payment policies for the 
forthcoming year, and respond to the timely comments of all public 
commenters in the final rule in which we establish the payments for the 
forthcoming year.
    We are specifically requesting public comments on our proposal to 
pay for acquisition and overhead costs of drugs and biologicals under 
the OPPS at ASP+5 percent and the adequacy of the payment rates to 
account for actual acquisition and overhead costs incurred by hospitals 
for these items.
    In its October 31, 2005 letter of comment on proposed 2006 SCOD 
rates titled ``Comments on Proposed 2006 SCOD Rates,'' the GAO 
recommended that to better approximate hospitals' acquisition costs of 
SCODs the Secretary reconsider the level of proposed payment rates for 
drug SCODs, in relation to survey data on average purchase price, the 
role of rebates in determining acquisition costs, and the desirability 
of setting payment rates for SCODs at average acquisition costs. In the 
CY 2006 OPPS proposed rule (70 FR 42726), we noted 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, we also 
indicated that using mean unit cost from the CY 2004 hospital claims 
data 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. Therefore, we had proposed 
to establish payment for drugs and biologicals and their overhead costs 
at a combined rate of ASP+8 percent, where ASP+6 percent represented 
the acquisition cost of these items and 2 percent of ASP was for their 
overhead costs. For the CY 2006 OPPS final rule with comment period, 
where more recent ASP data, updated CCRs, and updated CY 2004 hospital 
claims data were available, we found that the comparison between the 
GAO purchase price data and the ASP data indicated that the GAO data on 
average were equivalent to ASP+4 percent, and using mean unit cost from 
hospital claims to set the payment rates for the drugs and

[[Page 49586]]

biologicals that would be separately payable in CY 2006 would be 
equivalent to basing their payment rates, on average, at ASP+6 percent. 
Because pharmacy overhead costs are already built into the charges for 
drugs, biologicals, and radiopharmaceuticals, we noted in the CY 2006 
OPPS final rule with comment period that our claims data indicated that 
payment for drugs and biologicals and their pharmacy overhead at a 
combined ASP+6 percent rate served as the best proxy for the combined 
acquisition and overhead costs of each of these products. For the CY 
2007 proposed rule, as indicated earlier in the preamble, we compared 
the CY 2005 hospital claims data with more recent ASP data and 
determined that using mean unit cost to set payment rates for 
separately payable drugs and biologicals in CY 2007 would be equivalent 
to basing their payment rates, on average, at ASP+5 percent. This is 
the policy we are proposing for CY 2007, and we believe that this 
payment level would serve as the best proxy for the combined 
acquisition and overhead costs of separately payable drugs and 
biologicals in CY 2007.
    In the CY 2006 OPPS final rule with comment period (70 FR 68661), 
we indicated that we will be paying for blood clotting factors at ASP+6 
percent during CY 2006 under the OPPS and providing payment for the 
furnishing fee that is also a part of the payment for blood clotting 
factors furnished in physician offices under Medicare Part B. This 
furnishing fee will be updated each calendar year based on the consumer 
price index, and we will update the amount appropriately each year 
under the OPPS based upon the final amount noted in the Medicare 
Physician Fee Schedule final rule. In CY 2006, the furnishing fee is 
$0.146 per unit. For the CY 2007 OPPS, we are proposing to make payment 
for blood clotting factors at ASP+5 percent along with continuing 
payment for the furnishing fee using the updated amount for CY 2007. 
The proposed CY 2007 regulations establishing the ASP methodology and 
the furnishing fee for blood clotting factors under Medicare Part B can 
be found in the CY 2007 Medicare Physician Fee Schedule proposed rule. 
The updated furnishing fee amount for CY 2007 under the OPPS will be 
announced in the CY 2007 OPPS final rule.
(3) CY 2007 Proposed Payment Policy for Radiopharmaceuticals
    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. 
Consequently, we do not have ASP data for radiopharmaceuticals. 
However, the law also requires us to make payments for specified 
covered outpatient drugs, including radiopharmaceuticals, equal to the 
average acquisition cost for the drug as determined by the Secretary 
and subject to any adjustment for overhead costs. We expect hospitals' 
different purchasing and preparation and handling practices for 
radiopharmaceuticals to be reflected in their charges. Therefore, for 
CY 2006, we calculated per day costs of radiopharmaceuticals using mean 
unit costs from the CY 2004 hospital claims data to determine the 
items' packaging status similar to the drugs and biologicals with no 
ASP data. For CY 2006, we implemented a 1-year temporary policy to pay 
for separately payable radiopharmaceuticals based on the hospital's 
charge for each radiopharmaceutical adjusted to cost. We clearly stated 
in our CY 2006 OPPS final rule with comment period that we did not 
intend to maintain the CY 2006 methodology permanently (70 FR 68656) 
and that we would actively seek other methodologies for setting 
payments for radiopharmaceuticals in CY 2007.
    During the March 2006 meeting of the APC Panel, the Panel 
recommended that CMS work with stakeholders to continue to develop a 
methodology to pay for radiopharmaceuticals. We note that we routinely 
accept requests from interested organizations to discuss their views 
about OPPS payment policy issues. We will consider the input of any 
individual or organization to the extent allowed by Federal law, 
including the Administrative Procedure Act (APA) and the Federal 
Advisory Committee Act (FACA). We establish OPPS rates through 
regulations. We are required to consider the timely comments of 
interested organizations, establish the payment policies for the 
forthcoming year, and respond to the timely comments of all public 
commenters in the final rule in which we establish the payments for the 
forthcoming year. We have considered comments and information from 
interested organizations in developing these policy options for CY 
2007.
    Over this past year, despite reviews of the literature and numerous 
discussions with interested individuals and organizations from the 
radiopharmaceutical industry, we have received no specific suggestions 
from hospitals or industry regarding alternative prospective payment 
methodologies for radiopharmaceuticals that could be used in place of 
our CY 2006 cost-based payment methodology. However, in its final 
report on the hospital acquisition cost survey of specified covered 
outpatient drugs, titled `` Medicare Hospital Pharmaceuticals: Survey 
Shows Price Variations and Highlights Data Collection Lesson and 
Outpatient Rate-setting Challenges for CMS,'' the GAO acknowledged that 
the distinctive nature of radiopharmaceuticals as compared with other 
drugs poses special challenges for collecting and interpreting hospital 
cost data. They discussed the challenges of balancing accuracy and 
efficiency in obtaining price data on radiopharmaceutical specified 
covered outpatient drugs. They concluded that the best option available 
to CMS, in terms of accuracy and efficiency, is for the Secretary to 
collect and use ready-to-use unit-dose prices paid by hospitals when 
available as the data source for setting and updating Medicare payment 
rates for radiopharmaceutical specified covered outpatient drugs. As we 
indicated in our written comments to the GAO on its draft report, we 
remain uncertain about whether a survey to collect unit-dose 
acquisition costs would be conducted as a survey of hospitals or 
manufacturers. We are also concerned about the level of expense and 
administrative burden that would be placed on the party reporting such 
information, based on the GAO's experience in surveying hospitals 
regarding radiopharmaceutical acquisition costs. The survey approach 
could lead to a very inefficient methodology for establishing payment 
rates. We also note that in conducting a survey to obtain ready-to-use 
unit-dose prices for radiopharmaceuticals, we would be able to collect 
this information for only a small number of radiopharmaceuticals that 
are purchased in unit-dose forms by hospitals; however, we believe that 
it is important to apply a consistent payment methodology to determine 
payments for all separately payable radiopharmaceuticals. Even though 
we are not proposing to adopt the GAO's recommendation for CY 2007, we 
will continue to explore this recommendation for future updates of the 
OPPS.
    In developing the payment policy proposal for separately payable 
radiopharmaceuticals for the CY 2007 proposed rule, we considered 
several additional policy options. The first option we considered 
proposing was to package additional

[[Page 49587]]

radiopharmaceuticals, either through packaging payments for all 
radiopharmaceuticals with payments for the services with which they are 
billed or increasing the packaging threshold for radiopharmaceuticals 
from a cost of $55 per day to a higher amount. In contrast to other 
separately payable drugs where the administration of many drugs is 
reported with only a few drug administration HCPCS codes, only a small 
number of specific radiopharmaceuticals may be appropriately provided 
in the performance of each particular nuclear medicine procedure. 
Because the provision of nuclear medicine procedures always requires 
one or more radiopharmaceuticals, packaging more radiopharmaceuticals 
effectively results in some increases in the costs of the associated 
nuclear medicine procedures to reflect the greater packaging of the 
radiopharmaceuticals. The specific increased procedural costs observed 
are dependent upon the volumes and costs of various 
radiopharmaceuticals used in the procedures and thus reflect an average 
cost across clinical scenarios where providers may choose among several 
radiopharmaceuticals for the procedures. A policy to package additional 
radiopharmaceuticals would be very consistent with OPPS packaging 
principles and payment policies which generally provide appropriate 
payment for the average service and would provide greater 
administrative simplicity for hospitals. Because we believe that 
radiopharmaceutical handling costs are included in hospitals charges 
for the radiopharmaceuticals themselves, payments for the nuclear 
medicine procedures would include payments for the handling costs of 
the radiopharmaceuticals used under this option.
    In examining our claims data for CY 2005, we noted that significant 
numbers of claims for nuclear medicine procedures included no HCPCS 
codes for radiopharmaceuticals. While it is possible that hospitals 
used packaged radiopharmaceuticals in some studies and therefore chose 
not to report them separately, it is also possible that some hospitals 
may have included charges for the required radiopharmaceuticals in 
their charges for the nuclear medicine procedures themselves. Packaging 
additional radiopharmaceuticals would be consistent with the charging 
practices of some hospitals that already may not be separately 
reporting radiopharmaceuticals, even when those radiopharmaceuticals 
would receive separate payment under the OPPS. Were we to package 
additional radiopharmaceuticals under the OPPS, consistent with our 
packaging policies for implantable devices, we might need to establish 
edits to ensure that radiopharmaceutical charges were always included 
on claims for nuclear medicine procedures, as has been suggested to us 
by interested organizations.
    However, under a policy of increased packaging of 
radiopharmaceuticals, payments for certain nuclear medicine procedures 
could potentially be less than the costs of some of the packaged 
radiopharmaceuticals and relatively expensive and high volume 
radiopharmaceuticals could become packaged. In addition, our payment 
policy could discourage selection of the most clinically appropriate 
radiopharmaceutical for a particular nuclear medicine procedure, 
especially if that radiopharmaceutical were expensive and not commonly 
used so that its costs were not fully reflected in the payment for the 
nuclear medicine procedure. In addition, the statutory definition of a 
``specified covered outpatient drug'' for OPPS purposes that includes 
radiopharmaceutical agents appears more consistent with the treatment 
of radiopharmaceuticals like other drugs under the OPPS, at least when 
this is feasible. We solicit public comment on the merits of 
establishing a higher packaging threshold for radiopharmaceuticals, 
given their unique characteristics.
    The second option that we considered proposing was to continue the 
temporary CY 2006 methodology of paying for separately payable 
radiopharmaceuticals at charges reduced to cost, where payment would be 
determined using each hospital's overall CCR, and establishing our 
radiopharmaceutical packaging threshold at $55, as we are proposing for 
other drugs under the CY 2007 OPPS. This policy would provide stability 
to the payment methodology for radiopharmaceuticals from CY 2006 to CY 
2007. As we indicated for CY 2007, this payment methodology provides an 
acceptable proxy for the average acquisition of the radiopharmaceutical 
along with its handling cost.
    However, as also indicated previously, we stated in the CY 2006 
OPPS final rule with comment period that this payment policy was 
intended to be only a temporary policy, and that we would consider 
alternative methodologies to base radiopharmaceutical payments on for 
the CY 2007 OPPS update. We generally do not make payments under the 
OPPS for items and services at cost, particularly if we do not expect 
the costs of services to vary substantially and unpredictably over time 
and if we have hospital claims data available. Paying for 
radiopharmaceuticals at cost provides hospitals with no incentive to 
supply radiopharmaceuticals in the most efficient manner. In its 
comments on the CY 2006 OPPS proposed rule, the GAO expressed concern 
that this methodology would be likely to result in payments that exceed 
hospitals' acquisition costs for certain radiopharmaceuticals. 
Estimates of our CY 2006 payments for radiopharmaceuticals reveal 
variation from the 25th to 75th payment percentile of 2 to 9 fold, 
depending on the specific radiopharmaceutical. We do not believe that 
the radiopharmaceutical acquisition and handling costs for different 
hospitals to provide most radiopharmaceuticals should vary that 
greatly. In addition, using hospitals' overall CCRs to determine 
payments likely results in an overstatement of radiopharmaceutical 
costs, which are likely reported in several cost centers such as 
diagnostic radiology that have lower CCRs than hospitals' overall CCRs.
    The third option that we considered and are proposing for CY 2007 
is to establish prospective payment rates for separately payable 
radiopharmaceuticals using mean costs derived from the CY 2005 claims 
data, where the costs are determined using our standard methodology of 
applying hospital-specific departmental CCRs to radiopharmaceutical 
charges, defaulting to hospital-specific overall CCRs only if 
appropriate departmental CCRs are unavailable. This proposal 
establishes our packaging threshold for radiopharmaceuticals at $55, as 
for other drugs under the CY 2007 OPPS. We believe this option provides 
us with the most consistent, accurate, and efficient methodology for 
prospectively establishing payment rates for separately payable 
radiopharmaceuticals. This is our preferred payment proposal for 
radiopharmaceuticals because this methodology is consistent with how 
payment rates for other services are determined under the OPPS and 
provides for prospective payments that serve as appropriate proxies for 
the average acquisition costs of the radiopharmaceuticals along with 
their handling costs. The MedPAC has indicated that hospitals currently 
include the charge for radiopharmaceutical handling in their charge for 
the radiopharmaceutical. In addition, this approach provides an average 
payment to hospitals, consistent

[[Page 49588]]

with the statutory requirement that we pay the average acquisition 
cost, in comparison with our CY 2006 cost-based policy which paid each 
hospital differently for each claim based on the claim's charges and 
the hospital's overall CCR.
    We believe that this methodology would likely pay more accurately 
for radiopharmaceuticals, and provide incentives for their efficient 
acquisition and preparation. Also, as discussed earlier, MedPAC 
indicated that hospitals include charges for handling costs in their 
charge for radiopharmaceuticals; therefore, mean costs based on our 
claims data would represent both the acquisition and overhead costs of 
the separately payable radiopharmaceuticals. We believe that this 
payment policy could also be an appropriate long-term 
radiopharmaceutical payment policy that would allow us to consistently 
establish prospective OPPS payment rates for the acquisition and 
overhead costs of separately payable radiopharmaceuticals. Because we 
will be paying separately for radiopharmaceuticals with mean costs per 
day greater than $55, without additional radiopharmaceutical packaging 
for CY 2007, we see no reason to establish edits for the presence of 
radiopharmaceutical codes on claims for nuclear medicine procedures as, 
in many cases, payments for the procedures do not include payments for 
the radiopharmaceuticals used.
    Under each of the payment options for radiopharmaceuticals, we 
considered that beginning with CY 2007 and going forward we would 
update the packaging threshold for inflation using an inflation 
adjustment factor based on the Producer Price Index (PPI) for 
prescription preparations. As discussed elsewhere in the preamble, the 
adjusted amount for CY 2007 was determined to be $55.
    In its October 31, 2005 letter of comment on proposed 2006 SCOD 
rates titled ``Comments on Proposed 2006 SCOD Rates'', the GAO 
recommended that to better approximate hospitals' acquisition costs of 
SCODs that the Secretary reconsider the decision to base payment rates 
for radiopharmaceutical SCODs exclusively on estimated costs in light 
of the availability of data on actual prices paid for key 
radiopharmaceuticals. As we did not have ASPs for radiopharmaceuticals 
that best represent market prices, in the CY 2006 OPPS final rule with 
comment period, we finalized a temporary 1-year policy for CY 2006 to 
pay for radiopharmaceuticals that were separately payable in CY 2006 
based on the hospital's charge for each radiopharmaceutical agent 
adjusted to cost. We noted that MedPAC has indicated that hospitals 
currently include the charge for pharmacy overhead costs in their 
charge for the radiopharmaceutical. Therefore, we believed that paying 
for these items on the basis of charges converted to cost would be the 
best available proxy for the average acquisition cost of the 
radiopharmaceutical along with its handling cost in CY 2006. We did not 
use the GAO hospital purchase prices as the basis for setting payments 
because when we examined differences between the CY 2005 payment rates 
for these nine radiopharmaceuticals and their GAO mean purchase prices, 
we found that the GAO purchase prices were substantially lower for 
several of these agents. We indicated that our intent was to maintain 
consistency, whenever possible, between the payment rates for these 
agents from CY 2005 to CY 2006. For CY 2007, however, we considered 
several payment options for radiopharmaceuticals that we discussed 
above and are proposing to establish prospective payment rates for 
separately payable radiopharmaceuticals using mean costs derived from 
the CY 2005 claims data.
    We note that the National HCPCS Panel changed the codes and the 
descriptors of many of the radiopharmaceutical products effective 
January 1, 2006, in some cases moving from prior code descriptors based 
upon units of radioactivity to new descriptors based on study doses. 
The hospital claims data we used for our analysis are based on 
radiopharmaceutical HCPCS codes that were in effect during CY 2005. 
Because there were significant changes in HCPCS code descriptors for 
several radiopharmaceuticals from CY 2005 to CY 2006, implementation of 
the proposed payment methodology for radiopharmaceuticals requires us 
to crosswalk the cost data for these radiopharmaceuticals that are in 
terms of the CY 2005 codes to the updated CY 2006 codes that we expect 
to be in effect during CY 2007. The mean cost data per unit of many CY 
2005 codes can be directly crosswalked to the new CY 2006 codes because 
the products and units included in the code descriptors are essentially 
the same. However, there are several CY 2005 codes with descriptors 
specifying units of radioactivity that were changed to per study dose 
units in CY 2006. For these radiopharmaceuticals, we are proposing to 
calculate their per day costs based on the CY 2005 codes and use those 
per day costs as proxies for the per study dose costs of the CY 2006 
codes. We believe that patients would generally receive one study dose 
of these radiopharmaceuticals each day, and our CY 2005 claims data 
show that they were most commonly billed with specific nuclear medicine 
procedures that normally include a single radiopharmaceutical dose on a 
given day. Therefore, the per day costs of these radiopharmaceuticals 
calculated based on claims reporting the CY 2005 codes should be an 
appropriate basis for determining the payment rates for the CY 2006 
HCPCS codes.
    Out of the 39 radiopharmaceutical HCPCS codes that we are proposing 
to pay separately for in CY 2007, we are able to directly crosswalk the 
CY 2005 cost data to 31 of these codes. The descriptors for the 
remaining eight codes changed from per unit of radioactivity in CY 2005 
to new descriptors based on per study doses in CY 2006. Therefore, we 
are proposing to use the per day costs based on the CY 2005 claims data 
as proxies for the per study dose costs for this subset of 
radiopharmaceutical HCPCS codes to be reported in CY 2007.
    There are three cases where two CY 2005 HCPCS codes were mapped to 
one new CY 2006 code that will be reported in CY 2007. These three CY 
2006 HCPCS codes are A9550, A9553, and A9559. Because of the 
complicated nature of crosswalking the cost data for two predecessor 
HCPCS codes with different units in their descriptors to each of these 
new HCPCS codes, we are proposing to crosswalk the cost data only from 
the predecessor HCPCS codes with the most claims volume in CY 2005 to 
each of these three HCPCS codes to be reported for CY 2007.
    Table 26 below lists all of the CY 2007 separately payable 
radiopharmaceuticals and the predecessor HCPCS codes whose claims data 
were used to set the CY 2007 proposed payment rates and notes the 
crosswalk methodology used for the proposed rates.

BILLING CODE 4120-01-P

[[Page 49589]]

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[[Page 49591]]


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[[Page 49593]]


[GRAPHIC] [TIFF OMITTED] TP23AU06.026

BILLING CODE 4120-01-C
    We specifically request public comment on the radiopharmaceutical 
payment methodology that we are proposing for the CY 2007 OPPS update. 
We also seek public comment on the possibility of developing an 
alternative packaging threshold for radiopharmaceuticals to provide 
greater administrative simplicity for hospitals. Additionally, we 
request public comment on the crosswalk that we are proposing to use to 
determine the CY 2007 payment rates for separately payable 
radiopharmaceuticals.
    While payments for drugs, biologicals and radiopharmaceuticals are 
taken into account when calculating budget neutrality, we note that we 
are proposing to make payments for drugs, biologicals, and 
radiopharmaceuticals without scaling these payment amounts.

[[Page 49594]]

Section 1833(t)(14)(A)(iii)(I) requires that, beginning in CY 2006, we 
pay for a separately payable drug on the basis of ``the average 
acquisition cost of the drug.'' As we stated in the CY 2006 OPPS final 
rule with comment period (70 FR 42728), we believe that the best 
interpretation of the specific requirement that we pay for such drugs 
on the basis of average acquisition cost, is that these payments 
themselves should not be adjusted as part of meeting the statutory 
budget neutrality requirement. If we were to apply a budget neutrality 
scalar to these payments, we would no longer be paying the average 
acquisition cost, but rather an adjusted average acquisition cost, for 
separately payable drugs, biologicals, and radiopharmaceuticals. We 
believe that these amounts, without a budget neutrality scalar applied, 
are the best proxies we have for the aggregate average acquisition and 
pharmacy overhead and handling costs of drugs, biologicals, and 
radiopharmaceuticals.
b. Proposed CY 2007 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 CYs 2005 and 2006, we finalized the policy to pay separately 
for new drugs, biologicals, and radiopharmaceuticals with HCPCS codes, 
but which did not have pass-through status at a rate that was 
equivalent to the payment they received in the physician office 
setting, which was established in accordance with the ASP methodology. 
For CY 2007, we are proposing to continue payment for these new drugs 
and biologicals with HCPCS codes as of January 1, 2007, 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 2006 Medicare Physician Fee Schedule final rule, where payment would 
generally be equal to ASP+6 percent. In accordance with the ASP 
methodology, in the absence of ASP data, we are continuing the policy 
we implemented during CYs 2005 and 2006 of using the wholesale 
acquisition cost (WAC) for the product to establish the initial payment 
rate. We note, however, that if the WAC is also unavailable, we would 
make payment at 95 percent of the product's most recent AWP. We are 
proposing to adopt this interim payment methodology in order to be 
consistent with how we pay for new drugs, biologicals, and 
radiopharmaceuticals without HCPCS codes, as discussed in the CY 2006 
OPPS final rule with comment period (70 FR 68669). We further note that 
with respect to items for which we do not have ASP data, once their ASP 
data become available in later quarter submissions, their payment rates 
under OPPS will be adjusted so that the rates are based on the ASP 
methodology and set to ASP+6 percent. In the event that the drug or 
biological is covered under the competitive acquisition program, then 
we propose to pay for it at the payment rate calculated under this 
program consistent with the provisions in section 1847B of the Act. We 
propose to base payment for new radiopharmaceuticals with HCPCS codes 
as of January 1, 2007, but which do not have pass-through status, on 
the WACs for these products as ASP data for radiopharmaceuticals are 
not available. In addition, we note that if the WACs are also 
unavailable, then we would make payment for the radiopharmaceuticals at 
95 percent of their most recent AWPs. We are proposing to adopt this 
interim payment methodology in order to be consistent with how we pay 
for new drugs, biologicals, and radiopharmaceuticals without HCPCS 
codes, as discussed in the CY 2006 OPPS final rule with comment period 
(70 FR 68669). To be consistent with the ASP-based payments that would 
be made when the new drugs and biologicals are furnished in physician 
offices, we are proposing to make any appropriate adjustments to their 
payment amounts in the CY 2007 OPPS final rule and also on a quarterly 
basis on our Web site during CY 2007 if later quarter ASP submissions 
(or more recent WACs or AWPs) indicate that adjustments to the payment 
rates for these drugs and biologicals are necessary. The payment rates 
for new radiopharmaceuticals would also be adjusted accordingly. We are 
also proposing to make appropriate adjustments to the payment rates for 
new drugs and biologicals in the event that they become covered under 
the competitive acquisition program in the future.
    As discussed in the CY 2005 OPPS final rule with comment period (69 
FR 65797), and the CY 2006 OPPS final rule with comment period (70 FR 
68666), new drugs, biologicals, and radiopharmaceuticals may be 
expensive, and we are concerned that packaging these new items might 
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. The payment methodologies described 
above are the same as the methodologies that would be used to calculate 
the OPPS payment amount that pass-through drugs, biologicals, and 
radiopharmaceuticals would be paid in CY 2007. We refer readers to 
section V.A. of this preamble for a discussion of payment policies of 
pass-through drugs, biologicals, and radiopharmaceuticals under OPPS. 
Consequently, we are proposing to continue to treat new drugs, 
biologicals, and radiopharmaceuticals with newly established HCPCS 
codes the same, irrespective of whether pass-through status has been 
determined. We also are proposing to assign status indicator ``K'' to 
HCPCS codes for new drugs, biologicals, and radiopharmaceuticals for 
which we have not received a pass-through application. We specifically 
request comments on our proposed payment policies for new drugs, 
biologicals, and radiopharmaceuticals with HCPCS codes but which do not 
have pass-through status as of January 1, 2007. The new CY 2007 HCPCS 
codes for drugs, biologicals, and radiopharmaceuticals are not 
available at the time of the development of this proposed rule; 
however, they will be included in the CY 2007 OPPS final rule.
    There are several drugs, biologicals, and radiopharmaceuticals that 
were payable during CY 2005 or where HCPCS codes for products were 
created effective January 1, 2006, for which we do not have any CY 2005 
hospital claims data. In order to determine the packaging status of 
these items for CY 2007, we calculated an estimate of the per day cost 
of each of these items by multiplying the payment rate for each product 
based on ASP+5 percent similar to other separately payable nonpass-
through drugs and biologicals under the OPPS and, as determined using 
the ASP methodology as described in section V.B.3.a.2. of this 
preamble, by an estimated average number of units of each product that 
would typically be

[[Page 49595]]

furnished to a patient during one administration in the hospital 
outpatient setting. We are proposing to package items for which we 
estimate the per administration cost to be less than $55, which is the 
packaging threshold that we are proposing for drugs, biologicals, and 
radiopharmaceuticals in CY 2007, and pay separately for items with an 
estimated per administration cost greater than $55. We are proposing 
that the CY 2007 payment for separately payable items would be based on 
rates determined using the ASP methodology established in the physician 
office setting and set to ASP+5 percent, similar to other separately 
payable nonpass-through drugs and biologicals under the OPPS. In 
accordance with the ASP methodology used in the physician office 
setting, in the absence of ASP data, we would use the WAC for the 
product to establish the initial payment rate. We note, however, that 
if the WAC is also unavailable, then we would make payment at 95 
percent of the most recent AWP available. We note that for 
radiopharmaceutical agents that do not have any CY 2005 hospital claims 
data, we propose to determine their packaging status and, if the items 
are separately payable, then establish their payment rates using the 
WACs for the products because ASP data are not available for any 
radiopharmaceuticals. We also note that if the WACs are unavailable, 
then we would use payment at 95 percent of the most recent AWPs to 
determine their packaging status and payment rates. In order to 
determine the packaging status and payment rates for these drugs, 
biologicals, and radiopharmaceuticals in this proposed rule, we used 
ASP data from the fourth quarter of 2005 or the most recent WAC or AWP 
data available at this time, as appropriate.
    Table 27 below lists all of the items without available CY 2005 
claims data to which these policies would apply in CY 2007. There are 
three HCPCS codes for which we were not able to determine payment rates 
based on the ASP methodology. The HCPCS codes are 90393 (Vaccina ig, 
im), 90693 (Typhoid vaccine, akd, sc), and A9567 (Technitium TC-99m 
aerosol). Because we are unable to estimate the per administration cost 
of these items, we are proposing to package them in CY 2007. We are 
seeking comments on our proposed policies for determining the per 
administration cost of the drugs, biologicals, and radiopharmaceuticals 
that are payable under the OPPS, but do not have any CY 2005 claims 
data.

               Table 27.--Drugs, Biologicals, and Radiopharmaceuticals Without CY 2005 Claims Data
----------------------------------------------------------------------------------------------------------------
                                                                     Estimated average
                                                       ASP-based      number of  units
      HCPCS code               Description           payment rate           per            CY 2007 proposed SI
                                                                       administration
----------------------------------------------------------------------------------------------------------------
90714.................  Td vaccine no prsrv >/= 7            $18.09               1     N
                         im.
90727.................  Plague vaccine, im.......            150.00               1     K
A9535.................  Injection, methylene blue              2.87              10     N
J0132.................  Acetylcysteine injection.              1.86             210     K
J0200.................  Alatrofloxacin mesylate..             16.03               2.5   N
J0278.................  Amikacin sulfate                       1.33               5.25  N
                         injection.
J0288.................  Ampho b cholesteryl                   12.00              35     K
                         sulfate.
J0350.................  Injection anistreplase 30          2,265.46               1     K
                         u.
J0395.................  Arbutamine HCl injection.            160.00               1     K
J1452.................  Intraocular Fomivirsen na            210.00               1     K
J2425.................  Palifermin injection.....             11.37              84     K
J2805.................  Sincalide injection......             44.14               1     N
J2850.................  Inj secretin synthetic                20.31              14     K
                         human.
J3355.................  Urofollitropin, 75 iu....             48.84               2     K
J3471.................  Ovine, up to 999 USP                   0.11             150     N
                         units.
J3472.................  Ovine, 1000 USP units....            133.77               1     K
J7341.................  Non-human, metabolic                   1.64              50     K
                         tissue.
J8540.................  Oral dexamethasone.......              0.07              80     N
J9225.................  Histrelin implant........          2,019.82               1     K
Q9958.................  HOCM <= 149 mg/ml iodine,              0.06             100     N
                         1ml.
Q9959.................  HOCM 150-199mg/ml                      0.08             100     N
                         iodine,1ml.
Q9960.................  HOCM 200-249mg/ml                      0.09             100     N
                         iodine,1ml.
Q9961.................  HOCM 250-299mg/ml                      0.17             100     N
                         iodine,1ml.
Q9962.................  HOCM 300-349mg/ml                      0.14             100     N
                         iodine,1ml.
Q9963.................  HOCM 350-399mg/ml                      0.39             100     N
                         iodine,1ml.
Q9964.................  HOCM >= 400mg/ml iodine,               0.19             100     N
                         1ml.
----------------------------------------------------------------------------------------------------------------

VI. Proposed Estimate of OPPS Transitional Pass-Through Spending in CY 
2007 for Drugs, Biologicals, Radiopharmaceuticals, and Devices

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: 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 2004 and subsequent 
years, we specify the applicable percentage up to 2.0 percent.
    If we estimate before the beginning of the calendar year that the 
total amount of pass-through payments in that year would exceed the 
applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a 
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

[[Page 49596]]

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 2007 
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 2005 and CY 2006 and that would continue to be eligible for pass-
through payment in CY 2007. 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 2006 and would retain pass-through status 
in CY 2007, as well as items that would be newly eligible for pass-
through payment beginning in CY 2007.

B. Proposed Estimate of Pass-Through Spending for CY 2007

    We are proposing to set the applicable percentage cap at 2.0 
percent of the total OPPS projected payments for CY 2007. As we discuss 
in section IV.B. of this preamble, there is one device category 
receiving pass-through payment in CY 2006 that will continue for 
payment during CY 2007. Therefore, we estimate pass-through spending 
attributable to the first group of items described above to be $36.8 
million.
    To estimate CY 2007 pass-through spending for device categories in 
the second group, that is, items for which we have no direct claims 
data, we used the following approach: For additional device categories 
that are approved for pass-through status after July 1, 2006, but 
before January 1, 2007, 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 do not have 
any CY 2005 claims data upon which to base a spending estimate. We are 
proposing to project these data forward to CY 2007 using inflation and 
utilization factors based on total growth in OPPS services as projected 
by CMS' Office of the Actuary (OACT) to estimate CY 2007 pass-through 
spending for this group of device categories. We may use an alternate 
growth factor for any specific new device category based on our claims 
data or the device's clinical characteristics, or both. For device 
categories that become eligible for pass-through status in CY 2007, we 
are proposing to use the same methodology. We anticipate that any new 
categories for January 1, 2007, would be announced after the 
publication of this proposed rule, but before publication of the final 
rule with comment period. Therefore, the estimate of pass-through 
spending in the CY 2007 OPPS final rule with comment period would 
incorporate any pass-through spending for device categories made 
effective January 1, 2007, and during subsequent quarters of CY 2007.
    With respect to CY 2007 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 will equal zero. Therefore, our 
estimate of pass-through spending for drugs and biologicals with pass-
through status in CY 2007 equals zero.
    In the CY 2005 OPPS final rule with comment period (69 FR 65810), 
we indicated that we are accepting pass-through applications for new 
radiopharmaceuticals that are assigned a HCPCS code on or after January 
1, 2005. (Prior to this date, radiopharmaceuticals were not included in 
the category of drugs paid under the OPPS, and therefore, were not 
eligible for pass-through status.) We have no new radiopharmaceuticals 
that were added for pass-through payment in CY 2005 or to this point in 
CY 2006, and we currently have no information identifying new 
radiopharmaceuticals to which a HCPCS code might be assigned on or 
after January 1, 2007, for which pass-through payment status would be 
sought. We also have no data regarding payment for new 
radiopharmaceuticals with pass-through status under the methodology 
that we specified in the CY 2005 OPPS final rule with comment period. 
However, we do not believe that pass-through spending for new 
radiopharmaceuticals in CY 2007 will be significant enough to 
materially affect our estimate of total pass-through spending in CY 
2007. Therefore, we are not including radiopharmaceuticals in our 
estimate of pass-through spending for CY 2007. We discuss the 
methodology for determining the proposed CY 2007 payment amount for 
radiopharmaceuticals with pass-through status in section V.B.3.b. of 
this preamble.
    In accordance with the methodology described above, we estimate 
that total pass-through spending for both device categories that are 
continuing into CY 2007 and that first become eligible for pass-through 
status during CY 2007 would equal approximately $43.2 million, which 
represents 0.13 percent of total OPPS projected payments for CY 2007. 
This figure includes estimates for the current device category 
continuing into CY 2007, which equals $36.8 million, in addition to 
projections for categories that may become eligible after publication 
of this proposed rule but before the end of CY 2006, and for 
projections for new categories that may become eligible during CY 2007.

 Table 28.--Estimates for CY 2007 Transitional Pass-Through Spending for
         Current Pass-Through Categories Continuing Into CY 2007
------------------------------------------------------------------------
                                                              CY 2007
                          Existing pass-      CY 2007        estimated
    HCPCS         APC     through device     estimated     pass-through
                             category       utilization      payments
------------------------------------------------------------------------
C1820........  1820....  Generator,                4,568     $36,766,720
                          neurostimulato
                          r
                          (implantable),
                          with
                          rechargeable
                          battery and
                          charging
                          system.
------------------------------------------------------------------------

    Because we estimate pass-through spending in CY 2007 will not 
amount to 2.0 percent of total projected OPPS CY 2007 spending, we are 
proposing to return 1.87 percent of the pass-through pool to adjust the 
conversion factor, as we discuss in section II.C. of this preamble.

VII. Proposed Brachytherapy Source Payment Changes

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

A. Background

    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

[[Page 49597]]

reflect the number, isotope, and radioactive intensity of the devices 
of brachytherapy furnished, including separate groups for Palladium-103 
and Iodine-125 devices. In accordance with this provision, since CY 
2004 we have established four new brachytherapy source codes and 
descriptors.
    Section 1833(t)(16)(C) of the Act, as added by section 621(b)(1) of 
Pub. L. 108-173, established 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. The period of 
payment under this provision is for brachytherapy sources furnished 
from January 1, 2004, through December 31, 2006. Under section 
1833(t)(16)(C) of the Act, charges for the brachytherapy devices may 
not be used in determining any outlier payments under the OPPS for that 
period of payment. Consistent with our practice under the OPPS to 
exclude items paid at cost from budget neutrality consideration, these 
items have been excluded from budget neutrality for that time period as 
well.
    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 would 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. Since January 1, 2004, we have used status indicator ``H'' 
to denote nonpass-through brachytherapy sources paid on a cost basis, a 
policy that we finalized in the CY 2005 final rule with comment period 
(69 FR 65838).
    Furthermore, we adopted a standard policy for brachytherapy code 
descriptors, 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.
    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. 
The GAO's final report, published at the end of July 2006, was not 
available in time to review and discuss in this proposed rule. We plan 
to discuss the report's findings and recommendations in the CY 2007 
OPPS final rule with comment period.

B. Proposed Payments for Brachytherapy Sources in CY 2007

    As indicated above, the provision to pay for brachytherapy sources 
at charges reduced to cost expires after December 31, 2006, in 
accordance with section 1833(t)(16)(C) of the Act. However, under 
section 1833(t)(2)(H) of the Act, we are still required to create APC 
groupings that classify devices of brachytherapy separately from other 
services or groups of services in a manner reflecting the number, 
isotope, and radioactive intensity of the devices of brachytherapy 
furnished.
    We are proposing to pay separately for each of the sources listed 
in Table 29 below on a prospective basis for CY 2007, with payment 
rates to be determined using the CY 2005 claims-based median cost per 
source for each brachytherapy device. Consistent with our policy 
regarding APC payments made on a prospective basis, we are proposing 
that the cost of brachytherapy sources be subject to the outlier 
provisions of section 1833(t)(5) of the Act. As indicated in section 
II.A.2. of the preamble to this proposed rule, for CY 2007, we are 
proposing a specific payment rate for brachytherapy sources, which will 
be subject to scaling for budget neutrality.
    Table 29 includes a complete listing of the HCPCS codes, long 
descriptors, APC assignments, APC titles, and status indicators that we 
currently use for brachytherapy sources paid under the OPPS in CY 2006 
and that we are proposing to use for CY 2007. The brachytherapy sources 
and related information in Table 29 are the same sources and 
information as those listed in Table 28 of the OPPS CY 2006 final rule 
with comment period (70 FR 68676). No additional brachytherapy sources 
have been added since the CY 2006 final rule with comment period.

Table 29.--Proposed Separately Payable Brachytherapy Sources for CY 2007
------------------------------------------------------------------------
                                                            New status
 HCPCS code   Long descriptor    APC       APC title        indicator
------------------------------------------------------------------------
C1716.......  Brachytherapy       1716  Brachytx         K
               source, Gold              source, Gold
               198, per                  198.
               source.
C1717.......  Brachytherapy       1717  Brachytx         K
               source, High              source, HDR Ir-
               Dose Rate                 192.
               Iridium 192,
               per source.
C1718.......  Brachytherapy       1718  Brachytx         K
               source, Iodine            source, Iodine
               125, per                  125.
               source.
C1719.......  Brachytherapy       1719  Brachytx         K
               source, Non-              source, Non-
               High Dose Rate            HDR Ir-192.
               Iridium 192,
               per source.
C1720.......  Brachytherapy       1720  Brachytx         K
               source,                   source,
               Palladium 103,            Palladium 103.
               per source.
C2616.......  Brachytherapy       2616  Brachytx         K
               source,                   source,
               Yttrium-90,               Yttrium-90.
               per source.
C2632.......  Brachytherapy       2632  Brachytx sol, I- K
               solution,                 125, per mCi.
               Iodine125, per
               mCi.
C2633.......  Brachytherapy       2633  Brachytx         K
               source, Cesium-           source, Cesium-
               131, per                  131.
               source.
C2634.......  Brachytherapy       2634  Brachytx         K
               source, High              source, HA, I-
               Activity,                 125.
               Iodine-125,
               greater than
               1.01 mCi
               (NIST), per
               source.
C2635.......  Brachytherapy       2635  Brachytx         K
               source, High              source, HA, P-
               Activity,                 103.
               Palladium-103,
               greater than
               2.2 mCi
               (NIST), per
               source.
C2636.......  Brachytherapy       2636  Brachytx linear  K
               linear source,            source, P-103.
               Palladium-103,
               per 1MM.
C2637.......  Brachytherapy       2637  Brachytx,        K
               source,                   Ytterbium-169.
               Ytterbium-169,
               per source.
------------------------------------------------------------------------

    There are a number of advantages to this proposed payment method. 
The OPPS is a prospective payment system under which payment rates are 
generally established based on median costs from historical hospital 
claims. Therefore, under this payment method, brachytherapy sources 
would be paid using the same basic median cost methodology as the 
overall OPPS. The payment of sources would thus be an integral part of 
the OPPS, rather than a separate cost-based payment methodology within 
the OPPS. In addition, consistent and predictable prospectively 
established payment rates under the OPPS for brachytherapy sources are 
appropriate because we do not believe that the hospital resource costs 
associated with specific brachytherapy sources should vary

[[Page 49598]]

greatly across hospitals or across clinical conditions under treatment, 
other than through differences in the numbers of sources utilized, 
which are already accounted for in our per source payment methodology. 
This prospective payment methodology would promote efficiency in the 
provision of sources, while continuing to provide payments that reflect 
the wide clinical variation in the use of brachytherapy sources related 
to many factors, including tumor type and stage, patient anatomy, and 
planned brachytherapy dose. In addition, under this method, we would 
continue to pay for brachytherapy sources separately using the same C-
codes and descriptors that hospitals have reported for the last several 
years.
    We note that High Dose Rate (HDR) Iridium-192 (C1717) is a reusable 
source, across treatment sessions and across patients. It is unclear 
whether hospitals are reporting the number of units provided 
accurately. Thus, while we are currently proposing that HDR Iridium be 
paid separately on the basis of the median cost per source as we are 
proposing to pay for the other brachytherapy sources, we invite 
comments on alternatives to using this methodology for this source, 
such as on the basis of median costs per treatment day on hospital 
claims.
    During the March 1-2, 2006 APC Panel meeting, we discussed median 
cost data for brachytherapy sources developed from the partial CY 2005 
hospitals claims data available for analysis at the time of the 
meeting. While the APC Panel made no specific recommendations about a 
specific OPPS CY 2007 payment methodology for brachytherapy sources, 
the Panel reviewed the median costs for the sources of brachytherapy 
and generally commented that the median costs appeared reasonable for 
the commonly furnished brachytherapy sources.
    Because brachytherapy sources would no longer be paid on the basis 
of their charges reduced to costs, we are proposing to discontinue our 
use of payment status indicator ``H'' for APCs assigned to 
brachytherapy sources. We are proposing to use status indicator ``K'' 
for all brachytherapy source APCs for CY 2007. We are also proposing 
for CY 2007 to change the definition of status indicator ``K'' to 
ensure that ``K'' appropriately describes brachytherapy source APCs. 
Payment status indicators are discussed in section XV.A. of this 
preamble.
    There is one source for which we have no claims data or payment 
information. We added Ytterbium-169 (HCPCS code C2637) for payment 
effective October 1, 2005, because it met the requirements of section 
1833(t)(2)(H) of the Act as a separate brachytherapy source. It is our 
understanding that this source, which is for use in high dose rate 
(HDR) brachytherapy, is not yet marketed by the manufacturer, although 
it has been approved by the Food and Drug Administration (FDA). 
Therefore, we have no claims data for this brachytherapy source in 
order to develop a prospective payment rate, as we do for the other 
brachytherapy sources for CY 2007. In addition, it is our understanding 
that no price for the product exists, as it has not yet been marketed. 
Thus, we also have no external information regarding the cost of this 
source to hospitals. We are weighing our payment options for CY 2007 
for brachytherapy sources for which we have no payment or claims 
information, such as the present case with Ytterbium-169. This includes 
considering our CY 2007 payment options for other new brachytherapy 
sources that come to our attention, which historically have been newly 
recognized under the OPPS on a quarterly basis.
    One option for CY 2007 would be to pay for the currently existing 
HCPCS code C2637 at charges converted to costs. However, this would be 
inconsistent with our proposed policy with regard to payment for 
brachytherapy sources under prospectively established payment rates. We 
paid for all brachytherapy sources based upon charges converted to 
costs for CYs 2004 through 2006 because the law required us to do so. 
However, that provision will expire for the CY 2007 OPPS. In addition, 
this methodology would be inconsistent with the prospective payment 
methodologies we use to provide payments for other new items and 
services under the OPPS for which we do not yet have claims data.
    A second option would be to assign the code to its own APC or to a 
New Technology APC with a payment rate set at or near the lowest 
proposed payment rate for any source of brachytherapy paid on a per 
source basis (as opposed, for example, per mCi), for CY 2007. However, 
we have no claims data or other information regarding the cost of HCPCS 
code C2637 to hospitals. This payment policy would resemble our policy 
regarding the APC assignment of not otherwise classified codes, which 
are assigned to the lowest level APC in their clinically compatible 
series. However, HCPCS code C2637 is a specifically defined 
brachytherapy source, and such a payment rate would not recognize the 
clinical distinctions among brachytherapy sources, including their 
differences in isotopes, activity levels, and clinical uses in low dose 
rate (LDR) versus HDR brachytherapy. The solid brachytherapy source 
with the lowest proposed median cost for CY 2007 is HCPCS code C2634, 
for High Activity Iodine-125, with a median cost of $25.77 per source, 
which is implanted in LDR brachytherapy.
    A third option would be to assign HCPS code C2637 to its own APC or 
to a New Technology APC with a payment rate established at or near the 
proposed payment rate for HCPCS code C1717, which describes HDR 
Iridium-192. Like HCPCS code C2637, HCPCS code C1717 is used for HDR 
brachytherapy, and HCPCS code C1717 is the most commonly used source 
for HDR brachytherapy under the OPPS. However, this approach would not 
take into consideration significant differences in the two sources, 
including their radioactive isotopes and energy levels.
    The fourth option would be to assign HCPCS code C2637 to its own 
APC or to a New Technology APC with a prospective payment rate based on 
external data provided to us regarding the expected cost of the source 
to hospitals. If we were provided reliable and relevant cost 
information for the source, we could establish its payment rate based 
on that information and our review of other pertinent considerations, 
as we do for new technology services under the OPPS. Under this option, 
in the absence of external cost information, we would not recognize 
HCPCS code C2637 under the OPPS for CY 2007 until we received such 
information and could establish a payment rate in a quarterly OPPS 
update. CMS provided the brachytherapy source Ytterbium-169 a HCPCS 
code in CY 2005 at the manufacturer's request, based on the belief that 
the source would be marketed shortly. However, the product has not yet 
been marketed. Therefore, we currently have a recognized HCPCS code for 
an item that is not currently available to hospitals. We do not 
typically issue and maintain as payable a HCPCS code for an item that 
is not marketed. Under this option, if the source were marketed mid-
quarter in CY 2007 and cost information was provided to us, there would 
be no payment available for the source until the next OPPS quarterly 
update, which would establish the payment rate for HCPCS code C2637 and 
its effective date.
    After weighing the above options, we are proposing the second 
option discussed, that is, to assign C2637 to its own APC or a New 
Technology APC with a payment rate set at or near the lowest proposed 
payment rate for any

[[Page 49599]]

source of brachytherapy paid on a per source basis. This option 
resembles our policy regarding the APC assignment of not otherwise 
classified codes, in the absence of any data currently available. Once 
we have claims data, or obtain external data, we can consider movement 
to another APC, if warranted. However, as we indicate below, we are 
interested in the public's comments on the four options we have 
presented.
    We are specifically inviting comments on how we should establish 
the CY 2007 payment amount for Ytterbium-169 (HCPCS code C2637), 
especially with consideration of the four options discussed above, and 
on how we should generally proceed on setting payment amounts for 
established or new brachytherapy sources eligible for separate payment 
under section 1833(t)(2)(H) of the Act, for which we have no claims-
based cost data in the future. Note that under option 4, for a future 
new source we would need cost information regarding the source in order 
to establish a code for which we could set an appropriate OPPS payment 
rate. We intend to avoid routinely establishing HCPCS codes for 
brachytherapy sources which hospitals could not be using, and, 
therefore, for which payments would not be necessary.
    As we have consistently done in the past, we are inviting the 
public to submit recommendations for new codes to describe new 
brachytherapy sources in a manner reflecting the number, isotope, and 
radioactive intensity of the sources. We are requesting that commenters 
provide a detailed rationale to support recommended new sources and 
send recommendations to us. We will continue our endeavor to add new 
brachytherapy source codes and descriptors to our systems for payment 
on a quarterly basis. Such recommendations should be directed to the 
Division of Outpatient Care, Mail Stop C4-05-17, Centers for Medicare & 
Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244.
    We have considered the definition of the term ``brachytherapy 
source'' in the context of current medical practice, and in light of 
the language in section 1833(t)(2)(H) of the Act. We are proposing to 
define a device of brachytherapy eligible for separate payment under 
the OPPS as a ``seed or seeds (or radioactive source)'' as indicated in 
section 1833(t)(2)(H) of the Act, which refers to sources that are 
themselves radioactive, meaning that the sources contain a radioactive 
isotope. Therefore, for example, we do not consider specific devices 
that do not utilize radioactive isotopes to deliver radiation to be 
radioactive sources as envisioned by the statute. While the public may 
recommend any item that it wishes us to consider as a brachytherapy 
source, we remind the public of our interpretation of a device of 
brachytherapy eligible for separate payment under section 1833(t)(2)(H) 
of the Act.

VIII. Proposed Changes to OPPS Drug Administration Coding and Payment 
for CY 2007

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: 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 the 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 and moved to a combination of HCPCS codes Q0083 and Q0084 that 
allowed more accurate calculations when determining OPPS payment rates.
    In CY 2005, in response to the recommendations made by commenters 
and the hospital industry, OPPS transitioned to the use of CPT codes 
for drug administration services. These CPT codes allowed for more 
specific reporting of services, especially regarding the number of 
hours for an infusion, and provided consistency in coding between 
Medicare and other payers. However, we did not have any data to revise 
the CY 2005 per-visit APC payment structure for infusion services. In 
order to collect data for future ratesetting purposes, we implemented 
claims processing logic that collapsed payments for drug administration 
services and paid a single APC amount for those services for each 
visit, unless a modifier was used to identify drug administration 
services provided in a separate encounter on the same day. Hospitals 
were instructed to bill all applicable CPT codes for drug 
administration services provided in a hospital outpatient department, 
without regard to whether or not the CPT code would receive a separate 
APC payment during OPPS claims processing.
    While hospitals were just adopting CPT codes for outpatient drug 
administration services in CY 2005, physicians paid under the Medicare 
Physician Fee Schedule were using HCPCS G-codes in CY 2005 to report 
office-based drug administration services. These G-codes were developed 
in anticipation of substantial revisions to the drug administration CPT 
codes by the CPT Editorial Panel that were expected for CY 2006.
    In CY 2006, as anticipated, the CPT Editorial Panel revised its 
coding structure for drug administration services, incorporating new 
concepts such as initial, sequential, and concurrent services into a 
structure that previously distinguished services based on type of 
administration (chemotherapy/nonchemotherapy), method of administration 
(injection/infusion/push), and for infusion services, first hour and 
additional hours. For CY 2006, we proposed a crosswalk that mapped the 
expected CY 2006 CPT codes (represented by CY 2005 G-codes used in the 
physician office setting, the closest proxy at the time) to the APC 
payment structure implemented in CY 2005. Our crosswalk was reviewed by 
the APC Panel at both the February and August 2005 meetings, and was 
included in the CY 2006 OPPS proposed rule. During the proposed rule 
comment period, we received a number of comments that prompted several 
revisions to our proposed crosswalk, including the development of 
complex claims processing logic to assign correct payment for certain 
drug administration services that would vary based on other drug 
administration services provided during the same patient visit. These 
revisions were a result of the growing understanding, facilitated by 
the preview of CPT drug administration coding guidelines developed by 
the CPT Editorial Panel, in the hospital community of the multiple 
implications associated with adopting the newly

[[Page 49600]]

introduced CPT concepts of initial, sequential, and concurrent 
services.
    Upon review of the completed revisions to our proposed CY 2006 
methodology, and following comprehensive assessment of all public 
comments, we implemented 20 of the 33 CY 2006 drug administration CPT 
codes that did not reflect the concepts of initial, sequential, and 
concurrent services, and we created 6 new HCPCS C-codes that generally 
paralleled the CY 2005 CPT codes for the same services. We chose not to 
implement the full set of CY 2006 CPT codes because of our concerns 
regarding the interface between the complex claims processing logic 
required for correct payments and hospitals' challenges in correctly 
coding their claims to receive accurate payments for these services. In 
addition, numerous commenters indicated that implementing certain CPT 
codes in a fashion consistent with the code descriptors would present 
hospitals with difficult operational and administrative challenges 
because concepts integral to the codes were inconsistent with the 
clinical patterns of drug administration services provided in hospital 
outpatient departments. In addition to coding changes, CY 2006 payment 
rates for drug administration services were updated based upon CY 2004 
claims, and we continued the claims processing logic that required 
hospitals providing drug administration services to report all 
applicable drug administration HCPCS codes, despite some codes being 
collapsed into one APC for payment purposes.

B. Proposed CY 2007 Drug Administration Coding Changes

    For the CY 2007 OPPS, we are proposing to continue the CY 2006 OPPS 
drug administration coding structure, which combines CPT codes with 
several C-codes. However, we welcome comments from hospitals regarding 
their experiences in implementing, for purposes of reporting to other 
payers, the CY 2006 CPT codes that incorporate the concepts of initial, 
sequential, and concurrent drug administration services. While we are 
not proposing to transition to the full set of CPT codes in CY 2007, we 
retain this as an option for the future.
    In addition, because of the discrepancies between APC payments 
(based on per-visit hospital claims data) and per-service CPT/HCPCS 
coding, we provided special instructions to hospitals in CY 2005 and CY 
2006 regarding modifier 59 in order to ensure proper OPPS payments, 
consistent with our claims processing logic. As we do not expect any 
changes to our coding structure for CY 2007 and because we have updated 
service-specific claims data from CY 2005, we no longer have the need 
for specific drug administration instructions regarding modifier 59. 
Instead, for CY 2007 we are proposing that hospitals apply modifier 59 
to drug administration services using the same correct coding 
principles that they generally use for other OPPS services.

C. Proposed CY 2007 Drug Administration Payment Changes

    CY 2007 is the first year that we have more detailed claims data to 
inform our ratesetting process. Through CY 2006, payment for additional 
hours of drug infusion has always been packaged, although separate 
codes for reporting these hours have been used under the OPPS since CY 
2005. Specifically, hospitals began reporting more precise CPT codes in 
CY 2005 that included separate coding for the first hour of infusion 
versus additional hours of infusion. In order to analyze these data, 
because we expected that additional hours of infusion codes would 
always be reported with codes for the first hour of infusion, thereby 
resulting in multiple bills for the additional hours of infusion CPT 
codes, we added the following three CY 2005 drug administration CPT 
codes to the bypass list utilized to create ``pseudo'' single claims: 
CPT codes 90781 (Intravenous infusion for therapy/diagnosis, 
administered by physician or under direct supervision of physician; 
each additional hour, up to eight (8) hours); 96412 (Chemotherapy 
administration, intravenous; infusion technique, one to 8 hours, each 
additional hour); and 96423 (Chemotherapy administration, intra-
arterial; infusion technique, one to 8 hours, each additional hour). 
The standard OPPS methodology, as described in section II.A. of this 
proposed rule, was used to calculate HCPCS medians for these three drug 
administration codes. We then mapped all the data for the three 
additional hours of infusion CPT codes from the single and ``pseudo'' 
single claims to the APCs to which we are proposing to assign the CY 
2005 claims data for these codes for purposes of calculating APC median 
costs.
    While bypassing these three CPT codes and developing additional 
``per unit'' claims provide a methodology to calculate median costs for 
these previously packaged drug administration services and to attribute 
all of their cost data to their assigned APCs, we note that this 
methodology allocates all packaging on the claim related to drug 
administration to the associated first hour drug administration code. 
Because these additional hours of infusion codes are not reported alone 
in conjunction with other separately payable nondrug administration 
services, we would not expect that the packaging related to additional 
hours of infusion would be inappropriately assigned to nondrug 
administration services. While we realize that there are some packaged 
costs that truly are clinically related to the second and subsequent 
hours of infusion, especially for infusions of packaged drugs that span 
several hours, and would, therefore, be most appropriately allocated to 
the additional hours of infusion codes, we are not able at this time to 
accurately assign representative portions of packaging costs to 
multiple different services at this time due to the limitations of our 
claims data. We believe this proposed methodology takes into account 
all of the packaging on claims for drug administration services and 
provides a reasonable framework for developing median costs for drug 
administration services that are often provided in combination with one 
another.
    Upon review of the HCPCS median costs for all drug administration 
services, including injections and antigen therapy services, we created 
a comprehensive set of new APC groupings of CY 2005 HCPCS codes for 
drug administration services, with our assignments based both upon 
hospital resources utilized as reflected in HCPCS median costs and 
clinical coherence. The result of this analysis was the development of 
six proposed drug administration APC levels for the proposed CY 2007 
payment rates, as shown in Table 30-1.

[[Page 49601]]

[GRAPHIC] [TIFF OMITTED] TP23AU06.027

    As shown above, the placement of HCPCS codes into the proposed six 
levels follows logical, clinically coherent principles and is 
consistent with both expected and observed differences in hospital 
resource costs,

[[Page 49602]]

both across levels and within each level. For example, the first hour 
of chemotherapy infusion is assigned to proposed Level VI, while 
additional hours of chemotherapy infusion are assigned to proposed 
Level III. This proposed structure is mirrored by the nonchemotherapy 
codes that show the first hour of nonchemotherapy infusion assigned to 
proposed Level V, while additional hours of nonchemotherapy infusion 
are assigned to proposed Level II.
    Using this structure as a base, the CY 2006 OPPS drug 
administration codes were assigned to the proposed 6-level APC 
structure based on their clinical and expected hospital resource 
characteristics, as seen in Table 30-2.
    This proposed structure was presented to the APC Panel during the 
March 2006 meeting. The Panel recommended using the bypass methodology 
as described above for the three additional hours of infusion codes to 
develop their median costs and supported separate payment for each 
additional hour of infusion for CY 2007, as shown in Table 30-2.

[[Page 49603]]

[GRAPHIC] [TIFF OMITTED] TP23AU06.028

    We are accepting the APC Panel's recommendation for CY 2007 to use 
the bypass and ``per unit'' methodology as described in proposing a 
drug administration payment structure that includes a methodology to 
pay for

[[Page 49604]]

infusion services by the hour. Therefore, we are proposing to assign 
HCPCS codes for CY 2007 to six new drug administration APCs, as listed 
in Table 30-2, with payment rates based on median costs for the APCs 
from CY 2005 claims data as assigned in Table 30-1.
    For CY 2007, the APC Panel also recommended that CMS reevaluate 
payment for IVIG administration, especially considering the resource 
intensity of IVIG infusions. We are accepting this APC Panel 
recommendation and believe that our proposed CY 2007 drug 
administration payment policy that would provide specific payment for 
each hour of infusion would provide more accurate and appropriate 
payment for lengthy infusions, including the administration of IVIG. 
IVIG administration in the outpatient hospital setting typically occurs 
over 3-6 hours, and under our proposal hospitals would receive separate 
payment for the first hour of infusion, along with payments for each of 
the additional 2-5 hours generally required for the IVIG infusion. 
Considerable hospital resources are used throughout the infusion 
period, including significant clinical staff time to monitor and adjust 
infusions based on patients' evolving conditions, so we believe 
separate payment for each additional hour is appropriate. With respect 
to separate payment for IVIG preadministration-related services, the 
APC Panel recommended that CMS maintain separate payment as long as it 
remains appropriate. For CY 2006 only, we created the temporary G-code 
G0332 (Preadministration-related services for intravenous infusion of 
immunoglobulin, per infusion encounter). We are accepting this APC 
Panel recommendation and have considered whether separate payment for 
IVIG preadministration-related services remains appropriate. Based upon 
our ongoing review of the IVIG marketplace and our CY 2007 proposed 
payment policies for items and services under the OPPS, we believe that 
separate payment for preadministration-related services specific to 
IVIG infusions would not be necessary in CY 2007 to ensure Medicare 
beneficiary access to IVIG.
    Hospitals' cooperation during CY 2005 in reporting all drug 
administration services, whether or not separate payments were made for 
all such services, has allowed us to develop robust median costs for 
individual services so that we have sufficient information to propose 
this more specific APC payment structure for drug administration 
services for CY 2007. We believe that this proposed structure would 
make appropriate payments for the hospital resources required to 
provide drug administration services, as we have large numbers of 
claims for many specific drug administration services that reveal 
significant and differential costs. In particular, using this proposed 
APC structure should allow us to make more accurate payments to 
hospitals for complex and lengthy drug administration services 
furnished to Medicare beneficiaries for many medical conditions, while 
also providing accurate payments for individual services when they are 
provided alone.

IX. Proposed Hospital Coding and Payments for Visits

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

A. Background

    Currently, CMS instructs hospitals to use the CY 2006 CPT codes 
used by physicians and listed in Table 31 to report clinic and 
emergency department visits and critical care services on claims paid 
under the OPPS.

    Table 31.--CY 2006 CPT Codes Used To Report Clinic and Emergency
              Department Visits and Critical Care Services
------------------------------------------------------------------------
              CPT code                            Descriptor
------------------------------------------------------------------------
                   CPT Evaluation and Management Codes
------------------------------------------------------------------------
99201...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of a new patient (Level 1).
99202...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of a new patient (Level 2).
99203...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of a new patient (Level 3).
99204...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of a new patient (Level 4).
99205...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of a new patient (Level 5).
99211...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of an established patient (Level
                                       1).
99212...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of an established patient (Level
                                       2).
99213...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of an established patient (Level
                                       3).
99214...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of an established patient (Level
                                       4).
99215...............................  Office or other outpatient visit
                                       for the evaluation and management
                                       of an established patient (Level
                                       5).
99241...............................  Office consultation for a new or
                                       established patient (Level 1).
99242...............................  Office consultation for a new or
                                       established patient (Level 2).
99243...............................  Office consultation for a new or
                                       established patient (Level 3).
99244...............................  Office consultation for a new or
                                       established patient (Level 4).
99245...............................  Office consultation for a new or
                                       established patient (Level 5).
------------------------------------------------------------------------
                  Emergency Department Visit CPT Codes
------------------------------------------------------------------------
99281...............................  Emergency department visit for the
                                       evaluation and management of a
                                       patient (Level 1).
99282...............................  Emergency department visit for the
                                       evaluation and management of a
                                       patient (Level 2).
99283...............................  Emergency department visit for the
                                       evaluation and management of a
                                       patient (Level 3).
99284...............................  Emergency department visit for the
                                       evaluation and management of a
                                       patient (Level 4).
99285...............................  Emergency department visit for the
                                       evaluation and management of a
                                       patient (Level 5).
------------------------------------------------------------------------
                    Critical Care Services CPT Codes
------------------------------------------------------------------------
99291...............................  Critical care, evaluation and
                                       management of the critically ill
                                       or critically injured patient;
                                       first 30-74 minutes.
99292...............................  Each additional 30 minutes.
------------------------------------------------------------------------

    The majority of CPT code descriptors are applicable to both 
physician and facility resources associated with specific services. 
However, we have acknowledged from the beginning of the OPPS that we 
believe that CPT Evaluation and Management (E/M)

[[Page 49605]]

codes were defined to reflect the activities of physicians and do not 
describe well the range and mix of services provided by hospitals 
during visits of clinic and emergency department patients and critical 
care encounters. Presently, CPT indicates that office or other 
outpatient visit codes are used to report E/M services provided in the 
physician's office or in an outpatient or other ambulatory facility. 
For OPPS purposes, we refer to these as clinic visit codes. CPT also 
indicates that emergency department visit codes are used to report E/M 
services provided in the emergency department, defined as an 
``organized hospital-based facility for the provision of unscheduled 
episodic services to patients who present for immediate medical 
attention. The facility must be available 24 hours a day.'' For OPPS 
purposes, we refer to these as emergency visit codes. CPT defines 
critical care services as the ``direct delivery by a physician(s) of 
medical care for a critically ill or critically injured patient.'' It 
also states that ``critical care is usually, but not always, given in a 
critical care area, such as * * * the emergency care facility.''
    In the April 7, 2000 OPPS final rule (65 FR 18434), CMS instructed 
hospitals to report facility resources for clinic and emergency 
department visits using CPT E/M codes and to develop internal hospital 
guidelines to determine what level of visit to report for each patient. 
While awaiting the development of a national set of facility-specific 
codes and guidelines, we have advised that each hospital's internal 
guidelines should follow the intent of the CPT code descriptors, in 
that the guidelines should be designed to reasonably relate the 
intensity of hospital resources to the different levels of effort 
represented by the codes.
    During the January 2002 APC Panel meeting, the APC Panel 
recommended that CMS adopt the American College of Emergency Physicians 
(ACEP) intervention-based guidelines for facility coding of emergency 
department visits and develop guidelines for clinic visits that are 
modeled on the ACEP guidelines.
    In the August 9, 2002 OPPS proposed rule, we proposed 10 new G-
codes (Levels 1-5 Facility Emergency Services and Levels 1-5 Facility 
Clinic Services) for use in the OPPS to report hospital visits. We also 
asked for public comments regarding national guidelines for hospital 
coding of emergency and clinic visits. We discussed various types of 
models, reflecting on the advantages and disadvantages of each. We 
reviewed in detail the considerations around various discrete types of 
specific guidelines, including guidelines based on staff interventions, 
based upon staff time spent with the patient, based on resource 
intensity point scoring, and based on severity acuity point scoring 
related to patient complexity. We note below our analysis of the 
various models.
1. Guidelines Based on the Number or Type of Staff Interventions
    Under this model, the level of service reported would be based on 
the number and/or type of interventions performed by nursing or 
ancillary staff. In the intervention model, baseline care (including 
registration, triage, initial nursing assessment, periodic vital signs 
as appropriate, simple discharge instructions, and exam room set up/
clean up) and possibly a single minor intervention (for example, suture 
removal, rapid strep test, or visual acuity) would be reported by the 
lowest level of service. Higher levels of service would be reported as 
the number and/or complexity of staff interventions increased.
    The most commonly recommended intervention-based guidelines were 
the facility-coding guidelines developed by the ACEP. The ACEP model 
uses examples of interventions to illustrate appropriate coding. Coders 
extrapolate from these examples to determine the correct level of 
service to report. The ACEP model uses the types of interventions 
rather than the number of interventions to determine the appropriate 
level of service. This means that the single most complex intervention 
determines the level of service, whether it was the only service 
provided (in addition to baseline care), whether other similarly 
complex interventions were also provided, or whether other 
interventions of less complexity were also provided. The intervention 
model is based on emergency department/clinic resource use, is simple, 
reflects the care given to the patient, and does not require additional 
facility documentation. However, we expressed concern that the 
intervention model may provide an incentive to provide unnecessary 
services and that it is susceptible to upcoding. In addition, it is not 
particularly focused on measuring and appropriately reporting a code 
reflecting total hospital resources used in a visit. Furthermore, the 
ACEP model requires extrapolation from a set of examples that could 
make it prone to variability across hospitals.
2. Guidelines Based on the Time Staff Spent With the Patient
    Under this model, the level of service would be determined based on 
the amount of time hospital staff spent with a patient. The underlying 
assumption is that staff time spent with the patient is an appropriate 
proxy for total hospital resource consumption. In this model, if only 
baseline care (as described above) were provided, a Level 1 service 
would be reported. Higher levels of service would be reported based on 
increments of staff time beyond baseline care. For example, Level 2 
could be reported for 11 to 20 minutes beyond baseline care, and Level 
3 could be reported for 21 to 30 minutes beyond baseline care. This 
model is simple, correlates with total hospital resource use, and 
provides an objective standard for all hospitals to follow. However, we 
observed that this model would require additional, potentially 
burdensome documentation of staff time, could provide an incentive to 
work slowly or use less efficient personnel, and has the potential for 
upcoding and gaming.
3. Guidelines Based on a Point System Where a Certain Number of Points 
Are Assigned to Each Staff Intervention Based on the Time, Intensity, 
and Staff Type Required for the Intervention
    In this model, points or weights are assigned to each facility 
service and/or intervention provided to a patient in the clinic or 
emergency department. The level of service is determined by the sum of 
the points for all services/interventions provided. Commenters to the 
August 9, 2002 proposed rule recommended various approaches to a point 
system, including point systems that assigned points based on the 
amount of staff time spent with the patient, the number of activities 
performed during the visit, and a combination of patient condition and 
activities performed. A point system would correlate with facility 
resource consumption and provide an objective standard. In addition, it 
is not as easily gamed because time-based interventions can be assigned 
a set number of points. However, we noted that a point system could 
present a significant burden for hospitals in terms of requiring 
additional, clinically unnecessary documentation. Point systems that 
are complex could require dedicated staff to monitor and maintain them.
4. Guidelines Based on Patient Complexity
    Several variations were recommended in comments to the August 9, 
2002 proposed rule, including assignment of

[[Page 49606]]

levels of service based on ICD-9-CM (International Classification of 
Diseases, Ninth Edition, Clinical Modification) diagnosis codes, based 
on complexity of medical decision making, or based on presenting 
complaint or medical problem. The premise for these guideline systems 
is that many emergency departments follow established protocols based 
on patients' presenting complaints and/or diagnoses. Therefore, 
assigning a level of service based on patient diagnosis should 
correlate with facility resource consumption. These systems may require 
the use of a coding ``grid,'' which lists more than 100 examples of 
patient conditions and diagnoses and assigns a level of service to each 
example. When the patient presents with a condition that does not 
appear on the grid, the coder must extrapolate from the grid to the 
individual patient. We expressed concern that these systems are 
extremely complex, demand significant interpretive work on the part of 
the coder (who may not have clinical experience), and are subject to 
variability across hospitals. While no clinically unnecessary 
documentation would be required because the system is based on 
diagnoses that are already reported on claims, there is a significant 
potential for upcoding and gaming.
    In the August 9, 2002 OPPS proposed rule, we also stated that we 
were concerned about counting separately paid services (for example, 
intravenous infusions, x-rays, electrocardiograms, and lab tests) as 
``interventions'' or including their associated ``staff time'' in 
determining the level of service. We believed that the level of service 
should be determined by resource consumption that is not otherwise 
captured in payments for other separately payable services. We are now 
reconsidering this perspective and will discuss this further in section 
IX.D. of the preamble of this proposed rule.
    In the November 1, 2002 OPPS final rule, we specified that we would 
not create new codes to replace existing CPT E/M codes for reporting 
hospital visits until national guidelines have been developed, in 
response to commenters who were concerned about implementing code 
definitions without national guidelines. We noted that an independent 
panel of experts would be an appropriate forum to develop codes and 
guidelines that are simple to understand and implement, and that are 
compliant with the HIPAA requirements. We explained that organizations 
such as the American Hospital Associations (AHA) and the American 
Health Information Management Association (AHIMA) had such expertise 
and would be capable of creating hospital visit guidelines and 
providing ongoing education of providers. We also articulated a set of 
principles that any national guidelines for facility visit coding 
should satisfy, including that coding guidelines should be based on 
facility resources, should be clear to facilitate accurate payments and 
be usable for compliance purposes and audits, should meet the HIPAA 
requirements, should only require documentation that is clinically 
necessary for patient care, and should not facilitate upcoding or 
gaming. We stated that the distribution of codes should result in a 
normal curve. We concluded that we believed the most appropriate forum 
for development of code definitions and guidelines was an independent 
expert panel that would makes recommendations to CMS.
    The AHA and AHIMA originally supported the ACEP model for emergency 
visit coding, but we expressed concern that the ACEP guidelines allowed 
counting of separately payable services in determining a service level, 
which could result in the double counting of hospital resources in 
establishing visit payment rates and payment rates for those separately 
payable services. Subsequently, on their own initiative, the AHA and 
AHIMA formed an independent expert panel, the Hospital Evaluation and 
Management Coding Panel, comprised of members with coding, health 
information management, documentation, billing, nursing, finance, 
auditing, and medical experience. This panel included representatives 
from the AHA, AHIMA, ACEP, Emergency Nurses Association, and American 
Organization of Nurse Executives. CMS and AMA representatives observed 
the meetings. On June 24, 2003, the AHA and AHIMA submitted their 
recommended guidelines, hereafter referred to as the AHA/AHIMA 
guidelines, for reporting three levels of hospital clinic and emergency 
visits and a single level of critical care services to CMS, with the 
hope that CMS would publish the guidelines in the CY 2004 proposed 
rule. The AHA and AHIMA acknowledged that ``continued refinement will 
be required as in all coding systems. The Panel * * * looks forward to 
working with CMS to incorporate any recommendations raised during the 
public comment period'' (AHA/AHIMA guidelines report, page 9). The AHA 
and AHIMA indicated that the guidelines were field-tested several times 
by panel members at different stages of their development. The 
guidelines are based on an intervention model, where the levels are 
determined by the numbers and types of interventions performed by 
nursing or ancillary hospital staff. Higher levels of services are 
reported as the number and/or complexity of staff interventions 
increase.
    Although we did not publish the guidelines, the AHA and AHIMA 
released the guidelines through their Web sites. Consequently, we 
received numerous comments from providers and associations, some in 
favor and some opposed to the guidelines. We undertook a critical 
review of the recommendations from the AHA and AHIMA and made some 
modifications to the guidelines based on comments we received from 
outside hospitals and associations on the AHA/AHIMA guidelines, 
clinical review, and changing payment policies in the OPPS regarding 
some separately payable services.
    In an attempt to validate the modified AHA/AHIMA guidelines and 
examine the distribution of services that would result from their 
application to hospital clinic and emergency visits paid under the 
OPPS, we contracted a study that began in September 2004 and concluded 
in September 2005 to retrospectively code, under the modified AHA/AHIMA 
guidelines, hospital visits by reviewing hospital visit medical chart 
documentation gathered through the Comprehensive Error Rate Testing 
(CERT) work. While a review of documentation and assignment of visit 
levels based on the modified AHA/AHIMA guidelines to 12,500 clinic and 
emergency visits was initially planned, the study was terminated after 
a pilot review of only 750 visits. The contractor identified a number 
of elements in the guidelines that were difficult for coders to 
interpret, poorly defined, nonspecific, or regularly unavailable in the 
medical records. The contractor's coders were unable to determine any 
level for about 25 percent of the clinic cases and about 20 percent of 
the emergency cases reviewed. The only agreement observed between the 
levels reported on the claims and levels according to the modified AHA/
AHIMA guidelines was the classification of Level 1 services, where the 
review supported the level on the claims 54-70 percent of the time. In 
addition, the vast majority of the clinic and emergency visits reviewed 
were assigned to Level 1 during the review. Based on these findings, we 
believed that it was not necessary to review additional records after 
the initial sample. The contractor advised that multiple terms in the 
guidelines required clearer definition and believed

[[Page 49607]]

that more examples would be helpful. Although we believe that all of 
the visit documentation for each case was available for the 
contractor's review, we were unable to determine definitively that this 
was the case. Thus, there is some possibility that the contractor's 
assignments would have differed if additional documentation from the 
medical records was available for the visits. In summary, while testing 
of the modified AHA/AHIMA guidelines was helpful in illuminating areas 
of the guidelines that would benefit from refinement, we were unable to 
draw conclusions about the relationship between the distribution of 
current hospital reporting of visits using CPT E/M codes that are 
assigned according to each hospital's internal guidelines and the 
distribution of coding under the AHA/AHIMA guidelines, nor were we able 
to demonstrate a normal distribution of visit levels under the modified 
AHA/AHIMA guidelines.

B. CY 2007 Proposed Coding

    As discussed above, the majority of all CPT code descriptors are 
applicable to both physician and facility resources associated with 
specific services. However, we believe that CPT E/M codes were defined 
to reflect the activities of physicians and do not describe well the 
range and mix of services provided by hospitals during visits of clinic 
and emergency department patients and critical care encounters. While 
awaiting the development of a national set of facility-specific codes 
and guidelines, we have advised that each hospital's internal 
guidelines should follow the intent of the CPT code descriptors, in 
that the guidelines should be designed to reasonably relate the 
intensity of hospital resources to the different levels of effort 
represented by the codes.
    In the November 1, 2002 OPPS final rule, we specified that we would 
not create new codes to replace existing CPT E/M codes for reporting 
hospital visits until national guidelines have been developed, in 
response to commenters who were concerned about implementing code 
definitions without national guidelines. While we do not yet have a 
formal set of guidelines that we believe may be appropriately applied 
nationally to report different levels of hospital clinic and emergency 
department visit and to report critical care services, we have made 
significant progress in developing potential guidelines and, therefore, 
are proposing for CY 2007 the establishment of HCPCS codes to describe 
hospital clinic and emergency department visits and critical care 
services. Prior to our implementation of national guidelines for the 
new hospital visit HCPCS codes, we are proposing that hospitals may 
continue to use their existing internal guidelines to determine the 
visit levels to be reported with these codes. We anticipate that many 
providers would choose to use their existing guidelines for reporting 
visits with CPT codes. We do not expect a substantial workload for a 
provider that chooses to adjust its guidelines to reflect our proposed 
policies.
    We acknowledge that it can be burdensome for providers to bill G-
codes rather than CPT codes. In this case, because current CPT E/M 
codes do not describe hospital visit resources, we have no alternative 
other than to create new G-codes. CPT has not yet created clinic and 
emergency department visit and critical care services codes that 
describe hospital resource utilization. It is important to note that G-
codes may be recognized by other payers.
1. Clinic Visits
    For clinic visits, we are proposing five new codes, to replace 
hospitals' reporting of the CPT clinic visit E/M codes for new and 
established patients and consultations listed in Table 31. Providers 
have been reporting five levels of CPT codes through CY 2006, and we 
believe that it should be fairly easy to crosswalk current internal 
hospital guidelines to these five proposed new codes. Commenters to 
prior rules have stated that the hospital resources used for new and 
established patients to provide a specific level of service are very 
similar, and that it is unnecessary and burdensome from a coding 
perspective to distinguish between the two types of visits. The new 
codes are proposed in Table 32 below.

   Table 32.--Proposed CY 2007 HCPCS Codes To Be Used To Report Clinic
                                 Visits
------------------------------------------------------------------------
       HCPCS code            Short descriptor         Long descriptor
------------------------------------------------------------------------
Gxxx1..................  Level 1 hosp clinic      Level 1 hospital
                          visit.                   clinic visit.
Gxxx2..................  Level 2 hosp clinic      Level 2 hospital
                          visit.                   clinic visit.
Gxxx3..................  Level 3 hosp clinic      Level 3 hospital
                          visit.                   clinic visit.
Gxxx4..................  Level 4 hosp clinic      Level 4 hospital
                          visit.                   clinic visit.
Gxxx5..................  Level 5 hosp clinic      Level 5 hospital
                          visit.                   clinic visit.
------------------------------------------------------------------------

2. Emergency Department Visits
    As described above, CPT defines an emergency department as ``an 
organized hospital-based facility for the provision of unscheduled 
episodic services to patients who present for immediate medical 
attention. The facility must be available 24 hours a day.'' Under the 
OPPS, we have restricted the billing of emergency department CPT codes 
to services furnished at facilities that meet this CPT definition. 
Facilities open less than 24 hours a day should not use the emergency 
department codes.
    Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Act impose 
specific obligations on Medicare-participating hospitals and critical 
access hospitals that offer emergency services. These obligations 
concern individuals who come to a hospital's dedicated emergency 
department (DED) and request examination or treatment for medical 
conditions, and apply to all of these individuals, regardless of 
whether or not they are beneficiaries of any program under the Act. 
Section 1867(h) of the Act specifically prohibits a delay in providing 
required screening or stabilization services in order to inquire about 
the individual's payment method or insurance status. Section 1867(d) of 
the Act provides for the imposition of civil monetary penalties on 
hospitals and physicians responsible for failing to meet the provisions 
listed above. These provisions, taken together, are frequently referred 
to as the Emergency Medical Treatment and Labor Act (EMTALA). EMTALA 
was passed in 1986 as part of the Consolidated Omnibus Budget 
Reconciliation Act of 1985 Pub. L. 99-272 (COBRA).
    Section 489.24 of the EMTALA regulations defines ``dedicated 
emergency department'' as any department or facility of the hospital, 
regardless of whether it is located on or off the main hospital campus, 
that meets at least one of the following requirements: (1) It is 
licensed by the State in which it is located under applicable State law 
as an emergency room or emergency department; (2) It is

[[Page 49608]]

held out to the public (by name, posted signs, advertising, or other 
means) as a place that provides care for emergency medical conditions 
on an urgent basis without requiring a previously scheduled 
appointment; or (3) During the calendar year immediately preceding the 
calendar year in which a determination under this section is being 
made, based on a representative sample of patient visits that occurred 
during that calendar year, it provides at least one-third of all of its 
outpatient visits for the treatment of emergency medical conditions on 
an urgent basis without requiring a previously scheduled appointment.
    We believe that every emergency department that meets the CPT 
definition of emergency department also qualifies as a dedicated 
emergency department under EMTALA. However, we are aware that there are 
some departments or facilities of hospitals that meet the definition of 
a DED under the EMTALA regulations but that do not meet the more 
restrictive CPT definition of an emergency department. For example, a 
hospital department or facility that meets the definition of a DED may 
not be available 24 hours a day, 7 days a week. Nevertheless, hospitals 
with such departments or facilities incur EMTALA obligations with 
respect to an individual who presents to the department and requests, 
or has requested on his or her behalf, examination or treatment for an 
emergency medical condition. However, because they do not meet the CPT 
requirements for reporting emergency visit E/M codes, these facilities 
must bill clinic visit codes for the services they furnish. We have no 
way to distinguish in our hospital claims data the costs of visits 
provided in DEDs that do not meet the CPT definition of emergency 
department from the costs of clinic visits.
    Some hospitals have requested that they be permitted to bill 
emergency visit codes under the OPPS for services furnished in a 
facility that meets CPT's definition for reporting emergency visit E/M 
codes, except that they are not available 24 hours a day. These 
hospitals believe that their resource costs are more similar to those 
of emergency departments that meet the CPT definition than they are to 
the resource costs of clinics. Representatives of such facilities have 
argued that emergency department visit payments are more appropriate, 
on the grounds that their facilities treat patients with emergency 
conditions whose costs exceed the resources reflected in the clinic 
visit APC payments, even though these emergency departments are not 
available 24 hours per day. In addition, these hospital representatives 
indicated that their facilities have EMTALA obligations and should, 
therefore, be able to receive emergency visit payments. While these 
emergency departments may provide a broader range and intensity of 
hospital services and require significant resources to assure their 
availability and capabilities in comparison with typical hospital 
outpatient clinics, the fact that they do not operate with all 
capabilities full-time suggests that hospital resources associated with 
visits to emergency departments or facilities available less than 24 
hours a day may not be as great as the resources associated with 
emergency departments or facilities that are available 24 hours a day 
and that fully meet the CPT definition.
    To determine whether visits to emergency departments or facilities 
(referred to as Type B emergency departments) that incur EMTALA 
obligations but do not meet more prescriptive expectations that are 
consistent with the CPT definition of an emergency department (referred 
to as Type A emergency departments) have different resource costs than 
visits to either clinics or Type A emergency departments, for CY 2007 
we are proposing a set of five G-codes for use by all entities that 
meet the definition of a DED under the EMTALA regulations in Sec.  
489.24 but that are not Type A emergency departments, as described in 
Table 33 below. These codes will be called ``Type B emergency visit 
codes.''

   Table 33.--Proposed CY 2007 HCPCS Codes To Be Used To Report Emergency Visits Provided in Type B Emergency
                                                   Departments
----------------------------------------------------------------------------------------------------------------
          HCPCS code                 Short descriptor                          Long descriptor
----------------------------------------------------------------------------------------------------------------
Gzzz1........................  Lev 1 hosp type B ED visit.  Level 1 hospital emergency department visit provided
                                                             in a Type B emergency department. (The ED must meet
                                                             at least one of the following requirements: (1) It
                                                             is licensed by the State in which it is located
                                                             under applicable State law as an emergency room or
                                                             emergency department; (2) It is held out to the
                                                             public (by name, posted signs, advertising, or
                                                             other means) as a place that provides care for
                                                             emergency medical conditions on an urgent basis
                                                             without requiring a previously scheduled
                                                             appointment; or (3) During the calendar year
                                                             immediately preceding the calendar year in which a
                                                             determination under this section is being made,
                                                             based on a representative sample of patient visits
                                                             that occurred during that calendar year, it
                                                             provides at least one-third of all of its
                                                             outpatient visits for the treatment of emergency
                                                             medical conditions on an urgent basis without
                                                             requiring a previously scheduled appointment).
Gzzz2........................  Lev 2 hosp type B ED visit.  Level 2 hospital emergency department visit provided
                                                             in a Type B emergency department. (The ED must meet
                                                             at least one of the following requirements: (1) It
                                                             is licensed by the State in which it is located
                                                             under applicable State law as an emergency room or
                                                             emergency department; (2) It is held out to the
                                                             public (by name, posted signs, advertising, or
                                                             other means) as a place that provides care for
                                                             emergency medical conditions on an urgent basis
                                                             without requiring a previously scheduled
                                                             appointment; or (3) During the calendar year
                                                             immediately preceding the calendar year in which a
                                                             determination under this section is being made,
                                                             based on a representative sample of patient visits
                                                             that occurred during that calendar year, it
                                                             provides at least one-third of all of its
                                                             outpatient visits for the treatment of emergency
                                                             medical conditions on an urgent basis without
                                                             requiring a previously scheduled appointment).

[[Page 49609]]

 
Gzzz3........................  Lev 3 hosp type B ED visit.  Level 3 hospital emergency department visit provided
                                                             in a Type B emergency department. (The ED must meet
                                                             at least one of the following requirements: (1) It
                                                             is licensed by the State in which it is located
                                                             under applicable State law as an emergency room or
                                                             emergency department; (2) It is held out to the
                                                             public (by name, posted signs, advertising, or
                                                             other means) as a place that provides care for
                                                             emergency medical conditions on an urgent basis
                                                             without requiring a previously scheduled
                                                             appointment; or (3) During the calendar year
                                                             immediately preceding the calendar year in which a
                                                             determination under this section is being made,
                                                             based on a representative sample of patient visits
                                                             that occurred during that calendar year, it
                                                             provides at least one-third of all of its
                                                             outpatient visits for the treatment of emergency
                                                             medical conditions on an urgent basis without
                                                             requiring a previously scheduled appointment).
Gzzz4........................  Lev 4 hosp type B ED visit.  Level 4 hospital emergency department visit provided
                                                             in a Type B emergency department. (The ED must meet
                                                             at least one of the following requirements: (1) It
                                                             is licensed by the State in which it is located
                                                             under applicable State law as an emergency room or
                                                             emergency department; (2) It is held out to the
                                                             public (by name, posted signs, advertising, or
                                                             other means) as a place that provides care for
                                                             emergency medical conditions on an urgent basis
                                                             without requiring a previously scheduled
                                                             appointment; or (3) During the calendar year
                                                             immediately preceding the calendar year in which a
                                                             determination under this section is being made,
                                                             based on a representative sample of patient visits
                                                             that occurred during that calendar year, it
                                                             provides at least one-third of all of its
                                                             outpatient visits for the treatment of emergency
                                                             medical conditions on an urgent basis without
                                                             requiring a previously scheduled appointment).
Gzzz5........................  Lev 5 hosp type B ED visit.  Level 5 hospital emergency department visit provided
                                                             in a Type B emergency department. (The ED must meet
                                                             at least one of the following requirements: (1) It
                                                             is licensed by the State in which it is located
                                                             under applicable State law as an emergency room or
                                                             emergency department; (2) It is held out to the
                                                             public (by name, posted signs, advertising, or
                                                             other means) as a place that provides care for
                                                             emergency medical conditions on an urgent basis
                                                             without requiring a previously scheduled
                                                             appointment; or (3) During the calendar year
                                                             immediately preceding the calendar year in which a
                                                             determination under this section is being made,
                                                             based on a representative sample of patient visits
                                                             that occurred during that calendar year, it
                                                             provides at least one-third of all of its
                                                             outpatient visits for the treatment of emergency
                                                             medical conditions on an urgent basis without
                                                             requiring a previously scheduled appointment).
----------------------------------------------------------------------------------------------------------------

    For CY 2007, we also are proposing to create five G-codes to be 
reported by the subset of provider-based emergency departments or 
facilities of the hospital, called Type A emergency departments, that 
are available to provide services 24 hours a day, 7 days per week and 
meet one or both of the following requirements related to the EMTALA 
definition of DED, specifically: (1) It is licensed by the State in 
which it is located under the applicable State law as an emergency room 
or emergency department; or (2) It is held out to the public (by name, 
posted signs, advertising, or other means) as a place that provides 
care for emergency medical conditions on an urgent basis without 
requiring a previously scheduled appointment. These codes will be 
called ``Type A emergency visit codes'' and would replace hospitals' 
current reporting of the CPT emergency department visit E/M codes 
listed in Table 33. Our intention is to allow hospital-based emergency 
departments or facilities that are currently appropriately reporting 
CPT emergency department visit E/M codes to bill these new Type A 
emergency visit codes. We believe that this proposed definition of Type 
A emergency departments will neither narrow nor broaden the group of 
emergency departments or facilities that may bill the Type A emergency 
visit codes in comparison with those that are currently correctly 
billing CPT emergency department visit E/M codes. Rather, we are 
refining and clarifying the definition for use in the hospital context. 
We believe that because the concepts employed in the definition of a 
DED for EMTALA purposes are already familiar to hospitals, it is 
appropriate to employ those concepts, rather than the concepts employed 
in the CPT definition of emergency department, for purposes of defining 
these new G-codes. As we have previously noted, the CPT codes were 
defined to reflect the activities of physicians and do not always 
describe well the range and mix of services provided by hospitals 
during visits of emergency department patients. We believe that these 
new codes that we are proposing for reporting emergency visits to Type 
A emergency departments are more specific to the hospital context. For 
example, one feature that distinguishes Type A hospital emergency 
departments from other departments of the hospital is that Type A 
emergency departments do not generally provide scheduled care, but 
rather regularly operate to provide immediately available unscheduled 
services.
    The new codes that we are proposing for CY 2007 are listed in Table 
34 below.

[[Page 49610]]



   Table 34.--Proposed CY 2007 HCPCS Codes To Be Used To Report Emergency Visits Provided in Type A Emergency
                                                   Departments
----------------------------------------------------------------------------------------------------------------
          HCPCS code                 Short descriptor                          Long descriptor
----------------------------------------------------------------------------------------------------------------
Gyyy1........................  Lev 1 hosp type A ED visit.  Level 1 hospital emergency visit provided in a Type
                                                             A hospital-based facility or department. (The
                                                             facility or department must be open 24 hours a day,
                                                             7 days a week and meets at least one of the
                                                             following requirements: (1) It is licensed by the
                                                             State in which it is located under applicable State
                                                             law as an emergency room or emergency department;
                                                             or (2) It is held out to the public (by name,
                                                             posted signs, advertising, or other means) as a
                                                             place that provides care for emergency medical
                                                             conditions on an urgent basis without requiring a
                                                             previously scheduled appointment).
Gyyy2........................  Lev 2 hosp type A ED visit.  Level 2 hospital emergency visit provided in a Type
                                                             A hospital-based facility or department. (The
                                                             facility or department must be open 24 hours a day,
                                                             7 days a week and meets at least one of the
                                                             following requirements: (1) It is licensed by the
                                                             State in which it is located under applicable State
                                                             law as an emergency room or emergency department;
                                                             or (2) It is held out to the public (by name,
                                                             posted signs, advertising, or other means) as a
                                                             place that provides care for emergency medical
                                                             conditions on an urgent basis without requiring a
                                                             previously scheduled appointment).
Gyyy3........................  Lev 3 hosp type A ED visit.  Level 3 hospital emergency visit provided in a Type
                                                             A hospital-based facility or department. (The
                                                             facility or department must be open 24 hours a day,
                                                             7 days a week and meets at least one of the
                                                             following requirements: (1) It is licensed by the
                                                             State in which it is located under applicable State
                                                             law as an emergency room or emergency department;
                                                             or (2) It is held out to the public (by name,
                                                             posted signs, advertising, or other means) as a
                                                             place that provides care for emergency medical
                                                             conditions on an urgent basis without requiring a
                                                             previously scheduled appointment).
Gyyy4........................  Lev 4 hosp type A ED visit.  Level 4 hospital emergency visit provided in a Type
                                                             A hospital-based facility or department. (The
                                                             facility or department must be open 24 hours a day,
                                                             7 days a week and meets at least one of the
                                                             following requirements: (1) It is licensed by the
                                                             State in which it is located under applicable State
                                                             law as an emergency room or emergency department;
                                                             or (2) It is held out to the public (by name,
                                                             posted signs, advertising, or other means) as a
                                                             place that provides care for emergency medical
                                                             conditions on an urgent basis without requiring a
                                                             previously scheduled appointment).
Gyyy5........................  Lev 5 hosp type A ED visit.  Level 5 hospital emergency visit provided in a Type
                                                             A hospital-based facility or department. (The
                                                             facility or department must be open 24 hours a day,
                                                             7 days a week and meets at least one of the
                                                             following requirements: (1) It is licensed by the
                                                             State in which it is located under applicable State
                                                             law as an emergency room or emergency department;
                                                             or (2) It is held out to the public (by name,
                                                             posted signs, advertising, or other means) as a
                                                             place that provides care for emergency medical
                                                             conditions on an urgent basis without requiring a
                                                             previously scheduled appointment).
----------------------------------------------------------------------------------------------------------------

3. Critical Care Services
    For critical care services, we are proposing two new codes, to 
replace hospitals' reporting of the CPT E/M critical care codes listed 
in Table 31. Providers have been reporting two CPT codes through CY 
2006, and we believe that it should be fairly easy to crosswalk current 
internal hospital guidelines to these two new proposed codes. The 
proposed new codes are listed in Table 35 below.

  Table 35.--Proposed CY 2007 HCPCS Codes To Be Used To Report Critical
                              Care Services
------------------------------------------------------------------------
      HCPCS code           Short descriptor         Long descriptor
------------------------------------------------------------------------
Gccc1.................  Hosp critical care,    Hospital critical care
                         30-74 min.             services, first 30-74
                                                minutes.
Gccc2.................  Hosp critical care,    Hospital critical care
                         add 30 min.            services, each
                                                additional 30 minutes.
------------------------------------------------------------------------

C. CY 2007 Proposed Payment Policy

    Since the implementation of the OPPS, outpatient visits provided by 
hospitals have been paid at three payment levels for both clinic and 
emergency department visits, even though hospitals have been reporting 
five resource-based coding levels of clinic and emergency department 
visits using CPT E/M codes. Critical care services have been paid at 
one level, with separate payment for the first 30 to 74 minutes of care 
and bundling of payment for all additional 30 minute increments of 
critical care services into payment for the first 30-74 minutes. If the 
critical care service is less than 30 minutes in duration, then it is 
to be billed as either a clinic visit or an emergency visit CPT code. 
Because the three payment rates for clinic and emergency department 
visits are based on five levels of CPT codes as listed in Table 31, in 
general the two lowest levels of CPT codes (1 and 2) are assigned to 
the low-level visit APCs and the two highest levels of CPT codes (4 and 
5) are assigned to the high-level visit APCs, with the single middle 
CPT level CPT code (3) assigned to the mid-level visit APCs. Hospital 
claims data indicate that the cost of providing a visit of the same 
level is generally significantly higher for emergency visits in 
comparison with clinic visits, with the differential increasing at 
higher levels of services.
    Based upon CY 2005 claims data processed through December 31, 2005, 
the median costs of clinic visit, emergency visit, and critical care 
APCs as configured for CY 2006 are listed below.

[[Page 49611]]



 Table 36.--Median Costs of Clinic and Emergency Visit and Critical Care
                     APCs as Configured for CY 2006
------------------------------------------------------------------------
                                                   Levels of CPT codes
            APC title              APC  median       assigned to APC
------------------------------------------------------------------------
                              Clinic Visits
------------------------------------------------------------------------
Low Level Clinic Visits..........       $53.94  Level 1 Clinic Visit,
                                                 Level 2 Clinic Visit.
Mid Level Clinic Visits..........        63.73  Level 3 Clinic Visit.
High Level Clinic Visits.........        91.27  Level 4 Clinic Visit,
                                                 Level 5 Clinic Visit.
------------------------------------------------------------------------
                       Emergency Department Visits
------------------------------------------------------------------------
Low Level Emergency Visits.......        76.43  Level 1 ED Visit, Level
                                                 2 ED Visit.
Mid Level Emergency Visits.......       133.98  Level 3 ED Visit.
High Level Emergency Visits......       237.17  Level 4 ED Visit, Level
                                                 5 ED Visit.
------------------------------------------------------------------------
                         Critical Care Services
------------------------------------------------------------------------
Critical Care....................       495.16  Critical care, first
                                                 hour.
------------------------------------------------------------------------

    Historical hospitals claims data, however, have generally reflected 
significantly different median costs for the two levels of services 
assigned to the low and high level visit APCs. While the median costs 
of these services do not violate the 2 times rule within their assigned 
APCs, this may not be the most accurate method of payment for these 
very common hospital levels of visits which clearly demonstrate 
differential hospital resources. In particular, because of the 
relatively low volume of the highest levels of services in the clinic 
and emergency department, our payment rates may be especially low. 
Therefore, we are proposing five payment levels for clinic and 
emergency visits and one payment level for critical care services.
    As discussed in the previous section, we are proposing to create 17 
new G-codes to replace the CPT E/M codes that hospitals are currently 
billing to report visits and critical care services. To determine 
appropriate payment rates for the new G-codes, we are proposing to map 
the data from the CY 2005 CPT E/M codes and other HCPCS codes currently 
assigned to the clinic visit APCs to 11 new APCs, 5 for clinic visits, 
5 for emergency visits, and 1 for critical care services as shown in 
Table 37 to develop median costs for these APCs. We mapped the CPT E/M 
codes and other HCPCS codes to the new APCs based on median costs and 
clinical considerations.
BILLING CODE 4120-01-P

[[Page 49612]]

[GRAPHIC] [TIFF OMITTED] TP23AU06.029

BILLING CODE 4120-01-C
    In the case of the CPT E/M codes for emergency visits, the 
assignment of data from a single visit code to the new Type A Emergency 
Visit APC of the same level was straightforward. Similarly, the 
assignment of data from the only separately payable critical care CPT 
code to the new APC for critical care services was clear-cut. However, 
in some cases of the data for CPT clinic visit E/M codes, we assigned a 
code to

[[Page 49613]]

an appropriate clinic visit APC level based upon resource and clinical 
homogeneity considerations, and that APC assignment did not correspond 
to the visit level described by the code. For example, CPT 99213 is a 
level 3 clinic visit code for an established patient, which would seem 
to logically map to the Level 3 Clinic Visit APC. However, because CPT 
99213 has a median cost of $63.04, it maps more appropriately to the 
Level 2 Clinic Visit APC, which has an overall median cost of $62.12. 
In general, CPT codes for established patient visits had lower median 
costs than new patient visit or consultation codes of the same E/M 
level, and that variability is reflected in their respective proposed 
APC data assignments for CY 2007. We believe that in CY 2007, when 
hospitals utilize their own internal guidelines to report clinic 
visits, without codes that differentiate among new, established, or 
consultation visits, they will report G-code levels that reflect their 
resources used. We expect that payments provided for G-codes of each 
level, based upon the CY 2005 claims data assignments as listed in 
Table 38, would provide appropriate resource-based payments for visits 
reported at each level.
    After the CY 2005 CPT E/M codes and other HCPCS codes were mapped 
to an appropriate new APC as shown in Table 38, the next step required 
was to assign an APC to each new G-code for which no data were 
available. We assigned these 16 new separately payable G-codes to an 
appropriate APC level based on the code level alone as shown in Table 
38. For example, both the Level 1 Hospital Clinic Visit and Level 1 
Hospital Type B ED visit codes are mapped to the Level 1 Hospital 
Clinic Visit APC, 0604. Similarly, the Level 1 Hospital Type A ED visit 
code is mapped to the Level 1 Type A Emergency Visit APC, 0609. We 
expect that this configuration would provide appropriate resource-based 
payments for visits reported at each level. We are proposing to assign 
status indicator ``B'' to the CPT E/M codes for CY 2007, with no APC 
assignment, because we are proposing new G-codes for the OPPS for CY 
2007, as delineated in Table 38. Table 38 also removes codes that were 
deleted by CPT for CY 2007, and only includes codes that would be 
effective under the OPPS for CY 2007.
BILLING CODE 4120-01-P

[[Page 49614]]

[GRAPHIC] [TIFF OMITTED] TP23AU06.030

BILLING CODE 4120-01-C
    We are proposing to map the five new clinic visit G-codes to the 
five new Clinic Visit APCs, 0604, 0605, 0606, 0607, and 0608. We are 
proposing to assign the five new Type A emergency visit codes for 
services provided in a Type A emergency department to the five new Type 
A Emergency Visit APCs, 0609, 0613, 0614, 0615, and 0616. For CY 2007, 
we are proposing to assign the five new Type B emergency visit codes 
for services provided in a Type B emergency department to the five new 
Clinic Visit APCs, 0604, 0605, 0606, 0607, and 0608.
    This payment policy for Type B emergency visits is similar to our 
current policy which requires services furnished in emergency 
departments that have an EMTALA obligation but do not meet the CPT 
definition of emergency department to be reported using CPT clinic 
visit E/M codes, resulting in payments based upon clinic visit APCs. As 
mentioned above, CPT requires an emergency department to be open 24 
hours per day in order for it to be eligible to bill emergency 
department E/M codes. While maintaining the same payment policy for 
Type B emergency department visits in CY 2007, the reporting of 
specific G-codes for emergency visits provided in Type B emergency 
departments will permit us to specifically collect and analyze the 
hospital resource costs of visits to these facilities in order to 
determine in the future whether a proposal of an alternative payment 
policy may be warranted. This approach to more refined data collection 
is similar to our approach to drug administration services under the 
OPPS over the past several years. We collected hospital claims data for 
specific detailed services using CPT and HCPCS codes for CYs 2005 and 
2006, while making payments based on claims data available to us for 
the less specific HCPCS codes billed by hospitals prior to CY 2005. We 
recognize that reporting specific drug administration services for 
which hospitals received no separate or

[[Page 49615]]

additional payments created some additional administrative burden on 
hospitals for a period of time, but the resource information collected 
through the claims submissions has been critical to the development of 
our proposal of more refined drug administration payment policies. The 
hospital claims data based upon the CY 2005 drug administration coding 
structure now form the foundation of our CY 2007 proposal for drug 
administration services as described in section VIII.C. of the preamble 
to this proposed rule.
    Although we believe that our proposed payment policy for CY 2007 
for Type B emergency department visits is consistent with our past 
policy regarding visits to emergency departments that do not meet the 
CPT definition of an emergency department, we are interested in public 
comments regarding this policy. The OPPS rulemaking cycle for CY 2009 
will be the first year that we will have cost data for these new Type B 
emergency department HCPCS codes available for analysis. In the 
interim, we are particularly concerned with ensuring that necessary 
emergency department services are available to rural Medicare 
beneficiaries. We recognize that rural emergency departments may be 
disproportionately likely to offer essential emergency department 
services less than 24 hours per day, 7 days a week because of the 
limited demand for those services and the high costs and inefficiencies 
associated with providing full emergency department availability during 
times when few patients are present for emergency care. We believe that 
our OPPS payment policies for Type A and Type B emergency visits should 
support the ability of hospitals to provide their communities with 
essential and appropriate emergency department services efficiently and 
effectively. We also believe that the payment policies should present 
no payment incentive for hospitals to provide necessary emergency 
services less than 24 hours per day, 7 days per week, which could 
result in limited access to emergency services for Medicare 
beneficiaries, thereby leading to adverse effects on their health.
    We are proposing to map code Gccc1, the new proposed hospital 
critical care services code for the first 30-74 minutes of care, to the 
proposed new Critical Care APC 0617. We are proposing to assign status 
indicator ``N'' to proposed HCPCS code Gccc2, to indicate that the code 
is packaged, as the predecessor code to Gccc2 was also packaged.

D. CY 2007 Proposed Treatment of Guidelines

1. Background
    As described in section IX.A. of the preamble of this proposed 
rule, since April 7, 2000 we have instructed hospitals to report 
facility resources for clinic and emergency department outpatient 
hospital visits using the CPT E/M codes and to develop internal 
hospital guidelines for reporting the appropriate visit level. In the 
CY 2003 OPPS final rule with comment period, we noted that an 
independent panel of experts would be an appropriate forum to develop 
codes and guidelines. In that final rule with comment period, we also 
articulated a set of principles that any national guidelines for 
facility visit coding should satisfy, including that coding guidelines 
should be based on facility resources, should be clear to facilitate 
accurate payments and be usable for compliance purposes and audits, 
should meet the HIPAA requirements, should only require documentation 
that is clinically necessary for patient care, and should not 
facilitate upcoding or gaming. We stated that the distribution of codes 
should result in a normal curve.
    Subsequently, as described above, the AHA and AHIMA formed an 
independent expert panel, the Hospital Evaluation and Management Coding 
Panel, and submitted the AHA/AHIMA guidelines for reporting three 
levels of hospital clinic and emergency visits and a single level of 
critical care services to CMS. The guidelines are based on an 
intervention model, where the levels are determined by the numbers and 
types of interventions performed by nursing or ancillary hospital 
staff. We undertook a critical review of the recommendations and made 
some modifications to the guidelines based on comments we received from 
outside hospitals and associations, clinical review, and changing 
payment policies in the OPPS regarding some separately payable 
services. In addition, as previously stated, we contracted a study to 
retrospectively code, under the modified AHA/AHIMA guidelines, hospital 
visits by reviewing hospital visit medical chart documentation gathered 
through CERT work. In summary, while the testing of the modified AHA/
AHIMA guidelines was helpful in illuminating areas of the guidelines 
that would benefit from refinement, we were unable to draw conclusions 
about the relationship between the distribution of current hospital 
reporting of visits using CPT E/M codes that are assigned according to 
each hospital's internal guidelines and the distribution of code levels 
under the AHA/AHIMA guidelines, nor were we able to demonstrate a 
normal distribution of visit levels under the modified AHA/AHIMA 
guidelines.
    Despite the inconclusive findings from the validation study, after 
reviewing the AHA/AHIMA guidelines, as well as approximately a dozen 
other guidelines for outpatient visits submitted by various hospitals 
and hospital associations, we believe that the AHA/AHIMA guidelines are 
the most appropriate and well-developed guidelines for use in the OPPS 
of which we are aware. Our particular interest in these guidelines is 
based upon the broad-based input into their development, the need for 
CMS to move definitively to promulgate national outpatient hospital 
visit coding guidelines in the near future, and full consideration of 
the characteristics of alternative types of guidelines. We also think 
that hospitals will react favorably to guidelines developed and 
supported by the AHA and AHIMA, national organizations that have great 
interest in hospital coding and payment issues and possess significant 
medical, technical and practical expertise due to their broad 
membership, which includes hospitals and health information management 
professionals. Anecdotally, we have been told that a number of 
hospitals are successfully utilizing the AHA/AHIMA guidelines to report 
levels of hospital visits. However, other organizations have expressed 
concern that the AHA/AHIMA guidelines may result in a significant 
redistribution of hospital visits to higher levels, reducing the 
ability of the OPPS to discriminate among the hospital resources 
required for various different levels of visits. We, too, remain 
concerned about the potential redistributive effect on OPPS payments 
for other services or among levels of hospital visits when national 
guidelines for outpatient visit coding are adopted. We recognize that 
there may be difficulty crosswalking historical hospital claims data 
from current CPT E/M codes reported based on individual internal 
hospital guidelines to payments for any new coding system developed, in 
order to provide appropriate payment levels for hospital visits 
reported based on national guidelines in the future.
    There are several types of problems with the AHA/AHIMA guidelines 
that have been identified based upon extensive staff review and 
contractor use of the guidelines during the validation study. We 
believe the AHA/AHIMA guidelines require short-term refinement prior to 
their full adoption by the OPPS, as well as continued refinement over 
time after their

[[Page 49616]]

implementation. Our modified version of the AHA/AHIMA guidelines 
provides some possibilities for addressing certain issues. Our eight 
general areas of concern regarding the AHA/AHIMA model are listed 
below. In addition, we have posted to the CMS Web site both the 
original AHA/AHIMA guidelines and our modified draft version, and we 
are seeking public input before we adopt national guidelines. We 
continue to commit that we will provide a minimum of 6-12 months notice 
to hospitals prior to implementation of national guidelines to provide 
sufficient time for providers to make the necessary systems changes and 
educate their staff.
2. Outstanding Concerns With the AHA/AHIMA Guidelines
a. Three Versus Five Levels of Codes
    The AHA/AHIMA guidelines describe three levels of codes for clinic 
and emergency visits, rather than the five levels of codes that we are 
proposing for clinic and Type A and Type B emergency visits. It would 
be impossible to pay at five levels using these guidelines, unless the 
guidelines were revised. As discussed above, our claims data indicate 
that five payment levels are justified for both clinic and Type A 
emergency visits, and, therefore, we are proposing five levels of G-
codes so that providers may code at five visit levels and receive 
payments at five levels as well. In fact, the materials explaining the 
AHA/AHIMA guidelines state that one of the reasons that the model 
includes only three coding levels is because CMS only paid at three 
payment levels. We are now proposing to pay at five payment levels, and 
if our proposed CY 2007 payment policy is finalized, the AHA/AHIMA 
guidelines may need to be revised to reflect five visit levels.
b. Lack of Clarity for Some Interventions
    Some interventions are vague, unclear, or nonspecific, without 
sufficient examples of documentation in the medical record that may 
support those interventions. For instance, it is unclear what 
documentation for the intervention stated as ``Patient registration, 
room set up, patient use of room, room cleaning'' and assigned in the 
AHA/AHIMA guidelines to a low-level clinic visit would be necessary to 
support all aspects of that intervention. In another case, the 
intervention ``Frequent monitoring/assessment as evidenced by two sets 
of vital sign measurements or assessments'' that is attributable to a 
mid-level emergency visit in the guidelines explains that this may 
include assessment of cardiovascular, pulmonary, or neurological 
status. However, it is unclear exactly what coders should look for in 
the medical record to support this intervention and whether narrative 
hospital staff descriptions of patient status would be considered to be 
assessments. These examples, and others, were identified by the 
contractor engaged in medical chart reviews as part of the guidelines 
validation study. The AHA/AHIMA guidelines may benefit from revisions 
to clarify some interventions and/or provide additional examples based 
upon questions that arose during field testing of the guidelines or 
that are raised by hospitals reviewing the AHA/AHIMA guidelines and the 
modified version posted on our Web site.
c. Treatment of Separately Payable Services
    CMS and the APC Panel stated that separately payable services 
should be excluded from the guidelines because of their concern over 
the potential for double payment for hospital resources attributed to 
visit services when those resources were actually used to provide the 
separately payable services. Consistent with this policy, at the time 
of their development the AHA/AHIMA guidelines excluded all services 
separately payable under the OPPS from the list of interventions. For 
policy consistency, in our modified draft version of the guidelines, we 
removed interventions that have now become separately payable under the 
OPPS through CY 2006, such as bladder catheterizations and some wound 
care services. However, upon further reflection as we move forward to 
implement national guidelines, we are open to reconsidering whether the 
inclusion of some separately payable services in guidelines to 
determine visit levels could serve as a proxy for the resources that 
the patient will consume and that should be attributable to the 
hospital visit, not the separately payable services. In such cases, 
consideration of separately payable services in reporting visit levels 
may not result in double payment for components of those separately 
payable services. There may be hospital resources used in visits that 
are not captured in the AHA/AHIMA guidelines' limited number of 
interventions that are not separately payable. We believe that, in 
general, a patient with high medical acuity will consume more hospital 
resources in the visit than a patient with moderate acuity. However, 
when separately payable interventions are removed from the model, it 
may be difficult for the limited interventions remaining in the 
guidelines for each visit level to capture the acuity level of the 
patient. In addition, the list of HCPCS codes that are packaged can 
change annually. For example, in the CY 2006 OPPS, bladder 
catheterization services, which had been packaged in prior years, were 
first made separately payable. If the guidelines strictly excluded all 
separately payable services, then the guidelines could also change from 
year to year, possibly requiring additional education of hospital staff 
on an annual basis. An extremely ill emergency department patient who 
may need a significant number of separately payable procedures, but 
only one or two minor interventions that are not separately payable, 
may require significant time and attention from hospital staff that is 
unrelated to the hospital resources generally required for the 
separately payable procedures. The guidelines may indicate that a low 
level emergency department visit code should be billed, while in fact 
the patient may require significantly more hospital resources than a 
mildly ill patient who received the same two minor interventions. We 
are open to further discussion and welcome public comments on the 
exclusion of separately payable services from the national visit 
guidelines and whether their inclusion could pose a risk of attributing 
the same hospital resources to both visits and separately payable 
services, potentially resulting in duplicate payments for those 
resources.
d. Some Interventions Appear Overvalued
    Several interventions that we believe may be minor are valued at a 
high level in the guidelines. This could result in visits with 
relatively less resource intensive interventions being coded as high 
level visits, leading to an overall visit distribution that was skewed 
toward the high end. Claims data then would fail to reflect the 
differential hospital resources associated with hospital visits of five 
levels. For example, the AHA/AHIMA guidelines consider oxygen 
administration, described as initiation and/or adjustment from a 
baseline oxygen regimen, to be a mid level emergency department 
intervention, while we believe that the associated hospital resources 
could be more consistent with its characterization as a low level 
emergency department intervention. In another example, the AHA/AHIMA 
guidelines consider specimen collection(s), other than venipuncture and 
other separately payable services, to be a mid level clinic 
intervention, while we believe this may be more consistent with other 
low level clinic

[[Page 49617]]

interventions, depending upon the numbers and types of different 
specimens collected. We encourage specific comments on the levels 
assigned to various interventions in the guidelines, with the goal of 
differentiating five levels of services in a normal distribution, based 
on their respective hospital resources.
e. Concerns of Specialty Clinics
    The AHA/AHIMA guidelines are unlikely to sufficiently address the 
concerns of various specialty clinics (for example, pain management 
clinics, oncology clinics, and wound care centers). Anecdotally, we 
have heard that the interventions listed in the AHA/AHIMA guidelines do 
not include many of the interventions commonly performed in specialty 
clinics and that some of the interventions in the guidelines would 
never be performed in certain types of clinics. Currently, each 
provider has its own set of guidelines, and we believe that some 
specialty clinics have customized guidelines to facilitate coding their 
visits at different levels based upon the specific hospital resources 
commonly used in visits to their clinics. While we prefer to have one 
model that can be applied nationally to each level of clinic visit code 
for which we make a specific OPPS payment, we are unsure as to whether 
one model can adequately characterize visit levels for all types of 
clinics. For example, we have been told that the most appropriate proxy 
for facility resource consumption in cancer care is staff time due to 
the intensive staff interactions required to care for patients with 
cancer, regardless of the reasons for their clinic visits. We are 
interested in comments regarding the feasibility of applying national 
guidelines to specialty clinic visits while ensuring appropriate OPPS 
payments for those services and suggestions for revisions to the 
guideline models posted that could improve their utility in reporting 
such visits.
f. Americans With Disabilities Act
    We are concerned that the AHA/AHIMA guidelines' intervention 
related to the special needs of certain patients may be in violation of 
the Americans with Disabilities Act, as it may increase the visit level 
reported, thereby increasing a patient's copayment. Even if additional 
hospital resources are required to treat patients with disabilities, 
patients must not have additional financial liability for those 
services based on their disabilities.
g. Differentiation Between New and Established Patients, and Between 
Standard Visits and Consultations
    The AHA/AHIMA guidelines do not differentiate between new versus 
established patients or consultations versus standard visits for clinic 
visits. During the summer 2002 APC Panel meeting, the APC Panel 
recommended that CMS not differentiate among visit types, specifically 
new, established, and consultation visits, for the purposes of clinic 
visit facility coding. Therefore, in the August 9, 2002 OPPS proposed 
rule, we proposed to accept the APC Panel's recommendation to create 
five new G-codes to replace the CPT new and established clinic visit 
and consultation E/M codes. We did not finalize the codes for CY 2003 
because of concerns then about creating new G-codes without national 
guidelines.
    During CY 2006 and earlier, there has not been a payment difference 
between new and established patient visits of the same level, as 
generally both were mapped to the same APC. The information describing 
the AHA/AHIMA guidelines indicates that only one set of guidelines was 
developed for five levels of codes for clinic visits, regardless of a 
patient's status as a new or established patient or the provision of a 
consultation visit. This approach may have been related to the lack of 
a payment differential for different types of clinic visits of the same 
level under the OPPS when those guidelines were developed. However, 
several years of hospital claims data regarding the median costs of the 
specific CPT clinic visit E/M codes consistently indicate that new 
patients generally are more resource intensive than existing patients 
across all visit levels, and that consultations are more resource 
intensive than standard visits. For example, based upon CY 2005 claims 
used by the OPPS for CY 2007 ratesetting, CPT code 99213, the level 3 
clinic visit code for established patients, has a median cost of 
$63.04. CPT code 99203, the level 3 clinic visit code for new patients, 
has a median cost of $74.12. CPT code 99243, the level 3 consultation 
visit code, has a median cost of $84.14. Finally, CPT code 99273, the 
level 3 confirmatory consultation visit code which was deleted for CY 
2006, had a median cost of $100.77. We encourage public comments that 
discuss the potential differences in hospital clinic resource 
consumption for new patient visits, established patient visits, and 
consultations. If there are significant additional hospital resources 
required to provide new patient visits or consultations, we are unsure 
whether the interventions in the AHA/AHIMA guidelines would reliably 
capture these additional resources.
h. Distinction Between Type A and Type B Emergency Departments
    There are no AHA/AHIMA guidelines for the reporting of visits to 
Type B emergency departments that meet the EMTALA definition of a DED, 
but do not meet the proposed definition of a Type A emergency 
department, as discussed above. When the AHA and AHIMA created these 
guidelines, emergency departments that did not meet the CPT definition 
of emergency department were instructed to bill CPT clinic visit E/M 
codes. There was no distinction in reporting between emergency 
departments that, as DEDs, had an EMTALA obligation but did not meet 
the CPT definition of emergency department and outpatient hospital 
clinics that did not provide emergency services. If we finalize our 
proposal to create new G-codes for CY 2007 for Type B emergency 
departments to use in reporting visits, in the short run hospitals will 
use internal guidelines to determine their visit levels for Type B 
emergency department visits, as they will for visits to both clinics 
and Type A emergency departments. However, with the implementation of 
national hospital visit guidelines we will need to specify those 
guidelines to be used for the purposes of Type B emergency visit 
reporting. The AHA and AHIMA have not yet had the opportunity to 
consider the issue of Type B emergency visit reporting in their 
guidelines, and we welcome public comments to provide additional 
perspectives on the appropriate guidelines for reporting visit levels 
in these Type B emergency departments.
    The public comments that we receive on this guidelines section of 
this proposed rule will be publicly available to the AHA and AHIMA and 
their expert panel, along with comments that we receive on the two 
versions of the guidelines posted on our Web site. We hope to receive 
input from them over the upcoming months to address the eight areas of 
concern that are discussed above, as well as other issues brought to 
our attention by the public. We understand that some issues will not be 
able to be fully addressed by their expert panel until we finalize our 
CY 2007 payment policies for visits in the OPPS. We plan to communicate 
progress on the development of OPPS visit guidelines through updates to 
the OPPS Web site, and we may post other versions of draft guidelines 
in order to solicit additional public input during CY 2007. When we 
post additional

[[Page 49618]]

materials to the web for purposes of providing information or 
soliciting further comments regarding national guidelines, we will 
update the public through all means practically available to us, 
including communications with professional associations, list-serves, 
etc. While we understand the interest of some hospitals in our moving 
quickly to promulgate national guidelines that will assure standardized 
reporting of outpatient hospital visit levels, we believe that the 
issues we have identified and others that may arise are important and 
require serious consideration prior to the implementation of national 
guidelines. Because of our commitment to provide hospitals with 6-12 
months notice prior to implementation of national guidelines, we expect 
that we will not implement national guidelines prior to CY 2008. We 
acknowledge that, once implemented, the guidelines will require 
periodic review and updating based on factors such as changing medical 
practices, hospital experiences in reporting the codes, new payment 
policies under the OPPS, and median costs for levels of services 
calculated from claims data. We are hopeful that the information 
received from the AHA, AHIMA and others on such reviews would permit us 
to effectively, and in a timely manner, address emerging guideline 
implementation issues, as well as develop desirable future 
modifications to the guidelines based on hospitals' experiences 
reporting commonly provided visits. We believe that this ongoing system 
should provide the most successful approach to ensuring that OPPS 
national visit guidelines continue to facilitate consistent and 
standardized reporting of outpatient hospital visits, in a manner that 
is resource-based and supportive of appropriate OPPS payments for the 
efficient and effective provision of visits in hospital outpatient 
settings.

X. Proposed Payment for Blood and Blood Products

A. Background

    (If you choose to comment on issues in this section, please include 
the caption ``Blood and Blood Products'' at the beginning of your 
comment.)
    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 Program Transmittal 496 on March 4, 
2005. The comprehensive billing guidelines in the Program Transmittal 
also addressed specific concerns and issues related to billing for 
blood-related services, which the public had brought to our attention.
    In the CY 2000 OPPS, payments for blood and blood products were 
established based on external data provided by commenters due to 
limited Medicare claims data. From the CY 2000 OPPS to the CY 2002 
OPPS, payment rates for blood and blood products were updated for 
inflation. For the CY 2003 OPPS, as described in the November 1, 2002 
final rule with comment period (67 FR 66773), we applied a special 
adjustment methodology to blood and blood products that had significant 
reductions in payment rates from the CY 2002 OPPS to the CY 2003 OPPS, 
when median costs were first calculated from hospital claims. Using the 
adjustment methodology, we limited the decrease in payment rates for 
blood and blood products to approximately 15 percent. For the CY 2004 
OPPS, 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 the CY 2005 OPPS, 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 on 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 its February 2004 and September 2004 meetings, we 
conducted a thorough analysis of the 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 CCR was 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).
    For the CY 2005 OPPS, 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 OPPS payment rate on a 50/50 blend 
of the CY 2004 OPPS product-specific OPPS median costs and the CY 2005 
OPPS 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.
    Overall, median costs from CY 2003 (used for the 2005 OPPS) to CY 
2004 (used for the 2006 OPPS) were relatively stable, with a few 
significant increases and decreases from the CY 2005 adjusted median 
costs for some specific blood products. For the CY 2006 OPPS, we 
adopted a payment adjustment policy that limited significant decreases 
in APC payment rates for blood and blood products from the CY 2005 OPPS 
to the CY 2006 OPPS to not more than 5 percent. We applied this 
adjustment to 11 blood and blood product APCs for the CY 2006 OPPS, 
which we identified in Table 33 of the CY 2006 OPPS final rule with 
comment period. For the CY 2006 OPPS we set the final median costs for 
blood and blood products at the

[[Page 49619]]

greater of: (1) The simulated median costs calculated from the CY 2004 
claims data; or (2) 95 percent of the CY 2005 OPPS adjusted median 
costs for these products, as reflected in Table 33 published in the CY 
2006 OPPS final rule with comment period.

B. Proposed Policy Changes for CY 2007

    For the CY 2007 OPPS, we are proposing to establish payment rates 
for 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 for blood and blood 
products to costs. We continue to believe that using blood-specific 
CCRs applied to hospital claims data will result in 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.
    The median costs for blood and blood products in this proposed rule 
are derived from the CY 2005 claims data and have the benefit of 
reflecting, in part, the clarifications about reporting that were 
provided through CMS Program Transmittal 496, which we issued on March 
4, 2005. This instruction articulated and clarified many questions that 
had been raised by hospitals and others about how hospitals should 
report charges for blood and blood products. These instructions went 
into effect for services furnished on or after July 1, 2005, and 
therefore were in effect for the last 6 months of CY 2005. Thus, we 
expect that the reporting of charges and units for blood and blood 
products in CY 2005 has improved over past years, especially with 
respect to hospitals' inclusion of all charges related to the 
acquisition, processing, and handling of blood and blood products as 
specifically described in each of the relevant P-code descriptors. We 
believe that the median costs for blood and blood products from the CY 
2005 claims data reflect this improved reporting of charges and units 
for these products, particularly with regard to the most commonly 
furnished blood and blood products.
    Of the 34 blood products, median costs per unit (calculated using 
the simulated blood CCR methodology) rise for 23 of them compared to 
the CY 2006 final rule with comment period unadjusted median unit 
costs. These 23 products account for 92.4 percent of all units of blood 
products furnished in our CY 2005 claims data. As has been the case in 
the past, the low volume products (which we define as fewer than 1,000 
units) show the most volatility. Of the 12 low volume products, 6 
products have increases in their unit costs compared to their CY 2006 
unadjusted median unit costs, and 6 products show decreases in their 
median unit costs compared to their CY 2006 unadjusted median unit 
costs. The low-volume products for which the medians decline compared 
to their unadjusted median costs in CY 2006 represent only 0.29 percent 
of the total units of blood products furnished in the CY 2005 OPPS 
claims data.
    Fewer blood products increased in projected costs from CY 2006 to 
the proposed median costs for CY 2007 because we adjusted the CY 2006 
median costs for blood and blood products. Of the 34 blood products, 
median costs rise for 19 of them compared to the CY 2006 OPPS adjusted 
median costs on which the CY 2006 payments were based (and which were 
adjusted to no less than 95 percent of the CY 2005 payment medians). 
These 19 products accounted for 91.6 percent of all units of blood 
products furnished in our CY 2005 claims data. Of the 12 low-volume 
products, 4 show increases in their median unit costs compared to the 
CY 2006 OPPS adjusted median unit costs, and 8 show decreases compared 
to their CY 2006 OPPS adjusted median unit costs. The low-volume 
products that show a decline in medians compared to their CY 2006 
adjusted median costs represent only 0.4 percent of the total units of 
blood products reflected in the CY 2005 claims data.
    We are proposing to set the payment rates for blood and blood 
products for CY 2007 based on the unadjusted median costs for blood and 
blood products which are derived from the CY 2005 claims data as we 
have described. We believe that, in most cases, the unadjusted unit 
costs developed by this process are valid reflections of the estimated 
median costs of furnishing these specific blood products, and that no 
adjustment is required to result in appropriate payments for blood and 
blood products in CY 2007. Under this proposed policy, based on the CY 
2005 claims data, the projected payments would rise for approximately 
92 percent of the blood product units paid under OPPS if patterns of 
furnishing blood products in CY 2007 were similar to those in CY 2005. 
The low-volume products whose median costs decline compared to their CY 
2006 unadjusted median costs are furnished very rarely and by very few 
providers because, in part, more commonly available products may be 
used for similar clinical indications. We have no reason to believe 
that the median costs for low-volume products are not valid reflections 
of the costs of furnishing these low-volume services, particularly 
given that so few providers furnish them and it is their claims data 
that is used to develop the medians. We note, as well, that the median 
costs of several low-volume blood products show a significant increase 
for CY 2007. We welcome public comments on this issue.
    Displayed in Table 39 is the list of blood product HCPCS codes with 
their proposed CY 2007 payment medians.

                    Table 39.--Proposed CY 2007 Payment Medians for Blood and Blood Products
----------------------------------------------------------------------------------------------------------------
                                                                           Proposed CY
                                                              Proposed CY   2007 OPPS     CY 2006      CY 2006
   HCPCS code          SI         APC     Short description    2007 units  median unit   unadjusted    adjusted
                                                                               cost     median cost  median cost
----------------------------------------------------------------------------------------------------------------
P9010...........  K...........     0950  Whole blood for             2060      $134.80      $117.91      $117.91
                                          transfusion, per
                                          unit.
P9011...........  K...........     0967  Blood split unit,            136       136.42        82.50        82.50
                                          specify amount.
P9012...........  K...........     0952  Cryoprecipitate             4155        52.94        40.33        47.10
                                          each unit.
P9016...........  K...........     0954  RBC leukocytes            556100       177.51       163.16       163.16
                                          reduced, each unit.
P9017...........  K...........     9508  Plasma 1 donor frz         40113        72.12        70.40        70.40
                                          w/in 8 hr, each
                                          unit.
P9019...........  K...........     0957  Platelets, each            25796        60.49        51.50        51.50
                                          unit.
P9020...........  K...........     0958  Platelet rich                657       156.49       277.42       277.42
                                          plasma unit.
P9021...........  K...........     0959  Red blood cells           145507       129.99       121.48       121.48
                                          unit.
P9022...........  K...........     0960  Washed red blood            2455       216.35       172.40       189.22
                                          cells unit.
P9023...........  K...........     0949  Frozen plasma,               388        55.96        60.38        76.15
                                          pooled, sd, each
                                          unit.

[[Page 49620]]

 
P9031...........  K...........     1013  Platelets                  19368        94.61        98.30        98.30
                                          leukocytes
                                          reduced, each unit.
P9032...........  K...........     9500  Platelets,                  4579       129.45        73.46        86.55
                                          irradiated, each
                                          unit.
P9033...........  K...........     0968  Platelets                   4802       130.89       102.18       150.58
                                          leukoreduced
                                          irrad, each unit.
P9034*..........  K...........     9507  Platelets,                  9292       465.60       434.01       434.01
                                          pheresis, each
                                          unit.
P9035...........  K...........     9501  Platelet pheresis          40933       490.51       493.12       493.12
                                          leukoreduced, each
                                          unit.
P9036...........  K...........     9502  Platelet pheresis           1476       413.58       317.43       325.87
                                          irradiated, each
                                          unit.
P9037...........  K...........     1019  Plate pheresis             17766       616.68       581.01       581.01
                                          leukoredu irrad,
                                          each unit.
P9038...........  K...........     9505  RBC irradiated,             4130       201.36       147.47       147.47
                                          each unit.
P9039...........  K...........     9504  RBC deglycerolized,          818       352.72       343.44       343.44
                                          each unit.
P9040...........  K...........     0969  RBC leukoreduced           57857       228.76       218.04       218.04
                                          irradiated, each
                                          unit.
P9043...........  K...........     0956  Plasma protein               430        24.81        67.94        67.94
                                          fract, 5%, 50ml.
P9044...........  K...........     1009  Plasma,                     5868        80.23        74.52        74.52
                                          cryoprecipitate
                                          reduced, each unit.
P9048...........  K...........     0966  Plasma protein               398       193.39       127.36       315.70
                                          fract, 5%, 250ml.
P9050...........  K...........     9506  Granulocytes,                495       253.43       245.14       994.64
                                          pheresis unit.
P9051...........  K...........     1010  Blood, l/r, cmv-            3364       135.83       207.72       207.72
                                          neg, each unit.
P9052...........  K...........     1011  Platelets, hla-m, l/        1809       649.06       609.48       609.48
                                          r, unit.
P9053...........  K...........     1020  Plt, pher, l/r cmv-          895       722.82       654.13       654.13
                                          neg, irr, each
                                          unit.
P9054...........  K...........     1016  Blood, l/r, froz/            493        89.33        89.73       261.93
                                          degly/wash, each
                                          unit.
P9055...........  K...........     1017  Plt, aph/pher, l/r,          534       379.91       526.00       526.00
                                          cmv-neg, each unit.
P9056...........  K...........     1018  Blood, l/r,                 3720       134.43       162.42       178.37
                                          irradiated, each
                                          unit.
P9057...........  K...........     1021  RBC, frz/deg/wsh, l/          71       427.35       345.53       345.53
                                          r, irrad, each
                                          unit.
P9058...........  K...........     1022  RBC, l/r, cmv-neg,          1965       264.47       256.76       266.89
                                          irrad, each unit.
P9059...........  K...........     0955  Plasma, frz between         3118        73.28        74.70        74.70
                                          8-24hour, each
                                          unit.
P9060...........  K...........     9503  Fr frz plasma donor          283        73.60        94.72        94.72
                                          retested, each
                                          unit.
----------------------------------------------------------------------------------------------------------------
*After removal of two claims with grossly excessive units.

XI. Proposed OPPS Payment for Observation Services

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS: Observation Services'' at the beginning of your 
comment.)
    Observation care is a well-defined set of specific, clinically 
appropriate services that 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 CY 2006, we adopted two coding changes that affect how 
observation services are reported, and we made changes in the OCE to 
shift from individual providers to the OPPS claims processing systems 
the determination of whether or not observation services are separately 
payable or packaged. Observation services reported using HCPCS code 
G0378 (Hospital observation services, per hour) that are eligible for 
separate payment map to APC 0339 (Observation). The CY 2006 payment 
rate for APC 0339 is $425.08. The proposed CY 2007 median cost for APC 
0339 is $442.16, reflecting relative stability in hospital costs for 
separately payable observation care. Direct admission to observation 
(G0379), when separately payable, is currently assigned for payment to 
APC 0600 (Low Level Clinic Visit) with a CY 2006 payment rate of 
$52.37. As discussed below, for CY 2007 we are proposing to assign 
direct admission to observation, when separately payable, to APC 0604 
(Low Level Clinic Visit). The CY 2007 proposed median cost for APC 0604 
is $49.93.
    As we stated in the November 10, 2005 OPPS final rule with comment 
period (70 FR 68688), the changes that we adopted for CY 2006 were 
intended to ensure more consistent hospital billing for observation 
services in order to guide our future analyses of payment for 
observation care and to simplify how observation services are reported 
and paid. We refer readers to the CY 2006 OPPS final rule with comment 
period for a detailed discussion of the G-codes for observation 
services and the OCE logic changes implemented for CY 2006 (70 FR 
68688), and to Program Transmittal 787, issued on December 16, 2005, in 
which we updated Chapter 4, Section 290 of the Medicare Claims 
Processing Manual (Pub. 100-04) to reflect the CY 2006 changes and to 
provide additional guidance to contractors and hospitals.
    During the APC Panel's March 2006 meeting, the Observation 
Subcommittee did not make any recommendations to the Panel other than 
to request its review of additional data on observation services at the 
Panel's 2007 winter meeting. The APC Panel adopted the Observation 
Subcommittee's report and recommended no changes to the criteria for 
separate payment for observation services or to the coding and payment 
methodology for observation services.
    Therefore, for CY 2007, we are proposing to continue applying the 
criteria for separate payment for observation services and the coding 
and payment methodology for observation services that were implemented 
in CY 2006, with one exception. In section IX. of this preamble, we are 
proposing changes in coding and payment for clinic and emergency room 
visits. As part of these proposed changes, low level clinic visits 
would move from APC 0600 to APC 0604, with a CY 2007 proposed median 
cost of $49.93. Under the circumstances where direct admission to 
observation is separately payable, we are proposing to assign HCPCS 
code G0379 to APC 0604 consistent with its CY 2006 placement in the APC 
for Low Level Clinic Visits.
    As we stated in Program Transmittal A-02-129 released in January 
2003, we

[[Page 49621]]

will continue to include in the October quarterly update of the OPPS 
any changes to the list of ICD-9-CM codes required for separate payment 
of HCPCS code G0378 resulting from the October 1 annual update of ICD-
9-CM codes. The currently applicable ICD-9-CM codes are listed in Table 
34 of the CY 2006 OPPS final rule with comment period (70 FR 68692), 
and any changes to that list will be included in the CY 2007 OPPS final 
rule with comment period.

XII. Proposed Procedures That Will Be Paid Only as Inpatient Procedures

A. Background

    Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad 
authority to determine the services to be covered and paid for under 
the OPPS. 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 
66741), 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 numerous 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.

B. Proposed Changes to the Inpatient Only List

    (If you choose to comment on issues in this section, please include 
the caption ``Inpatient Only Procedures'' at the beginning of your 
comment.)
    For CY 2007 OPPS, we used the same methodology as described in the 
November 15, 2004 final rule with comment period (69 FR 65835) to 
identify a subset of procedures currently on the inpatient list that 
are 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 seven procedures from the inpatient list at the March 1, 
2006 APC Panel meeting. During CY 2006, we have received no other 
candidate HCPCS codes for removal from the OPPS inpatient list based on 
recommendations from the public. The APC Panel recommended that one of 
the procedures (CPT code 21181, Reconstruction by contouring of benign 
tumor of cranial bones, extracranial) be removed from the list and that 
we solicit approval from the relevant physician specialty societies 
prior to proposing removal of the other procedures.
    Consistent with our established policy for removing procedures from 
the inpatient list, we rely on our utilization data and clinical staff 
input in determining which procedures are candidates for removal. We 
believe that our policy of proposing the procedures for removal and 
soliciting comments from the public, which includes physician specialty 
societies, is the most appropriate process to receive input from the 
public on this issue. Rather than solicit approval from a select group 
(for example, specific physician specialty societies), we believe that 
solicitation of comments from all interested parties is more consistent 
with meeting our obligation to the public regarding outpatient services 
provided by hospitals. The utilization data and clinical review 
findings for the eight procedures support our proposal to remove them 
from the inpatient list, and therefore, we are proposing to remove 
these procedures from the inpatient list and to assign them to 
clinically appropriate APCs, as shown in Table 40. The changes to the 
inpatient list would be effective for services furnished on or after 
January 1, 2007.

    Table 40.--Proposed Procedure Codes To Remove From Inpatient List and Proposed APC Assignments, Effective
                                                 January 1, 2007
----------------------------------------------------------------------------------------------------------------
                                                       Proposed
        HCPCS code              Long descriptor        new APC        Current status        Proposed new status
                                                      assignment         indicator               indicator
----------------------------------------------------------------------------------------------------------------
16035....................  Escharotomy; initial             0016  C                       T
                            incision.
21181....................  Reconstruction by                0254  C                       T
                            contouring of benign
                            tumor of cranial bones,
                            extracranial.
22851....................  Apply spine prosth               0049  C                       T
                            device.
57292....................  Construction of                  0195  C                       T
                            artificial vagina; with
                            graft.
57335....................  Vaginoplasty for                 0195  C                       T
                            intersex state.
61720....................  Creation of lesion by            0221  C                       T
                            stereotactic method,
                            including burr holes
                            and localizing and
                            recording techniques,
                            single of multiple
                            stages; globus pallidus
                            or thalamus.
62000....................  Elevation of depressed           0254  C                       T
                            skull fracture; simple
                            extradural.

[[Page 49622]]

 
64804....................  Sympathectomy,                   0220  C                       T
                            cervicothoracic.
----------------------------------------------------------------------------------------------------------------

C. Proposed CY 2007 Payment for 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.)
1. Background
    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'' (to indicate inpatient services that are not paid 
under the OPPS). 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 (Ancillary Outpatient Services When Patient 
Expires) 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 $1,150, which was the 
payment amount for the newly structured New Technology APC that 
replaced APC 0977.
    For CYs 2005 and 2006, the payment rates for APC 0375 for services 
billed on the same date as a ``C'' status procedure appended with 
modifier -CA were established in accordance with the same methodology 
we followed to set payment rates for the other procedural APCs in those 
years, based on the relative payment weight calculated for APC 0375. 
For APC 0375 specifically, we calculated the relative payment weight 
from all claims reporting a ``C'' status procedure appended with 
modifier -CA, using charge data from the relevant calendar year 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. We continued to make one 
payment in CYs 2005 and 2006 under APC 0375 for the services that met 
the specific conditions discussed in previous rules for using modifier 
-CA.
    In the CY 2006 final rule with comment period (70 FR 68700) we 
discussed our concern about the large increase in the volume of 
hospital claims billed with modifier -CA from CY 2003 to CY 2004, 
growing from 18 to 300 claims over that 1-year time period. We 
acknowledged that because modifier -CA was first introduced for CY 
2003, the use of the modifier in CYs 2003 and 2004 may have reflected 
such an increase due to hospitals' learning curve with respect to the 
modifier's appropriate use on claims for services payable under the 
OPPS. We also expressed some concern that numerous claims reflected 
unanticipated examples of ``C'' status procedures reported with 
modifier -CA that may not have been provided to patients with emergency 
life threatening conditions, where the inpatient procedure was 
performed on an emergency basis to resuscitate or stabilize the 
patient. We promised to monitor CY 2005 claims data for similar 
increases.
    Our review of the CY 2005 claims data revealed a decrease in the 
use of modifier -CA in comparison with CY 2004 claims. In CY 2005 there 
were only 210 claims submitted reporting modifier -CA. Because of the 
diverse individual clinical scenarios where modifier -CA may be 
appropriately reported, we expect some variation from year to year in 
the number of OPPS claims reporting the modifier. It would appear that 
the hospital learning curve regarding use of modifier -CA may have been 
completed over the past 3 year period, and that we may expect 
relatively consistent reporting of this modifier in future years. We 
wish to particularly note that not only was there no increase in the 
number of claims reporting modifier -CA in CY 2005, but there were also 
far fewer apparently inappropriate instances of use. Our CY 2005 claims 
data show the majority of reporting of modifier -CA was in association 
with what were likely to have been urgent interventions, including the 
insertion of intra-aortic balloon assist devices and exploratory 
laparotomies. We believe that the data support our speculation that 
much of the increase in reporting of the modifier observed in CY 2004 
data was a result of hospitals' learning curve regarding the 
appropriate use of the modifier.
2. Proposed Policy for CY 2007
    We do not propose any change to our policies regarding reporting of 
modifier -CA for CY 2007, or to our payment policy regarding APC 0375. 
Therefore, for CY 2007, we are proposing that hospitals continue 
reporting modifier -CA 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, 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 as 
described above. We applaud hospitals' improved billing practices and 
as before, will continue to monitor use of modifier -CA. The CY 2007 
proposed APC 0375 median cost is $3,539, significantly increased from 
the $2,527

[[Page 49623]]

median cost proposed in the CY 2006 proposed rule. This variation in 
median costs, however, is expected because the specific cases that 
populate the claims data for APC 0375 likely exhibit only limited 
clinical and resource homogeneity among all the claims attributable to 
that APC in a given year and across different years for the same APC. 
The cost variation of APC 0375 from year to year could be expected 
because APC 0375 is unique in the OPPS and, by its definition, should 
always be limited in its use.

XIII. Proposed Nonrecurring Policy Changes

A. Removal of Comprehensive Outpatient Rehabilitation Facility (CORF) 
Services From the List of Services Paid under the OPPS

    (If you choose to comment on issues in this section, please include 
the caption ``CORF Services'' at the beginning of your comment.)
    We are proposing to make a technical change to the regulations at 
42 CFR 419.21(d) to remove from the list of services paid under the 
OPPS certain services furnished by a comprehensive outpatient 
rehabilitation facility (CORF) when they are provided outside the 
patient's plan of care (for example, hepatitis B vaccine). Section 
1834(k) of the Act, as added by section 4541(a) of Pub. L. 105-33 
(BBA), requires that CORF services be paid using the lesser of actual 
charges or a fee schedule amount. We instructed fiscal intermediaries 
to use the Medicare Physician Fee Schedule (MPFS) for payments to 
CORFs. We have not required CORF cost reports, or paid CORFs under the 
OPPS, since 2001. The proposed revision of the regulation to delete 
certain CORF services from the list of specified services paid under 
the OPPS is necessary to conform the regulations to the statutory 
requirement.

B. Addition of Ultrasound Screening for Abdominal Aortic Aneurysms 
(AAAs) (Section 5112 of Pub. 109-171 (DRA))

    (If you choose to comment on the issues in this section, please 
include the caption ``AAA Screening'' at the beginning of your 
comment.)
1. Background
    Section 5112 of the Deficit Reduction Act of 2005, Pub. L. 109-171 
(DRA), amended section 1861 and related provisions of the Act to 
provide for coverage under Part B of ultrasound screening for abdominal 
aortic aneurysms (AAAs), effective for services furnished on or after 
January 1, 2007, subject to certain eligibility and other limitations. 
The proposed rule governing this new Part B coverage will be 
established through a separate document, specifically the CY 2007 
Medicare Physician Fee Schedule proposed rule. We refer readers to that 
document for a full and complete explanation of this coverage 
provision.
2. Proposed Assignment of New HCPCS Code for Payment of Ultrasound 
Screening for Abdominal Aortic Aneurysm (AAA) (Section 5112)
    There is no current CPT code that specifically describes an 
ultrasound screening for AAA. Therefore, we are proposing to establish 
the following new HCPCS code, GXXXX (Ultrasound, B-scan and or real 
time with image documentation; for abdominal aortic aneurysm (AAA) 
screening) to be used to bill for the new service under both the 
Medicare Physician Fee Schedule and the OPPS. As required by the 
statute, Medicare will allow payment for a one-time only screening 
examination, and this screening test will be available even if the 
qualifying patient does not present signs or symptoms of disease or 
illness. In addition, this code does not include any other preventive 
services that are currently separately covered and paid under the 
Medicare Part B screening benefits. When these other preventive 
services are performed, they should be reported using the existing 
appropriate codes.
    We are proposing to base the payment for GXXXX on equivalent 
hospital resources and intensity to those contained in CPT code 76775, 
which is assigned to APC 0266 (Level II Diagnostic and Screening 
Ultrasound) under the OPPS for CY 2007. We believe that the hospital 
costs associated with the screening study are very similar to those of 
the limited retroperitoneal ultrasound diagnostic examination and, 
therefore, that the screening and diagnostic studies should be assigned 
to the same clinical APC for reasons of clinical and resource 
homogeneity. Thus, we are proposing to assign GXXXX to APC 0266 with a 
median cost of $98.59 for CY 2007.
3. Handling of Comments Received in Response to This Proposal
    We noted previously that ultrasound screening for AAAs is also 
addressed in detail in our proposed rule to update the Medicare 
Physician Fee Schedule for CY 2007. We will respond to all comments 
regarding the proposed elements required for the ultrasound screening 
for AAA, whether the examination is performed in a physician's office 
or an outpatient hospital setting, and the exception from the Part B 
annual deductible, in the final rule implementing the Medicare 
Physician Fee Schedule for CY 2007. We will respond to all comments 
regarding payment for GXXXX under the OPPS in the CY 2007 OPPS final 
rule.

XIV. Emergency Medical Screening in Critical Access Hospitals (CAHs)

    (If you choose to comment on issues in this section, please include 
the caption ``CAHs: Emergency Medical Screening'' 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, 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

    Existing regulations governing CAHs at Sec.  485.618(d) require on-
call doctors and nonphysician practitioners who may be attending to 
urgent/acute medical problems in other areas of the CAH or outside the 
CAH to report to the CAH's emergency room within 30 minutes (60 minutes 
if the CAH is located in a frontier or remote area or permissible under 
the State's rural health care plan) to see a patient in the emergency 
room of a CAH. Often, these patients do not have emergency medical 
conditions. With changes to the regulations at Sec.  489.24 that 
implement the Emergency Medical Treatment and Labor Act (EMTALA) over 
the past few years, some practitioners have noted to CMS that the 
requirements regarding who should respond to calls to see patients who 
present to the emergency department of a CAH are more stringent than 
for general hospitals.
    The provider community recently requested that we change the 
emergency on-call personnel requirements for CAHs to conform to the 
regulatory changes published in the FY 2005 IPPS final rule (69 FR 
49271). In response to this request, we are proposing to revise the 
current CAH CoPs to align the emergency medical screening requirements 
in CAHs with those applicable to acute care hospitals. The

[[Page 49624]]

proposed change would allow registered nurses, in addition to the 
personnel currently required at Sec.  485.618(d), to serve as qualified 
medical personnel to screen individuals who present to the CAH 
emergency room if the nature of the patient's request is within the 
registered nurse's scope of practice under State law and such screening 
is permitted by the CAH's bylaws. This proposed change would 
effectively eliminate the need for a doctor or mid-level practitioner 
to report to the emergency department to attend to a nonemergent 
request for medical care if a registered nurse is on site at the CAH 
and has made a determination that the care needed is of a non-emergent 
nature.
    The EMTALA statute at section 1867 of the Act states that a 
hospital in this context must provide an appropriate (suitable for the 
symptoms presented) medical screening examination within the capability 
of the hospital's emergency department to determine whether or not an 
emergency medical condition exists (section 1866(a)(1)(I) of the Act 
imposes the section 1867 requirements on a CAH). The EMTALA regulations 
at Sec.  489.24(a) state that the examination must be conducted by 
qualified medical personnel. These qualified medical personnel 
designated to perform medical screening examinations must be determined 
qualified by the hospital's bylaws or rules and regulations and must be 
practicing within the scope of practice under State law.
    The regulations at Sec.  489.24(c) relating to the use of dedicated 
emergency department for nonemergency services were added in September 
2003 (68 FR 53262) to state that if an individual goes to a hospital's 
dedicated emergency department to request medical treatment, and the 
nature of the request makes it clear that the medical condition is not 
of an emergency nature, the hospital is required only to perform such 
screening as would be appropriate to determine that the individual does 
not have an emergency medical condition.
    Although EMTALA also applies to CAHs, the CoP for CAH emergency 
services (Sec.  485.618(d)) states that a physician, a physician 
assistant, a nurse practitioner, or a clinical nurse specialist with 
training or experience in emergency care must be on call and available 
onsite at a CAH within a specified timeframe. These are the CAH 
personnel who would be available to conduct an emergency medical 
screening under Sec.  489.24(c). In contrast, the emergency services 
CoP for acute care hospitals at Sec.  482.55 does not specify the type 
of personnel who must be available to provide emergency services and 
who would, therefore, perform assessments and screenings. The 
regulation states only that the services must be organized and 
supervised under the direction of a qualified member of the medical 
staff. Therefore, an acute care hospital may, if it chooses, have 
protocols that permit a registered nurse to conduct specific emergency 
medical screenings if the nature of the individual's request for 
examination and treatment is within the scope of practice of a 
registered nurse. For emergencies that are outside of a registered 
nurse's scope of practice, another qualified medical personnel 
(operating within his or her scope of practice under State law) would 
conduct the emergency medical screening.
    We are proposing to revise the CAH standard at Sec.  485.618(d) to 
allow a CAH, if applicable, the flexibility of including a registered 
nurse, with training and experience in emergency care and who is on 
site at the CAH, as one of the qualified medical personnel available 
for emergency services, particularly emergency medical screenings, if 
the nature of the individual's request makes clear that the medical 
condition is not of an emergency nature and the individual's request 
for examination and treatment is within the registered nurse's scope of 
practice under State law. If the registered nurse begins the emergency 
medical screening and determines that the nature of the individual's 
conditions is outside his or her scope of practice under State law, the 
physician, physician assistant, nurse practitioner or a clinical nurse 
specialist must be contacted to see the patient within 30 or 60 minutes 
to conduct the emergency medical screening and provide stabilizing 
treatment. If the registered nurse knows initially that the medical 
screening for the presenting complaint is outside the applicable scope 
of practice under State law, the physician or other nonphysician 
practitioner must see the individual within the 30 or 60 minute 
timeframes (as currently specified in Sec.  485.618(d)(1)).
    We recognize that not all CAHs will be able to utilize this 
flexibility. Some State licensure boards have stated that it is not 
within the authorized scope of practice for a registered nurse to 
independently perform an appropriate emergency medical screening for 
the purpose of determining if an emergency medical condition exists. 
However, the licensure boards in these States further maintain that it 
is within the scope of practice for a registered nurse to assess the 
health status of an individual to determine a nonemergent condition and 
to provide nursing care or to refer the individual to appropriate 
medical resources. Therefore, based on State law, some CAHs will not be 
able to designate registered nurses as qualified medical personnel 
under our proposed revision to the regulations governing CAHs. However, 
as we wish to provide flexibility to CAHs and to be consistent with 
existing EMTALA policy, we are proposing the revision to the regulation 
at Sec.  485.618(d).

XV. Proposed OPPS Payment Status and Comment Indicators

A. Proposed CY 2007 Status Indicator Definitions

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS Status Indicator'' at the beginning of your 
comment.)
    The OPPS payment status indicators (SIs) that we assign to HCPCS 
codes and APCs play an important role in determining payment for 
services under the OPPS. 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. Our proposed 
CY 2007 status indicator assignments for APCs and HCPCS codes are shown 
in Addendum A and Addendum B, respectively. We are proposing to use the 
status indicators and definitions that are listed in Addendum D1, which 
we discuss below in greater detail:
1. Proposed Payment Status Indicators To Designate Services That Are 
Paid Under the OPPS

------------------------------------------------------------------------
       Indicator            Item/code/service       OPPS payment status
------------------------------------------------------------------------
G......................  Pass-Through Drugs and   Paid under OPPS;
                          Biologicals.             Separate APC payment
                                                   includes pass-through
                                                   amount.
H......................  (1) Pass-Through Device  (1) Separate cost-
                          Categories.              based pass-through
                                                   payment; Not subject
                                                   to coinsurance.
                         (2) Radiopharmaceutical  (2) Separate cost-
                          Agents.                  based non-pass-
                                                   through payment.

[[Page 49625]]

 
K......................  (1) Non-Pass-Through     (1) Paid under OPPS;
                          Drugs and Biologicals.   Separate APC payment.
                         (2) Brachytherapy        (2) Paid under OPPS;
                          Sources.                 Separate APC payment.
K......................  (3) Blood and Blood      (3) Paid under OPPS;
                          Products.                Separate APC payment.
N......................  Items and Services       Paid under OPPS;
                          Packaged into APC        Payment is packaged
                          Rates.                   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        Paid under OPPS;
                          Subject to Separate      Addendum B displays
                          Payment Under OPPS       APC assignments when
                          Payment Criteria.        services are
                                                   separately payable.
                                                  (1) Separate APC
                                                   payment based on OPPS
                                                   payment 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 Procedure,   Paid under OPPS;
                          Not Discounted when      Separate APC payment.
                          Multiple.
T......................  Significant Procedure,   Paid under OPPS;
                          Multiple Reduction       Separate APC payment.
                          Applies.
V......................  Clinic or Emergency      Paid under OPPS;
                          Department Visit.        Separate APC payment.
X......................  Ancillary Services.....  Paid under OPPS;
                                                   Separate APC payment.
------------------------------------------------------------------------

2. Proposed Payment Status Indicators To Designate Services That Are 
Paid Under a Payment System Other Than the OPPS

------------------------------------------------------------------------
       Indicator            Item/code/service       OPPS payment status
------------------------------------------------------------------------
A......................  Services furnished to a  Not paid under OPPS.
                          hospital outpatient      Paid by fiscal
                          that are paid under a    intermediaries under
                          fee schedule or          a fee schedule or
                          payment system other     payment system other
                          than OPPS, for example.  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.
C......................  Inpatient Procedures...  Not paid under OPPS.
                                                   Admit patient. Bill
                                                   as inpatient.
F......................  Corneal Tissue           Not paid under OPPS.
                          Acquisition; Certain     Paid at reasonable
                          CRNA Services; and       cost.
                          Hepatitis B Vaccines.
L......................  Influenza Vaccine;       Not paid under OPPS.
                          Pneumococcal Pneumonia   Paid at reasonable
                          Vaccine.                 cost; Not subject to
                                                   deductible or
                                                   coinsurance.
M......................  Items and Services Not   Not paid under OPPS.
                          Billable to the Fiscal
                          Intermediary.
Y......................  Non-Implantable Durable  Not paid under OPPS.
                          Medical Equipment.       All institutional
                                                   providers other than
                                                   home health agencies
                                                   bill to DMERC.
------------------------------------------------------------------------

3. Proposed Payment Status Indicators To Designate Services That Are 
Not Recognized Under the OPPS but That May Be Recognized by Other 
Institutional Providers

------------------------------------------------------------------------
       Indicator            Item/code/service       OPPS payment status
------------------------------------------------------------------------
B......................  Codes that are not       Not paid under OPPS.
                          recognized by OPPS       May be paid
                          when submitted on an     by intermediaries
                          outpatient hospital      when submitted on a
                          Part B bill type         different bill type,
                          (12x,13x, and 14x).      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.
------------------------------------------------------------------------

4. Proposed Payment Status Indicators to Designate Services That Are 
Not Payable by Medicare

[[Page 49626]]



------------------------------------------------------------------------
       Indicator            Item/code/service       OPPS payment status
------------------------------------------------------------------------
D......................  Discontinued Codes.....  Not paid under OPPS or
                                                   any other Medicare
                                                   payment system.
E......................  Items, Codes, and        Not paid under OPPS or
                          Services:.               any other Medicare
                                                   payment system.
                          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.
------------------------------------------------------------------------

    To make it more relevant to the proposed update of the OPPS, we are 
displaying in Addendum B of this proposed rule those HCPCS codes that 
describe items or services that are payable under the OPPS as well as 
nonpayable codes for which we are proposing a change in status. Status 
indicators for items and services that are payable under the OPPS are 
listed in section XV.A.1 of this preamble.
    A complete listing of HCPCS codes with OPPS payment status 
indicators and APC assignments proposed for CY 2007 is available 
electronically on the CMS Web site.

B. Proposed CY 2007 Comment Indicator Definitions

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS Comment Indicator'' at the beginning of your 
comment.)
    In the November 15, 2004 final rule with comment period (69 FR 
65827 and 65828), we made final our policy to use three comment 
indicators to identify in an 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. These three comment indicators 
are listed below:
     ``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.
    In the November 10, 2005 final rule with comment period (70 FR 
68702 and 68703), we adopted a new comment indicator:
     ``CH''--Active HCPCS codes in current and next calendar 
year; status indicator and/or APC assignment have changed.
    We implemented comment indicator ``CH'' to designate a change in 
payment status indicator and/or APC assignment for HCPCS codes in 
Addendum B of the CY 2006 final rule with comment period. We also 
stated that codes flagged with the ``CH'' indicator in that final rule 
would not be open to comment because the changes were previously 
subject to comment during the proposed rule comment period. We are 
proposing to continue that policy in the CY 2007 OPPS final rule. When 
used in an OPPS final rule, the ``CH'' indicator is only intended to 
facilitate the public's review of changes made from one calendar year 
to another. We are proposing to use the ``CH'' indicator in the CY 2007 
final rule to indicate HCPCS codes for which the status indicator and/
or APC assignment will change in CY 2007. However, only HCPCS codes 
with comment indicator ``NI'' in the CY 2007 OPPS final rule would be 
subject to comment during the final rule comment period.
    We also are proposing to use the ``CH'' indicator to call attention 
to changes in payment status indicator and/or APC assignment in this 
proposed rule to update the OPPS for CY 2007. We believe that using the 
``CH'' indicator in this proposed rule will facilitate the public's 
review of the changes that we are proposing to make final in CY 2007. 
Use of the ``CH'' indicator in the proposed rule is significant because 
it highlights changes that are subject to comment during the proposed 
rule comment period.
    The three comment indicators that we are proposing to implement in 
CY 2007 and their definitions are listed in Addendum D2 of this 
proposed rule.

XVI. OPPS Policy and Payment Recommendations

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

A. MedPAC Recommendations

    The Medicare Payment Advisory Commission (MedPAC) submits reports 
to Congress in March and June that summarize payment policy 
recommendations. The March 2006 MedPAC report included the following 
recommendation relating specifically to the hospital OPPS:
    Recommendation 2A: The Congress should increase payment rates for 
the acute inpatient and outpatient prospective payment systems in 2007 
by the projected increase in the hospital market basket index less half 
of the Commission's expectation for productivity growth. A discussion 
regarding updates to the market basket is included in section II.C. 
(``Proposed OPPS Conversion Factor Update for 2007'') of this preamble.

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 March 1-2, 2006 meeting are available online 
at http://www.cms.hhs.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp.

C. GAO Recommendations

    A discussion of the October 31, 2005 GAO letter of comment on 
proposed 2006 specified covered outpatient drug (SCOD) rates (GAO-06-
17R ``Comments on Proposed 2006 SCOD Rates'') is contained in section 
V.3.B.a. of this preamble.
    A discussion of the April 2006 GAO report entitled ``Medicare 
Hospital Pharmaceuticals: Survey Shows Price Variation and Highlights 
Data Collection Lessons and Outpatient Rate-setting Challenges for 
CMS'' (GAO-06-372) is contained in section V.3.B.a. of this preamble.

XVII. Proposed Policies Affecting Ambulatory Surgical Centers (ASCs) 
for CY 2007

A. ASC Background

1. Legislative History
    Section 1832(a)(2)(F)(i) of the Act provides that benefits under 
the Medicare Supplementary Medical Insurance program (Part B) include 
payment for facility services furnished in connection with surgical 
procedures the Secretary specifies which are performed in an ASC. To 
participate in the Medicare program as an ASC, a

[[Page 49627]]

facility must meet the standards specified in section 1832(a)(2)(F)(i) 
of the Act; in 42 CFR 416, subpart B of our regulations, which sets 
forth general conditions and requirements for ASCs; and in 42 CFR 416, 
subpart C of our regulations, which provides specific conditions for 
coverage for ASCs.
    The ASC services benefit was enacted by Congress through the 
Omnibus Reconciliation Act of 1980 (Pub. L. 96-499). For a detailed 
discussion of the legislative history related to ASCs, we refer readers 
to the June 12, 1998 proposed rule (63 FR 32291).
    Section 626(b) of Pub. L. 108-173, repealed the requirement 
formerly found in section 1833(i)(2)(A) of the Act that the Secretary 
conduct a survey of ASC costs for purposes of updating ASC payment 
rates and, instead, requires the Secretary to implement a revised ASC 
payment system, to be effective not later than January 1, 2008. Section 
XVIII. of this proposed rule contains our proposal for a revised ASC 
payment system that would be implemented on January 1, 2008.
    Section 5103 of Pub. L. 109-171, amended section 1833(i)(2) of the 
Act by adding a new subparagraph (E) to place a limitation on payments 
for surgical procedures in ASCs. If the standard overhead amount under 
section 1833(i)(2)(A) of the Act for a facility service for such 
procedure, without application of any geographic adjustment exceeds the 
Medicare OPPS payment amount for the service for that year, without 
application of any geographic adjustment, the Secretary shall 
substitute the OPPS payment amount for the ASC standard overhead 
amount. This provision applies to surgical procedures furnished in ASCs 
on or after January 1, 2007, and before the effective date of the 
revised ASC payment system.
    We discuss in section XVII.C. of this preamble, the regulatory 
changes that we are proposing for our current ASC payment system. In 
section XVII.D. of this proposed rule, we are addressing the changes in 
payment to ASCs mandated by section 5103 of Pub. L. 109-171, as well as 
additions to and deletions from the list of Medicare-approved ASC 
procedures to be implemented January 1, 2007, prior to implementation 
of the revised ASC payment system. In addition, in section XVII.E. of 
this preamble, we are proposing changes in the process to review 
payment adjustments for insertion of new technology intraocular lenses 
(NTIOLs). The CY 2007 OPPS final rule that we issue in the fall of 2006 
will implement changes to the ASC list that will go into effect January 
1, 2007. In section XVIII. of this preamble, we are proposing a revised 
payment system for ASCs to be implemented effective January 1, 2008, 
including revisions to the ASC list for CY 2008, the ratesetting 
method, and the applicable ASC regulations to incorporate the 
requirements and payments for ASC facility services under the proposed 
revised ASC system. We expect that a final rule implementing the 
revised ASC payment system will be published separately in the spring 
of 2007.
2. Current Payment Method
    There are two primary elements in the total cost of performing a 
surgical procedure: (a) The cost of the physician's professional 
services to perform the procedure and (b) the cost of items and 
services furnished by the facility where the procedure is performed 
(for example, surgical supplies, equipment, and nursing services). 
Payment for the first element is made under the Medicare physician fee 
schedule. This proposed rule addresses the second element, the payment 
of facility fees for ASC services. This proposed rule also addresses 
coverage of ASC services.
    Under the current ASC facility services payment system, the ASC 
payment rate is a standard overhead amount established on the basis of 
our estimate of a fee that takes into account the costs incurred by 
ASCs generally in providing facility services in connection with 
performing a specific procedure. The report of the Conference Committee 
accompanying section 934 of the Omnibus Reconciliation Act of 1980 
(ORA), Pub. L. 96-499, which enacted the ASC benefit in December 1980, 
states that this overhead amount is expected to be calculated on a 
prospective basis using sample survey data and similar techniques to 
establish reasonable estimated overhead allowances, which take into 
account volume (within reasonable limits), for each of the listed 
procedures. (H.R. Rep. No. 96-1479, at 134-35 (1980)).
    To establish those reasonable estimated allowances for services 
furnished prior to implementation of the revised ASC payment system, 
section 626(b)(1) of Pub. L. 108-173 amended section 1833(i)(2)(A)(i) 
of the Act to require us to take into account the audited costs 
incurred by ASCs to perform a procedure, in accordance with a survey. 
Payment for ASC facility services is subject to the usual Medicare Part 
B deductible and coinsurance requirements and the amounts paid by 
Medicare must be 80 percent of the standard fee.
    Section 1833(i)(1) of the Act requires us to specify, in 
consultation with appropriate medical organizations, surgical 
procedures that are appropriately performed on an inpatient basis in a 
hospital but that can be safely performed in an ASC and to review and 
update the list of ASC procedures at least every 2 years.
    Section 141(b) of the Social Security Act Amendments of 1994, Pub. 
L. 103-432, requires us to establish a process for reviewing the 
appropriateness of the payment amount provided under section 
1833(i)(2)(A)(iii) of the Act for intraocular lenses (IOLs) for a class 
of NTIOLs. That process was the subject of a separate final rule 
entitled ``Adjustment in Payment Amounts for New Technology Intraocular 
Lenses Furnished by Ambulatory Surgical Centers,'' published in the 
June 16, 1999 Federal Register (64 FR 32198). As stated earlier, in 
section XVII.E. of this proposed rule, we discuss the changes that we 
are proposing to that process.
    A summary of changes to ASC payment rates made prior to CY 1998 may 
be found in the June 12, 1998 proposed rule (63 FR 32292). The 1998 
rule proposed to rebase the ASC payment rates using cost, charge, and 
utilization data collected by a 1994 survey of ASCs. In that proposed 
rule, we also proposed to refine the ratesetting methodology that was 
implemented in the February 8, 1990 Federal Register (55 FR 4577). 
However, the changes that were proposed for the ratesetting methodology 
were not implemented because of a combination of circumstances 
resulting in the delayed publication of a final rule. Those 
circumstances included several extensions to the comment period which 
ended July 30, 1999, Year 2000 (Y2K) Medicare systems compliancy 
considerations, and legislative changes required by the Medicare, 
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), Pub. 
L. 106-113 and the Medicare, Medicaid, and SCHIP Benefits Improvement 
and Protection Act of 2000 (BIPA), Pub. L. 106-554. Readers may refer 
to the March 28, 2003 ASC List Update final rule (68 FR 15269) for a 
detailed discussion of these circumstances and the legislative changes.
3. Published Changes to the ASC List
    Section 1833(i)(1)(A) of the Act requires the Secretary to specify 
surgical procedures that, although appropriately performed in an 
inpatient hospital setting, can also be performed safely on an 
ambulatory basis in an ASC, a CAH, or a hospital outpatient department. 
The report accompanying the legislation

[[Page 49628]]

explained that the Congress intended procedures currently performed on 
an ambulatory basis in a physician's office that do not generally 
require the more elaborate facilities of an ASC not be included in the 
list of ASC covered procedures (H.R. Rep. No. 96-1167, at 390-91, 
reprinted in 1980 U.S.C.C.A.N. 5526, 5753-54). In a final rule 
published August 5, 1982, in the Federal Register (47 FR 34082), we 
established regulations that included criteria for specifying which 
surgical procedures were to be included for purposes of implementing 
the ASC facility benefit.
    Section 416.65(a) of the regulations specifies general standards 
for procedures on the ASC list. ASC procedures are those surgical and 
other medial procedures that are--
     Commonly performed on an inpatient basis but may be safely 
performed in an ASC;
     Not of a type that are commonly performed or that may be 
safely performed in physicians' offices;
     Limited to procedures requiring a dedicated operating room 
or suite and generally requiring a post-operative recovery room or 
short term (not overnight) convalescent room; and
     Not otherwise excluded from Medicare coverage.
    Specific standards in Sec.  416.65(b) limit covered ASC procedures 
to those that do not generally exceed 90 minutes operating time and a 
total of 4 hours recovery or convalescent time. If anesthesia is 
required, the anesthesia must be local or regional anesthesia, or 
general anesthesia of not more than 90 minutes duration.
    Section 416.65(b)(3) of the regulations excludes from the ASC list 
procedures that generally result in extensive blood loss, that require 
major or prolonged invasion of body cavities, that directly involve 
major blood vessels, or that are generally emergency or life-
threatening in nature.
    A detailed history of published changes to the ASC list and ASC 
payment rates may be found in the June 12, 1998 proposed rule (63 FR 
32292). Subsequently, in accordance with Sec.  416.65(c), we published 
updates of the ASC list in the Federal Register on March 28, 2003 (68 
FR 15268) and May 4, 2005 (70 FR 23690).
    During years when we have not updated the ASC list in the Federal 
Register, we have revised the list to be consistent with annual 
calendar year changes to HCPCS and CPT codes. These annual coding 
updates have been implemented through program instructions to the 
carriers that process ASC claims. The most recent update to the list to 
conform with CPT and HCPCS coding changes was published in Transmittal 
R-720-CP, Change Request 4082, on October 21, 2005. It may be found on 
our Web site at: http://www.cms.hhs.gov/Transmittals/.

B. Proposed ASC List Update Effective for Services Furnished On or 
After January 1, 2007

1. Criteria for Additions to or Deletions From the ASC List
    In April 1987, we adopted quantitative criteria for identifying 
procedures that were commonly performed either in a hospital inpatient 
setting or in a physician's office. Collectively, commenters responding 
to a notice published on February 16, 1984 in the Federal Register (49 
FR 6023) had recommended that virtually every surgical CPT code be 
included on the ASC list. Consulting with other specialist physicians 
and medical organizations as appropriate, our medical staff reviewed 
the recommended additions to the list to determine which code or series 
of codes were appropriately performed on an ambulatory basis within the 
framework of the regulatory criteria in Sec.  416.65. However, when we 
arrayed the proposed procedures by the site where they were most 
frequently performed according to our claims payment data files (1984 
Part B Medicare Data (BMAD)), we found that many procedures were not 
commonly performed on an inpatient basis or were performed in a 
physician's office the majority of the time, and, thus, would not meet 
the standards in our regulations. Therefore, we decided that if a 
procedure was performed on an inpatient basis 20 percent of the time or 
less, or in a physician's office 50 percent of the time or more, it 
would be excluded from the ASC list. (April 21, 1987 (52 FR 13176)).
    At the time, we believed that these utilization thresholds best 
reflected the legislative objectives of moving procedures from the more 
expensive hospital inpatient setting to the less expensive ASC setting 
without encouraging the migration of procedures from the generally less 
expensive physician's office setting to the ASC. We applied these 
quantitative standards not only to codes proposed for addition to the 
ASC list, but also to the codes that were currently on the list, to 
delete codes that did not meet the thresholds.
    The trend towards performing surgery on an ambulatory or outpatient 
basis grew steadily and, by 1995, we discovered that a number of 
procedures that were on the ASC list at the time fell short of the 20 
percent and 50 percent thresholds even though the procedures were 
obviously appropriate in the ASC setting. The most notable of these was 
cataract extraction with intraocular lens insertion that were already 
being performed predominately in outpatient settings by the early 
1990s, although more than 20 percent were also performed as inpatient 
procedures. The thresholds would also have excluded from the ASC list 
certain newer procedures, such as CPT code 66825 (Repositioning of 
intraocular lens prosthesis, requiring an incision (separate 
procedure)), that were rarely performed on a hospital inpatient basis 
but that were appropriate for the ASC setting. Strict adherence to the 
same 20 percent and 50 percent thresholds both to add and remove 
procedures did not provide latitude for minor fluctuations in 
utilization across settings or errors that could occur in the site-of-
service data drawn from the National Claims History File that we were 
then using for analysis.
    In an effort to avoid these anomalies but still retain a relatively 
objective standard for determining which procedures should comprise the 
ASC list, we adopted in the Federal Register notice with comment period 
published on January 26, 1995 (60 FR 5185), a modified standard for 
deleting procedures already on the list. We deleted from the list only 
those procedures whose combined inpatient, hospital outpatient, and ASC 
site-of-service volume was less than 46 percent of the procedure's 
total volume and that were either performed 50 percent of the time or 
more in the physician's office or 10 percent of the time or less in an 
inpatient hospital setting. We retained the 20 percent and 50 percent 
standard to determine which procedures would be appropriate additions 
to the ASC list.
    We are not proposing changes to the criteria for adding or deleting 
items from the ASC list effective January 1, 2007. However, please see 
section XVIII.B. of this proposed rule for a discussion of proposed 
changes in the context of developing a revised ASC payment system to be 
effective January 1, 2008. The proposed changes to the criteria result 
in the addition for CY 2008 of many procedures that do not meet the 
current criteria for addition to the list.
2. Response to Comments to May 4, 2005 Interim Final Rule for the ASC 
Update
    In accordance with section 1833(i)(1) of the Act, in this proposed 
rule, we are proposing to update the list of procedures that are 
covered when furnished in an ASC, effective January

[[Page 49629]]

1, 2007. In the process of determining which procedures to add to the 
list, we focused on requests we received from the public in their 
comments on our May 4, 2005 interim final rule (70 FR 23690). We 
evaluated codes for which we received requests from the public. The 
public comments include requests for addition and deletion of specific 
procedures and for assignment to higher payment groups for specific 
procedures.
3. Procedures Proposed for Addition to the ASC List
    Using the current criteria as described in section XVII.B.1. of 
this preamble, we identified 14 procedures that we are proposing to add 
to the ASC list effective January 1, 2007. The procedures would be 
assigned to one of the nine existing ASC payment groups as indicated in 
Table 41.

  Table 41.--Procedures Proposed for Addition to the ASC List Effective
                             January 1, 2007
------------------------------------------------------------------------
                                                                  ASC
              CPT                      Short descriptor         payment
                                                                 group
------------------------------------------------------------------------
13102.........................  Repair wound/lesion add-on...          1
13122.........................  Repair wound/lesion add-on...          1
13133.........................  Repair wound/lesion add-on...          1
19297.........................  Place breast cath for rad....          9
21356.........................  Treat cheek bone fracture....          3
22520.........................  Percutaneous vertebroplasty,           9
                                 thor.
22521.........................  Percutaneous vertebroplasty,           9
                                 lumb.
22522.........................  Percutaneous vertebroplasty,           1
                                 add'l.
35476.........................  Repair venous blockage.......          9
36818.........................  AV fuse, upper arm, cephalic.          3
37205.........................  Transcath IV stent,                    9
                                 percutaneous.
37206.........................  Transcath IV stent/perc,               1
                                 add'l.
43761.........................  Reposition gastrostomy tube..          1
46946.........................  Ligation of hemorrhoids......          1
------------------------------------------------------------------------

4. Suggested Additions Not Accepted
    There are a number of procedures for which we received requests for 
additions to the ASC list that we are not proposing to add to the ASC 
list because they do not meet the criteria set forth in section 416.65 
of the CFR. Those procedures are listed in Tables 42 and 43 below. Our 
medical advisors believe that the procedures listed in Tables 42 and 43 
may be of a type that:
     Are performed predominantly in the hospital inpatient or 
physician office setting;
     Require an overnight or inpatient stay;
     Require a total of 90 minutes of operating time or 4 hours 
or more of recovery time;
     Require major or prolonged invasion of body cavities or 
involve major blood vessels;
     Are generally emergent or life-threatening; or
     Are of a type that result in extensive blood loss.
    We are not proposing to add 19 procedures for which we received 
requests for addition to the ASC list because they are procedures that 
are furnished predominantly in the physician office setting and 
according to the current criteria are not eligible for inclusion on the 
list. Those procedures are displayed in Table 42.
    One request was made that we add CPT code 66990 (Use of ophthalmic 
endoscope) to the list. As we stated in our May 5, 2005 interim final 
rule (70 FR 23704), this code is used to recognize the use of equipment 
that is integral to a surgical procedure and is not a surgical 
procedure. For this reason, we do not believe that it is an appropriate 
addition to the list.

Table 42.--Procedures Not Proposed for Addition to 2007 ASC List Because
       They Are Predominantly Performed in the Physician's Office
------------------------------------------------------------------------
                CPT                           Short descriptor
------------------------------------------------------------------------
31040.............................  Exploration behind upper jaw.
45300.............................  Proctosigmoidoscopy dx.
45303.............................  Proctosigmoidoscopy dilate.
45330.............................  Diagnostic sigmoidoscopy.
46221.............................  Ligation of hemorrhoid(s).
46604.............................  Anoscopy and dilation.
46614.............................  Anoscopy, control bleeding.
46900.............................  Destruction, anal lesion(s).
46910.............................  Destruction, anal lesion(s).
46916.............................  Destruction, anal lesion(s).
62367.............................  Analyze spine infusion pump.
62368.............................  Analyze spine infusion pump.
67028.............................  Injection eye drug.
67105.............................  Repair detached retina.
67110.............................  Repair detached retina.
67145.............................  Treatment of retina.
67210.............................  Treatment of retinal lesion.
67221.............................  Ocular photodynamic ther.
67228.............................  Treatment of retinal lesion.
------------------------------------------------------------------------

    We are proposing not to add to the ASC list 14 procedures for which 
we received requests because our medical advisors determined that those 
procedures do not meet the clinical criteria (Sec.  416.65) for 
addition. That is, the procedures either require more than 4 hours of 
recovery time, or may result in excessive blood loss, etc., making them 
ineligible for addition to the list of ASC procedures. Those procedures 
are displayed in Table 43.

Table 43.--Procedures Not Added to the ASC List Because They Do Not Meet
         Current Clinical Criteria for Addition to the ASC List
------------------------------------------------------------------------
                CPT                           Short descriptor
------------------------------------------------------------------------
27412.............................  Autochondrocyte implant knee.
27415.............................  Osteochondral knee allograft.
29866.............................  Autgrft implnt, knee w/scope.
29867.............................  Allgrft implnt, knee w/scope.
29868.............................  Meniscal trnspl, knee w/scpe.
35470.............................  Repair arterial blockage.
35475.............................  Repair arterial blockage.
47562.............................  Laparoscopic cholecystectomy.
47563.............................  Laparo cholecystectomy/graph.
47564.............................  Laparo cholecystectomy/explr.
63030.............................  Low back disk surgery.
63035.............................  Spinal disk surgery add-on.
63042.............................  Laminotomy, single lumbar.
63047.............................  Removal of spinal lamina.
------------------------------------------------------------------------

5. Rationale for Payment Assignment
    Currently, procedures on the ASC list are assigned to one of nine 
payment groups based on our estimate of the costs incurred by the 
facility to perform the procedure. We are proposing no changes to those 
nine payment groups and are proposing to assign the additional 
procedures to one of those existing payment groups. The payment

[[Page 49630]]

group to which we propose each addition to the ASC list be classified 
is based on the payment group, which our medical advisors judged to be 
similar in terms of time and resource inputs to procedures currently on 
the list. The proposed list of procedures eligible for Medicare payment 
of a facility fee and the proposed rates are displayed in Addendum AA 
of this proposed rule. The procedures that are effected by the payment 
limit required by section 5103 of Pub. L. 109-171 are identified in 
that addendum along with their proposed rates.
6. Other Comments on the May 4, 2005 Interim Final Rule
    In the May 4, 2005 interim final rule (70 FR 23690), we also 
invited public comments on the payment assignments for specific 
procedure codes that we added to the ASC list in that rule that had not 
been proposed for addition to the ASC list in the November 26, 2004 
proposed rule (69 FR 69178). We received comments on 14 of those newly-
added procedures. A summary of those comments and our proposed 
treatment of them for CY 2007 is discussed below.
    Several comments requested that we delay adding to the ASC list CPT 
codes 33212 (Insertion or replacement of pacemaker pulse generator 
only; single chamber, atrial or ventricular), 33213 (Insertion or 
replacement of pacemaker pulse generator only; dual chamber), and 33233 
(Removal of permanent pacemaker pulse generator) until we implement the 
new ASC payment system.
    We added these procedures to the ASC list in response to a request 
from a commenter. Our medical advisors evaluated the request and 
determined that these were appropriate procedures for performance in 
the ASC setting. We continue to believe that the procedures are 
appropriate for performance in the ASC and see no reason to remove them 
from the list at this time. Therefore, we are proposing to make no 
change in the ASC assignments for these three procedures.
    Two commenters requested that we reassign CPT codes 57155 
(Insertion of uterine tandems and/or vaginal ovoids for clinical 
brachytherapy) and 58346 (Insertion of Heyman capsules for clinical 
brachytherapy) to the highest ASC payment group. The commenters believe 
that payment at a higher level is necessary in order to cover the costs 
of the equipment and supplies used in performing the procedures.
    We reviewed the OPPS cost data for these procedures and found that 
the median cost for CPT code 57155 is $506 and that for CPT code 58346 
is $364. We do not have median cost data for the procedures performed 
in the ASC but the ASC payment amount for both services is $446, which 
is within the range of the median costs for those procedures in the 
generally more costly hospital outpatient setting. This leads us to 
believe that the $446 payment in the ASC is quite adequate. We are not 
proposing to assign the procedures to higher ASC payment groups.
    Several commenters wrote regarding CPT codes 36475 (Endovenous 
ablation therapy of incompetent vein, extremity, inclusive of all 
imaging guidance and monitoring, percutaneous, radiofrequency; first 
vein); 36476 (Endovenous ablation therapy of incompetent vein, 
extremity, inclusive of all imaging guidance and monitoring, 
percutaneous, radiofrequency; second and subsequent veins in single 
extremity, each through separate access sites); 36478 (Endovenous 
ablation therapy of incompetent vein, extremity, inclusive of all 
imaging guidance and monitoring, percutaneous, laser; first vein); and 
36479 (Endovenous ablation therapy of incompetent vein, extremity, 
inclusive of all imaging guidance and monitoring, percutaneous, laser; 
second and subsequent veins treated in a single extremity, each through 
separate access sites). The commenters requested that we remove these 
procedures from the ASC list, and suggested that if we were unwilling 
to remove them from the list, that we assign the procedures to a higher 
payment group. They believe that these procedures require significantly 
more facility resources than other procedures with which they are 
currently grouped in payment level 3. The commenters explained that if 
the procedures were excluded from the list, more adequate payments 
would be made to physicians under the Medicare physician fee schedule 
for the required resources.
    We added these procedures to the list in response to public 
comments. We initially assigned the codes to ASC payment group 3, 
consistent with other procedures with similar clinical indications. We 
continue to believe that these procedures are appropriate for 
performance in the ASC setting and will not remove them from the list. 
However, we agree with the commenters' point that these procedures 
require significantly more facility resources than traditional vein 
removal procedures, and, therefore, we are proposing to reassign them 
to ASC payment group 9. We believe that this is an appropriate payment 
level that takes into consideration the costs of the required equipment 
and supplies.
    Two comments requested that we assign CPT code 46947 
(Hemorrhoidopexy by stapling) to a higher ASC payment group. The 
commenters stated that due to the cost of the stapler used in the 
procedure, the resources required for this procedure are not similar to 
the other surgical procedures for the treatment of hemorrhoids that are 
also assigned to ASC payment group 3. The commenters suggested that it 
would be more appropriate to assign this procedure to ASC payment group 
7.
    We agree with the commenters and are proposing to reassign this 
procedure to ASC payment group 7 for CY 2007.
    One commenter raised concern about payment for CPT code 49419 
(Insertion of intraperitoneal cannula or catheter, with subcutaneous 
reservoir, permanent). The commenter reported that the catheter that is 
used in performing this procedure is billed separately under the DMEPOS 
fee schedule, and that Medicare carriers have discretion over whether 
or not to allow that payment. According to the commenter, in some 
areas, separate payment is not made for the catheter that is integral 
to the procedure.
    We believe that the commenter may be misinformed, because cannulas 
and catheters are not considered durable medical equipment, and they 
are not paid under the DMEPOS fee schedule. Rather, they are considered 
to be supplies. Payment for supplies furnished by an ASC in connection 
with a surgical procedure is bundled into the payment for the surgical 
procedure for which the supplies are required.
    One commenter requested that we allow separate payment for the 
material used as the sling in the procedure described by CPT code 51992 
(Laparoscopy, surgical; sling operation for stress incontinence (e.g., 
fascia or synthetic)). The commenter stated that without separate 
payment for the sling material, the Medicare payment for performing the 
procedure is inadequate to cover the service. The commenter also stated 
that there is no specific HCPCS code to use for billing the synthetic 
sling material.
    We added CPT code 51992 to the ASC list in the last update in 
response to comments. We assigned CPT code 51992 to ASC payment group 
5, the same ASC payment group to which other procedures to treat stress 
incontinence are assigned. We realize that the synthetic material for 
the sling may be costly, but there is no identifiable HCPCS code 
available for use in ASCs to report the material, and such material is 
not eligible for separate payment from Medicare in the ASC or

[[Page 49631]]

in any other setting. Further, CPT code 51992 describes a procedure 
that may be performed using synthetic material or fascia. As such, we 
cannot know whether the more costly synthetic material is used in any 
specific procedure and do not believe it is appropriate to fully 
incorporate the synthetic supply costs into the payment for all of the 
procedures performed. We continue to believe that ASC payment group 5 
is an appropriate assignment for the procedure, and we are not 
proposing to change that assignment.
    One commenter requested that we make separate payment for the 
microinserts that are used in performing CPT code 58565 (Hysteroscopy, 
surgical; with bilateral fallopian tube cannulation to induce occlusion 
by placement of permanent implants) even though there is no specific 
HCPCS code to describe the microinserts for billing, making separate 
payment impossible.
    We added CPT code 58565 to the ASC list in the last update in 
response to public comment. We assigned the procedure to ASC payment 
group 4 with other procedures with similar clinical indications. After 
further review, we are convinced that the procedure described by CPT 
code 58565 is significantly more resource-intensive than the other 
procedures in ASC payment group 4 and, therefore, we are proposing to 
reassign it to ASC payment group 9 for CY 2007.
    Several comments requested that CMS issue instructions to permit 
separate payment for the catheters that are inserted during the 
procedures described by CPT codes 19296 (Placement of radiotherapy 
afterloading balloon catheter into the breast for interstitial 
radioelement application following partial mastectomy, includes imaging 
guidance; on date separate from partial mastectomy) and 19298 
(Placement of radiotherapy afterloading brachytherapy catheters into 
the breast for interstitial radioelement application following partial 
mastectomy, includes imaging guidance).
    One commenter supported adding CPT code 19296 to the ASC list and 
assigning it to ASC payment group 9, but asserted that separate payment 
should also be provided for the balloon catheter inserted during the 
procedure. With regard to CPT code 19298, other commenters also stated 
that the payment level is inadequate and that separate payment should 
be allowed for the catheters inserted during the procedure. One of the 
commenters explained that the catheters used to perform the procedure 
described by CPT code 19298 are not high cost items (about $18.50 each) 
but these procedures typically use 30 catheters which makes the 
catheters a significant cost factor in performing the procedure.
    The catheters used in these procedures are classified as surgical 
supplies and as such, are not included on the DMEPOS fee schedule and 
are, therefore, not eligible for separate payment in the ASC. Payments 
for the costs of the catheters are packaged into the payments for 
performing the procedures. Currently CPT code 19298 is assigned to ASC 
payment group 1. Based on the information provided by the commenters we 
are persuaded that reassignment to a higher ASC payment group is 
warranted. Therefore, we are proposing to reassign CPT code 19298 to 
ASC payment group 9 for CY 2007.

C. Proposed Regulatory Changes for CY 2007

    As stated earlier, we are proposing a revised payment system for 
ASCs to be implemented effective January 1, 2008, including revisions 
to the ASC list for CY 2008, the ratesetting method, and the applicable 
ASC regulations to incorporate the requirements and payments for ASC 
facility services under the proposed revised ASC system. We expect that 
a final rule implementing the revised ASC payment system will be 
published separately in the spring of 2007. The revised ASC payment 
system will not take effect until January 1, 2008. However, we need to 
revise our current regulations at part 416, subparts D and E to ensure 
that the rules governing our current system are clearly distinguishable 
from those that would apply to the revised system beginning January 1, 
2008. Therefore, we are proposing to revise subparts D and E to part 
416 to reflect that these are the rules governing the APC payment 
system prior to January 1, 2008, and to redesignate the existing 
subpart F as subpart G under part 416 to codify the rules governing the 
ASC payment adjustment for NTIOLs. In addition, we are proposing to 
revise existing--
     Sec.  416.1 (Basis and scope) to remove the obsolete 
reference to ``a hospital outpatient department,'' to add provisions of 
section 5103 of Pub. L. 109-171, and applicable provisions of Pub. L. 
108-173.
     Sec.  416.65 (Covered surgical procedures) to modify the 
introductory text to clearly denote the section's application to 
covered surgical procedures furnished before January 1, 2008. In 
addition, we are proposing to remove the obsolete cross-reference in 
paragraph (a)(4) to Sec.  405.310 and replace it with the correct 
cross-reference to Sec.  411.15.
     Sec.  416.125 (ASC facility services payment rate) to 
incorporate the limitation on payment imposed by section 5103 of Pub. 
L. 109-171.
     Sec.  488.1 (Definitions) to correct a longstanding error 
by adding ambulatory surgical centers to the definition of a supplier 
in conformance with section 1861(d) of the Act.
    We also are proposing to add a new Sec.  416.76 and Sec.  416.121 
to subparts D and E, respectively, to clearly state that the provisions 
of subparts D and E apply to services furnished before January 1, 2008.

D. Implementation of Section 5103 of Pub. L. 109-171 (DRA)

    (If you choose to comment on issues in this section, please include 
the caption ``Section 5103'' at the beginning of your comments.)
    As noted in section XVII.A.1. of this preamble, section 5103 of 
Pub. L. 109-171 requires us to substitute the OPPS payment amount for 
the ASC standard overhead amount for surgical procedures performed at 
an ASC on or after January 1, 2007, but prior to the revised payment 
system when the ASC standard overhead amount exceeds the OPPS payment 
amount for the procedure. In Addendum AA of this proposed rule, we 
identify the HCPCS codes that we believe would be subject to section 
5103 based on a comparison of the CY 2007 proposed OPPS payment rates 
and the ASC standard overhead amounts that are effective in CY 2007. We 
are proposing to add paragraph (c) to Sec.  416.125 to reflect this 
change.

E. Proposal To Modify the Current ASC Process for Adjusting Payment for 
New Technology Intraocular Lenses (NTIOLs)

1. Background
    (If you choose to comment on issues in this section, please include 
the caption ``NTIOL'' at the beginning of your comments.)
    At the inception of the ASC benefit on September 7, 1982, Medicare 
paid 80 percent of the reasonable charge for IOLs supplied for 
insertion concurrent with or following cataract surgery performed in an 
ASC (see 47 FR 34082, August 5, 1982). Section 4063(b) of OBRA 1987, 
Pub. L. 100-203, amended the Act to mandate that we include payment for 
an IOL furnished by an ASC for insertion during or following cataract 
surgery as part of the ASC facility fee for insertion of the IOL, and 
that the facility fee include payment that is reasonable and related to 
the cost of acquiring the class of lens involved in the procedure.
    Section 4151(c)(3) of the Omnibus Budget Reconciliation Act of 1990

[[Page 49632]]

(OBRA 1990), Pub. L. 101-508, froze the IOL payment amount at $200 for 
IOLs furnished by ASCs in conjunction with surgery performed during the 
period beginning November 5, 1990, and ending December 31, 1992. We 
continued paying an IOL allowance of $200 from January 1, 1993, through 
December 31, 1993.
    Section 13533 of the Omnibus Budget Reconciliation Act of 1993 
(OBRA 1993), Pub. L. 103-66, mandated that payment for an IOL furnished 
by an ASC be equal to $150 beginning January 1, 1994, through December 
31, 1998.
    Section 141(b)(1) of the Social Security Act Amendments of 1994 
(SSAA 1994), Pub. L. 103-432, required us to develop and implement a 
process under which interested parties may request a review of the 
appropriateness of the payment amount for insertion of an IOL, to 
ensure that the facility fee for the procedure includes payment that is 
reasonable and related to the cost of acquiring a lens that belongs to 
a class of NTIOLs.
    In the February 8, 1990 Federal Register (55 FR 4526), we published 
a final notice entitled ``Revision of Ambulatory Surgery Center Payment 
Rate Methodology,'' which implemented Medicare payment for an IOL 
furnished at an ASC as part of the ASC facility fee for insertion of 
the IOL.
    In the June 16, 1999 Federal Register (64 FR 32198), we published a 
final rule entitled ``Adjustment in Payment Amounts for New Technology 
Intraocular Lenses Furnished by Ambulatory Surgical Centers'' to add a 
subpart F (Sec. Sec.  416.180 through 416.200) to 42 CFR Part 416, 
which established a process for adjusting payment amounts for insertion 
of a class of NTIOLs furnished by ASCs.
    Our current regulations Sec. Sec.  416.180 through 416.200 define 
the terms relevant to the process, establish the payment review 
process, and establish $50 as the payment adjustment amount that is 
added to the ASC facility fee for insertion of a lens that CMS 
determines is an NTIOL. Section 416.200 provides that the payment 
adjustment applies for a 5-year period that begins when we recognize 
the first lens that establishes a class of NTIOLs. In accordance with 
Sec.  416.200(b), insertion of a lens that we subsequently recognize as 
belonging to an existing NTIOL class would receive the payment 
adjustment for the remainder of the 5-year period established for the 
class. Section 416.185(f)(2) provides that after July 16, 2002, we have 
the option of changing the $50 adjustment amount through proposed and 
final rulemaking in connection with ASC services.
    Since June 16, 1999, we have issued a series of Federal Register 
notices to list lenses for which we received requests for a NTIOL 
payment adjustment and to solicit comments on those requests, or to 
announce the lenses that we have determined meet the criteria and 
definition of NTIOLs. We last published a Federal Register notice 
pertaining to NTIOLs on April 28, 2006 (71 FR 25176).
a. Current ASC Payment for Insertion of IOLs
    The current ASC payment groups, payment rates and procedural HCPCS 
codes for cataract extraction with IOL insertion are as follows:

Payment Group 6--$826 ($676 + $150 IOL Allowance)

     CPT code 66985, Insertion of intraocular lens prosthesis 
(secondary implant), not associated with concurrent cataract removal
     CPT code 66986, Exchange of intraocular lens
Payment Group 8--$973 ($823 + $150 IOL allowance)

     CPT code 66982 Extracapsular cataract removal with 
insertion of intraocular lens prosthesis (one stage procedure), manual 
or mechanical technique (for example, irrigation and aspiration or 
phacoemulsification), complex, requiring devices or techniques not 
generally used in routine cataract surgery (for example, iris expansion 
device, suture support for intraocular lens, or primary posterior 
capsulorrhexis) or performed on patients in the amblyogenic 
developmental stage
     CPT code 66983 Intracapsular cataract extraction with 
insertion of intraocular lens prosthesis (one stage procedure)
     CPT code 66984 Extracapsular cataract removal with 
insertion of intraocular lens prosthesis (one stage procedure), manual 
or mechanical technique (for example, irrigation and aspiration or 
phacoemulsification)
b. Classes of NTIOLs Approved for Payment Adjustment
    Since implementation of the process for adjustment of payment 
amounts for NTIOLs, that was established in the June 16, 1999 Federal 
Register, we have approved three classes of NTIOLs, as shown in the 
following table:

----------------------------------------------------------------------------------------------------------------
                                                $50 approved for
      NTIOL category          HCPCS  code      services furnished         NTIOL             IOLs eligible for
                                                  on or after         characteristic           adjustment
----------------------------------------------------------------------------------------------------------------
1........................  Q1001............  May 18, 2000,        Multifocal.........  Allergan AMO Array
                                               through May 18,                           Multifocal lens, model
                                               2005.                                     SA40N.
2........................  Q1002............  May 18, 2000,        Reduction in         STAAR Surgical Elastic
                                               through May 18,      Preexisting          Ultraviolet-Absorbing
                                               2005.                Astigmatism.         Silicone Posterior
                                                                                         Chamber IOL with Toric
                                                                                         Optic, models AA4203T,
                                                                                         AA4203TF, and AA4203TL.
3........................  Q1003............  February 27, 2006,   Reduced Spherical    Advanced Medical Optics
                                               through February     Aberration.          (AMO) Tecnis([supreg])
                                               26, 2011.                                 IOL models Z9000,
                                                                                         Z9001, and ZA9003;
                                                                                         Alcon Acrysof IQ Model
                                                                                         SN60WF.
----------------------------------------------------------------------------------------------------------------

2. Proposed Changes
a. Process for Recognizing IOLs as Belonging to an Active NTIOL Class
    Currently, we accept and review applications for inclusion in an 
active NTIOL class on a continuous basis throughout the year in 
accordance with Sec. Sec.  416.180 through 416.200 of the regulations. 
We are proposing to continue this established process and to update and 
streamline it, as discussed below, to specify the request and comment 
review process, the information that a request must include to be 
accepted for review, the specific factors to be considered in 
evaluating requests, and the process to provide notification of 
determinations. As stated in section XVII.D. of this preamble, we are 
proposing to redesignate existing subpart F of part 416 as subpart G, 
which would include the regulations pertaining to the ASC payment 
adjustment for NTIOLs. In addition, we are proposing to revise 
redesignated subpart G to add new Sec.  416.180, Sec.  416.185, Sec.  
416.190, Sec.  416.195, and Sec.  416.200 to the regulations to reflect 
the changes that we are proposing to this process.
    One of the regulatory changes that we are proposing is to revise 
existing Sec.  416.180 to establish the basis and

[[Page 49633]]

scope for this ASC payment adjustment. This proposal would eliminate 
the definitions currently included in that section for ``Class of new 
technology intraocular lenses (IOLs),'' ``Interested party,'' ``New 
technology IOL,'' and ``New technology subset.'' We do not believe that 
we need to retain these definitions because additional revisions that 
we are proposing to the regulations at part 416 would eliminate the 
term ``interested party'' from Sec. Sec.  416.185(c) and 416.190 and 
the term ``new technology subset'' from Sec. Sec.  416.185(g), 
416.200(a), (b), and (c) and further clarify the terms ``new technology 
IOL'' and ``class of new technology intraocular lenses (IOLs).''
    The other changes that we are proposing to part 416, pertaining to 
the ASC payment adjustment for NTIOLs, are discussed in this section.
b. Public Notice and Comment Regarding Adjustments of NTIOL Payment 
Amounts
    We are proposing to update and streamline the process for 
determining whether an IOL that is to be inserted during or subsequent 
to cataract extraction qualifies for payment adjustment as a NTIOL, as 
set forth in existing Sec.  416.185 of our regulations. The basis for 
the current NTIOL payment review process was enacted in 1994 and has 
been implemented through a series of separate Federal Register notices 
specific to NTIOLs. We are proposing to modify the current process of 
using separate Federal Register notices to notify the public of 
requests to review lenses for membership in new NTIOL classes, to 
solicit public comment on requests, and to notify the public of CMS 
determinations concerning new classes of NTIOLs for which an ASC 
payment adjustment would be made. We are proposing that these NTIOL-
related notifications would be fully integrated into the annual notice 
and comment rulemaking for updating the ASC payment rates, the specific 
payment system in which NTIOL payment adjustments are made. Given that 
the NTIOL payment adjustments are applicable to ASC services and that 
the proposal for updating the new ASC payment system to be implemented 
in January 2008 anticipates an annual update process in coordination 
with notice and comment rulemaking on the OPPS, aligning the NTIOL 
process with this annual update would promote coordination and 
efficiency, thereby streamlining and expediting the NTIOL notification, 
comment, and review process.
    Specifically, we are proposing the following process:
     We would announce annually in the Federal Register 
document that proposes the update of ASC payment rates for the 
following calendar year, a list of all requests to establish new NTIOL 
classes accepted for review during the calendar year in which the 
proposal is published and the deadline for submission of public 
comments regarding those requests. The deadline would be 30 days 
following publication of the list of requests.
     In the Federal Register document that finalizes the update 
of ASC payment rates for the following calendar year we would--
    + Provide a list of determinations made as a result of our review 
of all requests and public comments; and
    + Publish the deadline for submitting requests for review in the 
following calendar year.
    We believe that the coordination of public notice and comment 
regarding requests to establish new NTIOL classes with the update of 
ASC payment rates would facilitate judicious and comprehensive review 
and comment by interested parties, thereby resulting in more timely 
access to improved health technologies for Medicare beneficiaries. 
Accordingly, we are proposing to revise Sec.  416.185 to reflect these 
proposed changes to the current process for publishing separate Federal 
Register notices specific to NTIOLs.
    We note that we did not receive any review requests in response to 
the specific NTIOL April 28, 2006 notice (71 FR 25176) soliciting CY 
2006 requests for review of the appropriateness of the payment amount 
for particular NTIOLs furnished in ASCs.
c. Factors CMS Considers in Determining Whether an Adjustment of 
Payment for Insertion of a New Class of NTIOL Is Appropriate
    In determining whether a lens belongs to a new class of NTIOLs for 
which the ASC payment amount for insertion in conjunction with cataract 
surgery is appropriate, we expect that the insertion of the candidate 
IOL would result in significantly improved clinical outcomes compared 
to currently available IOLs. In addition, to establish a new NTIOL 
class, the candidate lens must be distinguishable from lenses already 
approved as members of active or expired classes of NTIOLs that share a 
predominant characteristic associated with improved clinical outcomes 
that was identified for each class. We are proposing to base our 
determinations on consideration of the following factors:
     The IOL must have been approved by the FDA and claims of 
specific clinical benefits and/or lens characteristics with established 
clinical relevance in comparison with currently available IOLs must 
have been approved by the FDA for use in labeling and advertising.
     The IOL is not described by an active or expired NTIOL 
class; that is, it does not share the predominant, class-defining 
characteristic associated with improved clinical outcomes with 
designated members of an active or expired NTIOL class.
     Evidence demonstrating that use of the IOL results in 
measurable, clinically meaningful, improved outcomes in comparison with 
use of currently available IOLs. According to the statute, and 
consistent with previous examples provided by CMS, superior outcomes 
that would be considered include the following:
    + Reduced risk of intraoperative or postoperative complication or 
trauma;
    + Accelerated postoperative recovery;
    + Reduced induced astigmatism;
    + Improved postoperative visual acuity;
    + More stable postoperative vision;
    + Other comparable clinical advantages, such as--
    ++ Reduced dependence on other eyewear (for example, spectacles, 
contact lenses, and reading glasses)
    ++ Decreased rate of subsequent diagnostic or therapeutic 
interventions, such as the need for YAG laser treatment.
    ++ Decreased incidence of subsequent IOL exchange.
    ++ Decreased blurred vision, glare, other quantifiable symptom or 
vision deficiency.
    In order to assess the clinical performance of a candidate IOL to 
establish a new NTIOL class, outcomes from use of the candidate lens 
would be compared with outcomes of use of currently available IOLs. Due 
to the rapid evolution of medical technology, we expect that the 
baseline of currently available IOLs for comparison would change from 
year to year. It is our expectation that the current ASC payment 
adjustment for active NTIOL classes should support the development and 
dissemination of new IOL technologies that would continue to improve 
the clinical outcomes of Medicare beneficiaries furnished IOLs after 
cataract extraction.
    Accordingly, we are proposing to revise our process for determining 
whether a lens belongs to a new class of NTIOLs for which an ASC 
payment adjustment is appropriate by setting forth the factors that we 
propose to

[[Page 49634]]

consider in making this determination. In addition, we are proposing to 
revise Sec.  416.195 of the regulations to incorporate these proposed 
factors.
    Further, we are seeking public comments on the desirability of 
further interpreting the phrase ``currently available lenses'' for 
purposes of comparison and specific approaches to providing such 
clarifications. We believe that further interpretation could be helpful 
to requestors seeking to provide the most relevant, authoritative 
evidence concerning the clinical benefits of their lenses in comparison 
with those currently available lenses and to us as we review the 
information provided in requests to establish new NTIOL classes. 
However, we also believe that any clarifications should incorporate our 
expectations for technological progression of the baseline comparison 
lenses over time as we make future annual determinations regarding the 
establishment of new NTIOL classes. Therefore, we believe that the 
public's comments regarding practical and meaningful approaches to 
elaborating on the phrase ``currently available lenses'' would 
facilitate both requestors' submission of complete requests for review 
and appropriate determinations by CMS regarding new NTIOL classes to 
receive the ASC payment adjustment.
d. Proposal To Revise Content of a Request To Review
    To enable us to make a determination that the criteria for a 
payment adjustment for a new NTIOL class are met, we are proposing to 
require that a request include the information listed below. We are 
proposing to revise the content of a request (as currently set forth in 
Sec.  416.195(a)) based on our experience in evaluating applications 
for OPPS pass-through status for new device categories over the past 6 
years. We have found that the additional information allows our medical 
advisors to complete a more comprehensive evaluation, which would 
ensure that a payment adjustment is appropriate. We also have found 
that such information must be updated in a timely manner to ensure its 
relevancy to advancing technologies. Therefore, we also are proposing 
to post the information listed below on the CMS Web site at: http://www.cms.hhs.gov/center/asc/asp to provide easy access for updating 
rather than incorporating it in Sec.  416.195(a) of the regulations.
    In addition, we are proposing to continue to require that a 
separate request would be required for each NTIOL for which a payment 
review as member of a new class is sought. We are proposing that a 
request that does not include all of the following information would be 
considered incomplete and could not be accepted for review until all 
information is furnished:
     Proposed name or description of a new class of NTIOLs.
     Trade/brand name, manufacturer, and model number of the 
IOL for which the request to establish a new NTIOL class is being made. 
(Applications must include the name and description of at least one 
marketed IOL that would be placed in the proposed new NTIOL class.)
     A list of all active or expired NTIOL classes that 
describe similar IOLs. For each active or expired class, provide a 
detailed explanation as to why that class would not describe the 
candidate IOL.
     Detailed description of the FDA approved clinical 
indications for the candidate IOL.
     Description of the IOL--
    + What is it? Provide a complete physical description of the IOL, 
including its components, for example, its composition; coating or 
covering; haptics; material; and construction.
    + What does it do?
    + How is it used?
    + What makes it different from other currently available IOLs?
    + What makes it superior to other currently available IOLs used for 
similar indications?
    + What are its clinical characteristics, for example, is it used 
for treatment of specific pathology; what is its life span; what are 
the complications associated with its use; and for what patient 
populations is it intended?
    + Submit relevant booklets, pamphlets, brochures, product 
catalogues, price lists, and/or package inserts that further describe 
and illuminate the nature of the IOL.
     If the candidate IOL replaces or improves upon an existing 
IOL, identify the trade/brand name and model of the existing IOL(s).
     Full discussion of the clinically meaningful, improved 
outcomes that result from use of the candidate IOL compared to use of 
other currently available IOLs. This discussion must include evidence 
to demonstrate that use of the IOL results in measurable, clinically 
significant improvement over currently available IOLs in one or more of 
the following areas:
    + Reduced risk of intraoperative or postoperative complication or 
trauma.
    + Accelerated postoperative recovery.
    + Reduced induced astigmatism.
    + Improved postoperative visual acuity;
    + More stable postoperative vision.
    + Other comparable clinical advantages, such as--
    ++ Reduced dependence on other eyewear (for example, spectacles, 
contact lenses, and reading glasses);
     Decreased rate of subsequent diagnostic or therapeutic 
interventions, such as the need for YAG laser treatment;
    ++ Decreased incidence of subsequent IOL exchange; and
    ++ Decreased blurred vision, glare or other quantifiable symptom or 
vision deficiency.
     Provide the following information for the IOL(s) for which 
a new class is proposed:
    + Dates the candidate IOL was first marketed, reporting inside the 
United States and outside the United States separately.
    + Dates of sale of the first unit of the IOL, reporting inside the 
United States and outside the United States separately.
    + Number of IOLs that have been sold up to the date of the 
application.
    + A copy of the FDA's original approval notification.
     A copy of the labeling claims approved by the FDA for the 
IOL, indicating its clinical advantages and/or the lens characteristics 
with clinical relevance.
     A copy of the FDA's summary of the IOL's safety and 
effectiveness.
     Reports of modifications made after the original FDA 
approval.
    We strongly encourage and may give greater consideration for the 
submission of published, peer-reviewed literature and other materials 
that demonstrate substantial clinical improvement with use of the 
candidate IOL over use of currently available IOLs.
    Proposed Sec.  416.190(d) provides that, in order for CMS to invoke 
the protection allowed under Exemption 4 of the Freedom of Information 
Act (5 U.S.C. 552(b)(4)) and, with respect to trade secrets, the Trade 
Secrets Act (18 U.S.C. 1905), the requestor must clearly identify all 
information that is to be characterized as confidential.
    For the stated reasons, we are proposing to revise Sec.  416.190 to 
reflect these proposed changes to the content of a request for payment 
review of an IOL, to clarify when a request can be submitted and who 
may submit, and to also clarify the process for maintaining 
confidentiality of information included in a request. As stated 
earlier, we are not proposing to incorporate the list of proposed 
information required with each request in the regulations, but are 
proposing to post it on the CMS Web site to ensure that such 
information is updated in a timely manner and relevant to advancing IOL 
technologies. We are proposing to revise Sec.  416.190 to

[[Page 49635]]

require that the content of each request for an IOL review must include 
all information as specified on the CMS Web for the request to be 
considered complete.
e. Notice of CMS Determination
    We are proposing three possible outcomes from review of a request 
for determination of a new NTIOL class. As appropriate, for each 
completed request for a candidate IOL that is received by the 
established deadline, one of the following determinations would be 
announced annually in the final rule updating the ASC payment rates for 
the next calendar year:
     The request for a payment adjustment is approved for the 
IOL for 5 full years as a member of a new NTIOL class described by a 
new code.
     The request for a payment adjustment is approved for the 
IOL for the balance of time remaining as a member of an active NTIOL 
class.
     The request for a payment adjustment is not approved.
    We also are proposing to summarize briefly in the ASC final rule 
the evidence that was reviewed, the public comments, and the basis for 
our determination. When a new NTIOL class is established, we are 
proposing to identify the predominant characteristic of NTIOLs in that 
class that sets them apart from other IOLs (including those previously 
approved as members of other expired or active NTIOL classes) and is 
associated with improved clinical outcomes. The date of implementation 
of a payment adjustment in the case of approval of an IOL as a member 
of a new NTIOL class would be set prospectively as of 30 days after 
publication of the ASC payment update final rule, consistent with the 
statutory requirement. The date of implementation of a payment 
adjustment in the case of approval of a lens as a member of an active 
NTIOL class would be set prospectively as of the publication date of 
the ASC payment update final rule.
f. Proposed Payment Adjustment
    The current payment adjustment for a 5-year period from the 
implementation date of a new NTIOL class is $50. We are not proposing 
to revise this payment adjustment for CY 2007.
    For CY 2007, we are proposing to revise Sec.  416.200(a) through 
(c) to clarify how the IOL payment adjustment would be made and how an 
NTIOL would be paid after expiration of the payment adjustment. We also 
are proposing minor editorial changes to Sec.  416.200(d).

XVIII. Proposed Revised Ambulatory Surgical Center (ASC) Payment System 
for Implementation January 1, 2008

A. Background

    Generally, there are two primary elements in the total cost of 
performing a surgical procedure: the cost of the physician's 
professional services for performing the procedure and the cost of 
services furnished by the facility where the procedure is performed 
(for example, surgical supplies, equipment, nursing services, and 
overhead). The former is covered by the Medicare physician fee 
schedule. In 1980, a new Medicare benefit was enacted, authorizing 
payment of a fee to ASCs for facility services furnished in connection 
with performing certain surgical procedures.
    The statute requires us to specify surgical procedures that are 
appropriately and safely performed on an ambulatory basis in an ASC. 
Moreover, we are to review and update the list of these procedures not 
less often than every 2 years, in consultation with appropriate trade 
and professional associations. The ASC list was limited in 1982 to 
approximately 100 procedures. Currently, the list consists of more than 
2,500 CPT codes encompassing a cross-section of surgical services, 
although 150 of these codes account for more than 90 percent of the 
approximately 4.5 million procedures paid for each year under the ASC 
Part B benefit. Eye, pain management, and gastrointestinal endoscopic 
procedures are the highest volume ASC surgeries under the present 
payment system.
    Medicare only allows payment to ASCs for procedures on the ASC 
list. Medicare pays 80 percent of the prospectively determined fee; the 
coinsurance rate is 20 percent for all procedures on the ASC list. In 
Pub. L. 108-173, the Congress mandated implementation of a revised 
payment system for ASC surgical services by no later than January 1, 
2008. Pub. L. 108-173 sets forth several requirements for the revised 
payment system, but does not amend those provisions of the statute 
pertaining to the ASC list.
    In section XVIII. of this preamble, we describe the provisions of 
the revised ASC payment system that we are proposing to implement, as 
required by Pub. L.108-173, not later than January 1, 2008. Our 
proposal encompasses two components: first, our proposal for 
establishing and maintaining the ASC list of Medicare approved 
procedures under the revised payment system, and second, the method we 
are proposing to use to set payment rates for ASC facility services 
furnished in association with procedures on the ASC list. We also 
discuss in this section regulatory changes that we are proposing to 42 
CFR parts 416 and 488 to incorporate the rules governing ASC facility 
payments under the revised payment system that would be applicable 
beginning in CY 2008.
1. Provisions of Pub. L. 108-173
    Section 626(a) of Pub. L. 108-173 amended section 1833(i)(2)(C) of 
the Act, which requires the Secretary to update ASC payment rates using 
the Consumer Price Index for all urban consumers (U.S. City average) 
(CPI-U) if the Secretary has not otherwise updated the amounts under 
the revised ASC payment system. As amended by Pub. L. 108-173, this 
section requires that if the Secretary is required to apply the CPI-U 
increase, the CPI-U percentage increase is to be applied on a fiscal 
year basis beginning with FY 1986 through FY 2005 and on a calendar 
year basis beginning with 2006.
    Pub. L. 108-173 further amended section 1833(i)(2)(C) of the Act to 
require us in FY 2004, beginning April 1, 2004, to increase the ASC 
payment rates using the CPI-U as estimated for the 12-month period 
ending March 31, 2003, minus 3.0 percentage points. Pub. L. 108-173 
also requires that the CPI adjustment factor equal zero percent in FY 
2005, the last quarter of CY 2005, and each CY from 2006 through 2009.
    Section 626(b) of Pub. L. 108-173 repeals the requirement that CMS 
conduct a survey of ASC costs upon which to base a standard overhead 
payment amount for surgical services performed in ASCs, and adds 
section 1833(i)(2)(D)(iii) to the Act, which requires us to implement 
by no earlier than January 1, 2006, and not later than January 1, 2008, 
a revised ASC payment system. The revised payment system under section 
1833(i)(2)(D)(i) of the Act is to take into account the recommendations 
contained in a Report to Congress that the GAO was required to submit 
by January 1, 2005. Section 1833(i)(2)(D)(ii) of the Act requires that 
the revised ASC payment system be designed to result in the same 
aggregate amount of expenditures for surgical services furnished in 
ASCs the year the system is implemented as would be made if the new 
system did not apply as estimated by the Secretary. This requirement is 
to take into account the limitation in ASC expenditures resulting from 
implementation of section 5103 of Pub. L. 109-171 beginning January 1, 
2007, as we describe in section XVII.A.1 of this preamble.

[[Page 49636]]

    Section 1833(i)(2)(D)(iv) of the Act exempts the classification 
system, relative weights, payment amounts, and geographic adjustment 
factor (if any) under the revised ASC payment system from 
administrative and judicial review.
    Section 626(c) of Pub. L. 108-173 adds a conforming amendment to 
section 1833(a)(1) of the Act providing that the amounts paid under the 
revised ASC payment system shall equal 80 percent of the lesser of the 
actual charge for the services or the payment amount that we determine.
2. Other Factors Considered
    On August 2, 2005, we convened a listening session teleconference 
on revising the Medicare ASC payment system. Over 450 callers 
participated, including ASC staff, physicians, and representatives of 
industry trade associations. The listening session provided an 
opportunity for participants to identify the issues and concerns that 
they wanted us to address as we developed the revised ASC payment 
system.
    Callers encouraged us to foster beneficiary access to ASCs by 
creating incentives for physicians to use ASCs. The issues raised by 
participants included suggestions to expand or eliminate altogether the 
ASC list, recommendations to model payment on the hospital OPPS, and 
concerns about how we would propose to treat the geographic wage index 
adjustment and the annual ASC payment rate update. Several callers also 
raised concerns about ensuring adequate payment for supplies, ancillary 
services, and implantable devices under the new payment system, as well 
as developing a process to allow special payment for new technology.
    We have also met with representatives of the ASC industry over the 
past several years to discuss options for ratesetting other than 
conducting a survey, to discuss timely updates to the ASC list, and to 
listen to industry concerns related to the implementation of a new 
payment system. We appreciate the thoughtful suggestions that have been 
presented. We have carefully considered the concerns and issues brought 
to our attention, and a number of the proposals in this section for 
revising the ASC list and the method by which we set ASC payment rates 
take these concerns and issues into account. We look forward to 
receiving comments on the proposed changes set forth in this proposed 
rule and to continued input from representatives of industry 
associations and professional societies as we develop the final rule.

B. Procedures Proposed for Medicare Payment in ASCs Effective for 
Services Furnished On or After January 1, 2008

1. Proposed Payable Procedures
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Payable Procedures'' at the beginning of your 
comments.)
    In its March 2004 Report to the Congress, MedPAC recommended 
replacing the current ``inclusive'' list of procedures, which are the 
only procedures for which Medicare allows payment of an ASC facility 
fee, with an ``exclusionary'' list. That is, rather than limiting 
payment of an ASC facility fee to a list of procedures that CMS 
specifies, Medicare would allow payment to an ASC facility for any 
surgical procedure except those that CMS explicitly excludes from 
payment. MedPAC further recommended that clinical safety standards and 
the need for an overnight stay be the only criteria for excluding a 
procedure from payment of an ASC facility fee. MedPAC suggested that 
some of the criteria, such as site-of-service volume and time limits, 
which we have used in the past to identify procedures for the ASC list, 
are probably no longer clinically relevant.
    We have given careful consideration to MedPAC's recommendations and 
participated in considerable discussion and consultation with members 
of ASC trade associations and physicians who represent a variety of 
surgical specialties regarding the criteria that we would use to 
identify procedures that we would propose for payment under the new ASC 
payment system. We agree that adoption of a policy like that 
recommended by MedPAC would serve both to protect beneficiary safety 
and increase beneficiary access to procedures in appropriate clinical 
settings, recognizing the ASC industry's interest in obtaining Medicare 
payment for a much wider spectrum of services than is now allowed. 
Therefore, we are proposing that, under the revised ASC payment system 
for services furnished on or after January 1, 2008, Medicare would 
allow payment of an ASC facility fee for any surgical procedure 
performed at an ASC, except those surgical procedures that we determine 
are not payable under the ASC benefit.
    Further, we are proposing to establish beneficiary safety and the 
need for an overnight stay as the principal clinical considerations and 
factors in determining whether payment of an ASC facility fee would be 
allowed for a particular surgical procedure. As discussed in section 
XVIII.B.2 below, we also are proposing to exclude from payment under 
the ASC revised payment system those surgical procedures that are not 
eligible for separate payment under the OPPS and CPT surgical unlisted 
procedure codes.
    We discuss below the criteria that we are proposing as the basis 
for identifying procedures that would pose a significant safety risk to 
a Medicare beneficiary when performed in an ASC, or procedures 
following which we would expect a Medicare beneficiary to require 
overnight care.
a. Proposed Definition of Surgical Procedure
    In order to delineate the scope of procedures that constitute 
``outpatient surgical procedures,'' we must first clarify what we 
consider to be a ``surgical'' procedure. Under the current ASC payment 
system, we define as a surgical procedure any procedure described 
within the range of CPT Category I codes that the AMA defines as 
``surgery'' (CPT codes 10000-69999) for purposes of the ASC payment 
system. Under the revised payment system, we are proposing to continue 
that standard. However, we seek comment on whether all services 
contained in this range are appropriately defined as ``surgery.'' For 
example, should procedures that are primarily office-based (see 
Addendum CC) or procedures that require relatively inexpensive 
resources to perform be excluded from the list? Within the CPT surgical 
code range, such procedures that either require very limited facility 
resources or are primarily performed in procedure rooms in physician 
offices could be considered not to be surgical procedures, in that they 
may not require typical surgical resources, such as a fully equipped 
operating room or significant postoperative recovery area, that are 
generally associated with surgical procedures that are predominantly 
performed in facility settings or have significant associated resource 
costs. Procedures that require relatively inexpensive resources to 
perform could be defined based on an ASC payment threshold, for example 
$100 or $200, such that procedures below this threshold would be 
excluded from the ASC list of procedures. We seek comment on what an 
appropriate payment threshold would be for defining procedures that 
require relatively inexpensive resources.
    In addition, we are proposing to include within the scope of 
surgical procedures payable in an ASC certain services that are 
described by HCPCS alphanumeric codes (Level II HCPCS codes) or by CPT 
Category III codes which directly crosswalk to or are

[[Page 49637]]

clinically similar to procedures in the CPT surgical range. We are 
proposing to include these three types of codes in our definition of 
surgical procedures because they all are eligible for payment under the 
OPPS and, to the extent it is reasonable to do so, we are proposing 
that the new ASC payment system parallel the OPPS in its policies.
    An example of a Level II HCPCS code that we believe represents a 
procedure that could be safely and appropriately performed in an ASC is 
HCPCS code G0297 (Insertion of single chamber pacing cardioverter 
defibrillator pulse generator). We developed this alphanumeric code for 
use in the OPPS because CPT code 33240, which describes the surgical 
insertion of cardioverter defibrillator pulse generators, does not 
distinguish insertion of a single chamber cardioverter defibrillator 
generator from insertion of a dual chamber cardioverter defibrillator 
generator. We were concerned that different facility resources could be 
required for the insertion of these two types of cardioverter 
defibrillator pulse generators, so we developed alternate codes to 
permit hospitals to more accurately report the resources required when 
these surgical procedures are performed for payment under the OPPS. In 
instances such as this, when an alphanumeric Level II HCPCS code is 
established as a substitute for a CPT surgical procedure code which 
does not adequately describe, from a facility perspective, the nature 
of a surgical service, we are proposing to allow payment for the 
alphanumeric code under the proposed new ASC payment system. We are 
proposing not to allow payment of an ASC facility fee for Level II 
HCPCS codes or Category III CPT codes that describe services which fall 
outside the scope of surgical procedures described by CPT codes 10000-
69999.
    We recognize that continuing to use this definition of surgery 
would exclude from payment of an ASC facility fee certain invasive, 
``surgery-like'' procedures, such as cardiac catheterization or certain 
radiation treatment services which are assigned codes outside the CPT 
surgical range. However, we believe that continuing to rely on the CPT 
definition of surgery would be administratively straightforward, 
uncontroversial, and consistent with our proposal to allow ASC payment 
for all outpatient surgical procedures. Since 1987, the ASC list has 
consisted of CPT codes that are defined as surgery by CPT. Given the 
number of other changes that we expect to be implemented as part of the 
proposed new payment system, along with the significant expansion of 
the ASC list that we are proposing, we believe that it would be prudent 
at the outset to continue to define surgery as it is defined by the CPT 
code set, which is used to report services for payment under both the 
Medicare Physician Fee Schedule (MPFS) and the OPPS. However, we are 
interested in commenters' opinions regarding the appropriateness of 
including primarily office-based procedures or including procedures 
that require relatively inexpensive resources to perform on the 
approved list of ASC procedures and we seek comment on this issue. That 
said, we have reviewed thousands of CPT codes in the surgical range 
(CPT codes 10000 through 69999), and we are proposing to not exclude 
payment for more than 750 additional surgical procedures, as well as 
continuing to not exclude payment for the more than 2,500 CPT codes on 
the current ASC list. If we were to consider CPT codes in the surgical 
range that were predominantly office-based to not be surgical 
procedures for purposes of the ASC payment system, the additions to the 
ASC list for CY 2008 would be limited to no more than about 300 other 
procedures. Similarly, if we were to define procedures requiring 
relatively inexpensive resources to not be surgical procedures, then 
additions to the ASC list for ASC payment would be more limited than 
under our current proposal.
    However, we are cognizant of the dynamic nature of ambulatory 
surgery, which has resulted in a dramatic shift of services from 
inpatient to outpatient settings over the past two decades. Therefore, 
we are soliciting comments regarding other services which are invasive 
and ``surgery-like,'' which could safely and appropriately be performed 
at an ASC, and which require the resources typical of an ASC, even 
though the procedures are described by codes that fall outside the 
range of CPT surgical codes. In particular, we would be interested in 
considering commenters' views of what constitutes a ``surgical'' 
procedure.
b. Procedures Proposed for Exclusion From Payment Under the Revised ASC 
System
    As stated above, we are proposing to allow payment of an ASC 
facility fee for all procedures within the surgical range of CPT codes 
that do not pose a safety risk to Medicare beneficiaries or require an 
overnight stay. Having established what we would propose as 
constituting a ``surgical procedure,'' we next considered criteria that 
would enable us to identify procedures that could pose a significant 
safety risk when performed in an ASC or that would require an overnight 
stay within the bounds of prevailing medical practice. We discuss in 
this section how we propose to identify procedures that could pose a 
significant safety risk.
(1) Significant Safety Risk
    First, we are proposing to exclude from payment of an ASC facility 
fee any procedure that is included on the current OPPS inpatient list. 
(See Addendum E to this proposed rule and section XII. of this preamble 
for a discussion of the OPPS inpatient list.) The procedures included 
on that list are typically performed in the inpatient hospital setting 
due to 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. 
We believe that any procedure for which we do not allow payment in the 
hospital outpatient setting due to safety concerns would not be safe to 
perform in an ASC.
    Second, we are proposing to exclude from payment of an ASC facility 
fee procedures that the CY 2005 Part B Extract Summary System (BESS) 
data indicate are performed 80 percent or more of the time in the 
hospital inpatient setting, even if those procedures are not included 
on the OPPS inpatient list. (See Table 4.) We selected an 80 percent 
threshold because we believe that an 80 percent level of inpatient 
performance is a fair indicator that a procedure is most appropriately 
performed on an inpatient basis and as such, would pose significant 
safety risks for Medicare beneficiaries if performed in an ASC. We find 
that procedures with inpatient utilization frequencies above this 
proposed threshold are complex and are likely to require a longer and 
more intensive level of care postoperatively than what is provided in a 
typical ASC. We believe that performing these procedures in an ASC, 
where immediate access to the full resources of an acute care hospital 
is not the norm, would pose a significant safety risk for 
beneficiaries.
    Third, we are proposing to retain the specific criteria for 
evaluating safety risks that are listed in Sec.  416.65(b)(3). 
Procedures that involve major blood vessels; prolonged or extensive 
invasion of body cavities; extensive blood loss; or are emergent or 
life-threatening in nature could, by definition, pose a significant 
safety risk. Therefore, we are proposing to exclude from payment of an 
ASC facility fee, procedures that may be expected to involve any of 
these characteristics based on evaluation by

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our medical advisors. We note that most of the procedures that our 
medical advisors identified as involving any of the characteristics 
listed currently in Sec.  416.65(b)(3), also require overnight or 
inpatient stays, reinforcing their exclusion from being paid when 
performed in an ASC.
    Finally, we are proposing not to continue applying under our 
proposed revised system the current time-based prescriptive criteria at 
Sec.  416.65(b)(1) and (2), which exclude from the ASC list procedures 
that exceed 90 minutes of operating time or 4 hours of recovery time or 
90 minutes of anesthesia. We believe these criteria are no longer 
clinically appropriate for purposes of defining a significant safety 
risk for surgical procedures.
    In light of these proposed changes for evaluating procedures that 
pose a significant safety risk for beneficiaries under our proposed 
revised system, we believe that it would not be appropriate to apply 
the existing standard at Sec.  416.65(a)(1), which states that covered 
surgical procedures are those that are commonly performed on an 
inpatient basis but may be safely performed in an ASC, because this 
standard is no longer relevant to prevailing medical practice in the 
realm of ambulatory or outpatient surgery. Similarly, we believe that 
it would not be appropriate to continue applying the existing standard 
at Sec.  416.65(a)(2), which states that procedures performed in an ASC 
are not of a type that are commonly performed, or that may be performed 
in a physician's office. This standard is no longer relevant within the 
context of our proposal only to exclude from payment of an ASC facility 
fee under the revised payment system those surgical procedures that 
pose a safety risk or require an overnight stay. We would expect the 
types of procedures that are commonly performed or that may be 
performed in a physician's office to pose no significant safety risk 
and to require no overnight care.
    Therefore, we are proposing to add new subpart F to reflect 
coverage, scope and payment for ASC services under the revised payment 
system. Included in these changes will be new Sec.  416.166 that will 
reflect these changes that we are proposing to our current policy for 
evaluating and identifying those procedures that would pose a 
significant safety risk for beneficiaries and would be excluded from 
our list of ASC covered procedures beginning January 1, 2008. To set 
apart the provisions that are applicable to our current ASC payment 
system from those that would apply to our proposed revised system, we 
are proposing to revise the section headings of subparts D and E to 
clearly denote the provisions that would govern covered surgical 
procedures furnished before January 1, 2008. We also will add new 
Sec. Sec.  416.76 and 416.121 to clearly denote the effective dates of 
subparts D and E.
(2) Overnight Stay
    A longstanding criterion for determining which procedures are 
appropriate for inclusion on the ASC list has been that the procedures 
on the list do not require an extended recovery time. Section 
416.65(a)(3) of the regulations provides that ASC procedures ``[a]re 
limited to those requiring a dedicated operating room (or suite), and 
generally requiring a post-operative recovery room or short-term (not 
overnight) convalescent room.'' Under Sec.  416.65(b)(1)(ii), we have 
considered procedures that require more than 4 hours recovery or 
convalescent time to be inappropriately performed in the ASC.
    We have heard many differing opinions as to what constitutes an 
``overnight'' stay, ranging from ``more than 24 hours'' to time spent 
in recovery after sunset. After careful deliberation and consideration 
of several options, we are proposing to exclude from payment of an ASC 
facility fee any procedure for which prevailing medical practice 
dictates that the beneficiary will typically be expected to require 
active medical monitoring and care at midnight following the procedure. 
Our clinical staff evaluated each procedure using available claims and 
physician pricing data, as well as clinical judgment, to determine 
which procedures would be expected to require monitoring at midnight of 
the day on which the surgical procedure was performed.
    We are proposing to use midnight as the defining measure of an 
overnight stay for several reasons. First, a patient's location at 
midnight is a generally accepted standard for determining his or her 
status as a hospital inpatient or skilled nursing facility patient and 
as such, it seems reasonable to apply the same standard in the ASC 
setting. Second, overnight care is not within the scope of ASC facility 
services for which Medicare makes payment. The expectation is that 
procedures performed at an ASC are ambulatory in nature; that is, 
patients undergoing a procedure in an ASC will recover from anesthesia 
and return home on the same day that they report to the ASC for a 
scheduled procedure. Finally, the expected need for monitoring at 
midnight is a straightforward and easily understood definition of 
``overnight stay.'' We are proposing to add the requirement that 
procedures not require an overnight stay to proposed new Sec.  416.166.
2. Proposed Treatment of Unlisted Procedure Codes and Procedures That 
Are Not Paid Separately under the OPPS
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Unlisted Procedures'' at the beginning of your 
comment.)
    Unlisted procedure CPT codes are used to report services and 
procedures that are not accurately described by any other, more 
specific CPT codes. An example of an unlisted CPT code is 33999 
(Unlisted procedure, cardiac surgery). Within the surgical range of CPT 
codes, there are 91 such codes. None of the unlisted CPT codes in the 
surgical range is on the current ASC list of approved procedures. Under 
the OPPS, we assign unlisted CPT codes to the lowest weighted APC in 
the relevant clinical group regardless of the median cost for the 
unlisted procedure code, and we do not include the highly variable 
claims-based cost information for unlisted services in calculating APC 
median costs for purposes of establishing APC relative payment weights. 
Payment for unlisted CPT codes is made only at the discretion of the 
carrier under the MPFS.
    Because of concerns about the potential for safety risks when 
procedures that may only be reported with CPT unlisted procedure codes 
are performed, we are proposing to continue excluding unlisted 
procedure codes from payment of an ASC facility fee. For example, when 
CPT code 33999 is reported on a claim, we know only that some kind of 
cardiac surgery was performed. We have no other information about the 
procedure, and we have no way of knowing whether the procedure involved 
major blood vessels, prolonged or extensive invasion of body cavities, 
extensive blood loss, or was emergent or life-threatening in nature. 
Therefore, because of potential safety concerns, we are proposing to 
continue to exclude the unlisted surgical codes from payment of an ASC 
facility fee under the revised payment system.
    Prior to our evaluation of surgical procedure codes for their 
safety risk, we decided to propose that we would not make separate 
payment under the revised ASC payment system for CPT codes in the 
surgical range that are ``packaged'' under the OPPS. Packaged CPT codes 
under the OPPS are identified by status indicator `N' in Addendum B of 
this proposed rule. We are making this proposal for three reasons. 
First, we would not be able to

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establish an ASC payment rate for packaged surgical procedures using 
the same method we are proposing for all other ASC procedures because 
packaged surgical codes have no relative payment weights under the OPPS 
upon which to base an ASC payment rate. Second, because we want an ASC 
system that is as similar to the OPPS as possible, we believe that 
surgical procedures whose costs we package under the OPPS should also 
be packaged in the ASC system. Finally, ASCs, just like hospitals, 
would receive payment for these surgical procedures because their costs 
are already packaged into the APC relative payment weights for 
associated separately payable procedures, for which we are proposing to 
pay a derivative ASC facility fee.
3. Proposed Treatment of Office-Based Procedures
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Office-Based Procedures'' at the beginning of your 
comment.)
    According to the general standard in Sec.  416.65(a)(2) of the 
regulations, procedures that ``are commonly performed, or that may be 
safely performed, in physicians' offices'' are excluded from the ASC 
list. We are not proposing to continue to apply this provision under 
our revised system. Rather we are proposing to allow payment of an ASC 
facility fee for surgical procedures that are commonly and safely 
performed in the office setting. We reason that the types of procedures 
performed in physician offices would neither pose a significant safety 
risk nor require an overnight stay when performed in an ASC. However, 
we have concerns that allowing payment for office-based procedures 
under the ASC benefit may create an incentive for physicians 
inappropriately to convert their offices into ASCs or to move all their 
office surgery to an ASC. In section XVIII.C.5 below, to address this 
concern, we propose to limit payment for office-based procedures to 
help neutralize any such incentive. We also propose in new Sec.  
416.171(e) to set forth rules governing office-based procedures. We 
specifically invite comment regarding the effect on the Medicare 
program and on practice patterns for ambulatory surgery generally of 
our proposal to allow payment of an ASC facility fee for office-based 
procedures that historically have been excluded from the ASC list.
    As discussed elsewhere in this proposed rule, we are proposing to 
limit payment for office-based procedures in an attempt to mitigate 
potentially inappropriate migration of services from the physician 
office setting to the ASC. Alternatively, we could entirely exclude 
office-based procedures or procedures that require relatively 
inexpensive resources to perform from the approved ASC list of 
procedures.
4. Listing of Surgical Procedures Proposed for Exclusion From Payment 
of an ASC Facility Fee Under the Revised Payment System
    Tables 44 and 45 below, list the codes and short descriptors for 
surgical procedures that, in addition to the codes that comprise the 
inpatient list in Addendum E of this proposed rule, we are proposing to 
exclude from payment of an ASC facility fee for services furnished on 
or after January 1, 2008 because they pose a significant safety risk or 
require an overnight stay. We discuss in section XVIII.B.1.b.(1) above, 
our rationale for excluding the procedures in Table 44 from payment of 
an ASC facility fee.
    For many of the procedures listed in Table 45, several 
disqualifying criteria could be applicable, such as ``requires 
inpatient stay'' or ``could potentially cause extensive blood loss'' or 
``is emergent in nature.'' Rather than list multiple disqualifying 
criteria for individual codes in Table 45, we have defaulted to the one 
characteristic that is common to all the codes listed. That is, we 
believe that, at a minimum, prevailing medical practice would dictate 
the provision of overnight care following each of the procedures listed 
in Table 45. We acknowledge that we had to exercise a degree of 
clinical judgment in identifying procedures for which we are proposing 
to exclude payment of an ASC facility fee. Therefore, we are soliciting 
comments on the appropriateness of excluding these procedures from 
payment of an ASC facility fee under the revised payment system. We 
request that commenters who disagree with a proposed exclusion from 
payment of an ASC facility fee submit clinical evidence that 
demonstrates that the criteria we are proposing in proposed new Sec.  
416.166 of the regulations are not factors when the procedure is 
performed in the majority of cases, including data to support that the 
preponderance of Medicare beneficiaries upon whom the procedure is 
performed do not require overnight care or monitoring following the 
surgery. Simply asserting that the procedure can be safely performed in 
an ASC without providing corroborative evidence and data does not 
furnish us with sufficient information upon which to make an informed 
decision.
BILLING CODE 4120-01-P

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BILLING CODE 4120-01-C

C. Proposed Ratesetting Method

1. Overview of Current ASC Payment System
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Ratesetting'' at the beginning of your comment.)
    The current ASC payment system consists of 9 standard overhead 
amounts ranging from $333 to $1339, based on data collected in a 1986 
survey of ASC costs. An ASC payment ``group'' currently consists of all 
the procedures assigned to a particular standard overhead amount. ASC 
payment groups are heterogeneous in terms of clinical characteristics, 
cutting across all body systems and types of surgery. Medicare pays a 
$150 allowance for IOLs that are inserted during or subsequent to 
cataract surgery and an additional $50 for IOLs that we approved as 
NTIOLs. Medicare also makes separate payment for implantable prosthetic 
devices and implantable durable medical equipment surgically inserted 
at an ASC. Payment for all other facility services that are directly 
related to performing a surgical procedure is packaged into the 
prospectively determined ASC facility fee.
    The statute requires that ASC facility services amount be increased 
by the CPI-U in years when the amounts are not updated. However, since 
1990, the Congress has frozen or reduced the update adjustment for 
periods of varying duration. ASC payment rates are currently frozen at 
their FY 2003 level.
    Carriers account for geographic wage variations when calculating 
individual ASC payments by applying the hospital IPPS wage index value 
established for the county in which the ASC is located to 34.45 percent 
of the national ASC standard overhead amount. The 1986 survey data are 
the basis for attributing 34.45 percent of ASC overhead costs to labor-
related expenses. Medicare pays 80 percent of the standard overhead 
amount; the beneficiary coinsurance rate is 20 percent for all 
procedures on the list of Medicare approved ASC procedures.
    The standard overhead amounts for procedures on the ASC list were 
last rebased in 1990 using data collected in a 1986 survey of ASC 
costs. The process and methodology that we used to establish the 
current payment system are explained in the February 8, 1990 Federal 
Register (55 FR 4526). In the June 12, 1998 Federal Register, we issued 
a proposed rule to revise the ASC payment rates and ratesetting 
methodology based on data collected in a 1994 survey of ASC costs (63 
FR 32290). In that proposed rule, we also proposed to expand the ASC 
list and establish payment groups similar to those being considered for 
the hospital OPPS, which was under development at the time, but which 
was not implemented until August 2000. Although we never implemented 
the revised ASC payment rates and ratesetting methodology proposed in 
1998, we did make final some of the 1998 proposed additions to the ASC 
list in the March 28, 2003 final rule with comment period (68 FR 
15268). In that rule, we explained in detail why we did not implement 
the ratesetting methodology and payment amounts proposed in the June 
12, 1998 proposed rule.
    The ASC payment system that we are proposing in this proposed rule 
would implement requirements set forth in section 626 of Pub. L. 108-
173. The revised payment system mandated by section 626(d) of Pub. L. 
108-173 requires us to take into account recommendations in a report to 
Congress prepared by the GAO. The GAO recommendations are to be based 
on its study of the comparative relative costs of procedures furnished 
in ASCs and procedures furnished in hospital outpatient departments 
paid under the OPPS, and the extent to which the APCs reflect 
procedures performed in ASCs. Although the statutory due date for this 
report is January 1, 2005, CMS has not yet received the report or 
recommendations from the GAO. We are moving forward with our proposal 
for a revised ASC payment system without the benefit of GAO's 
recommendations because we are concerned that further delay would not 
give the public sufficient opportunity to review and comment on our 
proposed methodology, and the ASC industry and CMS would not have 
adequate time to prepare for changes scheduled for implementation 
January 1, 2008.

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2. Proposal to Base ASC Relative Payment Weights on APC Groups and 
Relative Payment Weights Established Under the OPPS
    We considered several strategies and methodologies for setting ASC 
payment rates under a revised payment system. We could require ASCs to 
submit modified cost reports as a basis for establishing ASC costs. We 
could simply expand the number and payment range of the current ASC 
payment groups. We could base payments to ASCs on the relative weights 
for surgical services established under the MPFS. We could base 
payments to ASCs on the relative weights for surgical services 
established under the Medicare OPPS, as suggested in Pub. L. 108-173. 
We could base payments to ASCs on a flat percentage of the payment for 
the same services established under the OPPS, as advocated by 
representatives of several ASC associations.
    After carefully reviewing the advantages and disadvantages of each 
of these approaches, we are proposing, within the parameters of section 
626 of Pub. L. 108-173, to use the APC groups and the relative payment 
weights for surgical procedures established under the OPPS as the basis 
of the payment groups and the relative payment weights for surgical 
procedures performed at ASCs. These payment weights would be multiplied 
by an ASC conversion factor in order to calculate the ASC payment 
rates. Several factors persuaded us to advance this proposal over the 
other approaches that we considered.
    First, in section 626(d) of Pub. L. 108-173, the Congress 
explicitly targets the OPPS for consideration by the GAO in its study 
of ASC payments. We believe it is reasonable to assume that Congress, 
by so doing, was highlighting the relative payment weights under the 
OPPS as a theoretical model for ASC relative payment weights under the 
revised payment system. Second, the ASC benefit provides payment for 
facility services associated with performing surgical procedures. The 
OPPS has equipped us with nearly a decade of experience in developing 
and refining a relative payment system for facility services furnished 
in connection with outpatient surgical procedures.
    Third, Pub. L. 108-173 applies for the first time a budget 
neutrality requirement to the ASC benefit. That is, in the year the 
revised system is implemented, the system is to be designed to result 
in the same aggregate amount of expenditures that would be made if the 
revised payment system were not implemented. Because the OPPS is also a 
prospective payment system for facility services that is subject to 
budget neutrality requirements, it provides useful parallels for a 
ratesetting methodology based on relative facility payment weights for 
surgical services under the revised ASC payment system.
    Fourth, in our analysis of the APC groups to which surgical 
procedures are assigned for payment under the OPPS, we found a 
significant overlap between surgical procedures furnished in the 
hospital outpatient setting and those performed in ASCs. Currently, of 
the 150 highest volume surgical procedures furnished in hospital 
outpatient departments, more than half (80) are also among the 150 
highest volume procedures performed in ASCs.
    Finally, the ASC industry in numerous meetings with us over the 
past several years has frequently voiced its preference for a payment 
system that parallels the OPPS for the sake of promoting transparency 
across sites of service in the arena of outpatient surgery and to 
streamline and modernize how Medicare sets payments and determines what 
is payable under the ASC benefit.
    As we explain in sections I through XVI of this proposed rule, the 
OPPS payment rates are based on relative payment weights which are 
updated annually. APCs to which surgical procedures are assigned are 
generally homogeneous both in terms of clinical characteristics and 
resource requirements. The APCs have been continually refined over the 
past 6 years through the work of the APC Panel and as a result of 
comments received during the OPPS annual rulemaking cycles.
    Moreover, we believe that the APC groups and the relativity in 
resource utilization among APCs containing surgical procedures have 
matured so that they are reasonable and appropriate models for grouping 
outpatient surgical procedures and determining the relativity in the 
ASC payment weights in terms of clinical and resource homogeneity. For 
example, whether performed in a hospital outpatient department or in an 
ASC, we believe the time and facility resources required to perform a 
routine laparoscopic hernia repair (CY 2006 OPPS relative payment 
weight of 43.0498) are approximately 4 times higher than those required 
to perform a diagnostic colonoscopy (CY 2006 OPPS relative payment 
weight of 8.5588). Thus, we believe that the relative payment weights 
established under the OPPS for procedures performed in the outpatient 
hospital setting reasonably reflect the relative resources required for 
such procedures and do so with sufficient coherence to be applicable to 
other ambulatory sites of service. Taking all these factors into 
account, we are proposing to use the APCs as a ``grouper'' and the APC 
relative payment weights as the basis for ASC relative payment weights 
and for calculating ASC payment rates under the revised payment system. 
Accordingly, we are proposing to establish provisions in proposed new 
subpart F Sec. Sec.  416.167, 416.169, and 416.171 to reflect these 
proposed changes for calculating the ASC payment rates beginning 
January 1, 2008.
    In the following sections, we focus on several additional basic 
assumptions that affect how we are proposing to calculate the ASC 
payment rates for implementation in January 2008.
3. Proposed Packaging Policy
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Packaging'' at the beginning of your comment.)
    Payment for a surgical procedure under both the current OPPS and 
ASC payment systems represents payment for a package of various items 
and services, all of which are directly related and required in order 
to perform the procedure. In both systems, we package into a single 
facility fee the payment for a bundle of direct and indirect costs 
incurred by the facility to perform the procedure. These costs include, 
but are not limited to, use of the facility, including an operating 
suite or procedure room and recovery room; nursing, technician, and 
related services; administrative, recordkeeping and housekeeping items 
and services; medical and surgical supplies and equipment; surgical 
dressings; and materials for anesthesia.
    Medicare currently applies different rules under the ASC payment 
system and the OPPS system for determining whether payment for other 
items and services directly related to a surgical procedure is packaged 
into the facility payment for the associated surgical procedure or paid 
for separately. These other items and services include drugs, 
biologicals, contrast agents, implantable devices, and diagnostic 
services such as imaging. Currently, Medicare packages payment for the 
costs for all drugs, biologicals, and diagnostic services, including 
imaging, into the ASC standard overhead amount for the surgical 
procedure with which these items and services are associated. Under the 
OPPS, Medicare pays separately for some of these items and services, in 
addition to paying for the surgical procedure.

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    ASCs currently receive separate payment for prosthetic implants and 
implantable durable medical equipment (DME). Conversely, under the 
OPPS, payment for prosthetic implants and implantable DME is packaged 
into the facility fee for the surgical procedure performed to insert 
the implants. Payment for IOLs and implantable surgical supplies, such 
as stents, mesh, guide wires, pins, and catheters is packaged into the 
associated surgical facility fee under both the OPPS and the ASC 
payment systems. We considered several packaging options for the 
revised ASC payment system. First, we considered making no change to 
the current policy regarding items and services for which payment is 
packaged into the ASC facility fee. That is, we would continue under 
the revised ASC payment system to package into the facility fee payment 
for overhead, payment for all drugs, biologicals, surgical dressings, 
supplies, splints, casts, and appliances and equipment directly related 
to the provision of surgical procedures; diagnostic or therapeutic 
services or items directly related to the provision of a surgical 
procedure; materials for anesthesia; and IOLs. In addition, we would 
continue to pay separately under other fee schedules for items and 
services such as NTIOLs, prosthetic implants and implantable DME 
surgically inserted at an ASC (DMEPOS fee schedule); laboratory 
services (clinical lab fee schedule); physician services (MPFS); and X-
ray or diagnostic procedures other than those directly related to 
performance of the surgical procedure (MPFS). Section 416.164(a) 
addresses the services for which payment is included in the ASC 
facility fee, and Sec.  416.164(b) addresses those services that are 
not included in the ASC facility fee.
    We also considered proposing to apply the OPPS packaging rules to 
the ASC payment system and to pay under the new ASC system the same way 
we pay under the OPPS for items and services directly related to a 
surgical procedure. If we adopted this option, payment for certain 
imaging procedures, drugs, biologicals, and contrast agents directly 
related to performing a surgical procedure would not be packaged into 
the facility fee for the procedure but would, instead, be paid 
separately. Conversely, payment for most surgically implanted devices 
and implantable DME would be packaged.
    Each of the preceding two options have characteristics that are 
inconsistent with a fundamental principle of a prospective payment 
system, which is to base payment on large bundles of items and services 
so as to promote the efficient provision of services. To preserve as 
much as possible the elements of a prospective payment system within 
the revised ASC payment system, we are proposing a third option. That 
is, we are proposing to continue the current policy of packaging into 
the ASC facility fee payment all direct and indirect costs incurred by 
the facility to perform a surgical procedure. This would include 
payment for all drugs, biologicals, contrast agents, anesthesia 
materials, and imaging services, as well as the other items and 
services that are currently packaged into the ASC facility fee as 
listed in Sec.  416.164(a).
    In addition, we are proposing to cease making separate payment for 
implantable prosthetic devices and implantable DME inserted surgically 
at an ASC. Instead, under the revised payment system, we are proposing 
to package into the ASC facility fee payment for implantable prosthetic 
devices and implantable DME when they are surgically inserted, as we do 
under the OPPS.
    However, we are proposing to continue excluding from payment as 
part of the ASC facility fee the other services addressed in Sec.  
416.164(b). That is, payment for items and services for which payment 
is made under other Part B fee schedules, with the exception of 
implantable prosthetic devices and implantable DME, would not be 
included in the ASC facility fee. Payment for items and services, such 
as physicians' professional services, for laboratory, X-ray or 
diagnostic procedures (other than those directly related to performance 
of the surgical procedure), nonimplantable prosthetic devices, 
ambulance services, leg, arm, back and neck braces, artificial limbs, 
and durable medical equipment for use in the patients' home would not 
be included in the ASC facility fee.
    We are proposing this option for a number of reasons. First, this 
approach to packaging is most consistent with the principles of a 
prospective payment system. Second, we believe that ASCs generally 
treat a less complex and severely ill patient case mix and, as a 
result, we believe that ASCs are less likely to provide on a regular 
basis many of the separately paid items and services that patients 
might receive more consistently in a hospital outpatient setting. Thus, 
we do not believe there is a need to pay for these services separately 
in ASCs, because that would unbundle some items and services that are 
currently packaged into the ASC facility fee, reduce incentives for 
cost-efficient delivery of services at ASCs, and increase the 
complexity of the revised ASC payment system. In addition, we believe 
it is critical to continue to focus the ASC payment system on 
appropriate payment for surgical services provided in ASCs.
    Moreover, after careful analysis of OPPS claims for surgical 
procedures, we were unable to identify ancillary items and services 
that are repeatedly and consistently reported separately in association 
with specific ambulatory surgical procedures. Rather, the OPPS claims 
for surgical procedures were of two types: one group showed a broad 
range of items and services that were provided on the same day that a 
surgical procedure was performed in the hospital outpatient department, 
only some of which were likely to be directly related to the surgical 
procedure; the second group of claims revealed that many surgical 
procedures are only infrequently associated with ancillary items and 
services paid separately under the OPPS. Therefore, we are proposing to 
reflect this proposed packaging policy in proposed new Sec.  416.164.
    We are seeking comments from ASC clinical and administrative staff 
and from physicians who perform surgery at ASCs regarding nonsurgical 
ancillary services or items that are directly related to a surgical 
procedure that would be paid separately under the OPPS but that would 
be packaged under our proposal for the revised ASC payment system. We 
are specifically requesting that commenters provide data to indicate 
the frequency with which specific items and services are typically 
furnished in association with given procedures, the reasons why one 
patient might require the additional items and services whereas another 
patient would not, and the costs of those items and services relative 
to the other costs incurred to perform the associated surgery.
4. Payment for Corneal Tissue Under the Revised ASC Payment System
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Payment for Corneal Tissue'' at the beginning of your 
comment.)
    In a memorandum dated May 21, 1992, CMS (known at the time as the 
Health Care Financing Administration or ``HCFA'') notified Regional 
Administrators that carriers could pay corneal tissue acquisition costs 
when HCPCS code V2785 (Processing, preserving and transporting corneal 
tissue), is reported with corneal transplant procedures performed in an 
ASC. The memorandum indicated that payment for corneal tissue 
acquisition costs is subject to the usual copayment

[[Page 49649]]

and deductible requirements, and could be paid as an add-on to either 
the ASC facility fee or the physician's fee for corneal transplant 
surgery performed at an ASC. In the June 12, 1998 proposed rule to 
revise the ASC ratesetting methodology and payment rates, we proposed 
to package the costs incurred by an ASC to procure corneal tissue into 
the payment for the associated cornea transplant procedure rather than 
continue making separate payment for those costs (63 FR 32312 and 
32313). We also proposed to package corneal tissue acquisition costs 
into the APC payment for corneal transplant procedures in the September 
8, 1998 proposed rule to implement the OPPS (63 FR 47760).
    We received numerous comments from physicians, eye banks, and 
health care associations opposing both proposals. In the April 7, 2000 
final rule with comment period, which implemented the OPPS, we 
summarize the comments that we received in response to the September 8, 
1998 proposal, and we determined that we would not implement our 
proposal to package payment under the OPPS for corneal tissue costs but 
would, instead, make separate payment based on hospitals' reasonable 
costs to procure corneal tissue (65 FR 18448 and 18449). Because we 
never made final the changes in the ASC payment rates and ratesetting 
methodology that we proposed in the June 12, 1998 Federal Register, the 
policy issued in the June 1992 memorandum remains in effect, which 
allows carriers to make separate payment for the costs incurred to 
procure corneal tissue for transplant at an ASC.
    We are proposing under the revised ASC payment system to continue 
to pay ASCs separately, based on their invoiced costs, for the 
procurement of corneal tissue. We have no evidence to suggest that 
costs incurred to procure corneal tissue are any less variable now than 
they were in 1992, in 1998 or in 2000. If we were to package payment 
for the procurement of corneal tissue into the APC for corneal 
transplant procedures, we believe the resulting payment rate would 
continue to overpay those facilities that are able to acquire corneal 
tissue at little or no cost through philanthropic organizations and 
underpay those facilities that must pay for corneal tissue processing, 
testing, preservation, and transportation costs. Therefore, we are 
proposing to include in proposed new Sec.  416.164, our proposal to 
exclude payment for corneal tissue furnished in an ASC on or after 
January 1, 2008, from the ASC facility payment rate.
    We invite comment and data that support or challenge this proposal 
to continue paying ASCs for corneal tissue on an acquisition cost 
basis.
5. Proposed Payment for Office-Based Procedures
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Payment for Office-Based Procedures'' at the 
beginning of your comment.)
    Since the inception of the ASC benefit, procedures that are 
commonly performed or that can be safely performed in a physician's 
office have generally been excluded from the ASC list. For the sake of 
convenience, we refer to these procedures as ``office-based'' in this 
preamble discussion. Over the past 15 years, physicians and ASC 
associations have urged CMS to add office-based procedures to the ASC 
list or to retain on the ASC list procedures that were originally 
performed most commonly in an institutional setting, but that have 
subsequently moved to an office setting as surgical techniques and 
technology have advanced. Representatives of the ASC industry argue 
that although, for most patients, the office is an appropriate setting 
for most high volume office procedures, there are some patients for 
whom an ASC or another more resource-intensive setting is required. The 
physician may decide that a facility setting is necessary for 
individual patients for various clinical reasons, such as the need for 
more nursing staff, a sterile operating room, or a piece of equipment 
not typically available in the office setting. CPT code 52000 
(Cystourethroscopy (separate procedure)) is a prime example of a high 
volume procedure that is performed more than 80 percent of the time in 
an office setting, but for which a small number of patients require 
resources usually available only at an ASC or hospital. Unless we make 
an exception to the criteria that currently govern which procedures 
comprise the ASC list and allow an office-based procedure to remain on 
the ASC list, as we have done with CPT code 52000, the hospital would 
be the only facility setting available as an alternative to the office 
setting. ASC industry commenters assert that this limitation is 
burdensome both to physicians and to beneficiaries and could, in some 
cases, limit beneficiary access to needed surgery.
    We generally interpret ``office-based'' or ``commonly performed in 
a physician's office'' to mean a surgical procedure that the most 
recent BESS data available indicate is performed more than 50 percent 
of the time in the physician's office setting. In section XVIII.B.1 of 
this preamble, we are proposing to expand the ASC list to allow payment 
for all surgical procedures, except those procedures that pose a 
significant safety risk or require an overnight stay. Because office-
based surgical procedures typically do not pose a significant safety 
risk and do not require an overnight stay, we are proposing not to 
exclude them from payment of an ASC facility fee under the revised ASC 
payment system. However, we are seeking comment on the appropriateness 
of excluding office-based procedures or procedures that require 
relatively inexpensive resources to perform from the approved ASC list 
of procedures. We recognize that paying an ASC facility fee for office-
based procedures based on OPPS relative payment weights could have a 
significant impact on Medicare program costs. Approximately two-thirds 
of the additional procedures for which we propose to not exclude for 
payment beginning in CY 2008 are office-based, that is, they are 
performed in the physician office more than 50 percent of the time. The 
Medicare payment for many of these procedures under the MPFS would be 
lower than the payment for the same procedures when they are performed 
in an ASC where the facility fee is based on OPPS relative weights. The 
separate physician payment and facility payment when the procedures are 
performed in an ASC would exceed the combined payment when they are 
performed in the physician office. Therefore, ASC payment rates based 
on the OPPS relative payment weights could result in a significant 
program cost were these high volume procedures to shift from the office 
to the ASC setting.
    One reason why we are concerned if there were to be a sizable shift 
of office-based procedures to ASCs is the impact that would have on ASC 
payments in light of the statutory requirements that the revised ASC 
payment system be designed to result in the same aggregate amount of 
expenditures as would be made if the revised payment system were not 
implemented. (See section XVIII.A.1. of this preamble for a discussion 
of this requirement). An influx of high-volume, relatively low cost 
office-based procedures into the ASC setting under the revised payment 
system could lower the payment amounts for other procedures paid for in 
the ASC due to the constraints of budget neutrality. In other words, we 
would have to scale the ASC conversion factor downward in order for 
estimated

[[Page 49650]]

aggregate expenditures under the revised system to not exceed what they 
would have been if the new payment system were not implemented. Payment 
for procedures with relatively high payments would have to be reduced 
in order to offset increased aggregate costs resulting from an influx 
of relatively low cost, high volume office procedures shifting to ASCs. 
(See section XVIII.C.10. of this preamble for a detailed discussion of 
our proposal for calculating an ASC conversion factor.)
    We are committed to refining Medicare payment systems wherever 
possible to prevent payment incentives from inappropriately driving 
decisions about where to perform a surgical procedure when those 
decisions should be based on clinical considerations. We strive to 
promote value-based purchasing in all Medicare payment systems that 
leads to significant positive effects on the health of Medicare 
beneficiaries by improving quality and efficiency in the delivery of 
health services. We are also committed to ensuring Medicare payments 
that are efficient and reasonable. To mitigate the impact of office-
based procedures migrating to the more expensive ASC setting if we were 
to implement our proposal not to exclude them from payment of an ASC 
facility fee under the revised ASC payment system, we are proposing to 
cap payment for office-based surgical procedures for which payment of 
an ASC facility fee would be allowed under the revised payment system 
as of January 1, 2008, at the lesser of the MPFS nonfacility practice 
expense payment or the ASC rate under the revised ASC payment system. 
We also are proposing to exempt procedures that are on the ASC list as 
of January 1, 2007, that meet our criterion for designation as office-
based, from the payment limitation proposed for office-based procedures 
for which payment of an ASC facility fee would be allowed for the first 
time beginning January 1, 2008. Accordingly, we are proposing to 
incorporate in proposed new Sec.  416.171(e) the limitation on payment 
for these procedures beginning January 1, 2008.
    As discussed elsewhere in this proposed rule, we are proposing to 
limit payment for office-based procedures in an attempt to mitigate 
potentially inappropriate migration of services from the physician 
office setting to the ASC. Alternatively, we could entirely exclude 
office-based procedures or procedures that require relatively 
inexpensive resources to perform from the approved ASC list of 
procedures, although this is not the approach we are advancing. In 
considering value-based purchasing, we seek comment concerning whether 
procedures that are currently primarily office-based or that require 
relatively inexpensive resources are most efficiently and effectively 
provided in the ASC facility setting, which typically possesses greater 
surgical capacity than such procedures would generally require.
    When we started to identify the codes that we would propose to 
classify as office-based beginning in CY 2008, we encountered some 
anomalous cases that required further refinement of our office-based 
criterion beyond strict application of a 50-percent utilization 
threshold. For example, we identified some CPT codes that meet the 50-
percent office utilization threshold for which a nonfacility practice 
expense amount has not been developed under the MPFS. We are proposing 
to classify as office-based any surgical codes that our physician 
claims data indicate are performed more than 50 percent in an office 
setting, even if the codes lack a nonfacility practice expense RVU 
under the MPFS. We further propose to cap payment for these procedures, 
as appropriate, once a nonfacility practice expense RVU is established. 
Until that time, we are proposing to calculate payment for these 
office-based surgical CPT codes using the methodology we propose in 
sections XVIII.C.11.c. and d. below, for other surgical procedures. 
Similarly, until a national nonfacility practice expense RVU is 
established for office-based surgical CPT codes that are ``carrier 
priced'' under the MPFS, we are proposing to calculate the ASC facility 
payment using the same methodology that we are proposing for surgical 
procedures that are not office-based. Application of the cap to codes 
designated as office-based would be updated through rulemaking as part 
of the annual ASC payment update.
    In applying the data-based 50-percent threshold, we discovered some 
contradictions in the data that required us to further refine our 
definition of office-based. For example, we noted instances in which 
seemingly very similar procedures had inconsistent site of service 
utilization. The BESS data showed high levels of office utilization for 
some complex procedures which we expected to be performed infrequently 
in an office setting whereas simpler but related procedures showed 
lower levels of office utilization.
    We therefore undertook another, more detailed level of review and 
identified groups of CPT surgical codes related to procedures that are 
performed 50 percent or more of the time in the office setting to 
determine if there was a logical correlation between procedure 
complexity within a group of related procedures and the frequency with 
which those procedures were performed in the office setting. For 
example, according to CPT coding, the following three codes are 
related:

13120, Repair, complex, scalp arms and/or legs; 1.1cm to 2.5 cm
13121, Repair, complex, scalp arms and/or legs; 2.6 cm to 7.5 cm
13122, Repair, complex, scalp arms and/or legs; each additional 5 cm or 
less

    As is often the case for groups of related codes in the CPT coding 
system, the first of these codes is the least complex clinically and, 
in this example, the complexity of the procedure increases in 
proportion to the increase in the size of the area to be repaired. If 
utilization data indicated that CPT code 13122 was performed in the 
office 67 percent of the time in CY 2005, we would expect to find that 
both CPT codes 13120 and 13121 were also performed in the physician 
office more than 50 percent of the time during that year. Because the 
most complex procedure was provided in the office most of the time, 
logically, the less complex procedures would also have been performed 
in that site of service. However, the BESS data showed that this was 
not always the case.
    So, although our expectation was that, the less complex procedures 
within a group of related procedure codes would typically be performed 
most often in the office and the more complex procedures less often in 
the office, there are instances in which the less complex procedures 
with the code group were billed more often in an ASC or hospital 
outpatient department and the more complex procedures within the code 
billed in the office setting.
    In our analysis of the BESS site of service data, we also took into 
consideration the volume of cases represented in the data. There were a 
few instances in which we initially identified a procedure as office-
based because the data indicated that 100 percent of the cases were 
performed in the physician office. However, closer inspection revealed 
that there was only one case reported for the procedure with 
physician's office as the site of service. We were concerned about 
using such low volume as the basis for identifying a procedure as 
office-based. Because of the unevenness of the data associated with 
some of the codes we initially classified as office-based, we conducted 
a code-by-code analysis to buttress inconclusive data with the clinical 
judgment of our medical advisors. As a result, on the basis of clinical 
judgement overriding inadequate or insufficient

[[Page 49651]]

claims data, there are some procedures that we deem meet the 50-percent 
threshold when taken in isolation from other closely related codes that 
we have designated as office-based.
    We are proposing to assess each year based on the most recent 
available BESS and other data available to us whether there are 
additional procedures that we would propose to classify as office-
based. We would solicit comment on proposed classification of 
additional codes as office-based as part of the annual OPPS/ASC 
rulemaking cycle. In addition, we are proposing that once we identify a 
procedure as office-based, that classification would not change in 
future updates of the ASC payment system. We reason that once a 
procedure becomes safe enough to be performed in more than 50 percent 
of cases in the office setting, it would be improbable for it to revert 
to an institutional setting.
    To summarize, the list of codes that we propose as office-based in 
this rule takes into account the most recent available volume and 
utilization data for each individual procedure code and, if 
appropriate, the utilization and volume of related codes. While we are 
proposing to apply the office-based designation only to procedures that 
would no longer be excluded from payment of an ASC facility fee 
beginning in CY 2008, were we to exclude office-based services from ASC 
payments, we expect that the same approach to developing and updating 
the set of procedures in the CPT surgical code range that we consider 
to be office-based would be applicable. Finally, we are concerned that 
our proposal to allow payment of an ASC facility fee for office-based 
procedures, even if the ASC payment amount were capped at the lesser of 
the MPFS nonfacility practice expense payment or the revised ASC rate, 
would result in a downward adjustment to ASC payments overall, and 
would increase Medicare spending.
    We propose to exempt all procedures on the CY 2007 ASC list from 
application of the office-based classification. The procedures that we 
are proposing to designate as subject to the office-based payment limit 
are identified in new Addendum CC of this proposed rule. Those 
procedures for which the proposed CY 2008 payment would be based on the 
MPFS nonfacility practice expense RVU are flagged in Addendum BB. The 
ASC relative payment weight shown for procedures in Addendum BB that 
would be capped by the MPFS nonfacility practice expense RVU has been 
adjusted to reflect the capped payment amount. We remind readers that 
the ASC payment rates in Addendum BB of this proposed rule are based on 
proposed CY 2007 OPPS relative payment weights and proposed MPFS 
nonfacility practice expense RVUs. The final ASC relative weights and 
payment amounts for CY 2008 would be different from the rates published 
in this proposed rule because they would take into account the CY 2008 
updates of both the OPPS and the MPFS. The proposed and final ASC 
relative weights and payment amounts for CY 2008 would be published in 
the Federal Register during the proposed and final rulemaking cycles 
for the CY 2008 OPPS.
6. Payment Policy for Multiple Procedure Discounting
    We are proposing to mirror the OPPS policy for discounting when a 
beneficiary has more than one surgical procedure performed on the same 
day at an ASC. The current policy for multiple procedure discounting in 
the ASC, as specified in Sec.  416.120(c)(2)(ii), is based on a simple 
count of procedures performed on the same day. The most costly 
procedure is paid the full amount and all other procedures are 
discounted by half.
    Under the OPPS, certain surgical procedures are not subject to the 
discounting policy. Generally, the procedures that are exempted are 
those performed to implant costly devices. They are not discounted even 
when performed in association with other surgical procedures because 
the cost of the implantable device does not change, so resource savings 
due to efficiencies would be minimal.
    Until now, there has been no reason to exempt any procedure from 
the multiple procedure discounting policy in ASCs because separate 
payments have been made for implantable devices. Thus, although the 
facility payment for the procedure may have been discounted, the cost 
of the device was paid outside of that rate and was unaffected by the 
multiple procedure discount.
    Under the revised ASC payment system, we are proposing to package 
into the payment for the procedure payment for implantable devices in 
the ASC, as in the OPPS. Because we are trying wherever possible to 
implement parallel payment policy across both systems, we are proposing 
to adopt the OPPS discounting policy that is applied more specifically 
to surgical procedures so that the costs of performing multiple 
procedures that require implantation of costly devices are taken into 
account. Thus, payment for the same set of multiple procedures in the 
OPPS and the ASC would be made using similar packaging and payment 
rules.
    Table 46 below lists the procedures that would be exempt from 
multiple procedure discounting. These exempt procedures are those 
surgical procedures proposed for payment of an ASC facility fee that 
are assigned a status indicator other than ``T'' under the OPPS, to 
indicate that a multiple surgical procedure reduction does not apply. 
We are proposing to update this list annually in the OPPS/ASC proposed 
rule, soliciting comment on the list.
    We are proposing to incorporate our proposed policy on multiple 
procedure discounts in proposed new Sec.  416.172(e).

BILLING CODE 4120-01-P

[[Page 49652]]

[GRAPHIC] [TIFF OMITTED] TP23AU06.038


[[Page 49653]]


[GRAPHIC] [TIFF OMITTED] TP23AU06.039


[[Page 49654]]


[GRAPHIC] [TIFF OMITTED] TP23AU06.040

BILLING CODE 4120-01-C

[[Page 49655]]

7. Proposed Geographic Adjustment
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Wage Index'' at the beginning of your comment.)
    Currently, Medicare adjusts 34.45 percent of the national ASC 
payment rates using wage index values and localities that were 
established under the IPPS prior to implementation of the new Core 
Based Statistical Areas (CBSAs) issued by OMB in June 2003. Medicare 
currently adjusts 60 percent of national OPPS payment rates by the IPPS 
wage index value assigned to hospitals using the June 2003 OMB 
definitions for geographical statistical areas and wage adjustments 
required under Pub. L. 108-173.
    Since 1990, ASC payments have been adjusted for regional wage 
variations using the hospital IPPS wage index values. We believe that 
standardization continues to be appropriate in recognition of widely 
varying labor market costs tied to geographic localities. We also 
believe that it is advisable to maintain the consistency in locality 
designations between ASCs and hospitals and acknowledge parity of labor 
costs between ASCs and HOPDs that are competing for staff in the same 
locality. Therefore, we are proposing to apply to ASCs the IPPS pre-
reclassification wage index values associated with the June 2003 OMB 
geographic localities, as recognized under the IPPS and OPPS, to adjust 
national ASC payment rates for geographic wage differences under the 
revised payment system.
    Although we have not collected new data to identify whether the 
current labor-related share is correct, the results of a 1994 survey of 
ASC costs supported the current 34.45 percent labor adjustment factor, 
and we have received no complaints from the ASC community about our 
continued use of the 34.45/65.55 ratio of labor to nonlabor costs for 
purposes of adjusting payments for regional wage differences. Moreover, 
we believe it is reasonable to expect ASCs to have a lower labor 
adjustment factor than that of a hospital. For example, most OPPS 
hospital outpatient departments are staffed 24 hours per day to provide 
emergency department services and observation care. Therefore, we are 
proposing to continue using 34.45 percent as the labor adjustment 
factor for regional wage differences under the ASC revised payment 
system, beginning in CY 2008. We are proposing to establish rules 
governing this proposed new Sec.  416.172(c).
8. Proposed Adjustment for Inflation
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Inflation'' at the beginning of your comment.)
    As noted above, section 1833(i)(2)(C)(iv) of the Act, as amended by 
section 626(a) of Pub. L. 108-173, requires the adjustment of ASC 
facility services amounts for inflation for FY 2005, the last quarter 
of CY 2005, and each of CYs 2006 through 2009, to equal zero percent. 
Otherwise, section 1833(i)(2)(C)(i) of the Act provides that ASC 
facility services amounts are to be adjusted by the percentage increase 
in the CPI-U during years when the ASC amounts are not updated.
    As explained in section II.C. of the preamble of this proposed 
rule, the OPPS conversion factor is updated annually using the hospital 
inpatient market basket percentage increase. Although section 626(d) of 
Pub. L. 108-173 suggests that the Congress found merit in linking the 
ASC payment system to the OPPS relative payment weights and APC groups, 
it did not require that the new ASC payment system be updated using the 
hospital market basket that is the basis for annual OPPS updates. 
However, we believe that an update of the ASC amount is performed 
through the annual relative ASC payment weight adjustments that we 
propose in section XVIII.C.11.d.(1) below, which obviates the 
requirement for the statutory CPI adjustment. Nonetheless, although we 
are not compelled to do so by the statute, we are proposing under the 
revised ASC payment system, beginning in CY 2008, to apply a CPI-U 
adjustment to update the ASC conversion factor for inflation on an 
annual basis, in accordance with the statutory formula. The CPI-U 
adjustment in CY 2008 and CY 2009 would equal zero. Beginning in CY 
2010, we would update the ASC conversion factor by the percentage 
increase in the CPI-U (U.S. city average) as estimated for the 12-month 
period ending with the midpoint of the year involved. As we explain in 
section XVIII.C.11.d.(2) below, we are proposing to adjust the 
conversion factor for inflation annually to ensure that ASC payments 
keep up with cost increases attributable to inflation. Accordingly, we 
are proposing to establish rules in proposed new Sec. Sec.  416.171 and 
416.172 to reflect our proposed policies for standardizing labor-
related costs, applying an inflationary adjustment, and calculating a 
conversion factor, respectively under the proposed new payment system 
beginning January 1, 2008.
9. Proposed Beneficiary Coinsurance
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Coinsurance'' at the beginning of your comment.)
    Payment for ASC facility services is subject to the Medicare Part B 
deductible and coinsurance requirements. Currently, Medicare pays 
participating ASCs 80 percent of a prospectively determined rate, 
adjusted for regional wage variations. The beneficiary deductible and 
coinsurance make up the other 20 percent.
    Section 626(c) of Pub. L. 108-173 amended section 1833(a)(1) of the 
Act to provide that, beginning with the implementation date of the 
revised payment system, the Medicare program payment to ASCs shall 
equal 80 percent of the lesser of the actual charge for the services or 
the payment amount that we determine under the revised payment system 
for the services. We are proposing to make this change and to continue 
to maintain the beneficiary deductible and coinsurance at 20 percent. 
We are proposing to reflect this statutory requirement in proposed new 
Sec.  416.172(b) and (d).
10. Proposal To Phase In Implementation of Payment Rates Calculated 
Under the CY 2008 Revised ASC Payment System
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Phase In'' at the beginning of your comment.)
    We discuss in section XXVII.D. of this preamble our analysis of the 
impact the revised ASC payment system and estimated payment rates 
proposed for implementation in CY 2008 could have on certain ASCs that 
specialize in or perform high volumes of procedures for which payment 
under the new system would decrease. We want to ensure that the revised 
payment system does not cause a sudden, unwarranted migration of 
services from ASCs to other ambulatory settings, or the reverse; that 
ASCs would have an opportunity to balance their Medicare case mix 
between procedures whose rates decrease and procedures whose rates 
increase; and, that beneficiaries and their physicians would continue 
to have a robust choice of sites where important preventive and other 
surgical services are paid for by Medicare. Therefore, we propose to 
implement the revised ASC payment system in CY 2008 using transitional 
payment rates that would be based upon a 50/50 blend of the payment 
rate for procedures on the CY

[[Page 49656]]

2007 list of approved ASC procedures and the payment rate for that 
procedure calculated under the revised payment methodology described in 
the next section and reflected in proposed new Sec.  416.171(c). 
(Procedures added for payment of an ASC facility fee beginning in CY 
2008 would be paid the full amount calculated under the revised payment 
methodology for CY 2008 rather than a blended amount.) We further 
propose that, in CY 2009, we would fully implement the ASC payment 
rates calculated under the payment methodology proposed in the next 
section, discontinuing the blended transitional payment rate for 
services furnished beginning January 1, 2009. This is proposed in new 
Sec.  416.171(d).
11. Proposed Calculation of ASC Conversion Factor and Payment Rates for 
CY 2008
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Conversion Factor'' at the beginning of your 
comment.)
a. Overview
    In section XVIII.C.2 of this preamble, we are proposing to base ASC 
relative payment weights and rates under the revised system on APC 
groups and relative payment weights established under the OPPS. In 
section XVIII.C.4 of this preamble, we are proposing to set the ASC 
relative payment weight for certain office-based surgical procedures so 
that the national ASC payment rate does not exceed the MPFS nonfacility 
practice expense payment. The proposed ASC payment weights are 
multiplied by an ASC conversion factor to calculate the proposed ASC 
payment rates. For CY 2008, our current estimate of the budget neutral 
ASC conversion factor is $39.688. The final ASC conversion factor may 
be higher or lower than this figure for a number of reasons, including 
(1) The final OPPS relative payment weights for CY 2008, (2) the final 
physician fee schedule practice expense payments for CY 2008 and (3) 
updated utilization data.
b. Budget Neutrality Requirement
    Section 626(b) of the MMA amended section 1833(i)(2) of the Act by 
adding subparagraph (D) to require that in the year the new system is 
implemented:
    ``* * * [S]uch system shall be designed to result in the same 
aggregate amount of expenditures for such services as would be made if 
this subparagraph did not apply, as estimated by the Secretary * * *''.
    The ASC conversion factor is calculated so that aggregate 
expenditures under the new system are estimated to be the same as the 
aggregate expenditures for ASC facility services in CY 2008 that would 
have been paid had the ASC payment system not been revised, taking into 
consideration the cap on payments in CY 2007 as required under section 
5103 of Pub. L. 109-171, which we discuss in section XVII.D., that is, 
the conversion factor is calculated so the new system is budget 
neutral.
    Note that we consider expenditures in the context of section 626(b) 
of the Pub. L. 108-173 budget neutrality requirement to mean 
expenditures from the Medicare Part B Trust Fund. We do not consider 
expenditures to include beneficiary coinsurance and copayments. We 
note, however, that the exclusion of beneficiary coinsurance payments 
does not impact the calculation of the ASC conversion factor under our 
proposed methodology. (See section XXVI.D. of this preamble for impacts 
of the revised ASC system on beneficiary coinsurance.)
c. Proposed Calculation of the ASC Payment Rates for CY 2008
    We are proposing to calculate the ASC payment rates for CY 2008 as 
follows:

Estimated payments under the current ASC system

    Step 1: To estimate the aggregate amount of expenditures that would 
be made in CY 2008 under the current ASC payment system, we first 
multiplied the estimated CY 2008 ASC volume for each CPT code on the 
current ASC list by the estimated CY 2008 ASC payment rate for the CPT 
code under the current ASC system. The estimated CY 2008 ASC payment 
rates are based on the proposed CY 2007 ASC payment rates, which are 
found in Addendum BB to take into account the OPPS cap on ASC services 
as required by section 5103 of Pub. L. 109-171 and to reflect the zero 
percent CY 2008 update for ASC services mandated by section 
1833(i)(2)(C) of the Act. We then summed the results over all services 
on the current ASC list.

Estimated payments under the new ASC system

    Step 2: To estimate the aggregate amount of expenditures that would 
be made in CY 2008, we used estimated CY 2008 OPPS payment amounts 
instead of estimated CY 2008 ASC payment amounts under the current 
system, and we multiplied the estimated CY 2008 ASC volume for each CPT 
code on the current ASC list by the estimated CY 2008 OPPS payment rate 
for the CPT code. We summed the results over all services on the 
current ASC list.

Calculate the CY 2008 budget neutrality adjustment

    Step 3: To calculate the CY 2008 ASC budget neutrality adjustment, 
we divided the total expenditures calculated in Step 1 by the total 
expenditures calculated in Step 2. The result is 0.62.

Apply the CY 2008 budget neutrality adjustment to determine the CY 2008 
ASC conversion factor

    Step 4: To determine the CY 2008 ASC conversion factor, we 
multiplied the estimated CY 2008 OPPS CF by the results in Step 3. Our 
current estimate of the CY 2008 OPPS CF is $64.013. Multiplying the 
estimated CY 2008 OPPS conversion factor by the 0.62 budget neutrality 
adjustment yields our current estimate of the CY 2008 ASC conversion 
factor: $39.688.

Calculate the CY 2008 ASC payment rate under the new ASC system

    Step 5: To determine the national ASC payment rate under the new 
system (including the beneficiary 20 percent coinsurance), we 
multiplied the ASC conversion factor from Step 4 by the ASC relative 
payment rate.
    The ASC relative payment weights are primarily based on the APC 
groups and relative payment weights established under the OPPS as 
described in section XVIII.C.2 of this preamble. However, as described 
in section XVIII.C.4 of this preamble, the ASC relative payment weights 
for certain office-based surgical procedures are set so that the 
national ASC payment rate does not exceed the MPFS nonfacility practice 
expense payment.
    As discussed elsewhere in this proposed rule, we are proposing to 
limit payment for office-based procedures in an attempt to mitigate 
potentially inappropriate migration of services from the physician 
office setting to the ASC. Alternatively, we could entirely exclude 
office-based procedures or procedures that require relatively 
inexpensive resources to perform from the approved ASC list of 
procedures, although this is not the approach we are advancing.
    The ASC relative payment weights are listed in Addendum BB of this 
proposed rule.

Calculate the CY 2008 ASC payment rate under the transition

    Step 6: As described in section XVIII.C.10. of this preamble, we 
are proposing under the revised payment system a 2-year transition to 
100 percent implementation of the new ASC payment rates for procedures 
on the CY 2007 list of approved ASC procedures. In the first year of 
this transition, the payment rate would be based on 50

[[Page 49657]]

percent of the final CY 2007 ASC standard overhead amount and 50 
percent of the final payment rate calculated under the revised payment 
methodology proposed in this section of the preamble.
d. Proposed Calculation of the ASC Payment Rates for CY 2009 and Future 
Years
(1) Updating the ASC Relative Payment Weights
    We are proposing to update the ASC relative payment weights each 
year using the national OPPS relative payment weights for that calendar 
year and, for the office-based procedures, the practice expense 
payments under the physician fee schedule for that calendar year. We 
further propose to uniformly scale the ASC relative payment weights 
each year so that estimated aggregate expenditures using updated ASC 
relative payment weights are the same as estimated aggregate 
expenditures using the current year ASC relative payment weights. That 
is, we propose to make the relative payment weights budget neutral to 
ensure that changes in the relative payment weights from year to year 
do not cause the estimated amount of expenditures to ASCs to increase 
or decrease as a function of those changes. For example, we propose to 
uniformly scale the ASC relative payment weights for CY 2009 so that 
estimated expenditures for CY 2009 using the updated CY 2009 ASC 
relative payment weights are the same as they would be using the CY 
2008 ASC relative payment weights. We propose to uniformly scale the 
ASC relative payment weights for CY 2010 so that estimated expenditures 
for CY 2010 using the updated CY 2010 ASC relative payment weights are 
the same as they would be using the CY 2009 ASC relative payment 
weights.
    We are proposing to scale the relative payment weights annually 
because we believe that the purpose of using relative payment weights 
as part of the rate setting methodology under the revised ASC system is 
to establish appropriate relativity among surgical procedures paid for 
in an ASC. Scaling the relative payment weights each year would also 
serve as a buffer to protect ASCs from sudden changes that could occur 
under the OPPS. For example, by making the relative payment weights 
budget neutral under the revised ASC payment system, the ASC relative 
weights would not drop were there to be a sudden upsurge in costs 
associated with hospital outpatient emergency or clinic visits relative 
to outpatient surgical costs. Moreover, making the ASC relative weights 
budget neutral would shield the ASC payment system against the 
inadvertent impact of unrelated aggregate changes in OPPS expenditures. 
We propose to continue this methodology to update the ASC payment 
system in future years.
(2) Updating the ASC Conversion Factor
    In section XVIII.11.d.1, above, we propose to scale the relativity 
among surgical procedures each year so that aggregate expenditures 
under the ASC are budget neutral notwithstanding changes in the 
relative payment weights. In section XVIII.11.c, above, we propose to 
calculate the ASC payment rates each year as the product of the ASC 
relative payment weight and the ASC conversion factor which have been 
adjusted for budget neutrality. Section 1833(i)(2)(C) of the Act 
requires that if the Secretary has not updated the ASC facility 
services amounts in a calendar year after CY 2009, the payment amounts 
shall be increased by the percentage increase in the CPI-U as estimated 
by the Secretary for the 12-month period ending with the midpoint of 
the year involved.
    Although we are only required to increase ASC payment rates by the 
percentage increase in the CPI-U in years when we do not update the ASC 
payment amounts, beginning with the CY 2008 revised ASC payment system, 
we propose to update the ASC conversion factor annually using the CPI-
U. For example, for CY 2009, the statute requires a zero percent CPI-U 
increase for ASC services. Therefore, the CY 2009 conversion factor 
would be equal to the CY 2008 conversion factor. For CY 2010, we would 
increase the CY 2009 conversion factor by the estimated percent 
increase in the CPI-U for the 12-month period ending June 30, 2010; in 
CY 2011, we would increase the CY 2010 conversion factor by the 
estimated percent increase in the CPI-U for the 12-month period ending 
June 30, 2011, and so forth, each year thereafter. We propose to apply 
this adjustment annually to ensure that ASC payments keep up with cost 
increases attributable to inflation. Moreover, we propose to use the 
CPI-U to adjust the conversion factor for inflation because we have 
used the CPI-U to adjust payments to ASCs for inflation since July 
1987, when we first updated the ASC payment rates in effect at the time 
by the projected increase in the CPI-U (52 FR 20467). This proposal is 
reflected in Sec.  416.167 and Sec.  416.171.
e. Alternative Option for Calculating the Budget Neutrality Adjustment 
Considered
    We considered an alternative approach to calculating the budget 
neutrality adjustment under the new payment system, which would take 
into account the effects of the migration of procedures between ASCs, 
physicians' offices, and hospital outpatient departments that might be 
attributable to the new ASC payment system. In the following discussion 
the phrase ``new ASC procedure'' refers to a procedure not currently on 
the ASC list of approved procedures that we are proposing for inclusion 
on the ASC list of approved procedures beginning in CY 2008.
    Under this alternative, we assumed that 25 percent of the hospital 
outpatient department utilization for new ASC procedures would migrate 
to the ASC and we assumed that 15 percent of the physician office 
utilization for new ASC procedures would migrate to the ASC. We believe 
that our assumptions of a 25 percent and 15 percent migration from 
hospital outpatient departments and physician offices to ASCs, 
respectively, are reasonable given the general utilization 
relationships between these settings for services currently on the ASC 
list. For services on the current ASC list that are predominately 
performed in ASC and outpatient hospital department settings, they are 
on average performed 30 percent of the time in the ASC setting. For 
services on the current ASC list that are predominately performed in 
the ASC and physician office settings, they are on average performed 17 
percent of the time in the physician office setting. We assumed that 
new ASC services would migrate at slightly lower rates in the first 
year of the revised ASC system, yielding our migration assumptions of 
25 percent for the hospital outpatient department setting and 15 
percent for the physician office setting.
    We also assumed that the net impact of migration on services 
currently on the ASC list is negligible. We note that payment rates for 
the current highest volume ASC procedures would generally decrease 
under the proposed new ASC system, and the lower volume ASC procedures 
would experience significant payment increases. We believe it is 
reasonable to assume that some of the higher volume services will 
migrate from ASCs to other settings, and some of the current lower 
volume procedures will migrate to the ASC setting as a result of the 
payment changes.

[[Page 49658]]

    In order to calculate the budget neutrality adjustment, first, we 
estimated expenditures that would occur if we did not revise the ASC 
payment system. We estimated CY 2008 expenditures if the ASC payment 
weights were not revised and the ASC list of approved procedures was 
not expanded. As described below (see Step 1).

Estimated payments under the current system

    Step 1: Hospital outpatient department migration valued using 
estimated CY 2008 OPPS payment rates
    (a) Assuming 25 percent of the outpatient hospital department 
utilization for new ASC procedures will migrate to the ASC, multiple 
0.25 times the hospital outpatient department utilization for each new 
ASC procedure.
    (b) For each new ASC procedure, multiple the results of Step 1(a) 
by the estimated CY 2008 OPPS payment rate for the procedure.
    (c) Sum the results of Step 1(b) across all new ASC procedures.
    Step 2: Physician office migration valued using estimated CY 2008 
physician payment rates
    (a) Assuming 15 percent of the physician office utilization for new 
ASC procedures will migrate to the ASC, multiple 0.15 times the 
physician office utilization for each new ASC procedure.
    (b) For each new ASC procedure, multiple the results of Step 2(a) 
by the estimated CY 2008 physician office payment rate for the 
procedure.
    (c) Sum the results of Step 2(b) across all new ASC procedures.
    Step 3: Current ASC services valued using the estimated CY 2008 ASC 
payment rates under the current ASC system
    (a) This is described under Step 1 in the Proposed Calculation of 
the ASC Conversion Factor section above.
    Step 4: Sum the results of Steps 1-3.

Estimated payments under the new system

    Step 5: Hospital outpatient department migration valued using 
estimated CY 2008 OPPS payment rates
    (a) Same as Step 1 in this section.
    Step 6: Identify new ASC procedures currently considered to be 
office-based (for example, insert examples and see Addendum BB)
    Step 7: Physician office migration for new ASC procedures currently 
considered to be office based valued using the estimated CY 2008 OPPS 
payment rates capped at the estimated CY 2008 physician office payment 
rates
    (a) For each new ASC procedure considered to be office based, 
multiply the results of Step 2(a) by the lesser of:
    (1) The estimated CY 2008 OPPS rate for the procedure; and
    (2) The estimated CY 2008 physician fee schedule office rate for 
the procedure.
    (b) Sum the results of Step 7(a) across all new ASC procedures 
considered to be office-based.
    Step 8: Physician office migration for new ASC procedures not 
currently considered office based valued using the estimated CY 2008 
OPPS rates
    (a) For each new ASC procedure not considered to be office based, 
multiply the results of Step 2(a) by the estimated CY 2008 OPPS rate 
for the procedure.
    (b) Sum the results of Step 8(a) across all new ASC procedures not 
considered to be office based.
    Step 9: Physician office migration valued using the estimated CY 
2008 physician fee schedule out-of-office payment rate.
    (a) For each new ASC procedure, multiple the results of Step 2(a) 
by the estimated CY 2008 out of office physician rate for the 
procedure.
    (b) Sum the results of Step 9(a) across all new ASC procedures.
    Step 10: Current ASC services valued using the estimated CY 2008 
OPPS payment rates
    (a) This is described under Step 2 in this section.
    Step 11: Sum the results of Steps 5, 7-10.

Calculate the budget neutrality adjustment

    Step 12: Divide the result of Step 4 by the result of Step 11.
    Step 13: The application of the cap at the estimated CY 2008 
physician office payment rates that occurs in Step 7 is dependent on 
the ASC conversion factor. The ASC budget neutrality adjustment 
resulting from Step 12 is calibrated to take into account the 
interactive nature of the ASC conversion factor and the physician 
office payment cap.
    The resulting budget neutrality adjustment is 0.62, indicating that 
under the migration assumptions described above the difference between 
our proposed budget neutrality adjustment without migration (0.62) and 
this alternative budget neutrality adjustment with migration (0.62) is 
equal rounded to the nearest hundredth.
    Discussion of the alternative calculation of the budget neutrality 
adjustment:
    We have chosen to propose calculation of the budget neutrality 
adjustment based on the CY 2007 final ASC list of approved services and 
current ASC utilization because we believe this is the most appropriate 
approach to estimating expenditures so as to result in a budget neutral 
payment system in CY 2008. We have no data which would enable us to 
precisely estimate the net potential migration of services between the 
ASC setting, the outpatient hospital setting, and the physician office 
setting that might result from implementation of the new ASC payment 
system. Moreover, basing our estimate of expenditures on current ASC 
utilization without including migration from other sites of service is 
consistent with how we estimate expenditures for purposes of 
maintaining budget neutrality in other Medicare payment systems.
    We expect that some commenters may believe it is more appropriate 
to estimate the ASC budget neutrality adjustment taking into account 
the potential migration of services between the ASC setting, the 
outpatient hospital setting, and the physician office setting. We 
welcome data supporting the use of specific migration assumptions in 
the calculation of the ASC budget neutrality adjustment. We describe 
above the budget neutrality calculation under the alternative approach 
based on our current best estimate of the potential migration of 
services between the different settings so as to facilitate and 
stimulate comment and to encourage the submission of pertinent 
quantitative evidence of surgical migration resulting from changes in 
payment rates. We welcome data on all of the migration assumptions 
under this alternative approach. We note again that under the 
reasonable migration assumptions described above, our proposed budget 
neutrality calculation without migration (0.62) and the alternative 
budget neutrality adjustment with migration (0.62) is equal rounded to 
the nearest hundredth. However, if we exclude office-based procedures 
from the approved list of procedures, under the alternative budget 
neutrality adjustment that takes into account migration across 
different practice settings, payment rates for the ASC services 
remaining on the list (those procedures that are not office-based) 
would be slightly higher due to the statutory budget neutrality 
requirement.
12. Proposed Annual Updates
    (If you choose to comment on issues in this section, please include 
the caption ``ASC Updates'' at the beginning of your comment.)
    Currently, we update the ASC list every 2 years through the notice 
and comment regulation process. We make additions to and deletions from 
the ASC list based on clinical judgment and data that are available 
regarding utilization of

[[Page 49659]]

care settings. The last update was published in the May 4, 2005 Federal 
Register (70 FR 23690) and the update for CY 2007 is proposed in 
section XVII of this preamble. The process we follow currently to 
update the ASC list is explained in section XVII of this preamble.
    Under the revised ASC payment system, which would be implemented 
effective January 1, 2008, we are proposing to update on an annual 
calendar year basis the ASC conversion factor, the relative payment 
weights and APC assignments, the ASC payment rates, and the list of 
procedures for which Medicare would not make payment of an ASC facility 
fee. To the extent possible under the rules and policies of the revised 
ASC payment system, we are proposing to maintain consistency between 
the OPPS and the ASC payment systems in the way we treat new and 
revised HCPCS and CPT codes for payment under the ASC payment system. 
We also are proposing to invite comment as part of the annual update 
cycle to determine if there are procedures that we exclude from payment 
in the ASC setting that merit reconsideration as a result of changes in 
clinical practice or innovations in technology.
    We are proposing to update the ASC list and payment system as part 
of the annual proposed and final rulemaking cycle updating the hospital 
OPPS. We believe that including the ASC update as part of the OPPS 
rulemaking cycle would ensure that updates of the ASC payment rates and 
the list of surgical procedures for which Medicare pays an ASC facility 
fee would be issued in a regular, predictable, and timely manner. 
Moreover, the ASC payment system would be updated concurrent with 
changes in the APC groups and the OPPS inpatient list, making it easier 
to predict changes in payment for particular services from year to 
year.
    In the first part of CY 2007, we are proposing to issue a final 
rule in which we would respond to comments submitted timely regarding 
the proposals set forth in this proposed rule and make final the policy 
and regulations for the revised ASC payment system for implementation 
effective January 1, 2008. We are proposing to include the CY 2008 ASC 
payment rates as part of the proposed and final rules for the CY 2008 
OPPS update.
    We are proposing to evaluate each year all new CPT and alphanumeric 
HCPCS codes that describe surgical procedures to make preliminary 
determinations regarding whether or not they should be payable in the 
ASC setting and, if so, whether they are office-based procedures. In 
the absence of claims data that would indicate where procedures 
described by new codes are being performed, and resources required to 
perform them, we are proposing to use other available information, 
including our clinical advisors' judgment, predecessor CPT and HCPCS 
codes, information submitted by representatives of specialty societies 
and professional associations, and information submitted by commenters 
during the public comment period following publication of the final 
rule with comment period in the Federal Register. We would publish in 
the annual OPPS/ASC payment update final rule those interim 
determinations for the new codes to be active January 1 of the update 
year. Those procedures would be open to comment on that final rule, and 
we would respond to comments about our determinations in the final rule 
for the following year, just as we currently respond to comments about 
our APC assignments for new codes in the OPPS final rule for the 
following year. After our review of public comments and in the absence 
of physicians' claims data, if our determination regarding the new 
codes is that they should reside on the ASC list as office-based 
procedures subject to the payment limitation, this determination would 
remain preliminary until there are adequate physicians' claims data 
available for these procedures to assess their predominant sites of 
service. Using those data, if we confirm our determination that the new 
codes are office-based because they were performed in the physician 
office setting more than 50 percent of the time, the codes would then 
be permanently assigned to the list of office-based procedures subject 
to the payment limitation.
    Accordingly, we are proposing to reflect this annual rulemaking and 
publication of revised payment methodologies and payment rates in new 
Sec.  416.173 in proposed new subpart F.

D. Information in Addenda Related to the Revised CY 2008 ASC Payment 
System

    (If you choose to comment on issues in this section, please include 
the caption ``ASC Addenda'' at the beginning of your comment.)
    The ASC payment rates, copayment amounts, and relative payment 
weights displayed in Addendum BB of this proposed rule are presented to 
model the ratesetting methodology that we are proposing for the revised 
ASC payment system required by Pub. L. 108-173. Actual payment rates 
proposed and made final for CY 2008 are dependent upon the final 
policies and regulations affecting the revised payment system that we 
would publish in a final rule in CY 2007; the proposed and final APC 
groups, APC relative payment weights, and MPFS nonfacility practice 
expense RVUs for CY 2008; and, the ASC conversion factor updated to 
reflect CY 2006 utilization data and CY 2007 ASC standard overhead 
payment amounts.

E. Technical Changes to 42 CFR Parts 414 and 416

    We are proposing to make the following technical change to 42 CFR 
414:
     Sec.  414.22 (Non-facility practice expense RVUs) is 
revised to conform to changes occurring under the ASC revised payment 
system. The change will be effective January 1, 2008.
    We are proposing to make the following technical changes to 42 CFR 
416:
     Sec.  416.65(a)(4) is revised to replace the obsolete 
cross-reference to Sec.  405.310 with Sec.  411.15.
     Sec.  416.120 is revised by replacing the incorrect cross-
reference to ``Part 413'' with ``Part 419.''
     Sec.  416.150 (Beneficiary appeals) is deleted because it 
does not conform with the appeals process provisions of 42 CFR Part 
405, subparts H and I.

XIX. Medicare Contracting Reform Mandate

A. Background

    Section 911 of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA), Pub. L. 108-173, amended Title XVIII 
of the Act to add section 1874A, Contracts with Medicare Administrative 
Contractors (MACs). Section 1874A of the Act replaces the prior 
Medicare intermediary and carrier contracting authorities formerly 
found in sections 1816 and 1842 of the Act, respectively. This reform 
(commonly referred to as ``Medicare contracting reform'' for Medicare 
fee-for-service) is intended to improve Medicare's administrative 
services to beneficiaries and health care providers and to bring 
standard contracting principles to Medicare, such as competition and 
performance incentives, which the government has long applied to other 
Federal programs under the Federal Acquisition Regulation (FAR). For 
Department of Health and Human Services acquisitions, the FAR is 
supplemented by the Department of Health and Human Services Acquisition 
Regulation (HHSAR) (48 CFR chapter 3). Using

[[Page 49660]]

competitive procedures, CMS will replace its current claims payment 
contractors (intermediaries and carriers) with new contract entities, 
MACs. Section 911(d)(1)(C) of Pub. L. 108-173 requires that CMS compete 
and transition all Medicare claims processing workloads to MACs by 
October 1, 2011.
    In accordance with section 911(e) of Pub. L. 108-173, on or after 
October 1, 2005, any reference to an ``intermediary'' or ``carrier'' in 
a regulation shall be deemed a reference to a MAC. The process of 
transition from intermediaries and carriers to MACs is not a single 
point-in-time occurrence, but rather necessarily happens over a 
multiyear period due to the size and nature of the claims workloads 
involved. Therefore, for the purposes of clarity, the term 
``intermediary'' is used throughout this proposed rule to describe a 
Medicare contractor, pursuant to the authority of section 1816 of the 
Act, that has not yet transitioned to a MAC. In addition, for the 
purpose of clarity, the term ``carrier'' is used throughout this 
proposed rule to describe a Medicare contractor, pursuant to the 
authority of section 1842 of the Act, that has not yet transitioned to 
a MAC.

B. CMS' Vision for Medicare Fee-for-Service and MACs

    CMS' vision for the Medicare fee-for-service (FFS) program is that 
of a premier health plan that allows for comprehensive, quality care 
and world-class beneficiary and provider service. Achieving this vision 
requires substantial improvement of CMS' current FFS administrative 
structure. Further information on CMS' plans to improve Medicare FFS 
may be obtained through the Medicare Contracting Reform Web site: 
http://www.cms.hhs.gov/medicarereform/contractingreform/.
    In 2006, there are 24 intermediaries and 17 carriers that process 
FFS claims. Intermediaries process claims for Medicare Parts A and B 
relating to services furnished by health care facilities, including 
hospitals and SNFs. Carriers process claims for Medicare Part B, in 
particular, for physician, laboratory, and other nonfacility services. 
In addition, 4 intermediaries serve as regional home health 
intermediaries (RHHIs) and process Medicare claims for home health 
services and hospice services. (Section 1816 of the Act was amended in 
1977 to allow the Secretary to designate regional or national 
intermediaries, which we refer to as RHHIs, to process claims for home 
health services. We have designated these RHHIs to serve both the home 
health agency (HHA) and the hospice provider communities.) For a 
complete listing of the current Medicare intermediaries and carriers, 
refer to the CMS Web site: http://www.cms.hhs.gov/contacts/incardir.asp.
    Although health care delivery in the United States has evolved with 
advances in modern technology, the contracting authorities relating to 
the Medicare FFS administrative structure did not substantially evolve 
between the enactment of the Medicare statute in 1965 and the enactment 
of Pub. L. 108-173.
    Prior to passage of Pub. L. 108-173, intermediary and carrier 
acquisition authorities did not permit full and open competition or 
unified processing of Medicare Part A and Part B claims. Medicare 
contracting was significantly hampered by the absence of performance-
based incentives and cumbersome termination procedures.
    In an effort to achieve Congress' goal of a more efficient and 
effective Medicare operation, CMS developed a plan for most current 
Medicare Part A and Part B intermediary and carrier responsibilities to 
be integrated into a single contract entity to be administered by a 
single contractor in each area of the country. These new MACs will 
handle claims processing and related activities traditionally performed 
by intermediaries and carriers.
    Under Medicare contracting reform, the MACs will perform all the 
core claims processing operations for both Medicare Part A and Part B. 
CMS will ensure that MACs focus on providing a high level of customer 
service to providers and beneficiaries. MACs will be the providers' 
primary contact with Medicare, and CMS will hold the MACs accountable 
for overall provider and beneficiary satisfaction and correct claims 
payment.
    With respect to financial management, as was required of 
intermediaries and carriers, MACs will promote the fiscal integrity of 
the program and be accountable stewards of the Medicare Trust Fund 
dollars. The MACs will be required to pay claims timely, accurately, 
and in a reliable manner while promoting cost efficiency and the 
delivery of maximum value to the program.
    We recognize the potential for improving the efficiency and 
effectiveness of services to Medicare beneficiaries and providers 
through the Medicare contracting reform provisions contained in section 
1874A of the Act. Through our implementation of these provisions, we 
expect to realize significant performance improvements. The future 
environment is designed to generate substantial savings both from an 
administrative and programmatic standpoint and will safeguard CMS' 
mission.

C. Provider Nomination and the Former Medicare Acquisition Authorities

    As originally enacted in 1965 and until the enactment of Pub. L. 
108-173, section 1816 of the Act afforded groups or associations and 
individual providers of services (as defined at section 1861(a) of the 
Act) the right to nominate (appoint) their intermediary. The 
intermediary agreements were governed by Medicare laws that diverge 
from the FAR in a number of important respects. Prior to Public Law 
108-173, section 1816 of the Act precluded the Medicare program from 
competing intermediary functions on a full and open basis. Rather, 
institutional providers of services, such as hospitals and nursing 
facilities, nominated a particular intermediary to process and pay 
their Medicare Part A claims.
    In a significant historical development that took place shortly 
after Medicare's enactment in 1965, the American Hospital Association 
and other provider trade associations nominated the Blue Cross 
Association (BCA) to serve as the intermediary for their membership. 
The BCA merged with the Blue Shield Association in the 1970s to form 
today's Blue Cross and Blue Shield Association (BCBSA.) CMS and the 
BCBSA then entered into a prime contract, which continues to currently 
exist through the annual renewal process. In turn, the BCBSA 
subcontracted most operational intermediary functions to its member 
plans. The BCBSA assigned the majority of the nation's hospitals to its 
local Blue Cross plans. Some providers of services nominated commercial 
insurers to serve as their intermediaries.
    Most recently, section 911(b) of Pub. L. 108-173 amended section 
1816 of the Act to remove the provider nomination authority. The 
section has been renamed: ``Provisions Relating to the Administration 
of Part A.'' Section 1816(a) of the Act, which authorized providers to 
select a contractor to perform claims payment and audit functions, has 
been amended. It now contains one sentence mandating the use of 
contracts with MACs to administer section 1816 of the Act. Sections 
1816(e), (f), and (g), which authorized the Secretary to develop 
standards, criteria, and procedures for the assignment of providers to 
intermediaries and to reassign providers periodically, have been 
repealed.

[[Page 49661]]

    Section 911(d) of Pub. L. 108-173 permits the Secretary to 
transition the current intermediary and carrier functions to the MACs. 
More information about CMS' plans to implement Medicare contracting 
reform, including the Report to the Congress on this subject, can be 
obtained at the CMS Web site: http://www.cms.hhs.gov/medicarereform/contractingreform/. MACs will perform all core claims processing 
operations for both Medicare Part A and Part B. The Part A and Part B 
MACs will operate in distinct, nonoverlapping geographic jurisdictions, 
which will form the basis of the Medicare claims processing operations. 
A transitional period runs between October 1, 2005, and October 1, 
2011. During this period, any existing intermediary and carrier 
contracts could be maintained until replaced by a MAC contract. The 
statute requires that all intermediary and carrier contract functions 
are to be competed and awarded as MAC contracts by October 1, 2011.

D. Summary of Changes Made to Section 1816 of the Act

    Substantial changes to section 1816 of the Act that were required 
by sections 911(b) and 911(c) of Pub. L. 108-173 took effect on October 
1, 2005. The changes that we are proposing in this proposed rule to the 
regulations under 42 CFR part 421, subpart B (discussed under section 
XIX.E. of this preamble) are intended to conform the regulations to 
these statutory changes.
    Prior to the statutory developments directed by Pub. L. 108-173, 
section 1816 of the Act provided the foundation acquisition authority 
for agreements between CMS, acting for the Secretary, and 
intermediaries, for the purpose of administering benefits under 
Medicare Part A and making payments to providers of services.
    In particular, section 1816(a) of the Act formerly gave groups and 
associations of providers of services (which, under section 1861(u) of 
the Act, includes hospitals, critical access hospitals (CAHs), skilled 
nursing facilities (SNFs), comprehensive outpatient rehabilitation 
facilities (CORFs), HHAs, hospices, and, for the purposes of sections 
1814(g) and 1835(e) of the Act, funds) the power to nominate their 
servicing intermediary to determine and make Medicare payments to their 
members. Under this provision, an intermediary could be a ``national, 
state, or other public or private agency or organization.'' As 
previously stated, under this provision, the American Hospital 
Association nominated the national Blue Cross Association to serve as 
the prime Medicare intermediary for its membership in 1965, an 
arrangement that continues to exist.
    Moreover, prior to the enactment of Pub. L. 108-173, section 
1816(d) of the Act allowed individual providers and groups of providers 
to--
     Part with their group or association and nominate another 
entity to serve as their intermediary; and
     Withdraw its/their nomination from an intermediary, and 
obtain services from another intermediary that had an agreement with 
the Secretary.
    Finally, section 1816(e) of the Act, as it formerly read, specified 
the substantial procedural requirements to be followed by the Secretary 
in the event that the Secretary desired to assign or reassign 
individual providers of services to any intermediary other than the 
nominated entity. This provision also gave limited authority to the 
Secretary to designate a regional or national intermediary for a 
particular ``class'' of providers of services. However, this authority 
was subject to substantial procedural requirements. Among these 
procedural requirements were:
     The Secretary had to promulgate standards, criteria and 
procedures for evaluating the performance of intermediaries under 
section 1816(f) of the Act;
     The Secretary had to make a finding, after applying such 
standards, criteria, and procedures, that the reassignment of the 
individual provider and/or the designation of the regional or national 
intermediary would result in more efficient and effective 
administration of the Medicare program;
     The Secretary had to provide a full explanation of his 
reasons for determining that the intermediary change would result in 
more efficient and effective administration; and
     Affected agencies and organizations were given the right 
to a hearing, and any determinations of the Secretary on nominations 
and provider assignments were subject to judicial review.
    In the former sections 1816(e)(4) and 1816(e)(5) of the Act, the 
Secretary was given authority to establish regional intermediaries with 
respect to HHAs and hospice providers, although certain procedural 
requirements still had to be met.
    In summary, while under section 1816 of the Act, the Secretary was 
not required to accept all Medicare intermediary nominations, the 
Secretary had no independent authority to contract with any entity for 
Medicare intermediary services outside the nomination process. 
Moreover, while providers of services were given the opportunity to 
seek a reassignment to a new intermediary, the Secretary could not 
assign or reassign individual providers or classes of providers unless 
substantial procedural requirements were followed.
    The existing Medicare regulations under 42 CFR Part 421, 
particularly those within Subparts A and B, were substantially shaped 
by this statutory framework relating to provider nominations and the 
assignment or reassignment of providers of services to intermediaries. 
In particular, the following regulatory provisions have their basis in 
the statutory provisions of sections 1816(a), (d), and (e) of the Act 
(all are located within 42 CFR Part 421):
     Sec.  421.1(c), which discusses criteria to be used in 
assigning and reassigning providers;
     Sec.  421.3, which provides exceptions to definitions to 
accommodate the designation of regional intermediaries for HHAs and 
intermediaries for hospices;
     Sec.  421.103, which identifies options available to 
providers for receiving Medicare payments;
     Sec.  421.104, which provides the procedural framework 
governing the administration of provider nominations for 
intermediaries;
     Sec.  421.105, which obligates CMS to provide notice as to 
its action on nominations;
     Sec.  421.106, which specifies the process to be used by a 
provider desiring a change of intermediary;
     Sec.  421.112, which provides the considerations to be 
taken into account by CMS when, among other things, it desires to 
assign or reassign a provider to an intermediary or designate a 
regional or national intermediary for a class of providers;
     Sec.  421.114, which governs the assignment or 
reassignment of individual providers;
     Sec.  421.116, which specifies the requirements for 
designating national or regional intermediaries consistent with 
sections 1816(e)(1) through (e)(3) of the Act; and
     Sec.  421.117, which specifies the parameters for 
assigning HHAs and hospice providers to regional intermediaries 
consistent with sections 1816(e)(4) and (e)(5) of the Act.
    In addition to the provisions discussed above that relate to 
provider nominations, prior to the enactment of Pub. L. 108-173, 
section 1816 of the Act also contained other provisions governing 
agreements with Medicare intermediaries that were not consistent with 
the mainstream of Federal acquisition and procurement

[[Page 49662]]

authorities, as this mainstream is reflected in the FAR. For instance--
     Section 1816(b) of the Act contains provisions that 
limited payment under all intermediary agreements to a cost-
reimbursement basis only;
     Section 1816(f) of the Act required the Secretary to 
publish his performance criteria and standards for intermediary 
agreements in the Federal Register, and specified requirements relating 
to the application of such criteria and standards; and
     Section 1816(g) afforded intermediaries the right to 
terminate their agreements with CMS, but limited the right of the 
Secretary to terminate the agreement; in particular, no provision was 
made for the normal right of the government to terminate for 
convenience.
    In section 911(b) of Pub. L. 108-173, Congress reiterated the 
requirement that CMS begin to move beyond the legacy nomination-based 
intermediary agreements during FY 2006. This was done by repealing 
outright or substantially modifying many of the provisions of section 
1816 of the Act, effective October 1, 2005. In particular, section 
911(b) of Pub. L. 108-173--
     Repealed the prior language of section 1816(a) of the Act, 
including the basic provider nomination provision, and replaced it with 
a statement indicating that Medicare Part A administrative functions 
would be contracted through section 1874A of the Act;
     Repealed section 1816(b) of the Act in full, including its 
provisions limiting payment to cost reimbursement;
     Repealed the contract-related provisions of section 
1816(c) of the Act;
     Repealed sections 1816(d), (e), (f), (g), (h), (i), and 
(l) of the Act; and
     Made conforming changes to sections 1816(c), (j), and (k) 
of the Act.
    With these changes, section 1816 of the Act is no longer an 
acquisition authority, and there is no vestige of the former provider 
nomination provisions or the partial exceptions to those provisions 
relating to home health and hospice providers.
    While section 911(d)(1)(B) of Pub. L. 108-173 allows the Secretary 
to continue intermediary and carrier contracts in effect prior to 
October 1, 2005, under their terms and conditions until October 1, 
2011, there was no similar extension for existing nomination 
arrangements. Section 911(d)(2)(A) of Pub. L. 108-173 provides the 
Secretary with authority to enter into intermediary agreements outside 
of the provider nomination process starting with the date of enactment 
of Pub. L. 108-173 (December 8, 2003). Therefore, while Congress 
specified that the Secretary should submit his plan for implementing 
section 911 at the start of FY 2005, the Secretary was authorized to 
contract outside of the section 1816 nomination provisions immediately 
and in advance of delivery of his report. This analysis requires that 
similar, conforming changes be made in our regulations as set forth in 
this proposed rule.

E. Provisions of the Proposed Regulations

    As discussed under section XIX.A. of this preamble, based on the 
authority provided in sections 1874A(a) through (d) of the Act, as 
established by section 911(a)(1) of Pub. L. 108-173, we are proposing 
to establish regulations pertaining to MACs in a new Subpart E of 42 
CFR Part 421. Moreover, based on the substantial changes to section 
1816 of the Act, including the repeal of all of the section 1816 
provisions relating to the ability of providers to nominate their 
servicing intermediary, as enacted by section 911(b) of Pub. L. 108-
173, we also are proposing a number of changes to Subparts A and B of 
42 CFR Part 421. In addition, we are proposing to change the title of 
Part 421 from ``Intermediaries and Carriers'' to ``Medicare 
Contracting'' and make conforming revisions to Subpart B of Part 421.
    As discussed earlier, section 911(b) of Pub. L. 108-173 either 
repealed outright or substantially modified sections 1816(a), (b), (c), 
(d), (e), (f), (g), (h), (i), and (l) of the Act, and made clear that 
the acquisition authority for Part A claims processing would, after 
October 1, 2005, be found in section 1874A of the Act. Among all these 
changes, each of the former ``provider nomination'' provisions within 
section 1816 of the Act was repealed. In addition, section 911(d)(2)(A) 
of Pub. L. 108-173 gave the Secretary authority to disregard the 
provider nomination provisions in his contracting, even prior to 
October 1, 2005. In accordance with these statutory changes, we are 
proposing to substantially modify or delete Sec. Sec.  421.1(c), 421.3, 
421.103, 421.104, 421.105, 421.106, 421.112, 421.114, 421.116, and 
421.117 of the regulations.
    As discussed earlier, the amendment to title XVIII of the Act (to 
allow for the new section 1874A: ``Contracts with Medicare 
Administrative Contractors'') requires CMS to contract with eligible 
entities to perform Medicare functions using the FAR. We are proposing 
to add regulations pertaining to MAC contracts in a new subpart E 
(Medicare Administrative Contractors) under Part 421 as follows:

Subpart E--Medicare Administrative Contractors

Sec.
421.400 Basis and scope.
421.401 Definitions.
421.404 Assignment of providers and suppliers to MACs.
1. Definitions
    Under proposed Sec.  421.401, we define a ``Medicare administrative 
contractor (MAC)'' as an agency, organization, or other person with a 
contract to perform any or all of the functions set forth under section 
1874A of the Act. With respect to the performance of a particular 
function in relation to an individual entitled to benefits under 
Medicare Part A or enrolled under Medicare Part B, or both, a specific 
provider of services or supplier (or class of such providers of 
services or suppliers), we are proposing to define an ``appropriate 
MAC'' as a MAC that has a contract to perform a Medicare administrative 
function in relation to a particular individual, provider of services, 
or supplier or class of providers.
2. Assignment of Providers and Suppliers to MACs
    We are proposing to establish a new Sec.  421.404 to incorporate 
the rules governing the processing of claims submitted by providers and 
suppliers that enroll with and receive Medicare payment and other 
Medicare services. As a general rule, Medicare providers and suppliers 
will be assigned to the MAC that is contracted to administer the types 
of services (benefits) billed by the provider or supplier within the 
geographic locale in which the provider or supplier is physically 
located or furnishes health care services, respectively. One 
significant exception to this general rule pertains to suppliers of 
durable medical equipment, prosthetics, orthotics, and supplies. CMS 
would continue to allow these suppliers to bill to the contractor 
assigned to the locale in which the beneficiary receiving the items or 
supplies resides.
    In the past, under the provider nomination provisions that were 
repealed by section 911 of Pub. L. 108-173, CMS had considered (and 
occasionally approved) requests from certain classes of institutional 
providers covered by these section 1816 provisions, primarily, 
hospitals, SNFs, and CAHs, to bill an intermediary other than the one 
servicing providers in the geographic locale of the provider. The

[[Page 49663]]

process and criteria for making these determinations are set forth in 
detail in the existing regulations under 42 CFR part 421, subpart B 
(which we are proposing to remove in accordance with the changes 
effectuated by section 911(b) of Pub. L. 108-173.
    In particular, not automatically but on a fairly frequent basis, 
CMS approved requests from large multi-State groups of such providers 
under common ownership and control, called ``chain providers,'' to bill 
a single intermediary on behalf of all the individual providers in the 
chain through the headquarters office, or ``home office,'' of the chain 
provider. These chain providers were granted ``single intermediary'' 
status.
    The premise behind granting privileges to bill a single 
intermediary to such large multi-State chain providers was that this 
might reduce administrative billing expenses for the chain and reduce 
the administrative expenses of the Medicare program. In particular, 
assigning a large multi-State chain provider to a single intermediary 
facilitated the Medicare cost report audit and reimbursement functions, 
because findings with respect to the cost report of the chain's home 
office could affect the individual provider's cost report. Otherwise, 
these audit and reimbursement issues would need to be coordinated among 
multiple intermediaries.
    In addition to applying the relevant regulatory requirements in 42 
CFR part 421, subpart B in our review of chain provider requests for 
single intermediary status, we applied additional criteria to focus our 
analysis and to ensure that the exception to our normal practice of 
assigning providers to their ``local'' intermediary was warranted. We 
advised the chain provider that it would have to demonstrate that 
having a single intermediary would be consistent with efficient and 
effective administration of the Medicare program, and that the 
intermediary would need to have sufficient capacity to effectively 
serve the chain (these elements were restatements of the regulatory 
criteria). In addition, we required the chain to meet the following 
requirements:
     Size--The provider chain had to be comprised of 10 
participating facilities or 500 certified beds, or 5 facilities or 300 
certified beds spread across 3 or more contiguous States.
     Central Controls--The provider chain had to demonstrate 
that it exercised central controls, assuring substantial uniformity in 
operating procedures, utilization controls, personnel administration, 
and fiscal operations among the individual providers.
    The administrative efficiencies gained by both the large multi-
State chain providers and the Medicare program by allowing single 
intermediary relationships to exist may not be as significant as they 
were formerly. Prior to the implementation of the Administration 
Simplification provisions of Part C of Title XI of the Act, the various 
intermediaries required providers to use somewhat divergent transaction 
and formatting standards in their electronic claims processing systems. 
A provider chain with centralized billing processes could make a good 
business case that it should be permitted to bill only one 
intermediary. Moreover, prior to the implementation of the many 
prospective payment systems required by the Balanced Budget Act of 1997 
and subsequent public laws, a greater percentage of Medicare program 
payments hinged on the Medicare cost report audit and reimbursement 
process. In such an environment, there was potential benefit to both a 
chain provider and the government to minimize coordination issues. 
Finally, the former Medicare environment involved many intermediaries, 
so there were naturally more geographic boundaries among contractors 
that a multi-State chain could cross.
    We understand the provisions of section 1874A of the Act and, more 
particularly, the revisions to section 1816 of the Act made by section 
911(b) of Pub. L. 108-173 to authorize the Secretary to assign all 
providers and suppliers, even the members of multi-State entities, to 
the geographically-based MACs based on their physical location. This 
action is consistent with CMS' vision, as articulated in the 
Secretary's Report to Congress on Medicare Contracting, of establishing 
a claims processing environment where most Medicare Part A and Part B 
claims involving a particular beneficiary are administered by the same 
contractor.
    However, as indicated in that Report (page V-4), we recognize that 
there may still be some legitimate business value to allowing large 
multi-State chains of providers that formerly were able to nominate 
their intermediary to bill on a consolidated basis to one MAC. While 
Congress has clearly mandated that the former provider nomination 
framework be abolished, we believe that allowing the practice of 
consolidated billing by large chains is within the discretion of the 
Secretary under section 911 of Pub. L. 108-173. Accordingly, in this 
proposed rule, we are proposing under Sec.  421.404 that--
     Providers (as defined in 42 CFR 400.202) will generally be 
assigned to the MAC with claims processing jurisdiction over the 
geographic locale in which the provider is physically located.
     Large chain providers comprised of individual providers 
that were formerly permitted by CMS to ``nominate'' an intermediary, 
which we refer to as ``qualified chain providers,'' will be permitted 
to request opportunity to consolidate their Medicare billing activities 
to the MAC with jurisdiction over the geographic locale in which the 
chain's home office is located.
     Qualified chain providers that were formerly granted 
single intermediary status do not need to re-request such privileges on 
behalf of the entire chain at this time.
     CMS may grant other exceptions to the general rule for 
assigning providers to MACs, but only based on a finding that such an 
exception will support the implementation of the MACs or if CMS deems 
the exception to be in the compelling interest of the Medicare program.
    We are proposing to incorporate a definition of ``qualified chain 
provider.'' The criteria that constitute the proposed definition of a 
``qualified chain provider'' mirror the elements that were historically 
applied. We believe these are appropriate criteria to employ in 
reviewing whether a chain provider should even be considered for 
consolidated billing. Less stringent criteria would clearly cut against 
the statutory mandate to establish MACs and end the provider nomination 
process. More stringent criteria might disrupt the operations of many 
entities that formerly were approved for single intermediary handling 
under the old criteria.
    Smaller chains of otherwise eligible providers (for example, 
hospitals, SNFs, and CAHs) might also desire consolidated billing, as 
well as other types of providers (for example, HHAs and hospices). In 
the latter case, the other types of providers (termed ``ineligible 
providers'' in this proposed rule) did not have the opportunity to 
request assignment to (nominate) a particular intermediary prior to 
October 1, 2005. In some cases, these other types of providers were 
assigned to regional intermediaries based on a nexus of statutory and 
administrative actions. In other cases, assignments were made through 
administrative action. In the case of smaller chains of otherwise 
eligible providers, we note that Pub. L. 108-173 clearly mandates the 
end of the provider nomination process and

[[Page 49664]]

appears to us to anticipate the use of regional contractors.
    We believe that our establishment of MACs that, in most cases, will 
administer claims from multiple States will largely resolve the 
concerns these other providers may have. Under our proposed approach, 
for instance, we believe that few chain providers will have to bill 
more than two MACs even if they fail to meet the tests for being a 
``qualified chain provider.''
    Finally, with respect to suppliers (as also defined in 42 CFR 
400.202 of our regulations), we are proposing to assign suppliers 
(including physicians and other practitioners) to MACs based on the 
geographic jurisdiction in which they operate and furnish services. 
These requirements mirror the various Part B claims jurisdiction rules 
that have been in place. CMS may grant an exception to this policy only 
if CMS finds the exception will support the implementation of MACs or 
will serve some compelling interest of the Medicare program.. However, 
we do incorporate the current special billing requirements relating to 
suppliers of durable medical equipment, prosthetics, orthotics, and 
supplies under Sec.  421.210 and Sec.  421.212.
    As we move forward to implement MAC contracting in keeping with the 
statutory mandate of section 911 of Pub. L. 108-173 and the Secretary's 
Report to Congress, we invite public comments on the above issues, 
including our proposed definitions and criteria. (Once the MACs are 
initially implemented, we may propose more stringent criteria for 
consolidated billing status, in keeping with the overall thrust of 
section 911 of Pub. L. 108-173.)
3. Other Proposed Technical and Conforming Changes
a. Definition of ``Intermediary'' (Sec.  421.3)
    We are proposing to revise the definition of the term 
``intermediary'' under existing Sec.  421.3 to delete reference to 
``alternative regional intermediaries.'' CMS no longer allows HHAs and 
hospice care providers to select an alternative regional intermediary. 
Over the years, as the number of intermediaries in the program has 
decreased, the availability of alternative intermediaries for HHAs and 
hospices has declined. We have implemented the policy that all HHAs and 
hospice care facilities are to be assigned to the designated regional 
intermediary that serves their geographic jurisdiction. This is 
required for the efficient and effective administration of the Medicare 
program as the agency moves forward to implement the MACs.
b. Intermediary Functions (Sec.  421.100)
    Section 1816(a) of the Act, which allowed providers to nominate an 
intermediary, required that only nominated intermediaries perform the 
functions of determining payment amounts and making payments to 
providers. Section 1874A of the Act, as added by section 911 of Pub. L. 
108-173, eliminates the intermediary nomination process. All activities 
carried out under intermediary agreements will be transitioned to MAC 
contracts by September 30, 2011.
    During the transition period, CMS will still require regulations to 
support its intermediary agreements. We are proposing to amend Sec.  
421.100, concerning functions to be included in intermediary 
agreements, to address the dual intermediary responsibilities.
    We are proposing to revise existing Sec.  421.100(i), Dual 
intermediary responsibilities, to delete the reference to Sec.  421.117 
from this section, as the statutory provision that made this necessary 
was repealed by Pub. L. 108-173.
c. Options Available to Providers and CMS (Sec.  421.103)
    We are proposing to change the title of Sec.  421.103 to ``Payment 
to Providers'' and to revise the contents of Sec.  421.103 to clarify 
that, all providers must receive payments for covered services 
furnished to Medicare beneficiaries through an intermediary (under 
Sec.  421.404) and eventually through a MAC (under Sec.  421.404). We 
are proposing that this function must remain with the intermediaries. 
We would no longer allow providers to receive payments directly from 
CMS, nor would we allow providers to receive payments from alternative 
regional intermediaries. We believe the inclusion of this function is 
consistent with the effective and efficient administration of the 
Medicare program.
d. Nomination for Intermediary (Sec.  421.104)
    We are proposing to change the title of Sec.  421.104 to 
``Assignment of Providers of Services to Intermediaries During 
Transition to Medicare Administrative Contractors (MACs)'' and to 
revise the contents of the section to provide that new providers that 
enter the Medicare program during the transition period will be 
assigned to the local designated intermediary that serves the 
jurisdiction in which the provider is located. We believe this change 
is necessary as we prepare to transition from intermediary agreements 
and carrier contracts to contracts with the MACs. In the MAC 
environment, providers will be assigned based on their geographic 
location to the MAC that has jurisdiction for their provider type.
e. Notification of Actions on Nominations, Changes to Another 
Intermediary or to Direct Payment, and Requirements for Approval of an 
Agreement (Sec.  421.105 and Sec.  421.106)
    We are proposing to remove Sec.  421.105 and Sec.  421.106 from the 
regulations, as the sections would no longer be applicable with 
implementation of the new Subpart E.
f. Considerations Relating to the Effective and Efficient 
Administration of the Medicare Program (Sec.  421.112)
    We are proposing to revise Sec.  421.112(a). As stated previously 
in this proposed rule, provider requests to be assigned or reassigned 
to a particular intermediary will no longer be considered. However, we 
may deem it necessary to reassign providers if we find it is necessary 
for the efficient and effective administration of the program. In 
addition, there will no longer be a national intermediary to serve a 
class of providers.
g. Assignment and Reassignment of Providers by CMS (Sec.  421.114)
    We are proposing to revise Sec.  421.114 to specify that we may 
consider it necessary to assign and reassign providers if the 
assignment or reassignment is in the best interest of the program. 
Before making these determinations, we will no longer review provider 
requests to be reassigned to another intermediary. This is consistent 
with the proposed policy to eliminate a provider request to change to 
another intermediary or to direct payment. Under Medicare contracting 
reform, we require increased flexibility to realign providers to 
geographical jurisdictions for effective implementation of the MACs. We 
reserve the right to reassign providers to other jurisdictions if we 
deem it to be in the best interest of the program.
h. Designation of National or Regional Intermediaries (Sec.  421.116) 
and Designation of Regional and Alternative Designated Regional 
Intermediaries for Home Health Agencies and Hospices (Sec.  421.117)
    We are proposing to delete Sec.  421.116, Designation of national 
or regional intermediaries, and Sec.  421.117, Designation of regional 
and alternative designated regional intermediaries for

[[Page 49665]]

HHAs and hospices. The statutory provisions that made these regulations 
necessary were repealed by Pub. L. 108-173. Therefore, we no longer 
need these regulations. All providers will receive payment for covered 
services as described in Sec.  421.103.
i. Awarding of Experimental Contracts (Sec.  421.118)
    We are proposing to delete Sec.  421.118, which specifies the 
provisions under which CMS may award a fixed price or performance 
incentive contract under the experimental authority contained in 42 
U.S.C. 1395b-1 for performance of intermediary functions under Sec.  
421.100. The provisions of this section became obsolete with the 
enactment of section 911 of Pub. L. 108-173.

XX. Reporting Quality Data for Improved Quality and Costs Under the 
OPPS

    (If you choose to comment of issues in this section, please include 
the caption ``Hospital Quality Data'' at the beginning of your 
comment.)
    As noted previously, CMS' Office of the Actuary currently projects 
that Medicare Part B expenditures will continue to grow at a 
significant rate, as a result of rapid growth in the use of both 
physician-related services and hospital outpatient services in the 
original Medicare fee-for-service program. Specifically, the actuaries 
project that the expenditures under the OPPS in CY 2007 will be 
approximately $32.540 billion. This represents approximately a 9.2 
percent increase over our estimated expenditure of $29.809 billion for 
the OPPS in CY 2006, and reflects even more rapid spending growth in 
recent years. As the following table shows, implementation of the OPPS 
has not slowed outpatient spending growth; in fact, double-digit 
spending growth has been occurring.

  Table 47.--Growth in Expenditures Under OPPS From CY 2001 Through CY 2007 (Projected Expenditures for CY 2006
                                                  and CY 2007)
                                                  [in millions]
----------------------------------------------------------------------------------------------------------------
         OPPS growth            CY 2001     CY 2002     CY 2003     CY 2004     CY 2005     CY 2006     CY 2007
----------------------------------------------------------------------------------------------------------------
Incurred Cost................     19,172    19,561      21,146      23,912      26,643      29,809      32,540
Percent Increase.............  .........         2.0         8.1        13.1        11.4        11.9         9.2 
----------------------------------------------------------------------------------------------------------------
Source: FY 2007 Mid-Session Review, Budget of the U.S. Government.

    The current rate of growth in expenditures for hospital outpatient 
services is of great concern to us. As with the other Medicare fee-for-
service payment systems that are experiencing rapid spending growth, 
brisk growth in the intensity and utilization of services is the 
primary reason for the current rate of growth in the OPPS, rather than 
general price or enrollment changes. The table below illustrates the 
increases in the volume and intensity of outpatient hospital services 
over the last several years.

                 Table 48.--Percent Increase in Volume/Intensity of Hospital Outpatient Services
----------------------------------------------------------------------------------------------------------------
                                                                                            CY 2005     CY 2006
                                                        CY 2002     CY 2003     CY 2004     (Est.)      (Est.)
----------------------------------------------------------------------------------------------------------------
Percent Increase....................................        3.0         2.0         8.0         8.0       10.0
----------------------------------------------------------------------------------------------------------------
Source: FY 2007 Mid-Session Review, Budget of the U.S. Government.

    For outpatient hospital services, the volume and intensity for CY 
2005 are estimated to continue to increase significantly at a rate of 8 
percent, in excess of the long-term trend. This increase follows the 8 
percent increase in CY 2004, and the growth is projected to be 10 
percent in CY 2006.
    As we have stated repeatedly, this rapid growth in utilization of 
services in the OPPS shows that Medicare is paying mainly for more 
services each year, regardless of their quality or impact on 
beneficiary health. The program should promote higher quality services, 
so that Medicare spending is directed in the most efficient manner 
toward higher quality services. Medicare payments should encourage 
doctors and other providers in their efforts to achieve better health 
outcomes for Medicare beneficiaries at a lower cost. Therefore, we have 
been examining the concept of ``value-based purchasing'' in a number of 
payment systems. ``Value-based purchasing'' may use a range of 
incentives to achieve identified quality and efficiency goals, as a 
means of promoting better quality of care and more effective resource 
use in the Medicare payment systems. In developing the concept of 
value-based purchasing, we have been working closely with stakeholder 
partners, including health professionals and providers.
    In this proposed rule, we are seeking public comment on value-based 
purchasing as related specifically to hospital outpatient departments. 
As part of our overall goal of promoting value-based purchasing in 
outpatient payment, we also make one specific proposal in the OPPS for 
CY 2007.
    Section 1833(t)(2)(E) of the statute permits the Secretary to 
``establish, in a budget neutral manner, * * * adjustments as 
determined to be necessary to ensure equitable payments'' under the 
OPPS. The absence of OPPS measures to promote high quality in the 
provision of services to Medicare beneficiaries creates an issue of 
payment equity. In general, payments to providers in Medicare's payment 
systems do not vary on the basis of quality or efficiency differences 
among the providers of services. As a result, Medicare's payment 
systems direct additional resources to hospitals that deliver care that 
is not of the highest quality. For that reason, each Medicare dollar 
spent does not result in the same quality and efficiency of care for 
Medicare beneficiaries.
    We believe that the collection and submission of performance data 
and the public reporting of comparative information about hospital 
performance can provide a strong incentive to encourage hospital 
accountability in general and quality improvement in particular. 
Measurement and reporting can focus the attention of hospitals and 
consumers on specific goals and on

[[Page 49666]]

hospitals' performance relative to those goals. Development and 
implementation of performance measurement and reporting by hospitals 
can thus produce quality improvement in actual health care delivery. 
Hospital performance measures may also provide a foundation for 
performance-based rather than volume-based payments, which are used in 
the OPPS today.
    We have obtained some evidence of the potential for improving 
quality of care in hospitals by means of the collection and submission 
of performance data from the Premier Hospital Quality Incentive 
Demonstration.\1\ This demonstration was designed to test whether the 
quality of inpatient care for Medicare beneficiaries can improve when 
financial incentives are provided. Under the demonstration, about 270 
hospitals of Premier, Inc., a nationwide alliance of not-for-profit 
hospitals, have been voluntarily providing data on 34 quality measures 
related to 5 clinical conditions: Heart attack, heart failure, 
pneumonia, coronary artery bypass graft, and hip and knee replacements. 
Using the quality measures, CMS identifies hospitals with the highest 
quality performance in each of the five clinical areas. Hospitals 
scoring in the top 10 percent in each clinical area receive a 2-percent 
bonus payment in addition to the regular Medicare DRG payment for the 
measured condition. Hospitals in the second highest 10 percent receive 
a 1-percent bonus payment. In the third year of the demonstration, if 
some hospitals do not achieve absolute improvements above the 
demonstration's first year composite score baseline (the lowest 20 
percent) for that condition, then they will have their DRG payments 
reduced by one or two percent, depending on how far their performance 
is below the baseline.
---------------------------------------------------------------------------

    \1\ The Premier Hospital Quality Incentive Demonstration was 
authorized under section 402 of Pub. L 90-248, Social Security 
Amendments of 1967 (42 U.S.C. 1395b-1). This section authorizes 
certain types of demonstration projects that waive compliance with 
the regular payment methods used in the Medicare program.
---------------------------------------------------------------------------

    Following the first year of the demonstration (FY 2004), CMS 
awarded a total of $8.85 million to participating hospitals in the top 
two deciles for each clinical area. In the aggregate, quality of care 
improved in all five clinical areas that were measured. Preliminary 
information from the second year of the demonstration indicates that 
quality is continuing to improve, particularly for the hospitals that 
were initially poorest performing.\2\ We believe that these results 
indicate that reporting of quality data may in and of itself lead to 
improved outcomes for Medicare beneficiaries.
---------------------------------------------------------------------------

    \2\ Additional information on the Premier Hospital Quality 
Incentive Demonstration is available on the CMS Web site at: http://www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp.
---------------------------------------------------------------------------

    Since 2003, we have operated the Hospital Quality Initiative,\3\ 
which is designed to stimulate improvements in inpatient hospital care 
by standardizing hospital performance measures and data transmission to 
ensure that all payers, hospitals, and oversight and accrediting 
entities use the same measures when publicly reporting on hospital 
performance. Section 501(b) of Pub. L. 108-173 authorized us to link 
the collection of data for an initial starter set of 10 quality 
measures to the hospital IPPS annual payment update. In order to 
implement this provision, we created the Reporting Hospital Quality 
Data for Annual Payment Update (RHQDAPU) program. For FYs 2005 and 
2006, hospitals that met the RHQDAPU program's requirements received 
the full IPPS annual payment update, while hospitals that did not 
comply received an update that was reduced by 0.4 percentage points. 
For FY 2005, virtually every hospital in the country that was eligible 
to participate submitted data (98.3 percent), and approximately 96 
percent of all participating hospitals met the requirements to receive 
the full update. The data regarding the starter set of 10 quality 
measures, as well as additional, voluntarily-reported data on other 
quality measures, are available to the public through the Hospital 
Compare Web site at: http://www.hospitalcompare.hhs.gov.
---------------------------------------------------------------------------

    \3\ Additional information on CMS' Hospital Quality Initiative 
is available on the CMS Web site at: http://www.cms.hhs.gov/HospitalQualityInits/.
---------------------------------------------------------------------------

    The starter set of 10 quality measures that was established for the 
IPPS RHQDAPU as of November 1, 2003, are:
Heart Attack (Acute Myocardial Infarction/AMI)
     Was aspirin given to the patient upon arrival to the 
hospital?
     Was aspirin prescribed when the patient was discharged?
     Was a beta-blocker given to the patient upon arrival to 
the hospital?
     Was a beta-blocker prescribed when the patient was 
discharged?
     Was an ACE inhibitor given for the patient with heart 
failure?
Heart Failure (HF)
     Did the patient get an assessment of his or her heart 
function?
     Was an ACE inhibitor given to the patient?
Pneumonia (PNE)
     Was an antibiotic given to the patient in a timely way?
     Had the patient received a pneumococcal vaccination?
     Was the patient's oxygen level assessed?
    For FY 2007 and each subsequent year, section 5001(a) of Pub. L. 
109-171 amended section 1886(b)(3)(B) of the Act and made changes to 
the program established under section 501(b) of Pub. L. 108-173. These 
changes require us to expand the number of measures for which data must 
be submitted, and to change the percentage point reduction in the 
annual payment update from 0.4 percentage points to 2.0 percentage 
points for IPPS hospitals that do not report the required quality 
measures in a form and manner, and at a time, specified by the 
Secretary.
    Effective for payments beginning with FY 2007, new section 
1886(b)(3)(B)(viii)(IV) of the Act requires the Secretary to begin to 
adopt the expanded set of performance measures set forth in the IOM's 
2005 report entitled, ``Performance Measurement: Accelerating 
Improvement.'' \4\ Those measures include the HQA measures and the 
HCAHPS[supreg] patient perspective survey. Effective for payments 
beginning with FY 2008, the Secretary must add other measures that 
reflect consensus among affected parties and may replace existing 
measures as appropriate. New section 1886(b)(3)(B)(viii)(VII) of the 
Act requires the Secretary to post hospital quality data on these 
measures on the CMS Web site. A proposed list of expanded quality 
measures to be used for the FY 2007 update was included in the FY 2007 
IPPS proposed rule (71 FR 24093). The final expanded set of 21 quality 
measures for the FY 2007 update, as listed in the FY 2007 IPPS final 
rule, is outlined below:
---------------------------------------------------------------------------

    \4\ Institute of Medicine, ``Performance Measurement: 
Accelerating Improvement,'' December 1, 2005, available at http://www.iom.edu/CMS/3809/19805/31310.aspx.
---------------------------------------------------------------------------

Heart Failure (Acute Myocardial Infarction/AMI)
     Aspirin at arrival
     Aspirin prescribed at discharge
     ACE inhibitor (ACE-I) or Angiotensin Receptor Blocker 
(ARBs) for left ventricular systolic dysfunction
     Beta blocker at arrival
     Beta blocker prescribed at discharge
     Thrombolytic agent received within 30 minutes of hospital 
arrival
     Percutaneous Coronary Intervention (PCI) received within 
120 minutes of hospital arrival

[[Page 49667]]

     Adult smoking cessation advice/counseling
Heart Failure (HF)
     Left ventricular function assessment
     ACE inhibitor (ACE-1) or Angiotensin Receptor Blocker 
(ARBs) for left ventricular systolic dysfunction
     Discharge instructions
     Adult smoking cessation advice/counseling
Pneumonia (PNE)
     Initial antibiotic received within 4 hours of hospital 
arrival
     Oxygenation assessment
     Pneumococcal vaccination status
     Blood culture performed before first antibiotic received 
in hospital
     Adult smoking cessation advice/counseling
     Appropriate initial antibiotic selection
     Influenza vaccination status
Surgical Care Improvement Project (SCIP)
     Prophylactic antibiotic received within 1 hour prior to 
surgical incision
     Prophylactic antibiotics discontinued within 24 hours 
after surgery end time
    In order to receive the full FY 2007 IPPS update, hospitals are 
required to continue to collect data for all 10 starter set quality 
measures (or begin collecting such data, if newly participating in the 
program) and are required to provide a written pledge to submit data on 
the set of 21 expanded quality measures, in addition to completing 
several administrative tasks regarding quality reporting. All of the 
measures for the IPPS RHQDAPU program are to be reported on inpatient 
hospital discharges.
    We are proposing to employ our equitable adjustment authority under 
section 1833(t)(2)(E) of the Act to adapt the quality improvement 
mechanism provided by the IPPS RHQDAPU program for use in the OPPS. As 
we have discussed above, failure to account at all for quality in 
payment systems raises a fundamental issue of payment equity. In the 
absence of mechanisms that provide incentives for higher quality care, 
Medicare's payment systems can direct more resources to hospitals that 
do not deliver high quality care to Medicare beneficiaries.
    In this rule, we are proposing to initiate a Reporting Hospital 
Quality Data for Annual Payment Update under the OPPS, (OPPS RHQDAPU 
program) effective for payments beginning January 1, 2007. We propose 
to add a new Sec.  419.43(h) to our regulations to implement this 
proposal. Under proposed new Sec.  419.43(h)(1), we would initially 
implement an OPPS RHQDAPU program by reducing the OPPS conversion 
factor update in CY 2007 for those hospitals that are required to 
report quality data under the IPPS RHQDAPU program in order to receive 
the FY 2007 update, and fail to meet the requirements for receiving the 
full FY 2007 IPPS payment update. These hospitals would receive an 
update to the CY 2007 OPPS conversion factor that is reduced by 2.0 
percentage points. Under proposed Sec.  419.43(h)(2), any reduction 
would not affect a hospital's OPPS update in a subsequent calendar 
year. Hospitals that meet the IPPS RHQDAPU program's requirements for 
FY 2007 and receive the full IPPS annual payment update would also 
receive the full update to the conversion factor used to determine 
payments for CY 2007 under the OPPS.
    For this initial phase of implementing an OPPS RHQDAPU program in 
CY 2007, it will be necessary to provide an exception for certain 
hospital outpatient departments to the requirement that quality data be 
submitted under the IPPS RHQDAPU program in order to receive the full 
OPPS update. The quality data submission requirements of the IPPS 
RHQDAPU program apply only to ``subsection (d)'' hospitals. 
``Subsection (d)'' hospitals are defined under section 1886(d)(1)(B) of 
the Act as hospitals that are located in the fifty states or the 
District of Columbia other than those categories of hospitals or 
hospital units that are specifically excluded from the IPPS, including 
psychiatric, rehabilitation, long-term care, children's, and cancer 
hospitals or hospital units. In other words, the provision does not 
apply to hospitals and hospital units excluded from the IPPS, or to 
hospitals located in Puerto Rico or the U.S. territories. For the 
initial stage of implementing the OPPS RHQDAPU program in CY 2007, 
hospitals that are paid under the OPPS but that do not qualify as 
``subsection (d)'' hospitals will continue to receive the full update 
to the OPPS conversion factor. However, as we discuss below, our 
intention is to expand the OPPS RHQDAPU in the future program by 
requiring all hospitals that receive payment under the OPPS to 
participate in the program in order to receive a full update, by 
appropriate expansion, adaptation, and/or extension of quality 
performance measures and quality reporting mechanisms.
    We believe that it is fair and appropriate, for purposes of the 
initial phase of implementing an OPPS RHQDAPU program, to take timely 
and accurate reporting of IPPS RHQDAPU program quality measures into 
account under our equitable adjustment authority. We think that the 10 
original quality measures and the expanded set of 21 process measures 
as reported for inpatient discharges for heart attack, heart failure, 
pneumonia, and surgical care reflect the quality of care in the 
outpatient department as well as the inpatient hospital, so they are 
appropriate for initial use in the OPPS as specific measures are being 
developed to reflect the quality of care for hospital outpatients. We 
believe that hospitals generally function as integrated systems that 
provide health care services to patients in both inpatient and 
outpatient settings for many of the same clinical conditions, while 
recognizing the different typical levels of acuity in the two settings. 
Hospital quality measures for multiple conditions reflect, in part, the 
systems of care established by hospitals in the outpatient setting such 
as the emergency department. Therefore, the well-developed quality 
measures reported for the FY 2007 IPPS regarding inpatient hospital 
discharges should reasonably represent the quality of care provided to 
hospital outpatients, so we are proposing their interim use for the CY 
2007 OPPS while quality measures specific to hospital outpatients are 
being developed and refined. This use of multiple measures for several 
clinical conditions serves as a proxy for the quality of the systems of 
care established by hospitals. As we expand quality measurement for the 
hospital outpatient setting, we intend to move from measures that serve 
as proxies for the quality of care to actual performance measures for 
the outpatient setting. The discussion below focuses on the expanded 
list of 21 quality of care measures, as the 10 original measures 
continue to be included in the quality measurement expansion.
    There are 7 quality measures assessing the processes of care for 
patients presenting to the hospital with an acute myocardial 
infarction, focused on the care on arrival, the promptness of 
interventions, and discharge care. For the common urgent condition of a 
patient presenting to the hospital with chest pain that results in a 
clinical suspicion of acute myocardial infarction, in their effort to 
provide consistent, high quality care that is founded on evidence-based 
guidelines, hospitals often utilize clinical care pathways that are 
standardized for such patients presenting to the emergency room of the 
hospital. Such care pathways generally apply to patients with specific 
medical conditions who

[[Page 49668]]

present to the hospital initially as outpatients, regardless of their 
eventual discharge home from the outpatient department or inpatient 
admission. Thus, we believe that all 7 of these measures likely serve 
as reasonable proxies for the quality of care for patients presenting 
to the hospital outpatient department with chest pain related to a 
myocardial infarction, who commonly receive care along the continuum 
from outpatient to inpatient services in a hospital that provides such 
care in an integrated system.
    Similarly, there are 7 process measures related to the care of 
patients with pneumonia, who often present urgently to the hospital's 
emergency room with symptoms suggestive of the diagnosis of pneumonia. 
Because of the established clinical evidence regarding assessment and 
treatment activities that improve the quality of care for patients with 
pneumonia, most of the interventions that are measured, including 
oxygenation assessment, drawing of blood cultures, assessment of the 
patient's pneumococcal and influenza vaccine status, and selection and 
provision of an initial antibiotic in a timely manner, would generally 
be performed in the outpatient department, sometimes prior to a 
clinical decision about the patient's ultimate need for inpatient 
admission. In particular, the measures of vaccine status are quality 
measures that may be especially appropriate as hospital outpatient 
prevention measures. Their use in the hospital setting provides an 
opportunity for quality improvement in the hospital by encouraging 
assessment of immunization status and appropriate provision of 
immunizations, so we see no reason why their reporting on hospital 
inpatients is not also reflective of the quality of hospital outpatient 
care. While we acknowledge that in general the clinical picture of 
patients who are admitted to the hospital with pneumonia differs from 
that of patients who are not hospitalized, we expect there to be many 
common elements in their assessment, treatment, and counseling 
regarding the significance of smoking as the hospital provides their 
initial and subsequent care in the outpatient and/or inpatient 
settings. Therefore, we believe that all 7 of the measures related to 
the treatment of pneumonia are likely appropriately reflective of the 
quality of the care systems established by hospitals for outpatients 
with a diagnosis of pneumonia.
    There are 4 quality measures related to the treatment of patients 
with heart failure, including assessment of their cardiac function, use 
of certain medications in their treatment, counseling regarding smoking 
cessation, and provision of discharge instructions. Patients with heart 
failure, a common chronic medical condition, are seen frequently in 
hospital clinics and emergency departments with exacerbations of their 
symptoms. Once again, their initial treatment is often standardized and 
provided in the outpatient setting without consideration of their 
eventual discharge from the outpatient department or inpatient 
admission, a decision which ultimately depends on clinical 
considerations, including their response to treatment. Thus, we believe 
that all 4 of the inpatient quality measures regarding the treatment of 
patients with heart failure are reasonable surrogates for the quality 
of hospital systems of care for outpatients with heart failure.
    Likewise, under the expanded list of quality measures for the FY 
2007 IPPS the surgical infection prevention quality measures indicating 
the provision of a prophylactic antibiotic within 1 hour prior to 
surgical incision and prophylactic antibiotics discontinued within 24 
hours after surgery end time likely serve as a reasonable 
representation of the quality of surgical care for hospital 
outpatients. Many of the same surgical procedures are commonly 
performed on both hospital outpatients and inpatients, sometimes in the 
same operating room suites with attendance by the same clinical staff. 
Hospitals often have standardized protocols for providing antibiotics 
prior to surgery and postoperatively based on the types of procedures 
performed, rather than on the inpatient or outpatient status of the 
patient, and a decision to admit a patient may not even be made until 
after the completion of a procedure. Thus, we have no reason to believe 
that the preoperative and postoperative antibiotic experiences of a 
patient undergoing outpatient surgery would systemically vary from that 
of a hospital inpatient.
    In summary, we believe that quality improvement is usually a 
function of the entire institution as an integrated system that 
provides both inpatient and outpatient services to patients with an 
overlapping range of medical conditions. Quality improvement in a 
hospital inpatient department is likely to correlate with, and indeed 
to promote, similar quality improvement in the hospital's outpatient 
department and other sectors of the institution. Conversely, hospitals 
that fail to promote quality improvement in key sectors such as 
inpatient care are also unlikely to improve quality in the hospital 
outpatient department. We believe that the FY 2007 IPPS quality 
measures for multiple clinical conditions reflect the quality of 
hospitals' systems of care that customarily include key outpatient 
settings such as the emergency department. Therefore, as an interim 
measure while specific quality measures are being developed and refined 
for reporting on the quality of care to hospital outpatients, we are 
proposing that the initial CY 2007 OPPS RHQDAPU incorporate all of the 
quality measures that are applicable to the IPPS during FY 2007.
    We welcome public comments on the applicability to the OPPS of the 
various FY 2007 IPPS quality measures as proxies for the quality of 
care in hospital systems that include outpatient departments, with 
consideration of both the 10 starter set measures and the 11 new 
measures in the expanded set for FY 2007.
    Elsewhere in this proposed rule (section XXIII.), proposed 
additional quality measures for hospital reporting of quality data for 
the FY 2008 IPPS are discussed in detail. The proposed areas of 
expansion for the FY 2008 IPPS include the HCAHPS[supreg] survey, which 
incorporates questions measuring patients' perspectives on their 
hospital experiences; 3 additional measures related to the processes of 
surgical care to supplement the 2 initial Surgical Care Improvement 
Project (SCIP) measures to be implemented in FY 2007; and 3 risk-
adjusted assessments of mortality within 30 days of hospital admission 
for acute myocardial infarction, heart failure, and pneumonia. For the 
same reasons detailed above for the FY 2007 IPPS SCIP measures, we 
believe that the additional surgical process of care measures are a 
reasonable interim proxy for the quality of surgical care for hospital 
outpatients.
    In addition, the questions on the hospital HCAHPS[supreg] survey 
assess aspects of the patient's hospital experience, including 
communication with doctors and nurses, responsiveness of the staff, 
pain management, and discharge information. These areas of questioning 
are all relevant to a hospital's care for its outpatients, who may be 
treated in the hospital outpatient department for an extended period of 
time, particularly if they are in observation status or recovering from 
a significant surgical procedure. As described above, because hospitals 
generally function as integrated systems, with both inpatients and 
outpatients with related medical conditions passing through the same 
departments and interacting with similar staff, we believe that this 
survey of patients who have

[[Page 49669]]

been admitted to the hospital may reasonably reflect hospital 
outpatients' perspectives on their care experiences as well.
    Finally, with respect to the 30-day mortality measures, these 
measures are linked to the same 3 medical conditions for which quality 
process measures have already been implemented in the IPPS RHQDAPU 
program, in order to expand the quality data to more fully reflect the 
true outcomes of care. These mortality measures are risk-adjusted based 
on historical medical care use, including inpatient and outpatient 
hospital care and physician offices visits, and reflect outcomes of 
care specifically for Medicare patients. Since we are proposing that 
the full set of FY 2007 IPPS process of care quality measures are 
acceptable proxies for the quality of care to hospital outpatients as 
previously discussed, and we believe that some of the value of health 
care process measures is their relative ease of measurement and their 
ultimate relationship to health outcomes, we believe that the 30-day 
mortality measures for inpatients may also reflect the quality of care 
to hospital outpatients with the same medical conditions. In addition, 
in view of the common clinical courses of acute myocardial infarction, 
heart failure, and pneumonia in Medicare beneficiaries, it is highly 
likely that hospital outpatient services may be provided to previously 
hospitalized patients within the measures' timeframe of 30 days after 
hospital discharge, thereby contributing to their care and health 
outcomes.
    Therefore, our intention is to adopt the full set of FY 2008 IPPS 
quality measures as proposed for the CY 2008 OPPS RHQDAPU program, 
while we continue to develop a set of specific quality measures for 
hospital outpatient care.
    We welcome public comments on the applicability of the FY 2008 IPPS 
additional quality measures that are proposed in this rule to the care 
of hospital outpatients. We also welcome public comments on alternative 
measures of quality of care, including measures of the cost or 
efficiency of care, that are suitable for adoption to reduce the 
incidence of lower-quality and high-cost outpatient hospital care for 
Medicare beneficiaries. We will formalize our proposal regarding the CY 
2008 OPPS RHQDAPU program in the CY 2008 OPPS proposed rule, which may 
include proposing to adopt none, some, or all of the FY 2008 IPPS 
RHQDAPU measures, and may also reflect quality measures that are 
discussed in comments on this proposed rule.
    For purposes of computing the update to the conversion factor under 
the OPPS in CY 2007, therefore, we are proposing to reduce the update 
to the OPPS conversion factor by 2.0 percentage points for any hospital 
that is eligible to participate in the IPPS RHQDAPU program, but that 
has had its IPPS payment update reduced because it failed to comply 
with that program's requirements. Under this proposal, hospitals that 
fail to qualify for the full CY 2007 OPPS update would receive payments 
based on a conversion factor of $60.36, reflecting an update of 1.4 
percent, in place of the conversion factor of $61.551 reflecting the 
full update of 3.4 percent.
    Under proposed Sec.  419.43(h)(1), in order to avoid reduction to 
the CY 2007 OPPS update, hospitals that are eligible to participate in 
the IPPS RHQDAPU program must meet the requirements for receiving the 
full IPPS update for FY 2007. Updated procedures and requirements for 
the IPPS RHQDAPU program are included in the FY 2007 IPPS final rule. 
In addition to publication in the final rule, all revised procedures 
will be added to the ``Reporting Hospital Quality Data for Annual 
Payment Update Reference Checklist'' section of the QualityNet Exchange 
Web site (www.qnetexchange.org). For purposes of determining which 
hospitals have not qualified to receive the full update under the OPPS 
for CY 2007, we will follow the determination for FY 2007 full IPPS 
payment update eligibility under the IPPS RHQDAPU program. These 
determinations will be released on or about September 1, 2006.
    As we noted above, we are undertaking this initiative under the 
authority granted by section 1833(t)(2)(E) of the Act, which authorizes 
the Secretary to ``establish, in a budget neutral manner, * * * 
adjustments as determined to be necessary to ensure equitable 
payments'' under the OPPS. Proposed Sec.  419.43(h)(3) provides that 
the reduction to the CY 2007 update that we will implement for 
hospitals that fail to meet the requirements described above will be 
implemented in a budget neutral manner. Therefore, if we determine that 
some hospitals will receive a reduced update for CY 2007 as a result of 
failure to meet the requirements established under this initial phase 
of the OPPS RHQDAPU program, we will also make an adjustment to the 
OPPS conversion factor, so that estimated aggregate payments under the 
OPPS for CY 2007, taking into account the reduced update for some 
hospitals, equal the aggregate payments that we estimate would have 
been made in CY 2007 if all hospitals received the full update to the 
conversion factor. As we noted above, determinations concerning which 
hospitals fail to meet the requirements for receiving the full update 
to the OPPS conversion factor in CY 2007 will be available on or about 
September 1, 2006. We are therefore unable at this time to determine 
how many hospitals will receive a reduced update in CY 2007, or to 
determine the budget neutrality adjustment factor that will be 
necessary to ensure that estimated aggregate payments under the OPPS 
for CY 2007 do not change as a result of implementing the proposed OPPS 
RHQDAPU program. However, very few hospitals have failed to qualify for 
the full annual updates under the IPPS RHQDAPU program. We therefore 
anticipate that any further adjustment to the CY 2007 conversion factor 
to satisfy the budget neutrality requirement under section 
1833(t)(2)(E) of the Act will be negligible.
    It is not our intention to maintain the specific requirements 
described above beyond a short initial phase of implementing an OPPS 
RHQDAPU program. Rather our intention is to develop this program beyond 
its initial stage in at least two ways. As we have stated previously, 
we believe that it is appropriate and fair during this initial phase of 
the OPPS RHQDAPU program, to take quality data reporting under the IPPS 
RHQDAPU program into consideration for purposes of determining the 
update for hospitals under the OPPS. However, it will be important for 
a fully developed OPPS RHQDAPU program to be based on reporting 
measures that are defined in terms of the quality considerations that 
are most appropriate and applicable in the hospital outpatient setting. 
In collaboration with health care stakeholders, we intend to begin work 
on a set of quality and cost of care measures specific to hospital 
outpatient departments for implementation in a later phase of the OPPS 
RHQDAPU program. We intend to implement a hospital outpatient-specific 
set of such quality and cost of care measures at the earliest possible 
date. Reporting of a more fully developed, outpatient-specific set of 
quality and cost of care measures may be effective for purposes of 
determining the update as early as CY 2009. However, in implementing 
the system we will allow adequate time for development of the 
appropriate measures; announcement of the quality and cost of care 
measures we have selected; consideration of comments from the hospital 
community, patient

[[Page 49670]]

advocates, and other stakeholders; establishment of the requisite 
mechanisms for reporting the measure; and initiation of actual 
reporting of the measures by hospitals. As we begin to develop such a 
set of hospital outpatient-specific quality and cost of care measures, 
we welcome comments on this issue.
    Specifically, we invite comments on the following (and related) 
questions: Which current quality and cost of care measures, such as 
IPPS quality measures (especially the measure set as expanded under the 
DRA), physician practice measures, HCAHPS[supreg]/ACAHPS[supreg], etc., 
are most applicable in the hospital outpatient setting? What would be 
the characteristics of an ideal measure set of quality and cost of care 
measures for the outpatient setting? What quality and cost of care 
measures are currently available for the outpatient setting? What 
privately-led organizations or alliances are best suited to conduct 
needed development and consensus endorsement of outpatient quality 
measures?
    As we discussed above, for the initial stage of implementing the 
OPPS RHQDAPU program in CY 2007, hospitals that are paid under the OPPS 
but that do not qualify as ``subsection (d)'' hospitals will receive 
the full update to the OPPS conversion factor. However, we believe that 
it is essential to expand the requirements of the OPPS RHQDAPU program 
that we are proposing to all hospital outpatient departments paid under 
the OPPS. We will therefore also undertake to study, for CYs 2008 and 
beyond, approaches to adapting and expanding the current quality and 
cost of care measures under the IPPS RHQDAPU program for use in 
reporting on the quality of outpatient care in hospitals that are paid 
under the OPPS but that do not qualify as ``subsection (d)'' hospitals. 
We will also begin development of mechanisms by which these hospitals 
can report the requisite quality data in a timely and effective manner. 
We welcome comments on ways in which we can expand the proposed OPPS 
RHQDAPU program to all hospital outpatient departments that are paid 
under the OPPS, and on quality and cost of care measures that are 
specifically appropriate for reporting by hospital outpatient 
departments paid under the OPPS but that do not qualify as ``subsection 
(d)'' hospitals.
    Our ultimate goal is implementation of an OPPS RHQDAPU program that 
extends to all hospital outpatient departments that are paid under the 
OPPS, that is based on a set of quality and cost of care reporting 
measures that are specific to the hospital outpatient setting, and that 
is appropriately aligned with developments in quality reporting and 
value-based purchasing in other payment systems such as the IPPS. We 
will take into consideration issues related to the appropriate 
alignment of quality and cost of care reporting and value-based 
purchasing under the IPPS and OPPS during the planning process mandated 
by section 5001(b) of the DRA for implementation of inpatient value-
based purchasing by FY 2009. We plan to include all hospital services, 
whether inpatient or outpatient, in the report on implementation of 
value-based purchasing. We have often heard from stakeholders that a 
more comprehensive, systematic approach to quality should be our focus. 
Quality reporting of inpatient and outpatient services is consistent 
with such comments, and will provide more comprehensive information 
about the quality of services provided by hospitals. We specifically 
request comments on the alignment of scope and other issues that should 
be considered during this planning process, including quality and cost 
of care reporting measures, data and program infrastructure, 
incentives, and public reporting of quality and cost of care measures 
under value-based purchasing.
    Finally, we request comments on the most effective use of our 
authority under section 1833(t)(2)(E) of the Act, in light of the 
concerning evidence of rapid and uneven payment growth in the OPPS with 
limited evidence of patient benefit. In particular, commenters who 
believe that the proposed quality reporting initiative is not the most 
effective use of this authority should consider submitting comments on 
alternative, more effective approaches to using this and related 
authorities available to CMS under the Act to promote higher quality, 
more equitable care. We do not believe that the status quo, with rapid 
and uneven growth in spending and limited evidence of its value, is 
consistent with a sustainable hospital outpatient payment program and 
affordable health care for Medicare beneficiaries, and we expect to 
take further steps to address this important concern. As we have noted 
elsewhere, continuing rapid growth in Medicare spending that is not 
addressed by effective payment reforms often results in across-the-
board reductions in payment rates. In addition, we seek comment on 
whether section 1833(t)(2)(F) of the Act also supports the proposed use 
of quality reporting to determine a hospital's update under the OPPS.

XXI. Promoting Effective Use of Health Information Technology

    (If you choose to comment on issues in this section, please include 
the caption ``Health Information Technology'' at the beginning of your 
comment.)
    We recognize the potential for health information technology (HIT) 
to facilitate improvements in the quality and efficiency of health care 
services. One recent RAND study found that broad adoption of electronic 
health records could save more than $81 billion annually and, at the 
same time, improve quality of care.\5\ The largest potential savings 
that the study identified was in the hospital setting because of 
shorter hospital stays promoted by better coordinated care; less 
nursing time spent on administrative tasks; better use of medications 
in hospitals; and better utilization of drugs, laboratory services, and 
radiology services in hospital outpatient settings. The study also 
identified potential quality gains through enhanced patient safety, 
decision support tools for evidence-based medicine, and reminder 
mechanisms for screening and preventive care. Despite such large 
potential benefits, the study found that only about 20 to 25 percent of 
hospitals have adopted HIT systems.
---------------------------------------------------------------------------

    \5\ RAND News Release: RAND Study Says Computerizing Medical 
Records Could Save $81 Billion Annually and Improve the Quality of 
Medical Care, September 14, 2005, available at: http://rand.org/news/press.05/09.14.html.
---------------------------------------------------------------------------

    It is important to note the caveats to the RAND study. The 
projected savings are across the health care sector, and any Federal 
savings would be a reduced percentage. In addition, there are 
significant assumptions made in the RAND study. National savings are 
projected in some cases based on one or two small studies. Also, the 
study assumes patient compliance, in the form of participation in 
disease management programs and following medical advice. For these 
reasons, extreme caution should be used in interpreting these results.
    In summary, there are mixed signals about the potential of HIT to 
reduce costs. Some studies have indicated that HIT adoption does not 
necessarily lead to lower costs and improved quality. In addition, some 
industry experts have stated that factors such as an aging population, 
medical advances, and increasing provider expenses would make any 
projected savings impossible.

[[Page 49671]]

    In his 2004 State of the Union Address, President Bush announced a 
plan to ensure that most Americans have electronic health records 
within 10 years.\6\ One part of this plan involves developing voluntary 
standards and promoting the adoption of interoperable HIT systems that 
use these standards. The 2007 Budget states that ``The Administration 
supports the adoption of health information technology (IT) as a normal 
cost of doing business to ensure patients receive high quality care.''
---------------------------------------------------------------------------

    \6\ Transforming Health Care: The President's Health Information 
Technology Plan, available at: http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html.
---------------------------------------------------------------------------

    Over the past several years, CMS has undertaken several activities 
to promote the adoption and effective use of HIT in coordination with 
other Federal agencies and with the Office of the National Coordinator 
for Health Information Technology. One of those activities is promotion 
of data standards for clinical information, as well as for claims and 
administrative data. In addition, through our 8th Scope of Work 
contract with the QIOs, we are offering assistance to hospitals on how 
to adopt and redesign care processes to effectively use HIT to improve 
the quality of care for Medicare beneficiaries, including computerized 
physician order entry (CPOE) and bar coding systems. Finally, our 
Premier Hospital Quality Incentive Demonstration provides additional 
financial payments for hospitals that achieve improvements in quality, 
which effective HIT systems can facilitate.
    We are considering the role of interoperable HIT systems in 
increasing the quality of hospital services while avoiding unnecessary 
costs. As noted above, the Administration supports the adoption of HIT 
as a normal cost of doing business. While payments under the OPPS do 
not vary depending on the adoption and use of HIT, hospitals that 
leverage HIT to provide better quality services may more efficiently 
reap the reward of any resulting cost savings. In addition, the 
adoption and use of HIT may contribute to improved processes and 
outcomes of care, including shortened hospital stays and the avoidance 
of adverse drug reactions. We are seeking comments on our statutory 
authority to encourage the adoption and use of HIT. We also are seeking 
comments on the appropriate role of HIT in any value-based purchasing 
program, beyond the intrinsic incentives of the OPPS, to provide 
efficient care, encourage the avoidance of unnecessary costs, and 
increase quality of care. In addition, we are seeking comments on 
promotion of the use of effective HIT through hospital conditions of 
participation, perhaps by adding a requirement that hospitals use HIT 
that is compliant with and certified in its use of the HIT standards 
adopted by the Secretary. We anticipate that the American Health 
Information Community will provide advice to the Secretary on these 
issues.

XXII. Health Care Information Transparency Initiative

    (If you choose to comment on issues in this section, please include 
the caption ``Transparency of Health Care Information'' at the 
beginning of your comment.)
    The United States (U.S.) faces a dilemma in health care. Although 
the rate of increase in health care spending slowed last year, costs 
are still growing at an unsustainable rate. The U.S. spends $1.9 
trillion on health care, or 16 percent of the gross domestic product 
(GDP). By 2015, projections are that health care will consume 20 
percent of GDP. The Medicare program alone consumes 3.4 percent of the 
GDP; by 2040, it will consume 8.1 percent of the GDP and by 2070, 14 
percent of the GDP.
    Part of the reason health care costs are rising so quickly is that 
most consumers of health care--the patients--are frequently not aware 
of the actual cost of their care. Health insurance shields them from 
the full cost of services, and they have only limited information about 
the quality and costs of their care. Consequently, consumers do not 
have the incentive or means to carefully shop for providers offering 
the best value. Thus, providers of care are not subject to the 
competitive pressures that exist in other markets for offering quality 
services at the best possible price. Reducing the rate of increase in 
health care prices and avoiding health services of little value could 
help to stem the growth in health care spending, and potentially reduce 
the number of individuals who are unable to afford health insurance. 
Part of the President's health care agenda is to expand Health Savings 
Accounts (HSAs), which would provide consumers with greater financial 
incentives to compare providers in terms of price and quality, and 
choose those that offer the best value.
    In order to exercise those choices, consumers must have accessible 
and useful information on the price and quality of health care items 
and services. Typically, health care providers do not publicly quote or 
publish their prices. Moreover, list prices, or charges, generally 
differ from the actual prices negotiated and paid by different health 
plans. Thus, even if consumers were financially motivated to shop for 
the best price, it would be very difficult at the current time for them 
to access usable information.
    For these reasons, DHHS is launching a major health care 
information transparency initiative in 2006. This effort builds on 
steps taken by CMS to make quality and price information available. For 
example, Medicare has provided unprecedented information about drug 
prices in the Medicare drug benefit, and is now adding to these efforts 
in other areas. We recently posted Medicare payment information for 
common elective procedures and other common admissions for all 
hospitals by county on our Web site at http://www.cms.hhs.gov/HealthCareConInit/01_Overview.asp#TopOfPage. We will post 
geographically-based Medicare payment information for common elective 
procedures for ambulatory surgery centers this summer and for common 
hospital outpatient and physician services this fall.
    In addition, a number of tools providing usable health care 
information are already available to Medicare beneficiaries. Consumers 
can access ``Compare'' Web sites through http://www.medicare.gov where 
they can evaluate important aspects of their health care options for 
care at a hospital, nursing home, home health agency, and dialysis 
facility, as well as compare their costs and coverage when choosing a 
prescription drug plan.
    CMS is developing a transparency initiative with the goals of 
providing more comprehensive information on quality and costs, 
including more complete measures of health outcomes, satisfaction, and 
volume of services that matter to consumers, and more comprehensive 
measures of costs for entire episodes of care, not just payments for 
particular services and admissions. We intend for the project to 
combine public and private health care data to provide cost and quality 
of care information at the physician and hospital levels. Quality, 
cost, pricing, and patient information will be reported to consumers 
and purchasers of health care in a meaningful and transparent way. In 
addition, we anticipate the project will provide a national template 
for performance measures and a payment structure that aligns payment 
and performance.

[[Page 49672]]

XXIII. Additional Quality Measures and Procedures for Hospital 
Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update

    (If you choose to comment on issues in this section, please include 
the caption ``FY 2008 IPPS RHQDAPU'' at the beginning of your 
comments.)

A. Background

    Section 5001(a) of the Deficit Reduction Act of 2005 (DRA) (Pub. L. 
109-171) sets out new requirements for the IPPS Reporting Hospital 
Quality Data for Annual Payment Update (RHQDAPU) program. The IPPS 
RHQDAPU program was established to implement section 501(b) of the 
Medicare Prescription Drug, Improvement and Modernization Act of 2003 
(MMA) (Pub. L. 108-173). It builds on our ongoing voluntary Hospital 
Quality Initiative which is intended to empower consumers with quality 
of care information to make more informed decisions about their health 
care while also encouraging hospitals and clinicians to improve the 
quality of care.
    Section 5001(a) of Pub. L. 109-171 revises the mechanism used to 
update the standardized amount for payment for hospital inpatient 
operating costs. New sections 1886(b)(3)(B)(viii)(I) and (II) of the 
Act provide that the payment update for FY 2007 and each subsequent 
fiscal year will be reduced by 2.0 percentage points for any 
``subsection (d) hospital'' that does not submit certain quality data 
in a form and manner, and at a time, specified by the Secretary. Under 
sections 1886(b)(3)(B)(viii)(III) and (IV) of the Act, we must expand 
the ``starter set'' of quality measures that we have used since FY 
2005, and to begin to adopt the baseline set of performance measures as 
set forth in a 2005 report issued by the Institute of Medicine of the 
National Academy of Sciences (IOM) under section 238(b) of the MMA, 
effective for payments beginning with FY 2007. The 2005 IOM report's 
``baseline'' quality measures include Hospital Quality Alliance (HQA)-
approved clinical quality measures, the Hospital Consumer Assessment of 
Healthcare Providers and Systems (HCAHPS[supreg]) patient perspective 
survey, and three structural measures. The structural measures are: (1) 
Implementation of computerized provider order entry for prescriptions, 
(2) staffing of intensive care units with intensivists, and (3) 
evidence-based hospital referrals. These measures originate from the 
Leapfrog Group's original ``three leaps,'' and are part of the NQF's 30 
safe practices.
    In 2002, the Secretary of HHS initiated a partnership with several 
collaborators intended to promote hospital quality improvement and 
public reporting of hospital quality information. This collaboration is 
known as the Hospital Quality Alliance (HQA). The collaborators include 
the American Hospital Association, the Federation of American 
Hospitals, the Association of American Medical Colleges, the Joint 
Commission on Accreditation of Healthcare Organizations (JCAHO), the 
National Quality Forum (NQF), the American Medical Association, the 
Consumer-Purchaser Disclosure Project, the American Association of 
Retired Persons, the American Federation of Labor Congress of 
Industrial Organizations, the Agency for Healthcare Research and 
Quality, as well as CMS, Quality Improvement Organizations (QIOs), and 
others.
    In the FY 2007 IPPS proposed rule, we proposed to add to our 10-
measure ``starter set'' of quality measures, 11 HQA-approved measures 
for purposes of the FY 2007 update (71 FR 24093).
    Under section 1886(b)(3)(B)(viii)(V) of the Act, for payments 
beginning with FY 2008, we are required to add other measures that 
reflect consensus among affected parties and, to the extent feasible 
and practicable, must include measures set forth by one or more 
national consensus building entities.
    Commenters on the FY 2007 IPPS proposed rule requested that we 
notify the public as far in advance as possible of any proposed 
expansions of the measure set and program procedures to encourage broad 
collaboration and to give hospitals time to prepare for any anticipated 
changes. Other commenters requested that we adopt additional quality 
measures and that we do as soon as feasible. For example, several 
commenters urged that we adopt the HCAHPS[supreg] patient survey as a 
part of the IPPS RHQDAPU program, while others suggested that we adopt 
more of the IOM measures as well as more outcome measures, including 
mortality measures that were not included in the 2005 IOM report's 
``baseline'' quality measures. In response to these comments and as 
part of our continuing efforts to strengthen the IPPS RHQDAPU program, 
we are seeking comments on this proposal to expand, for FY 2008, the 
measurement set beyond those measures we proposed to adopt for purposes 
of the FY 2007 update. This proposed expanded set would further broaden 
the scope of the IPPS RHQDAPU program by including the HCAHPS[supreg] 
patients' perspectives of care measures as well as surgical care and 
mortality outcome measures.

B. Proposed Additional Quality Measures for FY 2008

1. Introduction
    For FY 2008, we propose to add the following categories to the 
measure set:
     HCAHPS[supreg] Survey
    HCAHPS[supreg] is also known as Hospital CAHPS or the CAHPS 
Hospital Survey. The HCAHPS[supreg] survey is composed of the following 
27 questions:
    + 18 substantive questions that measure critical aspects of the 
hospital experience (communication with doctors; communication with 
nurses; responsiveness of hospital staff; cleanliness and quietness of 
hospital environment; pain management; communication about medicines; 
and discharge information).
    + 4 questions that direct patients to complete only those survey 
questions that apply to them.
    + 3 questions to be used to adjust the mix of patients across 
hospitals.
    + 2 questions that support Congressionally-mandated reports, the 
``National Healthcare Disparities Report,'' and the ``National 
Healthcare Quality Report.''
     Surgical Care Improvement Project (SCIP)
    + SCIP-VTE 1: Venous thromboembolism prophylaxis ordered for 
surgery patient
    + SCIP-VTE 2: VTE prophylaxis within 24 hours pre/post surgery
    + SCIP Infection 2: Prophylactic antibiotic selection for surgical 
patients
     Mortality
    + AMI 30-day mortality--Medicare patients
    + HF 30-day mortality--Medicare patients
    + Pneumonia 30-day mortality--Medicare patients
    We discuss these proposed measures in detail below.
2. HCAHPS[supreg] Survey and the Hospital Quality Initiative
    We have partnered with the Agency for Healthcare Research and 
Quality (AHRQ), another HHS agency, to develop HCAHPS[supreg]. The 
intent of the HCAHPS[supreg] initiative is to provide a standardized 
survey instrument and data collection methodology for measuring 
patients' perspectives of hospital care. While many hospitals currently 
collect information on patients' satisfaction with care, there is 
currently no national standard for collecting or publicly reporting 
this information that would enable valid comparisons to be made across 
hospitals. To make the appropriate comparisons to support consumer 
choice, we believe it is necessary to

[[Page 49673]]

introduce a standard measurement approach. HCAHPS[supreg] can be viewed 
as a core set of questions that can be combined with a broader, 
customized set of hospital-specific items. HCAHPS[supreg] is intended 
to complement the data hospitals currently collect to support 
improvements in internal customer services and quality related 
initiatives within the hospital.
    Three broad goals have shaped HCAHPS[supreg]. The survey is 
designed to produce data on the patient's perspective on care that 
allows objective and meaningful comparisons between hospitals on issues 
that are important to consumers. In addition, public reporting of the 
survey results is designed to create incentives for hospitals to 
improve their quality of care. Also, public reporting will serve to 
enhance public accountability in health care by increasing the 
transparency of the quality of hospital care provided in return for the 
public investment. With these goals in mind, the HCAHPS[supreg] 
initiative has taken substantial steps to assure that the survey will 
be credible, useful, and practical.
    Throughout the HCAHPS[supreg] development process, AHRQ and CMS 
have solicited and received a great deal of public input. AHRQ 
published a Federal Register notice that called for measures in July 
2002 (67 FR 48477) and we solicited input on drafts of the 
HCAHPS[supreg] instrument and its implementation strategy (February 
2003, June 2003, and December 2003--68 FR 5889, 68 FR 38346, 68 FR 
68087). In addition to the public comments received, results from a 3-
State Pilot Study were used to reduce the pool of 66 survey questions 
to 25 questions.
    In addition to the development and review processes, we submitted 
the 25-item version of the HCAHPS[supreg] instrument to the NQF. The 
NQF is a voluntary consensus standard-setting organization established 
to standardize health care quality measurement and reporting for its 
review and endorsement through its consensus development process. NQF 
endorsement represents the consensus of numerous health care providers, 
consumer groups, professional associations, purchasers, Federal 
agencies, and research and quality organizations. Following a thorough, 
multi-stage review process, HCAHPS[supreg] was endorsed by the NQF 
board in May 2005. In the process, NQF recommended a few modifications 
to the instrument. As a result of the recommendations of the NQF 
Consensus Development Process, questions regarding courtesy and respect 
were added to the survey. The NQF review committee believes that these 
questions are important to all patients, and may be particularly 
meaningful to patients who are members of racial and ethnic minority 
groups. Upon the recommendation of the NQF, we further examined the 
costs and benefits of the 27-item HCAHPS[supreg] survey. This cost-
benefit analysis of HCAHPS[supreg] was conducted by Abt Associates, 
Inc. The report of this analysis can be found at http://www.cms.hhs.gov/HospitalQualityInits/downloads/HCAHPSCostsBenefits200512.pdf. 
    We published a Federal Register notice soliciting comments on the 
draft 27-item HCAHPS[supreg] Survey in November 2005 (70 FR 67476). The 
HCAHPSreg; survey received approval by the Office of Management and 
Budget (OMB) on December 22, 2005.
    Shortly thereafter, we began final preparations for the voluntary 
national implementation (as a part of the Hospital Quality Initiative) 
with the support of the HQA. The HQA is a private/public partnership 
that includes the American Hospital Association, the Federation of 
American Hospitals, the Association of American Medical Colleges, 
JCHAO, NQF, American Association of Retired Persons (AARP), CMS, AHRQ, 
and other stakeholders who share a common interest in reporting on 
hospital quality. The HQA has been proactive in making performance data 
on hospitals accessible to the public, thereby improving patient care.
    We also offered training sessions for hospitals self-administering 
the survey and survey vendors acting on behalf of hospitals in February 
and April 2006. Since HCAHPS[supreg] was a new initiative, we decided 
that it was critical to hospitals, survey vendors, and CMS to acquire 
first-hand experience with data collection, including sampling and data 
submission to the QualityNet Exchange, prior to collecting data for 
public reporting. For hospitals participating in the national 
implementation of HCAHPS[supreg] on October 1, 2006, we required 
participation in a short dry run period of at least one month. A 
hospital could choose to sample and survey discharges in April, May, 
and/or June 2006. Data from this ``dry run'' are not publicly reported.
    National implementation begins October 2006 for this first set of 
hospitals and survey vendors that will be participating in the 
HCAHPS[supreg] voluntary initiative The initial public reporting period 
will cover nine months of patient discharges (October 2006 through June 
2007). In late 2007, hospital results will be publicly reported on the 
CMS Hospital Compare Web site (http://www.hospitalcompare.hhs.gov). 
After the initial implementation, the Web site will contain 12 months 
of HCAHPS[supreg] data and will be updated quarterly.
    The HCAHPS[supreg] survey is currently available in English and 
Spanish. During the HCAHPS[supreg] dry run and initial national 
implementation (discussed more fully below), we will be soliciting 
comments from participating hospitals and survey vendors regarding 
additional languages for HCAHPS[supreg]. This information can be 
submitted to our HCAHPS[supreg] mailbox, [email protected]. 
From the information we receive, we will establish priorities for 
HCAHPS translation into additional languages.
    In order for the remaining hospitals to participate in 
HCAHPS[supreg], future training sessions for hospital personnel and 
survey vendors will take place in early 2007. Hospitals may choose to 
self-administer HCAHPS[supreg], or may choose to hire a vendor who has 
completed the training. A brief dry run of March 2007 discharges will 
allow newly participating hospitals and vendors to get ``first-hand'' 
experience with all phases of the data collection and submission 
process. Details about the HCAHPS[supreg] requirements, and the 
additional requirements proposed for HCAHPS[supreg] under the IPPS 
RHQDAPU program, are included in section XXIII.C. and XXIII.D. of this 
preamble.
3. Surgical Care Improvement Project (SCIP) Quality Measures
    The Surgical Care Improvement Project (SCIP) is a national quality 
partnership of organizations committed to improving the safety of 
surgical care through the reduction of post-operative complications. 
The primary goal of the partnership is to save lives by reducing the 
incidence of surgical complications by 25 percent by the year 2010. 
Partners in SCIP believe that a meaningful reduction in complications 
requires a systems approach to our challenges, which means that 
surgeons, anesthesiologists, primary care physicians and internal 
medicine specialists, perioperative nurses, pharmacists, infection 
control professionals, and hospital executives must work together to 
make surgical care improvement a priority. SCIP partners coordinate 
their efforts through a steering committee that includes 
representatives of the American Hospital Association, the American 
College of Surgeons, the American Society of Anesthesiologists, the 
Association of Perioperative Registered Nurses, the JCAHO, the 
Institute of Healthcare Improvement, the

[[Page 49674]]

Department of Veterans Affair (VA), the Agency for Healthcare Research 
and Quality (AHRQ), CMS and the Centers for Disease Control and 
Prevention (CDC).
    SCIP is a comprehensive program, integrated into the quality 
improvement agenda of the CMS, JCAHO, the CDC, the American College of 
Surgeons, the Veterans Health Administration, as well as the other 
organizations that comprise the SCIP Steering Committee. There are a 
number of activities underway from these and other partnering 
organizations.
4. Mortality Outcome Measures
    CMS recognizes that the current set of hospital performance 
measures should be expanded to more fully reflect outcomes of care. The 
30-day mortality measures for patients with acute myocardial infarction 
(AMI), heart failure (HF) and pneumonia are three separate claims-
based, risk-adjusted assessments of mortality within 30 days of 
admission for each of the three conditions. The measures reflect 
outcomes of care for Medicare patients only, and rely on Medicare 
patients' historical medical care use, including inpatient and 
physician office visits and outpatient care 1 year before their 
hospitalizations, for the risk adjustment calculation.
    The 30-day mortality rate measures for AMI and HF were endorsed by 
the NQF in 2005 (see http://www.qualityforum.org/news/tb3Hospspecsforweb02-10-06.pdf). We anticipate that the 30-day 
mortality rate measure for pneumonia will also be endorsed by the NQF 
since it reflects the same underlying methodology as the other 30-day 
mortality measures.
    In contrast to the HCAHPS[supreg] and SCIP quality measures added 
to the measure set for FY 2008, no additional data collection from 
hospitals will be required to calculate the 30-day mortality measures. 
All three measures can be calculated based on Medicare inpatient and 
outpatient claims data that are already reported to the Medicare 
program for payment purposes. We anticipate that we will conduct a 
national dry run for the AMI and HF measures in late 2006 to test 
implementation and educate hospitals on the methodology. During this 
dry run, hospitals will be given the opportunity to examine their rates 
and other data associated with the measures, and to provide feedback to 
CMS on questions related to the calculation of the rates. The rates 
that will be developed for the dry run will be used for quality 
improvement purposes and will not be publicly reported to the Hospital 
Compare. More information about the dry run will be provided to 
hospitals through QualityNet Exchange Web site (http://www.qnetexchange.org).
    We expect to calculate and publicly report 30-day mortality rates 
for the AMI and HF conditions in the June 2007 update of the Hospital 
Compare Web site. Rates for the 30-day pneumonia mortality measure will 
be posted as soon as possible after we receive NQF endorsement. As is 
currently the case for the other measures, hospitals will be provided a 
30-day period in which they will be permitted to preview their rates 
before publication. As is currently the case for the ``starter set'' 
measures, hospitals that have pledged to submit data for full annual 
payment update for FY 2008 will not be permitted to suppress or 
withhold publication of the rates on the Hospital Compare Web site, 
except under highly limited circumstances.

C. General Procedures and Participation Requirements for the FY 2008 
IPPS RHQDAPU Program

    All revised procedures for FY 2008 also will be added to the 
``Reporting Hospital Quality Data for Annual Payment Update Reference 
Checklist'' section of the QualityNet Exchange Web site. This checklist 
also links to all of the forms to be completed by hospitals 
participating in the program.
    To participate in the RHQDAPU program, we are proposing that 
hospitals must follow these steps:
     Complete all registration steps; this information can be 
found on ``Reporting Hospital Quality Data for Annual Payment Update 
Reference Checklist'' located on the QualityNet Exchange Web site.
     Continue to collect data for all clinical quality measures 
that are currently part of the RHQDAPU program, and submit the data to 
the QIO Clinical Warehouse either using the CMS Abstraction & Reporting 
Tool (CART), the JCAHO ORYX[supreg] Core Measures Performance 
Measurement System, or another third-party vendor tool that has met 
specification requirements for data transmission to QualityNet 
Exchange. The submission must be done through QualityNet Exchange. 
Because the information in the QIO Clinical Warehouse is considered QIO 
information, it is subject to the stringent QIO confidentiality 
regulations in 42 CFR Part 480.
    In addition, for purposes of the annual payment update, we will 
continue to require hospitals to pass our validation requirements. We 
originally set forth these requirements in the FY 2006 IPPS final rule 
(70 FR 47421), and we will continue to require that hospitals achieve 
an 80-percent reliability. We will also continue to post information 
related to validation requirements on the QualityNet Exchange Web site.
    In addition to these general procedures, the specific procedures 
below apply to these proposed additional measures.

D. HCAHPS[supreg] Procedures and Participation Requirements for the FY 
2008 IPPS RHQDAPU Program

1. Introduction
    Under sections 1886(b)(3)(B)(viii)(III) and (IV) of the Act, CMS 
must begin to adopt the baseline set of performance measurements as set 
forth in a 2005 report issued by the Institute of Medicine (IOM) of the 
National Academy of Sciences under section 238(b) of Pub. L. 108-173, 
effective for payments beginning with FY 2007. The 2005 IOM report 
recommends that we expand the ``starter'' measures by including the 
HCAHPS[supreg] patient perspective survey. We began to adopt the IOM 
measures in the FY 2007 IPPS final rule, in which we adopted 11 
additional HQA-approved quality measures. In this proposed rule, we are 
proposing to expand the set of IOM measures hospitals will be required 
to report to receive the full IPPS market basket update for FY 2008. In 
addition, section 1886(b)(3)(B)(viii)(V) of the Act states that 
effective for payments beginning with FY 2008, we must add ``other 
measures that reflect consensus among affected parties and, to the 
extent feasible and practicable,'' include ``measures set forth by one 
or more national consensus building entities.'' Accordingly, we are 
proposing to add additional SCIP quality and measures and three 30-day 
mortality measures.
2. HCAHPS[supreg] Hospital Pledge and Beginning Date for Data 
Collection
    Under the FY 2008 RHQDAPU program, we are proposing that hospitals 
will need to submit HCAHPS[supreg] data to the QIO Clinical Warehouse 
beginning with discharges that occur in the third calendar quarter of 
2007 (July through September discharges). In order to meet 
HCAHPS[supreg] requirements for the RHQDAPU program, we are proposing 
that all hospitals, including hospitals new to HCAHPS[supreg] and 
hospitals that have been collecting data since October 1, 2006, must 
submit a formal pledge to CMS by July 1, 2007 stating that they will 
collect and submit HCAHPS[supreg] data to the QIO Clinical Warehouse 
starting

[[Page 49675]]

with July 2007 discharges. We are proposing that to meet HCAHPS[supreg] 
requirements for the RHQDAPU program for FY 2008, all hospitals must 
submit this pledge to CMS.
3. HCAHPS[supreg] Dry Run
    We are proposing to require that hospitals that have not had 
experience collecting and submitting HCAHPS[supreg] data to the QIO 
Clinical Warehouse as a result of participating in the 2006 voluntary 
initiative must participate in a dry run of the survey in March 2007. 
We are proposing to require the submission of March 2007 dry run data 
to the QIO Clinical Warehouse by July 13, 2007 from those hospitals not 
yet collecting and submitting HCAHPS[supreg] data.
4. HCAHPS[supreg] Data Collection Requirements
    To collect HCAHPS[supreg] data, we are proposing that a hospital 
can either contract with an approved HCAHPS[supreg] survey vendor that 
will conduct the survey and submit data on the hospital's behalf to the 
QIO Clinical Warehouse, or a hospital can self-administer the survey 
without using a survey vendor provided that the hospital meets Minimum 
Survey Requirements as specified at (http://www.HCAHPSonline.org/programapplication.asp). A current list of approved HCAHPS[supreg] 
survey vendors can be found at http://www.HCAHPSonline.org/app_vendor.asp.
5. HCAHPS[supreg] Registration Requirements
     We are proposing that HCAHPS[supreg] registration 
requirements for the RHQDAPU program will include:
    + The hospital must be a registered user of QualityNet Exchange. 
Hospitals that are self-administering HCAHPS[supreg] or survey vendors 
hired by the hospitals must collect and submit HCAHPS[supreg] survey 
person-level data electronically to the QIO Clinical Warehouse via 
QualityNet Exchange, using prescribed file specifications that can be 
found at http://www.HCAHPSonline.org/techspecs.asp.
6. Additional Steps for HCAHPS[supreg] Participation
    In order to participate in HCAHPS[supreg], we are proposing that 
hospitals that self-administer the survey and survey vendors that 
collect and submit data on behalf of client hospitals must follow these 
steps:
     Attend Hospital/Survey Vendor Training. Hospitals and 
survey vendors that intend to actually administer the survey must 
attend HCAHPS[supreg] training. Hospitals contracting with a survey 
vendor or another hospital to administer the survey on behalf of the 
hospital do not need to attend training. The next training session will 
be offered via Webinar in late January 2007. Please see http://www.HCAHPSonline.org for updated information on training opportunities 
and registration. At a minimum, the hospital's or survey vendor's 
project manager must attend the HCAHPS[supreg] training for 
administering the survey. Hospitals and survey vendors that attended 
training in February or April 2006 and are participating in the 
voluntary HCAHPS data submission beginning October 2006 do not need to 
participate in the January 2007 training sessions. In addition, we may 
hold short refresher training sessions for all hospitals self-
administering the survey and survey vendors in the spring of 2007.
     Review and follow the HCAHPS[supreg] Quality Assurance 
Guidelines and Updates. HCAHPS Quality Assurance Guidelines have been 
developed to standardize the survey data collection process and to 
ensure comparability of data reported through HCAHPS[supreg]. They are 
located on http://www.hcahpsonline.org and will also be presented at 
the HCAHPS[supreg] hospital/survey vendor training.
    The HCAHPS[supreg] Quality Assurance Guidelines (the Guidelines) 
provide detailed information regarding: technical support; sampling 
protocols; the four allowed modes of survey administration; data 
specifications and coding; data preparation and submission; data 
reporting and the exceptions process. The Guidelines describe technical 
support that is available to hospitals and survey vendors administering 
HCAHPS[supreg] by using a toll-free number or by e-mail. It provides 
details regarding the protocol for sampling involving drawing a simple 
random sample each month from the sampling frame of eligible 
discharges. Sampling can be done at one time after the end of the 
month, or continuously throughout the month, as long as a simple random 
sample is generated for the month. The Guidelines include very specific 
information about the four allowed modes of survey administration: mail 
only, telephone only, a mixed methodology of mail with telephone follow 
up, and active interactive voice response (IVR). All modes of 
administration require following a standardized protocol. The 
Guidelines describe a standardized approach for the coding of all data 
from assigning the unique tracking number, the decision rules for 
capturing data, the file specifications, the file layout, the procedure 
for assigning disposition codes, the definition of a completed survey, 
and the procedure for calculating the total survey response rate. Data 
preparation and submission guidelines cover registration for data 
submission via the QualityNet Exchange, creation of data files, 
instructions for data submission via the QualityNet Exchange, and 
confirmation of accuracy of data. Data reporting covers internal and 
external reports; among them are the hospital preview reports and the 
public reports on CMS Hospital Compare. The Quality Assurance 
Guidelines describe the exceptions process to review requests for 
methodologies that vary from the standard HCAHPS[supreg] protocols and 
the appeals process if an exception is denied. For the initial 
implementation phase of the HCAHPS[supreg] survey, we are proposing 
that no exceptions to the four approved modes of survey administration 
will be allowed.
    In addition, hospitals/survey vendors must follow any updates that 
are posted on http://www.HCAHPSonline.org.
     Develop Hospital/Survey Vendor HCAHPS[supreg] Quality 
Assurance Plan. Hospitals self-administering the survey and survey 
vendors must develop a Quality Assurance Plan for survey administration 
in accordance with the Quality Assurance Guidelines presented at the 
HCAHPS[supreg] hospital/survey vendor training and posted on http://www.HCAHPS[supreg] online.org/programapplication.asp. The 
HCAHPS[supreg] Quality Assurance Plan should include the following:
    + Organizational chart
    + Work plan for survey implementation
    + Description of survey procedures and quality controls
    + Plans for quality assurance oversight of on-site work and of all 
subcontractors' work (including survey vendor, if used)
    + Confidentiality/Privacy and Security procedures in accordance 
with the Health Insurance Portability and Accountability Act (HIPAA).
    The hospital or survey vendor must make the HCAHPS [supreg] Quality 
Assurance Plan available to the HCAHPS[supreg] project team upon 
request. The project team includes CMS, the Health Services Advisory 
Group (HSAG) that is helping CMS implement HCAHPS, and HSAG's 
subcontractors for this project.
     Attest to the Accuracy of the Organization's Data 
Collection. Hospitals self-administering the survey and survey vendors 
must review and agree that the HCAHPS survey was administered in 
accordance with the HCAHPS[supreg] Quality Assurance Guidelines.

[[Page 49676]]

     Participate in HCAHPS[supreg] oversight activities. 
Hospitals and survey vendors must participate in a quality oversight 
process conducted by the HCAHPS[supreg] project team. Prior to July 
2007, the purpose of the oversight activities will be to provide 
feedback to hospitals and survey vendors on data collection procedures. 
Starting in July 2007, CMS may ask hospitals/survey vendors to correct 
any problems that are found and provide follow-up documentation of 
corrections for review within a defined time period. If we find that 
the hospital has not made these corrections, CMS may determine that the 
hospital is not submitting appropriate HCAHPS[supreg] data for the 
RHQDAPU program.
    As part of these activities, HCAHPS[supreg] project staff will 
review and discuss with survey vendors and hospitals self-administering 
the survey their specific Quality Assurance Plans; survey management 
procedures; sampling and data collection protocols; and data 
preparation and submission. This review may take place in-person or 
through other means of communication.
7. HCAHPS[supreg] Survey Completion Requirements
    We are proposing that hospitals must submit complete HCAHPS[supreg] 
data in accordance with the HCAHPS[supreg] Quality Assurance Guidelines 
located at http://www.HCAHPSonline.org and made available at the 
hospital/survey vendor training. These requirements specify that 
hospitals are required to survey a random sample of eligible discharges 
on a monthly basis. Hospitals should target to collect at least 300 
completed surveys over the public reporting period. For the initial 
HCAHPS[supreg] national implementation, the public reporting period is 
9 months, from October 2006 through June 2007. After this initial 
implementation, the public reporting period will be 12 months and 
hospitals should be targeting to collect at least 300 completed 
HCAHPS[supreg] surveys over a 12 month period. The initial public 
reporting period is 9 months, because of the broad interest of making 
HCAHPS results publicly available as quickly as possible. Smaller 
hospitals that cannot collect 300 completed HCAHPS[supreg] surveys 
during a public reporting period will only be required to collect as 
many completed surveys as possible. A small hospital is defined for the 
purposes of HCAHPS[supreg] as any hospital that cannot achieve 300 
completed HCAHPS[supreg] surveys during a public reporting period, 
because of its dearth of eligible hospital discharges during that 
period. For those hospitals that cannot collect 300 completed 
HCAHPS[supreg] surveys, we plan to note this on http://www.hospitalcompare.hhs.gov that the results for those hospitals are 
based on less than 100 completed HCAHPS[supreg] surveys or between 100 
and 299 completed HCAHPS[supreg] surveys.
8. HCAHPS[supreg] Public Reporting
    We propose to display HCAHPS[supreg] data on our Web site for 
public viewing in accordance with section 1886(b)(3)(B)(viii)(VII) of 
the Act, which states that the Secretary must report quality measures 
that relate to patients' perspectives on care on our Web site. Before 
we display this information, hospitals will be permitted to review 
their data to be made public as we have recorded it.
    As we discussed above, there are 27 questions included in the 
HCAHPS[supreg] survey. The survey is comprised of substantive questions 
that directly pertain to seven domains of primary importance to the 
target audience: Doctor communication, nurse communication; cleanliness 
and quiet of the hospital environment; responsiveness of hospital 
staff; pain management; communication about medicines; and discharge 
information. It also includes two overall questions that measure the 
patient's overall satisfaction with the hospital and willingness to 
recommend the hospital.
    Each of the seven domains is constructed from two or three 
questions from the survey and is reported as a composite score. For 
public reporting purposes, the seven composite scores and two overall 
ratings will be displayed. There will be both national and state 
comparisons for each of the nine reported results. We are currently 
conducting testing with consumers to ensure that the HCAHPS[supreg] 
displays on http://www.hospitalcompare.hhs.gov are consumer friendly. 
Generally, for CAHPS [supreg] measures in other settings we display bar 
graphs with the top response categories, such as the percent of people 
surveyed that gave the hospital a ``10'' for a 0 to 10 rating, or the 
percent that said their doctors ``always'' communicate well. Users of 
the site can ``drill down'' to get more detailed information regarding 
the distribution for the response categories underlying the survey 
questions.
9. Reporting HCAHPS[supreg] Results for Multi-Campus Hospitals
    Currently, hospitals that share Medicare provider numbers combine 
their clinical data across campuses for submission and publication of 
their data. Our current plan for HCAHPS[supreg] is for these data to be 
combined across campuses. However, we are considering ways in which 
data could potentially be displayed by campus rather than by hospital 
system in the future. As a starting point, we are trying to determine a 
way to identify those hospitals that share Medicare provider numbers, 
which will allow CMS to denote that the measures are made up of 
multiple campuses on http://www.hospitalcompare.hhs.gov. In the future, 
if feasible, we would like to move towards obtaining and reporting 
information at the campus level. We encourage comments regarding this 
issue.

E. SCIP & Mortality Measure Requirements for the FY 2008 RHQDAPU 
Program

     We are proposing that hospitals be required to complete 
and return a written form on which they agree to participate in the 
RHQDAPU program for FY 2008.
     For the SCIP measures, we are proposing to require 
hospitals to submit data starting with discharges that occur in CY 
2007. Hospitals will be required to submit data on these measures to 
the QIO Clinical Warehouse beginning with discharges that occur in the 
first calendar year quarter of 2007 (January through March discharges). 
We are proposing that the deadline for hospitals to submit their data 
for first calendar quarter of 2007 will be August 15, 2007.
     For the Mortality measures, we are proposing to use claims 
data that is already being collected for index hospitalizations to 
calculate the mortality rates, therefore, no additional data will need 
to be submitted by hospitals for these measures. Index hospitalization 
is the initial hospitalization for an episode of care. Claims data 
submitted to CMS for index hospitalizations occurring from July 2005 
through June 2006 (3rd quarter CY 2005 through 2nd quarter CY 2006) 
will be used to calculate the mortality rates that will be used for FY 
2008 annual payment determination. These rates will be posted on 
Hospital Compare in June 2007.
     We are proposing to display on our Web site data collected 
on the SCIP and Mortality measures for public viewing in accordance 
with section 1886(b)(3)(B)(viii)(VII) of the Act. Before we display 
this information, hospitals will be permitted to review their data that 
are to be made public as we have recorded it.

F. Conclusion

    We believe that our proposal to include HCAHPS[supreg], SCIP and 
Mortality measures as part of the FY 2008 IPPS RHQDAPU program's 
reporting requirements meets the requirements of

[[Page 49677]]

section 1886(b)(3)(B)(viii)(III) of the Act. This provision states that 
we must expand for FY 2007 and each subsequent fiscal year, consistent 
with sections 1886(b)(3)(B)(viii)(IV) through 1886(b)(3)(viii)(VII) of 
the Act, the set of measures that the Secretary determines to be 
``appropriate'' for the measurement of care furnished by hospitals in 
inpatient settings beyond the original 10-measure starter set of 
quality measures that applied in FY 2005 and FY 2006.
    Section 1886(b)(3)(B)(viii)(IV) of the Act requires us to begin to 
adopt the baseline set of performance measures set forth in the 2005 
IOM report effective for payment beginning with FY 2007. We began to 
adopt these measures for FY 2007 and are now proposing to adopt 
additional measures, including several measures that are from this 
report. HCAHPS[supreg] and the SCIP Infection 2 measures are measures 
set forth in the 2005 IOM report. Thus, we believe our proposal to 
expand the measure set to include HCAHPS[supreg] and SCIP Infection 2 
measures for the FY 2008 IPPS RHQDAPU program meets this requirement of 
the Act.
    Section 1886(b)(3)(B)(viii)(V) of the Act states that effective for 
payments beginning with fiscal year 2008, we must add ``other measures 
that reflect consensus among affected parties and, to the extent 
feasible and practicable,'' include ``measures set forth by one or more 
national consensus building entities.'' In addition to proposing to add 
additional measures from the baseline measures found in the 2005 IOM 
report, we are proposing to add additional SCIP quality measures and 
three 30-day mortality measures. In selecting these measures to adopt 
consistent with this section for the FY 2008 payment update and 
thereafter, CMS is proposing to add standardized quality measures that 
have been adopted or endorsed by a national consensus building entity 
that utilizes a national consensus building process that endorses 
measures based on (1) its consideration of issues such as the validity, 
reliability, impact and feasibility of the measures, and (2) input from 
a wide variety of stakeholders including, but not limited to, health 
care consumers and patients, clinicians and providers, purchasers, and 
researchers.
    We believe that adopting measures that have been endorsed as a 
result of this process achieves the type of consensus that Congress 
envisioned in enacting section 5001(a) of Pub. L. 109-171. The NQF is 
one consensus building entity that administers this process and takes 
these factors into account when endorsing measures. NQF is a voluntary 
consensus standard-setting organization established to standardize 
health care quality measurement and reporting, for its review and 
endorsement through its consensus development process. NQF endorsement, 
which occurs following a thorough, multi-stage review process, 
represents the consensus of numerous health care providers, consumer 
groups, professional associations, purchasers, Federal agencies, and 
research and quality organizations. We recognize that the 30-day 
Pneumonia mortality is not currently NQF-endorsed. We anticipate, 
however, that the NQF will endorse this measure soon. We do not plan to 
adopt the 30-day Pneumonia mortality measure unless it is endorsed by 
the NQF.
    The HQA is another such consensus building entity. The HQA is a 
public-private collaboration of numerous stakeholder groups. One goal 
of HQA is to identify a robust set of standardized and easy-to-
understand hospital quality measures that would be used by all 
stakeholders in the health care system in order to improve quality of 
care and the ability of consumers to make informed health care choices. 
We also note that HQA currently relies on the NQF process as part of 
its process.
    CMS anticipates that other consensus building entities that take 
into account the issues of validity, reliability, impact and 
feasibility of the measures and involves a wide array of stakeholders 
may develop.

XXIV. Files Available to the Public Via the Internet

    Addenda A and B to this proposed rule provide various data 
pertaining to the proposed CY 2007 payments for services under the 
OPPS. Addenda AA, BB, and CC to this proposed rule include various data 
pertaining the proposed ASC list of covered procedures and payment 
rates for procedures furnished in ASCs in CYs 2007 and 2008, 
respectively.
    To conserve resources and to make Addendum B more relevant to the 
OPPS, we are including in Addendum B of this proposed rule HCPCS codes 
(including CPT codes) for services that are assigned a payable status 
indicator under the OPPS and HCPCS codes for which we are proposing a 
change in status indicator and/or APC assignment for CY 2007. A list of 
all active HCPCS codes, regardless of their assigned payable status, is 
available to the public on the CMS Web site at: http://www.cms.hhs.gov/providers/hopps.
    For the convenience of the public, we are also including on this 
same CMS Web site a table that displays the HCPCS data in Addendum B 
sorted by APC assignment, identified as Addendum C. In addition, we are 
including on the CMS Web site, in a format that can be easily 
downloaded and manipulated, Addendum A. Similarly, we are including 
Addenda AA, BB, and CC on the CMS Web site at: http://www.cms.hhs.gov/center/asc.asp.
    We are not including as addenda in this proposed rule, reprints of 
wage index related tables from the FY 2007 IPPS proposed rule (71 FR 
24235 through 24272) as they would be used for the OPPS for CY 2007. 
Rather, we are providing a link on the CMS Web site at: http://www.cms.hhs.gov/providers/hopps to all of the proposed FY 2007 IPPS 
wage index related tables. For additional assistance, contact Anita 
Heygster, (410) 786-4486.

XXV. 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 fairly evaluate whether an information collection should be 
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act 
of 1995 requires that we solicit comment on the following issues:
     The need for the information collection and its usefulness 
in carrying out the proper functions of our agency.
     The accuracy of our estimate of the information collection 
burden.
     The quality, utility, and clarity of the information to be 
collected.
     Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    The following information collection requirements included in this 
proposed rule and their associated burdens are subject to the PRA.
    We are soliciting public comment on each of the issues for the 
following section of this document that contain information collection 
requirements and are not currently approved by the OMB.

Proposed Additional Quality Measures for FY 2008: Surgical Care 
Improvement Project (SCIP)

    Section 5001(a) of the Deficit Reduction Act of 2005 (DRA) (Pub. L. 
109-171) sets out new requirements for the IPPS Reporting Hospital 
Quality Data for Annual Payment Update (RHQDAPU) program. Under section 
1886(b)(3)(B)(viii)(V) of the Act, for payments beginning with FY 2008, 
we

[[Page 49678]]

are required to add other measures that reflect consensus among 
affected parties and, to the extent feasible and practicable, must 
include measures set forth by one or more national consensus building 
entities. In this proposed rule, we are setting out the additional 
measures that we propose to require for FY 2008.
    The burden associated with this section is the time and effort 
associated with collecting, copying and submitting the data. As part of 
the Surgical Care Improvement Project (SCIP), we estimate that there 
will be approximately 3,700 respondents per year. All of these 
hospitals must submit SCIP Infection 1 and 3 to receive the annual 
payment update covering FY 2007. Additional surgical procedures 
covering approximately 6,000,000 discharges annually will be sampled at 
a 10 percent rate per hospital, so an additional 600,000 discharges 
will be abstracted and submitted by hospitals for the additional SCIP 
measures (SCIP Infection 2 and VTE 1, 2). The 10 percent sampling rate 
is a minimum threshold specified in the most current version of the 
joint CMS/JCAHO Hospital Quality Measures Specifications Manual. We 
estimate that it will take 450,000 hours (3/4 hour per sampled 
discharge) to abstract and submit data for these additional sampled 
discharges.
    In addition, hospitals must abstract and submit additional 
information needed for the additional SCIP measures covering the 
surgical procedures already covered in SCIP Infection 1 and 3. We 
estimate that about 275,000 discharges will be sampled and abstracted 
covering these surgical procedures. We estimate that it will take an 
additional 137,500 hours (\1/2\ hour per sampled discharge) for 
hospitals to abstract and submit this additional information. Both 
estimates include overhead.
    In total, we estimate that an additional 587,500 hours will be used 
by hospitals to abstract and submit the additional SCIP measures. This 
estimate includes overhead.
    Further, we note that there is no additional burden associated with 
the incorporation of mortality outcome measures, as this information is 
currently collected with claims data.
    We have submitted a copy of this proposed rule to the OMB for its 
review of the aforementioned information collection requirements.
    This proposed rule also includes associated information collections 
for which CMS has obtained the OMB's approval. The following is a 
discussion of these currently OMB approved collections.
    As discussed in section XXIII of this preamble, the IPPS RHQDAPU 
program expands upon the Hospital Quality Initiative which is intended 
to empower consumers with quality of care information to make more 
informed decisions about their health care while also encouraging 
hospitals and clinicians to improve the quality of care. The 
information collection associated with the IPPS RHQDAPU is the Hospital 
Quality Alliance (formerly known as the National Voluntary Hospital 
Reporting Initiative)--Hospital Quality Measures. The OMB approved this 
information collection under OMB control number 0938-0918, with an 
expiration date of December 31, 2008. As a result of the increase from 
10 to 21 quality measures, CMS created a revised information collection 
request to include the new quality measures. CMS announced the revised 
information collection in a 60-day Federal Register notice that 
published on June 9, 2006 (71 FR 33458). CMS will publish a 30-day 
Federal Register notice prior to the submission of the revised 
information collection being proposed in this rule to OMB.
    Further, as discussed in section XXIII. of this preamble, for FY 
2008, we are proposing to expand the IPPS RHQDAPU program to include 
the HCAHPS[supreg] Survey, also known as the Hospital CAHPS or the 
CAHPS Hospital Survey. The HCAHPS[supreg] Survey is composed of 27 
questions: 18 substantive questions that encompass critical aspects of 
the hospital experience (communication with doctors, communication with 
nurses, responsiveness of hospital staff, cleanliness and quietness of 
hospital environment, pain management, communication about medicines, 
and discharge information); four questions to skip patients to 
appropriate questions; three questions to adjust for the mix of 
patients across hospitals; and two questions to support 
congressionally-mandated reports. As explained in section XXIII. of 
this preamble, CMS published a Federal Register notice soliciting 
comments on the draft 27-item HCAHPS[supreg] Survey in November 2005 
(70 FR 67476). The OMB approved the HCAHPS[supreg] Survey under OMB 
control number 0938-0981, with an expiration date of December 31, 2007.

Proposed Revised Sec.  416.190(c)--Request for Review of Payment Amount

    The collection of information requirements at 5 CFR 1320 are 
applicable to requirements affecting 10 or more entities. Proposed 
revised Sec.  416.190(c) would require that a request for review of the 
ASC payment amount for insertion of an IOL must include all the 
information that CMS specifies on its Web site.
    While this section of the proposed rule contains information 
collection requirements, we estimate that less than 10 ASCs will be 
affected; therefore, we believe these collection requirements are 
exempt from OMB for review and approval, as specified at 5 CFR 
1320.3(c)(4). Consequently, this section of the proposed rule need not 
be reviewed by the OMB under the authority of the PRA.
    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 Group, Attn: 
Melissa Musotto, CMS-1506-P, Room C4-26-05, 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: Carolyn Lovett, CMS Desk Officer, (CMS-1506-P), [email protected]. Fax (202) 395-6974.

XXVI. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document(s), we will respond to 
those comments in the preamble to that document(s).

XXVII. 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. Overall Impact

    We have examined the impacts of this proposed rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 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.

[[Page 49679]]

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 that the effects of the OPPS provisions that would be 
implemented by this proposed rule would result in expenditures 
exceeding $100 million in any 1 year. We estimate that adding 14 
procedures to the ASC list and implementing section 5103 of Pub. L. 
109-171) in CY 2007 would result in savings to the Medicare program of 
approximately $150 million. We further estimate that the revised ASC 
payment system and expanded list of payable ASC services which we are 
proposing to implement in CY 2008 would have no effect on Medicare 
expenditures compared to CY 2007. A more detailed discussion of the 
effects of the proposed changes to the ASC list of procedures for CY 
2007 and the effects of proposed revisions to the ASC payment system in 
CY 2008 is provided in sections XXVII. C. and D. below.
    In addition, we estimate that the changes that we are proposing in 
section XIX. of this preamble to implement Medicare contracting reform 
mandated by section 911 of Pub. L. 108-173 have no economic effect on 
current Medicare payments in CY 2007. This aspect of our proposal would 
amend our current Medicare contractor regulations to conform them to 
the statutory changes mandated by Pub. L. 108-173 and in and of itself 
does not affect in any way Medicare's coverage or payment policies for 
hospital outpatient services or any other covered Medicare services. 
Accordingly, we believe that this provision has no immediate economic 
effect on Medicare payments in CY 2007.
    Further, we estimate that the changes that we are proposing in 
section XXIII. of this preamble to implement an expanded set of quality 
measures for the IPPS Reporting Hospital Quality Data for the Annual 
Payment Update (RHQDAPU) program in accordance with sections 
1886(b)(3)(B)(viii)(III) and (IV) of the Act will not have a 
significant economic effect on Medicare payments to hospitals in CY 
2007. A more detailed discussion of the effects of this proposal are 
included in section XXIII. of this preamble and section XXVII.F. below.
    However, 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 2007 compared to CY 2006 to be 
approximately $2.98 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 small governmental 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 and 73 percent of ambulatory surgery centers 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.
    Not for profit organizations are also considered to be small 
entities under the RFA. There are 2,163 voluntary hospitals that we 
consider to be not for profit organizations to which this proposed rule 
applies.
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 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 to the OPPS 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 although the proposed changes to the ASC payment system 
for CY 2007 and CY 2008 would have no effect on small rural hospitals. 
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 whose mandates require spending in any 
1 year of $100 million in 1995 dollars, updated annually for inflation. 
That threshold level is currently approximately $120 million. The 
maximum nationwide cost to hospitals will be $16.9 million for 
HCAHPS[supreg] (Abt Report), $58.7 million in noncaptial costs for 
SCIP, and no cost for mortality measure. This proposed rule will not 
mandate any requirements for State, local, or tribal government, nor 
will it affect private sector costs.
5. Federalism
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it publishes any rule (proposed or final) that 
imposes substantial direct costs on State and local governments, 
preempts State law,

[[Page 49680]]

or otherwise has Federalism implications.
    We have examined this proposed rule in accordance with Executive 
Order 13132, Federalism, and have determined that it would not have an 
impact on the rights, roles, and responsibilities of State, local or 
tribal governments. As reflected in Table 49 we estimate that OPPS 
payments to governmental hospitals (including State, local, and tribal 
governmental hospitals) would increase by 3.0 percent under this 
proposed rule. The proposals related to payments to ASCs in CYs 2007 
and 2008 would not affect payments to government hospitals. In 
addition, the proposals related to MACs and HCAHPS would not affect 
payments to government hospitals.

B. Effects of Proposed OPPS Changes in This Proposed Rule

    (If you choose to comment on issues in this section, please include 
the caption ``OPPS Impact'' at the beginning of your comment.)
    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, 2007, as we discuss in sections II.C. and II.D., 
respectively, of this preamble. However, we are also proposing to 
reduce the update to the CY 2007 OPPS conversion factor by 2.0 
percentage points for any hospital that is required to report quality 
data under the IPPS RHQDAPU for the FY 2007 update, and that fails to 
meet the requirements for receiving the full IPPS payment update in 
that payment year. We also are proposing to revise the relative APC 
payment weights using claims data from January 1, 2005, through 
December 31, 2005, and updated cost report information. 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 continue increased payments to rural SCHs, including 
EACHs. Section II.F. of this preamble provides greater detail on this 
rural adjustment. Finally, we are not proposing to remove any device 
categories from pass-through payment status in CY 2007.
    Under this proposed rule, the update change to the conversion 
factor as provided by statute would increase total OPPS payments by 3.4 
percent in CY 2007. The update change to the OPPS conversion factor for 
any hospital that is required to report quality data under the IPPS 
RHQDAPU for the FY 2007 update, but fails to meet the requirements for 
receiving the full IPPS payment update in that payment year would 
increase OPPS payments by 1.4 percent in CY 2007. The expiration of the 
one-time wage reclassification under section 508 in April 2007 which is 
not budget neutral and an increase in the fixed-dollar outlier 
threshold to account for the under estimation of outlier payments in CY 
2006 results in a net increase of 3.0 percent. The proposed changes to 
the APC weights, changes to the wage indices, the continuation of a 
payment adjustment for rural SCHs, and the proposed expansion of the 
rural adjustment to EACHs 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 49 and described in more detail in this section.
1. Alternatives Considered
    Alternatives to the changes we are proposing to make and the 
reasons that we have chosen these options are discussed throughout this 
proposed rule. Some of the major issues discussed in this proposed rule 
and the options considered are discussed below.
a. Alternatives Considered for CPT Coding and Payment Policy for 
Evaluation and Management Codes
    In section IX. of this preamble, we are proposing to create five 
new G-codes to replace CPT clinic E/M codes, five new G-codes for 
emergency visits provided in Type B emergency departments, five new G-
codes for emergency visits provided in Type A emergency departments to 
replace CPT emergency department E/M codes, and two new G-codes to 
replace CPT critical care codes. CMS instructed hospitals to report 
facility resources for clinic and emergency department visits using CPT 
E/M codes and to develop internal hospital guidelines to determine what 
level of visit to report for each patient. However, since the beginning 
of the OPPS, we have acknowledged that the CPT E/M codes do not 
adequately describe the facility resources required to perform the 
services. Therefore, we are proposing G-codes to be used by hospitals 
to report clinic and emergency visits, and critical care services, 
which describe hospital resource use.
    We acknowledge that it can be burdensome for providers to bill G-
codes rather than CPT codes. CPT has not yet created clinic and 
emergency department visit and critical care services codes that 
describe hospital resource utilization. In this case, because the 
current CPT E/M codes do not describe hospital visit resources, we have 
no alternative other than to create new G-codes. It is important to 
note that G-codes may be recognized by other payers.
    Some hospitals have requested that they be permitted to bill 
emergency visit codes under the OPPS for services furnished in a 
facility that meets CPT's definition for reporting emergency visit E/M 
codes, except that these hospitals are not available 24 hours a day. 
For CY 2007, we are proposing to establish a set of codes for visits 
provided in dedicated emergency departments that have an EMTALA 
obligation. These codes would be billed by Type B emergency 
departments, specifically those that do not meet the Type A 
requirements. We are also proposing to establish a separate set of 
codes for visits provided in a specific subset of dedicated emergency 
departments, called Type A emergency departments, that are open 24 
hours per day, 7 days per week and/or that do not have an EMTALA 
obligation solely based on providing at least one-third of their 
outpatient visits for the treatment of emergency medical conditions on 
an urgent basis without requiring a previously scheduled appointment. 
An alternative to this policy is to continue to uphold past policy and 
allow only the Type A subset of dedicated emergency departments to bill 
emergency department codes. However, this would not allow us to 
determine whether visits to dedicated emergency departments or 
facilities that incur EMTALA obligations but do not meet more 
prescriptive expectations that are consistent with the CPT definition 
of an emergency department have different resource costs than visits to 
either clinics or the Type A subset of dedicated emergency departments 
that meet more prescriptive expectations, including 24 hours per day, 7 
days per week availability.
    We must also establish payment rates for these new G-codes. For CY 
2007, we are proposing to pay at five payment levels for both clinic 
and emergency department visits and one payment level for critical care 
services. We see meaningful differences among the median costs of five 
levels of clinic and emergency department codes that

[[Page 49681]]

suggest that five payment levels are more appropriate than three 
levels. In addition, providers have indicated that it is 
administratively burdensome to code for five levels, but receive 
payment at only three levels, as has been the historical policy in the 
OPPS. If future data indicate that three payment levels are more 
appropriate, we may revert back to three payment levels. An alternative 
to this policy is to continue paying at three payment levels for both 
clinic and emergency department visits and one payment level for 
critical care services. However, for the reasons described above, we 
are proposing to pay at five levels for clinic and emergency department 
visits for CY 2007 to ensure that payments more accurately reflect the 
median costs of the services provided.
    For CY 2007, we are proposing to pay emergency visits to Type B 
dedicated emergency departments that are not part of the specific 
subset identified as Type A emergency departments at the same rate as 
clinic visits, consistent with current policy. This payment policy is 
similar to our current policy that requires services furnished in 
emergency departments that have an EMTALA obligation but do not meet 
the CPT definition of emergency department to be reported using CPT 
clinic visit E/M codes, resulting in payments based upon clinic visit 
APCs. While maintaining the same payment policy for CY 2007, the 
reporting of specific G-codes for emergency visits provided in Type B 
dedicated emergency departments would permit us to specifically collect 
and analyze the hospital resource costs of visits to these facilities 
in order to determine whether a future proposal of an alternative 
payment policy may be warranted. An alternative would be to provide 
payment for services billed by Type B emergency departments at payment 
rates other than the clinic visit rates. However, we do not know what 
the hospital facility costs of these visits would be because we are 
unable to identify these services in our historical claims data. In 
some respects, their costs may resemble the costs of visits to clinics 
because they may not be available 24 hours per day or may not require 
the same high state of readiness as Type A emergency departments. In 
other respects, their costs may resemble the costs of visits to Type A 
emergency departments because they both provide predominantly 
unscheduled visits. Therefore, we currently would have no accurate 
methodology for establishing payment rates that are appropriate for 
visits to Type B emergency departments. Therefore, consistent with past 
payment policies for certain services, such as drug administration, in 
which we maintained current payment policies while gathering more 
detailed cost data, we are proposing to continue payment to Type B 
emergency departments at clinic visit rates while we gather hospital 
claims data specific to these visits to review their costs.
b. Options Considered for Brachytherapy Source Payments
    Pursuant to sections 1833(t)(2)(H) and 1833(t)(16)(C) of the Act, 
we have paid for brachytherapy sources furnished on or after January 1, 
2004, and before January 1, 2007, on a per source basis at an amount 
equal to the hospital's charge adjusted to cost by application of the 
hospital specific overall CCR. For CY 2007, we are proposing to pay for 
brachytherapy sources at a prospectively based rate for each source, 
which is assigned to a source-specific APC. We are proposing to convert 
the median cost to a relative weight by dividing it by the median for 
APC 0606, to scale the unscaled weight for budget neutrality, and to 
multiply the scaled weight by the conversion factor to calculate the 
payment rate per source. This is our standard OPPS methodology for 
using median costs to calculate the payment for each APC.
    We considered establishing a per day payment for brachytherapy 
sources based on our CY 2005 claims data. While this alternative would 
be consistent with the philosophy of a prospective payment system and 
would mitigate the effects on payment of inaccurate coding of the 
number of sources used, we believe that a per day payment may not 
provide source payment variation specifically addressed to the hospital 
resources used under the unique clinical circumstances of each 
individual treatment. There is considerable clinical variation in the 
number of sources used for brachytherapy services, and we believe a per 
day payment based on an average number of sources used may not as 
accurately reflect appropriate payment for an individual Medicare 
beneficiary's treatment as the per source payment methodology. 
Therefore, we are not proposing to set payments on a per day basis.
    We also considered continuing to make separate payment for sources 
of brachytherapy under the current methodology of hospital charges 
reduced to costs. Although hospitals are familiar with this methodology 
and this alternative is consistent with the requirement that sources be 
paid separately, we believe that to continue to pay on this basis would 
be inconsistent with the general methodology of a prospective payment 
system and would provide no incentive for a hospital to provide 
services efficiently and at the lowest cost. Therefore, for CY 2007, we 
are proposing to pay for each brachytherapy source on a per source rate 
that is calculated using our standard OPPS methodology.
c. Options Considered for Payment of Radiopharmaceuticals
    In developing the payment policy proposal for separately payable 
radiopharmaceuticals for this CY 2007 proposed rule, we considered 
three policy options.
    The first option we considered was to propose packaging additional 
radiopharmaceuticals, either through packaging payments for all 
radiopharmaceuticals with payments for the services with which they are 
billed or increasing the packaging threshold for radiopharmaceuticals 
from a cost of $55 per day to a higher amount. In contrast to other 
separately payable drugs where the administration of many drugs is 
reported with only a few drug administration HCPCS codes, only a small 
number of specific radiopharmaceuticals may be appropriately provided 
in the performance of each particular nuclear medicine procedure. 
Because the provision of nuclear medicine procedures always requires 
one or more radiopharmaceuticals, packaging more radiopharmaceuticals 
effectively results in some increases in the costs of the associated 
nuclear medicine procedures to reflect the greater packaging of the 
radiopharmaceuticals. A policy to package additional 
radiopharmaceuticals would be very consistent with the OPPS packaging 
principles and payment policies which generally provide appropriate 
payment for the ``average'' service and would provide greater 
administrative simplicity for hospitals. However, under a policy of 
increased packaging of radiopharmaceuticals, payments for certain 
nuclear medicine procedures could potentially be less than the costs of 
some of the packaged radiopharmaceuticals and relatively expensive and 
high volume radiopharmaceuticals could become packaged. In addition, 
our payment policy could discourage selection of the most clinically 
appropriate radiopharmaceutical for a particular nuclear medicine 
procedure, especially if that radiopharmaceutical were expensive and 
not commonly used so that its costs were not fully reflected in

[[Page 49682]]

the payment for the nuclear medicine procedure.
    The second option that we considered was to propose to continue the 
temporary CY 2006 methodology of paying for separately payable 
radiopharmaceuticals at charges reduced to cost, where payment would be 
determined using each hospital's overall CCR, and establishing our 
radiopharmaceutical packaging threshold at $55, as we are proposing for 
other drugs for the CY 2007 OPPS. This policy would provide stability 
to the payment methodology for radiopharmaceuticals from CY 2006 to CY 
2007. As we indicated for CY 2007, this payment methodology would 
provide an acceptable proxy for the average acquisition of the 
radiopharmaceutical along with its handling cost. However, as indicated 
previously, we stated in the CY 2006 final rule with comment period 
that this payment policy was intended to be only a temporary policy, 
and that we would consider alternative methodologies on which to base 
radiopharmaceutical payments for the CY 2007 OPPS update. Paying for 
radiopharmaceuticals at cost provides hospitals with no incentive to 
supply radiopharmaceuticals in the most efficient manner. In addition, 
using hospitals' overall CCRs to determine payments likely results in 
an overestimation of radiopharmaceutical cost, which are likely 
reported in several cost centers such as diagnostic radiology that have 
lower CCRs than hospitals' overall CCRs.
    The third option that we considered and are proposing for CY 2007 
is to establish prospective payment rates for separately payable 
radiopharmaceuticals using mean costs derived from the CY 2005 claims 
data, where the costs are determined using our standard methodology of 
applying hospital-specific departmental CCRs to radiopharmaceutical 
charges and defaulting to hospital-specific overall CCRs only if 
appropriate departmental CCRs are unavailable. This proposal 
establishes our packaging threshold for radiopharmaceuticals at $55, as 
proposed for other drugs under the CY 2007 OPPS. We believe this option 
provides us with the most consistent, accurate, and efficient 
methodology for prospectively establishing payment rates for separately 
payable radiopharmaceuticals; in addition, this proposed methodology is 
consistent with how payment rates for other services are determined 
under the OPPS and provides for prospective payments that serve as 
appropriate proxies for the average acquisition costs of the 
radiopharmaceuticals along with their handling costs.
2. 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 2007, on various hospital groups. We estimate the 
effects of individual policy changes by estimating payments per service 
while holding all other payment policies constant. We use the best data 
available but do not attempt to predict behavioral responses to our 
policy changes. In addition, we do not make adjustments for future 
changes in variables such as service volume, service-mix, or number of 
encounters. As we have done in previous proposed rules, we are 
soliciting comments and information about the anticipated effect of 
these proposed changes on hospitals and our methodology for estimating 
them.
    One limitation of our analysis in this proposed rule is that we are 
unable at this time to estimate the impact of our proposal to reduce 
the update to the CY 2007 OPPS conversion factor by 2.0 percentage 
points for any hospital that is required to report quality data under 
the IPPS RHQDAPU for the FY 2007 update, and that fails to meet the 
requirements for receiving the full IPPS payment update in that payment 
year. As we discuss in section XXIII of the preamble of this proposed 
rule, we are unable at this time to determine how many hospitals will 
receive a reduced update in CY 2007. Determinations concerning which 
hospitals have failed to meet the requirements for receiving the full 
update to the OPPS conversion factor in CY 2007 will only become 
available on or about September 1, 2006.
    Experience with mandatory reporting of quality data under the IPPS 
RHQAPU indicates that only a small number of hospitals have failed to 
meet the requirements to receive the full update to their payments 
under the IPPS. However, the statute requires that the reduction to the 
update for those IPPS hospitals that fail to meet the quality reporting 
requirement will increase from 0.4 percentage point to 2.0 percentage 
points for purposes of payment in FY 2007. This increase in the size of 
the update reduction significantly increases the already strong 
incentive to submit quality data. We therefore believe that the already 
small number of hospitals that fail to meet the requirements for 
receiving the full update may actually decrease significantly. We 
expect that only very few, if any, hospitals will fail to receive the 
full update to the OPPS conversion factor in CY 2007. However, due to 
the uncertainty concerning the degree to which the increased incentive 
to report quality data will affect hospital behavior, we are unable to 
predict with any confidence the number of hospitals that will receive 
the reduced update under the OPPS RHQDAPU, or to incorporate any 
specific data concerning the impact of this proposal into impact Table 
49 below.
    We are also unable to determine the budget neutrality adjustment 
factor that will be necessary to ensure that estimated aggregate 
payments under the OPPS for CY 2007 do not change as a result of 
implementing the proposed OPPS RHQDAPU. We also expect, however, that 
the distributional impact of the proposal will be quite minimal. We 
also expect that any budget neutrality adjustment that we determine to 
be necessary once the determinations concerning compliance with the 
quality data reporting requirements become available will be 
correspondingly negligible. At the same time, any hospital that has 
reason to believe that it will not meet the requirements for receiving 
a full update under our proposal should be able to assess the potential 
impact of receiving the reduced update, simply by estimating the 
payments that the hospital will receive using the reduced conversion 
factor of $60.36, reflecting an update of 1.4 percent, in place of the 
conversion factor of $61.551 reflecting the full proposed update of 3.4 
percent. Over time, the proposed OPPS RHQDAPU may have a discernible, 
positive impact on the quality of care available to Medicare 
beneficiaries in hospital outpatient departments. Meanwhile, the impact 
analysis below assumes that there will be full compliance with the 
requirements of the proposed OPPS RHQDAPU for purposes of receiving the 
full update in CY 2007, that all OPPS outpatient departments will 
therefore receive payments reflecting the full update in CY 2007, and 
that no additional adjustment to the OPP conversion factor will be 
necessary to ensure budget neutrality in CY 2007.
3. Estimated Impacts of This Proposed Rule on Hospitals
    The estimated increase in the total payments made under the 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. The 
enactment of Pub. L. 108-173 on December 8, 2003, provided for the 
additional payment outside of the budget

[[Page 49683]]

neutrality requirement for wage indices for specific hospitals 
reclassified under section 508 through CY 2007. Table 49 shows the 
estimated redistribution of hospital payments among providers as a 
result of a new APC structure, wage indices, and proposed adjustment 
for rural SCHs and EACHs, which are budget neutral; the estimated 
distribution of increased payments in CY 2007 resulting from the 
combined impact of the proposed APC recalibration, wage effects, the 
rural SCH and EACH adjustment, and the proposed market basket update to 
the conversion factor; and, finally, estimated payments considering all 
proposed payments for CY 2007 relative to all payments for CY 2006, 
including the impact of expiring wage provisions and changes in the 
outlier threshold. Because updates to the conversion factor, including 
the update of the market basket and the addition of money not dedicated 
to pass-through 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), the 
impact of the wage index changes on the hospital, and the impact of the 
payment adjustment for rural SCHs, including EACHs. However, total 
payments made under this system and the extent to which this proposed 
rule would redistribute money during implementation also would depend 
on changes in volume, practice patterns, and the mix of services billed 
between CY 2006 and CY 2007, which CMS cannot forecast. Overall, the 
proposed OPPS rates for CY 2007 would have a positive effect for all 
hospitals paid under the OPPS. Proposed changes would result in a 3.0 
percent increase in Medicare payments to all hospitals, exclusive of 
transitional pass-through payments. Removing cancer and children's 
hospitals because their payments are held harmless to the pre-BBA ratio 
between payment and cost suggests that proposed changes would result in 
a 3.1 percent increase in Medicare payments to all other hospitals.
    To illustrate the impact of the proposed CY 2007 changes, our 
analysis begins with a baseline simulation model that uses the final CY 
2006 weights, the FY 2006 final post-reclassification IPPS wage indices 
without additional increases resulting from section 508 
reclassifications, and the final CY 2006 conversion factor. Column 2 in 
Table 49 reflects the independent effects of the proposed APC 
reclassification and recalibration changes. Column 3 reflects the 
effects of updated wage indices, and the adjustment for rural SCHs and 
EACHs. The clarification that the rural adjustment applies to EACHs is 
not shown separately because there are so few EACHs that the overall 
impact cannot be observed when payments are aggregated by type of 
hospital. 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 services codes among APC groups and the proposed 
recalibration of APC weights based on a complete year of CY 2005 
hospital OPPS claims data and more recent cost report data. We modeled 
the independent effect of APC recalibration by varying only the 
weights, the final CY 2006 weights versus the proposed CY 2007 weights, 
in our baseline model, and calculating the percent difference in 
payments.
    Column 3 shows the impact of updating the wage index used to 
calculate payment by applying the proposed FY 2007 IPPS wage index, 
combined with the impact of the proposed 7.1 percent rural adjustment 
for SCHs and EACHs for services other than drugs, biologicals, 
brachytherapy sources, and those receiving pass-through payments. The 
OPPS wage index used in Column 3 does not include changes to the wage 
index for hospitals reclassified under section 508 of Pub. L. 108-173. 
We modeled the independent effect of updating the wage index and the 
rural adjustment by varying only the wage index and the inclusion of 
EACHs, using the proposed CY 2007 scaled weights, and a CY 2006 
conversion factor that included a budget neutrality adjustment for 
changes in wage effects and the rural adjustment between CY 2006 and CY 
2007.
    Column 4 demonstrates the combined ``budget neutral'' impact of 
proposed APC recalibration, the wage index update, and the proposed 
rural adjustment for rural SCHs and EACHs on various classes of 
hospitals, as well as the impact of updating the conversion factor with 
the market basket update. 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, and using a CY 2006 conversion 
factor that included the proposed market basket update and budget 
neutrality adjustments for differences in wages and the adjustment for 
rural SCHs and EACHs.
    Finally, Column 5 depicts the full impact of the proposed CY 2007 
policy on each hospital group by including the effect of all the 
proposed changes for CY 2007 and comparing them to all estimated 
payments in CY 2006, including those required by Pub. L. 108-173. 
Column 5 shows the combined budget neutral effects of Columns 2 through 
4, plus the impact of increasing the outlier threshold after realigning 
the overall CCR calculation used to model the outlier threshold with 
the one used by the fiscal intermediary for payment, the impact of 
changing the percentage of total payments dedicated to transitional 
pass-through payments to 0.13 percent, and the expiration of payment 
for wage index increases for hospitals reclassified under section 508 
of Pub. L. 108-173 in April 2007. As noted in section II.D. of this 
preamble, because section 508 expires in April 2007 and OPPS operates 
on a calendar year basis, we used a blended wage index consisting of 25 
percent of the IPPS wage index with section 508 and 75 percent of the 
IPPS wage index after section 508 expires.
    We modeled the independent effect of all changes in Column 5 using 
the final weights for CY 2006 and the proposed weights for CY 2007. The 
wage indices in each year include wage index increases for hospitals 
eligible for reclassification under section 508 of Pub. L. 108-173, and 
in 2007, these provisions expire in April 2007. We used the final 
conversion factor for CY 2006 of $59.511 and the proposed CY 2007 
conversion factor of $61.551. Column 5 also contains simulated outlier 
payments for each year. We used the charge inflation factor used in the 
proposed FY 2007 IPPS rule of 7.57 percent (1.0757) to increase 
individual costs on the CY 2005 claims to reflect CY 2006 dollars, and 
we used the most recent overall CCR for each hospital as calculated for 
the APC median setting process. Using the CY 2005 claims and a 7.57 
percent charge inflation factor, we currently estimate that actual 
outlier payments for CY 2006, using a multiple threshold of 1.75 and a 
fixed-dollar threshold of $1,250 would be 1.25 percent of total 
payments, which is 0.25 percent higher than the 1.0 percent that we 
projected in setting outlier policies for CY 2006, due to the 
differences in the calculation of the overall CCR, as discussed in 
section II.A.1.c. of this preamble. Outlier payments of 1.25 percent 
appear in the CY 2006 comparison in Column 5. We used the same set of 
claims and a charge inflation factor of 15.15 percent (1.1515) to model 
the CY 2007 outliers at 1.0 percent of total payments using a multiple

[[Page 49684]]

threshold of 1.75 and a proposed fixed-dollar threshold of $1,825.
Column 1: Total Number of Hospitals
    Column 1 in Table 49 shows the total number of hospital providers 
(3,922) for which we were able to use CY 2005 hospital outpatient 
claims to model CY 2006 and CY 2007 payments by classes of hospitals. 
We excluded all hospitals for which we could not accurately estimate CY 
2006 or CY 2007 payment and entities that are not paid under the OPPS. 
The latter entities include CAHs, all-inclusive hospitals, and 
hospitals located in Guam, the U.S. Virgin Islands, Northern Marianas, 
American Samoa, and the State of Maryland. This process is discussed in 
greater detail in section II.A. of this preamble. At this time, we are 
unable to calculate a disproportionate share (DSH) variable for 
hospitals not participating in the IPPS. Hospitals for which we do not 
have a DSH variable are grouped separately and generally include 
psychiatric hospitals, rehabilitation hospitals, and LTCHs. Finally, 
section 1833(t)(7)(D) of the Act permanently holds harmless cancer 
hospitals and children's hospitals to the proportion of their pre-BBA 
payment relative to their costs. Because this proposed rule would not 
impact these hospitals negatively, we removed them from our impact 
analyses. We show the total number (3,864) of OPPS hospitals, excluding 
the hold-harmless cancer hospitals and children's hospitals, on the 
second line of the table.
Column 2: APC Recalibration
    The combined effect of the proposed APC reclassification and 
recalibration, in Column 2 are typical for APC recalibration. Overall, 
these changes have no impact on all urban hospitals, which show no 
projected change in payments, although some classes of urban hospitals 
experience decreases in payments. However, changes to the APC structure 
for CY 2007 tend to favor, slightly, urban hospitals that are not 
located in large urban areas. We estimate that large urban hospitals 
would experience a decline of 0.1 percent, while ``other'' urban 
hospitals experience an increase of 0.1 percent. Urban hospitals with 
between 0 and 299 beds experience increases, while the largest urban 
hospitals, those with beds greater than 299 experience decreases of 0.1 
to 0.2 percent. With regard to volume, all urban hospitals except those 
with volume less than 11,000 lines, experience increases in payments. 
The lowest volume hospitals experience the largest decrease of 7.1 
percent, largely as a result of decreases in payment for partial 
hospitalization and psychotherapy services. Urban hospitals providing 
the highest volume of services demonstrate no projected change as a 
result of APC recalibration. Estimated decreases in payment for urban 
hospitals are also concentrated in some regions, specifically, Middle 
Atlantic, West North Central, and Pacific, with decreases of 0.3, 0.4, 
and 0.2 percent respectively. On the other hand, most other regions 
experience moderate increases and urban hospitals in the East South 
Central and New England experience no change as a result of APC 
recalibration.
    Overall, rural hospitals show a modest 0.1 percent increase as a 
result of changes to the APC structure, and this 0.1 percent increase 
appears to be concentrated in rural hospitals that are not rural SCHs, 
which experience a 0.2 percent increase. Notwithstanding a modest 
overall increase in payments, there is substantial variation among 
classes of rural hospitals. Specifically, rural hospitals with more 
than 199 beds experience a decrease of 0.1 percent and rural hospitals 
with 150-199 beds experience the largest increase of 0.3 percent. With 
regard to volume, all rural hospitals, except those with the lowest 
volume, experience increases in payments. The lowest volume hospitals 
experience the largest decrease of 3.5 percent. Rural hospitals with 
greater than 5,000 lines of volume demonstrate projected increases of 
0.1 to 0.4 percent as a result of APC recalibration. Increases ranging 
from 0.2 to 0.5 percent occur for rural hospitals in every region 
except New England, the Middle Atlantic, and the West North Central. 
The largest decreases are observed in New England (-0.5 percent), 
Middle Atlantic (-0.5), West North Central (-0.2 percent) regions.
    Among other classes of hospitals, the largest observed impacts 
resulting from APC recalibration include an increase of 0.1 percent for 
nonteaching hospitals and a decrease of 0.3 percent for major teaching 
hospitals. Urban hospitals that are treating DSH patients and are also 
teaching hospitals experience decreases of 0.1 percent. We project that 
hospitals for which a DSH percentage is not available, including 
psychiatric hospitals, rehabilitation hospitals, and long-term care 
hospitals would experience decreases in payments of 8.9 percent, and 
for the urban subset, 9.2 percent, largely as a result of proposed 
changes to partial hospitalization and psychotherapy payments.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals would gain 0.4 percent, while governmental and 
voluntary hospitals would experience neither gains nor losses (0.0 
percent change).
Column 3: New Wage Indices and the Effect of the Rural Adjustment
    Changes introduced by the proposed FY 2007 IPPS wage indices 
together with the effect of including EACHs in the rural adjustment 
would have a modest impact in CY 2007, decreasing payments to rural 
hospitals other than SCHs slightly and having no effect overall on 
urban hospitals. We estimate that rural SCHs would experience an 
increase in payments of 0.1 percent, while all other rural hospitals 
experience a decrease of 0.2 percent. With respect to volume, rural 
hospitals with moderate volume experience decreases of 0.2 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 would experience decreases in payment up 
to 0.7 percent due to wage changes, including New England, East South 
Central, South Atlantic, Mountain, and West South Central regions. 
However, rural hospitals in the remaining regions experience increases. 
We estimate that the Pacific region would see the largest increase of 
0.6 percent.
    Overall, urban hospitals experience no change in payments as a 
result of the new wage indices and the rural adjustment. With respect 
to facility size, we estimate that urban hospitals with less than 100 
and greater than 499 beds would experience a decrease in payments of 
0.1 percent. Urban hospitals with 100-299 beds experience no change. 
Urban hospitals with between 300-499 beds have the largest increase of 
0.1 percent. When categorized by volume, urban hospitals with the 
largest volume experience no change in payment as a result of changes 
to the wage index and the presence of the rural adjustment, and urban 
hospitals with the lowest volume experience a 0.2 percent increase in 
payment. We estimate that urban hospitals in the South Atlantic, East 
South Central, and West South Central regions would experience modest 
decreases due to wage changes and the effect of the rural adjustment of 
no more than 0.3 percent (except for urban hospitals in Puerto Rico, 
with a decrease of 1.8 percent). Urban hospitals in all other regions 
(except New England) would experience an increase of 0.1 to 0.7 
percent. Urban hospitals in the New England region would experience no 
change in payments.

[[Page 49685]]

    Looking across other categories of hospitals, we estimate that 
updating the wage index and continuing the rural adjustment would lead 
major teaching hospitals to gain 0.1 percent and hospitals without 
graduate medical education programs are estimated to lose 0.1 percent. 
Hospitals serving 23-35 percent low-income patients are estimated to 
gain 0.1 percent. Hospitals serving no low-income patients, for which 
the percent of low-income patients cannot be determined and those 
serving more than 35 percent low-income patients lose 0.1 percent, 
whereas hospitals serving other percentages of low-income patients 
experience no change. Voluntary hospitals as classes would experience 
no change in payment due to wage changes and the effect of the rural 
adjustment. Governmental and proprietary hospitals would lose 0.1 
percent.
Column 4: All Budget Neutrality Changes and Market Basket Update
    The addition of the market basket update alleviates any negative 
impacts on payments for CY 2007 created by the budget neutrality 
adjustments made in Columns 2, and 3, with the exception of urban 
hospitals with the lowest volume of services and hospitals not paid 
under IPPS, including psychiatric hospitals, rehabilitation hospitals, 
and LTCHs (DSH not available). In many instances, the redistribution of 
payments created by proposed APC recalibration offset those introduced 
by updating the wage indices. However, in a few instances, negative APC 
recalibration changes compound a reduction in payment from updating the 
wage index.
    We estimate that the cumulative impact of the budget neutrality 
adjustments and the addition of the market basket update would result 
in an increase in payments for urban hospitals of 3.4 percent, which is 
equal to the market basket update of 3.4 percent. Large urban hospitals 
would experience an increase of 3.3 percent and other urban hospitals 
would experience an increase of 3.6 percent. Urban hospitals with the 
lowest volume experience a negative market basket update, which is 
largely a function of the 7.1 percent decrease in payments attributable 
to changes to the APC structure. Urban hospitals with moderate volume 
have an increase of 2.3 percent while urban hospitals with volumes 
greater than 10,999 lines have increases of 3.4 to 3.5 percent. When we 
examine the impact of the cumulative effect of APC changes, wage index 
and rural adjustment changes, and the market basket on urban hospitals 
by region, we see that urban hospitals in five regions (New England, 
East North Central, West South Central, Mountain, and Pacific) would 
experience an increase that is equal to or higher than the market 
basket increase. Hospitals in the remaining five regions (Middle 
Atlantic, South Atlantic, East South Central, West North Central, and 
Puerto Rico) receive an increase that is less than the market basket.
    We estimate that the cumulative impact of budget neutrality 
adjustments and the market basket update would result in an overall 
increase for rural hospitals of 3.4 percent, with rural SCHs 
experiencing an update of 3.4 percent and other rural hospitals also 
experiencing an update of 3.4 percent. In general, rural hospitals with 
less than 200 beds and rural hospitals with more than 5,000 lines of 
volume experience increases equal to or greater than the market basket 
update of 3.4 percent. We estimate that low-volume rural hospitals 
would experience no change (0.0 percent). Rural hospitals demonstrate 
variability by region. We estimate that four regions (East North 
Central, West North Central, West South Central, and Pacific) would 
experience increases larger than the market basket update. We also 
estimate that rural hospitals in the five remaining regions (New 
England, Middle Atlantic, South Atlantic, East South Central, and 
Mountain) would receive increases that would be less than the market 
basket increase.
    The changes across columns for other classes of hospitals are 
fairly moderate and most show updates relatively close to the market 
basket update with the exception of hospitals not paid under the IPPS. 
These hospitals show negative payment updates as a result of changes to 
payment rates for partial hospitalization and psychotherapy services. 
Voluntary, proprietary and governmental hospitals also show an increase 
equal to or greater than the market basket.
Column 5: All Proposed Changes for CY 2007
    Column 5 compares all proposed changes for CY 2007 to final payment 
for CY 2006 and includes any additional dollars resulting from 
provisions in Pub. L. 108-173 in both years, changes in outlier payment 
percentages and thresholds, and the difference in pass-through 
estimates. Overall, we estimate that hospitals would gain 3.0 percent 
under this proposed rule in CY 2007 relative to total spending in CY 
2006. When we excluded cancer and children's hospitals, which are held 
harmless, the gain is 3.1 percent. While hospitals would receive the 
3.4 percent increase due to the market basket update appearing in 
Column 4 and the additional 0.04 percent for the reduction in the pass-
through estimate between CY 2006 and CY 2007, we estimate that 
hospitals also experience a 0.25 percent loss due to outlier payments 
as a result of the increased threshold and the change to the overall 
CCR that is used to estimate outlier payments. In addition, there is a 
loss of 0.17 percent as a result of the expiration of the section 508 
wage adjustment.
    In general, urban hospitals appear to experience the largest 
negative impacts from the combined effects of these factors. We 
estimate that hospitals in large urban areas would gain 3.0 percent in 
CY 2007 and hospitals in other urban areas would gain 3.1 percent. We 
estimate that low-volume urban hospitals would experience a decrease in 
total payments of 3.2 percent between CY 2006 and CY 2007, largely as a 
result of changes to payment for partial hospitalization, psychotherapy 
and radiation therapy services. Hospitals reporting 5,000 to 10,999 
lines of volume show an increase of 1.9 percent but all hospitals with 
volume larger than 10,999 lines have increases equal to or greater than 
3.1 percent. Urban hospitals in all regions other than the Mountain 
region have overall increases that are less than the market basket 
increase and which range from 2.5 to 3.3 percent. Urban hospitals in 
the Mountain region are estimated to receive the largest increases for 
urban hospitals of 4.1 percent.
    Overall, rural hospitals experience increases similar to those 
observed for urban hospitals. Overall, we estimate that rural hospitals 
would experience an increase in payments of 3.1 percent, which is 
identical to the 3.1 percent increase we project for all hospitals when 
we exclude the 58 hospitals that are held harmless under the law. 
However, we also estimate that rural SCHs would experience an increase 
of 2.8 percent, and that the other rural hospitals would only 
experience an increase of 3.3 percent. No category of rural hospitals 
experiences a decrease in payments between CY 2006 and CY 2007, and 
rural hospitals in a few regions show increases comparable to, or 
better than, the market basket. Rural hospitals with fewer than 150 
beds and rural hospitals with volumes greater than 4,999 lines 
experience increases of at least 3.0 percent, the national average 
overall increase for all hospitals. Across the regions, rural hospitals 
in five regions (South Atlantic, East North Central, East South 
Central, West South Central, and Pacific) are projected to

[[Page 49686]]

receive increases equal to or greater than the projected 3.0 percent 
increase for all hospitals. Rural hospitals in four regions (New 
England, Middle Atlantic, West North Central, and Mountain) are 
projected to receive overall increases that are less than the projected 
increase for all hospitals. We project that low-volume rural hospitals 
would experience the lowest increase in overall payment of 0.8 percent 
(due largely to changes in payment for partial hospitalization, 
psychotherapy, and radiation therapy services).
    Among other classes of hospitals, we estimate that hospitals not 
paid under the IPPS (DSH Not Available) would experience decreases in 
payments between CY 2006 and CY 2007 of 5.4 percent. We estimate that 
major teaching hospitals would experience an increase of 2.6 percent 
and that nonteaching hospitals would experience an increase of 3.2 
percent.

BILLING CODE 4120-01-P

[[Page 49687]]

[GRAPHIC] [TIFF OMITTED] TP23AU06.041


[[Page 49688]]


[GRAPHIC] [TIFF OMITTED] TP23AU06.042

BILLING CODE 4120-01-C
4. Estimated Effect 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 would 
increase for services for which OPPS payments would rise and would 
decrease for services for which OPPS payments would fall. For example, 
for an electrocardiogram (APC 0099), the minimum unadjusted copayment 
in CY 2006 was $4.49. In this proposed rule, the minimum unadjusted 
copayment for APC 0099 is $4.72 because the OPPS payment for the 
service would increase under this proposed rule. In another example, 
for a Level IV Needle Biopsy (APC 0037), in the CY 2006 OPPS, the 
national unadjusted copayment in CY 2006 was $228.76, and the minimum 
unadjusted copayment was $114.38. In this

[[Page 49689]]

proposed rule, the national unadjusted copayment for APC 0037 is 
$228.76. The minimum unadjusted copayment for APC 0037 is $126.32, or 
20 percent of the proposed payment for APC 0037. In all cases, the 
statute limits beneficiary liability for copayment for a service to the 
inpatient hospital deductible for the applicable year. For 2006, the 
inpatient deductible is $962.
    In order to better understand the impact of changes in copayment on 
beneficiaries, we modeled the percent change in total copayment 
liability using CY 2005 claims. We estimate, using the claims of the 
3,922 hospitals on which our modeling is based, that total beneficiary 
liability for copayments would decline as an overall percentage of 
total payments from 27.5 percent in CY 2006 (revised from 29 percent 
that we estimated for CY 2006 in the November 1, 2005 final rule with 
comment period 70 FR 68727) to 26.3 percent in CY 2007. This estimated 
decline in beneficiary liability is a consequence of the APC 
recalibration and reconfiguration we are proposing for CY 2007. In 
particular, the proposed changes to the emergency department visit APCs 
would set the copayments for these high volume services to 20 percent 
of the proposed payment rates, resulting in a significant reduction in 
beneficiary copayments.
5. Accounting Statement
    As required by OMB Circular A-4 (available at http://www.whitehousegov/omb/circulars/a004/a-4.pdf, in Table 50 below, we 
have prepared an accounting statement showing the classification of the 
expenditures associated with the OPPS provisions of this proposed rule. 
This table provides our best estimate of the increase in Medicare 
payments under the OPPS as a result of the changes presented in this 
proposed rule on the data for 3,922 hospitals. All expenditures are 
classified as transfers to Medicare providers (that is, OPPS).

      Table 50.--Accounting Statement: Classification of Estimated
                  Expenditures From CY 2006 to CY 2007
------------------------------------------------------------------------
                Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.........  $1.0 Billion.
From Whom to Whom......................  Federal Government to OPPS
                                          Medicare Providers.
Category...............................  Transfers.
Annualized Monetized Transfer..........  $250 Million.
From Whom to Whom......................  Increase in Premium Payments
                                          from Beneficiaries to Federal
                                          Government.
                                        --------------------------------
    Total..............................  $750 Million.
------------------------------------------------------------------------

6. Conclusion
    The changes in this proposed rule would affect all classes of 
hospitals. Some hospitals experience significant gains and others less 
significant gains, but almost all hospitals would experience positive 
updates in OPPS payments in CY 2007. Table 49 demonstrates the 
estimated distributional impact of the OPPS budget neutrality 
requirements and an additional 3.0 percent increase in payments for CY 
2007, after considering the proposed market basket increase, the cost 
of outliers, changes to the pass-through estimate and the elimination 
of the section 508 adjustment of Pub. L. 108-173. The accompanying 
discussion, in combination with the rest of this proposed rule,2 
constitutes a regulatory impact analysis.

C. Effects of Proposed Changes to the ASC Payment System for CY 2007

    (If you choose to comment on issues in the section, please include 
the caption ``CY 2007 ASC Impact'' at the beginning of your comment.)
    We are proposing to add 14 surgical procedures to the Medicare list 
of ASC payable services and to implement section 5103 of Pub. L. 109-
171, which requires the Secretary to substitute the OPPS payment amount 
for the ASC standard overhead amount if the standard overhead amount 
for facility services for surgical procedures performed in an ASC, 
without application of any geographic adjustment, exceeds the Medicare 
OPPS payment amount for the service for that year, without application 
of any geographic adjustment. This provision applies to surgical 
procedures furnished in ASCs on or after January 1, 2007, and before 
the effective date of the revised ASC payment system. Except for the 
payment changes required under section 5103 of Pub. L. 109-171, we are 
proposing no changes in CY 2007 to the ASC payment rates that are 
currently in effect.
    The Office of the Actuary estimates that adding the 14 procedures 
we are proposing in section XVII. of this preamble and implementing the 
Pub. L. 109-171 mandate would result in a savings to the Medicare 
program of approximately $150 million in CY 2007.
1. Alternatives Considered
    We are issuing this proposed rule to meet a statutory requirement 
that we update the list of approved ASC procedures at least every two 
years. We implement the biennial update of the list through notice and 
comment in the Federal Register to give interested parties an 
opportunity to review and comment on proposed additions to and 
deletions from the ASC list. The last update of the ASC list through 
notice and comment was effective July 5, 2005. However, the statute 
requires us to update the list at least every 2 years, which means we 
must update the list by July 2007.
2. Limitations of Our Analysis
    Without datasets related to classes of ASCs which parallel the data 
maintained in the Medicare provider-specific files for hospitals, we 
cannot model distributional impacts of the proposed CY 2007 changes in 
the ASC list and ASC payments similar to those we prepare for our OPPS 
impact analysis (see Table 49). The actuarial estimate of Medicare 
program costs or savings resulting from the update of the ASC list and 
implementation of section 5103 of Pub. L. 109-171 in CY 2007 is based 
on estimated CY 2007 utilization. As we have done in previous proposed 
rules, we are soliciting comments and information about the anticipated 
effect of these changes that we are proposing for CY 2007 to gauge 
their impact on individual ASCs.
3. Estimated Effects of This Proposed Rule on ASCs
    The CMS Office of the Actuary estimates that approximately 25 
percent of the cases currently reported by hospitals using the 14 codes 
we are proposing to add to the ASC list would shift to the ASC setting 
in CY 2007. It estimates that the shift of these procedures to the less 
costly ASC setting

[[Page 49690]]

would result in modest savings for the Medicare program.
    Savings would also be realized because section 5103 of the Pub. L. 
109-171 would impose a payment limit for 81 procedures on the current 
ASC list. The Office of the Actuary estimates that adding 14 surgical 
procedures to the ASC list and capping payment for 81 procedures on the 
current ASC list would result in a combined savings to the Medicare 
program of approximately $150 million in CY 2007. We have not estimated 
the impact of our proposed changes for CY 2007 on Medicare expenditures 
in subsequent years because we are proposing to implement an entirely 
revised payment system in CY 2008. Our analysis of the impact of that 
proposed payment system is discussed in section XXVII.D.
    Currently, Medicare pays a facility fee to ASCs only for those 
procedures that have been approved for the ASC list. The addition of 14 
surgical procedures to the ASC list would be beneficial to ASCs by 
making it possible for them to offer more surgical procedures to 
Medicare beneficiaries. We believe that approximately 25 percent of the 
annual hospital outpatient volume of the 14 procedures proposed for 
addition to the ASC list would move to the ASC setting in CY 2007. To 
the extent that hospital outpatient utilization decreases and ASC 
utilization increases in CY 2007, the Medicare program would realize a 
savings because the ASC standard overhead amount for all procedures, 
including the proposed additions to the ASC list, would be equal to or 
lower than the payment rate for the same procedures under the OPPS. 
Because hospitals perform a much higher volume of ambulatory surgeries 
overall than are performed in ASCs, we do not expect significant 
hospital revenue losses to result from migration of procedures that we 
are proposing for addition to the ASC list to the ASC setting.
4. Estimated Effects of This Proposed Rule on Beneficiaries
    The proposed changes for CY 2007 would be positive for 
beneficiaries in at least two respects. First, for the procedures we 
are proposing to add to the ASC list in CY 2007, the beneficiary 
copayment amount would be lower when these procedures are performed in 
an ASC than if they were performed in a hospital outpatient department. 
The difference in copayment amounts is attributable to the difference 
in the coinsurance rate between the ASC payment system and the OPPS. 
That is, the coinsurance rate for all surgical procedures payable under 
the ASC benefit is 20 percent of the standard overhead amount, whereas 
the coinsurance rate for the same surgical procedures performed in a 
hospital outpatient setting ranges from 20 percent to 40 percent under 
the OPPS. In addition, in accordance with section 5103 of Pub. L. 109-
171, no ASC payment rate in CY 2007 may be greater than the OPPS rate 
for a given procedure. Thus, due to the limitations on the ASC facility 
rate required by Pub. L. 109-171, beneficiaries will be assured a lower 
ASC copayment amount for procedures in CY 2007 than in previous years. 
The only exceptions would be when the ASC copayment amount exceeds the 
inpatient deductible. The statute requires that copayment amounts under 
the OPPS not exceed the inpatient deductible.
    Second, beneficiary access to services would be expanded by the 
proposed addition of 14 surgical procedures to the ASC list. 
Beneficiaries would have an additional setting from which to choose 
were it necessary for them to undergo one of the surgical procedures 
that we are proposing to add the ASC list in CY 2007.
5. Conclusion
    The impact on ASCs of proposed changes to the ASC payment system 
for CY 2007 would depend on an individual ASC's mix of patients and its 
payers, specifically, the proportion of its patients who are Medicare 
beneficiaries, whether or not the ASC chooses to perform the procedures 
proposed for addition to the ASC list, and whether or not the ASC 
provides services that will be affected by the payment limits imposed 
by section 5103 of Pub. L. 109-171. Overall, the Office of the Actuary 
estimates that the Medicare program would realize a $35 million savings 
as a result of implementing the changes proposed for CY 2007.
6. Accounting Statement
    As required by OMB Circular A-4 (available at http://www.whitehousegov/omb/circulars/a004/a-4.pdf), in Table 51 below, we 
have prepared an accounting statement showing the classification of the 
expenditures associated with the CY 2007 ASC provisions of this 
proposed rule. This table provides our best estimate of the reduction 
in Medicare payments under the ASC payment system as a result of the 
changes presented in this proposed rule for CY 2007. All expenditures 
are classified as transfers to Medicare providers (that is, ASC).

    Table 51.--Accounting Statement: Classification of Estimated ASC
                  Expenditures From CY 2006 to CY 2007
------------------------------------------------------------------------
                Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.........  $150 million savings.
From Whom to Whom......................  Medicare ASC Suppliers to the
                                          Federal Government.
Annualized Monetized Transfer..........  $50 Million Impact.
From Whom to Whom......................  Decrease in Premium from
                                          Beneficiaries to Federal
                                          Government.
                                        --------------------------------
    Total..............................  $100 million savings.
------------------------------------------------------------------------

D. Effects of Proposed Revisions to the ASC Payment System for CY 2008

    (If you choose to comment on issues in this section, please include 
the caption ``CY 2008 ASC Impact'' at the beginning of your comment.)
    In CY 2008, we are proposing to implement a completely revised 
Medicare ASC payment system that could have a far-reaching effect on 
the provision of outpatient surgical services for a number of years to 
come. First, we are proposing to greatly expand the list of procedures 
that would be eligible for payment of an ASC facility fee. Second, we 
also are proposing to move from a limited fee schedule based on nine 
disparate payment groups to a payment system incorporating relative 
payment weights and APC groups, which are key elements of the hospital 
OPPS.
    Implementation by January 1, 2008 of a revised ASC payment system 
designed to result in budget neutrality is mandated by section 626 of 
Pub. L. 108-173. To set ASC payment rates for CY 2008 under the revised 
system, we are proposing to multiply ASC relative payment weights for 
surgical procedures by an ASC conversion factor that we would calculate 
to result in the same aggregate expenditures for ASC services

[[Page 49691]]

in CY 2008 that we estimate would have been made if the revised payment 
system were not implemented.
    The effects of the expanded ASC list combined with significant 
changes in payment rates for ASC facility services would vary across 
ASCs, depending on whether or not the ASC limits its services to those 
in a particular surgical specialty area, the volume of specific 
services provided by the ASC, and the percentage of its patients that 
are Medicare beneficiaries.
    The Office of the Actuary estimates that the revised payment system 
proposed in section XVIII. of this preamble would result in neither 
savings nor costs for the Medicare program. That is, because it is 
designed to be budget neutral, the revised ASC payment system proposed 
for implementation in CY 2008 would neither increase nor decrease 
expenditures under Part B of Medicare. The Office of the Actuary 
further estimates that beneficiaries would save approximately $30 
million under the revised ASC payment system proposed for 
implementation in CY 2008 because ASC payment rates would in all cases 
be lower than OPPS payment rates for the same services, and because 
beneficiary coinsurance for ASC services is a strict 20 percent rather 
than the 20-40 percent coinsurance rates allowed under the OPPS. (The 
only exceptions would be when the copayment amount for a procedure 
under the revised ASC payment system exceeds the hospital inpatient 
deductible. Section 1833(t)(8)(C)(i) of the Act provides that the 
copayment amount for a procedure paid under the OPPS cannot exceed the 
inpatient deductible established for the year in which the procedure is 
performed.)
1. Alternatives Considered
    We are issuing this proposal to meet a statutory requirement to 
implement, no later than January 1, 2008, a revised payment system for 
ASCs. We are proposing to implement the revised payment system and 
expanded list through rulemaking in the Federal Register to afford 
interested parties an opportunity to comment on revisions we are 
proposing to the policies and rules for identifying surgical procedures 
that would be approved for payment of an ASC facility fee and the 
revisions we are proposing to the ASC ratesetting methodology and 
payment policies and regulations under the revised ASC payment system.
    Throughout section XVIII. of this preamble, we discuss the various 
options we considered as we developed proposals to redesign the ASC 
payment system in broad terms, and specific policies, such as those 
affecting payment for ancillary services related to surgical 
procedures, the definition of a surgical procedure, criteria for 
identifying procedures that are not safely or appropriately performed 
in an ASC, and so forth.
    Although we propose in section XVIII. of this preamble to phase in 
the new ASC payment rates under the revised payment system over a 2-
year period, we initially considered fully implementing the new rates 
for ASC services furnished on or after January 1, 2008. However, as we 
discuss below, our analysis of the effect that the change in payments 
might have on ASCs led us to propose implementation of payment rates in 
CY 2008 that would be based upon a 50/50 blend of the estimated current 
payment rate with the new payment rate. We believe that allowing a 
blended rate in the first year is appropriate in light of the adverse 
financial impact that some ASCs could potentially experience if they 
perform a high volume of procedures whose rates would significantly 
decrease under the revised system. We want to emphasize that our 
proposed blended payment is but one of the numerous provisions we 
propose in section XVIII. of this preamble as comprising the revised 
ASC payment system. That is, our proposal to make payment for a 
surgical procedure in the first year we implement the revised payment 
system of only 50 percent of the payment rate determined in accordance 
with the current payment system, would be built into and considered 
integral to full implementation of the revised ASC payment system 
proposed for CY 2008.
2. Limitations of Our Analysis
    Without datasets related to classes of ASCs which parallel the data 
maintained in the Medicare provider-specific files for hospitals, we 
cannot model distributional impacts of the proposed CY 2007 changes in 
the ASC list and ASC payments similar to those that we prepare in our 
impact analysis for the OPPS (see Table 49 in section XXVII.B. above). 
The impacts presented here are the projected effects of the policy and 
statutory changes that would be effective for CY 2008, on aggregate ASC 
utilization and Medicare payments. We can only infer the effects of the 
revised payment system on different types of ASCs, for example, single 
or multispecialty, high or low volume, urban or nonurban ASCs, based on 
an overall comparison of procedure volume and facility payments between 
the current and the proposed payment system. Moreover, because ASCs are 
not required to file Medicare cost reports, we do not have those as a 
source of data to help evaluate whether or not the payments for ASC 
services are appropriate, taking into account the resources required by 
ASCs to perform different surgical procedures.
    Because the aggregated impact tables below are based upon a 
methodology that assumes no changes in service mix or volumes with 
respect to the most recent CY 2005 ASC data, our estimates of the 
percent change in allowed charges based on the revised payment system 
for CY 2008 are necessarily limited. We believe it is likely that the 
volumes and service mix of procedures provided in ASCs would change 
significantly in CY 2008 under the revised payment system, although we 
are unable to accurately project these changes. At this point, our data 
do not enable us to confidently estimate the net potential for 
migration of services among ambulatory care settings that might result 
from implementation of the proposed revised ASC payment system. As we 
have done in previous proposed rules, we rely on comments and 
information from stakeholders to mitigate the limitations in the data 
available to us for analysis of the impact these proposed changes would 
have on individual ASCs, on classes of specialty ASCs, on hospitals, on 
physicians and on beneficiaries.
3. Estimated Effect of This Proposed Rule on ASCs
    Some ASCs are multispecialty facilities that perform the gamut of 
surgical procedures from excision of lesions to hernia repair to 
cataract extraction; others focus on a single specialty and perform 
only a limited range of surgical procedures, such as eye procedures or 
gastrointestinal procedures or orthopedic surgery. The combined effect 
on an individual ASC of the proposed revised CY 2008 payment system and 
the proposed expanded list of procedures would depend on a number of 
factors including, but not limited to, the mix of services the ASC 
provides, the volume of specific services provided by the ASC, and the 
percentage of its patients who are Medicare beneficiaries. An 
individual ASC's revenues from non-Medicare sources might or might not 
be affected by the Medicare payment changes depending on the mix of 
services it provides to its non-Medicare patients and the extent to 
which revenues from other payors are influenced by the Medicare payment 
rates.
    To estimate changes in Medicare payments for current ASC services, 
we

[[Page 49692]]

compared estimated payment rates for CY 2008 under the current system 
with the estimated proposed payment rates for CY 2008 under the revised 
system. In analyzing these comparisons, we became concerned about the 
significant negative effect the new payment rates might have on 
Medicare revenues for certain surgical procedures that are frequently 
performed in ASCs. We also became concerned about the impact of the 
revised payment rates on ASCs that specialize in a limited number of 
surgical procedures for which payment would decrease under the new 
system. We do not want the revised payment system to cause procedures 
currently performed in high volume in ASCs to migrate to hospital 
outpatient departments in response to sudden payment reductions. On the 
contrary, we want to encourage procedures that are being frequently 
performed in ASCs at the present time to continue being performed in 
ASCs because, in all likelihood, the ASC has become an extremely 
efficient setting for high volume procedures, such as cataract 
extraction and colonoscopies. Moreover, we believe one of the positive 
outcomes of the revised ASC payment system could be to expand 
beneficiary and physician choice when it comes to selecting an 
appropriate site for ambulatory surgical services as a consequence of 
the expansion of surgical services available in the ASC setting and 
revised payment rates that pay more appropriately for ASC facility 
services. Therefore, to give ASCs additional time to reconfigure their 
case mix so that they can focus on achieving more efficient delivery of 
a broader range of services, we are proposing during the first year of 
the revised payment system (CY 2008) to pay ASCs using a blended rate, 
50 percent of the CY 2007 ASC rate for surgical procedures on the CY 
2007 ASC list added to 50 percent of the CY 2008 proposed ASC rate.
    Table 52 shows the impact at the APC group level, sorted by APC 
group, of the revised payment system if we were to apply a 50/50 blend 
of the old ASC payment rate and the new ASC payment within the 
particular APC group. The APC groups shown in this table are those for 
which we estimate CY 2008 allowed charges under the revised payment 
system would exceed $5 million. Procedures assigned to these APCs 
account for the highest aggregate allowed charges under the current 
payment system. The following is an explanation of the information 
represented in Table 52:
     Column 1--APC Group indicates the APC classification of 
procedures to which the ASC expenditures are attributed. For a listing 
of the individual HCPCS codes assigned to the APC groups, see Addendum 
C of this proposed rule, which can be found on the CMS Web site.
     Column 2--Allowed Charges are the Medicare payment amounts 
for covered ASC surgical procedures. Allowed charges include both 
Medicare program payments and coinsurance and deductibles, which are 
the financial responsibility of the beneficiary. These amounts have 
been summed across all procedures provided within the particular APC by 
ASCs. The allowed charges are expressed in millions of dollars.
     Column 3--CY 2008 Percent Change (under 50/50 Blend): The 
CY 2008 impact of the revised ASC payment system under the transition 
is the percentage increase or decrease in allowed charges attributable 
to changes in the ASC payment rates for CY 2008 under a 50/50 blend of 
the old ASC payment rate and the new ASC payment within the particular 
APC group.

 Table 52.--Estimated CY 2008 Impact of the Proposed Revised ASC Payment
 System on Aggregate Allowed Charges Under the 50/50 Blend, by APC Group
------------------------------------------------------------------------
                                                               CY 2008
                                                  Allowed      percent
                   APC group                    charges (in     change
                                                 millions)    (under 50/
                                                              50 Blend)
------------------------------------------------------------------------
0021--Level III Excision/ Biopsy..............           $7           20
0022--Level IV Excision/ Biopsy...............           12           34
0027--Level IV Skin Repair....................            6           33
0028--Level I Breast Surgery..................            7           25
0041--Level I Arthroscopy.....................           56           35
0042--Level II Arthroscopy....................           14          108
0051--Level III Musculoskeletal Procedures               17           55
 Except Hand and Foot.........................
0053--Level I Hand Musculoskeletal Procedures.           20           17
0054--Level II Hand Musculoskeletal Procedures            6           39
0055--Level I Foot Musculoskeletal Procedures.           36           28
0057--Bunion Procedures.......................            9           60
0075--Level V Endoscopy Upper Airway..........           14           27
0140--Esophageal Dilation without Endoscopy...           10          -18
0141--Level I Upper GI Procedures.............          233          -12
0143--Lower GI Endoscopy......................          427          -11
0154--Hernia/Hydrocele Procedures.............           15           31
0158--Colorectal Cancer Screening: Colonoscopy           63          -15
0160--Level I Cystourethroscopy and other                26          -11
 Genitourinary Procedures.....................
0161--Level II Cystourethroscopy and other               14           35
 Genitourinary Procedures.....................
0162--Level III Cystourethroscopy and other              11           51
 Genitourinary Procedures.....................
0163--Level IV Cystourethroscopy and other                5           20
 Genitourinary Procedures.....................
0184--Prostate Biopsy.........................            8          -18
0203--Level IV Nerve Injections...............            9           25
0206--Level II Nerve Injections...............           58          -17
0207--Level III Nerve Injections..............          209          -12
0220--Level I Nerve Procedures................           22           30
0233--Level II Anterior Segment Eye Procedures            8           17
0234--Level III Anterior Segment Eye                     17           23
 Procedures...................................
0240--Level III Repair and Plastic Eye                   47            7
 Procedures...................................
0244--Corneal Transplant......................            7           27

[[Page 49693]]

 
0246--Cataract Procedures with IOL Insert.....        1,100           -2
0247--Laser Eye Procedures Except Retinal.....           97          -18
0254--Level IV ENT Procedures.................            6           31
0672--Level IV Posterior Segment Eye                     23           41
 Procedures...................................
0686--Level III Skin Repair...................           54           -5
All Other (APC categories less than $5                  110           25
 million).....................................
                                               -------------------------
    Total.....................................        2,785            0
------------------------------------------------------------------------

    Table 53 below shows the impact of the revised payment system on 
total payments for selected high volume procedures during the first 
year the revised payment system is implemented (CY 2008). These are the 
most frequently performed procedures at ASCs under the current Medicare 
payment system. The HCPCS codes are sorted in descending order by 
estimated allowed charges. The percent change in this table again 
compares payment rates for CY 2008 under the current system with our 
estimate of the proposed payment rates for CY 2008, incorporating a 50/
50 blend of the ASC payment under the current system and the ASC 
payment under the revised system.

  Table 53.--Estimated CY 2008 Impact of Revised ASC Payment System on
 Aggregate Payments for Selected High Volume Procedures under the 50/50
                                  Blend
------------------------------------------------------------------------
                                                  Allowed      CY 2008
                                                  charges      percent
     HCPCS Code             Description             (in      change  (50/
                                                 millions)    50 Blend)
------------------------------------------------------------------------
66984..............  Cataract surg w/iol, 1          $1,062           -2
                      stage.
43239..............  Upper gi endoscopy,                166          -13
                      biopsy.
45378..............  Diagnostic colonoscopy...          147          -11
45380..............  Colonoscopy and biopsy...          112          -11
45385..............  Lesion removal                     108          -11
                      colonoscopy.
66821..............  After cataract laser                97          -18
                      surgery.
62311..............  Inject spine l/s (cd)....           78          -12
45384..............  Lesion remove colonoscopy           45          -11
64483..............  Inj foramen epidural l/s.           42          -12
64476..............  Inj paravertebral l/s add-          39          -17
                      on.
G0121..............  Colon ca scrn; not high             37          -15
                      rsk.
66982..............  Cataract surgery, complex           32           -2
15823..............  Revision of upper eyelid.           29          -13
43235..............  Uppr gi endoscopy,                  28           -1
                      diagnosis.
G0105..............  Colorectal scrn; hi risk            26          -15
                      ind.
64475..............  Inj paravertebral l/s....           25          -12
52000..............  Cystoscopy...............           24          -10
64484..............  Inj foramen epidural add-           20          -12
                      on.
67904..............  Repair eyelid defect.....           18            4
43248..............  Uppr gi endoscopy/guide             18          -13
                      wire.
64721..............  Carpal tunnel surgery....           17           30
29881..............  Knee arthroscopy/surgery.           17           41
28285..............  Repair of hammertoe......           15           29
64623..............  Destr paravertebral n add-          15          -12
                      on.
62310..............  Inject spine c/t.........           13          -12
29880..............  Knee arthroscopy/surgery.           12           41
26055..............  Incise finger tendon                11           22
                      sheath.
------------------------------------------------------------------------

    Over time, we believe the current ASC payment system has served as 
an incentive to ASCs to focus on providing procedures for which they 
determine Medicare payments are adequate to support the ASC's continued 
operation. In our analyses of the effects of the new payment rates, we 
found that the ASC payment rates for many of the procedures performed 
most frequently in ASCs are equal to or greater than the OPPS rates for 
the same procedures. Conversely, procedures for which the current ASC 
payment rates are lower than the OPPS rates for the same procedures 
tend to be performed less frequently in ASCs. We believe the proposed 
revised payment system represents a major stride towards encouraging 
greater efficiency in ASCs and promoting a significant increase in the 
scope and breadth of surgical procedures performed in ASCs because it 
would more appropriately distribute

[[Page 49694]]

payments across the entire spectrum of surgical procedures, based on a 
coherent system of relative payment weights. As a consequence, we 
expect that there would be changes in the mix of procedures provided in 
ASCs under the proposed revised payment system because the revised 
payment system would encourage ASCs to expand their service mix beyond 
the handful of the most lucrative procedures which comprise the bulk of 
ASC utilization under the current Medicare payment system.
    There are also some procedures for which the current ASC and OPPS 
rates are roughly equivalent. Under the proposed revised payment 
system, those services would be paid a significantly lower amount than 
they are currently. We believe that in some cases the payment under the 
current ASC system is generous relative to ASC costs, so ASCs would in 
all likelihood continue performing those procedures under the proposed 
revised payment system. To the extent that ASCs determine that the new 
rates for specific services or types of procedures are inadequate 
relative to the costs of those services, we would expect a change in 
the mix of services the ASC provides.
    Table 53 identifies a number of high volume procedures for which 
ASC payments would decrease under the revised system, although payments 
would increase significantly for other high volume procedures. What 
Table 53 does not show are the hundreds of other procedures currently 
on the ASC list that have very low volume, which we believe correlates 
with the low payment rates currently set for those procedures. Under 
the revised system, payment rates would increase significantly for 
numerous procedures that are currently underpaid when compared with 
payments for the same services under the OPPS. While an ASC may earn 
less from providing a service that has been its highest volume (and 
best paid) procedure under the current system because the payment rate 
for that procedure is lower under the revised payment system, that ASC 
may more than offset the reduction in revenues by beginning to perform 
other services for which the proposed rates under the revised system 
are significantly higher. The procedures displayed in Table 53 (current 
high volume procedures) are the highest volume procedures under the 
current system but we expect that other procedures will become high 
volume procedures under the revised system.
    While Table 52 suggests that payment for some types of procedures 
would decrease and others would increase, considering multiple 
procedures as a clinically related group generally moderates some of 
the extreme increases and decreases in payments displayed in Table 53 
for selected high volume procedures that are members of those groups. 
ASCs with particular capabilities for specializing in urological or 
gastrointestinal procedures could shift their focus to other related 
procedures in the same taxonomy whose payment rates were more 
favorable. Those specialty ASCs could potentially continue to draw upon 
their experiences and resources to perform other related services.
    The tables above show how payment for high volume procedures 
currently on the ASC list would be affected by changes in payment using 
the ASC relative payment weights and rate setting methodology proposed 
under the new payment system. We also propose to add in CY 2008 
hundreds of surgical procedures to the already extensive list of 
services for which Medicare allows payment of an ASC facility fee, 
creating new opportunities for ASCs to expand their range of Medicare-
approved surgical procedures. Table 54 suggests some of the potential 
for growth that ASCs could realize under the revised payment system. 
The codes in this table are selected high volume procedures currently 
performed predominantly in the office and/or hospital outpatient 
setting. We believe the payment rates for these procedures under the 
proposed revised system would make them attractive additions to the 
existing surgical choices that ASCs currently offer Medicare 
beneficiaries in the areas of gastroenterology, urology, and pain 
management. Note that we have included columns to show the MPFS 
nonfacility rate, office volume, and a column entitled ``OPPS Rate 
Adjusted to CY 2008 ASC Rate'' that shows the proposed blended CY 2008 
payment rate for each procedures that is compared to the MPFS 
nonfacility rate to determine which is the proposed CY 2008 rate. The 
procedures that are on the office-based list and, are therefore, 
subject to payment limitation (the lesser of the ASC rate or the MPFS 
nonfacility rate) are denoted with an asterisk. We have also denoted 
with an asterisk, those proposed CY 2008 ASC payments that are limited 
by the nonfacility rate.

                 Table 54.--Selected High Volume Procedures Proposed for ASC Payment for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                                        Payment
                                                                                                          for
                                                           Proposed   Proposed    Proposed   OPPS or    office-
                                                           CY 2007     CY 2008    CY 2008   physician    based
        CPT code                 Short descriptor            OPPS       MPFS        ASC       office   procedure
                                                           payment   nonfacilty   payment     volume     if no
                                                             rate       rate        rate                payment
                                                                                                          cap
----------------------------------------------------------------------------------------------------------------
45300*..................  Proctosigmoidoscopy dx........    $295.48      $60.03     $60.03      39524    $183.19
45330*..................  Diagnostic sigmoidoscopy......     295.48       81.86      81.86      42684     183.19
46600*..................  Diagnostic anoscopy...........      38.23       51.50      23.70      80577      23.70
46934...................  Destruction of hemorrhoids....     792.64      177.36     177.36      34423     491.43
47562...................  Laparoscopic cholecystectomy..   2,678.23         N/A   1,660.48     30,029   1,660.48
47563...................  Laparo cholecystectomy/graph..   2,678.23         N/A   1,660.48     13,979   1,660.48
50590...................  Fragmenting of kidney stone...   2,734.57         N/A   1,683.45  26,549.00   1,683.45
53850*..................  Prostatic microwave thermotx..   2,604.69    2,459.51   1,653.04      31796   1,653.04
53852*..................  Prostatic rf thermotx.........   2,604.69    2,320.01   1,653.04       8574   1,653.04
61795...................  Brain surgery using computer..     338.56         N/A     209.90      1,067     209.90
62368*..................  Analyze spine infusion pump...     173.90       21.83      21.83     122336     107.82
64450*..................  N block, other peripheral.....     138.43       42.29      42.29     132194      85.83
64612*..................  Destroy nerve, face muscle....     138.43       68.90      68.90      35679      85.83
64640*..................  Injection treatment of nerve..     341.23      189.09     189.09      79126     211.56
----------------------------------------------------------------------------------------------------------------


[[Page 49695]]

    Unlike hospital outpatient departments, ASCs typically provide only 
a select set of procedures, and those procedures are generally 
performed on a scheduled, elective basis, affording ASCs much greater 
control over their case mix and costs than is possible for a typical 
hospital outpatient department. We expect that, as a result of 
implementation of the changes proposed under the revised ASC payment 
system, some procedures for which payment would decrease could migrate 
to other ambulatory settings. Conversely, we expect ASC volume to 
increase for those procedures for which payment rates go up under the 
revised payment system. These decisions will be made at the individual 
ASC level, depending on its physician staff, types of patients and its 
payors, and other considerations.
4. Estimated Effects of This Proposed Rule on Beneficiaries
    We estimate that the proposed changes for CY 2008 would be positive 
for beneficiaries in at least two respects. The ASC coinsurance rate is 
set at 20 percent rather than between 20 percent and 40 percent as is 
the case under the OPPS. Because ASC payment rates under the revised 
payment system are lower than payment rates for the same procedures 
under the OPPS, the beneficiary copayment amount under the ASC payment 
system would generally be less than the OPPS copayment amount for like 
services. (The only exceptions would be when the ASC copayment amount 
exceeds the inpatient deductible. The statute requires that copayment 
amounts under the OPPS not exceed the inpatient deductible.)
    In addition to the potential for reduced copayments, beneficiary 
access to services could be expanded as a result of the addition of the 
proposed 763 surgical procedures to the ASC list of services eligible 
for Medicare payment. We expect that ASCs would provide a broader range 
of surgical services under the revised system and that beneficiaries 
would benefit from having access to a greater variety of surgical 
procedures in ASCs.
5. Conclusion
    The proposed changes to the ASC payment system for CY 2008 would 
affect each of the more than 4,000 ASCs currently approved for 
participation in the Medicare program. The effect on an individual ASC 
will depend on the ASC's mix of patients, the proportion of their 
patients that are Medicare beneficiaries, the degree to which the 
payments for the procedures offered by the ASC are changed under the 
proposed revised system, and the degree to which the ASC chooses to 
provide a different set of procedures. The revised payment system is 
designed to result in the same aggregate amount of expenditures that 
would be made under the ASC benefit if the revised system were not 
implemented. The budget neutrality of the new payment system would not 
be affected by the proposed two year transition to full implementation 
of the new payment rates.

E. Effects of the Medicare Contracting Reform Mandate

    (If you choose to comment on issues in this section, please include 
the caption ``Medicare Contracting Reform Impact'' at the beginning of 
your comment.)
    In section XIX. of this preamble, we discuss our proposal to revise 
the regulations under 42 CFR Part 421, Subpart B for Medicare 
intermediaries and carriers to conform the regulations to the statutory 
changes mandated by section 1874A of the Act as added by section 911 of 
Pub. L. 108-173, which took effect on October 1, 2005. As discussed in 
section XIX. of this preamble, section 1874A of the Act is intended to 
improve Medicare's administrative services to beneficiaries and health 
care providers and to bring standard contracting principles to 
Medicare, such as competition and performance incentives, which the 
government has long applied to other Federal programs under the FAR. 
This provision requires that CMS replace its current claims payment 
contractors by October 1, 2011 with new contract entities referred to 
as MACs. We believe that this provision has no immediate economic 
effect on Medicare payments in CY 2007 because it is administrative in 
nature and does not change Medicare's coverage and reimbursement 
policies for hospital outpatient services or any other covered Medicare 
services.

F. Effects of Proposed Additional Quality Measures and Procedures for 
Hospital Reporting of Quality Data for IPPS FY 2008

    We have tried to minimize the costs of HCAHPS[supreg], including 
minimizing the impact on small/rural hospitals. While there are no 
capital or operational/maintenance costs associated with the 
implementation of HCAHPS[supreg], there are costs for collecting the 
data. The nationwide cost of conducting the HCAHPS[supreg] survey are 
estimated to be between $3.6 million and $16.9 million per year 
assuming approximately 3,700 hospitals (see Abt Associates, Inc. 
report, http://www.cms.hhs.gov/HospitalQualityInits/downloads/HCAHPS[supreg]CostsBenefits200512.pdf).
    We have reduced the burden for small/rural hospitals by making it 
possible to conduct the HCAHPS[supreg] survey without hiring a survey 
vendor; we have provided a free online data entry tool to simplify 
submission for reporting; we have required significantly fewer 
completed surveys of small hospitals than of larger hospitals; and we 
have permitted four different modes of survey administration, which 
will allow hospitals to administer the survey in the manner most 
familiar to them.
    In addition, hospitals that are self-administering the survey (or 
their survey vendor, if the hospital chooses to employ one) beginning 
in 2007 will participate in free HCAHPS[supreg] training offered via 
Webinar in January 2007. All hospitals that join in 2007 will be 
required to participate in a month-long dry run in March 2007. 
Hospitals that chose not to participate in HCAHPS[supreg] will not meet 
the HCAHPS[supreg] requirements necessary to receive the full market 
basket update for FY 2008.
    The costs of collecting HCAHPS[supreg] patient survey data will 
vary across hospitals depending on the method used to collect patient 
survey data, the number of patients surveyed, and whether 
HCAHPS[supreg] is incorporated into their existing patient satisfaction 
surveys. While hospitals may choose to administer HCAHPS[supreg] as a 
stand-alone survey, there are significant cost savings associated with 
combining HCAHPS[supreg] with existing surveys. Hospitals will have a 
financial incentive to administer a single survey that includes both 
HCAHPS[supreg] and information necessary to support quality improvement 
activities.
    We have cited a cost/benefit report showing that the costs of 
conducting HCAHPS[supreg] would be as follows. HCAHPS[supreg] collected 
as a separate survey is between $11.00 and $15.25 per complete survey 
($3,300 to $4,575 per hospital), assuming that 80-85 percent of 
hospitals collect HCAHPS[supreg] by mail and the remainder by phone or 
active IVR. It would be considerably less expensive to combine 
HCAHPS[supreg] with existing surveys. In a combined survey, it is 
estimated that it would cost only $3.26 per complete survey (or $978 
per hospital) to incorporate the 27-item HCAHPS[supreg] instrument into 
existing surveys. Depending on the proportion of hospitals that 
incorporate HCAHPS[supreg] into existing surveys, it is therefore 
estimated that the costs of HCAHPS[supreg] is between $3.6 million and 
$16.9 million per year (Abt Associates, Inc. report, http://
www.cms.hhs.gov/

[[Page 49696]]

HospitalQualityInits/downloads/HCAHPS[supreg]CostsBenefits200512.pdf).
    We have made provisions to reduce the burden of the HCAHPS[supreg] 
initiative for small/rural hospitals. As a cost savings provisions for 
all hospitals (but one that is particularly useful for small 
hospitals), a free on-line tool for data entry is available to 
hospitals choosing to conduct data entry themselves in lieu of 
contracting with a survey vendor for this service. The sample size 
requirements are reduced for small hospitals unable to achieve 300 
completed surveys. For all hospitals, we are allowing four modes of 
survey administration (mail, telephone, combination of mail and 
telephone, and active interactive voice recognition), and we are 
allowing for hospitals to either use a vendor or conduct the survey on 
their own. Additionally, we are allowing hospitals to integrate the 
HCAHPS[supreg] survey with their own patient satisfaction surveys. This 
option provides significant cost savings to conduct HCAHPS[supreg] 
annually: for the mail mode, it is estimated to cost $603 per hospital; 
and for the telephone mode, it is estimated to be $2,478 per hospital. 
For hospitals collecting 100 completed surveys, it costs about $326 
annually per hospital. CMS is providing free HCAHPS[supreg] training 
and materials and the cost of reporting HCAHPS[supreg] results to CMS 
is minimal.
    The benefits of public reporting for hospitals are great. There are 
multiple reports of hospitals being motivated by these data and using 
them for improvement. Not only is there more consistent evidence 
regarding hospital impact, but there are also several well-designed 
studies that have found at least some impact on hospital clinical 
performance (Abt report).
    HCAHPS[supreg] provides many benefits to hospitals and also to 
society at-large. The HCAHPS[supreg] initiative has taken substantial 
steps to assure that the survey will be credible, useful, and 
practical. First, the survey is designed to produce comparable data on 
the patient's perspective on care that allows objective and meaningful 
comparisons between hospitals on domains that are important to 
consumers. Second, public reporting of the survey results is designed 
to create incentives for hospitals to improve their quality of care. 
Third, public reporting will serve to enhance public accountability in 
health care by increasing the transparency of the quality of hospital 
care provided in return for the public investment. For the public at-
large, there is the potential benefit of improved health through 
improvements in hospital care.
    The intent of having the HCAHPS[supreg] initiative that resulted in 
a unique hospital survey is to provide one standardized instrument and 
accompanying data collection methodology that is in the public domain 
for measuring patients' perspectives on hospital care. While many 
hospitals currently collect information on patients' satisfaction with 
care, there is no one national standard for collecting or publicly 
reporting this information that would enable valid comparisons to be 
made across all hospitals. In order to make ``apples to apples'' 
comparisons to support consumer choice, it is necessary to introduce a 
standard measurement approach. HCAHPS[supreg] can be viewed as a core 
set of questions that can be combined with a broader, customized set of 
hospital-specific items. HCAHPS[supreg] is meant to complement the data 
hospitals currently collect to support improvements in internal 
customer services and quality related activities.
 SCIP
    While there are no capital or operational/maintenance costs 
associated with the implementation of SCIP, our pilot study concluded 
that there will be costs associated with the collection of the data. 
The data collection costs have been calculated as follows: SCIP 
collection as additional measures has been calculated to be $75.00 and 
$100.00 per additional hour of data abstraction (approximately $16,000 
per hospital). Depending on the proportion of hospitals that already 
collect these measures, it is estimated that the costs of collecting 
the additional measures is approximately $58.7 million dollars per 
year. For a detailed discussion of the data collection burden (burden 
hours) associated with these costs, please refer to the information 
collection section of the preamble.
 Mortality
    The 30-day mortality measures for AMI, HF and Pneumonia are each 
individually calculated solely on administrative data already submitted 
to CMS for other purposes, such as claims submitted for payment by the 
hospitals. As no new or additional data will be required from hospitals 
to calculate the rates for these measures, we believe that there will 
be no measurable impact on the hospitals as a result of the inclusion 
of any or all of these measures in the RHQDAPU set.
1. Alternatives Considered
    The HCAHPS[supreg] survey and the SCIP and mortality measures are a 
subset of CMS's larger Quality Initiative for both the Medicare and 
Medicaid programs. The Hospital Quality Initiative was established 
nationally in November 2002 for nursing homes, and was expanded in 2003 
to the nation's home health care agencies and hospitals. The Hospital 
Quality Initiative supports significant improvement in the quality of 
hospital care that is integral to both the Medicare and Medicaid 
programs. This initiative aims to improve hospital's quality of care by 
distributing objective and easy to understand data on hospital 
performance. The public availability of this information will encourage 
consumers and their physicians to discuss and make better informed 
decisions on how to get the best hospital care, create incentives for 
hospitals to improve care, and support public accountability. In all, 
improved care equates to the improvement of health for Medicare and 
Medicaid beneficiaries.
    HCAHPS[supreg], SCIP and Mortality measures parallel the trend in 
both the federal and many state governments to make hospital 
performance information (generally clinical processes or outcomes of 
care) publicly available. The goals of HCAHPS[supreg] are to (1) 
Produce comparable data on the patient's perspective on care to allow 
objective and meaningful comparisons between hospitals on domains that 
are important to consumer decision-making, (2) to have these data 
publicly reported to create incentives for hospitals to improve their 
quality of care, and (3) to enhance public accountability by providers 
by increasing the transparency of the quality of hospital care provided 
in return for the public investment. HCAHPS[supreg], SCIP and Mortality 
measures fit into a larger context of performance reporting developed 
by the Strategic Framework Board of the National Quality Forum. This is 
based on the assumption that consumers take value (both cost and 
quality) into account in any major purchasing decision. Public 
reporting of both the clinical measures and HCAHPS[supreg] is vital to 
the value-based healthcare purchasing approach. Patient perspectives of 
care encompasses an important CMS priority, as indicated by the 
Agency's support for programs related to the Institute of Medicine's 
(IOM) call for public reporting, the Hospital Quality Initiative (HQI) 
and the Hospital Quality Alliance (HQA), a public-private measurement 
and reporting collaborative.
    The HCAHPS[supreg] survey has been endorsed by the Hospital Quality 
Alliance. Implementing this survey fulfills the requirements

[[Page 49697]]

1886(b)(3)(B)(viii)(III) and (IV) of the Act that require CMS to expand 
the starter set of 10 quality measures used since FY 2005. In expanding 
these measures, we must begin to adopt the baseline set of performance 
measures as set forth in a 2005 report issued by the Institute of 
Medicine (IOM) of the National Academy of Sciences under section 238(b) 
of Pub. L. 108-173, effective for payments beginning with FY 2007. The 
IOM measures include the Hospital Quality Alliance (HQA) measures, the 
Hospital Consumer Assessment of Healthcare Providers and Systems 
(HCAHPS[supreg]) patient perspective survey, and three structural 
measures.
    No alternatives were discussed for the SCIP and mortality measures.
2. Estimated Effects of This Proposed Rule
a. Effects on Hospitals
    Hospitals will benefit from the information that the HCAHPS[supreg] 
survey and the SCIP and Mortality measures data collection will 
provide. Hospitals are an essential part of the National Quality 
Forum's Strategic Framework Board. We have made provisions that reduce 
the burden of the HCAHPS[supreg] initiative, especially for small/rural 
hospitals. The public reporting of HCAHPS[supreg] results and 
additional quality measures may stimulate improvements in hospital 
quality of care in several ways. Hospitals can use the publicly 
reported data to benchmark their performance with other institutions. 
Consumers/patients would potentially seek care in hospitals that are 
publicly reported to perform well.
    CMS does not plan to make major revisions to the HCAHPS[supreg] 
survey itself or to its implementation procedures soon after 
HCAHPS[supreg] national implementation. With the core set of 
HCAHPS[supreg] measures, hospitals will have the beginnings of a 
benchmark for trending of their hospital results over time.
    To promote its wide and rapid adoption, HCAHPS[supreg] has been 
carefully designed to fit within the framework of patient satisfaction 
surveying that hospitals currently employ. Still, CMS fully understands 
that participation in the HCAHPS[supreg] initiative will require some 
effort and expense on the part of hospitals that volunteer to take 
part.
b. Effects on Other Providers
    Physicians will benefit by learning what surveyed consumers/
patients answered about their quality of care during their hospital 
stays, as well as become informed about surgical care improvement and 
mortality rates. Studies indicate that providers are potentially 
affected by public reporting. They may be motivated to improve the 
quality of care they deliver with the availability of performance 
information. Primary care physicians are also users of this information 
during the referral process of patients to hospitals. Studies indicate 
that the public reporting of hospital quality indicators may spur 
internal hospital quality improvement and lead to changes in physician 
behavior within the hospital environment.
c. Effects on the Medicare and Medicaid Programs
    Some potential benefits of publicly reporting quality information 
has been described in the literature as pertaining to consumers, 
providers and purchasers. Consumers (beneficiaries) could incorporate 
the quality information into their decision-making about hospital 
choices, and benefit from better care resulting from the additional 
measures as well as the questions asked by HCAHPS[supreg], such as 
questions about communication with providers (fewer medical errors due 
to patient feedback about medication effect) and discharge planning 
(fewer readmissions due to better patient awareness about what to 
expect when discharged) and the reporting of clinical measures.
    Providers could potentially be motivated to improve the quality of 
care they provide for results of more effective and efficient hospital 
operation. Providers could also use the information internally to 
improve communication and improve performance, use the information to 
justify the need to increase staff ratios, use the measures in choices 
about practitioner practice locales, use the information to improve 
their ratings on patient perspectives and potentially compete with one 
another in the area of improving accreditation results, and use the 
information to choose hospitals on the basis of quality of care for 
their patients.
    Purchasers could potentially benefit from this information for 
supporting shorter lengths of stay, availability of benchmarks, and 
availability of information to support purchasing decisions.

G. Executive Order 12866

    In accordance with the provisions of Executive Order 12866, this 
proposed rule was reviewed by the OMB.

List of Subjects

42 CFR Part 410

    Health facilities, Health professions, Laboratories, Medicare, 
Rural areas, X-rays.

42 CFR Part 414

    Administrative practice and procedure, Health facilities, Health 
professions, Kidney diseases, Medicare, Reporting and recordkeeping 
requirements.

42 CFR Part 416

    Health facilities, Kidney diseases, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 419

    Hospitals, Medicare, Reporting and recordkeeping requirements.

42 CFR Part 421

    Administrative practice and procedure, Health facilities, Health 
professions, Medicare, Reporting and recordkeeping requirements.

42 CFR Part 485

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

42 CFR Part 488

    Administrative practice and procedure, Health facilities, Medicare, 
Reporting and recordkeeping requirements.

    For 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 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

    1. The authority citation for part 410 continues to read as 
follows:

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

    2. Section 410.152 is amended by revising paragraph (i) to read as 
follows:


Sec.  410.152  Amounts of payment.

* * * * *
    (i) Amount of Payment: ASC facility services. (1) For ASC facility 
services furnished on or after July 1, 1987 and before January 1, 2008, 
in connection with the surgical procedures specified in part 416 of 
this chapter, Medicare Part B pays 80 percent of a standard overhead 
amount as specified in Sec.  416.120(c) of this chapter.
    (2) For ASC facility services furnished on or after January 1, 
2008, in connection with the surgical procedures specified in part 416 
of this chapter, Medicare Part B pays the lesser of 80 percent of the 
actual charge, 80 percent of the prospective payment amount as

[[Page 49698]]

determined under Subpart F of Part 416 of this chapter, or, under the 
limitation described in Sec.  416.167(b)(3), the amount determined 
under Subpart B of Part 414 of this chapter.
* * * * *

PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES

    3. The authority citation for Part 414 continues to read as 
follows:

    Authority: Secs. 1102, 1871, and 1834(l) of the Social Security 
Act (42 U.S.C. 1302, 1395hh, and 1395m(l)).

    4. Section 414.22 is amended by revising paragraph (b)(5)(i)(B) to 
read as follows:


Sec.  414.22  Relative Value Units (RVUs).

* * * * *
    (b) Practice Expense RVUs.
* * * * *
    (5) * * *
    (i) * * *
    (B) Non-facility practice expense RVUs. The higher non-facility 
practice expense RVUs apply to services performed in a physician's 
office, a patient's home, an ASC if the physician is performing a 
procedure for which an ASC facility fee is not paid under Part 416, a 
nursing facility, or a facility or institution other than a hospital or 
skilled nursing facility, community mental health center, or ASC 
performing an ASC approved procedure.
* * * * *

PART 416--AMBULATORY SURGICAL SERVICES

    5. The authority citation for part 416 continues to read as 
follows:

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

    6. Section 416.1 is amended by--
    a. Revising paragraph (a)(2).
    b. Revising paragraph (a)(3).
    c. Adding new paragraphs (a)(4) and (a)(5).
    The revisions and additions read as follows:


Sec.  416.1  Basis and scope.

    (a) * * *
    (2) Section 1833(i)(1)(A) of the Act requires the Secretary to 
specify the surgical procedures that can be performed safely on an 
ambulatory basis in an ambulatory surgical center.
    (3) Sections 1833(i)(2)(A) and (D), and 1833(a)(1)(G) of the Act 
specify the amounts to be paid for facility services furnished in 
connection with the specified surgical procedures when they are 
performed in an ASC.
    (4) Section 1833(i)(2)(C) of the Act provides that if the Secretary 
has not updated amounts for ASC facility services furnished during a 
fiscal year through 2005 or a calendar year beginning with 2006, the 
amounts shall be increased by the percentage increase in the Consumer 
Price Index for all urban consumers as estimated by the Secretary for 
the 12-month period ending with the midpoint of the year involved, 
except that, in fiscal year 2005, the last quarter of calendar year 
2005, and each of the calendar years 2006 through 2009, the increase 
shall be zero percent.
    (5) Section 1833(i)(2)(E) of the act provides that with respect to 
surgical procedures furnished on or after January 1, 2007, and before 
the effective date of the implementation of a revised payment system, 
the payment amount shall be the lesser of the ASC payment rate 
established under section 1833(i)(2) (A) of the act or the prospective 
payment rate for hospital outpatient department services established 
under section 1833(t)(3)(D). The lesser payment amount shall be 
determined prior to application of any geographic adjustment.
* * * * *
    7. Section 416.2 is amended by--
    a. Republishing the introductory test preceding the definitions
    b. Revising the definitions of ``Covered surgical procedures'' and 
``Facility services.''
    The republished introductory text preceding the definitions and 
revised definitions read as follows:


Sec.  416.2  Definitions.

    As used in this part:
* * * * *
    Covered surgical procedures means those surgical procedures that 
meet the criteria specified in Sec. Sec.  416.65 or 416.166, as 
applicable, and are published in the Federal Register.
    Facility services means services that are furnished in connection 
with covered surgical procedures performed in an ASC.
    8. The heading for Subpart D is revised to read as follows:

Subpart D--Scope of Benefits for Services Furnished Before January 
1, 2008

    9. Section 416.65 is amended by--
    a. Revising the introductory text.
    b. Revising paragraph (a)(4).
    The revisions read as follows:


Sec.  416.65  Covered surgical procedures.

    Effective for services furnished before January 1, 2008, covered 
surgical procedures are those procedures that meet the standards 
described in paragraphs (a) and (b) of this section and are included in 
the list published in accordance with paragraph (c) of this section.
    (a) * * *
    (4) Are not otherwise excluded under Sec.  411.15 of this chapter.
* * * * *
    10. A new Sec.  416.76 is added to read as follows:


Sec.  416.76  Applicability.

    The provisions of this subpart apply to facility services furnished 
before January 1, 2008.
    11. The heading for Subpart E is revised to read as follows:

Subpart E--Prospective Payment System For Facility Services 
Furnished Before January 1, 2008


Sec.  416.120  [Amended]

    12. In paragraph (a) of Sec.  416.120, the cross-reference ``Part 
413'' is removed and the cross-reference ``Part 419'' added in its 
place.
    13. A new Sec.  416.121 is added to read as follows:


Sec.  416.121  Applicability.

    The provisions of this subpart apply to facility services furnished 
before January 1, 2008.
    14. Section 416.125 is amended by adding a new paragraph (c) to 
read as follows:


Sec.  416.125  ASC facility services payment rate.

* * * * *
    (c) For services furnished on or after January 1, 2007, and before 
the effective date of implementation of a revised payment system, the 
ASC payment rate for a surgical procedure shall be the lesser of the 
ASC payment rate established under paragraph (a) of this section or the 
prospective payment rate for the procedure established under section 
419.32. The lesser payment amount shall be determined prior to 
application of any geographic adjustment.


Sec.  416.150  [Removed]

    15. Section 416.150 is removed.

Subpart F--[Redesignated as Subpart G]

    16. Existing Subpart F is redesignated Subpart G
    17. A new Subpart F is added to read as follows:

[[Page 49699]]

Subpart F--Coverage, Scope of ASC Facility Services, and 
Prospective Payment System For Facility Services Furnished On Or 
After January 1, 2008

Sec.
416.160 Basis and scope.
416.161 Applicability.
416.163 General rules.
416.164 Scope of ASC facility services.
416.166 Covered surgical procedures.
416.167 Basis of payment.
416.171 Calculation of prospective payment rates for ASC services.
416.172 Adjustments to national payment rates.
416.173 Publication of revised payment methodologies and payment 
rates.
416.178 Limitations on administrative and judicial review.

Sec.  416.160  Basis and scope.

    (a) Statutory basis. (1) Section 1833(a)(1)(G) of the Act provides 
that, beginning with the implementation date of a revised payment 
system for ASC facility services furnished in connection with a 
surgical procedure pursuant to section 1833(i)(1)(A) of the Act, the 
amount paid shall be 80 percent of the lesser of the actual charge for 
such services or the amount determined by the Secretary under the 
revised payment system.
    (2) Section 1833(i)(1)(A) of the Act requires the Secretary to 
specify the surgical procedures that can be performed safely on an 
ambulatory basis in an ASC.
    (3) Section 1833(i)(2)(D) of the Act requires the Secretary to 
implement a revised payment system for payment of surgical services 
furnished in ASCs. The statute requires that, in the year such system 
is implemented, the system shall be designed to result in the same 
amount of aggregate expenditures for such services as would be made if 
there were no requirement for a revised payment system. The revised 
payment system shall be implemented no earlier than January 1, 2006, 
and no later than January 1, 2008. There shall be no administrative or 
judicial review under section 1869 of the Act, section 1878 of the Act, 
or otherwise of the classification system, the relative weights, 
payment amounts, and the geographic adjustment factor, if any, of the 
revised payment system.
    (b) Scope. This subpart sets forth--
    (1) The scope of ASC facility services and the criteria for 
determining the procedures for which Medicare pays an ASC facility fee; 
and
    (2) The methodologies by which Medicare determines payment amounts 
for ASC facility services.


Sec.  416.161  Applicability.

    The provisions of this subpart apply to ASC facility services 
furnished on or after January 1, 2008.


Sec.  416.163  General rules.

    (a) The services for which payment is made under this subpart are 
ASC facility services as specified in Sec.  416.164(a) furnished to 
Medicare beneficiaries by a participating ASC in connection with 
covered surgical procedures as determined by the Secretary in 
accordance with Sec.  416.166.
    (b) Physician services, including surgical procedures and all 
preoperative and post-operative services that are performed by a 
physician, are paid in accordance with Part 414 of this chapter.
    (c) Items and services as specified in Sec.  416.164(b) for which 
payment may be made under other provisions of Part 410 of this chapter 
are not included in the payment amount for ASC facility services.


Sec.  416.164  Scope of ASC facility services.

    (a) Included services. ASC facility services include, but are not 
limited to--
    (1) Nursing, technician, and related services;
    (2) Use of the facility where the surgical procedures are 
performed;
    (3) Items and services directly related to the pre-operative 
preparation of patients upon their admission to the ASC for surgery, to 
the performance of a surgical procedure(s) and to the post-operative 
and post-anesthesia care of patients prior to their discharge from the 
ASC. This includes, but is not limited to: Any laboratory testing 
performed under a Clinical Laboratory Improvement Amendments of 1988 
(CLIA) certificate of waiver; drugs and biologicals; medical and 
surgical supplies and equipment; surgical dressings; implanted 
prosthetic devices, accessories and supplies including intraocular 
lenses (IOLs); implanted DME, accessories and supplies; splints and 
casts and related devices; and imaging services or other diagnostic 
tests or interpretive services directly related to a surgical 
procedure;
    (4) Administrative, recordkeeping and housekeeping items and 
services;
    (5) Materials, including supplies and equipment for the 
administration and monitoring of anesthesia; and
    (6) Supervision of the services of an anesthetist by the operating 
surgeon.
    (b) Excluded services. Facility services do not include costs 
incurred to procure corneal tissue or items and services for which 
payment may be made under other provisions of Parts 410 and 414 of this 
chapter, such as physicians' services; X-ray or diagnostic procedures 
(other than those directly related to performance of the surgical 
procedure); ambulance services; leg, arm, back and neck braces other 
than those that serve the function of a cast or splint; artificial 
limbs; non-implantable prosthetic devices and durable medical 
equipment. In addition, they do not include anesthetist services 
furnished on or after January 1, 1989.


Sec.  416.166  Covered surgical procedures.

    (a) Covered surgical procedures. Effective for services furnished 
on or after January 1, 2008, covered surgical procedures are those 
procedures that meet the general standards described in paragraph (b) 
of this section (whether commonly furnished in an ASC or a physician's 
office) and are not excluded under paragraph (c) of this section.
    (b) General standards. Subject to the exclusions in paragraph (c) 
of this section, covered surgical procedures are surgical procedures 
specified by the Secretary that would not be expected to pose a 
significant safety risk to a Medicare beneficiary when performed in an 
ASC.
    (c) General exclusions. Notwithstanding paragraph (b) of this 
section, covered surgical procedures do not include those surgical and 
other medical procedures that--
    (1) Generally result in extensive blood loss;
    (2) Require major or prolonged invasion of body cavities;
    (3) Directly involve major blood vessels;
    (4) Are generally emergent or life-threatening in nature;
    (5) Standard medical practice dictates that the beneficiary will 
typically be expected to require active medical monitoring and care at 
midnight following the procedure; or,
    (6) Are otherwise excluded under Sec.  411.15 of this chapter.


Sec.  416.167  Basis of payment.

    (a) Unit of payment. Under the ASC prospective payment system, 
prospectively determined amounts are paid for facility services 
furnished to Medicare beneficiaries in connection with designated 
surgical procedures. Surgical procedures are identified by codes 
established under the Centers for Medicare & Medicaid Services Common 
Procedure Coding System (HCPCS). The prospective payment rate for each 
procedure for which payment is allowed under the ASC payment system is 
determined according to the methodology described in Sec.  416.171. The 
manner in which the Medicare

[[Page 49700]]

payment amount and the beneficiary copayment amount for each procedure 
are determined is described in Sec.  416.172.
    (b) Ambulatory payment classification (APC) groups and payment 
weights
    (1) ASC covered surgical procedures are classified using the APC 
groups described in Sec.  419.31 of this chapter. An APC group consists 
of outpatient services and procedures that are comparable clinically 
and in terms of resources.
    (2) For purposes of calculating ASC national payment rates under 
the methodology described in Sec.  416.171, except as specified in 
paragraph (b)(3), of this section, an ASC covered surgical procedure is 
assigned the applicable APC relative payment weight described in Sec.  
419.31 of this chapter.
    (3) Notwithstanding paragraph (b)(2) of this section, the relative 
payment weights for procedures paid in accordance with Sec.  416.171(e) 
are determined so that the national ASC payment rate does not exceed 
the MPFS nonfacility amount paid for such procedures under Subpart B of 
Part 414 of this chapter.


Sec.  416.171  Calculation of prospective payment rates for ASC 
services.

    (a) Conversion factor for calendar year 2008. CMS calculates a 
conversion factor so that payment for ASC services furnished in 2008 
would result in the same aggregate amount of expenditures as would be 
made if the provisions in Subpart F did not apply.
    (b) Conversion factor for calendar year 2009 and subsequent years. 
The conversion factor for a calendar year is equal to the conversion 
factor calculated for the previous year adjusted as follows:
    (1) For calendar year 2009, the increase shall equal zero percent.
    (2) For calendar year 2010 and subsequent years, by the Consumer 
Price Index for all urban consumers (U.S. city average) as estimated by 
the Secretary for the 12-month period ending with the midpoint of the 
year involved.
    (c) Transitional payment rates for calendar year 2008. ASC payment 
rates for 2008 are a transitional blend of 50 percent of the CY 2007 
ASC payment rate for a surgical procedure on the CY 2007 ASC list of 
surgical procedures and 50 percent of the payment rate for the 
procedure calculated under the methodology described in paragraph (d) 
of this section.
    (d) Payment rates for calendar year 2009 and subsequent years. The 
national ASC payment rate for a covered surgical procedure designated 
in accordance with Sec.  416.166 is the product of the conversion 
factor calculated under paragraph (a) or paragraph (b) of this section 
and the relative weight determined under Sec.  416.167(b).
    (e) Limitation on payment for certain ASC procedures. 
Notwithstanding the provisions of paragraph (c) and paragraph (d) of 
this section, if CMS determines that a covered procedure under Sec.  
416.166 of this part is commonly performed in physicians' offices, 
payment for ASC facility services for such procedure shall be the 
lesser of the amount determined under paragraph (c) or paragraph (d) of 
this section or the amount paid for such procedure under Subpart B of 
Part 414 of this chapter.
    (f) Budget neutrality. (1) For calendar year 2008, CMS adjusts the 
conversion factor in accordance with paragraph (a) to result in budget 
neutrality as estimated by CMS.
    (2) For calendar year 2009 and subsequent years, CMS adjusts the 
ASC relative payment weights under Sec.  416.167(b)(2) as needed so 
that any updates and adjustments made under Sec.  419.50(a) of this 
chapter are budget neutral as estimated by CMS.


Sec.  416.172  Adjustments to national payment rates.

    (a) General rule. CMS establishes national prospective payment 
rates for ASC facility services to which certain adjustments are 
applied to determine Medicare program payment and beneficiary copayment 
amounts.
    (b) Lesser of actual charge or prospective rate. Payments to ASCs 
shall equal the lesser of 80 percent of:
    (1) the actual charge for the service; or,
    (2) the prospective rate determined under this subpart.
    (c) Geographic adjustment. National ASC payment rates established 
under Sec.  416.171 for covered surgical procedures are adjusted for 
variations in ASC labor costs across geographic areas using wage index 
values, labor and non-labor percentages, and localities specified by 
the Secretary.
    (d) Deductibles and coinsurance. Part B deductible and coinsurance 
amounts apply as specified in Sec.  410.152(a) and (i) of this chapter.
    (e) Payment reductions for multiple surgical procedures. (1) 
General rule. Except as provided in paragraph (e)(2) of this section, 
when more than one surgical procedure for which payment is made under 
the ASC prospective payment system is performed during an operative 
session, the Medicare program payment amount and the beneficiary 
copayment amount are based on--
    (i) The full amounts for the procedure with the highest APC payment 
rate; and
    (ii) One-half of the full program and the beneficiary payment 
amounts for all other covered procedures.
    (2) Exception. The Secretary may apply any policies or procedures 
used with respect to multiple procedures under the prospective payment 
system for hospital outpatient department services under part 419 of 
this chapter as may be consistent with the equitable and efficient 
administration of part 416.


Sec.  416.173  Publication of revised payment methodologies and payment 
rates.

    CMS will publish annually through notice and comment rulemaking in 
the Federal Register, the payment methodologies, payment rates and 
surgical procedures for which CMS will make an ASC facility payment, 
and other revisions as appropriate.


Sec.  416.178  Limitations on administrative and judicial review.

    There is no administrative or judicial review under sections 1869 
of the Act, section 1878 of the Act or otherwise of the following:
    (a) The APC classification system;
    (b) Relative payment weights;
    (c) Payment amounts; or
    (d) Geographic adjustment factors.
    18. Redesignated Subpart G is revised to read as follows:

Subpart G--Adjustment in Payment Amounts for New Technology 
Intraocular Lenses Furnished by Ambulatory Service Centers

Sec.
416.180 Basis and scope.
416.185 Process for establishing a new class of new technology IOLs.
416.190 Request for review of payment amount.
416.195 Determination of membership in new classes of new technology 
IOLs.
416.200 Payment adjustment.


Sec.  416.180  Basis and scope.

    (a) Basis. This subpart implements section 141 of Public Law 103-
432, which provides for adjustments to payment amounts for new 
technology intraocular lenses (IOLs) furnished at ambulatory surgical 
centers (ASCs).
    (b) Scope. This subpart sets forth--
    (1) The process for interested parties to request that CMS review 
the appropriateness of the ASC facility fee for insertion of an IOL. 
This process includes a review of whether that payment is reasonable 
and related to the cost of acquiring a lens determined by CMS as 
belonging to a class of new technology IOLs;

[[Page 49701]]

    (2) Factors that CMS considers for determination of a new class of 
new technology IOLs; and
    (3) Application of the payment adjustment.


Sec.  416.185  Process for establishing a new class of new technology 
IOLs.

    (a) Announcement of deadline for requests for review. CMS announces 
the deadline for each year's requests for review of a new class of new 
technology IOLs in the final rule updating the ASC payment rates for 
that calendar year.
    (b) Announcement of new classes of new technology IOLs for which 
review requests have been made and solicitation of public comments. CMS 
announces the requests for review received in a calendar year and the 
deadline for public comments regarding the requests in the proposed 
rule updating the ASC payment rates for the following calendar year. 
The deadline for submission of public comments is 30 days following the 
date of the publication of the proposed rule.
    (c) Announcement of determinations regarding requests for review. 
CMS announces its determinations for a calendar year in the final rule 
updating the ASC payment rates for the following calendar year. CMS 
publishes the codes and effective dates allowed for those lenses 
recognized by CMS as belonging to a class of new technology IOLs. New 
classes of new technology IOLs are effective 30 days following the date 
of publication of the final rule.


Sec.  416.190  Request for review of payment amount.

    (a) When requests can be submitted. A request for review of the 
appropriateness of ASC payment for insertion of an IOL that might 
qualify for a payment adjustment as belonging to a new class of new 
technology IOLs must be submitted to CMS in accordance with the annual 
published deadline.
    (b) Who may submit a request. Any individual, partnership, 
corporation, association, society, scientific or academic 
establishment, or professional or trade organization able to furnish 
the information required in paragraph(c) of this section may request 
that CMS review the appropriateness of the payment amount provided 
under section 1833(i)(2)(A)(iii) of the Act with respect to an IOL that 
meets the criteria of a new technology IOL under Sec.  416.195.
    (c) Content of a request. In order to be accepted by CMS for 
review, a request for review of the ASC payment amount for insertion of 
an IOL must include all the information as specified by CMS.
    (d) Confidential information. In order for CMS to invoke the 
protection allowed under Exemption 4 of the Freedom of Information Act 
(5 U.S.C. 552(b)(4)) and, with respect to trade secrets, the Trade 
Secrets Act (18 U.S.C. 1905), the requestor must clearly identify all 
information that is to be characterized as confidential.


Sec.  416.195  Determination of membership in new classes of new 
technology IOLs.

    (a) Factors to be considered. CMS uses the following criteria to 
determine whether an IOL qualifies for a payment adjustment as a member 
of a new class of new technology IOLs when inserted at an ASC.
    (1) The IOL is approved by the FDA.
    (2) Claims of specific clinical benefits and/or lens 
characteristics with established clinical relevance in comparison to 
currently available IOLs are approved by the FDA for use in labeling 
and advertising.
    (3) The IOL is not described by an active or expired class of new 
technology IOLs; that is, it does not share a predominant, class-
defining characteristic associated with improved clinical outcomes with 
members of an active or expired class.
    (4) Evidence demonstrated that use of the IOL results in 
measurable, clinically meaningful, improved outcomes in comparison with 
use of currently available IOLs. Superior outcomes include:
    (i) Reduced risk of intraoperative or postoperative complication or 
trauma;
    (ii) Accelerated postoperative recovery;
    (iii) Reduced induced astigmatism;
    (iv) Improved postoperative visual acuity;
    (v) More stable postoperative vision;
    (vi) Other comparable clinical advantages.
    (b) CMS determination of eligibility for payment adjustment. CMS 
reviews the information submitted with a completed request for review, 
public comments submitted timely, and other pertinent information and 
makes a determination as follows:
    (1) The IOL is eligible for a payment adjustment as a member of a 
new class of new technology IOLs.
    (2) The IOL is a member of an active class of new technology IOLs 
and is eligible for a payment adjustment for the remainder of the 
period established for that class.
    (3) The IOL does not meet the criteria for designation as a new 
technology IOL and a payment adjustment is not appropriate.


Sec.  416.200  Payment adjustment.

    (a) CMS establishes the amount of the payment adjustment for 
classes of new technology IOLs through proposed and final rulemaking in 
connection with ASC center services.
    (b) CMS adjusts the payment for insertion of an IOL approved as 
belonging to a class of new technology IOLs for the 5-year period of 
time established for that class.
    (c) Upon expiration of the 5-year period of the payment adjustment, 
payment reverts to the standard rate for IOL insertion procedures 
performed in ASCs.
    (d) ASCs that furnish an IOL designated by CMS as belonging to a 
class of new technology IOLs must submit claims using billing codes 
specified by CMS to receive the new technology IOL payment adjustment.

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

    19. 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).

    20. Section 419.21 is amended by revising the introductory text of 
paragraph (d) to read as follows:


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

* * * * *
    (d) The following medical and other health services furnished by a 
home health agency (HHA) to patients who are not under an HHA plan or 
treatment or by a hospice program furnishing services to patients 
outside the hospice benefit:
* * * * *
    21. Section 419.43 is amended by adding a new paragraph (h) to read 
as follows:


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

* * * * *
    (h) Applicable adjustments to conversion factor for CY 2007 and for 
subsequent calendar years.
    (1) General rule. For CY 2007, the applicable adjustment to the 
conversion factor specified in Sec.  419.32(b)(iv) is reduced by 2.0 
percentage points for any hospital that has its annual percentage 
change reduced under Sec.  412.64(d)(2) of this chapter for the 
corresponding fiscal year. For subsequent years, the applicable 
adjustment to the conversion factor is reduced for any hospital that

[[Page 49702]]

fails to satisfy quality reporting requirements as designated by CMS.
    (2) Limitation. Any reduction to a hospital's adjustment to its 
conversion factor specified in Sec.  419.32(b)(iv) which occurs as a 
result of paragraph (h)(1) of this section will apply only to the 
calendar year involved and will not be taken into account in computing 
that hospital's applicable adjustment for a subsequent calendar year.
    (3) Budget neutrality. For CY 2007 and for each subsequent calendar 
year, CMS makes an adjustment to the conversion factor, so that 
estimated aggregate payments under the OPPS for such calendar year are 
not affected by any reductions to hospital adjustments which occur as a 
result of paragraph (h)(1) of this section.
    22. A new section 419.45 is added to read as follows:


Sec.  419.45  Payment and copayment reduction for devices replaced 
under warranty or as a result of recall.

    (a) General rule. CMS reduces the amount of payment for an 
implanted device made under the hospital outpatient prospective payment 
system in accordance with Sec.  419.66 for which CMS determines that a 
significant portion of the payment is attributable to the cost of an 
implanted device, when one of the following situations occur:
    (1) The device is replaced without cost to the provider or the 
beneficiary; or
    (2) The provider receives full credit for the cost of a replaced 
device.
    (b) Amount of reduction to the APC payment. The amount of the 
reduction to the APC payment made under paragraph (a) of this section 
is calculated in the same manner as the offset amount that would be 
applied if the device implanted in a procedure assigned to the APC had 
transitional pass-through status under Sec.  419.66.
    (c) Amount of beneficiary copayment. The beneficiary copayment is 
calculated based on the APC payment after application of the reduction 
under paragraph (b) of this section.
    23. Section 419.70 is amended by--
    a. Revising paragraph (d)(1).
    b. Redesignating paragraphs (d)(2) and (d)(3) as paragraphs (d)(3) 
and (d)(4), respectively.
    c. Adding a new paragraph (d)(2).
    The revisions and addition read as follows:


Sec.  419.70  Transitional adjustment to limit decline in payments.

* * * * *
    (d) Hold harmless provisions.--(1) Temporary treatment for small 
rural hospitals before January 1, 2006. For covered hospital outpatient 
services furnished in a calendar year before January 1, 2006, for which 
the prospective payment system amount is less than the pre-BBA amount, 
the amount of payment under this part is increased by the amount of 
that difference if the hospital--
    (i) Is located in a rural area as defined in Sec.  412.63(b) of 
this chapter or is treated as being located in a rural area under 
section 1886(d)(8)(E) of the Act; and
    (ii) Has 100 or fewer beds as defined in Sec.  412.105(b) of this 
chapter.
    (2) Temporary treatment for small rural hospitals on or after 
January 1, 2006. For covered hospital outpatient services furnished in 
a calendar year from January 1, 2006, through December 31, 2008, for 
which the prospective payment system amount is less than the pre-BBA 
amount, the amount of payment under this paragraph is increased by 95 
percent of that difference for services furnished during 2006, 90 
percent of that difference for services furnished during 2007, and 85 
percent of that difference for services furnished during 2008 if the 
hospital--
    (i) Is located in a rural area as defined in Sec.  412.63(b) of 
this chapter or is treated as being located in a rural area under 
section 1886(d)(8)(E) of the Act;
    (ii) Has 100 or fewer beds as defined in Sec.  412.105(b) of this 
chapter;
    (iii) Is not a sole community hospital as defined in Sec.  412.92 
of this chapter; and
    (iv) Is not an essential access community hospital under Sec.  
412.109 of this chapter.
* * * * *

PART 421--MEDICARE CONTRACTING

    24. The heading of part 421 is revised to read as set out above.
    25. The authority citation for part 421 continues to read as 
follows:

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

    26. Section 421.3 is revised to read as follows:


Sec.  421.3  Definitions.

    As used in this part--
    Intermediary means an entity that has a contract with CMS (under 
statutory provisions in effect prior to October 1, 2005) to determine 
and make Medicare payments for Part A or Part B benefits payable on a 
cost basis (or under the prospective payment system for hospitals) and 
to perform other related functions. For purposes of applying the 
performance criteria in Sec.  421.120 and the performance standards in 
Sec.  421.122 and any adverse action resulting from that application, 
the term ``intermediary'' also means a Blue Cross plan that has entered 
into a subcontract approved by CMS with the Blue Cross and Blue Shield 
Association to perform intermediary functions.
    27. Section 421.100 is amended by revising paragraph (i) to read as 
follows:


Sec.  421.100  Intermediary functions.

* * * * *
    (i) Dual intermediary responsibilities. Regarding the 
responsibility for service to provider-based HHAs and provider-based 
hospices, where the HHA or the hospice and its parent provider will be 
served by different intermediaries, the designated regional 
intermediary will process bills, make coverage determinations, and make 
payments to the HHAs and the hospices. The intermediary serving the 
parent provider will perform all fiscal functions, including audits and 
settlement of the Medicare cost reports and the HHA and hospice 
supplement worksheets.
    28. Section 421.103 is revised to read as follows:


Sec.  421.103  Payment to providers.

    Providers are assigned to intermediaries in accordance with Sec.  
421.104. As the Medicare Administrative Contractors (MACs) are 
implemented, providers are reassigned from intermediaries to MACs in 
accordance with Sec.  412.404.
    29. Section 421.104 is revised to read as follows:


Sec.  421.104  Assignment of providers of services to intermediaries 
during transition to Medicare administrative contractors (MACs).

    (a) Beginning October 1, 2005, CMS assigns providers of services 
and other entities that may bill Part A benefits to intermediaries in a 
manner that will best support the transition to Medicare administrative 
contractors (MACs) under section 1874A of the Act in accordance with 
Subpart E of this part.
    (b) These providers of services and other entities must continue to 
bill the intermediary that they were billing prior to October 1, 2005, 
until one of the following events occurs:
    (1) The intermediary's agreement with CMS ends, and the provider or 
entity is directed by CMS to bill another CMS contractor.
    (2) The provider or entity is assigned to a MAC that has begun to 
administer claims within the geographic locale of the provider or 
entity.
    (3) CMS directs the provider or entity to begin billing another CMS 
contractor in order to support the implementation

[[Page 49703]]

of MACs under section 1874A of the Act and Subpart E of this part.
    (c) New providers of services and new entities will be assigned to 
the intermediary serving their geographic locale if no MAC has begun to 
administer Medicare claims in the locale. These providers or entities 
must continue to bill the intermediary until one of the events in 
paragraph (b) of this section occurs.
    (d) Providers or entities will only be granted exceptions to the 
provisions of paragraphs (b) or (c) of this section if CMS deems the 
exception to be in the compelling interest of the Medicare program.
    (e) CMS will notify the provider or entity, the outgoing 
intermediary, and the newly assigned intermediary of assignment or 
reassignment decisions.


Sec.  421.105  [Removed]

    30. Section 421.105 is removed.


Sec.  421.106  [Removed]

    31. Section 421.106 is removed.
    32. Section 421.112 is amended by--
    a. Revising paragraph (a).
    b. Revising paragraph (b).
    The revisions read as follows:


Sec.  421.112  Considerations relating to the effective and efficient 
administration of the program.

    (a) In order to accomplish the most effective and efficient 
administration of the Medicare program, the Secretary may make 
determinations with respect to the termination of an intermediary 
agreement, and CMS may make determinations with respect to renewal of 
an intermediary agreement under Sec.  421.110.
    (b) When taking the actions specified in paragraph (a) of this 
section, the Secretary or CMS will consider the performance of the 
individual intermediary in its Medicare operations using the factors 
contained in the performance criteria specified in Sec.  421.120 and 
the performance standards specified in section Sec.  421.122.
* * * * *
    33. Section 421.114 is revised to read as follows:


Sec.  421.114  Assignment and reassignment of providers by CMS.

    CMS may assign or reassign any provider to any intermediary if it 
determines that the assignment or reassignment will be in the best 
interests of the Medicare program.


Sec.  421.116  [Removed]

    34. Section 421.116 is removed.


Sec.  421.117  [Removed]

    35. Section 421.117 is removed.


Sec.  421.118  [Removed]

    36. Section 421.118 is removed.
    37. Reserve Subpart D and add a new Subpart E to Part 421 to read 
as follows:

Subpart E--Medicare Administrative Contractors (MACs)

Sec.
421.400 Statutory basis and scope.
421.401 Definitions.
421.404 Assignment of providers and suppliers to MACs.


Sec.  421.400  Statutory basis and scope.

    (a) Statutory basis. This subpart implements section 1874A of the 
Act, which provides for the transition of the claims processing 
functions and operations for both Medicare Part A and Part B 
intermediaries and carriers to Medicare administrative contractors 
(MACs). The transition will occur between October 1, 2005, and October 
1, 2011. MACs will be fully operational in distinct, nonoverlapping 
geographic jurisdictions by October 1, 2011.
    (b) Scope. This subpart specifies the requirements under which 
providers and suppliers will be assigned to MACs.


Sec.  421.401  Definitions.

    For purposes of this subpart--
    Appropriate MAC means a MAC that has a contract under section 1874A 
of the Act to perform a particular Medicare administrative function in 
relation to:
    (1) A particular individual entitled to benefits under Part A or 
enrolled under Part B, or both;
    (2) A specific provider of services or supplier; or
    (3) A class of providers of services or suppliers.
    Medicare administrative contractor (MAC) means an agency, 
organization, or other person with a contract under section 1874A of 
the Act.


Sec.  421.404  Assignment of providers and suppliers to MACs.

    (a) Definitions. As used in this section--
    Chain provider means a group of two or more providers under common 
ownership or control.
    Common control exists when an individual, a group of individuals, 
or an organization has the power, directly or indirectly, to 
significantly influence or direct the actions or policies of the group 
of suppliers or eligible providers.
    Common ownership exists when an individual, a group of individuals, 
or an organization possesses significant equity in the group of 
suppliers or eligible providers.
    Durable medical equipment, prosthetics, orthotics, and supplies 
(DMEPOS) means the types of services specified in Sec.  421.210(b).
    Eligible provider means a hospital, skilled nursing facility, or 
critical access hospital that meets the definition of a provider under 
Sec.  400.202 of this chapter.
    Home office means the entity that provides centralized management 
and administrative services to the individual providers or suppliers 
under common ownership and common control, such as centralized 
accounting, purchasing, personnel services, management direction and 
control, and other similar services.
    Ineligible provider means a provider under Sec.  400.202 of this 
chapter that is not an eligible provider.
    Medicare benefit category means a category of covered benefits 
under Part A or Part B of the Medicare program (for example, inpatient 
hospital services, post-hospital extended care services, and 
physicians' services).
    Provider has the same meaning as specified under Sec.  400.202 of 
this chapter.
    Qualified chain provider means a chain provider comprised of--
    (1) 10 or more eligible providers collectively totaling 500 or more 
certified beds; or
    (2) 5 or more eligible providers collectively totaling 300 or more 
certified beds, with eligible providers in 3 or more continuous States.
    Supplier has the same meaning as specified in Sec.  400.202 of this 
chapter.
    (b) Assignment of providers to MACs. (1) Providers enroll with and 
receive Medicare payment and other Medicare services from the MAC 
contracted by CMS to administer claims for the Medicare benefit 
category applicable to the provider's covered services for the 
geographic locale in which the provider is physically located.
    (2) Qualified chain providers may request and receive an exception 
from the requirement of paragraph (b)(1) of this section from CMS. Upon 
CMS' approval, a qualified chain provider may enroll with and bill on 
behalf of the eligible providers under its common ownership or common 
control to the MAC contracted by CMS to administer claims for the 
Medicare benefit category applicable to the eligible providers' covered 
services for the geographic locale in which the qualified chain 
provider's home office is physically located.
    (3) As MAC contractors become available, qualified chain providers, 
granted approval by CMS to enroll with and bill a single intermediary 
on behalf of their eligible member providers prior to October 1, 2005, 
will be assigned at an appropriate time to the MAC contracted by CMS to 
administer claims

[[Page 49704]]

for the applicable Medicare benefit category for the geographic locale 
in which the chain provider's home office is physically located. The 
qualified chain provider will not need to request an exception to the 
requirement of paragraph (b)(1) of this section in order for this 
assignment to take effect.
    (4) CMS may grant an exception to the requirement of paragraph 
(b)(1) of this section to eligible providers that are not under the 
common ownership or common control of a qualified chain provider, as 
well as ineligible providers, only if CMS finds the exception will 
support the implementation of MACs or will serve some other compelling 
interest of the Medicare program.
    (c) Assignment of suppliers to MACs. (1) Suppliers, including 
physicians and other practitioners, but excluding suppliers of DMEPOS, 
enroll with and receive Medicare payment and other Medicare services 
from the MAC contracted by CMS to administer claims for the Medicare 
benefit category applicable to the supplier's covered services for the 
geographic locale in which the supplier furnished such services.
    (2) Suppliers of DMEPOS receive Medicare payment and other Medicare 
services from the MAC assigned to administer claims for DMEPOS for the 
regional area in which the beneficiary receiving the DMEPOS resides. 
The terms of Sec. Sec.  421.210 and 421.212 continue to apply to 
suppliers of DMEPOS.
    (3) CMS may allow a group of ESRD suppliers under common ownership 
and common control to enroll with the MAC contracted by CMS to 
administer ESRD claims for the geographic locale in which the group's 
home office is located only if--
    (i) The group of ESRD suppliers requests such privileges; and
    (ii) CMS finds the exception will support the implementation of 
MACs or will serve some other compelling interest of the Medicare 
program.

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

    38. 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).

    39. Section 485.618 is amended by--
    a. Revising paragraph (d)(1) introductory text.
    b. Redesignating paragraphs (d)(2) and (d)(3) as paragraphs (d)(3) 
and (d)(4), respectively.
    c. Adding a new paragraph (d)(2).
    d. In redesignated paragraph (d)(3)(iv), removing the cross-
reference ``paragraph (d)(2)(iii)'' and adding the cross-reference 
``paragraph (d)(3)(iii)'' in its place.
    e. In redesignated paragraph (d)(4), removing the cross-reference 
``paragraph (d)(2)(iii)'' and adding the cross-reference ``paragraph 
(d)(3)(iii)'' in its place.
    The revisions and additions read as follows:


Sec.  485.618  Condition of participation: Emergency services.

* * * * *
    (d) Standard: Personnel.
    (1) Except as specified in paragraph (d)(3) of this section, there 
must be a doctor of medicine or osteopathy, a physician assistant, a 
nurse practitioner, or a clinical nurse specialist, with training or 
experience in emergency care, on call and immediately available by 
telephone or radio contact, and available onsite within the following 
timeframes:
* * * * *
    (2) A registered nurse with training and experience in emergency 
care can be utilized to conduct specific medical screening examinations 
only if--
    (i) The registered nurse is on site and immediately available at 
the CAH when a patient requests medical care; and
    (ii) The nature of the patient's request for medical care is within 
the scope of practice of a registered nurse and consistent with 
applicable State laws.
* * * * *

PART 488--SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES

    40. The authority citation for part 488 continues to read as 
follows:

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

    41. In Sec.  488.1, the definition of ``supplier'' is revised to 
read as follows:


Sec.  488.1  Definitions.

* * * * *
    Supplier means any of the following: Independent laboratory; 
portable X-ray services; physical therapist in independent practice; 
ESRD facility; rural health clinic; Federally qualified health center; 
chiropractor; or ambulatory surgical center.
* * * * *

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)
(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)


    Dated: July 28, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: August 7, 2006.
Michael O. Leavitt,
Secretary.

[[Page 49705]]



    Addendum A.--OPPS Proposed List of Ambulatory Payment Classifications (APCs) With Status Indicators (SI),
                    Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2007
----------------------------------------------------------------------------------------------------------------
                                                                                           National     Minimum
         APC                  Group title               SI         Relative     Payment   unadjusted  unadjusted
                                                                    weight       rate      copayment   copyment
----------------------------------------------------------------------------------------------------------------
0001.................  Level I Photochemotherapy  S                   0.4896       30.14        7.00        6.03
0002.................  Level I Fine Needle        T                   1.0948       67.39  ..........       13.48
                        Biopsy/Aspiration.
0003.................  Bone Marrow Biopsy/        T                   2.4295      149.54  ..........       29.91
                        Aspiration.
0004.................  Level I Needle Biopsy/     T                   2.0863      128.41  ..........       25.68
                        Aspiration Except Bone
                        Marrow.
0005.................  Level II Needle Biopsy/    T                   3.8051      234.21       71.59       46.84
                        Aspiration Except Bone
                        Marrow.
0006.................  Level I Incision &         T                   1.4821       91.22       21.76       18.24
                        Drainage.
0007.................  Level II Incision &        T                  10.9184      672.04  ..........      134.41
                        Drainage.
0008.................  Level III Incision and     T                  17.4686    1,075.21  ..........      215.04
                        Drainage.
0009.................  Nail Procedures..........  T                   0.6803       41.87  ..........        8.37
0010.................  Level I Destruction of     T                   0.4829       29.72        8.14        5.94
                        Lesion.
0011.................  Level II Destruction of    T                   2.6478      162.97  ..........       32.59
                        Lesion.
0012.................  Level I Debridement &      T                   0.8076       49.71       10.30        9.94
                        Destruction.
0013.................  Level II Debridement &     T                   1.0876       66.94  ..........       13.39
                        Destruction.
0015.................  Level III Debridement &    T                   1.6062       98.86       20.13       19.77
                        Destruction.
0016.................  Level IV Debridement &     T                   2.6253      161.59       32.68       32.32
                        Destruction.
0017.................  Level VI Debridement &     T                  17.7392    1,091.87      227.84      218.37
                        Destruction.
0018.................  Biopsy of Skin/Puncture    T                   1.0534       64.84       15.87       12.97
                        of Lesion.
0019.................  Level I Excision/ Biopsy.  T                   4.0123      246.96       71.87       49.39
0020.................  Level II Excision/ Biopsy  T                   6.5128      400.87       98.57       80.17
0021.................  Level III Excision/        T                  14.9563      920.58      219.48      184.12
                        Biopsy.
0022.................  Level IV Excision/ Biopsy  T                  19.9760    1,229.54      354.45      245.91
0023.................  Exploration Penetrating    T                   4.1133      253.18  ..........       50.64
                        Wound.
0024.................  Level I Skin Repair......  T                   1.4924       91.86       30.08       18.37
0025.................  Level II Skin Repair.....  T                   5.0931      313.49       95.46       62.70
0027.................  Level IV Skin Repair.....  T                  21.2645    1,308.85      329.72      261.77
0028.................  Level I Breast Surgery...  T                  19.2250    1,183.32      303.74      236.66
0029.................  Level II Breast Surgery..  T                  28.1505    1,732.69  ..........      346.54
0030.................  Level III Breast Surgery.  T                  40.7495    2,508.17      763.55      501.63
0031.................  Smoking Cessation          X                   0.1716       10.56  ..........        2.11
                        Services.
0033.................  Partial Hospitalization..  P                   3.3837      208.27  ..........       41.65
0035.................  Arterial/Venous Puncture.  T                   0.2016       12.41  ..........        2.48
0036.................  Level II Fine Needle       T                   2.0147      124.01  ..........       24.80
                        Biopsy/Aspiration.
0037.................  Level IV Needle Biopsy/    T                  10.2616      631.61      228.76      126.32
                        Aspiration Except Bone
                        Marrow.
0038.................  Spontaneous MEG..........  S                  51.2627    3,155.27  ..........      631.05
0039.................  Level I Implantation of    S                 175.9328   10,828.84  ..........    2,165.77
                        Neurostimulator.
0040.................  Percutaneous Implantation  S                  56.3855    3,470.58  ..........      694.12
                        of Neurostimulator
                        Electrodes, Excluding
                        Cranial Nerve.
0041.................  Level I Arthroscopy......  T                  28.6279    1,762.08  ..........      352.42
0042.................  Level II Arthroscopy.....  T                  45.0637    2,773.72      804.74      554.74
0043.................  Closed Treatment Fracture  T                   1.6914      104.11  ..........       20.82
                        Finger/Toe/Trunk.
0045.................  Bone/Joint Manipulation    T                  14.5502      895.58      268.47      179.12
                        Under Anesthesia.
0047.................  Arthroplasty without       T                  32.7543    2,016.06      537.03      403.21
                        Prosthesis.
0048.................  Level I Arthroplasty with  T                  47.1644    2,903.02  ..........      580.60
                        Prosthesis.
0049.................  Level I Musculoskeletal    T                  20.8214    1,281.58  ..........      256.32
                        Procedures Except Hand
                        and Foot.
0050.................  Level II Musculoskeletal   T                  25.0600    1,542.47  ..........      308.49
                        Procedures Except Hand
                        and Foot.
0051.................  Level III Musculoskeletal  T                  41.2543    2,539.24  ..........      507.85
                        Procedures Except Hand
                        and Foot.
0052.................  Level IV Musculoskeletal   T                  65.8846    4,055.26  ..........      811.05
                        Procedures Except Hand
                        and Foot.
0053.................  Level I Hand               T                  16.0343      986.93      253.49      197.39
                        Musculoskeletal
                        Procedures.
0054.................  Level II Hand              T                  25.8425    1,590.63  ..........      318.13
                        Musculoskeletal
                        Procedures.
0055.................  Level I Foot               T                  20.2255    1,244.90      355.34      248.98
                        Musculoskeletal
                        Procedures.
0056.................  Level II Foot              T                  41.2239    2,537.37  ..........      507.47
                        Musculoskeletal
                        Procedures.
0057.................  Bunion Procedures........  T                  28.0970    1,729.40      475.91      345.88
0058.................  Level I Strapping and      S                   1.0504       64.65  ..........       12.93
                        Cast Application.
0060.................  Manipulation Therapy.....  S                   0.4904       30.18  ..........        6.04
0061.................  Laminectomy or Incision    S                  84.2373    5,184.89  ..........    1,036.98
                        for Implantation of
                        Neurostimulator
                        Electrodes, Excluding
                        Cranial Nerve.
0062.................  Level I Treatment          T                  25.6702    1,580.03      375.46      316.01
                        Fracture/Dislocation.
0063.................  Level II Treatment         T                  37.5680    2,312.35      549.49      462.47
                        Fracture/Dislocation.
0064.................  Level III Treatment        T                  56.4195    3,472.68      825.22      694.54
                        Fracture/Dislocation.
0065.................  Level I Stereotactic       S                  22.4428    1,381.38  ..........      276.28
                        Radiosurgery.
0066.................  Level II Stereotactic      S                  47.2213    2,906.52  ..........      581.30
                        Radiosurgery.
0067.................  Level III Stereotactic     S                  65.7255    4,045.47  ..........      809.09
                        Radiosurgery.
0068.................  CPAP Initiation..........  S                   1.3718       84.44       29.48       16.89
0069.................  Thoracoscopy.............  T                  31.5464    1,941.71      591.64      388.34
0070.................  Thoracentesis/Lavage       T                   3.6425      224.20  ..........       44.84
                        Procedures.
0071.................  Level I Endoscopy Upper    T                   0.7572       46.61       11.03        9.32
                        Airway.
0072.................  Level II Endoscopy Upper   T                   1.4038       86.41       21.27       17.28
                        Airway.
0073.................  Level III Endoscopy Upper  T                   3.8737      238.43       69.72       47.69
                        Airway.
0074.................  Level IV Endoscopy Upper   T                  15.1300      931.27      295.70      186.25
                        Airway.

[[Page 49706]]

 
0075.................  Level V Endoscopy Upper    T                  21.8010    1,341.87      445.92      268.37
                        Airway.
0076.................  Level I Endoscopy Lower    T                   9.3905      577.99      189.82      115.60
                        Airway.
0077.................  Level I Pulmonary          S                   0.3383       20.82        7.74        4.16
                        Treatment.
0078.................  Level II Pulmonary         S                   1.0381       63.90       14.55       12.78
                        Treatment.
0079.................  Ventilation Initiation     S                   2.7732      170.69  ..........       34.14
                        and Management.
0080.................  Diagnostic Cardiac         T                  37.1008    2,283.59      838.92      456.72
                        Catheterization.
0081.................  Non-Coronary Angioplasty   T                  42.8894    2,639.89  ..........      527.98
                        or Atherectomy.
0082.................  Coronary Atherectomy.....  T                  76.2006    4,690.22    1,008.90      938.04
0083.................  Coronary Angioplasty and   T                  57.4937    3,538.79  ..........      707.76
                        Percutaneous
                        Valvuloplasty.
0084.................  Level I                    S                   9.9197      610.57  ..........      122.11
                        Electrophysiologic
                        Evaluation.
0085.................  Level II                   T                  34.7086    2,136.35  ..........      427.27
                        Electrophysiologic
                        Evaluation.
0086.................  Ablate Heart Dysrhythm     T                  47.1472    2,901.96      812.36      580.39
                        Focus.
0087.................  Cardiac                    T                  32.8298    2,020.71  ..........      404.14
                        Electrophysiologic
                        Recording/Mapping.
0088.................  Thrombectomy.............  T                  37.9652    2,336.80      655.22      467.36
0089.................  Insertion/Replacement of   T                 121.9402    7,505.54    1,682.28    1,501.11
                        Permanent Pacemaker and
                        Electrodes.
0090.................  Insertion/Replacement of   T                  97.8357    6,021.89    1,612.80    1,204.38
                        Pacemaker Pulse
                        Generator.
0091.................  Level II Vascular          T                  34.6279    2,131.38  ..........      426.28
                        Ligation.
0092.................  Level I Vascular Ligation  T                  24.5817    1,513.03      306.56      302.61
0093.................  Vascular Reconstruction/   T                  21.9703    1,352.29  ..........      270.46
                        Fistula Repair without
                        Device.
0094.................  Level I Resuscitation and  S                   2.4630      151.60       46.29       30.32
                        Cardioversion.
0095.................  Cardiac Rehabilitation...  S                   0.5792       35.65       13.86        7.13
0096.................  Non-Invasive Vascular      S                   1.5727       96.80       38.13       19.36
                        Studies.
0097.................  Cardiac and Ambulatory     X                   1.0245       63.06       23.79       12.61
                        Blood Pressure
                        Monitoring.
0098.................  Injection of Sclerosing    T                   1.1035       67.92  ..........       13.58
                        Solution.
0099.................  Electrocardiograms.......  S                   0.3835       23.60  ..........        4.72
0100.................  Cardiac Stress Tests.....  X                   2.5352      156.04       41.44       31.21
0101.................  Tilt Table Evaluation....  S                   4.3122      265.42      100.24       53.08
0103.................  Miscellaneous Vascular     T                  17.0436    1,049.05      223.63      209.81
                        Procedures.
0104.................  Transcatheter Placement    T                  87.9808    5,415.31  ..........    1,083.06
                        of Intracoronary Stents.
0105.................  Revision/Removal of        T                  23.4666    1,444.39      370.40      288.88
                        Pacemakers, AICD, or
                        Vascular.
0106.................  Insertion/Replacement/     T                  44.7574    2,754.86  ..........      550.97
                        Repair of Pacemaker and/
                        or Electrodes.
0107.................  Insertion of Cardioverter- T                 279.2049   17,185.34  ..........    3,437.07
                        Defibrillator.
0108.................  Insertion/Replacement/     T                 370.5535   22,807.94  ..........    4,561.59
                        Repair of Cardioverter-
                        Defibrillator Leads.
0109.................  Removal of Implanted       T                  10.9541      674.24  ..........      134.85
                        Devices.
0110.................  Transfusion..............  S                   3.4570      212.78  ..........       42.56
0111.................  Blood Product Exchange...  S                  11.7005      720.18      198.40      144.04
0112.................  Apheresis, Photopheresis,  S                  30.6602    1,887.17      433.29      377.43
                        and Plasmapheresis.
0113.................  Excision Lymphatic System  T                  21.3673    1,315.18  ..........      263.04
0114.................  Thyroid/Lymphadenectomy    T                  37.1283    2,285.28      461.19      457.06
                        Procedures.
0115.................  Cannula/Access Device      T                  29.4757    1,814.26      378.68      362.85
                        Procedures.
0121.................  Level I Tube changes and   T                   2.3431      144.22       43.80       28.84
                        Repositioning.
0122.................  Level II Tube changes and  T                   7.2859      448.45  ..........       89.69
                        Repositioning.
0123.................  Bone Marrow Harvesting     S                  23.2490    1,431.00  ..........      286.20
                        and Bone Marrow/Stem
                        Cell Transplant.
0125.................  Refilling of Infusion      T                   2.2200      136.64  ..........       27.33
                        Pump.
0126.................  Level I Urinary and Anal   T                   1.0844       66.75       16.40       13.35
                        Procedures.
0127.................  Level IV Stereotactic      S                 126.8566    7,808.15  ..........    1,561.63
                        Radiosurgery.
0130.................  Level I Laparoscopy......  T                  31.9353    1,965.65      659.53      393.13
0131.................  Level II Laparoscopy.....  T                  43.5124    2,678.23    1,001.89      535.65
0132.................  Level III Laparoscopy....  T                  70.8854    4,363.07    1,239.22      872.61
0140.................  Esophageal Dilation        T                   5.3134      327.05       91.40       65.41
                        without Endoscopy.
0141.................  Level I Upper GI           T                   8.3070      511.30      143.38      102.26
                        Procedures.
0142.................  Small Intestine Endoscopy  T                   9.3878      577.83      152.78      115.57
0143.................  Lower GI Endoscopy.......  T                   8.8143      542.53      186.06      108.51
0146.................  Level I Sigmoidoscopy and  T                   4.8005      295.48       64.40       59.10
                        Anoscopy.
0147.................  Level II Sigmoidoscopy     T                   8.5644      527.15  ..........      105.43
                        and Anoscopy.
0148.................  Level I Anal/Rectal        T                   4.8970      301.42  ..........       60.28
                        Procedures.
0149.................  Level III Anal/Rectal      T                  22.2336    1,368.50      293.06      273.70
                        Procedures.
0150.................  Level IV Anal/Rectal       T                  29.4386    1,811.98      437.12      362.40
                        Procedures.
0151.................  Endoscopic Retrograde      T                  19.8125    1,219.48      245.46      243.90
                        Cholangio-
                        Pancreatography (ERCP).
0152.................  Level I Percutaneous       T                  19.4515    1,197.26  ..........      239.45
                        Abdominal and Biliary
                        Procedures.
0153.................  Peritoneal and Abdominal   T                  22.1758    1,364.94      397.95      272.99
                        Procedures.
0154.................  Hernia/Hydrocele           T                  29.1491    1,794.16      464.85      358.83
                        Procedures.
0155.................  Level II Anal/Rectal       T                  12.8778      792.64  ..........      158.53
                        Procedures.
0156.................  Level III Urinary and      T                   3.5688      219.66  ..........       43.93
                        Anal Procedures.
0157.................  Colorectal Cancer          S                   2.4974      153.72  ..........       30.74
                        Screening: Barium Enema.
0158.................  Colorectal Cancer          T                   7.8134      480.92  ..........      120.23
                        Screening: Colonoscopy.
0159.................  Colorectal Cancer          S                   3.8973      239.88  ..........       59.97
                        Screening: Flexible
                        Sigmoidoscopy.
0160.................  Level I Cystourethroscopy  T                   6.7325      414.39      105.06       82.88
                        and other Genitourinary
                        Procedures.
0161.................  Level II                   T                  19.2766    1,186.49      249.36      237.30
                        Cystourethroscopy and
                        other Genitourinary
                        Procedures.

[[Page 49707]]

 
0162.................  Level III                  T                  23.8562    1,468.37  ..........      293.67
                        Cystourethroscopy and
                        other Genitourinary
                        Procedures.
0163.................  Level IV                   T                  35.1024    2,160.59  ..........      432.12
                        Cystourethroscopy and
                        other Genitourinary
                        Procedures.
0164.................  Level II Urinary and Anal  T                   2.1159      130.24  ..........       26.05
                        Procedures.
0165.................  Level IV Urinary and Anal  T                  18.2333    1,122.28  ..........      224.46
                        Procedures.
0166.................  Level I Urethral           T                  18.5138    1,139.54  ..........      227.91
                        Procedures.
0168.................  Level II Urethral          T                  28.5971    1,760.18      388.16      352.04
                        Procedures.
0169.................  Lithotripsy..............  T                  44.1144    2,715.29    1,009.47      543.06
0170.................  Dialysis.................  S                   6.8096      419.14  ..........       83.83
0171.................  Level V Anal/Rectal        T                  37.2425    2,292.31      705.28      458.46
                        Procedures.
0180.................  Circumcision.............  T                  20.7418    1,276.68      304.87      255.34
0181.................  Penile Procedures........  T                  32.9991    2,031.13      621.82      406.23
0183.................  Testes/Epididymis          T                  23.7072    1,459.20  ..........      291.84
                        Procedures.
0184.................  Prostate Biopsy..........  T                   5.9892      368.64       96.27       73.73
0188.................  Level II Female            T                   1.4050       86.48  ..........       17.30
                        Reproductive Proc.
0189.................  Level III Female           T                   2.9902      184.05  ..........       36.81
                        Reproductive Proc.
0190.................  Level I Hysteroscopy.....  T                  21.4199    1,318.42      424.28      263.68
0191.................  Level I Female             T                   0.1501        9.24  ..........        1.85
                        Reproductive Proc.
0192.................  Level IV Female            T                   6.9265      426.33  ..........       85.27
                        Reproductive Proc.
0193.................  Level V Female             T                  14.7958      910.70  ..........      182.14
                        Reproductive Proc.
0194.................  Level VIII Female          T                  20.5113    1,262.49      397.84      252.50
                        Reproductive Proc.
0195.................  Level IX Female            T                  28.7410    1,769.04      483.80      353.81
                        Reproductive Proc.
0196.................  Dilation and Curettage...  T                  17.7635    1,093.36      338.23      218.67
0197.................  Infertility Procedures...  T                   4.4108      271.49  ..........       54.30
0198.................  Pregnancy and Neonatal     T                   1.4026       86.33       32.19       17.27
                        Care Procedures.
0200.................  Level VII Female           T                  17.2607    1,062.41      248.39      212.48
                        Reproductive Proc.
0201.................  Level VI Female            T                  18.5251    1,140.24      329.65      228.05
                        Reproductive Proc.
0202.................  Level X Female             T                  42.8756    2,639.04      981.50      527.81
                        Reproductive Proc.
0203.................  Level IV Nerve Injections  T                  12.4432      765.89      240.33      153.18
0204.................  Level I Nerve Injections.  T                   2.2491      138.43       40.13       27.69
0206.................  Level II Nerve Injections  T                   5.5439      341.23       75.55       68.25
0207.................  Level III Nerve            T                   6.3788      392.62       86.92       78.52
                        Injections.
0208.................  Laminotomies and           T                  43.9030    2,702.27  ..........      540.45
                        Laminectomies.
0209.................  Level II MEG, Extended     S                  11.4847      706.89      268.73      141.38
                        EEG Studies and Sleep
                        Studies.
0212.................  Nervous System Injections  T                   3.0383      187.01       65.96       37.40
0213.................  Level I MEG, Extended EEG  S                   2.3133      142.39       53.58       28.48
                        Studies and Sleep
                        Studies.
0214.................  Electroencephalogram.....  S                   1.2353       76.03       28.24       15.21
0215.................  Level I Nerve and Muscle   S                   0.5760       35.45  ..........        7.09
                        Tests.
0216.................  Level III Nerve and        S                   2.6729      164.52  ..........       32.90
                        Muscle Tests.
0218.................  Level II Nerve and Muscle  S                   1.1993       73.82  ..........       14.76
                        Tests.
0220.................  Level I Nerve Procedures.  T                  17.7609    1,093.20  ..........      218.64
0221.................  Level II Nerve Procedures  T                  33.3035    2,049.86      463.62      409.97
0222.................  Implantation of            T                 178.1307   10,964.12  ..........    2,192.82
                        Neurological Device.
0223.................  Implantation or Revision   T                  29.2931    1,803.02  ..........      360.60
                        of Pain Management
                        Catheter.
0224.................  Implantation of Reservoir/ T                  45.6712    2,811.11  ..........      562.22
                        Pump/Shunt.
0225.................  Implantation of            S                 234.1628   14,412.95  ..........    2,882.59
                        Neurostimulator
                        Electrodes, Cranial
                        Nerve.
0226.................  Implantation of Drug       T                 112.0147    6,894.62  ..........    1,378.92
                        Infusion Reservoir.
0227.................  Implantation of Drug       T                 183.1974   11,275.98  ..........    2,255.20
                        Infusion Device.
0228.................  Creation of Lumbar         T                  36.1603    2,225.70  ..........      445.14
                        Subarachnoid Shunt.
0229.................  Transcatherter Placement   T                  66.0804    4,067.31  ..........      813.46
                        of Intravascular Shunts.
0230.................  Level I Eye Tests &        S                   0.8126       50.02       14.97       10.00
                        Treatments.
0231.................  Level III Eye Tests &      S                   2.1934      135.01  ..........       27.00
                        Treatments.
0232.................  Level I Anterior Segment   T                   5.9800      368.07       92.21       73.61
                        Eye Procedures.
0233.................  Level II Anterior Segment  T                  14.9969      923.07      266.33      184.61
                        Eye Procedures.
0234.................  Level III Anterior         T                  22.9479    1,412.47      511.31      282.49
                        Segment Eye Procedures.
0235.................  Level I Posterior Segment  T                   4.0750      250.82       61.14       50.16
                        Eye Procedures.
0236.................  Level II Posterior         T                  16.3433    1,005.95  ..........      201.19
                        Segment Eye Procedures.
0237.................  Level III Posterior        T                  26.9305    1,657.60  ..........      331.52
                        Segment Eye Procedures.
0238.................  Level I Repair and         T                   2.8099      172.95  ..........       34.59
                        Plastic Eye Procedures.
0239.................  Level II Repair and        T                   6.9354      426.88  ..........       85.38
                        Plastic Eye Procedures.
0240.................  Level III Repair and       T                  17.0126    1,047.14      307.90      209.43
                        Plastic Eye Procedures.
0241.................  Level IV Repair and        T                  24.8502    1,529.55      384.47      305.91
                        Plastic Eye Procedures.
0242.................  Level V Repair and         T                  35.5217    2,186.40      597.36      437.28
                        Plastic Eye Procedures.
0243.................  Strabismus/Muscle          T                  21.2885    1,310.33      431.09      262.07
                        Procedures.
0244.................  Corneal Transplant.......  T                  37.9446    2,335.53      803.26      467.11
0245.................  Level I Cataract           T                  14.5427      895.12      217.05      179.02
                        Procedures without IOL
                        Insert.
0246.................  Cataract Procedures with   T                  23.5664    1,450.54      495.96      290.11
                        IOL Insert.
0247.................  Laser Eye Procedures       T                   5.1266      315.55      104.31       63.11
                        Except Retinal.
0248.................  Laser Retinal Procedures.  T                   5.0285      309.51       95.08       61.90
0249.................  Level II Cataract          T                  28.5043    1,754.47      524.67      350.89
                        Procedures without IOL
                        Insert.

[[Page 49708]]

 
0250.................  Nasal Cauterization/       T                   1.2021       73.99       25.50       14.80
                        Packing.
0251.................  Level I ENT Procedures...  T                   2.3768      146.29  ..........       29.26
0252.................  Level II ENT Procedures..  T                   7.7261      475.55      111.84       95.11
0253.................  Level III ENT Procedures.  T                  16.4494    1,012.48      282.29      202.50
0254.................  Level IV ENT Procedures..  T                  23.1564    1,425.30      321.35      285.06
0256.................  Level V ENT Procedures...  T                  37.7719    2,324.90  ..........      464.98
0257.................  Level I Therapeutic        S                   0.9770       60.14  ..........       12.03
                        Radiologic Procedures.
0258.................  Tonsil and Adenoid         T                  22.7757    1,401.87      437.25      280.37
                        Procedures.
0259.................  Level VI ENT Procedures..  T                 406.8232   25,040.37    8,698.43    5,008.07
0260.................  Level I Plain Film Except  X                   0.7276       44.78  ..........        8.96
                        Teeth.
0261.................  Level II Plain Film        X                   1.2515       77.03  ..........       15.41
                        Except Teeth Including
                        Bone Density Measurement.
0262.................  Plain Film of Teeth......  X                   0.5818       35.81  ..........        7.16
0263.................  Level I Miscellaneous      X                   1.7120      105.38       23.77       21.08
                        Radiology Procedures.
0264.................  Level II Miscellaneous     X                   2.9791      183.37       70.84       36.67
                        Radiology Procedures.
0265.................  Level I Diagnostic and     S                   1.0145       62.44       23.63       12.49
                        Screening Ultrasound.
0266.................  Level II Diagnostic and    S                   1.5947       98.16       37.80       19.63
                        Screening Ultrasound.
0267.................  Level III Diagnostic and   S                   2.5166      154.90       60.80       30.98
                        Screening Ultrasound.
0268.................  Level I Ultrasound         S                   1.1967       73.66  ..........       14.73
                        Guidance Procedures.
0269.................  Level II Echocardiogram    S                   3.2432      199.62       75.60       39.92
                        Except Transesophageal.
0270.................  Transesophageal            S                   6.2689      385.86      141.32       77.17
                        Echocardiogram.
0272.................  Fluoroscopy..............  X                   1.2985       79.92       31.64       15.98
0274.................  Myelography..............  S                   2.6182      161.15       64.46       32.23
0275.................  Arthrography.............  S                   3.7021      227.87       69.09       45.57
0276.................  Level I Digestive          S                   1.4519       89.37       34.97       17.87
                        Radiology.
0277.................  Level II Digestive         S                   2.2764      140.11       54.63       28.02
                        Radiology.
0278.................  Diagnostic Urography.....  S                   2.4721      152.16       60.84       30.43
0279.................  Level II Angiography and   S                   9.6539      594.21      150.03      118.84
                        Venography.
0280.................  Level III Angiography and  S                  20.9479    1,289.36      353.85      257.87
                        Venography.
0282.................  Miscellaneous              S                   1.5552       95.72       37.92       19.14
                        Computerized Axial
                        Tomography.
0283.................  Computerized Axial         S                   4.1858      257.64      102.17       51.53
                        Tomography with Contrast
                        Material.
0284.................  Magnetic Resonance         S                   6.2589      385.24      148.40       77.05
                        Imaging and Magnetic
                        Resonance Angiography
                        with Contras.
0288.................  Bone Density:Axial         S                   1.2005       73.89  ..........       14.78
                        Skeleton.
0293.................  Level V Anterior Segment   T                  50.6347    3,116.62    1,100.34      623.32
                        Eye Procedures.
0296.................  Level II Therapeutic       S                   2.7106      166.84       53.99       33.37
                        Radiologic Procedures.
0297.................  Level III Therapeutic      S                   3.6483      224.56       89.82       44.91
                        Radiologic Procedures.
0298.................  Level IV Therapeutic       S                   8.4904      522.59      209.02      104.52
                        Radiologic Procedures.
0299.................  Miscellaneous Radiation    S                   6.0322      371.29  ..........       74.26
                        Treatment.
0300.................  Level I Radiation Therapy  S                   1.5004       92.35  ..........       18.47
0301.................  Level II Radiation         S                   2.2670      139.54  ..........       27.91
                        Therapy.
0302.................  Computer Assisted          S                   5.5005      338.56      105.94       67.71
                        Navigational Procedures.
0303.................  Treatment Device           X                   2.9637      182.42       66.95       36.48
                        Construction.
0304.................  Level I Therapeutic        X                   1.6062       98.86       39.54       19.77
                        Radiation Treatment
                        Preparation.
0305.................  Level II Therapeutic       X                   4.0232      247.63       91.38       49.53
                        Radiation Treatment
                        Preparation.
0307.................  Myocardial Positron        S                  11.6773      718.75      287.49      143.75
                        Emission Tomography
                        (PET) imaging.
0308.................  Non-Myocardial Positron    S                  14.0093      862.29  ..........      172.46
                        Emission Tomography
                        (PET) imaging.
0309.................  Level II Ultrasound        S                   2.1284      131.01  ..........       26.20
                        Guidance Procedures.
0310.................  Level III Therapeutic      X                  14.0578      865.27      325.27      173.05
                        Radiation Treatment
                        Preparation.
0312.................  Radioelement Applications  S                   5.0185      308.89  ..........       61.78
0313.................  Brachytherapy............  S                  13.3939      824.41  ..........      164.88
0314.................  Hyperthermic Therapies...  S                   3.6583      225.17       66.65       45.03
0315.................  Level II Implantation of   T                 235.5774   14,500.02  ..........    2,900.00
                        Neurostimulator.
0320.................  Electroconvulsive Therapy  S                   5.5017      338.64       80.06       67.73
0321.................  Biofeedback and Other      S                   1.3693       84.28       21.72       16.86
                        Training.
0322.................  Brief Individual           S                   1.1749       72.32  ..........       14.46
                        Psychotherapy.
0323.................  Extended Individual        S                   1.7170      105.68  ..........       21.14
                        Psychotherapy.
0324.................  Family Psychotherapy.....  S                   2.2087      135.95  ..........       27.19
0325.................  Group Psychotherapy......  S                   1.0787       66.40       14.51       13.28
0330.................  Dental Procedures........  S                   9.5891      590.22  ..........      118.04
0332.................  Computerized Axial         S                   3.1631      194.69       75.24       38.94
                        Tomography and
                        Computerized Angiography
                        without Contras.
0333.................  Computerized Axial         S                   5.0020      307.88      121.52       61.58
                        Tomography and
                        Computerized Angiography
                        without Contrast
                        followed by Contrast.
0335.................  Magnetic Resonance         S                   4.6629      287.01      114.80       57.40
                        Imaging, Miscellaneous.
0336.................  Magnetic Resonance         S                   5.8500      360.07      139.68       72.01
                        Imaging and Magnetic
                        Resonance Angiography
                        without Cont.
0337.................  MRI and Magnetic           S                   8.3423      513.48      202.50      102.70
                        Resonance Angiography
                        without Contrast
                        Material followed.
0339.................  Observation..............  S                   7.1587      440.63  ..........       88.13

[[Page 49709]]

 
0340.................  Minor Ancillary            X                   0.6211       38.23  ..........        7.65
                        Procedures.
0341.................  Skin Tests...............  X                   0.0914        5.63        2.25        1.13
0342.................  Level I Pathology........  X                   0.0813        5.00        2.00        1.00
0343.................  Level III Pathology......  X                   0.5309       32.68       10.84        6.54
0344.................  Level IV Pathology.......  X                   0.8107       49.90       15.66        9.98
0345.................  Level I Transfusion        X                   0.2218       13.65        2.87        2.73
                        Laboratory Procedures.
0346.................  Level II Transfusion       X                   0.3494       21.51        4.39        4.30
                        Laboratory Procedures.
0347.................  Level III Transfusion      X                   0.7394       45.51       11.24        9.10
                        Laboratory Procedures.
0348.................  Fertility Laboratory       X                   0.8928       54.95  ..........       10.99
                        Procedures.
0350.................  Administration of flu and  S                   0.4107       25.28        0.00        0.00
                        PPV vaccine.
0360.................  Level I Alimentary Tests.  X                   1.3789       84.87       33.88       16.97
0361.................  Level II Alimentary Tests  X                   3.9319      242.01       83.23       48.40
0362.................  Contact Lens and           X                   0.5328       32.79  ..........        6.56
                        Spectacle Services.
0363.................  Level I                    X                   0.8534       52.53       17.44       10.51
                        Otorhinolaryngologic
                        Function Tests.
0364.................  Level I Audiometry.......  X                   0.4637       28.54        7.06        5.71
0365.................  Level II Audiometry......  X                   1.2467       76.74       18.52       15.35
0366.................  Level III Audiometry.....  X                   1.8175      111.87       26.14       22.37
0367.................  Level I Pulmonary Test...  X                   0.6253       38.49       14.64        7.70
0368.................  Level II Pulmonary Tests.  X                   0.9568       58.89       22.77       11.78
0369.................  Level III Pulmonary Tests  X                   2.8329      174.37       44.18       34.87
0370.................  Allergy Tests............  X                   1.0769       66.28  ..........       13.26
0372.................  Therapeutic Phlebotomy...  X                   0.5814       35.79       10.09        7.16
0373.................  Level I                    X                   1.6262      100.09  ..........       20.02
                        Neuropsychological
                        Testing.
0374.................  Monitoring Psychiatric     X                   1.1509       70.84  ..........       14.17
                        Drugs.
0375.................  Ancillary Outpatient       S                  57.3014    3,526.96  ..........      705.39
                        Services When Patient
                        Expires.
0376.................  Level II Cardiac Imaging.  S                   4.9770      306.34      119.77       61.27
0377.................  Level III Cardiac Imaging  S                   6.7443      415.12      158.84       83.02
0378.................  Level II Pulmonary         S                   5.2084      320.58      128.23       64.12
                        Imaging.
0379.................  Injection adenosine 6 MG.  K               ..........       29.90  ..........        5.98
0381.................  Single Allergy Tests.....  X                   0.2151       13.24  ..........        2.65
0382.................  Level II                   X                   2.7541      169.52       67.80       33.90
                        Neuropsychological
                        Testing.
0384.................  GI Procedures with Stents  T                  22.6777    1,395.84      292.31      279.17
0385.................  Level I Prosthetic         S                  79.3730    4,885.49  ..........      977.10
                        Urological Procedures.
0386.................  Level II Prosthetic        S                 135.7295    8,354.29  ..........    1,670.86
                        Urological Procedures.
0387.................  Level II Hysteroscopy....  T                  33.3029    2,049.83      655.55      409.97
0388.................  Discography..............  S                  14.2706      878.37      289.72      175.67
0389.................  Level I Non-imaging        S                   1.4072       86.61       33.98       17.32
                        Nuclear Medicine.
0390.................  Level I Endocrine Imaging  S                   2.3732      146.07       58.42       29.21
0391.................  Level II Endocrine         S                   2.7556      169.61       66.18       33.92
                        Imaging.
0392.................  Level II Non-imaging       S                   2.0849      128.33       51.33       25.67
                        Nuclear Medicine.
0393.................  Red Cell/Plasma Studies..  S                   3.5902      220.98       82.04       44.20
0394.................  Hepatobiliary Imaging....  S                   4.4705      275.16      102.61       55.03
0395.................  GI Tract Imaging.........  S                   3.6937      227.35       89.73       45.47
0396.................  Bone Imaging.............  S                   4.0166      247.23       95.02       49.45
0397.................  Vascular Imaging.........  S                   2.2521      138.62       49.58       27.72
0398.................  Level I Cardiac Imaging..  S                   4.2511      261.66      100.06       52.33
0399.................  Nuclear Medicine Add-on    S                   1.5282       94.06       35.80       18.81
                        Imaging.
0400.................  Hematopoietic Imaging....  S                   3.9304      241.92       93.22       48.38
0401.................  Level I Pulmonary Imaging  S                   3.2013      197.04       78.81       39.41
0402.................  Brain Imaging............  S                   4.8596      299.11      119.64       59.82
0403.................  CSF Imaging..............  S                   3.4867      214.61       83.35       42.92
0404.................  Renal and Genitourinary    S                   3.4235      210.72       84.28       42.14
                        Studies Level I.
0405.................  Renal and Genitourinary    S                   4.1056      252.70       98.77       50.54
                        Studies Level II.
0406.................  Level I Tumor/Infection    S                   3.9386      242.42       96.96       48.48
                        Imaging.
0407.................  Level I Radionuclide       S                   3.1506      193.92       77.56       38.78
                        Therapy.
0408.................  Level II Tumor/Infection   S                   4.9998      307.74  ..........       61.55
                        Imaging.
0409.................  Red Blood Cell Tests.....  X                   0.1237        7.61        2.20        1.52
0411.................  Respiratory Procedures...  S                   0.3793       23.35  ..........        4.67
0412.................  IMRT Treatment Delivery..  S                   5.5021      338.66  ..........       67.73
0413.................  Level II Radionuclide      S                   5.1026      314.07  ..........       62.81
                        Therapy.
0415.................  Level II Endoscopy Lower   T                  21.8803    1,346.75      459.92      269.35
                        Airway.
0416.................  Level I Intravascular and  S                  32.2182    1,983.06  ..........      396.61
                        Intracardiac Ultrasound
                        and Flow Reserve.
0417.................  Computerized               S                   3.1140      191.67  ..........       38.33
                        Reconstruction.
0418.................  Insertion of Left          T                 267.8870   16,488.71  ..........    3,297.74
                        Ventricular Pacing
                        Elect..
0421.................  Prolonged Physiologic      X                   1.6486      101.47  ..........       20.29
                        Monitoring.
0422.................  Level II Upper GI          T                  27.5493    1,695.69      448.81      339.14
                        Procedures.
0423.................  Level II Percutaneous      T                  39.0235    2,401.94  ..........      480.39
                        Abdominal and Biliary
                        Procedures.
0425.................  Level II Arthroplasty      T                 105.1666    6,473.11    1,378.01    1,294.62
                        with Prosthesis.
0426.................  Level II Strapping and     S                   2.2728      139.89  ..........       27.98
                        Cast Application.

[[Page 49710]]

 
0427.................  Level III Tube Changes     T                  11.5220      709.19  ..........      141.84
                        and Repositioning.
0428.................  Level III Sigmoidoscopy    T                  20.4902    1,261.19  ..........      252.24
                        and Anoscopy.
0429.................  Level V Cystourethroscopy  T                  42.9327    2,642.55  ..........      528.51
                        and other Genitourinary
                        Procedures.
0432.................  Health and Behavior        S                   0.6006       36.97  ..........        7.39
                        Services.
0433.................  Level II Pathology.......  X                   0.2571       15.82        5.93        3.16
0434.................  Cardiac Defect Repair....  T                  87.3424    5,376.01  ..........    1,075.20
0436.................  Level I Drug               S                   0.1769       10.89  ..........        2.18
                        Administration.
0437.................  Level II Drug              S                   0.4107       25.28  ..........        5.06
                        Administration.
0438.................  Level III Drug             S                   0.7892       48.58  ..........        9.72
                        Administration.
0439.................  Level IV Drug              S                   1.5841       97.50  ..........       19.50
                        Administration.
0440.................  Level V Drug               S                   1.8285      112.55  ..........       22.51
                        Administration.
0441.................  Level VI Drug              S                   2.5071      154.31  ..........       30.86
                        Administration.
0442.................  Dosimetric Drug            S                  24.5410    1,510.52  ..........      302.10
                        Administration.
0443.................  Overnight Pulse Oximetry.  X                   0.9939       61.18       24.47       12.24
0604.................  Level 1 Clinic Visits....  V                   0.8083       49.75  ..........        9.95
0605.................  Level 2 Clinic Visits....  V                   1.0057       61.90  ..........       12.38
0606.................  Level 3 Clinic Visits....  V                   1.3546       83.38  ..........       16.68
0607.................  Level 4 Clinic Visits....  V                   1.7080      105.13  ..........       21.03
0608.................  Level 5 Clinic Visits....  V                   2.1226      130.65  ..........       26.13
0609.................  Level 1 Type A Emergency   V                   0.8323       51.23  ..........       10.25
                        Visits.
0613.................  Level 2 Type A Emergency   V                   1.3728       84.50  ..........       16.90
                        Visits.
0614.................  Level 3 Type A Emergency   V                   2.1692      133.52  ..........       26.70
                        Visits.
0615.................  Level 4 Type A Emergency   V                   3.4790      214.14  ..........       42.83
                        Visits.
0616.................  Level 5 Type A Emergency   V                   5.3773      330.98  ..........       66.20
                        Visits.
0617.................  Critical Care............  S                   8.0167      493.44  ..........       98.69
0621.................  Level I Vascular Access    T                   8.7841      540.67  ..........      108.13
                        Procedures.
0622.................  Level II Vascular Access   T                  22.6984    1,397.11  ..........      279.42
                        Procedures.
0623.................  Level III Vascular Access  T                  28.4646    1,752.02  ..........      350.40
                        Procedures.
0624.................  Minor Vascular Access      X                   0.5336       32.84       13.13        6.57
                        Device Procedures.
0648.................  Breast Reconstruction      T                  48.7796    3,002.43  ..........      600.49
                        with Prosthesis.
0651.................  Complex Interstitial       S                  16.6585    1,025.35  ..........      205.07
                        Radiation Source
                        Application.
0652.................  Insertion of               T                  29.2259    1,798.88  ..........      359.78
                        Intraperitoneal and
                        Pleural Catheters.
0653.................  Vascular Reconstruction/   T                  31.0004    1,908.11  ..........      381.62
                        Fistula Repair with
                        Device.
0654.................  Insertion/Replacement of   T                 112.2347    6,908.16  ..........    1,381.63
                        a permanent dual chamber
                        pacemaker.
0655.................  Insertion/Replacement/     T                 153.1524    9,426.68  ..........    1,885.34
                        Conversion of a
                        permanent dual chamber
                        pacemaker.
0656.................  Transcatheter Placement    T                 106.8902    6,579.20  ..........    1,315.84
                        of Intracoronary Drug-
                        Eluting Stents.
0657.................  Placement of Tissue Clips  S                   1.7625      108.48  ..........       21.70
0658.................  Percutaneous Breast        T                   6.4482      396.89  ..........       79.38
                        Biopsies.
0659.................  Hyperbaric Oxygen........  S                   1.5925       98.02  ..........       19.60
0660.................  Level II                   X                   1.4988       92.25       29.07       18.45
                        Otorhinolaryngologic
                        Function Tests.
0661.................  Level V Pathology........  X                   2.6066      160.44       64.17       32.09
0662.................  CT Angiography...........  S                   4.9203      302.85      118.88       60.57
0663.................  Level I Electronic         S                   1.0752       66.18       16.96       13.24
                        Analysis of
                        Neurostimulator Pulse
                        Generators.
0664.................  Level I Proton Beam        S                  18.4698    1,136.83  ..........      227.37
                        Radiation Therapy.
0665.................  Bone                       S                   0.5569       34.28  ..........        6.86
                        Density:AppendicularSkel
                        eton.
0667.................  Level II Proton Beam       S                  22.0972    1,360.10  ..........      272.02
                        Radiation Therapy.
0668.................  Level I Angiography and    S                   6.3684      391.98       88.26       78.40
                        Venography.
0670.................  Level II Intravascular     S                  29.7322    1,830.05      536.10      366.01
                        and Intracardiac
                        Ultrasound and Flow
                        Reserve.
0672.................  Level IV Posterior         T                  36.8820    2,270.12  ..........      454.02
                        Segment Eye Procedures.
0673.................  Level IV Anterior Segment  T                  37.3057    2,296.20      649.56      459.24
                        Eye Procedures.
0674.................  Prostate Cryoablation....  T                 107.8298    6,637.03  ..........    1,327.41
0675.................  Prostatic Thermotherapy..  T                  42.3176    2,604.69  ..........      520.94
0676.................  Thrombolysis and           T                   2.0612      126.87  ..........       25.37
                        Thrombectomy.
0678.................  External Counterpulsation  T                   1.7263      106.26  ..........       21.25
0679.................  Level II Resuscitation     S                   5.5435      341.21       95.30       68.24
                        and Cardioversion.
0680.................  Insertion of Patient       S                  74.8877    4,609.41  ..........      921.88
                        Activated Event
                        Recorders.
0681.................  Knee Arthroplasty........  T                 173.0706   10,652.67  ..........    2,130.53
0682.................  Level V Debridement &      T                   6.7529      415.65      158.65       83.13
                        Destruction.
0683.................  Level II                   S                   2.6902      165.58  ..........       33.12
                        Photochemotherapy.
0685.................  Level III Needle Biopsy/   T                   6.0729      373.79      115.47       74.76
                        Aspiration Except Bone
                        Marrow.
0686.................  Level III Skin Repair....  T                  13.3433      821.29  ..........      164.26
0687.................  Revision/Removal of        T                  17.1830    1,057.63      423.05      211.53
                        Neurostimulator
                        Electrodes.
0688.................  Revision/Removal of        T                  33.9521    2,089.79      835.91      417.96
                        Neurostimulator Pulse
                        Generator Receiver.
0689.................  Electronic Analysis of     S                   0.5400       33.24  ..........        6.65
                        Cardioverter-
                        defibrillators.
0690.................  Electronic Analysis of     S                   0.3628       22.33        8.67        4.47
                        Pacemakers and other
                        Cardiac Devices.
0691.................  Electronic Analysis of     S                   2.8253      173.90       60.61       34.78
                        Programmable Shunts/
                        Pumps.
0692.................  Level II Electronic        S                   1.9519      120.14       30.16       24.03
                        Analysis of
                        Neurostimulator Pulse
                        Generators.
0693.................  Breast Reconstruction....  T                  37.4843    2,307.20      731.74      461.44

[[Page 49711]]

 
0694.................  Mohs Surgery.............  T                   3.4844      214.47       58.14       42.89
0695.................  Level VII Debridement &    T                  20.5802    1,266.73      266.59      253.35
                        Destruction.
0697.................  Level I Echocardiogram     S                   1.6002       98.49       35.99       19.70
                        Except Transesophageal.
0698.................  Level II Eye Tests &       S                   1.2244       75.36       16.52       15.07
                        Treatments.
0699.................  Level IV Eye Tests &       T                  13.9509      858.69  ..........      171.74
                        Treatments.
0700.................  Antepartum Manipulation..  T                   2.8011      172.41  ..........       34.48
0701.................  Sr89 strontium...........  K               ..........      533.58  ..........      106.72
0702.................  Sm 153 lexidronm.........  K               ..........    1,316.41  ..........      263.28
0704.................  In111 satumomab..........  K               ..........      192.12  ..........       38.42
0705.................  Tc99m tetrofosmin........  K               ..........       73.81  ..........       14.76
0722.................  Tc99m pentetate..........  K               ..........       56.77  ..........       11.35
0723.................  Co57/58..................  K               ..........      149.44  ..........       29.89
0724.................  Co57 cyano...............  K               ..........       63.74  ..........       12.75
0726.................  Dexrazoxane HCl injection  K               ..........      179.62  ..........       35.92
0728.................  Filgrastim 300 mcg         K               ..........      182.53  ..........       36.51
                        injection.
0730.................  Pamidronate disodium /30   K               ..........       29.31  ..........        5.86
                        MG.
0731.................  Sargramostim injection...  K               ..........       23.12  ..........        4.62
0732.................  Mesna injection..........  K               ..........        7.87  ..........        1.57
0735.................  Ampho b cholesteryl        K               ..........       12.00  ..........        2.40
                        sulfate.
0736.................  Amphotericin b liposome    K               ..........       17.40  ..........        3.48
                        inj.
0737.................  Nitrogen N-13 ammonia....  K               ..........      230.77  ..........       46.15
0738.................  Rasburicase..............  K               ..........      110.36  ..........       22.07
0739.................  Tc99m depreotide.........  K               ..........       67.91  ..........       13.58
0740.................  Tc99m gluceptate.........  K               ..........      236.53  ..........       47.31
0741.................  Cr51 chromate............  K               ..........      167.62  ..........       33.52
0742.................  Tc99m labeled rbc........  K               ..........      132.95  ..........       26.59
0743.................  Tc99m mertiatide.........  K               ..........      180.08  ..........       36.02
0744.................  Plague vaccine, im.......  K               ..........      150.00  ..........       30.00
0750.................  Dolasetron mesylate......  K               ..........        6.76  ..........        1.35
0763.................  Dolasetron mesylate oral.  K               ..........       47.52  ..........        9.50
0764.................  Granisetron HCl injection  K               ..........        6.80  ..........        1.36
0765.................  Granisetron HCl 1 mg oral  K               ..........       37.08  ..........        7.42
0768.................  Ondansetron hcl injection  K               ..........        3.69  ..........        0.74
0769.................  Ondansetron HCl 8mg oral.  K               ..........       34.21  ..........        6.84
0800.................  Leuprolide acetate /3.75   K               ..........      440.36  ..........       88.07
                        MG.
0802.................  Etoposide oral 50 MG.....  K               ..........       32.73  ..........        6.55
0807.................  Aldesleukin/single use     K               ..........      734.10  ..........      146.82
                        vial.
0809.................  Bcg live intravesical vac  K               ..........      110.48  ..........       22.10
0810.................  Goserelin acetate implant  K               ..........      197.59  ..........       39.52
0811.................  Carboplatin injection....  K               ..........       13.74  ..........        2.75
0812.................  Carmus bischl nitro inj..  K               ..........      139.66  ..........       27.93
0814.................  Asparaginase injection...  K               ..........       53.66  ..........       10.73
0820.................  Daunorubicin.............  K               ..........       23.36  ..........        4.67
0821.................  Daunorubicin citrate       K               ..........       55.72  ..........       11.14
                        liposom.
0823.................  Docetaxel................  K               ..........      294.48  ..........       58.90
0827.................  Floxuridine injection....  K               ..........       62.61  ..........       12.52
0828.................  Gemcitabine HCl..........  K               ..........      116.59  ..........       23.32
0830.................  Irinotecan injection.....  K               ..........      125.28  ..........       25.06
0831.................  Ifosfomide injection.....  K               ..........       54.19  ..........       10.84
0832.................  Idarubicin hcl injection.  K               ..........      265.53  ..........       53.11
0834.................  Interferon alfa-2a inj...  K               ..........       33.53  ..........        6.71
0835.................  Inj cosyntropin per 0.25   K               ..........       63.55  ..........       12.71
                        MG.
0836.................  Interferon alfa-2b inj...  K               ..........       13.54  ..........        2.71
0838.................  Interferon gamma 1-b inj.  K               ..........      289.87  ..........       57.97
0840.................  Inj melphalan hydrochl 50  K               ..........    1,190.81  ..........      238.16
                        MG.
0842.................  Fludarabine phosphate inj  K               ..........      230.11  ..........       46.02
0843.................  Pegaspargase/singl dose    K               ..........    1,596.00  ..........      319.20
                        vial.
0844.................  Pentostatin injection....  K               ..........    2,000.96  ..........      400.19
0849.................  Rituximab cancer           K               ..........      465.23  ..........       93.05
                        treatment.
0850.................  Streptozocin injection...  K               ..........      147.45  ..........       29.49
0851.................  Thiotepa injection.......  K               ..........       45.38  ..........        9.08
0852.................  Topotecan................  K               ..........      780.54  ..........      156.11
0855.................  Vinorelbine tartrate/10    K               ..........       22.04  ..........        4.41
                        mg.
0856.................  Porfimer sodium..........  K               ..........    2,481.76  ..........      496.35
0858.................  Inj cladribine per 1 MG..  K               ..........       38.28  ..........        7.66
0860.................  Plicamycin (mithramycin)   K               ..........      173.66  ..........       34.73
                        inj.
0861.................  Leuprolide acetate         K               ..........        7.86  ..........        1.57
                        injeciton.
0862.................  Mitomycin 5 MG inj.......  K               ..........       18.82  ..........        3.76
0863.................  Paclitaxel injection.....  K               ..........       15.44  ..........        3.09

[[Page 49712]]

 
0864.................  Mitoxantrone hydrochl / 5  K               ..........      336.76  ..........       67.35
                        MG.
0865.................  Interferon alfa-n3 inj...  K               ..........       50.33  ..........       10.07
0868.................  Oral aprepitant..........  G               ..........        4.63  ..........        0.93
0876.................  Caffeine citrate           K               ..........        3.34  ..........        0.67
                        injection.
0884.................  Rho d immune globulin inj  K               ..........       97.11  ..........       19.42
0887.................  Azathioprine parenteral..  K               ..........       48.73  ..........        9.75
0888.................  Cyclosporine oral 100 mg.  K               ..........        3.88  ..........        0.78
0890.................  Lymphocyte immune          K               ..........      295.38  ..........       59.08
                        globulin.
0891.................  Tacrolimus oral per 1 MG.  K               ..........        3.40  ..........        0.68
0892.................  Edetate calcium disodium   K               ..........       39.80  ..........        7.96
                        inj.
0895.................  Deferoxamine mesylate inj  K               ..........       14.77  ..........        2.95
0900.................  Alglucerase injection....  K               ..........       38.85  ..........        7.77
0901.................  Alpha 1 proteinase         K               ..........        3.21  ..........        0.64
                        inhibitor.
0902.................  Botulinum toxin a per      K               ..........        4.85  ..........        0.97
                        unit.
0903.................  Cytomegalovirus imm IV /   K               ..........      755.79  ..........      151.16
                        vial.
0906.................  RSV-ivig.................  K               ..........       16.02  ..........        3.20
0910.................  Interferon beta-1b / .25   K               ..........       91.34  ..........       18.27
                        MG.
0911.................  Inj streptokinase /250000  K               ..........       78.75  ..........       15.75
                        IU.
0912.................  Interferon alfacon-1.....  K               ..........        3.92  ..........        0.78
0913.................  Ganciclovir long act       K               ..........    4,200.00  ..........      840.00
                        implant.
0916.................  Injection imiglucerase /   K               ..........        3.87  ..........        0.77
                        unit.
0917.................  Adenosine injection......  K               ..........       69.41  ..........       13.88
0925.................  Factor viii..............  K               ..........        0.68  ..........        0.14
0926.................  Factor VIII (porcine)....  K               ..........        0.66  ..........        0.13
0927.................  Factor viii recombinant..  K               ..........        1.05  ..........        0.21
0928.................  Factor ix complex........  K               ..........        0.63  ..........        0.13
0929.................  Anti-inhibitor...........  K               ..........        1.29  ..........        0.26
0930.................  Antithrombin iii           K               ..........        1.62  ..........        0.32
                        injection.
0931.................  Factor IX non-recombinant  K               ..........        0.88  ..........        0.18
0932.................  Factor IX recombinant....  K               ..........        0.98  ..........        0.20
0935.................  Clonidine hydrochloride..  K               ..........       62.71  ..........       12.54
0949.................  Frozen plasma, pooled, sd  K                   0.9060       55.77  ..........       11.15
0950.................  Whole blood for            K                   2.1824      134.33  ..........       26.87
                        transfusion.
0952.................  Cryoprecipitate each unit  K                   0.8571       52.76  ..........       10.55
0954.................  RBC leukocytes reduced...  K                   2.8738      176.89  ..........       35.38
0955.................  Plasma, frz between 8-24   K                   1.1864       73.02  ..........       14.60
                        hour.
0956.................  Plasma protein             K                   0.4016       24.72  ..........        4.94
                        fract,5%,50ml.
0957.................  Platelets, each unit.....  K                   0.9794       60.28  ..........       12.06
0958.................  Plaelet rich plasma unit.  K                   2.5336      155.95  ..........       31.19
0959.................  Red blood cells unit.....  K                   2.1045      129.53  ..........       25.91
0960.................  Washed red blood cells     K                   3.5028      215.60  ..........       43.12
                        unit.
0961.................  Albumin (human),5%, 50ml.  K               ..........       25.48  ..........        5.10
0963.................  Albumin (human), 5%, 250   K               ..........       72.09  ..........       14.42
                        ml.
0964.................  Albumin (human), 25%, 20   K               ..........       26.79  ..........        5.36
                        ml.
0965.................  Albumin (human), 25%,      K               ..........       61.77  ..........       12.35
                        50ml.
0966.................  Plasmaprotein              K                   3.1309      192.71  ..........       38.54
                        fract,5%,250ml.
0967.................  Blood split unit.........  K                   2.2087      135.95  ..........       27.19
0968.................  Platelets leukoreduced     K                   2.1192      130.44  ..........       26.09
                        irrad.
0969.................  RBC leukoreduced           K                   3.7037      227.97  ..........       45.59
                        irradiated.
1009.................  Cryoprecipitatereducedpla  K                   1.2990       79.95  ..........       15.99
                        sma.
1010.................  Blood, l/r, cmv-neg......  K                   2.1991      135.36  ..........       27.07
1011.................  Platelets, hla-m, l/r,     K                  10.5084      646.80  ..........      129.36
                        unit.
1013.................  Platelets leukocytes       K                   1.5318       94.28  ..........       18.86
                        reduced.
1016.................  Blood, l/r, froz/degly/    K                   1.4462       89.02  ..........       17.80
                        wash.
1017.................  Plt, aph/pher, l/r, cmv-   K                   6.1508      378.59  ..........       75.72
                        neg.
1018.................  Blood, l/r, irradiated...  K                   2.1765      133.97  ..........       26.79
1019.................  Plate pheres leukoredu     K                   9.9841      614.53  ..........      122.91
                        irrad.
1020.................  Plt, pher, l/r cmv-neg,    K                  11.7025      720.30  ..........      144.06
                        irr.
1021.................  RBC, frz/deg/wsh, l/r,     K                   6.9189      425.87  ..........       85.17
                        irrad.
1022.................  RBC, l/r, cmv-neg, irrad.  K                   4.2818      263.55  ..........       52.71
1045.................  I131 iodobenguate, dx....  K               ..........      429.55  ..........       85.91
1052.................  Injection, voriconazole..  K               ..........        4.55  ..........        0.91
1064.................  Th I131 so iodide cap      K               ..........       14.54  ..........        2.91
                        millic.
1083.................  Adalimumab injection.....  K               ..........      304.40  ..........       60.88
1084.................  Denileukin diftitox, 300   K               ..........    1,391.05  ..........      278.21
                        mcg.
1086.................  Temozolomide.............  K               ..........        7.16  ..........        1.43
1088.................  Iodine I-131 iodide cap,   K               ..........       24.86  ..........        4.97
                        dx.
1096.................  Tc99m exametazime........  K               ..........      317.07  ..........       63.41
1150.................  I131 iodide sol, rx......  K               ..........       12.60  ..........        2.52

[[Page 49713]]

 
1166.................  Cytarabine liposome......  K               ..........      374.75  ..........       74.95
1167.................  Inj, epirubicin hcl, 2 mg  K               ..........       24.47  ..........        4.89
1178.................  BUSULFAN IV, 6 Mg........  K               ..........       24.87  ..........        4.97
1203.................  Verteporfin injection....  K               ..........        8.89  ..........        1.78
1207.................  Octreotide injection,      K               ..........       89.50  ..........       17.90
                        depot.
1280.................  Corticotropin injection..  K               ..........      108.85  ..........       21.77
1330.................  Ergonovine maleate         K               ..........       27.56  ..........        5.51
                        injection.
1436.................  Etidronate disodium inj..  K               ..........       70.73  ..........       14.15
1491.................  New Technology--Level IA   S               ..........        5.00  ..........        1.00
                        ($0-$10).
1492.................  New Technology--Level IB   S               ..........       15.00  ..........        3.00
                        ($10-$20).
1493.................  New Technology--Level IC   S               ..........       25.00  ..........        5.00
                        ($20-$30).
1494.................  New Technology--Level ID   S               ..........       35.00  ..........        7.00
                        ($30-$40).
1495.................  New Technology--Level IE   S               ..........       45.00  ..........        9.00
                        ($40-$50).
1496.................  New Technology--Level IA   T               ..........        5.00  ..........        1.00
                        ($0-$10).
1497.................  New Technology--Level      T               ..........       15.00  ..........        3.00
                        IB($10-$20).
1498.................  New Technology--Level IC   T               ..........       25.00  ..........        5.00
                        ($20-$30).
1499.................  New Technology--Level      T               ..........       35.00  ..........        7.00
                        ID($30-$40).
1500.................  New Technology--Level IE   T               ..........       45.00  ..........        9.00
                        ($40-$50).
1502.................  New Technology--Level II   S               ..........       75.00  ..........       15.00
                        ($50-$100).
1503.................  New Technology--Level III  S               ..........      150.00  ..........       30.00
                        ($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 VII  S               ..........      550.00  ..........      110.00
                        ($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 XII  S               ..........    1,050.00  ..........      210.00
                        ($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 XVI  S               ..........    1,450.00  ..........      290.00
                        ($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 IXX  S               ..........    1,750.00  ..........      350.00
                        ($1700-$1800).
1520.................  New Technology--Level XX   S               ..........    1,850.00  ..........      370.00
                        ($1800-$1900).
1521.................  New Technology--Level XXI  S               ..........    1,950.00  ..........      390.00
                        ($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 XIV  S               ..........    3,250.00  ..........      650.00
                        ($3000-$3500).
1525.................  New Technology--Level XXV  S               ..........    3,750.00  ..........      750.00
                        ($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 XXX  S               ..........    6,250.00  ..........    1,250.00
                        ($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 III  T               ..........      150.00  ..........       30.00
                        ($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 VII  T               ..........      550.00  ..........      110.00
                        ($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 XII  T               ..........    1,050.00  ..........      210.00
                        ($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 XVI  T               ..........    1,450.00  ..........      290.00
                        ($1400-$1500).

[[Page 49714]]

 
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 XIX  T               ..........    1,750.00  ..........      350.00
                        ($1700-$1800).
1557.................  New Technology--Level XX   T               ..........    1,850.00  ..........      370.00
                        ($1800-$1900).
1558.................  New Technology--Level XXI  T               ..........    1,950.00  ..........      390.00
                        ($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 XXV  T               ..........    3,750.00  ..........      750.00
                        ($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 XXX  T               ..........    6,250.00  ..........    1,250.00
                        ($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.................  Tc99m sestamibi..........  K               ..........       82.58  ..........       16.52
1603.................  TL201 thallium...........  K               ..........       27.18  ..........        5.44
1604.................  In111 capromab...........  K               ..........      928.19  ..........      185.64
1605.................  Abciximab injection......  K               ..........      452.96  ..........       90.59
1606.................  Injection anistreplase 30  K               ..........    2,265.46  ..........      453.09
                        u.
1607.................  Eptifibatide injection...  K               ..........       13.31  ..........        2.66
1608.................  Etanercept injection.....  K               ..........      154.12  ..........       30.82
1609.................  Rho(D) immune globulin h,  K               ..........       13.57  ..........        2.71
                        sd.
1611.................  Hylan G-F 20 injection...  K               ..........      196.99  ..........       39.40
1612.................  Daclizumab, parenteral...  K               ..........      345.07  ..........       69.01
1613.................  Trastuzumab..............  K               ..........       54.59  ..........       10.92
1629.................  Nonmetabolic act d/e       K               ..........       15.20  ..........        3.04
                        tissue.
1630.................  Hep b ig, im.............  K               ..........      118.61  ..........       23.72
1631.................  Baclofen intrathecal       K               ..........       70.20  ..........       14.04
                        trial.
1632.................  Metabolic active D/E       K               ..........       27.56  ..........        5.51
                        tissue.
1633.................  Alefacept................  K               ..........       26.03  ..........        5.21
1642.................  In111 ibritumomab, dx....  K               ..........    1,344.34  ..........      268.87
1643.................  Y90 ibritumomab, rx......  K               ..........   12,130.20  ..........    2,426.04
1644.................  I131 tositumomab, dx.....  K               ..........    1,368.17  ..........      273.63
1645.................  I131 tositumomab, rx.....  K               ..........   11,868.78  ..........    2,373.76
1646.................  In111 oxyquinoline.......  K               ..........      306.51  ..........       61.30
1647.................  In111 pentetate..........  K               ..........      262.81  ..........       52.56
1648.................  Tc99m arcitumomab........  K               ..........      255.95  ..........       51.19
1650.................  Tc99m succimer...........  K               ..........       84.79  ..........       16.96
1651.................  F18 fdg..................  K               ..........      235.56  ..........       47.11
1654.................  Rb82 rubidium............  K               ..........      239.83  ..........       47.97
1655.................  Tinzaparin sodium          K               ..........        2.18  ..........        0.44
                        injection.
1670.................  Tetanus immune globulin    K               ..........       90.71  ..........       18.14
                        inj.
1671.................  Ga67 gallium.............  K               ..........       22.73  ..........        4.55
1672.................  Tc99m bicisate...........  K               ..........      254.46  ..........       50.89
1675.................  P32 Na phosphate.........  K               ..........      117.11  ..........       23.42
1676.................  P32 chromic phosphate....  K               ..........      222.35  ..........       44.47
1677.................  In111 pentetreotide......  K               ..........      185.60  ..........       37.12
1678.................  Tc99m fanolesomab........  K               ..........      527.31  ..........      105.46
1680.................  Acetylcysteine injection.  K               ..........        1.86  ..........        0.37
1682.................  Aprotonin, 10,000 kiu....  K               ..........        2.32  ..........        0.46
1683.................  Basiliximab..............  K               ..........    1,388.81  ..........      277.76
1684.................  Corticorelin ovine         K               ..........        4.22  ..........        0.84
                        triflutal.
1685.................  Darbepoetin alfa, non-     K               ..........        3.00  ..........        0.60
                        esrd.
1686.................  Epoetin alfa, non-esrd...  K               ..........        9.25  ..........        1.85
1687.................  Digoxin immune fab         K               ..........      527.46  ..........      105.49
                        (ovine).
1688.................  Ethanolamine oleate......  K               ..........       71.57  ..........       14.31
1689.................  Fomepizole...............  K               ..........       11.82  ..........        2.36
1690.................  Hemin....................  K               ..........        6.59  ..........        1.32
1691.................  Iron dextran 165           K               ..........       12.30  ..........        2.46
                        injection.
1692.................  Iron dextran 267           K               ..........       10.17  ..........        2.03
                        injection.
1693.................  Lepirudin................  K               ..........      146.38  ..........       29.28
1694.................  Ziconotide injection.....  G               ..........        6.20  ..........        1.24

[[Page 49715]]

 
1695.................  Nesiritide injection.....  K               ..........       29.72  ..........        5.94
1696.................  Palifermin injection.....  K               ..........       11.37  ..........        2.27
1697.................  Pegaptanib sodium          G               ..........    1,107.54  ..........      221.51
                        injection.
1700.................  Inj secretin synthetic     K               ..........       20.31  ..........        4.06
                        human.
1701.................  Treprostinil injection...  K               ..........       53.51  ..........       10.70
1703.................  Ovine, 1000 USP units....  K               ..........      133.77  ..........       26.75
1704.................  Inj Vonwillebrand factor   K               ..........        0.87  ..........        0.17
                        iu.
1705.................  Factor viia..............  K               ..........        1.08  ..........        0.22
1707.................  Non-human, metabolic       K               ..........        1.64  ..........        0.33
                        tissue.
1709.................  Azacitidine injection....  K               ..........        4.09  ..........        0.82
1710.................  Clofarabine injection....  G               ..........      116.68  ..........       23.34
1711.................  Histrelin implant........  K               ..........    2,019.82  ..........      403.96
1712.................  Paclitaxel injection.....  G               ..........        8.73  ..........        1.75
1713.................  Inj Fe-based MR            K               ..........       30.12  ..........        6.02
                        contrast,1ml.
1716.................  Brachytx source, Gold 198  K                   0.4493       27.65  ..........        5.53
1717.................  Brachytx source, HDR Ir-   K                   2.1922      134.93  ..........       26.99
                        192.
1718.................  Brachytx source, Iodine    K                   0.5754       35.42  ..........        7.08
                        125.
1719.................  Brachytx sour, Non-HDR Ir- K                   0.5108       31.44  ..........        6.29
                        192.
1720.................  Brachytx sour, Palladium   K                   0.7945       48.90  ..........        9.78
                        103.
1738.................  Oxaliplatin..............  K               ..........        8.47  ..........        1.69
1739.................  Pegademase bovine, 25 iu.  K               ..........      164.50  ..........       32.90
1740.................  Diazoxide injection......  K               ..........      110.88  ..........       22.18
1741.................  Urofollitropin, 75 iu....  K               ..........       48.84  ..........        9.77
1820.................  Generator neuro rechg bat  H               ..........  ..........  ..........  ..........
                        sys.
2210.................  Methyldopate hcl           K               ..........        9.86  ..........        1.97
                        injection.
2616.................  Brachytx source, Yttrium-  K                 272.7710   16,789.33  ..........    3,357.87
                        90.
2632.................  Brachytx sol, I-125, per   K                   0.3139       19.32  ..........        3.86
                        mCi.
2633.................  Brachytx source, Cesium-   K                   1.4622       90.00  ..........       18.00
                        131.
2634.................  Brachytx source, HA, I-    K                   0.4172       25.68  ..........        5.14
                        125.
2635.................  Brachytx source, HA, P-    K                   0.8820       54.29  ..........       10.86
                        103.
2636.................  Brachytx linear source, P- K                   0.6360       39.15  ..........        7.83
                        103.
2637.................  Brachytx, Ytterbium-169..  K                   0.4172       25.68  ..........        5.14
2731.................  Immune globulin, powder..  K               ..........       22.05  ..........        4.41
2732.................  Immune globulin, liquid..  K               ..........       28.82  ..........        5.76
2770.................  Quinupristin/dalfopristin  K               ..........      108.03  ..........       21.61
2940.................  Somatrem injection.......  K               ..........      583.74  ..........      116.75
3030.................  Sumatriptan succinate / 6  K               ..........       51.75  ..........       10.35
                        MG.
3032.................  Dtp/hib vaccine, im......  K               ..........       68.91  ..........       13.78
3038.................  Inj biperiden lactate/5    K               ..........       88.36  ..........       17.67
                        mg.
3039.................  Inj metaraminol            K               ..........       17.68  ..........        3.54
                        bitartrate.
3040.................  Penicillin g benzathine    K               ..........       67.86  ..........       13.57
                        inj.
3041.................  Bivalirudin..............  K               ..........        1.62  ..........        0.32
3042.................  Foscarnet sodium           K               ..........       10.69  ..........        2.14
                        injection.
3043.................  Gamma globulin 1 CC inj..  K               ..........       10.59  ..........        2.12
3045.................  Meropenem................  K               ..........        3.76  ..........        0.75
3046.................  Octreotide inj, non-depot  K               ..........        4.34  ..........        0.87
3047.................  Melphalan oral 2 MG......  K               ..........        4.39  ..........        0.88
3048.................  Doxorubic hcl 10 MG vl     K               ..........        6.23  ..........        1.25
                        chemo.
3049.................  Cyclophosphamide           K               ..........        5.47  ..........        1.09
                        lyophilized.
3050.................  Sermorelin acetate         K               ..........        1.73  ..........        0.35
                        injection.
7000.................  Amifostine...............  K               ..........      448.41  ..........       89.68
7005.................  Gonadorelin hydroch/ 100   K               ..........      178.59  ..........       35.72
                        mcg.
7011.................  Oprelvekin injection.....  K               ..........      243.39  ..........       48.68
7015.................  Oral busulfan............  K               ..........        1.95  ..........        0.39
7028.................  Fosphenytoin, 50 mg......  K               ..........        5.18  ..........        1.04
7034.................  Somatropin injection.....  K               ..........       43.73  ..........        8.75
7035.................  Teniposide, 50 mg........  K               ..........      264.26  ..........       52.85
7036.................  Urokinase 250,000 IU inj.  K               ..........      453.41  ..........       90.68
7038.................  Monoclonal antibodies....  K               ..........      860.94  ..........      172.19
7041.................  Tirofiban HCl............  K               ..........        7.61  ..........        1.52
7042.................  Capecitabine, oral, 150    K               ..........        3.60  ..........        0.72
                        mg.
7043.................  Infliximab injection.....  K               ..........       53.73  ..........       10.75
7045.................  Inj trimetrexate           K               ..........      144.39  ..........       28.88
                        glucoronate.
7046.................  Doxorubicin hcl liposome   K               ..........      367.56  ..........       73.51
                        inj.
7048.................  Alteplase recombinant....  K               ..........       31.06  ..........        6.21
7049.................  Filgrastim 480 mcg         K               ..........      289.59  ..........       57.92
                        injection.
7051.................  Leuprolide acetate         K               ..........    2,157.81  ..........      431.56
                        implant.
7308.................  Aminolevulinic acid hcl    K               ..........       99.92  ..........       19.98
                        top.
7316.................  Sodium hyaluronate         K               ..........      112.04  ..........       22.41
                        injection.

[[Page 49716]]

 
9001.................  Linezolid injection......  K               ..........       23.50  ..........        4.70
9002.................  Tenecteplase injection...  K               ..........    2,059.01  ..........      411.80
9003.................  Palivizumab, per 50 mg...  K               ..........      609.62  ..........      121.92
9004.................  Gemtuzumab ozogamicin....  K               ..........    2,265.57  ..........      453.11
9005.................  Reteplase injection......  K               ..........      754.71  ..........      150.94
9006.................  Tacrolimus injection.....  K               ..........      135.17  ..........       27.03
9012.................  Arsenic trioxide.........  K               ..........       32.92  ..........        6.58
9015.................  Mycophenolate mofetil      K               ..........        2.50  ..........        0.50
                        oral.
9018.................  Botulinum toxin type B...  K               ..........        7.85  ..........        1.57
9019.................  Caspofungin acetate......  K               ..........       32.19  ..........        6.44
9020.................  Sirolimus, oral..........  K               ..........        6.84  ..........        1.37
9022.................  IM inj interferon beta 1-  K               ..........       97.99  ..........       19.60
                        a.
9023.................  Rho d immune globulin 50   K               ..........       14.13  ..........        2.83
                        mcg.
9024.................  Amphotericin b lipid       K               ..........       11.10  ..........        2.22
                        complex.
9031.................  Arbutamine HCl injection.  K               ..........      160.00  ..........       32.00
9032.................  Baclofen 10 MG injection.  K               ..........      191.50  ..........       38.30
9033.................  Cidofovir injection......  K               ..........      757.03  ..........      151.41
9038.................  Inj estrogen conjugate 25  K               ..........       57.78  ..........       11.56
                        MG.
9040.................  Intraocular Fomivirsen na  K               ..........      210.00  ..........       42.00
9042.................  Glucagon hydrochloride/1   K               ..........       62.42  ..........       12.48
                        MG.
9044.................  Ibutilide fumarate         K               ..........      249.01  ..........       49.80
                        injection.
9046.................  Iron sucrose injection...  K               ..........        0.36  ..........        0.07
9047.................  Itraconazole injection...  K               ..........       36.23  ..........        7.25
9051.................  Urea injection...........  K               ..........       69.10  ..........       13.82
9054.................  Metabolically active       K               ..........       15.01  ..........        3.00
                        tissue.
9100.................  I131 serum albumin, dx...  K               ..........       36.78  ..........        7.36
9104.................  Antithymocyte globuln      K               ..........      301.48  ..........       60.30
                        rabbit.
9108.................  Thyrotropin injection....  K               ..........      766.61  ..........      153.32
9110.................  Alemtuzumab injection....  K               ..........      525.75  ..........      105.15
9112.................  Inj perflutren lip         K               ..........       61.25  ..........       12.25
                        micros,ml.
9115.................  Zoledronic acid..........  K               ..........      200.82  ..........       40.16
9119.................  Injection, pegfilgrastim   K               ..........    2,142.79  ..........      428.56
                        6mg.
9120.................  Injection, Fulvestrant...  K               ..........       80.31  ..........       16.06
9121.................  Injection, argatroban....  K               ..........       16.40  ..........        3.28
9122.................  Triptorelin pamoate......  K               ..........      300.90  ..........       60.18
9124.................  Daptomycin injection.....  K               ..........        0.31  ..........        0.06
9125.................  Risperidone, long acting.  K               ..........        4.73  ..........        0.95
9126.................  Natalizumab injection....  G               ..........        6.39  ..........        1.28
9133.................  Rabies ig, im/sc.........  K               ..........       63.98  ..........       12.80
9134.................  Rabies ig, heat treated..  K               ..........       68.58  ..........       13.72
9135.................  Varicella-zoster ig, im..  K               ..........      149.08  ..........       29.82
9137.................  Bcg vaccine, percut......  K               ..........      115.46  ..........       23.09
9139.................  Rabies vaccine, im.......  K               ..........      155.25  ..........       31.05
9140.................  Rabies vaccine, id.......  K               ..........      118.49  ..........       23.70
9141.................  Measles-rubella vaccine,   K               ..........       44.62  ..........        8.92
                        sc.
9142.................  Chicken pox vaccine, sc..  K               ..........       66.84  ..........       13.37
9143.................  Meningococcal vaccine, sc  K               ..........       84.46  ..........       16.89
9144.................  Encephalitis vaccine, sc.  K               ..........       99.15  ..........       19.83
9145.................  Meningococcal vaccine, im  K               ..........      143.12  ..........       28.62
9148.................  I123 iodide cap, dx......  K               ..........       27.44  ..........        5.49
9156.................  Nonmetabolic active        K               ..........       66.39  ..........       13.28
                        tissue.
9157.................  LOCM < = 149 mg/ml         K               ..........        0.30  ..........        0.06
                        iodine, 1ml.
9158.................  LOCM 150-199mg/ml          K               ..........        1.84  ..........        0.37
                        iodine,1ml.
9159.................  LOCM 200-249mg/ml          K               ..........        1.25  ..........        0.25
                        iodine,1ml.
9160.................  LOCM 250-299mg/ml          K               ..........        0.32  ..........        0.06
                        iodine,1ml.
9161.................  LOCM 300-349mg/ml          K               ..........        0.34  ..........        0.07
                        iodine,1ml.
9162.................  LOCM 350-399mg/ml          K               ..........        0.21  ..........        0.04
                        iodine,1ml.
9163.................  LOCM > = 400 mg/ml         K               ..........        0.30  ..........        0.06
                        iodine,1ml.
9164.................  Inj Gad-base MR            K               ..........        2.88  ..........        0.58
                        contrast,1ml.
9165.................  Oral MR contrast.........  K               ..........        8.87  ..........        1.77
9167.................  Valrubicin...............  K               ..........       76.03  ..........       15.21
9202.................  Inj octafluoropropane      K               ..........       40.75  ..........        8.15
                        mic,ml.
9203.................  Inj perflexane lip         K               ..........        8.22  ..........        1.64
                        micros,ml.
9207.................  Bortezomib injection.....  K               ..........       29.81  ..........        5.96
9208.................  Agalsidase beta injection  K               ..........      126.00  ..........       25.20
9209.................  Laronidase injection.....  K               ..........       23.64  ..........        4.73
9210.................  Palonosetron HCl.........  K               ..........       17.51  ..........        3.50
9213.................  Pemetrexed injection.....  K               ..........       40.90  ..........        8.18
9214.................  Bevacizumab injection....  K               ..........       56.36  ..........       11.27

[[Page 49717]]

 
9215.................  Cetuximab injection......  K               ..........       49.39  ..........        9.88
9216.................  Abarelix injection.......  K               ..........       66.20  ..........       13.24
9217.................  Leuprolide acetate         K               ..........      242.99  ..........       48.60
                        suspnsion.
9219.................  Mycophenolic acid........  K               ..........        2.15  ..........        0.43
9220.................  Sodium hyaluronate.......  K               ..........      197.62  ..........       39.52
9222.................  Graftjacket SftTis.......  K               ..........      883.78  ..........      176.76
9224.................  Injection, galsulfase....  K               ..........    1,503.23  ..........      300.65
9225.................  Fluocinolone acetonide...  G               ..........   19,345.00  ..........    3,869.00
9227.................  Injection, micafungin      G               ..........        1.98  ..........        0.40
                        sodium.
9228.................  Injection, tigecycline...  G               ..........        0.96  ..........        0.19
9300.................  Omalizumab injection.....  K               ..........       16.34  ..........        3.27
9500.................  Platelets, irradiated....  K                   2.0957      128.99  ..........       25.80
9501.................  Platelet pheres            K                   7.9414      488.80  ..........       97.76
                        leukoreduced.
9502.................  Platelet pheresis          K                   6.6959      412.14  ..........       82.43
                        irradiated.
9503.................  Fr frz plasma donor        K                   1.1915       73.34  ..........       14.67
                        retested.
9504.................  RBC deglycerolized.......  K                   5.7106      351.49  ..........       70.30
9505.................  RBC irradiated...........  K                   3.2600      200.66  ..........       40.13
9506.................  Granulocytes, pheresis     K                   4.1030      252.54  ..........       50.51
                        unit.
9507.................  Platelets, pheresis......  K                   7.5381      463.98  ..........       92.80
9508.................  Plasma 1 donor frz w/in 8  K                   1.1677       71.87  ..........       14.37
                        hr.
----------------------------------------------------------------------------------------------------------------


  Addendum AA.--Proposed List of Medicare Approved ASC Procedures for CY 2007 With Additions and Payment Rates;
                   Including Rates That Result From Implementation of Section 5103 of the DRA
----------------------------------------------------------------------------------------------------------------
                                                                  OPPS                                   ASC
       HCPCS              Short Descriptor       ASC Payment    Payment    ASC Payment    DRA Cap     Copayment
                                                    Group         Rate         Rate                     Amount
----------------------------------------------------------------------------------------------------------------
10121..............  Remove foreign body.......            2      $920.58      $446.00  ...........       $89.20
10180..............  Complex drainage, wound...            2    $1,075.21      $446.00  ...........       $89.20
11010..............  Debride skin, fx..........            2      $246.96      $246.96  Y..........       $49.39
11011..............  Debride skin/muscle, fx...            2      $246.96      $246.96  Y..........       $49.39
11012..............  Debride skin/muscle/bone,             2      $246.96      $246.96  Y..........       $49.39
                      fx.
11042..............  Debride skin/tissue.......            2      $161.59      $161.59  Y..........       $32.32
11043..............  Debride tissue/muscle.....            2      $161.59      $161.59  Y..........       $32.32
11044..............  Debride tissue/muscle/bone            2      $415.65      $415.65  Y..........       $83.13
11404..............  Exc tr-ext b9+marg 3.1-4              1      $920.58      $333.00  ...........       $66.60
                      cm.
11406..............  Exc tr-ext b9+marg > 4.0              2      $920.58      $446.00  ...........       $89.20
                      cm.
11424..............  Exc h-f-nk-sp b9+marg 3.1-            2      $920.58      $446.00  ...........       $89.20
                      4.
11426..............  Exc h-f-nk-sp b9+marg > 4             2    $1,229.54      $446.00  ...........       $89.20
                      cm.
11444..............  Exc face-mm b9+marg 3.1-4             1      $400.87      $333.00  ...........       $66.60
                      cm.
11446..............  Exc face-mm b9+marg > 4 cm            2    $1,229.54      $446.00  ...........       $89.20
11450..............  Removal, sweat gland                  2    $1,229.54      $446.00  ...........       $89.20
                      lesion.
11451..............  Removal, sweat gland                  2    $1,229.54      $446.00  ...........       $89.20
                      lesion.
11462..............  Removal, sweat gland                  2    $1,229.54      $446.00  ...........       $89.20
                      lesion.
11463..............  Removal, sweat gland                  2    $1,229.54      $446.00  ...........       $89.20
                      lesion.
11470..............  Removal, sweat gland                  2    $1,229.54      $446.00  ...........       $89.20
                      lesion.
11471..............  Removal, sweat gland                  2    $1,229.54      $446.00  ...........       $89.20
                      lesion.
11604..............  Exc tr-ext mlg+marg 3.1-4             2      $400.87      $400.87  Y..........       $80.17
                      cm.
11606..............  Exc tr-ext mlg+marg > 4 cm            2      $920.58      $446.00  ...........       $89.20
11624..............  Exc h-f-nk-sp mlg+marg 3.1-           2      $920.58      $446.00  ...........       $89.20
                      4.
11626..............  Exc h-f-nk-sp mlg+mar > 4             2    $1,229.54      $446.00  ...........       $89.20
                      cm.
11644..............  Exc face-mm malig+marg 3.1-           2      $920.58      $446.00  ...........       $89.20
                      4.
11646..............  Exc face-mm mlg+marg > 4              2    $1,229.54      $446.00  ...........       $89.20
                      cm.
11770..............  Removal of pilonidal                  3    $1,229.54      $510.00  ...........      $102.00
                      lesion.
11771..............  Removal of pilonidal                  3    $1,229.54      $510.00  ...........      $102.00
                      lesion.
11772..............  Removal of pilonidal                  3    $1,229.54      $510.00  ...........      $102.00
                      lesion.
11960..............  Insert tissue expander(s).            2    $1,308.85      $446.00  ...........       $89.20
11970..............  Replace tissue expander...            3    $2,539.24      $510.00  ...........      $102.00
11971..............  Remove tissue expander(s).            1    $1,229.54      $333.00  ...........       $66.60
12005..............  Repair superficial                    2       $91.86       $91.86  Y..........       $18.37
                      wound(s).
12006..............  Repair superficial                    2       $91.86       $91.86  Y..........       $18.37
                      wound(s).
12007..............  Repair superficial                    2       $91.86       $91.86  Y..........       $18.37
                      wound(s).
12016..............  Repair superficial                    2       $91.86       $91.86  Y..........       $18.37
                      wound(s).
12017..............  Repair superficial                    2       $91.86       $91.86  Y..........       $18.37
                      wound(s).
12018..............  Repair superficial                    2       $91.86       $91.86  Y..........       $18.37
                      wound(s).
12020..............  Closure of split wound....            1       $91.86       $91.86  Y..........       $18.37
12021..............  Closure of split wound....            1       $91.86       $91.86  Y..........       $18.37

[[Page 49718]]

 
12034..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12035..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12036..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12037..............  Layer closure of wound(s).            2      $313.49      $313.49  Y..........       $62.70
12044..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12045..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12046..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12047..............  Layer closure of wound(s).            2      $313.49      $313.49  Y..........       $62.70
12054..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12055..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12056..............  Layer closure of wound(s).            2       $91.86       $91.86  Y..........       $18.37
12057..............  Layer closure of wound(s).            2      $313.49      $313.49  Y..........       $62.70
13100..............  Repair of wound or lesion.            2      $313.49      $313.49  Y..........       $62.70
13101..............  Repair of wound or lesion.            3      $313.49      $313.49  Y..........       $62.70
13102..............  Repair wound/lesion add-on            1       $91.86       $91.86  Y..........       $18.37
13120..............  Repair of wound or lesion.            2       $91.86       $91.86  Y..........       $18.37
13121..............  Repair of wound or lesion.            3       $91.86       $91.86  Y..........       $18.37
13122..............  Repair wound/lesion add-on            1       $91.86       $91.86  Y..........       $18.37
13131..............  Repair of wound or lesion.            2       $91.86       $91.86  Y..........       $18.37
13132..............  Repair of wound or lesion.            3       $91.86       $91.86  Y..........       $18.37
13133..............  Repair wound/lesion add-on            1       $91.86       $91.86  Y..........       $18.37
13150..............  Repair of wound or lesion.            3      $313.49      $313.49  Y..........       $62.70
13151..............  Repair of wound or lesion.            3       $91.86       $91.86  Y..........       $18.37
13152..............  Repair of wound or lesion.            3      $313.49      $313.49  Y..........       $62.70
13160..............  Late closure of wound.....            2    $1,308.85      $446.00  ...........       $89.20
14000..............  Skin tissue rearrangement.            2      $821.29      $446.00  ...........       $89.20
14001..............  Skin tissue rearrangement.            3    $1,308.85      $510.00  ...........      $102.00
14020..............  Skin tissue rearrangement.            3      $821.29      $510.00  ...........      $102.00
14021..............  Skin tissue rearrangement.            3      $821.29      $510.00  ...........      $102.00
14040..............  Skin tissue rearrangement.            2      $821.29      $446.00  ...........       $89.20
14041..............  Skin tissue rearrangement.            3      $821.29      $510.00  ...........      $102.00
14060..............  Skin tissue rearrangement.            3      $821.29      $510.00  ...........      $102.00
14061..............  Skin tissue rearrangement.            3      $821.29      $510.00  ...........      $102.00
14300..............  Skin tissue rearrangement.            4    $1,308.85      $630.00  ...........      $126.00
14350..............  Skin tissue rearrangement.            3    $1,308.85      $510.00  ...........      $102.00
15000..............  Wound prep, 1st 100 sq cm.            2      $313.49      $313.49  Y..........       $62.70
15001..............  Wound prep, addl 100 sq cm            1      $313.49      $313.49  Y..........       $62.70
15040..............  Harvest cultured skin                 2       $91.86       $91.86  Y..........       $18.37
                      graft.
15050..............  Skin pinch graft..........            2      $313.49      $313.49  Y..........       $62.70
15100..............  Skin splt grft, trnk/arm/             2    $1,308.85      $446.00  ...........       $89.20
                      leg.
15101..............  Skin splt grft t/a/l, add-            3    $1,308.85      $510.00  ...........      $102.00
                      on.
15110..............  Epidrm autogrft trnk/arm/             2    $1,308.85      $446.00  ...........       $89.20
                      leg.
15111..............  Epidrm autogrft t/a/l add-            1    $1,308.85      $333.00  ...........       $66.60
                      on.
15115..............  Epidrm a-grft face/nck/hf/            2    $1,308.85      $446.00  ...........       $89.20
                      g.
15116..............  Epidrm a-grft f/n/hf/g                1    $1,308.85      $333.00  ...........       $66.60
                      addl.
15120..............  Skn splt a-grft fac/nck/hf/           2    $1,308.85      $446.00  ...........       $89.20
                      g.
15121..............  Skn splt a-grft f/n/hf/g              3    $1,308.85      $510.00  ...........      $102.00
                      add.
15130..............  Derm autograft, trnk/arm/             2    $1,308.85      $446.00  ...........       $89.20
                      leg.
15131..............  Derm autograft t/a/l add-             1    $1,308.85      $333.00  ...........       $66.60
                      on.
15135..............  Derm autograft face/nck/hf/           2    $1,308.85      $446.00  ...........       $89.20
                      g.
15136..............  Derm autograft, f/n/hf/g              1    $1,308.85      $333.00  ...........       $66.60
                      add.
15150..............  Cult epiderm grft t/arm/              2    $1,308.85      $446.00  ...........       $89.20
                      leg.
15151..............  Cult epiderm grft t/a/l               1    $1,308.85      $333.00  ...........       $66.60
                      addl.
15152..............  Cult epiderm graft t/a/l              1    $1,308.85      $333.00  ...........       $66.60
                      +%.
15155..............  Cult epiderm graft, f/n/hf/           2    $1,308.85      $446.00  ...........       $89.20
                      g.
15156..............  Cult epidrm grft f/n/hfg              1    $1,308.85      $333.00  ...........       $66.60
                      add.
15157..............  Cult epiderm grft f/n/hfg             1    $1,308.85      $333.00  ...........       $66.60
                      +%.
15200..............  Skin full graft, trunk....            3      $821.29      $510.00  ...........      $102.00
15201..............  Skin full graft trunk add-            2      $313.49      $313.49  Y..........       $62.70
                      on.
15220..............  Skin full graft sclp/arm/             2      $821.29      $446.00  ...........       $89.20
                      leg.
15221..............  Skin full graft add-on....            2      $313.49      $313.49  Y..........       $62.70
15240..............  Skin full grft face/genit/            3      $821.29      $510.00  ...........      $102.00
                      hf.
15241..............  Skin full graft add-on....            3      $313.49      $313.49  Y..........       $62.70
15260..............  Skin full graft een & lips            2      $821.29      $446.00  ...........       $89.20
15261..............  Skin full graft add-on....            2      $313.49      $313.49  Y..........       $62.70
15300..............  Apply skinallogrft, t/arm/            2      $313.49      $313.49  Y..........       $62.70
                      lg.
15301..............  Apply sknallogrft t/a/l               1      $313.49      $313.49  Y..........       $62.70
                      addl.
15320..............  Apply skin allogrft f/n/hf/           2      $313.49      $313.49  Y..........       $62.70
                      g.
15321..............  Aply sknallogrft f/n/hfg              1      $313.49      $313.49  Y..........       $62.70
                      add.

[[Page 49719]]

 
15330..............  Aply acell alogrft t/arm/             2      $313.49      $313.49  Y..........       $62.70
                      leg.
15331..............  Aply acell grft t/a/l add-            1      $313.49      $313.49  Y..........       $62.70
                      on.
15335..............  Apply acell graft, f/n/hf/            2      $313.49      $313.49  Y..........       $62.70
                      g.
15336..............  Aply acell grft f/n/hf/g              1      $313.49      $313.49  Y..........       $62.70
                      add.
15400..............  Apply skin xenograft, t/a/            2      $313.49      $313.49  Y..........       $62.70
                      l.
15401..............  Apply skn xenogrft t/a/l              2      $313.49      $313.49  Y..........       $62.70
                      add.
15420..............  Apply skin xgraft, f/n/hf/            2      $313.49      $313.49  Y..........       $62.70
                      g.
15421..............  Apply skn xgrft f/n/hf/g              1      $313.49      $313.49  Y..........       $62.70
                      add.
15430..............  Apply acellular xenograft.            2      $313.49      $313.49  Y..........       $62.70
15431..............  Apply acellular xgraft add            1      $313.49      $313.49  Y..........       $62.70
15570..............  Form skin pedicle flap....            3    $1,308.85      $510.00  ...........      $102.00
15572..............  Form skin pedicle flap....            3    $1,308.85      $510.00  ...........      $102.00
15574..............  Form skin pedicle flap....            3    $1,308.85      $510.00  ...........      $102.00
15576..............  Form skin pedicle flap....            3      $821.29      $510.00  ...........      $102.00
15600..............  Skin graft................            3    $1,308.85      $510.00  ...........      $102.00
15610..............  Skin graft................            3    $1,308.85      $510.00  ...........      $102.00
15620..............  Skin graft................            4    $1,308.85      $630.00  ...........      $126.00
15630..............  Skin graft................            3    $1,308.85      $510.00  ...........      $102.00
15650..............  Transfer skin pedicle flap            5    $1,308.85      $717.00  ...........      $143.40
15732..............  Muscle-skin graft, head/              3    $1,308.85      $510.00  ...........      $102.00
                      neck.
15734..............  Muscle-skin graft, trunk..            3    $1,308.85      $510.00  ...........      $102.00
15736..............  Muscle-skin graft, arm....            3    $1,308.85      $510.00  ...........      $102.00
15738..............  Muscle-skin graft, leg....            3    $1,308.85      $510.00  ...........      $102.00
15740..............  Island pedicle flap graft.            2      $821.29      $446.00  ...........       $89.20
15750..............  Neurovascular pedicle                 2    $1,308.85      $446.00  ...........       $89.20
                      graft.
15760..............  Composite skin graft......            2    $1,308.85      $446.00  ...........       $89.20
15770..............  Derma-fat-fascia graft....            3    $1,308.85      $510.00  ...........      $102.00
15775..............  Hair transplant punch                 3      $313.49      $313.49  Y..........       $62.70
                      grafts.
15776..............  Hair transplant punch                 3      $313.49      $313.49  Y..........       $62.70
                      grafts.
15820..............  Revision of lower eyelid..            3    $1,308.85      $510.00  ...........      $102.00
15821..............  Revision of lower eyelid..            3    $1,308.85      $510.00  ...........      $102.00
15822..............  Revision of upper eyelid..            3    $1,308.85      $510.00  ...........      $102.00
15823..............  Revision of upper eyelid..            5      $821.29      $717.00  ...........      $143.40
15824..............  Removal of forehead                   3    $1,308.85      $510.00  ...........      $102.00
                      wrinkles.
15825..............  Removal of neck wrinkles..            3    $1,308.85      $510.00  ...........      $102.00
15826..............  Removal of brow wrinkles..            3    $1,308.85      $510.00  ...........      $102.00
15828..............  Removal of face wrinkles..            3    $1,308.85      $510.00  ...........      $102.00
15829..............  Removal of skin wrinkles..            5    $1,308.85      $717.00  ...........      $143.40
15831..............  Excise excessive skin                 3    $1,229.54      $510.00  ...........      $102.00
                      tissue.
15832..............  Excise excessive skin                 3    $1,229.54      $510.00  ...........      $102.00
                      tissue.
15833..............  Excise excessive skin                 3    $1,229.54      $510.00  ...........      $102.00
                      tissue.
15834..............  Excise excessive skin                 3    $1,229.54      $510.00  ...........      $102.00
                      tissue.
15835..............  Excise excessive skin                 3      $313.49      $313.49  Y..........       $62.70
                      tissue.
15836..............  Excise excessive skin                 3      $920.58      $510.00  ...........      $102.00
                      tissue.
15839..............  Excise excessive skin                 3      $920.58      $510.00  ...........      $102.00
                      tissue.
15840..............  Graft for face nerve palsy            4    $1,308.85      $630.00  ...........      $126.00
15841..............  Graft for face nerve palsy            4    $1,308.85      $630.00  ...........      $126.00
15845..............  Skin and muscle repair,               4    $1,308.85      $630.00  ...........      $126.00
                      face.
15876..............  Suction assisted lipectomy            3    $1,308.85      $510.00  ...........      $102.00
15877..............  Suction assisted lipectomy            3    $1,308.85      $510.00  ...........      $102.00
15878..............  Suction assisted lipectomy            3      $821.29      $510.00  ...........      $102.00
15879..............  Suction assisted lipectomy            3    $1,308.85      $510.00  ...........      $102.00
15920..............  Removal of tail bone ulcer            3      $246.96      $246.96  Y..........       $49.39
15922..............  Removal of tail bone ulcer            4    $1,308.85      $630.00  ...........      $126.00
15931..............  Remove sacrum pressure                3    $1,229.54      $510.00  ...........      $102.00
                      sore.
15933..............  Remove sacrum pressure                3    $1,229.54      $510.00  ...........      $102.00
                      sore.
15934..............  Remove sacrum pressure                3    $1,308.85      $510.00  ...........      $102.00
                      sore.
15935..............  Remove sacrum pressure                4    $1,308.85      $630.00  ...........      $126.00
                      sore.
15936..............  Remove sacrum pressure                4    $1,308.85      $630.00  ...........      $126.00
                      sore.
15937..............  Remove sacrum pressure                4    $1,308.85      $630.00  ...........      $126.00
                      sore.
15940..............  Remove hip pressure sore..            3    $1,229.54      $510.00  ...........      $102.00
15941..............  Remove hip pressure sore..            3    $1,229.54      $510.00  ...........      $102.00
15944..............  Remove hip pressure sore..            3    $1,308.85      $510.00  ...........      $102.00
15945..............  Remove hip pressure sore..            4    $1,308.85      $630.00  ...........      $126.00
15946..............  Remove hip pressure sore..            4    $1,308.85      $630.00  ...........      $126.00
15950..............  Remove thigh pressure sore            3    $1,229.54      $510.00  ...........      $102.00
15951..............  Remove thigh pressure sore            4    $1,229.54      $630.00  ...........      $126.00
15952..............  Remove thigh pressure sore            3    $1,308.85      $510.00  ...........      $102.00
15953..............  Remove thigh pressure sore            4    $1,308.85      $630.00  ...........      $126.00

[[Page 49720]]

 
15956..............  Remove thigh pressure sore            3    $1,308.85      $510.00  ...........      $102.00
15958..............  Remove thigh pressure sore            4    $1,308.85      $630.00  ...........      $126.00
16025..............  Dress/debrid p-thick burn,            2       $66.94       $66.94  Y..........       $13.39
                      m.
16030..............  Dress/debrid p-thick burn,            2       $98.86       $98.86  Y..........       $19.77
                      l.
19020..............  Incision of breast lesion.            2    $1,075.21      $446.00  ...........       $89.20
19100..............  Bx breast percut w/o image            1      $234.21      $234.21  Y..........       $46.84
19101..............  Biopsy of breast, open....            2    $1,183.32      $446.00  ...........       $89.20
19102..............  Bx breast percut w/image..            2      $234.21      $234.21  Y..........       $46.84
19103..............  Bx breast percut w/device.            2      $396.89      $396.89  Y..........       $79.38
19110..............  Nipple exploration........            2    $1,183.32      $446.00  ...........       $89.20
19112..............  Excise breast duct fistula            3    $1,183.32      $510.00  ...........      $102.00
19120..............  Removal of breast lesion..            3    $1,183.32      $510.00  ...........      $102.00
19125..............  Excision, breast lesion...            3    $1,183.32      $510.00  ...........      $102.00
19126..............  Excision, addl breast                 3    $1,183.32      $510.00  ...........      $102.00
                      lesion.
19140..............  Removal of breast tissue..            4    $1,183.32      $630.00  ...........      $126.00
19160..............  Partial mastectomy........            3    $1,183.32      $510.00  ...........      $102.00
19162..............  P-mastectomy w/ln removal.            7    $2,307.20      $995.00  ...........      $199.00
19180..............  Removal of breast.........            4    $1,732.69      $630.00  ...........      $126.00
19182..............  Removal of breast.........            4    $1,732.69      $630.00  ...........      $126.00
19296..............  Place po breast cath for              9    $2,508.17    $1,339.00  ...........      $267.80
                      rad.
19297..............  Place breast cath for rad.            9    $1,732.69    $1,339.00  ...........      $267.80
19298..............  Place breast rad tube/                9    $3,250.00    $1,339.00  ...........      $267.80
                      caths.
19316..............  Suspension of breast......            4    $1,732.69      $630.00  ...........      $126.00
19318..............  Reduction of large breast.            4    $2,307.20      $630.00  ...........      $126.00
19324..............  Enlarge breast............            4    $2,307.20      $630.00  ...........      $126.00
19325..............  Enlarge breast with                   9    $3,002.43    $1,339.00  ...........      $267.80
                      implant.
19328..............  Removal of breast implant.            1    $1,732.69      $333.00  ...........       $66.60
19330..............  Removal of implant                    1    $1,732.69      $333.00  ...........       $66.60
                      material.
19340..............  Immediate breast                      2    $2,508.17      $446.00  ...........       $89.20
                      prosthesis.
19342..............  Delayed breast prosthesis.            3    $3,002.43      $510.00  ...........      $102.00
19350..............  Breast reconstruction.....            4    $1,183.32      $630.00  ...........      $126.00
19355..............  Correct inverted nipple(s)            4    $1,732.69      $630.00  ...........      $126.00
19357..............  Breast reconstruction.....            5    $3,002.43      $717.00  ...........      $143.40
19366..............  Breast reconstruction.....            5    $1,732.69      $717.00  ...........      $143.40
19370..............  Surgery of breast capsule.            4    $1,732.69      $630.00  ...........      $126.00
19371..............  Removal of breast capsule.            4    $1,732.69      $630.00  ...........      $126.00
19380..............  Revise breast                         5    $2,508.17      $717.00  ...........      $143.40
                      reconstruction.
20005..............  Incision of deep abscess..            2    $1,281.58      $446.00  ...........       $89.20
20200..............  Muscle biopsy.............            2      $920.58      $446.00  ...........       $89.20
20205..............  Deep muscle biopsy........            3      $920.58      $510.00  ...........      $102.00
20206..............  Needle biopsy, muscle.....            1      $234.21      $234.21  Y..........       $46.84
20220..............  Bone biopsy, trocar/needle            1      $246.96      $246.96  Y..........       $49.39
20225..............  Bone biopsy, trocar/needle            2      $400.87      $400.87  Y..........       $80.17
20240..............  Bone biopsy, excisional...            2    $1,229.54      $446.00  ...........       $89.20
20245..............  Bone biopsy, excisional...            3    $1,229.54      $510.00  ...........      $102.00
20250..............  Open bone biopsy..........            3    $1,281.58      $510.00  ...........      $102.00
20251..............  Open bone biopsy..........            3    $1,281.58      $510.00  ...........      $102.00
20525..............  Removal of foreign body...            3    $1,229.54      $510.00  ...........      $102.00
20650..............  Insert and remove bone pin            3    $1,281.58      $510.00  ...........      $102.00
20670..............  Removal of support implant            1      $920.58      $333.00  ...........       $66.60
20680..............  Removal of support implant            3    $1,229.54      $510.00  ...........      $102.00
20690..............  Apply bone fixation device            2    $1,542.47      $446.00  ...........       $89.20
20692..............  Apply bone fixation device            3    $1,542.47      $510.00  ...........      $102.00
20693..............  Adjust bone fixation                  3    $1,281.58      $510.00  ...........      $102.00
                      device.
20694..............  Remove bone fixation                  1    $1,281.58      $333.00  ...........       $66.60
                      device.
20900..............  Removal of bone for graft.            3    $1,542.47      $510.00  ...........      $102.00
20902..............  Removal of bone for graft.            4    $1,542.47      $630.00  ...........      $126.00
20910..............  Remove cartilage for graft            3    $1,308.85      $510.00  ...........      $102.00
20912..............  Remove cartilage for graft            3    $1,308.85      $510.00  ...........      $102.00
20920..............  Removal of fascia for                 4      $821.29      $630.00  ...........      $126.00
                      graft.
20922..............  Removal of fascia for                 3    $1,308.85      $510.00  ...........      $102.00
                      graft.
20924..............  Removal of tendon for                 4    $1,542.47      $630.00  ...........      $126.00
                      graft.
20926..............  Removal of tissue for                 4      $821.29      $630.00  ...........      $126.00
                      graft.
20975..............  Electrical bone                       2       $38.23       $38.23  Y..........        $7.65
                      stimulation.
21010..............  Incision of jaw joint.....            2    $1,425.30      $446.00  ...........       $89.20
21015..............  Resection of facial tumor.            3    $1,012.48      $510.00  ...........      $102.00
21025..............  Excision of bone, lower               2    $2,324.90      $446.00  ...........       $89.20
                      jaw.
21026..............  Excision of facial bone(s)            2    $2,324.90      $446.00  ...........       $89.20
21029..............  Contour of face bone                  2    $2,324.90      $446.00  ...........       $89.20
                      lesion.

[[Page 49721]]

 
21034..............  Excise max/zygoma mlg                 3    $2,324.90      $510.00  ...........      $102.00
                      tumor.
21040..............  Excise mandible lesion....            2    $1,425.30      $446.00  ...........       $89.20
21044..............  Removal of jaw bone lesion            2    $2,324.90      $446.00  ...........       $89.20
21046..............  Remove mandible cyst                  2    $2,324.90      $446.00  ...........       $89.20
                      complex.
21047..............  Excise lwr jaw cyst w/                2    $2,324.90      $446.00  ...........       $89.20
                      repair.
21050..............  Removal of jaw joint......            3    $2,324.90      $510.00  ...........      $102.00
21060..............  Remove jaw joint cartilage            2    $2,324.90      $446.00  ...........       $89.20
21070..............  Remove coronoid process...            3    $2,324.90      $510.00  ...........      $102.00
21100..............  Maxillofacial fixation....            2    $2,324.90      $446.00  ...........       $89.20
21120..............  Reconstruction of chin....            7    $1,425.30      $995.00  ...........      $199.00
21121..............  Reconstruction of chin....            7    $1,425.30      $995.00  ...........      $199.00
21122..............  Reconstruction of chin....            7    $1,425.30      $995.00  ...........      $199.00
21123..............  Reconstruction of chin....            7    $1,425.30      $995.00  ...........      $199.00
21125..............  Augmentation, lower jaw               7    $1,425.30      $995.00  ...........      $199.00
                      bone.
21127..............  Augmentation, lower jaw               9    $2,324.90    $1,339.00  ...........      $267.80
                      bone.
21181..............  Contour cranial bone                  7    $1,425.30      $995.00  ...........      $199.00
                      lesion.
21206..............  Reconstruct upper jaw bone            5    $2,324.90      $717.00  ...........      $143.40
21208..............  Augmentation of facial                7    $2,324.90      $995.00  ...........      $199.00
                      bones.
21209..............  Reduction of facial bones.            5    $2,324.90      $717.00  ...........      $143.40
21210..............  Face bone graft...........            7    $2,324.90      $995.00  ...........      $199.00
21215..............  Lower jaw bone graft......            7    $2,324.90      $995.00  ...........      $199.00
21230..............  Rib cartilage graft.......            7    $2,324.90      $995.00  ...........      $199.00
21235..............  Ear cartilage graft.......            7    $1,425.30      $995.00  ...........      $199.00
21240..............  Reconstruction of jaw                 4    $2,324.90      $630.00  ...........      $126.00
                      joint.
21242..............  Reconstruction of jaw                 5    $2,324.90      $717.00  ...........      $143.40
                      joint.
21243..............  Reconstruction of jaw                 5    $2,324.90      $717.00  ...........      $143.40
                      joint.
21244..............  Reconstruction of lower               7    $2,324.90      $995.00  ...........      $199.00
                      jaw.
21245..............  Reconstruction of jaw.....            7    $2,324.90      $995.00  ...........      $199.00
21246..............  Reconstruction of jaw.....            7    $2,324.90      $995.00  ...........      $199.00
21248..............  Reconstruction of jaw.....            7    $2,324.90      $995.00  ...........      $199.00
21249..............  Reconstruction of jaw.....            7    $2,324.90      $995.00  ...........      $199.00
21267..............  Revise eye sockets........            7    $2,324.90      $995.00  ...........      $199.00
21270..............  Augmentation, cheek bone..            5    $2,324.90      $717.00  ...........      $143.40
21275..............  Revision, orbitofacial                7    $2,324.90      $995.00  ...........      $199.00
                      bones.
21280..............  Revision of eyelid........            5    $2,324.90      $717.00  ...........      $143.40
21282..............  Revision of eyelid........            5    $1,012.48      $717.00  ...........      $143.40
21295..............  Revision of jaw muscle/               1      $475.55      $333.00  ...........       $66.60
                      bone.
21296..............  Revision of jaw muscle/               1    $1,425.30      $333.00  ...........       $66.60
                      bone.
21300..............  Treatment of skull                    2    $1,012.48      $446.00  ...........       $89.20
                      fracture.
21310..............  Treatment of nose fracture            2      $146.29      $146.29  Y..........       $29.26
21315..............  Treatment of nose fracture            2      $146.29      $146.29  Y..........       $29.26
21320..............  Treatment of nose fracture            2      $475.55      $446.00  ...........       $89.20
21325..............  Treatment of nose fracture            4    $1,425.30      $630.00  ...........      $126.00
21330..............  Treatment of nose fracture            5    $1,425.30      $717.00  ...........      $143.40
21335..............  Treatment of nose fracture            7    $1,425.30      $995.00  ...........      $199.00
21336..............  Treat nasal septal                    4    $2,312.35      $630.00  ...........      $126.00
                      fracture.
21337..............  Treat nasal septal                    2    $1,012.48      $446.00  ...........       $89.20
                      fracture.
21338..............  Treat nasoethmoid fracture            4    $1,425.30      $630.00  ...........      $126.00
21339..............  Treat nasoethmoid fracture            5    $1,425.30      $717.00  ...........      $143.40
21340..............  Treatment of nose fracture            4    $2,324.90      $630.00  ...........      $126.00
21345..............  Treat nose/jaw fracture...            7    $1,425.30      $995.00  ...........      $199.00
21355..............  Treat cheek bone fracture.            3    $2,324.90      $510.00  ...........      $102.00
21356..............  Treat cheek bone fracture.            3    $1,425.30      $510.00  ...........      $102.00
21400..............  Treat eye socket fracture.            2      $475.55      $446.00  ...........       $89.20
21401..............  Treat eye socket fracture.            3    $1,012.48      $510.00  ...........      $102.00
21421..............  Treat mouth roof fracture.            4    $1,425.30      $630.00  ...........      $126.00
21445..............  Treat dental ridge                    4    $1,425.30      $630.00  ...........      $126.00
                      fracture.
21450..............  Treat lower jaw fracture..            3      $146.29      $146.29  Y..........       $29.26
21451..............  Treat lower jaw fracture..            4      $475.55      $475.55  Y..........       $95.11
21452..............  Treat lower jaw fracture..            2    $1,012.48      $446.00  ...........       $89.20
21453..............  Treat lower jaw fracture..            3    $2,324.90      $510.00  ...........      $102.00
21454..............  Treat lower jaw fracture..            5    $1,425.30      $717.00  ...........      $143.40
21461..............  Treat lower jaw fracture..            4    $2,324.90      $630.00  ...........      $126.00
21462..............  Treat lower jaw fracture..            5    $2,324.90      $717.00  ...........      $143.40
21465..............  Treat lower jaw fracture..            4    $2,324.90      $630.00  ...........      $126.00
21480..............  Reset dislocated jaw......            1      $146.29      $146.29  Y..........       $29.26
21485..............  Reset dislocated jaw......            2    $1,012.48      $446.00  ...........       $89.20
21490..............  Repair dislocated jaw.....            3    $2,324.90      $510.00  ...........      $102.00
21497..............  Interdental wiring........            2    $1,012.48      $446.00  ...........       $89.20

[[Page 49722]]

 
21501..............  Drain neck/chest lesion...            2    $1,075.21      $446.00  ...........       $89.20
21502..............  Drain chest lesion........            2    $1,281.58      $446.00  ...........       $89.20
21555..............  Remove lesion, neck/chest.            2    $1,229.54      $446.00  ...........       $89.20
21556..............  Remove lesion, neck/chest.            2    $1,229.54      $446.00  ...........       $89.20
21600..............  Partial removal of rib....            2    $1,542.47      $446.00  ...........       $89.20
21610..............  Partial removal of rib....            2    $1,542.47      $446.00  ...........       $89.20
21700..............  Revision of neck muscle...            2    $1,281.58      $446.00  ...........       $89.20
21720..............  Revision of neck muscle...            3    $1,281.58      $510.00  ...........      $102.00
21725..............  Revision of neck muscle...            3       $91.22       $91.22  Y..........       $18.24
21800..............  Treatment of rib fracture.            1      $104.11      $104.11  Y..........       $20.82
21805..............  Treatment of rib fracture.            2    $1,580.03      $446.00  ...........       $89.20
21820..............  Treat sternum fracture....            1      $104.11      $104.11  Y..........       $20.82
21925..............  Biopsy soft tissue of back            2    $1,229.54      $446.00  ...........       $89.20
21930..............  Remove lesion, back or                2    $1,229.54      $446.00  ...........       $89.20
                      flank.
21935..............  Remove tumor, back........            3    $1,229.54      $510.00  ...........      $102.00
22305..............  Treat spine process                   1      $104.11      $104.11  Y..........       $20.82
                      fracture.
22310..............  Treat spine fracture......            1      $104.11      $104.11  Y..........       $20.82
22315..............  Treat spine fracture......            2      $104.11      $104.11  Y..........       $20.82
22505..............  Manipulation of spine.....            2      $895.58      $446.00  ...........       $89.20
22520..............  Percutaneous                          9    $1,542.47     $1339.00  ...........      $267.80
                      vertebroplasty,.
22521..............  Percutaneous                          9    $1,542.47     $1339.00  ...........      $267.80
                      vertebroplasty,.
22522..............  Percutaneous                          1    $1,542.47      $373.00  ...........       $66.00
                      vertebroplasty,.
22900..............  Remove abdominal wall                 4    $1,229.54      $630.00  ...........      $126.00
                      lesion.
23000..............  Removal of calcium                    2      $920.58      $446.00  ...........       $89.20
                      deposits.
23020..............  Release shoulder joint....            2    $2,539.24      $446.00  ...........       $89.20
23030..............  Drain shoulder lesion.....            1    $1,075.21      $333.00  ...........       $66.60
23031..............  Drain shoulder bursa......            3    $1,075.21      $510.00  ...........      $102.00
23035..............  Drain shoulder bone lesion            3    $1,281.58      $510.00  ...........      $102.00
23040..............  Exploratory shoulder                  3    $1,542.47      $510.00  ...........      $102.00
                      surgery.
23044..............  Exploratory shoulder                  4    $1,542.47      $630.00  ...........      $126.00
                      surgery.
23066..............  Biopsy shoulder tissues...            2    $1,229.54      $446.00  ...........       $89.20
23075..............  Removal of shoulder lesion            2      $920.58      $446.00  ...........       $89.20
23076..............  Removal of shoulder lesion            2    $1,229.54      $446.00  ...........       $89.20
23077..............  Remove tumor of shoulder..            3    $1,229.54      $510.00  ...........      $102.00
23100..............  Biopsy of shoulder joint..            2    $1,281.58      $446.00  ...........       $89.20
23101..............  Shoulder joint surgery....            7    $1,542.47      $995.00  ...........      $199.00
23105..............  Remove shoulder joint                 4    $1,542.47      $630.00  ...........      $126.00
                      lining.
23106..............  Incision of collarbone                4    $1,542.47      $630.00  ...........      $126.00
                      joint.
23107..............  Explore treat shoulder                4    $1,542.47      $630.00  ...........      $126.00
                      joint.
23120..............  Partial removal, collar               5    $2,539.24      $717.00  ...........      $143.40
                      bone.
23125..............  Removal of collar bone....            5    $2,539.24      $717.00  ...........      $143.40
23130..............  Remove shoulder bone, part            5    $2,539.24      $717.00  ...........      $143.40
23140..............  Removal of bone lesion....            4    $1,281.58      $630.00  ...........      $126.00
23145..............  Removal of bone lesion....            5    $1,542.47      $717.00  ...........      $143.40
23146..............  Removal of bone lesion....            5    $1,542.47      $717.00  ...........      $143.40
23150..............  Removal of humerus lesion.            4    $1,542.47      $630.00  ...........      $126.00
23155..............  Removal of humerus lesion.            5    $1,542.47      $717.00  ...........      $143.40
23156..............  Removal of humerus lesion.            5    $1,542.47      $717.00  ...........      $143.40
23170..............  Remove collar bone lesion.            2    $1,542.47      $446.00  ...........       $89.20
23172..............  Remove shoulder blade                 2    $1,542.47      $446.00  ...........       $89.20
                      lesion.
23174..............  Remove humerus lesion.....            2    $1,542.47      $446.00  ...........       $89.20
23180..............  Remove collar bone lesion.            4    $1,542.47      $630.00  ...........      $126.00
23182..............  Remove shoulder blade                 4    $1,542.47      $630.00  ...........      $126.00
                      lesion.
23184..............  Remove humerus lesion.....            4    $1,542.47      $630.00  ...........      $126.00
23190..............  Partial removal of scapula            4    $1,542.47      $630.00  ...........      $126.00
23195..............  Removal of head of humerus            5    $1,542.47      $717.00  ...........      $143.40
23330..............  Remove shoulder foreign               1      $400.87      $333.00  ...........       $66.60
                      body.
23331..............  Remove shoulder foreign               1    $1,229.54      $333.00  ...........       $66.60
                      body.
23395..............  Muscle transfer,shoulder/             5    $2,539.24      $717.00  ...........      $143.40
                      arm.
23397..............  Muscle transfers..........            7    $4,055.26      $995.00  ...........      $199.00
23400..............  Fixation of shoulder blade            7    $1,542.47      $995.00  ...........      $199.00
23405..............  Incision of tendon &                  2    $1,542.47      $446.00  ...........       $89.20
                      muscle.
23406..............  Incise tendon(s) &                    2    $1,542.47      $446.00  ...........       $89.20
                      muscle(s).
23410..............  Repair rotator cuff, acute            5    $2,539.24      $717.00  ...........      $143.40
23412..............  Repair rotator cuff,                  7    $2,539.24      $995.00  ...........      $199.00
                      chronic.
23415..............  Release of shoulder                   5    $2,539.24      $717.00  ...........      $143.40
                      ligament.
23420..............  Repair of shoulder........            7    $2,539.24      $995.00  ...........      $199.00
23430..............  Repair biceps tendon......            4    $2,539.24      $630.00  ...........      $126.00
23440..............  Remove/transplant tendon..            4    $2,539.24      $630.00  ...........      $126.00

[[Page 49723]]

 
23450..............  Repair shoulder capsule...            5    $4,055.26      $717.00  ...........      $143.40
23455..............  Repair shoulder capsule...            7    $4,055.26      $995.00  ...........      $199.00
23460..............  Repair shoulder capsule...            5    $4,055.26      $717.00  ...........      $143.40
23462..............  Repair shoulder capsule...            7    $2,539.24      $995.00  ...........      $199.00
23465..............  Repair shoulder capsule...            5    $4,055.26      $717.00  ...........      $143.40
23466..............  Repair shoulder capsule...            7    $2,539.24      $995.00  ...........      $199.00
23480..............  Revision of collar bone...            4    $2,539.24      $630.00  ...........      $126.00
23485..............  Revision of collar bone...            7    $4,055.26      $995.00  ...........      $199.00
23490..............  Reinforce clavicle........            3    $2,539.24      $510.00  ...........      $102.00
23491..............  Reinforce shoulder bones..            3    $4,055.26      $510.00  ...........      $102.00
23500..............  Treat clavicle fracture...            1      $104.11      $104.11  Y..........       $20.82
23505..............  Treat clavicle fracture...            1      $104.11      $104.11  Y..........       $20.82
23515..............  Treat clavicle fracture...            3    $3,472.68      $510.00  ...........      $102.00
23520..............  Treat clavicle dislocation            1      $104.11      $104.11  Y..........       $20.82
23525..............  Treat clavicle dislocation            1      $104.11      $104.11  Y..........       $20.82
23530..............  Treat clavicle dislocation            3    $2,312.35      $510.00  ...........      $102.00
23532..............  Treat clavicle dislocation            4    $1,580.03      $630.00  ...........      $126.00
23540..............  Treat clavicle dislocation            1      $104.11      $104.11  Y..........       $20.82
23545..............  Treat clavicle dislocation            1      $104.11      $104.11  Y..........       $20.82
23550..............  Treat clavicle dislocation            3    $2,312.35      $510.00  ...........      $102.00
23552..............  Treat clavicle dislocation            4    $2,312.35      $630.00  ...........      $126.00
23570..............  Treat shoulder blade fx...            1      $104.11      $104.11  Y..........       $20.82
23575..............  Treat shoulder blade fx...            1      $104.11      $104.11  Y..........       $20.82
23585..............  Treat scapula fracture....            3    $3,472.68      $510.00  ...........      $102.00
23605..............  Treat humerus fracture....            2      $104.11      $104.11  Y..........       $20.82
23615..............  Treat humerus fracture....            4    $3,472.68      $630.00  ...........      $126.00
23616..............  Treat humerus fracture....            4    $3,472.68      $630.00  ...........      $126.00
23625..............  Treat humerus fracture....            2      $104.11      $104.11  Y..........       $20.82
23630..............  Treat humerus fracture....            5    $3,472.68      $717.00  ...........      $143.40
23650..............  Treat shoulder dislocation            1      $104.11      $104.11  Y..........       $20.82
23655..............  Treat shoulder dislocation            1      $895.58      $333.00  ...........       $66.60
23660..............  Treat shoulder dislocation            3    $2,312.35      $510.00  ...........      $102.00
23665..............  Treat dislocation/fracture            2      $104.11      $104.11  Y..........       $20.82
23670..............  Treat dislocation/fracture            3    $3,472.68      $510.00  ...........      $102.00
23675..............  Treat dislocation/fracture            2      $104.11      $104.11  Y..........       $20.82
23680..............  Treat dislocation/fracture            3    $2,312.35      $510.00  ...........      $102.00
23700..............  Fixation of shoulder......            1      $895.58      $333.00  ...........       $66.60
23800..............  Fusion of shoulder joint..            4    $4,055.26      $630.00  ...........      $126.00
23802..............  Fusion of shoulder joint..            7    $2,539.24      $995.00  ...........      $199.00
23921..............  Amputation follow-up                  3      $313.49      $313.49  Y..........       $62.70
                      surgery.
23930..............  Drainage of arm lesion....            1    $1,075.21      $333.00  ...........       $66.60
23931..............  Drainage of arm bursa.....            2    $1,075.21      $446.00  ...........       $89.20
23935..............  Drain arm/elbow bone                  2    $1,281.58      $446.00  ...........       $89.20
                      lesion.
24000..............  Exploratory elbow surgery.            4    $1,542.47      $630.00  ...........      $126.00
24006..............  Release elbow joint.......            4    $1,542.47      $630.00  ...........      $126.00
24066..............  Biopsy arm/elbow soft                 2      $920.58      $446.00  ...........       $89.20
                      tissue.
24075..............  Remove arm/elbow lesion...            2      $920.58      $446.00  ...........       $89.20
24076..............  Remove arm/elbow lesion...            2    $1,229.54      $446.00  ...........       $89.20
24077..............  Remove tumor of arm/elbow.            3    $1,229.54      $510.00  ...........      $102.00
24100..............  Biopsy elbow joint lining.            1    $1,281.58      $333.00  ...........       $66.60
24101..............  Explore/treat elbow joint.            4    $1,542.47      $630.00  ...........      $126.00
24102..............  Remove elbow joint lining.            4    $1,542.47      $630.00  ...........      $126.00
24105..............  Removal of elbow bursa....            3    $1,281.58      $510.00  ...........      $102.00
24110..............  Remove humerus lesion.....            2    $1,281.58      $446.00  ...........       $89.20
24115..............  Remove/graft bone lesion..            3    $1,542.47      $510.00  ...........      $102.00
24116..............  Remove/graft bone lesion..            3    $1,542.47      $510.00  ...........      $102.00
24120..............  Remove elbow lesion.......            3    $1,281.58      $510.00  ...........      $102.00
24125..............  Remove/graft bone lesion..            3    $1,542.47      $510.00  ...........      $102.00
24126..............  Remove/graft bone lesion..            3    $1,542.47      $510.00  ...........      $102.00
24130..............  Removal of head of radius.            3    $1,542.47      $510.00  ...........      $102.00
24134..............  Removal of arm bone lesion            2    $1,542.47      $446.00  ...........       $89.20
24136..............  Remove radius bone lesion.            2    $1,542.47      $446.00  ...........       $89.20
24138..............  Remove elbow bone lesion..            2    $1,542.47      $446.00  ...........       $89.20
24140..............  Partial removal of arm                3    $1,542.47      $510.00  ...........      $102.00
                      bone.
24145..............  Partial removal of radius.            3    $1,542.47      $510.00  ...........      $102.00
24147..............  Partial removal of elbow..            2    $1,542.47      $446.00  ...........       $89.20
24155..............  Removal of elbow joint....            3    $2,539.24      $510.00  ...........      $102.00
24160..............  Remove elbow joint implant            2    $1,542.47      $446.00  ...........       $89.20
24164..............  Remove radius head implant            3    $1,542.47      $510.00  ...........      $102.00

[[Page 49724]]

 
24201..............  Removal of arm foreign                2      $920.58      $446.00  ...........       $89.20
                      body.
24301..............  Muscle/tendon transfer....            4    $1,542.47      $630.00  ...........      $126.00
24305..............  Arm tendon lengthening....            4    $1,542.47      $630.00  ...........      $126.00
24310..............  Revision of arm tendon....            3    $1,281.58      $510.00  ...........      $102.00
24320..............  Repair of arm tendon......            3    $2,539.24      $510.00  ...........      $102.00
24330..............  Revision of arm muscles...            3    $4,055.26      $510.00  ...........      $102.00
24331..............  Revision of arm muscles...            3    $2,539.24      $510.00  ...........      $102.00
24340..............  Repair of biceps tendon...            3    $2,539.24      $510.00  ...........      $102.00
24341..............  Repair arm tendon/muscle..            3    $2,539.24      $510.00  ...........      $102.00
24342..............  Repair of ruptured tendon.            3    $2,539.24      $510.00  ...........      $102.00
24345..............  Repr elbw med ligmnt w/               2    $1,542.47      $446.00  ...........       $89.20
                      tissu.
24350..............  Repair of tennis elbow....            3    $1,542.47      $510.00  ...........      $102.00
24351..............  Repair of tennis elbow....            3    $1,542.47      $510.00  ...........      $102.00
24352..............  Repair of tennis elbow....            3    $1,542.47      $510.00  ...........      $102.00
24354..............  Repair of tennis elbow....            3    $1,542.47      $510.00  ...........      $102.00
24356..............  Revision of tennis elbow..            3    $1,542.47      $510.00  ...........      $102.00
24360..............  Reconstruct elbow joint...            5    $2,016.06      $717.00  ...........      $143.40
24361..............  Reconstruct elbow joint...            5    $6,473.11      $717.00  ...........      $143.40
24362..............  Reconstruct elbow joint...            5    $2,903.02      $717.00  ...........      $143.40
24363..............  Replace elbow joint.......            7    $6,473.11      $995.00  ...........      $199.00
24365..............  Reconstruct head of radius            5    $2,016.06      $717.00  ...........      $143.40
24366..............  Reconstruct head of radius            5    $6,473.11      $717.00  ...........      $143.40
24400..............  Revision of humerus.......            4    $1,542.47      $630.00  ...........      $126.00
24410..............  Revision of humerus.......            4    $1,542.47      $630.00  ...........      $126.00
24420..............  Revision of humerus.......            3    $2,539.24      $510.00  ...........      $102.00
24430..............  Repair of humerus.........            3    $4,055.26      $510.00  ...........      $102.00
24435..............  Repair humerus with graft.            4    $4,055.26      $630.00  ...........      $126.00
24470..............  Revision of elbow joint...            3    $2,539.24      $510.00  ...........      $102.00
24495..............  Decompression of forearm..            2    $1,542.47      $446.00  ...........       $89.20
24498..............  Reinforce humerus.........            3    $4,055.26      $510.00  ...........      $102.00
24500..............  Treat humerus fracture....            1      $104.11      $104.11  Y..........       $20.82
24505..............  Treat humerus fracture....            1      $104.11      $104.11  Y..........       $20.82
24515..............  Treat humerus fracture....            4    $3,472.68      $630.00  ...........      $126.00
24516..............  Treat humerus fracture....            4    $3,472.68      $630.00  ...........      $126.00
24530..............  Treat humerus fracture....            1      $104.11      $104.11  Y..........       $20.82
24535..............  Treat humerus fracture....            1      $104.11      $104.11  Y..........       $20.82
24538..............  Treat humerus fracture....            2    $1,580.03      $446.00  ...........       $89.20
24545..............  Treat humerus fracture....            4    $3,472.68      $630.00  ...........      $126.00
24546..............  Treat humerus fracture....            5    $3,472.68      $717.00  ...........      $143.40
24560..............  Treat humerus fracture....            1      $104.11      $104.11  Y..........       $20.82
24565..............  Treat humerus fracture....            2      $104.11      $104.11  Y..........       $20.82
24566..............  Treat humerus fracture....            2    $1,580.03      $446.00  ...........       $89.20
24575..............  Treat humerus fracture....            3    $3,472.68      $510.00  ...........      $102.00
24576..............  Treat humerus fracture....            1      $104.11      $104.11  Y..........       $20.82
24577..............  Treat humerus fracture....            1      $104.11      $104.11  Y..........       $20.82
24579..............  Treat humerus fracture....            3    $3,472.68      $510.00  ...........      $102.00
24582..............  Treat humerus fracture....            2    $1,580.03      $446.00  ...........       $89.20
24586..............  Treat elbow fracture......            4    $3,472.68      $630.00  ...........      $126.00
24587..............  Treat elbow fracture......            5    $3,472.68      $717.00  ...........      $143.40
24600..............  Treat elbow dislocation...            1      $104.11      $104.11  Y..........       $20.82
24605..............  Treat elbow dislocation...            2      $895.58      $446.00  ...........       $89.20
24615..............  Treat elbow dislocation...            3    $3,472.68      $510.00  ...........      $102.00
24620..............  Treat elbow fracture......            2      $104.11      $104.11  Y..........       $20.82
24635..............  Treat elbow fracture......            3    $3,472.68      $510.00  ...........      $102.00
24655..............  Treat radius fracture.....            1      $104.11      $104.11  Y..........       $20.82
24665..............  Treat radius fracture.....            4    $2,312.35      $630.00  ...........      $126.00
24666..............  Treat radius fracture.....            4    $3,472.68      $630.00  ...........      $126.00
24670..............  Treat ulnar fracture......            1      $104.11      $104.11  Y..........       $20.82
24675..............  Treat ulnar fracture......            1      $104.11      $104.11  Y..........       $20.82
24685..............  Treat ulnar fracture......            3    $2,312.35      $510.00  ...........      $102.00
24800..............  Fusion of elbow joint.....            4    $2,539.24      $630.00  ...........      $126.00
24802..............  Fusion/graft of elbow                 5    $2,539.24      $717.00  ...........      $143.40
                      joint.
24925..............  Amputation follow-up                  3    $1,281.58      $510.00  ...........      $102.00
                      surgery.
25000..............  Incision of tendon sheath.            3    $1,281.58      $510.00  ...........      $102.00
25020..............  Decompress forearm 1 space            3    $1,281.58      $510.00  ...........      $102.00
25023..............  Decompress forearm 1 space            3    $1,542.47      $510.00  ...........      $102.00
25024..............  Decompress forearm 2                  3    $1,542.47      $510.00  ...........      $102.00
                      spaces.
25025..............  Decompress forearm 2                  3    $1,542.47      $510.00  ...........      $102.00
                      spaces.
25028..............  Drainage of forearm lesion            1    $1,281.58      $333.00  ...........       $66.60

[[Page 49725]]

 
25031..............  Drainage of forearm bursa.            2    $1,281.58      $446.00  ...........       $89.20
25035..............  Treat forearm bone lesion.            2    $1,281.58      $446.00  ...........       $89.20
25040..............  Explore/treat wrist joint.            5    $1,542.47      $717.00  ...........      $143.40
25066..............  Biopsy forearm soft                   2    $1,229.54      $446.00  ...........       $89.20
                      tissues.
25075..............  Removal forearm lesion                2      $920.58      $446.00  ...........       $89.20
                      subcu.
25076..............  Removal forearm lesion                3    $1,229.54      $510.00  ...........      $102.00
                      deep.
25077..............  Remove tumor, forearm/                3    $1,229.54      $510.00  ...........      $102.00
                      wrist.
25085..............  Incision of wrist capsule.            3    $1,281.58      $510.00  ...........      $102.00
25100..............  Biopsy of wrist joint.....            2    $1,281.58      $446.00  ...........       $89.20
25101..............  Explore/treat wrist joint.            3    $1,542.47      $510.00  ...........      $102.00
25105..............  Remove wrist joint lining.            4    $1,542.47      $630.00  ...........      $126.00
25107..............  Remove wrist joint                    3    $1,542.47      $510.00  ...........      $102.00
                      cartilage.
25110..............  Remove wrist tendon lesion            3    $1,281.58      $510.00  ...........      $102.00
25111..............  Remove wrist tendon lesion            3      $986.93      $510.00  ...........      $102.00
25112..............  Reremove wrist tendon                 4      $986.93      $630.00  ...........      $126.00
                      lesion.
25115..............  Remove wrist/forearm                  4    $1,281.58      $630.00  ...........      $126.00
                      lesion.
25116..............  Remove wrist/forearm                  4    $1,281.58      $630.00  ...........      $126.00
                      lesion.
25118..............  Excise wrist tendon sheath            2    $1,542.47      $446.00  ...........       $89.20
25119..............  Partial removal of ulna...            3    $1,542.47      $510.00  ...........      $102.00
25120..............  Removal of forearm lesion.            3    $1,542.47      $510.00  ...........      $102.00
25125..............  Remove/graft forearm                  3    $1,542.47      $510.00  ...........      $102.00
                      lesion.
25126..............  Remove/graft forearm                  3    $1,542.47      $510.00  ...........      $102.00
                      lesion.
25130..............  Removal of wrist lesion...            3    $1,542.47      $510.00  ...........      $102.00
25135..............  Remove & graft wrist                  3    $1,542.47      $510.00  ...........      $102.00
                      lesion.
25136..............  Remove & graft wrist                  3    $1,542.47      $510.00  ...........      $102.00
                      lesion.
25145..............  Remove forearm bone lesion            2    $1,542.47      $446.00  ...........       $89.20
25150..............  Partial removal of ulna...            2    $1,542.47      $446.00  ...........       $89.20
25151..............  Partial removal of radius.            2    $1,542.47      $446.00  ...........       $89.20
25210..............  Removal of wrist bone.....            3    $1,590.63      $510.00  ...........      $102.00
25215..............  Removal of wrist bones....            4    $1,590.63      $630.00  ...........      $126.00
25230..............  Partial removal of radius.            4    $1,542.47      $630.00  ...........      $126.00
25240..............  Partial removal of ulna...            4    $1,542.47      $630.00  ...........      $126.00
25248..............  Remove forearm foreign                2    $1,281.58      $446.00  ...........       $89.20
                      body.
25250..............  Removal of wrist                      1    $1,542.47      $333.00  ...........       $66.60
                      prosthesis.
25251..............  Removal of wrist                      1    $1,542.47      $333.00  ...........       $66.60
                      prosthesis.
25260..............  Repair forearm tendon/                4    $1,542.47      $630.00  ...........      $126.00
                      muscle.
25263..............  Repair forearm tendon/                2    $1,542.47      $446.00  ...........       $89.20
                      muscle.
25265..............  Repair forearm tendon/                3    $1,542.47      $510.00  ...........      $102.00
                      muscle.
25270..............  Repair forearm tendon/                4    $1,542.47      $630.00  ...........      $126.00
                      muscle.
25272..............  Repair forearm tendon/                3    $1,542.47      $510.00  ...........      $102.00
                      muscle.
25274..............  Repair forearm tendon/                4    $1,542.47      $630.00  ...........      $126.00
                      muscle.
25275..............  Repair forearm tendon                 4    $1,542.47      $630.00  ...........      $126.00
                      sheath.
25280..............  Revise wrist/forearm                  4    $1,542.47      $630.00  ...........      $126.00
                      tendon.
25290..............  Incise wrist/forearm                  3    $1,542.47      $510.00  ...........      $102.00
                      tendon.
25295..............  Release wrist/forearm                 3    $1,281.58      $510.00  ...........      $102.00
                      tendon.
25300..............  Fusion of tendons at wrist            3    $1,542.47      $510.00  ...........      $102.00
25301..............  Fusion of tendons at wrist            3    $1,542.47      $510.00  ...........      $102.00
25310..............  Transplant forearm tendon.            3    $2,539.24      $510.00  ...........      $102.00
25312..............  Transplant forearm tendon.            4    $2,539.24      $630.00  ...........      $126.00
25315..............  Revise palsy hand                     3    $2,539.24      $510.00  ...........      $102.00
                      tendon(s).
25316..............  Revise palsy hand                     3    $4,055.26      $510.00  ...........      $102.00
                      tendon(s).
25320..............  Repair/revise wrist joint.            3    $2,539.24      $510.00  ...........      $102.00
25332..............  Revise wrist joint........            5    $2,016.06      $717.00  ...........      $143.40
25335..............  Realignment of hand.......            3    $2,539.24      $510.00  ...........      $102.00
25337..............  Reconstruct ulna/                     5    $2,539.24      $717.00  ...........      $143.40
                      radioulnar.
25350..............  Revision of radius........            3    $4,055.26      $510.00  ...........      $102.00
25355..............  Revision of radius........            3    $2,539.24      $510.00  ...........      $102.00
25360..............  Revision of ulna..........            3    $1,542.47      $510.00  ...........      $102.00
25365..............  Revise radius & ulna......            3    $1,542.47      $510.00  ...........      $102.00
25370..............  Revise radius or ulna.....            3    $2,539.24      $510.00  ...........      $102.00
25375..............  Revise radius & ulna......            4    $2,539.24      $630.00  ...........      $126.00
25390..............  Shorten radius or ulna....            3    $1,542.47      $510.00  ...........      $102.00
25391..............  Lengthen radius or ulna...            4    $2,539.24      $630.00  ...........      $126.00
25392..............  Shorten radius & ulna.....            3    $1,542.47      $510.00  ...........      $102.00
25393..............  Lengthen radius & ulna....            4    $2,539.24      $630.00  ...........      $126.00
25400..............  Repair radius or ulna.....            3    $1,542.47      $510.00  ...........      $102.00
25405..............  Repair/graft radius or                4    $1,542.47      $630.00  ...........      $126.00
                      ulna.
25415..............  Repair radius & ulna......            3    $1,542.47      $510.00  ...........      $102.00
25420..............  Repair/graft radius & ulna            4    $4,055.26      $630.00  ...........      $126.00

[[Page 49726]]

 
25425..............  Repair/graft radius or                3    $2,539.24      $510.00  ...........      $102.00
                      ulna.
25426..............  Repair/graft radius & ulna            4    $2,539.24      $630.00  ...........      $126.00
25440..............  Repair/graft wrist bone...            4    $4,055.26      $630.00  ...........      $126.00
25441..............  Reconstruct wrist joint...            5    $6,473.11      $717.00  ...........      $143.40
25442..............  Reconstruct wrist joint...            5    $6,473.11      $717.00  ...........      $143.40
25443..............  Reconstruct wrist joint...            5    $2,903.02      $717.00  ...........      $143.40
25444..............  Reconstruct wrist joint...            5    $2,903.02      $717.00  ...........      $143.40
25445..............  Reconstruct wrist joint...            5    $2,903.02      $717.00  ...........      $143.40
25446..............  Wrist replacement.........            7    $6,473.11      $995.00  ...........      $199.00
25447..............  Repair wrist joint(s).....            5    $2,016.06      $717.00  ...........      $143.40
25449..............  Remove wrist joint implant            5    $2,016.06      $717.00  ...........      $143.40
25450..............  Revision of wrist joint...            3    $2,539.24      $510.00  ...........      $102.00
25455..............  Revision of wrist joint...            3    $2,539.24      $510.00  ...........      $102.00
25490..............  Reinforce radius..........            3    $2,539.24      $510.00  ...........      $102.00
25491..............  Reinforce ulna............            3    $2,539.24      $510.00  ...........      $102.00
25492..............  Reinforce radius and ulna.            3    $2,539.24      $510.00  ...........      $102.00
25505..............  Treat fracture of radius..            1      $104.11      $104.11  Y..........       $20.82
25515..............  Treat fracture of radius..            3    $2,312.35      $510.00  ...........      $102.00
25520..............  Treat fracture of radius..            1      $104.11      $104.11  Y..........       $20.82
25525..............  Treat fracture of radius..            4    $2,312.35      $630.00  ...........      $126.00
25526..............  Treat fracture of radius..            5    $2,312.35      $717.00  ...........      $143.40
25535..............  Treat fracture of ulna....            1      $104.11      $104.11  Y..........       $20.82
25545..............  Treat fracture of ulna....            3    $2,312.35      $510.00  ...........      $102.00
25565..............  Treat fracture radius &               2      $104.11      $104.11  Y..........       $20.82
                      ulna.
25574..............  Treat fracture radius &               3    $3,472.68      $510.00  ...........      $102.00
                      ulna.
25575..............  Treat fracture radius/ulna            3    $3,472.68      $510.00  ...........      $102.00
25605..............  Treat fracture radius/ulna            3      $104.11      $104.11  Y..........       $20.82
25611..............  Treat fracture radius/ulna            3    $1,580.03      $510.00  ...........      $102.00
25620..............  Treat fracture radius/ulna            5    $3,472.68      $717.00  ...........      $143.40
25624..............  Treat wrist bone fracture.            2      $104.11      $104.11  Y..........       $20.82
25628..............  Treat wrist bone fracture.            3    $2,312.35      $510.00  ...........      $102.00
25635..............  Treat wrist bone fracture.            1      $104.11      $104.11  Y..........       $20.82
25645..............  Treat wrist bone fracture.            3    $2,312.35      $510.00  ...........      $102.00
25660..............  Treat wrist dislocation...            1      $104.11      $104.11  Y..........       $20.82
25670..............  Treat wrist dislocation...            3    $1,580.03      $510.00  ...........      $102.00
25671..............  Pin radioulnar dislocation            1    $1,580.03      $333.00  ...........       $66.60
25675..............  Treat wrist dislocation...            1      $104.11      $104.11  Y..........       $20.82
25676..............  Treat wrist dislocation...            2    $1,580.03      $446.00  ...........       $89.20
25680..............  Treat wrist fracture......            2      $104.11      $104.11  Y..........       $20.82
25685..............  Treat wrist fracture......            3    $1,580.03      $510.00  ...........      $102.00
25690..............  Treat wrist dislocation...            1      $104.11      $104.11  Y..........       $20.82
25695..............  Treat wrist dislocation...            2    $1,580.03      $446.00  ...........       $89.20
25800..............  Fusion of wrist joint.....            4    $4,055.26      $630.00  ...........      $126.00
25805..............  Fusion/graft of wrist                 5    $2,539.24      $717.00  ...........      $143.40
                      joint.
25810..............  Fusion/graft of wrist                 5    $4,055.26      $717.00  ...........      $143.40
                      joint.
25820..............  Fusion of hand bones......            4      $986.93      $630.00  ...........      $126.00
25825..............  Fuse hand bones with graft            5    $1,590.63      $717.00  ...........      $143.40
25830..............  Fusion, radioulnar jnt/               5    $4,055.26      $717.00  ...........      $143.40
                      ulna.
25907..............  Amputation follow-up                  3    $1,281.58      $510.00  ...........      $102.00
                      surgery.
25922..............  Amputate hand at wrist....            3    $1,281.58      $510.00  ...........      $102.00
25929..............  Amputation follow-up                  3      $821.29      $510.00  ...........      $102.00
                      surgery.
26011..............  Drainage of finger abscess            1      $672.04      $333.00  ...........       $66.60
26020..............  Drain hand tendon sheath..            2      $986.93      $446.00  ...........       $89.20
26025..............  Drainage of palm bursa....            1      $986.93      $333.00  ...........       $66.60
26030..............  Drainage of palm bursa(s).            2      $986.93      $446.00  ...........       $89.20
26034..............  Treat hand bone lesion....            2      $986.93      $446.00  ...........       $89.20
26040..............  Release palm contracture..            4    $1,590.63      $630.00  ...........      $126.00
26045..............  Release palm contracture..            3    $1,590.63      $510.00  ...........      $102.00
26055..............  Incise finger tendon                  2      $986.93      $446.00  ...........       $89.20
                      sheath.
26060..............  Incision of finger tendon.            2      $986.93      $446.00  ...........       $89.20
26070..............  Explore/treat hand joint..            2      $986.93      $446.00  ...........       $89.20
26075..............  Explore/treat finger joint            4      $986.93      $630.00  ...........      $126.00
26080..............  Explore/treat finger joint            4      $986.93      $630.00  ...........      $126.00
26100..............  Biopsy hand joint lining..            2      $986.93      $446.00  ...........       $89.20
26105..............  Biopsy finger joint lining            1      $986.93      $333.00  ...........       $66.60
26110..............  Biopsy finger joint lining            1      $986.93      $333.00  ...........       $66.60
26115..............  Removal hand lesion subcut            2    $1,229.54      $446.00  ...........       $89.20
26116..............  Removal hand lesion, deep.            2    $1,229.54      $446.00  ...........       $89.20
26117..............  Remove tumor, hand/finger.            3    $1,229.54      $510.00  ...........      $102.00

[[Page 49727]]

 
26121..............  Release palm contracture..            4    $1,590.63      $630.00  ...........      $126.00
26123..............  Release palm contracture..            4    $1,590.63      $630.00  ...........      $126.00
26125..............  Release palm contracture..            4      $986.93      $630.00  ...........      $126.00
26130..............  Remove wrist joint lining.            3      $986.93      $510.00  ...........      $102.00
26135..............  Revise finger joint, each.            4    $1,590.63      $630.00  ...........      $126.00
26140..............  Revise finger joint, each.            2      $986.93      $446.00  ...........       $89.20
26145..............  Tendon excision, palm/                3      $986.93      $510.00  ...........      $102.00
                      finger.
26160..............  Remove tendon sheath                  3      $986.93      $510.00  ...........      $102.00
                      lesion.
26170..............  Removal of palm tendon,               3      $986.93      $510.00  ...........      $102.00
                      each.
26180..............  Removal of finger tendon..            3      $986.93      $510.00  ...........      $102.00
26185..............  Remove finger bone........            4      $986.93      $630.00  ...........      $126.00
26200..............  Remove hand bone lesion...            2      $986.93      $446.00  ...........       $89.20
26205..............  Remove/graft bone lesion..            3    $1,590.63      $510.00  ...........      $102.00
26210..............  Removal of finger lesion..            2      $986.93      $446.00  ...........       $89.20
26215..............  Remove/graft finger lesion            3      $986.93      $510.00  ...........      $102.00
26230..............  Partial removal of hand               7      $986.93      $986.93  Y..........      $197.39
                      bone.
26235..............  Partial removal, finger               3      $986.93      $510.00  ...........      $102.00
                      bone.
26236..............  Partial removal, finger               3      $986.93      $510.00  ...........      $102.00
                      bone.
26250..............  Extensive hand surgery....            3      $986.93      $510.00  ...........      $102.00
26255..............  Extensive hand surgery....            3    $1,590.63      $510.00  ...........      $102.00
26260..............  Extensive finger surgery..            3      $986.93      $510.00  ...........      $102.00
26261..............  Extensive finger surgery..            3      $986.93      $510.00  ...........      $102.00
26262..............  Partial removal of finger.            2      $986.93      $446.00  ...........       $89.20
26320..............  Removal of implant from               2      $920.58      $446.00  ...........       $89.20
                      hand.
26350..............  Repair finger/hand tendon.            1    $1,590.63      $333.00  ...........       $66.60
26352..............  Repair/graft hand tendon..            4    $1,590.63      $630.00  ...........      $126.00
26356..............  Repair finger/hand tendon.            4    $1,590.63      $630.00  ...........      $126.00
26357..............  Repair finger/hand tendon.            4    $1,590.63      $630.00  ...........      $126.00
26358..............  Repair/graft hand tendon..            4    $1,590.63      $630.00  ...........      $126.00
26370..............  Repair finger/hand tendon.            4    $1,590.63      $630.00  ...........      $126.00
26372..............  Repair/graft hand tendon..            4    $1,590.63      $630.00  ...........      $126.00
26373..............  Repair finger/hand tendon.            3    $1,590.63      $510.00  ...........      $102.00
26390..............  Revise hand/finger tendon.            4    $1,590.63      $630.00  ...........      $126.00
26392..............  Repair/graft hand tendon..            3    $1,590.63      $510.00  ...........      $102.00
26410..............  Repair hand tendon........            3      $986.93      $510.00  ...........      $102.00
26412..............  Repair/graft hand tendon..            3    $1,590.63      $510.00  ...........      $102.00
26415..............  Excision, hand/finger                 4    $1,590.63      $630.00  ...........      $126.00
                      tendon.
26416..............  Graft hand or finger                  3    $1,590.63      $510.00  ...........      $102.00
                      tendon.
26418..............  Repair finger tendon......            4      $986.93      $630.00  ...........      $126.00
26420..............  Repair/graft finger tendon            4    $1,590.63      $630.00  ...........      $126.00
26426..............  Repair finger/hand tendon.            3    $1,590.63      $510.00  ...........      $102.00
26428..............  Repair/graft finger tendon            3    $1,590.63      $510.00  ...........      $102.00
26432..............  Repair finger tendon......            3      $986.93      $510.00  ...........      $102.00
26433..............  Repair finger tendon......            3      $986.93      $510.00  ...........      $102.00
26434..............  Repair/graft finger tendon            3    $1,590.63      $510.00  ...........      $102.00
26437..............  Realignment of tendons....            3      $986.93      $510.00  ...........      $102.00
26440..............  Release palm/finger tendon            3      $986.93      $510.00  ...........      $102.00
26442..............  Release palm & finger                 3    $1,590.63      $510.00  ...........      $102.00
                      tendon.
26445..............  Release hand/finger tendon            3      $986.93      $510.00  ...........      $102.00
26449..............  Release forearm/hand                  3    $1,590.63      $510.00  ...........      $102.00
                      tendon.
26450..............  Incision of palm tendon...            3      $986.93      $510.00  ...........      $102.00
26455..............  Incision of finger tendon.            3      $986.93      $510.00  ...........      $102.00
26460..............  Incise hand/finger tendon.            3      $986.93      $510.00  ...........      $102.00
26471..............  Fusion of finger tendons..            2      $986.93      $446.00  ...........       $89.20
26474..............  Fusion of finger tendons..            2      $986.93      $446.00  ...........       $89.20
26476..............  Tendon lengthening........            1      $986.93      $333.00  ...........       $66.60
26477..............  Tendon shortening.........            1      $986.93      $333.00  ...........       $66.60
26478..............  Lengthening of hand tendon            1      $986.93      $333.00  ...........       $66.60
26479..............  Shortening of hand tendon.            1      $986.93      $333.00  ...........       $66.60
26480..............  Transplant hand tendon....            3    $1,590.63      $510.00  ...........      $102.00
26483..............  Transplant/graft hand                 3    $1,590.63      $510.00  ...........      $102.00
                      tendon.
26485..............  Transplant palm tendon....            2    $1,590.63      $446.00  ...........       $89.20
26489..............  Transplant/graft palm                 3    $1,590.63      $510.00  ...........      $102.00
                      tendon.
26490..............  Revise thumb tendon.......            3    $1,590.63      $510.00  ...........      $102.00
26492..............  Tendon transfer with graft            3    $1,590.63      $510.00  ...........      $102.00
26494..............  Hand tendon/muscle                    3    $1,590.63      $510.00  ...........      $102.00
                      transfer.
26496..............  Revise thumb tendon.......            3    $1,590.63      $510.00  ...........      $102.00
26497..............  Finger tendon transfer....            3    $1,590.63      $510.00  ...........      $102.00
26498..............  Finger tendon transfer....            4    $1,590.63      $630.00  ...........      $126.00

[[Page 49728]]

 
26499..............  Revision of finger........            3    $1,590.63      $510.00  ...........      $102.00
26500..............  Hand tendon reconstruction            4      $986.93      $630.00  ...........      $126.00
26502..............  Hand tendon reconstruction            4    $1,590.63      $630.00  ...........      $126.00
26504..............  Hand tendon reconstruction            4    $1,590.63      $630.00  ...........      $126.00
26508..............  Release thumb contracture.            3      $986.93      $510.00  ...........      $102.00
26510..............  Thumb tendon transfer.....            3    $1,590.63      $510.00  ...........      $102.00
26516..............  Fusion of knuckle joint...            1    $1,590.63      $333.00  ...........       $66.60
26517..............  Fusion of knuckle joints..            3    $1,590.63      $510.00  ...........      $102.00
26518..............  Fusion of knuckle joints..            3    $1,590.63      $510.00  ...........      $102.00
26520..............  Release knuckle                       3      $986.93      $510.00  ...........      $102.00
                      contracture.
26525..............  Release finger contracture            3      $986.93      $510.00  ...........      $102.00
26530..............  Revise knuckle joint......            3    $2,016.06      $510.00  ...........      $102.00
26531..............  Revise knuckle with                   7    $2,903.02      $995.00  ...........      $199.00
                      implant.
26535..............  Revise finger joint.......            5    $2,016.06      $717.00  ...........      $143.40
26536..............  Revise/implant finger                 5    $2,903.02      $717.00  ...........      $143.40
                      joint.
26540..............  Repair hand joint.........            4      $986.93      $630.00  ...........      $126.00
26541..............  Repair hand joint with                7    $1,590.63      $995.00  ...........      $199.00
                      graft.
26542..............  Repair hand joint with                4      $986.93      $630.00  ...........      $126.00
                      graft.
26545..............  Reconstruct finger joint..            4    $1,590.63      $630.00  ...........      $126.00
26546..............  Repair nonunion hand......            4    $1,590.63      $630.00  ...........      $126.00
26548..............  Reconstruct finger joint..            4    $1,590.63      $630.00  ...........      $126.00
26550..............  Construct thumb                       2    $1,590.63      $446.00  ...........       $89.20
                      replacement.
26555..............  Positional change of                  3    $1,590.63      $510.00  ...........      $102.00
                      finger.
26560..............  Repair of web finger......            2      $986.93      $446.00  ...........       $89.20
26561..............  Repair of web finger......            3    $1,590.63      $510.00  ...........      $102.00
26562..............  Repair of web finger......            4    $1,590.63      $630.00  ...........      $126.00
26565..............  Correct metacarpal flaw...            5    $1,590.63      $717.00  ...........      $143.40
26567..............  Correct finger deformity..            5    $1,590.63      $717.00  ...........      $143.40
26568..............  Lengthen metacarpal/finger            3    $1,590.63      $510.00  ...........      $102.00
26580..............  Repair hand deformity.....            5      $986.93      $717.00  ...........      $143.40
26587..............  Reconstruct extra finger..            5      $986.93      $717.00  ...........      $143.40
26590..............  Repair finger deformity...            5      $986.93      $717.00  ...........      $143.40
26591..............  Repair muscles of hand....            3    $1,590.63      $510.00  ...........      $102.00
26593..............  Release muscles of hand...            3      $986.93      $510.00  ...........      $102.00
26596..............  Excision constricting                 2      $986.93      $446.00  ...........       $89.20
                      tissue.
26605..............  Treat metacarpal fracture.            2      $104.11      $104.11  Y..........       $20.82
26607..............  Treat metacarpal fracture.            2      $104.11      $104.11  Y..........       $20.82
26608..............  Treat metacarpal fracture.            4    $1,580.03      $630.00  ...........      $126.00
26615..............  Treat metacarpal fracture.            4    $2,312.35      $630.00  ...........      $126.00
26645..............  Treat thumb fracture......            1      $104.11      $104.11  Y..........       $20.82
26650..............  Treat thumb fracture......            2    $1,580.03      $446.00  ...........       $89.20
26665..............  Treat thumb fracture......            4    $2,312.35      $630.00  ...........      $126.00
26675..............  Treat hand dislocation....            2      $104.11      $104.11  Y..........       $20.82
26676..............  Pin hand dislocation......            2    $1,580.03      $446.00  ...........       $89.20
26685..............  Treat hand dislocation....            3    $2,312.35      $510.00  ...........      $102.00
26686..............  Treat hand dislocation....            3    $3,472.68      $510.00  ...........      $102.00
26705..............  Treat knuckle dislocation.            2      $104.11      $104.11  Y..........       $20.82
26706..............  Pin knuckle dislocation...            2      $104.11      $104.11  Y..........       $20.82
26715..............  Treat knuckle dislocation.            4    $2,312.35      $630.00  ...........      $126.00
26727..............  Treat finger fracture,                7    $1,580.03      $995.00  ...........      $199.00
                      each.
26735..............  Treat finger fracture,                4    $2,312.35      $630.00  ...........      $126.00
                      each.
26742..............  Treat finger fracture,                2      $104.11      $104.11  Y..........       $20.82
                      each.
26746..............  Treat finger fracture,                5    $2,312.35      $717.00  ...........      $143.40
                      each.
26756..............  Pin finger fracture, each.            2    $1,580.03      $446.00  ...........       $89.20
26765..............  Treat finger fracture,                4    $2,312.35      $630.00  ...........      $126.00
                      each.
26776..............  Pin finger dislocation....            2    $1,580.03      $446.00  ...........       $89.20
26785..............  Treat finger dislocation..            2    $1,580.03      $446.00  ...........       $89.20
26820..............  Thumb fusion with graft...            5    $1,590.63      $717.00  ...........      $143.40
26841..............  Fusion of thumb...........            4    $1,590.63      $630.00  ...........      $126.00
26842..............  Thumb fusion with graft...            4    $1,590.63      $630.00  ...........      $126.00
26843..............  Fusion of hand joint......            3    $1,590.63      $510.00  ...........      $102.00
26844..............  Fusion/graft of hand joint            3    $1,590.63      $510.00  ...........      $102.00
26850..............  Fusion of knuckle.........            4    $1,590.63      $630.00  ...........      $126.00
26852..............  Fusion of knuckle with                4    $1,590.63      $630.00  ...........      $126.00
                      graft.
26860..............  Fusion of finger joint....            3    $1,590.63      $510.00  ...........      $102.00
26861..............  Fusion of finger jnt, add-            2    $1,590.63      $446.00  ...........       $89.20
                      on.
26862..............  Fusion/graft of finger                4    $1,590.63      $630.00  ...........      $126.00
                      joint.
26863..............  Fuse/graft added joint....            3    $1,590.63      $510.00  ...........      $102.00
26910..............  Amputate metacarpal bone..            3    $1,590.63      $510.00  ...........      $102.00

[[Page 49729]]

 
26951..............  Amputation of finger/thumb            2      $986.93      $446.00  ...........       $89.20
26952..............  Amputation of finger/thumb            4      $986.93      $630.00  ...........      $126.00
26990..............  Drainage of pelvis lesion.            1    $1,281.58      $333.00  ...........       $66.60
26991..............  Drainage of pelvis bursa..            1    $1,281.58      $333.00  ...........       $66.60
27000..............  Incision of hip tendon....            2    $1,281.58      $446.00  ...........       $89.20
27001..............  Incision of hip tendon....            3    $1,542.47      $510.00  ...........      $102.00
27003..............  Incision of hip tendon....            3    $1,542.47      $510.00  ...........      $102.00
27033..............  Exploration of hip joint..            3    $2,539.24      $510.00  ...........      $102.00
27035..............  Denervation of hip joint..            4    $2,539.24      $630.00  ...........      $126.00
27040..............  Biopsy of soft tissues....            1      $400.87      $333.00  ...........       $66.60
27041..............  Biopsy of soft tissues....            2      $400.87      $400.87  Y..........       $80.17
27047..............  Remove hip/pelvis lesion..            2    $1,229.54      $446.00  ...........       $89.20
27048..............  Remove hip/pelvis lesion..            3    $1,229.54      $510.00  ...........      $102.00
27049..............  Remove tumor, hip/pelvis..            3    $1,229.54      $510.00  ...........      $102.00
27050..............  Biopsy of sacroiliac joint            3    $1,281.58      $510.00  ...........      $102.00
27052..............  Biopsy of hip joint.......            3    $1,281.58      $510.00  ...........      $102.00
27060..............  Removal of ischial bursa..            5    $1,281.58      $717.00  ...........      $143.40
27062..............  Remove femur lesion/bursa.            5    $1,281.58      $717.00  ...........      $143.40
27065..............  Removal of hip bone lesion            5    $1,281.58      $717.00  ...........      $143.40
27066..............  Removal of hip bone lesion            5    $1,542.47      $717.00  ...........      $143.40
27067..............  Remove/graft hip bone                 5    $1,542.47      $717.00  ...........      $143.40
                      lesion.
27080..............  Removal of tail bone......            2    $1,542.47      $446.00  ...........       $89.20
27086..............  Remove hip foreign body...            1      $400.87      $333.00  ...........       $66.60
27087..............  Remove hip foreign body...            3    $1,281.58      $510.00  ...........      $102.00
27097..............  Revision of hip tendon....            3    $1,542.47      $510.00  ...........      $102.00
27098..............  Transfer tendon to pelvis.            3    $1,542.47      $510.00  ...........      $102.00
27100..............  Transfer of abdominal                 4    $2,539.24      $630.00  ...........      $126.00
                      muscle.
27105..............  Transfer of spinal muscle.            4    $2,539.24      $630.00  ...........      $126.00
27110..............  Transfer of iliopsoas                 4    $2,539.24      $630.00  ...........      $126.00
                      muscle.
27111..............  Transfer of iliopsoas                 4    $2,539.24      $630.00  ...........      $126.00
                      muscle.
27193..............  Treat pelvic ring fracture            1      $104.11      $104.11  Y..........       $20.82
27194..............  Treat pelvic ring fracture            2      $895.58      $446.00  ...........       $89.20
27202..............  Treat tail bone fracture..            2    $2,312.35      $446.00  ...........       $89.20
27230..............  Treat thigh fracture......            1      $104.11      $104.11  Y..........       $20.82
27238..............  Treat thigh fracture......            1      $104.11      $104.11  Y..........       $20.82
27246..............  Treat thigh fracture......            1      $104.11      $104.11  Y..........       $20.82
27250..............  Treat hip dislocation.....            1      $104.11      $104.11  Y..........       $20.82
27252..............  Treat hip dislocation.....            2      $895.58      $446.00  ...........       $89.20
27257..............  Treat hip dislocation.....            3      $895.58      $510.00  ...........      $102.00
27265..............  Treat hip dislocation.....            1      $104.11      $104.11  Y..........       $20.82
27266..............  Treat hip dislocation.....            2      $895.58      $446.00  ...........       $89.20
27275..............  Manipulation of hip joint.            2      $895.58      $446.00  ...........       $89.20
27301..............  Drain thigh/knee lesion...            3    $1,075.21      $510.00  ...........      $102.00
27305..............  Incise thigh tendon &                 2    $1,281.58      $446.00  ...........       $89.20
                      fascia.
27306..............  Incision of thigh tendon..            3    $1,281.58      $510.00  ...........      $102.00
27307..............  Incision of thigh tendons.            3    $1,281.58      $510.00  ...........      $102.00
27310..............  Exploration of knee joint.            4    $1,542.47      $630.00  ...........      $126.00
27315..............  Partial removal, thigh                2    $1,093.20      $446.00  ...........       $89.20
                      nerve.
27320..............  Partial removal, thigh                2    $1,093.20      $446.00  ...........       $89.20
                      nerve.
27323..............  Biopsy, thigh soft tissues            1      $400.87      $333.00  ...........       $66.60
27324..............  Biopsy, thigh soft tissues            1    $1,229.54      $333.00  ...........       $66.60
27327..............  Removal of thigh lesion...            2    $1,229.54      $446.00  ...........       $89.20
27328..............  Removal of thigh lesion...            3    $1,229.54      $510.00  ...........      $102.00
27329..............  Remove tumor, thigh/knee..            4    $1,229.54      $630.00  ...........      $126.00
27330..............  Biopsy, knee joint lining.            4    $1,542.47      $630.00  ...........      $126.00
27331..............  Explore/treat knee joint..            4    $1,542.47      $630.00  ...........      $126.00
27332..............  Removal of knee cartilage.            4    $1,542.47      $630.00  ...........      $126.00
27333..............  Removal of knee cartilage.            4    $1,542.47      $630.00  ...........      $126.00
27334..............  Remove knee joint lining..            4    $1,542.47      $630.00  ...........      $126.00
27335..............  Remove knee joint lining..            4    $1,542.47      $630.00  ...........      $126.00
27340..............  Removal of kneecap bursa..            3    $1,281.58      $510.00  ...........      $102.00
27345..............  Removal of knee cyst......            4    $1,281.58      $630.00  ...........      $126.00
27347..............  Remove knee cyst..........            4    $1,281.58      $630.00  ...........      $126.00
27350..............  Removal of kneecap........            4    $1,542.47      $630.00  ...........      $126.00
27355..............  Remove femur lesion.......            3    $1,542.47      $510.00  ...........      $102.00
27356..............  Remove femur lesion/graft.            4    $1,542.47      $630.00  ...........      $126.00
27357..............  Remove femur lesion/graft.            5    $1,542.47      $717.00  ...........      $143.40
27358..............  Remove femur lesion/                  5    $1,542.47      $717.00  ...........      $143.40
                      fixation.
27360..............  Partial removal, leg                  5    $1,542.47      $717.00  ...........      $143.40
                      bone(s).

[[Page 49730]]

 
27372..............  Removal of foreign body...            7    $1,229.54      $995.00  ...........      $199.00
27380..............  Repair of kneecap tendon..            1    $1,281.58      $333.00  ...........       $66.60
27381..............  Repair/graft kneecap                  3    $1,281.58      $510.00  ...........      $102.00
                      tendon.
27385..............  Repair of thigh muscle....            3    $1,281.58      $510.00  ...........      $102.00
27386..............  Repair/graft of thigh                 3    $1,281.58      $510.00  ...........      $102.00
                      muscle.
27390..............  Incision of thigh tendon..            1    $1,281.58      $333.00  ...........       $66.60
27391..............  Incision of thigh tendons.            2    $1,281.58      $446.00  ...........       $89.20
27392..............  Incision of thigh tendons.            3    $1,281.58      $510.00  ...........      $102.00
27393..............  Lengthening of thigh                  2    $1,542.47      $446.00  ...........       $89.20
                      tendon.
27394..............  Lengthening of thigh                  3    $1,542.47      $510.00  ...........      $102.00
                      tendons.
27395..............  Lengthening of thigh                  3    $2,539.24      $510.00  ...........      $102.00
                      tendons.
27396..............  Transplant of thigh tendon            3    $1,542.47      $510.00  ...........      $102.00
27397..............  Transplants of thigh                  3    $2,539.24      $510.00  ...........      $102.00
                      tendons.
27400..............  Revise thigh muscles/                 3    $2,539.24      $510.00  ...........      $102.00
                      tendons.
27403..............  Repair of knee cartilage..            4    $1,542.47      $630.00  ...........      $126.00
27405..............  Repair of knee ligament...            4    $2,539.24      $630.00  ...........      $126.00
27407..............  Repair of knee ligament...            4    $4,055.26      $630.00  ...........      $126.00
27409..............  Repair of knee ligaments..            4    $2,539.24      $630.00  ...........      $126.00
27418..............  Repair degenerated kneecap            3    $2,539.24      $510.00  ...........      $102.00
27420..............  Revision of unstable                  3    $2,539.24      $510.00  ...........      $102.00
                      kneecap.
27422..............  Revision of unstable                  7    $2,539.24      $995.00  ...........      $199.00
                      kneecap.
27424..............  Revision/removal of                   3    $2,539.24      $510.00  ...........      $102.00
                      kneecap.
27425..............  Lat retinacular release               7    $1,542.47      $995.00  ...........      $199.00
                      open.
27427..............  Reconstruction, knee......            3    $2,539.24      $510.00  ...........      $102.00
27428..............  Reconstruction, knee......            4    $4,055.26      $630.00  ...........      $126.00
27429..............  Reconstruction, knee......            4    $4,055.26      $630.00  ...........      $126.00
27430..............  Revision of thigh muscles.            4    $2,539.24      $630.00  ...........      $126.00
27435..............  Incision of knee joint....            4    $2,539.24      $630.00  ...........      $126.00
27437..............  Revise kneecap............            4    $2,016.06      $630.00  ...........      $126.00
27438..............  Revise kneecap with                   5    $2,903.02      $717.00  ...........      $143.40
                      implant.
27441..............  Revision of knee joint....            5    $2,016.06      $717.00  ...........      $143.40
27442..............  Revision of knee joint....            5    $2,016.06      $717.00  ...........      $143.40
27443..............  Revision of knee joint....            5    $2,016.06      $717.00  ...........      $143.40
27496..............  Decompression of thigh/               5    $1,281.58      $717.00  ...........      $143.40
                      knee.
27497..............  Decompression of thigh/               3    $1,281.58      $510.00  ...........      $102.00
                      knee.
27498..............  Decompression of thigh/               3    $1,281.58      $510.00  ...........      $102.00
                      knee.
27499..............  Decompression of thigh/               3    $1,281.58      $510.00  ...........      $102.00
                      knee.
27500..............  Treatment of thigh                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27501..............  Treatment of thigh                    2      $104.11      $104.11  Y..........       $20.82
                      fracture.
27502..............  Treatment of thigh                    2      $104.11      $104.11  Y..........       $20.82
                      fracture.
27503..............  Treatment of thigh                    3      $104.11      $104.11  Y..........       $20.82
                      fracture.
27508..............  Treatment of thigh                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27509..............  Treatment of thigh                    3    $1,580.03      $510.00  ...........      $102.00
                      fracture.
27510..............  Treatment of thigh                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27516..............  Treat thigh fx growth                 1      $104.11      $104.11  Y..........       $20.82
                      plate.
27517..............  Treat thigh fx growth                 1      $104.11      $104.11  Y..........       $20.82
                      plate.
27520..............  Treat kneecap fracture....            1      $104.11      $104.11  Y..........       $20.82
27530..............  Treat knee fracture.......            1      $104.11      $104.11  Y..........       $20.82
27532..............  Treat knee fracture.......            1      $104.11      $104.11  Y..........       $20.82
27538..............  Treat knee fracture(s)....            1      $104.11      $104.11  Y..........       $20.82
27550..............  Treat knee dislocation....            1      $104.11      $104.11  Y..........       $20.82
27552..............  Treat knee dislocation....            1      $895.58      $333.00  ...........       $66.60
27560..............  Treat kneecap dislocation.            1      $104.11      $104.11  Y..........       $20.82
27562..............  Treat kneecap dislocation.            1      $895.58      $333.00  ...........       $66.60
27566..............  Treat kneecap dislocation.            2    $2,312.35      $446.00  ...........       $89.20
27570..............  Fixation of knee joint....            1      $895.58      $333.00  ...........       $66.60
27594..............  Amputation follow-up                  3    $1,281.58      $510.00  ...........      $102.00
                      surgery.
27600..............  Decompression of lower leg            3    $1,281.58      $510.00  ...........      $102.00
27601..............  Decompression of lower leg            3    $1,281.58      $510.00  ...........      $102.00
27602..............  Decompression of lower leg            3    $1,281.58      $510.00  ...........      $102.00
27603..............  Drain lower leg lesion....            2    $1,075.21      $446.00  ...........       $89.20
27604..............  Drain lower leg bursa.....            2    $1,281.58      $446.00  ...........       $89.20
27605..............  Incision of achilles                  1    $1,244.90      $333.00  ...........       $66.60
                      tendon.
27606..............  Incision of achilles                  1    $1,281.58      $333.00  ...........       $66.60
                      tendon.
27607..............  Treat lower leg bone                  2    $1,281.58      $446.00  ...........       $89.20
                      lesion.
27610..............  Explore/treat ankle joint.            2    $1,542.47      $446.00  ...........       $89.20
27612..............  Exploration of ankle joint            3    $1,542.47      $510.00  ...........      $102.00
27614..............  Biopsy lower leg soft                 2    $1,229.54      $446.00  ...........       $89.20
                      tissue.
27615..............  Remove tumor, lower leg...            3    $1,542.47      $510.00  ...........      $102.00

[[Page 49731]]

 
27618..............  Remove lower leg lesion...            2      $920.58      $446.00  ...........       $89.20
27619..............  Remove lower leg lesion...            3    $1,229.54      $510.00  ...........      $102.00
27620..............  Explore/treat ankle joint.            4    $1,542.47      $630.00  ...........      $126.00
27625..............  Remove ankle joint lining.            4    $1,542.47      $630.00  ...........      $126.00
27626..............  Remove ankle joint lining.            4    $1,542.47      $630.00  ...........      $126.00
27630..............  Removal of tendon lesion..            3    $1,281.58      $510.00  ...........      $102.00
27635..............  Remove lower leg bone                 3    $1,542.47      $510.00  ...........      $102.00
                      lesion.
27637..............  Remove/graft leg bone                 3    $1,542.47      $510.00  ...........      $102.00
                      lesion.
27638..............  Remove/graft leg bone                 3    $1,542.47      $510.00  ...........      $102.00
                      lesion.
27640..............  Partial removal of tibia..            2    $2,539.24      $446.00  ...........       $89.20
27641..............  Partial removal of fibula.            2    $1,542.47      $446.00  ...........       $89.20
27647..............  Extensive ankle/heel                  3    $2,539.24      $510.00  ...........      $102.00
                      surgery.
27650..............  Repair achilles tendon....            3    $2,539.24      $510.00  ...........      $102.00
27652..............  Repair/graft achilles                 3    $4,055.26      $510.00  ...........      $102.00
                      tendon.
27654..............  Repair of achilles tendon.            3    $2,539.24      $510.00  ...........      $102.00
27656..............  Repair leg fascia defect..            2    $1,281.58      $446.00  ...........       $89.20
27658..............  Repair of leg tendon, each            1    $1,281.58      $333.00  ...........       $66.60
27659..............  Repair of leg tendon, each            2    $1,281.58      $446.00  ...........       $89.20
27664..............  Repair of leg tendon, each            2    $1,281.58      $446.00  ...........       $89.20
27665..............  Repair of leg tendon, each            2    $1,542.47      $446.00  ...........       $89.20
27675..............  Repair lower leg tendons..            2    $1,281.58      $446.00  ...........       $89.20
27676..............  Repair lower leg tendons..            3    $1,542.47      $510.00  ...........      $102.00
27680..............  Release of lower leg                  3    $1,542.47      $510.00  ...........      $102.00
                      tendon.
27681..............  Release of lower leg                  2    $1,542.47      $446.00  ...........       $89.20
                      tendons.
27685..............  Revision of lower leg                 3    $1,542.47      $510.00  ...........      $102.00
                      tendon.
27686..............  Revise lower leg tendons..            3    $1,542.47      $510.00  ...........      $102.00
27687..............  Revision of calf tendon...            3    $1,542.47      $510.00  ...........      $102.00
27690..............  Revise lower leg tendon...            4    $2,539.24      $630.00  ...........      $126.00
27691..............  Revise lower leg tendon...            4    $2,539.24      $630.00  ...........      $126.00
27692..............  Revise additional leg                 3    $2,539.24      $510.00  ...........      $102.00
                      tendon.
27695..............  Repair of ankle ligament..            2    $1,542.47      $446.00  ...........       $89.20
27696..............  Repair of ankle ligaments.            2    $1,542.47      $446.00  ...........       $89.20
27698..............  Repair of ankle ligament..            2    $1,542.47      $446.00  ...........       $89.20
27700..............  Revision of ankle joint...            5    $2,016.06      $717.00  ...........      $143.40
27704..............  Removal of ankle implant..            2    $1,281.58      $446.00  ...........       $89.20
27705..............  Incision of tibia.........            2    $2,539.24      $446.00  ...........       $89.20
27707..............  Incision of fibula........            2    $1,281.58      $446.00  ...........       $89.20
27709..............  Incision of tibia & fibula            2    $1,542.47      $446.00  ...........       $89.20
27730..............  Repair of tibia epiphysis.            2    $1,542.47      $446.00  ...........       $89.20
27732..............  Repair of fibula epiphysis            2    $1,542.47      $446.00  ...........       $89.20
27734..............  Repair lower leg epiphyses            2    $1,542.47      $446.00  ...........       $89.20
27740..............  Repair of leg epiphyses...            2    $1,542.47      $446.00  ...........       $89.20
27742..............  Repair of leg epiphyses...            2    $2,539.24      $446.00  ...........       $89.20
27745..............  Reinforce tibia...........            3    $4,055.26      $510.00  ...........      $102.00
27750..............  Treatment of tibia                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27752..............  Treatment of tibia                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27756..............  Treatment of tibia                    3    $1,580.03      $510.00  ...........      $102.00
                      fracture.
27758..............  Treatment of tibia                    4    $2,312.35      $630.00  ...........      $126.00
                      fracture.
27759..............  Treatment of tibia                    4    $3,472.68      $630.00  ...........      $126.00
                      fracture.
27760..............  Treatment of ankle                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27762..............  Treatment of ankle                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27766..............  Treatment of ankle                    3    $2,312.35      $510.00  ...........      $102.00
                      fracture.
27780..............  Treatment of fibula                   1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27781..............  Treatment of fibula                   1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27784..............  Treatment of fibula                   3    $2,312.35      $510.00  ...........      $102.00
                      fracture.
27786..............  Treatment of ankle                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27788..............  Treatment of ankle                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27792..............  Treatment of ankle                    3    $2,312.35      $510.00  ...........      $102.00
                      fracture.
27808..............  Treatment of ankle                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27810..............  Treatment of ankle                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27814..............  Treatment of ankle                    3    $2,312.35      $510.00  ...........      $102.00
                      fracture.
27816..............  Treatment of ankle                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27818..............  Treatment of ankle                    1      $104.11      $104.11  Y..........       $20.82
                      fracture.
27822..............  Treatment of ankle                    3    $2,312.35      $510.00  ...........      $102.00
                      fracture.
27823..............  Treatment of ankle                    3    $3,472.68      $510.00  ...........      $102.00
                      fracture.
27824..............  Treat lower leg fracture..            1      $104.11      $104.11  Y..........       $20.82
27825..............  Treat lower leg fracture..            2      $104.11      $104.11  Y..........       $20.82
27826..............  Treat lower leg fracture..            3    $2,312.35      $510.00  ...........      $102.00
27827..............  Treat lower leg fracture..            3    $3,472.68      $510.00  ...........      $102.00

[[Page 49732]]

 
27828..............  Treat lower leg fracture..            4    $3,472.68      $630.00  ...........      $126.00
27829..............  Treat lower leg joint.....            2    $2,312.35      $446.00  ...........       $89.20
27830..............  Treat lower leg                       1      $104.11      $104.11  Y..........       $20.82
                      dislocation.
27831..............  Treat lower leg                       1      $104.11      $104.11  Y..........       $20.82
                      dislocation.
27832..............  Treat lower leg                       2    $2,312.35      $446.00  ...........       $89.20
                      dislocation.
27840..............  Treat ankle dislocation...            1      $104.11      $104.11  Y..........       $20.82
27842..............  Treat ankle dislocation...            1      $895.58      $333.00  ...........       $66.60
27846..............  Treat ankle dislocation...            3    $2,312.35      $510.00  ...........      $102.00
27848..............  Treat ankle dislocation...            3    $2,312.35      $510.00  ...........      $102.00
27860..............  Fixation of ankle joint...            1      $895.58      $333.00  ...........       $66.60
27870..............  Fusion of ankle joint,                4    $4,055.26      $630.00  ...........      $126.00
                      open.
27871..............  Fusion of tibiofibular                4    $4,055.26      $630.00  ...........      $126.00
                      joint.
27884..............  Amputation follow-up                  3    $1,281.58      $510.00  ...........      $102.00
                      surgery.
27889..............  Amputation of foot at                 3    $1,542.47      $510.00  ...........      $102.00
                      ankle.
27892..............  Decompression of leg......            3    $1,281.58      $510.00  ...........      $102.00
27893..............  Decompression of leg......            3    $1,281.58      $510.00  ...........      $102.00
27894..............  Decompression of leg......            3    $1,281.58      $510.00  ...........      $102.00
28002..............  Treatment of foot                     3    $1,281.58      $510.00  ...........      $102.00
                      infection.
28003..............  Treatment of foot                     3    $1,281.58      $510.00  ...........      $102.00
                      infection.
28005..............  Treat foot bone lesion....            3    $1,244.90      $510.00  ...........      $102.00
28008..............  Incision of foot fascia...            3    $1,244.90      $510.00  ...........      $102.00
28011..............  Incision of toe tendons...            3    $1,244.90      $510.00  ...........      $102.00
28020..............  Exploration of foot joint.            2    $1,244.90      $446.00  ...........       $89.20
28022..............  Exploration of foot joint.            2    $1,244.90      $446.00  ...........       $89.20
28024..............  Exploration of toe joint..            2    $1,244.90      $446.00  ...........       $89.20
28030..............  Removal of foot nerve.....            4    $1,093.20      $630.00  ...........      $126.00
28035..............  Decompression of tibia                4    $1,093.20      $630.00  ...........      $126.00
                      nerve.
28043..............  Excision of foot lesion...            2    $1,229.54      $446.00  ...........       $89.20
28045..............  Excision of foot lesion...            3    $1,244.90      $510.00  ...........      $102.00
28046..............  Resection of tumor, foot..            3    $1,244.90      $510.00  ...........      $102.00
28050..............  Biopsy of foot joint                  2    $1,244.90      $446.00  ...........       $89.20
                      lining.
28052..............  Biopsy of foot joint                  2    $1,244.90      $446.00  ...........       $89.20
                      lining.
28054..............  Biopsy of toe joint lining            2    $1,244.90      $446.00  ...........       $89.20
28060..............  Partial removal, foot                 2    $1,244.90      $446.00  ...........       $89.20
                      fascia.
28062..............  Removal of foot fascia....            3    $1,244.90      $510.00  ...........      $102.00
28070..............  Removal of foot joint                 3    $1,244.90      $510.00  ...........      $102.00
                      lining.
28072..............  Removal of foot joint                 3    $1,244.90      $510.00  ...........      $102.00
                      lining.
28080..............  Removal of foot lesion....            3    $1,244.90      $510.00  ...........      $102.00
28086..............  Excise foot tendon sheath.            2    $1,244.90      $446.00  ...........       $89.20
28088..............  Excise foot tendon sheath.            2    $1,244.90      $446.00  ...........       $89.20
28090..............  Removal of foot lesion....            3    $1,244.90      $510.00  ...........      $102.00
28092..............  Removal of toe lesions....            3    $1,244.90      $510.00  ...........      $102.00
28100..............  Removal of ankle/heel                 2    $1,244.90      $446.00  ...........       $89.20
                      lesion.
28102..............  Remove/graft foot lesion..            3    $2,537.37      $510.00  ...........      $102.00
28103..............  Remove/graft foot lesion..            3    $2,537.37      $510.00  ...........      $102.00
28104..............  Removal of foot lesion....            2    $1,244.90      $446.00  ...........       $89.20
28106..............  Remove/graft foot lesion..            3    $2,537.37      $510.00  ...........      $102.00
28107..............  Remove/graft foot lesion..            3    $2,537.37      $510.00  ...........      $102.00
28108..............  Removal of toe lesions....            2    $1,244.90      $446.00  ...........       $89.20
28110..............  Part removal of metatarsal            3    $1,244.90      $510.00  ...........      $102.00
28111..............  Part removal of metatarsal            3    $1,244.90      $510.00  ...........      $102.00
28112..............  Part removal of metatarsal            3    $1,244.90      $510.00  ...........      $102.00
28113..............  Part removal of metatarsal            3    $1,244.90      $510.00  ...........      $102.00
28114..............  Removal of metatarsal                 3    $1,244.90      $510.00  ...........      $102.00
                      heads.
28116..............  Revision of foot..........            3    $1,244.90      $510.00  ...........      $102.00
28118..............  Removal of heel bone......            4    $1,244.90      $630.00  ...........      $126.00
28119..............  Removal of heel spur......            4    $1,244.90      $630.00  ...........      $126.00
28120..............  Part removal of ankle/heel            7    $1,244.90      $995.00  ...........      $199.00
28122..............  Partial removal of foot               3    $1,244.90      $510.00  ...........      $102.00
                      bone.
28126..............  Partial removal of toe....            3    $1,244.90      $510.00  ...........      $102.00
28130..............  Removal of ankle bone.....            3    $1,244.90      $510.00  ...........      $102.00
28140..............  Removal of metatarsal.....            3    $1,244.90      $510.00  ...........      $102.00
28150..............  Removal of toe............            3    $1,244.90      $510.00  ...........      $102.00
28153..............  Partial removal of toe....            3    $1,244.90      $510.00  ...........      $102.00
28160..............  Partial removal of toe....            3    $1,244.90      $510.00  ...........      $102.00
28171..............  Extensive foot surgery....            3    $1,244.90      $510.00  ...........      $102.00
28173..............  Extensive foot surgery....            3    $1,244.90      $510.00  ...........      $102.00
28175..............  Extensive foot surgery....            3    $1,244.90      $510.00  ...........      $102.00
28192..............  Removal of foot foreign               2      $920.58      $446.00  ...........       $89.20
                      body.

[[Page 49733]]

 
28193..............  Removal of foot foreign               4      $400.87      $400.87  Y..........       $80.17
                      body.
28200..............  Repair of foot tendon.....            3    $1,244.90      $510.00  ...........      $102.00
28202..............  Repair/graft of foot                  3    $1,244.90      $510.00  ...........      $102.00
                      tendon.
28208..............  Repair of foot tendon.....            3    $1,244.90      $510.00  ...........      $102.00
28210..............  Repair/graft of foot                  3    $2,537.37      $510.00  ...........      $102.00
                      tendon.
28222..............  Release of foot tendons...            1    $1,244.90      $333.00  ...........       $66.60
28225..............  Release of foot tendon....            1    $1,244.90      $333.00  ...........       $66.60
28226..............  Release of foot tendons...            1    $1,244.90      $333.00  ...........       $66.60
28234..............  Incision of foot tendon...            2    $1,244.90      $446.00  ...........       $89.20
28238..............  Revision of foot tendon...            3    $2,537.37      $510.00  ...........      $102.00
28240..............  Release of big toe........            2    $1,244.90      $446.00  ...........       $89.20
28250..............  Revision of foot fascia...            3    $1,244.90      $510.00  ...........      $102.00
28260..............  Release of midfoot joint..            3    $1,244.90      $510.00  ...........      $102.00
28261..............  Revision of foot tendon...            3    $1,244.90      $510.00  ...........      $102.00
28262..............  Revision of foot and ankle            4    $1,244.90      $630.00  ...........      $126.00
28264..............  Release of midfoot joint..            1    $2,537.37      $333.00  ...........       $66.60
28270..............  Release of foot                       3    $1,244.90      $510.00  ...........      $102.00
                      contracture.
28280..............  Fusion of toes............            2    $1,244.90      $446.00  ...........       $89.20
28285..............  Repair of hammertoe.......            3    $1,244.90      $510.00  ...........      $102.00
28286..............  Repair of hammertoe.......            4    $1,244.90      $630.00  ...........      $126.00
28288..............  Partial removal of foot               3    $1,244.90      $510.00  ...........      $102.00
                      bone.
28289..............  Repair hallux rigidus.....            3    $1,244.90      $510.00  ...........      $102.00
28290..............  Correction of bunion......            2    $1,729.40      $446.00  ...........       $89.20
28292..............  Correction of bunion......            2    $1,729.40      $446.00  ...........       $89.20
28293..............  Correction of bunion......            3    $1,729.40      $510.00  ...........      $102.00
28294..............  Correction of bunion......            3    $1,729.40      $510.00  ...........      $102.00
28296..............  Correction of bunion......            3    $1,729.40      $510.00  ...........      $102.00
28297..............  Correction of bunion......            3    $1,729.40      $510.00  ...........      $102.00
28298..............  Correction of bunion......            3    $1,729.40      $510.00  ...........      $102.00
28299..............  Correction of bunion......            5    $1,729.40      $717.00  ...........      $143.40
28300..............  Incision of heel bone.....            2    $2,537.37      $446.00  ...........       $89.20
28302..............  Incision of ankle bone....            2    $1,244.90      $446.00  ...........       $89.20
28304..............  Incision of midfoot bones.            2    $2,537.37      $446.00  ...........       $89.20
28305..............  Incise/graft midfoot bones            3    $2,537.37      $510.00  ...........      $102.00
28306..............  Incision of metatarsal....            4    $1,244.90      $630.00  ...........      $126.00
28307..............  Incision of metatarsal....            4    $1,244.90      $630.00  ...........      $126.00
28308..............  Incision of metatarsal....            2    $1,244.90      $446.00  ...........       $89.20
28309..............  Incision of metatarsals...            4    $2,537.37      $630.00  ...........      $126.00
28310..............  Revision of big toe.......            3    $1,244.90      $510.00  ...........      $102.00
28312..............  Revision of toe...........            3    $1,244.90      $510.00  ...........      $102.00
28313..............  Repair deformity of toe...            2    $1,244.90      $446.00  ...........       $89.20
28315..............  Removal of sesamoid bone..            4    $1,244.90      $630.00  ...........      $126.00
28320..............  Repair of foot bones......            4    $2,537.37      $630.00  ...........      $126.00
28322..............  Repair of metatarsals.....            4    $2,537.37      $630.00  ...........      $126.00
28340..............  Resect enlarged toe tissue            4    $1,244.90      $630.00  ...........      $126.00
28341..............  Resect enlarged toe.......            4    $1,244.90      $630.00  ...........      $126.00
28344..............  Repair extra toe(s).......            4    $1,244.90      $630.00  ...........      $126.00
28345..............  Repair webbed toe(s)......            4    $1,244.90      $630.00  ...........      $126.00
28400..............  Treatment of heel fracture            1      $104.11      $104.11  Y..........       $20.82
28405..............  Treatment of heel fracture            2      $104.11      $104.11  Y..........       $20.82
28406..............  Treatment of heel fracture            2    $1,580.03      $446.00  ...........       $89.20
28415..............  Treat heel fracture.......            3    $2,312.35      $510.00  ...........      $102.00
28420..............  Treat/graft heel fracture.            4    $2,312.35      $630.00  ...........      $126.00
28435..............  Treatment of ankle                    2      $104.11      $104.11  Y..........       $20.82
                      fracture.
28436..............  Treatment of ankle                    2    $1,580.03      $446.00  ...........       $89.20
                      fracture.
28445..............  Treat ankle fracture......            3    $2,312.35      $510.00  ...........      $102.00
28456..............  Treat midfoot fracture....            2    $1,580.03      $446.00  ...........       $89.20
28465..............  Treat midfoot fracture,               3    $2,312.35      $510.00  ...........      $102.00
                      each.
28476..............  Treat metatarsal fracture.            2    $1,580.03      $446.00  ...........       $89.20
28485..............  Treat metatarsal fracture.            4    $2,312.35      $630.00  ...........      $126.00
28496..............  Treat big toe fracture....            2    $1,580.03      $446.00  ...........       $89.20
28505..............  Treat big toe fracture....            3    $2,312.35      $510.00  ...........      $102.00
28525..............  Treat toe fracture........            3    $2,312.35      $510.00  ...........      $102.00
28531..............  Treat sesamoid bone                   3    $2,312.35      $510.00  ...........      $102.00
                      fracture.
28545..............  Treat foot dislocation....            1    $1,580.03      $333.00  ...........       $66.60
28546..............  Treat foot dislocation....            2    $1,580.03      $446.00  ...........       $89.20
28555..............  Repair foot dislocation...            2    $2,312.35      $446.00  ...........       $89.20
28575..............  Treat foot dislocation....            1      $104.11      $104.11  Y..........       $20.82
28576..............  Treat foot dislocation....            3    $1,580.03      $510.00  ...........      $102.00

[[Page 49734]]

 
28585..............  Repair foot dislocation...            3    $2,312.35      $510.00  ...........      $102.00
28605..............  Treat foot dislocation....            1      $104.11      $104.11  Y..........       $20.82
28606..............  Treat foot dislocation....            2    $1,580.03      $446.00  ...........       $89.20
28615..............  Repair foot dislocation...            3    $2,312.35      $510.00  ...........      $102.00
28635..............  Treat toe dislocation.....            1      $895.58      $333.00  ...........       $66.60
28636..............  Treat toe dislocation.....            3    $1,580.03      $510.00  ...........      $102.00
28645..............  Repair toe dislocation....            3    $2,312.35      $510.00  ...........      $102.00
28665..............  Treat toe dislocation.....            1      $895.58      $333.00  ...........       $66.60
28666..............  Treat toe dislocation.....            3    $1,580.03      $510.00  ...........      $102.00
28675..............  Repair of toe dislocation.            3    $2,312.35      $510.00  ...........      $102.00
28705..............  Fusion of foot bones......            4    $2,537.37      $630.00  ...........      $126.00
28715..............  Fusion of foot bones......            4    $2,537.37      $630.00  ...........      $126.00
28725..............  Fusion of foot bones......            4    $2,537.37      $630.00  ...........      $126.00
28730..............  Fusion of foot bones......            4    $2,537.37      $630.00  ...........      $126.00
28735..............  Fusion of foot bones......            4    $2,537.37      $630.00  ...........      $126.00
28737..............  Revision of foot bones....            5    $2,537.37      $717.00  ...........      $143.40
28740..............  Fusion of foot bones......            4    $2,537.37      $630.00  ...........      $126.00
28750..............  Fusion of big toe joint...            4    $2,537.37      $630.00  ...........      $126.00
28755..............  Fusion of big toe joint...            4    $1,244.90      $630.00  ...........      $126.00
28760..............  Fusion of big toe joint...            4    $2,537.37      $630.00  ...........      $126.00
28810..............  Amputation toe &                      2    $1,244.90      $446.00  ...........       $89.20
                      metatarsal.
28820..............  Amputation of toe.........            2    $1,244.90      $446.00  ...........       $89.20
28825..............  Partial amputation of toe.            2    $1,244.90      $446.00  ...........       $89.20
29800..............  Jaw arthroscopy/surgery...            3    $1,762.08      $510.00  ...........      $102.00
29804..............  Jaw arthroscopy/surgery...            3    $1,762.08      $510.00  ...........      $102.00
29805..............  Shoulder arthroscopy, dx..            3    $1,762.08      $510.00  ...........      $102.00
29806..............  Shoulder arthroscopy/                 3    $2,773.72      $510.00  ...........      $102.00
                      surgery.
29807..............  Shoulder arthroscopy/                 3    $2,773.72      $510.00  ...........      $102.00
                      surgery.
29819..............  Shoulder arthroscopy/                 3    $1,762.08      $510.00  ...........      $102.00
                      surgery.
29820..............  Shoulder arthroscopy/                 3    $1,762.08      $510.00  ...........      $102.00
                      surgery.
29821..............  Shoulder arthroscopy/                 3    $1,762.08      $510.00  ...........      $102.00
                      surgery.
29822..............  Shoulder arthroscopy/                 3    $1,762.08      $510.00  ...........      $102.00
                      surgery.
29823..............  Shoulder arthroscopy/                 3    $1,762.08      $510.00  ...........      $102.00
                      surgery.
29824..............  Shoulder arthroscopy/                 5    $1,762.08      $717.00  ...........      $143.40
                      surgery.
29825..............  Shoulder arthroscopy/                 3    $1,762.08      $510.00  ...........      $102.00
                      surgery.
29826..............  Shoulder arthroscopy/                 3    $2,773.72      $510.00  ...........      $102.00
                      surgery.
29827..............  Arthroscop rotator cuff               5    $2,773.72      $717.00  ...........      $143.40
                      repr.
29830..............  Elbow arthroscopy.........            3    $1,762.08      $510.00  ...........      $102.00
29834..............  Elbow arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29835..............  Elbow arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29836..............  Elbow arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29837..............  Elbow arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29838..............  Elbow arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29840..............  Wrist arthroscopy.........            3    $1,762.08      $510.00  ...........      $102.00
29843..............  Wrist arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29844..............  Wrist arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29845..............  Wrist arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29846..............  Wrist arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29847..............  Wrist arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29848..............  Wrist endoscopy/surgery...            9    $1,762.08    $1,339.00  ...........      $267.80
29850..............  Knee arthroscopy/surgery..            4    $1,762.08      $630.00  ...........      $126.00
29851..............  Knee arthroscopy/surgery..            4    $2,773.72      $630.00  ...........      $126.00
29855..............  Tibial arthroscopy/surgery            4    $2,773.72      $630.00  ...........      $126.00
29856..............  Tibial arthroscopy/surgery            4    $1,762.08      $630.00  ...........      $126.00
29860..............  Hip arthroscopy, dx.......            4    $1,762.08      $630.00  ...........      $126.00
29861..............  Hip arthroscopy/surgery...            4    $1,762.08      $630.00  ...........      $126.00
29862..............  Hip arthroscopy/surgery...            9    $2,773.72    $1,339.00  ...........      $267.80
29863..............  Hip arthroscopy/surgery...            4    $2,773.72      $630.00  ...........      $126.00
29870..............  Knee arthroscopy, dx......            3    $1,762.08      $510.00  ...........      $102.00
29871..............  Knee arthroscopy/drainage.            3    $1,762.08      $510.00  ...........      $102.00
29873..............  Knee arthroscopy/surgery..            3    $1,762.08      $510.00  ...........      $102.00
29874..............  Knee arthroscopy/surgery..            3    $1,762.08      $510.00  ...........      $102.00
29875..............  Knee arthroscopy/surgery..            4    $1,762.08      $630.00  ...........      $126.00
29876..............  Knee arthroscopy/surgery..            4    $1,762.08      $630.00  ...........      $126.00
29877..............  Knee arthroscopy/surgery..            4    $1,762.08      $630.00  ...........      $126.00
29879..............  Knee arthroscopy/surgery..            3    $1,762.08      $510.00  ...........      $102.00
29880..............  Knee arthroscopy/surgery..            4    $1,762.08      $630.00  ...........      $126.00
29881..............  Knee arthroscopy/surgery..            4    $1,762.08      $630.00  ...........      $126.00
29882..............  Knee arthroscopy/surgery..            3    $1,762.08      $510.00  ...........      $102.00

[[Page 49735]]

 
29883..............  Knee arthroscopy/surgery..            3    $1,762.08      $510.00  ...........      $102.00
29884..............  Knee arthroscopy/surgery..            3    $1,762.08      $510.00  ...........      $102.00
29885..............  Knee arthroscopy/surgery..            3    $2,773.72      $510.00  ...........      $102.00
29886..............  Knee arthroscopy/surgery..            3    $1,762.08      $510.00  ...........      $102.00
29887..............  Knee arthroscopy/surgery..            3    $1,762.08      $510.00  ...........      $102.00
29888..............  Knee arthroscopy/surgery..            3    $2,773.72      $510.00  ...........      $102.00
29889..............  Knee arthroscopy/surgery..            3    $2,773.72      $510.00  ...........      $102.00
29891..............  Ankle arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29892..............  Ankle arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29893..............  Scope, plantar fasciotomy.            9    $1,244.90    $1,244.90  Y..........      $248.98
29894..............  Ankle arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29895..............  Ankle arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29897..............  Ankle arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29898..............  Ankle arthroscopy/surgery.            3    $1,762.08      $510.00  ...........      $102.00
29899..............  Ankle arthroscopy/surgery.            3    $2,773.72      $510.00  ...........      $102.00
29900..............  Mcp joint arthroscopy, dx.            3      $986.93      $510.00  ...........      $102.00
29901..............  Mcp joint arthroscopy,                3      $986.93      $510.00  ...........      $102.00
                      surg.
29902..............  Mcp joint arthroscopy,                3      $986.93      $510.00  ...........      $102.00
                      surg.
30115..............  Removal of nose polyp(s)..            2    $1,012.48      $446.00  ...........       $89.20
30117..............  Removal of intranasal                 3    $1,012.48      $510.00  ...........      $102.00
                      lesion.
30118..............  Removal of intranasal                 3    $1,425.30      $510.00  ...........      $102.00
                      lesion.
30120..............  Revision of nose..........            1    $1,012.48      $333.00  ...........       $66.60
30125..............  Removal of nose lesion....            2    $2,324.90      $446.00  ...........       $89.20
30130..............  Excise inferior turbinate.            3    $1,012.48      $510.00  ...........      $102.00
30140..............  Resect inferior turbinate.            2    $1,425.30      $446.00  ...........       $89.20
30150..............  Partial removal of nose...            3    $2,324.90      $510.00  ...........      $102.00
30160..............  Removal of nose...........            4    $2,324.90      $630.00  ...........      $126.00
30220..............  Insert nasal septal button            3      $475.55      $475.55  Y..........       $95.11
30310..............  Remove nasal foreign body.            1    $1,012.48      $333.00  ...........       $66.60
30320..............  Remove nasal foreign body.            2    $1,012.48      $446.00  ...........       $89.20
30400..............  Reconstruction of nose....            4    $2,324.90      $630.00  ...........      $126.00
30410..............  Reconstruction of nose....            5    $2,324.90      $717.00  ...........      $143.40
30420..............  Reconstruction of nose....            5    $2,324.90      $717.00  ...........      $143.40
30430..............  Revision of nose..........            3    $1,425.30      $510.00  ...........      $102.00
30435..............  Revision of nose..........            5    $2,324.90      $717.00  ...........      $143.40
30450..............  Revision of nose..........            7    $2,324.90      $995.00  ...........      $199.00
30460..............  Revision of nose..........            7    $2,324.90      $995.00  ...........      $199.00
30462..............  Revision of nose..........            9    $2,324.90    $1,339.00  ...........      $267.80
30465..............  Repair nasal stenosis.....            9    $2,324.90    $1,339.00  ...........      $267.80
30520..............  Repair of nasal septum....            4    $1,425.30      $630.00  ...........      $126.00
30540..............  Repair nasal defect.......            5    $2,324.90      $717.00  ...........      $143.40
30545..............  Repair nasal defect.......            5    $2,324.90      $717.00  ...........      $143.40
30560..............  Release of nasal adhesions            2      $146.29      $146.29  Y..........       $29.26
30580..............  Repair upper jaw fistula..            4    $2,324.90      $630.00  ...........      $126.00
30600..............  Repair mouth/nose fistula.            4    $2,324.90      $630.00  ...........      $126.00
30620..............  Intranasal reconstruction.            7    $2,324.90      $995.00  ...........      $199.00
30630..............  Repair nasal septum defect            7    $1,425.30      $995.00  ...........      $199.00
30801..............  Ablate inf turbinate,                 1      $475.55      $333.00  ...........       $66.60
                      superf.
30802..............  Cauterization, inner nose.            1      $475.55      $333.00  ...........       $66.60
30903..............  Control of nosebleed......            1       $73.99       $73.99  Y..........       $14.80
30905..............  Control of nosebleed......            1       $73.99       $73.99  Y..........       $14.80
30906..............  Repeat control of                     1       $73.99       $73.99  Y..........       $14.80
                      nosebleed.
30915..............  Ligation, nasal sinus                 2    $1,513.03      $446.00  ...........       $89.20
                      artery.
30920..............  Ligation, upper jaw artery            3    $1,513.03      $510.00  ...........      $102.00
30930..............  Ther fx, nasal inf                    4    $1,012.48      $630.00  ...........      $126.00
                      turbinate.
31020..............  Exploration, maxillary                2    $1,425.30      $446.00  ...........       $89.20
                      sinus.
31030..............  Exploration, maxillary                3    $2,324.90      $510.00  ...........      $102.00
                      sinus.
31032..............  Explore sinus, remove                 4    $2,324.90      $630.00  ...........      $126.00
                      polyps.
31050..............  Exploration, sphenoid                 2    $2,324.90      $446.00  ...........       $89.20
                      sinus.
31051..............  Sphenoid sinus surgery....            4    $2,324.90      $630.00  ...........      $126.00
31070..............  Exploration of frontal                2    $1,425.30      $446.00  ...........       $89.20
                      sinus.
31075..............  Exploration of frontal                4    $2,324.90      $630.00  ...........      $126.00
                      sinus.
31080..............  Removal of frontal sinus..            4    $2,324.90      $630.00  ...........      $126.00
31081..............  Removal of frontal sinus..            4    $2,324.90      $630.00  ...........      $126.00
31084..............  Removal of frontal sinus..            4    $2,324.90      $630.00  ...........      $126.00
31085..............  Removal of frontal sinus..            4    $2,324.90      $630.00  ...........      $126.00
31086..............  Removal of frontal sinus..            4    $2,324.90      $630.00  ...........      $126.00
31087..............  Removal of frontal sinus..            4    $2,324.90      $630.00  ...........      $126.00
31090..............  Exploration of sinuses....            5    $2,324.90      $717.00  ...........      $143.40

[[Page 49736]]

 
31200..............  Removal of ethmoid sinus..            2    $2,324.90      $446.00  ...........       $89.20
31201..............  Removal of ethmoid sinus..            5    $2,324.90      $717.00  ...........      $143.40
31205..............  Removal of ethmoid sinus..            3    $2,324.90      $510.00  ...........      $102.00
31233..............  Nasal/sinus endoscopy, dx.            2       $86.41       $86.41  Y..........       $17.28
31235..............  Nasal/sinus endoscopy, dx.            1      $931.27      $333.00  ...........       $66.60
31237..............  Nasal/sinus endoscopy,                2      $931.27      $446.00  ...........       $89.20
                      surg.
31238..............  Nasal/sinus endoscopy,                1      $931.27      $333.00  ...........       $66.60
                      surg.
31239..............  Nasal/sinus endoscopy,                4    $1,341.87      $630.00  ...........      $126.00
                      surg.
31240..............  Nasal/sinus endoscopy,                2      $931.27      $446.00  ...........       $89.20
                      surg.
31254..............  Revision of ethmoid sinus.            3    $1,341.87      $510.00  ...........      $102.00
31255..............  Removal of ethmoid sinus..            5    $1,341.87      $717.00  ...........      $143.40
31256..............  Exploration maxillary                 3    $1,341.87      $510.00  ...........      $102.00
                      sinus.
31267..............  Endoscopy, maxillary sinus            3    $1,341.87      $510.00  ...........      $102.00
31276..............  Sinus endoscopy, surgical.            3    $1,341.87      $510.00  ...........      $102.00
31287..............  Nasal/sinus endoscopy,                3    $1,341.87      $510.00  ...........      $102.00
                      surg.
31288..............  Nasal/sinus endoscopy,                3    $1,341.87      $510.00  ...........      $102.00
                      surg.
31300..............  Removal of larynx lesion..            5    $1,425.30      $717.00  ...........      $143.40
31320..............  Diagnostic incision,                  2    $2,324.90      $446.00  ...........       $89.20
                      larynx.
31400..............  Revision of larynx........            2    $2,324.90      $446.00  ...........       $89.20
31420..............  Removal of epiglottis.....            2    $2,324.90      $446.00  ...........       $89.20
31510..............  Laryngoscopy with biopsy..            2      $931.27      $446.00  ...........       $89.20
31511..............  Remove foreign body,                  2       $86.41       $86.41  Y..........       $17.28
                      larynx.
31512..............  Removal of larynx lesion..            2      $931.27      $446.00  ...........       $89.20
31513..............  Injection into vocal cord.            2       $86.41       $86.41  Y..........       $17.28
31515..............  Laryngoscopy for                      1      $931.27      $333.00  ...........       $66.60
                      aspiration.
31525..............  Dx laryngoscopy excl nb...            1      $931.27      $333.00  ...........       $66.60
31526..............  Dx laryngoscopy w/oper                2    $1,341.87      $446.00  ...........       $89.20
                      scope.
31527..............  Laryngoscopy for treatment            1    $1,341.87      $333.00  ...........       $66.60
31528..............  Laryngoscopy and dilation.            2      $931.27      $446.00  ...........       $89.20
31529..............  Laryngoscopy and dilation.            2      $931.27      $446.00  ...........       $89.20
31530..............  Laryngoscopy w/fb removal.            2    $1,341.87      $446.00  ...........       $89.20
31531..............  Laryngoscopy w/fb & op                3    $1,341.87      $510.00  ...........      $102.00
                      scope.
31535..............  Laryngoscopy w/biopsy.....            2    $1,341.87      $446.00  ...........       $89.20
31536..............  Laryngoscopy w/bx & op                3    $1,341.87      $510.00  ...........      $102.00
                      scope.
31540..............  Laryngoscopy w/exc of                 3    $1,341.87      $510.00  ...........      $102.00
                      tumor.
31541..............  Larynscop w/tumr exc +                4    $1,341.87      $630.00  ...........      $126.00
                      scope.
31545..............  Remove vc lesion w/scope..            4    $1,341.87      $630.00  ...........      $126.00
31546..............  Remove vc lesion scope/               4    $1,341.87      $630.00  ...........      $126.00
                      graft.
31560..............  Laryngoscop w/                        5    $1,341.87      $717.00  ...........      $143.40
                      arytenoidectom.
31561..............  Larynscop, remve cart +               5    $1,341.87      $717.00  ...........      $143.40
                      scop.
31570..............  Laryngoscope w/vc inj.....            2      $931.27      $446.00  ...........       $89.20
31571..............  Laryngoscop w/vc inj +                2    $1,341.87      $446.00  ...........       $89.20
                      scope.
31576..............  Laryngoscopy with biopsy..            2    $1,341.87      $446.00  ...........       $89.20
31577..............  Remove foreign body,                  2      $238.43      $238.43  Y..........       $47.69
                      larynx.
31578..............  Removal of larynx lesion..            2    $1,341.87      $446.00  ...........       $89.20
31580..............  Revision of larynx........            5    $2,324.90      $717.00  ...........      $143.40
31582..............  Revision of larynx........            5    $2,324.90      $717.00  ...........      $143.40
31588..............  Revision of larynx........            5    $2,324.90      $717.00  ...........      $143.40
31590..............  Reinnervate larynx........            5    $2,324.90      $717.00  ...........      $143.40
31595..............  Larynx nerve surgery......            2    $2,324.90      $446.00  ...........       $89.20
31603..............  Incision of windpipe......            1      $475.55      $333.00  ...........       $66.60
31611..............  Surgery/speech prosthesis.            3    $1,425.30      $510.00  ...........      $102.00
31612..............  Puncture/clear windpipe...            1    $1,425.30      $333.00  ...........       $66.60
31613..............  Repair windpipe opening...            2    $1,425.30      $446.00  ...........       $89.20
31614..............  Repair windpipe opening...            2    $2,324.90      $446.00  ...........       $89.20
31615..............  Visualization of windpipe.            1      $577.99      $333.00  ...........       $66.60
31622..............  Dx bronchoscope/wash......            1      $577.99      $333.00  ...........       $66.60
31623..............  Dx bronchoscope/brush.....            2      $577.99      $446.00  ...........       $89.20
31624..............  Dx bronchoscope/lavage....            2      $577.99      $446.00  ...........       $89.20
31625..............  Bronchoscopy w/biopsy(s)..            2      $577.99      $446.00  ...........       $89.20
31628..............  Bronchoscopy/lung bx, each            2      $577.99      $446.00  ...........       $89.20
31629..............  Bronchoscopy/needle bx,               2      $577.99      $446.00  ...........       $89.20
                      each.
31630..............  Bronchoscopy dilate/fx                2    $1,346.75      $446.00  ...........       $89.20
                      repr.
31631..............  Bronchoscopy, dilate w/               2    $1,346.75      $446.00  ...........       $89.20
                      stent.
31635..............  Bronchoscopy w/fb removal.            2      $577.99      $446.00  ...........       $89.20
31636..............  Bronchoscopy, bronch                  2    $1,346.75      $446.00  ...........       $89.20
                      stents.
31637..............  Bronchoscopy, stent add-on            1      $577.99      $333.00  ...........       $66.60
31638..............  Bronchoscopy, revise stent            2    $1,346.75      $446.00  ...........       $89.20
31640..............  Bronchoscopy w/tumor                  2    $1,346.75      $446.00  ...........       $89.20
                      excise.

[[Page 49737]]

 
31641..............  Bronchoscopy, treat                   2    $1,346.75      $446.00  ...........       $89.20
                      blockage.
31643..............  Diag bronchoscope/catheter            2      $577.99      $446.00  ...........       $89.20
31645..............  Bronchoscopy, clear                   1      $577.99      $333.00  ...........       $66.60
                      airways.
31646..............  Bronchoscopy, reclear                 1      $577.99      $333.00  ...........       $66.60
                      airway.
31656..............  Bronchoscopy, inj for x-              1      $577.99      $333.00  ...........       $66.60
                      ray.
31700..............  Insertion of airway                   1       $86.41       $86.41  Y..........       $17.28
                      catheter.
31717..............  Bronchial brush biopsy....            1      $238.43      $238.43  Y..........       $47.69
31720..............  Clearance of airways......            1       $46.61       $46.61  Y..........        $9.32
31730..............  Intro, windpipe wire/tube.            1      $238.43      $238.43  Y..........       $47.69
31750..............  Repair of windpipe........            5    $2,324.90      $717.00  ...........      $143.40
31755..............  Repair of windpipe........            2    $2,324.90      $446.00  ...........       $89.20
31820..............  Closure of windpipe lesion            1    $1,012.48      $333.00  ...........       $66.60
31825..............  Repair of windpipe defect.            2    $1,425.30      $446.00  ...........       $89.20
31830..............  Revise windpipe scar......            2    $1,425.30      $446.00  ...........       $89.20
32000..............  Drainage of chest.........            1      $224.20      $224.20  Y..........       $44.84
32400..............  Needle biopsy chest lining            1      $373.79      $333.00  ...........       $66.60
32405..............  Biopsy, lung or                       1      $373.79      $333.00  ...........       $66.60
                      mediastinum.
32420..............  Puncture/clear lung.......            1      $224.20      $224.20  Y..........       $44.84
33010..............  Drainage of heart sac.....            2      $224.20      $224.20  Y..........       $44.84
33011..............  Repeat drainage of heart              2      $224.20      $224.20  Y..........       $44.84
                      sac.
33212..............  Insertion of pulse                    3    $6,021.89      $510.00  ...........      $102.00
                      generator.
33213..............  Insertion of pulse                    3    $6,908.16      $510.00  ...........      $102.00
                      generator.
33222..............  Revise pocket, pacemaker..            2    $1,308.85      $446.00  ...........       $89.20
33223..............  Revise pocket, pacing-                2    $1,308.85      $446.00  ...........       $89.20
                      defib.
33233..............  Removal of pacemaker                  2    $1,444.39      $446.00  ...........       $89.20
                      system.
35188..............  Repair blood vessel lesion            4    $2,336.80      $630.00  ...........      $126.00
35207..............  Repair blood vessel lesion            4    $2,336.80      $630.00  ...........      $126.00
35476..............  Repair venous blockage....            9    $2,639.89    $1,339.00  ...........      $267.80
35875..............  Removal of clot in graft..            9    $2,336.80    $1,339.00  ...........      $267.80
35876..............  Removal of clot in graft..            9    $2,336.80    $1,339.00  ...........      $267.80
36260..............  Insertion of infusion pump            3    $1,752.02      $510.00  ...........      $102.00
36261..............  Revision of infusion pump.            2    $1,752.02      $446.00  ...........       $89.20
36262..............  Removal of infusion pump..            1    $1,397.11      $333.00  ...........       $66.60
36475..............  Endovenous rf, 1st vein...            8    $2,131.38      $973.00  ...........      $194.60
36476..............  Endovenous rf, vein add-on            8    $2,131.38      $973.00  ...........      $194.60
36478..............  Endovenous laser, 1st vein            8    $1,513.03      $973.00  ...........      $194.60
36479..............  Endovenous laser vein                 8    $1,513.03      $973.00  ...........      $194.60
                      addon.
36555..............  Insert non-tunnel cv cath.            1      $540.67      $333.00  ...........       $66.60
36556..............  Insert non-tunnel cv cath.            1      $540.67      $333.00  ...........       $66.60
36557..............  Insert tunneled cv cath...            2    $1,397.11      $446.00  ...........       $89.20
36558..............  Insert tunneled cv cath...            2    $1,397.11      $446.00  ...........       $89.20
36560..............  Insert tunneled cv cath...            3    $1,752.02      $510.00  ...........      $102.00
36561..............  Insert tunneled cv cath...            3    $1,752.02      $510.00  ...........      $102.00
36563..............  Insert tunneled cv cath...            3    $1,752.02      $510.00  ...........      $102.00
36565..............  Insert tunneled cv cath...            3    $1,752.02      $510.00  ...........      $102.00
36566..............  Insert tunneled cv cath...            3    $1,752.02      $510.00  ...........      $102.00
36568..............  Insert picc cath..........            1      $540.67      $333.00  ...........       $66.60
36569..............  Insert picc cath..........            1      $540.67      $333.00  ...........       $66.60
36570..............  Insert picvad cath........            3    $1,397.11      $510.00  ...........      $102.00
36571..............  Insert picvad cath........            3    $1,397.11      $510.00  ...........      $102.00
36575..............  Repair tunneled cv cath...            2      $540.67      $446.00  ...........       $89.20
36576..............  Repair tunneled cv cath...            2      $540.67      $446.00  ...........       $89.20
36578..............  Replace tunneled cv cath..            2    $1,397.11      $446.00  ...........       $89.20
36580..............  Replace cvad cath.........            1      $540.67      $333.00  ...........       $66.60
36581..............  Replace tunneled cv cath..            2    $1,397.11      $446.00  ...........       $89.20
36582..............  Replace tunneled cv cath..            3    $1,752.02      $510.00  ...........      $102.00
36583..............  Replace tunneled cv cath..            3    $1,752.02      $510.00  ...........      $102.00
36584..............  Replace picc cath.........            1      $540.67      $333.00  ...........       $66.60
36585..............  Replace picvad cath.......            3    $1,397.11      $510.00  ...........      $102.00
36589..............  Removal tunneled cv cath..            1      $540.67      $333.00  ...........       $66.60
36590..............  Removal tunneled cv cath..            1      $540.67      $333.00  ...........       $66.60
36640..............  Insertion catheter, artery            1    $1,752.02      $333.00  ...........       $66.60
36800..............  Insertion of cannula......            3    $1,814.26      $510.00  ...........      $102.00
36810..............  Insertion of cannula......            3    $1,814.26      $510.00  ...........      $102.00
36815..............  Insertion of cannula......            3    $1,814.26      $510.00  ...........      $102.00
36818..............  AV fuse, upper arm,                   3    $2,336.80      $510.00  ...........      $102.00
                      cephalic.
36819..............  Av fuse, uppr arm, basilic            3    $2,336.80      $510.00  ...........      $102.00
36820..............  Av fusion/forearm vein....            3    $2,336.80      $510.00  ...........      $102.00
36821..............  Av fusion direct any site.            3    $2,336.80      $510.00  ...........      $102.00

[[Page 49738]]

 
36825..............  Artery-vein autograft.....            4    $2,336.80      $630.00  ...........      $126.00
36830..............  Artery-vein nonautograft..            4    $2,336.80      $630.00  ...........      $126.00
36831..............  Open thrombect av fistula.            9    $2,336.80    $1,339.00  ...........      $267.80
36832..............  Av fistula revision, open.            4    $2,336.80      $630.00  ...........      $126.00
36833..............  Av fistula revision.......            4    $2,336.80      $630.00  ...........      $126.00
36834..............  Repair a-v aneurysm.......            3    $2,336.80      $510.00  ...........      $102.00
36835..............  Artery to vein shunt......            4    $1,814.26      $630.00  ...........      $126.00
36860..............  External cannula                      2      $126.87      $126.87  Y..........       $25.37
                      declotting.
36861..............  Cannula declotting........            3    $1,814.26      $510.00  ...........      $102.00
36870..............  Percut thrombect av                   9    $1,908.11    $1,339.00  ...........      $267.80
                      fistula.
37205..............  Transcath IV stent,                   9    $4,067.31    $1,339.00  ...........      $267.80
                      percutan.
37206..............  Transcath IV stent/perc,              1    $4,067.31      $333.00  ...........       $66.60
                      add.
37500..............  Endoscopy ligate perf                 3    $2,131.38      $510.00  ...........      $102.00
                      veins.
37607..............  Ligation of a-v fistula...            3    $1,513.03      $510.00  ...........      $102.00
37609..............  Temporal artery procedure.            2      $920.58      $446.00  ...........       $89.20
37650..............  Revision of major vein....            2    $1,513.03      $446.00  ...........       $89.20
37700..............  Revise leg vein...........            2    $2,131.38      $446.00  ...........       $89.20
37718..............  Ligate/strip short leg                3    $2,131.38      $510.00  ...........      $102.00
                      vein.
37722..............  Ligate/strip long leg vein            3    $2,131.38      $510.00  ...........      $102.00
37735..............  Removal of leg veins/                 3    $2,131.38      $510.00  ...........      $102.00
                      lesion.
37760..............  Ligation, leg veins, open.            3    $1,513.03      $510.00  ...........      $102.00
37780..............  Revision of leg vein......            3    $1,513.03      $510.00  ...........      $102.00
37785..............  Ligate/divide/excise vein.            3    $1,513.03      $510.00  ...........      $102.00
37790..............  Penile venous occlusion...            3    $2,031.13      $510.00  ...........      $102.00
38300..............  Drainage, lymph node                  1      $672.04      $333.00  ...........       $66.60
                      lesion.
38305..............  Drainage, lymph node                  2    $1,075.21      $446.00  ...........       $89.20
                      lesion.
38308..............  Incision of lymph channels            2    $1,315.18      $446.00  ...........       $89.20
38500..............  Biopsy/removal, lymph                 2    $1,315.18      $446.00  ...........       $89.20
                      nodes.
38505..............  Needle biopsy, lymph nodes            1      $234.21      $234.21  Y..........       $46.84
38510..............  Biopsy/removal, lymph                 2    $1,315.18      $446.00  ...........       $89.20
                      nodes.
38520..............  Biopsy/removal, lymph                 2    $1,315.18      $446.00  ...........       $89.20
                      nodes.
38525..............  Biopsy/removal, lymph                 2    $1,315.18      $446.00  ...........       $89.20
                      nodes.
38530..............  Biopsy/removal, lymph                 2    $1,315.18      $446.00  ...........       $89.20
                      nodes.
38542..............  Explore deep node(s), neck            2    $2,285.28      $446.00  ...........       $89.20
38550..............  Removal, neck/armpit                  3    $1,315.18      $510.00  ...........      $102.00
                      lesion.
38555..............  Removal, neck/armpit                  4    $1,315.18      $630.00  ...........      $126.00
                      lesion.
38570..............  Laparoscopy, lymph node               9    $2,678.23    $1,339.00  ...........      $267.80
                      biop.
38571..............  Laparoscopy,                          9    $4,363.07    $1,339.00  ...........      $267.80
                      lymphadenectomy.
38572..............  Laparoscopy,                          9    $2,678.23    $1,339.00  ...........      $267.80
                      lymphadenectomy.
38740..............  Remove armpit lymph nodes.            2    $2,285.28      $446.00  ...........       $89.20
38745..............  Remove armpit lymph nodes.            4    $2,285.28      $630.00  ...........      $126.00
38760..............  Remove groin lymph nodes..            2    $1,315.18      $446.00  ...........       $89.20
40500..............  Partial excision of lip...            2    $1,012.48      $446.00  ...........       $89.20
40510..............  Partial excision of lip...            2    $1,425.30      $446.00  ...........       $89.20
40520..............  Partial excision of lip...            2    $1,012.48      $446.00  ...........       $89.20
40525..............  Reconstruct lip with flap.            2    $1,425.30      $446.00  ...........       $89.20
40527..............  Reconstruct lip with flap.            2    $1,425.30      $446.00  ...........       $89.20
40530..............  Partial removal of lip....            2    $1,425.30      $446.00  ...........       $89.20
40650..............  Repair lip................            3      $475.55      $475.55  Y..........       $95.11
40652..............  Repair lip................            3      $475.55      $475.55  Y..........       $95.11
40654..............  Repair lip................            3      $475.55      $475.55  Y..........       $95.11
40700..............  Repair cleft lip/nasal....            7    $2,324.90      $995.00  ...........      $199.00
40701..............  Repair cleft lip/nasal....            7    $2,324.90      $995.00  ...........      $199.00
40720..............  Repair cleft lip/nasal....            7    $2,324.90      $995.00  ...........      $199.00
40761..............  Repair cleft lip/nasal....            3    $2,324.90      $510.00  ...........      $102.00
40801..............  Drainage of mouth lesion..            2      $475.55      $446.00  ...........       $89.20
40814..............  Excise/repair mouth lesion            2    $1,012.48      $446.00  ...........       $89.20
40816..............  Excision of mouth lesion..            2    $1,425.30      $446.00  ...........       $89.20
40818..............  Excise oral mucosa for                1      $146.29      $146.29  Y..........       $29.26
                      graft.
40819..............  Excise lip or cheek fold..            1      $475.55      $333.00  ...........       $66.60
40831..............  Repair mouth laceration...            1      $475.55      $333.00  ...........       $66.60
40840..............  Reconstruction of mouth...            2    $1,425.30      $446.00  ...........       $89.20
40842..............  Reconstruction of mouth...            3    $1,425.30      $510.00  ...........      $102.00
40843..............  Reconstruction of mouth...            3    $1,425.30      $510.00  ...........      $102.00
40844..............  Reconstruction of mouth...            5    $2,324.90      $717.00  ...........      $143.40
40845..............  Reconstruction of mouth...            5    $2,324.90      $717.00  ...........      $143.40
41005..............  Drainage of mouth lesion..            1      $146.29      $146.29  Y..........       $29.26
41006..............  Drainage of mouth lesion..            1    $1,425.30      $333.00  ...........       $66.60
41007..............  Drainage of mouth lesion..            1    $1,012.48      $333.00  ...........       $66.60

[[Page 49739]]

 
41008..............  Drainage of mouth lesion..            1    $1,012.48      $333.00  ...........       $66.60
41009..............  Drainage of mouth lesion..            1      $146.29      $146.29  Y..........       $29.26
41010..............  Incision of tongue fold...            1      $475.55      $333.00  ...........       $66.60
41015..............  Drainage of mouth lesion..            1      $146.29      $146.29  Y..........       $29.26
41016..............  Drainage of mouth lesion..            1      $475.55      $333.00  ...........       $66.60
41017..............  Drainage of mouth lesion..            1      $475.55      $333.00  ...........       $66.60
41018..............  Drainage of mouth lesion..            1      $475.55      $333.00  ...........       $66.60
41112..............  Excision of tongue lesion.            2    $1,012.48      $446.00  ...........       $89.20
41113..............  Excision of tongue lesion.            2    $1,012.48      $446.00  ...........       $89.20
41114..............  Excision of tongue lesion.            2    $1,425.30      $446.00  ...........       $89.20
41116..............  Excision of mouth lesion..            1    $1,012.48      $333.00  ...........       $66.60
41120..............  Partial removal of tongue.            5    $1,425.30      $717.00  ...........      $143.40
41250..............  Repair tongue laceration..            2      $146.29      $146.29  Y..........       $29.26
41251..............  Repair tongue laceration..            2      $146.29      $146.29  Y..........       $29.26
41252..............  Repair tongue laceration..            2      $475.55      $446.00  ...........       $89.20
41500..............  Fixation of tongue........            1    $1,425.30      $333.00  ...........       $66.60
41510..............  Tongue to lip surgery.....            1    $1,012.48      $333.00  ...........       $66.60
41520..............  Reconstruction, tongue                2      $475.55      $446.00  ...........       $89.20
                      fold.
41800..............  Drainage of gum lesion....            1       $91.22       $91.22  Y..........       $18.24
41827..............  Excision of gum lesion....            2    $1,425.30      $446.00  ...........       $89.20
42000..............  Drainage mouth roof lesion            2      $146.29      $146.29  Y..........       $29.26
42107..............  Excision lesion, mouth                2    $1,425.30      $446.00  ...........       $89.20
                      roof.
42120..............  Remove palate/lesion......            4    $2,324.90      $630.00  ...........      $126.00
42140..............  Excision of uvula.........            2      $475.55      $446.00  ...........       $89.20
42145..............  Repair palate, pharynx/               5    $1,425.30      $717.00  ...........      $143.40
                      uvula.
42180..............  Repair palate.............            1      $146.29      $146.29  Y..........       $29.26
42182..............  Repair palate.............            2    $2,324.90      $446.00  ...........       $89.20
42200..............  Reconstruct cleft palate..            5    $2,324.90      $717.00  ...........      $143.40
42205..............  Reconstruct cleft palate..            5    $2,324.90      $717.00  ...........      $143.40
42210..............  Reconstruct cleft palate..            5    $2,324.90      $717.00  ...........      $143.40
42215..............  Reconstruct cleft palate..            7    $2,324.90      $995.00  ...........      $199.00
42220..............  Reconstruct cleft palate..            5    $2,324.90      $717.00  ...........      $143.40
42226..............  Lengthening of palate.....            5    $2,324.90      $717.00  ...........      $143.40
42235..............  Repair palate.............            5    $1,012.48      $717.00  ...........      $143.40
42260..............  Repair nose to lip fistula            4    $1,425.30      $630.00  ...........      $126.00
42300..............  Drainage of salivary gland            1    $1,012.48      $333.00  ...........       $66.60
42305..............  Drainage of salivary gland            2    $1,012.48      $446.00  ...........       $89.20
42310..............  Drainage of salivary gland            1      $146.29      $146.29  Y..........       $29.26
42320..............  Drainage of salivary gland            1      $146.29      $146.29  Y..........       $29.26
42340..............  Removal of salivary stone.            2    $1,012.48      $446.00  ...........       $89.20
42405..............  Biopsy of salivary gland..            2    $1,012.48      $446.00  ...........       $89.20
42408..............  Excision of salivary cyst.            3    $1,012.48      $510.00  ...........      $102.00
42409..............  Drainage of salivary cyst.            3    $1,012.48      $510.00  ...........      $102.00
42410..............  Excise parotid gland/                 3    $2,324.90      $510.00  ...........      $102.00
                      lesion.
42415..............  Excise parotid gland/                 7    $2,324.90      $995.00  ...........      $199.00
                      lesion.
42420..............  Excise parotid gland/                 7    $2,324.90      $995.00  ...........      $199.00
                      lesion.
42425..............  Excise parotid gland/                 7    $2,324.90      $995.00  ...........      $199.00
                      lesion.
42440..............  Excise submaxillary gland.            3    $2,324.90      $510.00  ...........      $102.00
42450..............  Excise sublingual gland...            2    $1,425.30      $446.00  ...........       $89.20
42500..............  Repair salivary duct......            3    $1,425.30      $510.00  ...........      $102.00
42505..............  Repair salivary duct......            4    $2,324.90      $630.00  ...........      $126.00
42507..............  Parotid duct diversion....            3    $2,324.90      $510.00  ...........      $102.00
42508..............  Parotid duct diversion....            4    $2,324.90      $630.00  ...........      $126.00
42509..............  Parotid duct diversion....            4    $2,324.90      $630.00  ...........      $126.00
42510..............  Parotid duct diversion....            4    $2,324.90      $630.00  ...........      $126.00
42600..............  Closure of salivary                   1    $1,012.48      $333.00  ...........       $66.60
                      fistula.
42665..............  Ligation of salivary duct.            7    $1,425.30      $995.00  ...........      $199.00
42700..............  Drainage of tonsil abscess            1      $146.29      $146.29  Y..........       $29.26
42720..............  Drainage of throat abscess            1    $1,012.48      $333.00  ...........       $66.60
42725..............  Drainage of throat abscess            2    $2,324.90      $446.00  ...........       $89.20
42802..............  Biopsy of throat..........            1    $1,012.48      $333.00  ...........       $66.60
42804..............  Biopsy of upper nose/                 1    $1,012.48      $333.00  ...........       $66.60
                      throat.
42806..............  Biopsy of upper nose/                 2    $1,425.30      $446.00  ...........       $89.20
                      throat.
42808..............  Excise pharynx lesion.....            2    $1,012.48      $446.00  ...........       $89.20
42810..............  Excision of neck cyst.....            3    $1,425.30      $510.00  ...........      $102.00
42815..............  Excision of neck cyst.....            5    $2,324.90      $717.00  ...........      $143.40
42820..............  Remove tonsils and                    3    $1,401.87      $510.00  ...........      $102.00
                      adenoids.
42821..............  Remove tonsils and                    5    $1,401.87      $717.00  ...........      $143.40
                      adenoids.
42825..............  Removal of tonsils........            4    $1,401.87      $630.00  ...........      $126.00

[[Page 49740]]

 
42826..............  Removal of tonsils........            4    $1,401.87      $630.00  ...........      $126.00
42830..............  Removal of adenoids.......            4    $1,401.87      $630.00  ...........      $126.00
42831..............  Removal of adenoids.......            4    $1,401.87      $630.00  ...........      $126.00
42835..............  Removal of adenoids.......            4    $1,401.87      $630.00  ...........      $126.00
42836..............  Removal of adenoids.......            4    $1,401.87      $630.00  ...........      $126.00
42860..............  Excision of tonsil tags...            3    $1,401.87      $510.00  ...........      $102.00
42870..............  Excision of lingual tonsil            3    $1,401.87      $510.00  ...........      $102.00
42890..............  Partial removal of pharynx            7    $2,324.90      $995.00  ...........      $199.00
42892..............  Revision of pharyngeal                7    $2,324.90      $995.00  ...........      $199.00
                      walls.
42900..............  Repair throat wound.......            1      $475.55      $333.00  ...........       $66.60
42950..............  Reconstruction of throat..            2    $1,425.30      $446.00  ...........       $89.20
42955..............  Surgical opening of throat            2    $1,425.30      $446.00  ...........       $89.20
42960..............  Control throat bleeding...            1       $73.99       $73.99  Y..........       $14.80
42962..............  Control throat bleeding...            2    $2,324.90      $446.00  ...........       $89.20
42972..............  Control nose/throat                   3    $1,012.48      $510.00  ...........      $102.00
                      bleeding.
43200..............  Esophagus endoscopy.......            1      $511.30      $333.00  ...........       $66.60
43201..............  Esoph scope w/submucous               1      $511.30      $333.00  ...........       $66.60
                      inj.
43202..............  Esophagus endoscopy,                  1      $511.30      $333.00  ...........       $66.60
                      biopsy.
43204..............  Esoph scope w/sclerosis               1      $511.30      $333.00  ...........       $66.60
                      inj.
43205..............  Esophagus endoscopy/                  1      $511.30      $333.00  ...........       $66.60
                      ligation.
43215..............  Esophagus endoscopy.......            1      $511.30      $333.00  ...........       $66.60
43216..............  Esophagus endoscopy/lesion            1      $511.30      $333.00  ...........       $66.60
43217..............  Esophagus endoscopy.......            1      $511.30      $333.00  ...........       $66.60
43219..............  Esophagus endoscopy.......            1    $1,395.84      $333.00  ...........       $66.60
43220..............  Esoph endoscopy, dilation.            1      $511.30      $333.00  ...........       $66.60
43226..............  Esoph endoscopy, dilation.            1      $511.30      $333.00  ...........       $66.60
43227..............  Esoph endoscopy, repair...            2      $511.30      $446.00  ...........       $89.20
43228..............  Esoph endoscopy, ablation.            2    $1,695.69      $446.00  ...........       $89.20
43231..............  Esoph endoscopy w/us exam.            2      $511.30      $446.00  ...........       $89.20
43232..............  Esoph endoscopy w/us fn bx            2      $511.30      $446.00  ...........       $89.20
43234..............  Upper gi endoscopy, exam..            1      $511.30      $333.00  ...........       $66.60
43235..............  Uppr gi endoscopy,                    1      $511.30      $333.00  ...........       $66.60
                      diagnosis.
43236..............  Uppr gi scope w/submuc inj            2      $511.30      $446.00  ...........       $89.20
43237..............  Endoscopic us exam, esoph.            2      $511.30      $446.00  ...........       $89.20
43238..............  Uppr gi endoscopy w/us fn             2      $511.30      $446.00  ...........       $89.20
                      bx.
43239..............  Upper gi endoscopy, biopsy            2      $511.30      $446.00  ...........       $89.20
43240..............  Esoph endoscope w/drain               2      $511.30      $446.00  ...........       $89.20
                      cyst.
43241..............  Upper gi endoscopy with               2      $511.30      $446.00  ...........       $89.20
                      tube.
43242..............  Uppr gi endoscopy w/us fn             2      $511.30      $446.00  ...........       $89.20
                      bx.
43243..............  Upper gi endoscopy &                  2      $511.30      $446.00  ...........       $89.20
                      inject.
43244..............  Upper gi endoscopy/                   2      $511.30      $446.00  ...........       $89.20
                      ligation.
43245..............  Uppr gi scope dilate                  2      $511.30      $446.00  ...........       $89.20
                      strictr.
43246..............  Place gastrostomy tube....            2      $511.30      $446.00  ...........       $89.20
43247..............  Operative upper gi                    2      $511.30      $446.00  ...........       $89.20
                      endoscopy.
43248..............  Uppr gi endoscopy/guide               2      $511.30      $446.00  ...........       $89.20
                      wire.
43249..............  Esoph endoscopy, dilation.            2      $511.30      $446.00  ...........       $89.20
43250..............  Upper gi endoscopy/tumor..            2      $511.30      $446.00  ...........       $89.20
43251..............  Operative upper gi                    2      $511.30      $446.00  ...........       $89.20
                      endoscopy.
43255..............  Operative upper gi                    2      $511.30      $446.00  ...........       $89.20
                      endoscopy.
43256..............  Uppr gi endoscopy w/stent.            3    $1,395.84      $510.00  ...........      $102.00
43258..............  Operative upper gi                    3      $511.30      $510.00  ...........      $102.00
                      endoscopy.
43259..............  Endoscopic ultrasound exam            3      $511.30      $510.00  ...........      $102.00
43260..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43261..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43262..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43263..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43264..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43265..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43267..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43268..............  Endo                                  2    $1,395.84      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43269..............  Endo                                  2    $1,395.84      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43271..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43272..............  Endo                                  2    $1,219.48      $446.00  ...........       $89.20
                      cholangiopancreatograph.
43450..............  Dilate esophagus..........            1      $327.05      $327.05  Y..........       $65.41
43453..............  Dilate esophagus..........            1      $327.05      $327.05  Y..........       $65.41
43456..............  Dilate esophagus..........            2      $327.05      $327.05  Y..........       $65.41
43458..............  Dilate esophagus..........            2      $327.05      $327.05  Y..........       $65.41
43600..............  Biopsy of stomach.........            1      $511.30      $333.00  ...........       $66.60
43653..............  Laparoscopy, gastrostomy..            9    $2,678.23    $1,339.00  ...........      $267.80

[[Page 49741]]

 
43750..............  Place gastrostomy tube....            2      $511.30      $446.00  ...........       $89.20
43760..............  Change gastrostomy tube...            1      $144.22      $144.22  Y..........       $28.84
43761..............  Reposition gastrostomy                1      $448.45      $333.00  ...........       $66.60
                      tube.
43870..............  Repair stomach opening....            1      $511.30      $333.00  ...........       $66.60
44100..............  Biopsy of bowel...........            1      $511.30      $333.00  ...........       $66.60
44312..............  Revision of ileostomy.....            1    $1,308.85      $333.00  ...........       $66.60
44340..............  Revision of colostomy.....            3    $1,308.85      $510.00  ...........      $102.00
44360..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44361..............  Small bowel endoscopy/                2      $577.83      $446.00  ...........       $89.20
                      biopsy.
44363..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44364..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44365..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44366..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44369..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44370..............  Small bowel endoscopy/                9    $1,395.84    $1,339.00  ...........      $267.80
                      stent.
44372..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44373..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44376..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44377..............  Small bowel endoscopy/                2      $577.83      $446.00  ...........       $89.20
                      biopsy.
44378..............  Small bowel endoscopy.....            2      $577.83      $446.00  ...........       $89.20
44379..............  Sbowel endoscope w/stent..            9    $1,395.84    $1,339.00  ...........      $267.80
44380..............  Small bowel endoscopy.....            1      $577.83      $333.00  ...........       $66.60
44382..............  Small bowel endoscopy.....            1      $577.83      $333.00  ...........       $66.60
44383..............  Ileoscopy w/stent.........            9    $1,395.84    $1,339.00  ...........      $267.80
44385..............  Endoscopy of bowel pouch..            1      $542.53      $333.00  ...........       $66.60
44386..............  Endoscopy, bowel pouch/               1      $542.53      $333.00  ...........       $66.60
                      biop.
44388..............  Colonoscopy...............            1      $542.53      $333.00  ...........       $66.60
44389..............  Colonoscopy with biopsy...            1      $542.53      $333.00  ...........       $66.60
44390..............  Colonoscopy for foreign               1      $542.53      $333.00  ...........       $66.60
                      body.
44391..............  Colonoscopy for bleeding..            1      $542.53      $333.00  ...........       $66.60
44392..............  Colonoscopy & polypectomy.            1      $542.53      $333.00  ...........       $66.60
44393..............  Colonoscopy, lesion                   1      $542.53      $333.00  ...........       $66.60
                      removal.
44394..............  Colonoscopy w/snare.......            1      $542.53      $333.00  ...........       $66.60
44397..............  Colonoscopy w/stent.......            1    $1,395.84      $333.00  ...........       $66.60
45000..............  Drainage of pelvic abscess            1      $301.42      $301.42  Y..........       $60.28
45005..............  Drainage of rectal abscess            2      $792.64      $446.00  ...........       $89.20
45020..............  Drainage of rectal abscess            2      $792.64      $446.00  ...........       $89.20
45100..............  Biopsy of rectum..........            1    $1,368.50      $333.00  ...........       $66.60
45108..............  Removal of anorectal                  2    $1,368.50      $446.00  ...........       $89.20
                      lesion.
45150..............  Excision of rectal                    2    $1,368.50      $446.00  ...........       $89.20
                      stricture.
45160..............  Excision of rectal lesion.            2    $1,368.50      $446.00  ...........       $89.20
45170..............  Excision of rectal lesion.            2    $1,368.50      $446.00  ...........       $89.20
45190..............  Destruction, rectal tumor.            9    $1,368.50    $1,339.00  ...........      $267.80
45305..............  Proctosigmoidoscopy w/bx..            1      $527.15      $333.00  ...........       $66.60
45307..............  Proctosigmoidoscopy fb....            1    $1,261.19      $333.00  ...........       $66.60
45308..............  Proctosigmoidoscopy                   1      $527.15      $333.00  ...........       $66.60
                      removal.
45309..............  Proctosigmoidoscopy                   1      $527.15      $333.00  ...........       $66.60
                      removal.
45315..............  Proctosigmoidoscopy                   1      $527.15      $333.00  ...........       $66.60
                      removal.
45317..............  Proctosigmoidoscopy bleed.            1      $527.15      $333.00  ...........       $66.60
45320..............  Proctosigmoidoscopy ablate            1    $1,261.19      $333.00  ...........       $66.60
45321..............  Proctosigmoidoscopy volvul            1    $1,261.19      $333.00  ...........       $66.60
45327..............  Proctosigmoidoscopy w/                1    $1,395.84      $333.00  ...........       $66.60
                      stent.
45331..............  Sigmoidoscopy and biopsy..            1      $295.48      $295.48  Y..........       $59.10
45332..............  Sigmoidoscopy w/fb removal            1      $295.48      $295.48  Y..........       $59.10
45333..............  Sigmoidoscopy &                       1      $527.15      $333.00  ...........       $66.60
                      polypectomy.
45334..............  Sigmoidoscopy for bleeding            1      $527.15      $333.00  ...........       $66.60
45335..............  Sigmoidoscopy w/submuc inj            1      $295.48      $295.48  Y..........       $59.10
45337..............  Sigmoidoscopy & decompress            1      $295.48      $295.48  Y..........       $59.10
45338..............  Sigmoidoscopy w/tumr                  1      $527.15      $333.00  ...........       $66.60
                      remove.
45339..............  Sigmoidoscopy w/ablate                1      $527.15      $333.00  ...........       $66.60
                      tumr.
45340..............  Sig w/balloon dilation....            1      $527.15      $333.00  ...........       $66.60
45341..............  Sigmoidoscopy w/ultrasound            1      $527.15      $333.00  ...........       $66.60
45342..............  Sigmoidoscopy w/us guide              1      $527.15      $333.00  ...........       $66.60
                      bx.
45345..............  Sigmoidoscopy w/stent.....            1    $1,395.84      $333.00  ...........       $66.60
45355..............  Surgical colonoscopy......            1      $542.53      $333.00  ...........       $66.60
45378..............  Diagnostic colonoscopy....            2      $542.53      $446.00  ...........       $89.20
45379..............  Colonoscopy w/fb removal..            2      $542.53      $446.00  ...........       $89.20
45380..............  Colonoscopy and biopsy....            2      $542.53      $446.00  ...........       $89.20
45381..............  Colonoscopy, submucous inj            2      $542.53      $446.00  ...........       $89.20

[[Page 49742]]

 
45382..............  Colonoscopy/control                   2      $542.53      $446.00  ...........       $89.20
                      bleeding.
45383..............  Lesion removal colonoscopy            2      $542.53      $446.00  ...........       $89.20
45384..............  Lesion remove colonoscopy.            2      $542.53      $446.00  ...........       $89.20
45385..............  Lesion removal colonoscopy            2      $542.53      $446.00  ...........       $89.20
45386..............  Colonoscopy dilate                    2      $542.53      $446.00  ...........       $89.20
                      stricture.
45387..............  Colonoscopy w/stent.......            1    $1,395.84      $333.00  ...........       $66.60
45391..............  Colonoscopy w/endoscope us            2      $542.53      $446.00  ...........       $89.20
45392..............  Colonoscopy w/endoscopic              2      $542.53      $446.00  ...........       $89.20
                      fnb.
45500..............  Repair of rectum..........            2    $1,368.50      $446.00  ...........       $89.20
45505..............  Repair of rectum..........            2    $1,811.98      $446.00  ...........       $89.20
45560..............  Repair of rectocele.......            2    $1,811.98      $446.00  ...........       $89.20
45900..............  Reduction of rectal                   1      $301.42      $301.42  Y..........       $60.28
                      prolapse.
45905..............  Dilation of anal sphincter            1    $1,368.50      $333.00  ...........       $66.60
45910..............  Dilation of rectal                    1    $1,368.50      $333.00  ...........       $66.60
                      narrowing.
45915..............  Remove rectal obstruction.            1      $301.42      $301.42  Y..........       $60.28
45990..............  Surg dx exam, anorcctal...            2      $301.42      $301.42  Y..........       $60.28
46020..............  Placement of seton........            3    $1,368.50      $510.00  ...........      $102.00
46030..............  Removal of rectal marker..            1      $301.42      $301.42  Y..........       $60.28
46040..............  Incision of rectal abscess            3    $1,368.50      $510.00  ...........      $102.00
46045..............  Incision of rectal abscess            2    $1,368.50      $446.00  ...........       $89.20
46050..............  Incision of anal abscess..            1      $301.42      $301.42  Y..........       $60.28
46060..............  Incision of rectal abscess            2    $1,368.50      $446.00  ...........       $89.20
46080..............  Incision of anal sphincter            3    $1,368.50      $510.00  ...........      $102.00
46200..............  Removal of anal fissure...            2    $1,368.50      $446.00  ...........       $89.20
46210..............  Removal of anal crypt.....            2    $1,368.50      $446.00  ...........       $89.20
46211..............  Removal of anal crypts....            2    $1,368.50      $446.00  ...........       $89.20
46220..............  Removal of anal tag.......            1    $1,368.50      $333.00  ...........       $66.60
46230..............  Removal of anal tags......            1    $1,368.50      $333.00  ...........       $66.60
46250..............  Hemorrhoidectomy..........            3    $1,368.50      $510.00  ...........      $102.00
46255..............  Hemorrhoidectomy..........            3    $1,368.50      $510.00  ...........      $102.00
46257..............  Remove hemorrhoids &                  3    $1,368.50      $510.00  ...........      $102.00
                      fissure.
46258..............  Remove hemorrhoids &                  3    $1,368.50      $510.00  ...........      $102.00
                      fistula.
46260..............  Hemorrhoidectomy..........            3    $1,368.50      $510.00  ...........      $102.00
46261..............  Remove hemorrhoids &                  4    $1,368.50      $630.00  ...........      $126.00
                      fissure.
46262..............  Remove hemorrhoids &                  4    $1,368.50      $630.00  ...........      $126.00
                      fistula.
46270..............  Removal of anal fistula...            3    $1,368.50      $510.00  ...........      $102.00
46275..............  Removal of anal fistula...            3    $1,368.50      $510.00  ...........      $102.00
46280..............  Removal of anal fistula...            4    $1,368.50      $630.00  ...........      $126.00
46285..............  Removal of anal fistula...            1    $1,368.50      $333.00  ...........       $66.60
46288..............  Repair anal fistula.......            4    $1,368.50      $630.00  ...........      $126.00
46608..............  Anoscopy, remove for body.            1      $527.15      $333.00  ...........       $66.60
46610..............  Anoscopy, remove lesion...            1    $1,261.19      $333.00  ...........       $66.60
46611..............  Anoscopy..................            1      $527.15      $333.00  ...........       $66.60
46612..............  Anoscopy, remove lesions..            1    $1,261.19      $333.00  ...........       $66.60
46615..............  Anoscopy..................            2    $1,261.19      $446.00  ...........       $89.20
46700..............  Repair of anal stricture..            3    $1,368.50      $510.00  ...........      $102.00
46706..............  Repr of anal fistula w/               1    $1,811.98      $333.00  ...........       $66.60
                      glue.
46750..............  Repair of anal sphincter..            3    $2,292.31      $510.00  ...........      $102.00
46753..............  Reconstruction of anus....            3    $1,368.50      $510.00  ...........      $102.00
46754..............  Removal of suture from                2    $1,368.50      $446.00  ...........       $89.20
                      anus.
46760..............  Repair of anal sphincter..            2    $2,292.31      $446.00  ...........       $89.20
46761..............  Repair of anal sphincter..            3    $2,292.31      $510.00  ...........      $102.00
46762..............  Implant artificial                    7    $2,292.31      $995.00  ...........      $199.00
                      sphincter.
46917..............  Laser surgery, anal                   1    $1,266.73      $333.00  ...........       $66.60
                      lesions.
46922..............  Excision of anal lesion(s)            1    $1,266.73      $333.00  ...........       $66.60
46924..............  Destruction, anal                     1    $1,266.73      $333.00  ...........       $66.60
                      lesion(s).
46937..............  Cryotherapy of rectal                 2    $1,368.50      $446.00  ...........       $89.20
                      lesion.
46938..............  Cryotherapy of rectal                 2    $1,811.98      $446.00  ...........       $89.20
                      lesion.
46946..............  Ligation of hemorrhoids...            1      $792.64      $333.00  ...........       $66.60
46947..............  Hemorrhoidopexy by                    7    $1,811.98      $995.00  ...........      $199.00
                      stapling.
47000..............  Needle biopsy of liver....            1      $373.79      $333.00  ...........       $66.60
47510..............  Insert catheter, bile duct            2    $1,197.26      $446.00  ...........       $89.20
47511..............  Insert bile duct drain....            9    $1,197.26    $1,197.26  Y..........      $239.45
47525..............  Change bile duct catheter.            1      $709.19      $333.00  ...........       $66.60
47530..............  Revise/reinsert bile tube.            1      $709.19      $333.00  ...........       $66.60
47552..............  Biliary endoscopy thru                2    $1,197.26      $446.00  ...........       $89.20
                      skin.
47553..............  Biliary endoscopy thru                3    $1,197.26      $510.00  ...........      $102.00
                      skin.
47554..............  Biliary endoscopy thru                3    $1,197.26      $510.00  ...........      $102.00
                      skin.
47555..............  Biliary endoscopy thru                3    $1,197.26      $510.00  ...........      $102.00
                      skin.

[[Page 49743]]

 
47556..............  Biliary endoscopy thru                9    $1,197.26    $1,197.26  Y..........      $239.45
                      skin.
47560..............  Laparoscopy w/cholangio...            3    $1,965.65      $510.00  ...........      $102.00
47561..............  Laparo w/cholangio/biopsy.            3    $1,965.65      $510.00  ...........      $102.00
47630..............  Remove bile duct stone....            3    $1,197.26      $510.00  ...........      $102.00
48102..............  Needle biopsy, pancreas...            1      $373.79      $333.00  ...........       $66.60
49080..............  Puncture, peritoneal                  2      $224.20      $224.20  Y..........       $44.84
                      cavity.
49081..............  Removal of abdominal fluid            2      $224.20      $224.20  Y..........       $44.84
49085..............  Remove abdomen foreign                2    $1,364.94      $446.00  ...........       $89.20
                      body.
49180..............  Biopsy, abdominal mass....            1      $373.79      $333.00  ...........       $66.60
49250..............  Excision of umbilicus.....            4    $1,364.94      $630.00  ...........      $126.00
49320..............  Diag laparo separate proc.            3    $1,965.65      $510.00  ...........      $102.00
49321..............  Laparoscopy, biopsy.......            4    $1,965.65      $630.00  ...........      $126.00
49322..............  Laparoscopy, aspiration...            4    $1,965.65      $630.00  ...........      $126.00
49419..............  Insrt abdom cath for                  1    $1,814.26      $333.00  ...........       $66.60
                      chemotx.
49420..............  Insert abdom drain, temp..            1    $1,798.88      $333.00  ...........       $66.60
49421..............  Insert abdom drain, perm..            1    $1,798.88      $333.00  ...........       $66.60
49422..............  Remove perm cannula/                  1    $1,444.39      $333.00  ...........       $66.60
                      catheter.
49426..............  Revise abdomen-venous                 2    $1,364.94      $446.00  ...........       $89.20
                      shunt.
49495..............  Rpr ing hernia baby, reduc            4    $1,794.16      $630.00  ...........      $126.00
49496..............  Rpr ing hernia baby,                  4    $1,794.16      $630.00  ...........      $126.00
                      blocked.
49500..............  Rpr ing hernia, init,                 4    $1,794.16      $630.00  ...........      $126.00
                      reduce.
49501..............  Rpr ing hernia, init                  9    $1,794.16    $1,339.00  ...........      $267.80
                      blocked.
49505..............  Prp i/hern init reduc > 5             4    $1,794.16      $630.00  ...........      $126.00
                      yr.
49507..............  Prp i/hern init block > 5             9    $1,794.16    $1,339.00  ...........      $267.80
                      yr.
49520..............  Rerepair ing hernia,                  7    $1,794.16      $995.00  ...........      $199.00
                      reduce.
49521..............  Rerepair ing hernia,                  9    $1,794.16    $1,339.00  ...........      $267.80
                      blocked.
49525..............  Repair ing hernia, sliding            4    $1,794.16      $630.00  ...........      $126.00
49540..............  Repair lumbar hernia......            2    $1,794.16      $446.00  ...........       $89.20
49550..............  Rpr rem hernia, init,                 5    $1,794.16      $717.00  ...........      $143.40
                      reduce.
49553..............  Rpr fem hernia, init                  9    $1,794.16    $1,339.00  ...........      $267.80
                      blocked.
49555..............  Rerepair fem hernia,                  5    $1,794.16      $717.00  ...........      $143.40
                      reduce.
49557..............  Rerepair fem hernia,                  9    $1,794.16    $1,339.00  ...........      $267.80
                      blocked.
49560..............  Rpr ventral hern init,                4    $1,794.16      $630.00  ...........      $126.00
                      reduc.
49561..............  Rpr ventral hern init,                9    $1,794.16    $1,339.00  ...........      $267.80
                      block.
49565..............  Rerepair ventrl hern,                 4    $1,794.16      $630.00  ...........      $126.00
                      reduce.
49566..............  Rerepair ventrl hern,                 9    $1,794.16    $1,339.00  ...........      $267.80
                      block.
49568..............  Hernia repair w/mesh......            7    $1,794.16      $995.00  ...........      $199.00
49570..............  Rpr epigastric hern,                  4    $1,794.16      $630.00  ...........      $126.00
                      reduce.
49572..............  Rpr epigastric hern,                  9    $1,794.16    $1,339.00  ...........      $267.80
                      blocked.
49580..............  Rpr umbil hern, reduc < 5             4    $1,794.16      $630.00  ...........      $126.00
                      yr.
49582..............  Rpr umbil hern, block < 5             9    $1,794.16    $1,339.00  ...........      $267.80
                      yr.
49585..............  Rpr umbil hern, reduc > 5             4    $1,794.16      $630.00  ...........      $126.00
                      yr.
49587..............  Rpr umbil hern, block > 5             9    $1,794.16    $1,339.00  ...........      $267.80
                      yr.
49590..............  Repair spigelian hernia...            3    $1,794.16      $510.00  ...........      $102.00
49600..............  Repair umbilical lesion...            4    $1,794.16      $630.00  ...........      $126.00
49650..............  Laparo hernia repair                  4    $2,678.23      $630.00  ...........      $126.00
                      initial.
49651..............  Laparo hernia repair recur            7    $2,678.23      $995.00  ...........      $199.00
50200..............  Biopsy of kidney..........            1      $373.79      $333.00  ...........       $66.60
50390..............  Drainage of kidney lesion.            1      $373.79      $333.00  ...........       $66.60
50392..............  Insert kidney drain.......            1    $1,186.49      $333.00  ...........       $66.60
50393..............  Insert ureteral tube......            1    $1,186.49      $333.00  ...........       $66.60
50395..............  Create passage to kidney..            1    $1,186.49      $333.00  ...........       $66.60
50396..............  Measure kidney pressure...            1      $130.24      $130.24  Y..........       $26.05
50398..............  Change kidney tube........            1      $448.45      $333.00  ...........       $66.60
50551..............  Kidney endoscopy..........            1      $414.39      $333.00  ...........       $66.60
50553..............  Kidney endoscopy..........            1    $1,186.49      $333.00  ...........       $66.60
50555..............  Kidney endoscopy & biopsy.            1      $414.39      $333.00  ...........       $66.60
50557..............  Kidney endoscopy &                    1    $1,468.37      $333.00  ...........       $66.60
                      treatment.
50561..............  Kidney endoscopy &                    1    $1,186.49      $333.00  ...........       $66.60
                      treatment.
50688..............  Change of ureter tube/                1      $448.45      $333.00  ...........       $66.60
                      stent.
50947..............  Laparo new ureter/bladder.            9    $2,678.23    $1,339.00  ...........      $267.80
50948..............  Laparo new ureter/bladder.            9    $2,678.23    $1,339.00  ...........      $267.80
50951..............  Endoscopy of ureter.......            1      $414.39      $333.00  ...........       $66.60
50953..............  Endoscopy of ureter.......            1      $414.39      $333.00  ...........       $66.60
50955..............  Ureter endoscopy & biopsy.            1    $1,186.49      $333.00  ...........       $66.60
50957..............  Ureter endoscopy &                    1    $1,186.49      $333.00  ...........       $66.60
                      treatment.
50961..............  Ureter endoscopy &                    1    $1,186.49      $333.00  ...........       $66.60
                      treatment.
50970..............  Ureter endoscopy..........            1      $414.39      $333.00  ...........       $66.60
50972..............  Ureter endoscopy &                    1      $414.39      $333.00  ...........       $66.60
                      catheter.

[[Page 49744]]

 
50974..............  Ureter endoscopy & biopsy.            1    $1,186.49      $333.00  ...........       $66.60
50976..............  Ureter endoscopy &                    1    $1,186.49      $333.00  ...........       $66.60
                      treatment.
50980..............  Ureter endoscopy &                    1    $1,186.49      $333.00  ...........       $66.60
                      treatment.
51010..............  Drainage of bladder.......            1    $1,122.28      $333.00  ...........       $66.60
51020..............  Incise & treat bladder....            4    $1,468.37      $630.00  ...........      $126.00
51030..............  Incise & treat bladder....            4    $1,468.37      $630.00  ...........      $126.00
51040..............  Incise & drain bladder....            4    $1,468.37      $630.00  ...........      $126.00
51045..............  Incise bladder/drain                  4      $414.39      $414.39  Y..........       $82.88
                      ureter.
51050..............  Removal of bladder stone..            4    $1,468.37      $630.00  ...........      $126.00
51065..............  Remove ureter calculus....            4    $1,468.37      $630.00  ...........      $126.00
51080..............  Drainage of bladder                   1    $1,075.21      $333.00  ...........       $66.60
                      abscess.
51500..............  Removal of bladder cyst...            4    $1,794.16      $630.00  ...........      $126.00
51520..............  Removal of bladder lesion.            4    $1,468.37      $630.00  ...........      $126.00
51710..............  Change of bladder tube....            1      $448.45      $333.00  ...........       $66.60
51715..............  Endoscopic injection/                 3    $1,760.18      $510.00  ...........      $102.00
                      implant.
51726..............  Complex cystometrogram....            1      $219.66      $219.66  Y..........       $43.93
51772..............  Urethra pressure profile..            1      $130.24      $130.24  Y..........       $26.05
51785..............  Anal/urinary muscle study.            1       $66.75       $66.75  Y..........       $13.35
51880..............  Repair of bladder opening.            1    $1,468.37      $333.00  ...........       $66.60
51992..............  Laparo sling operation....            5    $2,678.23      $717.00  ...........      $143.40
52000..............  Cystoscopy................            1      $414.39      $333.00  ...........       $66.60
52001..............  Cystoscopy, removal of                2      $414.39      $414.39  Y..........       $82.88
                      clots.
52005..............  Cystoscopy & ureter                   2    $1,186.49      $446.00  ...........       $89.20
                      catheter.
52007..............  Cystoscopy and biopsy.....            2    $1,186.49      $446.00  ...........       $89.20
52010..............  Cystoscopy & duct catheter            2      $414.39      $414.39  Y..........       $82.88
52204..............  Cystoscopy................            2    $1,186.49      $446.00  ...........       $89.20
52214..............  Cystoscopy and treatment..            2    $1,468.37      $446.00  ...........       $89.20
52224..............  Cystoscopy and treatment..            2    $1,468.37      $446.00  ...........       $89.20
52234..............  Cystoscopy and treatment..            2    $1,468.37      $446.00  ...........       $89.20
52235..............  Cystoscopy and treatment..            3    $1,468.37      $510.00  ...........      $102.00
52240..............  Cystoscopy and treatment..            3    $1,468.37      $510.00  ...........      $102.00
52250..............  Cystoscopy and radiotracer            4    $1,468.37      $630.00  ...........      $126.00
52260..............  Cystoscopy and treatment..            2    $1,186.49      $446.00  ...........       $89.20
52270..............  Cystoscopy & revise                   2    $1,186.49      $446.00  ...........       $89.20
                      urethra.
52275..............  Cystoscopy & revise                   2    $1,186.49      $446.00  ...........       $89.20
                      urethra.
52276..............  Cystoscopy and treatment..            3    $1,186.49      $510.00  ...........      $102.00
52277..............  Cystoscopy and treatment..            2    $1,468.37      $446.00  ...........       $89.20
52281..............  Cystoscopy and treatment..            2    $1,186.49      $446.00  ...........       $89.20
52282..............  Cystoscopy, implant stent.            9    $2,160.59    $1,339.00  ...........      $267.80
52283..............  Cystoscopy and treatment..            2    $1,186.49      $446.00  ...........       $89.20
52285..............  Cystoscopy and treatment..            2    $1,186.49      $446.00  ...........       $89.20
52290..............  Cystoscopy and treatment..            2    $1,186.49      $446.00  ...........       $89.20
52300..............  Cystoscopy and treatment..            2    $1,186.49      $446.00  ...........       $89.20
52301..............  Cystoscopy and treatment..            3    $1,186.49      $510.00  ...........      $102.00
52305..............  Cystoscopy and treatment..            2    $1,186.49      $446.00  ...........       $89.20
52310..............  Cystoscopy and treatment..            2      $414.39      $414.39  Y..........       $82.88
52315..............  Cystoscopy and treatment..            2    $1,186.49      $446.00  ...........       $89.20
52317..............  Remove bladder stone......            1    $1,468.37      $333.00  ...........       $66.60
52318..............  Remove bladder stone......            2    $1,468.37      $446.00  ...........       $89.20
52320..............  Cystoscopy and treatment..            5    $1,468.37      $717.00  ...........      $143.40
52325..............  Cystoscopy, stone removal.            4    $1,468.37      $630.00  ...........      $126.00
52327..............  Cystoscopy, inject                    2    $1,468.37      $446.00  ...........       $89.20
                      material.
52330..............  Cystoscopy and treatment..            2    $1,468.37      $446.00  ...........       $89.20
52332..............  Cystoscopy and treatment..            2    $1,468.37      $446.00  ...........       $89.20
52334..............  Create passage to kidney..            3    $1,468.37      $510.00  ...........      $102.00
52341..............  Cysto w/ureter stricture              3    $1,468.37      $510.00  ...........      $102.00
                      tx.
52342..............  Cysto w/up stricture tx...            3    $1,468.37      $510.00  ...........      $102.00
52343..............  Cysto w/renal stricture tx            3    $1,468.37      $510.00  ...........      $102.00
52344..............  Cysto/uretero, stricture              3    $1,468.37      $510.00  ...........      $102.00
                      tx.
52345..............  Cysto/uretero w/up                    3    $1,468.37      $510.00  ...........      $102.00
                      stricture.
52346..............  Cystouretero w/renal                  3    $1,468.37      $510.00  ...........      $102.00
                      strict.
52351..............  Cystouretero & or                     3    $1,186.49      $510.00  ...........      $102.00
                      pyeloscope.
52352..............  Cystouretero w/stone                  4    $1,468.37      $630.00  ...........      $126.00
                      remove.
52353..............  Cystouretero w/lithotripsy            4    $2,160.59      $630.00  ...........      $126.00
52354..............  Cystouretero w/biopsy.....            4    $1,468.37      $630.00  ...........      $126.00
52355..............  Cystouretero w/excise                 4    $1,468.37      $630.00  ...........      $126.00
                      tumor.
52400..............  Cystouretero w/congen repr            3    $1,468.37      $510.00  ...........      $102.00
52402..............  Cystourethro cut ejacul               3    $1,468.37      $510.00  ...........      $102.00
                      duct.
52450..............  Incision of prostate......            3    $1,468.37      $510.00  ...........      $102.00

[[Page 49745]]

 
52500..............  Revision of bladder neck..            3    $1,468.37      $510.00  ...........      $102.00
52510..............  Dilation prostatic urethra            3    $1,186.49      $510.00  ...........      $102.00
52601..............  Prostatectomy (turp)......            4    $2,160.59      $630.00  ...........      $126.00
52606..............  Control postop bleeding...            1    $1,468.37      $333.00  ...........       $66.60
52612..............  Prostatectomy, first stage            2    $2,160.59      $446.00  ...........       $89.20
52614..............  Prostatectomy, second                 1    $2,160.59      $333.00  ...........       $66.60
                      stage.
52620..............  Remove residual prostate..            1    $2,160.59      $333.00  ...........       $66.60
52630..............  Remove prostate regrowth..            2    $2,160.59      $446.00  ...........       $89.20
52640..............  Relieve bladder                       2    $1,468.37      $446.00  ...........       $89.20
                      contracture.
52647..............  Laser surgery of prostate.            9    $2,642.55    $1,339.00  ...........      $267.80
52648..............  Laser surgery of prostate.            9    $2,642.55    $1,339.00  ...........      $267.80
52700..............  Drainage of prostate                  2    $1,468.37      $446.00  ...........       $89.20
                      abscess.
53000..............  Incision of urethra.......            1    $1,139.54      $333.00  ...........       $66.60
53010..............  Incision of urethra.......            1    $1,139.54      $333.00  ...........       $66.60
53020..............  Incision of urethra.......            1    $1,139.54      $333.00  ...........       $66.60
53040..............  Drainage of urethra                   2    $1,139.54      $446.00  ...........       $89.20
                      abscess.
53080..............  Drainage of urinary                   3    $1,139.54      $510.00  ...........      $102.00
                      leakage.
53200..............  Biopsy of urethra.........            1    $1,139.54      $333.00  ...........       $66.60
53210..............  Removal of urethra........            5    $1,760.18      $717.00  ...........      $143.40
53215..............  Removal of urethra........            5    $1,139.54      $717.00  ...........      $143.40
53220..............  Treatment of urethra                  2    $1,760.18      $446.00  ...........       $89.20
                      lesion.
53230..............  Removal of urethra lesion.            2    $1,760.18      $446.00  ...........       $89.20
53235..............  Removal of urethra lesion.            3    $1,139.54      $510.00  ...........      $102.00
53240..............  Surgery for urethra pouch.            2    $1,760.18      $446.00  ...........       $89.20
53250..............  Removal of urethra gland..            2    $1,139.54      $446.00  ...........       $89.20
53260..............  Treatment of urethra                  2    $1,139.54      $446.00  ...........       $89.20
                      lesion.
53265..............  Treatment of urethra                  2    $1,139.54      $446.00  ...........       $89.20
                      lesion.
53270..............  Removal of urethra gland..            2    $1,139.54      $446.00  ...........       $89.20
53275..............  Repair of urethra defect..            2    $1,139.54      $446.00  ...........       $89.20
53400..............  Revise urethra, stage 1...            3    $1,760.18      $510.00  ...........      $102.00
53405..............  Revise urethra, stage 2...            2    $1,760.18      $446.00  ...........       $89.20
53410..............  Reconstruction of urethra.            2    $1,760.18      $446.00  ...........       $89.20
53420..............  Reconstruct urethra, stage            3    $1,760.18      $510.00  ...........      $102.00
                      1.
53425..............  Reconstruct urethra, stage            2    $1,760.18      $446.00  ...........       $89.20
                      2.
53430..............  Reconstruction of urethra.            2    $1,760.18      $446.00  ...........       $89.20
53431..............  Reconstruct urethra/                  2    $1,760.18      $446.00  ...........       $89.20
                      bladder.
53440..............  Male sling procedure......            2    $4,885.49      $446.00  ...........       $89.20
53442..............  Remove/revise male sling..            1    $1,760.18      $333.00  ...........       $66.60
53444..............  Insert tandem cuff........            2    $4,885.49      $446.00  ...........       $89.20
53445..............  Insert uro/ves nck                    1    $8,354.29      $333.00  ...........       $66.60
                      sphincter.
53446..............  Remove uro sphincter......            1    $1,760.18      $333.00  ...........       $66.60
53447..............  Remove/replace ur                     1    $8,354.29      $333.00  ...........       $66.60
                      sphincter.
53449..............  Repair uro sphincter......            1    $1,760.18      $333.00  ...........       $66.60
53450..............  Revision of urethra.......            1    $1,760.18      $333.00  ...........       $66.60
53460..............  Revision of urethra.......            1    $1,139.54      $333.00  ...........       $66.60
53502..............  Repair of urethra injury..            2    $1,139.54      $446.00  ...........       $89.20
53505..............  Repair of urethra injury..            2    $1,760.18      $446.00  ...........       $89.20
53510..............  Repair of urethra injury..            2    $1,139.54      $446.00  ...........       $89.20
53515..............  Repair of urethra injury..            2    $1,760.18      $446.00  ...........       $89.20
53520..............  Repair of urethra defect..            2    $1,760.18      $446.00  ...........       $89.20
53605..............  Dilate urethra stricture..            2    $1,186.49      $446.00  ...........       $89.20
53665..............  Dilation of urethra.......            1    $1,139.54      $333.00  ...........       $66.60
54000..............  Slitting of prepuce.......            2    $1,139.54      $446.00  ...........       $89.20
54001..............  Slitting of prepuce.......            2    $1,139.54      $446.00  ...........       $89.20
54015..............  Drain penis lesion........            4    $1,075.21      $630.00  ...........      $126.00
54057..............  Laser surg, penis                     1    $1,091.87      $333.00  ...........       $66.60
                      lesion(s).
54060..............  Excision of penis                     1    $1,091.87      $333.00  ...........       $66.60
                      lesion(s).
54065..............  Destruction, penis                    1    $1,266.73      $333.00  ...........       $66.60
                      lesion(s).
54100..............  Biopsy of penis...........            1      $920.58      $333.00  ...........       $66.60
54105..............  Biopsy of penis...........            1    $1,229.54      $333.00  ...........       $66.60
54110..............  Treatment of penis lesion.            2    $2,031.13      $446.00  ...........       $89.20
54111..............  Treat penis lesion, graft.            2    $2,031.13      $446.00  ...........       $89.20
54112..............  Treat penis lesion, graft.            2    $2,031.13      $446.00  ...........       $89.20
54115..............  Treatment of penis lesion.            1    $1,075.21      $333.00  ...........       $66.60
54120..............  Partial removal of penis..            2    $2,031.13      $446.00  ...........       $89.20
54150..............  Circumcision..............            1    $1,276.68      $333.00  ...........       $66.60
54152..............  Circumcision..............            1    $1,276.68      $333.00  ...........       $66.60
54160..............  Circumcision..............            2    $1,276.68      $446.00  ...........       $89.20
54161..............  Circumcision..............            2    $1,276.68      $446.00  ...........       $89.20

[[Page 49746]]

 
54162..............  Lysis penil circumic                  2    $1,276.68      $446.00  ...........       $89.20
                      lesion.
54163..............  Repair of circumcision....            2    $1,276.68      $446.00  ...........       $89.20
54164..............  Frenulotomy of penis......            2    $1,276.68      $446.00  ...........       $89.20
54205..............  Treatment of penis lesion.            4    $2,031.13      $630.00  ...........      $126.00
54220..............  Treatment of penis lesion.            1      $130.24      $130.24  Y..........       $26.05
54300..............  Revision of penis.........            3    $2,031.13      $510.00  ...........      $102.00
54304..............  Revision of penis.........            3    $2,031.13      $510.00  ...........      $102.00
54308..............  Reconstruction of urethra.            3    $2,031.13      $510.00  ...........      $102.00
54312..............  Reconstruction of urethra.            3    $2,031.13      $510.00  ...........      $102.00
54316..............  Reconstruction of urethra.            3    $2,031.13      $510.00  ...........      $102.00
54318..............  Reconstruction of urethra.            3    $2,031.13      $510.00  ...........      $102.00
54322..............  Reconstruction of urethra.            3    $2,031.13      $510.00  ...........      $102.00
54324..............  Reconstruction of urethra.            3    $2,031.13      $510.00  ...........      $102.00
54326..............  Reconstruction of urethra.            3    $2,031.13      $510.00  ...........      $102.00
54328..............  Revise penis/urethra......            3    $2,031.13      $510.00  ...........      $102.00
54340..............  Secondary urethral surgery            3    $2,031.13      $510.00  ...........      $102.00
54344..............  Secondary urethral surgery            3    $2,031.13      $510.00  ...........      $102.00
54348..............  Secondary urethral surgery            3    $2,031.13      $510.00  ...........      $102.00
54352..............  Reconstruct urethra/penis.            3    $2,031.13      $510.00  ...........      $102.00
54360..............  Penis plastic surgery.....            3    $2,031.13      $510.00  ...........      $102.00
54380..............  Repair penis..............            3    $2,031.13      $510.00  ...........      $102.00
54385..............  Repair penis..............            3    $2,031.13      $510.00  ...........      $102.00
54400..............  Insert semi-rigid                     3    $4,885.49      $510.00  ...........      $102.00
                      prosthesis.
54401..............  Insert self-contd                     3    $8,354.29      $510.00  ...........      $102.00
                      prosthesis.
54405..............  Insert multi-comp penis               3    $8,354.29      $510.00  ...........      $102.00
                      pros.
54406..............  Remove muti-comp penis                3    $2,031.13      $510.00  ...........      $102.00
                      pros.
54408..............  Repair multi-comp penis               3    $2,031.13      $510.00  ...........      $102.00
                      pros.
54410..............  Remove/replace penis                  3    $8,354.29      $510.00  ...........      $102.00
                      prosth.
54415..............  Remove self-contd penis               3    $2,031.13      $510.00  ...........      $102.00
                      pros.
54416..............  Remv/repl penis contain               3    $8,354.29      $510.00  ...........      $102.00
                      pros.
54420..............  Revision of penis.........            4    $2,031.13      $630.00  ...........      $126.00
54435..............  Revision of penis.........            4    $2,031.13      $630.00  ...........      $126.00
54440..............  Repair of penis...........            4    $2,031.13      $630.00  ...........      $126.00
54450..............  Preputial stretching......            1      $219.66      $219.66  Y..........       $43.93
54500..............  Biopsy of testis..........            1      $631.61      $333.00  ...........       $66.60
54505..............  Biopsy of testis..........            1    $1,459.20      $333.00  ...........       $66.60
54512..............  Excise lesion testis......            2    $1,459.20      $446.00  ...........       $89.20
54520..............  Removal of testis.........            3    $1,459.20      $510.00  ...........      $102.00
54522..............  Orchiectomy, partial......            3    $1,459.20      $510.00  ...........      $102.00
54530..............  Removal of testis.........            4    $1,794.16      $630.00  ...........      $126.00
54550..............  Exploration for testis....            4    $1,794.16      $630.00  ...........      $126.00
54600..............  Reduce testis torsion.....            4    $1,459.20      $630.00  ...........      $126.00
54620..............  Suspension of testis......            3    $1,459.20      $510.00  ...........      $102.00
54640..............  Suspension of testis......            4    $1,794.16      $630.00  ...........      $126.00
54660..............  Revision of testis........            2    $1,459.20      $446.00  ...........       $89.20
54670..............  Repair testis injury......            3    $1,459.20      $510.00  ...........      $102.00
54680..............  Relocation of testis(es)..            3    $1,459.20      $510.00  ...........      $102.00
54690..............  Laparoscopy, orchiectomy..            9    $2,678.23    $1,339.00  ...........      $267.80
54700..............  Drainage of scrotum.......            2    $1,459.20      $446.00  ...........       $89.20
54800..............  Biopsy of epididymis......            1      $128.41      $128.41  Y..........       $25.68
54820..............  Exploration of epididymis.            1    $1,459.20      $333.00  ...........       $66.60
54830..............  Remove epididymis lesion..            3    $1,459.20      $510.00  ...........      $102.00
54840..............  Remove epididymis lesion..            4    $1,459.20      $630.00  ...........      $126.00
54860..............  Removal of epididymis.....            3    $1,459.20      $510.00  ...........      $102.00
54861..............  Removal of epididymis.....            4    $1,459.20      $630.00  ...........      $126.00
54900..............  Fusion of spermatic ducts.            4    $1,459.20      $630.00  ...........      $126.00
54901..............  Fusion of spermatic ducts.            4    $1,459.20      $630.00  ...........      $126.00
55040..............  Removal of hydrocele......            3    $1,794.16      $510.00  ...........      $102.00
55041..............  Removal of hydroceles.....            5    $1,794.16      $717.00  ...........      $143.40
55060..............  Repair of hydrocele.......            4    $1,459.20      $630.00  ...........      $126.00
55100..............  Drainage of scrotum                   1      $672.04      $333.00  ...........       $66.60
                      abscess.
55110..............  Explore scrotum...........            2    $1,459.20      $446.00  ...........       $89.20
55120..............  Removal of scrotum lesion.            2    $1,459.20      $446.00  ...........       $89.20
55150..............  Removal of scrotum........            1    $1,459.20      $333.00  ...........       $66.60
55175..............  Revision of scrotum.......            1    $1,459.20      $333.00  ...........       $66.60
55180..............  Revision of scrotum.......            2    $1,459.20      $446.00  ...........       $89.20
55200..............  Incision of sperm duct....            2    $1,459.20      $446.00  ...........       $89.20
55250..............  Removal of sperm duct(s)..            2    $1,459.20      $446.00  ...........       $89.20
55400..............  Repair of sperm duct......            1    $1,459.20      $333.00  ...........       $66.60

[[Page 49747]]

 
55500..............  Removal of hydrocele......            3    $1,459.20      $510.00  ...........      $102.00
55520..............  Removal of sperm cord                 4    $1,459.20      $630.00  ...........      $126.00
                      lesion.
55530..............  Revise spermatic cord                 4    $1,459.20      $630.00  ...........      $126.00
                      veins.
55535..............  Revise spermatic cord                 4    $1,794.16      $630.00  ...........      $126.00
                      veins.
55540..............  Revise hernia & sperm                 5    $1,794.16      $717.00  ...........      $143.40
                      veins.
55550..............  Laparo ligate spermatic               9    $2,678.23    $1,339.00  ...........      $267.80
                      vein.
55680..............  Remove sperm pouch lesion.            1    $1,459.20      $333.00  ...........       $66.60
55700..............  Biopsy of prostate........            2      $368.64      $368.64  Y..........       $73.73
55705..............  Biopsy of prostate........            2      $368.64      $368.64  Y..........       $73.73
55720..............  Drainage of prostate                  1    $1,468.37      $333.00  ...........       $66.60
                      abscess.
55725..............  Drainage of prostate                  2    $1,468.37      $446.00  ...........       $89.20
                      abscess.
55859..............  Percut/needle insert, pros            9    $2,160.59    $1,339.00  ...........      $267.80
55873..............  Cryoablate prostate.......            9    $6,637.03    $1,339.00  ...........      $267.80
56440..............  Surgery for vulva lesion..            2    $1,262.49      $446.00  ...........       $89.20
56441..............  Lysis of labial lesion(s).            1      $910.70      $333.00  ...........       $66.60
56515..............  Destroy vulva lesion/s                3    $1,266.73      $510.00  ...........      $102.00
                      compl.
56620..............  Partial removal of vulva..            5    $1,769.04      $717.00  ...........      $143.40
56625..............  Complete removal of vulva.            7    $1,769.04      $995.00  ...........      $199.00
56700..............  Partial removal of hymen..            1    $1,262.49      $333.00  ...........       $66.60
56720..............  Incision of hymen.........            1      $910.70      $333.00  ...........       $66.60
56740..............  Remove vagina gland lesion            3    $1,262.49      $510.00  ...........      $102.00
56800..............  Repair of vagina..........            3    $1,262.49      $510.00  ...........      $102.00
56810..............  Repair of perineum........            5    $1,262.49      $717.00  ...........      $143.40
57000..............  Exploration of vagina.....            1      $910.70      $333.00  ...........       $66.60
57010..............  Drainage of pelvic abscess            2      $910.70      $446.00  ...........       $89.20
57020..............  Drainage of pelvic fluid..            2      $426.33      $426.33  Y..........       $85.27
57023..............  I& d vag hematoma, non-ob.            1    $1,075.21      $333.00  ...........       $66.60
57065..............  Destroy vag lesions,                  1    $1,262.49      $333.00  ...........       $66.60
                      complex.
57105..............  Biopsy of vagina..........            2    $1,262.49      $446.00  ...........       $89.20
57130..............  Remove vagina lesion......            2    $1,262.49      $446.00  ...........       $89.20
57135..............  Remove vagina lesion......            2    $1,262.49      $446.00  ...........       $89.20
57155..............  Insert uteri tandems/                 2      $426.33      $426.33  Y..........       $85.27
                      ovoids.
57180..............  Treat vaginal bleeding....            1      $184.05      $184.05  Y..........       $36.81
57200..............  Repair of vagina..........            1    $1,262.49      $333.00  ...........       $66.60
57210..............  Repair vagina/perineum....            2    $1,262.49      $446.00  ...........       $89.20
57220..............  Revision of urethra.......            3    $2,639.04      $510.00  ...........      $102.00
57230..............  Repair of urethral lesion.            3    $1,769.04      $510.00  ...........      $102.00
57240..............  Repair bladder & vagina...            5    $1,769.04      $717.00  ...........      $143.40
57250..............  Repair rectum & vagina....            5    $1,769.04      $717.00  ...........      $143.40
57260..............  Repair of vagina..........            5    $1,769.04      $717.00  ...........      $143.40
57265..............  Extensive repair of vagina            7    $2,639.04      $995.00  ...........      $199.00
57268..............  Repair of bowel bulge.....            3    $1,769.04      $510.00  ...........      $102.00
57288..............  Repair bladder defect.....            5    $2,639.04      $717.00  ...........      $143.40
57289..............  Repair bladder & vagina...            5    $1,769.04      $717.00  ...........      $143.40
57291..............  Construction of vagina....            5    $1,769.04      $717.00  ...........      $143.40
57300..............  Repair rectum-vagina                  3    $1,769.04      $510.00  ...........      $102.00
                      fistula.
57400..............  Dilation of vagina........            2    $1,262.49      $446.00  ...........       $89.20
57410..............  Pelvic examination........            2      $910.70      $446.00  ...........       $89.20
57415..............  Remove vaginal foreign                2    $1,262.49      $446.00  ...........       $89.20
                      body.
57513..............  Laser surgery of cervix...            2      $910.70      $446.00  ...........       $89.20
57520..............  Conization of cervix......            2    $1,262.49      $446.00  ...........       $89.20
57522..............  Conization of cervix......            2    $1,769.04      $446.00  ...........       $89.20
57530..............  Removal of cervix.........            3    $1,769.04      $510.00  ...........      $102.00
57550..............  Removal of residual cervix            3    $1,769.04      $510.00  ...........      $102.00
57556..............  Remove cervix, repair                 5    $2,639.04      $717.00  ...........      $143.40
                      bowel.
57700..............  Revision of cervix........            1    $1,262.49      $333.00  ...........       $66.60
57720..............  Revision of cervix........            3    $1,262.49      $510.00  ...........      $102.00
57820..............  D& c of residual cervix...            3    $1,093.36      $510.00  ...........      $102.00
58120..............  Dilation and curettage....            2    $1,093.36      $446.00  ...........       $89.20
58145..............  Myomectomy vag method.....            5    $1,769.04      $717.00  ...........      $143.40
58346..............  Insert heyman uteri                   2      $910.70      $446.00  ...........       $89.20
                      capsule.
58350..............  Reopen fallopian tube.....            3    $1,769.04      $510.00  ...........      $102.00
58353..............  Endometr ablate, thermal..            4    $1,769.04      $630.00  ...........      $126.00
58545..............  Laparoscopic myomectomy...            9    $1,965.65    $1,339.00  ...........      $267.80
58546..............  Laparo-myomectomy, complex            9    $2,678.23    $1,339.00  ...........      $267.80
58550..............  Laparo-asst vag                       9    $4,363.07    $1,339.00  ...........      $267.80
                      hysterectomy.
58555..............  Hysteroscopy, dx, sep proc            1    $1,318.42      $333.00  ...........       $66.60
58558..............  Hysteroscopy, biopsy......            3    $1,318.42      $510.00  ...........      $102.00
58559..............  Hysteroscopy, lysis.......            2    $1,318.42      $446.00  ...........       $89.20

[[Page 49748]]

 
58560..............  Hysteroscopy, resect                  3    $2,049.83      $510.00  ...........      $102.00
                      septum.
58561..............  Hysteroscopy, remove myoma            3    $2,049.83      $510.00  ...........      $102.00
58562..............  Hysteroscopy, remove fb...            3    $1,318.42      $510.00  ...........      $102.00
58563..............  Hysteroscopy, ablation....            4    $2,049.83      $630.00  ...........      $126.00
58565..............  Hysteroscopy,                         9    $2,639.04    $1,339.00  ...........      $267.80
                      sterilization.
58660..............  Laparoscopy, lysis........            5    $2,678.23      $717.00  ...........      $143.40
58661..............  Laparoscopy, remove adnexa            5    $2,678.23      $717.00  ...........      $143.40
58662..............  Laparoscopy, excise                   5    $2,678.23      $717.00  ...........      $143.40
                      lesions.
58670..............  Laparoscopy, tubal cautery            3    $2,678.23      $510.00  ...........      $102.00
58671..............  Laparoscopy, tubal block..            3    $2,678.23      $510.00  ...........      $102.00
58672..............  Laparoscopy, fimbrioplasty            5    $2,678.23      $717.00  ...........      $143.40
58673..............  Laparoscopy, salpingostomy            5    $2,678.23      $717.00  ...........      $143.40
58800..............  Drainage of ovarian                   3      $910.70      $510.00  ...........      $102.00
                      cyst(s).
58820..............  Drain ovary abscess, open.            3    $1,769.04      $510.00  ...........      $102.00
58900..............  Biopsy of ovary(s)........            3      $910.70      $510.00  ...........      $102.00
58970..............  Retrieval of oocyte.......            1      $271.49      $271.49  Y..........       $54.30
58974..............  Transfer of embryo........            1      $271.49      $271.49  Y..........       $54.30
58976..............  Transfer of embryo........            1      $271.49      $271.49  Y..........       $54.30
59160..............  D& c after delivery.......            3    $1,093.36      $510.00  ...........      $102.00
59320..............  Revision of cervix........            1    $1,262.49      $333.00  ...........       $66.60
59812..............  Treatment of miscarriage..            5    $1,140.24      $717.00  ...........      $143.40
59820..............  Care of miscarriage.......            5    $1,140.24      $717.00  ...........      $143.40
59821..............  Treatment of miscarriage..            5    $1,140.24      $717.00  ...........      $143.40
59840..............  Abortion..................            5    $1,062.41      $717.00  ...........      $143.40
59841..............  Abortion..................            5    $1,062.41      $717.00  ...........      $143.40
59870..............  Evacuate mole of uterus...            5    $1,140.24      $717.00  ...........      $143.40
59871..............  Remove cerclage suture....            5    $1,262.49      $717.00  ...........      $143.40
60000..............  Drain thyroid/tongue cyst.            1      $475.55      $333.00  ...........       $66.60
60200..............  Remove thyroid lesion.....            2    $2,285.28      $446.00  ...........       $89.20
60280..............  Remove thyroid duct lesion            4    $2,285.28      $630.00  ...........      $126.00
60281..............  Remove thyroid duct lesion            4    $2,285.28      $630.00  ...........      $126.00
61020..............  Remove brain cavity fluid.            1      $187.01      $187.01  Y..........       $37.40
61026..............  Injection into brain canal            1      $187.01      $187.01  Y..........       $37.40
61050..............  Remove brain canal fluid..            1      $187.01      $187.01  Y..........       $37.40
61055..............  Injection into brain canal            1      $187.01      $187.01  Y..........       $37.40
61070..............  Brain canal shunt                     1      $187.01      $187.01  Y..........       $37.40
                      procedure.
61215..............  Insert brain-fluid device.            3    $2,811.11      $510.00  ...........      $102.00
61790..............  Treat trigeminal nerve....            3    $1,093.20      $510.00  ...........      $102.00
61791..............  Treat trigeminal tract....            3      $341.23      $341.23  Y..........       $68.25
61885..............  Insrt/redo neurostim 1                2   $10,828.84      $446.00  ...........       $89.20
                      array.
61886..............  Implant neurostim arrays..            3   $14,500.02      $510.00  ...........      $102.00
61888..............  Revise/remove                         1    $2,089.79      $333.00  ...........       $66.60
                      neuroreceiver.
62194..............  Replace/irrigate catheter.            1      $709.19      $333.00  ...........       $66.60
62225..............  Replace/irrigate catheter.            1      $709.19      $333.00  ...........       $66.60
62230..............  Replace/revise brain shunt            2    $2,811.11      $446.00  ...........       $89.20
62263..............  Epidural lysis mult                   1      $765.89      $333.00  ...........       $66.60
                      sessions.
62264..............  Epidural lysis on single              1      $765.89      $333.00  ...........       $66.60
                      day.
62268..............  Drain spinal cord cyst....            1      $187.01      $187.01  Y..........       $37.40
62269..............  Needle biopsy, spinal cord            1      $373.79      $333.00  ...........       $66.60
62270..............  Spinal fluid tap,                     1      $138.43      $138.43  Y..........       $27.69
                      diagnostic.
62272..............  Drain cerebro spinal fluid            1      $138.43      $138.43  Y..........       $27.69
62273..............  Inject epidural patch.....            1      $341.23      $333.00  ...........       $66.60
62280..............  Treat spinal cord lesion..            1      $392.62      $333.00  ...........       $66.60
62281..............  Treat spinal cord lesion..            1      $392.62      $333.00  ...........       $66.60
62282..............  Treat spinal canal lesion.            1      $392.62      $333.00  ...........       $66.60
62287..............  Percutaneous diskectomy...            9    $2,049.86    $1,339.00  ...........      $267.80
62294..............  Injection into spinal                 3      $187.01      $187.01  Y..........       $37.40
                      artery.
62310..............  Inject spine c/t..........            1      $392.62      $333.00  ...........       $66.60
62311..............  Inject spine l/s (cd).....            1      $392.62      $333.00  ...........       $66.60
62318..............  Inject spine w/cath, c/t..            1      $392.62      $333.00  ...........       $66.60
62319..............  Inject spine w/cath l/s               1      $392.62      $333.00  ...........       $66.60
                      (cd).
62350..............  Implant spinal canal cath.            2    $1,803.02      $446.00  ...........       $89.20
62355..............  Remove spinal canal                   2      $765.89      $446.00  ...........       $89.20
                      catheter.
62360..............  Insert spine infusion                 2    $6,894.62      $446.00  ...........       $89.20
                      device.
62361..............  Implant spine infusion                2   $11,275.98      $446.00  ...........       $89.20
                      pump.
62362..............  Implant spine infusion                2   $11,275.98      $446.00  ...........       $89.20
                      pump.
62365..............  Remove spine infusion                 2    $2,049.86      $446.00  ...........       $89.20
                      device.
63600..............  Remove spinal cord lesion.            2    $1,093.20      $446.00  ...........       $89.20
63610..............  Stimulation of spinal cord            1    $1,093.20      $333.00  ...........       $66.60

[[Page 49749]]

 
63650..............  Implant neuroelectrodes...            2    $3,470.58      $446.00  ...........       $89.20
63660..............  Revise/remove                         1    $1,057.63      $333.00  ...........       $66.60
                      neuroelectrode.
63685..............  Insrt/redo spine n                    2   $10,964.12      $446.00  ...........       $89.20
                      generator.
63688..............  Revise/remove                         1    $2,089.79      $333.00  ...........       $66.60
                      neuroreceiver.
63744..............  Revision of spinal shunt..            3    $2,225.70      $510.00  ...........      $102.00
63746..............  Removal of spinal shunt...            2      $674.24      $446.00  ...........       $89.20
64410..............  Nblock inj, phrenic.......            1      $341.23      $333.00  ...........       $66.60
64415..............  Nblock inj, brachial                  1      $138.43      $138.43  Y..........       $27.69
                      plexus.
64417..............  Nblock inj, axillary......            1      $138.43      $138.43  Y..........       $27.69
64420..............  Nblock inj, intercost, sng            1      $138.43      $138.43  Y..........       $27.69
64421..............  Nblock inj, intercost, mlt            1      $341.23      $333.00  ...........       $66.60
64430..............  Nblock inj, pudendal......            1      $138.43      $138.43  Y..........       $27.69
64470..............  Inj paravertebral c/t.....            1      $392.62      $333.00  ...........       $66.60
64472..............  Inj paravertebral c/t add-            1      $341.23      $333.00  ...........       $66.60
                      on.
64475..............  Inj paravertebral l/s.....            1      $392.62      $333.00  ...........       $66.60
64476..............  Inj paravertebral l/s add-            1      $341.23      $333.00  ...........       $66.60
                      on.
64479..............  Inj foramen epidural c/t..            1      $392.62      $333.00  ...........       $66.60
64480..............  Inj foramen epidural add-             1      $392.62      $333.00  ...........       $66.60
                      on.
64483..............  Inj foramen epidural l/s..            1      $392.62      $333.00  ...........       $66.60
64484..............  Inj foramen epidural add-             1      $392.62      $333.00  ...........       $66.60
                      on.
64510..............  Nblock, stellate ganglion.            1      $392.62      $333.00  ...........       $66.60
64517..............  Nblock inj, hypogas plxs..            2      $138.43      $138.43  Y..........       $27.69
64520..............  Nblock, lumbar/thoracic...            1      $392.62      $333.00  ...........       $66.60
64530..............  Nblock inj, celiac pelus..            1      $392.62      $333.00  ...........       $66.60
64553..............  Implant neuroelectrodes...            1   $14,412.95      $333.00  ...........       $66.60
64561..............  Implant neuroelectrodes...            3    $3,470.58      $510.00  ...........      $102.00
64573..............  Implant neuroelectrodes...            1   $14,412.95      $333.00  ...........       $66.60
64575..............  Implant neuroelectrodes...            1    $5,184.89      $333.00  ...........       $66.60
64577..............  Implant neuroelectrodes...            1    $5,184.89      $333.00  ...........       $66.60
64580..............  Implant neuroelectrodes...            1    $5,184.89      $333.00  ...........       $66.60
64581..............  Implant neuroelectrodes...            3    $5,184.89      $510.00  ...........      $102.00
64585..............  Revise/remove                         1    $1,057.63      $333.00  ...........       $66.60
                      neuroelectrode.
64590..............  Insrt/redo perph n                    2   $10,964.12      $446.00  ...........       $89.20
                      generator.
64595..............  Revise/remove                         1    $2,089.79      $333.00  ...........       $66.60
                      neuroreceiver.
64600..............  Injection treatment of                1      $765.89      $333.00  ...........       $66.60
                      nerve.
64605..............  Injection treatment of                1      $765.89      $333.00  ...........       $66.60
                      nerve.
64610..............  Injection treatment of                1      $765.89      $333.00  ...........       $66.60
                      nerve.
64620..............  Injection treatment of                1      $765.89      $333.00  ...........       $66.60
                      nerve.
64622..............  Destr paravertebrl nerve l/           1      $765.89      $333.00  ...........       $66.60
                      s.
64623..............  Destr paravertebral n add-            1      $392.62      $333.00  ...........       $66.60
                      on.
64626..............  Destr paravertebrl nerve c/           1      $765.89      $333.00  ...........       $66.60
                      t.
64627..............  Destr paravertebral n add-            1      $392.62      $333.00  ...........       $66.60
                      on.
64630..............  Injection treatment of                2      $341.23      $341.23  Y..........       $68.25
                      nerve.
64680..............  Injection treatment of                2      $392.62      $392.62  Y..........       $78.52
                      nerve.
64681..............  Injection treatment of                2      $765.89      $446.00  ...........       $89.20
                      nerve.
64702..............  Revise finger/toe nerve...            1    $1,093.20      $333.00  ...........       $66.60
64704..............  Revise hand/foot nerve....            1    $1,093.20      $333.00  ...........       $66.60
64708..............  Revise arm/leg nerve......            2    $1,093.20      $446.00  ...........       $89.20
64712..............  Revision of sciatic nerve.            2    $1,093.20      $446.00  ...........       $89.20
64713..............  Revision of arm nerve(s)..            2    $1,093.20      $446.00  ...........       $89.20
64714..............  Revise low back nerve(s)..            2    $1,093.20      $446.00  ...........       $89.20
64716..............  Revision of cranial nerve.            3    $1,093.20      $510.00  ...........      $102.00
64718..............  Revise ulnar nerve at                 2    $1,093.20      $446.00  ...........       $89.20
                      elbow.
64719..............  Revise ulnar nerve at                 2    $1,093.20      $446.00  ...........       $89.20
                      wrist.
64721..............  Carpal tunnel surgery.....            2    $1,093.20      $446.00  ...........       $89.20
64722..............  Relieve pressure on                   1    $1,093.20      $333.00  ...........       $66.60
                      nerve(s).
64726..............  Release foot/toe nerve....            1    $1,093.20      $333.00  ...........       $66.60
64727..............  Internal nerve revision...            1    $1,093.20      $333.00  ...........       $66.60
64732..............  Incision of brow nerve....            2    $1,093.20      $446.00  ...........       $89.20
64734..............  Incision of cheek nerve...            2    $1,093.20      $446.00  ...........       $89.20
64736..............  Incision of chin nerve....            2    $1,093.20      $446.00  ...........       $89.20
64738..............  Incision of jaw nerve.....            2    $1,093.20      $446.00  ...........       $89.20
64740..............  Incision of tongue nerve..            2    $1,093.20      $446.00  ...........       $89.20
64742..............  Incision of facial nerve..            2    $1,093.20      $446.00  ...........       $89.20
64744..............  Incise nerve, back of head            2    $1,093.20      $446.00  ...........       $89.20
64746..............  Incise diaphragm nerve....            2    $1,093.20      $446.00  ...........       $89.20
64771..............  Sever cranial nerve.......            2    $1,093.20      $446.00  ...........       $89.20
64772..............  Incision of spinal nerve..            2    $1,093.20      $446.00  ...........       $89.20
64774..............  Remove skin nerve lesion..            2    $1,093.20      $446.00  ...........       $89.20

[[Page 49750]]

 
64776..............  Remove digit nerve lesion.            3    $1,093.20      $510.00  ...........      $102.00
64778..............  Digit nerve surgery add-on            2    $1,093.20      $446.00  ...........       $89.20
64782..............  Remove limb nerve lesion..            3    $1,093.20      $510.00  ...........      $102.00
64783..............  Limb nerve surgery add-on.            2    $1,093.20      $446.00  ...........       $89.20
64784..............  Remove nerve lesion.......            3    $1,093.20      $510.00  ...........      $102.00
64786..............  Remove sciatic nerve                  3    $2,049.86      $510.00  ...........      $102.00
                      lesion.
64787..............  Implant nerve end.........            2    $1,093.20      $446.00  ...........       $89.20
64788..............  Remove skin nerve lesion..            3    $1,093.20      $510.00  ...........      $102.00
64790..............  Removal of nerve lesion...            3    $1,093.20      $510.00  ...........      $102.00
64792..............  Removal of nerve lesion...            3    $2,049.86      $510.00  ...........      $102.00
64795..............  Biopsy of nerve...........            2    $1,093.20      $446.00  ...........       $89.20
64802..............  Remove sympathetic nerves.            2    $1,093.20      $446.00  ...........       $89.20
64821..............  Remove sympathetic nerves.            4    $1,590.63      $630.00  ...........      $126.00
64831..............  Repair of digit nerve.....            4    $2,049.86      $630.00  ...........      $126.00
64832..............  Repair nerve add-on.......            1    $2,049.86      $333.00  ...........       $66.60
64834..............  Repair of hand or foot                2    $2,049.86      $446.00  ...........       $89.20
                      nerve.
64835..............  Repair of hand or foot                3    $2,049.86      $510.00  ...........      $102.00
                      nerve.
64836..............  Repair of hand or foot                3    $2,049.86      $510.00  ...........      $102.00
                      nerve.
64837..............  Repair nerve add-on.......            1    $2,049.86      $333.00  ...........       $66.60
64840..............  Repair of leg nerve.......            2    $2,049.86      $446.00  ...........       $89.20
64856..............  Repair/transpose nerve....            2    $2,049.86      $446.00  ...........       $89.20
64857..............  Repair arm/leg nerve......            2    $2,049.86      $446.00  ...........       $89.20
64858..............  Repair sciatic nerve......            2    $2,049.86      $446.00  ...........       $89.20
64859..............  Nerve surgery.............            1    $2,049.86      $333.00  ...........       $66.60
64861..............  Repair of arm nerves......            3    $2,049.86      $510.00  ...........      $102.00
64862..............  Repair of low back nerves.            3    $2,049.86      $510.00  ...........      $102.00
64864..............  Repair of facial nerve....            3    $2,049.86      $510.00  ...........      $102.00
64865..............  Repair of facial nerve....            4    $2,049.86      $630.00  ...........      $126.00
64870..............  Fusion of facial/other                4    $2,049.86      $630.00  ...........      $126.00
                      nerve.
64872..............  Subsequent repair of nerve            2    $2,049.86      $446.00  ...........       $89.20
64874..............  Repair & revise nerve add-            3    $2,049.86      $510.00  ...........      $102.00
                      on.
64876..............  Repair nerve/shorten bone.            3    $2,049.86      $510.00  ...........      $102.00
64885..............  Nerve graft, head or neck.            2    $2,049.86      $446.00  ...........       $89.20
64886..............  Nerve graft, head or neck.            2    $2,049.86      $446.00  ...........       $89.20
64890..............  Nerve graft, hand or foot.            2    $2,049.86      $446.00  ...........       $89.20
64891..............  Nerve graft, hand or foot.            2    $2,049.86      $446.00  ...........       $89.20
64892..............  Nerve graft, arm or leg...            2    $2,049.86      $446.00  ...........       $89.20
64893..............  Nerve graft, arm or leg...            2    $2,049.86      $446.00  ...........       $89.20
64895..............  Nerve graft, hand or foot.            3    $2,049.86      $510.00  ...........      $102.00
64896..............  Nerve graft, hand or foot.            3    $2,049.86      $510.00  ...........      $102.00
64897..............  Nerve graft, arm or leg...            3    $2,049.86      $510.00  ...........      $102.00
64898..............  Nerve graft, arm or leg...            3    $2,049.86      $510.00  ...........      $102.00
64901..............  Nerve graft add-on........            2    $2,049.86      $446.00  ...........       $89.20
64902..............  Nerve graft add-on........            2    $2,049.86      $446.00  ...........       $89.20
64905..............  Nerve pedicle transfer....            2    $2,049.86      $446.00  ...........       $89.20
64907..............  Nerve pedicle transfer....            1    $2,049.86      $333.00  ...........       $66.60
65091..............  Revise eye................            3    $2,186.40      $510.00  ...........      $102.00
65093..............  Revise eye with implant...            3    $2,186.40      $510.00  ...........      $102.00
65101..............  Removal of eye............            3    $2,186.40      $510.00  ...........      $102.00
65103..............  Remove eye/insert implant.            3    $2,186.40      $510.00  ...........      $102.00
65105..............  Remove eye/attach implant.            4    $2,186.40      $630.00  ...........      $126.00
65110..............  Removal of eye............            5    $2,186.40      $717.00  ...........      $143.40
65112..............  Remove eye/revise socket..            7    $2,186.40      $995.00  ...........      $199.00
65114..............  Remove eye/revise socket..            7    $2,186.40      $995.00  ...........      $199.00
65130..............  Insert ocular implant.....            3    $1,529.55      $510.00  ...........      $102.00
65135..............  Insert ocular implant.....            2    $1,529.55      $446.00  ...........       $89.20
65140..............  Attach ocular implant.....            3    $2,186.40      $510.00  ...........      $102.00
65150..............  Revise ocular implant.....            2    $1,529.55      $446.00  ...........       $89.20
65155..............  Reinsert ocular implant...            3    $2,186.40      $510.00  ...........      $102.00
65175..............  Removal of ocular implant.            1    $1,047.14      $333.00  ...........       $66.60
65235..............  Remove foreign body from              2      $923.07      $446.00  ...........       $89.20
                      eye.
65260..............  Remove foreign body from              3    $1,005.95      $510.00  ...........      $102.00
                      eye.
65265..............  Remove foreign body from              4    $1,657.60      $630.00  ...........      $126.00
                      eye.
65270..............  Repair of eye wound.......            2    $1,047.14      $446.00  ...........       $89.20
65272..............  Repair of eye wound.......            2    $1,412.47      $446.00  ...........       $89.20
65275..............  Repair of eye wound.......            4    $1,412.47      $630.00  ...........      $126.00
65280..............  Repair of eye wound.......            4    $1,005.95      $630.00  ...........      $126.00
65285..............  Repair of eye wound.......            4    $2,270.12      $630.00  ...........      $126.00
65290..............  Repair of eye socket wound            3    $1,310.33      $510.00  ...........      $102.00

[[Page 49751]]

 
65400..............  Removal of eye lesion.....            1      $923.07      $333.00  ...........       $66.60
65410..............  Biopsy of cornea..........            2      $923.07      $446.00  ...........       $89.20
65420..............  Removal of eye lesion.....            2      $923.07      $446.00  ...........       $89.20
65426..............  Removal of eye lesion.....            5    $1,412.47      $717.00  ...........      $143.40
65710..............  Corneal transplant........            7    $2,335.53      $995.00  ...........      $199.00
65730..............  Corneal transplant........            7    $2,335.53      $995.00  ...........      $199.00
65750..............  Corneal transplant........            7    $2,335.53      $995.00  ...........      $199.00
65755..............  Corneal transplant........            7    $2,335.53      $995.00  ...........      $199.00
65770..............  Revise cornea with implant            7    $3,116.62      $995.00  ...........      $199.00
65772..............  Correction of astigmatism.            4      $923.07      $630.00  ...........      $126.00
65775..............  Correction of astigmatism.            4      $923.07      $630.00  ...........      $126.00
65780..............  Ocular reconst, transplant            5    $2,335.53      $717.00  ...........      $143.40
65781..............  Ocular reconst, transplant            5    $2,335.53      $717.00  ...........      $143.40
65782..............  Ocular reconst, transplant            5    $2,335.53      $717.00  ...........      $143.40
65800..............  Drainage of eye...........            1      $923.07      $333.00  ...........       $66.60
65805..............  Drainage of eye...........            1      $923.07      $333.00  ...........       $66.60
65810..............  Drainage of eye...........            3    $1,412.47      $510.00  ...........      $102.00
65815..............  Drainage of eye...........            2    $1,412.47      $446.00  ...........       $89.20
65820..............  Relieve inner eye pressure            1      $368.07      $333.00  ...........       $66.60
65850..............  Incision of eye...........            4    $1,412.47      $630.00  ...........      $126.00
65865..............  Incise inner eye adhesions            1      $923.07      $333.00  ...........       $66.60
65870..............  Incise inner eye adhesions            4    $1,412.47      $630.00  ...........      $126.00
65875..............  Incise inner eye adhesions            4    $1,412.47      $630.00  ...........      $126.00
65880..............  Incise inner eye adhesions            4      $923.07      $630.00  ...........      $126.00
65900..............  Remove eye lesion.........            5      $923.07      $717.00  ...........      $143.40
65920..............  Remove implant of eye.....            7    $1,412.47      $995.00  ...........      $199.00
65930..............  Remove blood clot from eye            5    $1,412.47      $717.00  ...........      $143.40
66020..............  Injection treatment of eye            1      $923.07      $333.00  ...........       $66.60
66030..............  Injection treatment of eye            1      $368.07      $333.00  ...........       $66.60
66130..............  Remove eye lesion.........            7    $1,412.47      $995.00  ...........      $199.00
66150..............  Glaucoma surgery..........            4    $1,412.47      $630.00  ...........      $126.00
66155..............  Glaucoma surgery..........            4    $1,412.47      $630.00  ...........      $126.00
66160..............  Glaucoma surgery..........            2    $1,412.47      $446.00  ...........       $89.20
66165..............  Glaucoma surgery..........            4    $1,412.47      $630.00  ...........      $126.00
66170..............  Glaucoma surgery..........            4    $1,412.47      $630.00  ...........      $126.00
66172..............  Incision of eye...........            4    $1,412.47      $630.00  ...........      $126.00
66180..............  Implant eye shunt.........            5    $2,296.20      $717.00  ...........      $143.40
66185..............  Revise eye shunt..........            2    $2,296.20      $446.00  ...........       $89.20
66220..............  Repair eye lesion.........            3    $2,270.12      $510.00  ...........      $102.00
66225..............  Repair/graft eye lesion...            4    $2,296.20      $630.00  ...........      $126.00
66250..............  Follow-up surgery of eye..            2      $923.07      $446.00  ...........       $89.20
66500..............  Incision of iris..........            1      $368.07      $333.00  ...........       $66.60
66505..............  Incision of iris..........            1      $368.07      $333.00  ...........       $66.60
66600..............  Remove iris and lesion....            3    $1,412.47      $510.00  ...........      $102.00
66605..............  Removal of iris...........            3    $1,412.47      $510.00  ...........      $102.00
66625..............  Removal of iris...........            3      $368.07      $368.07  Y..........       $73.61
66630..............  Removal of iris...........            3    $1,412.47      $510.00  ...........      $102.00
66635..............  Removal of iris...........            3    $1,412.47      $510.00  ...........      $102.00
66680..............  Repair iris & ciliary body            3    $1,412.47      $510.00  ...........      $102.00
66682..............  Repair iris & ciliary body            2    $1,412.47      $446.00  ...........       $89.20
66700..............  Destruction, ciliary body.            2      $923.07      $446.00  ...........       $89.20
66710..............  Ciliary transsleral                   2      $923.07      $446.00  ...........       $89.20
                      therapy.
66711..............  Ciliary endoscopic                    2      $923.07      $446.00  ...........       $89.20
                      ablation.
66720..............  Destruction, ciliary body.            2      $923.07      $446.00  ...........       $89.20
66740..............  Destruction, ciliary body.            2    $1,412.47      $446.00  ...........       $89.20
66821..............  After cataract laser                  2      $315.55      $315.55  Y..........       $63.11
                      surgery.
66825..............  Reposition intraocular                4    $1,412.47      $630.00  ...........      $126.00
                      lens.
66830..............  Removal of lens lesion....            4      $368.07      $368.07  Y..........       $73.61
66840..............  Removal of lens material..            4      $895.12      $630.00  ...........      $126.00
66850..............  Removal of lens material..            7    $1,754.47      $995.00  ...........      $199.00
66852..............  Removal of lens material..            4    $1,754.47      $630.00  ...........      $126.00
66920..............  Extraction of lens........            4    $1,754.47      $630.00  ...........      $126.00
66930..............  Extraction of lens........            5    $1,754.47      $717.00  ...........      $143.40
66940..............  Extraction of lens........            5      $895.12      $717.00  ...........      $143.40
66982..............  Cataract surgery, complex.            8    $1,450.54      $973.00  ...........      $194.60
66983..............  Cataract surg w/iol, 1                8    $1,450.54      $973.00  ...........      $194.60
                      stage.
66984..............  Cataract surg w/iol, 1                8    $1,450.54      $973.00  ...........      $194.60
                      stage.
66985..............  Insert lens prosthesis....            6    $1,450.54      $826.00  ...........      $165.20
66986..............  Exchange lens prosthesis..            6    $1,450.54      $826.00  ...........      $165.20

[[Page 49752]]

 
67005..............  Partial removal of eye                4    $1,657.60      $630.00  ...........      $126.00
                      fluid.
67010..............  Partial removal of eye                4    $1,657.60      $630.00  ...........      $126.00
                      fluid.
67015..............  Release of eye fluid......            1    $1,657.60      $333.00  ...........       $66.60
67025..............  Replace eye fluid.........            1    $1,657.60      $333.00  ...........       $66.60
67027..............  Implant eye drug system...            4    $2,270.12      $630.00  ...........      $126.00
67030..............  Incise inner eye strands..            1    $1,005.95      $333.00  ...........       $66.60
67031..............  Laser surgery, eye strands            2      $315.55      $315.55  Y..........       $63.11
67036..............  Removal of inner eye fluid            4    $2,270.12      $630.00  ...........      $126.00
67038..............  Strip retinal membrane....            5    $2,270.12      $717.00  ...........      $143.40
67039..............  Laser treatment of retina.            7    $2,270.12      $995.00  ...........      $199.00
67040..............  Laser treatment of retina.            7    $2,270.12      $995.00  ...........      $199.00
67107..............  Repair detached retina....            5    $2,270.12      $717.00  ...........      $143.40
67108..............  Repair detached retina....            7    $2,270.12      $995.00  ...........      $199.00
67112..............  Rerepair detached retina..            7    $2,270.12      $995.00  ...........      $199.00
67115..............  Release encircling                    2    $1,005.95      $446.00  ...........       $89.20
                      material.
67120..............  Remove eye implant                    2    $1,005.95      $446.00  ...........       $89.20
                      material.
67121..............  Remove eye implant                    2    $1,657.60      $446.00  ...........       $89.20
                      material.
67141..............  Treatment of retina.......            2      $250.82      $250.82  Y..........       $50.16
67218..............  Treatment of retinal                  5    $1,005.95      $717.00  ...........      $143.40
                      lesion.
67227..............  Treatment of retinal                  1    $1,657.60      $333.00  ...........       $66.60
                      lesion.
67250..............  Reinforce eye wall........            3    $1,047.14      $510.00  ...........      $102.00
67255..............  Reinforce/graft eye wall..            3    $1,657.60      $510.00  ...........      $102.00
67311..............  Revise eye muscle.........            3    $1,310.33      $510.00  ...........      $102.00
67312..............  Revise two eye muscles....            4    $1,310.33      $630.00  ...........      $126.00
67314..............  Revise eye muscle.........            4    $1,310.33      $630.00  ...........      $126.00
67316..............  Revise two eye muscles....            4    $1,310.33      $630.00  ...........      $126.00
67318..............  Revise eye muscle(s)......            4    $1,310.33      $630.00  ...........      $126.00
67320..............  Revise eye muscle(s) add-             4    $1,310.33      $630.00  ...........      $126.00
                      on.
67331..............  Eye surgery follow-up add-            4    $1,310.33      $630.00  ...........      $126.00
                      on.
67332..............  Rerevise eye muscles add-             4    $1,310.33      $630.00  ...........      $126.00
                      on.
67334..............  Revise eye muscle w/suture            4    $1,310.33      $630.00  ...........      $126.00
67335..............  Eye suture during surgery.            4    $1,310.33      $630.00  ...........      $126.00
67340..............  Revise eye muscle add-on..            4    $1,310.33      $630.00  ...........      $126.00
67343..............  Release eye tissue........            7    $1,310.33      $995.00  ...........      $199.00
67350..............  Biopsy eye muscle.........            1      $858.69      $333.00  ...........       $66.60
67400..............  Explore/biopsy eye socket.            3    $1,529.55      $510.00  ...........      $102.00
67405..............  Explore/drain eye socket..            4    $1,529.55      $630.00  ...........      $126.00
67412..............  Explore/treat eye socket..            5    $1,529.55      $717.00  ...........      $143.40
67413..............  Explore/treat eye socket..            5    $1,529.55      $717.00  ...........      $143.40
67415..............  Aspiration, orbital                   1    $1,047.14      $333.00  ...........       $66.60
                      contents.
67420..............  Explore/treat eye socket..            5    $2,186.40      $717.00  ...........      $143.40
67430..............  Explore/treat eye socket..            5    $2,186.40      $717.00  ...........      $143.40
67440..............  Explore/drain eye socket..            5    $2,186.40      $717.00  ...........      $143.40
67445..............  Explr/decompress eye                  5    $2,186.40      $717.00  ...........      $143.40
                      socket.
67450..............  Explore/biopsy eye socket.            5    $2,186.40      $717.00  ...........      $143.40
67550..............  Insert eye socket implant.            4    $2,186.40      $630.00  ...........      $126.00
67560..............  Revise eye socket implant.            2    $1,529.55      $446.00  ...........       $89.20
67570..............  Decompress optic nerve....            4    $2,186.40      $630.00  ...........      $126.00
67715..............  Incision of eyelid fold...            1    $1,047.14      $333.00  ...........       $66.60
67808..............  Remove eyelid lesion(s)...            2    $1,047.14      $446.00  ...........       $89.20
67830..............  Revise eyelashes..........            2      $426.88      $426.88  Y..........       $85.38
67835..............  Revise eyelashes..........            2    $1,047.14      $446.00  ...........       $89.20
67880..............  Revision of eyelid........            3      $923.07      $510.00  ...........      $102.00
67882..............  Revision of eyelid........            3    $1,047.14      $510.00  ...........      $102.00
67900..............  Repair brow defect........            4    $1,047.14      $630.00  ...........      $126.00
67901..............  Repair eyelid defect......            5    $1,047.14      $717.00  ...........      $143.40
67902..............  Repair eyelid defect......            5    $1,047.14      $717.00  ...........      $143.40
67903..............  Repair eyelid defect......            4    $1,047.14      $630.00  ...........      $126.00
67904..............  Repair eyelid defect......            4    $1,047.14      $630.00  ...........      $126.00
67906..............  Repair eyelid defect......            5    $1,047.14      $717.00  ...........      $143.40
67908..............  Repair eyelid defect......            4    $1,047.14      $630.00  ...........      $126.00
67909..............  Revise eyelid defect......            4    $1,047.14      $630.00  ...........      $126.00
67911..............  Revise eyelid defect......            3    $1,047.14      $510.00  ...........      $102.00
67912..............  Correction eyelid w/                  3    $1,047.14      $510.00  ...........      $102.00
                      implant.
67914..............  Repair eyelid defect......            3    $1,047.14      $510.00  ...........      $102.00
67916..............  Repair eyelid defect......            4    $1,047.14      $630.00  ...........      $126.00
67917..............  Repair eyelid defect......            4    $1,047.14      $630.00  ...........      $126.00
67921..............  Repair eyelid defect......            3    $1,047.14      $510.00  ...........      $102.00
67923..............  Repair eyelid defect......            4    $1,047.14      $630.00  ...........      $126.00

[[Page 49753]]

 
67924..............  Repair eyelid defect......            4    $1,047.14      $630.00  ...........      $126.00
67935..............  Repair eyelid wound.......            2    $1,047.14      $446.00  ...........       $89.20
67950..............  Revision of eyelid........            2    $1,047.14      $446.00  ...........       $89.20
67961..............  Revision of eyelid........            3    $1,047.14      $510.00  ...........      $102.00
67966..............  Revision of eyelid........            3    $1,047.14      $510.00  ...........      $102.00
67971..............  Reconstruction of eyelid..            3    $1,529.55      $510.00  ...........      $102.00
67973..............  Reconstruction of eyelid..            3    $1,529.55      $510.00  ...........      $102.00
67974..............  Reconstruction of eyelid..            3    $1,529.55      $510.00  ...........      $102.00
67975..............  Reconstruction of eyelid..            3    $1,047.14      $510.00  ...........      $102.00
68115..............  Remove eyelid lining                  2    $1,047.14      $446.00  ...........       $89.20
                      lesion.
68130..............  Remove eyelid lining                  2      $923.07      $446.00  ...........       $89.20
                      lesion.
68320..............  Revise/graft eyelid lining            4    $1,047.14      $630.00  ...........      $126.00
68325..............  Revise/graft eyelid lining            4    $1,529.55      $630.00  ...........      $126.00
68326..............  Revise/graft eyelid lining            4    $1,529.55      $630.00  ...........      $126.00
68328..............  Revise/graft eyelid lining            4    $1,529.55      $630.00  ...........      $126.00
68330..............  Revise eyelid lining......            4    $1,412.47      $630.00  ...........      $126.00
68335..............  Revise/graft eyelid lining            4    $1,529.55      $630.00  ...........      $126.00
68340..............  Separate eyelid adhesions.            4    $1,047.14      $630.00  ...........      $126.00
68360..............  Revise eyelid lining......            2    $1,412.47      $446.00  ...........       $89.20
68362..............  Revise eyelid lining......            2    $1,412.47      $446.00  ...........       $89.20
68371..............  Harvest eye tissue,                   2      $923.07      $446.00  ...........       $89.20
                      alograft.
68500..............  Removal of tear gland.....            3    $1,529.55      $510.00  ...........      $102.00
68505..............  Partial removal, tear                 3    $1,529.55      $510.00  ...........      $102.00
                      gland.
68510..............  Biopsy of tear gland......            1    $1,047.14      $333.00  ...........       $66.60
68520..............  Removal of tear sac.......            3    $1,529.55      $510.00  ...........      $102.00
68525..............  Biopsy of tear sac........            1    $1,047.14      $333.00  ...........       $66.60
68540..............  Remove tear gland lesion..            3    $1,529.55      $510.00  ...........      $102.00
68550..............  Remove tear gland lesion..            3    $1,529.55      $510.00  ...........      $102.00
68700..............  Repair tear ducts.........            2    $1,529.55      $446.00  ...........       $89.20
68720..............  Create tear sac drain.....            4    $1,529.55      $630.00  ...........      $126.00
68745..............  Create tear duct drain....            4    $1,529.55      $630.00  ...........      $126.00
68750..............  Create tear duct drain....            4    $1,529.55      $630.00  ...........      $126.00
68770..............  Close tear system fistula.            4    $1,047.14      $630.00  ...........      $126.00
68810..............  Probe nasolacrimal duct...            1      $135.01      $135.01  Y..........       $27.00
68811..............  Probe nasolacrimal duct...            2    $1,047.14      $446.00  ...........       $89.20
68815..............  Probe nasolacrimal duct...            2    $1,047.14      $446.00  ...........       $89.20
69110..............  Remove external ear,                  1      $920.58      $333.00  ...........       $66.60
                      partial.
69120..............  Removal of external ear...            2    $1,425.30      $446.00  ...........       $89.20
69140..............  Remove ear canal lesion(s)            2    $1,425.30      $446.00  ...........       $89.20
69145..............  Remove ear canal lesion(s)            2      $920.58      $446.00  ...........       $89.20
69150..............  Extensive ear canal                   3      $475.55      $475.55  Y..........       $95.11
                      surgery.
69205..............  Clear outer ear canal.....            1    $1,229.54      $333.00  ...........       $66.60
69300..............  Revise external ear.......            3    $1,425.30      $510.00  ...........      $102.00
69310..............  Rebuild outer ear canal...            3    $2,324.90      $510.00  ...........      $102.00
69320..............  Rebuild outer ear canal...            7    $2,324.90      $995.00  ...........      $199.00
69421..............  Incision of eardrum.......            3    $1,012.48      $510.00  ...........      $102.00
69436..............  Create eardrum opening....            3    $1,012.48      $510.00  ...........      $102.00
69440..............  Exploration of middle ear.            3    $1,425.30      $510.00  ...........      $102.00
69450..............  Eardrum revision..........            1    $2,324.90      $333.00  ...........       $66.60
69501..............  Mastoidectomy.............            7    $2,324.90      $995.00  ...........      $199.00
69502..............  Mastoidectomy.............            7    $1,425.30      $995.00  ...........      $199.00
69505..............  Remove mastoid structures.            7    $2,324.90      $995.00  ...........      $199.00
69511..............  Extensive mastoid surgery.            7    $2,324.90      $995.00  ...........      $199.00
69530..............  Extensive mastoid surgery.            7    $2,324.90      $995.00  ...........      $199.00
69550..............  Remove ear lesion.........            5    $2,324.90      $717.00  ...........      $143.40
69552..............  Remove ear lesion.........            7    $2,324.90      $995.00  ...........      $199.00
69601..............  Mastoid surgery revision..            7    $2,324.90      $995.00  ...........      $199.00
69602..............  Mastoid surgery revision..            7    $2,324.90      $995.00  ...........      $199.00
69603..............  Mastoid surgery revision..            7    $2,324.90      $995.00  ...........      $199.00
69604..............  Mastoid surgery revision..            7    $2,324.90      $995.00  ...........      $199.00
69605..............  Mastoid surgery revision..            7    $2,324.90      $995.00  ...........      $199.00
69620..............  Repair of eardrum.........            2    $1,425.30      $446.00  ...........       $89.20
69631..............  Repair eardrum structures.            5    $2,324.90      $717.00  ...........      $143.40
69632..............  Rebuild eardrum structures            5    $2,324.90      $717.00  ...........      $143.40
69633..............  Rebuild eardrum structures            5    $2,324.90      $717.00  ...........      $143.40
69635..............  Repair eardrum structures.            7    $2,324.90      $995.00  ...........      $199.00
69636..............  Rebuild eardrum structures            7    $2,324.90      $995.00  ...........      $199.00
69637..............  Rebuild eardrum structures            7    $2,324.90      $995.00  ...........      $199.00
69641..............  Revise middle ear &                   7    $2,324.90      $995.00  ...........      $199.00
                      mastoid.

[[Page 49754]]

 
69642..............  Revise middle ear &                   7    $2,324.90      $995.00  ...........      $199.00
                      mastoid.
69643..............  Revise middle ear &                   7    $2,324.90      $995.00  ...........      $199.00
                      mastoid.
69644..............  Revise middle ear &                   7    $2,324.90      $995.00  ...........      $199.00
                      mastoid.
69645..............  Revise middle ear &                   7    $2,324.90      $995.00  ...........      $199.00
                      mastoid.
69646..............  Revise middle ear &                   7    $2,324.90      $995.00  ...........      $199.00
                      mastoid.
69650..............  Release middle ear bone...            7    $1,425.30      $995.00  ...........      $199.00
69660..............  Revise middle ear bone....            5    $2,324.90      $717.00  ...........      $143.40
69661..............  Revise middle ear bone....            5    $2,324.90      $717.00  ...........      $143.40
69662..............  Revise middle ear bone....            5    $2,324.90      $717.00  ...........      $143.40
69666..............  Repair middle ear                     4    $2,324.90      $630.00  ...........      $126.00
                      structures.
69667..............  Repair middle ear                     4    $2,324.90      $630.00  ...........      $126.00
                      structures.
69670..............  Remove mastoid air cells..            3    $2,324.90      $510.00  ...........      $102.00
69676..............  Remove middle ear nerve...            3    $2,324.90      $510.00  ...........      $102.00
69700..............  Close mastoid fistula.....            3    $2,324.90      $510.00  ...........      $102.00
69711..............  Remove/repair hearing aid.            1    $2,324.90      $333.00  ...........       $66.60
69714..............  Implant temple bone w/                9    $2,324.90    $1,339.00  ...........      $267.80
                      stimul.
69715..............  Temple bne implnt w/                  9    $2,324.90    $1,339.00  ...........      $267.80
                      stimulat.
69717..............  Temple bone implant                   9    $2,324.90    $1,339.00  ...........      $267.80
                      revision.
69718..............  Revise temple bone implant            9    $2,324.90    $1,339.00  ...........      $267.80
69720..............  Release facial nerve......            5    $2,324.90      $717.00  ...........      $143.40
69740..............  Repair facial nerve.......            5    $2,324.90      $717.00  ...........      $143.40
69745..............  Repair facial nerve.......            5    $2,324.90      $717.00  ...........      $143.40
69801..............  Incise inner ear..........            5    $2,324.90      $717.00  ...........      $143.40
69802..............  Incise inner ear..........            7    $2,324.90      $995.00  ...........      $199.00
69805..............  Explore inner ear.........            7    $2,324.90      $995.00  ...........      $199.00
69806..............  Explore inner ear.........            7    $2,324.90      $995.00  ...........      $199.00
69820..............  Establish inner ear window            5    $2,324.90      $717.00  ...........      $143.40
69840..............  Revise inner ear window...            5    $2,324.90      $717.00  ...........      $143.40
69905..............  Remove inner ear..........            7    $2,324.90      $995.00  ...........      $199.00
69910..............  Remove inner ear & mastoid            7    $2,324.90      $995.00  ...........      $199.00
69915..............  Incise inner ear nerve....            7    $2,324.90      $995.00  ...........      $199.00
69930..............  Implant cochlear device...            7   $25,040.37      $995.00  ...........      $199.00
G0105..............  Colorectal scrn; hi risk              2      $480.92      $446.00  ...........       $89.20
                      ind.
G0121..............  Colon ca scrn; not high               2      $480.92      $446.00  ...........       $89.20
                      rsk.
G0260..............  Inj for sacroiliac jt                 1      $341.23      $333.00  ...........       $66.60
                      anesth.
----------------------------------------------------------------------------------------------------------------


              Addendum B.--Payment Status by HCPCS Code and Related Information Calendar Year 2007
----------------------------------------------------------------------------------------------------------------
                                                                                          National     Minimum
   CPT/HCPCS       Description       CI        SI       APC     Relative     Payment     unadjusted   unadjusted
                                                                 weight        rate      copayment    copayment
----------------------------------------------------------------------------------------------------------------
00100.........  Anesth, salivary  ........  N.......  ......  ...........  ...........  ...........  ...........
                 gland.
00102.........  Anesth, repair    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of cleft lip.
00103.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 blepharoplasty.
00104.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 electroshock.
00120.........  Anesth, ear       ........  N.......  ......  ...........  ...........  ...........  ...........
                 surgery.
00124.........  Anesth, ear exam  ........  N.......  ......  ...........  ...........  ...........  ...........
00126.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 tympanotomy.
00140.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedures on
                 eye.
00142.........  Anesth, lens      ........  N.......  ......  ...........  ...........  ...........  ...........
                 surgery.
00144.........  Anesth, corneal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 transplant.
00145.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 vitreoretinal
                 surg.
00147.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 iridectomy.
00148.........  Anesth, eye exam  ........  N.......  ......  ...........  ...........  ...........  ...........
00160.........  Anesth, nose/     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sinus surgery.
00162.........  Anesth, nose/     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sinus surgery.
00164.........  Anesth, biopsy    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of nose.
00170.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedure on
                 mouth.
00172.........  Anesth, cleft     ........  N.......  ......  ...........  ...........  ...........  ...........
                 palate repair.
00174.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 pharyngeal
                 surgery.
00190.........  Anesth, face/     ........  N.......  ......  ...........  ...........  ...........  ...........
                 skull bone surg.
00210.........  Anesth, open      ........  N.......  ......  ...........  ...........  ...........  ...........
                 head surgery.
00212.........  Anesth, skull     ........  N.......  ......  ...........  ...........  ...........  ...........
                 drainage.
00216.........  Anesth, head      ........  N.......  ......  ...........  ...........  ...........  ...........
                 vessel surgery.
00218.........  Anesth, special   ........  N.......  ......  ...........  ...........  ...........  ...........
                 head surgery.
00220.........  Anesth, intrcrn   ........  N.......  ......  ...........  ...........  ...........  ...........
                 nerve.
00222.........  Anesth, head      ........  N.......  ......  ...........  ...........  ...........  ...........
                 nerve surgery.

[[Page 49755]]

 
00300.........  Anesth, head/     ........  N.......  ......  ...........  ...........  ...........  ...........
                 neck/ptrunk.
00320.........  Anesth, neck      ........  N.......  ......  ...........  ...........  ...........  ...........
                 organ, 1 & over.
00322.........  Anesth, biopsy    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of thyroid.
00326.........  Anesth, larynx/   ........  N.......  ......  ...........  ...........  ...........  ...........
                 trach, < 1 yr.
00350.........  Anesth, neck      ........  N.......  ......  ...........  ...........  ...........  ...........
                 vessel surgery.
00352.........  Anesth, neck      ........  N.......  ......  ...........  ...........  ...........  ...........
                 vessel surgery.
00400.........  Anesth, skin,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 ext/per/atrunk.
00402.........  Anesth, surgery   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of breast.
00410.........  Anesth, correct   ........  N.......  ......  ...........  ...........  ...........  ...........
                 heart rhythm.
00450.........  Anesth, surgery   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of shoulder.
00454.........  Anesth, collar    ........  N.......  ......  ...........  ...........  ...........  ...........
                 bone biopsy.
00470.........  Anesth, removal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of rib.
00472.........  Anesth, chest     ........  N.......  ......  ...........  ...........  ...........  ...........
                 wall repair.
00500.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 esophageal
                 surgery.
00520.........  Anesth, chest     ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedure.
00522.........  Anesth, chest     ........  N.......  ......  ...........  ...........  ...........  ...........
                 lining biopsy.
00528.........  Anesth, chest     ........  N.......  ......  ...........  ...........  ...........  ...........
                 partition view.
00529.........  Anesth, chest     ........  N.......  ......  ...........  ...........  ...........  ...........
                 partition view.
00530.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 pacemaker
                 insertion.
00532.........  Anesth, vascular  ........  N.......  ......  ...........  ...........  ...........  ...........
                 access.
00534.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 cardioverter/
                 defib.
00537.........  Anesth, cardiac   ........  N.......  ......  ...........  ...........  ...........  ...........
                 electrophys.
00539.........  Anesth, trach-    ........  N.......  ......  ...........  ...........  ...........  ...........
                 bronch reconst.
00541.........  Anesth, one lung  ........  N.......  ......  ...........  ...........  ...........  ...........
                 ventilation.
00548.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 trachea,bronchi
                 surg.
00550.........  Anesth, sternal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 debridement.
00563.........  Anesth, heart     ........  N.......  ......  ...........  ...........  ...........  ...........
                 surg w/arrest.
00566.........  Anesth, cabg w/o  ........  N.......  ......  ...........  ...........  ...........  ...........
                 pump.
00600.........  Anesth, spine,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 cord surgery.
00620.........  Anesth, spine,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 cord surgery.
00630.........  Anesth, spine,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 cord surgery.
00634.........  Anesth for        ........  N.......  ......  ...........  ...........  ...........  ...........
                 chemonucleolysi
                 s.
00635.........  Anesth, lumbar    ........  N.......  ......  ...........  ...........  ...........  ...........
                 puncture.
00640.........  Anesth, spine     ........  N.......  ......  ...........  ...........  ...........  ...........
                 manipulation.
00700.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 abdominal wall
                 surg.
00702.........  Anesth, for       ........  N.......  ......  ...........  ...........  ...........  ...........
                 liver biopsy.
00730.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 abdominal wall
                 surg.
00740.........  Anesth, upper gi  ........  N.......  ......  ...........  ...........  ...........  ...........
                 visualize.
00750.........  Anesth, repair    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of hernia.
00752.........  Anesth, repair    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of hernia.
00754.........  Anesth, repair    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of hernia.
00756.........  Anesth, repair    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of hernia.
00770.........  Anesth, blood     ........  N.......  ......  ...........  ...........  ...........  ...........
                 vessel repair.
00790.........  Anesth, surg      ........  N.......  ......  ...........  ...........  ...........  ...........
                 upper abdomen.
00797.........  Anesth, surgery   ........  N.......  ......  ...........  ...........  ...........  ...........
                 for obesity.
00800.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 abdominal wall
                 surg.
00810.........  Anesth, low       ........  N.......  ......  ...........  ...........  ...........  ...........
                 intestine scope.
00820.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 abdominal wall
                 surg.
00830.........  Anesth, repair    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of hernia.
00832.........  Anesth, repair    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of hernia.
00834.........  Anesth, hernia    ........  N.......  ......  ...........  ...........  ...........  ...........
                 repair < 1 yr.
00836.........  Anesth hernia     ........  N.......  ......  ...........  ...........  ...........  ...........
                 repair preemie.
00840.........  Anesth, surg      ........  N.......  ......  ...........  ...........  ...........  ...........
                 lower abdomen.
00842.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 amniocentesis.
00851.........  Anesth, tubal     ........  N.......  ......  ...........  ...........  ...........  ...........
                 ligation.
00860.........  Anesth, surgery   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of abdomen.
00862.........  Anesth, kidney/   ........  N.......  ......  ...........  ...........  ...........  ...........
                 ureter surg.
00870.........  Anesth, bladder   ........  N.......  ......  ...........  ...........  ...........  ...........
                 stone surg.
00872.........  Anesth kidney     ........  N.......  ......  ...........  ...........  ...........  ...........
                 stone destruct.
00873.........  Anesth kidney     ........  N.......  ......  ...........  ...........  ...........  ...........
                 stone destruct.
00880.........  Anesth, abdomen   ........  N.......  ......  ...........  ...........  ...........  ...........
                 vessel surg.
00902.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 anorectal
                 surgery.
00906.........  Anesth, removal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of vulva.
00910.........  Anesth, bladder   ........  N.......  ......  ...........  ...........  ...........  ...........
                 surgery.
00912.........  Anesth, bladder   ........  N.......  ......  ...........  ...........  ...........  ...........
                 tumor surg.
00914.........  Anesth, removal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of prostate.
00916.........  Anesth, bleeding  ........  N.......  ......  ...........  ...........  ...........  ...........
                 control.
00918.........  Anesth, stone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 removal.
00920.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 genitalia
                 surgery.
00921.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 vasectomy.

[[Page 49756]]

 
00922.........  Anesth, sperm     ........  N.......  ......  ...........  ...........  ...........  ...........
                 duct surgery.
00924.........  Anesth, testis    ........  N.......  ......  ...........  ...........  ...........  ...........
                 exploration.
00926.........  Anesth, removal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of testis.
00928.........  Anesth, removal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of testis.
00930.........  Anesth, testis    ........  N.......  ......  ...........  ...........  ...........  ...........
                 suspension.
00938.........  Anesth, insert    ........  N.......  ......  ...........  ...........  ...........  ...........
                 penis device.
00940.........  Anesth, vaginal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedures.
00942.........  Anesth, surg on   ........  N.......  ......  ...........  ...........  ...........  ...........
                 vag/urethral.
00948.........  Anesth, repair    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of cervix.
00950.........  Anesth, vaginal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 endoscopy.
00952.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 hysteroscope/
                 graph.
01112.........  Anesth, bone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 aspirate/bx.
01120.........  Anesth, pelvis    ........  N.......  ......  ...........  ...........  ...........  ...........
                 surgery.
01130.........  Anesth, body      ........  N.......  ......  ...........  ...........  ...........  ...........
                 cast procedure.
01160.........  Anesth, pelvis    ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedure.
01170.........  Anesth, pelvis    ........  N.......  ......  ...........  ...........  ...........  ...........
                 surgery.
01173.........  Anesth, fx        ........  N.......  ......  ...........  ...........  ...........  ...........
                 repair, pelvis.
01180.........  Anesth, pelvis    ........  N.......  ......  ...........  ...........  ...........  ...........
                 nerve removal.
01190.........  Anesth, pelvis    ........  N.......  ......  ...........  ...........  ...........  ...........
                 nerve removal.
01200.........  Anesth, hip       ........  N.......  ......  ...........  ...........  ...........  ...........
                 joint procedure.
01202.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 arthroscopy of
                 hip.
01210.........  Anesth, hip       ........  N.......  ......  ...........  ...........  ...........  ...........
                 joint surgery.
01215.........  Anesth, revise    ........  N.......  ......  ...........  ...........  ...........  ...........
                 hip repair.
01220.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedure on
                 femur.
01230.........  Anesth, surgery   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of femur.
01250.........  Anesth, upper     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg surgery.
01260.........  Anesth, upper     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg veins surg.
01270.........  Anesth, thigh     ........  N.......  ......  ...........  ...........  ...........  ...........
                 arteries surg.
01320.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 area surgery.
01340.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 area procedure.
01360.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 area surgery.
01380.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 joint procedure.
01382.........  Anesth, dx knee   ........  N.......  ......  ...........  ...........  ...........  ...........
                 arthroscopy.
01390.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 area procedure.
01392.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 area surgery.
01400.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 joint surgery.
01420.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 joint casting.
01430.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 veins surgery.
01432.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 vessel surg.
01440.........  Anesth, knee      ........  N.......  ......  ...........  ...........  ...........  ...........
                 arteries surg.
01462.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg procedure.
01464.........  Anesth, ankle/ft  ........  N.......  ......  ...........  ...........  ...........  ...........
                 arthroscopy.
01470.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg surgery.
01472.........  Anesth, achilles  ........  N.......  ......  ...........  ...........  ...........  ...........
                 tendon surg.
01474.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg surgery.
01480.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg bone surg.
01482.........  Anesth, radical   ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg surgery.
01484.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg revision.
01490.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg casting.
01500.........  Anesth, leg       ........  N.......  ......  ...........  ...........  ...........  ...........
                 arteries surg.
01520.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg vein surg.
01522.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 leg vein surg.
01610.........  Anesth, surgery   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of shoulder.
01620.........  Anesth, shoulder  ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedure.
01622.........  Anes dx shoulder  ........  N.......  ......  ...........  ...........  ...........  ...........
                 arthroscopy.
01630.........  Anesth, surgery   ........  N.......  ......  ...........  ...........  ...........  ...........
                 of shoulder.
01650.........  Anesth, shoulder  ........  N.......  ......  ...........  ...........  ...........  ...........
                 artery surg.
01670.........  Anesth, shoulder  ........  N.......  ......  ...........  ...........  ...........  ...........
                 vein surg.
01680.........  Anesth, shoulder  ........  N.......  ......  ...........  ...........  ...........  ...........
                 casting.
01682.........  Anesth, airplane  ........  N.......  ......  ...........  ...........  ...........  ...........
                 cast.
01710.........  Anesth, elbow     ........  N.......  ......  ...........  ...........  ...........  ...........
                 area surgery.
01712.........  Anesth, uppr arm  ........  N.......  ......  ...........  ...........  ...........  ...........
                 tendon surg.
01714.........  Anesth, uppr arm  ........  N.......  ......  ...........  ...........  ...........  ...........
                 tendon surg.
01716.........  Anesth, biceps    ........  N.......  ......  ...........  ...........  ...........  ...........
                 tendon repair.
01730.........  Anesth, uppr arm  ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedure.
01732.........  Anesth, dx elbow  ........  N.......  ......  ...........  ...........  ...........  ...........
                 arthroscopy.
01740.........  Anesth, upper     ........  N.......  ......  ...........  ...........  ...........  ...........
                 arm surgery.
01742.........  Anesth, humerus   ........  N.......  ......  ...........  ...........  ...........  ...........
                 surgery.
01744.........  Anesth, humerus   ........  N.......  ......  ...........  ...........  ...........  ...........
                 repair.
01758.........  Anesth, humeral   ........  N.......  ......  ...........  ...........  ...........  ...........
                 lesion surg.

[[Page 49757]]

 
01760.........  Anesth, elbow     ........  N.......  ......  ...........  ...........  ...........  ...........
                 replacement.
01770.........  Anesth, uppr arm  ........  N.......  ......  ...........  ...........  ...........  ...........
                 artery surg.
01772.........  Anesth, uppr arm  ........  N.......  ......  ...........  ...........  ...........  ...........
                 embolectomy.
01780.........  Anesth, upper     ........  N.......  ......  ...........  ...........  ...........  ...........
                 arm vein surg.
01782.........  Anesth, uppr arm  ........  N.......  ......  ...........  ...........  ...........  ...........
                 vein repair.
01810.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 arm surgery.
01820.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 arm procedure.
01829.........  Anesth, dx wrist  ........  N.......  ......  ...........  ...........  ...........  ...........
                 arthroscopy.
01830.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 arm surgery.
01832.........  Anesth, wrist     ........  N.......  ......  ...........  ...........  ...........  ...........
                 replacement.
01840.........  Anesth, lwr arm   ........  N.......  ......  ...........  ...........  ...........  ...........
                 artery surg.
01842.........  Anesth, lwr arm   ........  N.......  ......  ...........  ...........  ...........  ...........
                 embolectomy.
01844.........  Anesth, vascular  ........  N.......  ......  ...........  ...........  ...........  ...........
                 shunt surg.
01850.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 arm vein surg.
01852.........  Anesth, lwr arm   ........  N.......  ......  ...........  ...........  ...........  ...........
                 vein repair.
01860.........  Anesth, lower     ........  N.......  ......  ...........  ...........  ...........  ...........
                 arm casting.
01905.........  Anes, spine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 inject, x-ray/
                 re.
01916.........  Anesth, dx        ........  N.......  ......  ...........  ...........  ...........  ...........
                 arteriography.
01920.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 catheterize
                 heart.
01922.........  Anesth, cat or    ........  N.......  ......  ...........  ...........  ...........  ...........
                 MRI scan.
01924.........  Anes, ther        ........  N.......  ......  ...........  ...........  ...........  ...........
                 interven rad,
                 art.
01925.........  Anes, ther        ........  N.......  ......  ...........  ...........  ...........  ...........
                 interven rad,
                 car.
01926.........  Anes, tx interv   ........  N.......  ......  ...........  ...........  ...........  ...........
                 rad hrt/cran.
01930.........  Anes, ther        ........  N.......  ......  ...........  ...........  ...........  ...........
                 interven rad,
                 vei.
01931.........  Anes, ther        ........  N.......  ......  ...........  ...........  ...........  ...........
                 interven rad,
                 tip.
01932.........  Anes, tx interv   ........  N.......  ......  ...........  ...........  ...........  ...........
                 rad, th vein.
01933.........  Anes, tx interv   ........  N.......  ......  ...........  ...........  ...........  ...........
                 rad, cran v.
01951.........  Anesth, burn,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 less 4 percent.
01952.........  Anesth, burn, 4-  ........  N.......  ......  ...........  ...........  ...........  ...........
                 9 percent.
01953.........  Anesth, burn,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 each 9 percent.
01958.........  Anesth,           ........  N.......  ......  ...........  ...........  ...........  ...........
                 antepartum
                 manipul.
01960.........  Anesth, vaginal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 delivery.
01961.........  Anesth, cs        ........  N.......  ......  ...........  ...........  ...........  ...........
                 delivery.
01962.........  Anesth, emer      ........  N.......  ......  ...........  ...........  ...........  ...........
                 hysterectomy.
01963.........  Anesth, cs        ........  N.......  ......  ...........  ...........  ...........  ...........
                 hysterectomy.
01965.........  Anesth, inc/      ........  N.......  ......  ...........  ...........  ...........  ...........
                 missed ab proc.
01966.........  Anesth, induced   ........  N.......  ......  ...........  ...........  ...........  ...........
                 ab procedure.
01967.........  Anesth/analg,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 vag delivery.
01968.........  Anes/analg cs     ........  N.......  ......  ...........  ...........  ...........  ...........
                 deliver add-on.
01969.........  Anesth/analg cs   ........  N.......  ......  ...........  ...........  ...........  ...........
                 hyst add-on.
01991.........  Anesth, nerve     ........  N.......  ......  ...........  ...........  ...........  ...........
                 block/inj.
01992.........  Anesth, n block/  ........  N.......  ......  ...........  ...........  ...........  ...........
                 inj, prone.
01995.........  Regional          ........  N.......  ......  ...........  ...........  ...........  ...........
                 anesthesia limb.
01996.........  Hosp manage cont  ........  N.......  ......  ...........  ...........  ...........  ...........
                 drug admin.
01999.........  Unlisted anesth   ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedure.
10021.........  Fna w/o image...  ........  T.......    0002       1.0948        67.39  ...........        13.48
10022.........  Fna w/image.....  ........  T.......    0036       2.0147       124.01  ...........        24.80
10040.........  Acne surgery....  ........  T.......    0010       0.4829        29.72         8.14         5.94
10060.........  Drainage of skin  ........  T.......    0006       1.4821        91.22        21.76        18.24
                 abscess.
10061.........  Drainage of skin  ........  T.......    0006       1.4821        91.22        21.76        18.24
                 abscess.
10080.........  Drainage of       ........  T.......    0006       1.4821        91.22        21.76        18.24
                 pilonidal cyst.
10081.........  Drainage of       ........  T.......    0007      10.9184       672.04  ...........       134.41
                 pilonidal cyst.
10120.........  Remove foreign    ........  T.......    0006       1.4821        91.22        21.76        18.24
                 body.
10121.........  Remove foreign    ........  T.......    0021      14.9563       920.58       219.48       184.12
                 body.
10140.........  Drainage of       ........  T.......    0007      10.9184       672.04  ...........       134.41
                 hematoma/fluid.
10160.........  Puncture          ........  T.......    0018       1.0534        64.84        15.87        12.97
                 drainage of
                 lesion.
10180.........  Complex           ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 drainage, wound.
11000.........  Debride infected  ........  T.......    0013       1.0876        66.94  ...........        13.39
                 skin.
11001.........  Debride infected  ........  T.......    0012       0.8076        49.71        10.30         9.94
                 skin add-on.
11010.........  Debride skin, fx  ........  T.......    0019       4.0123       246.96        71.87        49.39
11011.........  Debride skin/     ........  T.......    0019       4.0123       246.96        71.87        49.39
                 muscle, fx.
11012.........  Debride skin/     ........  T.......    0019       4.0123       246.96        71.87        49.39
                 muscle/bone, fx.
11040.........  Debride skin,     ........  T.......    0015       1.6062        98.86        20.13        19.77
                 partial.
11041.........  Debride skin,     ........  T.......    0015       1.6062        98.86        20.13        19.77
                 full.
11042.........  Debride skin/     ........  T.......    0016       2.6253       161.59        32.68        32.32
                 tissue.
11043.........  Debride tissue/   ........  T.......    0016       2.6253       161.59        32.68        32.32
                 muscle.
11044.........  Debride tissue/   ........  T.......    0682       6.7529       415.65       158.65        83.13
                 muscle/bone.
11055.........  Trim skin lesion  ........  T.......    0012       0.8076        49.71        10.30         9.94
11056.........  Trim skin         ........  T.......    0012       0.8076        49.71        10.30         9.94
                 lesions, 2 to 4.
11057.........  Trim skin         ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesions, over 4.

[[Page 49758]]

 
11100.........  Biopsy, skin      ........  T.......    0018       1.0534        64.84        15.87        12.97
                 lesion.
11101.........  Biopsy, skin add- ........  T.......    0018       1.0534        64.84        15.87        12.97
                 on.
11200.........  Removal of skin   ........  T.......    0013       1.0876        66.94  ...........        13.39
                 tags.
11201.........  Remove skin tags  ........  T.......    0015       1.6062        98.86        20.13        19.77
                 add-on.
11300.........  Shave skin        ........  T.......    0012       0.8076        49.71        10.30         9.94
                 lesion.
11301.........  Shave skin        ........  T.......    0012       0.8076        49.71        10.30         9.94
                 lesion.
11302.........  Shave skin        ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion.
11303.........  Shave skin        ........  T.......    0015       1.6062        98.86        20.13        19.77
                 lesion.
11305.........  Shave skin        ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion.
11306.........  Shave skin        ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion.
11307.........  Shave skin        ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion.
11308.........  Shave skin        ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion.
11310.........  Shave skin        ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion.
11311.........  Shave skin        ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion.
11312.........  Shave skin        ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion.
11313.........  Shave skin        ........  T.......    0016       2.6253       161.59        32.68        32.32
                 lesion.
11400.........  Exc tr-ext        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 b9+marg 0.5 <
                 cm.
11401.........  Exc tr-ext        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 b9+marg 0.6-1
                 cm.
11402.........  Exc tr-ext        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 b9+marg 1.1-2
                 cm.
11403.........  Exc tr-ext        ........  T.......    0020       6.5128       400.87        98.57        80.17
                 b9+marg 2.1-3
                 cm.
11404.........  Exc tr-ext        ........  T.......    0021      14.9563       920.58       219.48       184.12
                 b9+marg 3.1-4
                 cm.
11406.........  Exc tr-ext        ........  T.......    0021      14.9563       920.58       219.48       184.12
                 b9+marg > 4.0
                 cm.
11420.........  Exc h-f-nk-sp     ........  T.......    0020       6.5128       400.87        98.57        80.17
                 b9+marg 0.5 <.
11421.........  Exc h-f-nk-sp     ........  T.......    0020       6.5128       400.87        98.57        80.17
                 b9+marg 0.6-1.
11422.........  Exc h-f-nk-sp     ........  T.......    0020       6.5128       400.87        98.57        80.17
                 b9+marg 1.1-2.
11423.........  Exc h-f-nk-sp     ........  T.......    0021      14.9563       920.58       219.48       184.12
                 b9+marg 2.1-3.
11424.........  Exc h-f-nk-sp     ........  T.......    0021      14.9563       920.58       219.48       184.12
                 b9+marg 3.1-4.
11426.........  Exc h-f-nk-sp     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 b9+marg > 4 cm.
11440.........  Exc face-mm       ........  T.......    0019       4.0123       246.96        71.87        49.39
                 b9+marg 0.5 <
                 cm.
11441.........  Exc face-mm       ........  T.......    0019       4.0123       246.96        71.87        49.39
                 b9+marg 0.6-1
                 cm.
11442.........  Exc face-mm       ........  T.......    0020       6.5128       400.87        98.57        80.17
                 b9+marg 1.1-2
                 cm.
11443.........  Exc face-mm       ........  T.......    0020       6.5128       400.87        98.57        80.17
                 b9+marg 2.1-3
                 cm.
11444.........  Exc face-mm       ........  T.......    0020       6.5128       400.87        98.57        80.17
                 b9+marg 3.1-4
                 cm.
11446.........  Exc face-mm       ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 b9+marg > 4 cm.
11450.........  Removal, sweat    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 gland lesion.
11451.........  Removal, sweat    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 gland lesion.
11462.........  Removal, sweat    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 gland lesion.
11463.........  Removal, sweat    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 gland lesion.
11470.........  Removal, sweat    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 gland lesion.
11471.........  Removal, sweat    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 gland lesion.
11600.........  Exc tr-ext        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 mlg+marg 0.5 <
                 cm.
11601.........  Exc tr-ext        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 mlg+marg 0.6-1
                 cm.
11602.........  Exc tr-ext        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 mlg+marg 1.1-2
                 cm.
11603.........  Exc tr-ext        ........  T.......    0020       6.5128       400.87        98.57        80.17
                 mlg+marg 2.1-3
                 cm.
11604.........  Exc tr-ext        ........  T.......    0020       6.5128       400.87        98.57        80.17
                 mlg+marg 3.1-4
                 cm.
11606.........  Exc tr-ext        ........  T.......    0021      14.9563       920.58       219.48       184.12
                 mlg+marg > 4 cm.
11620.........  Exc h-f-nk-sp     ........  T.......    0020       6.5128       400.87        98.57        80.17
                 mlg+marg 0.5 <.
11621.........  Exc h-f-nk-sp     ........  T.......    0019       4.0123       246.96        71.87        49.39
                 mlg+marg 0.6-1.
11622.........  Exc h-f-nk-sp     ........  T.......    0020       6.5128       400.87        98.57        80.17
                 mlg+marg 1.1-2.
11623.........  Exc h-f-nk-sp     ........  T.......    0021      14.9563       920.58       219.48       184.12
                 mlg+marg 2.1-3.
11624.........  Exc h-f-nk-sp     ........  T.......    0021      14.9563       920.58       219.48       184.12
                 mlg+marg 3.1-4.
11626.........  Exc h-f-nk-sp     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 mlg+mar > 4 cm.
11640.........  Exc face-mm       ........  T.......    0020       6.5128       400.87        98.57        80.17
                 malig+marg 0.5
                 <.
11641.........  Exc face-mm       ........  T.......    0020       6.5128       400.87        98.57        80.17
                 malig+marg 0.6-
                 1.
11642.........  Exc face-mm       ........  T.......    0020       6.5128       400.87        98.57        80.17
                 malig+marg 1.1-
                 2.
11643.........  Exc face-mm       ........  T.......    0020       6.5128       400.87        98.57        80.17
                 malig+marg 2.1-
                 3.
11644.........  Exc face-mm       ........  T.......    0021      14.9563       920.58       219.48       184.12
                 malig+marg 3.1-
                 4.
11646.........  Exc face-mm       ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 mlg+marg > 4 cm.
11719.........  Trim nail(s)....  ........  T.......    0009       0.6803        41.87  ...........         8.37
11720.........  Debride nail, 1-  ........  T.......    0009       0.6803        41.87  ...........         8.37
                 5.
11721.........  Debride nail, 6   ........  T.......    0009       0.6803        41.87  ...........         8.37
                 or more.
11730.........  Removal of nail   ........  T.......    0013       1.0876        66.94  ...........        13.39
                 plate.
11732.........  Remove nail       ........  T.......    0012       0.8076        49.71        10.30         9.94
                 plate, add-on.
11740.........  Drain blood from  ........  T.......    0009       0.6803        41.87  ...........         8.37
                 under nail.
11750.........  Removal of nail   ........  T.......    0019       4.0123       246.96        71.87        49.39
                 bed.
11752.........  Remove nail bed/  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 finger tip.
11755.........  Biopsy, nail      ........  T.......    0019       4.0123       246.96        71.87        49.39
                 unit.
11760.........  Repair of nail    ........  T.......    0024       1.4924        91.86        30.08        18.37
                 bed.
11762.........  Reconstruction    ........  T.......    0024       1.4924        91.86        30.08        18.37
                 of nail bed.
11765.........  Excision of nail  ........  T.......    0015       1.6062        98.86        20.13        19.77
                 fold, toe.

[[Page 49759]]

 
11770.........  Removal of        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pilonidal
                 lesion.
11771.........  Removal of        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pilonidal
                 lesion.
11772.........  Removal of        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pilonidal
                 lesion.
11900.........  Injection into    ........  T.......    0012       0.8076        49.71        10.30         9.94
                 skin lesions.
11901.........  Added skin        ........  T.......    0012       0.8076        49.71        10.30         9.94
                 lesions
                 injection.
11920.........  Correct skin      ........  T.......    0024       1.4924        91.86        30.08        18.37
                 color defects.
11921.........  Correct skin      ........  T.......    0024       1.4924        91.86        30.08        18.37
                 color defects.
11922.........  Correct skin      ........  T.......    0024       1.4924        91.86        30.08        18.37
                 color defects.
11950.........  Therapy for       ........  T.......    0024       1.4924        91.86        30.08        18.37
                 contour defects.
11951.........  Therapy for       ........  T.......    0024       1.4924        91.86        30.08        18.37
                 contour defects.
11952.........  Therapy for       ........  T.......    0024       1.4924        91.86        30.08        18.37
                 contour defects.
11954.........  Therapy for       ........  T.......    0024       1.4924        91.86        30.08        18.37
                 contour defects.
11960.........  Insert tissue     ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 expander(s).
11970.........  Replace tissue    CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 expander.
11971.........  Remove tissue     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 expander(s).
11976.........  Removal of        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 contraceptive
                 cap.
11980.........  Implant hormone   ........  X.......    0340       0.6211        38.23  ...........         7.65
                 pellet(s).
11981.........  Insert drug       ........  X.......    0340       0.6211        38.23  ...........         7.65
                 implant device.
11982.........  Remove drug       ........  X.......    0340       0.6211        38.23  ...........         7.65
                 implant device.
11983.........  Remove/insert     ........  X.......    0340       0.6211        38.23  ...........         7.65
                 drug implant.
12001.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12002.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12004.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12005.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12006.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12007.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12011.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12013.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12014.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12015.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12016.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12017.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12018.........  Repair            ........  T.......    0024       1.4924        91.86        30.08        18.37
                 superficial
                 wound(s).
12020.........  Closure of split  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound.
12021.........  Closure of split  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound.
12031.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12032.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12034.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12035.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12036.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12037.........  Layer closure of  ........  T.......    0025       5.0931       313.49        95.46        62.70
                 wound(s).
12041.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12042.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12044.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12045.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12046.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12047.........  Layer closure of  ........  T.......    0025       5.0931       313.49        95.46        62.70
                 wound(s).
12051.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12052.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12053.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12054.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12055.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12056.........  Layer closure of  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 wound(s).
12057.........  Layer closure of  ........  T.......    0025       5.0931       313.49        95.46        62.70
                 wound(s).
13100.........  Repair of wound   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 or lesion.
13101.........  Repair of wound   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 or lesion.
13102.........  Repair wound/     ........  T.......    0024       1.4924        91.86        30.08        18.37
                 lesion add-on.
13120.........  Repair of wound   ........  T.......    0024       1.4924        91.86        30.08        18.37
                 or lesion.
13121.........  Repair of wound   ........  T.......    0024       1.4924        91.86        30.08        18.37
                 or lesion.
13122.........  Repair wound/     ........  T.......    0024       1.4924        91.86        30.08        18.37
                 lesion add-on.
13131.........  Repair of wound   ........  T.......    0024       1.4924        91.86        30.08        18.37
                 or lesion.
13132.........  Repair of wound   ........  T.......    0024       1.4924        91.86        30.08        18.37
                 or lesion.
13133.........  Repair wound/     ........  T.......    0024       1.4924        91.86        30.08        18.37
                 lesion add-on.
13150.........  Repair of wound   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 or lesion.
13151.........  Repair of wound   ........  T.......    0024       1.4924        91.86        30.08        18.37
                 or lesion.
13152.........  Repair of wound   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 or lesion.
13153.........  Repair wound/     ........  T.......    0024       1.4924        91.86        30.08        18.37
                 lesion add-on.
13160.........  Late closure of   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 wound.
14000.........  Skin tissue       ........  T.......    0686      13.3433       821.29  ...........       164.26
                 rearrangement.
14001.........  Skin tissue       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 rearrangement.

[[Page 49760]]

 
14020.........  Skin tissue       ........  T.......    0686      13.3433       821.29  ...........       164.26
                 rearrangement.
14021.........  Skin tissue       CH......  T.......    0686      13.3433       821.29  ...........       164.26
                 rearrangement.
14040.........  Skin tissue       ........  T.......    0686      13.3433       821.29  ...........       164.26
                 rearrangement.
14041.........  Skin tissue       CH......  T.......    0686      13.3433       821.29  ...........       164.26
                 rearrangement.
14060.........  Skin tissue       CH......  T.......    0686      13.3433       821.29  ...........       164.26
                 rearrangement.
14061.........  Skin tissue       ........  T.......    0686      13.3433       821.29  ...........       164.26
                 rearrangement.
14300.........  Skin tissue       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 rearrangement.
14350.........  Skin tissue       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 rearrangement.
15000.........  Wound prep, 1st   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 100 sq cm.
15001.........  Wound prep, addl  ........  T.......    0025       5.0931       313.49        95.46        62.70
                 100 sq cm.
15040.........  Harvest cultured  ........  T.......    0024       1.4924        91.86        30.08        18.37
                 skin graft.
15050.........  Skin pinch graft  ........  T.......    0025       5.0931       313.49        95.46        62.70
15100.........  Skin splt grft,   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 trnk/arm/leg.
15101.........  Skin splt grft t/ ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 a/l, add-on.
15110.........  Epidrm autogrft   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 trnk/arm/leg.
15111.........  Epidrm autogrft   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 t/a/l add-on.
15115.........  Epidrm a-grft     ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 face/nck/hf/g.
15116.........  Epidrm a-grft f/  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 n/hf/g addl.
15120.........  Skn splt a-grft   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 fac/nck/hf/g.
15121.........  Skn splt a-grft   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 f/n/hf/g add.
15130.........  Derm autograft,   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 trnk/arm/leg.
15131.........  Derm autograft t/ ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 a/l add-on.
15135.........  Derm autograft    ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 face/nck/hf/g.
15136.........  Derm autograft,   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 f/n/hf/g add.
15150.........  Cult epiderm      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 grft t/arm/leg.
15151.........  Cult epiderm      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 grft t/a/l addl.
15152.........  Cult epiderm      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 graft t/a/l +%.
15155.........  Cult epiderm      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 graft, f/n/hf/g.
15156.........  Cult epidrm grft  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 f/n/hfg add.
15157.........  Cult epiderm      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 grft f/n/hfg +%.
15170.........  Acell graft       CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 trunk/arms/legs.
15171.........  Acell graft t/    CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 arm/leg add-on.
15175.........  Acellular graft,  CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 f/n/hf/g.
15176.........  Acell graft, f/n/ CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 hf/g add-on.
15200.........  Skin full graft,  CH......  T.......    0686      13.3433       821.29  ...........       164.26
                 trunk.
15201.........  Skin full graft   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 trunk add-on.
15220.........  Skin full graft   CH......  T.......    0686      13.3433       821.29  ...........       164.26
                 sclp/arm/leg.
15221.........  Skin full graft   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 add-on.
15240.........  Skin full grft    ........  T.......    0686      13.3433       821.29  ...........       164.26
                 face/genit/hf.
15241.........  Skin full graft   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 add-on.
15260.........  Skin full graft   ........  T.......    0686      13.3433       821.29  ...........       164.26
                 een&lips.
15261.........  Skin full graft   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 add-on.
15300.........  Apply             CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 skinallogrft, t/
                 arm/lg.
15301.........  Apply             ........  T.......    0025       5.0931       313.49        95.46        62.70
                 sknallogrft t/a/
                 l addl.
15320.........  Apply skin        ........  T.......    0025       5.0931       313.49        95.46        62.70
                 allogrft f/n/hf/
                 g.
15321.........  Aply sknallogrft  ........  T.......    0025       5.0931       313.49        95.46        62.70
                 f/n/hfg add.
15330.........  Aply acell        ........  T.......    0025       5.0931       313.49        95.46        62.70
                 alogrft t/arm/
                 leg.
15331.........  Aply acell grft   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 t/a/l add-on.
15335.........  Apply acell       ........  T.......    0025       5.0931       313.49        95.46        62.70
                 graft, f/n/hf/g.
15336.........  Aply acell grft   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 f/n/hf/g add.
15340.........  Apply cult skin   CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 substitute.
15341.........  Apply cult skin   CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 sub add-on.
15360.........  Apply cult derm   CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 sub, t/a/l.
15361.........  Aply cult derm    CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 sub t/a/l add.
15365.........  Apply cult derm   CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 sub f/n/hf/g.
15366.........  Apply cult derm   CH......  T.......    0025       5.0931       313.49        95.46        62.70
                 f/hf/g add.
15400.........  Apply skin        ........  T.......    0025       5.0931       313.49        95.46        62.70
                 xenograft, t/a/
                 l.
15401.........  Apply skn         ........  T.......    0025       5.0931       313.49        95.46        62.70
                 xenogrft t/a/l
                 add.
15420.........  Apply skin        ........  T.......    0025       5.0931       313.49        95.46        62.70
                 xgraft, f/n/hf/
                 g.
15421.........  Apply skn xgrft   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 f/n/hf/g add.
15430.........  Apply acellular   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 xenograft.
15431.........  Apply acellular   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 xgraft add.
15570.........  Form skin         ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pedicle flap.
15572.........  Form skin         ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pedicle flap.
15574.........  Form skin         ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pedicle flap.
15576.........  Form skin         ........  T.......    0686      13.3433       821.29  ...........       164.26
                 pedicle flap.
15600.........  Skin graft......  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
15610.........  Skin graft......  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
15620.........  Skin graft......  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
15630.........  Skin graft......  ........  T.......    0027      21.2645     1,308.85       329.72       261.77

[[Page 49761]]

 
15650.........  Transfer skin     ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pedicle flap.
15732.........  Muscle-skin       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 graft, head/
                 neck.
15734.........  Muscle-skin       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 graft, trunk.
15736.........  Muscle-skin       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 graft, arm.
15738.........  Muscle-skin       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 graft, leg.
15740.........  Island pedicle    ........  T.......    0686      13.3433       821.29  ...........       164.26
                 flap graft.
15750.........  Neurovascular     ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pedicle graft.
15760.........  Composite skin    ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 graft.
15770.........  Derma-fat-fascia  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 graft.
15775.........  Hair transplant   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 punch grafts.
15776.........  Hair transplant   ........  T.......    0025       5.0931       313.49        95.46        62.70
                 punch grafts.
15780.........  Abrasion          ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 treatment of
                 skin.
15781.........  Abrasion          ........  T.......    0019       4.0123       246.96        71.87        49.39
                 treatment of
                 skin.
15782.........  Abrasion          ........  T.......    0019       4.0123       246.96        71.87        49.39
                 treatment of
                 skin.
15783.........  Abrasion          ........  T.......    0016       2.6253       161.59        32.68        32.32
                 treatment of
                 skin.
15786.........  Abrasion,         ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesion, single.
15787.........  Abrasion,         ........  T.......    0013       1.0876        66.94  ...........        13.39
                 lesions, add-on.
15788.........  Chemical peel,    ........  T.......    0012       0.8076        49.71        10.30         9.94
                 face, epiderm.
15789.........  Chemical peel,    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 face, dermal.
15792.........  Chemical peel,    ........  T.......    0013       1.0876        66.94  ...........        13.39
                 nonfacial.
15793.........  Chemical peel,    ........  T.......    0012       0.8076        49.71        10.30         9.94
                 nonfacial.
15819.........  Plastic surgery,  ........  T.......    0025       5.0931       313.49        95.46        62.70
                 neck.
15820.........  Revision of       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 lower eyelid.
15821.........  Revision of       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 lower eyelid.
15822.........  Revision of       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 upper eyelid.
15823.........  Revision of       CH......  T.......    0686      13.3433       821.29  ...........       164.26
                 upper eyelid.
15824.........  Removal of        ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 forehead
                 wrinkles.
15825.........  Removal of neck   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 wrinkles.
15826.........  Removal of brow   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 wrinkles.
15828.........  Removal of face   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 wrinkles.
15829.........  Removal of skin   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 wrinkles.
15831.........  Excise excessive  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 skin tissue.
15832.........  Excise excessive  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 skin tissue.
15833.........  Excise excessive  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 skin tissue.
15834.........  Excise excessive  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 skin tissue.
15835.........  Excise excessive  ........  T.......    0025       5.0931       313.49        95.46        62.70
                 skin tissue.
15836.........  Excise excessive  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 skin tissue.
15837.........  Excise excessive  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 skin tissue.
15838.........  Excise excessive  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 skin tissue.
15839.........  Excise excessive  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 skin tissue.
15840.........  Graft for face    ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 nerve palsy.
15841.........  Graft for face    ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 nerve palsy.
15842.........  Flap for face     ........  T.......    0686      13.3433       821.29  ...........       164.26
                 nerve palsy.
15845.........  Skin and muscle   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 repair, face.
15850.........  Removal of        ........  T.......    0016       2.6253       161.59        32.68        32.32
                 sutures.
15851.........  Removal of        ........  T.......    0016       2.6253       161.59        32.68        32.32
                 sutures.
15852.........  Dressing change   ........  X.......    0340       0.6211        38.23  ...........         7.65
                 not for burn.
15860.........  Test for blood    CH......  X.......    0340       0.6211        38.23  ...........         7.65
                 flow in graft.
15876.........  Suction assisted  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 lipectomy.
15877.........  Suction assisted  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 lipectomy.
15878.........  Suction assisted  ........  T.......    0686      13.3433       821.29  ...........       164.26
                 lipectomy.
15879.........  Suction assisted  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 lipectomy.
15920.........  Removal of tail   ........  T.......    0019       4.0123       246.96        71.87        49.39
                 bone ulcer.
15922.........  Removal of tail   ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 bone ulcer.
15931.........  Remove sacrum     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pressure sore.
15933.........  Remove sacrum     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pressure sore.
15934.........  Remove sacrum     ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15935.........  Remove sacrum     ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15936.........  Remove sacrum     ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15937.........  Remove sacrum     ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15940.........  Remove hip        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pressure sore.
15941.........  Remove hip        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pressure sore.
15944.........  Remove hip        ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15945.........  Remove hip        ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15946.........  Remove hip        ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15950.........  Remove thigh      ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pressure sore.
15951.........  Remove thigh      ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pressure sore.
15952.........  Remove thigh      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15953.........  Remove thigh      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15956.........  Remove thigh      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.

[[Page 49762]]

 
15958.........  Remove thigh      ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pressure sore.
15999.........  Removal of        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 pressure sore.
16000.........  Initial           ........  T.......    0012       0.8076        49.71        10.30         9.94
                 treatment of
                 burn(s).
16020.........  Dress/debrid p-   ........  T.......    0013       1.0876        66.94  ...........        13.39
                 thick burn, s.
16025.........  Dress/debrid p-   ........  T.......    0013       1.0876        66.94  ...........        13.39
                 thick burn, m.
16030.........  Dress/debrid p-   ........  T.......    0015       1.6062        98.86        20.13        19.77
                 thick burn, l.
16035.........  Incision of burn  CH......  T.......    0016       2.6253       161.59        32.68        32.32
                 scab, initi.
17000.........  Destroy benign/   ........  T.......    0010       0.4829        29.72         8.14         5.94
                 premlg lesion.
17003.........  Destroy lesions,  ........  T.......    0010       0.4829        29.72         8.14         5.94
                 2-14.
17004.........  Destroy lesions,  ........  T.......    0011       2.6478       162.97  ...........        32.59
                 15 or more.
17106.........  Destruction of    ........  T.......    0011       2.6478       162.97  ...........        32.59
                 skin lesions.
17107.........  Destruction of    ........  T.......    0011       2.6478       162.97  ...........        32.59
                 skin lesions.
17108.........  Destruction of    ........  T.......    0011       2.6478       162.97  ...........        32.59
                 skin lesions.
17110.........  Destruct lesion,  CH......  T.......    0012       0.8076        49.71        10.30         9.94
                 1-14.
17111.........  Destruct lesion,  ........  T.......    0013       1.0876        66.94  ...........        13.39
                 15 or more.
17250.........  Chemical          ........  T.......    0013       1.0876        66.94  ...........        13.39
                 cautery, tissue.
17260.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17261.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17262.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17263.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17264.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17266.........  Destruction of    ........  T.......    0016       2.6253       161.59        32.68        32.32
                 skin lesions.
17270.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17271.........  Destruction of    ........  T.......    0013       1.0876        66.94  ...........        13.39
                 skin lesions.
17272.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17273.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17274.........  Destruction of    ........  T.......    0016       2.6253       161.59        32.68        32.32
                 skin lesions.
17276.........  Destruction of    ........  T.......    0016       2.6253       161.59        32.68        32.32
                 skin lesions.
17280.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17281.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17282.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17283.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17284.........  Destruction of    ........  T.......    0016       2.6253       161.59        32.68        32.32
                 skin lesions.
17286.........  Destruction of    ........  T.......    0015       1.6062        98.86        20.13        19.77
                 skin lesions.
17304.........  1 stage mohs, up  ........  T.......    0694       3.4844       214.47        58.14        42.89
                 to 5 spec.
17305.........  2 stage mohs, up  ........  T.......    0694       3.4844       214.47        58.14        42.89
                 to 5 spec.
17306.........  3 stage mohs, up  ........  T.......    0694       3.4844       214.47        58.14        42.89
                 to 5 spec.
17307.........  Mohs addl stage   ........  T.......    0694       3.4844       214.47        58.14        42.89
                 up to 5 spec.
17310.........  Mohs any stage >  ........  T.......    0694       3.4844       214.47        58.14        42.89
                 5 spec each.
17340.........  Cryotherapy of    CH......  T.......    0016       2.6253       161.59        32.68        32.32
                 skin.
17360.........  Skin peel         ........  T.......    0013       1.0876        66.94  ...........        13.39
                 therapy.
17380.........  Hair removal by   ........  T.......    0013       1.0876        66.94  ...........        13.39
                 electrolysis.
17999.........  Skin tissue       CH......  T.......    0012       0.8076        49.71        10.30         9.94
                 procedure.
19000.........  Drainage of       ........  T.......    0004       2.0863       128.41  ...........        25.68
                 breast lesion.
19001.........  Drain breast      CH......  T.......    0002       1.0948        67.39  ...........        13.48
                 lesion add-on.
19020.........  Incision of       ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 breast lesion.
19030.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 breast x-ray.
19100.........  Bx breast percut  ........  T.......    0005       3.8051       234.21        71.59        46.84
                 w/o image.
19101.........  Biopsy of         ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 breast, open.
19102.........  Bx breast percut  ........  T.......    0005       3.8051       234.21        71.59        46.84
                 w/image.
19103.........  Bx breast percut  ........  T.......    0658       6.4482       396.89  ...........        79.38
                 w/device.
19110.........  Nipple            ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 exploration.
19112.........  Excise breast     ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 duct fistula.
19120.........  Removal of        ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 breast lesion.
19125.........  Excision, breast  ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 lesion.
19126.........  Excision, addl    ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 breast lesion.
19140.........  Removal of        ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 breast tissue.
19160.........  Partial           ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 mastectomy.
19162.........  P-mastectomy w/   ........  T.......    0693      37.4843     2,307.20       731.74       461.44
                 ln removal.
19180.........  Removal of        ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 breast.
19182.........  Removal of        ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 breast.
19240.........  Removal of        ........  T.......    0030      40.7495     2,508.17       763.55       501.63
                 breast.
19260.........  Removal of chest  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 wall lesion.
19290.........  Place needle      ........  N.......  ......  ...........  ...........  ...........  ...........
                 wire, breast.
19291.........  Place needle      ........  N.......  ......  ...........  ...........  ...........  ...........
                 wire, breast.
19295.........  Place breast      ........  S.......    0657       1.7625       108.48  ...........        21.70
                 clip, percut.
19296.........  Place po breast   CH......  T.......    0030      40.7495     2,508.17       763.55       501.63
                 cath for rad.
19297.........  Place breast      CH......  T.......    0029      28.1505     1,732.69  ...........       346.54
                 cath for rad.
19298.........  Place breast rad  ........  S.......    1524  ...........     3,250.00  ...........       650.00
                 tube/caths.
19316.........  Suspension of     ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 breast.

[[Page 49763]]

 
19318.........  Reduction of      ........  T.......    0693      37.4843     2,307.20       731.74       461.44
                 large breast.
19324.........  Enlarge breast..  ........  T.......    0693      37.4843     2,307.20       731.74       461.44
19325.........  Enlarge breast    ........  T.......    0648      48.7796     3,002.43  ...........       600.49
                 with implant.
19328.........  Removal of        ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 breast implant.
19330.........  Removal of        ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 implant
                 material.
19340.........  Immediate breast  ........  T.......    0030      40.7495     2,508.17       763.55       501.63
                 prosthesis.
19342.........  Delayed breast    ........  T.......    0648      48.7796     3,002.43  ...........       600.49
                 prosthesis.
19350.........  Breast            ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 reconstruction.
19355.........  Correct inverted  ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 nipple(s).
19357.........  Breast            ........  T.......    0648      48.7796     3,002.43  ...........       600.49
                 reconstruction.
19366.........  Breast            ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 reconstruction.
19370.........  Surgery of        ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 breast capsule.
19371.........  Removal of        ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 breast capsule.
19380.........  Revise breast     ........  T.......    0030      40.7495     2,508.17       763.55       501.63
                 reconstruction.
19396.........  Design custom     ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 breast implant.
19499.........  Breast surgery    ........  T.......    0028      19.2250     1,183.32       303.74       236.66
                 procedure.
20000.........  Incision of       ........  T.......    0006       1.4821        91.22        21.76        18.24
                 abscess.
20005.........  Incision of deep  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 abscess.
20100.........  Explore wound,    ........  T.......    0023       4.1133       253.18  ...........        50.64
                 neck.
20101.........  Explore wound,    ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 chest.
20102.........  Explore wound,    ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 abdomen.
20103.........  Explore wound,    ........  T.......    0023       4.1133       253.18  ...........        50.64
                 extremity.
20150.........  Excise            ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 epiphyseal bar.
20200.........  Muscle biopsy...  ........  T.......    0021      14.9563       920.58       219.48       184.12
20205.........  Deep muscle       ........  T.......    0021      14.9563       920.58       219.48       184.12
                 biopsy.
20206.........  Needle biopsy,    ........  T.......    0005       3.8051       234.21        71.59        46.84
                 muscle.
20220.........  Bone biopsy,      ........  T.......    0019       4.0123       246.96        71.87        49.39
                 trocar/needle.
20225.........  Bone biopsy,      ........  T.......    0020       6.5128       400.87        98.57        80.17
                 trocar/needle.
20240.........  Bone biopsy,      ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 excisional.
20245.........  Bone biopsy,      ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 excisional.
20250.........  Open bone biopsy  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
20251.........  Open bone biopsy  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
20500.........  Injection of      ........  T.......    0251       2.3768       146.29  ...........        29.26
                 sinus tract.
20501.........  Inject sinus      ........  N.......  ......  ...........  ...........  ...........  ...........
                 tract for x-ray.
20520.........  Removal of        ........  T.......    0019       4.0123       246.96        71.87        49.39
                 foreign body.
20525.........  Removal of        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 foreign body.
20526.........  Ther injection,   ........  T.......    0204       2.2491       138.43        40.13        27.69
                 carp tunnel.
20550.........  Inj tendon        ........  T.......    0204       2.2491       138.43        40.13        27.69
                 sheath/ligament.
20551.........  Inj tendon        ........  T.......    0204       2.2491       138.43        40.13        27.69
                 origin/
                 insertion.
20552.........  Inj trigger       ........  T.......    0204       2.2491       138.43        40.13        27.69
                 point, 1/2
                 muscl.
20553.........  Inject trigger    ........  T.......    0204       2.2491       138.43        40.13        27.69
                 points, =/> 3.
20600.........  Drain/inject,     ........  T.......    0204       2.2491       138.43        40.13        27.69
                 joint/bursa.
20605.........  Drain/inject,     ........  T.......    0204       2.2491       138.43        40.13        27.69
                 joint/bursa.
20610.........  Drain/inject,     ........  T.......    0204       2.2491       138.43        40.13        27.69
                 joint/bursa.
20612.........  Aspirate/inj      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 ganglion cyst.
20615.........  Treatment of      ........  T.......    0004       2.0863       128.41  ...........        25.68
                 bone cyst.
20650.........  Insert and        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 remove bone pin.
20662.........  Application of    ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 pelvis brace.
20663.........  Application of    ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh brace.
20665.........  Removal of        ........  X.......    0340       0.6211        38.23  ...........         7.65
                 fixation device.
20670.........  Removal of        ........  T.......    0021      14.9563       920.58       219.48       184.12
                 support implant.
20680.........  Removal of        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 support implant.
20690.........  Apply bone        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 fixation device.
20692.........  Apply bone        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 fixation device.
20693.........  Adjust bone       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 fixation device.
20694.........  Remove bone       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 fixation device.
20822.........  Replantation      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 digit, complete.
20900.........  Removal of bone   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 for graft.
20902.........  Removal of bone   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 for graft.
20910.........  Remove cartilage  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 for graft.
20912.........  Remove cartilage  ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 for graft.
20920.........  Removal of        ........  T.......    0686      13.3433       821.29  ...........       164.26
                 fascia for
                 graft.
20922.........  Removal of        ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 fascia for
                 graft.
20924.........  Removal of        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon for
                 graft.
20926.........  Removal of        ........  T.......    0686      13.3433       821.29  ...........       164.26
                 tissue for
                 graft.
20950.........  Fluid pressure,   ........  T.......    0006       1.4821        91.22        21.76        18.24
                 muscle.
20972.........  Bone/skin graft,  ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 metatarsal.
20973.........  Bone/skin graft,  ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 great toe.
20975.........  Electrical bone   ........  X.......    0340       0.6211        38.23  ...........         7.65
                 stimulation.
20982.........  Ablate, bone      CH......  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tumor(s) perq.

[[Page 49764]]

 
20999.........  Musculoskeletal   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 surgery.
21010.........  Incision of jaw   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 joint.
21015.........  Resection of      ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 facial tumor.
21025.........  Excision of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 bone, lower jaw.
21026.........  Excision of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 facial bone(s).
21029.........  Contour of face   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 bone lesion.
21030.........  Excise max/       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 zygoma b9 tumor.
21031.........  Remove            ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 exostosis,
                 mandible.
21032.........  Remove            ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 exostosis,
                 maxilla.
21034.........  Excise max/       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 zygoma mlg
                 tumor.
21040.........  Excise mandible   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 lesion.
21044.........  Removal of jaw    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 bone lesion.
21046.........  Remove mandible   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cyst complex.
21047.........  Excise lwr jaw    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cyst w/repair.
21048.........  Remove maxilla    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cyst complex.
21049.........  Excis uppr jaw    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cyst w/repair.
21050.........  Removal of jaw    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 joint.
21060.........  Remove jaw joint  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cartilage.
21070.........  Remove coronoid   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 process.
21076.........  Prepare face/     ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 oral prosthesis.
21077.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21079.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21080.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21081.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21082.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21083.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21084.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21085.........  Prepare face/     ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 oral prosthesis.
21086.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21087.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21088.........  Prepare face/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 oral prosthesis.
21089.........  Prepare face/     ........  T.......    0251       2.3768       146.29  ...........        29.26
                 oral prosthesis.
21100.........  Maxillofacial     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fixation.
21110.........  Interdental       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 fixation.
21116.........  Injection, jaw    ........  N.......  ......  ...........  ...........  ...........  ...........
                 joint x-ray.
21120.........  Reconstruction    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of chin.
21121.........  Reconstruction    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of chin.
21122.........  Reconstruction    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of chin.
21123.........  Reconstruction    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of chin.
21125.........  Augmentation,     ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 lower jaw bone.
21127.........  Augmentation,     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 lower jaw bone.
21137.........  Reduction of      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 forehead.
21138.........  Reduction of      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 forehead.
21139.........  Reduction of      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 forehead.
21150.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 midface, lefort.
21175.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 orbit/forehead.
21181.........  Contour cranial   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 bone lesion.
21195.........  Reconst lwr jaw   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 w/o fixation.
21198.........  Reconstr lwr jaw  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 segment.
21199.........  Reconstr lwr jaw  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 w/advance.
21206.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 upper jaw bone.
21208.........  Augmentation of   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 facial bones.
21209.........  Reduction of      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 facial bones.
21210.........  Face bone graft.  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
21215.........  Lower jaw bone    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 graft.
21230.........  Rib cartilage     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 graft.
21235.........  Ear cartilage     ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 graft.
21240.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of jaw joint.
21242.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of jaw joint.
21243.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of jaw joint.
21244.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of lower jaw.
21245.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of jaw.
21246.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of jaw.
21248.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of jaw.
21249.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of jaw.
21260.........  Revise eye        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 sockets.
21261.........  Revise eye        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 sockets.
21263.........  Revise eye        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 sockets.
21267.........  Revise eye        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 sockets.
21270.........  Augmentation,     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cheek bone.

[[Page 49765]]

 
21275.........  Revision,         ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 orbitofacial
                 bones.
21280.........  Revision of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 eyelid.
21282.........  Revision of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 eyelid.
21295.........  Revision of jaw   ........  T.......    0252       7.7261       475.55       111.84        95.11
                 muscle/bone.
21296.........  Revision of jaw   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 muscle/bone.
21299.........  Cranio/           ........  T.......    0251       2.3768       146.29  ...........        29.26
                 maxillofacial
                 surgery.
21300.........  Treatment of      ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 skull fracture.
21310.........  Treatment of      ........  T.......    0251       2.3768       146.29  ...........        29.26
                 nose fracture.
21315.........  Treatment of      ........  T.......    0251       2.3768       146.29  ...........        29.26
                 nose fracture.
21320.........  Treatment of      ........  T.......    0252       7.7261       475.55       111.84        95.11
                 nose fracture.
21325.........  Treatment of      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 nose fracture.
21330.........  Treatment of      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 nose fracture.
21335.........  Treatment of      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 nose fracture.
21336.........  Treat nasal       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 septal fracture.
21337.........  Treat nasal       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 septal fracture.
21338.........  Treat             ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 nasoethmoid
                 fracture.
21339.........  Treat             ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 nasoethmoid
                 fracture.
21340.........  Treatment of      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nose fracture.
21345.........  Treat nose/jaw    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 fracture.
21355.........  Treat cheek bone  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21356.........  Treat cheek bone  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 fracture.
21390.........  Treat eye socket  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21400.........  Treat eye socket  ........  T.......    0252       7.7261       475.55       111.84        95.11
                 fracture.
21401.........  Treat eye socket  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 fracture.
21406.........  Treat eye socket  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21407.........  Treat eye socket  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21408.........  Treat eye socket  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21421.........  Treat mouth roof  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 fracture.
21440.........  Treat dental      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 ridge fracture.
21445.........  Treat dental      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 ridge fracture.
21450.........  Treat lower jaw   ........  T.......    0251       2.3768       146.29  ...........        29.26
                 fracture.
21451.........  Treat lower jaw   ........  T.......    0252       7.7261       475.55       111.84        95.11
                 fracture.
21452.........  Treat lower jaw   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 fracture.
21453.........  Treat lower jaw   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21454.........  Treat lower jaw   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 fracture.
21461.........  Treat lower jaw   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21462.........  Treat lower jaw   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21465.........  Treat lower jaw   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21470.........  Treat lower jaw   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fracture.
21480.........  Reset dislocated  ........  T.......    0251       2.3768       146.29  ...........        29.26
                 jaw.
21485.........  Reset dislocated  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 jaw.
21490.........  Repair            ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 dislocated jaw.
21495.........  Treat hyoid bone  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 fracture.
21497.........  Interdental       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 wiring.
21499.........  Head surgery      ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
21501.........  Drain neck/chest  ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 lesion.
21502.........  Drain chest       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 lesion.
21550.........  Biopsy of neck/   CH......  T.......    0020       6.5128       400.87        98.57        80.17
                 chest.
21555.........  Remove lesion,    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 neck/chest.
21556.........  Remove lesion,    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 neck/chest.
21557.........  Remove tumor,     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 neck/chest.
21600.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of rib.
21610.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of rib.
21685.........  Hyoid             ........  T.......    0252       7.7261       475.55       111.84        95.11
                 myotomy&suspens
                 ion.
21700.........  Revision of neck  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 muscle.
21720.........  Revision of neck  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 muscle.
21725.........  Revision of neck  ........  T.......    0006       1.4821        91.22        21.76        18.24
                 muscle.
21742.........  Repair stern/     ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 nuss w/o scope.
21743.........  Repair sternum/   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 nuss w/scope.
21800.........  Treatment of rib  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
21805.........  Treatment of rib  CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
21820.........  Treat sternum     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
21899.........  Neck/chest        ........  T.......    0251       2.3768       146.29  ...........        29.26
                 surgery
                 procedure.
21920.........  Biopsy soft       ........  T.......    0020       6.5128       400.87        98.57        80.17
                 tissue of back.
21925.........  Biopsy soft       ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 tissue of back.
21930.........  Remove lesion,    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 back or flank.
21935.........  Remove tumor,     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 back.
22100.........  Remove part of    ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 neck vertebra.
22101.........  Remove part,      ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 thorax vertebra.
22102.........  Remove part,      ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 lumbar vertebra.

[[Page 49766]]

 
22103.........  Remove extra      ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spine segment.
22222.........  Revision of       ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 thorax spine.
22305.........  Treat spine       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 process
                 fracture.
22310.........  Treat spine       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
22315.........  Treat spine       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
22505.........  Manipulation of   ........  T.......    0045      14.5502       895.58       268.47       179.12
                 spine.
22520.........  Percut            ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 vertebroplasty
                 thor.
22521.........  Percut            ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 vertebroplasty
                 lumb.
22522.........  Percut            ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 vertebroplasty
                 add'l.
22523.........  Percut            ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 kyphoplasty,
                 thor.
22524.........  Percut            ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 kyphoplasty,
                 lumbar.
22525.........  Percut            ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 kyphoplasty,
                 add-on.
22612.........  Lumbar spine      ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 fusion.
22614.........  Spine fusion,     ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 extra segment.
22851.........  Apply spine       CH......  T.......    0049      20.8214     1,281.58  ...........       256.32
                 prosth device.
22899.........  Spine surgery     CH......  T.......    0049      20.8214     1,281.58  ...........       256.32
                 procedure.
22900.........  Remove abdominal  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 wall lesion.
22999.........  Abdomen surgery   CH......  T.......    0049      20.8214     1,281.58  ...........       256.32
                 procedure.
23000.........  Removal of        ........  T.......    0021      14.9563       920.58       219.48       184.12
                 calcium
                 deposits.
23020.........  Release shoulder  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 joint.
23030.........  Drain shoulder    ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 lesion.
23031.........  Drain shoulder    ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 bursa.
23035.........  Drain shoulder    ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 bone lesion.
23040.........  Exploratory       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 shoulder
                 surgery.
23044.........  Exploratory       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 shoulder
                 surgery.
23065.........  Biopsy shoulder   CH......  T.......    0020       6.5128       400.87        98.57        80.17
                 tissues.
23066.........  Biopsy shoulder   ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 tissues.
23075.........  Removal of        ........  T.......    0021      14.9563       920.58       219.48       184.12
                 shoulder lesion.
23076.........  Removal of        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 shoulder lesion.
23077.........  Remove tumor of   ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 shoulder.
23100.........  Biopsy of         ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 shoulder joint.
23101.........  Shoulder joint    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 surgery.
23105.........  Remove shoulder   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint lining.
23106.........  Incision of       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 collarbone
                 joint.
23107.........  Explore treat     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 shoulder joint.
23120.........  Partial removal,  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 collar bone.
23125.........  Removal of        ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 collar bone.
23130.........  Remove shoulder   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 bone, part.
23140.........  Removal of bone   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 lesion.
23145.........  Removal of bone   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion.
23146.........  Removal of bone   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion.
23150.........  Removal of        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 humerus lesion.
23155.........  Removal of        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 humerus lesion.
23156.........  Removal of        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 humerus lesion.
23170.........  Remove collar     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
23172.........  Remove shoulder   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 blade lesion.
23174.........  Remove humerus    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion.
23180.........  Remove collar     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
23182.........  Remove shoulder   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 blade lesion.
23184.........  Remove humerus    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion.
23190.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of scapula.
23195.........  Removal of head   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of humerus.
23330.........  Remove shoulder   ........  T.......    0020       6.5128       400.87        98.57        80.17
                 foreign body.
23331.........  Remove shoulder   ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 foreign body.
23350.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 shoulder x-ray.
23395.........  Muscle            ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 transfer,should
                 er/arm.
23397.........  Muscle transfers  ........  T.......    0052      65.8846     4,055.26  ...........       811.05
23400.........  Fixation of       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 shoulder blade.
23405.........  Incision of       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon&muscle.
23406.........  Incise            ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon(s)&muscl
                 e(s).
23410.........  Repair rotator    CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 cuff, acute.
23412.........  Repair rotator    CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 cuff, chronic.
23415.........  Release of        ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 shoulder
                 ligament.
23420.........  Repair of         CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 shoulder.
23430.........  Repair biceps     CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 tendon.
23440.........  Remove/           CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 transplant
                 tendon.
23450.........  Repair shoulder   ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 capsule.
23455.........  Repair shoulder   ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 capsule.
23460.........  Repair shoulder   ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 capsule.
23462.........  Repair shoulder   CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 capsule.

[[Page 49767]]

 
23465.........  Repair shoulder   ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 capsule.
23466.........  Repair shoulder   CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 capsule.
23470.........  Reconstruct       ........  T.......    0425     105.1666     6,473.11     1,378.01     1,294.62
                 shoulder joint.
23480.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 collar bone.
23485.........  Revision of       CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 collar bone.
23490.........  Reinforce         ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 clavicle.
23491.........  Reinforce         CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 shoulder bones.
23500.........  Treat clavicle    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
23505.........  Treat clavicle    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
23515.........  Treat clavicle    CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
23520.........  Treat clavicle    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
23525.........  Treat clavicle    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
23530.........  Treat clavicle    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
23532.........  Treat clavicle    CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
23540.........  Treat clavicle    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
23545.........  Treat clavicle    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
23550.........  Treat clavicle    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
23552.........  Treat clavicle    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
23570.........  Treat shoulder    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 blade fx.
23575.........  Treat shoulder    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 blade fx.
23585.........  Treat scapula     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
23600.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
23605.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
23615.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
23616.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
23620.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
23625.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
23630.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
23650.........  Treat shoulder    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
23655.........  Treat shoulder    ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
23660.........  Treat shoulder    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
23665.........  Treat             ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation/
                 fracture.
23670.........  Treat             CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 dislocation/
                 fracture.
23675.........  Treat             ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation/
                 fracture.
23680.........  Treat             CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation/
                 fracture.
23700.........  Fixation of       ........  T.......    0045      14.5502       895.58       268.47       179.12
                 shoulder.
23800.........  Fusion of         CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 shoulder joint.
23802.........  Fusion of         ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 shoulder joint.
23921.........  Amputation        ........  T.......    0025       5.0931       313.49        95.46        62.70
                 follow-up
                 surgery.
23929.........  Shoulder surgery  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 procedure.
23930.........  Drainage of arm   ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 lesion.
23931.........  Drainage of arm   ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 bursa.
23935.........  Drain arm/elbow   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 bone lesion.
24000.........  Exploratory       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 elbow surgery.
24006.........  Release elbow     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint.
24065.........  Biopsy arm/elbow  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 soft tissue.
24066.........  Biopsy arm/elbow  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 soft tissue.
24075.........  Remove arm/elbow  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 lesion.
24076.........  Remove arm/elbow  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 lesion.
24077.........  Remove tumor of   ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 arm/elbow.
24100.........  Biopsy elbow      ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 joint lining.
24101.........  Explore/treat     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 elbow joint.
24102.........  Remove elbow      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint lining.
24105.........  Removal of elbow  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 bursa.
24110.........  Remove humerus    ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 lesion.
24115.........  Remove/graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
24116.........  Remove/graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
24120.........  Remove elbow      ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 lesion.
24125.........  Remove/graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
24126.........  Remove/graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
24130.........  Removal of head   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of radius.
24134.........  Removal of arm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
24136.........  Remove radius     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
24138.........  Remove elbow      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
24140.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of arm bone.
24145.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of radius.
24147.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of elbow.
24149.........  Radical           ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 resection of
                 elbow.
24150.........  Extensive         CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 humerus surgery.
24151.........  Extensive         ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 humerus surgery.

[[Page 49768]]

 
24152.........  Extensive radius  CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 surgery.
24153.........  Extensive radius  ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 surgery.
24155.........  Removal of elbow  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 joint.
24160.........  Remove elbow      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint implant.
24164.........  Remove radius     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 head implant.
24200.........  Removal of arm    ........  T.......    0019       4.0123       246.96        71.87        49.39
                 foreign body.
24201.........  Removal of arm    ........  T.......    0021      14.9563       920.58       219.48       184.12
                 foreign body.
24220.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 elbow x-ray.
24300.........  Manipulate elbow  ........  T.......    0045      14.5502       895.58       268.47       179.12
                 w/anesth.
24301.........  Muscle/tendon     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 transfer.
24305.........  Arm tendon        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lengthening.
24310.........  Revision of arm   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon.
24320.........  Repair of arm     ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 tendon.
24330.........  Revision of arm   CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 muscles.
24331.........  Revision of arm   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 muscles.
24332.........  Tenolysis,        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 triceps.
24340.........  Repair of biceps  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 tendon.
24341.........  Repair arm        ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 tendon/muscle.
24342.........  Repair of         ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 ruptured tendon.
24343.........  Repr elbow lat    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ligmnt w/tiss.
24344.........  Reconstruct       CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 elbow lat
                 ligmnt.
24345.........  Repr elbw med     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ligmnt w/tissu.
24346.........  Reconstruct       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 elbow med
                 ligmnt.
24350.........  Repair of tennis  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 elbow.
24351.........  Repair of tennis  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 elbow.
24352.........  Repair of tennis  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 elbow.
24354.........  Repair of tennis  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 elbow.
24356.........  Revision of       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tennis elbow.
24360.........  Reconstruct       ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 elbow joint.
24361.........  Reconstruct       ........  T.......    0425     105.1666     6,473.11     1,378.01     1,294.62
                 elbow joint.
24362.........  Reconstruct       ........  T.......    0048      47.1644     2,903.02  ...........       580.60
                 elbow joint.
24363.........  Replace elbow     ........  T.......    0425     105.1666     6,473.11     1,378.01     1,294.62
                 joint.
24365.........  Reconstruct head  ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 of radius.
24366.........  Reconstruct head  ........  T.......    0425     105.1666     6,473.11     1,378.01     1,294.62
                 of radius.
24400.........  Revision of       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 humerus.
24410.........  Revision of       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 humerus.
24420.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 humerus.
24430.........  Repair of         CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 humerus.
24435.........  Repair humerus    CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 with graft.
24470.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 elbow joint.
24495.........  Decompression of  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm.
24498.........  Reinforce         CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 humerus.
24500.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24505.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24515.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24516.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24530.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24535.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24538.........  Treat humerus     CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
24545.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24546.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24560.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24565.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24566.........  Treat humerus     CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
24575.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24576.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24577.........  Treat humerus     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24579.........  Treat humerus     CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24582.........  Treat humerus     CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
24586.........  Treat elbow       CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24587.........  Treat elbow       CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24600.........  Treat elbow       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
24605.........  Treat elbow       ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
24615.........  Treat elbow       CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 dislocation.
24620.........  Treat elbow       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24635.........  Treat elbow       CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24640.........  Treat elbow       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
24650.........  Treat radius      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24655.........  Treat radius      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24665.........  Treat radius      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.

[[Page 49769]]

 
24666.........  Treat radius      CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
24670.........  Treat ulnar       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24675.........  Treat ulnar       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
24685.........  Treat ulnar       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
24800.........  Fusion of elbow   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 joint.
24802.........  Fusion/graft of   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 elbow joint.
24925.........  Amputation        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 follow-up
                 surgery.
24935.........  Revision of       ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 amputation.
24999.........  Upper arm/elbow   ........  T.......    0043       1.6914       104.11  ...........        20.82
                 surgery.
25000.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon sheath.
25001.........  Incise flexor     ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 carpi radialis.
25020.........  Decompress        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 forearm 1 space.
25023.........  Decompress        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm 1 space.
25024.........  Decompress        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm 2
                 spaces.
25025.........  Decompress        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm 2
                 spaces.
25028.........  Drainage of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 forearm lesion.
25031.........  Drainage of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 forearm bursa.
25035.........  Treat forearm     ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 bone lesion.
25040.........  Explore/treat     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 wrist joint.
25065.........  Biopsy forearm    CH......  T.......    0020       6.5128       400.87        98.57        80.17
                 soft tissues.
25066.........  Biopsy forearm    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 soft tissues.
25075.........  Removal forearm   ........  T.......    0021      14.9563       920.58       219.48       184.12
                 lesion subcu.
25076.........  Removal forearm   ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 lesion deep.
25077.........  Remove tumor,     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 forearm/wrist.
25085.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 wrist capsule.
25100.........  Biopsy of wrist   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 joint.
25101.........  Explore/treat     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 wrist joint.
25105.........  Remove wrist      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint lining.
25107.........  Remove wrist      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint cartilage.
25110.........  Remove wrist      ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon lesion.
25111.........  Remove wrist      ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon lesion.
25112.........  Reremove wrist    ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon lesion.
25115.........  Remove wrist/     ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 forearm lesion.
25116.........  Remove wrist/     ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 forearm lesion.
25118.........  Excise wrist      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon sheath.
25119.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of ulna.
25120.........  Removal of        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm lesion.
25125.........  Remove/graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm lesion.
25126.........  Remove/graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm lesion.
25130.........  Removal of wrist  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion.
25135.........  Remove&graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 wrist lesion.
25136.........  Remove&graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 wrist lesion.
25145.........  Remove forearm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
25150.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of ulna.
25151.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of radius.
25170.........  Extensive         CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 forearm surgery.
25210.........  Removal of wrist  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 bone.
25215.........  Removal of wrist  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 bones.
25230.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of radius.
25240.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of ulna.
25246.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 wrist x-ray.
25248.........  Remove forearm    ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 foreign body.
25250.........  Removal of wrist  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 prosthesis.
25251.........  Removal of wrist  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 prosthesis.
25259.........  Manipulate wrist  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 w/anesthes.
25260.........  Repair forearm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon/muscle.
25263.........  Repair forearm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon/muscle.
25265.........  Repair forearm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon/muscle.
25270.........  Repair forearm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon/muscle.
25272.........  Repair forearm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon/muscle.
25274.........  Repair forearm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon/muscle.
25275.........  Repair forearm    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon sheath.
25280.........  Revise wrist/     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm tendon.
25290.........  Incise wrist/     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 forearm tendon.
25295.........  Release wrist/    ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 forearm tendon.
25300.........  Fusion of         ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendons at
                 wrist.
25301.........  Fusion of         ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendons at
                 wrist.
25310.........  Transplant        ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 forearm tendon.
25312.........  Transplant        ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 forearm tendon.
25315.........  Revise palsy      ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 hand tendon(s).

[[Page 49770]]

 
25316.........  Revise palsy      CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 hand tendon(s).
25320.........  Repair/revise     ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 wrist joint.
25332.........  Revise wrist      ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint.
25335.........  Realignment of    ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 hand.
25337.........  Reconstruct ulna/ ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 radioulnar.
25350.........  Revision of       CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 radius.
25355.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 radius.
25360.........  Revision of ulna  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
25365.........  Revise            ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 radius&ulna.
25370.........  Revise radius or  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 ulna.
25375.........  Revise            ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 radius&ulna.
25390.........  Shorten radius    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 or ulna.
25391.........  Lengthen radius   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 or ulna.
25392.........  Shorten           ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 radius&ulna.
25393.........  Lengthen          ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 radius&ulna.
25394.........  Repair carpal     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 bone, shorten.
25400.........  Repair radius or  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ulna.
25405.........  Repair/graft      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 radius or ulna.
25415.........  Repair            ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 radius&ulna.
25420.........  Repair/graft      CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 radius&ulna.
25425.........  Repair/graft      ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 radius or ulna.
25426.........  Repair/graft      ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 radius&ulna.
25430.........  Vasc graft into   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 carpal bone.
25431.........  Repair nonunion   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 carpal bone.
25440.........  Repair/graft      CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 wrist bone.
25441.........  Reconstruct       ........  T.......    0425     105.1666     6,473.11     1,378.01     1,294.62
                 wrist joint.
25442.........  Reconstruct       ........  T.......    0425     105.1666     6,473.11     1,378.01     1,294.62
                 wrist joint.
25443.........  Reconstruct       ........  T.......    0048      47.1644     2,903.02  ...........       580.60
                 wrist joint.
25444.........  Reconstruct       ........  T.......    0048      47.1644     2,903.02  ...........       580.60
                 wrist joint.
25445.........  Reconstruct       ........  T.......    0048      47.1644     2,903.02  ...........       580.60
                 wrist joint.
25446.........  Wrist             ........  T.......    0425     105.1666     6,473.11     1,378.01     1,294.62
                 replacement.
25447.........  Repair wrist      ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint(s).
25449.........  Remove wrist      ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint implant.
25450.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 wrist joint.
25455.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 wrist joint.
25490.........  Reinforce radius  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
25491.........  Reinforce ulna..  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
25492.........  Reinforce radius  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 and ulna.
25500.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 of radius.
25505.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 of radius.
25515.........  Treat fracture    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 of radius.
25520.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 of radius.
25525.........  Treat fracture    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 of radius.
25526.........  Treat fracture    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 of radius.
25530.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 of ulna.
25535.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 of ulna.
25545.........  Treat fracture    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 of ulna.
25560.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 radius&ulna.
25565.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 radius&ulna.
25574.........  Treat fracture    CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 radius&ulna.
25575.........  Treat fracture    CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 radius/ulna.
25600.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 radius/ulna.
25605.........  Treat fracture    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 radius/ulna.
25611.........  Treat fracture    CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 radius/ulna.
25620.........  Treat fracture    CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 radius/ulna.
25622.........  Treat wrist bone  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
25624.........  Treat wrist bone  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
25628.........  Treat wrist bone  CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
25630.........  Treat wrist bone  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
25635.........  Treat wrist bone  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
25645.........  Treat wrist bone  CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
25650.........  Treat wrist bone  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
25651.........  Pin ulnar         CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 styloid
                 fracture.
25652.........  Treat fracture    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 ulnar styloid.
25660.........  Treat wrist       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
25670.........  Treat wrist       CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
25671.........  Pin radioulnar    CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
25675.........  Treat wrist       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
25676.........  Treat wrist       CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
25680.........  Treat wrist       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.

[[Page 49771]]

 
25685.........  Treat wrist       CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
25690.........  Treat wrist       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
25695.........  Treat wrist       CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
25800.........  Fusion of wrist   CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 joint.
25805.........  Fusion/graft of   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 wrist joint.
25810.........  Fusion/graft of   CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 wrist joint.
25820.........  Fusion of hand    ........  T.......    0053      16.0343       986.93       253.49       197.39
                 bones.
25825.........  Fuse hand bones   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 with graft.
25830.........  Fusion,           CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 radioulnar jnt/
                 ulna.
25907.........  Amputation        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 follow-up
                 surgery.
25922.........  Amputate hand at  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 wrist.
25929.........  Amputation        ........  T.......    0686      13.3433       821.29  ...........       164.26
                 follow-up
                 surgery.
25999.........  Forearm or wrist  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 surgery.
26010.........  Drainage of       ........  T.......    0006       1.4821        91.22        21.76        18.24
                 finger abscess.
26011.........  Drainage of       ........  T.......    0007      10.9184       672.04  ...........       134.41
                 finger abscess.
26020.........  Drain hand        ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon sheath.
26025.........  Drainage of palm  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 bursa.
26030.........  Drainage of palm  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 bursa(s).
26034.........  Treat hand bone   ........  T.......    0053      16.0343       986.93       253.49       197.39
                 lesion.
26035.........  Decompress        ........  T.......    0053      16.0343       986.93       253.49       197.39
                 fingers/hand.
26037.........  Decompress        ........  T.......    0053      16.0343       986.93       253.49       197.39
                 fingers/hand.
26040.........  Release palm      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 contracture.
26045.........  Release palm      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 contracture.
26055.........  Incise finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon sheath.
26060.........  Incision of       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger tendon.
26070.........  Explore/treat     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 hand joint.
26075.........  Explore/treat     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger joint.
26080.........  Explore/treat     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger joint.
26100.........  Biopsy hand       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 joint lining.
26105.........  Biopsy finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 joint lining.
26110.........  Biopsy finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 joint lining.
26115.........  Removal hand      ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 lesion subcut.
26116.........  Removal hand      ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 lesion, deep.
26117.........  Remove tumor,     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 hand/finger.
26121.........  Release palm      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 contracture.
26123.........  Release palm      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 contracture.
26125.........  Release palm      ........  T.......    0053      16.0343       986.93       253.49       197.39
                 contracture.
26130.........  Remove wrist      ........  T.......    0053      16.0343       986.93       253.49       197.39
                 joint lining.
26135.........  Revise finger     ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 joint, each.
26140.........  Revise finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 joint, each.
26145.........  Tendon excision,  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 palm/finger.
26160.........  Remove tendon     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 sheath lesion.
26170.........  Removal of palm   ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon, each.
26180.........  Removal of        ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger tendon.
26185.........  Remove finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 bone.
26200.........  Remove hand bone  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 lesion.
26205.........  Remove/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 bone lesion.
26210.........  Removal of        ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger lesion.
26215.........  Remove/graft      ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger lesion.
26230.........  Partial removal   ........  T.......    0053      16.0343       986.93       253.49       197.39
                 of hand bone.
26235.........  Partial removal,  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger bone.
26236.........  Partial removal,  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger bone.
26250.........  Extensive hand    ........  T.......    0053      16.0343       986.93       253.49       197.39
                 surgery.
26255.........  Extensive hand    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 surgery.
26260.........  Extensive finger  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 surgery.
26261.........  Extensive finger  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 surgery.
26262.........  Partial removal   ........  T.......    0053      16.0343       986.93       253.49       197.39
                 of finger.
26320.........  Removal of        ........  T.......    0021      14.9563       920.58       219.48       184.12
                 implant from
                 hand.
26340.........  Manipulate        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 finger w/anesth.
26350.........  Repair finger/    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26352.........  Repair/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26356.........  Repair finger/    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26357.........  Repair finger/    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26358.........  Repair/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26370.........  Repair finger/    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26372.........  Repair/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26373.........  Repair finger/    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26390.........  Revise hand/      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger tendon.
26392.........  Repair/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26410.........  Repair hand       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon.

[[Page 49772]]

 
26412.........  Repair/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26415.........  Excision, hand/   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger tendon.
26416.........  Graft hand or     ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger tendon.
26418.........  Repair finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon.
26420.........  Repair/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger tendon.
26426.........  Repair finger/    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26428.........  Repair/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger tendon.
26432.........  Repair finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon.
26433.........  Repair finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon.
26434.........  Repair/graft      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger tendon.
26437.........  Realignment of    ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendons.
26440.........  Release palm/     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger tendon.
26442.........  Release           ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 palm&finger
                 tendon.
26445.........  Release hand/     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger tendon.
26449.........  Release forearm/  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26450.........  Incision of palm  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendon.
26455.........  Incision of       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger tendon.
26460.........  Incise hand/      ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger tendon.
26471.........  Fusion of finger  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendons.
26474.........  Fusion of finger  ........  T.......    0053      16.0343       986.93       253.49       197.39
                 tendons.
26476.........  Tendon            ........  T.......    0053      16.0343       986.93       253.49       197.39
                 lengthening.
26477.........  Tendon            ........  T.......    0053      16.0343       986.93       253.49       197.39
                 shortening.
26478.........  Lengthening of    ........  T.......    0053      16.0343       986.93       253.49       197.39
                 hand tendon.
26479.........  Shortening of     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 hand tendon.
26480.........  Transplant hand   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 tendon.
26483.........  Transplant/graft  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand tendon.
26485.........  Transplant palm   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 tendon.
26489.........  Transplant/graft  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 palm tendon.
26490.........  Revise thumb      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 tendon.
26492.........  Tendon transfer   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 with graft.
26494.........  Hand tendon/      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 muscle transfer.
26496.........  Revise thumb      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 tendon.
26497.........  Finger tendon     ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 transfer.
26498.........  Finger tendon     ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 transfer.
26499.........  Revision of       ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger.
26500.........  Hand tendon       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 reconstruction.
26502.........  Hand tendon       ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 reconstruction.
26504.........  Hand tendon       ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 reconstruction.
26508.........  Release thumb     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 contracture.
26510.........  Thumb tendon      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 transfer.
26516.........  Fusion of         ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 knuckle joint.
26517.........  Fusion of         ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 knuckle joints.
26518.........  Fusion of         ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 knuckle joints.
26520.........  Release knuckle   ........  T.......    0053      16.0343       986.93       253.49       197.39
                 contracture.
26525.........  Release finger    ........  T.......    0053      16.0343       986.93       253.49       197.39
                 contracture.
26530.........  Revise knuckle    ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint.
26531.........  Revise knuckle    ........  T.......    0048      47.1644     2,903.02  ...........       580.60
                 with implant.
26535.........  Revise finger     ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint.
26536.........  Revise/implant    ........  T.......    0048      47.1644     2,903.02  ...........       580.60
                 finger joint.
26540.........  Repair hand       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 joint.
26541.........  Repair hand       ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 joint with
                 graft.
26542.........  Repair hand       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 joint with
                 graft.
26545.........  Reconstruct       ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger joint.
26546.........  Repair nonunion   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand.
26548.........  Reconstruct       ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger joint.
26550.........  Construct thumb   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 replacement.
26555.........  Positional        ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 change of
                 finger.
26560.........  Repair of web     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger.
26561.........  Repair of web     ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger.
26562.........  Repair of web     ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger.
26565.........  Correct           ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 metacarpal flaw.
26567.........  Correct finger    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 deformity.
26568.........  Lengthen          ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 metacarpal/
                 finger.
26580.........  Repair hand       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 deformity.
26587.........  Reconstruct       ........  T.......    0053      16.0343       986.93       253.49       197.39
                 extra finger.
26590.........  Repair finger     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 deformity.
26591.........  Repair muscles    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 of hand.
26593.........  Release muscles   ........  T.......    0053      16.0343       986.93       253.49       197.39
                 of hand.
26596.........  Excision          ........  T.......    0053      16.0343       986.93       253.49       197.39
                 constricting
                 tissue.
26600.........  Treat metacarpal  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.

[[Page 49773]]

 
26605.........  Treat metacarpal  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
26607.........  Treat metacarpal  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
26608.........  Treat metacarpal  CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
26615.........  Treat metacarpal  CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
26641.........  Treat thumb       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
26645.........  Treat thumb       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
26650.........  Treat thumb       CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
26665.........  Treat thumb       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
26670.........  Treat hand        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
26675.........  Treat hand        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
26676.........  Pin hand          CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
26685.........  Treat hand        CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
26686.........  Treat hand        CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 dislocation.
26700.........  Treat knuckle     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
26705.........  Treat knuckle     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
26706.........  Pin knuckle       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
26715.........  Treat knuckle     CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
26720.........  Treat finger      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture, each.
26725.........  Treat finger      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture, each.
26727.........  Treat finger      CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture, each.
26735.........  Treat finger      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture, each.
26740.........  Treat finger      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture, each.
26742.........  Treat finger      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture, each.
26746.........  Treat finger      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture, each.
26750.........  Treat finger      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture, each.
26755.........  Treat finger      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture, each.
26756.........  Pin finger        CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture, each.
26765.........  Treat finger      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture, each.
26770.........  Treat finger      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
26775.........  Treat finger      ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
26776.........  Pin finger        CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
26785.........  Treat finger      CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
26820.........  Thumb fusion      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 with graft.
26841.........  Fusion of thumb.  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
26842.........  Thumb fusion      ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 with graft.
26843.........  Fusion of hand    ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 joint.
26844.........  Fusion/graft of   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 hand joint.
26850.........  Fusion of         ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 knuckle.
26852.........  Fusion of         ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 knuckle with
                 graft.
26860.........  Fusion of finger  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 joint.
26861.........  Fusion of finger  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 jnt, add-on.
26862.........  Fusion/graft of   ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 finger joint.
26863.........  Fuse/graft added  ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 joint.
26910.........  Amputate          ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 metacarpal bone.
26951.........  Amputation of     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger/thumb.
26952.........  Amputation of     ........  T.......    0053      16.0343       986.93       253.49       197.39
                 finger/thumb.
26989.........  Hand/finger       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 surgery.
26990.........  Drainage of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 pelvis lesion.
26991.........  Drainage of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 pelvis bursa.
27000.........  Incision of hip   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon.
27001.........  Incision of hip   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon.
27003.........  Incision of hip   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon.
27033.........  Exploration of    ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 hip joint.
27035.........  Denervation of    CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 hip joint.
27040.........  Biopsy of soft    ........  T.......    0020       6.5128       400.87        98.57        80.17
                 tissues.
27041.........  Biopsy of soft    ........  T.......    0020       6.5128       400.87        98.57        80.17
                 tissues.
27047.........  Remove hip/       ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pelvis lesion.
27048.........  Remove hip/       ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 pelvis lesion.
27049.........  Remove tumor,     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 hip/pelvis.
27050.........  Biopsy of         ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 sacroiliac
                 joint.
27052.........  Biopsy of hip     ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 joint.
27060.........  Removal of        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 ischial bursa.
27062.........  Remove femur      ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 lesion/bursa.
27065.........  Removal of hip    ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 bone lesion.
27066.........  Removal of hip    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
27067.........  Remove/graft hip  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
27080.........  Removal of tail   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone.
27086.........  Remove hip        ........  T.......    0020       6.5128       400.87        98.57        80.17
                 foreign body.
27087.........  Remove hip        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 foreign body.
27093.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 hip x-ray.

[[Page 49774]]

 
27095.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 hip x-ray.
27097.........  Revision of hip   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon.
27098.........  Transfer tendon   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 to pelvis.
27100.........  Transfer of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 abdominal
                 muscle.
27105.........  Transfer of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 spinal muscle.
27110.........  Transfer of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 iliopsoas
                 muscle.
27111.........  Transfer of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 iliopsoas
                 muscle.
27193.........  Treat pelvic      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ring fracture.
27194.........  Treat pelvic      ........  T.......    0045      14.5502       895.58       268.47       179.12
                 ring fracture.
27200.........  Treat tail bone   ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27202.........  Treat tail bone   CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
27216.........  Treat pelvic      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ring fracture.
27220.........  Treat hip socket  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27230.........  Treat thigh       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27235.........  Treat thigh       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 fracture.
27238.........  Treat thigh       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27246.........  Treat thigh       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27250.........  Treat hip         ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
27252.........  Treat hip         ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
27256.........  Treat hip         ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
27257.........  Treat hip         ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
27265.........  Treat hip         ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
27266.........  Treat hip         ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
27275.........  Manipulation of   ........  T.......    0045      14.5502       895.58       268.47       179.12
                 hip joint.
27299.........  Pelvis/hip joint  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 surgery.
27301.........  Drain thigh/knee  ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 lesion.
27305.........  Incise thigh      ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon&fascia.
27306.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh tendon.
27307.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh tendons.
27310.........  Exploration of    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 knee joint.
27315.........  Partial removal,  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 thigh nerve.
27320.........  Partial removal,  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 thigh nerve.
27323.........  Biopsy, thigh     CH......  T.......    0020       6.5128       400.87        98.57        80.17
                 soft tissues.
27324.........  Biopsy, thigh     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 soft tissues.
27327.........  Removal of thigh  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 lesion.
27328.........  Removal of thigh  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 lesion.
27329.........  Remove tumor,     ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 thigh/knee.
27330.........  Biopsy, knee      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint lining.
27331.........  Explore/treat     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 knee joint.
27332.........  Removal of knee   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 cartilage.
27333.........  Removal of knee   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 cartilage.
27334.........  Remove knee       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint lining.
27335.........  Remove knee       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint lining.
27340.........  Removal of        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 kneecap bursa.
27345.........  Removal of knee   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 cyst.
27347.........  Remove knee cyst  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
27350.........  Removal of        ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 kneecap.
27355.........  Remove femur      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion.
27356.........  Remove femur      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion/graft.
27357.........  Remove femur      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion/graft.
27358.........  Remove femur      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lesion/fixation.
27360.........  Partial removal,  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 leg bone(s).
27370.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 knee x-ray.
27372.........  Removal of        ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 foreign body.
27380.........  Repair of         ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 kneecap tendon.
27381.........  Repair/graft      ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 kneecap tendon.
27385.........  Repair of thigh   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 muscle.
27386.........  Repair/graft of   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh muscle.
27390.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh tendon.
27391.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh tendons.
27392.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh tendons.
27393.........  Lengthening of    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 thigh tendon.
27394.........  Lengthening of    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 thigh tendons.
27395.........  Lengthening of    ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 thigh tendons.
27396.........  Transplant of     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 thigh tendon.
27397.........  Transplants of    ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 thigh tendons.
27400.........  Revise thigh      ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 muscles/tendons.
27403.........  Repair of knee    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 cartilage.
27405.........  Repair of knee    ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 ligament.
27407.........  Repair of knee    CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 ligament.

[[Page 49775]]

 
27409.........  Repair of knee    ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 ligaments.
27412.........  Autochondrocyte   ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 implant knee.
27415.........  Osteochondral     ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 knee allograft.
27418.........  Repair            ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 degenerated
                 kneecap.
27420.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 unstable
                 kneecap.
27422.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 unstable
                 kneecap.
27424.........  Revision/removal  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 of kneecap.
27425.........  Lat retinacular   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 release open.
27427.........  Reconstruction,   CH......  T.......    0051      41.2543     2,539.24  ...........       507.85
                 knee.
27428.........  Reconstruction,   ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 knee.
27429.........  Reconstruction,   ........  T.......    0052      65.8846     4,055.26  ...........       811.05
                 knee.
27430.........  Revision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 thigh muscles.
27435.........  Incision of knee  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 joint.
27437.........  Revise kneecap..  ........  T.......    0047      32.7543     2,016.06       537.03       403.21
27438.........  Revise kneecap    ........  T.......    0048      47.1644     2,903.02  ...........       580.60
                 with implant.
27440.........  Revision of knee  ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint.
27441.........  Revision of knee  ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint.
27442.........  Revision of knee  ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint.
27443.........  Revision of knee  ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 joint.
27446.........  Revision of knee  ........  T.......    0681     173.0706    10,652.67  ...........     2,130.53
                 joint.
27475.........  Surgery to stop   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 leg growth.
27496.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh/knee.
27497.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh/knee.
27498.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh/knee.
27499.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 thigh/knee.
27500.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 thigh fracture.
27501.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 thigh fracture.
27502.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 thigh fracture.
27503.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 thigh fracture.
27508.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 thigh fracture.
27509.........  Treatment of      CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 thigh fracture.
27510.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 thigh fracture.
27516.........  Treat thigh fx    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 growth plate.
27517.........  Treat thigh fx    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 growth plate.
27520.........  Treat kneecap     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27524.........  Treat kneecap     CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
27530.........  Treat knee        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27532.........  Treat knee        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27538.........  Treat knee        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture(s).
27550.........  Treat knee        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
27552.........  Treat knee        ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
27560.........  Treat kneecap     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
27562.........  Treat kneecap     ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
27566.........  Treat kneecap     CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
27570.........  Fixation of knee  ........  T.......    0045      14.5502       895.58       268.47       179.12
                 joint.
27594.........  Amputation        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 follow-up
                 surgery.
27599.........  Leg surgery       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 procedure.
27600.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 lower leg.
27601.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 lower leg.
27602.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 lower leg.
27603.........  Drain lower leg   ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 lesion.
27604.........  Drain lower leg   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 bursa.
27605.........  Incision of       ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 achilles tendon.
27606.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 achilles tendon.
27607.........  Treat lower leg   ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 bone lesion.
27610.........  Explore/treat     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ankle joint.
27612.........  Exploration of    ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ankle joint.
27613.........  Biopsy lower leg  ........  T.......    0020       6.5128       400.87        98.57        80.17
                 soft tissue.
27614.........  Biopsy lower leg  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 soft tissue.
27615.........  Remove tumor,     CH......  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lower leg.
27618.........  Remove lower leg  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 lesion.
27619.........  Remove lower leg  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 lesion.
27620.........  Explore/treat     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ankle joint.
27625.........  Remove ankle      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint lining.
27626.........  Remove ankle      ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 joint lining.
27630.........  Removal of        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon lesion.
27635.........  Remove lower leg  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
27637.........  Remove/graft leg  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
27638.........  Remove/graft leg  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 bone lesion.
27640.........  Partial removal   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 of tibia.

[[Page 49776]]

 
27641.........  Partial removal   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 of fibula.
27647.........  Extensive ankle/  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 heel surgery.
27648.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 ankle x-ray.
27650.........  Repair achilles   ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 tendon.
27652.........  Repair/graft      CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 achilles tendon.
27654.........  Repair of         ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 achilles tendon.
27656.........  Repair leg        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 fascia defect.
27658.........  Repair of leg     ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon, each.
27659.........  Repair of leg     ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon, each.
27664.........  Repair of leg     ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendon, each.
27665.........  Repair of leg     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon, each.
27675.........  Repair lower leg  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 tendons.
27676.........  Repair lower leg  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendons.
27680.........  Release of lower  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 leg tendon.
27681.........  Release of lower  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 leg tendons.
27685.........  Revision of       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 lower leg
                 tendon.
27686.........  Revise lower leg  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendons.
27687.........  Revision of calf  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tendon.
27690.........  Revise lower leg  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 tendon.
27691.........  Revise lower leg  ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 tendon.
27692.........  Revise            ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 additional leg
                 tendon.
27695.........  Repair of ankle   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ligament.
27696.........  Repair of ankle   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ligaments.
27698.........  Repair of ankle   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 ligament.
27700.........  Revision of       ........  T.......    0047      32.7543     2,016.06       537.03       403.21
                 ankle joint.
27704.........  Removal of ankle  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 implant.
27705.........  Incision of       ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 tibia.
27707.........  Incision of       ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 fibula.
27709.........  Incision of       ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 tibia&fibula.
27730.........  Repair of tibia   ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 epiphysis.
27732.........  Repair of fibula  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 epiphysis.
27734.........  Repair lower leg  ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 epiphyses.
27740.........  Repair of leg     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 epiphyses.
27742.........  Repair of leg     ........  T.......    0051      41.2543     2,539.24  ...........       507.85
                 epiphyses.
27745.........  Reinforce tibia.  CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
27750.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 tibia fracture.
27752.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 tibia fracture.
27756.........  Treatment of      CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 tibia fracture.
27758.........  Treatment of      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 tibia fracture.
27759.........  Treatment of      CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 tibia fracture.
27760.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
27762.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
27766.........  Treatment of      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 ankle fracture.
27780.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fibula fracture.
27781.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fibula fracture.
27784.........  Treatment of      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fibula fracture.
27786.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
27788.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
27792.........  Treatment of      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 ankle fracture.
27808.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
27810.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
27814.........  Treatment of      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 ankle fracture.
27816.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
27818.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
27822.........  Treatment of      CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 ankle fracture.
27823.........  Treatment of      CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 ankle fracture.
27824.........  Treat lower leg   ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27825.........  Treat lower leg   ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
27826.........  Treat lower leg   CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
27827.........  Treat lower leg   CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
27828.........  Treat lower leg   CH......  T.......    0064      56.4195     3,472.68       825.22       694.54
                 fracture.
27829.........  Treat lower leg   CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 joint.
27830.........  Treat lower leg   ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
27831.........  Treat lower leg   ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
27832.........  Treat lower leg   CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
27840.........  Treat ankle       ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
27842.........  Treat ankle       ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
27846.........  Treat ankle       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
27848.........  Treat ankle       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
27860.........  Fixation of       ........  T.......    0045      14.5502       895.58       268.47       179.12
                 ankle joint.

[[Page 49777]]

 
27870.........  Fusion of ankle   CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 joint, open.
27871.........  Fusion of         CH......  T.......    0052      65.8846     4,055.26  ...........       811.05
                 tibiofibular
                 joint.
27884.........  Amputation        ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 follow-up
                 surgery.
27889.........  Amputation of     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 foot at ankle.
27892.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 leg.
27893.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 leg.
27894.........  Decompression of  ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 leg.
27899.........  Leg/ankle         ........  T.......    0043       1.6914       104.11  ...........        20.82
                 surgery
                 procedure.
28001.........  Drainage of       ........  T.......    0007      10.9184       672.04  ...........       134.41
                 bursa of foot.
28002.........  Treatment of      ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 foot infection.
28003.........  Treatment of      ........  T.......    0049      20.8214     1,281.58  ...........       256.32
                 foot infection.
28005.........  Treat foot bone   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 lesion.
28008.........  Incision of foot  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 fascia.
28010.........  Incision of toe   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon.
28011.........  Incision of toe   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendons.
28020.........  Exploration of    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 foot joint.
28022.........  Exploration of    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 foot joint.
28024.........  Exploration of    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe joint.
28030.........  Removal of foot   ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
28035.........  Decompression of  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 tibia nerve.
28043.........  Excision of foot  CH......  T.......    0022      19.9760     1,229.54       354.45       245.91
                 lesion.
28045.........  Excision of foot  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 lesion.
28046.........  Resection of      ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tumor, foot.
28050.........  Biopsy of foot    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 joint lining.
28052.........  Biopsy of foot    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 joint lining.
28054.........  Biopsy of toe     ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 joint lining.
28060.........  Partial removal,  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 foot fascia.
28062.........  Removal of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 fascia.
28070.........  Removal of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 joint lining.
28072.........  Removal of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 joint lining.
28080.........  Removal of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 lesion.
28086.........  Excise foot       ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon sheath.
28088.........  Excise foot       ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon sheath.
28090.........  Removal of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 lesion.
28092.........  Removal of toe    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 lesions.
28100.........  Removal of ankle/ ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 heel lesion.
28102.........  Remove/graft      ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 foot lesion.
28103.........  Remove/graft      ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 foot lesion.
28104.........  Removal of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 lesion.
28106.........  Remove/graft      ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 foot lesion.
28107.........  Remove/graft      ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 foot lesion.
28108.........  Removal of toe    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 lesions.
28110.........  Part removal of   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal.
28111.........  Part removal of   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal.
28112.........  Part removal of   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal.
28113.........  Part removal of   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal.
28114.........  Removal of        ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal
                 heads.
28116.........  Revision of foot  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
28118.........  Removal of heel   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 bone.
28119.........  Removal of heel   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 spur.
28120.........  Part removal of   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 ankle/heel.
28122.........  Partial removal   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 of foot bone.
28124.........  Partial removal   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 of toe.
28126.........  Partial removal   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 of toe.
28130.........  Removal of ankle  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 bone.
28140.........  Removal of        ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal.
28150.........  Removal of toe..  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
28153.........  Partial removal   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 of toe.
28160.........  Partial removal   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 of toe.
28171.........  Extensive foot    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 surgery.
28173.........  Extensive foot    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 surgery.
28175.........  Extensive foot    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 surgery.
28190.........  Removal of foot   ........  T.......    0019       4.0123       246.96        71.87        49.39
                 foreign body.
28192.........  Removal of foot   ........  T.......    0021      14.9563       920.58       219.48       184.12
                 foreign body.
28193.........  Removal of foot   ........  T.......    0020       6.5128       400.87        98.57        80.17
                 foreign body.
28200.........  Repair of foot    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon.
28202.........  Repair/graft of   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 foot tendon.
28208.........  Repair of foot    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon.
28210.........  Repair/graft of   ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 foot tendon.
28220.........  Release of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon.

[[Page 49778]]

 
28222.........  Release of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendons.
28225.........  Release of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon.
28226.........  Release of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendons.
28230.........  Incision of foot  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon(s).
28232.........  Incision of toe   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon.
28234.........  Incision of foot  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon.
28238.........  Revision of foot  ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 tendon.
28240.........  Release of big    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe.
28250.........  Revision of foot  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 fascia.
28260.........  Release of        ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 midfoot joint.
28261.........  Revision of foot  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 tendon.
28262.........  Revision of foot  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 and ankle.
28264.........  Release of        ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 midfoot joint.
28270.........  Release of foot   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 contracture.
28272.........  Release of toe    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 joint, each.
28280.........  Fusion of toes..  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
28285.........  Repair of         ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 hammertoe.
28286.........  Repair of         ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 hammertoe.
28288.........  Partial removal   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 of foot bone.
28289.........  Repair hallux     ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 rigidus.
28290.........  Correction of     ........  T.......    0057      28.0970     1,729.40       475.91       345.88
                 bunion.
28292.........  Correction of     ........  T.......    0057      28.0970     1,729.40       475.91       345.88
                 bunion.
28293.........  Correction of     ........  T.......    0057      28.0970     1,729.40       475.91       345.88
                 bunion.
28294.........  Correction of     ........  T.......    0057      28.0970     1,729.40       475.91       345.88
                 bunion.
28296.........  Correction of     ........  T.......    0057      28.0970     1,729.40       475.91       345.88
                 bunion.
28297.........  Correction of     ........  T.......    0057      28.0970     1,729.40       475.91       345.88
                 bunion.
28298.........  Correction of     ........  T.......    0057      28.0970     1,729.40       475.91       345.88
                 bunion.
28299.........  Correction of     ........  T.......    0057      28.0970     1,729.40       475.91       345.88
                 bunion.
28300.........  Incision of heel  ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bone.
28302.........  Incision of       ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 ankle bone.
28304.........  Incision of       ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 midfoot bones.
28305.........  Incise/graft      ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 midfoot bones.
28306.........  Incision of       ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal.
28307.........  Incision of       ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal.
28308.........  Incision of       ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 metatarsal.
28309.........  Incision of       ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 metatarsals.
28310.........  Revision of big   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe.
28312.........  Revision of toe.  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
28313.........  Repair deformity  ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 of toe.
28315.........  Removal of        ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 sesamoid bone.
28320.........  Repair of foot    ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bones.
28322.........  Repair of         ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 metatarsals.
28340.........  Resect enlarged   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe tissue.
28341.........  Resect enlarged   ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe.
28344.........  Repair extra      ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe(s).
28345.........  Repair webbed     ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe(s).
28360.........  Reconstruct       ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 cleft foot.
28400.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 heel fracture.
28405.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 heel fracture.
28406.........  Treatment of      CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 heel fracture.
28415.........  Treat heel        CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
28420.........  Treat/graft heel  CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
28430.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
28435.........  Treatment of      ........  T.......    0043       1.6914       104.11  ...........        20.82
                 ankle fracture.
28436.........  Treatment of      CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 ankle fracture.
28445.........  Treat ankle       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
28450.........  Treat midfoot     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture, each.
28455.........  Treat midfoot     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture, each.
28456.........  Treat midfoot     CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
28465.........  Treat midfoot     CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture, each.
28470.........  Treat metatarsal  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
28475.........  Treat metatarsal  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
28476.........  Treat metatarsal  CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
28485.........  Treat metatarsal  CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
28490.........  Treat big toe     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
28495.........  Treat big toe     ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
28496.........  Treat big toe     CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 fracture.
28505.........  Treat big toe     CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
28510.........  Treatment of toe  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.
28515.........  Treatment of toe  ........  T.......    0043       1.6914       104.11  ...........        20.82
                 fracture.

[[Page 49779]]

 
28525.........  Treat toe         CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 fracture.
28530.........  Treat sesamoid    ........  T.......    0043       1.6914       104.11  ...........        20.82
                 bone fracture.
28531.........  Treat sesamoid    CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 bone fracture.
28540.........  Treat foot        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
28545.........  Treat foot        CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
28546.........  Treat foot        CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
28555.........  Repair foot       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
28570.........  Treat foot        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
28575.........  Treat foot        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
28576.........  Treat foot        CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
28585.........  Repair foot       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
28600.........  Treat foot        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
28605.........  Treat foot        ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
28606.........  Treat foot        CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
28615.........  Repair foot       CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
28630.........  Treat toe         ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
28635.........  Treat toe         ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
28636.........  Treat toe         CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
28645.........  Repair toe        CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
28660.........  Treat toe         ........  T.......    0043       1.6914       104.11  ...........        20.82
                 dislocation.
28665.........  Treat toe         ........  T.......    0045      14.5502       895.58       268.47       179.12
                 dislocation.
28666.........  Treat toe         CH......  T.......    0062      25.6702     1,580.03       375.46       316.01
                 dislocation.
28675.........  Repair of toe     CH......  T.......    0063      37.5680     2,312.35       549.49       462.47
                 dislocation.
28705.........  Fusion of foot    ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bones.
28715.........  Fusion of foot    ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bones.
28725.........  Fusion of foot    ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bones.
28730.........  Fusion of foot    ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bones.
28735.........  Fusion of foot    ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bones.
28737.........  Revision of foot  ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bones.
28740.........  Fusion of foot    ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 bones.
28750.........  Fusion of big     ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 toe joint.
28755.........  Fusion of big     ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe joint.
28760.........  Fusion of big     ........  T.......    0056      41.2239     2,537.37  ...........       507.47
                 toe joint.
28810.........  Amputation        ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe&metatarsal.
28820.........  Amputation of     ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 toe.
28825.........  Partial           ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 amputation of
                 toe.
28890.........  High energy       CH......  T.......    0050      25.0600     1,542.47  ...........       308.49
                 eswt, plantar f.
28899.........  Foot/toes         ........  T.......    0043       1.6914       104.11  ...........        20.82
                 surgery
                 procedure.
29000.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 body cast.
29010.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 body cast.
29015.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 body cast.
29020.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 body cast.
29025.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 body cast.
29035.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 body cast.
29040.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 body cast.
29044.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 body cast.
29046.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 body cast.
29049.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 figure eight.
29055.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 shoulder cast.
29058.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 shoulder cast.
29065.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 long arm cast.
29075.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 forearm cast.
29085.........  Apply hand/wrist  ........  S.......    0058       1.0504        64.65  ...........        12.93
                 cast.
29086.........  Apply finger      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 cast.
29105.........  Apply long arm    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 splint.
29125.........  Apply forearm     ........  S.......    0058       1.0504        64.65  ...........        12.93
                 splint.
29126.........  Apply forearm     ........  S.......    0058       1.0504        64.65  ...........        12.93
                 splint.
29130.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 finger splint.
29131.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 finger splint.
29200.........  Strapping of      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 chest.
29220.........  Strapping of low  ........  S.......    0058       1.0504        64.65  ...........        12.93
                 back.
29240.........  Strapping of      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 shoulder.
29260.........  Strapping of      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 elbow or wrist.
29280.........  Strapping of      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 hand or finger.
29305.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 hip cast.
29325.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 hip casts.
29345.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 long leg cast.
29355.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 long leg cast.
29358.........  Apply long leg    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 cast brace.
29365.........  Application of    ........  S.......    0426       2.2728       139.89  ...........        27.98
                 long leg cast.

[[Page 49780]]

 
29405.........  Apply short leg   ........  S.......    0426       2.2728       139.89  ...........        27.98
                 cast.
29425.........  Apply short leg   ........  S.......    0426       2.2728       139.89  ...........        27.98
                 cast.
29435.........  Apply short leg   ........  S.......    0426       2.2728       139.89  ...........        27.98
                 cast.
29440.........  Addition of       ........  S.......    0058       1.0504        64.65  ...........        12.93
                 walker to cast.
29445.........  Apply rigid leg   ........  S.......    0426       2.2728       139.89  ...........        27.98
                 cast.
29450.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 leg cast.
29505.........  Application,      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 long leg splint.
29515.........  Application       ........  S.......    0058       1.0504        64.65  ...........        12.93
                 lower leg
                 splint.
29520.........  Strapping of hip  ........  S.......    0058       1.0504        64.65  ...........        12.93
29530.........  Strapping of      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 knee.
29540.........  Strapping of      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 ankle and/or ft.
29550.........  Strapping of      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 toes.
29580.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 paste boot.
29590.........  Application of    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 foot splint.
29700.........  Removal/revision  ........  S.......    0058       1.0504        64.65  ...........        12.93
                 of cast.
29705.........  Removal/revision  ........  S.......    0058       1.0504        64.65  ...........        12.93
                 of cast.
29710.........  Removal/revision  ........  S.......    0426       2.2728       139.89  ...........        27.98
                 of cast.
29715.........  Removal/revision  ........  S.......    0058       1.0504        64.65  ...........        12.93
                 of cast.
29720.........  Repair of body    ........  S.......    0058       1.0504        64.65  ...........        12.93
                 cast.
29730.........  Windowing of      ........  S.......    0058       1.0504        64.65  ...........        12.93
                 cast.
29740.........  Wedging of cast.  ........  S.......    0058       1.0504        64.65  ...........        12.93
29750.........  Wedging of        ........  S.......    0058       1.0504        64.65  ...........        12.93
                 clubfoot cast.
29799.........  Casting/          ........  S.......    0058       1.0504        64.65  ...........        12.93
                 strapping
                 procedure.
29800.........  Jaw arthroscopy/  ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29804.........  Jaw arthroscopy/  ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29805.........  Shoulder          ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy, dx.
29806.........  Shoulder          ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 arthroscopy/
                 surgery.
29807.........  Shoulder          ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 arthroscopy/
                 surgery.
29819.........  Shoulder          ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29820.........  Shoulder          ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29821.........  Shoulder          ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29822.........  Shoulder          ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29823.........  Shoulder          ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29824.........  Shoulder          ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29825.........  Shoulder          ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29826.........  Shoulder          ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 arthroscopy/
                 surgery.
29827.........  Arthroscop        ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 rotator cuff
                 repr.
29830.........  Elbow             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy.
29834.........  Elbow             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29835.........  Elbow             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29836.........  Elbow             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29837.........  Elbow             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29838.........  Elbow             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29840.........  Wrist             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy.
29843.........  Wrist             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29844.........  Wrist             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29845.........  Wrist             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29846.........  Wrist             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29847.........  Wrist             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29848.........  Wrist endoscopy/  ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29850.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29851.........  Knee arthroscopy/ ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 surgery.
29855.........  Tibial            ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 arthroscopy/
                 surgery.
29856.........  Tibial            ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29860.........  Hip arthroscopy,  ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 dx.
29861.........  Hip arthroscopy/  ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29862.........  Hip arthroscopy/  ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 surgery.
29863.........  Hip arthroscopy/  ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 surgery.
29866.........  Autgrft implnt,   ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 knee w/scope.
29867.........  Allgrft implnt,   ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 knee w/scope.
29868.........  Meniscal trnspl,  ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 knee w/scpe.
29870.........  Knee              ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy, dx.
29871.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 drainage.
29873.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29874.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29875.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29876.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29877.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29879.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29880.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.

[[Page 49781]]

 
29881.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29882.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29883.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29884.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29885.........  Knee arthroscopy/ ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 surgery.
29886.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29887.........  Knee arthroscopy/ ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 surgery.
29888.........  Knee arthroscopy/ ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 surgery.
29889.........  Knee arthroscopy/ ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 surgery.
29891.........  Ankle             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29892.........  Ankle             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29893.........  Scope, plantar    ........  T.......    0055      20.2255     1,244.90       355.34       248.98
                 fasciotomy.
29894.........  Ankle             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29895.........  Ankle             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29897.........  Ankle             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29898.........  Ankle             ........  T.......    0041      28.6279     1,762.08  ...........       352.42
                 arthroscopy/
                 surgery.
29899.........  Ankle             ........  T.......    0042      45.0637     2,773.72       804.74       554.74
                 arthroscopy/
                 surgery.
29900.........  Mcp joint         ........  T.......    0053      16.0343       986.93       253.49       197.39
                 arthroscopy, dx.
29901.........  Mcp joint         ........  T.......    0053      16.0343       986.93       253.49       197.39
                 arthroscopy,
                 surg.
29902.........  Mcp joint         ........  T.......    0053      16.0343       986.93       253.49       197.39
                 arthroscopy,
                 surg.
29999.........  Arthroscopy of    ........  T.......    0252       7.7261       475.55       111.84        95.11
                 joint.
30110.........  Removal of nose   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 polyp(s).
30115.........  Removal of nose   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 polyp(s).
30117.........  Removal of        ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 intranasal
                 lesion.
30118.........  Removal of        ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 intranasal
                 lesion.
30120.........  Revision of nose  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
30124.........  Removal of nose   ........  T.......    0252       7.7261       475.55       111.84        95.11
                 lesion.
30125.........  Removal of nose   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 lesion.
30130.........  Excise inferior   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 turbinate.
30140.........  Resect inferior   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 turbinate.
30150.........  Partial removal   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of nose.
30160.........  Removal of nose.  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
30200.........  Injection         ........  T.......    0252       7.7261       475.55       111.84        95.11
                 treatment of
                 nose.
30210.........  Nasal sinus       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 therapy.
30220.........  Insert nasal      ........  T.......    0252       7.7261       475.55       111.84        95.11
                 septal button.
30300.........  Remove nasal      ........  X.......    0340       0.6211        38.23  ...........         7.65
                 foreign body.
30310.........  Remove nasal      ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 foreign body.
30320.........  Remove nasal      ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 foreign body.
30400.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of nose.
30410.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of nose.
30420.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of nose.
30430.........  Revision of nose  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
30435.........  Revision of nose  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
30450.........  Revision of nose  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
30460.........  Revision of nose  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
30462.........  Revision of nose  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
30465.........  Repair nasal      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 stenosis.
30520.........  Repair of nasal   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 septum.
30540.........  Repair nasal      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 defect.
30545.........  Repair nasal      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 defect.
30560.........  Release of nasal  ........  T.......    0251       2.3768       146.29  ...........        29.26
                 adhesions.
30580.........  Repair upper jaw  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fistula.
30600.........  Repair mouth/     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nose fistula.
30620.........  Intranasal        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 reconstruction.
30630.........  Repair nasal      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 septum defect.
30801.........  Ablate inf        ........  T.......    0252       7.7261       475.55       111.84        95.11
                 turbinate,
                 superf.
30802.........  Cauterization,    ........  T.......    0252       7.7261       475.55       111.84        95.11
                 inner nose.
30901.........  Control of        ........  T.......    0250       1.2021        73.99        25.50        14.80
                 nosebleed.
30903.........  Control of        ........  T.......    0250       1.2021        73.99        25.50        14.80
                 nosebleed.
30905.........  Control of        ........  T.......    0250       1.2021        73.99        25.50        14.80
                 nosebleed.
30906.........  Repeat control    ........  T.......    0250       1.2021        73.99        25.50        14.80
                 of nosebleed.
30915.........  Ligation, nasal   CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 sinus artery.
30920.........  Ligation, upper   ........  T.......    0092      24.5817     1,513.03       306.56       302.61
                 jaw artery.
30930.........  Ther fx, nasal    ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 inf turbinate.
30999.........  Nasal surgery     ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
31000.........  Irrigation,       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 maxillary sinus.
31002.........  Irrigation,       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 sphenoid sinus.
31020.........  Exploration,      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 maxillary sinus.
31030.........  Exploration,      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 maxillary sinus.
31032.........  Explore sinus,    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 remove polyps.

[[Page 49782]]

 
31040.........  Exploration       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 behind upper
                 jaw.
31050.........  Exploration,      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 sphenoid sinus.
31051.........  Sphenoid sinus    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 surgery.
31070.........  Exploration of    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 frontal sinus.
31075.........  Exploration of    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 frontal sinus.
31080.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 frontal sinus.
31081.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 frontal sinus.
31084.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 frontal sinus.
31085.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 frontal sinus.
31086.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 frontal sinus.
31087.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 frontal sinus.
31090.........  Exploration of    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 sinuses.
31200.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ethmoid sinus.
31201.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ethmoid sinus.
31205.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ethmoid sinus.
31231.........  Nasal endoscopy,  ........  T.......    0072       1.4038        86.41        21.27        17.28
                 dx.
31233.........  Nasal/sinus       ........  T.......    0072       1.4038        86.41        21.27        17.28
                 endoscopy, dx.
31235.........  Nasal/sinus       ........  T.......    0074      15.1300       931.27       295.70       186.25
                 endoscopy, dx.
31237.........  Nasal/sinus       CH......  T.......    0074      15.1300       931.27       295.70       186.25
                 endoscopy, surg.
31238.........  Nasal/sinus       ........  T.......    0074      15.1300       931.27       295.70       186.25
                 endoscopy, surg.
31239.........  Nasal/sinus       ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 endoscopy, surg.
31240.........  Nasal/sinus       ........  T.......    0074      15.1300       931.27       295.70       186.25
                 endoscopy, surg.
31254.........  Revision of       ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 ethmoid sinus.
31255.........  Removal of        ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 ethmoid sinus.
31256.........  Exploration       ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 maxillary sinus.
31267.........  Endoscopy,        ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 maxillary sinus.
31276.........  Sinus endoscopy,  ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 surgical.
31287.........  Nasal/sinus       ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 endoscopy, surg.
31288.........  Nasal/sinus       ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 endoscopy, surg.
31292.........  Nasal/sinus       ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 endoscopy, surg.
31293.........  Nasal/sinus       ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 endoscopy, surg.
31294.........  Nasal/sinus       ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 endoscopy, surg.
31299.........  Sinus surgery     ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
31300.........  Removal of        ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 larynx lesion.
31320.........  Diagnostic        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 incision,
                 larynx.
31400.........  Revision of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 larynx.
31420.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 epiglottis.
31500.........  Insert emergency  ........  S.......    0094       2.4630       151.60        46.29        30.32
                 airway.
31502.........  Change of         ........  T.......    0121       2.3431       144.22        43.80        28.84
                 windpipe airway.
31505.........  Diagnostic        ........  T.......    0071       0.7572        46.61        11.03         9.32
                 laryngoscopy.
31510.........  Laryngoscopy      ........  T.......    0074      15.1300       931.27       295.70       186.25
                 with biopsy.
31511.........  Remove foreign    ........  T.......    0072       1.4038        86.41        21.27        17.28
                 body, larynx.
31512.........  Removal of        ........  T.......    0074      15.1300       931.27       295.70       186.25
                 larynx lesion.
31513.........  Injection into    ........  T.......    0072       1.4038        86.41        21.27        17.28
                 vocal cord.
31515.........  Laryngoscopy for  ........  T.......    0074      15.1300       931.27       295.70       186.25
                 aspiration.
31520.........  Dx laryngoscopy,  ........  T.......    0072       1.4038        86.41        21.27        17.28
                 newborn.
31525.........  Dx laryngoscopy   ........  T.......    0074      15.1300       931.27       295.70       186.25
                 excl nb.
31526.........  Dx laryngoscopy   ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 w/oper scope.
31527.........  Laryngoscopy for  ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 treatment.
31528.........  Laryngoscopy and  ........  T.......    0074      15.1300       931.27       295.70       186.25
                 dilation.
31529.........  Laryngoscopy and  ........  T.......    0074      15.1300       931.27       295.70       186.25
                 dilation.
31530.........  Laryngoscopy w/   ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 fb removal.
31531.........  Laryngoscopy w/   ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 fb&op scope.
31535.........  Laryngoscopy w/   ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 biopsy.
31536.........  Laryngoscopy w/   ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 bx&op scope.
31540.........  Laryngoscopy w/   ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 exc of tumor.
31541.........  Larynscop w/tumr  ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 exc + scope.
31545.........  Remove vc lesion  ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 w/scope.
31546.........  Remove vc lesion  ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 scope/graft.
31560.........  Laryngoscop w/    ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 arytenoidectom.
31561.........  Larynscop, remve  ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 cart + scop.
31570.........  Laryngoscope w/   ........  T.......    0074      15.1300       931.27       295.70       186.25
                 vc inj.
31571.........  Laryngoscop w/vc  ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 inj + scope.
31575.........  Diagnostic        ........  T.......    0072       1.4038        86.41        21.27        17.28
                 laryngoscopy.
31576.........  Laryngoscopy      ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 with biopsy.
31577.........  Remove foreign    ........  T.......    0073       3.8737       238.43        69.72        47.69
                 body, larynx.
31578.........  Removal of        ........  T.......    0075      21.8010     1,341.87       445.92       268.37
                 larynx lesion.
31579.........  Diagnostic        ........  T.......    0073       3.8737       238.43        69.72        47.69
                 laryngoscopy.
31580.........  Revision of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 larynx.
31582.........  Revision of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 larynx.

[[Page 49783]]

 
31588.........  Revision of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 larynx.
31590.........  Reinnervate       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 larynx.
31595.........  Larynx nerve      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 surgery.
31599.........  Larynx surgery    ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
31600.........  Incision of       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 windpipe.
31601.........  Incision of       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 windpipe.
31603.........  Incision of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 windpipe.
31605.........  Incision of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 windpipe.
31610.........  Incision of       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 windpipe.
31611.........  Surgery/speech    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 prosthesis.
31612.........  Puncture/clear    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 windpipe.
31613.........  Repair windpipe   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 opening.
31614.........  Repair windpipe   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 opening.
31615.........  Visualization of  ........  T.......    0076       9.3905       577.99       189.82       115.60
                 windpipe.
31620.........  Endobronchial us  ........  S.......    0670      29.7322     1,830.05       536.10       366.01
                 add-on.
31622.........  Dx bronchoscope/  ........  T.......    0076       9.3905       577.99       189.82       115.60
                 wash.
31623.........  Dx bronchoscope/  ........  T.......    0076       9.3905       577.99       189.82       115.60
                 brush.
31624.........  Dx bronchoscope/  ........  T.......    0076       9.3905       577.99       189.82       115.60
                 lavage.
31625.........  Bronchoscopy w/   ........  T.......    0076       9.3905       577.99       189.82       115.60
                 biopsy(s).
31628.........  Bronchoscopy/     ........  T.......    0076       9.3905       577.99       189.82       115.60
                 lung bx, each.
31629.........  Bronchoscopy/     ........  T.......    0076       9.3905       577.99       189.82       115.60
                 needle bx, each.
31630.........  Bronchoscopy      ........  T.......    0415      21.8803     1,346.75       459.92       269.35
                 dilate/fx repr.
31631.........  Bronchoscopy,     ........  T.......    0415      21.8803     1,346.75       459.92       269.35
                 dilate w/stent.
31632.........  Bronchoscopy/     ........  T.......    0076       9.3905       577.99       189.82       115.60
                 lung bx, add'l.
31633.........  Bronchoscopy/     ........  T.......    0076       9.3905       577.99       189.82       115.60
                 needle bx add'l.
31635.........  Bronchoscopy w/   ........  T.......    0076       9.3905       577.99       189.82       115.60
                 fb removal.
31636.........  Bronchoscopy,     ........  T.......    0415      21.8803     1,346.75       459.92       269.35
                 bronch stents.
31637.........  Bronchoscopy,     ........  T.......    0076       9.3905       577.99       189.82       115.60
                 stent add-on.
31638.........  Bronchoscopy,     ........  T.......    0415      21.8803     1,346.75       459.92       269.35
                 revise stent.
31640.........  Bronchoscopy w/   ........  T.......    0415      21.8803     1,346.75       459.92       269.35
                 tumor excise.
31641.........  Bronchoscopy,     ........  T.......    0415      21.8803     1,346.75       459.92       269.35
                 treat blockage.
31643.........  Diag              ........  T.......    0076       9.3905       577.99       189.82       115.60
                 bronchoscope/
                 catheter.
31645.........  Bronchoscopy,     ........  T.......    0076       9.3905       577.99       189.82       115.60
                 clear airways.
31646.........  Bronchoscopy,     ........  T.......    0076       9.3905       577.99       189.82       115.60
                 reclear airway.
31656.........  Bronchoscopy,     ........  T.......    0076       9.3905       577.99       189.82       115.60
                 inj for x-ray.
31700.........  Insertion of      ........  T.......    0072       1.4038        86.41        21.27        17.28
                 airway catheter.
31708.........  Instill airway    ........  N.......  ......  ...........  ...........  ...........  ...........
                 contrast dye.
31710.........  Insertion of      ........  N.......  ......  ...........  ...........  ...........  ...........
                 airway catheter.
31715.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 bronchus x-ray.
31717.........  Bronchial brush   ........  T.......    0073       3.8737       238.43        69.72        47.69
                 biopsy.
31720.........  Clearance of      ........  T.......    0071       0.7572        46.61        11.03         9.32
                 airways.
31730.........  Intro, windpipe   ........  T.......    0073       3.8737       238.43        69.72        47.69
                 wire/tube.
31750.........  Repair of         ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 windpipe.
31755.........  Repair of         ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 windpipe.
31785.........  Remove windpipe   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 lesion.
31820.........  Closure of        ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 windpipe lesion.
31825.........  Repair of         ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 windpipe defect.
31830.........  Revise windpipe   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 scar.
31899.........  Airways surgical  ........  T.......    0076       9.3905       577.99       189.82       115.60
                 procedure.
32000.........  Drainage of       ........  T.......    0070       3.6425       224.20  ...........        44.84
                 chest.
32002.........  Treatment of      ........  T.......    0070       3.6425       224.20  ...........        44.84
                 collapsed lung.
32005.........  Treat lung        ........  T.......    0070       3.6425       224.20  ...........        44.84
                 lining
                 chemically.
32019.........  Insert pleural    CH......  T.......    0652      29.2259     1,798.88  ...........       359.78
                 catheter.
32020.........  Insertion of      ........  T.......    0070       3.6425       224.20  ...........        44.84
                 chest tube.
32201.........  Drain, percut,    ........  T.......    0070       3.6425       224.20  ...........        44.84
                 lung lesion.
32400.........  Needle biopsy     ........  T.......    0685       6.0729       373.79       115.47        74.76
                 chest lining.
32405.........  Biopsy, lung or   ........  T.......    0685       6.0729       373.79       115.47        74.76
                 mediastinum.
32420.........  Puncture/clear    ........  T.......    0070       3.6425       224.20  ...........        44.84
                 lung.
32601.........  Thoracoscopy,     ........  T.......    0069      31.5464     1,941.71       591.64       388.34
                 diagnostic.
32602.........  Thoracoscopy,     ........  T.......    0069      31.5464     1,941.71       591.64       388.34
                 diagnostic.
32603.........  Thoracoscopy,     ........  T.......    0069      31.5464     1,941.71       591.64       388.34
                 diagnostic.
32604.........  Thoracoscopy,     ........  T.......    0069      31.5464     1,941.71       591.64       388.34
                 diagnostic.
32605.........  Thoracoscopy,     ........  T.......    0069      31.5464     1,941.71       591.64       388.34
                 diagnostic.
32606.........  Thoracoscopy,     ........  T.......    0069      31.5464     1,941.71       591.64       388.34
                 diagnostic.
32960.........  Therapeutic       ........  T.......    0070       3.6425       224.20  ...........        44.84
                 pneumothorax.
32999.........  Chest surgery     ........  T.......    0070       3.6425       224.20  ...........        44.84
                 procedure.
33010.........  Drainage of       ........  T.......    0070       3.6425       224.20  ...........        44.84
                 heart sac.
33011.........  Repeat drainage   ........  T.......    0070       3.6425       224.20  ...........        44.84
                 of heart sac.
33206.........  Insertion of      ........  T.......    0089     121.9402     7,505.54     1,682.28     1,501.11
                 heart pacemaker.
33207.........  Insertion of      ........  T.......    0089     121.9402     7,505.54     1,682.28     1,501.11
                 heart pacemaker.

[[Page 49784]]

 
33208.........  Insertion of      ........  T.......    0655     153.1524     9,426.68  ...........     1,885.34
                 heart pacemaker.
33210.........  Insertion of      ........  T.......    0106      44.7574     2,754.86  ...........       550.97
                 heart electrode.
33211.........  Insertion of      ........  T.......    0106      44.7574     2,754.86  ...........       550.97
                 heart electrode.
33212.........  Insertion of      ........  T.......    0090      97.8357     6,021.89     1,612.80     1,204.38
                 pulse generator.
33213.........  Insertion of      ........  T.......    0654     112.2347     6,908.16  ...........     1,381.63
                 pulse generator.
33214.........  Upgrade of        ........  T.......    0655     153.1524     9,426.68  ...........     1,885.34
                 pacemaker
                 system.
33215.........  Reposition        ........  T.......    0105      23.4666     1,444.39       370.40       288.88
                 pacing-defib
                 lead.
33216.........  Insert lead pace- ........  T.......    0106      44.7574     2,754.86  ...........       550.97
                 defib, one.
33217.........  Insert lead pace- ........  T.......    0106      44.7574     2,754.86  ...........       550.97
                 defib, dual.
33218.........  Repair lead pace- ........  T.......    0106      44.7574     2,754.86  ...........       550.97
                 defib, one.
33220.........  Repair lead pace- ........  T.......    0106      44.7574     2,754.86  ...........       550.97
                 defib, dual.
33222.........  Revise pocket,    ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pacemaker.
33223.........  Revise pocket,    ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 pacing-defib.
33224.........  Insert pacing     ........  T.......    0418     267.8870    16,488.71  ...........     3,297.74
                 lead&connect.
33225.........  L ventric pacing  ........  T.......    0418     267.8870    16,488.71  ...........     3,297.74
                 lead add-on.
33226.........  Reposition l      ........  T.......    0105      23.4666     1,444.39       370.40       288.88
                 ventric lead.
33233.........  Removal of        ........  T.......    0105      23.4666     1,444.39       370.40       288.88
                 pacemaker
                 system.
33234.........  Removal of        ........  T.......    0105      23.4666     1,444.39       370.40       288.88
                 pacemaker
                 system.
33235.........  Removal           ........  T.......    0105      23.4666     1,444.39       370.40       288.88
                 pacemaker
                 electrode.
33241.........  Remove pulse      ........  T.......    0105      23.4666     1,444.39       370.40       288.88
                 generator.
33244.........  Remove eltrd,     ........  T.......    0105      23.4666     1,444.39       370.40       288.88
                 transven.
33282.........  Implant pat-      ........  S.......    0680      74.8877     4,609.41  ...........       921.88
                 active ht
                 record.
33284.........  Remove pat-       ........  T.......    0109      10.9541       674.24  ...........       134.85
                 active ht
                 record.
33508.........  Endoscopic vein   ........  N.......  ......  ...........  ...........  ...........  ...........
                 harvest.
33999.........  Cardiac surgery   ........  T.......    0070       3.6425       224.20  ...........        44.84
                 procedure.
34101.........  Removal of        ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 artery clot.
34111.........  Removal of arm    ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 artery clot.
34201.........  Removal of        ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 artery clot.
34203.........  Removal of leg    ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 artery clot.
34421.........  Removal of vein   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 clot.
34471.........  Removal of vein   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 clot.
34490.........  Removal of vein   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 clot.
34501.........  Repair valve,     ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 femoral vein.
34510.........  Transposition of  ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 vein valve.
34520.........  Cross-over vein   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 graft.
34530.........  Leg vein fusion.  ........  T.......    0088      37.9652     2,336.80       655.22       467.36
35011.........  Repair defect of  ........  T.......    0653      31.0004     1,908.11  ...........       381.62
                 artery.
35180.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35184.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35188.........  Repair blood      ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 vessel lesion.
35190.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35201.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35206.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35207.........  Repair blood      ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 vessel lesion.
35226.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35231.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35236.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35256.........  Repair blood      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessel lesion.
35261.........  Repair blood      ........  T.......    0653      31.0004     1,908.11  ...........       381.62
                 vessel lesion.
35266.........  Repair blood      ........  T.......    0653      31.0004     1,908.11  ...........       381.62
                 vessel lesion.
35286.........  Repair blood      ........  T.......    0653      31.0004     1,908.11  ...........       381.62
                 vessel lesion.
35321.........  Rechanneling of   ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 artery.
35458.........  Repair arterial   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35459.........  Repair arterial   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35460.........  Repair venous     ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35470.........  Repair arterial   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35471.........  Repair arterial   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35472.........  Repair arterial   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35473.........  Repair arterial   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35474.........  Repair arterial   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35475.........  Repair arterial   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35476.........  Repair venous     ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 blockage.
35484.........  Atherectomy,      ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 open.
35485.........  Atherectomy,      ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 open.
35490.........  Atherectomy,      ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 percutaneous.
35491.........  Atherectomy,      ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 percutaneous.
35492.........  Atherectomy,      ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 percutaneous.
35493.........  Atherectomy,      ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 percutaneous.
35494.........  Atherectomy,      ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 percutaneous.
35495.........  Atherectomy,      ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 percutaneous.

[[Page 49785]]

 
35500.........  Harvest vein for  ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 bypass.
35572.........  Harvest           ........  N.......  ......  ...........  ...........  ...........  ...........
                 femoropopliteal
                 vein.
35685.........  Bypass graft      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 patency/patch.
35686.........  Bypass graft/av   ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 fist patency.
35761.........  Exploration of    ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 artery/vein.
35860.........  Explore limb      ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vessels.
35875.........  Removal of clot   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 in graft.
35876.........  Removal of clot   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 in graft.
35879.........  Revise graft w/   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 vein.
35881.........  Revise graft w/   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 vein.
35903.........  Excision, graft,  ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 extremity.
36000.........  Place needle in   ........  N.......  ......  ...........  ...........  ...........  ...........
                 vein.
36002.........  Pseudoaneurysm    ........  S.......    0267       2.5166       154.90        60.80        30.98
                 injection trt.
36005.........  Injection ext     ........  N.......  ......  ...........  ...........  ...........  ...........
                 venography.
36010.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in vein.
36011.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in vein.
36012.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in vein.
36013.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36014.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36015.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36100.........  Establish access  ........  N.......  ......  ...........  ...........  ...........  ...........
                 to artery.
36120.........  Establish access  ........  N.......  ......  ...........  ...........  ...........  ...........
                 to artery.
36140.........  Establish access  ........  N.......  ......  ...........  ...........  ...........  ...........
                 to artery.
36145.........  Artery to vein    ........  N.......  ......  ...........  ...........  ...........  ...........
                 shunt.
36160.........  Establish access  ........  N.......  ......  ...........  ...........  ...........  ...........
                 to aorta.
36200.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in aorta.
36215.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36216.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36217.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36218.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36245.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36246.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36247.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36248.........  Place catheter    ........  N.......  ......  ...........  ...........  ...........  ...........
                 in artery.
36260.........  Insertion of      ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 infusion pump.
36261.........  Revision of       ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 infusion pump.
36262.........  Removal of        ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 infusion pump.
36299.........  Vessel injection  ........  N.......  ......  ...........  ...........  ...........  ...........
                 procedure.
36400.........  Bl draw < 3 yrs   ........  N.......  ......  ...........  ...........  ...........  ...........
                 fem/jugular.
36405.........  Bl draw < 3 yrs   ........  N.......  ......  ...........  ...........  ...........  ...........
                 scalp vein.
36406.........  Bl draw < 3 yrs   ........  N.......  ......  ...........  ...........  ...........  ...........
                 other vein.
36410.........  Non-routine bl    ........  N.......  ......  ...........  ...........  ...........  ...........
                 draw > 3 yrs.
36416.........  Capillary blood   ........  N.......  ......  ...........  ...........  ...........  ...........
                 draw.
36420.........  Vein access       ........  T.......    0035       0.2016        12.41  ...........         2.48
                 cutdown < 1 yr.
36425.........  Vein access       ........  T.......    0035       0.2016        12.41  ...........         2.48
                 cutdown > 1 yr.
36430.........  Blood             ........  S.......    0110       3.4570       212.78  ...........        42.56
                 transfusion
                 service.
36440.........  Bl push           ........  S.......    0110       3.4570       212.78  ...........        42.56
                 transfuse, 2 yr
                 or <.
36450.........  Bl exchange/      ........  S.......    0110       3.4570       212.78  ...........        42.56
                 transfuse, nb.
36455.........  Bl exchange/      ........  S.......    0110       3.4570       212.78  ...........        42.56
                 transfuse non-
                 nb.
36460.........  Transfusion       ........  S.......    0110       3.4570       212.78  ...........        42.56
                 service, fetal.
36468.........  Injection(s),     ........  T.......    0098       1.1035        67.92  ...........        13.58
                 spider veins.
36469.........  Injection(s),     ........  T.......    0098       1.1035        67.92  ...........        13.58
                 spider veins.
36470.........  Injection         ........  T.......    0098       1.1035        67.92  ...........        13.58
                 therapy of vein.
36471.........  Injection         ........  T.......    0098       1.1035        67.92  ...........        13.58
                 therapy of
                 veins.
36475.........  Endovenous rf,    ........  T.......    0091      34.6279     2,131.38  ...........       426.28
                 1st vein.
36476.........  Endovenous rf,    ........  T.......    0091      34.6279     2,131.38  ...........       426.28
                 vein add-on.
36478.........  Endovenous        CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 laser, 1st vein.
36479.........  Endovenous laser  CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 vein addon.
36481.........  Insertion of      ........  N.......  ......  ...........  ...........  ...........  ...........
                 catheter, vein.
36500.........  Insertion of      ........  N.......  ......  ...........  ...........  ...........  ...........
                 catheter, vein.
36510.........  Insertion of      ........  N.......  ......  ...........  ...........  ...........  ...........
                 catheter, vein.
36511.........  Apheresis wbc...  ........  S.......    0111      11.7005       720.18       198.40       144.04
36512.........  Apheresis rbc...  ........  S.......    0111      11.7005       720.18       198.40       144.04
36513.........  Apheresis         ........  S.......    0111      11.7005       720.18       198.40       144.04
                 platelets.
36514.........  Apheresis plasma  ........  S.......    0111      11.7005       720.18       198.40       144.04
36515.........  Apheresis,        ........  S.......    0112      30.6602     1,887.17       433.29       377.43
                 adsorp/reinfuse.
36516.........  Apheresis,        ........  S.......    0112      30.6602     1,887.17       433.29       377.43
                 selective.
36522.........  Photopheresis...  ........  S.......    0112      30.6602     1,887.17       433.29       377.43
36540.........  Collect blood     CH......  Q.......    0624       0.5336        32.84        13.13         6.57
                 venous device.
36550.........  Declot vascular   ........  T.......    0676       2.0612       126.87  ...........        25.37
                 device.

[[Page 49786]]

 
36555.........  Insert non-       ........  T.......    0621       8.7841       540.67  ...........       108.13
                 tunnel cv cath.
36556.........  Insert non-       ........  T.......    0621       8.7841       540.67  ...........       108.13
                 tunnel cv cath.
36557.........  Insert tunneled   ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 cv cath.
36558.........  Insert tunneled   ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 cv cath.
36560.........  Insert tunneled   ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 cv cath.
36561.........  Insert tunneled   ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 cv cath.
36563.........  Insert tunneled   ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 cv cath.
36565.........  Insert tunneled   ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 cv cath.
36566.........  Insert tunneled   CH......  T.......    0623      28.4646     1,752.02  ...........       350.40
                 cv cath.
36568.........  Insert picc cath  ........  T.......    0621       8.7841       540.67  ...........       108.13
36569.........  Insert picc cath  ........  T.......    0621       8.7841       540.67  ...........       108.13
36570.........  Insert picvad     ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 cath.
36571.........  Insert picvad     ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 cath.
36575.........  Repair tunneled   ........  T.......    0621       8.7841       540.67  ...........       108.13
                 cv cath.
36576.........  Repair tunneled   ........  T.......    0621       8.7841       540.67  ...........       108.13
                 cv cath.
36578.........  Replace tunneled  ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 cv cath.
36580.........  Replace cvad      ........  T.......    0621       8.7841       540.67  ...........       108.13
                 cath.
36581.........  Replace tunneled  ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 cv cath.
36582.........  Replace tunneled  ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 cv cath.
36583.........  Replace tunneled  ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 cv cath.
36584.........  Replace picc      ........  T.......    0621       8.7841       540.67  ...........       108.13
                 cath.
36585.........  Replace picvad    ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 cath.
36589.........  Removal tunneled  ........  T.......    0621       8.7841       540.67  ...........       108.13
                 cv cath.
36590.........  Removal tunneled  ........  T.......    0621       8.7841       540.67  ...........       108.13
                 cv cath.
36595.........  Mech remov        ........  T.......    0622      22.6984     1,397.11  ...........       279.42
                 tunneled cv
                 cath.
36596.........  Mech remov        ........  T.......    0621       8.7841       540.67  ...........       108.13
                 tunneled cv
                 cath.
36597.........  Reposition        ........  T.......    0621       8.7841       540.67  ...........       108.13
                 venous catheter.
36598.........  Inj w/fluor,      ........  X.......    0340       0.6211        38.23  ...........         7.65
                 eval cv device.
36600.........  Withdrawal of     CH......  Q.......    0035       0.2016        12.41  ...........         2.48
                 arterial blood.
36620.........  Insertion         ........  N.......  ......  ...........  ...........  ...........  ...........
                 catheter,
                 artery.
36625.........  Insertion         ........  N.......  ......  ...........  ...........  ...........  ...........
                 catheter,
                 artery.
36640.........  Insertion         ........  T.......    0623      28.4646     1,752.02  ...........       350.40
                 catheter,
                 artery.
36680.........  Insert needle,    ........  T.......    0002       1.0948        67.39  ...........        13.48
                 bone cavity.
36800.........  Insertion of      ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 cannula.
36810.........  Insertion of      ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 cannula.
36815.........  Insertion of      ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 cannula.
36818.........  Av fuse, uppr     ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 arm, cephalic.
36819.........  Av fuse, uppr     ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 arm, basilic.
36820.........  Av fusion/        ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 forearm vein.
36821.........  Av fusion direct  ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 any site.
36825.........  Artery-vein       ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 autograft.
36830.........  Artery-vein       ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 nonautograft.
36831.........  Open thrombect    ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 av fistula.
36832.........  Av fistula        ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 revision, open.
36833.........  Av fistula        ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 revision.
36834.........  Repair A-V        ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 aneurysm.
36835.........  Artery to vein    ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 shunt.
36838.........  Dist revas        ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 ligation, hemo.
36860.........  External cannula  ........  T.......    0676       2.0612       126.87  ...........        25.37
                 declotting.
36861.........  Cannula           ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 declotting.
36870.........  Percut thrombect  ........  T.......    0653      31.0004     1,908.11  ...........       381.62
                 av fistula.
37183.........  Remove hepatic    ........  T.......    0229      66.0804     4,067.31  ...........       813.46
                 shunt (tips).
37184.........  Prim art mech     ........  T.......    0653      31.0004     1,908.11  ...........       381.62
                 thrombectomy.
37185.........  Prim art m-       ........  T.......    0103      17.0436     1,049.05       223.63       209.81
                 thrombect add-
                 on.
37186.........  Sec art m-        ........  T.......    0103      17.0436     1,049.05       223.63       209.81
                 thrombect add-
                 on.
37187.........  Venous mech       ........  T.......    0653      31.0004     1,908.11  ...........       381.62
                 thrombectomy.
37188.........  Venous m-         ........  T.......    0653      31.0004     1,908.11  ...........       381.62
                 thrombectomy
                 add-on.
37195.........  Thrombolytic      ........  T.......    0676       2.0612       126.87  ...........        25.37
                 therapy, stroke.
37200.........  Transcatheter     ........  T.......    0685       6.0729       373.79       115.47        74.76
                 biopsy.
37201.........  Transcatheter     ........  T.......    0676       2.0612       126.87  ...........        25.37
                 therapy infuse.
37202.........  Transcatheter     ........  T.......    0676       2.0612       126.87  ...........        25.37
                 therapy infuse.
37203.........  Transcatheter     ........  T.......    0103      17.0436     1,049.05       223.63       209.81
                 retrieval.
37204.........  Transcatheter     ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 occlusion.
37205.........  Transcath iv      ........  T.......    0229      66.0804     4,067.31  ...........       813.46
                 stent, percut.
37206.........  Transcath iv      ........  T.......    0229      66.0804     4,067.31  ...........       813.46
                 stent/perc addl.
37207.........  Transcath iv      ........  T.......    0229      66.0804     4,067.31  ...........       813.46
                 stent, open.
37208.........  Transcath iv      ........  T.......    0229      66.0804     4,067.31  ...........       813.46
                 stent/open addl.
37209.........  Change iv cath    ........  T.......    0103      17.0436     1,049.05       223.63       209.81
                 at thromb tx.
37250.........  Iv us first       ........  S.......    0416      32.2182     1,983.06  ...........       396.61
                 vessel add-on.
37251.........  Iv us each add    ........  S.......    0416      32.2182     1,983.06  ...........       396.61
                 vessel add-on.

[[Page 49787]]

 
37500.........  Endoscopy ligate  CH......  T.......    0091      34.6279     2,131.38  ...........       426.28
                 perf veins.
37501.........  Vascular          ........  T.......    0092      24.5817     1,513.03       306.56       302.61
                 endoscopy
                 procedure.
37565.........  Ligation of neck  ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 vein.
37600.........  Ligation of neck  ........  T.......    0093      21.9703     1,352.29  ...........       270.46
                 artery.
37605.........  Ligation of neck  ........  T.......    0091      34.6279     2,131.38  ...........       426.28
                 artery.
37606.........  Ligation of neck  CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 artery.
37607.........  Ligation of a-v   ........  T.......    0092      24.5817     1,513.03       306.56       302.61
                 fistula.
37609.........  Temporal artery   ........  T.......    0021      14.9563       920.58       219.48       184.12
                 procedure.
37615.........  Ligation of neck  CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 artery.
37620.........  Revision of       ........  T.......    0091      34.6279     2,131.38  ...........       426.28
                 major vein.
37650.........  Revision of       CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 major vein.
37700.........  Revise leg vein.  ........  T.......    0091      34.6279     2,131.38  ...........       426.28
37718.........  Ligate/strip      CH......  T.......    0091      34.6279     2,131.38  ...........       426.28
                 short leg vein.
37722.........  Ligate/strip      CH......  T.......    0091      34.6279     2,131.38  ...........       426.28
                 long leg vein.
37735.........  Removal of leg    CH......  T.......    0091      34.6279     2,131.38  ...........       426.28
                 veins/lesion.
37760.........  Ligation, leg     CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 veins, open.
37765.........  Phleb veins -     CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 extrem - to 20.
37766.........  Phleb veins -     CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 extrem 20+.
37780.........  Revision of leg   CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 vein.
37785.........  Ligate/divide/    CH......  T.......    0092      24.5817     1,513.03       306.56       302.61
                 excise vein.
37790.........  Penile venous     ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 occlusion.
37799.........  Vascular surgery  ........  T.......    0103      17.0436     1,049.05       223.63       209.81
                 procedure.
38120.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 splenectomy.
38129.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, spleen.
38200.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 spleen x-ray.
38204.........  Bl donor search   ........  N.......  ......  ...........  ...........  ...........  ...........
                 management.
38205.........  Harvest           ........  S.......    0111      11.7005       720.18       198.40       144.04
                 allogenic stem
                 cells.
38206.........  Harvest auto      ........  S.......    0111      11.7005       720.18       198.40       144.04
                 stem cells.
38220.........  Bone marrow       ........  T.......    0003       2.4295       149.54  ...........        29.91
                 aspiration.
38221.........  Bone marrow       ........  T.......    0003       2.4295       149.54  ...........        29.91
                 biopsy.
38230.........  Bone marrow       ........  S.......    0123      23.2490     1,431.00  ...........       286.20
                 collection.
38240.........  Bone marrow/stem  ........  S.......    0123      23.2490     1,431.00  ...........       286.20
                 transplant.
38241.........  Bone marrow/stem  ........  S.......    0123      23.2490     1,431.00  ...........       286.20
                 transplant.
38242.........  Lymphocyte        ........  S.......    0111      11.7005       720.18       198.40       144.04
                 infuse
                 transplant.
38300.........  Drainage, lymph   ........  T.......    0007      10.9184       672.04  ...........       134.41
                 node lesion.
38305.........  Drainage, lymph   ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 node lesion.
38308.........  Incision of       ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 lymph channels.
38500.........  Biopsy/removal,   ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 lymph nodes.
38505.........  Needle biopsy,    ........  T.......    0005       3.8051       234.21        71.59        46.84
                 lymph nodes.
38510.........  Biopsy/removal,   ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 lymph nodes.
38520.........  Biopsy/removal,   ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 lymph nodes.
38525.........  Biopsy/removal,   ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 lymph nodes.
38530.........  Biopsy/removal,   ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 lymph nodes.
38542.........  Explore deep      ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 node(s), neck.
38550.........  Removal, neck/    ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 armpit lesion.
38555.........  Removal, neck/    ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 armpit lesion.
38570.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 lymph node biop.
38571.........  Laparoscopy,      ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 lymphadenectomy.
38572.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 lymphadenectomy.
38589.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, lymphatic.
38700.........  Removal of lymph  ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 nodes, neck.
38720.........  Removal of lymph  ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 nodes, neck.
38740.........  Remove armpit     ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 lymph nodes.
38745.........  Remove armpit     ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 lymph nodes.
38760.........  Remove groin      ........  T.......    0113      21.3673     1,315.18  ...........       263.04
                 lymph nodes.
38790.........  Inject for        ........  N.......  ......  ...........  ...........  ...........  ...........
                 lymphatic x-ray.
38792.........  Identify          CH......  Q.......    0389       1.4072        86.61        33.98        17.32
                 sentinel node.
38794.........  Access thoracic   ........  N.......  ......  ...........  ...........  ...........  ...........
                 lymph duct.
38999.........  Blood/lymph       ........  S.......    0110       3.4570       212.78  ...........        42.56
                 system
                 procedure.
39400.........  Visualization of  ........  T.......    0069      31.5464     1,941.71       591.64       388.34
                 chest.
40490.........  Biopsy of lip...  ........  T.......    0251       2.3768       146.29  ...........        29.26
40500.........  Partial excision  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 of lip.
40510.........  Partial excision  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of lip.
40520.........  Partial excision  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 of lip.
40525.........  Reconstruct lip   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 with flap.
40527.........  Reconstruct lip   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 with flap.
40530.........  Partial removal   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of lip.
40650.........  Repair lip......  ........  T.......    0252       7.7261       475.55       111.84        95.11
40652.........  Repair lip......  ........  T.......    0252       7.7261       475.55       111.84        95.11
40654.........  Repair lip......  ........  T.......    0252       7.7261       475.55       111.84        95.11

[[Page 49788]]

 
40700.........  Repair cleft lip/ ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nasal.
40701.........  Repair cleft lip/ ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nasal.
40702.........  Repair cleft lip/ ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nasal.
40720.........  Repair cleft lip/ ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nasal.
40761.........  Repair cleft lip/ ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nasal.
40799.........  Lip surgery       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
40800.........  Drainage of       CH......  T.......    0006       1.4821        91.22        21.76        18.24
                 mouth lesion.
40801.........  Drainage of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 mouth lesion.
40804.........  Removal, foreign  ........  X.......    0340       0.6211        38.23  ...........         7.65
                 body, mouth.
40805.........  Removal, foreign  ........  T.......    0252       7.7261       475.55       111.84        95.11
                 body, mouth.
40806.........  Incision of lip   ........  T.......    0251       2.3768       146.29  ...........        29.26
                 fold.
40808.........  Biopsy of mouth   ........  T.......    0251       2.3768       146.29  ...........        29.26
                 lesion.
40810.........  Excision of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth lesion.
40812.........  Excise/repair     ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth lesion.
40814.........  Excise/repair     ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth lesion.
40816.........  Excision of       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 mouth lesion.
40818.........  Excise oral       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 mucosa for
                 graft.
40819.........  Excise lip or     ........  T.......    0252       7.7261       475.55       111.84        95.11
                 cheek fold.
40820.........  Treatment of      ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth lesion.
40830.........  Repair mouth      ........  T.......    0251       2.3768       146.29  ...........        29.26
                 laceration.
40831.........  Repair mouth      ........  T.......    0252       7.7261       475.55       111.84        95.11
                 laceration.
40840.........  Reconstruction    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of mouth.
40842.........  Reconstruction    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of mouth.
40843.........  Reconstruction    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of mouth.
40844.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of mouth.
40845.........  Reconstruction    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of mouth.
40899.........  Mouth surgery     ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
41000.........  Drainage of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth lesion.
41005.........  Drainage of       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 mouth lesion.
41006.........  Drainage of       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 mouth lesion.
41007.........  Drainage of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth lesion.
41008.........  Drainage of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth lesion.
41009.........  Drainage of       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 mouth lesion.
41010.........  Incision of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 tongue fold.
41015.........  Drainage of       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 mouth lesion.
41016.........  Drainage of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 mouth lesion.
41017.........  Drainage of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 mouth lesion.
41018.........  Drainage of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 mouth lesion.
41100.........  Biopsy of tongue  ........  T.......    0252       7.7261       475.55       111.84        95.11
41105.........  Biopsy of tongue  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
41108.........  Biopsy of floor   ........  T.......    0252       7.7261       475.55       111.84        95.11
                 of mouth.
41110.........  Excision of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 tongue lesion.
41112.........  Excision of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 tongue lesion.
41113.........  Excision of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 tongue lesion.
41114.........  Excision of       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 tongue lesion.
41115.........  Excision of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 tongue fold.
41116.........  Excision of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth lesion.
41120.........  Partial removal   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of tongue.
41250.........  Repair tongue     ........  T.......    0251       2.3768       146.29  ...........        29.26
                 laceration.
41251.........  Repair tongue     ........  T.......    0251       2.3768       146.29  ...........        29.26
                 laceration.
41252.........  Repair tongue     ........  T.......    0252       7.7261       475.55       111.84        95.11
                 laceration.
41500.........  Fixation of       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 tongue.
41510.........  Tongue to lip     ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 surgery.
41520.........  Reconstruction,   ........  T.......    0252       7.7261       475.55       111.84        95.11
                 tongue fold.
41599.........  Tongue and mouth  ........  T.......    0251       2.3768       146.29  ...........        29.26
                 surgery.
41800.........  Drainage of gum   CH......  T.......    0006       1.4821        91.22        21.76        18.24
                 lesion.
41805.........  Removal foreign   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 body, gum.
41806.........  Removal foreign   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 body,jawbone.
41820.........  Excision, gum,    ........  T.......    0252       7.7261       475.55       111.84        95.11
                 each quadrant.
41821.........  Excision of gum   ........  T.......    0252       7.7261       475.55       111.84        95.11
                 flap.
41822.........  Excision of gum   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 lesion.
41823.........  Excision of gum   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 lesion.
41825.........  Excision of gum   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 lesion.
41826.........  Excision of gum   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 lesion.
41827.........  Excision of gum   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 lesion.
41828.........  Excision of gum   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 lesion.
41830.........  Removal of gum    ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 tissue.
41850.........  Treatment of gum  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 lesion.
41870.........  Gum graft.......  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
41872.........  Repair gum......  ........  T.......    0253      16.4494     1,012.48       282.29       202.50

[[Page 49789]]

 
41874.........  Repair tooth      ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 socket.
41899.........  Dental surgery    ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
42000.........  Drainage mouth    ........  T.......    0251       2.3768       146.29  ...........        29.26
                 roof lesion.
42100.........  Biopsy roof of    ........  T.......    0252       7.7261       475.55       111.84        95.11
                 mouth.
42104.........  Excision lesion,  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth roof.
42106.........  Excision lesion,  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 mouth roof.
42107.........  Excision lesion,  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 mouth roof.
42120.........  Remove palate/    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 lesion.
42140.........  Excision of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 uvula.
42145.........  Repair palate,    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 pharynx/uvula.
42160.........  Treatment mouth   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 roof lesion.
42180.........  Repair palate...  ........  T.......    0251       2.3768       146.29  ...........        29.26
42182.........  Repair palate...  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
42200.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cleft palate.
42205.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cleft palate.
42210.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cleft palate.
42215.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cleft palate.
42220.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cleft palate.
42225.........  Reconstruct       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cleft palate.
42226.........  Lengthening of    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 palate.
42227.........  Lengthening of    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 palate.
42235.........  Repair palate...  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
42260.........  Repair nose to    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 lip fistula.
42280.........  Preparation,      ........  T.......    0251       2.3768       146.29  ...........        29.26
                 palate mold.
42281.........  Insertion,        ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 palate
                 prosthesis.
42299.........  Palate/uvula      ........  T.......    0251       2.3768       146.29  ...........        29.26
                 surgery.
42300.........  Drainage of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary gland.
42305.........  Drainage of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary gland.
42310.........  Drainage of       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 salivary gland.
42320.........  Drainage of       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 salivary gland.
42330.........  Removal of        ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary stone.
42335.........  Removal of        ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary stone.
42340.........  Removal of        ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary stone.
42400.........  Biopsy of         ........  T.......    0005       3.8051       234.21        71.59        46.84
                 salivary gland.
42405.........  Biopsy of         ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary gland.
42408.........  Excision of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary cyst.
42409.........  Drainage of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary cyst.
42410.........  Excise parotid    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 gland/lesion.
42415.........  Excise parotid    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 gland/lesion.
42420.........  Excise parotid    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 gland/lesion.
42425.........  Excise parotid    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 gland/lesion.
42440.........  Excise            ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 submaxillary
                 gland.
42450.........  Excise            ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 sublingual
                 gland.
42500.........  Repair salivary   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 duct.
42505.........  Repair salivary   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 duct.
42507.........  Parotid duct      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 diversion.
42508.........  Parotid duct      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 diversion.
42509.........  Parotid duct      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 diversion.
42510.........  Parotid duct      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 diversion.
42550.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 salivary x-ray.
42600.........  Closure of        ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 salivary
                 fistula.
42650.........  Dilation of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 salivary duct.
42660.........  Dilation of       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 salivary duct.
42665.........  Ligation of       ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 salivary duct.
42699.........  Salivary surgery  ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
42700.........  Drainage of       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 tonsil abscess.
42720.........  Drainage of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 throat abscess.
42725.........  Drainage of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 throat abscess.
42800.........  Biopsy of throat  CH......  T.......    0252       7.7261       475.55       111.84        95.11
42802.........  Biopsy of throat  ........  T.......    0253      16.4494     1,012.48       282.29       202.50
42804.........  Biopsy of upper   ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 nose/throat.
42806.........  Biopsy of upper   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 nose/throat.
42808.........  Excise pharynx    ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 lesion.
42809.........  Remove pharynx    ........  X.......    0340       0.6211        38.23  ...........         7.65
                 foreign body.
42810.........  Excision of neck  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 cyst.
42815.........  Excision of neck  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 cyst.
42820.........  Remove tonsils    ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 and adenoids.
42821.........  Remove tonsils    ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 and adenoids.
42825.........  Removal of        ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 tonsils.
42826.........  Removal of        ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 tonsils.

[[Page 49790]]

 
42830.........  Removal of        ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 adenoids.
42831.........  Removal of        ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 adenoids.
42835.........  Removal of        ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 adenoids.
42836.........  Removal of        ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 adenoids.
42842.........  Extensive         ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 surgery of
                 throat.
42844.........  Extensive         ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 surgery of
                 throat.
42860.........  Excision of       ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 tonsil tags.
42870.........  Excision of       ........  T.......    0258      22.7757     1,401.87       437.25       280.37
                 lingual tonsil.
42890.........  Partial removal   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 of pharynx.
42892.........  Revision of       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 pharyngeal
                 walls.
42900.........  Repair throat     ........  T.......    0252       7.7261       475.55       111.84        95.11
                 wound.
42950.........  Reconstruction    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of throat.
42955.........  Surgical opening  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 of throat.
42960.........  Control throat    ........  T.......    0250       1.2021        73.99        25.50        14.80
                 bleeding.
42962.........  Control throat    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 bleeding.
42970.........  Control nose/     ........  T.......    0250       1.2021        73.99        25.50        14.80
                 throat bleeding.
42972.........  Control nose/     ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 throat bleeding.
42999.........  Throat surgery    ........  T.......    0251       2.3768       146.29  ...........        29.26
                 procedure.
43020.........  Incision of       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 esophagus.
43030.........  Throat muscle     ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 surgery.
43130.........  Removal of        CH......  T.......    0256      37.7719     2,324.90  ...........       464.98
                 esophagus pouch.
43200.........  Esophagus         ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy.
43201.........  Esoph scope w/    ........  T.......    0141       8.3070       511.30       143.38       102.26
                 submucous inj.
43202.........  Esophagus         ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy,
                 biopsy.
43204.........  Esoph scope w/    ........  T.......    0141       8.3070       511.30       143.38       102.26
                 sclerosis inj.
43205.........  Esophagus         ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy/
                 ligation.
43215.........  Esophagus         ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy.
43216.........  Esophagus         ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy/
                 lesion.
43217.........  Esophagus         ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy.
43219.........  Esophagus         ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 endoscopy.
43220.........  Esoph endoscopy,  ........  T.......    0141       8.3070       511.30       143.38       102.26
                 dilation.
43226.........  Esoph endoscopy,  ........  T.......    0141       8.3070       511.30       143.38       102.26
                 dilation.
43227.........  Esoph endoscopy,  ........  T.......    0141       8.3070       511.30       143.38       102.26
                 repair.
43228.........  Esoph endoscopy,  ........  T.......    0422      27.5493     1,695.69       448.81       339.14
                 ablation.
43231.........  Esoph endoscopy   ........  T.......    0141       8.3070       511.30       143.38       102.26
                 w/us exam.
43232.........  Esoph endoscopy   ........  T.......    0141       8.3070       511.30       143.38       102.26
                 w/us fn bx.
43234.........  Upper GI          ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy, exam.
43235.........  Uppr gi           ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy,
                 diagnosis.
43236.........  Uppr gi scope w/  ........  T.......    0141       8.3070       511.30       143.38       102.26
                 submuc inj.
43237.........  Endoscopic us     ........  T.......    0141       8.3070       511.30       143.38       102.26
                 exam, esoph.
43238.........  Uppr gi           ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy w/us
                 fn bx.
43239.........  Upper GI          ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy,
                 biopsy.
43240.........  Esoph endoscope   ........  T.......    0141       8.3070       511.30       143.38       102.26
                 w/drain cyst.
43241.........  Upper GI          ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy with
                 tube.
43242.........  Uppr gi           ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy w/us
                 fn bx.
43243.........  Upper gi          ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy&injec
                 t.
43244.........  Upper GI          ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy/
                 ligation.
43245.........  Uppr gi scope     ........  T.......    0141       8.3070       511.30       143.38       102.26
                 dilate strictr.
43246.........  Place             ........  T.......    0141       8.3070       511.30       143.38       102.26
                 gastrostomy
                 tube.
43247.........  Operative upper   ........  T.......    0141       8.3070       511.30       143.38       102.26
                 GI endoscopy.
43248.........  Uppr gi           ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy/guide
                 wire.
43249.........  Esoph endoscopy,  ........  T.......    0141       8.3070       511.30       143.38       102.26
                 dilation.
43250.........  Upper GI          ........  T.......    0141       8.3070       511.30       143.38       102.26
                 endoscopy/tumor.
43251.........  Operative upper   ........  T.......    0141       8.3070       511.30       143.38       102.26
                 GI endoscopy.
43255.........  Operative upper   ........  T.......    0141       8.3070       511.30       143.38       102.26
                 GI endoscopy.
43256.........  Uppr gi           ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 endoscopy w/
                 stent.
43257.........  Uppr gi scope w/  ........  T.......    0422      27.5493     1,695.69       448.81       339.14
                 thrml txmnt.
43258.........  Operative upper   ........  T.......    0141       8.3070       511.30       143.38       102.26
                 GI endoscopy.
43259.........  Endoscopic        ........  T.......    0141       8.3070       511.30       143.38       102.26
                 ultrasound exam.
43260.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.
43261.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.
43262.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.
43263.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.
43264.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.
43265.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.
43267.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.
43268.........  Endo              ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 cholangiopancre
                 atograph.
43269.........  Endo              ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 cholangiopancre
                 atograph.
43271.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.
43272.........  Endo              ........  T.......    0151      19.8125     1,219.48       245.46       243.90
                 cholangiopancre
                 atograph.

[[Page 49791]]

 
43280.........  Laparoscopy,      ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 fundoplasty.
43289.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, esoph.
43450.........  Dilate esophagus  ........  T.......    0140       5.3134       327.05        91.40        65.41
43453.........  Dilate esophagus  ........  T.......    0140       5.3134       327.05        91.40        65.41
43456.........  Dilate esophagus  ........  T.......    0140       5.3134       327.05        91.40        65.41
43458.........  Dilate esophagus  ........  T.......    0140       5.3134       327.05        91.40        65.41
43499.........  Esophagus         ........  T.......    0141       8.3070       511.30       143.38       102.26
                 surgery
                 procedure.
43510.........  Surgical opening  ........  T.......    0141       8.3070       511.30       143.38       102.26
                 of stomach.
43600.........  Biopsy of         ........  T.......    0141       8.3070       511.30       143.38       102.26
                 stomach.
43651.........  Laparoscopy,      ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 vagus nerve.
43652.........  Laparoscopy,      ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 vagus nerve.
43653.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 gastrostomy.
43659.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, stom.
43750.........  Place             ........  T.......    0141       8.3070       511.30       143.38       102.26
                 gastrostomy
                 tube.
43752.........  Nasal/orogastric  ........  X.......    0272       1.2985        79.92        31.64        15.98
                 w/stent.
43760.........  Change            ........  T.......    0121       2.3431       144.22        43.80        28.84
                 gastrostomy
                 tube.
43761.........  Reposition        ........  T.......    0122       7.2859       448.45  ...........        89.69
                 gastrostomy
                 tube.
43830.........  Place             ........  T.......    0422      27.5493     1,695.69       448.81       339.14
                 gastrostomy
                 tube.
43831.........  Place             ........  T.......    0141       8.3070       511.30       143.38       102.26
                 gastrostomy
                 tube.
43870.........  Repair stomach    ........  T.......    0141       8.3070       511.30       143.38       102.26
                 opening.
43886.........  Revise gastric    ........  T.......    0025       5.0931       313.49        95.46        62.70
                 port, open.
43887.........  Remove gastric    ........  T.......    0025       5.0931       313.49        95.46        62.70
                 port, open.
43888.........  Change gastric    ........  T.......    0686      13.3433       821.29  ...........       164.26
                 port, open.
43999.........  Stomach surgery   ........  T.......    0141       8.3070       511.30       143.38       102.26
                 procedure.
44100.........  Biopsy of bowel.  ........  T.......    0141       8.3070       511.30       143.38       102.26
44180.........  Lap, enterolysis  ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
44186.........  Lap, jejunostomy  ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
44206.........  Lap part          ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 colectomy w/
                 stoma.
44207.........  L colectomy/      ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 coloproctostomy.
44208.........  L colectomy/      ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 coloproctostomy.
44213.........  Lap, mobil        ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 splenic fl add-
                 on.
44238.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, intestine.
44312.........  Revision of       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 ileostomy.
44340.........  Revision of       ........  T.......    0027      21.2645     1,308.85       329.72       261.77
                 colostomy.
44360.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44361.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy/
                 biopsy.
44363.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44364.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44365.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44366.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44369.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44370.........  Small bowel       ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 endoscopy/stent.
44372.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44373.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44376.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44377.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy/
                 biopsy.
44378.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44379.........  S bowel           ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 endoscope w/
                 stent.
44380.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44382.........  Small bowel       ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
44383.........  Ileoscopy w/      ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 stent.
44385.........  Endoscopy of      ........  T.......    0143       8.8143       542.53       186.06       108.51
                 bowel pouch.
44386.........  Endoscopy, bowel  ........  T.......    0143       8.8143       542.53       186.06       108.51
                 pouch/biop.
44388.........  Colonoscopy.....  ........  T.......    0143       8.8143       542.53       186.06       108.51
44389.........  Colonoscopy with  ........  T.......    0143       8.8143       542.53       186.06       108.51
                 biopsy.
44390.........  Colonoscopy for   ........  T.......    0143       8.8143       542.53       186.06       108.51
                 foreign body.
44391.........  Colonoscopy for   ........  T.......    0143       8.8143       542.53       186.06       108.51
                 bleeding.
44392.........  Colonoscopy&poly  ........  T.......    0143       8.8143       542.53       186.06       108.51
                 pectomy.
44393.........  Colonoscopy,      ........  T.......    0143       8.8143       542.53       186.06       108.51
                 lesion removal.
44394.........  Colonoscopy w/    ........  T.......    0143       8.8143       542.53       186.06       108.51
                 snare.
44397.........  Colonoscopy w/    ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 stent.
44500.........  Intro,            ........  T.......    0121       2.3431       144.22        43.80        28.84
                 gastrointestina
                 l tube.
44701.........  Intraop colon     ........  N.......  ......  ...........  ...........  ...........  ...........
                 lavage add-on.
44799.........  Unlisted          CH......  T.......    0153      22.1758     1,364.94       397.95       272.99
                 procedure
                 intestine.
44901.........  Drain app         ........  T.......    0037      10.2616       631.61       228.76       126.32
                 abscess, percut.
44970.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 appendectomy.
44979.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, app.
45000.........  Drainage of       ........  T.......    0148       4.8970       301.42  ...........        60.28
                 pelvic abscess.
45005.........  Drainage of       ........  T.......    0155      12.8778       792.64  ...........       158.53
                 rectal abscess.
45020.........  Drainage of       ........  T.......    0155      12.8778       792.64  ...........       158.53
                 rectal abscess.

[[Page 49792]]

 
45100.........  Biopsy of rectum  ........  T.......    0149      22.2336     1,368.50       293.06       273.70
45108.........  Removal of        CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 anorectal
                 lesion.
45150.........  Excision of       ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal
                 stricture.
45160.........  Excision of       CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal lesion.
45170.........  Excision of       CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal lesion.
45190.........  Destruction,      CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal tumor.
45300.........  Proctosigmoidosc  ........  T.......    0146       4.8005       295.48        64.40        59.10
                 opy dx.
45303.........  Proctosigmoidosc  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 opy dilate.
45305.........  Proctosigmoidosc  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 opy w/bx.
45307.........  Proctosigmoidosc  ........  T.......    0428      20.4902     1,261.19  ...........       252.24
                 opy fb.
45308.........  Proctosigmoidosc  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 opy removal.
45309.........  Proctosigmoidosc  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 opy removal.
45315.........  Proctosigmoidosc  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 opy removal.
45317.........  Proctosigmoidosc  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 opy bleed.
45320.........  Proctosigmoidosc  ........  T.......    0428      20.4902     1,261.19  ...........       252.24
                 opy ablate.
45321.........  Proctosigmoidosc  ........  T.......    0428      20.4902     1,261.19  ...........       252.24
                 opy volvul.
45327.........  Proctosigmoidosc  ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 opy w/stent.
45330.........  Diagnostic        ........  T.......    0146       4.8005       295.48        64.40        59.10
                 sigmoidoscopy.
45331.........  Sigmoidoscopy     ........  T.......    0146       4.8005       295.48        64.40        59.10
                 and biopsy.
45332.........  Sigmoidoscopy w/  ........  T.......    0146       4.8005       295.48        64.40        59.10
                 fb removal.
45333.........  Sigmoidoscopy&po  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 lypectomy.
45334.........  Sigmoidoscopy     ........  T.......    0147       8.5644       527.15  ...........       105.43
                 for bleeding.
45335.........  Sigmoidoscopy w/  ........  T.......    0146       4.8005       295.48        64.40        59.10
                 submuc inj.
45337.........  Sigmoidoscopy&de  ........  T.......    0146       4.8005       295.48        64.40        59.10
                 compress.
45338.........  Sigmoidoscopy w/  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 tumr remove.
45339.........  Sigmoidoscopy w/  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 ablate tumr.
45340.........  Sig w/balloon     ........  T.......    0147       8.5644       527.15  ...........       105.43
                 dilation.
45341.........  Sigmoidoscopy w/  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 ultrasound.
45342.........  Sigmoidoscopy w/  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 us guide bx.
45345.........  Sigmoidoscopy w/  ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 stent.
45355.........  Surgical          ........  T.......    0143       8.8143       542.53       186.06       108.51
                 colonoscopy.
45378.........  Diagnostic        ........  T.......    0143       8.8143       542.53       186.06       108.51
                 colonoscopy.
45379.........  Colonoscopy w/fb  ........  T.......    0143       8.8143       542.53       186.06       108.51
                 removal.
45380.........  Colonoscopy and   ........  T.......    0143       8.8143       542.53       186.06       108.51
                 biopsy.
45381.........  Colonoscopy,      ........  T.......    0143       8.8143       542.53       186.06       108.51
                 submucous inj.
45382.........  Colonoscopy/      ........  T.......    0143       8.8143       542.53       186.06       108.51
                 control
                 bleeding.
45383.........  Lesion removal    ........  T.......    0143       8.8143       542.53       186.06       108.51
                 colonoscopy.
45384.........  Lesion remove     ........  T.......    0143       8.8143       542.53       186.06       108.51
                 colonoscopy.
45385.........  Lesion removal    ........  T.......    0143       8.8143       542.53       186.06       108.51
                 colonoscopy.
45386.........  Colonoscopy       ........  T.......    0143       8.8143       542.53       186.06       108.51
                 dilate
                 stricture.
45387.........  Colonoscopy w/    ........  T.......    0384      22.6777     1,395.84       292.31       279.17
                 stent.
45391.........  Colonoscopy w/    ........  T.......    0143       8.8143       542.53       186.06       108.51
                 endoscope us.
45392.........  Colonoscopy w/    ........  T.......    0143       8.8143       542.53       186.06       108.51
                 endoscopic fnb.
45499.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, rectum.
45500.........  Repair of rectum  ........  T.......    0149      22.2336     1,368.50       293.06       273.70
45505.........  Repair of rectum  ........  T.......    0150      29.4386     1,811.98       437.12       362.40
45520.........  Treatment of      ........  T.......    0098       1.1035        67.92  ...........        13.58
                 rectal prolapse.
45541.........  Correct rectal    ........  T.......    0150      29.4386     1,811.98       437.12       362.40
                 prolapse.
45560.........  Repair of         ........  T.......    0150      29.4386     1,811.98       437.12       362.40
                 rectocele.
45900.........  Reduction of      ........  T.......    0148       4.8970       301.42  ...........        60.28
                 rectal prolapse.
45905.........  Dilation of anal  ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 sphincter.
45910.........  Dilation of       ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal
                 narrowing.
45915.........  Remove rectal     ........  T.......    0148       4.8970       301.42  ...........        60.28
                 obstruction.
45990.........  Surg dx exam,     ........  T.......    0148       4.8970       301.42  ...........        60.28
                 anorectal.
45999.........  Rectum surgery    ........  T.......    0148       4.8970       301.42  ...........        60.28
                 procedure.
46020.........  Placement of      CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 seton.
46030.........  Removal of        ........  T.......    0148       4.8970       301.42  ...........        60.28
                 rectal marker.
46040.........  Incision of       ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal abscess.
46045.........  Incision of       CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal abscess.
46050.........  Incision of anal  ........  T.......    0148       4.8970       301.42  ...........        60.28
                 abscess.
46060.........  Incision of       CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal abscess.
46070.........  Incision of anal  ........  T.......    0155      12.8778       792.64  ...........       158.53
                 septum.
46080.........  Incision of anal  ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 sphincter.
46083.........  Incise external   CH......  T.......    0164       2.1159       130.24  ...........        26.05
                 hemorrhoid.
46200.........  Removal of anal   CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 fissure.
46210.........  Removal of anal   ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 crypt.
46211.........  Removal of anal   CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 crypts.
46220.........  Removal of anal   ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 tag.
46221.........  Ligation of       ........  T.......    0148       4.8970       301.42  ...........        60.28
                 hemorrhoid(s).
46230.........  Removal of anal   ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 tags.

[[Page 49793]]

 
46250.........  Hemorrhoidectomy  CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
46255.........  Hemorrhoidectomy  CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
46257.........  Remove            CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 hemorrhoids&fis
                 sure.
46258.........  Remove            CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 hemorrhoids&fis
                 tula.
46260.........  Hemorrhoidectomy  CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
46261.........  Remove            CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 hemorrhoids&fis
                 sure.
46262.........  Remove            CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 hemorrhoids&fis
                 tula.
46270.........  Removal of anal   CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 fistula.
46275.........  Removal of anal   CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 fistula.
46280.........  Removal of anal   CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 fistula.
46285.........  Removal of anal   CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 fistula.
46288.........  Repair anal       CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 fistula.
46320.........  Removal of        CH......  T.......    0155      12.8778       792.64  ...........       158.53
                 hemorrhoid clot.
46500.........  Injection into    ........  T.......    0155      12.8778       792.64  ...........       158.53
                 hemorrhoid(s).
46505.........  Chemodenervation  ........  T.......    0148       4.8970       301.42  ...........        60.28
                 anal musc.
46600.........  Diagnostic        ........  X.......    0340       0.6211        38.23  ...........         7.65
                 anoscopy.
46604.........  Anoscopy and      ........  T.......    0147       8.5644       527.15  ...........       105.43
                 dilation.
46606.........  Anoscopy and      ........  T.......    0146       4.8005       295.48        64.40        59.10
                 biopsy.
46608.........  Anoscopy, remove  ........  T.......    0147       8.5644       527.15  ...........       105.43
                 for body.
46610.........  Anoscopy, remove  ........  T.......    0428      20.4902     1,261.19  ...........       252.24
                 lesion.
46611.........  Anoscopy........  ........  T.......    0147       8.5644       527.15  ...........       105.43
46612.........  Anoscopy, remove  ........  T.......    0428      20.4902     1,261.19  ...........       252.24
                 lesions.
46614.........  Anoscopy,         ........  T.......    0146       4.8005       295.48        64.40        59.10
                 control
                 bleeding.
46615.........  Anoscopy........  ........  T.......    0428      20.4902     1,261.19  ...........       252.24
46700.........  Repair of anal    CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 stricture.
46706.........  Repr of anal      ........  T.......    0150      29.4386     1,811.98       437.12       362.40
                 fistula w/glue.
46750.........  Repair of anal    CH......  T.......    0171      37.2425     2,292.31       705.28       458.46
                 sphincter.
46753.........  Reconstruction    CH......  T.......    0149      22.2336     1,368.50       293.06       273.70
                 of anus.
46754.........  Removal of        ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 suture from
                 anus.
46760.........  Repair of anal    CH......  T.......    0171      37.2425     2,292.31       705.28       458.46
                 sphincter.
46761.........  Repair of anal    CH......  T.......    0171      37.2425     2,292.31       705.28       458.46
                 sphincter.
46762.........  Implant           CH......  T.......    0171      37.2425     2,292.31       705.28       458.46
                 artificial
                 sphincter.
46900.........  Destruction,      ........  T.......    0016       2.6253       161.59        32.68        32.32
                 anal lesion(s).
46910.........  Destruction,      ........  T.......    0017      17.7392     1,091.87       227.84       218.37
                 anal lesion(s).
46916.........  Cryosurgery,      ........  T.......    0013       1.0876        66.94  ...........        13.39
                 anal lesion(s).
46917.........  Laser surgery,    ........  T.......    0695      20.5802     1,266.73       266.59       253.35
                 anal lesions.
46922.........  Excision of anal  ........  T.......    0695      20.5802     1,266.73       266.59       253.35
                 lesion(s).
46924.........  Destruction,      ........  T.......    0695      20.5802     1,266.73       266.59       253.35
                 anal lesion(s).
46934.........  Destruction of    ........  T.......    0155      12.8778       792.64  ...........       158.53
                 hemorrhoids.
46935.........  Destruction of    ........  T.......    0155      12.8778       792.64  ...........       158.53
                 hemorrhoids.
46936.........  Destruction of    ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 hemorrhoids.
46937.........  Cryotherapy of    ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 rectal lesion.
46938.........  Cryotherapy of    ........  T.......    0150      29.4386     1,811.98       437.12       362.40
                 rectal lesion.
46940.........  Treatment of      ........  T.......    0149      22.2336     1,368.50       293.06       273.70
                 anal fissure.
46942.........  Treatment of      ........  T.......    0148       4.8970       301.42  ...........        60.28
                 anal fissure.
46945.........  Ligation of       ........  T.......    0155      12.8778       792.64  ...........       158.53
                 hemorrhoids.
46946.........  Ligation of       ........  T.......    0155      12.8778       792.64  ...........       158.53
                 hemorrhoids.
46947.........  Hemorrhoidopexy   ........  T.......    0150      29.4386     1,811.98       437.12       362.40
                 by stapling.
46999.........  Anus surgery      ........  T.......    0148       4.8970       301.42  ...........        60.28
                 procedure.
47000.........  Needle biopsy of  ........  T.......    0685       6.0729       373.79       115.47        74.76
                 liver.
47001.........  Needle biopsy,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 liver add-on.
47011.........  Percut drain,     ........  T.......    0037      10.2616       631.61       228.76       126.32
                 liver lesion.
47370.........  Laparo ablate     ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 liver tumor rf.
47371.........  Laparo ablate     ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 liver cryosurg.
47379.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 procedure,
                 liver.
47382.........  Percut ablate     ........  T.......    0423      39.0235     2,401.94  ...........       480.39
                 liver rf.
47399.........  Liver surgery     CH......  T.......    0004       2.0863       128.41  ...........        25.68
                 procedure.
47490.........  Incision of       ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 gallbladder.
47500.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 liver x-rays.
47505.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 liver x-rays.
47510.........  Insert catheter,  ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 bile duct.
47511.........  Insert bile duct  ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 drain.
47525.........  Change bile duct  ........  T.......    0427      11.5220       709.19  ...........       141.84
                 catheter.
47530.........  Revise/reinsert   ........  T.......    0427      11.5220       709.19  ...........       141.84
                 bile tube.
47552.........  Biliary           ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 endoscopy thru
                 skin.
47553.........  Biliary           ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 endoscopy thru
                 skin.
47554.........  Biliary           ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 endoscopy thru
                 skin.
47555.........  Biliary           ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 endoscopy thru
                 skin.
47556.........  Biliary           ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 endoscopy thru
                 skin.
47560.........  Laparoscopy w/    ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 cholangio.

[[Page 49794]]

 
47561.........  Laparo w/         ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 cholangio/
                 biopsy.
47562.........  Laparoscopic      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 cholecystectomy.
47563.........  Laparo            ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 cholecystectomy/
                 graph.
47564.........  Laparo            ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 cholecystectomy/
                 explr.
47579.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, biliary.
47630.........  Remove bile duct  ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 stone.
47999.........  Bile tract        ........  T.......    0152      19.4515     1,197.26  ...........       239.45
                 surgery
                 procedure.
48102.........  Needle biopsy,    ........  T.......    0685       6.0729       373.79       115.47        74.76
                 pancreas.
48511.........  Drain pancreatic  ........  T.......    0037      10.2616       631.61       228.76       126.32
                 pseudocyst.
48999.........  Pancreas surgery  ........  T.......    0004       2.0863       128.41  ...........        25.68
                 procedure.
49021.........  Drain abdominal   ........  T.......    0037      10.2616       631.61       228.76       126.32
                 abscess.
49041.........  Drain, percut,    ........  T.......    0037      10.2616       631.61       228.76       126.32
                 abdom abscess.
49061.........  Drain, percut,    ........  T.......    0037      10.2616       631.61       228.76       126.32
                 retroper absc.
49080.........  Puncture,         ........  T.......    0070       3.6425       224.20  ...........        44.84
                 peritoneal
                 cavity.
49081.........  Removal of        ........  T.......    0070       3.6425       224.20  ...........        44.84
                 abdominal fluid.
49085.........  Remove abdomen    ........  T.......    0153      22.1758     1,364.94       397.95       272.99
                 foreign body.
49180.........  Biopsy,           ........  T.......    0685       6.0729       373.79       115.47        74.76
                 abdominal mass.
49200.........  Removal of        ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 abdominal
                 lesion.
49250.........  Excision of       ........  T.......    0153      22.1758     1,364.94       397.95       272.99
                 umbilicus.
49320.........  Diag laparo       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 separate proc.
49321.........  Laparoscopy,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 biopsy.
49322.........  Laparoscopy,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 aspiration.
49323.........  Laparo drain      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 lymphocele.
49329.........  Laparo proc,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 abdm/per/oment.
49400.........  Air injection     ........  N.......  ......  ...........  ...........  ...........  ...........
                 into abdomen.
49419.........  Insrt abdom cath  ........  T.......    0115      29.4757     1,814.26       378.68       362.85
                 for chemotx.
49420.........  Insert abdom      ........  T.......    0652      29.2259     1,798.88  ...........       359.78
                 drain, temp.
49421.........  Insert abdom      ........  T.......    0652      29.2259     1,798.88  ...........       359.78
                 drain, perm.
49422.........  Remove perm       ........  T.......    0105      23.4666     1,444.39       370.40       288.88
                 cannula/
                 catheter.
49423.........  Exchange          ........  T.......    0427      11.5220       709.19  ...........       141.84
                 drainage
                 catheter.
49424.........  Assess cyst,      ........  N.......  ......  ...........  ...........  ...........  ...........
                 contrast inject.
49426.........  Revise abdomen-   ........  T.......    0153      22.1758     1,364.94       397.95       272.99
                 venous shunt.
49427.........  Injection,        ........  N.......  ......  ...........  ...........  ...........  ...........
                 abdominal shunt.
49429.........  Removal of shunt  ........  T.......    0105      23.4666     1,444.39       370.40       288.88
49491.........  Rpr hern preemie  ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 reduc.
49492.........  Rpr ing hern      ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 premie, blocked.
49495.........  Rpr ing hernia    ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 baby, reduc.
49496.........  Rpr ing hernia    ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 baby, blocked.
49500.........  Rpr ing hernia,   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 init, reduce.
49501.........  Rpr ing hernia,   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 init blocked.
49505.........  Prp i/hern init   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 reduc >5 yr.
49507.........  Prp i/hern init   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 block >5 yr.
49520.........  Rerepair ing      ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hernia, reduce.
49521.........  Rerepair ing      ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hernia, blocked.
49525.........  Repair ing        ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hernia, sliding.
49540.........  Repair lumbar     ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hernia.
49550.........  Rpr rem hernia,   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 init, reduce.
49553.........  Rpr fem hernia,   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 init blocked.
49555.........  Rerepair fem      ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hernia, reduce.
49557.........  Rerepair fem      ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hernia, blocked.
49560.........  Rpr ventral hern  ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 init, reduc.
49561.........  Rpr ventral hern  ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 init, block.
49565.........  Rerepair ventrl   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hern, reduce.
49566.........  Rerepair ventrl   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hern, block.
49568.........  Hernia repair w/  ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 mesh.
49570.........  Rpr epigastric    ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hern, reduce.
49572.........  Rpr epigastric    ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hern, blocked.
49580.........  Rpr umbil hern,   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 reduc < 5 yr.
49582.........  Rpr umbil hern,   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 block < 5 yr.
49585.........  Rpr umbil hern,   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 reduc > 5 yr.
49587.........  Rpr umbil hern,   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 block > 5 yr.
49590.........  Repair spigelian  ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hernia.
49600.........  Repair umbilical  ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 lesion.
49650.........  Laparo hernia     ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 repair initial.
49651.........  Laparo hernia     ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 repair recur.
49659.........  Laparo proc,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 hernia repair.
49999.........  Abdomen surgery   ........  T.......    0153      22.1758     1,364.94       397.95       272.99
                 procedure.
50020.........  Renal abscess,    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 open drain.
50021.........  Renal abscess,    ........  T.......    0037      10.2616       631.61       228.76       126.32
                 percut drain.
50080.........  Removal of        ........  T.......    0429      42.9327     2,642.55  ...........       528.51
                 kidney stone.

[[Page 49795]]

 
50081.........  Removal of        ........  T.......    0429      42.9327     2,642.55  ...........       528.51
                 kidney stone.
50200.........  Biopsy of kidney  ........  T.......    0685       6.0729       373.79       115.47        74.76
50382.........  Change ureter     ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 stent, percut.
50384.........  Remove ureter     ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 stent, percut.
50387.........  Change ext/int    ........  T.......    0122       7.2859       448.45  ...........        89.69
                 ureter stent.
50389.........  Remove renal      ........  T.......    0156       3.5688       219.66  ...........        43.93
                 tube w/fluoro.
50390.........  Drainage of       ........  T.......    0685       6.0729       373.79       115.47        74.76
                 kidney lesion.
50391.........  Instll rx agnt    CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 into rnal tub.
50392.........  Insert kidney     ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 drain.
50393.........  Insert ureteral   ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 tube.
50394.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 kidney x-ray.
50395.........  Create passage    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 to kidney.
50396.........  Measure kidney    ........  T.......    0164       2.1159       130.24  ...........        26.05
                 pressure.
50398.........  Change kidney     ........  T.......    0122       7.2859       448.45  ...........        89.69
                 tube.
50541.........  Laparo ablate     ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 renal cyst.
50542.........  Laparo ablate     ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 renal mass.
50543.........  Laparo partial    ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 nephrectomy.
50544.........  Laparoscopy,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 pyeloplasty.
50549.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, renal.
50551.........  Kidney endoscopy  ........  T.......    0160       6.7325       414.39       105.06        82.88
50553.........  Kidney endoscopy  ........  T.......    0161      19.2766     1,186.49       249.36       237.30
50555.........  Kidney            ........  T.......    0160       6.7325       414.39       105.06        82.88
                 endoscopy&biops
                 y.
50557.........  Kidney            ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 endoscopy&treat
                 ment.
50561.........  Kidney            ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 endoscopy&treat
                 ment.
50562.........  Renal scope w/    ........  T.......    0160       6.7325       414.39       105.06        82.88
                 tumor resect.
50570.........  Kidney endoscopy  ........  T.......    0160       6.7325       414.39       105.06        82.88
50572.........  Kidney endoscopy  ........  T.......    0160       6.7325       414.39       105.06        82.88
50574.........  Kidney            ........  T.......    0160       6.7325       414.39       105.06        82.88
                 endoscopy&biops
                 y.
50575.........  Kidney endoscopy  ........  T.......    0163      35.1024     2,160.59  ...........       432.12
50576.........  Kidney            ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 endoscopy&treat
                 ment.
50590.........  Fragmenting of    ........  T.......    0169      44.1144     2,715.29     1,009.47       543.06
                 kidney stone.
50592.........  Perc rf ablate    ........  T.......    0423      39.0235     2,401.94  ...........       480.39
                 renal tumor.
50684.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 ureter x-ray.
50686.........  Measure ureter    CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 pressure.
50688.........  Change of ureter  ........  T.......    0122       7.2859       448.45  ...........        89.69
                 tube/stent.
50690.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 ureter x-ray.
50945.........  Laparoscopy       ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 ureterolithotom
                 y.
50947.........  Laparo new        ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 ureter/bladder.
50948.........  Laparo new        ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 ureter/bladder.
50949.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, ureter.
50951.........  Endoscopy of      ........  T.......    0160       6.7325       414.39       105.06        82.88
                 ureter.
50953.........  Endoscopy of      ........  T.......    0160       6.7325       414.39       105.06        82.88
                 ureter.
50955.........  Ureter            ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 endoscopy&biops
                 y.
50957.........  Ureter            ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 endoscopy&treat
                 ment.
50961.........  Ureter            ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 endoscopy&treat
                 ment.
50970.........  Ureter endoscopy  ........  T.......    0160       6.7325       414.39       105.06        82.88
50972.........  Ureter            ........  T.......    0160       6.7325       414.39       105.06        82.88
                 endoscopy&cathe
                 ter.
50974.........  Ureter            ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 endoscopy&biops
                 y.
50976.........  Ureter            ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 endoscopy&treat
                 ment.
50980.........  Ureter            ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 endoscopy&treat
                 ment.
51000.........  Drainage of       ........  T.......    0164       2.1159       130.24  ...........        26.05
                 bladder.
51005.........  Drainage of       CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 bladder.
51010.........  Drainage of       ........  T.......    0165      18.2333     1,122.28  ...........       224.46
                 bladder.
51020.........  Incise&treat      ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 bladder.
51030.........  Incise&treat      ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 bladder.
51040.........  Incise&drain      ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 bladder.
51045.........  Incise bladder/   ........  T.......    0160       6.7325       414.39       105.06        82.88
                 drain ureter.
51050.........  Removal of        ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 bladder stone.
51065.........  Remove ureter     ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 calculus.
51080.........  Drainage of       ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 bladder abscess.
51500.........  Removal of        ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 bladder cyst.
51520.........  Removal of        ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 bladder lesion.
51600.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 bladder x-ray.
51605.........  Preparation for   ........  N.......  ......  ...........  ...........  ...........  ...........
                 bladder xray.
51610.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 bladder x-ray.
51700.........  Irrigation of     ........  T.......    0164       2.1159       130.24  ...........        26.05
                 bladder.
51701.........  Insert bladder    ........  X.......    0340       0.6211        38.23  ...........         7.65
                 catheter.
51702.........  Insert temp       ........  X.......    0340       0.6211        38.23  ...........         7.65
                 bladder cath.
51703.........  Insert bladder    CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 cath, complex.
51705.........  Change of         ........  T.......    0121       2.3431       144.22        43.80        28.84
                 bladder tube.

[[Page 49796]]

 
51710.........  Change of         ........  T.......    0122       7.2859       448.45  ...........        89.69
                 bladder tube.
51715.........  Endoscopic        ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 injection/
                 implant.
51720.........  Treatment of      CH......  T.......    0164       2.1159       130.24  ...........        26.05
                 bladder lesion.
51725.........  Simple            CH......  T.......    0164       2.1159       130.24  ...........        26.05
                 cystometrogram.
51726.........  Complex           ........  T.......    0156       3.5688       219.66  ...........        43.93
                 cystometrogram.
51736.........  Urine flow        CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 measurement.
51741.........  Electro-          CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 uroflowmetry,
                 first.
51772.........  Urethra pressure  CH......  T.......    0164       2.1159       130.24  ...........        26.05
                 profile.
51784.........  Anal/urinary      CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 muscle study.
51785.........  Anal/urinary      CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 muscle study.
51792.........  Urinary reflex    CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 study.
51795.........  Urine voiding     ........  T.......    0164       2.1159       130.24  ...........        26.05
                 pressure study.
51797.........  Intraabdominal    ........  T.......    0164       2.1159       130.24  ...........        26.05
                 pressure test.
51798.........  Us urine          ........  X.......    0340       0.6211        38.23  ...........         7.65
                 capacity
                 measure.
51880.........  Repair of         ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 bladder opening.
51990.........  Laparo urethral   ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 suspension.
51992.........  Laparo sling      CH......  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 operation.
51999.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, bladder.
52000.........  Cystoscopy......  ........  T.......    0160       6.7325       414.39       105.06        82.88
52001.........  Cystoscopy,       ........  T.......    0160       6.7325       414.39       105.06        82.88
                 removal of
                 clots.
52005.........  Cystoscopy&urete  ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 r catheter.
52007.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 biopsy.
52010.........  Cystoscopy&duct   ........  T.......    0160       6.7325       414.39       105.06        82.88
                 catheter.
52204.........  Cystoscopy......  ........  T.......    0161      19.2766     1,186.49       249.36       237.30
52214.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52224.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52234.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52235.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52240.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52250.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 radiotracer.
52260.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52265.........  Cystoscopy and    ........  T.......    0160       6.7325       414.39       105.06        82.88
                 treatment.
52270.........  Cystoscopy&revis  ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 e urethra.
52275.........  Cystoscopy&revis  ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 e urethra.
52276.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52277.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52281.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52282.........  Cystoscopy,       ........  T.......    0163      35.1024     2,160.59  ...........       432.12
                 implant stent.
52283.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52285.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52290.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52300.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52301.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52305.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52310.........  Cystoscopy and    ........  T.......    0160       6.7325       414.39       105.06        82.88
                 treatment.
52315.........  Cystoscopy and    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 treatment.
52317.........  Remove bladder    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 stone.
52318.........  Remove bladder    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 stone.
52320.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52325.........  Cystoscopy,       ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 stone removal.
52327.........  Cystoscopy,       ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 inject material.
52330.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52332.........  Cystoscopy and    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 treatment.
52334.........  Create passage    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 to kidney.
52341.........  Cysto w/ureter    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 stricture tx.
52342.........  Cysto w/up        ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 stricture tx.
52343.........  Cysto w/renal     ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 stricture tx.
52344.........  Cysto/uretero,    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 stricture tx.
52345.........  Cysto/uretero w/  ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 up stricture.
52346.........  Cystouretero w/   ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 renal strict.
52351.........  Cystouretero∨   ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 pyeloscope.
52352.........  Cystouretero w/   ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 stone remove.
52353.........  Cystouretero w/   ........  T.......    0163      35.1024     2,160.59  ...........       432.12
                 lithotripsy.
52354.........  Cystouretero w/   ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 biopsy.
52355.........  Cystouretero w/   ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 excise tumor.
52400.........  Cystouretero w/   ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 congen repr.
52402.........  Cystourethro cut  ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 ejacul duct.
52450.........  Incision of       ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 prostate.
52500.........  Revision of       ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 bladder neck.
52510.........  Dilation          ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 prostatic
                 urethra.

[[Page 49797]]

 
52601.........  Prostatectomy     ........  T.......    0163      35.1024     2,160.59  ...........       432.12
                 (TURP).
52606.........  Control postop    ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 bleeding.
52612.........  Prostatectomy,    ........  T.......    0163      35.1024     2,160.59  ...........       432.12
                 first stage.
52614.........  Prostatectomy,    ........  T.......    0163      35.1024     2,160.59  ...........       432.12
                 second stage.
52620.........  Remove residual   ........  T.......    0163      35.1024     2,160.59  ...........       432.12
                 prostate.
52630.........  Remove prostate   ........  T.......    0163      35.1024     2,160.59  ...........       432.12
                 regrowth.
52640.........  Relieve bladder   ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 contracture.
52647.........  Laser surgery of  ........  T.......    0429      42.9327     2,642.55  ...........       528.51
                 prostate.
52648.........  Laser surgery of  ........  T.......    0429      42.9327     2,642.55  ...........       528.51
                 prostate.
52700.........  Drainage of       ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 prostate
                 abscess.
53000.........  Incision of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra.
53010.........  Incision of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra.
53020.........  Incision of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra.
53025.........  Incision of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra.
53040.........  Drainage of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra abscess.
53060.........  Drainage of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra abscess.
53080.........  Drainage of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urinary leakage.
53085.........  Drainage of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urinary leakage.
53200.........  Biopsy of         ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra.
53210.........  Removal of        ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra.
53215.........  Removal of        ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra.
53220.........  Treatment of      ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra lesion.
53230.........  Removal of        ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra lesion.
53235.........  Removal of        ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra lesion.
53240.........  Surgery for       ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra pouch.
53250.........  Removal of        ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra gland.
53260.........  Treatment of      ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra lesion.
53265.........  Treatment of      ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra lesion.
53270.........  Removal of        ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra gland.
53275.........  Repair of         ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra defect.
53400.........  Revise urethra,   ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 stage 1.
53405.........  Revise urethra,   ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 stage 2.
53410.........  Reconstruction    ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 of urethra.
53420.........  Reconstruct       ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra, stage
                 1.
53425.........  Reconstruct       ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra, stage
                 2.
53430.........  Reconstruction    ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 of urethra.
53431.........  Reconstruct       ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra/bladder.
53440.........  Male sling        ........  S.......    0385      79.3730     4,885.49  ...........       977.10
                 procedure.
53442.........  Remove/revise     ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 male sling.
53444.........  Insert tandem     ........  S.......    0385      79.3730     4,885.49  ...........       977.10
                 cuff.
53445.........  Insert uro/ves    ........  S.......    0386     135.7295     8,354.29  ...........     1,670.86
                 nck sphincter.
53446.........  Remove uro        ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 sphincter.
53447.........  Remove/replace    ........  S.......    0386     135.7295     8,354.29  ...........     1,670.86
                 ur sphincter.
53449.........  Repair uro        ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 sphincter.
53450.........  Revision of       ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra.
53460.........  Revision of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra.
53500.........  Urethrlys,        ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 transvag w/
                 scope.
53502.........  Repair of         ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra injury.
53505.........  Repair of         ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra injury.
53510.........  Repair of         ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra injury.
53515.........  Repair of         ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra injury.
53520.........  Repair of         ........  T.......    0168      28.5971     1,760.18       388.16       352.04
                 urethra defect.
53600.........  Dilate urethra    ........  T.......    0156       3.5688       219.66  ...........        43.93
                 stricture.
53601.........  Dilate urethra    CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 stricture.
53605.........  Dilate urethra    ........  T.......    0161      19.2766     1,186.49       249.36       237.30
                 stricture.
53620.........  Dilate urethra    ........  T.......    0165      18.2333     1,122.28  ...........       224.46
                 stricture.
53621.........  Dilate urethra    ........  T.......    0164       2.1159       130.24  ...........        26.05
                 stricture.
53660.........  Dilation of       CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 urethra.
53661.........  Dilation of       CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 urethra.
53665.........  Dilation of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 urethra.
53850.........  Prostatic         ........  T.......    0675      42.3176     2,604.69  ...........       520.94
                 microwave
                 thermotx.
53852.........  Prostatic rf      ........  T.......    0675      42.3176     2,604.69  ...........       520.94
                 thermotx.
53853.........  Prostatic water   ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 thermother.
53899.........  Urology surgery   CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 procedure.
54000.........  Slitting of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 prepuce.
54001.........  Slitting of       ........  T.......    0166      18.5138     1,139.54  ...........       227.91
                 prepuce.
54015.........  Drain penis       ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 lesion.
54050.........  Destruction,      ........  T.......    0013       1.0876        66.94  ...........        13.39
                 penis lesion(s).
54055.........  Destruction,      ........  T.......    0017      17.7392     1,091.87       227.84       218.37
                 penis lesion(s).
54056.........  Cryosurgery,      ........  T.......    0012       0.8076        49.71        10.30         9.94
                 penis lesion(s).

[[Page 49798]]

 
54057.........  Laser surg,       ........  T.......    0017      17.7392     1,091.87       227.84       218.37
                 penis lesion(s).
54060.........  Excision of       ........  T.......    0017      17.7392     1,091.87       227.84       218.37
                 penis lesion(s).
54065.........  Destruction,      ........  T.......    0695      20.5802     1,266.73       266.59       253.35
                 penis lesion(s).
54100.........  Biopsy of penis.  ........  T.......    0021      14.9563       920.58       219.48       184.12
54105.........  Biopsy of penis.  ........  T.......    0022      19.9760     1,229.54       354.45       245.91
54110.........  Treatment of      ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 penis lesion.
54111.........  Treat penis       ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 lesion, graft.
54112.........  Treat penis       ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 lesion, graft.
54115.........  Treatment of      ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 penis lesion.
54120.........  Partial removal   ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 of penis.
54150.........  Circumcision....  ........  T.......    0180      20.7418     1,276.68       304.87       255.34
54152.........  Circumcision....  ........  T.......    0180      20.7418     1,276.68       304.87       255.34
54160.........  Circumcision....  ........  T.......    0180      20.7418     1,276.68       304.87       255.34
54161.........  Circumcision....  ........  T.......    0180      20.7418     1,276.68       304.87       255.34
54162.........  Lysis penil       ........  T.......    0180      20.7418     1,276.68       304.87       255.34
                 circumic lesion.
54163.........  Repair of         ........  T.......    0180      20.7418     1,276.68       304.87       255.34
                 circumcision.
54164.........  Frenulotomy of    ........  T.......    0180      20.7418     1,276.68       304.87       255.34
                 penis.
54200.........  Treatment of      CH......  T.......    0164       2.1159       130.24  ...........        26.05
                 penis lesion.
54205.........  Treatment of      ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 penis lesion.
54220.........  Treatment of      CH......  T.......    0164       2.1159       130.24  ...........        26.05
                 penis lesion.
54230.........  Prepare penis     ........  N.......  ......  ...........  ...........  ...........  ...........
                 study.
54231.........  Dynamic           ........  T.......    0165      18.2333     1,122.28  ...........       224.46
                 cavernosometry.
54235.........  Penile injection  ........  T.......    0164       2.1159       130.24  ...........        26.05
54240.........  Penis study.....  CH......  T.......    0126       1.0844        66.75        16.40        13.35
54250.........  Penis study.....  ........  T.......    0164       2.1159       130.24  ...........        26.05
54300.........  Revision of       ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 penis.
54304.........  Revision of       ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 penis.
54308.........  Reconstruction    ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 of urethra.
54312.........  Reconstruction    ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 of urethra.
54316.........  Reconstruction    ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 of urethra.
54318.........  Reconstruction    ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 of urethra.
54322.........  Reconstruction    ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 of urethra.
54324.........  Reconstruction    ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 of urethra.
54326.........  Reconstruction    ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 of urethra.
54328.........  Revise penis/     ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 urethra.
54340.........  Secondary         ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 urethral
                 surgery.
54344.........  Secondary         ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 urethral
                 surgery.
54348.........  Secondary         ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 urethral
                 surgery.
54352.........  Reconstruct       ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 urethra/penis.
54360.........  Penis plastic     ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 surgery.
54380.........  Repair penis....  ........  T.......    0181      32.9991     2,031.13       621.82       406.23
54385.........  Repair penis....  ........  T.......    0181      32.9991     2,031.13       621.82       406.23
54400.........  Insert semi-      ........  S.......    0385      79.3730     4,885.49  ...........       977.10
                 rigid
                 prosthesis.
54401.........  Insert self-      ........  S.......    0386     135.7295     8,354.29  ...........     1,670.86
                 contd
                 prosthesis.
54405.........  Insert multi-     ........  S.......    0386     135.7295     8,354.29  ...........     1,670.86
                 comp penis pros.
54406.........  Remove muti-comp  ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 penis pros.
54408.........  Repair multi-     ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 comp penis pros.
54410.........  Remove/replace    ........  S.......    0386     135.7295     8,354.29  ...........     1,670.86
                 penis prosth.
54415.........  Remove self-      ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 contd penis
                 pros.
54416.........  Remv/repl penis   ........  S.......    0386     135.7295     8,354.29  ...........     1,670.86
                 contain pros.
54420.........  Revision of       ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 penis.
54435.........  Revision of       ........  T.......    0181      32.9991     2,031.13       621.82       406.23
                 penis.
54440.........  Repair of penis.  ........  T.......    0181      32.9991     2,031.13       621.82       406.23
54450.........  Preputial         ........  T.......    0156       3.5688       219.66  ...........        43.93
                 stretching.
54500.........  Biopsy of testis  ........  T.......    0037      10.2616       631.61       228.76       126.32
54505.........  Biopsy of testis  ........  T.......    0183      23.7072     1,459.20  ...........       291.84
54512.........  Excise lesion     ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 testis.
54520.........  Removal of        ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 testis.
54522.........  Orchiectomy,      ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 partial.
54530.........  Removal of        ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 testis.
54550.........  Exploration for   ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 testis.
54560.........  Exploration for   ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 testis.
54600.........  Reduce testis     ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 torsion.
54620.........  Suspension of     ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 testis.
54640.........  Suspension of     ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 testis.
54660.........  Revision of       ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 testis.
54670.........  Repair testis     ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 injury.
54680.........  Relocation of     ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 testis(es).
54690.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 orchiectomy.
54692.........  Laparoscopy,      ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 orchiopexy.

[[Page 49799]]

 
54699.........  Laparoscope       ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 proc, testis.
54700.........  Drainage of       ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 scrotum.
54800.........  Biopsy of         ........  T.......    0004       2.0863       128.41  ...........        25.68
                 epididymis.
54820.........  Exploration of    ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 epididymis.
54830.........  Remove            ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 epididymis
                 lesion.
54840.........  Remove            ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 epididymis
                 lesion.
54860.........  Removal of        ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 epididymis.
54861.........  Removal of        ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 epididymis.
54900.........  Fusion of         ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 spermatic ducts.
54901.........  Fusion of         ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 spermatic ducts.
55000.........  Drainage of       ........  T.......    0004       2.0863       128.41  ...........        25.68
                 hydrocele.
55040.........  Removal of        ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hydrocele.
55041.........  Removal of        ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hydroceles.
55060.........  Repair of         ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 hydrocele.
55100.........  Drainage of       CH......  T.......    0007      10.9184       672.04  ...........       134.41
                 scrotum abscess.
55110.........  Explore scrotum.  ........  T.......    0183      23.7072     1,459.20  ...........       291.84
55120.........  Removal of        ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 scrotum lesion.
55150.........  Removal of        ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 scrotum.
55175.........  Revision of       ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 scrotum.
55180.........  Revision of       ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 scrotum.
55200.........  Incision of       ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 sperm duct.
55250.........  Removal of sperm  ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 duct(s).
55300.........  Prepare, sperm    ........  N.......  ......  ...........  ...........  ...........  ...........
                 duct x-ray.
55400.........  Repair of sperm   ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 duct.
55450.........  Ligation of       ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 sperm duct.
55500.........  Removal of        ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 hydrocele.
55520.........  Removal of sperm  ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 cord lesion.
55530.........  Revise spermatic  ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 cord veins.
55535.........  Revise spermatic  ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 cord veins.
55540.........  Revise            ........  T.......    0154      29.1491     1,794.16       464.85       358.83
                 hernia&sperm
                 veins.
55550.........  Laparo ligate     ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 spermatic vein.
55559.........  Laparo proc,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 spermatic cord.
55600.........  Incise sperm      ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 duct pouch.
55680.........  Remove sperm      ........  T.......    0183      23.7072     1,459.20  ...........       291.84
                 pouch lesion.
55700.........  Biopsy of         ........  T.......    0184       5.9892       368.64        96.27        73.73
                 prostate.
55705.........  Biopsy of         ........  T.......    0184       5.9892       368.64        96.27        73.73
                 prostate.
55720.........  Drainage of       ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 prostate
                 abscess.
55725.........  Drainage of       ........  T.......    0162      23.8562     1,468.37  ...........       293.67
                 prostate
                 abscess.
55859.........  Percut/needle     ........  T.......    0163      35.1024     2,160.59  ...........       432.12
                 insert, pros.
55860.........  Surgical          ........  T.......    0165      18.2333     1,122.28  ...........       224.46
                 exposure,
                 prostate.
55870.........  Electroejaculati  ........  T.......    0197       4.4108       271.49  ...........        54.30
                 on.
55873.........  Cryoablate        ........  T.......    0674     107.8298     6,637.03  ...........     1,327.41
                 prostate.
55899.........  Genital surgery   CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 procedure.
56405.........  I&D of vulva/     ........  T.......    0189       2.9902       184.05  ...........        36.81
                 perineum.
56420.........  Drainage of       CH......  T.......    0188       1.4050        86.48  ...........        17.30
                 gland abscess.
56440.........  Surgery for       ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 vulva lesion.
56441.........  Lysis of labial   ........  T.......    0193      14.7958       910.70  ...........       182.14
                 lesion(s).
56501.........  Destroy, vulva    ........  T.......    0017      17.7392     1,091.87       227.84       218.37
                 lesions, sim.
56515.........  Destroy vulva     ........  T.......    0695      20.5802     1,266.73       266.59       253.35
                 lesion/s compl.
56605.........  Biopsy of vulva/  ........  T.......    0019       4.0123       246.96        71.87        49.39
                 perineum.
56606.........  Biopsy of vulva/  ........  T.......    0019       4.0123       246.96        71.87        49.39
                 perineum.
56620.........  Partial removal   ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 of vulva.
56625.........  Complete removal  ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 of vulva.
56700.........  Partial removal   ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 of hymen.
56720.........  Incision of       ........  T.......    0193      14.7958       910.70  ...........       182.14
                 hymen.
56740.........  Remove vagina     ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 gland lesion.
56800.........  Repair of vagina  ........  T.......    0194      20.5113     1,262.49       397.84       252.50
56805.........  Repair clitoris.  ........  T.......    0193      14.7958       910.70  ...........       182.14
56810.........  Repair of         ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 perineum.
56820.........  Exam of vulva w/  ........  T.......    0188       1.4050        86.48  ...........        17.30
                 scope.
56821.........  Exam/biopsy of    ........  T.......    0189       2.9902       184.05  ...........        36.81
                 vulva w/scope.
57000.........  Exploration of    ........  T.......    0193      14.7958       910.70  ...........       182.14
                 vagina.
57010.........  Drainage of       ........  T.......    0193      14.7958       910.70  ...........       182.14
                 pelvic abscess.
57020.........  Drainage of       ........  T.......    0192       6.9265       426.33  ...........        85.27
                 pelvic fluid.
57022.........  I&d vaginal       ........  T.......    0007      10.9184       672.04  ...........       134.41
                 hematoma, pp.
57023.........  I&d vag           ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 hematoma, non-
                 ob.
57061.........  Destroy vag       ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 lesions, simple.
57065.........  Destroy vag       ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 lesions,
                 complex.
57100.........  Biopsy of vagina  ........  T.......    0192       6.9265       426.33  ...........        85.27
57105.........  Biopsy of vagina  ........  T.......    0194      20.5113     1,262.49       397.84       252.50

[[Page 49800]]

 
57106.........  Remove vagina     ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 wall, partial.
57107.........  Remove vagina     ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 tissue, part.
57109.........  Vaginectomy       ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 partial w/nodes.
57120.........  Closure of        ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 vagina.
57130.........  Remove vagina     ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 lesion.
57135.........  Remove vagina     ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 lesion.
57150.........  Treat vagina      ........  T.......    0191       0.1501         9.24  ...........         1.85
                 infection.
57155.........  Insert uteri      ........  T.......    0192       6.9265       426.33  ...........        85.27
                 tandems/ovoids.
57160.........  Insert pessary/   ........  T.......    0188       1.4050        86.48  ...........        17.30
                 other device.
57170.........  Fitting of        ........  T.......    0191       0.1501         9.24  ...........         1.85
                 diaphragm/cap.
57180.........  Treat vaginal     ........  T.......    0189       2.9902       184.05  ...........        36.81
                 bleeding.
57200.........  Repair of vagina  ........  T.......    0194      20.5113     1,262.49       397.84       252.50
57210.........  Repair vagina/    ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 perineum.
57220.........  Revision of       ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 urethra.
57230.........  Repair of         ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 urethral lesion.
57240.........  Repair            ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 bladder&vagina.
57250.........  Repair            ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 rectum&vagina.
57260.........  Repair of vagina  ........  T.......    0195      28.7410     1,769.04       483.80       353.81
57265.........  Extensive repair  ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 of vagina.
57267.........  Insert mesh/      CH......  T.......    0195      28.7410     1,769.04       483.80       353.81
                 pelvic flr
                 addon.
57268.........  Repair of bowel   ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 bulge.
57284.........  Repair            ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 paravaginal
                 defect.
57287.........  Revise/remove     CH......  T.......    0195      28.7410     1,769.04       483.80       353.81
                 sling repair.
57288.........  Repair bladder    ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 defect.
57289.........  Repair            ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 bladder&vagina.
57291.........  Construction of   ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 vagina.
57292.........  Construct vagina  CH......  T.......    0195      28.7410     1,769.04       483.80       353.81
                 with graft.
57295.........  Change vaginal    ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 graft.
57300.........  Repair rectum-    ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 vagina fistula.
57310.........  Repair            ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 urethrovaginal
                 lesion.
57320.........  Repair bladder-   ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 vagina lesion.
57330.........  Repair bladder-   ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 vagina lesion.
57335.........  Repair vagina...  CH......  T.......    0195      28.7410     1,769.04       483.80       353.81
57400.........  Dilation of       ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 vagina.
57410.........  Pelvic            ........  T.......    0193      14.7958       910.70  ...........       182.14
                 examination.
57415.........  Remove vaginal    ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 foreign body.
57420.........  Exam of vagina w/ ........  T.......    0189       2.9902       184.05  ...........        36.81
                 scope.
57421.........  Exam/biopsy of    ........  T.......    0189       2.9902       184.05  ...........        36.81
                 vag w/scope.
57425.........  Laparoscopy,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 surg, colpopexy.
57452.........  Exam of cervix w/ CH......  T.......    0188       1.4050        86.48  ...........        17.30
                 scope.
57454.........  Bx/curett of      ........  T.......    0189       2.9902       184.05  ...........        36.81
                 cervix w/scope.
57455.........  Biopsy of cervix  ........  T.......    0189       2.9902       184.05  ...........        36.81
                 w/scope.
57456.........  Endocerv          ........  T.......    0189       2.9902       184.05  ...........        36.81
                 curettage w/
                 scope.
57460.........  Bx of cervix w/   ........  T.......    0193      14.7958       910.70  ...........       182.14
                 scope, leep.
57461.........  Conz of cervix w/ ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 scope, leep.
57500.........  Biopsy of cervix  CH......  T.......    0189       2.9902       184.05  ...........        36.81
57505.........  Endocervical      ........  T.......    0189       2.9902       184.05  ...........        36.81
                 curettage.
57510.........  Cauterization of  ........  T.......    0193      14.7958       910.70  ...........       182.14
                 cervix.
57511.........  Cryocautery of    CH......  T.......    0188       1.4050        86.48  ...........        17.30
                 cervix.
57513.........  Laser surgery of  ........  T.......    0193      14.7958       910.70  ...........       182.14
                 cervix.
57520.........  Conization of     ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 cervix.
57522.........  Conization of     ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 cervix.
57530.........  Removal of        ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 cervix.
57550.........  Removal of        ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 residual cervix.
57555.........  Remove cervix/    ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 repair vagina.
57556.........  Remove cervix,    ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 repair bowel.
57700.........  Revision of       ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 cervix.
57720.........  Revision of       ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 cervix.
57800.........  Dilation of       ........  T.......    0193      14.7958       910.70  ...........       182.14
                 cervical canal.
57820.........  D&c of residual   ........  T.......    0196      17.7635     1,093.36       338.23       218.67
                 cervix.
58100.........  Biopsy of uterus  ........  T.......    0188       1.4050        86.48  ...........        17.30
                 lining.
58110.........  Bx done w/        ........  T.......    0188       1.4050        86.48  ...........        17.30
                 colposcopy add-
                 on.
58120.........  Dilation and      ........  T.......    0196      17.7635     1,093.36       338.23       218.67
                 curettage.
58145.........  Myomectomy vag    ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 method.
58301.........  Remove            CH......  T.......    0188       1.4050        86.48  ...........        17.30
                 intrauterine
                 device.
58321.........  Artificial        ........  T.......    0197       4.4108       271.49  ...........        54.30
                 insemination.
58322.........  Artificial        ........  T.......    0197       4.4108       271.49  ...........        54.30
                 insemination.
58323.........  Sperm washing...  ........  T.......    0197       4.4108       271.49  ...........        54.30
58340.........  Catheter for      ........  N.......  ......  ...........  ...........  ...........  ...........
                 hysterography.
58345.........  Reopen fallopian  ........  T.......    0193      14.7958       910.70  ...........       182.14
                 tube.

[[Page 49801]]

 
58346.........  Insert heyman     ........  T.......    0193      14.7958       910.70  ...........       182.14
                 uteri capsule.
58350.........  Reopen fallopian  ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 tube.
58353.........  Endometr ablate,  ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 thermal.
58356.........  Endometrial       ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 cryoablation.
58545.........  Laparoscopic      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 myomectomy.
58546.........  Laparo-           ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 myomectomy,
                 complex.
58550.........  Laparo-asst vag   ........  T.......    0132      70.8854     4,363.07     1,239.22       872.61
                 hysterectomy.
58552.........  Laparo-vag hyst   ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 incl t/o.
58553.........  Laparo-vag hyst,  ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 complex.
58554.........  Laparo-vag hyst   ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 w/t/o, compl.
58555.........  Hysteroscopy,     ........  T.......    0190      21.4199     1,318.42       424.28       263.68
                 dx, sep proc.
58558.........  Hysteroscopy,     ........  T.......    0190      21.4199     1,318.42       424.28       263.68
                 biopsy.
58559.........  Hysteroscopy,     ........  T.......    0190      21.4199     1,318.42       424.28       263.68
                 lysis.
58560.........  Hysteroscopy,     ........  T.......    0387      33.3029     2,049.83       655.55       409.97
                 resect septum.
58561.........  Hysteroscopy,     ........  T.......    0387      33.3029     2,049.83       655.55       409.97
                 remove myoma.
58562.........  Hysteroscopy,     ........  T.......    0190      21.4199     1,318.42       424.28       263.68
                 remove fb.
58563.........  Hysteroscopy,     ........  T.......    0387      33.3029     2,049.83       655.55       409.97
                 ablation.
58565.........  Hysteroscopy,     ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 sterilization.
58578.........  Laparo proc,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 uterus.
58579.........  Hysteroscope      ........  T.......    0190      21.4199     1,318.42       424.28       263.68
                 procedure.
58600.........  Division of       ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 fallopian tube.
58615.........  Occlude           ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 fallopian
                 tube(s).
58660.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 lysis.
58661.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 remove adnexa.
58662.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 excise lesions.
58670.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 tubal cautery.
58671.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 tubal block.
58672.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 fimbrioplasty.
58673.........  Laparoscopy,      ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 salpingostomy.
58679.........  Laparo proc,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 oviduct-ovary.
58770.........  Create new tubal  ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 opening.
58800.........  Drainage of       ........  T.......    0193      14.7958       910.70  ...........       182.14
                 ovarian cyst(s).
58820.........  Drain ovary       ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 abscess, open.
58823.........  Drain pelvic      ........  T.......    0193      14.7958       910.70  ...........       182.14
                 abscess, percut.
58900.........  Biopsy of         ........  T.......    0193      14.7958       910.70  ...........       182.14
                 ovary(s).
58920.........  Partial removal   ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 of ovary(s).
58925.........  Removal of        ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 ovarian cyst(s).
58970.........  Retrieval of      ........  T.......    0197       4.4108       271.49  ...........        54.30
                 oocyte.
58974.........  Transfer of       ........  T.......    0197       4.4108       271.49  ...........        54.30
                 embryo.
58976.........  Transfer of       ........  T.......    0197       4.4108       271.49  ...........        54.30
                 embryo.
58999.........  Genital surgery   ........  T.......    0191       0.1501         9.24  ...........         1.85
                 procedure.
59000.........  Amniocentesis,    ........  T.......    0198       1.4026        86.33        32.19        17.27
                 diagnostic.
59001.........  Amniocentesis,    ........  T.......    0192       6.9265       426.33  ...........        85.27
                 therapeutic.
59012.........  Fetal cord        ........  T.......    0198       1.4026        86.33        32.19        17.27
                 puncture,prenat
                 al.
59015.........  Chorion biopsy..  ........  T.......    0198       1.4026        86.33        32.19        17.27
59020.........  Fetal contract    CH......  T.......    0189       2.9902       184.05  ...........        36.81
                 stress test.
59025.........  Fetal non-stress  ........  T.......    0198       1.4026        86.33        32.19        17.27
                 test.
59030.........  Fetal scalp       ........  T.......    0198       1.4026        86.33        32.19        17.27
                 blood sample.
59070.........  Transabdom        ........  T.......    0198       1.4026        86.33        32.19        17.27
                 amnioinfus w/us.
59072.........  Umbilical cord    ........  T.......    0198       1.4026        86.33        32.19        17.27
                 occlud w/us.
59074.........  Fetal fluid       ........  T.......    0198       1.4026        86.33        32.19        17.27
                 drainage w/us.
59076.........  Fetal shunt       ........  T.......    0198       1.4026        86.33        32.19        17.27
                 placement, w/us.
59100.........  Remove uterus     ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 lesion.
59150.........  Treat ectopic     ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 pregnancy.
59151.........  Treat ectopic     ........  T.......    0131      43.5124     2,678.23     1,001.89       535.65
                 pregnancy.
59160.........  D&c after         ........  T.......    0196      17.7635     1,093.36       338.23       218.67
                 delivery.
59200.........  Insert cervical   ........  T.......    0189       2.9902       184.05  ...........        36.81
                 dilator.
59300.........  Episiotomy or     ........  T.......    0193      14.7958       910.70  ...........       182.14
                 vaginal repair.
59320.........  Revision of       ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 cervix.
59409.........  Obstetrical care  ........  T.......    0194      20.5113     1,262.49       397.84       252.50
59412.........  Antepartum        ........  T.......    0700       2.8011       172.41  ...........        34.48
                 manipulation.
59414.........  Deliver placenta  ........  T.......    0193      14.7958       910.70  ...........       182.14
59612.........  Vbac delivery     ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 only.
59812.........  Treatment of      ........  T.......    0201      18.5251     1,140.24       329.65       228.05
                 miscarriage.
59820.........  Care of           ........  T.......    0201      18.5251     1,140.24       329.65       228.05
                 miscarriage.
59821.........  Treatment of      ........  T.......    0201      18.5251     1,140.24       329.65       228.05
                 miscarriage.
59840.........  Abortion........  ........  T.......    0200      17.2607     1,062.41       248.39       212.48
59841.........  Abortion........  ........  T.......    0200      17.2607     1,062.41       248.39       212.48
59866.........  Abortion (mpr)..  ........  T.......    0198       1.4026        86.33        32.19        17.27
59870.........  Evacuate mole of  ........  T.......    0201      18.5251     1,140.24       329.65       228.05
                 uterus.

[[Page 49802]]

 
59871.........  Remove cerclage   ........  T.......    0194      20.5113     1,262.49       397.84       252.50
                 suture.
59897.........  Fetal invas px w/ ........  T.......    0198       1.4026        86.33        32.19        17.27
                 us.
59898.........  Laparo proc, ob   ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 care/deliver.
59899.........  Maternity care    ........  T.......    0198       1.4026        86.33        32.19        17.27
                 procedure.
60000.........  Drain thyroid/    ........  T.......    0252       7.7261       475.55       111.84        95.11
                 tongue cyst.
60001.........  Aspirate/inject   ........  T.......    0004       2.0863       128.41  ...........        25.68
                 thyriod cyst.
60100.........  Biopsy of         ........  T.......    0004       2.0863       128.41  ...........        25.68
                 thyroid.
60200.........  Remove thyroid    ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 lesion.
60210.........  Partial thyroid   ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 excision.
60212.........  Partial thyroid   ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 excision.
60220.........  Partial removal   ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 of thyroid.
60225.........  Partial removal   ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 of thyroid.
60240.........  Removal of        ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 thyroid.
60252.........  Removal of        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 thyroid.
60260.........  Repeat thyroid    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 surgery.
60280.........  Remove thyroid    ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 duct lesion.
60281.........  Remove thyroid    ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 duct lesion.
60500.........  Explore           ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 parathyroid
                 glands.
60512.........  Autotransplant    ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 parathyroid.
60659.........  Laparo proc,      ........  T.......    0130      31.9353     1,965.65       659.53       393.13
                 endocrine.
60699.........  Endocrine         ........  T.......    0114      37.1283     2,285.28       461.19       457.06
                 surgery
                 procedure.
61000.........  Remove cranial    ........  T.......    0212       3.0383       187.01        65.96        37.40
                 cavity fluid.
61001.........  Remove cranial    ........  T.......    0212       3.0383       187.01        65.96        37.40
                 cavity fluid.
61020.........  Remove brain      ........  T.......    0212       3.0383       187.01        65.96        37.40
                 cavity fluid.
61026.........  Injection into    ........  T.......    0212       3.0383       187.01        65.96        37.40
                 brain canal.
61050.........  Remove brain      ........  T.......    0212       3.0383       187.01        65.96        37.40
                 canal fluid.
61055.........  Injection into    ........  T.......    0212       3.0383       187.01        65.96        37.40
                 brain canal.
61070.........  Brain canal       ........  T.......    0212       3.0383       187.01        65.96        37.40
                 shunt procedure.
61215.........  Insert brain-     ........  T.......    0224      45.6712     2,811.11  ...........       562.22
                 fluid device.
61330.........  Decompress eye    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 socket.
61334.........  Explore orbit/    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 remove object.
61623.........  Endovasc tempory  ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 vessel occl.
61626.........  Transcath         ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 occlusion, non-
                 cns.
61720.........  Incise skull/     CH......  T.......    0221      33.3035     2,049.86       463.62       409.97
                 brain surgery.
61790.........  Treat trigeminal  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
61791.........  Treat trigeminal  ........  T.......    0206       5.5439       341.23        75.55        68.25
                 tract.
61795.........  Brain surgery     ........  S.......    0302       5.5005       338.56       105.94        67.71
                 using computer.
61880.........  Revise/remove     ........  T.......    0687      17.1830     1,057.63       423.05       211.53
                 neuroelectrode.
61885.........  Insrt/redo        ........  S.......    0039     175.9328    10,828.84  ...........     2,165.77
                 neurostim 1
                 array.
61886.........  Implant           ........  T.......    0315     235.5774    14,500.02  ...........     2,900.00
                 neurostim
                 arrays.
61888.........  Revise/remove     ........  T.......    0688      33.9521     2,089.79       835.91       417.96
                 neuroreceiver.
62000.........  Treat skull       CH......  T.......    0254      23.1564     1,425.30       321.35       285.06
                 fracture.
62160.........  Neuroendoscopy    ........  T.......    0122       7.2859       448.45  ...........        89.69
                 add-on.
62194.........  Replace/irrigate  ........  T.......    0427      11.5220       709.19  ...........       141.84
                 catheter.
62225.........  Replace/irrigate  ........  T.......    0427      11.5220       709.19  ...........       141.84
                 catheter.
62230.........  Replace/revise    ........  T.......    0224      45.6712     2,811.11  ...........       562.22
                 brain shunt.
62252.........  Csf shunt         ........  S.......    0691       2.8253       173.90        60.61        34.78
                 reprogram.
62263.........  Epidural lysis    ........  T.......    0203      12.4432       765.89       240.33       153.18
                 mult sessions.
62264.........  Epidural lysis    ........  T.......    0203      12.4432       765.89       240.33       153.18
                 on single day.
62268.........  Drain spinal      ........  T.......    0212       3.0383       187.01        65.96        37.40
                 cord cyst.
62269.........  Needle biopsy,    ........  T.......    0685       6.0729       373.79       115.47        74.76
                 spinal cord.
62270.........  Spinal fluid      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 tap, diagnostic.
62272.........  Drain cerebro     ........  T.......    0204       2.2491       138.43        40.13        27.69
                 spinal fluid.
62273.........  Inject epidural   ........  T.......    0206       5.5439       341.23        75.55        68.25
                 patch.
62280.........  Treat spinal      ........  T.......    0207       6.3788       392.62        86.92        78.52
                 cord lesion.
62281.........  Treat spinal      ........  T.......    0207       6.3788       392.62        86.92        78.52
                 cord lesion.
62282.........  Treat spinal      ........  T.......    0207       6.3788       392.62        86.92        78.52
                 canal lesion.
62284.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 myelogram.
62287.........  Percutaneous      ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 diskectomy.
62290.........  Inject for spine  ........  N.......  ......  ...........  ...........  ...........  ...........
                 disk x-ray.
62291.........  Inject for spine  ........  N.......  ......  ...........  ...........  ...........  ...........
                 disk x-ray.
62292.........  Injection into    ........  T.......    0212       3.0383       187.01        65.96        37.40
                 disk lesion.
62294.........  Injection into    ........  T.......    0212       3.0383       187.01        65.96        37.40
                 spinal artery.
62310.........  Inject spine c/t  ........  T.......    0207       6.3788       392.62        86.92        78.52
62311.........  Inject spine l/s  ........  T.......    0207       6.3788       392.62        86.92        78.52
                 (cd).
62318.........  Inject spine w/   ........  T.......    0207       6.3788       392.62        86.92        78.52
                 cath, c/t.
62319.........  Inject spine w/   ........  T.......    0207       6.3788       392.62        86.92        78.52
                 cath l/s (cd).
62350.........  Implant spinal    ........  T.......    0223      29.2931     1,803.02  ...........       360.60
                 canal cath.
62351.........  Implant spinal    ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 canal cath.
62355.........  Remove spinal     ........  T.......    0203      12.4432       765.89       240.33       153.18
                 canal catheter.

[[Page 49803]]

 
62360.........  Insert spine      ........  T.......    0226     112.0147     6,894.62  ...........     1,378.92
                 infusion device.
62361.........  Implant spine     ........  T.......    0227     183.1974    11,275.98  ...........     2,255.20
                 infusion pump.
62362.........  Implant spine     ........  T.......    0227     183.1974    11,275.98  ...........     2,255.20
                 infusion pump.
62365.........  Remove spine      ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 infusion device.
62367.........  Analyze spine     ........  S.......    0691       2.8253       173.90        60.61        34.78
                 infusion pump.
62368.........  Analyze spine     ........  S.......    0691       2.8253       173.90        60.61        34.78
                 infusion pump.
63001.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63003.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63005.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63011.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63012.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63015.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63016.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63017.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63020.........  Neck spine disk   ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 surgery.
63030.........  Low back disk     ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 surgery.
63035.........  Spinal disk       ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 surgery add-on.
63040.........  Laminotomy,       ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 single cervical.
63042.........  Laminotomy,       ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 single lumbar.
63045.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63046.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63047.........  Removal of        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal lamina.
63048.........  Remove spinal     ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 lamina add-on.
63055.........  Decompress        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal cord.
63056.........  Decompress        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal cord.
63057.........  Decompress spine  ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 cord add-on.
63064.........  Decompress        ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 spinal cord.
63066.........  Decompress spine  ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 cord add-on.
63075.........  Neck spine disk   ........  T.......    0208      43.9030     2,702.27  ...........       540.45
                 surgery.
63600.........  Remove spinal     ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 cord lesion.
63610.........  Stimulation of    ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 spinal cord.
63615.........  Remove lesion of  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 spinal cord.
63650.........  Implant           ........  S.......    0040      56.3855     3,470.58  ...........       694.12
                 neuroelectrodes.
63655.........  Implant           ........  S.......    0061      84.2373     5,184.89  ...........     1,036.98
                 neuroelectrodes.
63660.........  Revise/remove     ........  T.......    0687      17.1830     1,057.63       423.05       211.53
                 neuroelectrode.
63685.........  Insrt/redo spine  ........  T.......    0222     178.1307    10,964.12  ...........     2,192.82
                 n generator.
63688.........  Revise/remove     ........  T.......    0688      33.9521     2,089.79       835.91       417.96
                 neuroreceiver.
63741.........  Install spinal    ........  T.......    0228      36.1603     2,225.70  ...........       445.14
                 shunt.
63744.........  Revision of       ........  T.......    0228      36.1603     2,225.70  ...........       445.14
                 spinal shunt.
63746.........  Removal of        ........  T.......    0109      10.9541       674.24  ...........       134.85
                 spinal shunt.
64400.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 trigeminal.
64402.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 facial.
64405.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 occipital.
64408.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 vagus.
64410.........  N block inj,      ........  T.......    0206       5.5439       341.23        75.55        68.25
                 phrenic.
64412.........  N block inj,      ........  T.......    0206       5.5439       341.23        75.55        68.25
                 spinal accessor.
64413.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 cervical plexus.
64415.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 brachial plexus.
64416.........  N block cont      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 infuse, b plex.
64417.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 axillary.
64418.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 suprascapular.
64420.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 intercost, sng.
64421.........  N block inj,      ........  T.......    0206       5.5439       341.23        75.55        68.25
                 intercost, mlt.
64425.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 ilio-ing/hypogi.
64430.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 pudendal.
64435.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 paracervical.
64445.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 sciatic, sng.
64446.........  N blk inj,        ........  T.......    0206       5.5439       341.23        75.55        68.25
                 sciatic, cont
                 inf.
64447.........  N block inj fem,  ........  T.......    0204       2.2491       138.43        40.13        27.69
                 single.
64448.........  N block inj fem,  ........  T.......    0204       2.2491       138.43        40.13        27.69
                 cont inf.
64449.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 lumbar plexus.
64450.........  N block, other    ........  T.......    0204       2.2491       138.43        40.13        27.69
                 peripheral.
64470.........  Inj               ........  T.......    0207       6.3788       392.62        86.92        78.52
                 paravertebral c/
                 t.
64472.........  Inj               ........  T.......    0206       5.5439       341.23        75.55        68.25
                 paravertebral c/
                 t add-on.
64475.........  Inj               ........  T.......    0207       6.3788       392.62        86.92        78.52
                 paravertebral l/
                 s.
64476.........  Inj               ........  T.......    0206       5.5439       341.23        75.55        68.25
                 paravertebral l/
                 s add-on.
64479.........  Inj foramen       ........  T.......    0207       6.3788       392.62        86.92        78.52
                 epidural c/t.
64480.........  Inj foramen       ........  T.......    0207       6.3788       392.62        86.92        78.52
                 epidural add-on.
64483.........  Inj foramen       ........  T.......    0207       6.3788       392.62        86.92        78.52
                 epidural l/s.
64484.........  Inj foramen       ........  T.......    0207       6.3788       392.62        86.92        78.52
                 epidural add-on.

[[Page 49804]]

 
64505.........  N block,          ........  T.......    0204       2.2491       138.43        40.13        27.69
                 spenopalatine
                 gangl.
64508.........  N block, carotid  ........  T.......    0204       2.2491       138.43        40.13        27.69
                 sinus s/p.
64510.........  N block,          ........  T.......    0207       6.3788       392.62        86.92        78.52
                 stellate
                 ganglion.
64517.........  N block inj,      ........  T.......    0204       2.2491       138.43        40.13        27.69
                 hypogas plxs.
64520.........  N block, lumbar/  ........  T.......    0207       6.3788       392.62        86.92        78.52
                 thoracic.
64530.........  N block inj,      ........  T.......    0207       6.3788       392.62        86.92        78.52
                 celiac pelus.
64553.........  Implant           ........  S.......    0225     234.1628    14,412.95  ...........     2,882.59
                 neuroelectrodes.
64555.........  Implant           ........  S.......    0040      56.3855     3,470.58  ...........       694.12
                 neuroelectrodes.
64560.........  Implant           ........  S.......    0040      56.3855     3,470.58  ...........       694.12
                 neuroelectrodes.
64561.........  Implant           ........  S.......    0040      56.3855     3,470.58  ...........       694.12
                 neuroelectrodes.
64565.........  Implant           ........  S.......    0040      56.3855     3,470.58  ...........       694.12
                 neuroelectrodes.
64573.........  Implant           ........  S.......    0225     234.1628    14,412.95  ...........     2,882.59
                 neuroelectrodes.
64575.........  Implant           ........  S.......    0061      84.2373     5,184.89  ...........     1,036.98
                 neuroelectrodes.
64577.........  Implant           ........  S.......    0061      84.2373     5,184.89  ...........     1,036.98
                 neuroelectrodes.
64580.........  Implant           ........  S.......    0061      84.2373     5,184.89  ...........     1,036.98
                 neuroelectrodes.
64581.........  Implant           ........  S.......    0061      84.2373     5,184.89  ...........     1,036.98
                 neuroelectrodes.
64585.........  Revise/remove     ........  T.......    0687      17.1830     1,057.63       423.05       211.53
                 neuroelectrode.
64590.........  Insrt/redo perph  ........  T.......    0222     178.1307    10,964.12  ...........     2,192.82
                 n generator.
64595.........  Revise/remove     ........  T.......    0688      33.9521     2,089.79       835.91       417.96
                 neuroreceiver.
64600.........  Injection         ........  T.......    0203      12.4432       765.89       240.33       153.18
                 treatment of
                 nerve.
64605.........  Injection         ........  T.......    0203      12.4432       765.89       240.33       153.18
                 treatment of
                 nerve.
64610.........  Injection         ........  T.......    0203      12.4432       765.89       240.33       153.18
                 treatment of
                 nerve.
64612.........  Destroy nerve,    ........  T.......    0204       2.2491       138.43        40.13        27.69
                 face muscle.
64613.........  Destroy nerve,    ........  T.......    0204       2.2491       138.43        40.13        27.69
                 neck muscle.
64614.........  Destroy nerve,    ........  T.......    0204       2.2491       138.43        40.13        27.69
                 extrem musc.
64620.........  Injection         ........  T.......    0203      12.4432       765.89       240.33       153.18
                 treatment of
                 nerve.
64622.........  Destr             ........  T.......    0203      12.4432       765.89       240.33       153.18
                 paravertebrl
                 nerve l/s.
64623.........  Destr             ........  T.......    0207       6.3788       392.62        86.92        78.52
                 paravertebral n
                 add-on.
64626.........  Destr             ........  T.......    0203      12.4432       765.89       240.33       153.18
                 paravertebrl
                 nerve c/t.
64627.........  Destr             ........  T.......    0207       6.3788       392.62        86.92        78.52
                 paravertebral n
                 add-on.
64630.........  Injection         ........  T.......    0206       5.5439       341.23        75.55        68.25
                 treatment of
                 nerve.
64640.........  Injection         ........  T.......    0206       5.5439       341.23        75.55        68.25
                 treatment of
                 nerve.
64650.........  Chemodenerv       ........  T.......    0204       2.2491       138.43        40.13        27.69
                 eccrine glands.
64653.........  Chemodenerv       ........  T.......    0204       2.2491       138.43        40.13        27.69
                 eccrine glands.
64680.........  Injection         ........  T.......    0207       6.3788       392.62        86.92        78.52
                 treatment of
                 nerve.
64681.........  Injection         ........  T.......    0203      12.4432       765.89       240.33       153.18
                 treatment of
                 nerve.
64702.........  Revise finger/    ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 toe nerve.
64704.........  Revise hand/foot  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64708.........  Revise arm/leg    ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64712.........  Revision of       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 sciatic nerve.
64713.........  Revision of arm   ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve(s).
64714.........  Revise low back   ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve(s).
64716.........  Revision of       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 cranial nerve.
64718.........  Revise ulnar      ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve at elbow.
64719.........  Revise ulnar      ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve at wrist.
64721.........  Carpal tunnel     ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 surgery.
64722.........  Relieve pressure  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 on nerve(s).
64726.........  Release foot/toe  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64727.........  Internal nerve    ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 revision.
64732.........  Incision of brow  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64734.........  Incision of       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 cheek nerve.
64736.........  Incision of chin  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64738.........  Incision of jaw   ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64740.........  Incision of       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 tongue nerve.
64742.........  Incision of       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 facial nerve.
64744.........  Incise nerve,     ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 back of head.
64746.........  Incise diaphragm  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64761.........  Incision of       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 pelvis nerve.
64763.........  Incise hip/thigh  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64766.........  Incise hip/thigh  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve.
64771.........  Sever cranial     ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve.
64772.........  Incision of       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 spinal nerve.
64774.........  Remove skin       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve lesion.
64776.........  Remove digit      ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve lesion.
64778.........  Digit nerve       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 surgery add-on.
64782.........  Remove limb       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve lesion.
64783.........  Limb nerve        ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 surgery add-on.
64784.........  Remove nerve      ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 lesion.
64786.........  Remove sciatic    ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve lesion.
64787.........  Implant nerve     ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 end.

[[Page 49805]]

 
64788.........  Remove skin       ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 nerve lesion.
64790.........  Removal of nerve  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 lesion.
64792.........  Removal of nerve  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 lesion.
64795.........  Biopsy of nerve.  ........  T.......    0220      17.7609     1,093.20  ...........       218.64
64802.........  Remove            ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 sympathetic
                 nerves.
64804.........  Remove            CH......  T.......    0220      17.7609     1,093.20  ...........       218.64
                 sympathetic
                 nerves.
64820.........  Remove            ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 sympathetic
                 nerves.
64821.........  Remove            ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 sympathetic
                 nerves.
64822.........  Remove            ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 sympathetic
                 nerves.
64823.........  Remove            ........  T.......    0054      25.8425     1,590.63  ...........       318.13
                 sympathetic
                 nerves.
64831.........  Repair of digit   ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve.
64832.........  Repair nerve add- ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 on.
64834.........  Repair of hand    ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 or foot nerve.
64835.........  Repair of hand    ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 or foot nerve.
64836.........  Repair of hand    ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 or foot nerve.
64837.........  Repair nerve add- ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 on.
64840.........  Repair of leg     ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve.
64856.........  Repair/transpose  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve.
64857.........  Repair arm/leg    ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve.
64858.........  Repair sciatic    ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve.
64859.........  Nerve surgery...  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
64861.........  Repair of arm     ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerves.
64862.........  Repair of low     ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 back nerves.
64864.........  Repair of facial  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve.
64865.........  Repair of facial  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve.
64870.........  Fusion of facial/ ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 other nerve.
64872.........  Subsequent        ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 repair of nerve.
64874.........  Repair&revise     ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 nerve add-on.
64876.........  Repair nerve/     ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 shorten bone.
64885.........  Nerve graft,      ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 head or neck.
64886.........  Nerve graft,      ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 head or neck.
64890.........  Nerve graft,      ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 hand or foot.
64891.........  Nerve graft,      ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 hand or foot.
64892.........  Nerve graft, arm  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 or leg.
64893.........  Nerve graft, arm  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 or leg.
64895.........  Nerve graft,      ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 hand or foot.
64896.........  Nerve graft,      ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 hand or foot.
64897.........  Nerve graft, arm  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 or leg.
64898.........  Nerve graft, arm  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 or leg.
64901.........  Nerve graft add-  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 on.
64902.........  Nerve graft add-  ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 on.
64905.........  Nerve pedicle     ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 transfer.
64907.........  Nerve pedicle     ........  T.......    0221      33.3035     2,049.86       463.62       409.97
                 transfer.
64999.........  Nervous system    ........  T.......    0204       2.2491       138.43        40.13        27.69
                 surgery.
65091.........  Revise eye......  ........  T.......    0242      35.5217     2,186.40       597.36       437.28
65093.........  Revise eye with   CH......  T.......    0242      35.5217     2,186.40       597.36       437.28
                 implant.
65101.........  Removal of eye..  ........  T.......    0242      35.5217     2,186.40       597.36       437.28
65103.........  Remove eye/       ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 insert implant.
65105.........  Remove eye/       ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 attach implant.
65110.........  Removal of eye..  ........  T.......    0242      35.5217     2,186.40       597.36       437.28
65112.........  Remove eye/       ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 revise socket.
65114.........  Remove eye/       ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 revise socket.
65125.........  Revise ocular     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 implant.
65130.........  Insert ocular     ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 implant.
65135.........  Insert ocular     ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 implant.
65140.........  Attach ocular     ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 implant.
65150.........  Revise ocular     ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 implant.
65155.........  Reinsert ocular   ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 implant.
65175.........  Removal of        ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 ocular implant.
65205.........  Remove foreign    ........  S.......    0698       1.2244        75.36        16.52        15.07
                 body from eye.
65210.........  Remove foreign    ........  S.......    0698       1.2244        75.36        16.52        15.07
                 body from eye.
65220.........  Remove foreign    ........  S.......    0698       1.2244        75.36        16.52        15.07
                 body from eye.
65222.........  Remove foreign    ........  S.......    0698       1.2244        75.36        16.52        15.07
                 body from eye.
65235.........  Remove foreign    ........  T.......    0233      14.9969       923.07       266.33       184.61
                 body from eye.
65260.........  Remove foreign    ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 body from eye.
65265.........  Remove foreign    ........  T.......    0237      26.9305     1,657.60  ...........       331.52
                 body from eye.
65270.........  Repair of eye     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 wound.
65272.........  Repair of eye     ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 wound.
65275.........  Repair of eye     ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 wound.
65280.........  Repair of eye     ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 wound.

[[Page 49806]]

 
65285.........  Repair of eye     ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 wound.
65286.........  Repair of eye     ........  T.......    0232       5.9800       368.07        92.21        73.61
                 wound.
65290.........  Repair of eye     ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 socket wound.
65400.........  Removal of eye    ........  T.......    0233      14.9969       923.07       266.33       184.61
                 lesion.
65410.........  Biopsy of cornea  ........  T.......    0233      14.9969       923.07       266.33       184.61
65420.........  Removal of eye    ........  T.......    0233      14.9969       923.07       266.33       184.61
                 lesion.
65426.........  Removal of eye    ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 lesion.
65430.........  Corneal smear...  ........  S.......    0698       1.2244        75.36        16.52        15.07
65435.........  Curette/treat     ........  T.......    0239       6.9354       426.88  ...........        85.38
                 cornea.
65436.........  Curette/treat     ........  T.......    0233      14.9969       923.07       266.33       184.61
                 cornea.
65450.........  Treatment of      ........  S.......    0231       2.1934       135.01  ...........        27.00
                 corneal lesion.
65600.........  Revision of       ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 cornea.
65710.........  Corneal           ........  T.......    0244      37.9446     2,335.53       803.26       467.11
                 transplant.
65730.........  Corneal           ........  T.......    0244      37.9446     2,335.53       803.26       467.11
                 transplant.
65750.........  Corneal           ........  T.......    0244      37.9446     2,335.53       803.26       467.11
                 transplant.
65755.........  Corneal           ........  T.......    0244      37.9446     2,335.53       803.26       467.11
                 transplant.
65770.........  Revise cornea     CH......  T.......    0293      50.6347     3,116.62     1,100.34       623.32
                 with implant.
65772.........  Correction of     ........  T.......    0233      14.9969       923.07       266.33       184.61
                 astigmatism.
65775.........  Correction of     ........  T.......    0233      14.9969       923.07       266.33       184.61
                 astigmatism.
65780.........  Ocular reconst,   ........  T.......    0244      37.9446     2,335.53       803.26       467.11
                 transplant.
65781.........  Ocular reconst,   ........  T.......    0244      37.9446     2,335.53       803.26       467.11
                 transplant.
65782.........  Ocular reconst,   ........  T.......    0244      37.9446     2,335.53       803.26       467.11
                 transplant.
65800.........  Drainage of eye.  ........  T.......    0233      14.9969       923.07       266.33       184.61
65805.........  Drainage of eye.  ........  T.......    0233      14.9969       923.07       266.33       184.61
65810.........  Drainage of eye.  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
65815.........  Drainage of eye.  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
65820.........  Relieve inner     ........  T.......    0232       5.9800       368.07        92.21        73.61
                 eye pressure.
65850.........  Incision of eye.  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
65855.........  Laser surgery of  ........  T.......    0247       5.1266       315.55       104.31        63.11
                 eye.
65860.........  Incise inner eye  ........  T.......    0247       5.1266       315.55       104.31        63.11
                 adhesions.
65865.........  Incise inner eye  ........  T.......    0233      14.9969       923.07       266.33       184.61
                 adhesions.
65870.........  Incise inner eye  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 adhesions.
65875.........  Incise inner eye  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 adhesions.
65880.........  Incise inner eye  ........  T.......    0233      14.9969       923.07       266.33       184.61
                 adhesions.
65900.........  Remove eye        ........  T.......    0233      14.9969       923.07       266.33       184.61
                 lesion.
65920.........  Remove implant    ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 of eye.
65930.........  Remove blood      ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 clot from eye.
66020.........  Injection         ........  T.......    0233      14.9969       923.07       266.33       184.61
                 treatment of
                 eye.
66030.........  Injection         ........  T.......    0232       5.9800       368.07        92.21        73.61
                 treatment of
                 eye.
66130.........  Remove eye        ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 lesion.
66150.........  Glaucoma surgery  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
66155.........  Glaucoma surgery  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
66160.........  Glaucoma surgery  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
66165.........  Glaucoma surgery  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
66170.........  Glaucoma surgery  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
66172.........  Incision of eye.  CH......  T.......    0234      22.9479     1,412.47       511.31       282.49
66180.........  Implant eye       ........  T.......    0673      37.3057     2,296.20       649.56       459.24
                 shunt.
66185.........  Revise eye shunt  ........  T.......    0673      37.3057     2,296.20       649.56       459.24
66220.........  Repair eye        ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 lesion.
66225.........  Repair/graft eye  ........  T.......    0673      37.3057     2,296.20       649.56       459.24
                 lesion.
66250.........  Follow-up         ........  T.......    0233      14.9969       923.07       266.33       184.61
                 surgery of eye.
66500.........  Incision of iris  ........  T.......    0232       5.9800       368.07        92.21        73.61
66505.........  Incision of iris  ........  T.......    0232       5.9800       368.07        92.21        73.61
66600.........  Remove iris and   ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 lesion.
66605.........  Removal of iris.  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
66625.........  Removal of iris.  ........  T.......    0232       5.9800       368.07        92.21        73.61
66630.........  Removal of iris.  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
66635.........  Removal of iris.  ........  T.......    0234      22.9479     1,412.47       511.31       282.49
66680.........  Repair            ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 iris&ciliary
                 body.
66682.........  Repair            ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 iris&ciliary
                 body.
66700.........  Destruction,      ........  T.......    0233      14.9969       923.07       266.33       184.61
                 ciliary body.
66710.........  Ciliary           ........  T.......    0233      14.9969       923.07       266.33       184.61
                 transsleral
                 therapy.
66711.........  Ciliary           ........  T.......    0233      14.9969       923.07       266.33       184.61
                 endoscopic
                 ablation.
66720.........  Destruction,      ........  T.......    0233      14.9969       923.07       266.33       184.61
                 ciliary body.
66740.........  Destruction,      ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 ciliary body.
66761.........  Revision of iris  ........  T.......    0247       5.1266       315.55       104.31        63.11
66762.........  Revision of iris  ........  T.......    0247       5.1266       315.55       104.31        63.11
66770.........  Removal of inner  ........  T.......    0247       5.1266       315.55       104.31        63.11
                 eye lesion.
66820.........  Incision,         ........  T.......    0232       5.9800       368.07        92.21        73.61
                 secondary
                 cataract.
66821.........  After cataract    ........  T.......    0247       5.1266       315.55       104.31        63.11
                 laser surgery.

[[Page 49807]]

 
66825.........  Reposition        ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 intraocular
                 lens.
66830.........  Removal of lens   ........  T.......    0232       5.9800       368.07        92.21        73.61
                 lesion.
66840.........  Removal of lens   ........  T.......    0245      14.5427       895.12       217.05       179.02
                 material.
66850.........  Removal of lens   ........  T.......    0249      28.5043     1,754.47       524.67       350.89
                 material.
66852.........  Removal of lens   ........  T.......    0249      28.5043     1,754.47       524.67       350.89
                 material.
66920.........  Extraction of     ........  T.......    0249      28.5043     1,754.47       524.67       350.89
                 lens.
66930.........  Extraction of     ........  T.......    0249      28.5043     1,754.47       524.67       350.89
                 lens.
66940.........  Extraction of     ........  T.......    0245      14.5427       895.12       217.05       179.02
                 lens.
66982.........  Cataract          ........  T.......    0246      23.5664     1,450.54       495.96       290.11
                 surgery,
                 complex.
66983.........  Cataract surg w/  ........  T.......    0246      23.5664     1,450.54       495.96       290.11
                 iol, 1 stage.
66984.........  Cataract surg w/  ........  T.......    0246      23.5664     1,450.54       495.96       290.11
                 iol, 1 stage.
66985.........  Insert lens       ........  T.......    0246      23.5664     1,450.54       495.96       290.11
                 prosthesis.
66986.........  Exchange lens     ........  T.......    0246      23.5664     1,450.54       495.96       290.11
                 prosthesis.
66990.........  Ophthalmic        ........  N.......  ......  ...........  ...........  ...........  ...........
                 endoscope add-
                 on.
66999.........  Eye surgery       ........  T.......    0232       5.9800       368.07        92.21        73.61
                 procedure.
67005.........  Partial removal   ........  T.......    0237      26.9305     1,657.60  ...........       331.52
                 of eye fluid.
67010.........  Partial removal   ........  T.......    0237      26.9305     1,657.60  ...........       331.52
                 of eye fluid.
67015.........  Release of eye    ........  T.......    0237      26.9305     1,657.60  ...........       331.52
                 fluid.
67025.........  Replace eye       ........  T.......    0237      26.9305     1,657.60  ...........       331.52
                 fluid.
67027.........  Implant eye drug  ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 system.
67028.........  Injection eye     ........  T.......    0235       4.0750       250.82        61.14        50.16
                 drug.
67030.........  Incise inner eye  ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 strands.
67031.........  Laser surgery,    ........  T.......    0247       5.1266       315.55       104.31        63.11
                 eye strands.
67036.........  Removal of inner  ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 eye fluid.
67038.........  Strip retinal     ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 membrane.
67039.........  Laser treatment   ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 of retina.
67040.........  Laser treatment   ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 of retina.
67101.........  Repair detached   ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 retina.
67105.........  Repair detached   ........  T.......    0248       5.0285       309.51        95.08        61.90
                 retina.
67107.........  Repair detached   ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 retina.
67108.........  Repair detached   ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 retina.
67110.........  Repair detached   ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 retina.
67112.........  Rerepair          ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 detached retina.
67115.........  Release           ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 encircling
                 material.
67120.........  Remove eye        ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 implant
                 material.
67121.........  Remove eye        ........  T.......    0237      26.9305     1,657.60  ...........       331.52
                 implant
                 material.
67141.........  Treatment of      ........  T.......    0235       4.0750       250.82        61.14        50.16
                 retina.
67145.........  Treatment of      ........  T.......    0248       5.0285       309.51        95.08        61.90
                 retina.
67208.........  Treatment of      ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 retinal lesion.
67210.........  Treatment of      ........  T.......    0248       5.0285       309.51        95.08        61.90
                 retinal lesion.
67218.........  Treatment of      ........  T.......    0236      16.3433     1,005.95  ...........       201.19
                 retinal lesion.
67220.........  Treatment of      ........  T.......    0235       4.0750       250.82        61.14        50.16
                 choroid lesion.
67221.........  Ocular            ........  T.......    0235       4.0750       250.82        61.14        50.16
                 photodynamic
                 ther.
67225.........  Eye photodynamic  ........  T.......    0235       4.0750       250.82        61.14        50.16
                 ther add-on.
67227.........  Treatment of      CH......  T.......    0237      26.9305     1,657.60  ...........       331.52
                 retinal lesion.
67228.........  Treatment of      ........  T.......    0248       5.0285       309.51        95.08        61.90
                 retinal lesion.
67250.........  Reinforce eye     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 wall.
67255.........  Reinforce/graft   ........  T.......    0237      26.9305     1,657.60  ...........       331.52
                 eye wall.
67299.........  Eye surgery       ........  T.......    0235       4.0750       250.82        61.14        50.16
                 procedure.
67311.........  Revise eye        ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscle.
67312.........  Revise two eye    ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscles.
67314.........  Revise eye        ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscle.
67316.........  Revise two eye    ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscles.
67318.........  Revise eye        ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscle(s).
67320.........  Revise eye        ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscle(s) add-
                 on.
67331.........  Eye surgery       ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 follow-up add-
                 on.
67332.........  Rerevise eye      ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscles add-on.
67334.........  Revise eye        ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscle w/suture.
67335.........  Eye suture        ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 during surgery.
67340.........  Revise eye        ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 muscle add-on.
67343.........  Release eye       ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 tissue.
67345.........  Destroy nerve of  ........  T.......    0238       2.8099       172.95  ...........        34.59
                 eye muscle.
67350.........  Biopsy eye        ........  T.......    0699      13.9509       858.69  ...........       171.74
                 muscle.
67399.........  Eye muscle        ........  T.......    0243      21.2885     1,310.33       431.09       262.07
                 surgery
                 procedure.
67400.........  Explore/biopsy    ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 eye socket.
67405.........  Explore/drain     ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 eye socket.
67412.........  Explore/treat     ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 eye socket.
67413.........  Explore/treat     ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 eye socket.
67414.........  Explr/decompress  ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 eye socket.
67415.........  Aspiration,       ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 orbital
                 contents.

[[Page 49808]]

 
67420.........  Explore/treat     ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 eye socket.
67430.........  Explore/treat     ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 eye socket.
67440.........  Explore/drain     ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 eye socket.
67445.........  Explr/decompress  ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 eye socket.
67450.........  Explore/biopsy    ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 eye socket.
67500.........  Inject/treat eye  ........  S.......    0231       2.1934       135.01  ...........        27.00
                 socket.
67505.........  Inject/treat eye  ........  T.......    0238       2.8099       172.95  ...........        34.59
                 socket.
67515.........  Inject/treat eye  ........  T.......    0238       2.8099       172.95  ...........        34.59
                 socket.
67550.........  Insert eye        ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 socket implant.
67560.........  Revise eye        ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 socket implant.
67570.........  Decompress optic  ........  T.......    0242      35.5217     2,186.40       597.36       437.28
                 nerve.
67599.........  Orbit surgery     ........  T.......    0238       2.8099       172.95  ...........        34.59
                 procedure.
67700.........  Drainage of       ........  T.......    0238       2.8099       172.95  ...........        34.59
                 eyelid abscess.
67710.........  Incision of       ........  T.......    0239       6.9354       426.88  ...........        85.38
                 eyelid.
67715.........  Incision of       ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 eyelid fold.
67800.........  Remove eyelid     ........  T.......    0238       2.8099       172.95  ...........        34.59
                 lesion.
67801.........  Remove eyelid     ........  T.......    0239       6.9354       426.88  ...........        85.38
                 lesions.
67805.........  Remove eyelid     ........  T.......    0238       2.8099       172.95  ...........        34.59
                 lesions.
67808.........  Remove eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 lesion(s).
67810.........  Biopsy of eyelid  ........  T.......    0238       2.8099       172.95  ...........        34.59
67820.........  Revise eyelashes  ........  S.......    0698       1.2244        75.36        16.52        15.07
67825.........  Revise eyelashes  ........  T.......    0238       2.8099       172.95  ...........        34.59
67830.........  Revise eyelashes  ........  T.......    0239       6.9354       426.88  ...........        85.38
67835.........  Revise eyelashes  ........  T.......    0240      17.0126     1,047.14       307.90       209.43
67840.........  Remove eyelid     ........  T.......    0239       6.9354       426.88  ...........        85.38
                 lesion.
67850.........  Treat eyelid      ........  T.......    0239       6.9354       426.88  ...........        85.38
                 lesion.
67875.........  Closure of        ........  T.......    0239       6.9354       426.88  ...........        85.38
                 eyelid by
                 suture.
67880.........  Revision of       ........  T.......    0233      14.9969       923.07       266.33       184.61
                 eyelid.
67882.........  Revision of       ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 eyelid.
67900.........  Repair brow       ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67901.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67902.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67903.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67904.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67906.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67908.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67909.........  Revise eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67911.........  Revise eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67912.........  Correction        ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 eyelid w/
                 implant.
67914.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67915.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67916.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67917.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67921.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67922.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67923.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67924.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 defect.
67930.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 wound.
67935.........  Repair eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 wound.
67938.........  Remove eyelid     ........  S.......    0698       1.2244        75.36        16.52        15.07
                 foreign body.
67950.........  Revision of       ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 eyelid.
67961.........  Revision of       ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 eyelid.
67966.........  Revision of       ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 eyelid.
67971.........  Reconstruction    ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 of eyelid.
67973.........  Reconstruction    ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 of eyelid.
67974.........  Reconstruction    ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 of eyelid.
67975.........  Reconstruction    ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 of eyelid.
67999.........  Revision of       ........  T.......    0238       2.8099       172.95  ...........        34.59
                 eyelid.
68020.........  Incise/drain      ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 eyelid lining.
68040.........  Treatment of      ........  S.......    0698       1.2244        75.36        16.52        15.07
                 eyelid lesions.
68100.........  Biopsy of eyelid  ........  T.......    0232       5.9800       368.07        92.21        73.61
                 lining.
68110.........  Remove eyelid     ........  T.......    0699      13.9509       858.69  ...........       171.74
                 lining lesion.
68115.........  Remove eyelid     ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 lining lesion.
68130.........  Remove eyelid     ........  T.......    0233      14.9969       923.07       266.33       184.61
                 lining lesion.
68135.........  Remove eyelid     ........  T.......    0239       6.9354       426.88  ...........        85.38
                 lining lesion.
68200.........  Treat eyelid by   ........  S.......    0230       0.8126        50.02        14.97        10.00
                 injection.
68320.........  Revise/graft      ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 eyelid lining.
68325.........  Revise/graft      CH......  T.......    0241      24.8502     1,529.55       384.47       305.91
                 eyelid lining.
68326.........  Revise/graft      ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 eyelid lining.
68328.........  Revise/graft      ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 eyelid lining.

[[Page 49809]]

 
68330.........  Revise eyelid     ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 lining.
68335.........  Revise/graft      ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 eyelid lining.
68340.........  Separate eyelid   ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 adhesions.
68360.........  Revise eyelid     ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 lining.
68362.........  Revise eyelid     ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 lining.
68371.........  Harvest eye       ........  T.......    0233      14.9969       923.07       266.33       184.61
                 tissue,
                 alograft.
68399.........  Eyelid lining     ........  T.......    0238       2.8099       172.95  ...........        34.59
                 surgery.
68400.........  Incise/drain      ........  T.......    0238       2.8099       172.95  ...........        34.59
                 tear gland.
68420.........  Incise/drain      ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 tear sac.
68440.........  Incise tear duct  ........  T.......    0238       2.8099       172.95  ...........        34.59
                 opening.
68500.........  Removal of tear   ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 gland.
68505.........  Partial removal,  ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 tear gland.
68510.........  Biopsy of tear    ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 gland.
68520.........  Removal of tear   ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 sac.
68525.........  Biopsy of tear    ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 sac.
68530.........  Clearance of      ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 tear duct.
68540.........  Remove tear       ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 gland lesion.
68550.........  Remove tear       CH......  T.......    0241      24.8502     1,529.55       384.47       305.91
                 gland lesion.
68700.........  Repair tear       ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 ducts.
68705.........  Revise tear duct  ........  T.......    0238       2.8099       172.95  ...........        34.59
                 opening.
68720.........  Create tear sac   CH......  T.......    0241      24.8502     1,529.55       384.47       305.91
                 drain.
68745.........  Create tear duct  ........  T.......    0241      24.8502     1,529.55       384.47       305.91
                 drain.
68750.........  Create tear duct  CH......  T.......    0241      24.8502     1,529.55       384.47       305.91
                 drain.
68760.........  Close tear duct   CH......  S.......    0231       2.1934       135.01  ...........        27.00
                 opening.
68761.........  Close tear duct   ........  S.......    0231       2.1934       135.01  ...........        27.00
                 opening.
68770.........  Close tear        ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 system fistula.
68801.........  Dilate tear duct  ........  S.......    0698       1.2244        75.36        16.52        15.07
                 opening.
68810.........  Probe             ........  S.......    0231       2.1934       135.01  ...........        27.00
                 nasolacrimal
                 duct.
68811.........  Probe             ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 nasolacrimal
                 duct.
68815.........  Probe             ........  T.......    0240      17.0126     1,047.14       307.90       209.43
                 nasolacrimal
                 duct.
68840.........  Explore/irrigate  CH......  S.......    0698       1.2244        75.36        16.52        15.07
                 tear ducts.
68850.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 tear sac x-ray.
68899.........  Tear duct system  CH......  T.......    0238       2.8099       172.95  ...........        34.59
                 surgery.
69000.........  Drain external    ........  T.......    0006       1.4821        91.22        21.76        18.24
                 ear lesion.
69005.........  Drain external    ........  T.......    0008      17.4686     1,075.21  ...........       215.04
                 ear lesion.
69020.........  Drain outer ear   ........  T.......    0006       1.4821        91.22        21.76        18.24
                 canal lesion.
69100.........  Biopsy of         ........  T.......    0019       4.0123       246.96        71.87        49.39
                 external ear.
69105.........  Biopsy of         ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 external ear
                 canal.
69110.........  Remove external   ........  T.......    0021      14.9563       920.58       219.48       184.12
                 ear, partial.
69120.........  Removal of        ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 external ear.
69140.........  Remove ear canal  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 lesion(s).
69145.........  Remove ear canal  ........  T.......    0021      14.9563       920.58       219.48       184.12
                 lesion(s).
69150.........  Extensive ear     ........  T.......    0252       7.7261       475.55       111.84        95.11
                 canal surgery.
69200.........  Clear outer ear   ........  X.......    0340       0.6211        38.23  ...........         7.65
                 canal.
69205.........  Clear outer ear   ........  T.......    0022      19.9760     1,229.54       354.45       245.91
                 canal.
69210.........  Remove impacted   ........  X.......    0340       0.6211        38.23  ...........         7.65
                 ear wax.
69220.........  Clean out         ........  T.......    0012       0.8076        49.71        10.30         9.94
                 mastoid cavity.
69222.........  Clean out         CH......  T.......    0252       7.7261       475.55       111.84        95.11
                 mastoid cavity.
69300.........  Revise external   ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 ear.
69310.........  Rebuild outer     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear canal.
69320.........  Rebuild outer     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear canal.
69399.........  Outer ear         ........  T.......    0251       2.3768       146.29  ...........        29.26
                 surgery
                 procedure.
69400.........  Inflate middle    ........  T.......    0251       2.3768       146.29  ...........        29.26
                 ear canal.
69401.........  Inflate middle    ........  T.......    0251       2.3768       146.29  ...........        29.26
                 ear canal.
69405.........  Catheterize       ........  T.......    0252       7.7261       475.55       111.84        95.11
                 middle ear
                 canal.
69420.........  Incision of       ........  T.......    0251       2.3768       146.29  ...........        29.26
                 eardrum.
69421.........  Incision of       ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 eardrum.
69424.........  Remove            ........  T.......    0252       7.7261       475.55       111.84        95.11
                 ventilating
                 tube.
69433.........  Create eardrum    ........  T.......    0252       7.7261       475.55       111.84        95.11
                 opening.
69436.........  Create eardrum    ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 opening.
69440.........  Exploration of    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 middle ear.
69450.........  Eardrum revision  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
69501.........  Mastoidectomy...  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
69502.........  Mastoidectomy...  ........  T.......    0254      23.1564     1,425.30       321.35       285.06
69505.........  Remove mastoid    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 structures.
69511.........  Extensive         ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 mastoid surgery.
69530.........  Extensive         ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 mastoid surgery.
69540.........  Remove ear        ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 lesion.
69550.........  Remove ear        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 lesion.
69552.........  Remove ear        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 lesion.

[[Page 49810]]

 
69601.........  Mastoid surgery   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 revision.
69602.........  Mastoid surgery   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 revision.
69603.........  Mastoid surgery   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 revision.
69604.........  Mastoid surgery   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 revision.
69605.........  Mastoid surgery   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 revision.
69610.........  Repair of         ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 eardrum.
69620.........  Repair of         ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 eardrum.
69631.........  Repair eardrum    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 structures.
69632.........  Rebuild eardrum   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 structures.
69633.........  Rebuild eardrum   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 structures.
69635.........  Repair eardrum    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 structures.
69636.........  Rebuild eardrum   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 structures.
69637.........  Rebuild eardrum   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 structures.
69641.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear&mastoid.
69642.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear&mastoid.
69643.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear&mastoid.
69644.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear&mastoid.
69645.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear&mastoid.
69646.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear&mastoid.
69650.........  Release middle    ........  T.......    0254      23.1564     1,425.30       321.35       285.06
                 ear bone.
69660.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear bone.
69661.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear bone.
69662.........  Revise middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear bone.
69666.........  Repair middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear structures.
69667.........  Repair middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear structures.
69670.........  Remove mastoid    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 air cells.
69676.........  Remove middle     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear nerve.
69700.........  Close mastoid     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 fistula.
69711.........  Remove/repair     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 hearing aid.
69714.........  Implant temple    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 bone w/stimul.
69715.........  Temple bne        ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 implnt w/
                 stimulat.
69717.........  Temple bone       ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 implant
                 revision.
69718.........  Revise temple     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 bone implant.
69720.........  Release facial    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nerve.
69725.........  Release facial    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nerve.
69740.........  Repair facial     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nerve.
69745.........  Repair facial     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nerve.
69799.........  Middle ear        ........  T.......    0251       2.3768       146.29  ...........        29.26
                 surgery
                 procedure.
69801.........  Incise inner ear  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
69802.........  Incise inner ear  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
69805.........  Explore inner     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear.
69806.........  Explore inner     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear.
69820.........  Establish inner   ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear window.
69840.........  Revise inner ear  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 window.
69905.........  Remove inner ear  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
69910.........  Remove inner      ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear&mastoid.
69915.........  Incise inner ear  ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nerve.
69930.........  Implant cochlear  ........  T.......    0259     406.8232    25,040.37     8,698.43     5,008.07
                 device.
69949.........  Inner ear         ........  T.......    0251       2.3768       146.29  ...........        29.26
                 surgery
                 procedure.
69955.........  Release facial    ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 nerve.
69960.........  Release inner     ........  T.......    0256      37.7719     2,324.90  ...........       464.98
                 ear canal.
69979.........  Temporal bone     ........  T.......    0251       2.3768       146.29  ...........        29.26
                 surgery.
69990.........  Microsurgery add- ........  N.......  ......  ...........  ...........  ...........  ...........
                 on.
70010.........  Contrast x-ray    ........  S.......    0274       2.6182       161.15        64.46        32.23
                 of brain.
70015.........  Contrast x-ray    ........  S.......    0274       2.6182       161.15        64.46        32.23
                 of brain.
70030.........  X-ray eye for     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 foreign body.
70100.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 jaw.
70110.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 jaw.
70120.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 mastoids.
70130.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 mastoids.
70134.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 middle ear.
70140.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 facial bones.
70150.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 facial bones.
70160.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 nasal bones.
70170.........  X-ray exam of     ........  X.......    0264       2.9791       183.37        70.84        36.67
                 tear duct.
70190.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 eye sockets.
70200.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 eye sockets.
70210.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 sinuses.
70220.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 sinuses.
70240.........  X-ray exam,       ........  X.......    0260       0.7276        44.78  ...........         8.96
                 pituitary
                 saddle.

[[Page 49811]]

 
70250.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 skull.
70260.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 skull.
70300.........  X-ray exam of     ........  X.......    0262       0.5818        35.81  ...........         7.16
                 teeth.
70310.........  X-ray exam of     ........  X.......    0262       0.5818        35.81  ...........         7.16
                 teeth.
70320.........  Full mouth x-ray  ........  X.......    0262       0.5818        35.81  ...........         7.16
                 of teeth.
70328.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 jaw joint.
70330.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 jaw joints.
70332.........  X-ray exam of     ........  S.......    0275       3.7021       227.87        69.09        45.57
                 jaw joint.
70336.........  Magnetic image,   ........  S.......    0335       4.6629       287.01       114.80        57.40
                 jaw joint.
70350.........  X-ray head for    ........  X.......    0260       0.7276        44.78  ...........         8.96
                 orthodontia.
70355.........  Panoramic x-ray   ........  X.......    0260       0.7276        44.78  ...........         8.96
                 of jaws.
70360.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 neck.
70370.........  Throat x-         ........  X.......    0272       1.2985        79.92        31.64        15.98
                 ray&fluoroscopy.
70371.........  Speech            ........  X.......    0272       1.2985        79.92        31.64        15.98
                 evaluation,
                 complex.
70373.........  Contrast x-ray    ........  X.......    0263       1.7120       105.38        23.77        21.08
                 of larynx.
70380.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 salivary gland.
70390.........  X-ray exam of     ........  X.......    0263       1.7120       105.38        23.77        21.08
                 salivary duct.
70450.........  Ct head/brain w/  ........  S.......    0332       3.1631       194.69        75.24        38.94
                 o dye.
70460.........  Ct head/brain w/  ........  S.......    0283       4.1858       257.64       102.17        51.53
                 dye.
70470.........  Ct head/brain w/  ........  S.......    0333       5.0020       307.88       121.52        61.58
                 o&w/dye.
70480.........  Ct orbit/ear/     ........  S.......    0332       3.1631       194.69        75.24        38.94
                 fossa w/o dye.
70481.........  Ct orbit/ear/     ........  S.......    0283       4.1858       257.64       102.17        51.53
                 fossa w/dye.
70482.........  Ct orbit/ear/     ........  S.......    0333       5.0020       307.88       121.52        61.58
                 fossa w/o&w/dye.
70486.........  Ct maxillofacial  ........  S.......    0332       3.1631       194.69        75.24        38.94
                 w/o dye.
70487.........  Ct maxillofacial  ........  S.......    0283       4.1858       257.64       102.17        51.53
                 w/dye.
70488.........  Ct maxillofacial  ........  S.......    0333       5.0020       307.88       121.52        61.58
                 w/o&w/dye.
70490.........  Ct soft tissue    ........  S.......    0332       3.1631       194.69        75.24        38.94
                 neck w/o dye.
70491.........  Ct soft tissue    ........  S.......    0283       4.1858       257.64       102.17        51.53
                 neck w/dye.
70492.........  Ct sft tsue nck   ........  S.......    0333       5.0020       307.88       121.52        61.58
                 w/o&w/dye.
70496.........  Ct angiography,   ........  S.......    0662       4.9203       302.85       118.88        60.57
                 head.
70498.........  Ct angiography,   ........  S.......    0662       4.9203       302.85       118.88        60.57
                 neck.
70540.........  Mri orbit/face/   ........  S.......    0336       5.8500       360.07       139.68        72.01
                 neck w/o dye.
70542.........  Mri orbit/face/   ........  S.......    0284       6.2589       385.24       148.40        77.05
                 neck w/dye.
70543.........  Mri orbt/fac/nck  ........  S.......    0337       8.3423       513.48       202.50       102.70
                 w/o&w/dye.
70544.........  Mr angiography    ........  S.......    0336       5.8500       360.07       139.68        72.01
                 head w/o dye.
70545.........  Mr angiography    ........  S.......    0284       6.2589       385.24       148.40        77.05
                 head w/dye.
70546.........  Mr angiograph     ........  S.......    0337       8.3423       513.48       202.50       102.70
                 head w/o&w/dye.
70547.........  Mr angiography    ........  S.......    0336       5.8500       360.07       139.68        72.01
                 neck w/o dye.
70548.........  Mr angiography    ........  S.......    0284       6.2589       385.24       148.40        77.05
                 neck w/dye.
70549.........  Mr angiograph     ........  S.......    0337       8.3423       513.48       202.50       102.70
                 neck w/o&w/dye.
70551.........  Mri brain w/o     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 dye.
70552.........  Mri brain w/dye.  ........  S.......    0284       6.2589       385.24       148.40        77.05
70553.........  Mri brain w/o&w/  ........  S.......    0337       8.3423       513.48       202.50       102.70
                 dye.
70557.........  Mri brain w/o     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 dye.
70558.........  Mri brain w/dye.  ........  S.......    0284       6.2589       385.24       148.40        77.05
70559.........  Mri brain w/o&w/  ........  S.......    0337       8.3423       513.48       202.50       102.70
                 dye.
71010.........  Chest x-ray.....  ........  X.......    0260       0.7276        44.78  ...........         8.96
71015.........  Chest x-ray.....  ........  X.......    0260       0.7276        44.78  ...........         8.96
71020.........  Chest x-ray.....  ........  X.......    0260       0.7276        44.78  ...........         8.96
71021.........  Chest x-ray.....  ........  X.......    0260       0.7276        44.78  ...........         8.96
71022.........  Chest x-ray.....  ........  X.......    0260       0.7276        44.78  ...........         8.96
71023.........  Chest x-ray and   ........  X.......    0272       1.2985        79.92        31.64        15.98
                 fluoroscopy.
71030.........  Chest x-ray.....  ........  X.......    0260       0.7276        44.78  ...........         8.96
71034.........  Chest x-ray and   ........  X.......    0272       1.2985        79.92        31.64        15.98
                 fluoroscopy.
71035.........  Chest x-ray.....  ........  X.......    0260       0.7276        44.78  ...........         8.96
71040.........  Contrast x-ray    ........  X.......    0263       1.7120       105.38        23.77        21.08
                 of bronchi.
71060.........  Contrast x-ray    ........  X.......    0263       1.7120       105.38        23.77        21.08
                 of bronchi.
71090.........  X-ray&pacemaker   ........  X.......    0272       1.2985        79.92        31.64        15.98
                 insertion.
71100.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 ribs.
71101.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 ribs/chest.
71110.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 ribs.
71111.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 ribs/chest.
71120.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 breastbone.
71130.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 breastbone.
71250.........  Ct thorax w/o     ........  S.......    0332       3.1631       194.69        75.24        38.94
                 dye.
71260.........  Ct thorax w/dye.  ........  S.......    0283       4.1858       257.64       102.17        51.53
71270.........  Ct thorax w/o&w/  ........  S.......    0333       5.0020       307.88       121.52        61.58
                 dye.
71275.........  Ct angiography,   ........  S.......    0662       4.9203       302.85       118.88        60.57
                 chest.
71550.........  Mri chest w/o     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 dye.
71551.........  Mri chest w/dye.  ........  S.......    0284       6.2589       385.24       148.40        77.05

[[Page 49812]]

 
71552.........  Mri chest w/o&w/  ........  S.......    0337       8.3423       513.48       202.50       102.70
                 dye.
72010.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 spine.
72020.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 spine.
72040.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 neck spine.
72050.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 neck spine.
72052.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 neck spine.
72069.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 trunk spine.
72070.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 thoracic spine.
72072.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 thoracic spine.
72074.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 thoracic spine.
72080.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 trunk spine.
72090.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 trunk spine.
72100.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 lower spine.
72110.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 lower spine.
72114.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 lower spine.
72120.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 lower spine.
72125.........  Ct neck spine w/  ........  S.......    0332       3.1631       194.69        75.24        38.94
                 o dye.
72126.........  Ct neck spine w/  ........  S.......    0283       4.1858       257.64       102.17        51.53
                 dye.
72127.........  Ct neck spine w/  ........  S.......    0333       5.0020       307.88       121.52        61.58
                 o&w/dye.
72128.........  Ct chest spine w/ ........  S.......    0332       3.1631       194.69        75.24        38.94
                 o dye.
72129.........  Ct chest spine w/ ........  S.......    0283       4.1858       257.64       102.17        51.53
                 dye.
72130.........  Ct chest spine w/ ........  S.......    0333       5.0020       307.88       121.52        61.58
                 o&w/dye.
72131.........  Ct lumbar spine   ........  S.......    0332       3.1631       194.69        75.24        38.94
                 w/o dye.
72132.........  Ct lumbar spine   ........  S.......    0283       4.1858       257.64       102.17        51.53
                 w/dye.
72133.........  Ct lumbar spine   ........  S.......    0333       5.0020       307.88       121.52        61.58
                 w/o&w/dye.
72141.........  Mri neck spine w/ ........  S.......    0336       5.8500       360.07       139.68        72.01
                 o dye.
72142.........  Mri neck spine w/ ........  S.......    0284       6.2589       385.24       148.40        77.05
                 dye.
72146.........  Mri chest spine   ........  S.......    0336       5.8500       360.07       139.68        72.01
                 w/o dye.
72147.........  Mri chest spine   ........  S.......    0284       6.2589       385.24       148.40        77.05
                 w/dye.
72148.........  Mri lumbar spine  ........  S.......    0336       5.8500       360.07       139.68        72.01
                 w/o dye.
72149.........  Mri lumbar spine  ........  S.......    0284       6.2589       385.24       148.40        77.05
                 w/dye.
72156.........  Mri neck spine w/ ........  S.......    0337       8.3423       513.48       202.50       102.70
                 o&w/dye.
72157.........  Mri chest spine   ........  S.......    0337       8.3423       513.48       202.50       102.70
                 w/o&w/dye.
72158.........  Mri lumbar spine  ........  S.......    0337       8.3423       513.48       202.50       102.70
                 w/o&w/dye.
72170.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 pelvis.
72190.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 pelvis.
72191.........  Ct angiograph     ........  S.......    0662       4.9203       302.85       118.88        60.57
                 pelv w/o&w/dye.
72192.........  Ct pelvis w/o     ........  S.......    0332       3.1631       194.69        75.24        38.94
                 dye.
72193.........  Ct pelvis w/dye.  ........  S.......    0283       4.1858       257.64       102.17        51.53
72194.........  Ct pelvis w/o&w/  ........  S.......    0333       5.0020       307.88       121.52        61.58
                 dye.
72195.........  Mri pelvis w/o    ........  S.......    0336       5.8500       360.07       139.68        72.01
                 dye.
72196.........  Mri pelvis w/dye  ........  S.......    0284       6.2589       385.24       148.40        77.05
72197.........  Mri pelvis w/o&w/ ........  S.......    0337       8.3423       513.48       202.50       102.70
                 dye.
72200.........  X-ray exam        ........  X.......    0260       0.7276        44.78  ...........         8.96
                 sacroiliac
                 joints.
72202.........  X-ray exam        ........  X.......    0260       0.7276        44.78  ...........         8.96
                 sacroiliac
                 joints.
72220.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 tailbone.
72240.........  Contrast x-ray    ........  S.......    0274       2.6182       161.15        64.46        32.23
                 of neck spine.
72255.........  Contrast x-ray,   ........  S.......    0274       2.6182       161.15        64.46        32.23
                 thorax spine.
72265.........  Contrast x-ray,   ........  S.......    0274       2.6182       161.15        64.46        32.23
                 lower spine.
72270.........  Contrast x-ray,   ........  S.......    0274       2.6182       161.15        64.46        32.23
                 spine.
72275.........  Epidurography...  ........  S.......    0274       2.6182       161.15        64.46        32.23
72285.........  X-ray c/t spine   ........  S.......    0388      14.2706       878.37       289.72       175.67
                 disk.
72295.........  X-ray of lower    ........  S.......    0388      14.2706       878.37       289.72       175.67
                 spine disk.
73000.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 collar bone.
73010.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 shoulder blade.
73020.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 shoulder.
73030.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 shoulder.
73040.........  Contrast x-ray    ........  S.......    0275       3.7021       227.87        69.09        45.57
                 of shoulder.
73050.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 shoulders.
73060.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 humerus.
73070.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 elbow.
73080.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 elbow.
73085.........  Contrast x-ray    ........  S.......    0275       3.7021       227.87        69.09        45.57
                 of elbow.
73090.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 forearm.
73092.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 arm, infant.
73100.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 wrist.
73110.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 wrist.
73115.........  Contrast x-ray    ........  S.......    0275       3.7021       227.87        69.09        45.57
                 of wrist.
73120.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 hand.
73130.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 hand.

[[Page 49813]]

 
73140.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 finger(s).
73200.........  Ct upper          ........  S.......    0332       3.1631       194.69        75.24        38.94
                 extremity w/o
                 dye.
73201.........  Ct upper          ........  S.......    0283       4.1858       257.64       102.17        51.53
                 extremity w/dye.
73202.........  Ct uppr           ........  S.......    0333       5.0020       307.88       121.52        61.58
                 extremity w/o&w/
                 dye.
73206.........  Ct angio upr      ........  S.......    0662       4.9203       302.85       118.88        60.57
                 extrm w/o&w/dye.
73218.........  Mri upper         ........  S.......    0336       5.8500       360.07       139.68        72.01
                 extremity w/o
                 dye.
73219.........  Mri upper         ........  S.......    0284       6.2589       385.24       148.40        77.05
                 extremity w/dye.
73220.........  Mri uppr          ........  S.......    0337       8.3423       513.48       202.50       102.70
                 extremity w/o&w/
                 dye.
73221.........  Mri joint upr     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 extrem w/o dye.
73222.........  Mri joint upr     ........  S.......    0284       6.2589       385.24       148.40        77.05
                 extrem w/dye.
73223.........  Mri joint upr     ........  S.......    0337       8.3423       513.48       202.50       102.70
                 extr w/o&w/dye.
73500.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 hip.
73510.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 hip.
73520.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 hips.
73525.........  Contrast x-ray    ........  S.......    0275       3.7021       227.87        69.09        45.57
                 of hip.
73530.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 hip.
73540.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 pelvis&hips.
73542.........  X-ray exam,       ........  S.......    0275       3.7021       227.87        69.09        45.57
                 sacroiliac
                 joint.
73550.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 thigh.
73560.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 knee, 1 or 2.
73562.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 knee, 3.
73564.........  X-ray exam,       ........  X.......    0260       0.7276        44.78  ...........         8.96
                 knee, 4 or more.
73565.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 knees.
73580.........  Contrast x-ray    ........  S.......    0275       3.7021       227.87        69.09        45.57
                 of knee joint.
73590.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 lower leg.
73592.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 leg, infant.
73600.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 ankle.
73610.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 ankle.
73615.........  Contrast x-ray    ........  S.......    0275       3.7021       227.87        69.09        45.57
                 of ankle.
73620.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 foot.
73630.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 foot.
73650.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 heel.
73660.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 toe(s).
73700.........  Ct lower          ........  S.......    0332       3.1631       194.69        75.24        38.94
                 extremity w/o
                 dye.
73701.........  Ct lower          ........  S.......    0283       4.1858       257.64       102.17        51.53
                 extremity w/dye.
73702.........  Ct lwr extremity  ........  S.......    0333       5.0020       307.88       121.52        61.58
                 w/o&w/dye.
73706.........  Ct angio lwr      ........  S.......    0662       4.9203       302.85       118.88        60.57
                 extr w/o&w/dye.
73718.........  Mri lower         ........  S.......    0336       5.8500       360.07       139.68        72.01
                 extremity w/o
                 dye.
73719.........  Mri lower         ........  S.......    0284       6.2589       385.24       148.40        77.05
                 extremity w/dye.
73720.........  Mri lwr           ........  S.......    0337       8.3423       513.48       202.50       102.70
                 extremity w/o&w/
                 dye.
73721.........  Mri jnt of lwr    ........  S.......    0336       5.8500       360.07       139.68        72.01
                 extre w/o dye.
73722.........  Mri joint of lwr  ........  S.......    0284       6.2589       385.24       148.40        77.05
                 extr w/dye.
73723.........  Mri joint lwr     ........  S.......    0337       8.3423       513.48       202.50       102.70
                 extr w/o&w/dye.
74000.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 abdomen.
74010.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 abdomen.
74020.........  X-ray exam of     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 abdomen.
74022.........  X-ray exam        ........  X.......    0261       1.2515        77.03  ...........        15.41
                 series, abdomen.
74150.........  Ct abdomen w/o    ........  S.......    0332       3.1631       194.69        75.24        38.94
                 dye.
74160.........  Ct abdomen w/dye  ........  S.......    0283       4.1858       257.64       102.17        51.53
74170.........  Ct abdomen w/o&w/ ........  S.......    0333       5.0020       307.88       121.52        61.58
                 dye.
74175.........  Ct angio abdom w/ ........  S.......    0662       4.9203       302.85       118.88        60.57
                 o&w/dye.
74181.........  Mri abdomen w/o   ........  S.......    0336       5.8500       360.07       139.68        72.01
                 dye.
74182.........  Mri abdomen w/    ........  S.......    0284       6.2589       385.24       148.40        77.05
                 dye.
74183.........  Mri abdomen w/    ........  S.......    0337       8.3423       513.48       202.50       102.70
                 o&w/dye.
74190.........  X-ray exam of     ........  X.......    0264       2.9791       183.37        70.84        36.67
                 peritoneum.
74210.........  Contrst x-ray     ........  S.......    0276       1.4519        89.37        34.97        17.87
                 exam of throat.
74220.........  Contrast x-ray,   ........  S.......    0276       1.4519        89.37        34.97        17.87
                 esophagus.
74230.........  Cine/vid x-ray,   ........  S.......    0276       1.4519        89.37        34.97        17.87
                 throat/esoph.
74235.........  Remove esophagus  CH......  S.......    0257       0.9770        60.14  ...........        12.03
                 obstruction.
74240.........  X-ray exam,       ........  S.......    0276       1.4519        89.37        34.97        17.87
                 upper gi tract.
74241.........  X-ray exam,       ........  S.......    0276       1.4519        89.37        34.97        17.87
                 upper gi tract.
74245.........  X-ray exam,       ........  S.......    0277       2.2764       140.11        54.63        28.02
                 upper gi tract.
74246.........  Contrst x-ray     ........  S.......    0276       1.4519        89.37        34.97        17.87
                 uppr gi tract.
74247.........  Contrst x-ray     ........  S.......    0276       1.4519        89.37        34.97        17.87
                 uppr gi tract.
74249.........  Contrst x-ray     ........  S.......    0277       2.2764       140.11        54.63        28.02
                 uppr gi tract.
74250.........  X-ray exam of     ........  S.......    0276       1.4519        89.37        34.97        17.87
                 small bowel.
74251.........  X-ray exam of     ........  S.......    0277       2.2764       140.11        54.63        28.02
                 small bowel.
74260.........  X-ray exam of     CH......  S.......    0276       1.4519        89.37        34.97        17.87
                 small bowel.
74270.........  Contrast x-ray    ........  S.......    0276       1.4519        89.37        34.97        17.87
                 exam of colon.
74280.........  Contrast x-ray    ........  S.......    0277       2.2764       140.11        54.63        28.02
                 exam of colon.

[[Page 49814]]

 
74283.........  Contrast x-ray    ........  S.......    0276       1.4519        89.37        34.97        17.87
                 exam of colon.
74290.........  Contrast x-ray,   ........  S.......    0276       1.4519        89.37        34.97        17.87
                 gallbladder.
74291.........  Contrast x-rays,  ........  S.......    0276       1.4519        89.37        34.97        17.87
                 gallbladder.
74300.........  X-ray bile ducts/ ........  X.......    0263       1.7120       105.38        23.77        21.08
                 pancreas.
74301.........  X-rays at         ........  X.......    0263       1.7120       105.38        23.77        21.08
                 surgery add-on.
74305.........  X-ray bile ducts/ ........  X.......    0263       1.7120       105.38        23.77        21.08
                 pancreas.
74320.........  Contrast x-ray    ........  X.......    0264       2.9791       183.37        70.84        36.67
                 of bile ducts.
74327.........  X-ray bile stone  ........  S.......    0296       2.7106       166.84        53.99        33.37
                 removal.
74328.........  X-ray bile duct   ........  N.......  ......  ...........  ...........  ...........  ...........
                 endoscopy.
74329.........  X-ray for         ........  N.......  ......  ...........  ...........  ...........  ...........
                 pancreas
                 endoscopy.
74330.........  X-ray bile/panc   ........  N.......  ......  ...........  ...........  ...........  ...........
                 endoscopy.
74340.........  X-ray guide for   ........  X.......    0272       1.2985        79.92        31.64        15.98
                 GI tube.
74350.........  X-ray guide,      ........  X.......    0263       1.7120       105.38        23.77        21.08
                 stomach tube.
74355.........  X-ray guide,      ........  X.......    0263       1.7120       105.38        23.77        21.08
                 intestinal tube.
74360.........  X-ray guide, GI   CH......  S.......    0257       0.9770        60.14  ...........        12.03
                 dilation.
74363.........  X-ray, bile duct  ........  S.......    0297       3.6483       224.56        89.82        44.91
                 dilation.
74400.........  Contrst x-ray,    ........  S.......    0278       2.4721       152.16        60.84        30.43
                 urinary tract.
74410.........  Contrst x-ray,    ........  S.......    0278       2.4721       152.16        60.84        30.43
                 urinary tract.
74415.........  Contrst x-ray,    ........  S.......    0278       2.4721       152.16        60.84        30.43
                 urinary tract.
74420.........  Contrst x-ray,    ........  S.......    0278       2.4721       152.16        60.84        30.43
                 urinary tract.
74425.........  Contrst x-ray,    ........  S.......    0278       2.4721       152.16        60.84        30.43
                 urinary tract.
74430.........  Contrast x-ray,   ........  S.......    0278       2.4721       152.16        60.84        30.43
                 bladder.
74440.........  X-ray, male       ........  S.......    0278       2.4721       152.16        60.84        30.43
                 genital tract.
74445.........  X-ray exam of     ........  S.......    0278       2.4721       152.16        60.84        30.43
                 penis.
74450.........  X-ray, urethra/   ........  S.......    0278       2.4721       152.16        60.84        30.43
                 bladder.
74455.........  X-ray, urethra/   ........  S.......    0278       2.4721       152.16        60.84        30.43
                 bladder.
74470.........  X-ray exam of     ........  X.......    0263       1.7120       105.38        23.77        21.08
                 kidney lesion.
74475.........  X-ray control,    ........  S.......    0297       3.6483       224.56        89.82        44.91
                 cath insert.
74480.........  X-ray control,    ........  S.......    0296       2.7106       166.84        53.99        33.37
                 cath insert.
74485.........  X-ray guide, GU   ........  S.......    0296       2.7106       166.84        53.99        33.37
                 dilation.
74710.........  X-ray             ........  X.......    0261       1.2515        77.03  ...........        15.41
                 measurement of
                 pelvis.
74740.........  X-ray, female     ........  X.......    0264       2.9791       183.37        70.84        36.67
                 genital tract.
74742.........  X-ray, fallopian  ........  X.......    0264       2.9791       183.37        70.84        36.67
                 tube.
74775.........  X-ray exam of     ........  S.......    0278       2.4721       152.16        60.84        30.43
                 perineum.
75552.........  Heart mri for     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 morph w/o dye.
75553.........  Heart mri for     ........  S.......    0284       6.2589       385.24       148.40        77.05
                 morph w/dye.
75554.........  Cardiac MRI/      ........  S.......    0336       5.8500       360.07       139.68        72.01
                 function.
75555.........  Cardiac MRI/      ........  S.......    0336       5.8500       360.07       139.68        72.01
                 limited study.
75600.........  Contrast x-ray    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 exam of aorta.
75605.........  Contrast x-ray    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 exam of aorta.
75625.........  Contrast x-ray    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 exam of aorta.
75630.........  X-ray aorta, leg  ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 arteries.
75635.........  Ct angio          ........  S.......    0662       4.9203       302.85       118.88        60.57
                 abdominal
                 arteries.
75650.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 head&neck.
75658.........  Artery x-rays,    ........  S.......    0279       9.6539       594.21       150.03       118.84
                 arm.
75660.........  Artery x-rays,    ........  S.......    0668       6.3684       391.98        88.26        78.40
                 head&neck.
75662.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 head&neck.
75665.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 head&neck.
75671.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 head&neck.
75676.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 neck.
75680.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 neck.
75685.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 spine.
75705.........  Artery x-rays,    ........  S.......    0668       6.3684       391.98        88.26        78.40
                 spine.
75710.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 arm/leg.
75716.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 arms/legs.
75722.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 kidney.
75724.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 kidneys.
75726.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 abdomen.
75731.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 adrenal gland.
75733.........  Artery x-rays,    ........  S.......    0668       6.3684       391.98        88.26        78.40
                 adrenals.
75736.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 pelvis.
75741.........  Artery x-rays,    ........  S.......    0279       9.6539       594.21       150.03       118.84
                 lung.
75743.........  Artery x-rays,    ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 lungs.
75746.........  Artery x-rays,    ........  S.......    0279       9.6539       594.21       150.03       118.84
                 lung.
75756.........  Artery x-rays,    ........  S.......    0279       9.6539       594.21       150.03       118.84
                 chest.
75774.........  Artery x-ray,     ........  S.......    0279       9.6539       594.21       150.03       118.84
                 each vessel.
75790.........  Visualize A-V     ........  S.......    0279       9.6539       594.21       150.03       118.84
                 shunt.
75801.........  Lymph vessel x-   ........  X.......    0264       2.9791       183.37        70.84        36.67
                 ray, arm/leg.
75803.........  Lymph vessel x-   ........  X.......    0264       2.9791       183.37        70.84        36.67
                 ray,arms/legs.
75805.........  Lymph vessel x-   ........  X.......    0264       2.9791       183.37        70.84        36.67
                 ray, trunk.

[[Page 49815]]

 
75807.........  Lymph vessel x-   ........  X.......    0264       2.9791       183.37        70.84        36.67
                 ray, trunk.
75809.........  Nonvascular       ........  X.......    0263       1.7120       105.38        23.77        21.08
                 shunt, x-ray.
75810.........  Vein x-ray,       ........  S.......    0279       9.6539       594.21       150.03       118.84
                 spleen/liver.
75820.........  Vein x-ray, arm/  ........  S.......    0668       6.3684       391.98        88.26        78.40
                 leg.
75822.........  Vein x-ray, arms/ ........  S.......    0668       6.3684       391.98        88.26        78.40
                 legs.
75825.........  Vein x-ray,       ........  S.......    0279       9.6539       594.21       150.03       118.84
                 trunk.
75827.........  Vein x-ray,       ........  S.......    0279       9.6539       594.21       150.03       118.84
                 chest.
75831.........  Vein x-ray,       ........  S.......    0279       9.6539       594.21       150.03       118.84
                 kidney.
75833.........  Vein x-ray,       ........  S.......    0279       9.6539       594.21       150.03       118.84
                 kidneys.
75840.........  Vein x-ray,       ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 adrenal gland.
75842.........  Vein x-ray,       ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 adrenal glands.
75860.........  Vein x-ray, neck  ........  S.......    0668       6.3684       391.98        88.26        78.40
75870.........  Vein x-ray,       ........  S.......    0668       6.3684       391.98        88.26        78.40
                 skull.
75872.........  Vein x-ray,       ........  S.......    0279       9.6539       594.21       150.03       118.84
                 skull.
75880.........  Vein x-ray, eye   ........  S.......    0668       6.3684       391.98        88.26        78.40
                 socket.
75885.........  Vein x-ray,       ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 liver.
75887.........  Vein x-ray,       ........  S.......    0279       9.6539       594.21       150.03       118.84
                 liver.
75889.........  Vein x-ray,       ........  S.......    0280      20.9479     1,289.36       353.85       257.87
                 liver.
75891.........  Vein x-ray,       ........  S.......    0279       9.6539       594.21       150.03       118.84
                 liver.
75893.........  Venous sampling   CH......  Q.......    0668       6.3684       391.98        88.26        78.40
                 by catheter.
75894.........  X-rays,           CH......  S.......    0298       8.4904       522.59       209.02       104.52
                 transcath
                 therapy.
75896.........  X-rays,           CH......  S.......    0298       8.4904       522.59       209.02       104.52
                 transcath
                 therapy.
75898.........  Follow-up         ........  X.......    0263       1.7120       105.38        23.77        21.08
                 angiography.
75901.........  Remove cva        ........  X.......    0263       1.7120       105.38        23.77        21.08
                 device obstruct.
75902.........  Remove cva lumen  ........  X.......    0263       1.7120       105.38        23.77        21.08
                 obstruct.
75940.........  X-ray placement,  CH......  S.......    0298       8.4904       522.59       209.02       104.52
                 vein filter.
75945.........  Intravascular us  ........  S.......    0267       2.5166       154.90        60.80        30.98
75946.........  Intravascular us  ........  S.......    0266       1.5947        98.16        37.80        19.63
                 add-on.
75960.........  Transcath iv      ........  S.......    0668       6.3684       391.98        88.26        78.40
                 stent rs&i.
75961.........  Retrieval,        ........  S.......    0668       6.3684       391.98        88.26        78.40
                 broken catheter.
75962.........  Repair arterial   ........  S.......    0668       6.3684       391.98        88.26        78.40
                 blockage.
75964.........  Repair artery     ........  S.......    0668       6.3684       391.98        88.26        78.40
                 blockage, each.
75966.........  Repair arterial   ........  S.......    0668       6.3684       391.98        88.26        78.40
                 blockage.
75968.........  Repair artery     ........  S.......    0668       6.3684       391.98        88.26        78.40
                 blockage, each.
75970.........  Vascular biopsy.  ........  S.......    0668       6.3684       391.98        88.26        78.40
75978.........  Repair venous     ........  S.......    0668       6.3684       391.98        88.26        78.40
                 blockage.
75980.........  Contrast xray     ........  S.......    0297       3.6483       224.56        89.82        44.91
                 exam bile duct.
75982.........  Contrast xray     ........  S.......    0297       3.6483       224.56        89.82        44.91
                 exam bile duct.
75984.........  Xray control      ........  X.......    0263       1.7120       105.38        23.77        21.08
                 catheter change.
75989.........  Abscess drainage  ........  N.......  ......  ...........  ...........  ...........  ...........
                 under x-ray.
75992.........  Atherectomy, x-   CH......  S.......    0668       6.3684       391.98        88.26        78.40
                 ray exam.
75993.........  Atherectomy, x-   CH......  S.......    0668       6.3684       391.98        88.26        78.40
                 ray exam.
75994.........  Atherectomy, x-   CH......  S.......    0668       6.3684       391.98        88.26        78.40
                 ray exam.
75995.........  Atherectomy, x-   CH......  S.......    0668       6.3684       391.98        88.26        78.40
                 ray exam.
75996.........  Atherectomy, x-   CH......  S.......    0668       6.3684       391.98        88.26        78.40
                 ray exam.
75998.........  Fluoroguide for   ........  N.......  ......  ...........  ...........  ...........  ...........
                 vein device.
76000.........  Fluoroscope       ........  X.......    0272       1.2985        79.92        31.64        15.98
                 examination.
76001.........  Fluoroscope       ........  N.......  ......  ...........  ...........  ...........  ...........
                 exam, extensive.
76003.........  Needle            ........  N.......  ......  ...........  ...........  ...........  ...........
                 localization by
                 x-ray.
76005.........  Fluoroguide for   ........  N.......  ......  ...........  ...........  ...........  ...........
                 spine inject.
76006.........  X-ray stress      ........  X.......    0260       0.7276        44.78  ...........         8.96
                 view.
76010.........  X-ray, nose to    ........  X.......    0260       0.7276        44.78  ...........         8.96
                 rectum.
76012.........  Percut            ........  S.......    0274       2.6182       161.15        64.46        32.23
                 vertebroplasty
                 fluor.
76013.........  Percut            ........  S.......    0274       2.6182       161.15        64.46        32.23
                 vertebroplasty,
                 ct.
76020.........  X-rays for bone   ........  X.......    0260       0.7276        44.78  ...........         8.96
                 age.
76040.........  X-rays, bone      CH......  X.......    0260       0.7276        44.78  ...........         8.96
                 evaluation.
76061.........  X-rays, bone      ........  X.......    0261       1.2515        77.03  ...........        15.41
                 survey.
76062.........  X-rays, bone      ........  X.......    0261       1.2515        77.03  ...........        15.41
                 survey.
76065.........  X-rays, bone      CH......  X.......    0260       0.7276        44.78  ...........         8.96
                 evaluation.
76066.........  Joint survey,     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 single view.
76070.........  Ct bone density,  ........  S.......    0288       1.2005        73.89  ...........        14.78
                 axial.
76071.........  Ct bone density,  ........  S.......    0282       1.5552        95.72        37.92        19.14
                 peripheral.
76075.........  Dxa bone          ........  S.......    0288       1.2005        73.89  ...........        14.78
                 density, axial.
76076.........  Dxa bone density/ ........  S.......    0665       0.5569        34.28  ...........         6.86
                 peripheral.
76077.........  Dxa bone density/ ........  X.......    0260       0.7276        44.78  ...........         8.96
                 v-fracture.
76078.........  Radiographic      CH......  X.......    0261       1.2515        77.03  ...........        15.41
                 absorptiometry.
76080.........  X-ray exam of     ........  X.......    0263       1.7120       105.38        23.77        21.08
                 fistula.
76086.........  X-ray of mammary  ........  X.......    0263       1.7120       105.38        23.77        21.08
                 duct.
76088.........  X-ray of mammary  ........  X.......    0263       1.7120       105.38        23.77        21.08
                 ducts.
76095.........  Stereotactic      ........  X.......    0264       2.9791       183.37        70.84        36.67
                 breast biopsy.

[[Page 49816]]

 
76096.........  X-ray of needle   ........  X.......    0263       1.7120       105.38        23.77        21.08
                 wire, breast.
76098.........  X-ray exam,       ........  X.......    0260       0.7276        44.78  ...........         8.96
                 breast specimen.
76100.........  X-ray exam of     ........  X.......    0261       1.2515        77.03  ...........        15.41
                 body section.
76101.........  Complex body      ........  X.......    0263       1.7120       105.38        23.77        21.08
                 section x-ray.
76102.........  Complex body      ........  X.......    0264       2.9791       183.37        70.84        36.67
                 section x-rays.
76120.........  Cine/video x-     ........  X.......    0272       1.2985        79.92        31.64        15.98
                 rays.
76125.........  Cine/video x-     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 rays add-on.
76150.........  X-ray exam, dry   ........  X.......    0260       0.7276        44.78  ...........         8.96
                 process.
76350.........  Special x-ray     ........  N.......  ......  ...........  ...........  ...........  ...........
                 contrast study.
76355.........  Ct scan for       ........  S.......    0283       4.1858       257.64       102.17        51.53
                 localization.
76360.........  Ct scan for       ........  S.......    0283       4.1858       257.64       102.17        51.53
                 needle biopsy.
76362.........  Ct guide for      ........  S.......    0333       5.0020       307.88       121.52        61.58
                 tissue ablation.
76370.........  Ct scan for       ........  S.......    0282       1.5552        95.72        37.92        19.14
                 therapy guide.
76376.........  3d render w/o     ........  X.......    0340       0.6211        38.23  ...........         7.65
                 postprocess.
76377.........  3d rendering w/   ........  S.......    0282       1.5552        95.72        37.92        19.14
                 postprocess.
76380.........  CAT scan follow-  ........  S.......    0282       1.5552        95.72        37.92        19.14
                 up study.
76393.........  Mr guidance for   ........  S.......    0335       4.6629       287.01       114.80        57.40
                 needle place.
76394.........  Mri for tissue    ........  S.......    0335       4.6629       287.01       114.80        57.40
                 ablation.
76400.........  Magnetic image,   ........  S.......    0335       4.6629       287.01       114.80        57.40
                 bone marrow.
76496.........  Fluoroscopic      ........  X.......    0272       1.2985        79.92        31.64        15.98
                 procedure.
76497.........  Ct procedure....  ........  S.......    0282       1.5552        95.72        37.92        19.14
76498.........  Mri procedure...  ........  S.......    0335       4.6629       287.01       114.80        57.40
76499.........  Radiographic      ........  X.......    0260       0.7276        44.78  ...........         8.96
                 procedure.
76506.........  Echo exam of      ........  S.......    0265       1.0145        62.44        23.63        12.49
                 head.
76510.........  Ophth us,         ........  S.......    0266       1.5947        98.16        37.80        19.63
                 b&quant a.
76511.........  Ophth us, quant   ........  S.......    0266       1.5947        98.16        37.80        19.63
                 a only.
76512.........  Ophth us, b w/    ........  S.......    0266       1.5947        98.16        37.80        19.63
                 non-quant a.
76513.........  Echo exam of      ........  S.......    0266       1.5947        98.16        37.80        19.63
                 eye, water bath.
76514.........  Echo exam of      ........  X.......    0340       0.6211        38.23  ...........         7.65
                 eye, thickness.
76516.........  Echo exam of eye  ........  S.......    0265       1.0145        62.44        23.63        12.49
76519.........  Echo exam of eye  ........  S.......    0266       1.5947        98.16        37.80        19.63
76529.........  Echo exam of eye  ........  S.......    0265       1.0145        62.44        23.63        12.49
76536.........  Us exam of head   ........  S.......    0266       1.5947        98.16        37.80        19.63
                 and neck.
76604.........  Us exam, chest,   CH......  S.......    0265       1.0145        62.44        23.63        12.49
                 b-scan.
76645.........  Us exam,          ........  S.......    0265       1.0145        62.44        23.63        12.49
                 breast(s).
76700.........  Us exam, abdom,   ........  S.......    0266       1.5947        98.16        37.80        19.63
                 complete.
76705.........  Echo exam of      ........  S.......    0266       1.5947        98.16        37.80        19.63
                 abdomen.
76770.........  Us exam abdo      ........  S.......    0266       1.5947        98.16        37.80        19.63
                 back wall, comp.
76775.........  Us exam abdo      ........  S.......    0266       1.5947        98.16        37.80        19.63
                 back wall, lim.
76778.........  Us exam kidney    ........  S.......    0266       1.5947        98.16        37.80        19.63
                 transplant.
76800.........  Us exam, spinal   ........  S.......    0266       1.5947        98.16        37.80        19.63
                 canal.
76801.........  Ob us < 14 wks,   ........  S.......    0266       1.5947        98.16        37.80        19.63
                 single fetus.
76802.........  Ob us < 14 wks,   ........  S.......    0265       1.0145        62.44        23.63        12.49
                 add'l fetus.
76805.........  Ob us >/= 14      ........  S.......    0266       1.5947        98.16        37.80        19.63
                 wks, sngl fetus.
76810.........  Ob us >/= 14      ........  S.......    0266       1.5947        98.16        37.80        19.63
                 wks, addl fetus.
76811.........  Ob us, detailed,  ........  S.......    0267       2.5166       154.90        60.80        30.98
                 sngl fetus.
76812.........  Ob us, detailed,  CH......  S.......    0265       1.0145        62.44        23.63        12.49
                 addl fetus.
76815.........  Ob us, limited,   ........  S.......    0265       1.0145        62.44        23.63        12.49
                 fetus(s).
76816.........  Ob us, follow-    ........  S.......    0265       1.0145        62.44        23.63        12.49
                 up, per fetus.
76817.........  Transvaginal us,  CH......  S.......    0265       1.0145        62.44        23.63        12.49
                 obstetric.
76818.........  Fetal biophys     ........  S.......    0266       1.5947        98.16        37.80        19.63
                 profile w/nst.
76819.........  Fetal biophys     ........  S.......    0266       1.5947        98.16        37.80        19.63
                 profil w/o nst.
76820.........  Umbilical artery  ........  S.......    0096       1.5727        96.80        38.13        19.36
                 echo.
76821.........  Middle cerebral   ........  S.......    0096       1.5727        96.80        38.13        19.36
                 artery echo.
76825.........  Echo exam of      CH......  S.......    0697       1.6002        98.49        35.99        19.70
                 fetal heart.
76826.........  Echo exam of      ........  S.......    0697       1.6002        98.49        35.99        19.70
                 fetal heart.
76827.........  Echo exam of      CH......  S.......    0697       1.6002        98.49        35.99        19.70
                 fetal heart.
76828.........  Echo exam of      ........  S.......    0697       1.6002        98.49        35.99        19.70
                 fetal heart.
76830.........  Transvaginal us,  ........  S.......    0266       1.5947        98.16        37.80        19.63
                 non-ob.
76831.........  Echo exam,        ........  S.......    0267       2.5166       154.90        60.80        30.98
                 uterus.
76856.........  Us exam, pelvic,  ........  S.......    0266       1.5947        98.16        37.80        19.63
                 complete.
76857.........  Us exam, pelvic,  ........  S.......    0265       1.0145        62.44        23.63        12.49
                 limited.
76870.........  Us exam, scrotum  ........  S.......    0266       1.5947        98.16        37.80        19.63
76872.........  Us, transrectal.  ........  S.......    0266       1.5947        98.16        37.80        19.63
76873.........  Echograp trans    ........  S.......    0266       1.5947        98.16        37.80        19.63
                 r, pros study.
76880.........  Us exam,          ........  S.......    0266       1.5947        98.16        37.80        19.63
                 extremity.
76885.........  Us exam infant    ........  S.......    0265       1.0145        62.44        23.63        12.49
                 hips, dynamic.
76886.........  Us exam infant    CH......  S.......    0265       1.0145        62.44        23.63        12.49
                 hips, static.
76930.........  Echo guide,       ........  S.......    0268       1.1967        73.66  ...........        14.73
                 cardiocentesis.
76932.........  Echo guide for    CH......  S.......    0309       2.1284       131.01  ...........        26.20
                 heart biopsy.

[[Page 49817]]

 
76936.........  Echo guide for    CH......  S.......    0309       2.1284       131.01  ...........        26.20
                 artery repair.
76937.........  Us guide,         ........  N.......  ......  ...........  ...........  ...........  ...........
                 vascular access.
76940.........  Us guide, tissue  ........  S.......    0268       1.1967        73.66  ...........        14.73
                 ablation.
76941.........  Echo guide for    ........  S.......    0268       1.1967        73.66  ...........        14.73
                 transfusion.
76942.........  Echo guide for    ........  S.......    0268       1.1967        73.66  ...........        14.73
                 biopsy.
76945.........  Echo guide,       ........  S.......    0268       1.1967        73.66  ...........        14.73
                 villus sampling.
76946.........  Echo guide for    ........  S.......    0268       1.1967        73.66  ...........        14.73
                 amniocentesis.
76948.........  Echo guide, ova   CH......  S.......    0309       2.1284       131.01  ...........        26.20
                 aspiration.
76950.........  Echo guidance     ........  S.......    0268       1.1967        73.66  ...........        14.73
                 radiotherapy.
76965.........  Echo guidance     CH......  S.......    0309       2.1284       131.01  ...........        26.20
                 radiotherapy.
76970.........  Ultrasound exam   ........  S.......    0265       1.0145        62.44        23.63        12.49
                 follow-up.
76975.........  GI endoscopic     ........  S.......    0266       1.5947        98.16        37.80        19.63
                 ultrasound.
76977.........  Us bone density   ........  X.......    0340       0.6211        38.23  ...........         7.65
                 measure.
76986.........  Ultrasound guide  ........  S.......    0266       1.5947        98.16        37.80        19.63
                 intraoper.
76999.........  Echo examination  ........  S.......    0265       1.0145        62.44        23.63        12.49
                 procedure.
77280.........  Set radiation     ........  X.......    0304       1.6062        98.86        39.54        19.77
                 therapy field.
77285.........  Set radiation     ........  X.......    0305       4.0232       247.63        91.38        49.53
                 therapy field.
77290.........  Set radiation     ........  X.......    0305       4.0232       247.63        91.38        49.53
                 therapy field.
77295.........  Set radiation     ........  X.......    0310      14.0578       865.27       325.27       173.05
                 therapy field.
77299.........  Radiation         ........  X.......    0304       1.6062        98.86        39.54        19.77
                 therapy
                 planning.
77300.........  Radiation         ........  X.......    0304       1.6062        98.86        39.54        19.77
                 therapy dose
                 plan.
77301.........  Radiotherapy      ........  X.......    0310      14.0578       865.27       325.27       173.05
                 dose plan, imrt.
77305.........  Teletx isodose    ........  X.......    0304       1.6062        98.86        39.54        19.77
                 plan simple.
77310.........  Teletx isodose    ........  X.......    0305       4.0232       247.63        91.38        49.53
                 plan intermed.
77315.........  Teletx isodose    ........  X.......    0305       4.0232       247.63        91.38        49.53
                 plan complex.
77321.........  Special teletx    ........  X.......    0305       4.0232       247.63        91.38        49.53
                 port plan.
77326.........  Brachytx isodose  ........  X.......    0304       1.6062        98.86        39.54        19.77
                 calc simp.
77327.........  Brachytx isodose  ........  X.......    0305       4.0232       247.63        91.38        49.53
                 calc interm.
77328.........  Brachytx isodose  ........  X.......    0305       4.0232       247.63        91.38        49.53
                 plan compl.
77331.........  Special           ........  X.......    0304       1.6062        98.86        39.54        19.77
                 radiation
                 dosimetry.
77332.........  Radiation         ........  X.......    0303       2.9637       182.42        66.95        36.48
                 treatment
                 aid(s).
77333.........  Radiation         ........  X.......    0303       2.9637       182.42        66.95        36.48
                 treatment
                 aid(s).
77334.........  Radiation         ........  X.......    0303       2.9637       182.42        66.95        36.48
                 treatment
                 aid(s).
77336.........  Radiation         ........  X.......    0304       1.6062        98.86        39.54        19.77
                 physics consult.
77370.........  Radiation         ........  X.......    0304       1.6062        98.86        39.54        19.77
                 physics consult.
77399.........  External          ........  X.......    0304       1.6062        98.86        39.54        19.77
                 radiation
                 dosimetry.
77401.........  Radiation         ........  S.......    0300       1.5004        92.35  ...........        18.47
                 treatment
                 delivery.
77402.........  Radiation         ........  S.......    0300       1.5004        92.35  ...........        18.47
                 treatment
                 delivery.
77403.........  Radiation         ........  S.......    0300       1.5004        92.35  ...........        18.47
                 treatment
                 delivery.
77404.........  Radiation         ........  S.......    0300       1.5004        92.35  ...........        18.47
                 treatment
                 delivery.
77406.........  Radiation         ........  S.......    0300       1.5004        92.35  ...........        18.47
                 treatment
                 delivery.
77407.........  Radiation         ........  S.......    0300       1.5004        92.35  ...........        18.47
                 treatment
                 delivery.
77408.........  Radiation         ........  S.......    0300       1.5004        92.35  ...........        18.47
                 treatment
                 delivery.
77409.........  Radiation         ........  S.......    0300       1.5004        92.35  ...........        18.47
                 treatment
                 delivery.
77411.........  Radiation         ........  S.......    0301       2.2670       139.54  ...........        27.91
                 treatment
                 delivery.
77412.........  Radiation         ........  S.......    0301       2.2670       139.54  ...........        27.91
                 treatment
                 delivery.
77413.........  Radiation         ........  S.......    0301       2.2670       139.54  ...........        27.91
                 treatment
                 delivery.
77414.........  Radiation         ........  S.......    0301       2.2670       139.54  ...........        27.91
                 treatment
                 delivery.
77416.........  Radiation         ........  S.......    0301       2.2670       139.54  ...........        27.91
                 treatment
                 delivery.
77417.........  Radiology port    ........  X.......    0260       0.7276        44.78  ...........         8.96
                 film(s).
77418.........  Radiation tx      ........  S.......    0412       5.5021       338.66  ...........        67.73
                 delivery, imrt.
77421.........  Stereoscopic x-   CH......  S.......    0257       0.9770        60.14  ...........        12.03
                 ray guidance.
77422.........  Neutron beam tx,  ........  S.......    0301       2.2670       139.54  ...........        27.91
                 simple.
77423.........  Neutron beam tx,  ........  S.......    0301       2.2670       139.54  ...........        27.91
                 complex.
77470.........  Special           ........  S.......    0299       6.0322       371.29  ...........        74.26
                 radiation
                 treatment.
77520.........  Proton trmt,      ........  S.......    0664      18.4698     1,136.83  ...........       227.37
                 simple w/o comp.
77522.........  Proton trmt,      ........  S.......    0664      18.4698     1,136.83  ...........       227.37
                 simple w/comp.
77523.........  Proton trmt,      ........  S.......    0667      22.0972     1,360.10  ...........       272.02
                 intermediate.
77525.........  Proton            ........  S.......    0667      22.0972     1,360.10  ...........       272.02
                 treatment,
                 complex.
77600.........  Hyperthermia      ........  S.......    0314       3.6583       225.17        66.65        45.03
                 treatment.
77605.........  Hyperthermia      ........  S.......    0314       3.6583       225.17        66.65        45.03
                 treatment.
77610.........  Hyperthermia      ........  S.......    0314       3.6583       225.17        66.65        45.03
                 treatment.
77615.........  Hyperthermia      ........  S.......    0314       3.6583       225.17        66.65        45.03
                 treatment.
77620.........  Hyperthermia      ........  S.......    0314       3.6583       225.17        66.65        45.03
                 treatment.
77750.........  Infuse            ........  S.......    0301       2.2670       139.54  ...........        27.91
                 radioactive
                 materials.
77761.........  Apply intrcav     ........  S.......    0312       5.0185       308.89  ...........        61.78
                 radiat simple.
77762.........  Apply intrcav     ........  S.......    0312       5.0185       308.89  ...........        61.78
                 radiat interm.
77763.........  Apply intrcav     ........  S.......    0312       5.0185       308.89  ...........        61.78
                 radiat compl.
77776.........  Apply interstit   ........  S.......    0312       5.0185       308.89  ...........        61.78
                 radiat simpl.
77777.........  Apply interstit   ........  S.......    0312       5.0185       308.89  ...........        61.78
                 radiat inter.

[[Page 49818]]

 
77778.........  Apply interstit   ........  S.......    0651      16.6585     1,025.35  ...........       205.07
                 radiat compl.
77781.........  High intensity    ........  S.......    0313      13.3939       824.41  ...........       164.88
                 brachytherapy.
77782.........  High intensity    ........  S.......    0313      13.3939       824.41  ...........       164.88
                 brachytherapy.
77783.........  High intensity    ........  S.......    0313      13.3939       824.41  ...........       164.88
                 brachytherapy.
77784.........  High intensity    ........  S.......    0313      13.3939       824.41  ...........       164.88
                 brachytherapy.
77789.........  Apply surface     ........  S.......    0300       1.5004        92.35  ...........        18.47
                 radiation.
77790.........  Radiation         ........  N.......  ......  ...........  ...........  ...........  ...........
                 handling.
77799.........  Radium/           CH......  S.......    0312       5.0185       308.89  ...........        61.78
                 radioisotope
                 therapy.
78000.........  Thyroid, single   ........  S.......    0389       1.4072        86.61        33.98        17.32
                 uptake.
78001.........  Thyroid,          ........  S.......    0389       1.4072        86.61        33.98        17.32
                 multiple
                 uptakes.
78003.........  Thyroid suppress/ ........  S.......    0392       2.0849       128.33        51.33        25.67
                 stimul.
78006.........  Thyroid imaging   ........  S.......    0390       2.3732       146.07        58.42        29.21
                 with uptake.
78007.........  Thyroid image,    ........  S.......    0391       2.7556       169.61        66.18        33.92
                 mult uptakes.
78010.........  Thyroid imaging.  ........  S.......    0390       2.3732       146.07        58.42        29.21
78011.........  Thyroid imaging   ........  S.......    0390       2.3732       146.07        58.42        29.21
                 with flow.
78015.........  Thyroid met       ........  S.......    0406       3.9386       242.42        96.96        48.48
                 imaging.
78016.........  Thyroid met       ........  S.......    0406       3.9386       242.42        96.96        48.48
                 imaging/studies.
78018.........  Thyroid met       ........  S.......    0406       3.9386       242.42        96.96        48.48
                 imaging, body.
78020.........  Thyroid met       ........  S.......    0399       1.5282        94.06        35.80        18.81
                 uptake.
78070.........  Parathyroid       ........  S.......    0391       2.7556       169.61        66.18        33.92
                 nuclear imaging.
78075.........  Adrenal nuclear   ........  S.......    0391       2.7556       169.61        66.18        33.92
                 imaging.
78099.........  Endocrine         ........  S.......    0390       2.3732       146.07        58.42        29.21
                 nuclear
                 procedure.
78102.........  Bone marrow       ........  S.......    0400       3.9304       241.92        93.22        48.38
                 imaging, ltd.
78103.........  Bone marrow       ........  S.......    0400       3.9304       241.92        93.22        48.38
                 imaging, mult.
78104.........  Bone marrow       ........  S.......    0400       3.9304       241.92        93.22        48.38
                 imaging, body.
78110.........  Plasma volume,    ........  S.......    0393       3.5902       220.98        82.04        44.20
                 single.
78111.........  Plasma volume,    ........  S.......    0393       3.5902       220.98        82.04        44.20
                 multiple.
78120.........  Red cell mass,    ........  S.......    0393       3.5902       220.98        82.04        44.20
                 single.
78121.........  Red cell mass,    ........  S.......    0393       3.5902       220.98        82.04        44.20
                 multiple.
78122.........  Blood volume....  ........  S.......    0393       3.5902       220.98        82.04        44.20
78130.........  Red cell          ........  S.......    0393       3.5902       220.98        82.04        44.20
                 survival study.
78135.........  Red cell          ........  S.......    0393       3.5902       220.98        82.04        44.20
                 survival
                 kinetics.
78140.........  Red cell          ........  S.......    0393       3.5902       220.98        82.04        44.20
                 sequestration.
78185.........  Spleen imaging..  ........  S.......    0400       3.9304       241.92        93.22        48.38
78190.........  Platelet          ........  S.......    0392       2.0849       128.33        51.33        25.67
                 survival,
                 kinetics.
78191.........  Platelet          ........  S.......    0392       2.0849       128.33        51.33        25.67
                 survival.
78195.........  Lymph system      ........  S.......    0400       3.9304       241.92        93.22        48.38
                 imaging.
78199.........  Blood/lymph       ........  S.......    0400       3.9304       241.92        93.22        48.38
                 nuclear exam.
78201.........  Liver imaging...  ........  S.......    0394       4.4705       275.16       102.61        55.03
78202.........  Liver imaging     ........  S.......    0394       4.4705       275.16       102.61        55.03
                 with flow.
78205.........  Liver imaging     ........  S.......    0394       4.4705       275.16       102.61        55.03
                 (3D).
78206.........  Liver image (3d)  ........  S.......    0394       4.4705       275.16       102.61        55.03
                 with flow.
78215.........  Liver and spleen  ........  S.......    0394       4.4705       275.16       102.61        55.03
                 imaging.
78216.........  Liver&spleen      ........  S.......    0394       4.4705       275.16       102.61        55.03
                 image/flow.
78220.........  Liver function    ........  S.......    0394       4.4705       275.16       102.61        55.03
                 study.
78223.........  Hepatobiliary     ........  S.......    0394       4.4705       275.16       102.61        55.03
                 imaging.
78230.........  Salivary gland    ........  S.......    0395       3.6937       227.35        89.73        45.47
                 imaging.
78231.........  Serial salivary   ........  S.......    0395       3.6937       227.35        89.73        45.47
                 imaging.
78232.........  Salivary gland    ........  S.......    0395       3.6937       227.35        89.73        45.47
                 function exam.
78258.........  Esophageal        ........  S.......    0395       3.6937       227.35        89.73        45.47
                 motility study.
78261.........  Gastric mucosa    ........  S.......    0395       3.6937       227.35        89.73        45.47
                 imaging.
78262.........  Gastroesophageal  ........  S.......    0395       3.6937       227.35        89.73        45.47
                 reflux exam.
78264.........  Gastric emptying  ........  S.......    0395       3.6937       227.35        89.73        45.47
                 study.
78270.........  Vit B-12          ........  S.......    0392       2.0849       128.33        51.33        25.67
                 absorption exam.
78271.........  Vit b-12 absrp    ........  S.......    0392       2.0849       128.33        51.33        25.67
                 exam, int fac.
78272.........  Vit B-12 absorp,  ........  S.......    0392       2.0849       128.33        51.33        25.67
                 combined.
78278.........  Acute GI blood    ........  S.......    0395       3.6937       227.35        89.73        45.47
                 loss imaging.
78282.........  GI protein loss   ........  S.......    0395       3.6937       227.35        89.73        45.47
                 exam.
78290.........  Meckel's divert   ........  S.......    0395       3.6937       227.35        89.73        45.47
                 exam.
78291.........  Leveen/shunt      ........  S.......    0395       3.6937       227.35        89.73        45.47
                 patency exam.
78299.........  GI nuclear        ........  S.......    0395       3.6937       227.35        89.73        45.47
                 procedure.
78300.........  Bone imaging,     ........  S.......    0396       4.0166       247.23        95.02        49.45
                 limited area.
78305.........  Bone imaging,     ........  S.......    0396       4.0166       247.23        95.02        49.45
                 multiple areas.
78306.........  Bone imaging,     ........  S.......    0396       4.0166       247.23        95.02        49.45
                 whole body.
78315.........  Bone imaging, 3   ........  S.......    0396       4.0166       247.23        95.02        49.45
                 phase.
78320.........  Bone imaging      ........  S.......    0396       4.0166       247.23        95.02        49.45
                 (3D).
78350.........  Bone mineral,     ........  X.......    0260       0.7276        44.78  ...........         8.96
                 single photon.
78399.........  Musculoskeletal   ........  S.......    0396       4.0166       247.23        95.02        49.45
                 nuclear exam.
78414.........  Non-imaging       ........  S.......    0398       4.2511       261.66       100.06        52.33
                 heart function.
78428.........  Cardiac shunt     ........  S.......    0398       4.2511       261.66       100.06        52.33
                 imaging.

[[Page 49819]]

 
78445.........  Vascular flow     ........  S.......    0397       2.2521       138.62        49.58        27.72
                 imaging.
78456.........  Acute venous      ........  S.......    0397       2.2521       138.62        49.58        27.72
                 thrombus image.
78457.........  Venous            ........  S.......    0397       2.2521       138.62        49.58        27.72
                 thrombosis
                 imaging.
78458.........  Ven thrombosis    ........  S.......    0397       2.2521       138.62        49.58        27.72
                 images, bilat.
78459.........  Heart muscle      CH......  S.......    0307      11.6773       718.75       287.49       143.75
                 imaging (PET).
78460.........  Heart muscle      ........  S.......    0398       4.2511       261.66       100.06        52.33
                 blood, single.
78461.........  Heart muscle      ........  S.......    0377       6.7443       415.12       158.84        83.02
                 blood, multiple.
78464.........  Heart image       ........  S.......    0398       4.2511       261.66       100.06        52.33
                 (3d), single.
78465.........  Heart image       ........  S.......    0377       6.7443       415.12       158.84        83.02
                 (3d), multiple.
78466.........  Heart infarct     ........  S.......    0398       4.2511       261.66       100.06        52.33
                 image.
78468.........  Heart infarct     ........  S.......    0398       4.2511       261.66       100.06        52.33
                 image (ef).
78469.........  Heart infarct     ........  S.......    0398       4.2511       261.66       100.06        52.33
                 image (3D).
78472.........  Gated heart,      ........  S.......    0398       4.2511       261.66       100.06        52.33
                 planar, single.
78473.........  Gated heart,      ........  S.......    0376       4.9770       306.34       119.77        61.27
                 multiple.
78478.........  Heart wall        ........  S.......    0399       1.5282        94.06        35.80        18.81
                 motion add-on.
78480.........  Heart function    ........  S.......    0399       1.5282        94.06        35.80        18.81
                 add-on.
78481.........  Heart first       ........  S.......    0398       4.2511       261.66       100.06        52.33
                 pass, single.
78483.........  Heart first       ........  S.......    0376       4.9770       306.34       119.77        61.27
                 pass, multiple.
78491.........  Heart image       CH......  S.......    0307      11.6773       718.75       287.49       143.75
                 (pet), single.
78492.........  Heart image       ........  S.......    0307      11.6773       718.75       287.49       143.75
                 (pet), multiple.
78494.........  Heart image,      ........  S.......    0398       4.2511       261.66       100.06        52.33
                 spect.
78496.........  Heart first pass  ........  S.......    0399       1.5282        94.06        35.80        18.81
                 add-on.
78499.........  Cardiovascular    ........  S.......    0398       4.2511       261.66       100.06        52.33
                 nuclear exam.
78580.........  Lung perfusion    ........  S.......    0401       3.2013       197.04        78.81        39.41
                 imaging.
78584.........  Lung V/Q image    ........  S.......    0378       5.2084       320.58       128.23        64.12
                 single breath.
78585.........  Lung V/Q imaging  ........  S.......    0378       5.2084       320.58       128.23        64.12
78586.........  Aerosol lung      ........  S.......    0401       3.2013       197.04        78.81        39.41
                 image, single.
78587.........  Aerosol lung      ........  S.......    0401       3.2013       197.04        78.81        39.41
                 image, multiple.
78588.........  Perfusion lung    ........  S.......    0378       5.2084       320.58       128.23        64.12
                 image.
78591.........  Vent image, 1     ........  S.......    0401       3.2013       197.04        78.81        39.41
                 breath, 1 proj.
78593.........  Vent image, 1     ........  S.......    0401       3.2013       197.04        78.81        39.41
                 proj, gas.
78594.........  Vent image, mult  ........  S.......    0401       3.2013       197.04        78.81        39.41
                 proj, gas.
78596.........  Lung              ........  S.......    0378       5.2084       320.58       128.23        64.12
                 differential
                 function.
78599.........  Respiratory       ........  S.......    0401       3.2013       197.04        78.81        39.41
                 nuclear exam.
78600.........  Brain imaging,    ........  S.......    0402       4.8596       299.11       119.64        59.82
                 ltd static.
78601.........  Brain imaging,    ........  S.......    0402       4.8596       299.11       119.64        59.82
                 ltd w/flow.
78605.........  Brain imaging,    ........  S.......    0402       4.8596       299.11       119.64        59.82
                 complete.
78606.........  Brain imaging,    ........  S.......    0402       4.8596       299.11       119.64        59.82
                 compl w/flow.
78607.........  Brain imaging     ........  S.......    0402       4.8596       299.11       119.64        59.82
                 (3D).
78608.........  Brain imaging     CH......  S.......    0308      14.0093       862.29  ...........       172.46
                 (PET).
78610.........  Brain flow        ........  S.......    0402       4.8596       299.11       119.64        59.82
                 imaging only.
78615.........  Cerebral          ........  S.......    0402       4.8596       299.11       119.64        59.82
                 vascular flow
                 image.
78630.........  Cerebrospinal     ........  S.......    0403       3.4867       214.61        83.35        42.92
                 fluid scan.
78635.........  CSF               ........  S.......    0403       3.4867       214.61        83.35        42.92
                 ventriculograph
                 y.
78645.........  CSF shunt         ........  S.......    0403       3.4867       214.61        83.35        42.92
                 evaluation.
78647.........  Cerebrospinal     ........  S.......    0403       3.4867       214.61        83.35        42.92
                 fluid scan.
78650.........  CSF leakage       ........  S.......    0403       3.4867       214.61        83.35        42.92
                 imaging.
78660.........  Nuclear exam of   ........  S.......    0403       3.4867       214.61        83.35        42.92
                 tear flow.
78699.........  Nervous system    ........  S.......    0402       4.8596       299.11       119.64        59.82
                 nuclear exam.
78700.........  Kidney imaging,   ........  S.......    0404       3.4235       210.72        84.28        42.14
                 static.
78701.........  Kidney imaging    ........  S.......    0404       3.4235       210.72        84.28        42.14
                 with flow.
78704.........  Imaging renogram  ........  S.......    0404       3.4235       210.72        84.28        42.14
78707.........  Kidney flow/      ........  S.......    0404       3.4235       210.72        84.28        42.14
                 function image.
78708.........  Kidney flow/      ........  S.......    0405       4.1056       252.70        98.77        50.54
                 function image.
78709.........  Kidney flow/      ........  S.......    0405       4.1056       252.70        98.77        50.54
                 function image.
78710.........  Kidney imaging    ........  S.......    0404       3.4235       210.72        84.28        42.14
                 (3D).
78715.........  Renal vascular    ........  S.......    0404       3.4235       210.72        84.28        42.14
                 flow exam.
78725.........  Kidney function   ........  S.......    0389       1.4072        86.61        33.98        17.32
                 study.
78730.........  Urinary bladder   ........  X.......    0340       0.6211        38.23  ...........         7.65
                 retention.
78740.........  Ureteral reflux   ........  S.......    0404       3.4235       210.72        84.28        42.14
                 study.
78760.........  Testicular        ........  S.......    0404       3.4235       210.72        84.28        42.14
                 imaging.
78761.........  Testicular        ........  S.......    0404       3.4235       210.72        84.28        42.14
                 imaging/flow.
78799.........  Genitourinary     ........  S.......    0404       3.4235       210.72        84.28        42.14
                 nuclear exam.
78800.........  Tumor imaging,    ........  S.......    0406       3.9386       242.42        96.96        48.48
                 limited area.
78801.........  Tumor imaging,    ........  S.......    0406       3.9386       242.42        96.96        48.48
                 mult areas.
78802.........  Tumor imaging,    ........  S.......    0406       3.9386       242.42        96.96        48.48
                 whole body.
78803.........  Tumor imaging     ........  S.......    0406       3.9386       242.42        96.96        48.48
                 (3D).
78804.........  Tumor imaging,    CH......  S.......    0408       4.9998       307.74  ...........        61.55
                 whole body.
78805.........  Abscess imaging,  ........  S.......    0406       3.9386       242.42        96.96        48.48
                 ltd area.
78806.........  Abscess imaging,  CH......  S.......    0408       4.9998       307.74  ...........        61.55
                 whole body.

[[Page 49820]]

 
78807.........  Nuclear           ........  S.......    0406       3.9386       242.42        96.96        48.48
                 localization/
                 abscess.
78811.........  Tumor imaging     CH......  S.......    0308      14.0093       862.29  ...........       172.46
                 (pet), limited.
78812.........  Tumor image       CH......  S.......    0308      14.0093       862.29  ...........       172.46
                 (pet)/skul-
                 thigh.
78813.........  Tumor image       CH......  S.......    0308      14.0093       862.29  ...........       172.46
                 (pet) full body.
78814.........  Tumor image pet/  CH......  S.......    0308      14.0093       862.29  ...........       172.46
                 ct, limited.
78815.........  Tumorimage pet/   CH......  S.......    0308      14.0093       862.29  ...........       172.46
                 ct skul-thigh.
78816.........  Tumor image pet/  CH......  S.......    0308      14.0093       862.29  ...........       172.46
                 ct full body.
78890.........  Nuclear medicine  ........  N.......  ......  ...........  ...........  ...........  ...........
                 data proc.
78891.........  Nuclear med data  ........  N.......  ......  ...........  ...........  ...........  ...........
                 proc.
78999.........  Nuclear           ........  S.......    0389       1.4072        86.61        33.98        17.32
                 diagnostic exam.
79005.........  Nuclear rx, oral  ........  S.......    0407       3.1506       193.92        77.56        38.78
                 admin.
79101.........  Nuclear rx, iv    ........  S.......    0407       3.1506       193.92        77.56        38.78
                 admin.
79200.........  Nuclear rx,       CH......  S.......    0413       5.1026       314.07  ...........        62.81
                 intracav admin.
79300.........  Nuclr rx,         ........  S.......    0407       3.1506       193.92        77.56        38.78
                 interstit
                 colloid.
79403.........  Hematopoietic     CH......  S.......    0413       5.1026       314.07  ...........        62.81
                 nuclear tx.
79440.........  Nuclear rx,       CH......  S.......    0413       5.1026       314.07  ...........        62.81
                 intra-articular.
79445.........  Nuclear rx,       ........  S.......    0407       3.1506       193.92        77.56        38.78
                 intra-arterial.
79999.........  Nuclear medicine  ........  S.......    0407       3.1506       193.92        77.56        38.78
                 therapy.
80103.........  Drug analysis,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 tissue prep.
80500.........  Lab pathology     ........  X.......    0433       0.2571        15.82         5.93         3.16
                 consultation.
80502.........  Lab pathology     ........  X.......    0342       0.0813         5.00         2.00         1.00
                 consultation.
85097.........  Bone marrow       ........  X.......    0343       0.5309        32.68        10.84         6.54
                 interpretation.
85396.........  Clotting assay,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 whole blood.
86077.........  Physician blood   ........  X.......    0433       0.2571        15.82         5.93         3.16
                 bank service.
86078.........  Physician blood   ........  X.......    0343       0.5309        32.68        10.84         6.54
                 bank service.
86079.........  Physician blood   ........  X.......    0433       0.2571        15.82         5.93         3.16
                 bank service.
86485.........  Skin test,        ........  X.......    0341       0.0914         5.63         2.25         1.13
                 candida.
86490.........  Coccidioidomycos  ........  X.......    0341       0.0914         5.63         2.25         1.13
                 is skin test.
86510.........  Histoplasmosis    ........  X.......    0341       0.0914         5.63         2.25         1.13
                 skin test.
86580.........  TB intradermal    ........  X.......    0341       0.0914         5.63         2.25         1.13
                 test.
86850.........  RBC antibody      ........  X.......    0345       0.2218        13.65         2.87         2.73
                 screen.
86860.........  RBC antibody      ........  X.......    0346       0.3494        21.51         4.39         4.30
                 elution.
86870.........  RBC antibody      ........  X.......    0346       0.3494        21.51         4.39         4.30
                 identification.
86880.........  Coombs test,      ........  X.......    0409       0.1237         7.61         2.20         1.52
                 direct.
86885.........  Coombs test,      ........  X.......    0409       0.1237         7.61         2.20         1.52
                 indirect, qual.
86886.........  Coombs test,      ........  X.......    0409       0.1237         7.61         2.20         1.52
                 indirect, titer.
86890.........  Autologous blood  ........  X.......    0347       0.7394        45.51        11.24         9.10
                 process.
86891.........  Autologous        ........  X.......    0346       0.3494        21.51         4.39         4.30
                 blood, op
                 salvage.
86900.........  Blood typing,     ........  X.......    0409       0.1237         7.61         2.20         1.52
                 ABO.
86901.........  Blood typing, Rh  ........  X.......    0409       0.1237         7.61         2.20         1.52
                 (D).
86903.........  Blood typing,     ........  X.......    0345       0.2218        13.65         2.87         2.73
                 antigen screen.
86904.........  Blood typing,     ........  X.......    0346       0.3494        21.51         4.39         4.30
                 patient serum.
86905.........  Blood typing,     ........  X.......    0345       0.2218        13.65         2.87         2.73
                 RBC antigens.
86906.........  Blood typing, Rh  ........  X.......    0345       0.2218        13.65         2.87         2.73
                 phenotype.
86920.........  Compatibility     ........  X.......    0346       0.3494        21.51         4.39         4.30
                 test, spin.
86921.........  Compatibility     ........  X.......    0345       0.2218        13.65         2.87         2.73
                 test, incubate.
86922.........  Compatibility     ........  X.......    0346       0.3494        21.51         4.39         4.30
                 test, antiglob.
86923.........  Compatibility     ........  X.......    0345       0.2218        13.65         2.87         2.73
                 test, electric.
86927.........  Plasma, fresh     ........  X.......    0345       0.2218        13.65         2.87         2.73
                 frozen.
86930.........  Frozen blood      ........  X.......    0347       0.7394        45.51        11.24         9.10
                 prep.
86931.........  Frozen blood      ........  X.......    0347       0.7394        45.51        11.24         9.10
                 thaw.
86932.........  Frozen blood      ........  X.......    0347       0.7394        45.51        11.24         9.10
                 freeze/thaw.
86945.........  Blood product/    ........  X.......    0345       0.2218        13.65         2.87         2.73
                 irradiation.
86950.........  Leukacyte         ........  X.......    0345       0.2218        13.65         2.87         2.73
                 transfusion.
86960.........  Vol reduction of  ........  X.......    0345       0.2218        13.65         2.87         2.73
                 blood/prod.
86965.........  Pooling blood     CH......  X.......    0346       0.3494        21.51         4.39         4.30
                 platelets.
86970.........  RBC pretreatment  ........  X.......    0345       0.2218        13.65         2.87         2.73
86971.........  RBC pretreatment  ........  X.......    0345       0.2218        13.65         2.87         2.73
86972.........  RBC pretreatment  ........  X.......    0346       0.3494        21.51         4.39         4.30
86975.........  RBC               CH......  X.......    0346       0.3494        21.51         4.39         4.30
                 pretreatment,
                 serum.
86976.........  RBC               ........  X.......    0345       0.2218        13.65         2.87         2.73
                 pretreatment,
                 serum.
86977.........  RBC               CH......  X.......    0346       0.3494        21.51         4.39         4.30
                 pretreatment,
                 serum.
86978.........  RBC               CH......  X.......    0346       0.3494        21.51         4.39         4.30
                 pretreatment,
                 serum.
86985.........  Split blood or    ........  X.......    0345       0.2218        13.65         2.87         2.73
                 products.
86999.........  Transfusion       ........  X.......    0345       0.2218        13.65         2.87         2.73
                 procedure.
88104.........  Cytopathology,    ........  X.......    0433       0.2571        15.82         5.93         3.16
                 fluids.
88106.........  Cytopathology,    ........  X.......    0433       0.2571        15.82         5.93         3.16
                 fluids.
88107.........  Cytopathology,    ........  X.......    0433       0.2571        15.82         5.93         3.16
                 fluids.
88108.........  Cytopath,         ........  X.......    0433       0.2571        15.82         5.93         3.16
                 concentrate
                 tech.
88112.........  Cytopath, cell    ........  X.......    0343       0.5309        32.68        10.84         6.54
                 enhance tech.

[[Page 49821]]

 
88125.........  Forensic          CH......  X.......    0433       0.2571        15.82         5.93         3.16
                 cytopathology.
88141.........  Cytopath, c/v,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 interpret.
88160.........  Cytopath smear,   ........  X.......    0433       0.2571        15.82         5.93         3.16
                 other source.
88161.........  Cytopath smear,   ........  X.......    0433       0.2571        15.82         5.93         3.16
                 other source.
88162.........  Cytopath smear,   ........  X.......    0433       0.2571        15.82         5.93         3.16
                 other source.
88172.........  Cytopathology     ........  X.......    0343       0.5309        32.68        10.84         6.54
                 eval of fna.
88173.........  Cytopath eval,    ........  X.......    0343       0.5309        32.68        10.84         6.54
                 fna, report.
88182.........  Cell marker       CH......  X.......    0343       0.5309        32.68        10.84         6.54
                 study.
88184.........  Flowcytometry/    CH......  X.......    0433       0.2571        15.82         5.93         3.16
                 tc, 1 marker.
88185.........  Flowcytometry/    CH......  X.......    0433       0.2571        15.82         5.93         3.16
                 tc, add-on.
88187.........  Flowcytometry/    ........  X.......    0433       0.2571        15.82         5.93         3.16
                 read, 2-8.
88188.........  Flowcytometry/    ........  X.......    0433       0.2571        15.82         5.93         3.16
                 read, 9-15.
88189.........  Flowcytometry/    ........  X.......    0343       0.5309        32.68        10.84         6.54
                 read, 16&>.
88299.........  Cytogenetic       ........  X.......    0342       0.0813         5.00         2.00         1.00
                 study.
88300.........  Surgical path,    ........  X.......    0433       0.2571        15.82         5.93         3.16
                 gross.
88302.........  Tissue exam by    ........  X.......    0433       0.2571        15.82         5.93         3.16
                 pathologist.
88304.........  Tissue exam by    ........  X.......    0343       0.5309        32.68        10.84         6.54
                 pathologist.
88305.........  Tissue exam by    ........  X.......    0343       0.5309        32.68        10.84         6.54
                 pathologist.
88307.........  Tissue exam by    ........  X.......    0344       0.8107        49.90        15.66         9.98
                 pathologist.
88309.........  Tissue exam by    ........  X.......    0344       0.8107        49.90        15.66         9.98
                 pathologist.
88311.........  Decalcify tissue  CH......  X.......    0433       0.2571        15.82         5.93         3.16
88312.........  Special stains..  ........  X.......    0433       0.2571        15.82         5.93         3.16
88313.........  Special stains..  ........  X.......    0433       0.2571        15.82         5.93         3.16
88314.........  Histochemical     ........  X.......    0342       0.0813         5.00         2.00         1.00
                 stain.
88318.........  Chemical          ........  X.......    0433       0.2571        15.82         5.93         3.16
                 histochemistry.
88319.........  Enzyme            ........  X.......    0343       0.5309        32.68        10.84         6.54
                 histochemistry.
88321.........  Microslide        ........  X.......    0433       0.2571        15.82         5.93         3.16
                 consultation.
88323.........  Microslide        ........  X.......    0343       0.5309        32.68        10.84         6.54
                 consultation.
88325.........  Comprehensive     ........  X.......    0344       0.8107        49.90        15.66         9.98
                 review of data.
88329.........  Path consult      ........  X.......    0433       0.2571        15.82         5.93         3.16
                 introp.
88331.........  Path consult      ........  X.......    0343       0.5309        32.68        10.84         6.54
                 intraop, 1 bloc.
88332.........  Path consult      ........  X.......    0433       0.2571        15.82         5.93         3.16
                 intraop, add'l.
88333.........  Intraop cyto      ........  X.......    0343       0.5309        32.68        10.84         6.54
                 path consult, 1.
88334.........  Intraop cyto      ........  X.......    0433       0.2571        15.82         5.93         3.16
                 path consult, 2.
88342.........  Immunohistochemi  ........  X.......    0343       0.5309        32.68        10.84         6.54
                 stry.
88346.........  Immunofluorescen  ........  X.......    0343       0.5309        32.68        10.84         6.54
                 t study.
88347.........  Immunofluorescen  ........  X.......    0343       0.5309        32.68        10.84         6.54
                 t study.
88348.........  Electron          ........  X.......    0661       2.6066       160.44        64.17        32.09
                 microscopy.
88349.........  Scanning          ........  X.......    0661       2.6066       160.44        64.17        32.09
                 electron
                 microscopy.
88355.........  Analysis,         ........  X.......    0343       0.5309        32.68        10.84         6.54
                 skeletal muscle.
88356.........  Analysis, nerve.  ........  X.......    0344       0.8107        49.90        15.66         9.98
88358.........  Analysis, tumor.  ........  X.......    0344       0.8107        49.90        15.66         9.98
88360.........  Tumor             CH......  X.......    0343       0.5309        32.68        10.84         6.54
                 immunohistochem/
                 manual.
88361.........  Tumor             ........  X.......    0344       0.8107        49.90        15.66         9.98
                 immunohistochem/
                 comput.
88362.........  Nerve teasing     ........  X.......    0344       0.8107        49.90        15.66         9.98
                 preparations.
88365.........  Insitu            ........  X.......    0344       0.8107        49.90        15.66         9.98
                 hybridization
                 (fish).
88367.........  Insitu            ........  X.......    0344       0.8107        49.90        15.66         9.98
                 hybridization,
                 auto.
88368.........  Insitu            ........  X.......    0344       0.8107        49.90        15.66         9.98
                 hybridization,
                 manual.
88380.........  Microdissection.  ........  N.......  ......  ...........  ...........  ...........  ...........
88384.........  Eval molecular    ........  X.......    0433       0.2571        15.82         5.93         3.16
                 probes, 11-50.
88385.........  Eval molecul      ........  X.......    0343       0.5309        32.68        10.84         6.54
                 probes, 51-250.
88386.........  Eval molecul      ........  X.......    0344       0.8107        49.90        15.66         9.98
                 probes, 251-500.
89049.........  Chct for mal      ........  X.......    0343       0.5309        32.68        10.84         6.54
                 hyperthermia.
89100.........  Sample            ........  X.......    0360       1.3789        84.87        33.88        16.97
                 intestinal
                 contents.
89105.........  Sample            ........  X.......    0360       1.3789        84.87        33.88        16.97
                 intestinal
                 contents.
89130.........  Sample stomach    ........  X.......    0360       1.3789        84.87        33.88        16.97
                 contents.
89132.........  Sample stomach    ........  X.......    0360       1.3789        84.87        33.88        16.97
                 contents.
89135.........  Sample stomach    ........  X.......    0360       1.3789        84.87        33.88        16.97
                 contents.
89136.........  Sample stomach    ........  X.......    0360       1.3789        84.87        33.88        16.97
                 contents.
89140.........  Sample stomach    ........  X.......    0360       1.3789        84.87        33.88        16.97
                 contents.
89141.........  Sample stomach    ........  X.......    0360       1.3789        84.87        33.88        16.97
                 contents.
89220.........  Sputum specimen   ........  X.......    0343       0.5309        32.68        10.84         6.54
                 collection.
89230.........  Collect sweat     ........  X.......    0433       0.2571        15.82         5.93         3.16
                 for test.
89250.........  Cultr oocyte/     ........  X.......    0348       0.8928        54.95  ...........        10.99
                 embryo <4 days.
89251.........  Cultr oocyte/     ........  X.......    0348       0.8928        54.95  ...........        10.99
                 embryo <4 days.
89253.........  Embryo hatching.  ........  X.......    0348       0.8928        54.95  ...........        10.99
89254.........  Oocyte            ........  X.......    0348       0.8928        54.95  ...........        10.99
                 identification.
89255.........  Prepare embryo    ........  X.......    0348       0.8928        54.95  ...........        10.99
                 for transfer.
89257.........  Sperm             ........  X.......    0348       0.8928        54.95  ...........        10.99
                 identification.
89258.........  Cryopreservation  ........  X.......    0348       0.8928        54.95  ...........        10.99
                 ; embryo(s).

[[Page 49822]]

 
89259.........  Cryopreservation  ........  X.......    0348       0.8928        54.95  ...........        10.99
                 , sperm.
89260.........  Sperm isolation,  ........  X.......    0348       0.8928        54.95  ...........        10.99
                 simple.
89261.........  Sperm isolation,  ........  X.......    0348       0.8928        54.95  ...........        10.99
                 complex.
89264.........  Identify sperm    ........  X.......    0348       0.8928        54.95  ...........        10.99
                 tissue.
89268.........  Insemination of   ........  X.......    0348       0.8928        54.95  ...........        10.99
                 oocytes.
89272.........  Extended culture  ........  X.......    0348       0.8928        54.95  ...........        10.99
                 of oocytes.
89280.........  Assist oocyte     ........  X.......    0348       0.8928        54.95  ...........        10.99
                 fertilization.
89281.........  Assist oocyte     ........  X.......    0348       0.8928        54.95  ...........        10.99
                 fertilization.
89290.........  Biopsy, oocyte    ........  X.......    0348       0.8928        54.95  ...........        10.99
                 polar body.
89291.........  Biopsy, oocyte    ........  X.......    0348       0.8928        54.95  ...........        10.99
                 polar body.
89335.........  Cryopreserve      ........  X.......    0348       0.8928        54.95  ...........        10.99
                 testicular tiss.
89342.........  Storage/year;     ........  X.......    0348       0.8928        54.95  ...........        10.99
                 embryo(s).
89343.........  Storage/year;     ........  X.......    0348       0.8928        54.95  ...........        10.99
                 sperm/semen.
89344.........  Storage/year;     ........  X.......    0348       0.8928        54.95  ...........        10.99
                 reprod tissue.
89346.........  Storage/year;     ........  X.......    0348       0.8928        54.95  ...........        10.99
                 oocyte(s).
89352.........  Thawing           ........  X.......    0348       0.8928        54.95  ...........        10.99
                 cryopresrved;
                 embryo.
89353.........  Thawing           ........  X.......    0348       0.8928        54.95  ...........        10.99
                 cryopresrved;
                 sperm.
89354.........  Thaw cryoprsvrd;  ........  X.......    0348       0.8928        54.95  ...........        10.99
                 reprod tiss.
89356.........  Thawing           ........  X.......    0348       0.8928        54.95  ...........        10.99
                 cryopresrved;
                 oocyte.
90296.........  Diphtheria        ........  N.......  ......  ...........  ...........  ...........  ...........
                 antitoxin.
90371.........  Hep b ig, im....  ........  K.......    1630  ...........       118.61  ...........        23.72
90375.........  Rabies ig, im/sc  ........  K.......    9133  ...........        63.98  ...........        12.80
90376.........  Rabies ig, heat   ........  K.......    9134  ...........        68.58  ...........        13.72
                 treated.
90385.........  Rh ig, minidose,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 im.
90393.........  Vaccina ig, im..  ........  N.......  ......  ...........  ...........  ...........  ...........
90396.........  Varicella-zoster  ........  K.......    9135  ...........       149.08  ...........        29.82
                 ig, im.
90471.........  Immunization      CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 admin.
90472.........  Immunization      CH......  S.......    0436       0.1769        10.89  ...........         2.18
                 admin, each add.
90473.........  Immune admin      CH......  S.......    0436       0.1769        10.89  ...........         2.18
                 oral/nasal.
90474.........  Immune admin      CH......  S.......    0436       0.1769        10.89  ...........         2.18
                 oral/nasal addl.
90476.........  Adenovirus        CH......  N.......  ......  ...........  ...........  ...........  ...........
                 vaccine, type 4.
90477.........  Adenovirus        ........  N.......  ......  ...........  ...........  ...........  ...........
                 vaccine, type 7.
90581.........  Anthrax vaccine,  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 sc.
90585.........  Bcg vaccine,      ........  K.......    9137  ...........       115.46  ...........        23.09
                 percut.
90632.........  Hep a vaccine,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 adult im.
90633.........  Hep a vacc, ped/  ........  N.......  ......  ...........  ...........  ...........  ...........
                 adol, 2 dose.
90634.........  Hep a vacc, ped/  ........  N.......  ......  ...........  ...........  ...........  ...........
                 adol, 3 dose.
90636.........  Hep a/hep b       CH......  N.......  ......  ...........  ...........  ...........  ...........
                 vacc, adult im.
90645.........  Hib vaccine,      ........  N.......  ......  ...........  ...........  ...........  ...........
                 hboc, im.
90646.........  Hib vaccine, prp- ........  N.......  ......  ...........  ...........  ...........  ...........
                 d, im.
90647.........  Hib vaccine, prp- ........  N.......  ......  ...........  ...........  ...........  ...........
                 omp, im.
90648.........  Hib vaccine, prp- ........  N.......  ......  ...........  ...........  ...........  ...........
                 t, im.
90665.........  Lyme disease      CH......  N.......  ......  ...........  ...........  ...........  ...........
                 vaccine, im.
90675.........  Rabies vaccine,   ........  K.......    9139  ...........       155.25  ...........        31.05
                 im.
90676.........  Rabies vaccine,   ........  K.......    9140  ...........       118.49  ...........        23.70
                 id.
90680.........  Rotovirus vacc 3  ........  N.......  ......  ...........  ...........  ...........  ...........
                 dose, oral.
90690.........  Typhoid vaccine,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 oral.
90691.........  Typhoid vaccine,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 im.
90692.........  Typhoid vaccine,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 h-p, sc/id.
90693.........  Typhoid vaccine,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 akd, sc.
90698.........  Dtap-hib-ip       ........  N.......  ......  ...........  ...........  ...........  ...........
                 vaccine, im.
90700.........  Dtap vaccine, <   ........  N.......  ......  ...........  ...........  ...........  ...........
                 7 yrs, im.
90701.........  Dtp vaccine, im.  ........  N.......  ......  ...........  ...........  ...........  ...........
90702.........  Dt vaccine < 7,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 im.
90703.........  Tetanus vaccine,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 im.
90704.........  Mumps vaccine,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 sc.
90705.........  Measles vaccine,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 sc.
90706.........  Rubella vaccine,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 sc.
90707.........  Mmr vaccine, sc.  ........  N.......  ......  ...........  ...........  ...........  ...........
90708.........  Measles-rubella   ........  K.......    9141  ...........        44.62  ...........         8.92
                 vaccine, sc.
90710.........  Mmrv vaccine, sc  ........  N.......  ......  ...........  ...........  ...........  ...........
90712.........  Oral poliovirus   ........  N.......  ......  ...........  ...........  ...........  ...........
                 vaccine.
90713.........  Poliovirus, ipv,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 sc/im.
90714.........  Td vaccine no     CH......  N.......  ......  ...........  ...........  ...........  ...........
                 prsrv >/= 7 im.
90715.........  Tdap vaccine >7   ........  N.......  ......  ...........  ...........  ...........  ...........
                 im.
90716.........  Chicken pox       ........  K.......    9142  ...........        66.84  ...........        13.37
                 vaccine, sc.
90717.........  Yellow fever      CH......  N.......  ......  ...........  ...........  ...........  ...........
                 vaccine, sc.
90718.........  Td vaccine > 7,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 im.
90719.........  Diphtheria        ........  N.......  ......  ...........  ...........  ...........  ...........
                 vaccine, im.
90720.........  Dtp/hib vaccine,  CH......  K.......    3032  ...........        68.91  ...........        13.78
                 im.

[[Page 49823]]

 
90721.........  Dtap/hib          ........  N.......  ......  ...........  ...........  ...........  ...........
                 vaccine, im.
90725.........  Cholera vaccine,  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injectable.
90727.........  Plague vaccine,   CH......  K.......    0744  ...........       150.00  ...........        30.00
                 im.
90733.........  Meningococcal     ........  K.......    9143  ...........        84.46  ...........        16.89
                 vaccine, sc.
90734.........  Meningococcal     ........  K.......    9145  ...........       143.12  ...........        28.62
                 vaccine, im.
90735.........  Encephalitis      ........  K.......    9144  ...........        99.15  ...........        19.83
                 vaccine, sc.
90749.........  Vaccine toxoid..  ........  N.......  ......  ...........  ...........  ...........  ...........
90772.........  Ther/proph/diag   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 inj, sc/im.
90773.........  Ther/proph/diag   CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 inj, ia.
90779.........  Ther/prop/diag    CH......  S.......    0436       0.1769        10.89  ...........         2.18
                 inj/inf proc.
90801.........  Psy dx interview  ........  S.......    0323       1.7170       105.68  ...........        21.14
90802.........  Intac psy dx      ........  S.......    0323       1.7170       105.68  ...........        21.14
                 interview.
90804.........  Psytx, office,    ........  S.......    0322       1.1749        72.32  ...........        14.46
                 20-30 min.
90805.........  Psytx, off, 20-   ........  S.......    0322       1.1749        72.32  ...........        14.46
                 30 min w/e&m.
90806.........  Psytx, off, 45-   ........  S.......    0323       1.7170       105.68  ...........        21.14
                 50 min.
90807.........  Psytx, off, 45-   ........  S.......    0323       1.7170       105.68  ...........        21.14
                 50 min w/e&m.
90808.........  Psytx, office,    ........  S.......    0323       1.7170       105.68  ...........        21.14
                 75-80 min.
90809.........  Psytx, off, 75-   ........  S.......    0323       1.7170       105.68  ...........        21.14
                 80, w/e&m.
90810.........  Intac psytx,      ........  S.......    0322       1.1749        72.32  ...........        14.46
                 off, 20-30 min.
90811.........  Intac psytx, 20-  ........  S.......    0322       1.1749        72.32  ...........        14.46
                 30, w/e&m.
90812.........  Intac psytx,      ........  S.......    0323       1.7170       105.68  ...........        21.14
                 off, 45-50 min.
90813.........  Intac psytx, 45-  ........  S.......    0323       1.7170       105.68  ...........        21.14
                 50 min w/e&m.
90814.........  Intac psytx,      ........  S.......    0323       1.7170       105.68  ...........        21.14
                 off, 75-80 min.
90815.........  Intac psytx, 75-  ........  S.......    0323       1.7170       105.68  ...........        21.14
                 80 w/e&m.
90816.........  Psytx, hosp, 20-  ........  S.......    0322       1.1749        72.32  ...........        14.46
                 30 min.
90817.........  Psytx, hosp, 20-  ........  S.......    0322       1.1749        72.32  ...........        14.46
                 30 min w/e&m.
90818.........  Psytx, hosp, 45-  ........  S.......    0323       1.7170       105.68  ...........        21.14
                 50 min.
90819.........  Psytx, hosp, 45-  ........  S.......    0323       1.7170       105.68  ...........        21.14
                 50 min w/e&m.
90821.........  Psytx, hosp, 75-  ........  S.......    0323       1.7170       105.68  ...........        21.14
                 80 min.
90822.........  Psytx, hosp, 75-  ........  S.......    0323       1.7170       105.68  ...........        21.14
                 80 min w/e&m.
90823.........  Intac psytx,      ........  S.......    0322       1.1749        72.32  ...........        14.46
                 hosp, 20-30 min.
90824.........  Intac psytx, hsp  ........  S.......    0322       1.1749        72.32  ...........        14.46
                 20-30 w/e&m.
90826.........  Intac psytx,      ........  S.......    0323       1.7170       105.68  ...........        21.14
                 hosp, 45-50 min.
90827.........  Intac psytx, hsp  ........  S.......    0323       1.7170       105.68  ...........        21.14
                 45-50 w/e&m.
90828.........  Intac psytx,      ........  S.......    0323       1.7170       105.68  ...........        21.14
                 hosp, 75-80 min.
90829.........  Intac psytx, hsp  ........  S.......    0323       1.7170       105.68  ...........        21.14
                 75-80 w/e&m.
90845.........  Psychoanalysis..  ........  S.......    0323       1.7170       105.68  ...........        21.14
90846.........  Family psytx w/o  ........  S.......    0324       2.2087       135.95  ...........        27.19
                 patient.
90847.........  Family psytx w/   ........  S.......    0324       2.2087       135.95  ...........        27.19
                 patient.
90849.........  Multiple family   ........  S.......    0325       1.0787        66.40        14.51        13.28
                 group psytx.
90853.........  Group             ........  S.......    0325       1.0787        66.40        14.51        13.28
                 psychotherapy.
90857.........  Intac group       ........  S.......    0325       1.0787        66.40        14.51        13.28
                 psytx.
90862.........  Medication        ........  X.......    0374       1.1509        70.84  ...........        14.17
                 management.
90865.........  Narcosynthesis..  ........  S.......    0323       1.7170       105.68  ...........        21.14
90870.........  Electroconvulsiv  ........  S.......    0320       5.5017       338.64        80.06        67.73
                 e therapy.
90880.........  Hypnotherapy....  ........  S.......    0323       1.7170       105.68  ...........        21.14
90885.........  Psy evaluation    ........  N.......  ......  ...........  ...........  ...........  ...........
                 of records.
90887.........  Consultation      ........  N.......  ......  ...........  ...........  ...........  ...........
                 with family.
90889.........  Preparation of    ........  N.......  ......  ...........  ...........  ...........  ...........
                 report.
90899.........  Psychiatric       ........  S.......    0322       1.1749        72.32  ...........        14.46
                 service/therapy.
90911.........  Biofeedback peri/ ........  S.......    0321       1.3693        84.28        21.72        16.86
                 uro/rectal.
90935.........  Hemodialysis,     ........  S.......    0170       6.8096       419.14  ...........        83.83
                 one evaluation.
90940.........  Hemodialysis      ........  N.......  ......  ...........  ...........  ...........  ...........
                 access study.
90945.........  Dialysis, one     ........  S.......    0170       6.8096       419.14  ...........        83.83
                 evaluation.
91000.........  Esophageal        ........  X.......    0361       3.9319       242.01        83.23        48.40
                 intubation.
91010.........  Esophagus         ........  X.......    0361       3.9319       242.01        83.23        48.40
                 motility study.
91011.........  Esophagus         ........  X.......    0361       3.9319       242.01        83.23        48.40
                 motility study.
91012.........  Esophagus         ........  X.......    0361       3.9319       242.01        83.23        48.40
                 motility study.
91020.........  Gastric motility  ........  X.......    0361       3.9319       242.01        83.23        48.40
                 studies.
91022.........  Duodenal          ........  X.......    0361       3.9319       242.01        83.23        48.40
                 motility study.
91030.........  Acid perfusion    ........  X.......    0361       3.9319       242.01        83.23        48.40
                 of esophagus.
91034.........  Gastroesophageal  ........  X.......    0361       3.9319       242.01        83.23        48.40
                 reflux test.
91035.........  G-esoph reflx     CH......  X.......    0361       3.9319       242.01        83.23        48.40
                 tst w/electrod.
91037.........  Esoph imped       ........  X.......    0361       3.9319       242.01        83.23        48.40
                 function test.
91038.........  Esoph imped       ........  X.......    0361       3.9319       242.01        83.23        48.40
                 funct test > 1h.
91040.........  Esoph balloon     ........  X.......    0360       1.3789        84.87        33.88        16.97
                 distension tst.
91052.........  Gastric analysis  ........  X.......    0361       3.9319       242.01        83.23        48.40
                 test.
91055.........  Gastric           ........  X.......    0360       1.3789        84.87        33.88        16.97
                 intubation for
                 smear.
91060.........  Gastric saline    ........  X.......    0360       1.3789        84.87        33.88        16.97
                 load test.
91065.........  Breath hydrogen   ........  X.......    0360       1.3789        84.87        33.88        16.97
                 test.

[[Page 49824]]

 
91100.........  Pass intestine    ........  X.......    0360       1.3789        84.87        33.88        16.97
                 bleeding tube.
91105.........  Gastric           ........  X.......    0360       1.3789        84.87        33.88        16.97
                 intubation
                 treatment.
91110.........  Gi tract capsule  ........  T.......    0142       9.3878       577.83       152.78       115.57
                 endoscopy.
91120.........  Rectal sensation  CH......  T.......    0126       1.0844        66.75        16.40        13.35
                 test.
91122.........  Anal pressure     CH......  T.......    0164       2.1159       130.24  ...........        26.05
                 record.
91123.........  Irrigate fecal    ........  N.......  ......  ...........  ...........  ...........  ...........
                 impaction.
91132.........  Electrogastrogra  ........  X.......    0360       1.3789        84.87        33.88        16.97
                 phy.
91133.........  Electrogastrogra  ........  X.......    0360       1.3789        84.87        33.88        16.97
                 phy w/test.
91299.........  Gastroenterology  ........  X.......    0360       1.3789        84.87        33.88        16.97
                 procedure.
92002.........  Eye exam, new     CH......  V.......    0605       1.0057        61.90  ...........        12.38
                 patient.
92004.........  Eye exam, new     CH......  V.......    0606       1.3546        83.38  ...........        16.68
                 patient.
92012.........  Eye exam          CH......  V.......    0604       0.8083        49.75  ...........         9.95
                 established pat.
92014.........  Eye               CH......  V.......    0605       1.0057        61.90  ...........        12.38
                 exam&treatment.
92018.........  New eye           ........  T.......    0699      13.9509       858.69  ...........       171.74
                 exam&treatment.
92019.........  Eye               ........  T.......    0699      13.9509       858.69  ...........       171.74
                 exam&treatment.
92020.........  Special eye       ........  S.......    0230       0.8126        50.02        14.97        10.00
                 evaluation.
92060.........  Special eye       ........  S.......    0230       0.8126        50.02        14.97        10.00
                 evaluation.
92065.........  Orthoptic/        CH......  S.......    0230       0.8126        50.02        14.97        10.00
                 pleoptic
                 training.
92070.........  Fitting of        ........  N.......  ......  ...........  ...........  ...........  ...........
                 contact lens.
92081.........  Visual field      ........  S.......    0230       0.8126        50.02        14.97        10.00
                 examination(s).
92082.........  Visual field      ........  S.......    0230       0.8126        50.02        14.97        10.00
                 examination(s).
92083.........  Visual field      ........  S.......    0230       0.8126        50.02        14.97        10.00
                 examination(s).
92100.........  Serial tonometry  ........  N.......  ......  ...........  ...........  ...........  ...........
                 exam(s).
92120.........  Tonography&eye    ........  S.......    0230       0.8126        50.02        14.97        10.00
                 evaluation.
92130.........  Water             ........  S.......    0230       0.8126        50.02        14.97        10.00
                 provocation
                 tonography.
92135.........  Opthalmic dx      ........  S.......    0230       0.8126        50.02        14.97        10.00
                 imaging.
92136.........  Ophthalmic        ........  S.......    0698       1.2244        75.36        16.52        15.07
                 biometry.
92140.........  Glaucoma          CH......  S.......    0230       0.8126        50.02        14.97        10.00
                 provocative
                 tests.
92225.........  Special eye       CH......  S.......    0230       0.8126        50.02        14.97        10.00
                 exam, initial.
92226.........  Special eye       CH......  S.......    0230       0.8126        50.02        14.97        10.00
                 exam,
                 subsequent.
92230.........  Eye exam with     CH......  S.......    0231       2.1934       135.01  ...........        27.00
                 photos.
92235.........  Eye exam with     ........  S.......    0231       2.1934       135.01  ...........        27.00
                 photos.
92240.........  Icg angiography.  ........  S.......    0231       2.1934       135.01  ...........        27.00
92250.........  Eye exam with     ........  S.......    0230       0.8126        50.02        14.97        10.00
                 photos.
92260.........  Ophthalmoscopy/   CH......  S.......    0230       0.8126        50.02        14.97        10.00
                 dynamometry.
92265.........  Eye muscle        ........  S.......    0230       0.8126        50.02        14.97        10.00
                 evaluation.
92270.........  Electro-          ........  S.......    0230       0.8126        50.02        14.97        10.00
                 oculography.
92275.........  Electroretinogra  ........  S.......    0231       2.1934       135.01  ...........        27.00
                 phy.
92283.........  Color vision      ........  S.......    0230       0.8126        50.02        14.97        10.00
                 examination.
92284.........  Dark adaptation   ........  S.......    0698       1.2244        75.36        16.52        15.07
                 eye exam.
92285.........  Eye photography.  ........  S.......    0230       0.8126        50.02        14.97        10.00
92286.........  Internal eye      ........  S.......    0698       1.2244        75.36        16.52        15.07
                 photography.
92287.........  Internal eye      ........  S.......    0698       1.2244        75.36        16.52        15.07
                 photography.
92311.........  Contact lens      ........  X.......    0362       0.5328        32.79  ...........         6.56
                 fitting.
92312.........  Contact lens      ........  X.......    0362       0.5328        32.79  ...........         6.56
                 fitting.
92313.........  Contact lens      ........  X.......    0362       0.5328        32.79  ...........         6.56
                 fitting.
92315.........  Prescription of   ........  X.......    0362       0.5328        32.79  ...........         6.56
                 contact lens.
92316.........  Prescription of   ........  X.......    0362       0.5328        32.79  ...........         6.56
                 contact lens.
92317.........  Prescription of   ........  X.......    0362       0.5328        32.79  ...........         6.56
                 contact lens.
92325.........  Modification of   ........  X.......    0362       0.5328        32.79  ...........         6.56
                 contact lens.
92326.........  Replacement of    ........  X.......    0362       0.5328        32.79  ...........         6.56
                 contact lens.
92352.........  Special           ........  X.......    0362       0.5328        32.79  ...........         6.56
                 spectacles
                 fitting.
92353.........  Special           ........  X.......    0362       0.5328        32.79  ...........         6.56
                 spectacles
                 fitting.
92354.........  Special           ........  X.......    0362       0.5328        32.79  ...........         6.56
                 spectacles
                 fitting.
92355.........  Special           ........  X.......    0362       0.5328        32.79  ...........         6.56
                 spectacles
                 fitting.
92358.........  Eye prosthesis    ........  X.......    0362       0.5328        32.79  ...........         6.56
                 service.
92371.........  Repair&adjust     ........  X.......    0362       0.5328        32.79  ...........         6.56
                 spectacles.
92499.........  Eye service or    ........  S.......    0230       0.8126        50.02        14.97        10.00
                 procedure.
92502.........  Ear and throat    ........  T.......    0251       2.3768       146.29  ...........        29.26
                 examination.
92504.........  Ear microscopy    ........  N.......  ......  ...........  ...........  ...........  ...........
                 examination.
92511.........  Nasopharyngoscop  ........  T.......    0071       0.7572        46.61        11.03         9.32
                 y.
92512.........  Nasal function    ........  X.......    0363       0.8534        52.53        17.44        10.51
                 studies.
92516.........  Facial nerve      ........  X.......    0660       1.4988        92.25        29.07        18.45
                 function test.
92520.........  Laryngeal         ........  X.......    0660       1.4988        92.25        29.07        18.45
                 function
                 studies.
92531.........  Spontaneous       ........  N.......  ......  ...........  ...........  ...........  ...........
                 nystagmus study.
92532.........  Positional        ........  N.......  ......  ...........  ...........  ...........  ...........
                 nystagmus test.
92533.........  Caloric           ........  N.......  ......  ...........  ...........  ...........  ...........
                 vestibular test.
92534.........  Optokinetic       ........  N.......  ......  ...........  ...........  ...........  ...........
                 nystagmus test.
92541.........  Spontaneous       ........  X.......    0363       0.8534        52.53        17.44        10.51
                 nystagmus test.
92542.........  Positional        ........  X.......    0363       0.8534        52.53        17.44        10.51
                 nystagmus test.

[[Page 49825]]

 
92543.........  Caloric           ........  X.......    0660       1.4988        92.25        29.07        18.45
                 vestibular test.
92544.........  Optokinetic       ........  X.......    0363       0.8534        52.53        17.44        10.51
                 nystagmus test.
92545.........  Oscillating       ........  X.......    0363       0.8534        52.53        17.44        10.51
                 tracking test.
92546.........  Sinusoidal        ........  X.......    0660       1.4988        92.25        29.07        18.45
                 rotational test.
92547.........  Supplemental      ........  X.......    0363       0.8534        52.53        17.44        10.51
                 electrical test.
92548.........  Posturography...  ........  X.......    0660       1.4988        92.25        29.07        18.45
92552.........  Pure tone         ........  X.......    0364       0.4637        28.54         7.06         5.71
                 audiometry, air.
92553.........  Audiometry,       ........  X.......    0365       1.2467        76.74        18.52        15.35
                 air&bone.
92555.........  Speech threshold  ........  X.......    0364       0.4637        28.54         7.06         5.71
                 audiometry.
92556.........  Speech            ........  X.......    0364       0.4637        28.54         7.06         5.71
                 audiometry,
                 complete.
92557.........  Comprehensive     ........  X.......    0365       1.2467        76.74        18.52        15.35
                 hearing test.
92561.........  Bekesy            ........  X.......    0364       0.4637        28.54         7.06         5.71
                 audiometry,
                 diagnosis.
92562.........  Loudness balance  ........  X.......    0364       0.4637        28.54         7.06         5.71
                 test.
92563.........  Tone decay        ........  X.......    0364       0.4637        28.54         7.06         5.71
                 hearing test.
92564.........  Sisi hearing      ........  X.......    0364       0.4637        28.54         7.06         5.71
                 test.
92565.........  Stenger test,     ........  X.......    0364       0.4637        28.54         7.06         5.71
                 pure tone.
92567.........  Tympanometry....  ........  X.......    0364       0.4637        28.54         7.06         5.71
92568.........  Acoustic refl     ........  X.......    0364       0.4637        28.54         7.06         5.71
                 threshold tst.
92569.........  Acoustic reflex   ........  X.......    0364       0.4637        28.54         7.06         5.71
                 decay test.
92571.........  Filtered speech   ........  X.......    0364       0.4637        28.54         7.06         5.71
                 hearing test.
92572.........  Staggered         ........  X.......    0366       1.8175       111.87        26.14        22.37
                 spondaic word
                 test.
92573.........  Lombard test....  ........  X.......    0364       0.4637        28.54         7.06         5.71
92575.........  Sensorineural     ........  X.......    0364       0.4637        28.54         7.06         5.71
                 acuity test.
92576.........  Synthetic         ........  X.......    0364       0.4637        28.54         7.06         5.71
                 sentence test.
92577.........  Stenger test,     ........  X.......    0366       1.8175       111.87        26.14        22.37
                 speech.
92579.........  Visual            ........  X.......    0365       1.2467        76.74        18.52        15.35
                 audiometry
                 (vra).
92582.........  Conditioning      ........  X.......    0365       1.2467        76.74        18.52        15.35
                 play audiometry.
92583.........  Select picture    ........  X.......    0364       0.4637        28.54         7.06         5.71
                 audiometry.
92584.........  Electrocochleogr  ........  X.......    0660       1.4988        92.25        29.07        18.45
                 aphy.
92585.........  Auditor evoke     ........  S.......    0216       2.6729       164.52  ...........        32.90
                 potent, compre.
92586.........  Auditor evoke     ........  S.......    0218       1.1993        73.82  ...........        14.76
                 potent, limit.
92587.........  Evoked auditory   ........  X.......    0363       0.8534        52.53        17.44        10.51
                 test.
92588.........  Evoked auditory   ........  X.......    0660       1.4988        92.25        29.07        18.45
                 test.
92596.........  Ear protector     ........  X.......    0364       0.4637        28.54         7.06         5.71
                 evaluation.
92601.........  Cochlear implt f/ ........  X.......    0366       1.8175       111.87        26.14        22.37
                 up exam < 7.
92602.........  Reprogram         ........  X.......    0366       1.8175       111.87        26.14        22.37
                 cochlear implt
                 < 7.
92603.........  Cochlear implt f/ ........  X.......    0366       1.8175       111.87        26.14        22.37
                 up exam 7 >.
92604.........  Reprogram         ........  X.......    0366       1.8175       111.87        26.14        22.37
                 cochlear implt
                 7 >.
92620.........  Auditory          ........  X.......    0365       1.2467        76.74        18.52        15.35
                 function, 60
                 min.
92621.........  Auditory          ........  N.......  ......  ...........  ...........  ...........  ...........
                 function, + 15
                 min.
92625.........  Tinnitus          ........  X.......    0365       1.2467        76.74        18.52        15.35
                 assessment.
92626.........  Eval aud rehab    ........  X.......    0365       1.2467        76.74        18.52        15.35
                 status.
92627.........  Eval aud status   ........  N.......  ......  ...........  ...........  ...........  ...........
                 rehab add-on.
92700.........  Ent procedure/    ........  X.......    0364       0.4637        28.54         7.06         5.71
                 service.
92950.........  Heart/lung        ........  S.......    0094       2.4630       151.60        46.29        30.32
                 resuscitation
                 cpr.
92953.........  Temporary         ........  S.......    0094       2.4630       151.60        46.29        30.32
                 external pacing.
92960.........  Cardioversion     ........  S.......    0679       5.5435       341.21        95.30        68.24
                 electric, ext.
92961.........  Cardioversion,    ........  S.......    0679       5.5435       341.21        95.30        68.24
                 electric, int.
92973.........  Percut coronary   ........  T.......    0088      37.9652     2,336.80       655.22       467.36
                 thrombectomy.
92974.........  Cath place,       ........  T.......    0103      17.0436     1,049.05       223.63       209.81
                 cardio brachytx.
92977.........  Dissolve clot,    ........  T.......    0676       2.0612       126.87  ...........        25.37
                 heart vessel.
92978.........  Intravasc us,     ........  S.......    0670      29.7322     1,830.05       536.10       366.01
                 heart add-on.
92979.........  Intravasc us,     ........  S.......    0416      32.2182     1,983.06  ...........       396.61
                 heart add-on.
92980.........  Insert            ........  T.......    0104      87.9808     5,415.31  ...........     1,083.06
                 intracoronary
                 stent.
92981.........  Insert            ........  T.......    0104      87.9808     5,415.31  ...........     1,083.06
                 intracoronary
                 stent.
92982.........  Coronary artery   ........  T.......    0083      57.4937     3,538.79  ...........       707.76
                 dilation.
92984.........  Coronary artery   ........  T.......    0083      57.4937     3,538.79  ...........       707.76
                 dilation.
92986.........  Revision of       ........  T.......    0083      57.4937     3,538.79  ...........       707.76
                 aortic valve.
92987.........  Revision of       ........  T.......    0083      57.4937     3,538.79  ...........       707.76
                 mitral valve.
92990.........  Revision of       ........  T.......    0083      57.4937     3,538.79  ...........       707.76
                 pulmonary valve.
92995.........  Coronary          ........  T.......    0082      76.2006     4,690.22     1,008.90       938.04
                 atherectomy.
92996.........  Coronary          ........  T.......    0082      76.2006     4,690.22     1,008.90       938.04
                 atherectomy add-
                 on.
92997.........  Pul art balloon   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 repr, percut.
92998.........  Pul art balloon   ........  T.......    0081      42.8894     2,639.89  ...........       527.98
                 repr, percut.
93005.........  Electrocardiogra  ........  S.......    0099       0.3835        23.60  ...........         4.72
                 m, tracing.
93012.........  Transmission of   ........  N.......  ......  ...........  ...........  ...........  ...........
                 ecg.
93017.........  Cardiovascular    ........  X.......    0100       2.5352       156.04        41.44        31.21
                 stress test.
93024.........  Cardiac drug      ........  X.......    0100       2.5352       156.04        41.44        31.21
                 stress test.
93025.........  Microvolt t-wave  ........  X.......    0100       2.5352       156.04        41.44        31.21
                 assess.
93041.........  Rhythm ECG,       ........  S.......    0099       0.3835        23.60  ...........         4.72
                 tracing.

[[Page 49826]]

 
93225.........  ECG monitor/      ........  X.......    0097       1.0245        63.06        23.79        12.61
                 record, 24 hrs.
93226.........  ECG monitor/      ........  X.......    0097       1.0245        63.06        23.79        12.61
                 report, 24 hrs.
93231.........  Ecg monitor/      ........  X.......    0097       1.0245        63.06        23.79        12.61
                 record, 24 hrs.
93232.........  ECG monitor/      ........  X.......    0097       1.0245        63.06        23.79        12.61
                 report, 24 hrs.
93236.........  ECG monitor/      ........  X.......    0097       1.0245        63.06        23.79        12.61
                 report, 24 hrs.
93270.........  ECG recording...  ........  X.......    0097       1.0245        63.06        23.79        12.61
93271.........  Ecg/monitoring    ........  X.......    0097       1.0245        63.06        23.79        12.61
                 and analysis.
93278.........  ECG/signal-       ........  S.......    0099       0.3835        23.60  ...........         4.72
                 averaged.
93303.........  Echo              ........  S.......    0269       3.2432       199.62        75.60        39.92
                 transthoracic.
93304.........  Echo              ........  S.......    0697       1.6002        98.49        35.99        19.70
                 transthoracic.
93307.........  Echo exam of      ........  S.......    0269       3.2432       199.62        75.60        39.92
                 heart.
93308.........  Echo exam of      ........  S.......    0697       1.6002        98.49        35.99        19.70
                 heart.
93312.........  Echo              ........  S.......    0270       6.2689       385.86       141.32        77.17
                 transesophageal.
93313.........  Echo              ........  S.......    0270       6.2689       385.86       141.32        77.17
                 transesophageal.
93314.........  Echo              ........  N.......  ......  ...........  ...........  ...........  ...........
                 transesophageal.
93315.........  Echo              ........  S.......    0270       6.2689       385.86       141.32        77.17
                 transesophageal.
93316.........  Echo              ........  S.......    0270       6.2689       385.86       141.32        77.17
                 transesophageal.
93317.........  Echo              ........  N.......  ......  ...........  ...........  ...........  ...........
                 transesophageal.
93318.........  Echo              ........  S.......    0270       6.2689       385.86       141.32        77.17
                 transesophageal
                 intraop.
93320.........  Doppler echo      CH......  S.......    0697       1.6002        98.49        35.99        19.70
                 exam, heart.
93321.........  Doppler echo      ........  S.......    0697       1.6002        98.49        35.99        19.70
                 exam, heart.
93325.........  Doppler color     ........  S.......    0697       1.6002        98.49        35.99        19.70
                 flow add-on.
93350.........  Echo              ........  S.......    0269       3.2432       199.62        75.60        39.92
                 transthoracic.
93501.........  Right heart       ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheterization.
93503.........  Insert/place      ........  T.......    0103      17.0436     1,049.05       223.63       209.81
                 heart catheter.
93505.........  Biopsy of heart   ........  T.......    0103      17.0436     1,049.05       223.63       209.81
                 lining.
93508.........  Cath placement,   ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 angiography.
93510.........  Left heart        ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheterization.
93511.........  Left heart        ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheterization.
93514.........  Left heart        ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheterization.
93524.........  Left heart        ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheterization.
93526.........  Rt≪ heart       ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheters.
93527.........  Rt≪ heart       ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheters.
93528.........  Rt≪ heart       ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheters.
93529.........  Rt, lt heart      ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 catheterization.
93530.........  Rt heart cath,    ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 congenital.
93531.........  R&l heart cath,   ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 congenital.
93532.........  R&l heart cath,   ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 congenital.
93533.........  R&l heart cath,   ........  T.......    0080      37.1008     2,283.59       838.92       456.72
                 congenital.
93539.........  Injection,        ........  N.......  ......  ...........  ...........  ...........  ...........
                 cardiac cath.
93540.........  Injection,        ........  N.......  ......  ...........  ...........  ...........  ...........
                 cardiac cath.
93541.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 lung angiogram.
93542.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 heart x-rays.
93543.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 heart x-rays.
93544.........  Injection for     ........  N.......  ......  ...........  ...........  ...........  ...........
                 aortography.
93545.........  Inject for        ........  N.......  ......  ...........  ...........  ...........  ...........
                 coronary x-rays.
93555.........  Imaging, cardiac  ........  N.......  ......  ...........  ...........  ...........  ...........
                 cath.
93556.........  Imaging, cardiac  ........  N.......  ......  ...........  ...........  ...........  ...........
                 cath.
93561.........  Cardiac output    ........  N.......  ......  ...........  ...........  ...........  ...........
                 measurement.
93562.........  Cardiac output    ........  N.......  ......  ...........  ...........  ...........  ...........
                 measurement.
93571.........  Heart flow        ........  S.......    0670      29.7322     1,830.05       536.10       366.01
                 reserve measure.
93572.........  Heart flow        ........  S.......    0416      32.2182     1,983.06  ...........       396.61
                 reserve measure.
93580.........  Transcath         ........  T.......    0434      87.3424     5,376.01  ...........     1,075.20
                 closure of asd.
93581.........  Transcath         ........  T.......    0434      87.3424     5,376.01  ...........     1,075.20
                 closure of vsd.
93600.........  Bundle of His     ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 recording.
93602.........  Intra-atrial      ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 recording.
93603.........  Right             ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 ventricular
                 recording.
93609.........  Map tachycardia,  ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 add-on.
93610.........  Intra-atrial      ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 pacing.
93612.........  Intraventricular  ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 pacing.
93613.........  Electrophys map   ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 3d, add-on.
93615.........  Esophageal        ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 recording.
93616.........  Esophageal        ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 recording.
93618.........  Heart rhythm      ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 pacing.
93619.........  Electrophysiolog  ........  T.......    0085      34.7086     2,136.35  ...........       427.27
                 y evaluation.
93620.........  Electrophysiolog  ........  T.......    0085      34.7086     2,136.35  ...........       427.27
                 y evaluation.
93621.........  Electrophysiolog  ........  T.......    0085      34.7086     2,136.35  ...........       427.27
                 y evaluation.
93622.........  Electrophysiolog  ........  T.......    0085      34.7086     2,136.35  ...........       427.27
                 y evaluation.
93623.........  Stimulation,      ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 pacing heart.
93624.........  Electrophysiolog  ........  T.......    0085      34.7086     2,136.35  ...........       427.27
                 ic study.

[[Page 49827]]

 
93631.........  Heart pacing,     ........  T.......    0087      32.8298     2,020.71  ...........       404.14
                 mapping.
93640.........  Evaluation heart  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 device.
93641.........  Electrophysiolog  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 y evaluation.
93642.........  Electrophysiolog  ........  S.......    0084       9.9197       610.57  ...........       122.11
                 y evaluation.
93650.........  Ablate heart      ........  T.......    0086      47.1472     2,901.96       812.36       580.39
                 dysrhythm focus.
93651.........  Ablate heart      ........  T.......    0086      47.1472     2,901.96       812.36       580.39
                 dysrhythm focus.
93652.........  Ablate heart      ........  T.......    0086      47.1472     2,901.96       812.36       580.39
                 dysrhythm focus.
93660.........  Tilt table        ........  S.......    0101       4.3122       265.42       100.24        53.08
                 evaluation.
93662.........  Intracardiac ecg  ........  S.......    0670      29.7322     1,830.05       536.10       366.01
                 (ice).
93701.........  Bioimpedance,     ........  S.......    0099       0.3835        23.60  ...........         4.72
                 thoracic.
93721.........  Plethysmography   ........  X.......    0368       0.9568        58.89        22.77        11.78
                 tracing.
93724.........  Analyze           ........  S.......    0690       0.3628        22.33         8.67         4.47
                 pacemaker
                 system.
93727.........  Analyze ilr       ........  S.......    0690       0.3628        22.33         8.67         4.47
                 system.
93731.........  Analyze           ........  S.......    0690       0.3628        22.33         8.67         4.47
                 pacemaker
                 system.
93732.........  Analyze           ........  S.......    0690       0.3628        22.33         8.67         4.47
                 pacemaker
                 system.
93733.........  Telephone analy,  ........  S.......    0690       0.3628        22.33         8.67         4.47
                 pacemaker.
93734.........  Analyze           ........  S.......    0690       0.3628        22.33         8.67         4.47
                 pacemaker
                 system.
93735.........  Analyze           ........  S.......    0690       0.3628        22.33         8.67         4.47
                 pacemaker
                 system.
93736.........  Telephonic        ........  S.......    0690       0.3628        22.33         8.67         4.47
                 analy,
                 pacemaker.
93740.........  Temperature       ........  X.......    0368       0.9568        58.89        22.77        11.78
                 gradient
                 studies.
93741.........  Analyze ht pace   ........  S.......    0689       0.5400        33.24  ...........         6.65
                 device sngl.
93742.........  Analyze ht pace   ........  S.......    0689       0.5400        33.24  ...........         6.65
                 device sngl.
93743.........  Analyze ht pace   ........  S.......    0689       0.5400        33.24  ...........         6.65
                 device dual.
93744.........  Analyze ht pace   ........  S.......    0689       0.5400        33.24  ...........         6.65
                 device dual.
93745.........  Set-up            ........  S.......    0689       0.5400        33.24  ...........         6.65
                 cardiovert-
                 defibrill.
93770.........  Measure venous    ........  N.......  ......  ...........  ...........  ...........  ...........
                 pressure.
93786.........  Ambulatory BP     ........  X.......    0097       1.0245        63.06        23.79        12.61
                 recording.
93788.........  Ambulatory BP     ........  X.......    0097       1.0245        63.06        23.79        12.61
                 analysis.
93797.........  Cardiac rehab...  ........  S.......    0095       0.5792        35.65        13.86         7.13
93798.........  Cardiac rehab/    ........  S.......    0095       0.5792        35.65        13.86         7.13
                 monitor.
93799.........  Cardiovascular    CH......  X.......    0097       1.0245        63.06        23.79        12.61
                 procedure.
93875.........  Extracranial      ........  S.......    0096       1.5727        96.80        38.13        19.36
                 study.
93880.........  Extracranial      ........  S.......    0267       2.5166       154.90        60.80        30.98
                 study.
93882.........  Extracranial      ........  S.......    0267       2.5166       154.90        60.80        30.98
                 study.
93886.........  Intracranial      ........  S.......    0267       2.5166       154.90        60.80        30.98
                 study.
93888.........  Intracranial      CH......  S.......    0265       1.0145        62.44        23.63        12.49
                 study.
93890.........  Tcd,              ........  S.......    0266       1.5947        98.16        37.80        19.63
                 vasoreactivity
                 study.
93892.........  Tcd, emboli       ........  S.......    0266       1.5947        98.16        37.80        19.63
                 detect w/o inj.
93893.........  Tcd, emboli       ........  S.......    0266       1.5947        98.16        37.80        19.63
                 detect w/inj.
93922.........  Extremity study.  ........  S.......    0096       1.5727        96.80        38.13        19.36
93923.........  Extremity study.  ........  S.......    0096       1.5727        96.80        38.13        19.36
93924.........  Extremity study.  ........  S.......    0096       1.5727        96.80        38.13        19.36
93925.........  Lower extremity   ........  S.......    0267       2.5166       154.90        60.80        30.98
                 study.
93926.........  Lower extremity   ........  S.......    0266       1.5947        98.16        37.80        19.63
                 study.
93930.........  Upper extremity   ........  S.......    0267       2.5166       154.90        60.80        30.98
                 study.
93931.........  Upper extremity   ........  S.......    0266       1.5947        98.16        37.80        19.63
                 study.
93965.........  Extremity study.  ........  S.......    0096       1.5727        96.80        38.13        19.36
93970.........  Extremity study.  ........  S.......    0267       2.5166       154.90        60.80        30.98
93971.........  Extremity study.  ........  S.......    0266       1.5947        98.16        37.80        19.63
93975.........  Vascular study..  ........  S.......    0267       2.5166       154.90        60.80        30.98
93976.........  Vascular study..  ........  S.......    0267       2.5166       154.90        60.80        30.98
93978.........  Vascular study..  ........  S.......    0266       1.5947        98.16        37.80        19.63
93979.........  Vascular study..  ........  S.......    0266       1.5947        98.16        37.80        19.63
93980.........  Penile vascular   ........  S.......    0267       2.5166       154.90        60.80        30.98
                 study.
93981.........  Penile vascular   ........  S.......    0266       1.5947        98.16        37.80        19.63
                 study.
93990.........  Doppler flow      ........  S.......    0266       1.5947        98.16        37.80        19.63
                 testing.
94010.........  Breathing         ........  X.......    0368       0.9568        58.89        22.77        11.78
                 capacity test.
94014.........  Patient recorded  ........  X.......    0367       0.6253        38.49        14.64         7.70
                 spirometry.
94015.........  Patient recorded  ........  X.......    0367       0.6253        38.49        14.64         7.70
                 spirometry.
94060.........  Evaluation of     ........  X.......    0368       0.9568        58.89        22.77        11.78
                 wheezing.
94070.........  Evaluation of     ........  X.......    0369       2.8329       174.37        44.18        34.87
                 wheezing.
94150.........  Vital capacity    ........  X.......    0367       0.6253        38.49        14.64         7.70
                 test.
94200.........  Lung function     ........  X.......    0367       0.6253        38.49        14.64         7.70
                 test (MBC/MVV).
94240.........  Residual lung     ........  X.......    0368       0.9568        58.89        22.77        11.78
                 capacity.
94250.........  Expired gas       ........  X.......    0367       0.6253        38.49        14.64         7.70
                 collection.
94260.........  Thoracic gas      CH......  X.......    0368       0.9568        58.89        22.77        11.78
                 volume.
94350.........  Lung nitrogen     CH......  X.......    0368       0.9568        58.89        22.77        11.78
                 washout curve.
94360.........  Measure airflow   ........  X.......    0367       0.6253        38.49        14.64         7.70
                 resistance.
94370.........  Breath airway     ........  X.......    0367       0.6253        38.49        14.64         7.70
                 closing volume.
94375.........  Respiratory flow  ........  X.......    0367       0.6253        38.49        14.64         7.70
                 volume loop.

[[Page 49828]]

 
94400.........  CO2 breathing     ........  X.......    0367       0.6253        38.49        14.64         7.70
                 response curve.
94450.........  Hypoxia response  ........  X.......    0368       0.9568        58.89        22.77        11.78
                 curve.
94452.........  Hast w/report...  ........  X.......    0368       0.9568        58.89        22.77        11.78
94453.........  Hast w/oxygen     CH......  X.......    0367       0.6253        38.49        14.64         7.70
                 titrate.
94620.........  Pulmonary stress  ........  X.......    0368       0.9568        58.89        22.77        11.78
                 test/simple.
94621.........  Pulm stress test/ ........  X.......    0369       2.8329       174.37        44.18        34.87
                 complex.
94640.........  Airway            ........  S.......    0077       0.3383        20.82         7.74         4.16
                 inhalation
                 treatment.
94642.........  Aerosol           ........  S.......    0078       1.0381        63.90        14.55        12.78
                 inhalation
                 treatment.
94656.........  Initial           ........  S.......    0079       2.7732       170.69  ...........        34.14
                 ventilator mgmt.
94657.........  Continued         ........  S.......    0079       2.7732       170.69  ...........        34.14
                 ventilator mgmt.
94660.........  Pos airway        ........  S.......    0068       1.3718        84.44        29.48        16.89
                 pressure, CPAP.
94662.........  Neg press         ........  S.......    0079       2.7732       170.69  ...........        34.14
                 ventilation,
                 cnp.
94664.........  Evaluate pt use   ........  S.......    0077       0.3383        20.82         7.74         4.16
                 of inhaler.
94667.........  Chest wall        ........  S.......    0077       0.3383        20.82         7.74         4.16
                 manipulation.
94668.........  Chest wall        ........  S.......    0077       0.3383        20.82         7.74         4.16
                 manipulation.
94680.........  Exhaled air       ........  X.......    0367       0.6253        38.49        14.64         7.70
                 analysis, o2.
94681.........  Exhaled air       ........  X.......    0368       0.9568        58.89        22.77        11.78
                 analysis, o2/
                 co2.
94690.........  Exhaled air       CH......  X.......    0367       0.6253        38.49        14.64         7.70
                 analysis.
94720.........  Monoxide          ........  X.......    0368       0.9568        58.89        22.77        11.78
                 diffusing
                 capacity.
94725.........  Membrane          ........  X.......    0368       0.9568        58.89        22.77        11.78
                 diffusion
                 capacity.
94750.........  Pulmonary         CH......  X.......    0367       0.6253        38.49        14.64         7.70
                 compliance
                 study.
94760.........  Measure blood     ........  N.......  ......  ...........  ...........  ...........  ...........
                 oxygen level.
94761.........  Measure blood     ........  N.......  ......  ...........  ...........  ...........  ...........
                 oxygen level.
94762.........  Measure blood     CH......  Q.......    0443       0.9939        61.18        24.47        12.24
                 oxygen level.
94770.........  Exhaled carbon    ........  X.......    0367       0.6253        38.49        14.64         7.70
                 dioxide test.
94772.........  Breath            ........  X.......    0369       2.8329       174.37        44.18        34.87
                 recording,
                 infant.
94799.........  Pulmonary         ........  X.......    0367       0.6253        38.49        14.64         7.70
                 service/
                 procedure.
95004.........  Percut allergy    ........  X.......    0381       0.2151        13.24  ...........         2.65
                 skin tests.
95010.........  Percut allergy    ........  X.......    0381       0.2151        13.24  ...........         2.65
                 titrate test.
95015.........  Id allergy        ........  X.......    0381       0.2151        13.24  ...........         2.65
                 titrate-drug/
                 bug.
95024.........  Id allergy test,  ........  X.......    0381       0.2151        13.24  ...........         2.65
                 drug/bug.
95027.........  Id allergy        ........  X.......    0381       0.2151        13.24  ...........         2.65
                 titrate-
                 airborne.
95028.........  Id allergy test-  ........  X.......    0381       0.2151        13.24  ...........         2.65
                 delayed type.
95044.........  Allergy patch     ........  X.......    0381       0.2151        13.24  ...........         2.65
                 tests.
95052.........  Photo patch test  ........  X.......    0381       0.2151        13.24  ...........         2.65
95056.........  Photosensitivity  ........  X.......    0370       1.0769        66.28  ...........        13.26
                 tests.
95060.........  Eye allergy       ........  X.......    0370       1.0769        66.28  ...........        13.26
                 tests.
95065.........  Nose allergy      ........  X.......    0381       0.2151        13.24  ...........         2.65
                 test.
95070.........  Bronchial         ........  X.......    0369       2.8329       174.37        44.18        34.87
                 allergy tests.
95071.........  Bronchial         ........  X.......    0369       2.8329       174.37        44.18        34.87
                 allergy tests.
95075.........  Ingestion         ........  X.......    0361       3.9319       242.01        83.23        48.40
                 challenge test.
95078.........  Provocative       ........  X.......    0370       1.0769        66.28  ...........        13.26
                 testing.
95115.........  Immunotherapy,    CH......  S.......    0436       0.1769        10.89  ...........         2.18
                 one injection.
95117.........  Immunotherapy     CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 injections.
95144.........  Antigen therapy   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 services.
95145.........  Antigen therapy   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 services.
95146.........  Antigen therapy   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 services.
95147.........  Antigen therapy   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 services.
95148.........  Antigen therapy   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 services.
95149.........  Antigen therapy   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 services.
95165.........  Antigen therapy   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 services.
95170.........  Antigen therapy   CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 services.
95180.........  Rapid             ........  X.......    0370       1.0769        66.28  ...........        13.26
                 desensitization.
95199.........  Allergy           CH......  X.......    0381       0.2151        13.24  ...........         2.65
                 immunology
                 services.
95250.........  Glucose           ........  X.......    0421       1.6486       101.47  ...........        20.29
                 monitoring,
                 cont.
95805.........  Multiple sleep    ........  S.......    0209      11.4847       706.89       268.73       141.38
                 latency test.
95806.........  Sleep study,      ........  S.......    0213       2.3133       142.39        53.58        28.48
                 unattended.
95807.........  Sleep study,      ........  S.......    0209      11.4847       706.89       268.73       141.38
                 attended.
95808.........  Polysomnography,  ........  S.......    0209      11.4847       706.89       268.73       141.38
                 1-3.
95810.........  Polysomnography,  ........  S.......    0209      11.4847       706.89       268.73       141.38
                 4 or more.
95811.........  Polysomnography   ........  S.......    0209      11.4847       706.89       268.73       141.38
                 w/cpap.
95812.........  Eeg, 41-60        ........  S.......    0213       2.3133       142.39        53.58        28.48
                 minutes.
95813.........  Eeg, over 1 hour  ........  S.......    0213       2.3133       142.39        53.58        28.48
95816.........  Eeg, awake and    ........  S.......    0213       2.3133       142.39        53.58        28.48
                 drowsy.
95819.........  Eeg, awake and    ........  S.......    0213       2.3133       142.39        53.58        28.48
                 asleep.
95822.........  Eeg, coma or      ........  S.......    0213       2.3133       142.39        53.58        28.48
                 sleep only.
95824.........  Eeg, cerebral     ........  S.......    0214       1.2353        76.03        28.24        15.21
                 death only.
95827.........  Eeg, all night    ........  S.......    0213       2.3133       142.39        53.58        28.48
                 recording.
95829.........  Surgery           ........  S.......    0214       1.2353        76.03        28.24        15.21
                 electrocorticog
                 ram.
95857.........  Tensilon test...  ........  S.......    0218       1.1993        73.82  ...........        14.76

[[Page 49829]]

 
95860.........  Muscle test, one  ........  S.......    0218       1.1993        73.82  ...........        14.76
                 limb.
95861.........  Muscle test, 2    ........  S.......    0218       1.1993        73.82  ...........        14.76
                 limbs.
95863.........  Muscle test, 3    ........  S.......    0218       1.1993        73.82  ...........        14.76
                 limbs.
95864.........  Muscle test, 4    ........  S.......    0218       1.1993        73.82  ...........        14.76
                 limbs.
95865.........  Muscle test,      ........  S.......    0218       1.1993        73.82  ...........        14.76
                 larynx.
95866.........  Muscle test,      ........  S.......    0218       1.1993        73.82  ...........        14.76
                 hemidiaphragm.
95867.........  Muscle test cran  ........  S.......    0218       1.1993        73.82  ...........        14.76
                 nerv unilat.
95868.........  Muscle test cran  ........  S.......    0218       1.1993        73.82  ...........        14.76
                 nerve bilat.
95869.........  Muscle test,      ........  S.......    0215       0.5760        35.45  ...........         7.09
                 thor paraspinal.
95870.........  Muscle test,      ........  S.......    0215       0.5760        35.45  ...........         7.09
                 nonparaspinal.
95872.........  Muscle test, one  ........  S.......    0218       1.1993        73.82  ...........        14.76
                 fiber.
95873.........  Guide nerv        ........  S.......    0215       0.5760        35.45  ...........         7.09
                 destr, elec
                 stim.
95874.........  Guide nerv        ........  S.......    0215       0.5760        35.45  ...........         7.09
                 destr, needle
                 emg.
95875.........  Limb exercise     ........  S.......    0215       0.5760        35.45  ...........         7.09
                 test.
95900.........  Motor nerve       ........  S.......    0215       0.5760        35.45  ...........         7.09
                 conduction test.
95903.........  Motor nerve       ........  S.......    0215       0.5760        35.45  ...........         7.09
                 conduction test.
95904.........  Sense nerve       ........  S.......    0215       0.5760        35.45  ...........         7.09
                 conduction test.
95920.........  Intraop nerve     ........  S.......    0216       2.6729       164.52  ...........        32.90
                 test add-on.
95921.........  Autonomic nerv    CH......  S.......    0215       0.5760        35.45  ...........         7.09
                 function test.
95922.........  Autonomic nerv    CH......  S.......    0215       0.5760        35.45  ...........         7.09
                 function test.
95923.........  Autonomic nerv    CH......  S.......    0215       0.5760        35.45  ...........         7.09
                 function test.
95925.........  Somatosensory     ........  S.......    0216       2.6729       164.52  ...........        32.90
                 testing.
95926.........  Somatosensory     ........  S.......    0216       2.6729       164.52  ...........        32.90
                 testing.
95927.........  Somatosensory     ........  S.......    0216       2.6729       164.52  ...........        32.90
                 testing.
95928.........  C motor evoked,   ........  S.......    0218       1.1993        73.82  ...........        14.76
                 uppr limbs.
95929.........  C motor evoked,   ........  S.......    0218       1.1993        73.82  ...........        14.76
                 lwr limbs.
95930.........  Visual evoked     ........  S.......    0216       2.6729       164.52  ...........        32.90
                 potential test.
95933.........  Blink reflex      ........  S.......    0215       0.5760        35.45  ...........         7.09
                 test.
95934.........  H-reflex test...  ........  S.......    0215       0.5760        35.45  ...........         7.09
95936.........  H-reflex test...  ........  S.......    0215       0.5760        35.45  ...........         7.09
95937.........  Neuromuscular     CH......  S.......    0215       0.5760        35.45  ...........         7.09
                 junction test.
95950.........  Ambulatory eeg    ........  S.......    0209      11.4847       706.89       268.73       141.38
                 monitoring.
95951.........  EEG monitoring/   ........  S.......    0209      11.4847       706.89       268.73       141.38
                 videorecord.
95953.........  EEG monitoring/   ........  S.......    0209      11.4847       706.89       268.73       141.38
                 computer.
95954.........  EEG monitoring/   ........  S.......    0214       1.2353        76.03        28.24        15.21
                 giving drugs.
95955.........  EEG during        ........  S.......    0213       2.3133       142.39        53.58        28.48
                 surgery.
95956.........  Eeg monitoring,   ........  S.......    0209      11.4847       706.89       268.73       141.38
                 cable/radio.
95957.........  EEG digital       ........  S.......    0214       1.2353        76.03        28.24        15.21
                 analysis.
95958.........  EEG monitoring/   ........  S.......    0213       2.3133       142.39        53.58        28.48
                 function test.
95961.........  Electrode         ........  S.......    0216       2.6729       164.52  ...........        32.90
                 stimulation,
                 brain.
95962.........  Electrode stim,   ........  S.......    0216       2.6729       164.52  ...........        32.90
                 brain add-on.
95965.........  Meg, spontaneous  CH......  S.......    0038      51.2627     3,155.27  ...........       631.05
95966.........  Meg, evoked,      CH......  S.......    0209      11.4847       706.89       268.73       141.38
                 single.
95967.........  Meg, evoked,      CH......  S.......    0209      11.4847       706.89       268.73       141.38
                 each add'l.
95970.........  Analyze           ........  S.......    0218       1.1993        73.82  ...........        14.76
                 neurostim, no
                 prog.
95971.........  Analyze           ........  S.......    0692       1.9519       120.14        30.16        24.03
                 neurostim,
                 simple.
95972.........  Analyze           ........  S.......    0692       1.9519       120.14        30.16        24.03
                 neurostim,
                 complex.
95973.........  Analyze           CH......  S.......    0663       1.0752        66.18        16.96        13.24
                 neurostim,
                 complex.
95974.........  Cranial           ........  S.......    0692       1.9519       120.14        30.16        24.03
                 neurostim,
                 complex.
95975.........  Cranial           ........  S.......    0692       1.9519       120.14        30.16        24.03
                 neurostim,
                 complex.
95978.........  Analyze           ........  S.......    0692       1.9519       120.14        30.16        24.03
                 neurostim brain/
                 1h.
95979.........  Analyz neurostim  CH......  S.......    0663       1.0752        66.18        16.96        13.24
                 brain addon.
95990.........  Spin/brain pump   ........  T.......    0125       2.2200       136.64  ...........        27.33
                 refil&main.
95991.........  Spin/brain pump   ........  T.......    0125       2.2200       136.64  ...........        27.33
                 refil&main.
95999.........  Neurological      ........  S.......    0215       0.5760        35.45  ...........         7.09
                 procedure.
96000.........  Motion analysis,  ........  S.......    0216       2.6729       164.52  ...........        32.90
                 video/3d.
96001.........  Motion test w/ft  ........  S.......    0216       2.6729       164.52  ...........        32.90
                 press meas.
96002.........  Dynamic surface   ........  S.......    0218       1.1993        73.82  ...........        14.76
                 emg.
96003.........  Dynamic fine      ........  S.......    0215       0.5760        35.45  ...........         7.09
                 wire emg.
96101.........  Psycho testing    ........  X.......    0373       1.6262       100.09  ...........        20.02
                 by psych/phys.
96102.........  Psycho testing    ........  X.......    0382       2.7541       169.52        67.80        33.90
                 by technician.
96103.........  Psycho testing    ........  X.......    0373       1.6262       100.09  ...........        20.02
                 admin by comp.
96110.........  Developmental     ........  X.......    0373       1.6262       100.09  ...........        20.02
                 test, lim.
96111.........  Developmental     ........  X.......    0373       1.6262       100.09  ...........        20.02
                 test, extend.
96116.........  Neurobehavioral   ........  X.......    0373       1.6262       100.09  ...........        20.02
                 status exam.
96118.........  Neuropsych tst    ........  X.......    0373       1.6262       100.09  ...........        20.02
                 by psych/phys.
96119.........  Neuropsych        ........  X.......    0382       2.7541       169.52        67.80        33.90
                 testing by tech.
96120.........  Neuropsych tst    ........  X.......    0373       1.6262       100.09  ...........        20.02
                 admin w/comp.
96150.........  Assess hlth/      ........  S.......    0432       0.6006        36.97  ...........         7.39
                 behave, init.
96151.........  Assess hlth/      ........  S.......    0432       0.6006        36.97  ...........         7.39
                 behave, subseq.

[[Page 49830]]

 
96152.........  Intervene hlth/   ........  S.......    0432       0.6006        36.97  ...........         7.39
                 behave, indiv.
96153.........  Intervene hlth/   ........  S.......    0432       0.6006        36.97  ...........         7.39
                 behave, group.
96154.........  Interv hlth/      ........  S.......    0432       0.6006        36.97  ...........         7.39
                 behav, fam w/pt.
96401.........  Chemo, anti-      CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 neopl, sq/im.
96402.........  Chemo hormon      CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 antineopl sq/im.
96405.........  Chemo             CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 intralesional,
                 up to 7.
96406.........  Chemo             CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 intralesional
                 over 7.
96416.........  Chemo prolong     CH......  S.......    0441       2.5071       154.31  ...........        30.86
                 infuse w/pump.
96420.........  Chemo, ia, push   CH......  S.......    0439       1.5841        97.50  ...........        19.50
                 tecnique.
96422.........  Chemo ia          CH......  S.......    0441       2.5071       154.31  ...........        30.86
                 infusion up to
                 1 hr.
96423.........  Chemo ia infuse   CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 each addl hr.
96425.........  Chemotherapy,inf  CH......  S.......    0441       2.5071       154.31  ...........        30.86
                 usion method.
96440.........  Chemotherapy,     CH......  S.......    0439       1.5841        97.50  ...........        19.50
                 intracavitary.
96445.........  Chemotherapy,     CH......  S.......    0439       1.5841        97.50  ...........        19.50
                 intracavitary.
96450.........  Chemotherapy,     CH......  S.......    0441       2.5071       154.31  ...........        30.86
                 into CNS.
96521.........  Refill/maint,     CH......  S.......    0440       1.8285       112.55  ...........        22.51
                 portable pump.
96522.........  Refill/maint      CH......  S.......    0440       1.8285       112.55  ...........        22.51
                 pump/resvr syst.
96523.........  Irrig drug        CH......  Q.......    0624       0.5336        32.84        13.13         6.57
                 delivery device.
96542.........  Chemotherapy      CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 injection.
96549.........  Chemotherapy,     CH......  S.......    0436       0.1769        10.89  ...........         2.18
                 unspecified.
96567.........  Photodynamic tx,  ........  T.......    0016       2.6253       161.59        32.68        32.32
                 skin.
96570.........  Photodynamic tx,  ........  T.......    0015       1.6062        98.86        20.13        19.77
                 30 min.
96571.........  Photodynamic tx,  ........  T.......    0015       1.6062        98.86        20.13        19.77
                 addl 15 min.
96900.........  Ultraviolet       ........  S.......    0001       0.4896        30.14         7.00         6.03
                 light therapy.
96902.........  Trichogram......  ........  N.......  ......  ...........  ...........  ...........  ...........
96910.........  Photochemotherap  ........  S.......    0001       0.4896        30.14         7.00         6.03
                 y with UV-B.
96912.........  Photochemotherap  ........  S.......    0001       0.4896        30.14         7.00         6.03
                 y with UV-A.
96913.........  Photochemotherap  ........  S.......    0683       2.6902       165.58  ...........        33.12
                 y, UV-A or B.
96920.........  Laser tx, skin <  ........  T.......    0013       1.0876        66.94  ...........        13.39
                 250 sq cm.
96921.........  Laser tx, skin    ........  T.......    0013       1.0876        66.94  ...........        13.39
                 250-500 sq cm.
96922.........  Laser tx, skin >  ........  T.......    0013       1.0876        66.94  ...........        13.39
                 500 sq cm.
96999.........  Dermatological    ........  T.......    0010       0.4829        29.72         8.14         5.94
                 procedure.
97597.........  Active wound      ........  T.......    0012       0.8076        49.71        10.30         9.94
                 care/20 cm or <.
97598.........  Active wound      ........  T.......    0013       1.0876        66.94  ...........        13.39
                 care > 20 cm.
97602.........  Wound(s) care     ........  X.......    0340       0.6211        38.23  ...........         7.65
                 non-selective.
97605.........  Neg press wound   ........  T.......    0012       0.8076        49.71        10.30         9.94
                 tx, < 50 cm.
97606.........  Neg press wound   ........  T.......    0013       1.0876        66.94  ...........        13.39
                 tx, > 50 cm.
98925.........  Osteopathic       ........  S.......    0060       0.4904        30.18  ...........         6.04
                 manipulation.
98926.........  Osteopathic       ........  S.......    0060       0.4904        30.18  ...........         6.04
                 manipulation.
98927.........  Osteopathic       ........  S.......    0060       0.4904        30.18  ...........         6.04
                 manipulation.
98928.........  Osteopathic       ........  S.......    0060       0.4904        30.18  ...........         6.04
                 manipulation.
98929.........  Osteopathic       ........  S.......    0060       0.4904        30.18  ...........         6.04
                 manipulation.
98940.........  Chiropractic      ........  S.......    0060       0.4904        30.18  ...........         6.04
                 manipulation.
98941.........  Chiropractic      ........  S.......    0060       0.4904        30.18  ...........         6.04
                 manipulation.
98942.........  Chiropractic      ........  S.......    0060       0.4904        30.18  ...........         6.04
                 manipulation.
99078.........  Group health      ........  N.......  ......  ...........  ...........  ...........  ...........
                 education.
99091.........  Collect/review    ........  N.......  ......  ...........  ...........  ...........  ...........
                 data from pt.
99143.........  Mod cs by same    ........  N.......  ......  ...........  ...........  ...........  ...........
                 phys, < 5 yrs.
99144.........  Mod cs by same    ........  N.......  ......  ...........  ...........  ...........  ...........
                 phys, 5 yrs +.
99145.........  Mod cs by same    ........  N.......  ......  ...........  ...........  ...........  ...........
                 phys add-on.
99148.........  Mod cs diff phys  ........  N.......  ......  ...........  ...........  ...........  ...........
                 < 5 yrs.
99149.........  Mod cs diff phys  ........  N.......  ......  ...........  ...........  ...........  ...........
                 5 yrs +.
99150.........  Mod cs diff phys  ........  N.......  ......  ...........  ...........  ...........  ...........
                 add-on.
99170.........  Anogenital exam,  ........  T.......    0191       0.1501         9.24  ...........         1.85
                 child.
99175.........  Induction of      ........  N.......  ......  ...........  ...........  ...........  ...........
                 vomiting.
99185.........  Regional          ........  N.......  ......  ...........  ...........  ...........  ...........
                 hypothermia.
99186.........  Total body        ........  N.......  ......  ...........  ...........  ...........  ...........
                 hypothermia.
99195.........  Phlebotomy......  ........  X.......    0372       0.5814        35.79        10.09         7.16
99201.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, new.
99202.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, new.
99203.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, new.
99204.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, new.
99205.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, new.
99211.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, est.
99212.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, est.
99213.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, est.
99214.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, est.
99215.........  Office/           CH......  B.......  ......  ...........  ...........  ...........  ...........
                 outpatient
                 visit, est.
99241.........  Office            CH......  B.......  ......  ...........  ...........  ...........  ...........
                 consultation.
99242.........  Office            CH......  B.......  ......  ...........  ...........  ...........  ...........
                 consultation.

[[Page 49831]]

 
99243.........  Office            CH......  B.......  ......  ...........  ...........  ...........  ...........
                 consultation.
99244.........  Office            CH......  B.......  ......  ...........  ...........  ...........  ...........
                 consultation.
99245.........  Office            CH......  B.......  ......  ...........  ...........  ...........  ...........
                 consultation.
99281.........  Emergency dept    CH......  B.......  ......  ...........  ...........  ...........  ...........
                 visit.
99282.........  Emergency dept    CH......  B.......  ......  ...........  ...........  ...........  ...........
                 visit.
99283.........  Emergency dept    CH......  B.......  ......  ...........  ...........  ...........  ...........
                 visit.
99284.........  Emergency dept    CH......  B.......  ......  ...........  ...........  ...........  ...........
                 visit.
99285.........  Emergency dept    CH......  B.......  ......  ...........  ...........  ...........  ...........
                 visit.
99289.........  Ped crit care     ........  N.......  ......  ...........  ...........  ...........  ...........
                 transport.
99290.........  Ped crit care     ........  N.......  ......  ...........  ...........  ...........  ...........
                 transport addl.
99291.........  Critical care,    CH......  B.......  ......  ...........  ...........  ...........  ...........
                 first hour.
99292.........  Critical care,    CH......  B.......  ......  ...........  ...........  ...........  ...........
                 add'l 30 min.
99300.........  Ic, infant pbw    ........  N.......  ......  ...........  ...........  ...........  ...........
                 2501-5000 gm.
99354.........  Prolonged         ........  N.......  ......  ...........  ...........  ...........  ...........
                 service, office.
99355.........  Prolonged         ........  N.......  ......  ...........  ...........  ...........  ...........
                 service, office.
99358.........  Prolonged serv,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 w/o contact.
99359.........  Prolonged serv,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 w/o contact.
99361.........  Physician/team    ........  N.......  ......  ...........  ...........  ...........  ...........
                 conference.
99362.........  Physician/team    ........  N.......  ......  ...........  ...........  ...........  ...........
                 conference.
99431.........  Initial care,     CH......  V.......    0605       1.0057        61.90  ...........        12.38
                 normal newborn.
99432.........  Newborn care,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 not in hosp.
99436.........  Attendance,       ........  N.......  ......  ...........  ...........  ...........  ...........
                 birth.
99440.........  Newborn           ........  S.......    0094       2.4630       151.60        46.29        30.32
                 resuscitation.
0003T.........  Cervicography...  CH......  T.......    0191       0.1501         9.24  ...........         1.85
0008T.........  Upper gi          ........  T.......    0422      27.5493     1,695.69       448.81       339.14
                 endoscopy w/
                 suture.
0016T.........  Thermotx choroid  ........  T.......    0235       4.0750       250.82        61.14        50.16
                 vasc lesion.
0017T.........  Photocoagulat     ........  T.......    0235       4.0750       250.82        61.14        50.16
                 macular drusen.
0018T.........  Transcranial      ........  S.......    0215       0.5760        35.45  ...........         7.09
                 magnetic stimul.
0027T.........  Endoscopic        ........  T.......    0220      17.7609     1,093.20  ...........       218.64
                 epidural lysis.
0028T.........  Dexa body         ........  N.......  ......  ...........  ...........  ...........  ...........
                 composition
                 study.
0031T.........  Speculoscopy....  ........  N.......  ......  ...........  ...........  ...........  ...........
0032T.........  Speculoscopy w/   ........  N.......  ......  ...........  ...........  ...........  ...........
                 direct sample.
0042T.........  Ct perfusion w/   ........  N.......  ......  ...........  ...........  ...........  ...........
                 contrast, cbf.
0044T.........  Whole body        ........  N.......  ......  ...........  ...........  ...........  ...........
                 photography.
0045T.........  Whole body        ........  N.......  ......  ...........  ...........  ...........  ...........
                 photography.
0046T.........  Cath lavage,      ........  T.......    0021      14.9563       920.58       219.48       184.12
                 mammary duct(s.
0047T.........  Cath lavage,      ........  T.......    0021      14.9563       920.58       219.48       184.12
                 mammary duct(s).
0054T.........  Bone surgery      ........  S.......    0302       5.5005       338.56       105.94        67.71
                 using computer.
0055T.........  Bone surgery      ........  S.......    0302       5.5005       338.56       105.94        67.71
                 using computer.
0056T.........  Bone surgery      ........  S.......    0302       5.5005       338.56       105.94        67.71
                 using computer.
0058T.........  Cryopreservation  ........  X.......    0348       0.8928        54.95  ...........        10.99
                 , ovary tiss.
0059T.........  Cryopreservation  ........  X.......    0348       0.8928        54.95  ...........        10.99
                 , oocyte.
0062T.........  Rep intradisc     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 annulus;1 lev.
0063T.........  Rep intradisc     ........  T.......    0050      25.0600     1,542.47  ...........       308.49
                 annulus;>1lev.
0064T.........  Spectroscop eval  ........  X.......    0367       0.6253        38.49        14.64         7.70
                 expired gas.
0067T.........  Ct                ........  S.......    0333       5.0020       307.88       121.52        61.58
                 colonography;dx.
0069T.........  Analysis only     ........  N.......  ......  ...........  ...........  ...........  ...........
                 heart sound.
0070T.........  Interp only       ........  N.......  ......  ...........  ...........  ...........  ...........
                 heart sound.
0071T.........  U/s leiomyomata   ........  T.......    0195      28.7410     1,769.04       483.80       353.81
                 ablate <200.
0072T.........  U/s leiomyomata   ........  T.......    0202      42.8756     2,639.04       981.50       527.81
                 ablate >200.
0073T.........  Delivery, comp    ........  S.......    0412       5.5021       338.66  ...........        67.73
                 imrt.
0083T.........  Stereotactic rad  ........  N.......  ......  ...........  ...........  ...........  ...........
                 tx mngmt.
0084T.........  Temp prostate     ........  T.......    0164       2.1159       130.24  ...........        26.05
                 urethral stent.
0085T.........  Breath test       ........  X.......    0340       0.6211        38.23  ...........         7.65
                 heart reject.
0086T.........  L ventricle fill  ........  N.......  ......  ...........  ...........  ...........  ...........
                 pressure.
0087T.........  Sperm eval        ........  X.......    0348       0.8928        54.95  ...........        10.99
                 hyaluronan.
0088T.........  Rf tongue base    ........  T.......    0253      16.4494     1,012.48       282.29       202.50
                 vol reduxn.
0089T.........  Actigraphy        ........  S.......    0218       1.1993        73.82  ...........        14.76
                 testing, 3-day.
0099T.........  Implant corneal   ........  T.......    0233      14.9969       923.07       266.33       184.61
                 ring.
0100T.........  Prosth retina     ........  T.......    0672      36.8820     2,270.12  ...........       454.02
                 receive&gen.
0101T.........  Extracorp         CH......  T.......    0050      25.0600     1,542.47  ...........       308.49
                 shockwv tx,hi
                 enrg.
0102T.........  Extracorp         CH......  T.......    0050      25.0600     1,542.47  ...........       308.49
                 shockwv
                 tx,anesth.
0106T.........  Touch quant       ........  X.......    0341       0.0914         5.63         2.25         1.13
                 sensory test.
0107T.........  Vibrate quant     ........  X.......    0341       0.0914         5.63         2.25         1.13
                 sensory test.
0108T.........  Cool quant        ........  X.......    0341       0.0914         5.63         2.25         1.13
                 sensory test.
0109T.........  Heat quant        ........  X.......    0341       0.0914         5.63         2.25         1.13
                 sensory test.
0110T.........  Nos quant         ........  X.......    0341       0.0914         5.63         2.25         1.13
                 sensory test.
0120T.........  Fibroadenoma      ........  T.......    0029      28.1505     1,732.69  ...........       346.54
                 cryoablate, ea.
0123T.........  Scleral           ........  T.......    0234      22.9479     1,412.47       511.31       282.49
                 fistulization.
0124T.........  Conjunctival      ........  T.......    0232       5.9800       368.07        92.21        73.61
                 drug placement.

[[Page 49832]]

 
0126T.........  Chd risk imt      ........  N.......  ......  ...........  ...........  ...........  ...........
                 study.
0133T.........  Esophageal        CH......  T.......    0422      27.5493     1,695.69       448.81       339.14
                 implant injexn.
0135T.........  Perq cryoablate   CH......  T.......    0423      39.0235     2,401.94  ...........       480.39
                 renal tumor.
0137T.........  Prostate          ........  T.......    0184       5.9892       368.64        96.27        73.73
                 saturation
                 sampling.
0144T.........  CT heart wo dye;  ........  S.......    0398       4.2511       261.66       100.06        52.33
                 qual calc.
0145T.........  CT heart w/wo     ........  S.......    0376       4.9770       306.34       119.77        61.27
                 dye funct.
0146T.........  CCTA w/wo dye...  ........  S.......    0376       4.9770       306.34       119.77        61.27
0147T.........  CCTA w/wo, quan   ........  S.......    0376       4.9770       306.34       119.77        61.27
                 calcium.
0148T.........  CCTA w/wo, strxr  ........  S.......    0377       6.7443       415.12       158.84        83.02
0149T.........  CCTA w/wo, strxr  ........  S.......    0377       6.7443       415.12       158.84        83.02
                 quan calc.
0150T.........  CCTA w/wo,        ........  S.......    0398       4.2511       261.66       100.06        52.33
                 disease strxr.
0151T.........  CT heart funct    ........  S.......    0282       1.5552        95.72        37.92        19.14
                 add-on.
0152T.........  Computer chest    ........  N.......  ......  ...........  ...........  ...........  ...........
                 add-on.
0154T.........  Implant aneur     ........  X.......    0097       1.0245        63.06        23.79        12.61
                 sensor study.
A0800.........  Amb trans 7pm-    CH......  E.......  ......  ...........  ...........  ...........  ...........
                 7am.
A4218.........  Sterile saline    ........  N.......  ......  ...........  ...........  ...........  ...........
                 or water.
A4220.........  Infusion pump     ........  N.......  ......  ...........  ...........  ...........  ...........
                 refill kit.
A4248.........  Chlorhexidine     ........  N.......  ......  ...........  ...........  ...........  ...........
                 antisept.
A4262.........  Temporary tear    ........  N.......  ......  ...........  ...........  ...........  ...........
                 duct plug.
A4263.........  Permanent tear    ........  N.......  ......  ...........  ...........  ...........  ...........
                 duct plug.
A4270.........  Disposable        ........  N.......  ......  ...........  ...........  ...........  ...........
                 endoscope
                 sheath.
A4300.........  Cath impl vasc    ........  N.......  ......  ...........  ...........  ...........  ...........
                 access portal.
A4301.........  Implantable       ........  N.......  ......  ...........  ...........  ...........  ...........
                 access syst
                 perc.
A4561.........  Pessary rubber,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 any type.
A4562.........  Pessary, non      ........  N.......  ......  ...........  ...........  ...........  ...........
                 rubber,any type.
A4641.........  Radiopharm dx     ........  N.......  ......  ...........  ...........  ...........  ...........
                 agent noc.
A4642.........  In111 satumomab.  CH......  K.......    0704  ...........       192.12  ...........        38.42
A9500.........  Tc99m sestamibi.  CH......  K.......    1600  ...........        82.58  ...........        16.52
A9502.........  Tc99m             CH......  K.......    0705  ...........        73.81  ...........        14.76
                 tetrofosmin.
A9503.........  Tc99m medronate.  ........  N.......  ......  ...........  ...........  ...........  ...........
A9504.........  Tc99m apcitide..  CH......  N.......  ......  ...........  ...........  ...........  ...........
A9505.........  TL201 thallium..  CH......  K.......    1603  ...........        27.18  ...........         5.44
A9507.........  In111 capromab..  CH......  K.......    1604  ...........       928.19  ...........       185.64
A9508.........  I131              CH......  K.......    1045  ...........       429.55  ...........        85.91
                 iodobenguate,
                 dx.
A9510.........  Tc99m disofenin.  CH......  N.......  ......  ...........  ...........  ...........  ...........
A9512.........  Tc99m             ........  N.......  ......  ...........  ...........  ...........  ...........
                 pertechnetate.
A9516.........  I123 iodide cap,  CH......  K.......    9148  ...........        27.44  ...........         5.49
                 dx.
A9517.........  I131 iodide cap,  CH......  K.......    1064  ...........        14.54  ...........         2.91
                 rx.
A9521.........  Tc99m             CH......  K.......    1096  ...........       317.07  ...........        63.41
                 exametazime.
A9524.........  I131 serum        CH......  K.......    9100  ...........        36.78  ...........         7.36
                 albumin, dx.
A9526.........  Nitrogen N-13     CH......  K.......    0737  ...........       230.77  ...........        46.15
                 ammonia.
A9528.........  Iodine I-131      CH......  K.......    1088  ...........        24.86  ...........         4.97
                 iodide cap, dx.
A9529.........  I131 iodide sol,  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 dx.
A9530.........  I131 iodide sol,  CH......  K.......    1150  ...........        12.60  ...........         2.52
                 rx.
A9531.........  I131 max 100uCi.  CH......  N.......  ......  ...........  ...........  ...........  ...........
A9532.........  I125 serum        CH......  N.......  ......  ...........  ...........  ...........  ...........
                 albumin, dx.
A9535.........  Injection,        CH......  N.......  ......  ...........  ...........  ...........  ...........
                 methylene blue.
A9536.........  Tc99m depreotide  CH......  K.......    0739  ...........        67.91  ...........        13.58
A9537.........  Tc99m mebrofenin  ........  N.......  ......  ...........  ...........  ...........  ...........
A9538.........  Tc99m             ........  N.......  ......  ...........  ...........  ...........  ...........
                 pyrophosphate.
A9539.........  Tc99m pentetate.  CH......  K.......    0722  ...........        56.77  ...........        11.35
A9540.........  Tc99m MAA.......  ........  N.......  ......  ...........  ...........  ...........  ...........
A9541.........  Tc99m sulfur      ........  N.......  ......  ...........  ...........  ...........  ...........
                 colloid.
A9542.........  In111             CH......  K.......    1642  ...........     1,344.34  ...........       268.87
                 ibritumomab, dx.
A9543.........  Y90 ibritumomab,  CH......  K.......    1643  ...........    12,130.20  ...........     2,426.04
                 rx.
A9544.........  I131              CH......  K.......    1644  ...........     1,368.17  ...........       273.63
                 tositumomab, dx.
A9545.........  I131              CH......  K.......    1645  ...........    11,868.78  ...........     2,373.76
                 tositumomab, rx.
A9546.........  Co57/58.........  CH......  K.......    0723  ...........       149.44  ...........        29.89
A9547.........  In111             CH......  K.......    1646  ...........       306.51  ...........        61.30
                 oxyquinoline.
A9548.........  In111 pentetate.  CH......  K.......    1647  ...........       262.81  ...........        52.56
A9549.........  Tc99m             CH......  K.......    1648  ...........       255.95  ...........        51.19
                 arcitumomab.
A9550.........  Tc99m gluceptate  CH......  K.......    0740  ...........       236.53  ...........        47.31
A9551.........  Tc99m succimer..  CH......  K.......    1650  ...........        84.79  ...........        16.96
A9552.........  F18 fdg.........  CH......  K.......    1651  ...........       235.56  ...........        47.11
A9553.........  Cr51 chromate...  CH......  K.......    0741  ...........       167.62  ...........        33.52
A9554.........  I125              CH......  N.......  ......  ...........  ...........  ...........  ...........
                 iothalamate, dx.
A9555.........  Rb82 rubidium...  CH......  K.......    1654  ...........       239.83  ...........        47.97
A9556.........  Ga67 gallium....  CH......  K.......    1671  ...........        22.73  ...........         4.55
A9557.........  Tc99m bicisate..  CH......  K.......    1672  ...........       254.46  ...........        50.89
A9558.........  Xe133 xenon       ........  N.......  ......  ...........  ...........  ...........  ...........
                 10mci.

[[Page 49833]]

 
A9559.........  Co57 cyano......  CH......  K.......    0724  ...........        63.74  ...........        12.75
A9560.........  Tc99m labeled     CH......  K.......    0742  ...........       132.95  ...........        26.59
                 rbc.
A9561.........  Tc99m oxidronate  ........  N.......  ......  ...........  ...........  ...........  ...........
A9562.........  Tc99m mertiatide  CH......  K.......    0743  ...........       180.08  ...........        36.02
A9563.........  P32 Na phosphate  CH......  K.......    1675  ...........       117.11  ...........        23.42
A9564.........  P32 chromic       CH......  K.......    1676  ...........       222.35  ...........        44.47
                 phosphate.
A9565.........  In111             CH......  K.......    1677  ...........       185.60  ...........        37.12
                 pentetreotide.
A9566.........  Tc99m             CH......  K.......    1678  ...........       527.31  ...........       105.46
                 fanolesomab.
A9567.........  Technetium TC-    CH......  N.......  ......  ...........  ...........  ...........  ...........
                 99m aerosol.
A9600.........  Sr89 strontium..  CH......  K.......    0701  ...........       533.58  ...........       106.72
A9605.........  Sm 153 lexidronm  CH......  K.......    0702  ...........     1,316.41  ...........       263.28
A9698.........  Non-rad contrast  ........  N.......  ......  ...........  ...........  ...........  ...........
                 materialNOC.
A9699.........  Radiopharm rx     ........  N.......  ......  ...........  ...........  ...........  ...........
                 agent noc.
C1178.........  BUSULFAN IV, 6    ........  K.......    1178  ...........        24.87  ...........         4.97
                 Mg.
C1300.........  HYPERBARIC        ........  S.......    0659       1.5925        98.02  ...........        19.60
                 Oxygen.
C1713.........  Anchor/screw bn/  ........  N.......  ......  ...........  ...........  ...........  ...........
                 bn,tis/bn.
C1714.........  Cath, trans       ........  N.......  ......  ...........  ...........  ...........  ...........
                 atherectomy,
                 dir.
C1715.........  Brachytherapy     ........  N.......  ......  ...........  ...........  ...........  ...........
                 needle.
C1716.........  Brachytx source,  CH......  K.......    1716       0.4493        27.65  ...........         5.53
                 Gold 198.
C1717.........  Brachytx source,  CH......  K.......    1717       2.1922       134.93  ...........        26.99
                 HDR Ir-192.
C1718.........  Brachytx source,  CH......  K.......    1718       0.5754        35.42  ...........         7.08
                 Iodine 125.
C1719.........  Brachytx          CH......  K.......    1719       0.5108        31.44  ...........         6.29
                 sour,Non-HDR Ir-
                 192.
C1720.........  Brachytx sour,    CH......  K.......    1720       0.7945        48.90  ...........         9.78
                 Palladium 103.
C1721.........  AICD, dual        ........  N.......  ......  ...........  ...........  ...........  ...........
                 chamber.
C1722.........  AICD, single      ........  N.......  ......  ...........  ...........  ...........  ...........
                 chamber.
C1724.........  Cath, trans       ........  N.......  ......  ...........  ...........  ...........  ...........
                 atherec,rotatio
                 n.
C1725.........  Cath, translumin  ........  N.......  ......  ...........  ...........  ...........  ...........
                 non-laser.
C1726.........  Cath, bal dil,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 non-vascular.
C1727.........  Cath, bal tis     ........  N.......  ......  ...........  ...........  ...........  ...........
                 dis, non-vas.
C1728.........  Cath, brachytx    ........  N.......  ......  ...........  ...........  ...........  ...........
                 seed adm.
C1729.........  Cath, drainage..  ........  N.......  ......  ...........  ...........  ...........  ...........
C1730.........  Cath, EP, 19 or   ........  N.......  ......  ...........  ...........  ...........  ...........
                 few elect.
C1731.........  Cath, EP, 20 or   ........  N.......  ......  ...........  ...........  ...........  ...........
                 more elec.
C1732.........  Cath, EP, diag/   ........  N.......  ......  ...........  ...........  ...........  ...........
                 abl, 3D/vect.
C1733.........  Cath, EP, othr    ........  N.......  ......  ...........  ...........  ...........  ...........
                 than cool-tip.
C1750.........  Cath,             ........  N.......  ......  ...........  ...........  ...........  ...........
                 hemodialysis,lo
                 ng-term.
C1751.........  Cath, inf, per/   ........  N.......  ......  ...........  ...........  ...........  ...........
                 cent/midline.
C1752.........  Cath,hemodialysi  ........  N.......  ......  ...........  ...........  ...........  ...........
                 s,short-term.
C1753.........  Cath, intravas    ........  N.......  ......  ...........  ...........  ...........  ...........
                 ultrasound.
C1754.........  Catheter,         ........  N.......  ......  ...........  ...........  ...........  ...........
                 intradiscal.
C1755.........  Catheter,         ........  N.......  ......  ...........  ...........  ...........  ...........
                 intraspinal.
C1756.........  Cath, pacing,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 transesoph.
C1757.........  Cath,             ........  N.......  ......  ...........  ...........  ...........  ...........
                 thrombectomy/
                 embolect.
C1758.........  Catheter,         ........  N.......  ......  ...........  ...........  ...........  ...........
                 ureteral.
C1759.........  Cath, intra       ........  N.......  ......  ...........  ...........  ...........  ...........
                 echocardiograph
                 y.
C1760.........  Closure dev,      ........  N.......  ......  ...........  ...........  ...........  ...........
                 vasc.
C1762.........  Conn tiss,        ........  N.......  ......  ...........  ...........  ...........  ...........
                 human(inc
                 fascia).
C1763.........  Conn tiss, non-   ........  N.......  ......  ...........  ...........  ...........  ...........
                 human.
C1764.........  Event recorder,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 cardiac.
C1765.........  Adhesion barrier  ........  N.......  ......  ...........  ...........  ...........  ...........
C1766.........  Intro/            ........  N.......  ......  ...........  ...........  ...........  ...........
                 sheath,strble,n
                 on-peel.
C1767.........  Generator, neuro  ........  N.......  ......  ...........  ...........  ...........  ...........
                 non-recharg.
C1768.........  Graft, vascular.  ........  N.......  ......  ...........  ...........  ...........  ...........
C1769.........  Guide wire......  ........  N.......  ......  ...........  ...........  ...........  ...........
C1770.........  Imaging coil,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 MR, insertable.
C1771.........  Rep dev,          ........  N.......  ......  ...........  ...........  ...........  ...........
                 urinary, w/
                 sling.
C1772.........  Infusion pump,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 programmable.
C1773.........  Ret dev,          ........  N.......  ......  ...........  ...........  ...........  ...........
                 insertable.
C1776.........  Joint device      ........  N.......  ......  ...........  ...........  ...........  ...........
                 (implantable).
C1777.........  Lead, AICD, endo  ........  N.......  ......  ...........  ...........  ...........  ...........
                 single coil.
C1778.........  Lead,             ........  N.......  ......  ...........  ...........  ...........  ...........
                 neurostimulator.
C1779.........  Lead, pmkr,       ........  N.......  ......  ...........  ...........  ...........  ...........
                 transvenous VDD.
C1780.........  Lens,             ........  N.......  ......  ...........  ...........  ...........  ...........
                 intraocular
                 (new tech).
C1781.........  Mesh              ........  N.......  ......  ...........  ...........  ...........  ...........
                 (implantable).
C1782.........  Morcellator.....  ........  N.......  ......  ...........  ...........  ...........  ...........
C1783.........  Ocular imp,       ........  N.......  ......  ...........  ...........  ...........  ...........
                 aqueous drain
                 de.
C1784.........  Ocular dev,       ........  N.......  ......  ...........  ...........  ...........  ...........
                 intraop, det
                 ret.
C1785.........  Pmkr, dual, rate- ........  N.......  ......  ...........  ...........  ...........  ...........
                 resp.
C1786.........  Pmkr, single,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 rate-resp.
C1787.........  Patient progr,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 neurostim.

[[Page 49834]]

 
C1788.........  Port,             ........  N.......  ......  ...........  ...........  ...........  ...........
                 indwelling, imp.
C1789.........  Prosthesis,       ........  N.......  ......  ...........  ...........  ...........  ...........
                 breast, imp.
C1813.........  Prosthesis,       ........  N.......  ......  ...........  ...........  ...........  ...........
                 penile,
                 inflatab.
C1814.........  Retinal tamp,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 silicone oil.
C1815.........  Pros, urinary     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sph, imp.
C1816.........  Receiver/         ........  N.......  ......  ...........  ...........  ...........  ...........
                 transmitter,
                 neuro.
C1817.........  Septal defect     ........  N.......  ......  ...........  ...........  ...........  ...........
                 imp sys.
C1818.........  Integrated        ........  N.......  ......  ...........  ...........  ...........  ...........
                 keratoprosthesi
                 s.
C1819.........  Tissue            ........  N.......  ......  ...........  ...........  ...........  ...........
                 localization-
                 excision.
C1820.........  Generator neuro   ........  H.......    1820  ...........  ...........  ...........  ...........
                 rechg bat sy.
C1874.........  Stent, coated/    ........  N.......  ......  ...........  ...........  ...........  ...........
                 cov w/del sys.
C1875.........  Stent, coated/    ........  N.......  ......  ...........  ...........  ...........  ...........
                 cov w/o del sy.
C1876.........  Stent, non-coa/   ........  N.......  ......  ...........  ...........  ...........  ...........
                 non-cov w/del.
C1877.........  Stent, non-coat/  ........  N.......  ......  ...........  ...........  ...........  ...........
                 cov w/o del.
C1878.........  Matrl for vocal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 cord.
C1879.........  Tissue marker,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 implantable.
C1880.........  Vena cava filter  ........  N.......  ......  ...........  ...........  ...........  ...........
C1881.........  Dialysis access   ........  N.......  ......  ...........  ...........  ...........  ...........
                 system.
C1882.........  AICD, other than  ........  N.......  ......  ...........  ...........  ...........  ...........
                 sing/dual.
C1883.........  Adapt/ext,        ........  N.......  ......  ...........  ...........  ...........  ...........
                 pacing/neuro
                 lead.
C1884.........  Embolization      ........  N.......  ......  ...........  ...........  ...........  ...........
                 Protect syst.
C1885.........  Cath, translumin  ........  N.......  ......  ...........  ...........  ...........  ...........
                 angio laser.
C1887.........  Catheter,         ........  N.......  ......  ...........  ...........  ...........  ...........
                 guiding.
C1888.........  Endovas non-      ........  N.......  ......  ...........  ...........  ...........  ...........
                 cardiac abl
                 cath.
C1891.........  Infusion          ........  N.......  ......  ...........  ...........  ...........  ...........
                 pump,non-prog,
                 perm.
C1892.........  Intro/            ........  N.......  ......  ...........  ...........  ...........  ...........
                 sheath,fixed,pe
                 el-away.
C1893.........  Intro/sheath,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 fixed,non-peel.
C1894.........  Intro/sheath,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 non-laser.
C1895.........  Lead, AICD, endo  ........  N.......  ......  ...........  ...........  ...........  ...........
                 dual coil.
C1896.........  Lead, AICD, non   ........  N.......  ......  ...........  ...........  ...........  ...........
                 sing/dual.
C1897.........  Lead, neurostim   ........  N.......  ......  ...........  ...........  ...........  ...........
                 test kit.
C1898.........  Lead, pmkr,       ........  N.......  ......  ...........  ...........  ...........  ...........
                 other than
                 trans.
C1899.........  Lead, pmkr/AICD   ........  N.......  ......  ...........  ...........  ...........  ...........
                 combination.
C1900.........  Lead, coronary    ........  N.......  ......  ...........  ...........  ...........  ...........
                 venous.
C2614.........  Probe, perc lumb  ........  N.......  ......  ...........  ...........  ...........  ...........
                 disc.
C2615.........  Sealant,          ........  N.......  ......  ...........  ...........  ...........  ...........
                 pulmonary,
                 liquid.
C2616.........  Brachytx source,  CH......  K.......    2616     272.7710    16,789.33  ...........     3,357.87
                 Yttrium-90.
C2617.........  Stent, non-cor,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 tem w/o del.
C2618.........  Probe,            ........  N.......  ......  ...........  ...........  ...........  ...........
                 cryoablation.
C2619.........  Pmkr, dual, non   ........  N.......  ......  ...........  ...........  ...........  ...........
                 rate-resp.
C2620.........  Pmkr, single,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 non rate-resp.
C2621.........  Pmkr, other than  ........  N.......  ......  ...........  ...........  ...........  ...........
                 sing/dual.
C2622.........  Prosthesis,       ........  N.......  ......  ...........  ...........  ...........  ...........
                 penile, non-inf.
C2625.........  Stent, non-cor,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 tem w/del sy.
C2626.........  Infusion pump,    ........  N.......  ......  ...........  ...........  ...........  ...........
                 non-prog,temp.
C2627.........  Cath, suprapubic/ ........  N.......  ......  ...........  ...........  ...........  ...........
                 cystoscopic.
C2628.........  Catheter,         ........  N.......  ......  ...........  ...........  ...........  ...........
                 occlusion.
C2629.........  Intro/sheath,     ........  N.......  ......  ...........  ...........  ...........  ...........
                 laser.
C2630.........  Cath, EP, cool-   ........  N.......  ......  ...........  ...........  ...........  ...........
                 tip.
C2631.........  Rep dev,          ........  N.......  ......  ...........  ...........  ...........  ...........
                 urinary, w/o
                 sling.
C2632.........  Brachytx sol, I-  CH......  K.......    2632       0.3139        19.32  ...........         3.86
                 125, per mCi.
C2633.........  Brachytx source,  CH......  K.......    2633       1.4622        90.00  ...........        18.00
                 Cesium-131.
C2634.........  Brachytx source,  CH......  K.......    2634       0.4172        25.68  ...........         5.14
                 HA, I-125.
C2635.........  Brachytx source,  CH......  K.......    2635       0.8820        54.29  ...........        10.86
                 HA, P-103.
C2636.........  Brachytx linear   CH......  K.......    2636       0.6360        39.15  ...........         7.83
                 source,P-103.
C2637.........  Brachytx,         CH......  K.......    2637       0.4172        25.68  ...........         5.14
                 Ytterbium-169.
C8900.........  MRA w/cont, abd.  ........  S.......    0284       6.2589       385.24       148.40        77.05
C8901.........  MRA w/o cont,     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 abd.
C8902.........  MRA w/o fol w/    ........  S.......    0337       8.3423       513.48       202.50       102.70
                 cont, abd.
C8903.........  MRI w/cont,       ........  S.......    0284       6.2589       385.24       148.40        77.05
                 breast, uni.
C8904.........  MRI w/o cont,     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 breast, uni.
C8905.........  MRI w/o fol w/    ........  S.......    0337       8.3423       513.48       202.50       102.70
                 cont, brst, un.
C8906.........  MRI w/cont,       ........  S.......    0284       6.2589       385.24       148.40        77.05
                 breast, bi.
C8907.........  MRI w/o cont,     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 breast, bi.
C8908.........  MRI w/o fol w/    ........  S.......    0337       8.3423       513.48       202.50       102.70
                 cont, breast,.
C8909.........  MRA w/cont,       ........  S.......    0284       6.2589       385.24       148.40        77.05
                 chest.
C8910.........  MRA w/o cont,     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 chest.
C8911.........  MRA w/o fol w/    ........  S.......    0337       8.3423       513.48       202.50       102.70
                 cont, chest.
C8912.........  MRA w/cont, lwr   ........  S.......    0284       6.2589       385.24       148.40        77.05
                 ext.
C8913.........  MRA w/o cont,     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 lwr ext.

[[Page 49835]]

 
C8914.........  MRA w/o fol w/    ........  S.......    0337       8.3423       513.48       202.50       102.70
                 cont, lwr ext.
C8918.........  MRA w/cont,       ........  S.......    0284       6.2589       385.24       148.40        77.05
                 pelvis.
C8919.........  MRA w/o cont,     ........  S.......    0336       5.8500       360.07       139.68        72.01
                 pelvis.
C8920.........  MRA w/o fol w/    ........  S.......    0337       8.3423       513.48       202.50       102.70
                 cont, pelvis.
C8950.........  IV inf, tx/dx,    CH......  S.......    0440       1.8285       112.55  ...........        22.51
                 up to 1 hr.
C8951.........  IV inf, tx/dx,    CH......  S.......    0437       0.4107        25.28  ...........         5.06
                 each addl hr.
C8952.........  Tx, prophy, dx    CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 IV push.
C8953.........  Chemotx adm, IV   CH......  S.......    0439       1.5841        97.50  ...........        19.50
                 push.
C8954.........  Chemotx adm, IV   CH......  S.......    0441       2.5071       154.31  ...........        30.86
                 inf up to 1h.
C8955.........  Chemotx adm, IV   CH......  S.......    0438       0.7892        48.58  ...........         9.72
                 inf, addl hr.
C8957.........  Prolonged IV      CH......  S.......    0441       2.5071       154.31  ...........        30.86
                 inf, req pump.
C9003.........  Palivizumab, per  ........  K.......    9003  ...........       609.62  ...........       121.92
                 50 mg.
C9113.........  Inj pantoprazole  ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium, via.
C9121.........  Injection,        ........  K.......    9121  ...........        16.40  ...........         3.28
                 argatroban.
C9220.........  Sodium            CH......  K.......    9220  ...........       197.62  ...........        39.52
                 hyaluronate.
C9221.........  Graftjacket Reg   CH......  B.......  ......  ...........  ...........  ...........  ...........
                 Matrix.
C9222.........  Graftjacket       CH......  K.......    9222  ...........       883.78  ...........       176.76
                 SftTis.
C9224.........  Injection,        ........  K.......    9224  ...........     1,503.23  ...........       300.65
                 galsulfase.
C9225.........  Fluocinolone      ........  G.......    9225  ...........    19,345.00  ...........     3,869.00
                 acetonide.
C9227.........  Injection,        ........  G.......    9227  ...........         1.98  ...........         0.40
                 micafungin
                 sodium.
C9228.........  Injection,        ........  G.......    9228  ...........         0.96  ...........         0.19
                 tigecycline.
C9716.........  Radiofrequency    CH......  T.......    0150      29.4386     1,811.98       437.12       362.40
                 energy to anu.
C9723.........  Dyn IR Perf Img.  ........  S.......    1502  ...........        75.00  ...........        15.00
C9724.........  EPS gast cardia   ........  T.......    0422      27.5493     1,695.69       448.81       339.14
                 plic.
C9725.........  Place endorectal  ........  S.......    1507  ...........       550.00  ...........       110.00
                 app.
C9726.........  Rxt breast appl   ........  S.......    1508  ...........       650.00  ...........       130.00
                 place/remov.
D0150.........  Comprehensve      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 oral evaluation.
D0240.........  Intraoral         ........  S.......    0330       9.5891       590.22  ...........       118.04
                 occlusal film.
D0250.........  Extraoral first   ........  S.......    0330       9.5891       590.22  ...........       118.04
                 film.
D0260.........  Extraoral ea      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 additional film.
D0270.........  Dental bitewing   ........  S.......    0330       9.5891       590.22  ...........       118.04
                 single film.
D0272.........  Dental bitewings  ........  S.......    0330       9.5891       590.22  ...........       118.04
                 two films.
D0274.........  Dental bitewings  ........  S.......    0330       9.5891       590.22  ...........       118.04
                 four films.
D0277.........  Vert bitewings-   ........  S.......    0330       9.5891       590.22  ...........       118.04
                 sev to eight.
D0460.........  Pulp vitality     ........  S.......    0330       9.5891       590.22  ...........       118.04
                 test.
D1510.........  Space maintainer  ........  S.......    0330       9.5891       590.22  ...........       118.04
                 fxd unilat.
D1515.........  Fixed bilat       ........  S.......    0330       9.5891       590.22  ...........       118.04
                 space
                 maintainer.
D1520.........  Remove unilat     ........  S.......    0330       9.5891       590.22  ...........       118.04
                 space maintain.
D1525.........  Remove bilat      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 space maintain.
D1550.........  Recement space    ........  S.......    0330       9.5891       590.22  ...........       118.04
                 maintainer.
D2999.........  Dental unspec     ........  S.......    0330       9.5891       590.22  ...........       118.04
                 restorative pr.
D3460.........  Endodontic        ........  S.......    0330       9.5891       590.22  ...........       118.04
                 endosseous
                 implan.
D3999.........  Endodontic        ........  S.......    0330       9.5891       590.22  ...........       118.04
                 procedure.
D4260.........  Osseous surgery   ........  S.......    0330       9.5891       590.22  ...........       118.04
                 per quadrant.
D4263.........  Bone replce       ........  S.......    0330       9.5891       590.22  ...........       118.04
                 graft first
                 site.
D4264.........  Bone replce       ........  S.......    0330       9.5891       590.22  ...........       118.04
                 graft each add.
D4268.........  Surgical          ........  S.......    0330       9.5891       590.22  ...........       118.04
                 revision
                 procedure.
D4270.........  Pedicle soft      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 tissue graft pr.
D4271.........  Free soft tissue  ........  S.......    0330       9.5891       590.22  ...........       118.04
                 graft proc.
D4273.........  Subepithelial     ........  S.......    0330       9.5891       590.22  ...........       118.04
                 tissue graft.
D4355.........  Full mouth        ........  S.......    0330       9.5891       590.22  ...........       118.04
                 debridement.
D4381.........  Localized         ........  S.......    0330       9.5891       590.22  ...........       118.04
                 delivery
                 antimicro.
D5911.........  Facial moulage    ........  S.......    0330       9.5891       590.22  ...........       118.04
                 sectional.
D5912.........  Facial moulage    ........  S.......    0330       9.5891       590.22  ...........       118.04
                 complete.
D5983.........  Radiation         ........  S.......    0330       9.5891       590.22  ...........       118.04
                 applicator.
D5984.........  Radiation shield  ........  S.......    0330       9.5891       590.22  ...........       118.04
D5985.........  Radiation cone    ........  S.......    0330       9.5891       590.22  ...........       118.04
                 locator.
D5987.........  Commissure        ........  S.......    0330       9.5891       590.22  ...........       118.04
                 splint.
D6920.........  Dental connector  ........  S.......    0330       9.5891       590.22  ...........       118.04
                 bar.
D7111.........  Extraction        ........  S.......    0330       9.5891       590.22  ...........       118.04
                 coronal
                 remnants.
D7140.........  Extraction        ........  S.......    0330       9.5891       590.22  ...........       118.04
                 erupted tooth/
                 exr.
D7210.........  Rem imp tooth w   ........  S.......    0330       9.5891       590.22  ...........       118.04
                 mucoper flp.
D7220.........  Impact tooth      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 remov soft tiss.
D7230.........  Impact tooth      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 remov part bony.
D7240.........  Impact tooth      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 remov comp bony.
D7241.........  Impact tooth rem  ........  S.......    0330       9.5891       590.22  ...........       118.04
                 bony w/comp.
D7250.........  Tooth root        ........  S.......    0330       9.5891       590.22  ...........       118.04
                 removal.
D7260.........  Oral antral       ........  S.......    0330       9.5891       590.22  ...........       118.04
                 fistula closure.
D7261.........  Primary closure   ........  S.......    0330       9.5891       590.22  ...........       118.04
                 sinus perf.
D7291.........  Transseptal       ........  S.......    0330       9.5891       590.22  ...........       118.04
                 fiberotomy.

[[Page 49836]]

 
D7940.........  Reshaping bone    ........  S.......    0330       9.5891       590.22  ...........       118.04
                 orthognathic.
D9110.........  Tx dental pain    ........  N.......  ......  ...........  ...........  ...........  ...........
                 minor proc.
D9230.........  Analgesia.......  ........  N.......  ......  ...........  ...........  ...........  ...........
D9248.........  Sedation (non-    ........  N.......  ......  ...........  ...........  ...........  ...........
                 iv).
D9630.........  Other drugs/      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 medicaments.
D9930.........  Treatment of      ........  S.......    0330       9.5891       590.22  ...........       118.04
                 complications.
D9940.........  Dental occlusal   ........  S.......    0330       9.5891       590.22  ...........       118.04
                 guard.
D9950.........  Occlusion         ........  S.......    0330       9.5891       590.22  ...........       118.04
                 analysis.
D9951.........  Limited occlusal  ........  S.......    0330       9.5891       590.22  ...........       118.04
                 adjustment.
D9952.........  Complete          ........  S.......    0330       9.5891       590.22  ...........       118.04
                 occlusal
                 adjustment.
E0616.........  Cardiac event     ........  N.......  ......  ...........  ...........  ...........  ...........
                 recorder.
E0749.........  Elec osteogen     ........  N.......  ......  ...........  ...........  ...........  ...........
                 stim implanted.
E0782.........  Non-programble    ........  N.......  ......  ...........  ...........  ...........  ...........
                 infusion pump.
E0783.........  Programmable      ........  N.......  ......  ...........  ...........  ...........  ...........
                 infusion pump.
E0785.........  Replacement impl  ........  N.......  ......  ...........  ...........  ...........  ...........
                 pump cathet.
E0786.........  Implantable pump  ........  N.......  ......  ...........  ...........  ...........  ...........
                 replacement.
E0830.........  Ambulatory        ........  N.......  ......  ...........  ...........  ...........  ...........
                 traction device.
E1399.........  Durable medical   ........  N.......  ......  ...........  ...........  ...........  ...........
                 equipment mi.
G0008.........  Admin influenza   CH......  S.......    0350       0.4107        25.28         0.00         0.00
                 virus vac.
G0009.........  Admin             CH......  S.......    0350       0.4107        25.28         0.00         0.00
                 pneumococcal
                 vaccine.
G0101.........  CA screen;pelvic/ CH......  V.......    0604       0.8083        49.75  ...........         9.95
                 breast exam.
G0102.........  Prostate ca       ........  N.......  ......  ...........  ...........  ...........  ...........
                 screening; dre.
G0104.........  CA screen;flexi   ........  S.......    0159       3.8973       239.88  ...........        59.97
                 sigmoidscope.
G0105.........  Colorectal scrn;  ........  T.......    0158       7.8134       480.92  ...........       120.23
                 hi risk ind.
G0106.........  Colon CA          ........  S.......    0157       2.4974       153.72  ...........        30.74
                 screen;barium
                 enema.
G0117.........  Glaucoma scrn     ........  S.......    0230       0.8126        50.02        14.97        10.00
                 hgh risk direc.
G0118.........  Glaucoma scrn     ........  S.......    0230       0.8126        50.02        14.97        10.00
                 hgh risk direc.
G0120.........  Colon ca scrn;    ........  S.......    0157       2.4974       153.72  ...........        30.74
                 barium enema.
G0121.........  Colon ca scrn     ........  T.......    0158       7.8134       480.92  ...........       120.23
                 not hi rsk ind.
G0127.........  Trim nail(s)....  ........  T.......    0009       0.6803        41.87  ...........         8.37
G0129.........  Partial hosp      ........  P.......    0033       3.3837       208.27  ...........        41.65
                 prog service.
G0130.........  Single energy x-  ........  X.......    0260       0.7276        44.78  ...........         8.96
                 ray study.
G0166.........  Extrnl            ........  T.......    0678       1.7263       106.26  ...........        21.25
                 counterpulse,
                 per tx.
G0173.........  Linear acc        CH......  S.......    0067      65.7255     4,045.47  ...........       809.09
                 stereo radsur
                 com.
G0175.........  OPPS              CH......  V.......    0608       2.1226       130.65  ...........        26.13
                 Service,sched
                 team conf.
G0176.........  OPPS/             ........  P.......    0033       3.3837       208.27  ...........        41.65
                 PHP;activity
                 therapy.
G0177.........  OPPS/PHP;         ........  P.......    0033       3.3837       208.27  ...........        41.65
                 train&educ serv.
G0186.........  Dstry eye         ........  T.......    0235       4.0750       250.82        61.14        50.16
                 lesn,fdr vssl
                 tech.
G0237.........  Therapeutic       ........  S.......    0411       0.3793        23.35  ...........         4.67
                 procd strg
                 endur.
G0238.........  Oth resp proc,    ........  S.......    0411       0.3793        23.35  ...........         4.67
                 indiv.
G0239.........  Oth resp proc,    ........  S.......    0411       0.3793        23.35  ...........         4.67
                 group.
G0243.........  Multisour photon  ........  S.......    0127     126.8566     7,808.15  ...........     1,561.63
                 stero treat.
G0245.........  Initial foot      CH......  V.......    0604       0.8083        49.75  ...........         9.95
                 exam pt lops.
G0246.........  Followup eval of  CH......  V.......    0605       1.0057        61.90  ...........        12.38
                 foot pt lop.
G0247.........  Routine footcare  ........  T.......    0009       0.6803        41.87  ...........         8.37
                 pt w lops.
G0248.........  Demonstrate use   CH......  V.......    0604       0.8083        49.75  ...........         9.95
                 home inr mon.
G0249.........  Provide test      CH......  V.......    0604       0.8083        49.75  ...........         9.95
                 material,equipm.
G0251.........  Linear acc based  CH......  S.......    0065      22.4428     1,381.38  ...........       276.28
                 stero radio.
G0257.........  Unsched dialysis  ........  S.......    0170       6.8096       419.14  ...........        83.83
                 ESRD pt hos.
G0259.........  Inject for        ........  N.......  ......  ...........  ...........  ...........  ...........
                 sacroiliac
                 joint.
G0260.........  Inj for           ........  T.......    0206       5.5439       341.23        75.55        68.25
                 sacroiliac jt
                 anesth.
G0267.........  Bone marrow or    ........  S.......    0110       3.4570       212.78  ...........        42.56
                 psc harvest.
G0268.........  Removal of        ........  X.......    0340       0.6211        38.23  ...........         7.65
                 impacted wax md.
G0269.........  Occlusive device  ........  N.......  ......  ...........  ...........  ...........  ...........
                 in vein art.
G0275.........  Renal angio,      ........  N.......  ......  ...........  ...........  ...........  ...........
                 cardiac cath.
G0278.........  Iliac art         ........  N.......  ......  ...........  ...........  ...........  ...........
                 angio,cardiac
                 cath.
G0288.........  Recon, CTA for    ........  S.......    0417       3.1140       191.67  ...........        38.33
                 surg plan.
G0289.........  Arthro, loose     ........  N.......  ......  ...........  ...........  ...........  ...........
                 body + chondro.
G0290.........  Drug-eluting      ........  T.......    0656     106.8902     6,579.20  ...........     1,315.84
                 stents, single.
G0291.........  Drug-eluting      ........  T.......    0656     106.8902     6,579.20  ...........     1,315.84
                 stents,each add.
G0293.........  Non-cov surg      CH......  X.......    0340       0.6211        38.23  ...........         7.65
                 proc,clin trial.
G0294.........  Non-cov proc,     CH......  X.......    0340       0.6211        38.23  ...........         7.65
                 clinical trial.
G0297.........  Insert single     ........  T.......    0107     279.2049    17,185.34  ...........     3,437.07
                 chamber/cd.
G0298.........  Insert dual       ........  T.......    0107     279.2049    17,185.34  ...........     3,437.07
                 chamber/cd.
G0299.........  Inser/repos       ........  T.......    0108     370.5535    22,807.94  ...........     4,561.59
                 single
                 icd+leads.
G0300.........  Insert reposit    ........  T.......    0108     370.5535    22,807.94  ...........     4,561.59
                 lead dual+gen.
G0302.........  Pre-op service    ........  S.......    1509  ...........       750.00  ...........       150.00
                 LVRS complete.
G0303.........  Pre-op service    ........  S.......    1507  ...........       550.00  ...........       110.00
                 LVRS 10-15dos.
G0304.........  Pre-op service    ........  S.......    1504  ...........       250.00  ...........        50.00
                 LVRS 1-9 dos.
G0305.........  Post op service   ........  S.......    1504  ...........       250.00  ...........        50.00
                 LVRS min 6.

[[Page 49837]]

 
G0332.........  Preadmin IV       CH......  B.......  ......  ...........  ...........  ...........  ...........
                 immunoglobulin.
G0339.........  Robot lin-        CH......  S.......    0067      65.7255     4,045.47  ...........       809.09
                 radsurg com,
                 first.
G0340.........  Robt lin-radsurg  CH......  S.......    0066      47.2213     2,906.52  ...........       581.30
                 fractx 2-5.
G0344.........  Initial           CH......  V.......    0605       1.0057        61.90  ...........        12.38
                 preventive exam.
G0364.........  Bone marrow       CH......  T.......    0002       1.0948        67.39  ...........        13.48
                 aspirate
                 &biopsy.
G0365.........  Vessel mapping    ........  S.......    0267       2.5166       154.90        60.80        30.98
                 hemo access.
G0367.........  EKG tracing for   ........  S.......    0099       0.3835        23.60  ...........         4.72
                 initial prev.
G0375.........  Smoke/tobacco     CH......  X.......    0031       0.1716        10.56  ...........         2.11
                 counselng 3-10.
G0376.........  Smoke/tobacco     CH......  X.......    0031       0.1716        10.56  ...........         2.11
                 counseling >10.
G0378.........  Hospital          ........  Q.......    0339       7.1587       440.63  ...........        88.13
                 observation per
                 hr.
G0379.........  Direct admit      CH......  Q.......    0604       0.8083        49.75  ...........         9.95
                 hospital observ.
G3001.........  Admin + supply,   CH......  S.......    0442      24.5410     1,510.52  ...........       302.10
                 tositumomab.
J0120.........  Tetracyclin       ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0128.........  Abarelix          CH......  K.......    9216  ...........        66.20  ...........        13.24
                 injection.
J0130.........  Abciximab         ........  K.......    1605  ...........       452.96  ...........        90.59
                 injection.
J0132.........  Acetylcysteine    ........  K.......    1680  ...........         1.86  ...........         0.37
                 injection.
J0133.........  Acyclovir         ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0135.........  Adalimumab        ........  K.......    1083  ...........       304.40  ...........        60.88
                 injection.
J0150.........  Injection         ........  K.......    0379  ...........        29.90  ...........         5.98
                 adenosine 6 MG.
J0152.........  Adenosine         ........  K.......    0917  ...........        69.41  ...........        13.88
                 injection.
J0170.........  Adrenalin         ........  N.......  ......  ...........  ...........  ...........  ...........
                 epinephrin
                 inject.
J0180.........  Agalsidase beta   ........  K.......    9208  ...........       126.00  ...........        25.20
                 injection.
J0190.........  Inj biperiden     CH......  K.......    3038  ...........        88.36  ...........        17.67
                 lactate/5 mg.
J0200.........  Alatrofloxacin    ........  N.......  ......  ...........  ...........  ...........  ...........
                 mesylate.
J0205.........  Alglucerase       ........  K.......    0900  ...........        38.85  ...........         7.77
                 injection.
J0207.........  Amifostine......  ........  K.......    7000  ...........       448.41  ...........        89.68
J0210.........  Methyldopate hcl  ........  K.......    2210  ...........         9.86  ...........         1.97
                 injection.
J0215.........  Alefacept.......  ........  K.......    1633  ...........        26.03  ...........         5.21
J0256.........  Alpha 1           ........  K.......    0901  ...........         3.21  ...........         0.64
                 proteinase
                 inhibitor.
J0278.........  Amikacin sulfate  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0280.........  Aminophyllin 250  ........  N.......  ......  ...........  ...........  ...........  ...........
                 MG inj.
J0282.........  Amiodarone HCl..  ........  N.......  ......  ...........  ...........  ...........  ...........
J0285.........  Amphotericin B..  CH......  N.......  ......  ...........  ...........  ...........  ...........
J0287.........  Amphotericin b    ........  K.......    9024  ...........        11.10  ...........         2.22
                 lipid complex.
J0288.........  Ampho b           ........  K.......    0735  ...........        12.00  ...........         2.40
                 cholesteryl
                 sulfate.
J0289.........  Amphotericin b    ........  K.......    0736  ...........        17.40  ...........         3.48
                 liposome inj.
J0290.........  Ampicillin 500    ........  N.......  ......  ...........  ...........  ...........  ...........
                 MG inj.
J0295.........  Ampicillin        ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium per 1.5
                 gm.
J0300.........  Amobarbital 125   ........  N.......  ......  ...........  ...........  ...........  ...........
                 MG inj.
J0330.........  Succinycholine    ........  N.......  ......  ...........  ...........  ...........  ...........
                 chloride inj.
J0350.........  Injection         ........  K.......    1606  ...........     2,265.46  ...........       453.09
                 anistreplase 30
                 u.
J0360.........  Hydralazine hcl   ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0365.........  Aprotonin,        ........  K.......    1682  ...........         2.32  ...........         0.46
                 10,000 kiu.
J0380.........  Inj metaraminol   CH......  K.......    3039  ...........        17.68  ...........         3.54
                 bitartrate.
J0390.........  Chloroquine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0395.........  Arbutamine HCl    ........  K.......    9031  ...........       160.00  ...........        32.00
                 injection.
J0456.........  Azithromycin....  ........  N.......  ......  ...........  ...........  ...........  ...........
J0460.........  Atropine sulfate  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0470.........  Dimecaprol        CH......  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0475.........  Baclofen 10 MG    ........  K.......    9032  ...........       191.50  ...........        38.30
                 injection.
J0476.........  Baclofen          ........  K.......    1631  ...........        70.20  ...........        14.04
                 intrathecal
                 trial.
J0480.........  Basiliximab.....  ........  K.......    1683  ...........     1,388.81  ...........       277.76
J0500.........  Dicyclomine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0515.........  Inj benztropine   ........  N.......  ......  ...........  ...........  ...........  ...........
                 mesylate.
J0520.........  Bethanechol       ........  N.......  ......  ...........  ...........  ...........  ...........
                 chloride inject.
J0530.........  Penicillin g      ........  N.......  ......  ...........  ...........  ...........  ...........
                 benzathine inj.
J0540.........  Penicillin g      ........  N.......  ......  ...........  ...........  ...........  ...........
                 benzathine inj.
J0550.........  Penicillin g      ........  N.......  ......  ...........  ...........  ...........  ...........
                 benzathine inj.
J0560.........  Penicillin g      ........  N.......  ......  ...........  ...........  ...........  ...........
                 benzathine inj.
J0570.........  Penicillin g      ........  N.......  ......  ...........  ...........  ...........  ...........
                 benzathine inj.
J0580.........  Penicillin g      CH......  K.......    3040  ...........        67.86  ...........        13.57
                 benzathine inj.
J0583.........  Bivalirudin.....  CH......  K.......    3041  ...........         1.62  ...........         0.32
J0585.........  Botulinum toxin   ........  K.......    0902  ...........         4.85  ...........         0.97
                 a per unit.
J0587.........  Botulinum toxin   ........  K.......    9018  ...........         7.85  ...........         1.57
                 type B.
J0592.........  Buprenorphine     ........  N.......  ......  ...........  ...........  ...........  ...........
                 hydrochloride.
J0595.........  Butorphanol       ........  N.......  ......  ...........  ...........  ...........  ...........
                 tartrate 1 mg.
J0600.........  Edetate calcium   ........  K.......    0892  ...........        39.80  ...........         7.96
                 disodium inj.
J0610.........  Calcium           ........  N.......  ......  ...........  ...........  ...........  ...........
                 gluconate
                 injection.
J0620.........  Calcium           ........  N.......  ......  ...........  ...........  ...........  ...........
                 glycer&lact/10
                 ML.
J0630.........  Calcitonin        CH......  N.......  ......  ...........  ...........  ...........  ...........
                 salmon
                 injection.

[[Page 49838]]

 
J0636.........  Inj calcitriol    ........  N.......  ......  ...........  ...........  ...........  ...........
                 per 0.1 mcg.
J0637.........  Caspofungin       ........  K.......    9019  ...........        32.19  ...........         6.44
                 acetate.
J0640.........  Leucovorin        ........  N.......  ......  ...........  ...........  ...........  ...........
                 calcium
                 injection.
J0670.........  Inj mepivacaine   ........  N.......  ......  ...........  ...........  ...........  ...........
                 HCL/10 ml.
J0690.........  Cefazolin sodium  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0692.........  Cefepime HCl for  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0694.........  Cefoxitin sodium  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0696.........  Ceftriaxone       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium
                 injection.
J0697.........  Sterile           ........  N.......  ......  ...........  ...........  ...........  ...........
                 cefuroxime
                 injection.
J0698.........  Cefotaxime        ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium
                 injection.
J0702.........  Betamethasone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 acet&sod phosp.
J0704.........  Betamethasone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sod phosp/4 MG.
J0706.........  Caffeine citrate  ........  K.......    0876  ...........         3.34  ...........         0.67
                 injection.
J0710.........  Cephapirin        ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium
                 injection.
J0713.........  Inj ceftazidime   ........  N.......  ......  ...........  ...........  ...........  ...........
                 per 500 mg.
J0715.........  Ceftizoxime       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium/500 MG.
J0720.........  Chloramphenicol   ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium injec.
J0725.........  Chorionic         ........  N.......  ......  ...........  ...........  ...........  ...........
                 gonadotropin/
                 1000u.
J0735.........  Clonidine         ........  K.......    0935  ...........        62.71  ...........        12.54
                 hydrochloride.
J0740.........  Cidofovir         ........  K.......    9033  ...........       757.03  ...........       151.41
                 injection.
J0743.........  Cilastatin        ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium
                 injection.
J0744.........  Ciprofloxacin iv  ........  N.......  ......  ...........  ...........  ...........  ...........
J0745.........  Inj codeine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 phosphate/30 MG.
J0760.........  Colchicine        ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0770.........  Colistimethate    ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium inj.
J0780.........  Prochlorperazine  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J0795.........  Corticorelin      ........  K.......    1684  ...........         4.22  ...........         0.84
                 ovine triflutal.
J0800.........  Corticotropin     ........  K.......    1280  ...........       108.85  ...........        21.77
                 injection.
J0835.........  Inj cosyntropin   ........  K.......    0835  ...........        63.55  ...........        12.71
                 per 0.25 MG.
J0850.........  Cytomegalovirus   ........  K.......    0903  ...........       755.79  ...........       151.16
                 imm IV/vial.
J0878.........  Daptomycin        CH......  K.......    9124  ...........         0.31  ...........         0.06
                 injection.
J0881.........  Darbepoetin       ........  K.......    1685  ...........         3.00  ...........         0.60
                 alfa, non-esrd.
J0882.........  Darbepoetin       CH......  A.......  ......  ...........  ...........  ...........  ...........
                 alfa, esrd use.
J0885.........  Epoetin alfa,     ........  K.......    1686  ...........         9.25  ...........         1.85
                 non-esrd.
J0886.........  Epoetin alfa,     CH......  A.......  ......  ...........  ...........  ...........  ...........
                 esrd.
J0895.........  Deferoxamine      ........  K.......    0895  ...........        14.77  ...........         2.95
                 mesylate inj.
J0900.........  Testosterone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 enanthate inj.
J0945.........  Brompheniramine   ........  N.......  ......  ...........  ...........  ...........  ...........
                 maleate inj.
J0970.........  Estradiol         ........  N.......  ......  ...........  ...........  ...........  ...........
                 valerate
                 injection.
J1000.........  Depo-estradiol    ........  N.......  ......  ...........  ...........  ...........  ...........
                 cypionate inj.
J1020.........  Methylprednisolo  ........  N.......  ......  ...........  ...........  ...........  ...........
                 ne 20 MG inj.
J1030.........  Methylprednisolo  ........  N.......  ......  ...........  ...........  ...........  ...........
                 ne 40 MG inj.
J1040.........  Methylprednisolo  ........  N.......  ......  ...........  ...........  ...........  ...........
                 ne 80 MG inj.
J1051.........  Medroxyprogester  ........  N.......  ......  ...........  ...........  ...........  ...........
                 one inj.
J1060.........  Testosterone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 cypionate 1 ML.
J1070.........  Testosterone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 cypionat 100 MG.
J1080.........  Testosterone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 cypionat 200 MG.
J1094.........  Inj               ........  N.......  ......  ...........  ...........  ...........  ...........
                 dexamethasone
                 acetate.
J1100.........  Dexamethasone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium phos.
J1110.........  Inj               CH......  N.......  ......  ...........  ...........  ...........  ...........
                 dihydroergotami
                 ne mesylt.
J1120.........  Acetazolamid      ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium injectio.
J1160.........  Digoxin           ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1162.........  Digoxin immune    ........  K.......    1687  ...........       527.46  ...........       105.49
                 fab (ovine).
J1165.........  Phenytoin sodium  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1170.........  Hydromorphone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1180.........  Dyphylline        CH......  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1190.........  Dexrazoxane HCl   ........  K.......    0726  ...........       179.62  ...........        35.92
                 injection.
J1200.........  Diphenhydramine   ........  N.......  ......  ...........  ...........  ...........  ...........
                 hcl injectio.
J1205.........  Chlorothiazide    ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium inj.
J1212.........  Dimethyl          ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfoxide 50%
                 50 ML.
J1230.........  Methadone         ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1240.........  Dimenhydrinate    ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1245.........  Dipyridamole      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1250.........  Inj dobutamine    ........  N.......  ......  ...........  ...........  ...........  ...........
                 HCL/250 mg.
J1260.........  Dolasetron        ........  K.......    0750  ...........         6.76  ...........         1.35
                 mesylate.
J1265.........  Dopamine          ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1270.........  Injection,        ........  N.......  ......  ...........  ...........  ...........  ...........
                 doxercalciferol.
J1320.........  Amitriptyline     ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1325.........  Epoprostenol      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1327.........  Eptifibatide      ........  K.......    1607  ...........        13.31  ...........         2.66
                 injection.

[[Page 49839]]

 
J1330.........  Ergonovine        ........  K.......    1330  ...........        27.56  ...........         5.51
                 maleate
                 injection.
J1335.........  Ertapenem         ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1364.........  Erythro           ........  N.......  ......  ...........  ...........  ...........  ...........
                 lactobionate/
                 500 MG.
J1380.........  Estradiol         ........  N.......  ......  ...........  ...........  ...........  ...........
                 valerate 10 MG
                 inj.
J1390.........  Estradiol         ........  N.......  ......  ...........  ...........  ...........  ...........
                 valerate 20 MG
                 inj.
J1410.........  Inj estrogen      ........  K.......    9038  ...........        57.78  ...........        11.56
                 conjugate 25 MG.
J1430.........  Ethanolamine      ........  K.......    1688  ...........        71.57  ...........        14.31
                 oleate 100 mg.
J1435.........  Injection         ........  N.......  ......  ...........  ...........  ...........  ...........
                 estrone per 1
                 MG.
J1436.........  Etidronate        ........  K.......    1436  ...........        70.73  ...........        14.15
                 disodium inj.
J1438.........  Etanercept        ........  K.......    1608  ...........       154.12  ...........        30.82
                 injection.
J1440.........  Filgrastim 300    ........  K.......    0728  ...........       182.53  ...........        36.51
                 mcg injection.
J1441.........  Filgrastim 480    ........  K.......    7049  ...........       289.59  ...........        57.92
                 mcg injection.
J1450.........  Fluconazole.....  ........  N.......  ......  ...........  ...........  ...........  ...........
J1451.........  Fomepizole, 15    ........  K.......    1689  ...........        11.82  ...........         2.36
                 mg.
J1452.........  Intraocular       ........  K.......    9040  ...........       210.00  ...........        42.00
                 Fomivirsen na.
J1455.........  Foscarnet sodium  CH......  K.......    3042  ...........        10.69  ...........         2.14
                 injection.
J1457.........  Gallium nitrate   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1460.........  Gamma globulin 1  CH......  K.......    3043  ...........        10.59  ...........         2.12
                 CC inj.
J1565.........  RSV-ivig........  ........  K.......    0906  ...........        16.02  ...........         3.20
J1566.........  Immune globulin,  ........  K.......    2731  ...........        22.05  ...........         4.41
                 powder.
J1567.........  Immune globulin,  ........  K.......    2732  ...........        28.82  ...........         5.76
                 liquid.
J1570.........  Ganciclovir       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium
                 injection.
J1580.........  Garamycin         ........  N.......  ......  ...........  ...........  ...........  ...........
                 gentamicin inj.
J1590.........  Gatifloxacin      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1595.........  Injection         ........  N.......  ......  ...........  ...........  ...........  ...........
                 glatiramer
                 acetate.
J1600.........  Gold sodium       ........  N.......  ......  ...........  ...........  ...........  ...........
                 thiomaleate inj.
J1610.........  Glucagon          ........  K.......    9042  ...........        62.42  ...........        12.48
                 hydrochloride/1
                 MG.
J1620.........  Gonadorelin       ........  K.......    7005  ...........       178.59  ...........        35.72
                 hydroch/100 mcg.
J1626.........  Granisetron HCl   ........  K.......    0764  ...........         6.80  ...........         1.36
                 injection.
J1630.........  Haloperidol       ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1631.........  Haloperidol       ........  N.......  ......  ...........  ...........  ...........  ...........
                 decanoate inj.
J1640.........  Hemin, 1 mg.....  ........  K.......    1690  ...........         6.59  ...........         1.32
J1642.........  Inj heparin       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium per 10 u.
J1644.........  Inj heparin       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium per
                 1000u.
J1645.........  Dalteparin        ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium.
J1650.........  Inj enoxaparin    ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium.
J1652.........  Fondaparinux      ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium.
J1655.........  Tinzaparin        ........  K.......    1655  ...........         2.18  ...........         0.44
                 sodium
                 injection.
J1670.........  Tetanus immune    ........  K.......    1670  ...........        90.71  ...........        18.14
                 globulin inj.
J1700.........  Hydrocortisone    ........  N.......  ......  ...........  ...........  ...........  ...........
                 acetate inj.
J1710.........  Hydrocortisone    ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium ph inj.
J1720.........  Hydrocortisone    ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium succ i.
J1730.........  Diazoxide         ........  K.......    1740  ...........       110.88  ...........        22.18
                 injection.
J1742.........  Ibutilide         ........  K.......    9044  ...........       249.01  ...........        49.80
                 fumarate
                 injection.
J1745.........  Infliximab        ........  K.......    7043  ...........        53.73  ...........        10.75
                 injection.
J1751.........  Iron dextran 165  ........  K.......    1691  ...........        12.30  ...........         2.46
                 injection.
J1752.........  Iron dextran 267  ........  K.......    1692  ...........        10.17  ...........         2.03
                 injection.
J1756.........  Iron sucrose      ........  K.......    9046  ...........         0.36  ...........         0.07
                 injection.
J1785.........  Injection         ........  K.......    0916  ...........         3.87  ...........         0.77
                 imiglucerase/
                 unit.
J1790.........  Droperidol        ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1800.........  Propranolol       ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1815.........  Insulin           ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1817.........  Insulin for       ........  N.......  ......  ...........  ...........  ...........  ...........
                 insulin pump
                 use.
J1830.........  Interferon beta-  ........  K.......    0910  ...........        91.34  ...........        18.27
                 1b/.25 MG.
J1835.........  Itraconazole      ........  K.......    9047  ...........        36.23  ...........         7.25
                 injection.
J1840.........  Kanamycin         ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate 500 MG
                 inj.
J1850.........  Kanamycin         ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate 75 MG
                 inj.
J1885.........  Ketorolac         ........  N.......  ......  ...........  ...........  ...........  ...........
                 tromethamine
                 inj.
J1890.........  Cephalothin       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium
                 injection.
J1931.........  Laronidase        ........  K.......    9209  ...........        23.64  ...........         4.73
                 injection.
J1940.........  Furosemide        ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1945.........  Lepirudin.......  ........  K.......    1693  ...........       146.38  ...........        29.28
J1950.........  Leuprolide        ........  K.......    0800  ...........       440.36  ...........        88.07
                 acetate/3.75 MG.
J1956.........  Levofloxacin      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J1960.........  Levorphanol       ........  N.......  ......  ...........  ...........  ...........  ...........
                 tartrate inj.
J1980.........  Hyoscyamine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate inj.
J1990.........  Chlordiazepoxide  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2001.........  Lidocaine         ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2010.........  Lincomycin        ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2020.........  Linezolid         ........  K.......    9001  ...........        23.50  ...........         4.70
                 injection.

[[Page 49840]]

 
J2060.........  Lorazepam         ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2150.........  Mannitol          ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2175.........  Meperidine        ........  N.......  ......  ...........  ...........  ...........  ...........
                 hydrochl/100 MG.
J2180.........  Meperidine/       ........  N.......  ......  ...........  ...........  ...........  ...........
                 promethazine
                 inj.
J2185.........  Meropenem.......  CH......  K.......    3045  ...........         3.76  ...........         0.75
J2210.........  Methylergonovin   ........  N.......  ......  ...........  ...........  ...........  ...........
                 maleate inj.
J2250.........  Inj midazolam     ........  N.......  ......  ...........  ...........  ...........  ...........
                 hydrochloride.
J2260.........  Inj milrinone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 lactate/5 MG.
J2270.........  Morphine sulfate  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2271.........  Morphine so4      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection 100mg.
J2275.........  Morphine sulfate  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2278.........  Ziconotide        ........  G.......    1694  ...........         6.20  ...........         1.24
                 injection.
J2280.........  Inj,              ........  N.......  ......  ...........  ...........  ...........  ...........
                 moxifloxacin
                 100 mg.
J2300.........  Inj nalbuphine    ........  N.......  ......  ...........  ...........  ...........  ...........
                 hydrochloride.
J2310.........  Inj naloxone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 hydrochloride.
J2320.........  Nandrolone        ........  N.......  ......  ...........  ...........  ...........  ...........
                 decanoate 50 MG.
J2321.........  Nandrolone        ........  N.......  ......  ...........  ...........  ...........  ...........
                 decanoate 100
                 MG.
J2322.........  Nandrolone        ........  N.......  ......  ...........  ...........  ...........  ...........
                 decanoate 200
                 MG.
J2325.........  Nesiritide        ........  K.......    1695  ...........        29.72  ...........         5.94
                 injection.
J2353.........  Octreotide        ........  K.......    1207  ...........        89.50  ...........        17.90
                 injection,
                 depot.
J2354.........  Octreotide inj,   CH......  K.......    3046  ...........         4.34  ...........         0.87
                 non-depot.
J2355.........  Oprelvekin        ........  K.......    7011  ...........       243.39  ...........        48.68
                 injection.
J2357.........  Omalizumab        CH......  K.......    9300  ...........        16.34  ...........         3.27
                 injection.
J2360.........  Orphenadrine      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2370.........  Phenylephrine     ........  N.......  ......  ...........  ...........  ...........  ...........
                 hcl injection.
J2400.........  Chloroprocaine    ........  N.......  ......  ...........  ...........  ...........  ...........
                 hcl injection.
J2405.........  Ondansetron hcl   ........  K.......    0768  ...........         3.69  ...........         0.74
                 injection.
J2410.........  Oxymorphone hcl   ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2425.........  Palifermin        ........  K.......    1696  ...........        11.37  ...........         2.27
                 injection.
J2430.........  Pamidronate       ........  K.......    0730  ...........        29.31  ...........         5.86
                 disodium/30 MG.
J2440.........  Papaverin hcl     ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2460.........  Oxytetracycline   ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2469.........  Palonosetron HCl  ........  K.......    9210  ...........        17.51  ...........         3.50
J2501.........  Paricalcitol....  ........  N.......  ......  ...........  ...........  ...........  ...........
J2503.........  Pegaptanib        ........  G.......    1697  ...........     1,107.54  ...........       221.51
                 sodium
                 injection.
J2504.........  Pegademase        ........  K.......    1739  ...........       164.50  ...........        32.90
                 bovine, 25 iu.
J2505.........  Injection,        ........  K.......    9119  ...........     2,142.79  ...........       428.56
                 pegfilgrastim
                 6mg.
J2510.........  Penicillin g      ........  N.......  ......  ...........  ...........  ...........  ...........
                 procaine inj.
J2513.........  Pentastarch 10%   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 solution.
J2515.........  Pentobarbital     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium inj.
J2540.........  Penicillin g      ........  N.......  ......  ...........  ...........  ...........  ...........
                 potassium inj.
J2543.........  Piperacillin/     ........  N.......  ......  ...........  ...........  ...........  ...........
                 tazobactam.
J2550.........  Promethazine hcl  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2560.........  Phenobarbital     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium inj.
J2590.........  Oxytocin          ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2597.........  Inj desmopressin  ........  N.......  ......  ...........  ...........  ...........  ...........
                 acetate.
J2650.........  Prednisolone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 acetate inj.
J2670.........  Totazoline hcl    ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2675.........  Inj progesterone  ........  N.......  ......  ...........  ...........  ...........  ...........
                 per 50 MG.
J2680.........  Fluphenazine      ........  N.......  ......  ...........  ...........  ...........  ...........
                 decanoate 25 MG.
J2690.........  Procainamide hcl  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2700.........  Oxacillin sodium  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 injeciton.
J2710.........  Neostigmine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 methylslfte inj.
J2720.........  Inj protamine     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate/10 MG.
J2725.........  Inj protirelin    ........  N.......  ......  ...........  ...........  ...........  ...........
                 per 250 mcg.
J2730.........  Pralidoxime       CH......  N.......  ......  ...........  ...........  ...........  ...........
                 chloride inj.
J2760.........  Phentolaine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 mesylate inj.
J2765.........  Metoclopramide    ........  N.......  ......  ...........  ...........  ...........  ...........
                 hcl injection.
J2770.........  Quinupristin/     ........  K.......    2770  ...........       108.03  ...........        21.61
                 dalfopristin.
J2780.........  Ranitidine        ........  N.......  ......  ...........  ...........  ...........  ...........
                 hydrochloride
                 inj.
J2783.........  Rasburicase.....  CH......  K.......    0738  ...........       110.36  ...........        22.07
J2788.........  Rho d immune      ........  K.......    9023  ...........        14.13  ...........         2.83
                 globulin 50 mcg.
J2790.........  Rho d immune      ........  K.......    0884  ...........        97.11  ...........        19.42
                 globulin inj.
J2792.........  Rho(D) immune     ........  K.......    1609  ...........        13.57  ...........         2.71
                 globulin h, sd.
J2794.........  Risperidone,      CH......  K.......    9125  ...........         4.73  ...........         0.95
                 long acting.
J2795.........  Ropivacaine HCl   ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2800.........  Methocarbamol     ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2805.........  Sincalide         CH......  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2810.........  Inj theophylline  ........  N.......  ......  ...........  ...........  ...........  ...........
                 per 40 MG.
J2820.........  Sargramostim      ........  K.......    0731  ...........        23.12  ...........         4.62
                 injection.

[[Page 49841]]

 
J2850.........  Inj secretin      ........  K.......    1700  ...........        20.31  ...........         4.06
                 synthetic human.
J2910.........  Aurothioglucose   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 injeciton.
J2912.........  Sodium chloride   ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2916.........  Na ferric         ........  N.......  ......  ...........  ...........  ...........  ...........
                 gluconate
                 complex.
J2920.........  Methylprednisolo  ........  N.......  ......  ...........  ...........  ...........  ...........
                 ne injection.
J2930.........  Methylprednisolo  ........  N.......  ......  ...........  ...........  ...........  ...........
                 ne injection.
J2940.........  Somatrem          ........  K.......    2940  ...........       583.74  ...........       116.75
                 injection.
J2941.........  Somatropin        ........  K.......    7034  ...........        43.73  ...........         8.75
                 injection.
J2950.........  Promazine hcl     ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J2993.........  Reteplase         ........  K.......    9005  ...........       754.71  ...........       150.94
                 injection.
J2995.........  Inj               ........  K.......    0911  ...........        78.75  ...........        15.75
                 streptokinase/
                 250000 IU.
J2997.........  Alteplase         ........  K.......    7048  ...........        31.06  ...........         6.21
                 recombinant.
J3000.........  Streptomycin      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J3010.........  Fentanyl citrate  ........  N.......  ......  ...........  ...........  ...........  ...........
                 injeciton.
J3030.........  Sumatriptan       ........  K.......    3030  ...........        51.75  ...........        10.35
                 succinate/6 MG.
J3070.........  Pentazocine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J3100.........  Tenecteplase      ........  K.......    9002  ...........     2,059.01  ...........       411.80
                 injection.
J3105.........  Terbutaline       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate inj.
J3120.........  Testosterone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 enanthate inj.
J3130.........  Testosterone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 enanthate inj.
J3140.........  Testosterone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 suspension inj.
J3150.........  Testosteron       ........  N.......  ......  ...........  ...........  ...........  ...........
                 propionate inj.
J3230.........  Chlorpromazine    ........  N.......  ......  ...........  ...........  ...........  ...........
                 hcl injection.
J3240.........  Thyrotropin       ........  K.......    9108  ...........       766.61  ...........       153.32
                 injection.
J3246.........  Tirofiban HCl...  ........  K.......    7041  ...........         7.61  ...........         1.52
J3250.........  Trimethobenzamid  ........  N.......  ......  ...........  ...........  ...........  ...........
                 e hcl inj.
J3260.........  Tobramycin        ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate
                 injection.
J3265.........  Injection         ........  N.......  ......  ...........  ...........  ...........  ...........
                 torsemide 10 mg/
                 ml.
J3280.........  Thiethylperazine  ........  N.......  ......  ...........  ...........  ...........  ...........
                 maleate inj.
J3285.........  Treprostinil      ........  K.......    1701  ...........        53.51  ...........        10.70
                 injection.
J3301.........  Triamcinolone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 acetonide inj.
J3302.........  Triamcinolone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 diacetate inj.
J3303.........  Triamcinolone     ........  N.......  ......  ...........  ...........  ...........  ...........
                 hexacetonl inj.
J3305.........  Inj trimetrexate  ........  K.......    7045  ...........       144.39  ...........        28.88
                 glucoronate.
J3310.........  Perphenazine      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injeciton.
J3315.........  Triptorelin       ........  K.......    9122  ...........       300.90  ...........        60.18
                 pamoate.
J3320.........  Spectinomycn di-  ........  N.......  ......  ...........  ...........  ...........  ...........
                 hcl inj.
J3350.........  Urea injection..  ........  K.......    9051  ...........        69.10  ...........        13.82
J3355.........  Urofollitropin,   ........  K.......    1741  ...........        48.84  ...........         9.77
                 75 iu.
J3360.........  Diazepam          ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J3364.........  Urokinase 5000    ........  N.......  ......  ...........  ...........  ...........  ...........
                 IU injection.
J3365.........  Urokinase         ........  K.......    7036  ...........       453.41  ...........        90.68
                 250,000 IU inj.
J3370.........  Vancomycin hcl    ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J3396.........  Verteporfin       ........  K.......    1203  ...........         8.89  ...........         1.78
                 injection.
J3400.........  Triflupromazine   ........  N.......  ......  ...........  ...........  ...........  ...........
                 hcl inj.
J3410.........  Hydroxyzine hcl   ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J3411.........  Thiamine hcl 100  ........  N.......  ......  ...........  ...........  ...........  ...........
                 mg.
J3415.........  Pyridoxine hcl    ........  N.......  ......  ...........  ...........  ...........  ...........
                 100 mg.
J3420.........  Vitamin b12       ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J3430.........  Vitamin k         ........  N.......  ......  ...........  ...........  ...........  ...........
                 phytonadione
                 inj.
J3465.........  Injection,        ........  K.......    1052  ...........         4.55  ...........         0.91
                 voriconazole.
J3470.........  Hyaluronidase     CH......  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J3471.........  Ovine, up to 999  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 USP units.
J3472.........  Ovine, 1000 USP   ........  K.......    1703  ...........       133.77  ...........        26.75
                 units.
J3475.........  Inj magnesium     ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate.
J3480.........  Inj potassium     ........  N.......  ......  ...........  ...........  ...........  ...........
                 chloride.
J3485.........  Zidovudine......  ........  N.......  ......  ...........  ...........  ...........  ...........
J3486.........  Ziprasidone       ........  N.......  ......  ...........  ...........  ...........  ...........
                 mesylate.
J3487.........  Zoledronic acid.  ........  K.......    9115  ...........       200.82  ...........        40.16
J3490.........  Drugs             ........  N.......  ......  ...........  ...........  ...........  ...........
                 unclassified
                 injection.
J3530.........  Nasal vaccine     ........  N.......  ......  ...........  ...........  ...........  ...........
                 inhalation.
J3590.........  Unclassified      ........  N.......  ......  ...........  ...........  ...........  ...........
                 biologics.
J7030.........  Normal saline     ........  N.......  ......  ...........  ...........  ...........  ...........
                 solution infus.
J7040.........  Normal saline     ........  N.......  ......  ...........  ...........  ...........  ...........
                 solution infus.
J7042.........  5% dextrose/      ........  N.......  ......  ...........  ...........  ...........  ...........
                 normal saline.
J7050.........  Normal saline     ........  N.......  ......  ...........  ...........  ...........  ...........
                 solution infus.
J7060.........  5% dextrose/      ........  N.......  ......  ...........  ...........  ...........  ...........
                 water.
J7070.........  D5w infusion....  ........  N.......  ......  ...........  ...........  ...........  ...........
J7100.........  Dextran 40        ........  N.......  ......  ...........  ...........  ...........  ...........
                 infusion.
J7110.........  Dextran 75        ........  N.......  ......  ...........  ...........  ...........  ...........
                 infusion.

[[Page 49842]]

 
J7120.........  Ringers lactate   ........  N.......  ......  ...........  ...........  ...........  ...........
                 infusion.
J7130.........  Hypertonic        ........  N.......  ......  ...........  ...........  ...........  ...........
                 saline solution.
J7188.........  Inj               ........  K.......    1704  ...........         0.87  ...........         0.17
                 Vonwillebrand
                 factor iu.
J7189.........  Factor viia.....  ........  K.......    1705  ...........         1.08  ...........         0.22
J7190.........  Factor viii.....  ........  K.......    0925  ...........         0.68  ...........         0.14
J7191.........  Factor VIII       ........  K.......    0926  ...........         0.66  ...........         0.13
                 (porcine).
J7192.........  Factor viii       ........  K.......    0927  ...........         1.05  ...........         0.21
                 recombinant.
J7193.........  Factor IX non-    ........  K.......    0931  ...........         0.88  ...........         0.18
                 recombinant.
J7194.........  Factor ix         ........  K.......    0928  ...........         0.63  ...........         0.13
                 complex.
J7195.........  Factor IX         ........  K.......    0932  ...........         0.98  ...........         0.20
                 recombinant.
J7197.........  Antithrombin iii  ........  K.......    0930  ...........         1.62  ...........         0.32
                 injection.
J7198.........  Anti-inhibitor..  ........  K.......    0929  ...........         1.29  ...........         0.26
J7308.........  Aminolevulinic    ........  K.......    7308  ...........        99.92  ...........        19.98
                 acid hcl top.
J7310.........  Ganciclovir long  ........  K.......    0913  ...........     4,200.00  ...........       840.00
                 act implant.
J7317.........  Sodium            ........  K.......    7316  ...........       112.04  ...........        22.41
                 hyaluronate
                 injection.
J7320.........  Hylan G-F 20      ........  K.......    1611  ...........       196.99  ...........        39.40
                 injection.
J7340.........  Metabolic active  ........  K.......    1632  ...........        27.56  ...........         5.51
                 D/E tissue.
J7341.........  Non-human,        ........  K.......    1707  ...........         1.64  ...........         0.33
                 metabolic
                 tissue.
J7342.........  Metabolically     ........  K.......    9054  ...........        15.01  ...........         3.00
                 active tissue.
J7343.........  Nonmetabolic act  ........  K.......    1629  ...........        15.20  ...........         3.04
                 d/e tissue.
J7344.........  Nonmetabolic      ........  K.......    9156  ...........        66.39  ...........        13.28
                 active tissue.
J7350.........  Injectable human  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 tissue.
J7500.........  Azathioprine      ........  N.......  ......  ...........  ...........  ...........  ...........
                 oral 50mg.
J7501.........  Azathioprine      ........  K.......    0887  ...........        48.73  ...........         9.75
                 parenteral.
J7502.........  Cyclosporine      ........  K.......    0888  ...........         3.88  ...........         0.78
                 oral 100 mg.
J7504.........  Lymphocyte        ........  K.......    0890  ...........       295.38  ...........        59.08
                 immune globulin.
J7505.........  Monoclonal        ........  K.......    7038  ...........       860.94  ...........       172.19
                 antibodies.
J7506.........  Prednisone oral.  ........  N.......  ......  ...........  ...........  ...........  ...........
J7507.........  Tacrolimus oral   ........  K.......    0891  ...........         3.40  ...........         0.68
                 per 1 MG.
J7509.........  Methylprednisolo  ........  N.......  ......  ...........  ...........  ...........  ...........
                 ne oral.
J7510.........  Prednisolone      ........  N.......  ......  ...........  ...........  ...........  ...........
                 oral per 5 mg.
J7511.........  Antithymocyte     ........  K.......    9104  ...........       301.48  ...........        60.30
                 globuln rabbit.
J7513.........  Daclizumab,       ........  K.......    1612  ...........       345.07  ...........        69.01
                 parenteral.
J7515.........  Cyclosporine      CH......  N.......  ......  ...........  ...........  ...........  ...........
                 oral 25 mg.
J7516.........  Cyclosporin       ........  N.......  ......  ...........  ...........  ...........  ...........
                 parenteral
                 250mg.
J7517.........  Mycophenolate     ........  K.......    9015  ...........         2.50  ...........         0.50
                 mofetil oral.
J7518.........  Mycophenolic      CH......  K.......    9219  ...........         2.15  ...........         0.43
                 acid.
J7520.........  Sirolimus, oral.  ........  K.......    9020  ...........         6.84  ...........         1.37
J7525.........  Tacrolimus        ........  K.......    9006  ...........       135.17  ...........        27.03
                 injection.
J7599.........  Immunosuppressiv  ........  N.......  ......  ...........  ...........  ...........  ...........
                 e drug noc.
J7674.........  Methacholine      ........  N.......  ......  ...........  ...........  ...........  ...........
                 chloride, neb.
J7799.........  Non-inhalation    ........  N.......  ......  ...........  ...........  ...........  ...........
                 drug for DME.
J8501.........  Oral aprepitant.  ........  G.......    0868  ...........         4.63  ...........         0.93
J8510.........  Oral busulfan...  ........  K.......    7015  ...........         1.95  ...........         0.39
J8520.........  Capecitabine,     ........  K.......    7042  ...........         3.60  ...........         0.72
                 oral, 150 mg.
J8530.........  Cyclophosphamide  ........  N.......  ......  ...........  ...........  ...........  ...........
                 oral 25 MG.
J8540.........  Oral              CH......  N.......  ......  ...........  ...........  ...........  ...........
                 dexamethasone.
J8560.........  Etoposide oral    ........  K.......    0802  ...........        32.73  ...........         6.55
                 50 MG.
J8597.........  Antiemetic drug   ........  N.......  ......  ...........  ...........  ...........  ...........
                 oral NOS.
J8600.........  Melphalan oral 2  CH......  K.......    3047  ...........         4.39  ...........         0.88
                 MG.
J8610.........  Methotrexate      ........  N.......  ......  ...........  ...........  ...........  ...........
                 oral 2.5 MG.
J8700.........  Temozolomide....  ........  K.......    1086  ...........         7.16  ...........         1.43
J9000.........  Doxorubic hcl 10  CH......  K.......    3048  ...........         6.23  ...........         1.25
                 MG vl chemo.
J9001.........  Doxorubicin hcl   ........  K.......    7046  ...........       367.56  ...........        73.51
                 liposome inj.
J9010.........  Alemtuzumab       ........  K.......    9110  ...........       525.75  ...........       105.15
                 injection.
J9015.........  Aldesleukin/      ........  K.......    0807  ...........       734.10  ...........       146.82
                 single use vial.
J9017.........  Arsenic trioxide  ........  K.......    9012  ...........        32.92  ...........         6.58
J9020.........  Asparaginase      ........  K.......    0814  ...........        53.66  ...........        10.73
                 injection.
J9025.........  Azacitidine       ........  K.......    1709  ...........         4.09  ...........         0.82
                 injection.
J9027.........  Clofarabine       ........  G.......    1710  ...........       116.68  ...........        23.34
                 injection.
J9031.........  Bcg live          ........  K.......    0809  ...........       110.48  ...........        22.10
                 intravesical
                 vac.
J9035.........  Bevacizumab       CH......  K.......    9214  ...........        56.36  ...........        11.27
                 injection.
J9040.........  Bleomycin         CH......  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate
                 injection.
J9041.........  Bortezomib        ........  K.......    9207  ...........        29.81  ...........         5.96
                 injection.
J9045.........  Carboplatin       ........  K.......    0811  ...........        13.74  ...........         2.75
                 injection.
J9050.........  Carmus bischl     ........  K.......    0812  ...........       139.66  ...........        27.93
                 nitro inj.
J9055.........  Cetuximab         CH......  K.......    9215  ...........        49.39  ...........         9.88
                 injection.
J9060.........  Cisplatin 10 MG   ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J9065.........  Inj cladribine    ........  K.......    0858  ...........        38.28  ...........         7.66
                 per 1 MG.
J9070.........  Cyclophosphamide  ........  N.......  ......  ...........  ...........  ...........  ...........
                 100 MG inj.

[[Page 49843]]

 
J9093.........  Cyclophosphamide  CH......  K.......    3049  ...........         5.47  ...........         1.09
                 lyophilized.
J9098.........  Cytarabine        ........  K.......    1166  ...........       374.75  ...........        74.95
                 liposome.
J9100.........  Cytarabine hcl    ........  N.......  ......  ...........  ...........  ...........  ...........
                 100 MG inj.
J9120.........  Dactinomycin      ........  N.......  ......  ...........  ...........  ...........  ...........
                 actinomycin d.
J9130.........  Dacarbazine 100   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 mg inj.
J9150.........  Daunorubicin....  ........  K.......    0820  ...........        23.36  ...........         4.67
J9151.........  Daunorubicin      ........  K.......    0821  ...........        55.72  ...........        11.14
                 citrate liposom.
J9160.........  Denileukin        ........  K.......    1084  ...........     1,391.05  ...........       278.21
                 diftitox, 300
                 mcg.
J9165.........  Diethylstilbestr  ........  N.......  ......  ...........  ...........  ...........  ...........
                 ol injection.
J9170.........  Docetaxel.......  ........  K.......    0823  ...........       294.48  ...........        58.90
J9175.........  Elliotts b        ........  N.......  ......  ...........  ...........  ...........  ...........
                 solution per ml.
J9178.........  Inj, epirubicin   ........  K.......    1167  ...........        24.47  ...........         4.89
                 hcl, 2 mg.
J9181.........  Etoposide 10 MG   ........  N.......  ......  ...........  ...........  ...........  ...........
                 inj.
J9185.........  Fludarabine       ........  K.......    0842  ...........       230.11  ...........        46.02
                 phosphate inj.
J9190.........  Fluorouracil      ........  N.......  ......  ...........  ...........  ...........  ...........
                 injection.
J9200.........  Floxuridine       ........  K.......    0827  ...........        62.61  ...........        12.52
                 injection.
J9201.........  Gemcitabine HCl.  ........  K.......    0828  ...........       116.59  ...........        23.32
J9202.........  Goserelin         ........  K.......    0810  ...........       197.59  ...........        39.52
                 acetate implant.
J9206.........  Irinotecan        ........  K.......    0830  ...........       125.28  ...........        25.06
                 injection.
J9208.........  Ifosfomide        ........  K.......    0831  ...........        54.19  ...........        10.84
                 injection.
J9209.........  Mesna injection.  ........  K.......    0732  ...........         7.87  ...........         1.57
J9211.........  Idarubicin hcl    ........  K.......    0832  ...........       265.53  ...........        53.11
                 injection.
J9212.........  Interferon        ........  K.......    0912  ...........         3.92  ...........         0.78
                 alfacon-1.
J9213.........  Interferon alfa-  ........  K.......    0834  ...........        33.53  ...........         6.71
                 2a inj.
J9214.........  Interferon alfa-  ........  K.......    0836  ...........        13.54  ...........         2.71
                 2b inj.
J9215.........  Interferon alfa-  ........  K.......    0865  ...........        50.33  ...........        10.07
                 n3 inj.
J9216.........  Interferon gamma  ........  K.......    0838  ...........       289.87  ...........        57.97
                 1-b inj.
J9217.........  Leuprolide        ........  K.......    9217  ...........       242.99  ...........        48.60
                 acetate
                 suspnsion.
J9218.........  Leuprolide        ........  K.......    0861  ...........         7.86  ...........         1.57
                 acetate
                 injeciton.
J9219.........  Leuprolide        ........  K.......    7051  ...........     2,157.81  ...........       431.56
                 acetate implant.
J9225.........  Histrelin         ........  K.......    1711  ...........     2,019.82  ...........       403.96
                 implant.
J9230.........  Mechlorethamine   ........  N.......  ......  ...........  ...........  ...........  ...........
                 hcl inj.
J9245.........  Inj melphalan     ........  K.......    0840  ...........     1,190.81  ...........       238.16
                 hydrochl 50 MG.
J9250.........  Methotrexate      ........  N.......  ......  ...........  ...........  ...........  ...........
                 sodium inj.
J9263.........  Oxaliplatin.....  ........  K.......    1738  ...........         8.47  ...........         1.69
J9264.........  Paclitaxel        ........  G.......    1712  ...........         8.73  ...........         1.75
                 injection.
J9265.........  Paclitaxel        ........  K.......    0863  ...........        15.44  ...........         3.09
                 injection.
J9266.........  Pegaspargase/     ........  K.......    0843  ...........     1,596.00  ...........       319.20
                 singl dose vial.
J9268.........  Pentostatin       ........  K.......    0844  ...........     2,000.96  ...........       400.19
                 injection.
J9270.........  Plicamycin        ........  K.......    0860  ...........       173.66  ...........        34.73
                 (mithramycin)
                 inj.
J9280.........  Mitomycin 5 MG    ........  K.......    0862  ...........        18.82  ...........         3.76
                 inj.
J9293.........  Mitoxantrone      ........  K.......    0864  ...........       336.76  ...........        67.35
                 hydrochl/5 MG.
J9300.........  Gemtuzumab        ........  K.......    9004  ...........     2,265.57  ...........       453.11
                 ozogamicin.
J9305.........  Pemetrexed        CH......  K.......    9213  ...........        40.90  ...........         8.18
                 injection.
J9310.........  Rituximab cancer  ........  K.......    0849  ...........       465.23  ...........        93.05
                 treatment.
J9320.........  Streptozocin      ........  K.......    0850  ...........       147.45  ...........        29.49
                 injection.
J9340.........  Thiotepa          ........  K.......    0851  ...........        45.38  ...........         9.08
                 injection.
J9350.........  Topotecan.......  ........  K.......    0852  ...........       780.54  ...........       156.11
J9355.........  Trastuzumab.....  ........  K.......    1613  ...........        54.59  ...........        10.92
J9357.........  Valrubicin, 200   ........  K.......    9167  ...........        76.03  ...........        15.21
                 mg.
J9360.........  Vinblastine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate inj.
J9370.........  Vincristine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 sulfate 1 MG
                 inj.
J9390.........  Vinorelbine       ........  K.......    0855  ...........        22.04  ...........         4.41
                 tartrate/10 mg.
J9395.........  Injection,        ........  K.......    9120  ...........        80.31  ...........        16.06
                 Fulvestrant.
J9600.........  Porfimer sodium.  ........  K.......    0856  ...........     2,481.76  ...........       496.35
J9999.........  Chemotherapy      ........  N.......  ......  ...........  ...........  ...........  ...........
                 drug.
L8600.........  Implant breast    ........  N.......  ......  ...........  ...........  ...........  ...........
                 silicone/eq.
L8603.........  Collagen imp      ........  N.......  ......  ...........  ...........  ...........  ...........
                 urinary 2.5 ml.
L8606.........  Synthetic implnt  ........  N.......  ......  ...........  ...........  ...........  ...........
                 urinary 1ml.
L8609.........  Artificial        ........  N.......  ......  ...........  ...........  ...........  ...........
                 cornea.
L8610.........  Ocular implant..  ........  N.......  ......  ...........  ...........  ...........  ...........
L8612.........  Aqueous shunt     ........  N.......  ......  ...........  ...........  ...........  ...........
                 prosthesis.
L8613.........  Ossicular         ........  N.......  ......  ...........  ...........  ...........  ...........
                 implant.
L8614.........  Cochlear device/  ........  N.......  ......  ...........  ...........  ...........  ...........
                 system.
L8630.........  Metacarpophalang  ........  N.......  ......  ...........  ...........  ...........  ...........
                 eal implant.
L8631.........  MCP joint repl 2  ........  N.......  ......  ...........  ...........  ...........  ...........
                 pc or more.
L8641.........  Metatarsal joint  ........  N.......  ......  ...........  ...........  ...........  ...........
                 implant.
L8642.........  Hallux implant..  ........  N.......  ......  ...........  ...........  ...........  ...........
L8658.........  Interphalangeal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 joint spacer.
L8659.........  Interphalangeal   ........  N.......  ......  ...........  ...........  ...........  ...........
                 joint repl.

[[Page 49844]]

 
L8670.........  Vascular graft,   ........  N.......  ......  ...........  ...........  ...........  ...........
                 synthetic.
L8682.........  Implt neurostim   ........  N.......  ......  ...........  ...........  ...........  ...........
                 radiofq rec.
L8699.........  Prosthetic        ........  N.......  ......  ...........  ...........  ...........  ...........
                 implant NOS.
M0064.........  Visit for drug    ........  X.......    0374       1.1509        70.84  ...........        14.17
                 monitoring.
P9010.........  Whole blood for   ........  K.......    0950       2.1824       134.33  ...........        26.87
                 transfusion.
P9011.........  Blood split unit  ........  K.......    0967       2.2087       135.95  ...........        27.19
P9012.........  Cryoprecipitate   ........  K.......    0952       0.8571        52.76  ...........        10.55
                 each unit.
P9016.........  RBC leukocytes    ........  K.......    0954       2.8738       176.89  ...........        35.38
                 reduced.
P9017.........  Plasma 1 donor    ........  K.......    9508       1.1677        71.87  ...........        14.37
                 frz w/in 8 hr.
P9019.........  Platelets, each   ........  K.......    0957       0.9794        60.28  ...........        12.06
                 unit.
P9020.........  Plaelet rich      ........  K.......    0958       2.5336       155.95  ...........        31.19
                 plasma unit.
P9021.........  Red blood cells   ........  K.......    0959       2.1045       129.53  ...........        25.91
                 unit.
P9022.........  Washed red blood  ........  K.......    0960       3.5028       215.60  ...........        43.12
                 cells unit.
P9023.........  Frozen plasma,    ........  K.......    0949       0.9060        55.77  ...........        11.15
                 pooled, sd.
P9031.........  Platelets         ........  K.......    1013       1.5318        94.28  ...........        18.86
                 leukocytes
                 reduced.
P9032.........  Platelets,        ........  K.......    9500       2.0957       128.99  ...........        25.80
                 irradiated.
P9033.........  Platelets         ........  K.......    0968       2.1192       130.44  ...........        26.09
                 leukoreduced
                 irrad.
P9034.........  Platelets,        ........  K.......    9507       7.5381       463.98  ...........        92.80
                 pheresis.
P9035.........  Platelet pheres   ........  K.......    9501       7.9414       488.80  ...........        97.76
                 leukoreduced.
P9036.........  Platelet          ........  K.......    9502       6.6959       412.14  ...........        82.43
                 pheresis
                 irradiated.
P9037.........  Plate pheres      ........  K.......    1019       9.9841       614.53  ...........       122.91
                 leukoredu irrad.
P9038.........  RBC irradiated..  ........  K.......    9505       3.2600       200.66  ...........        40.13
P9039.........  RBC               ........  K.......    9504       5.7106       351.49  ...........        70.30
                 deglycerolized.
P9040.........  RBC leukoreduced  ........  K.......    0969       3.7037       227.97  ...........        45.59
                 irradiated.
P9041.........  Albumin           ........  K.......    0961  ...........        25.48  ...........         5.10
                 (human),5%,
                 50ml.
P9043.........  Plasma protein    ........  K.......    0956       0.4016        24.72  ...........         4.94
                 fract,5%,50ml.
P9044.........  Cryoprecipitater  ........  K.......    1009       1.2990        79.95  ...........        15.99
                 educedplasma.
P9045.........  Albumin (human),  ........  K.......    0963  ...........        72.09  ...........        14.42
                 5%, 250 ml.
P9046.........  Albumin (human),  ........  K.......    0964  ...........        26.79  ...........         5.36
                 25%, 20 ml.
P9047.........  Albumin (human),  ........  K.......    0965  ...........        61.77  ...........        12.35
                 25%, 50ml.
P9048.........  Plasmaprotein     ........  K.......    0966       3.1309       192.71  ...........        38.54
                 fract,5%,250ml.
P9050.........  Granulocytes,     ........  K.......    9506       4.1030       252.54  ...........        50.51
                 pheresis unit.
P9051.........  Blood, l/r, cmv-  ........  K.......    1010       2.1991       135.36  ...........        27.07
                 neg.
P9052.........  Platelets, hla-   ........  K.......    1011      10.5084       646.80  ...........       129.36
                 m, l/r, unit.
P9053.........  Plt, pher, l/r    ........  K.......    1020      11.7025       720.30  ...........       144.06
                 cmv-neg, irr.
P9054.........  Blood, l/r, froz/ ........  K.......    1016       1.4462        89.02  ...........        17.80
                 degly/wash.
P9055.........  Plt, aph/pher, l/ ........  K.......    1017       6.1508       378.59  ...........        75.72
                 r, cmv-neg.
P9056.........  Blood, l/r,       ........  K.......    1018       2.1765       133.97  ...........        26.79
                 irradiated.
P9057.........  RBC, frz/deg/     ........  K.......    1021       6.9189       425.87  ...........        85.17
                 wsh, l/r, irrad.
P9058.........  RBC, l/r, cmv-    ........  K.......    1022       4.2818       263.55  ...........        52.71
                 neg, irrad.
P9059.........  Plasma, frz       ........  K.......    0955       1.1864        73.02  ...........        14.60
                 between 8-
                 24hour.
P9060.........  Fr frz plasma     ........  K.......    9503       1.1915        73.34  ...........        14.67
                 donor retested.
P9612.........  Catheterize for   CH......  A.......  ......  ...........  ...........  ...........  ...........
                 urine spec.
P9615.........  Urine specimen    ........  N.......  ......  ...........  ...........  ...........  ...........
                 collect mult.
Q0035.........  Cardiokymography  ........  X.......    0100       2.5352       156.04        41.44        31.21
Q0091.........  Obtaining screen  ........  T.......    0191       0.1501         9.24  ...........         1.85
                 pap smear.
Q0092.........  Set up port xray  ........  N.......  ......  ...........  ...........  ...........  ...........
                 equipment.
Q0163.........  Diphenhydramine   ........  N.......  ......  ...........  ...........  ...........  ...........
                 HCl 50mg.
Q0164.........  Prochlorperazine  ........  N.......  ......  ...........  ...........  ...........  ...........
                 maleate 5mg.
Q0166.........  Granisetron HCl   ........  K.......    0765  ...........        37.08  ...........         7.42
                 1 mg oral.
Q0167.........  Dronabinol 2.5mg  ........  N.......  ......  ...........  ...........  ...........  ...........
                 oral.
Q0169.........  Promethazine HCl  ........  N.......  ......  ...........  ...........  ...........  ...........
                 12.5mg oral.
Q0171.........  Chlorpromazine    ........  N.......  ......  ...........  ...........  ...........  ...........
                 HCl 10mg oral.
Q0173.........  Trimethobenzamid  ........  N.......  ......  ...........  ...........  ...........  ...........
                 e HCl 250mg.
Q0174.........  Thiethylperazine  ........  N.......  ......  ...........  ...........  ...........  ...........
                 maleate10mg.
Q0175.........  Perphenazine 4mg  ........  N.......  ......  ...........  ...........  ...........  ...........
                 oral.
Q0177.........  Hydroxyzine       ........  N.......  ......  ...........  ...........  ...........  ...........
                 pamoate 25mg.
Q0179.........  Ondansetron HCl   ........  K.......    0769  ...........        34.21  ...........         6.84
                 8mg oral.
Q0180.........  Dolasetron        ........  K.......    0763  ...........        47.52  ...........         9.50
                 mesylate oral.
Q0512.........  Px sup fee anti-  CH......  B.......  ......  ...........  ...........  ...........  ...........
                 can sub pres.
Q0515.........  Sermorelin        CH......  K.......    3050  ...........         1.73  ...........         0.35
                 acetate
                 injection.
Q1003.........  Ntiol category 3  ........  N.......  ......  ...........  ...........  ...........  ...........
Q1004.........  Ntiol category 4  ........  N.......  ......  ...........  ...........  ...........  ...........
Q1005.........  Ntiol category 5  ........  N.......  ......  ...........  ...........  ...........  ...........
Q2004.........  Bladder calculi   ........  N.......  ......  ...........  ...........  ...........  ...........
                 irrig sol.
Q2009.........  Fosphenytoin, 50  ........  K.......    7028  ...........         5.18  ...........         1.04
                 mg.
Q2017.........  Teniposide, 50    ........  K.......    7035  ...........       264.26  ...........        52.85
                 mg.
Q3019.........  ALS emer trans    CH......  E.......  ......  ...........  ...........  ...........  ...........
                 no ALS serv.
Q3020.........  ALS nonemer       CH......  E.......  ......  ...........  ...........  ...........  ...........
                 trans no ALS
                 ser.
Q3025.........  IM inj            ........  K.......    9022  ...........        97.99  ...........        19.60
                 interferon beta
                 1-a.

[[Page 49845]]

 
Q3031.........  Collagen skin     ........  N.......  ......  ...........  ...........  ...........  ...........
                 test.
Q4079.........  Natalizumab       ........  G.......    9126  ...........         6.39  ...........         1.28
                 injection.
Q9945.........  LOCM <=149 mg/ml  ........  K.......    9157  ...........         0.30  ...........         0.06
                 iodine, 1ml.
Q9946.........  LOCM 150-199mg/   ........  K.......    9158  ...........         1.84  ...........         0.37
                 ml iodine,1ml.
Q9947.........  LOCM 200-249mg/   ........  K.......    9159  ...........         1.25  ...........         0.25
                 ml iodine,1ml.
Q9948.........  LOCM 250-299mg/   ........  K.......    9160  ...........         0.32  ...........         0.06
                 ml iodine,1ml.
Q9949.........  LOCM 300-349mg/   ........  K.......    9161  ...........         0.34  ...........         0.07
                 ml iodine,1ml.
Q9950.........  LOCM 350-399mg/   ........  K.......    9162  ...........         0.21  ...........         0.04
                 ml iodine,1ml.
Q9951.........  LOCM >= 400 mg/   ........  K.......    9163  ...........         0.30  ...........         0.06
                 ml iodine,1ml.
Q9952.........  Inj Gad-base MR   ........  K.......    9164  ...........         2.88  ...........         0.58
                 contrast,1ml.
Q9953.........  Inj Fe-based MR   ........  K.......    1713  ...........        30.12  ...........         6.02
                 contrast,1ml.
Q9954.........  Oral MR           ........  K.......    9165  ...........         8.87  ...........         1.77
                 contrast, 100
                 ml.
Q9955.........  Inj perflexane    ........  K.......    9203  ...........         8.22  ...........         1.64
                 lip micros,ml.
Q9956.........  Inj               ........  K.......    9202  ...........        40.75  ...........         8.15
                 octafluoropropa
                 ne mic,ml.
Q9957.........  Inj perflutren    ........  K.......    9112  ...........        61.25  ...........        12.25
                 lip micros,ml.
Q9958.........  HOCM <=149 mg/ml  CH......  N.......  ......  ...........  ...........  ...........  ...........
                 iodine, 1ml.
Q9959.........  HOCM 150-199mg/   ........  N.......  ......  ...........  ...........  ...........  ...........
                 ml iodine,1ml.
Q9960.........  HOCM 200-249mg/   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 ml iodine,1ml.
Q9961.........  HOCM 250-299mg/   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 ml iodine,1ml.
Q9962.........  HOCM 300-349mg/   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 ml iodine,1ml.
Q9963.........  HOCM 350-399mg/   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 ml iodine,1ml.
Q9964.........  HOCM>= 400mg/ml   CH......  N.......  ......  ...........  ...........  ...........  ...........
                 iodine, 1ml.
V2630.........  Anter chamber     ........  N.......  ......  ...........  ...........  ...........  ...........
                 intraocul lens.
V2631.........  Iris support      ........  N.......  ......  ...........  ...........  ...........  ...........
                 intraoclr lens.
V2632.........  Post chmbr        ........  N.......  ......  ...........  ...........  ...........  ...........
                 intraocular
                 lens.
V2790.........  Amniotic          ........  N.......  ......  ...........  ...........  ...........  ...........
                 membrane.
----------------------------------------------------------------------------------------------------------------


                      Addendum BB.--Proposed List of Medicare Approved ASC Procedures For CY 2008 With Additions and Payment Rates
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                         CY 08                     CY 08
                                        New 2008 ASC                                      CY 08 ASC     payment       CY 08      copayment      CY 08
      HCPCS        Short Description      approved      Designated as    Payment capped    relative   without 50/    payment    without 50/   copayment
                                         procedure       office based     at MPFS rate     payment         50       with 50/50       50       with 50/50
                                                                                            weight     transition   transition   transition   transition
--------------------------------------------------------------------------------------------------------------------------------------------------------
10021...........  Fna w/o image.....  Y..............  Y..............  ...............       1.0948       $43.45       $43.45        $8.69        $8.69
10022...........  Fna w/image.......  Y..............  ...............  ...............       2.0147       $79.96       $79.96       $15.99       $15.99
10040...........  Acne surgery......  Y..............  Y..............  ...............       0.4829       $19.17       $19.17        $3.83        $3.83
10060...........  Drainage of skin    Y..............  Y..............  Y..............       1.1457       $45.47       $45.47        $9.09        $9.09
                   abscess.
10061...........  Drainage of skin    Y..............  Y..............  ...............       1.4821       $58.82       $58.82       $11.76       $11.76
                   abscess.
10080...........  Drainage of         Y..............  Y..............  ...............       1.4821       $58.82       $58.82       $11.76       $11.76
                   pilonidal cyst.
10081...........  Drainage of         Y..............  Y..............  Y..............       3.2148      $127.59      $127.59       $25.52       $25.52
                   pilonidal cyst.
10120...........  Remove foreign      Y..............  Y..............  ...............       1.4821       $58.82       $58.82       $11.76       $11.76
                   body.
10121...........  Remove foreign      ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   body.
10140...........  Drainage of         Y..............  Y..............  Y..............       1.7090       $67.83       $67.83       $13.57       $13.57
                   hematoma/fluid.
10160...........  Puncture drainage   Y..............  Y..............  ...............       1.0534       $41.81       $41.81        $8.36        $8.36
                   of lesion.
10180...........  Complex drainage,   ...............  ...............  ...............      17.4686      $693.30      $569.65      $138.66      $113.93
                   wound.
11000...........  Debride infected    Y..............  Y..............  Y..............       0.5503       $21.84       $21.84        $4.37        $4.37
                   skin.
11001...........  Debride infected    Y..............  Y..............  Y..............       0.1942        $7.71        $7.71        $1.54        $1.54
                   skin add-on.
11010...........  Debride skin, fx..  ...............  ...............  ...............       4.0123      $159.24      $203.10       $31.85       $40.62
11011...........  Debride skin/       ...............  ...............  ...............       4.0123      $159.24      $203.10       $31.85       $40.62
                   muscle, fx.
11012...........  Debride skin/       ...............  ...............  ...............       4.0123      $159.24      $203.10       $31.85       $40.62
                   muscle/bone, fx.
11040...........  Debride skin,       Y..............  Y..............  Y..............       0.5040       $20.00       $20.00        $4.00        $4.00
                   partial.

[[Page 49846]]

 
11041...........  Debride skin, full  Y..............  Y..............  Y..............       0.6042       $23.98       $23.98        $4.80        $4.80
11042...........  Debride skin/       ...............  ...............  ...............       2.6253      $104.19      $132.89       $20.84       $26.58
                   tissue.
11043...........  Debride tissue/     ...............  ...............  ...............       2.6253      $104.19      $132.89       $20.84       $26.58
                   muscle.
11044...........  Debride tissue/     ...............  ...............  ...............       6.7529      $268.01      $341.83       $53.60       $68.37
                   muscle/bone.
11055...........  Trim skin lesion..  Y..............  Y..............  Y..............       0.5762       $22.87       $22.87        $4.57        $4.57
11056...........  Trim skin lesions,  Y..............  Y..............  Y..............       0.6403       $25.41       $25.41        $5.08        $5.08
                   2 to 4.
11057...........  Trim skin lesions,  Y..............  Y..............  Y..............       0.7268       $28.85       $28.85        $5.77        $5.77
                   over 4.
11100...........  Biopsy, skin        Y..............  Y..............  ...............       1.0534       $41.81       $41.81        $8.36        $8.36
                   lesion.
11101...........  Biopsy, skin add-   Y..............  Y..............  Y..............       0.3217       $12.77       $12.77        $2.55        $2.55
                   on.
11200...........  Removal of skin     Y..............  Y..............  Y..............       0.9713       $38.55       $38.55        $7.71        $7.71
                   tags.
11201...........  Remove skin tags    Y..............  Y..............  Y..............       0.1365        $5.42        $5.42        $1.08        $1.08
                   add-on.
11300...........  Shave skin lesion.  Y..............  Y..............  ...............       0.8076       $32.05       $32.05        $6.41        $6.41
11301...........  Shave skin lesion.  Y..............  Y..............  ...............       0.8076       $32.05       $32.05        $6.41        $6.41
11302...........  Shave skin lesion.  Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
11303...........  Shave skin lesion.  Y..............  Y..............  Y..............       1.5547       $61.70       $61.70       $12.34       $12.34
11305...........  Shave skin lesion.  Y..............  Y..............  Y..............       0.8112       $32.20       $32.20        $6.44        $6.44
11306...........  Shave skin lesion.  Y..............  Y..............  Y..............       1.0789       $42.82       $42.82        $8.56        $8.56
11307...........  Shave skin lesion.  Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
11308...........  Shave skin lesion.  Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
11310...........  Shave skin lesion.  Y..............  Y..............  Y..............       1.0785       $42.80       $42.80        $8.56        $8.56
11311...........  Shave skin lesion.  Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
11312...........  Shave skin lesion.  Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
11313...........  Shave skin lesion.  Y..............  Y..............  Y..............       1.7299       $68.66       $68.66       $13.73       $13.73
11400...........  Removal of skin     Y..............  Y..............  Y..............       1.6618       $65.96       $65.96       $13.19       $13.19
                   lesion.
11401...........  Removal of skin     Y..............  Y..............  Y..............       1.8178       $72.14       $72.14       $14.43       $14.43
                   lesion.
11402...........  Removal of skin     Y..............  Y..............  Y..............       1.9768       $78.45       $78.45       $15.69       $15.69
                   lesion.
11403...........  Removal of skin     Y..............  Y..............  Y..............       2.1118       $83.81       $83.81       $16.76       $16.76
                   lesion.
11404...........  Exc tr-ext b9+marg  ...............  ...............  ...............      14.9563      $593.59      $463.29      $118.72       $92.66
                   3.1-4 cm.
11406...........  Exc tr-ext b9+marg  ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   > 4.0 cm.
11420...........  Removal of skin     Y..............  Y..............  Y..............       1.5323       $60.81       $60.81       $12.16       $12.16
                   lesion.
11421...........  Removal of skin     Y..............  Y..............  Y..............       1.8294       $72.61       $72.61       $14.52       $14.52
                   lesion.
11422...........  Removal of skin     Y..............  Y..............  Y..............       1.9996       $79.36       $79.36       $15.87       $15.87
                   lesion.
11423...........  Removal of skin     Y..............  Y..............  Y..............       2.2405       $88.92       $88.92       $17.78       $17.78
                   lesion.

[[Page 49847]]

 
11424...........  Exc h-f-nk-sp       ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   b9+marg 3.1-4.
11426...........  Exc h-f-nk-sp       ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   b9+marg > 4 cm.
11440...........  Removal of skin     Y..............  Y..............  Y..............       1.8212       $72.28       $72.28       $14.46       $14.46
                   lesion.
11441...........  Removal of skin     Y..............  Y..............  Y..............       2.0319       $80.64       $80.64       $16.13       $16.13
                   lesion.
11442...........  Removal of skin     Y..............  Y..............  Y..............       2.2205       $88.13       $88.13       $17.63       $17.63
                   lesion.
11443...........  Removal of skin     Y..............  Y..............  Y..............       2.4880       $98.75       $98.75       $19.75       $19.75
                   lesion.
11444...........  Exc face-mm         ...............  ...............  ...............       6.5128      $258.48      $295.74       $51.70       $59.15
                   b9+marg 3.1-4 cm.
11446...........  Exc face-mm         ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   b9+marg > 4 cm.
11450...........  Removal, sweat      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   gland lesion.
11451...........  Removal, sweat      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   gland lesion.
11462...........  Removal, sweat      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   gland lesion.
11463...........  Removal, sweat      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   gland lesion.
11470...........  Removal, sweat      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   gland lesion.
11471...........  Removal, sweat      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   gland lesion.
11600...........  Removal of skin     Y..............  Y..............  Y..............       2.2612       $89.74       $89.74       $17.95       $17.95
                   lesion.
11601...........  Removal of skin     Y..............  Y..............  Y..............       2.5980      $103.11      $103.11       $20.62       $20.62
                   lesion.
11602...........  Removal of skin     Y..............  Y..............  Y..............       2.8188      $111.87      $111.87       $22.37       $22.37
                   lesion.
11603...........  Removal of skin     Y..............  Y..............  Y..............       3.0099      $119.46      $119.46       $23.89       $23.89
                   lesion.
11604...........  Exc tr-ext          ...............  ...............  ...............       6.5128      $258.48      $329.68       $51.70       $65.94
                   mlg+marg 3.1-4 cm.
11606...........  Exc tr-ext          ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   mlg+marg > 4 cm.
11620...........  Removal of skin     Y..............  Y..............  Y..............       2.2902       $90.89       $90.89       $18.18       $18.18
                   lesion.
11621...........  Removal of skin     Y..............  Y..............  Y..............       2.6216      $104.05      $104.05       $20.81       $20.81
                   lesion.
11622...........  Removal of skin     Y..............  Y..............  Y..............       2.9059      $115.33      $115.33       $23.07       $23.07
                   lesion.
11623...........  Removal of skin     Y..............  Y..............  Y..............       3.1563      $125.27      $125.27       $25.05       $25.05
                   lesion.
11624...........  Exc h-f-nk-sp       ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   mlg+marg 3.1-4.
11626...........  Exc h-f-nk-sp       ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   mlg+mar > 4 cm.
11640...........  Removal of skin     Y..............  Y..............  Y..............       2.4089       $95.60       $95.60       $19.12       $19.12
                   lesion.
11641...........  Removal of skin     Y..............  Y..............  Y..............       2.8188      $111.87      $111.87       $22.37       $22.37
                   lesion.
11642...........  Removal of skin     Y..............  Y..............  Y..............       3.1554      $125.23      $125.23       $25.05       $25.05
                   lesion.
11643...........  Removal of skin     Y..............  Y..............  Y..............       3.4305      $136.15      $136.15       $27.23       $27.23
                   lesion.

[[Page 49848]]

 
11644...........  Exc face-mm         ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   malig+marg 3.1-4.
11646...........  Exc face-mm         ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   mlg+marg > 4 cm.
11719...........  Trim nail(s)......  Y..............  Y..............  Y..............       0.2643       $10.49       $10.49        $2.10        $2.10
11720...........  Debride nail, 1-5.  Y..............  Y..............  Y..............       0.3393       $13.47       $13.47        $2.69        $2.69
11721...........  Debride nail, 6 or  Y..............  Y..............  Y..............       0.4134       $16.41       $16.41        $3.28        $3.28
                   more.
11730...........  Removal of nail     Y..............  Y..............  Y..............       0.9967       $39.56       $39.56        $7.91        $7.91
                   plate.
11732...........  Remove nail plate,  Y..............  Y..............  Y..............       0.4138       $16.42       $16.42        $3.28        $3.28
                   add-on.
11740...........  Drain blood from    Y..............  Y..............  Y..............       0.5675       $22.52       $22.52        $4.50        $4.50
                   under nail.
11750...........  Removal of nail     Y..............  Y..............  Y..............       2.1520       $85.41       $85.41       $17.08       $17.08
                   bed.
11752...........  Remove nail bed/    Y..............  Y..............  Y..............       3.0179      $119.78      $119.78       $23.96       $23.96
                   finger tip.
11755...........  Biopsy, nail unit.  Y..............  Y..............  Y..............       1.5236       $60.47       $60.47       $12.09       $12.09
11760...........  Repair of nail bed  Y..............  ...............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
11762...........  Reconstruction of   Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   nail bed.
11765...........  Excision of nail    Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   fold, toe.
11770...........  Removal of          ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pilonidal lesion.
11771...........  Removal of          ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pilonidal lesion.
11772...........  Removal of          ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pilonidal lesion.
11900...........  Injection into      Y..............  Y..............  Y..............       0.6789       $26.94       $26.94        $5.39        $5.39
                   skin lesions.
11901...........  Added skin lesions  Y..............  Y..............  Y..............       0.7259       $28.81       $28.81        $5.76        $5.76
                   injection.
11920...........  Correct skin color  Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   defects.
11921...........  Correct skin color  Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   defects.
11922...........  Correct skin color  Y..............  Y..............  Y..............       0.8864       $35.18       $35.18        $7.04        $7.04
                   defects.
11950...........  Therapy for         Y..............  Y..............  Y..............       0.8811       $34.97       $34.97        $6.99        $6.99
                   contour defects.
11951...........  Therapy for         Y..............  Y..............  Y..............       1.1485       $45.58       $45.58        $9.12        $9.12
                   contour defects.
11952...........  Therapy for         Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   contour defects.
11954...........  Therapy for         Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   contour defects.
11960...........  Insert tissue       ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   expander(s).
11970...........  Replace tissue      ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   expander.
11971...........  Remove tissue       ...............  ...............  ...............      19.9760      $792.81      $562.90      $158.56      $112.58
                   expander(s).
11976...........  Removal of          Y..............  Y..............  Y..............       1.4625       $58.04       $58.04       $11.61       $11.61
                   contraceptive cap.

[[Page 49849]]

 
11980...........  Implant hormone     Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   pellet(s).
11981...........  Insert drug         Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   implant device.
11982...........  Remove drug         Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   implant device.
11983...........  Remove/insert drug  Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   implant.
12001...........  Repair superficial  Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12002...........  Repair superficial  Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12004...........  Repair superficial  Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12005...........  Repair superficial  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12006...........  Repair superficial  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12007...........  Repair superficial  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12011...........  Repair superficial  Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12013...........  Repair superficial  Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12014...........  Repair superficial  Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12015...........  Repair superficial  Y..............  ...............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12016...........  Repair superficial  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12017...........  Repair superficial  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12018...........  Repair superficial  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12020...........  Closure of split    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound.
12021...........  Closure of split    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound.
12031...........  Layer closure of    Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12032...........  Layer closure of    Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12034...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12035...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12036...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12037...........  Layer closure of    ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   wound(s).
12041...........  Layer closure of    Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12042...........  Layer closure of    Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).

[[Page 49850]]

 
12044...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12045...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12046...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12047...........  Layer closure of    ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   wound(s).
12051...........  Layer closure of    Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12052...........  Layer closure of    Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12053...........  Layer closure of    Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   wound(s).
12054...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12055...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12056...........  Layer closure of    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   wound(s).
12057...........  Layer closure of    ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   wound(s).
13100...........  Repair of wound or  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   lesion.
13101...........  Repair of wound or  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   lesion.
13102...........  Repair wound/       Y..............  ...............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   lesion add-on.
13120...........  Repair of wound or  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   lesion.
13121...........  Repair of wound or  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   lesion.
13122...........  Repair wound/       Y..............  ...............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   lesion add-on.
13131...........  Repair of wound or  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   lesion.
13132...........  Repair of wound or  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   lesion.
13133...........  Repair wound/       Y..............  Y..............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   lesion add-on.
13150...........  Repair of wound or  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   lesion.
13151...........  Repair of wound or  ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   lesion.
13152...........  Repair of wound or  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   lesion.
13153...........  Repair wound/       Y..............  ...............  ...............       1.4924       $59.23       $59.23       $11.85       $11.85
                   lesion add-on.
13160...........  Late closure of     ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   wound.
14000...........  Skin tissue         ...............  ...............  ...............      13.3433      $529.57      $487.79      $105.91       $97.56
                   rearrangement.
14001...........  Skin tissue         ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   rearrangement.
14020...........  Skin tissue         ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   rearrangement.
14021...........  Skin tissue         ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   rearrangement.
14040...........  Skin tissue         ...............  ...............  ...............      13.3433      $529.57      $487.79      $105.91       $97.56
                   rearrangement.
14041...........  Skin tissue         ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   rearrangement.
14060...........  Skin tissue         ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   rearrangement.
14061...........  Skin tissue         ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   rearrangement.
14300...........  Skin tissue         ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   rearrangement.

[[Page 49851]]

 
14350...........  Skin tissue         ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   rearrangement.
15000...........  Wound prep, 1st     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   100 sq cm.
15001...........  Wound prep, addl    ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   100 sq cm.
15040...........  Harvest cultured    ...............  ...............  ...............       1.4924       $59.23       $75.55       $11.85       $15.11
                   skin graft.
15050...........  Skin pinch graft..  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
15100...........  Skin splt grft,     ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   trnk/arm/leg.
15101...........  Skin splt grft t/a/ ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   l, add-on.
15110...........  Epidrm autogrft     ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   trnk/arm/leg.
15111...........  Epidrm autogrft t/  ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   a/l add-on.
15115...........  Epidrm a-grft face/ ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   nck/hf/g.
15116...........  Epidrm a-grft f/n/  ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   hf/g addl.
15120...........  Skn splt a-grft     ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   fac/nck/hf/g.
15121...........  Skn splt a-grft f/  ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   n/hf/g add.
15130...........  Derm autograft,     ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   trnk/arm/leg.
15131...........  Derm autograft t/a/ ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   l add-on.
15135...........  Derm autograft      ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   face/nck/hf/g.
15136...........  Derm autograft, f/  ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   n/hf/g add.
15150...........  Cult epiderm grft   ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   t/arm/leg.
15151...........  Cult epiderm grft   ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   t/a/l addl.
15152...........  Cult epiderm graft  ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   t/a/l +%.
15155...........  Cult epiderm        ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   graft, f/n/hf/g.
15156...........  Cult epidrm grft f/ ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   n/hfg add.
15157...........  Cult epiderm grft   ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   f/n/hfg +%.
15200...........  Skin full graft,    ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   trunk.
15201...........  Skin full graft     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   trunk add-on.
15220...........  Skin full graft     ...............  ...............  ...............      13.3433      $529.57      $487.79      $105.91       $97.56
                   sclp/arm/leg.
15221...........  Skin full graft     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   add-on.
15240...........  Skin full grft      ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   face/genit/hf.
15241...........  Skin full graft     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   add-on.
15260...........  Skin full graft     ...............  ...............  ...............      13.3433      $529.57      $487.79      $105.91       $97.56
                   een & lips.
15261...........  Skin full graft     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   add-on.
15300...........  Apply               ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   skinallogrft, t/
                   arm/lg.
15301...........  Apply sknallogrft   ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   t/a/l addl.

[[Page 49852]]

 
15320...........  Apply skin          ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   allogrft f/n/hf/g.
15321...........  Aply sknallogrft f/ ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   n/hfg add.
15330...........  Aply acell alogrft  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   t/arm/leg.
15331...........  Aply acell grft t/  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   a/l add-on.
15335...........  Apply acell graft,  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   f/n/hf/g.
15336...........  Aply acell grft f/  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   n/hf/g add.
15340...........  Apply cult skin     Y..............  Y..............  Y..............       3.2865      $130.44      $130.44       $26.09       $26.09
                   substitute.
15341...........  Apply cult skin     Y..............  ...............  ...............       5.0931      $202.14      $202.14       $40.43       $40.43
                   sub add-on.
15360...........  Apply cult derm     Y..............  ...............  ...............       5.0931      $202.14      $202.14       $40.43       $40.43
                   sub, t/a/l.
15361...........  Aply cult derm sub  Y..............  ...............  ...............       5.0931      $202.14      $202.14       $40.43       $40.43
                   t/a/l add.
15365...........  Apply cult derm     Y..............  ...............  ...............       5.0931      $202.14      $202.14       $40.43       $40.43
                   sub f/n/hf/g.
15366...........  Apply cult derm f/  Y..............  ...............  ...............       5.0931      $202.14      $202.14       $40.43       $40.43
                   hf/g add.
15400...........  Apply skin          ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   xenograft, t/a/l.
15401...........  Apply skn xenogrft  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   t/a/l add.
15420...........  Apply skin xgraft,  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   f/n/hf/g.
15421...........  Apply skn xgrft f/  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   n/hf/g add.
15430...........  Apply acellular     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   xenograft.
15431...........  Apply acellular     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   xgraft add.
15570...........  Form skin pedicle   ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   flap.
15572...........  Form skin pedicle   ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   flap.
15574...........  Form skin pedicle   ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   flap.
15576...........  Form skin pedicle   ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   flap.
15600...........  Skin graft........  ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
15610...........  Skin graft........  ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
15620...........  Skin graft........  ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
15630...........  Skin graft........  ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
15650...........  Transfer skin       ...............  ...............  ...............      21.2645      $843.95      $780.47      $168.79      $156.09
                   pedicle flap.
15732...........  Muscle-skin graft,  ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   head/neck.
15734...........  Muscle-skin graft,  ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   trunk.
15736...........  Muscle-skin graft,  ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   arm.
15738...........  Muscle-skin graft,  ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   leg.
15740...........  Island pedicle      ...............  ...............  ...............      13.3433      $529.57      $487.79      $105.91       $97.56
                   flap graft.
15750...........  Neurovascular       ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   pedicle graft.
15760...........  Composite skin      ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   graft.

[[Page 49853]]

 
15770...........  Derma-fat-fascia    ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   graft.
15775...........  Hair transplant     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   punch grafts.
15776...........  Hair transplant     ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   punch grafts.
15780...........  Abrasion treatment  Y..............  Y..............  Y..............      10.0118      $397.35      $397.35       $79.47       $79.47
                   of skin.
15781...........  Abrasion treatment  Y..............  Y..............  ...............       4.0123      $159.24      $159.24       $31.85       $31.85
                   of skin.
15782...........  Dressing change     Y..............  Y..............  ...............       4.0123      $159.24      $159.24       $31.85       $31.85
                   not for burn.
15783...........  Abrasion treatment  Y..............  Y..............  ...............       2.6253      $104.19      $104.19       $20.84       $20.84
                   of skin.
15786...........  Abrasion, lesion,   Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
                   single.
15787...........  Abrasion, lesions,  Y..............  Y..............  Y..............       0.8221       $32.63       $32.63        $6.53        $6.53
                   add-on.
15788...........  Chemical peel,      Y..............  Y..............  ...............       0.8076       $32.05       $32.05        $6.41        $6.41
                   face, epiderm.
15789...........  Chemical peel,      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   face, dermal.
15792...........  Chemical peel,      Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
                   nonfacial.
15793...........  Chemical peel,      Y..............  Y..............  ...............       0.8076       $32.05       $32.05        $6.41        $6.41
                   nonfacial.
15819...........  Plastic surgery,    Y..............  ...............  ...............       5.0931      $202.14      $202.14       $40.43       $40.43
                   neck.
15820...........  Revision of lower   ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   eyelid.
15821...........  Revision of lower   ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   eyelid.
15822...........  Revision of upper   ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   eyelid.
15823...........  Revision of upper   ...............  ...............  ...............      13.3433      $529.57      $623.29      $105.91      $124.66
                   eyelid.
15824...........  Removal of          ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   forehead wrinkles.
15825...........  Removal of neck     ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   wrinkles.
15826...........  Removal of brow     ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   wrinkles.
15828...........  Removal of face     ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   wrinkles.
15829...........  Removal of skin     ...............  ...............  ...............      21.2645      $843.95      $780.47      $168.79      $156.09
                   wrinkles.
15831...........  Excise excessive    ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   skin tissue.
15832...........  Excise excessive    ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   skin tissue.
15833...........  Excise excessive    ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   skin tissue.
15834...........  Excise excessive    ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   skin tissue.
15835...........  Excise excessive    ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   skin tissue.
15836...........  Excise excessive    ...............  ...............  ...............      14.9563      $593.59      $551.79      $118.72      $110.36
                   skin tissue.

[[Page 49854]]

 
15837...........  Excise excessive    Y..............  ...............  ...............      14.9563      $593.59      $593.59      $118.72      $118.72
                   skin tissue.
15838...........  Excise excessive    Y..............  ...............  ...............      14.9563      $593.59      $593.59      $118.72      $118.72
                   skin tissue.
15839...........  Excise excessive    ...............  ...............  ...............      14.9563      $593.59      $551.79      $118.72      $110.36
                   skin tissue.
15840...........  Graft for face      ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   nerve palsy.
15841...........  Graft for face      ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   nerve palsy.
15845...........  Skin and muscle     ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   repair, face.
15850...........  Removal of sutures  Y..............  ...............  ...............       2.6253      $104.19      $104.19       $20.84       $20.84
15851...........  Removal of sutures  Y..............  Y..............  Y..............       1.2829       $50.92       $50.92       $10.18       $10.18
15852...........  Dressing change     Y..............  ...............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   not for burn.
15860...........  Test for blood      Y..............  ...............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   flow in graft.
15876...........  Suction assisted    ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   lipectomy.
15877...........  Suction assisted    ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   lipectomy.
15878...........  Suction assisted    ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   lipectomy.
15879...........  Suction assisted    ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   lipectomy.
15920...........  Removal of tail     ...............  ...............  ...............       4.0123      $159.24      $203.10       $31.85       $40.62
                   bone ulcer.
15922...........  Removal of tail     ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   bone ulcer.
15931...........  Remove sacrum       ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pressure sore.
15933...........  Remove sacrum       ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pressure sore.
15934...........  Remove sacrum       ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   pressure sore.
15935...........  Remove sacrum       ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   pressure sore.
15936...........  Remove sacrum       ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   pressure sore.
15937...........  Remove sacrum       ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   pressure sore.
15940...........  Remove hip          ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pressure sore.
15941...........  Remove hip          ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pressure sore.
15944...........  Remove hip          ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   pressure sore.
15945...........  Remove hip          ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   pressure sore.
15946...........  Remove hip          ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   pressure sore.
15950...........  Remove thigh        ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pressure sore.
15951...........  Remove thigh        ...............  ...............  ...............      19.9760      $792.81      $711.40      $158.56      $142.28
                   pressure sore.
15952...........  Remove thigh        ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   pressure sore.
15953...........  Remove thigh        ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   pressure sore.

[[Page 49855]]

 
15956...........  Remove thigh        ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   pressure sore.
15958...........  Remove thigh        ...............  ...............  ...............      21.2645      $843.95      $736.97      $168.79      $147.39
                   pressure sore.
16000...........  Initial treatment   Y..............  Y..............  Y..............       0.6709       $26.63       $26.63        $5.33        $5.33
                   of burn(s).
16020...........  Treatment of        Y..............  Y..............  Y..............       1.0167       $40.35       $40.35        $8.07        $8.07
                   burn(s).
16025...........  Dress/debrid p-     ...............  ...............  ...............       1.0876       $43.16       $55.05        $8.63       $11.01
                   thick burn, m.
16030...........  Dress/debrid p-     ...............  ...............  ...............       1.6062       $63.75       $81.30       $12.75       $16.26
                   thick burn, l.
17000...........  Destroy benign/     Y..............  Y..............  ...............       0.4829       $19.17       $19.17        $3.83        $3.83
                   premlg lesion.
17003...........  Destroy lesions, 2- Y..............  Y..............  Y..............       0.0928        $3.68        $3.68        $0.74        $0.74
                   14.
17004...........  Destroy lesions,    Y..............  Y..............  Y..............       2.0221       $80.25       $80.25       $16.05       $16.05
                   15 or more.
17106...........  Destruction of      Y..............  Y..............  ...............       2.6478      $105.09      $105.09       $21.02       $21.02
                   skin lesions.
17107...........  Destruction of      Y..............  Y..............  ...............       2.6478      $105.09      $105.09       $21.02       $21.02
                   skin lesions.
17108...........  Destruction of      Y..............  Y..............  ...............       2.6478      $105.09      $105.09       $21.02       $21.02
                   skin lesions.
17110...........  Destruct lesion, 1- Y..............  Y..............  ...............       0.8076       $32.05       $32.05        $6.41        $6.41
                   14.
17111...........  Destruct lesion,    Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
                   15 or more.
17250...........  Chemical cautery,   Y..............  Y..............  Y..............       1.0812       $42.91       $42.91        $8.58        $8.58
                   tissue.
17260...........  Destruction of      Y..............  Y..............  Y..............       1.1651       $46.24       $46.24        $9.25        $9.25
                   skin lesions.
17261...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17262...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17263...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17264...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17266...........  Destruction of      Y..............  Y..............  Y..............       2.6129      $103.70      $103.70       $20.74       $20.74
                   skin lesions.
17270...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17271...........  Destruction of      Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
                   skin lesions.
17272...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17273...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17274...........  Destruction of      Y..............  Y..............  ...............       2.6253      $104.19      $104.19       $20.84       $20.84
                   skin lesions.
17276...........  Destruction of      Y..............  Y..............  ...............       2.6253      $104.19      $104.19       $20.84       $20.84
                   skin lesions.
17280...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17281...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17282...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17283...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17284...........  Destruction of      Y..............  Y..............  ...............       2.6253      $104.19      $104.19       $20.84       $20.84
                   skin lesions.
17286...........  Destruction of      Y..............  Y..............  ...............       1.6062       $63.75       $63.75       $12.75       $12.75
                   skin lesions.
17304...........  1 stage mohs, up    Y..............  Y..............  ...............       3.4844      $138.29      $138.29       $27.66       $27.66
                   to 5 spec.

[[Page 49856]]

 
17305...........  2 stage mohs, up    Y..............  Y..............  ...............       3.4844      $138.29      $138.29       $27.66       $27.66
                   to 5 spec.
17306...........  3 stage mohs, up    Y..............  Y..............  ...............       3.4844      $138.29      $138.29       $27.66       $27.66
                   to 5 spec.
17307...........  Mohs addl stage up  Y..............  Y..............  ...............       3.4844      $138.29      $138.29       $27.66       $27.66
                   to 5 spec.
17310...........  Mohs any stage > 5  Y..............  Y..............  Y..............       1.5657       $62.14       $62.14       $12.43       $12.43
                   spec each.
17340...........  Cryotherapy of      Y..............  Y..............  Y..............       0.3096       $12.29       $12.29        $2.46        $2.46
                   skin.
17360...........  Skin peel therapy.  Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
17380...........  Hair removal by     Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
                   electrolysis.
19000...........  Drainage of breast  Y..............  Y..............  Y..............       1.7129       $67.98       $67.98       $13.60       $13.60
                   lesion.
19001...........  Drain breast        Y..............  Y..............  Y..............       0.2210        $8.77        $8.77        $1.75        $1.75
                   lesion add-on.
19020...........  Incision of breast  ...............  ...............  ...............      17.4686      $693.30      $569.65      $138.66      $113.93
                   lesion.
19100...........  Bx breast percut w/ ...............  ...............  ...............       3.8051      $151.02      $192.61       $30.20       $38.52
                   o image.
19101...........  Biopsy of breast,   ...............  ...............  ...............      19.2250      $763.00      $604.50      $152.60      $120.90
                   open.
19102...........  Bx breast percut w/ ...............  ...............  ...............       3.8051      $151.02      $192.61       $30.20       $38.52
                   image.
19103...........  Bx breast percut w/ ...............  ...............  ...............       6.4482      $255.92      $326.40       $51.18       $65.28
                   device.
19110...........  Nipple exploration  ...............  ...............  ...............      19.2250      $763.00      $604.50      $152.60      $120.90
19112...........  Excise breast duct  ...............  ...............  ...............      19.2250      $763.00      $636.50      $152.60      $127.30
                   fistula.
19120...........  Removal of breast   ...............  ...............  ...............      19.2250      $763.00      $636.50      $152.60      $127.30
                   lesion.
19125...........  Excision, breast    ...............  ...............  ...............      19.2250      $763.00      $636.50      $152.60      $127.30
                   lesion.
19126...........  Excision, addl      ...............  ...............  ...............      19.2250      $763.00      $636.50      $152.60      $127.30
                   breast lesion.
19140...........  Removal of breast   ...............  ...............  ...............      19.2250      $763.00      $696.50      $152.60      $139.30
                   tissue.
19160...........  Partial mastectomy  ...............  ...............  ...............      19.2250      $763.00      $636.50      $152.60      $127.30
19162...........  P-mastectomy w/ln   ...............  ...............  ...............      37.4843    $1,487.68    $1,241.34      $297.54      $248.27
                   removal.
19180...........  Removal of breast.  ...............  ...............  ...............      28.1505    $1,117.24      $873.62      $223.45      $174.72
19182...........  Removal of breast.  ...............  ...............  ...............      28.1505    $1,117.24      $873.62      $223.45      $174.72
19295...........  Place breast clip,  Y..............  ...............  ...............       1.7625       $69.95       $69.95       $13.99       $13.99
                   percut.
19296...........  Place po breast     ...............  ...............  ...............      40.7495    $1,617.27    $1,478.13      $323.45      $295.63
                   cath for rad.
19297...........  Place breast cath   Y..............  ...............  ...............      28.1505    $1,117.24    $1,117.24      $223.45      $223.45
                   for rad.
19298...........  Place breast rad    ...............  ...............  ...............            -          $ -      $166.50          $ -       $33.30
                   tube/caths.
19316...........  Suspension of       ...............  ...............  ...............      28.1505    $1,117.24      $873.62      $223.45      $174.72
                   breast.
19318...........  Reduction of large  ...............  ...............  ...............      37.4843    $1,487.68    $1,058.84      $297.54      $211.77
                   breast.
19324...........  Enlarge breast....  ...............  ...............  ...............      37.4843    $1,487.68    $1,058.84      $297.54      $211.77
19325...........  Enlarge breast      ...............  ...............  ...............      48.7796    $1,935.97    $1,637.48      $387.19      $327.50
                   with implant.
19328...........  Removal of breast   ...............  ...............  ...............      28.1505    $1,117.24      $725.12      $223.45      $145.02
                   implant.
19330...........  Removal of implant  ...............  ...............  ...............      28.1505    $1,117.24      $725.12      $223.45      $145.02
                   material.

[[Page 49857]]

 
19340...........  Immediate breast    ...............  ...............  ...............      40.7495    $1,617.27    $1,031.63      $323.45      $206.33
                   prosthesis.
19342...........  Delayed breast      ...............  ...............  ...............      48.7796    $1,935.97    $1,222.98      $387.19      $244.60
                   prosthesis.
19350...........  Breast              ...............  ...............  ...............      19.2250      $763.00      $696.50      $152.60      $139.30
                   reconstruction.
19355...........  Correct inverted    ...............  ...............  ...............      28.1505    $1,117.24      $873.62      $223.45      $174.72
                   nipple(s).
19357...........  Breast              ...............  ...............  ...............      48.7796    $1,935.97    $1,326.48      $387.19      $265.30
                   reconstruction.
19366...........  Breast              ...............  ...............  ...............      28.1505    $1,117.24      $917.12      $223.45      $183.42
                   reconstruction.
19370...........  Surgery of breast   ...............  ...............  ...............      28.1505    $1,117.24      $873.62      $223.45      $174.72
                   capsule.
19371...........  Removal of breast   ...............  ...............  ...............      28.1505    $1,117.24      $873.62      $223.45      $174.72
                   capsule.
19380...........  Revise breast       ...............  ...............  ...............      40.7495    $1,617.27    $1,167.13      $323.45      $233.43
                   reconstruction.
19396...........  Design custom       Y..............  ...............  ...............      28.1505    $1,117.24    $1,117.24      $223.45      $223.45
                   breast implant.
20000...........  Incision of         Y..............  Y..............  ...............       1.4821       $58.82       $58.82       $11.76       $11.76
                   abscess.
20005...........  Incision of deep    ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   abscess.
20103...........  Explore wound,      Y..............  ...............  ...............       4.1133      $163.25      $163.25       $32.65       $32.65
                   extremity.
20150...........  Excise epiphyseal   Y..............  ...............  ...............      41.2543    $1,637.30    $1,637.30      $327.46      $327.46
                   bar.
20200...........  Muscle biopsy.....  ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
20205...........  Deep muscle biopsy  ...............  ...............  ...............      14.9563      $593.59      $551.79      $118.72      $110.36
20206...........  Needle biopsy,      ...............  ...............  ...............       3.8051      $151.02      $192.61       $30.20       $38.52
                   muscle.
20220...........  Bone biopsy,        ...............  ...............  ...............       4.0123      $159.24      $203.10       $31.85       $40.62
                   trocar/needle.
20225...........  Bone biopsy,        ...............  ...............  ...............       6.5128      $258.48      $329.68       $51.70       $65.94
                   trocar/needle.
20240...........  Bone biopsy,        ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   excisional.
20245...........  Bone biopsy,        ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   excisional.
20250...........  Open bone biopsy..  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
20251...........  Open bone biopsy..  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
20500...........  Injection of sinus  Y..............  Y..............  Y..............       1.5496       $61.50       $61.50       $12.30       $12.30
                   tract.
20520...........  Removal of foreign  Y..............  Y..............  Y..............       2.3536       $93.41       $93.41       $18.68       $18.68
                   body.
20525...........  Removal of foreign  ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   body.
20526...........  Ther injection,     Y..............  Y..............  Y..............       0.7740       $30.72       $30.72        $6.14        $6.14
                   carp tunnel.
20550...........  Inject tendon/      Y..............  Y..............  Y..............       0.5718       $22.69       $22.69        $4.54        $4.54
                   ligament/cyst.
20551...........  Inj tendon origin/  Y..............  Y..............  Y..............       0.5635       $22.37       $22.37        $4.47        $4.47
                   insertion.
20552...........  Inj trigger point,  Y..............  Y..............  Y..............       0.5564       $22.08       $22.08        $4.42        $4.42
                   1/2 muscl.
20553...........  Inject trigger      Y..............  Y..............  Y..............       0.6242       $24.77       $24.77        $4.95        $4.95
                   points, > 3.
20600...........  Drain/inject,       Y..............  Y..............  Y..............       0.5622       $22.31       $22.31        $4.46        $4.46
                   joint/bursa.

[[Page 49858]]

 
20605...........  Drain/inject,       Y..............  Y..............  Y..............       0.6427       $25.51       $25.51        $5.10        $5.10
                   joint/bursa.
20610...........  Drain/inject,       Y..............  Y..............  Y..............       0.8759       $34.76       $34.76        $6.95        $6.95
                   joint/bursa.
20612...........  Aspirate/inj        Y..............  Y..............  Y..............       0.6035       $23.95       $23.95        $4.79        $4.79
                   ganglion cyst.
20615...........  Treatment of bone   Y..............  Y..............  ...............       2.0863       $82.80       $82.80       $16.56       $16.56
                   cyst.
20650...........  Insert and remove   ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   bone pin.
20662...........  Application of      Y..............  Y..............  Y..............       4.4737      $177.55      $177.55       $35.51       $35.51
                   pelvis brace.
20663...........  Application of      Y..............  Y..............  Y..............       4.2278      $167.79      $167.79       $33.56       $33.56
                   thigh brace.
20665...........  Removal of          Y..............  ...............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   fixation device.
20670...........  Removal of support  ...............  ...............  ...............      14.9563      $593.59      $463.29      $118.72       $92.66
                   implant.
20680...........  Removal of support  ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   implant.
20690...........  Apply bone          ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   fixation device.
20692...........  Apply bone          ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   fixation device.
20693...........  Adjust bone         ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   fixation device.
20694...........  Remove bone         ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   fixation device.
20822...........  Replantation        Y..............  ...............  ...............      25.8425    $1,025.64    $1,025.64      $205.13      $205.13
                   digit, complete.
20900...........  Removal of bone     ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   for graft.
20902...........  Removal of bone     ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   for graft.
20910...........  Remove cartilage    ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   for graft.
20912...........  Remove cartilage    ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   for graft.
20920...........  Removal of fascia   ...............  ...............  ...............      13.3433      $529.57      $579.79      $105.91      $115.96
                   for graft.
20922...........  Removal of fascia   ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   for graft.
20924...........  Removal of tendon   ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   for graft.
20926...........  Removal of tissue   ...............  ...............  ...............      13.3433      $529.57      $579.79      $105.91      $115.96
                   for graft.
20972...........  Bone/skin graft,    Y..............  ...............  ...............      41.2239    $1,636.10    $1,636.10      $327.22      $327.22
                   metatarsal.
20973...........  Bone/skin graft,    Y..............  Y..............  Y..............      16.9974      $674.60      $674.60      $134.92      $134.92
                   great toe.
20975...........  Electrical bone     ...............  ...............  ...............       0.6211       $24.65       $31.44        $4.93        $6.29
                   stimulation.
20982...........  Ablate, bone        Y..............  ...............  ...............      25.0600      $994.58      $994.58      $198.92      $198.92
                   tumor(s) perq.
21010...........  Incision of jaw     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   joint.
21015...........  Resection of        ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   facial tumor.
21025...........  Excision of bone,   ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   lower jaw.
21026...........  Excision of facial  ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   bone(s).
21029...........  Contour of face     ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   bone lesion.

[[Page 49859]]

 
21030...........  Removal of face     Y..............  Y..............  Y..............       5.9541      $236.31      $236.31       $47.26       $47.26
                   bone lesion.
21031...........  Remove exostosis,   Y..............  Y..............  Y..............       4.9253      $195.47      $195.47       $39.09       $39.09
                   mandible.
21032...........  Remove exostosis,   Y..............  Y..............  Y..............       5.0435      $200.17      $200.17       $40.03       $40.03
                   maxilla.
21034...........  Excise max/zygoma   ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   mlg tumor.
21040...........  Excise mandible     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   lesion.
21044...........  Removal of jaw      ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   bone lesion.
21046...........  Remove mandible     ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   cyst complex.
21047...........  Excise lwr jaw      ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   cyst w/repair.
21048...........  Remove maxilla      Y..............  Y..............  Y..............      10.3744      $411.74      $411.74       $82.35       $82.35
                   cyst complex.
21050...........  Removal of jaw      ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   joint.
21060...........  Remove jaw joint    ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   cartilage.
21070...........  Remove coronoid     ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   process.
21076...........  Prepare face/oral   Y..............  Y..............  Y..............       8.9380      $354.73      $354.73       $70.95       $70.95
                   prosthesis.
21077...........  Prepare face/oral   Y..............  Y..............  Y..............      21.8677      $867.89      $867.89      $173.58      $173.58
                   prosthesis.
21079...........  Prepare face/oral   Y..............  Y..............  Y..............      15.4101      $611.60      $611.60      $122.32      $122.32
                   prosthesis.
21080...........  Prepare face/oral   Y..............  Y..............  Y..............      17.6321      $699.78      $699.78      $139.96      $139.96
                   prosthesis.
21081...........  Prepare face/oral   Y..............  Y..............  Y..............      16.1148      $639.56      $639.56      $127.91      $127.91
                   prosthesis.
21082...........  Prepare face/oral   Y..............  Y..............  Y..............      14.8249      $588.37      $588.37      $117.67      $117.67
                   prosthesis.
21083...........  Prepare face/oral   Y..............  Y..............  Y..............      14.5513      $577.51      $577.51      $115.50      $115.50
                   prosthesis.
21084...........  Prepare face/oral   Y..............  Y..............  Y..............      16.8041      $666.92      $666.92      $133.38      $133.38
                   prosthesis.
21085...........  Prepare face/oral   Y..............  Y..............  Y..............       6.5587      $260.30      $260.30       $52.06       $52.06
                   prosthesis.
21086...........  Prepare face/oral   Y..............  Y..............  Y..............      16.0903      $638.59      $638.59      $127.72      $127.72
                   prosthesis.
21087...........  Prepare face/oral   Y..............  Y..............  Y..............      15.9673      $633.71      $633.71      $126.74      $126.74
                   prosthesis.
21088...........  Prepare face/oral   Y..............  Y..............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   prosthesis.
21100...........  Maxillofacial       ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   fixation.

[[Page 49860]]

 
21110...........  Interdental         Y..............  Y..............  ...............       7.7261      $306.63      $306.63       $61.33       $61.33
                   fixation.
21120...........  Reconstruction of   ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   chin.
21121...........  Reconstruction of   ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   chin.
21122...........  Reconstruction of   ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   chin.
21123...........  Reconstruction of   ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   chin.
21125...........  Augmentation,       ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   lower jaw bone.
21127...........  Augmentation,       ...............  ...............  ...............      37.7719    $1,499.09    $1,419.05      $299.82      $283.81
                   lower jaw bone.
21137...........  Reduction of        Y..............  ...............  ...............      23.1564      $919.03      $919.03      $183.81      $183.81
                   forehead.
21138...........  Reduction of        Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   forehead.
21139...........  Reduction of        Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   forehead.
21150...........  Reconstruct         Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   midface, lefort.
21181...........  Contour cranial     ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   bone lesion.
21198...........  Reconstr lwr jaw    Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   segment.
21199...........  Reconstr lwr jaw w/ Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   advance.
21206...........  Reconstruct upper   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   jaw bone.
21208...........  Augmentation of     ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   facial bones.
21209...........  Reduction of        ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   facial bones.
21210...........  Face bone graft...  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
21215...........  Lower jaw bone      ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   graft.
21230...........  Rib cartilage       ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   graft.
21235...........  Ear cartilage       ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   graft.
21240...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   jaw joint.
21242...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   jaw joint.
21243...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   jaw joint.
21244...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   lower jaw.
21245...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   jaw.
21246...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   jaw.
21248...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   jaw.
21249...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   jaw.
21260...........  Revise eye sockets  Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
21267...........  Revise eye sockets  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
21270...........  Augmentation,       ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   cheek bone.

[[Page 49861]]

 
21275...........  Revision,           ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   orbitofacial
                   bones.
21280...........  Revision of eyelid  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
21282...........  Revision of eyelid  ...............  ...............  ...............      16.4494      $652.85      $684.92      $130.57      $136.98
21295...........  Revision of jaw     ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   muscle/bone.
21296...........  Revision of jaw     ...............  ...............  ...............      23.1564      $919.03      $626.02      $183.81      $125.20
                   muscle/bone.
21300...........  Treatment of skull  ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   fracture.
21310...........  Treatment of nose   ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   fracture.
21315...........  Treatment of nose   ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   fracture.
21320...........  Treatment of nose   ...............  ...............  ...............       7.7261      $306.63      $376.32       $61.33       $75.26
                   fracture.
21325...........  Treatment of nose   ...............  ...............  ...............      23.1564      $919.03      $774.52      $183.81      $154.90
                   fracture.
21330...........  Treatment of nose   ...............  ...............  ...............      23.1564      $919.03      $818.02      $183.81      $163.60
                   fracture.
21335...........  Treatment of nose   ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   fracture.
21336...........  Treat nasal septal  ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture.
21337...........  Treat nasal septal  ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   fracture.
21338...........  Treat nasoethmoid   ...............  ...............  ...............      23.1564      $919.03      $774.52      $183.81      $154.90
                   fracture.
21339...........  Treat nasoethmoid   ...............  ...............  ...............      23.1564      $919.03      $818.02      $183.81      $163.60
                   fracture.
21340...........  Treatment of nose   ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   fracture.
21345...........  Treat nose/jaw      ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   fracture.
21355...........  Treat cheek bone    ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   fracture.
21356...........  Treat cheek bone    Y..............  ...............  ...............      23.1564      $919.03      $919.03      $183.81      $183.81
                   fracture.
21390...........  Treat eye socket    Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   fracture.
21400...........  Treat eye socket    ...............  ...............  ...............       7.7261      $306.63      $376.32       $61.33       $75.26
                   fracture.
21401...........  Treat eye socket    ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   fracture.
21406...........  Treat eye socket    Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   fracture.
21407...........  Treat eye socket    Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   fracture.
21421...........  Treat mouth roof    ...............  ...............  ...............      23.1564      $919.03      $774.52      $183.81      $154.90
                   fracture.
21440...........  Treat dental ridge  Y..............  Y..............  Y..............       7.6734      $304.54      $304.54       $60.91       $60.91
                   fracture.
21445...........  Treat dental ridge  ...............  ...............  ...............      23.1564      $919.03      $774.52      $183.81      $154.90
                   fracture.
21450...........  Treat lower jaw     ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   fracture.
21451...........  Treat lower jaw     ...............  ...............  ...............       7.7261      $306.63      $391.09       $61.33       $78.22
                   fracture.
21452...........  Treat lower jaw     ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   fracture.
21453...........  Treat lower jaw     ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   fracture.

[[Page 49862]]

 
21454...........  Treat lower jaw     ...............  ...............  ...............      23.1564      $919.03      $818.02      $183.81      $163.60
                   fracture.
21461...........  Treat lower jaw     ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   fracture.
21462...........  Treat lower jaw     ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   fracture.
21465...........  Treat lower jaw     ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   fracture.
21480...........  Reset dislocated    ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   jaw.
21485...........  Reset dislocated    ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   jaw.
21490...........  Repair dislocated   ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   jaw.
21495...........  Treat hyoid bone    Y..............  ...............  ...............      16.4494      $652.85      $652.85      $130.57      $130.57
                   fracture.
21497...........  Interdental wiring  ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
21501...........  Drain neck/chest    ...............  ...............  ...............      17.4686      $693.30      $569.65      $138.66      $113.93
                   lesion.
21502...........  Drain chest lesion  ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
21550...........  Biopsy of neck/     Y..............  ...............  ...............       6.5128      $258.48      $258.48       $51.70       $51.70
                   chest.
21555...........  Remove lesion,      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   neck/chest.
21556...........  Remove lesion,      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   neck/chest.
21557...........  Remove tumor, neck/ Y..............  ...............  ...............      19.9760      $792.81      $792.81      $158.56      $158.56
                   chest.
21600...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   rib.
21610...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   rib.
21685...........  Hyoid myotomy &     Y..............  ...............  ...............       7.7261      $306.63      $306.63       $61.33       $61.33
                   suspension.
21700...........  Revision of neck    ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   muscle.
21720...........  Revision of neck    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   muscle.
21725...........  Revision of neck    ...............  ...............  ...............       1.4821       $58.82       $75.02       $11.76       $15.00
                   muscle.
21800...........  Treatment of rib    ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
21805...........  Treatment of rib    ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
21820...........  Treat sternum       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
21920...........  Biopsy soft tissue  Y..............  Y..............  Y..............       3.3341      $132.32      $132.32       $26.46       $26.46
                   of back.
21925...........  Biopsy soft tissue  ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   of back.
21930...........  Remove lesion,      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   back or flank.
21935...........  Remove tumor, back  ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
22102...........  Remove part,        Y..............  ...............  ...............      43.9030    $1,742.43    $1,742.43      $348.49      $348.49
                   lumbar vertebra.
22103...........  Remove extra spine  Y..............  ...............  ...............      43.9030    $1,742.43    $1,742.43      $348.49      $348.49
                   segment.
22305...........  Treat spine         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   process fracture.
22310...........  Treat spine         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.

[[Page 49863]]

 
22315...........  Treat spine         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
22505...........  Manipulation of     ...............  ...............  ...............      14.5502      $577.47      $511.73      $115.49      $102.35
                   spine.
22520...........  Percut              Y..............  ...............  ...............      25.0600      $994.58      $994.58      $198.92      $198.92
                   vertebroplasty
                   thor.
22521...........  Percut              Y..............  ...............  ...............      25.0600      $994.58      $994.58      $198.92      $198.92
                   vertebroplasty
                   lumb.
22522...........  Percut              Y..............  ...............  ...............      25.0600      $994.58      $994.58      $198.92      $198.92
                   vertebroplasty
                   add'l.
22523...........  Percut              Y..............  ...............  ...............      65.8846    $2,614.83    $2,614.83      $522.97      $522.97
                   kyphoplasty, thor.
22524...........  Percut              Y..............  ...............  ...............      65.8846    $2,614.83    $2,614.83      $522.97      $522.97
                   kyphoplasty,
                   lumbar.
22525...........  Percut              Y..............  ...............  ...............      65.8846    $2,614.83    $2,614.83      $522.97      $522.97
                   kyphoplasty, add-
                   on.
22900...........  Remove abdominal    ...............  ...............  ...............      19.9760      $792.81      $711.40      $158.56      $142.28
                   wall lesion.
23000...........  Removal of calcium  ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   deposits.
23020...........  Release shoulder    ...............  ...............  ...............      41.2543    $1,637.30    $1,041.65      $327.46      $208.33
                   joint.
23030...........  Drain shoulder      ...............  ...............  ...............      17.4686      $693.30      $513.15      $138.66      $102.63
                   lesion.
23031...........  Drain shoulder      ...............  ...............  ...............      17.4686      $693.30      $601.65      $138.66      $120.33
                   bursa.
23035...........  Drain shoulder      ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   bone lesion.
23040...........  Exploratory         ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   shoulder surgery.
23044...........  Exploratory         ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   shoulder surgery.
23065...........  Biopsy shoulder     Y..............  Y..............  Y..............       2.3504       $93.28       $93.28       $18.66       $18.66
                   tissues.
23066...........  Biopsy shoulder     ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   tissues.
23075...........  Removal of          ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   shoulder lesion.
23076...........  Removal of          ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   shoulder lesion.
23077...........  Remove tumor of     ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   shoulder.
23100...........  Biopsy of shoulder  ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   joint.
23101...........  Shoulder joint      ...............  ...............  ...............      25.0600      $994.58      $994.79      $198.92      $198.96
                   surgery.
23105...........  Remove shoulder     ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   joint lining.
23106...........  Incision of         ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   collarbone joint.
23107...........  Explore treat       ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   shoulder joint.
23120...........  Partial removal,    ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   collar bone.
23125...........  Removal of collar   ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   bone.

[[Page 49864]]

 
23130...........  Remove shoulder     ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   bone, part.
23140...........  Removal of bone     ...............  ...............  ...............      20.8214      $826.36      $728.18      $165.27      $145.64
                   lesion.
23145...........  Removal of bone     ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   lesion.
23146...........  Removal of bone     ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   lesion.
23150...........  Removal of humerus  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lesion.
23155...........  Removal of humerus  ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   lesion.
23156...........  Removal of humerus  ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   lesion.
23170...........  Remove collar bone  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   lesion.
23172...........  Remove shoulder     ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   blade lesion.
23174...........  Remove humerus      ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   lesion.
23180...........  Remove collar bone  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lesion.
23182...........  Remove shoulder     ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   blade lesion.
23184...........  Remove humerus      ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lesion.
23190...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   scapula.
23195...........  Removal of head of  ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   humerus.
23330...........  Remove shoulder     ...............  ...............  ...............       6.5128      $258.48      $295.74       $51.70       $59.15
                   foreign body.
23331...........  Remove shoulder     ...............  ...............  ...............      19.9760      $792.81      $562.90      $158.56      $112.58
                   foreign body.
23395...........  Muscle              ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   transfer,shoulder/
                   arm.
23397...........  Muscle transfers..  ...............  ...............  ...............      65.8846    $2,614.83    $1,804.92      $522.97      $360.98
23400...........  Fixation of         ...............  ...............  ...............      25.0600      $994.58      $994.79      $198.92      $198.96
                   shoulder blade.
23405...........  Incision of tendon  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   & muscle.
23406...........  Incise tendon(s) &  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   muscle(s).
23410...........  Repair rotator      ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   cuff, acute.
23412...........  Repair rotator      ...............  ...............  ...............      41.2543    $1,637.30    $1,316.15      $327.46      $263.23
                   cuff, chronic.
23415...........  Release of          ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   shoulder ligament.
23420...........  Repair of shoulder  ...............  ...............  ...............      41.2543    $1,637.30    $1,316.15      $327.46      $263.23
23430...........  Repair biceps       ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   tendon.
23440...........  Remove/transplant   ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   tendon.
23450...........  Repair shoulder     ...............  ...............  ...............      65.8846    $2,614.83    $1,665.92      $522.97      $333.18
                   capsule.
23455...........  Repair shoulder     ...............  ...............  ...............      65.8846    $2,614.83    $1,804.92      $522.97      $360.98
                   capsule.

[[Page 49865]]

 
23460...........  Repair shoulder     ...............  ...............  ...............      65.8846    $2,614.83    $1,665.92      $522.97      $333.18
                   capsule.
23462...........  Repair shoulder     ...............  ...............  ...............      41.2543    $1,637.30    $1,316.15      $327.46      $263.23
                   capsule.
23465...........  Repair shoulder     ...............  ...............  ...............      65.8846    $2,614.83    $1,665.92      $522.97      $333.18
                   capsule.
23466...........  Repair shoulder     ...............  ...............  ...............      41.2543    $1,637.30    $1,316.15      $327.46      $263.23
                   capsule.
23480...........  Revision of collar  ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   bone.
23485...........  Revision of collar  ...............  ...............  ...............      65.8846    $2,614.83    $1,804.92      $522.97      $360.98
                   bone.
23490...........  Reinforce clavicle  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
23491...........  Reinforce shoulder  ...............  ...............  ...............      65.8846    $2,614.83    $1,562.42      $522.97      $312.48
                   bones.
23500...........  Treat clavicle      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
23505...........  Treat clavicle      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
23515...........  Treat clavicle      ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   fracture.
23520...........  Treat clavicle      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
23525...........  Treat clavicle      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
23530...........  Treat clavicle      ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
23532...........  Treat clavicle      ...............  ...............  ...............      25.6702    $1,018.80      $824.40      $203.76      $164.88
                   dislocation.
23540...........  Treat clavicle      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
23545...........  Treat clavicle      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
23550...........  Treat clavicle      ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
23552...........  Treat clavicle      ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   dislocation.
23570...........  Treat shoulder      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   blade fx.
23575...........  Treat shoulder      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   blade fx.
23585...........  Treat scapula       ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   fracture.
23600...........  Treat humerus       Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
23605...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
23615...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.
23616...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.
23620...........  Treat humerus       Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
23625...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
23630...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,478.09      $447.84      $295.62
                   fracture.
23650...........  Treat shoulder      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
23655...........  Treat shoulder      ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   dislocation.
23660...........  Treat shoulder      ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
23665...........  Treat dislocation/  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
23670...........  Treat dislocation/  ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   fracture.

[[Page 49866]]

 
23675...........  Treat dislocation/  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
23680...........  Treat dislocation/  ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
23700...........  Fixation of         ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   shoulder.
23800...........  Fusion of shoulder  ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   joint.
23802...........  Fusion of shoulder  ...............  ...............  ...............      41.2543    $1,637.30    $1,316.15      $327.46      $263.23
                   joint.
23921...........  Amputation follow-  ...............  ...............  ...............       5.0931      $202.14      $257.81       $40.43       $51.56
                   up surgery.
23930...........  Drainage of arm     ...............  ...............  ...............      17.4686      $693.30      $513.15      $138.66      $102.63
                   lesion.
23931...........  Drainage of arm     ...............  ...............  ...............      17.4686      $693.30      $569.65      $138.66      $113.93
                   bursa.
23935...........  Drain arm/elbow     ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   bone lesion.
24000...........  Exploratory elbow   ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   surgery.
24006...........  Release elbow       ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   joint.
24065...........  Biopsy arm/elbow    Y..............  Y..............  Y..............       3.1861      $126.45      $126.45       $25.29       $25.29
                   soft tissue.
24066...........  Biopsy arm/elbow    ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   soft tissue.
24075...........  Remove arm/elbow    ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   lesion.
24076...........  Remove arm/elbow    ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   lesion.
24077...........  Remove tumor of     ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   arm/elbow.
24100...........  Biopsy elbow joint  ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   lining.
24101...........  Explore/treat       ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   elbow joint.
24102...........  Remove elbow joint  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lining.
24105...........  Removal of elbow    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   bursa.
24110...........  Remove humerus      ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   lesion.
24115...........  Remove/graft bone   ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   lesion.
24116...........  Remove/graft bone   ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   lesion.
24120...........  Remove elbow        ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   lesion.
24125...........  Remove/graft bone   ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   lesion.
24126...........  Remove/graft bone   ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   lesion.
24130...........  Removal of head of  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   radius.
24134...........  Removal of arm      ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   bone lesion.
24136...........  Remove radius bone  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   lesion.
24138...........  Remove elbow bone   ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   lesion.
24140...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   arm bone.
24145...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   radius.

[[Page 49867]]

 
24147...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   elbow.
24149...........  Radical resection   Y..............  ...............  ...............      25.0600      $994.58      $994.58      $198.92      $198.92
                   of elbow.
24152...........  Extensive radius    Y..............  ...............  ...............      41.2543    $1,637.30    $1,637.30      $327.46      $327.46
                   surgery.
24153...........  Extensive radius    Y..............  ...............  ...............      65.8846    $2,614.83    $2,614.83      $522.97      $522.97
                   surgery.
24155...........  Removal of elbow    ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   joint.
24160...........  Remove elbow joint  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   implant.
24164...........  Remove radius head  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   implant.
24200...........  Removal of arm      Y..............  Y..............  Y..............       2.6370      $104.66      $104.66       $20.93       $20.93
                   foreign body.
24201...........  Removal of arm      ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   foreign body.
24300...........  Manipulate elbow w/ Y..............  ...............  ...............      14.5502      $577.47      $577.47      $115.49      $115.49
                   anesth.
24301...........  Muscle/tendon       ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   transfer.
24305...........  Arm tendon          ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lengthening.
24310...........  Revision of arm     ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   tendon.
24320...........  Repair of arm       ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   tendon.
24330...........  Revision of arm     ...............  ...............  ...............      65.8846    $2,614.83    $1,562.42      $522.97      $312.48
                   muscles.
24331...........  Revision of arm     ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   muscles.
24332...........  Tenolysis, triceps  Y..............  ...............  ...............      20.8214      $826.36      $826.36      $165.27      $165.27
24340...........  Repair of biceps    ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   tendon.
24341...........  Repair arm tendon/  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   muscle.
24342...........  Repair of ruptured  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   tendon.
24343...........  Repr elbow lat      Y..............  ...............  ...............      25.0600      $994.58      $994.58      $198.92      $198.92
                   ligmnt w/tiss.
24344...........  Reconstruct elbow   Y..............  ...............  ...............      65.8846    $2,614.83    $2,614.83      $522.97      $522.97
                   lat ligmnt.
24345...........  Repr elbw med       ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   ligmnt w/tissu.
24346...........  Reconstruct elbow   Y..............  ...............  ...............      41.2543    $1,637.30    $1,637.30      $327.46      $327.46
                   med ligmnt.
24350...........  Repair of tennis    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   elbow.
24351...........  Repair of tennis    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   elbow.
24352...........  Repair of tennis    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   elbow.
24354...........  Repair of tennis    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   elbow.
24356...........  Revision of tennis  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   elbow.
24360...........  Reconstruct elbow   ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   joint.
24361...........  Reconstruct elbow   ...............  ...............  ...............     105.1666    $4,173.86    $2,445.43      $834.77      $489.09
                   joint.
24362...........  Reconstruct elbow   ...............  ...............  ...............      47.1644    $1,871.86    $1,294.43      $374.37      $258.89
                   joint.

[[Page 49868]]

 
24363...........  Replace elbow       ...............  ...............  ...............     105.1666    $4,173.86    $2,584.43      $834.77      $516.89
                   joint.
24365...........  Reconstruct head    ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   of radius.
24366...........  Reconstruct head    ...............  ...............  ...............     105.1666    $4,173.86    $2,445.43      $834.77      $489.09
                   of radius.
24400...........  Revision of         ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   humerus.
24410...........  Revision of         ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   humerus.
24420...........  Revision of         ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   humerus.
24430...........  Repair of humerus.  ...............  ...............  ...............      65.8846    $2,614.83    $1,562.42      $522.97      $312.48
24435...........  Repair humerus      ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   with graft.
24470...........  Revision of elbow   ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   joint.
24495...........  Decompression of    ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   forearm.
24498...........  Reinforce humerus.  ...............  ...............  ...............      65.8846    $2,614.83    $1,562.42      $522.97      $312.48
24500...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24505...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24515...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.
24516...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.
24530...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24535...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24538...........  Treat humerus       ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
24545...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.
24546...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,478.09      $447.84      $295.62
                   fracture.
24560...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24565...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24566...........  Treat humerus       ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
24575...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   fracture.
24576...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24577...........  Treat humerus       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24579...........  Treat humerus       ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   fracture.
24582...........  Treat humerus       ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
24586...........  Treat elbow         ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.
24587...........  Treat elbow         ...............  ...............  ...............      56.4195    $2,239.18    $1,478.09      $447.84      $295.62
                   fracture.
24600...........  Treat elbow         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
24605...........  Treat elbow         ...............  ...............  ...............      14.5502      $577.47      $511.73      $115.49      $102.35
                   dislocation.
24615...........  Treat elbow         ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   dislocation.

[[Page 49869]]

 
24620...........  Treat elbow         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24635...........  Treat elbow         ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   fracture.
24640...........  Treat elbow         Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
24650...........  Treat radius        Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
24655...........  Treat radius        ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24665...........  Treat radius        ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture.
24666...........  Treat radius        ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.
24670...........  Treat ulnar         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24675...........  Treat ulnar         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
24685...........  Treat ulnar         ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
24800...........  Fusion of elbow     ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   joint.
24802...........  Fusion/graft of     ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   elbow joint.
24925...........  Amputation follow-  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   up surgery.
25000...........  Incision of tendon  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   sheath.
25001...........  Incise flexor       Y..............  ...............  ...............      20.8214      $826.36      $826.36      $165.27      $165.27
                   carpi radialis.
25020...........  Decompress forearm  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   1 space.
25023...........  Decompress forearm  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   1 space.
25024...........  Decompress forearm  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   2 spaces.
25025...........  Decompress forearm  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   2 spaces.
25028...........  Drainage of         ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   forearm lesion.
25031...........  Drainage of         ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   forearm bursa.
25035...........  Treat forearm bone  ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   lesion.
25040...........  Explore/treat       ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   wrist joint.
25065...........  Biopsy forearm      Y..............  Y..............  Y..............       3.2509      $129.02      $129.02       $25.80       $25.80
                   soft tissues.
25066...........  Biopsy forearm      ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   soft tissues.
25075...........  Removal forearm     ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   lesion subcu.
25076...........  Removal forearm     ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   lesion deep.
25077...........  Remove tumor,       ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   forearm/wrist.
25085...........  Incision of wrist   ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   capsule.
25100...........  Biopsy of wrist     ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   joint.

[[Page 49870]]

 
25101...........  Explore/treat       ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   wrist joint.
25105...........  Remove wrist joint  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lining.
25107...........  Remove wrist joint  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   cartilage.
25110...........  Remove wrist        ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   tendon lesion.
25111...........  Remove wrist        ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendon lesion.
25112...........  Reremove wrist      ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   tendon lesion.
25115...........  Remove wrist/       ...............  ...............  ...............      20.8214      $826.36      $728.18      $165.27      $145.64
                   forearm lesion.
25116...........  Remove wrist/       ...............  ...............  ...............      20.8214      $826.36      $728.18      $165.27      $145.64
                   forearm lesion.
25118...........  Excise wrist        ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   tendon sheath.
25119...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   ulna.
25120...........  Removal of forearm  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   lesion.
25125...........  Remove/graft        ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   forearm lesion.
25126...........  Remove/graft        ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   forearm lesion.
25130...........  Removal of wrist    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   lesion.
25135...........  Remove & graft      ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   wrist lesion.
25136...........  Remove & graft      ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   wrist lesion.
25145...........  Remove forearm      ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   bone lesion.
25150...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   ulna.
25151...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   radius.
25210...........  Removal of wrist    ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   bone.
25215...........  Removal of wrist    ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   bones.
25230...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   radius.
25240...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   ulna.
25248...........  Remove forearm      ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   foreign body.
25250...........  Removal of wrist    ...............  ...............  ...............      25.0600      $994.58      $663.79      $198.92      $132.76
                   prosthesis.
25251...........  Removal of wrist    ...............  ...............  ...............      25.0600      $994.58      $663.79      $198.92      $132.76
                   prosthesis.
25259...........  Manipulate wrist w/ Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   anesthes.
25260...........  Repair forearm      ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   tendon/muscle.
25263...........  Repair forearm      ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   tendon/muscle.
25265...........  Repair forearm      ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   tendon/muscle.

[[Page 49871]]

 
25270...........  Repair forearm      ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   tendon/muscle.
25272...........  Repair forearm      ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   tendon/muscle.
25274...........  Repair forearm      ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   tendon/muscle.
25275...........  Repair forearm      ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   tendon sheath.
25280...........  Revise wrist/       ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   forearm tendon.
25290...........  Incise wrist/       ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   forearm tendon.
25295...........  Release wrist/      ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   forearm tendon.
25300...........  Fusion of tendons   ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   at wrist.
25301...........  Fusion of tendons   ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   at wrist.
25310...........  Transplant forearm  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   tendon.
25312...........  Transplant forearm  ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   tendon.
25315...........  Revise palsy hand   ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   tendon(s).
25316...........  Revise palsy hand   ...............  ...............  ...............      65.8846    $2,614.83    $1,562.42      $522.97      $312.48
                   tendon(s).
25320...........  Repair/revise       ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   wrist joint.
25332...........  Revise wrist joint  ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
25335...........  Realignment of      ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   hand.
25337...........  Reconstruct ulna/   ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   radioulnar.
25350...........  Revision of radius  ...............  ...............  ...............      65.8846    $2,614.83    $1,562.42      $522.97      $312.48
25355...........  Revision of radius  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
25360...........  Revision of ulna..  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
25365...........  Revise radius &     ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   ulna.
25370...........  Revise radius or    ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   ulna.
25375...........  Revise radius &     ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   ulna.
25390...........  Shorten radius or   ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   ulna.
25391...........  Lengthen radius or  ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   ulna.
25392...........  Shorten radius &    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   ulna.
25393...........  Lengthen radius &   ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   ulna.
25394...........  Repair carpal       Y..............  ...............  ...............      16.0343      $636.37      $636.37      $127.27      $127.27
                   bone, shorten.
25400...........  Repair radius or    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   ulna.
25405...........  Repair/graft        ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   radius or ulna.

[[Page 49872]]

 
25415...........  Repair radius &     ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   ulna.
25420...........  Repair/graft        ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   radius & ulna.
25425...........  Repair/graft        ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   radius or ulna.
25426...........  Repair/graft        ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   radius & ulna.
25430...........  Vasc graft into     Y..............  ...............  ...............      25.8425    $1,025.64    $1,025.64      $205.13      $205.13
                   carpal bone.
25431...........  Repair nonunion     Y..............  ...............  ...............      25.8425    $1,025.64    $1,025.64      $205.13      $205.13
                   carpal bone.
25440...........  Repair/graft wrist  ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   bone.
25441...........  Reconstruct wrist   ...............  ...............  ...............     105.1666    $4,173.86    $2,445.43      $834.77      $489.09
                   joint.
25442...........  Reconstruct wrist   ...............  ...............  ...............     105.1666    $4,173.86    $2,445.43      $834.77      $489.09
                   joint.
25443...........  Reconstruct wrist   ...............  ...............  ...............      47.1644    $1,871.86    $1,294.43      $374.37      $258.89
                   joint.
25444...........  Reconstruct wrist   ...............  ...............  ...............      47.1644    $1,871.86    $1,294.43      $374.37      $258.89
                   joint.
25445...........  Reconstruct wrist   ...............  ...............  ...............      47.1644    $1,871.86    $1,294.43      $374.37      $258.89
                   joint.
25446...........  Wrist replacement.  ...............  ...............  ...............     105.1666    $4,173.86    $2,584.43      $834.77      $516.89
25447...........  Repair wrist        ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   joint(s).
25449...........  Remove wrist joint  ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   implant.
25450...........  Revision of wrist   ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   joint.
25455...........  Revision of wrist   ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   joint.
25490...........  Reinforce radius..  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
25491...........  Reinforce ulna....  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
25492...........  Reinforce radius    ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   and ulna.
25500...........  Treat fracture of   Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   radius.
25505...........  Treat fracture of   ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   radius.
25515...........  Treat fracture of   ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   radius.
25520...........  Treat fracture of   ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   radius.
25525...........  Treat fracture of   ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   radius.
25526...........  Treat fracture of   ...............  ...............  ...............      37.5680    $1,491.00    $1,104.00      $298.20      $220.80
                   radius.
25530...........  Treat fracture of   Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   ulna.
25535...........  Treat fracture of   ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   ulna.
25545...........  Treat fracture of   ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   ulna.
25560...........  Treat fracture      Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   radius & ulna.
25565...........  Treat fracture      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   radius & ulna.
25574...........  Treat fracture      ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   radius & ulna.
25575...........  Treat fracture      ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   radius/ulna.
25600...........  Treat fracture      Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   radius/ulna.
25605...........  Treat fracture      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   radius/ulna.

[[Page 49873]]

 
25611...........  Treat fracture      ...............  ...............  ...............      25.6702    $1,018.80      $764.40      $203.76      $152.88
                   radius/ulna.
25620...........  Treat fracture      ...............  ...............  ...............      56.4195    $2,239.18    $1,478.09      $447.84      $295.62
                   radius/ulna.
25622...........  Treat wrist bone    Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
25624...........  Treat wrist bone    ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
25628...........  Treat wrist bone    ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
25630...........  Treat wrist bone    Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
25635...........  Treat wrist bone    ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
25645...........  Treat wrist bone    ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
25650...........  Treat wrist bone    Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
25651...........  Pin ulnar styloid   Y..............  ...............  ...............      25.6702    $1,018.80    $1,018.80      $203.76      $203.76
                   fracture.
25652...........  Treat fracture      Y..............  ...............  ...............      37.5680    $1,491.00    $1,491.00      $298.20      $298.20
                   ulnar styloid.
25660...........  Treat wrist         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
25670...........  Treat wrist         ...............  ...............  ...............      25.6702    $1,018.80      $764.40      $203.76      $152.88
                   dislocation.
25671...........  Pin radioulnar      ...............  ...............  ...............      25.6702    $1,018.80      $675.90      $203.76      $135.18
                   dislocation.
25675...........  Treat wrist         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
25676...........  Treat wrist         ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   dislocation.
25680...........  Treat wrist         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
25685...........  Treat wrist         ...............  ...............  ...............      25.6702    $1,018.80      $764.40      $203.76      $152.88
                   fracture.
25690...........  Treat wrist         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
25695...........  Treat wrist         ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   dislocation.
25800...........  Fusion of wrist     ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   joint.
25805...........  Fusion/graft of     ...............  ...............  ...............      41.2543    $1,637.30    $1,177.15      $327.46      $235.43
                   wrist joint.
25810...........  Fusion/graft of     ...............  ...............  ...............      65.8846    $2,614.83    $1,665.92      $522.97      $333.18
                   wrist joint.
25820...........  Fusion of hand      ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   bones.
25825...........  Fuse hand bones     ...............  ...............  ...............      25.8425    $1,025.64      $871.32      $205.13      $174.26
                   with graft.
25830...........  Fusion, radioulnar  ...............  ...............  ...............      65.8846    $2,614.83    $1,665.92      $522.97      $333.18
                   jnt/ulna.
25907...........  Amputation follow-  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   up surgery.
25922...........  Amputate hand at    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   wrist.
25929...........  Amputation follow-  ...............  ...............  ...............      13.3433      $529.57      $519.79      $105.91      $103.96
                   up surgery.
26010...........  Drainage of finger  Y..............  Y..............  ...............       1.4821       $58.82       $58.82       $11.76       $11.76
                   abscess.
26011...........  Drainage of finger  ...............  ...............  ...............      10.9184      $433.33      $383.17       $86.67       $76.63
                   abscess.
26020...........  Drain hand tendon   ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   sheath.

[[Page 49874]]

 
26025...........  Drainage of palm    ...............  ...............  ...............      16.0343      $636.37      $484.69      $127.27       $96.94
                   bursa.
26030...........  Drainage of palm    ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   bursa(s).
26034...........  Treat hand bone     ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   lesion.
26035...........  Decompress fingers/ Y..............  ...............  ...............      16.0343      $636.37      $636.37      $127.27      $127.27
                   hand.
26040...........  Release palm        ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   contracture.
26045...........  Release palm        ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   contracture.
26055...........  Incise finger       ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   tendon sheath.
26060...........  Incision of finger  ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   tendon.
26070...........  Explore/treat hand  ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   joint.
26075...........  Explore/treat       ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   finger joint.
26080...........  Explore/treat       ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   finger joint.
26100...........  Biopsy hand joint   ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   lining.
26105...........  Biopsy finger       ...............  ...............  ...............      16.0343      $636.37      $484.69      $127.27       $96.94
                   joint lining.
26110...........  Biopsy finger       ...............  ...............  ...............      16.0343      $636.37      $484.69      $127.27       $96.94
                   joint lining.
26115...........  Removal hand        ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   lesion subcut.
26116...........  Removal hand        ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   lesion, deep.
26117...........  Remove tumor, hand/ ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   finger.
26121...........  Release palm        ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   contracture.
26123...........  Release palm        ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   contracture.
26125...........  Release palm        ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   contracture.
26130...........  Remove wrist joint  ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   lining.
26135...........  Revise finger       ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   joint, each.
26140...........  Revise finger       ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   joint, each.
26145...........  Tendon excision,    ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   palm/finger.
26160...........  Remove tendon       ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   sheath lesion.
26170...........  Removal of palm     ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendon, each.
26180...........  Removal of finger   ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendon.
26185...........  Remove finger bone  ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
26200...........  Remove hand bone    ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   lesion.
26205...........  Remove/graft bone   ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   lesion.
26210...........  Removal of finger   ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   lesion.
26215...........  Remove/graft        ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   finger lesion.
26230...........  Partial removal of  ...............  ...............  ...............      16.0343      $636.37      $811.65      $127.27      $162.33
                   hand bone.

[[Page 49875]]

 
26235...........  Partial removal,    ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   finger bone.
26236...........  Partial removal,    ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   finger bone.
26250...........  Extensive hand      ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   surgery.
26255...........  Extensive hand      ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   surgery.
26260...........  Extensive finger    ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   surgery.
26261...........  Extensive finger    ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   surgery.
26262...........  Partial removal of  ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   finger.
26320...........  Removal of implant  ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   from hand.
26340...........  Manipulate finger   Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   w/anesth.
26350...........  Repair finger/hand  ...............  ...............  ...............      25.8425    $1,025.64      $679.32      $205.13      $135.86
                   tendon.
26352...........  Repair/graft hand   ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   tendon.
26356...........  Repair finger/hand  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   tendon.
26357...........  Repair finger/hand  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   tendon.
26358...........  Repair/graft hand   ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   tendon.
26370...........  Repair finger/hand  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   tendon.
26372...........  Repair/graft hand   ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   tendon.
26373...........  Repair finger/hand  ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   tendon.
26390...........  Revise hand/finger  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   tendon.
26392...........  Repair/graft hand   ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   tendon.
26410...........  Repair hand tendon  ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
26412...........  Repair/graft hand   ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   tendon.
26415...........  Excision, hand/     ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   finger tendon.
26416...........  Graft hand or       ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   finger tendon.
26418...........  Repair finger       ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   tendon.
26420...........  Repair/graft        ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   finger tendon.
26426...........  Repair finger/hand  ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   tendon.
26428...........  Repair/graft        ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   finger tendon.
26432...........  Repair finger       ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendon.
26433...........  Repair finger       ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendon.
26434...........  Repair/graft        ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   finger tendon.
26437...........  Realignment of      ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendons.
26440...........  Release palm/       ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   finger tendon.
26442...........  Release palm &      ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   finger tendon.

[[Page 49876]]

 
26445...........  Release hand/       ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   finger tendon.
26449...........  Release forearm/    ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   hand tendon.
26450...........  Incision of palm    ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendon.
26455...........  Incision of finger  ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendon.
26460...........  Incise hand/finger  ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   tendon.
26471...........  Fusion of finger    ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   tendons.
26474...........  Fusion of finger    ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   tendons.
26476...........  Tendon lengthening  ...............  ...............  ...............      16.0343      $636.37      $484.69      $127.27       $96.94
26477...........  Tendon shortening.  ...............  ...............  ...............      16.0343      $636.37      $484.69      $127.27       $96.94
26478...........  Lengthening of      ...............  ...............  ...............      16.0343      $636.37      $484.69      $127.27       $96.94
                   hand tendon.
26479...........  Shortening of hand  ...............  ...............  ...............      16.0343      $636.37      $484.69      $127.27       $96.94
                   tendon.
26480...........  Transplant hand     ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   tendon.
26483...........  Transplant/graft    ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   hand tendon.
26485...........  Transplant palm     ...............  ...............  ...............      25.8425    $1,025.64      $735.82      $205.13      $147.16
                   tendon.
26489...........  Transplant/graft    ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   palm tendon.
26490...........  Revise thumb        ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   tendon.
26492...........  Tendon transfer     ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   with graft.
26494...........  Hand tendon/muscle  ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   transfer.
26496...........  Revise thumb        ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   tendon.
26497...........  Finger tendon       ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   transfer.
26498...........  Finger tendon       ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   transfer.
26499...........  Revision of finger  ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
26500...........  Hand tendon         ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   reconstruction.
26502...........  Hand tendon         ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   reconstruction.
26504...........  Hand tendon         ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   reconstruction.
26508...........  Release thumb       ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   contracture.
26510...........  Thumb tendon        ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   transfer.
26516...........  Fusion of knuckle   ...............  ...............  ...............      25.8425    $1,025.64      $679.32      $205.13      $135.86
                   joint.
26517...........  Fusion of knuckle   ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   joints.
26518...........  Fusion of knuckle   ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   joints.
26520...........  Release knuckle     ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   contracture.
26525...........  Release finger      ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   contracture.
26530...........  Revise knuckle      ...............  ...............  ...............      32.7543    $1,299.96      $904.98      $259.99      $181.00
                   joint.

[[Page 49877]]

 
26531...........  Revise knuckle      ...............  ...............  ...............      47.1644    $1,871.86    $1,433.43      $374.37      $286.69
                   with implant.
26535...........  Revise finger       ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   joint.
26536...........  Revise/implant      ...............  ...............  ...............      47.1644    $1,871.86    $1,294.43      $374.37      $258.89
                   finger joint.
26540...........  Repair hand joint.  ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
26541...........  Repair hand joint   ...............  ...............  ...............      25.8425    $1,025.64    $1,010.32      $205.13      $202.06
                   with graft.
26542...........  Repair hand joint   ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   with graft.
26545...........  Reconstruct finger  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   joint.
26546...........  Repair nonunion     ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   hand.
26548...........  Reconstruct finger  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   joint.
26550...........  Construct thumb     ...............  ...............  ...............      25.8425    $1,025.64      $735.82      $205.13      $147.16
                   replacement.
26555...........  Positional change   ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   of finger.
26560...........  Repair of web       ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   finger.
26561...........  Repair of web       ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   finger.
26562...........  Repair of web       ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   finger.
26565...........  Correct metacarpal  ...............  ...............  ...............      25.8425    $1,025.64      $871.32      $205.13      $174.26
                   flaw.
26567...........  Correct finger      ...............  ...............  ...............      25.8425    $1,025.64      $871.32      $205.13      $174.26
                   deformity.
26568...........  Lengthen            ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   metacarpal/finger.
26580...........  Repair hand         ...............  ...............  ...............      16.0343      $636.37      $676.69      $127.27      $135.34
                   deformity.
26587...........  Reconstruct extra   ...............  ...............  ...............      16.0343      $636.37      $676.69      $127.27      $135.34
                   finger.
26590...........  Repair finger       ...............  ...............  ...............      16.0343      $636.37      $676.69      $127.27      $135.34
                   deformity.
26591...........  Repair muscles of   ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   hand.
26593...........  Release muscles of  ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   hand.
26596...........  Excision            ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   constricting
                   tissue.
26600...........  Treat metacarpal    Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
26605...........  Treat metacarpal    ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
26607...........  Treat metacarpal    ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
26608...........  Treat metacarpal    ...............  ...............  ...............      25.6702    $1,018.80      $824.40      $203.76      $164.88
                   fracture.
26615...........  Treat metacarpal    ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture.
26641...........  Treat thumb         Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
26645...........  Treat thumb         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
26650...........  Treat thumb         ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.

[[Page 49878]]

 
26665...........  Treat thumb         ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture.
26670...........  Treat hand          Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
26675...........  Treat hand          ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
26676...........  Pin hand            ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   dislocation.
26685...........  Treat hand          ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
26686...........  Treat hand          ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   dislocation.
26700...........  Treat knuckle       Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
26705...........  Treat knuckle       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
26706...........  Pin knuckle         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
26715...........  Treat knuckle       ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   dislocation.
26720...........  Treat finger        Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture, each.
26725...........  Treat finger        Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture, each.
26727...........  Treat finger        ...............  ...............  ...............      25.6702    $1,018.80    $1,006.90      $203.76      $201.38
                   fracture, each.
26735...........  Treat finger        ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture, each.
26740...........  Treat finger        Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture, each.
26742...........  Treat finger        ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture, each.
26746...........  Treat finger        ...............  ...............  ...............      37.5680    $1,491.00    $1,104.00      $298.20      $220.80
                   fracture, each.
26750...........  Treat finger        Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture, each.
26755...........  Treat finger        Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture, each.
26756...........  Pin finger          ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture, each.
26765...........  Treat finger        ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture, each.
26770...........  Treat finger        Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
26775...........  Treat finger        Y..............  ...............  ...............      14.5502      $577.47      $577.47      $115.49      $115.49
                   dislocation.
26776...........  Pin finger          ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   dislocation.
26785...........  Treat finger        ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   dislocation.
26820...........  Thumb fusion with   ...............  ...............  ...............      25.8425    $1,025.64      $871.32      $205.13      $174.26
                   graft.
26841...........  Fusion of thumb...  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
26842...........  Thumb fusion with   ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   graft.
26843...........  Fusion of hand      ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   joint.
26844...........  Fusion/graft of     ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   hand joint.
26850...........  Fusion of knuckle.  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
26852...........  Fusion of knuckle   ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   with graft.
26860...........  Fusion of finger    ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   joint.
26861...........  Fusion of finger    ...............  ...............  ...............      25.8425    $1,025.64      $735.82      $205.13      $147.16
                   jnt, add-on.

[[Page 49879]]

 
26862...........  Fusion/graft of     ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   finger joint.
26863...........  Fuse/graft added    ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   joint.
26910...........  Amputate            ...............  ...............  ...............      25.8425    $1,025.64      $767.82      $205.13      $153.56
                   metacarpal bone.
26951...........  Amputation of       ...............  ...............  ...............      16.0343      $636.37      $541.19      $127.27      $108.24
                   finger/thumb.
26952...........  Amputation of       ...............  ...............  ...............      16.0343      $636.37      $633.19      $127.27      $126.64
                   finger/thumb.
26990...........  Drainage of pelvis  ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   lesion.
26991...........  Drainage of pelvis  ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   bursa.
27000...........  Incision of hip     ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   tendon.
27001...........  Incision of hip     ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   tendon.
27003...........  Incision of hip     ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   tendon.
27033...........  Exploration of hip  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   joint.
27035...........  Denervation of hip  ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   joint.
27040...........  Biopsy of soft      ...............  ...............  ...............       6.5128      $258.48      $295.74       $51.70       $59.15
                   tissues.
27041...........  Biopsy of soft      ...............  ...............  ...............       6.5128      $258.48      $329.68       $51.70       $65.94
                   tissues.
27047...........  Remove hip/pelvis   ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   lesion.
27048...........  Remove hip/pelvis   ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   lesion.
27049...........  Remove tumor, hip/  ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   pelvis.
27050...........  Biopsy of           ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   sacroiliac joint.
27052...........  Biopsy of hip       ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   joint.
27060...........  Removal of ischial  ...............  ...............  ...............      20.8214      $826.36      $771.68      $165.27      $154.34
                   bursa.
27062...........  Remove femur        ...............  ...............  ...............      20.8214      $826.36      $771.68      $165.27      $154.34
                   lesion/bursa.
27065...........  Removal of hip      ...............  ...............  ...............      20.8214      $826.36      $771.68      $165.27      $154.34
                   bone lesion.
27066...........  Removal of hip      ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   bone lesion.
27067...........  Remove/graft hip    ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   bone lesion.
27080...........  Removal of tail     ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   bone.
27086...........  Remove hip foreign  ...............  ...............  ...............       6.5128      $258.48      $295.74       $51.70       $59.15
                   body.
27087...........  Remove hip foreign  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   body.
27097...........  Revision of hip     ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   tendon.
27098...........  Transfer tendon to  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   pelvis.
27100...........  Transfer of         ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   abdominal muscle.
27105...........  Transfer of spinal  ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   muscle.
27110...........  Transfer of         ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   iliopsoas muscle.

[[Page 49880]]

 
27111...........  Transfer of         ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   iliopsoas muscle.
27193...........  Treat pelvic ring   ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27194...........  Treat pelvic ring   ...............  ...............  ...............      14.5502      $577.47      $511.73      $115.49      $102.35
                   fracture.
27200...........  Treat tail bone     Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
27202...........  Treat tail bone     ...............  ...............  ...............      37.5680    $1,491.00      $968.50      $298.20      $193.70
                   fracture.
27230...........  Treat thigh         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27238...........  Treat thigh         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27246...........  Treat thigh         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27250...........  Treat hip           ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
27252...........  Treat hip           ...............  ...............  ...............      14.5502      $577.47      $511.73      $115.49      $102.35
                   dislocation.
27256...........  Treat hip           Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
27257...........  Treat hip           ...............  ...............  ...............      14.5502      $577.47      $543.73      $115.49      $108.75
                   dislocation.
27265...........  Treat hip           ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
27266...........  Treat hip           ...............  ...............  ...............      14.5502      $577.47      $511.73      $115.49      $102.35
                   dislocation.
27275...........  Manipulation of     ...............  ...............  ...............      14.5502      $577.47      $511.73      $115.49      $102.35
                   hip joint.
27301...........  Drain thigh/knee    ...............  ...............  ...............      17.4686      $693.30      $601.65      $138.66      $120.33
                   lesion.
27305...........  Incise thigh        ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   tendon & fascia.
27306...........  Incision of thigh   ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   tendon.
27307...........  Incision of thigh   ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   tendons.
27310...........  Exploration of      ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   knee joint.
27315...........  Partial removal,    ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   thigh nerve.
27320...........  Partial removal,    ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   thigh nerve.
27323...........  Biopsy, thigh soft  ...............  ...............  ...............       6.5128      $258.48      $295.74       $51.70       $59.15
                   tissues.
27324...........  Biopsy, thigh soft  ...............  ...............  ...............      19.9760      $792.81      $562.90      $158.56      $112.58
                   tissues.
27327...........  Removal of thigh    ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   lesion.
27328...........  Removal of thigh    ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   lesion.
27329...........  Remove tumor,       ...............  ...............  ...............      19.9760      $792.81      $711.40      $158.56      $142.28
                   thigh/knee.
27330...........  Biopsy, knee joint  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lining.
27331...........  Explore/treat knee  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   joint.
27332...........  Removal of knee     ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   cartilage.
27333...........  Removal of knee     ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   cartilage.
27334...........  Remove knee joint   ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lining.
27335...........  Remove knee joint   ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lining.

[[Page 49881]]

 
27340...........  Removal of kneecap  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   bursa.
27345...........  Removal of knee     ...............  ...............  ...............      20.8214      $826.36      $728.18      $165.27      $145.64
                   cyst.
27347...........  Remove knee cyst..  ...............  ...............  ...............      20.8214      $826.36      $728.18      $165.27      $145.64
27350...........  Removal of kneecap  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
27355...........  Remove femur        ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   lesion.
27356...........  Remove femur        ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lesion/graft.
27357...........  Remove femur        ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   lesion/graft.
27358...........  Remove femur        ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   lesion/fixation.
27360...........  Partial removal,    ...............  ...............  ...............      25.0600      $994.58      $855.79      $198.92      $171.16
                   leg bone(s).
27372...........  Removal of foreign  ...............  ...............  ...............      19.9760      $792.81      $893.90      $158.56      $178.78
                   body.
27380...........  Repair of kneecap   ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   tendon.
27381...........  Repair/graft        ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   kneecap tendon.
27385...........  Repair of thigh     ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   muscle.
27386...........  Repair/graft of     ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   thigh muscle.
27390...........  Incision of thigh   ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   tendon.
27391...........  Incision of thigh   ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   tendons.
27392...........  Incision of thigh   ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   tendons.
27393...........  Lengthening of      ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   thigh tendon.
27394...........  Lengthening of      ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   thigh tendons.
27395...........  Lengthening of      ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   thigh tendons.
27396...........  Transplant of       ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   thigh tendon.
27397...........  Transplants of      ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   thigh tendons.
27400...........  Revise thigh        ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   muscles/tendons.
27403...........  Repair of knee      ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   cartilage.
27405...........  Repair of knee      ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   ligament.
27407...........  Repair of knee      ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   ligament.
27409...........  Repair of knee      ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   ligaments.
27418...........  Repair degenerated  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   kneecap.
27420...........  Revision of         ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   unstable kneecap.
27422...........  Revision of         ...............  ...............  ...............      41.2543    $1,637.30    $1,316.15      $327.46      $263.23
                   unstable kneecap.

[[Page 49882]]

 
27424...........  Revision/removal    ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   of kneecap.
27425...........  Lat retinacular     ...............  ...............  ...............      25.0600      $994.58      $994.79      $198.92      $198.96
                   release open.
27427...........  Reconstruction,     ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   knee.
27428...........  Reconstruction,     ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   knee.
27429...........  Reconstruction,     ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   knee.
27430...........  Revision of thigh   ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   muscles.
27435...........  Incision of knee    ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   joint.
27437...........  Revise kneecap....  ...............  ...............  ...............      32.7543    $1,299.96      $964.98      $259.99      $193.00
27438...........  Revise kneecap      ...............  ...............  ...............      47.1644    $1,871.86    $1,294.43      $374.37      $258.89
                   with implant.
27441...........  Revision of knee    ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   joint.
27442...........  Revision of knee    ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   joint.
27443...........  Revision of knee    ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   joint.
27496...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $771.68      $165.27      $154.34
                   thigh/knee.
27497...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   thigh/knee.
27498...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   thigh/knee.
27499...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   thigh/knee.
27500...........  Treatment of thigh  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27501...........  Treatment of thigh  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27502...........  Treatment of thigh  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27503...........  Treatment of thigh  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27508...........  Treatment of thigh  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27509...........  Treatment of thigh  ...............  ...............  ...............      25.6702    $1,018.80      $764.40      $203.76      $152.88
                   fracture.
27510...........  Treatment of thigh  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27516...........  Treat thigh fx      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   growth plate.
27517...........  Treat thigh fx      ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   growth plate.
27520...........  Treat kneecap       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27530...........  Treat knee          ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27532...........  Treat knee          ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27538...........  Treat knee          ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture(s).
27550...........  Treat knee          ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
27552...........  Treat knee          ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   dislocation.
27560...........  Treat kneecap       ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
27562...........  Treat kneecap       ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   dislocation.
27566...........  Treat kneecap       ...............  ...............  ...............      37.5680    $1,491.00      $968.50      $298.20      $193.70
                   dislocation.

[[Page 49883]]

 
27570...........  Fixation of knee    ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   joint.
27594...........  Amputation follow-  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   up surgery.
27600...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   lower leg.
27601...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   lower leg.
27602...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   lower leg.
27603...........  Drain lower leg     ...............  ...............  ...............      17.4686      $693.30      $569.65      $138.66      $113.93
                   lesion.
27604...........  Drain lower leg     ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   bursa.
27605...........  Incision of         ...............  ...............  ...............      20.2255      $802.71      $567.86      $160.54      $113.57
                   achilles tendon.
27606...........  Incision of         ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   achilles tendon.
27607...........  Treat lower leg     ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   bone lesion.
27610...........  Explore/treat       ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   ankle joint.
27612...........  Exploration of      ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   ankle joint.
27613...........  Biopsy lower leg    Y..............  Y..............  Y..............       3.0423      $120.74      $120.74       $24.15       $24.15
                   soft tissue.
27614...........  Biopsy lower leg    ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   soft tissue.
27615...........  Remove tumor,       ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   lower leg.
27618...........  Remove lower leg    ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   lesion.
27619...........  Remove lower leg    ...............  ...............  ...............      19.9760      $792.81      $651.40      $158.56      $130.28
                   lesion.
27620...........  Explore/treat       ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   ankle joint.
27625...........  Remove ankle joint  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lining.
27626...........  Remove ankle joint  ...............  ...............  ...............      25.0600      $994.58      $812.29      $198.92      $162.46
                   lining.
27630...........  Removal of tendon   ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   lesion.
27635...........  Remove lower leg    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   bone lesion.
27637...........  Remove/graft leg    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   bone lesion.
27638...........  Remove/graft leg    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   bone lesion.
27640...........  Partial removal of  ...............  ...............  ...............      41.2543    $1,637.30    $1,041.65      $327.46      $208.33
                   tibia.
27641...........  Partial removal of  ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   fibula.
27647...........  Extensive ankle/    ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   heel surgery.
27650...........  Repair achilles     ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   tendon.
27652...........  Repair/graft        ...............  ...............  ...............      65.8846    $2,614.83    $1,562.42      $522.97      $312.48
                   achilles tendon.
27654...........  Repair of achilles  ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   tendon.
27656...........  Repair leg fascia   ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   defect.

[[Page 49884]]

 
27658...........  Repair of leg       ...............  ...............  ...............      20.8214      $826.36      $579.68      $165.27      $115.94
                   tendon, each.
27659...........  Repair of leg       ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   tendon, each.
27664...........  Repair of leg       ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   tendon, each.
27665...........  Repair of leg       ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   tendon, each.
27675...........  Repair lower leg    ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   tendons.
27676...........  Repair lower leg    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   tendons.
27680...........  Release of lower    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   leg tendon.
27681...........  Release of lower    ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   leg tendons.
27685...........  Revision of lower   ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   leg tendon.
27686...........  Revise lower leg    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   tendons.
27687...........  Revision of calf    ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   tendon.
27690...........  Revise lower leg    ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   tendon.
27691...........  Revise lower leg    ...............  ...............  ...............      41.2543    $1,637.30    $1,133.65      $327.46      $226.73
                   tendon.
27692...........  Revise additional   ...............  ...............  ...............      41.2543    $1,637.30    $1,073.65      $327.46      $214.73
                   leg tendon.
27695...........  Repair of ankle     ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   ligament.
27696...........  Repair of ankle     ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   ligaments.
27698...........  Repair of ankle     ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   ligament.
27700...........  Revision of ankle   ...............  ...............  ...............      32.7543    $1,299.96    $1,008.48      $259.99      $201.70
                   joint.
27704...........  Removal of ankle    ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
                   implant.
27705...........  Incision of tibia.  ...............  ...............  ...............      41.2543    $1,637.30    $1,041.65      $327.46      $208.33
27707...........  Incision of fibula  ...............  ...............  ...............      20.8214      $826.36      $636.18      $165.27      $127.24
27709...........  Incision of tibia   ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   & fibula.
27730...........  Repair of tibia     ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   epiphysis.
27732...........  Repair of fibula    ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   epiphysis.
27734...........  Repair lower leg    ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   epiphyses.
27740...........  Repair of leg       ...............  ...............  ...............      25.0600      $994.58      $720.29      $198.92      $144.06
                   epiphyses.
27742...........  Repair of leg       ...............  ...............  ...............      41.2543    $1,637.30    $1,041.65      $327.46      $208.33
                   epiphyses.
27745...........  Reinforce tibia...  ...............  ...............  ...............      65.8846    $2,614.83    $1,562.42      $522.97      $312.48
27750...........  Treatment of tibia  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27752...........  Treatment of tibia  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27756...........  Treatment of tibia  ...............  ...............  ...............      25.6702    $1,018.80      $764.40      $203.76      $152.88
                   fracture.
27758...........  Treatment of tibia  ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture.
27759...........  Treatment of tibia  ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.

[[Page 49885]]

 
27760...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27762...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27766...........  Treatment of ankle  ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
27780...........  Treatment of        ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fibula fracture.
27781...........  Treatment of        ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fibula fracture.
27784...........  Treatment of        ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fibula fracture.
27786...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27788...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27792...........  Treatment of ankle  ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
27808...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27810...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27814...........  Treatment of ankle  ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
27816...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27818...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27822...........  Treatment of ankle  ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
27823...........  Treatment of ankle  ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   fracture.
27824...........  Treat lower leg     ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27825...........  Treat lower leg     ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
27826...........  Treat lower leg     ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
27827...........  Treat lower leg     ...............  ...............  ...............      56.4195    $2,239.18    $1,374.59      $447.84      $274.92
                   fracture.
27828...........  Treat lower leg     ...............  ...............  ...............      56.4195    $2,239.18    $1,434.59      $447.84      $286.92
                   fracture.
27829...........  Treat lower leg     ...............  ...............  ...............      37.5680    $1,491.00      $968.50      $298.20      $193.70
                   joint.
27830...........  Treat lower leg     ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
27831...........  Treat lower leg     ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
27832...........  Treat lower leg     ...............  ...............  ...............      37.5680    $1,491.00      $968.50      $298.20      $193.70
                   dislocation.
27840...........  Treat ankle         ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
27842...........  Treat ankle         ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   dislocation.
27846...........  Treat ankle         ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
27848...........  Treat ankle         ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
27860...........  Fixation of ankle   ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   joint.
27870...........  Fusion of ankle     ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   joint, open.
27871...........  Fusion of           ...............  ...............  ...............      65.8846    $2,614.83    $1,622.42      $522.97      $324.48
                   tibiofibular
                   joint.
27884...........  Amputation follow-  ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   up surgery.

[[Page 49886]]

 
27889...........  Amputation of foot  ...............  ...............  ...............      25.0600      $994.58      $752.29      $198.92      $150.46
                   at ankle.
27892...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   leg.
27893...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   leg.
27894...........  Decompression of    ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   leg.
28001...........  Drainage of bursa   Y..............  Y..............  Y..............       2.9456      $116.90      $116.90       $23.38       $23.38
                   of foot.
28002...........  Treatment of foot   ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   infection.
28003...........  Treatment of foot   ...............  ...............  ...............      20.8214      $826.36      $668.18      $165.27      $133.64
                   infection.
28005...........  Treat foot bone     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   lesion.
28008...........  Incision of foot    ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   fascia.
28010...........  Incision of toe     Y..............  Y..............  Y..............       2.2064       $87.57       $87.57       $17.51       $17.51
                   tendon.
28011...........  Incision of toe     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   tendons.
28020...........  Exploration of      ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   foot joint.
28022...........  Exploration of      ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   foot joint.
28024...........  Exploration of toe  ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   joint.
28030...........  Removal of foot     ...............  ...............  ...............      17.7609      $704.90      $667.45      $140.98      $133.49
                   nerve.
28035...........  Decompression of    ...............  ...............  ...............      17.7609      $704.90      $667.45      $140.98      $133.49
                   tibia nerve.
28043...........  Excision of foot    ...............  ...............  ...............      19.9760      $792.81      $619.40      $158.56      $123.88
                   lesion.
28045...........  Excision of foot    ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   lesion.
28046...........  Resection of        ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   tumor, foot.
28050...........  Biopsy of foot      ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   joint lining.
28052...........  Biopsy of foot      ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   joint lining.
28054...........  Biopsy of toe       ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   joint lining.
28060...........  Partial removal,    ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   foot fascia.
28062...........  Removal of foot     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   fascia.
28070...........  Removal of foot     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   joint lining.
28072...........  Removal of foot     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   joint lining.
28080...........  Removal of foot     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   lesion.
28086...........  Excise foot tendon  ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   sheath.
28088...........  Excise foot tendon  ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   sheath.
28090...........  Removal of foot     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   lesion.
28092...........  Removal of toe      ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   lesions.
28100...........  Removal of ankle/   ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   heel lesion.
28102...........  Remove/graft foot   ...............  ...............  ...............      41.2239    $1,636.10    $1,073.05      $327.22      $214.61
                   lesion.

[[Page 49887]]

 
28103...........  Remove/graft foot   ...............  ...............  ...............      41.2239    $1,636.10    $1,073.05      $327.22      $214.61
                   lesion.
28104...........  Removal of foot     ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   lesion.
28106...........  Remove/graft foot   ...............  ...............  ...............      41.2239    $1,636.10    $1,073.05      $327.22      $214.61
                   lesion.
28107...........  Remove/graft foot   ...............  ...............  ...............      41.2239    $1,636.10    $1,073.05      $327.22      $214.61
                   lesion.
28108...........  Removal of toe      ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   lesions.
28110...........  Part removal of     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   metatarsal.
28111...........  Part removal of     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   metatarsal.
28112...........  Part removal of     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   metatarsal.
28113...........  Part removal of     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   metatarsal.
28114...........  Removal of          ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   metatarsal heads.
28116...........  Revision of foot..  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
28118...........  Removal of heel     ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   bone.
28119...........  Removal of heel     ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   spur.
28120...........  Part removal of     ...............  ...............  ...............      20.2255      $802.71      $898.86      $160.54      $179.77
                   ankle/heel.
28122...........  Partial removal of  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   foot bone.
28124...........  Partial removal of  Y..............  Y..............  Y..............       4.9541      $196.62      $196.62       $39.32       $39.32
                   toe.
28126...........  Partial removal of  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   toe.
28130...........  Removal of ankle    ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   bone.
28140...........  Removal of          ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   metatarsal.
28150...........  Removal of toe....  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
28153...........  Partial removal of  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   toe.
28160...........  Partial removal of  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   toe.
28171...........  Extensive foot      ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   surgery.
28173...........  Extensive foot      ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   surgery.
28175...........  Extensive foot      ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   surgery.
28190...........  Removal of foot     Y..............  Y..............  Y..............       3.1309      $124.26      $124.26       $24.85       $24.85
                   foreign body.
28192...........  Removal of foot     ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   foreign body.
28193...........  Removal of foot     ...............  ...............  ...............       6.5128      $258.48      $329.68       $51.70       $65.94
                   foreign body.
28200...........  Repair of foot      ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   tendon.
28202...........  Repair/graft of     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   foot tendon.
28208...........  Repair of foot      ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   tendon.
28210...........  Repair/graft of     ...............  ...............  ...............      41.2239    $1,636.10    $1,073.05      $327.22      $214.61
                   foot tendon.
28220...........  Release of foot     Y..............  Y..............  Y..............       4.6712      $185.39      $185.39       $37.08       $37.08
                   tendon.
28222...........  Release of foot     ...............  ...............  ...............      20.2255      $802.71      $567.86      $160.54      $113.57
                   tendons.

[[Page 49888]]

 
28225...........  Release of foot     ...............  ...............  ...............      20.2255      $802.71      $567.86      $160.54      $113.57
                   tendon.
28226...........  Release of foot     ...............  ...............  ...............      20.2255      $802.71      $567.86      $160.54      $113.57
                   tendons.
28230...........  Incision of foot    Y..............  Y..............  Y..............       4.6363      $184.00      $184.00       $36.80       $36.80
                   tendon(s).
28232...........  Incision of toe     Y..............  Y..............  Y..............       4.4311      $175.86      $175.86       $35.17       $35.17
                   tendon.
28234...........  Incision of foot    ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   tendon.
28238...........  Revision of foot    ...............  ...............  ...............      41.2239    $1,636.10    $1,073.05      $327.22      $214.61
                   tendon.
28240...........  Release of big toe  ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
28250...........  Revision of foot    ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   fascia.
28260...........  Release of midfoot  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   joint.
28261...........  Revision of foot    ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   tendon.
28262...........  Revision of foot    ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   and ankle.
28264...........  Release of midfoot  ...............  ...............  ...............      41.2239    $1,636.10      $984.55      $327.22      $196.91
                   joint.
28270...........  Release of foot     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   contracture.
28272...........  Release of toe      Y..............  Y..............  Y..............       4.2127      $167.19      $167.19       $33.44       $33.44
                   joint, each.
28280...........  Fusion of toes....  ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
28285...........  Repair of           ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   hammertoe.
28286...........  Repair of           ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   hammertoe.
28288...........  Partial removal of  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   foot bone.
28289...........  Repair hallux       ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   rigidus.
28290...........  Correction of       ...............  ...............  ...............      28.0970    $1,115.12      $780.56      $223.02      $156.11
                   bunion.
28292...........  Correction of       ...............  ...............  ...............      28.0970    $1,115.12      $780.56      $223.02      $156.11
                   bunion.
28293...........  Correction of       ...............  ...............  ...............      28.0970    $1,115.12      $812.56      $223.02      $162.51
                   bunion.
28294...........  Correction of       ...............  ...............  ...............      28.0970    $1,115.12      $812.56      $223.02      $162.51
                   bunion.
28296...........  Correction of       ...............  ...............  ...............      28.0970    $1,115.12      $812.56      $223.02      $162.51
                   bunion.
28297...........  Correction of       ...............  ...............  ...............      28.0970    $1,115.12      $812.56      $223.02      $162.51
                   bunion.
28298...........  Correction of       ...............  ...............  ...............      28.0970    $1,115.12      $812.56      $223.02      $162.51
                   bunion.
28299...........  Correction of       ...............  ...............  ...............      28.0970    $1,115.12      $916.06      $223.02      $183.21
                   bunion.
28300...........  Incision of heel    ...............  ...............  ...............      41.2239    $1,636.10    $1,041.05      $327.22      $208.21
                   bone.
28302...........  Incision of ankle   ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   bone.
28304...........  Incision of         ...............  ...............  ...............      41.2239    $1,636.10    $1,041.05      $327.22      $208.21
                   midfoot bones.
28305...........  Incise/graft        ...............  ...............  ...............      41.2239    $1,636.10    $1,073.05      $327.22      $214.61
                   midfoot bones.
28306...........  Incision of         ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   metatarsal.
28307...........  Incision of         ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   metatarsal.
28308...........  Incision of         ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   metatarsal.

[[Page 49889]]

 
28309...........  Incision of         ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   metatarsals.
28310...........  Revision of big     ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
                   toe.
28312...........  Revision of toe...  ...............  ...............  ...............      20.2255      $802.71      $656.36      $160.54      $131.27
28313...........  Repair deformity    ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   of toe.
28315...........  Removal of          ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   sesamoid bone.
28320...........  Repair of foot      ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   bones.
28322...........  Repair of           ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   metatarsals.
28340...........  Resect enlarged     ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   toe tissue.
28341...........  Resect enlarged     ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   toe.
28344...........  Repair extra        ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   toe(s).
28345...........  Repair webbed       ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   toe(s).
28400...........  Treatment of heel   ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
28405...........  Treatment of heel   ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
28406...........  Treatment of heel   ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
28415...........  Treat heel          ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
28420...........  Treat/graft heel    ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture.
28430...........  Treatment of ankle  Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
28435...........  Treatment of ankle  ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   fracture.
28436...........  Treatment of ankle  ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
28445...........  Treat ankle         ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
28450...........  Treat midfoot       Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture, each.
28455...........  Treat midfoot       Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture, each.
28456...........  Treat midfoot       ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
28465...........  Treat midfoot       ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture, each.
28470...........  Treat metatarsal    Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
28475...........  Treat metatarsal    Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
28476...........  Treat metatarsal    ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
28485...........  Treat metatarsal    ...............  ...............  ...............      37.5680    $1,491.00    $1,060.50      $298.20      $212.10
                   fracture.
28490...........  Treat big toe       Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
28495...........  Treat big toe       Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.
28496...........  Treat big toe       ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   fracture.
28505...........  Treat big toe       ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   fracture.
28510...........  Treatment of toe    Y..............  Y..............  Y..............       1.3651       $54.18       $54.18       $10.84       $10.84
                   fracture.
28515...........  Treatment of toe    Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   fracture.

[[Page 49890]]

 
28525...........  Treat toe fracture  ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
28530...........  Treat sesamoid      Y..............  Y..............  Y..............       1.3078       $51.90       $51.90       $10.38       $10.38
                   bone fracture.
28531...........  Treat sesamoid      ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   bone fracture.
28540...........  Treat foot          Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
28545...........  Treat foot          ...............  ...............  ...............      25.6702    $1,018.80      $675.90      $203.76      $135.18
                   dislocation.
28546...........  Treat foot          ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   dislocation.
28555...........  Repair foot         ...............  ...............  ...............      37.5680    $1,491.00      $968.50      $298.20      $193.70
                   dislocation.
28570...........  Treat foot          Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
28575...........  Treat foot          ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
28576...........  Treat foot          ...............  ...............  ...............      25.6702    $1,018.80      $764.40      $203.76      $152.88
                   dislocation.
28585...........  Repair foot         ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
28600...........  Treat foot          Y..............  Y..............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
28605...........  Treat foot          ...............  ...............  ...............       1.6914       $67.13       $85.62       $13.43       $17.12
                   dislocation.
28606...........  Treat foot          ...............  ...............  ...............      25.6702    $1,018.80      $732.40      $203.76      $146.48
                   dislocation.
28615...........  Repair foot         ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
28630...........  Treat toe           Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
28635...........  Treat toe           ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   dislocation.
28636...........  Treat toe           ...............  ...............  ...............      25.6702    $1,018.80      $764.40      $203.76      $152.88
                   dislocation.
28645...........  Repair toe          ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
28660...........  Treat toe           Y..............  ...............  ...............       1.6914       $67.13       $67.13       $13.43       $13.43
                   dislocation.
28665...........  Treat toe           ...............  ...............  ...............      14.5502      $577.47      $455.23      $115.49       $91.05
                   dislocation.
28666...........  Treat toe           ...............  ...............  ...............      25.6702    $1,018.80      $764.40      $203.76      $152.88
                   dislocation.
28675...........  Repair of toe       ...............  ...............  ...............      37.5680    $1,491.00    $1,000.50      $298.20      $200.10
                   dislocation.
28705...........  Fusion of foot      ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   bones.
28715...........  Fusion of foot      ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   bones.
28725...........  Fusion of foot      ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   bones.
28730...........  Fusion of foot      ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   bones.
28735...........  Fusion of foot      ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   bones.
28737...........  Revision of foot    ...............  ...............  ...............      41.2239    $1,636.10    $1,176.55      $327.22      $235.31
                   bones.
28740...........  Fusion of foot      ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   bones.
28750...........  Fusion of big toe   ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   joint.
28755...........  Fusion of big toe   ...............  ...............  ...............      20.2255      $802.71      $716.36      $160.54      $143.27
                   joint.
28760...........  Fusion of big toe   ...............  ...............  ...............      41.2239    $1,636.10    $1,133.05      $327.22      $226.61
                   joint.
28810...........  Amputation toe &    ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   metatarsal.

[[Page 49891]]

 
28820...........  Amputation of toe.  ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
28825...........  Partial amputation  ...............  ...............  ...............      20.2255      $802.71      $624.36      $160.54      $124.87
                   of toe.
28890...........  High energy eswt,   Y..............  ...............  ...............      25.0600      $994.58      $994.58      $198.92      $198.92
                   plantar f.
29010...........  Application of      Y..............  Y..............  ...............       2.2728       $90.20       $90.20       $18.04       $18.04
                   body cast.
29015...........  Application of      Y..............  Y..............  ...............       2.2728       $90.20       $90.20       $18.04       $18.04
                   body cast.
29020...........  Application of      Y..............  ...............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   body cast.
29025...........  Application of      Y..............  Y..............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   body cast.
29035...........  Application of      Y..............  ...............  ...............       2.2728       $90.20       $90.20       $18.04       $18.04
                   body cast.
29040...........  Application of      Y..............  ...............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   body cast.
29044...........  Application of      Y..............  Y..............  ...............       2.2728       $90.20       $90.20       $18.04       $18.04
                   body cast.
29049...........  Application of      Y..............  Y..............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   figure eight.
29055...........  Application of      Y..............  Y..............  ...............       2.2728       $90.20       $90.20       $18.04       $18.04
                   shoulder cast.
29058...........  Application of      Y..............  Y..............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   shoulder cast.
29065...........  Application of      Y..............  Y..............  Y..............       1.1406       $45.27       $45.27        $9.05        $9.05
                   long arm cast.
29075...........  Application of      Y..............  Y..............  Y..............       1.0379       $41.19       $41.19        $8.24        $8.24
                   forearm cast.
29085...........  Apply hand/wrist    Y..............  Y..............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   cast.
29086...........  Apply finger cast.  Y..............  Y..............  Y..............       0.8720       $34.61       $34.61        $6.92        $6.92
29105...........  Apply long arm      Y..............  Y..............  Y..............       1.0024       $39.78       $39.78        $7.96        $7.96
                   splint.
29125...........  Apply forearm       Y..............  Y..............  Y..............       0.8527       $33.84       $33.84        $6.77        $6.77
                   splint.
29126...........  Apply forearm       Y..............  Y..............  Y..............       0.9572       $37.99       $37.99        $7.60        $7.60
                   splint.
29130...........  Application of      Y..............  Y..............  Y..............       0.3862       $15.33       $15.33        $3.07        $3.07
                   finger splint.
29131...........  Application of      Y..............  Y..............  Y..............       0.5869       $23.29       $23.29        $4.66        $4.66
                   finger splint.
29200...........  Strapping of chest  Y..............  Y..............  Y..............       0.5597       $22.21       $22.21        $4.44        $4.44
29220...........  Strapping of low    Y..............  Y..............  Y..............       0.5669       $22.50       $22.50        $4.50        $4.50
                   back.
29240...........  Strapping of        Y..............  Y..............  Y..............       0.6464       $25.66       $25.66        $5.13        $5.13
                   shoulder.
29260...........  Strapping of elbow  Y..............  Y..............  Y..............       0.5940       $23.58       $23.58        $4.72        $4.72
                   or wrist.
29280...........  Strapping of hand   Y..............  Y..............  Y..............       0.6225       $24.70       $24.70        $4.94        $4.94
                   or finger.
29305...........  Application of hip  Y..............  ...............  ...............       2.2728       $90.20       $90.20       $18.04       $18.04
                   cast.
29325...........  Application of hip  Y..............  ...............  ...............       2.2728       $90.20       $90.20       $18.04       $18.04
                   casts.
29345...........  Application of      Y..............  Y..............  Y..............       1.5007       $59.56       $59.56       $11.91       $11.91
                   long leg cast.
29355...........  Application of      Y..............  Y..............  Y..............       1.4561       $57.79       $57.79       $11.56       $11.56
                   long leg cast.
29358...........  Apply long leg      Y..............  Y..............  Y..............       1.7938       $71.19       $71.19       $14.24       $14.24
                   cast brace.
29365...........  Application of      Y..............  Y..............  Y..............       1.4129       $56.08       $56.08       $11.22       $11.22
                   long leg cast.
29405...........  Apply short leg     Y..............  Y..............  Y..............       1.0527       $41.78       $41.78        $8.36        $8.36
                   cast.

[[Page 49892]]

 
29425...........  Apply short leg     Y..............  Y..............  Y..............       1.0639       $42.22       $42.22        $8.44        $8.44
                   cast.
29435...........  Apply short leg     Y..............  Y..............  Y..............       1.3502       $53.59       $53.59       $10.72       $10.72
                   cast.
29440...........  Addition of walker  Y..............  Y..............  Y..............       0.5600       $22.23       $22.23        $4.45        $4.45
                   to cast.
29445...........  Apply rigid leg     Y..............  Y..............  Y..............       1.4713       $58.39       $58.39       $11.68       $11.68
                   cast.
29450...........  Application of leg  Y..............  Y..............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   cast.
29505...........  Application, long   Y..............  ...............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   leg splint.
29515...........  Application lower   Y..............  ...............  ...............       1.0504       $41.69       $41.69        $8.34        $8.34
                   leg splint.
29520...........  Strapping of hip..  Y..............  Y..............  Y..............       0.6469       $25.67       $25.67        $5.13        $5.13
29530...........  Strapping of knee.  Y..............  Y..............  Y..............       0.6104       $24.23       $24.23        $4.85        $4.85
29540...........  Strapping of ankle  Y..............  Y..............  Y..............       0.4057       $16.10       $16.10        $3.22        $3.22
                   and/or ft.
29550...........  Strapping of toes.  Y..............  Y..............  Y..............       0.4128       $16.38       $16.38        $3.28        $3.28
29580...........  Application of      Y..............  Y..............  Y..............       0.5844       $23.19       $23.19        $4.64        $4.64
                   paste boot.
29590...........  Application of      Y..............  Y..............  Y..............       0.4639       $18.41       $18.41        $3.68        $3.68
                   foot splint.
29700...........  Removal/revision    Y..............  Y..............  Y..............       0.7997       $31.74       $31.74        $6.35        $6.35
                   of cast.
29705...........  Removal/revision    Y..............  Y..............  Y..............       0.6912       $27.43       $27.43        $5.49        $5.49
                   of cast.
29710...........  Removal/revision    Y..............  Y..............  Y..............       1.3029       $51.71       $51.71       $10.34       $10.34
                   of cast.
29715...........  Removal/revision    Y..............  Y..............  Y..............       1.0504       $41.69       $41.69        $8.34        $8.34
                   of cast.
29720...........  Repair of body      Y..............  Y..............  Y..............       1.0084       $40.02       $40.02        $8.00        $8.00
                   cast.
29730...........  Windowing of cast.  Y..............  Y..............  Y..............       0.6775       $26.89       $26.89        $5.38        $5.38
29740...........  Wedging of cast...  Y..............  Y..............  Y..............       0.9533       $37.83       $37.83        $7.57        $7.57
29750...........  Wedging of          Y..............  Y..............  Y..............       0.8453       $33.55       $33.55        $6.71        $6.71
                   clubfoot cast.
29800...........  Jaw arthroscopy/    ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29804...........  Jaw arthroscopy/    ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29805...........  Shoulder            ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   arthroscopy, dx.
29806...........  Shoulder            ...............  ...............  ...............      45.0637    $1,788.49    $1,149.25      $357.70      $229.85
                   arthroscopy/
                   surgery.
29807...........  Shoulder            ...............  ...............  ...............      45.0637    $1,788.49    $1,149.25      $357.70      $229.85
                   arthroscopy/
                   surgery.
29819...........  Shoulder            ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   arthroscopy/
                   surgery.
29820...........  Shoulder            ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   arthroscopy/
                   surgery.
29821...........  Shoulder            ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   arthroscopy/
                   surgery.
29822...........  Shoulder            ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   arthroscopy/
                   surgery.

[[Page 49893]]

 
29823...........  Shoulder            ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   arthroscopy/
                   surgery.
29824...........  Shoulder            ...............  ...............  ...............      28.6279    $1,136.19      $926.59      $227.24      $185.32
                   arthroscopy/
                   surgery.
29825...........  Shoulder            ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   arthroscopy/
                   surgery.
29826...........  Shoulder            ...............  ...............  ...............      45.0637    $1,788.49    $1,149.25      $357.70      $229.85
                   arthroscopy/
                   surgery.
29827...........  Arthroscop rotator  ...............  ...............  ...............      45.0637    $1,788.49    $1,252.75      $357.70      $250.55
                   cuff repr.
29830...........  Elbow arthroscopy.  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
29834...........  Elbow arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29835...........  Elbow arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29836...........  Elbow arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29837...........  Elbow arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29838...........  Elbow arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29840...........  Wrist arthroscopy.  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
29843...........  Wrist arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29844...........  Wrist arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29845...........  Wrist arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29846...........  Wrist arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29847...........  Wrist arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29848...........  Wrist endoscopy/    ...............  ...............  ...............      28.6279    $1,136.19    $1,237.59      $227.24      $247.52
                   surgery.
29850...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   surgery.
29851...........  Knee arthroscopy/   ...............  ...............  ...............      45.0637    $1,788.49    $1,209.25      $357.70      $241.85
                   surgery.
29855...........  Tibial arthroscopy/ ...............  ...............  ...............      45.0637    $1,788.49    $1,209.25      $357.70      $241.85
                   surgery.
29856...........  Tibial arthroscopy/ ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   surgery.
29860...........  Hip arthroscopy,    ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   dx.
29861...........  Hip arthroscopy/    ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   surgery.
29862...........  Hip arthroscopy/    ...............  ...............  ...............      45.0637    $1,788.49    $1,563.75      $357.70      $312.75
                   surgery.
29863...........  Hip arthroscopy/    ...............  ...............  ...............      45.0637    $1,788.49    $1,209.25      $357.70      $241.85
                   surgery.
29866...........  Autgrft implnt,     Y..............  ...............  ...............      45.0637    $1,788.49    $1,788.49      $357.70      $357.70
                   knee w/scope.
29870...........  Knee arthroscopy,   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   dx.
29871...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   drainage.
29873...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29874...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29875...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   surgery.

[[Page 49894]]

 
29876...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   surgery.
29877...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   surgery.
29879...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29880...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   surgery.
29881...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $883.09      $227.24      $176.62
                   surgery.
29882...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29883...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29884...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29885...........  Knee arthroscopy/   ...............  ...............  ...............      45.0637    $1,788.49    $1,149.25      $357.70      $229.85
                   surgery.
29886...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29887...........  Knee arthroscopy/   ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29888...........  Knee arthroscopy/   ...............  ...............  ...............      45.0637    $1,788.49    $1,149.25      $357.70      $229.85
                   surgery.
29889...........  Knee arthroscopy/   ...............  ...............  ...............      45.0637    $1,788.49    $1,149.25      $357.70      $229.85
                   surgery.
29891...........  Ankle arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29892...........  Ankle arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29893...........  Scope, plantar      ...............  ...............  ...............      20.2255      $802.71    $1,023.81      $160.54      $204.76
                   fasciotomy.
29894...........  Ankle arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29895...........  Ankle arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29897...........  Ankle arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29898...........  Ankle arthroscopy/  ...............  ...............  ...............      28.6279    $1,136.19      $823.09      $227.24      $164.62
                   surgery.
29899...........  Ankle arthroscopy/  ...............  ...............  ...............      45.0637    $1,788.49    $1,149.25      $357.70      $229.85
                   surgery.
29900...........  Mcp joint           ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   arthroscopy, dx.
29901...........  Mcp joint           ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   arthroscopy, surg.
29902...........  Mcp joint           ...............  ...............  ...............      16.0343      $636.37      $573.19      $127.27      $114.64
                   arthroscopy, surg.
30000...........  Drainage of nose    Y..............  Y..............  ...............       2.3768       $94.33       $94.33       $18.87       $18.87
                   lesion.
30020...........  Drainage of nose    Y..............  Y..............  ...............       2.3768       $94.33       $94.33       $18.87       $18.87
                   lesion.
30100...........  Intranasal biopsy.  Y..............  Y..............  Y..............       1.9302       $76.60       $76.60       $15.32       $15.32
30110...........  Removal of nose     Y..............  Y..............  Y..............       3.0207      $119.89      $119.89       $23.98       $23.98
                   polyp(s).
30115...........  Removal of nose     ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   polyp(s).
30117...........  Removal of          ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   intranasal lesion.
30118...........  Removal of          ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
                   intranasal lesion.
30120...........  Revision of nose..  ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58

[[Page 49895]]

 
30124...........  Removal of nose     Y..............  Y..............  Y..............       3.1426      $124.72      $124.72       $24.94       $24.94
                   lesion.
30125...........  Removal of nose     ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   lesion.
30130...........  Excise inferior     ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   turbinate.
30140...........  Resect inferior     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   turbinate.
30150...........  Partial removal of  ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   nose.
30160...........  Removal of nose...  ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
30200...........  Injection           Y..............  Y..............  Y..............       1.5377       $61.03       $61.03       $12.21       $12.21
                   treatment of nose.
30210...........  Nasal sinus         Y..............  Y..............  Y..............       1.9430       $77.11       $77.11       $15.42       $15.42
                   therapy.
30220...........  Insert nasal        ...............  ...............  ...............       7.7261      $306.63      $391.09       $61.33       $78.22
                   septal button.
30300...........  Remove nasal        Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   foreign body.
30310...........  Remove nasal        ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   foreign body.
30320...........  Remove nasal        ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   foreign body.
30400...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   nose.
30410...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   nose.
30420...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   nose.
30430...........  Revision of nose..  ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
30435...........  Revision of nose..  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
30450...........  Revision of nose..  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
30460...........  Revision of nose..  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
30462...........  Revision of nose..  ...............  ...............  ...............      37.7719    $1,499.09    $1,419.05      $299.82      $283.81
30465...........  Repair nasal        ...............  ...............  ...............      37.7719    $1,499.09    $1,419.05      $299.82      $283.81
                   stenosis.
30520...........  Repair of nasal     ...............  ...............  ...............      23.1564      $919.03      $774.52      $183.81      $154.90
                   septum.
30540...........  Repair nasal        ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   defect.
30545...........  Repair nasal        ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   defect.
30560...........  Release of nasal    ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   adhesions.
30580...........  Repair upper jaw    ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   fistula.
30600...........  Repair mouth/nose   ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   fistula.
30620...........  Intranasal          ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   reconstruction.
30630...........  Repair nasal        ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   septum defect.
30801...........  Ablate inf          ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   turbinate, superf.
30802...........  Cauterization,      ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   inner nose.
30901...........  Control of          Y..............  Y..............  Y..............       1.1029       $43.77       $43.77        $8.75        $8.75
                   nosebleed.
30903...........  Control of          ...............  ...............  ...............       1.2021       $47.71       $60.85        $9.54       $12.17
                   nosebleed.

[[Page 49896]]

 
30905...........  Control of          ...............  ...............  ...............       1.2021       $47.71       $60.85        $9.54       $12.17
                   nosebleed.
30906...........  Repeat control of   ...............  ...............  ...............       1.2021       $47.71       $60.85        $9.54       $12.17
                   nosebleed.
30915...........  Ligation, nasal     ...............  ...............  ...............      24.5817      $975.60      $710.80      $195.12      $142.16
                   sinus artery.
30920...........  Ligation, upper     ...............  ...............  ...............      24.5817      $975.60      $742.80      $195.12      $148.56
                   jaw artery.
30930...........  Ther fx, nasal inf  ...............  ...............  ...............      16.4494      $652.85      $641.42      $130.57      $128.28
                   turbinate.
31000...........  Irrigation,         Y..............  Y..............  ...............       2.3768       $94.33       $94.33       $18.87       $18.87
                   maxillary sinus.
31002...........  Irrigation,         Y..............  Y..............  Y..............       2.4899       $98.82       $98.82       $19.76       $19.76
                   sphenoid sinus.
31020...........  Exploration,        ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   maxillary sinus.
31030...........  Exploration,        ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   maxillary sinus.
31032...........  Explore sinus,      ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   remove polyps.
31040...........  Exploration behind  Y..............  Y..............  Y..............       7.3501      $291.71      $291.71       $58.34       $58.34
                   upper jaw.
31050...........  Exploration,        ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   sphenoid sinus.
31051...........  Sphenoid sinus      ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   surgery.
31070...........  Exploration of      ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   frontal sinus.
31075...........  Exploration of      ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   frontal sinus.
31080...........  Removal of frontal  ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   sinus.
31081...........  Removal of frontal  ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   sinus.
31084...........  Removal of frontal  ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   sinus.
31085...........  Removal of frontal  ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   sinus.
31086...........  Removal of frontal  ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   sinus.
31087...........  Removal of frontal  ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   sinus.
31090...........  Exploration of      ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   sinuses.
31200...........  Removal of ethmoid  ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   sinus.
31201...........  Removal of ethmoid  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   sinus.
31205...........  Removal of ethmoid  ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   sinus.
31231...........  Nasal endoscopy,    Y..............  Y..............  ...............       1.4038       $55.71       $55.71       $11.14       $11.14
                   dx.
31233...........  Nasal/sinus         ...............  ...............  ...............       1.4038       $55.71       $71.06       $11.14       $14.21
                   endoscopy, dx.
31235...........  Nasal/sinus         ...............  ...............  ...............      15.1300      $600.48      $466.74      $120.10       $93.35
                   endoscopy, dx.
31237...........  Nasal/sinus         ...............  ...............  ...............      15.1300      $600.48      $523.24      $120.10      $104.65
                   endoscopy, surg.
31238...........  Nasal/sinus         ...............  ...............  ...............      15.1300      $600.48      $466.74      $120.10       $93.35
                   endoscopy, surg.
31239...........  Nasal/sinus         ...............  ...............  ...............      21.8010      $865.24      $747.62      $173.05      $149.52
                   endoscopy, surg.

[[Page 49897]]

 
31240...........  Nasal/sinus         ...............  ...............  ...............      15.1300      $600.48      $523.24      $120.10      $104.65
                   endoscopy, surg.
31254...........  Revision of         ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   ethmoid sinus.
31255...........  Removal of ethmoid  ...............  ...............  ...............      21.8010      $865.24      $791.12      $173.05      $158.22
                   sinus.
31256...........  Exploration         ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   maxillary sinus.
31267...........  Endoscopy,          ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   maxillary sinus.
31276...........  Sinus endoscopy,    ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   surgical.
31287...........  Nasal/sinus         ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   endoscopy, surg.
31288...........  Nasal/sinus         ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   endoscopy, surg.
31300...........  Removal of larynx   ...............  ...............  ...............      23.1564      $919.03      $818.02      $183.81      $163.60
                   lesion.
31320...........  Diagnostic          ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   incision, larynx.
31400...........  Revision of larynx  ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
31420...........  Removal of          ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   epiglottis.
31502...........  Change of windpipe  Y..............  ...............  ...............       2.3431       $92.99       $92.99       $18.60       $18.60
                   airway.
31505...........  Diagnostic          Y..............  Y..............  ...............       0.7572       $30.05       $30.05        $6.01        $6.01
                   laryngoscopy.
31510...........  Laryngoscopy with   ...............  ...............  ...............      15.1300      $600.48      $523.24      $120.10      $104.65
                   biopsy.
31511...........  Remove foreign      ...............  ...............  ...............       1.4038       $55.71       $71.06       $11.14       $14.21
                   body, larynx.
31512...........  Removal of larynx   ...............  ...............  ...............      15.1300      $600.48      $523.24      $120.10      $104.65
                   lesion.
31513...........  Injection into      ...............  ...............  ...............       1.4038       $55.71       $71.06       $11.14       $14.21
                   vocal cord.
31515...........  Laryngoscopy for    ...............  ...............  ...............      15.1300      $600.48      $466.74      $120.10       $93.35
                   aspiration.
31520...........  Diagnostic          Y..............  ...............  ...............       1.4038       $55.71       $55.71       $11.14       $11.14
                   laryngoscopy.
31525...........  Dx laryngoscopy     ...............  ...............  ...............      15.1300      $600.48      $466.74      $120.10       $93.35
                   excl nb.
31526...........  Dx laryngoscopy w/  ...............  ...............  ...............      21.8010      $865.24      $655.62      $173.05      $131.12
                   oper scope.
31527...........  Laryngoscopy for    ...............  ...............  ...............      21.8010      $865.24      $599.12      $173.05      $119.82
                   treatment.
31528...........  Laryngoscopy and    ...............  ...............  ...............      15.1300      $600.48      $523.24      $120.10      $104.65
                   dilation.
31529...........  Laryngoscopy and    ...............  ...............  ...............      15.1300      $600.48      $523.24      $120.10      $104.65
                   dilation.
31530...........  Laryngoscopy w/fb   ...............  ...............  ...............      21.8010      $865.24      $655.62      $173.05      $131.12
                   removal.
31531...........  Laryngoscopy w/fb   ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   & op scope.
31535...........  Laryngoscopy w/     ...............  ...............  ...............      21.8010      $865.24      $655.62      $173.05      $131.12
                   biopsy.
31536...........  Laryngoscopy w/bx   ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   & op scope.
31540...........  Laryngoscopy w/exc  ...............  ...............  ...............      21.8010      $865.24      $687.62      $173.05      $137.52
                   of tumor.

[[Page 49898]]

 
31541...........  Larynscop w/tumr    ...............  ...............  ...............      21.8010      $865.24      $747.62      $173.05      $149.52
                   exc + scope.
31545...........  Remove vc lesion w/ ...............  ...............  ...............      21.8010      $865.24      $747.62      $173.05      $149.52
                   scope.
31546...........  Remove vc lesion    ...............  ...............  ...............      21.8010      $865.24      $747.62      $173.05      $149.52
                   scope/graft.
31560...........  Laryngoscop w/      ...............  ...............  ...............      21.8010      $865.24      $791.12      $173.05      $158.22
                   arytenoidectom.
31561...........  Larynscop, remve    ...............  ...............  ...............      21.8010      $865.24      $791.12      $173.05      $158.22
                   cart + scop.
31570...........  Laryngoscope w/vc   ...............  ...............  ...............      15.1300      $600.48      $523.24      $120.10      $104.65
                   inj.
31571...........  Laryngoscop w/vc    ...............  ...............  ...............      21.8010      $865.24      $655.62      $173.05      $131.12
                   inj + scope.
31575...........  Diagnostic          Y..............  Y..............  ...............       1.4038       $55.71       $55.71       $11.14       $11.14
                   laryngoscopy.
31576...........  Laryngoscopy with   ...............  ...............  ...............      21.8010      $865.24      $655.62      $173.05      $131.12
                   biopsy.
31577...........  Remove foreign      ...............  ...............  ...............       3.8737      $153.74      $196.08       $30.75       $39.22
                   body, larynx.
31578...........  Removal of larynx   ...............  ...............  ...............      21.8010      $865.24      $655.62      $173.05      $131.12
                   lesion.
31579...........  Diagnostic          Y..............  Y..............  Y..............       2.8542      $113.28      $113.28       $22.66       $22.66
                   laryngoscopy.
31580...........  Revision of larynx  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
31582...........  Revision of larynx  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
31588...........  Revision of larynx  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
31590...........  Reinnervate larynx  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
31595...........  Larynx nerve        ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   surgery.
31603...........  Incision of         ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   windpipe.
31605...........  Incision of         Y..............  ...............  ...............       7.7261      $306.63      $306.63       $61.33       $61.33
                   windpipe.
31611...........  Surgery/speech      ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
                   prosthesis.
31612...........  Puncture/clear      ...............  ...............  ...............      23.1564      $919.03      $626.02      $183.81      $125.20
                   windpipe.
31613...........  Repair windpipe     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   opening.
31614...........  Repair windpipe     ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   opening.
31615...........  Visualization of    ...............  ...............  ...............       9.3905      $372.69      $352.85       $74.54       $70.57
                   windpipe.
31620...........  Endobronchial us    Y..............  ...............  ...............      29.7322    $1,180.01    $1,180.01      $236.00      $236.00
                   add-on.
31622...........  Dx bronchoscope/    ...............  ...............  ...............       9.3905      $372.69      $352.85       $74.54       $70.57
                   wash.
31623...........  Dx bronchoscope/    ...............  ...............  ...............       9.3905      $372.69      $409.35       $74.54       $81.87
                   brush.
31624...........  Dx bronchoscope/    ...............  ...............  ...............       9.3905      $372.69      $409.35       $74.54       $81.87
                   lavage.
31625...........  Bronchoscopy w/     ...............  ...............  ...............       9.3905      $372.69      $409.35       $74.54       $81.87
                   biopsy(s).
31628...........  Bronchoscopy/lung   ...............  ...............  ...............       9.3905      $372.69      $409.35       $74.54       $81.87
                   bx, each.
31629...........  Bronchoscopy/       ...............  ...............  ...............       9.3905      $372.69      $409.35       $74.54       $81.87
                   needle bx, each.

[[Page 49899]]

 
31630...........  Bronchoscopy        ...............  ...............  ...............      21.8803      $868.39      $657.19      $173.68      $131.44
                   dilate/fx repr.
31631...........  Bronchoscopy,       ...............  ...............  ...............      21.8803      $868.39      $657.19      $173.68      $131.44
                   dilate w/stent.
31632...........  Bronchoscopy/lung   Y..............  ...............  ...............       9.3905      $372.69      $372.69       $74.54       $74.54
                   bx, add'l.
31633...........  Bronchoscopy/       Y..............  ...............  ...............       9.3905      $372.69      $372.69       $74.54       $74.54
                   needle bx add'l.
31635...........  Bronchoscopy w/fb   ...............  ...............  ...............       9.3905      $372.69      $409.35       $74.54       $81.87
                   removal.
31636...........  Bronchoscopy,       ...............  ...............  ...............      21.8803      $868.39      $657.19      $173.68      $131.44
                   bronch stents.
31637...........  Bronchoscopy,       ...............  ...............  ...............       9.3905      $372.69      $352.85       $74.54       $70.57
                   stent add-on.
31638...........  Bronchoscopy,       ...............  ...............  ...............      21.8803      $868.39      $657.19      $173.68      $131.44
                   revise stent.
31640...........  Bronchoscopy w/     ...............  ...............  ...............      21.8803      $868.39      $657.19      $173.68      $131.44
                   tumor excise.
31641...........  Bronchoscopy,       ...............  ...............  ...............      21.8803      $868.39      $657.19      $173.68      $131.44
                   treat blockage.
31643...........  Diag bronchoscope/  ...............  ...............  ...............       9.3905      $372.69      $409.35       $74.54       $81.87
                   catheter.
31645...........  Bronchoscopy,       ...............  ...............  ...............       9.3905      $372.69      $352.85       $74.54       $70.57
                   clear airways.
31646...........  Bronchoscopy,       ...............  ...............  ...............       9.3905      $372.69      $352.85       $74.54       $70.57
                   reclear airway.
31656...........  Bronchoscopy, inj   ...............  ...............  ...............       9.3905      $372.69      $352.85       $74.54       $70.57
                   for x-ray.
31700...........  Insertion of        ...............  ...............  ...............       1.4038       $55.71       $71.06       $11.14       $14.21
                   airway catheter.
31717...........  Bronchial brush     ...............  ...............  ...............       3.8737      $153.74      $196.08       $30.75       $39.22
                   biopsy.
31720...........  Clearance of        ...............  ...............  ...............       0.7572       $30.05       $38.33        $6.01        $7.67
                   airways.
31730...........  Intro, windpipe     ...............  ...............  ...............       3.8737      $153.74      $196.08       $30.75       $39.22
                   wire/tube.
31750...........  Repair of windpipe  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
31755...........  Repair of windpipe  ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
31820...........  Closure of          ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   windpipe lesion.
31825...........  Repair of windpipe  ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   defect.
31830...........  Revise windpipe     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   scar.
32000...........  Drainage of chest.  ...............  ...............  ...............       3.6425      $144.56      $184.38       $28.91       $36.88
32002...........  Treatment of        Y..............  ...............  ...............       3.6425      $144.56      $144.56       $28.91       $28.91
                   collapsed lung.
32019...........  Insert pleural      Y..............  ...............  ...............      29.2259    $1,159.92    $1,159.92      $231.98      $231.98
                   catheter.
32020...........  Tube thoracostomy.  Y..............  ...............  ...............       3.6425      $144.56      $144.56       $28.91       $28.91
32400...........  Needle biopsy       ...............  ...............  ...............       6.0729      $241.02      $287.01       $48.20       $57.40
                   chest lining.
32405...........  Biopsy, lung or     ...............  ...............  ...............       6.0729      $241.02      $287.01       $48.20       $57.40
                   mediastinum.
32420...........  Puncture/clear      ...............  ...............  ...............       3.6425      $144.56      $184.38       $28.91       $36.88
                   lung.
32960...........  Therapeutic         Y..............  ...............  ...............       3.6425      $144.56      $144.56       $28.91       $28.91
                   pneumothorax.
33010...........  Drainage of heart   ...............  ...............  ...............       3.6425      $144.56      $184.38       $28.91       $36.88
                   sac.

[[Page 49900]]

 
33011...........  Repeat drainage of  ...............  ...............  ...............       3.6425      $144.56      $184.38       $28.91       $36.88
                   heart sac.
33206...........  Insertion of heart  Y..............  ...............  ...............     121.9402    $4,839.57    $4,839.57      $967.91      $967.91
                   pacemaker.
33212...........  Insertion of pulse  ...............  ...............  ...............      97.8357    $3,882.91    $2,196.46      $776.58      $439.29
                   generator.
33213...........  Insertion of pulse  ...............  ...............  ...............     112.2347    $4,454.38    $2,482.19      $890.88      $496.44
                   generator.
33214...........  Upgrade of          Y..............  ...............  ...............     153.1524    $6,078.33    $6,078.33    $1,215.67    $1,215.67
                   pacemaker system.
33215...........  Reposition pacing-  Y..............  ...............  ...............      23.4666      $931.34      $931.34      $186.27      $186.27
                   defib lead.
33216...........  Insert lead pace-   Y..............  ...............  ...............      44.7574    $1,776.34    $1,776.34      $355.27      $355.27
                   defib, one.
33217...........  Insert lead pace-   Y..............  ...............  ...............      44.7574    $1,776.34    $1,776.34      $355.27      $355.27
                   defib, dual.
33218...........  Repair lead pace-   Y..............  ...............  ...............      44.7574    $1,776.34    $1,776.34      $355.27      $355.27
                   defib, one.
33220...........  Repair lead pace-   Y..............  ...............  ...............      44.7574    $1,776.34    $1,776.34      $355.27      $355.27
                   defib, dual.
33222...........  Revise pocket,      ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   pacemaker.
33223...........  Revise pocket,      ...............  ...............  ...............      21.2645      $843.95      $644.97      $168.79      $128.99
                   pacing-defib.
33224...........  Insert pacing lead  Y..............  ...............  ...............     267.8870   $10,631.92   $10,631.92    $2,126.38    $2,126.38
                   & connect.
33225...........  L ventric pacing    Y..............  ...............  ...............     267.8870   $10,631.92   $10,631.92    $2,126.38    $2,126.38
                   lead add-on.
33226...........  Reposition l        Y..............  ...............  ...............      23.4666      $931.34      $931.34      $186.27      $186.27
                   ventric lead.
33233...........  Removal of          ...............  ...............  ...............      23.4666      $931.34      $688.67      $186.27      $137.73
                   pacemaker system.
33234...........  Removal of          Y..............  ...............  ...............      23.4666      $931.34      $931.34      $186.27      $186.27
                   pacemaker system.
33241...........  Remove pulse        Y..............  ...............  ...............      23.4666      $931.34      $931.34      $186.27      $186.27
                   generator.
33282...........  Implant pat-active  Y..............  ...............  ...............      74.8877    $2,972.15    $2,972.15      $594.43      $594.43
                   ht record.
33284...........  Remove pat-active   Y..............  ...............  ...............      10.9541      $434.75      $434.75       $86.95       $86.95
                   ht record.
35188...........  Repair blood        ...............  ...............  ...............      37.9652    $1,506.77    $1,068.38      $301.35      $213.68
                   vessel lesion.
35207...........  Repair blood        ...............  ...............  ...............      37.9652    $1,506.77    $1,068.38      $301.35      $213.68
                   vessel lesion.
35473...........  Repair arterial     Y..............  ...............  ...............      42.8894    $1,702.20    $1,702.20      $340.44      $340.44
                   blockage.
35474...........  Repair arterial     Y..............  ...............  ...............      42.8894    $1,702.20    $1,702.20      $340.44      $340.44
                   blockage.
35476...........  Repair venous       Y..............  ...............  ...............      42.8894    $1,702.20    $1,702.20      $340.44      $340.44
                   blockage.
35492...........  Atherectomy,        Y..............  ...............  ...............      42.8894    $1,702.20    $1,702.20      $340.44      $340.44
                   percutaneous.
35761...........  Exploration of      Y..............  ...............  ...............      29.4757    $1,169.83    $1,169.83      $233.97      $233.97
                   artery/vein.
35875...........  Removal of clot in  ...............  ...............  ...............      37.9652    $1,506.77    $1,422.88      $301.35      $284.58
                   graft.

[[Page 49901]]

 
35876...........  Removal of clot in  ...............  ...............  ...............      37.9652    $1,506.77    $1,422.88      $301.35      $284.58
                   graft.
36002...........  Pseudoaneurysm      Y..............  ...............  ...............       2.5166       $99.88       $99.88       $19.98       $19.98
                   injection trt.
36260...........  Insertion of        ...............  ...............  ...............      28.4646    $1,129.71      $819.85      $225.94      $163.97
                   infusion pump.
36261...........  Revision of         ...............  ...............  ...............      28.4646    $1,129.71      $787.85      $225.94      $157.57
                   infusion pump.
36262...........  Removal of          ...............  ...............  ...............      22.6984      $900.86      $616.93      $180.17      $123.39
                   infusion pump.
36420...........  Vein access         Y..............  ...............  ...............       0.2016        $8.00        $8.00        $1.60        $1.60
                   cutdown < 1 yr.
36425...........  Vein access         Y..............  Y..............  Y..............       0.1841        $7.31        $7.31        $1.46        $1.46
                   cutdown > 1 yr.
36430...........  Blood transfusion   Y..............  Y..............  Y..............       0.8269       $32.82       $32.82        $6.56        $6.56
                   service.
36440...........  Bl push transfuse,  Y..............  Y..............  Y..............       0.3133       $12.43       $12.43        $2.49        $2.49
                   2 yr or.
36450...........  Bl exchange/        Y..............  Y..............  ...............       0.6213       $24.66       $24.66        $4.93        $4.93
                   transfuse, nb.
36468...........  Injection(s),       Y..............  Y..............  ...............       1.1035       $43.80       $43.80        $8.76        $8.76
                   spider veins.
36469...........  Injection(s),       Y..............  ...............  ...............       1.1035       $43.80       $43.80        $8.76        $8.76
                   spider veins.
36470...........  Injection therapy   Y..............  Y..............  ...............       1.1035       $43.80       $43.80        $8.76        $8.76
                   of vein.
36471...........  Injection therapy   Y..............  Y..............  ...............       1.1035       $43.80       $43.80        $8.76        $8.76
                   of veins.
36475...........  Endovenous rf, 1st  ...............  ...............  ...............      34.6279    $1,374.32      $942.16      $274.86      $188.43
                   vein.
36476...........  Endovenous rf,      ...............  ...............  ...............      34.6279    $1,374.32      $942.16      $274.86      $188.43
                   vein add-on.
36478...........  Endovenous laser,   ...............  ...............  ...............      24.5817      $975.60      $742.80      $195.12      $148.56
                   1st vein.
36479...........  Endovenous laser    ...............  ...............  ...............      24.5817      $975.60      $742.80      $195.12      $148.56
                   vein addon.
36511...........  Apheresis wbc.....  Y..............  ...............  ...............      11.7005      $464.37      $464.37       $92.87       $92.87
36512...........  Apheresis rbc.....  Y..............  ...............  ...............      11.7005      $464.37      $464.37       $92.87       $92.87
36513...........  Apheresis           Y..............  ...............  ...............      11.7005      $464.37      $464.37       $92.87       $92.87
                   platelets.
36514...........  Apheresis plasma..  Y..............  ...............  ...............      11.7005      $464.37      $464.37       $92.87       $92.87
36515...........  Apheresis, adsorp/  Y..............  ...............  ...............      30.6602    $1,216.84    $1,216.84      $243.37      $243.37
                   reinfuse.
36516...........  Apheresis,          Y..............  ...............  ...............      30.6602    $1,216.84    $1,216.84      $243.37      $243.37
                   selective.
36522...........  Photopheresis.....  Y..............  ...............  ...............      30.6602    $1,216.84    $1,216.84      $243.37      $243.37
36550...........  Declot vascular     Y..............  Y..............  Y..............       0.5176       $20.54       $20.54        $4.11        $4.11
                   device.
36555...........  Insert non-tunnel   ...............  ...............  ...............       8.7841      $348.62      $340.81       $69.72       $68.16
                   cv cath.
36556...........  Insert non-tunnel   ...............  ...............  ...............       8.7841      $348.62      $340.81       $69.72       $68.16
                   cv cath.
36557...........  Insert tunneled cv  ...............  ...............  ...............      22.6984      $900.86      $673.43      $180.17      $134.69
                   cath.
36558...........  Insert tunneled cv  ...............  ...............  ...............      22.6984      $900.86      $673.43      $180.17      $134.69
                   cath.
36560...........  Insert tunneled cv  ...............  ...............  ...............      28.4646    $1,129.71      $819.85      $225.94      $163.97
                   cath.
36561...........  Insert tunneled cv  ...............  ...............  ...............      28.4646    $1,129.71      $819.85      $225.94      $163.97
                   cath.
36563...........  Insert tunneled cv  ...............  ...............  ...............      28.4646    $1,129.71      $819.85      $225.94      $163.97
                   cath.

[[Page 49902]]

 
36565...........  Insert tunneled cv  ...............  ...............  ...............      28.4646    $1,129.71      $819.85      $225.94      $163.97
                   cath.
36566...........  Insert tunneled cv  ...............  ...............  ...............      28.4646    $1,129.71      $819.85      $225.94      $163.97
                   cath.
36568...........  Insert picc cath..  ...............  ...............  ...............       8.7841      $348.62      $340.81       $69.72       $68.16
36569...........  Insert picc cath..  ...............  ...............  ...............       8.7841      $348.62      $340.81       $69.72       $68.16
36570...........  Insert picvad cath  ...............  ...............  ...............      22.6984      $900.86      $705.43      $180.17      $141.09
36571...........  Insert picvad cath  ...............  ...............  ...............      22.6984      $900.86      $705.43      $180.17      $141.09
36575...........  Repair tunneled cv  ...............  ...............  ...............       8.7841      $348.62      $397.31       $69.72       $79.46
                   cath.
36576...........  Repair tunneled cv  ...............  ...............  ...............       8.7841      $348.62      $397.31       $69.72       $79.46
                   cath.
36578...........  Replace tunneled    ...............  ...............  ...............      22.6984      $900.86      $673.43      $180.17      $134.69
                   cv cath.
36580...........  Replace cvad cath.  ...............  ...............  ...............       8.7841      $348.62      $340.81       $69.72       $68.16
36581...........  Replace tunneled    ...............  ...............  ...............      22.6984      $900.86      $673.43      $180.17      $134.69
                   cv cath.
36582...........  Replace tunneled    ...............  ...............  ...............      28.4646    $1,129.71      $819.85      $225.94      $163.97
                   cv cath.
36583...........  Replace tunneled    ...............  ...............  ...............      28.4646    $1,129.71      $819.85      $225.94      $163.97
                   cv cath.
36584...........  Replace picc cath.  ...............  ...............  ...............       8.7841      $348.62      $340.81       $69.72       $68.16
36585...........  Replace picvad      ...............  ...............  ...............      22.6984      $900.86      $705.43      $180.17      $141.09
                   cath.
36589...........  Removal tunneled    ...............  ...............  ...............       8.7841      $348.62      $340.81       $69.72       $68.16
                   cv cath.
36590...........  Removal tunneled    ...............  ...............  ...............       8.7841      $348.62      $340.81       $69.72       $68.16
                   cv cath.
36595...........  Mech remov          Y..............  ...............  ...............      22.6984      $900.86      $900.86      $180.17      $180.17
                   tunneled cv cath.
36596...........  Mech remov          Y..............  ...............  ...............       8.7841      $348.62      $348.62       $69.72       $69.72
                   tunneled cv cath.
36598...........  Inj w/fluor, eval   Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   cv device.
36640...........  Insertion           ...............  ...............  ...............      28.4646    $1,129.71      $731.35      $225.94      $146.27
                   catheter, artery.
36680...........  Insert needle,      Y..............  ...............  ...............       1.0948       $43.45       $43.45        $8.69        $8.69
                   bone cavity.
36800...........  Insertion of        ...............  ...............  ...............      29.4757    $1,169.83      $839.92      $233.97      $167.98
                   cannula.
36810...........  Insertion of        ...............  ...............  ...............      29.4757    $1,169.83      $839.92      $233.97      $167.98
                   cannula.
36815...........  Insertion of        ...............  ...............  ...............      29.4757    $1,169.83      $839.92      $233.97      $167.98
                   cannula.
36818...........  Av fuse, uppr arm,  Y..............  ...............  ...............      37.9652    $1,506.77    $1,506.77      $301.35      $301.35
                   cephalic.
36819...........  Av fuse, uppr arm,  ...............  ...............  ...............      37.9652    $1,506.77    $1,008.38      $301.35      $201.68
                   basilic.
36820...........  Av fusion/forearm   ...............  ...............  ...............      37.9652    $1,506.77    $1,008.38      $301.35      $201.68
                   vein.
36821...........  Av fusion direct    ...............  ...............  ...............      37.9652    $1,506.77    $1,008.38      $301.35      $201.68
                   any site.
36825...........  Artery-vein         ...............  ...............  ...............      37.9652    $1,506.77    $1,068.38      $301.35      $213.68
                   autograft.
36830...........  Artery-vein         ...............  ...............  ...............      37.9652    $1,506.77    $1,068.38      $301.35      $213.68
                   nonautograft.
36831...........  Open thrombect av   ...............  ...............  ...............      37.9652    $1,506.77    $1,422.88      $301.35      $284.58
                   fistula.
36832...........  Av fistula          ...............  ...............  ...............      37.9652    $1,506.77    $1,068.38      $301.35      $213.68
                   revision, open.
36833...........  Av fistula          ...............  ...............  ...............      37.9652    $1,506.77    $1,068.38      $301.35      $213.68
                   revision.

[[Page 49903]]

 
36834...........  Repair a-v          ...............  ...............  ...............      37.9652    $1,506.77    $1,008.38      $301.35      $201.68
                   aneurysm.
36835...........  Artery to vein      ...............  ...............  ...............      29.4757    $1,169.83      $899.92      $233.97      $179.98
                   shunt.
36860...........  External cannula    ...............  ...............  ...............       2.0612       $81.81      $104.34       $16.36       $20.87
                   declotting.
36861...........  Cannula declotting  ...............  ...............  ...............      29.4757    $1,169.83      $839.92      $233.97      $167.98
36870...........  Percut thrombect    ...............  ...............  ...............      31.0004    $1,230.35    $1,284.67      $246.07      $256.93
                   av fistula.
37184...........  Prim art mech       Y..............  ...............  ...............      31.0004    $1,230.35    $1,230.35      $246.07      $246.07
                   thrombectomy.
37185...........  Prim art m-         Y..............  ...............  ...............      17.0436      $676.43      $676.43      $135.29      $135.29
                   thrombect add-on.
37186...........  Sec art m-          Y..............  ...............  ...............      17.0436      $676.43      $676.43      $135.29      $135.29
                   thrombect add-on.
37187...........  Venous mech         Y..............  ...............  ...............      31.0004    $1,230.35    $1,230.35      $246.07      $246.07
                   thrombectomy.
37188...........  Venous m-           Y..............  ...............  ...............      31.0004    $1,230.35    $1,230.35      $246.07      $246.07
                   thrombectomy add-
                   on.
37200...........  Transcatheter       Y..............  ...............  ...............       6.0729      $241.02      $241.02       $48.20       $48.20
                   biopsy.
37203...........  Transcatheter       Y..............  ...............  ...............      17.0436      $676.43      $676.43      $135.29      $135.29
                   retrieval.
37205...........  Transcath iv        Y..............  ...............  ...............      66.0804    $2,622.60    $2,622.60      $524.52      $524.52
                   stent, percut.
37250...........  Iv us first vessel  Y..............  ...............  ...............      32.2182    $1,278.68    $1,278.68      $255.74      $255.74
                   add-on.
37251...........  Iv us each add      Y..............  ...............  ...............      32.2182    $1,278.68    $1,278.68      $255.74      $255.74
                   vessel add-on.
37500...........  Endoscopy ligate    ...............  ...............  ...............      34.6279    $1,374.32      $942.16      $274.86      $188.43
                   perf veins.
37607...........  Ligation of a-v     ...............  ...............  ...............      24.5817      $975.60      $742.80      $195.12      $148.56
                   fistula.
37609...........  Temporal artery     ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   procedure.
37650...........  Revision of major   ...............  ...............  ...............      24.5817      $975.60      $710.80      $195.12      $142.16
                   vein.
37700...........  Revise leg vein...  ...............  ...............  ...............      34.6279    $1,374.32      $910.16      $274.86      $182.03
37718...........  Ligate/strip short  ...............  ...............  ...............      34.6279    $1,374.32      $942.16      $274.86      $188.43
                   leg vein.
37722...........  Ligate/strip long   ...............  ...............  ...............      34.6279    $1,374.32      $942.16      $274.86      $188.43
                   leg vein.
37735...........  Removal of leg      ...............  ...............  ...............      34.6279    $1,374.32      $942.16      $274.86      $188.43
                   veins/lesion.
37760...........  Ligation, leg       ...............  ...............  ...............      24.5817      $975.60      $742.80      $195.12      $148.56
                   veins, open.
37765...........  Phleb veins -       Y..............  Y..............  Y..............       3.5230      $139.82      $139.82       $27.96       $27.96
                   extrem - to 20.
37766...........  Phleb veins -       Y..............  Y..............  Y..............       4.0582      $161.06      $161.06       $32.21       $32.21
                   extrem 20+.
37780...........  Revision of leg     ...............  ...............  ...............      24.5817      $975.60      $742.80      $195.12      $148.56
                   vein.
37785...........  Ligate/divide/      ...............  ...............  ...............      24.5817      $975.60      $742.80      $195.12      $148.56
                   excise vein.
37790...........  Penile venous       ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   occlusion.
38205...........  Harvest allogenic   Y..............  ...............  ...............      11.7005      $464.37      $464.37       $92.87       $92.87
                   stem cells.
38206...........  Harvest auto stem   Y..............  ...............  ...............      11.7005      $464.37      $464.37       $92.87       $92.87
                   cells.

[[Page 49904]]

 
38220...........  Bone marrow         Y..............  Y..............  ...............       2.4295       $96.42       $96.42       $19.28       $19.28
                   aspiration.
38221...........  Bone marrow biopsy  Y..............  Y..............  ...............       2.4295       $96.42       $96.42       $19.28       $19.28
38230...........  Bone marrow         Y..............  ...............  ...............      23.2490      $922.71      $922.71      $184.54      $184.54
                   collection.
38241...........  Bone marrow/stem    Y..............  ...............  ...............      23.2490      $922.71      $922.71      $184.54      $184.54
                   transplant.
38242...........  Lymphocyte infuse   Y..............  Y..............  Y..............       0.6143       $24.38       $24.38        $4.88        $4.88
                   transplant.
38300...........  Drainage, lymph     ...............  ...............  ...............      10.9184      $433.33      $383.17       $86.67       $76.63
                   node lesion.
38305...........  Drainage, lymph     ...............  ...............  ...............      17.4686      $693.30      $569.65      $138.66      $113.93
                   node lesion.
38308...........  Incision of lymph   ...............  ...............  ...............      21.3673      $848.03      $647.01      $169.61      $129.40
                   channels.
38500...........  Biopsy/removal,     ...............  ...............  ...............      21.3673      $848.03      $647.01      $169.61      $129.40
                   lymph nodes.
38505...........  Needle biopsy,      ...............  ...............  ...............       3.8051      $151.02      $192.61       $30.20       $38.52
                   lymph nodes.
38510...........  Biopsy/removal,     ...............  ...............  ...............      21.3673      $848.03      $647.01      $169.61      $129.40
                   lymph nodes.
38520...........  Biopsy/removal,     ...............  ...............  ...............      21.3673      $848.03      $647.01      $169.61      $129.40
                   lymph nodes.
38525...........  Biopsy/removal,     ...............  ...............  ...............      21.3673      $848.03      $647.01      $169.61      $129.40
                   lymph nodes.
38530...........  Biopsy/removal,     ...............  ...............  ...............      21.3673      $848.03      $647.01      $169.61      $129.40
                   lymph nodes.
38542...........  Explore deep        ...............  ...............  ...............      37.1283    $1,473.55      $959.78      $294.71      $191.96
                   node(s), neck.
38550...........  Removal, neck/      ...............  ...............  ...............      21.3673      $848.03      $679.01      $169.61      $135.80
                   armpit lesion.
38555...........  Removal, neck/      ...............  ...............  ...............      21.3673      $848.03      $739.01      $169.61      $147.80
                   armpit lesion.
38570...........  Laparoscopy, lymph  ...............  ...............  ...............      43.5124    $1,726.92    $1,532.96      $345.38      $306.59
                   node biop.
38571...........  Laparoscopy,        ...............  ...............  ...............      70.8854    $2,813.31    $2,076.15      $562.66      $415.23
                   lymphadenectomy.
38572...........  Laparoscopy,        ...............  ...............  ...............      43.5124    $1,726.92    $1,532.96      $345.38      $306.59
                   lymphadenectomy.
38700...........  Removal of lymph    Y..............  ...............  ...............      21.3673      $848.03      $848.03      $169.61      $169.61
                   nodes, neck.
38740...........  Remove armpit       ...............  ...............  ...............      37.1283    $1,473.55      $959.78      $294.71      $191.96
                   lymph nodes.
38745...........  Remove armpit       ...............  ...............  ...............      37.1283    $1,473.55    $1,051.78      $294.71      $210.36
                   lymph nodes.
38760...........  Remove groin lymph  ...............  ...............  ...............      21.3673      $848.03      $647.01      $169.61      $129.40
                   nodes.
40490...........  Biopsy of lip.....  Y..............  Y..............  Y..............       1.6094       $63.87       $63.87       $12.77       $12.77
40500...........  Partial excision    ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   of lip.
40510...........  Partial excision    ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   of lip.
40520...........  Partial excision    ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   of lip.
40525...........  Reconstruct lip     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   with flap.
40527...........  Reconstruct lip     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   with flap.
40530...........  Partial removal of  ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   lip.

[[Page 49905]]

 
40650...........  Repair lip........  ...............  ...............  ...............       7.7261      $306.63      $391.09       $61.33       $78.22
40652...........  Repair lip........  ...............  ...............  ...............       7.7261      $306.63      $391.09       $61.33       $78.22
40654...........  Repair lip........  ...............  ...............  ...............       7.7261      $306.63      $391.09       $61.33       $78.22
40700...........  Repair cleft lip/   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   nasal.
40701...........  Repair cleft lip/   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   nasal.
40702...........  Repair cleft lip/   Y..............  Y..............  Y..............       6.6019      $262.02      $262.02       $52.40       $52.40
                   nasal.
40720...........  Repair cleft lip/   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   nasal.
40761...........  Repair cleft lip/   ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   nasal.
40800...........  Drainage of mouth   Y..............  Y..............  ...............       1.4821       $58.82       $58.82       $11.76       $11.76
                   lesion.
40801...........  Drainage of mouth   ...............  ...............  ...............       7.7261      $306.63      $376.32       $61.33       $75.26
                   lesion.
40804...........  Removal, foreign    Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   body, mouth.
40805...........  Removal, foreign    Y..............  Y..............  Y..............       4.1994      $166.66      $166.66       $33.33       $33.33
                   body, mouth.
40806...........  Incision of lip     Y..............  Y..............  Y..............       1.8622       $73.91       $73.91       $14.78       $14.78
                   fold.
40808...........  Biopsy of mouth     Y..............  Y..............  ...............       2.3768       $94.33       $94.33       $18.87       $18.87
                   lesion.
40810...........  Excision of mouth   Y..............  Y..............  Y..............       2.8430      $112.83      $112.83       $22.57       $22.57
                   lesion.
40812...........  Excise/repair       Y..............  Y..............  Y..............       3.6275      $143.97      $143.97       $28.79       $28.79
                   mouth lesion.
40814...........  Excise/repair       ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   mouth lesion.
40816...........  Excision of mouth   ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   lesion.
40818...........  Excise oral mucosa  ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   for graft.
40819...........  Excise lip or       ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   cheek fold.
40820...........  Treatment of mouth  Y..............  Y..............  Y..............       3.9656      $157.39      $157.39       $31.48       $31.48
                   lesion.
40830...........  Repair mouth        Y..............  ...............  ...............       2.3768       $94.33       $94.33       $18.87       $18.87
                   laceration.
40831...........  Repair mouth        ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   laceration.
40840...........  Reconstruction of   ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   mouth.
40842...........  Reconstruction of   ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
                   mouth.
40843...........  Reconstruction of   ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
                   mouth.
40844...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   mouth.
40845...........  Reconstruction of   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   mouth.
41000...........  Drainage of mouth   Y..............  Y..............  Y..............       2.1048       $83.53       $83.53       $16.71       $16.71
                   lesion.
41005...........  Drainage of mouth   ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   lesion.
41006...........  Drainage of mouth   ...............  ...............  ...............      23.1564      $919.03      $626.02      $183.81      $125.20
                   lesion.
41007...........  Drainage of mouth   ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   lesion.
41008...........  Drainage of mouth   ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   lesion.
41009...........  Drainage of mouth   ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   lesion.

[[Page 49906]]

 
41010...........  Incision of tongue  ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   fold.
41015...........  Drainage of mouth   ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   lesion.
41016...........  Drainage of mouth   ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   lesion.
41017...........  Drainage of mouth   ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   lesion.
41018...........  Drainage of mouth   ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   lesion.
41100...........  Biopsy of tongue..  Y..............  Y..............  Y..............       2.1907       $86.95       $86.95       $17.39       $17.39
41105...........  Biopsy of tongue..  Y..............  Y..............  Y..............       2.1418       $85.00       $85.00       $17.00       $17.00
41108...........  Biopsy of floor of  Y..............  Y..............  Y..............       1.9697       $78.17       $78.17       $15.63       $15.63
                   mouth.
41110...........  Excision of tongue  Y..............  Y..............  Y..............       2.8336      $112.46      $112.46       $22.49       $22.49
                   lesion.
41112...........  Excision of tongue  ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   lesion.
41113...........  Excision of tongue  ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   lesion.
41114...........  Excision of tongue  ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   lesion.
41115...........  Excision of tongue  Y..............  Y..............  Y..............       3.3338      $132.31      $132.31       $26.46       $26.46
                   fold.
41116...........  Excision of mouth   ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   lesion.
41120...........  Partial removal of  ...............  ...............  ...............      23.1564      $919.03      $818.02      $183.81      $163.60
                   tongue.
41250...........  Repair tongue       ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   laceration.
41251...........  Repair tongue       ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   laceration.
41252...........  Repair tongue       ...............  ...............  ...............       7.7261      $306.63      $376.32       $61.33       $75.26
                   laceration.
41500...........  Fixation of tongue  ...............  ...............  ...............      23.1564      $919.03      $626.02      $183.81      $125.20
41510...........  Tongue to lip       ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   surgery.
41520...........  Reconstruction,     ...............  ...............  ...............       7.7261      $306.63      $376.32       $61.33       $75.26
                   tongue fold.
41800...........  Drainage of gum     ...............  ...............  ...............       1.4821       $58.82       $75.02       $11.76       $15.00
                   lesion.
41805...........  Removal foreign     Y..............  Y..............  Y..............       3.2618      $129.45      $129.45       $25.89       $25.89
                   body, gum.
41806...........  Removal foreign     Y..............  Y..............  Y..............       4.1774      $165.79      $165.79       $33.16       $33.16
                   body,jawbone.
41820...........  Excision, gum,      Y..............  Y..............  ...............       7.7261      $306.63      $306.63       $61.33       $61.33
                   each quadrant.
41821...........  Excision of gum     Y..............  ...............  ...............       7.7261      $306.63      $306.63       $61.33       $61.33
                   flap.
41822...........  Excision of gum     Y..............  Y..............  Y..............       3.7793      $149.99      $149.99       $30.00       $30.00
                   lesion.
41823...........  Excision of gum     Y..............  Y..............  Y..............       5.3407      $211.96      $211.96       $42.39       $42.39
                   lesion.
41825...........  Excision of gum     Y..............  Y..............  Y..............       2.9473      $116.97      $116.97       $23.39       $23.39
                   lesion.
41826...........  Excision of gum     Y..............  Y..............  Y..............       3.3501      $132.96      $132.96       $26.59       $26.59
                   lesion.
41827...........  Excision of gum     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   lesion.
41828...........  Excision of gum     Y..............  Y..............  Y..............       3.4999      $138.90      $138.90       $27.78       $27.78
                   lesion.
41830...........  Removal of gum      Y..............  Y..............  Y..............       4.8590      $192.84      $192.84       $38.57       $38.57
                   tissue.

[[Page 49907]]

 
41850...........  Treatment of gum    Y..............  Y..............  ...............      16.4494      $652.85      $652.85      $130.57      $130.57
                   lesion.
41870...........  Gum graft.........  Y..............  ...............  ...............      23.1564      $919.03      $919.03      $183.81      $183.81
41872...........  Repair gum........  Y..............  Y..............  Y..............       1.6239       $64.45       $64.45       $12.89       $12.89
41874...........  Repair tooth        Y..............  Y..............  Y..............       4.6763      $185.59      $185.59       $37.12       $37.12
                   socket.
42000...........  Drainage mouth      ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   roof lesion.
42100...........  Biopsy roof of      Y..............  Y..............  Y..............       1.8757       $74.44       $74.44       $14.89       $14.89
                   mouth.
42104...........  Excision lesion,    Y..............  Y..............  Y..............       2.6328      $104.49      $104.49       $20.90       $20.90
                   mouth roof.
42106...........  Excision lesion,    Y..............  Y..............  Y..............       3.3670      $133.63      $133.63       $26.73       $26.73
                   mouth roof.
42107...........  Excision lesion,    ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   mouth roof.
42120...........  Remove palate/      ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   lesion.
42140...........  Excision of uvula.  ...............  ...............  ...............       7.7261      $306.63      $376.32       $61.33       $75.26
42145...........  Repair palate,      ...............  ...............  ...............      23.1564      $919.03      $818.02      $183.81      $163.60
                   pharynx/uvula.
42160...........  Treatment mouth     Y..............  Y..............  Y..............       3.4534      $137.06      $137.06       $27.41       $27.41
                   roof lesion.
42180...........  Repair palate.....  ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
42182...........  Repair palate.....  ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
42200...........  Reconstruct cleft   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   palate.
42205...........  Reconstruct cleft   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   palate.
42210...........  Reconstruct cleft   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   palate.
42215...........  Reconstruct cleft   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   palate.
42220...........  Reconstruct cleft   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   palate.
42226...........  Lengthening of      ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   palate.
42235...........  Repair palate.....  ...............  ...............  ...............      16.4494      $652.85      $684.92      $130.57      $136.98
42260...........  Repair nose to lip  ...............  ...............  ...............      23.1564      $919.03      $774.52      $183.81      $154.90
                   fistula.
42280...........  Preparation,        Y..............  Y..............  Y..............       1.8635       $73.96       $73.96       $14.79       $14.79
                   palate mold.
42281...........  Insertion, palate   Y..............  ...............  ...............      16.4494      $652.85      $652.85      $130.57      $130.57
                   prosthesis.
42300...........  Drainage of         ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   salivary gland.
42305...........  Drainage of         ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   salivary gland.
42310...........  Drainage of         ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   salivary gland.
42320...........  Drainage of         ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   salivary gland.
42330...........  Removal of          Y..............  Y..............  Y..............       2.7864      $110.59      $110.59       $22.12       $22.12
                   salivary stone.
42335...........  Removal of          Y..............  Y..............  Y..............       4.5522      $180.67      $180.67       $36.13       $36.13
                   salivary stone.
42340...........  Removal of          ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   salivary stone.
42400...........  Biopsy of salivary  Y..............  Y..............  Y..............       1.5674       $62.21       $62.21       $12.44       $12.44
                   gland.
42405...........  Biopsy of salivary  ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   gland.
42408...........  Excision of         ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   salivary cyst.
42409...........  Drainage of         ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   salivary cyst.

[[Page 49908]]

 
42410...........  Excise parotid      ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   gland/lesion.
42415...........  Excise parotid      ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   gland/lesion.
42420...........  Excise parotid      ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   gland/lesion.
42425...........  Excise parotid      ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   gland/lesion.
42440...........  Excise              ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   submaxillary
                   gland.
42450...........  Excise sublingual   ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   gland.
42500...........  Repair salivary     ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
                   duct.
42505...........  Repair salivary     ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   duct.
42507...........  Parotid duct        ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   diversion.
42508...........  Parotid duct        ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   diversion.
42509...........  Parotid duct        ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   diversion.
42510...........  Parotid duct        ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   diversion.
42600...........  Closure of          ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   salivary fistula.
42650...........  Dilation of         Y..............  Y..............  Y..............       1.0121       $40.17       $40.17        $8.03        $8.03
                   salivary duct.
42660...........  Dilation of         Y..............  Y..............  Y..............       1.2294       $48.79       $48.79        $9.76        $9.76
                   salivary duct.
42665...........  Ligation of         ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   salivary duct.
42700...........  Drainage of tonsil  ...............  ...............  ...............       2.3768       $94.33      $120.31       $18.87       $24.06
                   abscess.
42720...........  Drainage of throat  ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   abscess.
42725...........  Drainage of throat  ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   abscess.
42800...........  Biopsy of throat..  Y..............  Y..............  Y..............       1.9620       $77.87       $77.87       $15.57       $15.57
42802...........  Biopsy of throat..  ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
42804...........  Biopsy of upper     ...............  ...............  ...............      16.4494      $652.85      $492.92      $130.57       $98.58
                   nose/throat.
42806...........  Biopsy of upper     ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   nose/throat.
42808...........  Excise pharynx      ...............  ...............  ...............      16.4494      $652.85      $549.42      $130.57      $109.88
                   lesion.
42809...........  Remove pharynx      Y..............  ...............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   foreign body.
42810...........  Excision of neck    ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
                   cyst.
42815...........  Excision of neck    ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   cyst.
42820...........  Remove tonsils and  ...............  ...............  ...............      22.7757      $903.92      $706.96      $180.78      $141.39
                   adenoids.
42821...........  Remove tonsils and  ...............  ...............  ...............      22.7757      $903.92      $810.46      $180.78      $162.09
                   adenoids.
42825...........  Removal of tonsils  ...............  ...............  ...............      22.7757      $903.92      $766.96      $180.78      $153.39
42826...........  Removal of tonsils  ...............  ...............  ...............      22.7757      $903.92      $766.96      $180.78      $153.39
42830...........  Removal of          ...............  ...............  ...............      22.7757      $903.92      $766.96      $180.78      $153.39
                   adenoids.
42831...........  Removal of          ...............  ...............  ...............      22.7757      $903.92      $766.96      $180.78      $153.39
                   adenoids.

[[Page 49909]]

 
42835...........  Removal of          ...............  ...............  ...............      22.7757      $903.92      $766.96      $180.78      $153.39
                   adenoids.
42836...........  Removal of          ...............  ...............  ...............      22.7757      $903.92      $766.96      $180.78      $153.39
                   adenoids.
42860...........  Excision of tonsil  ...............  ...............  ...............      22.7757      $903.92      $706.96      $180.78      $141.39
                   tags.
42870...........  Excision of         ...............  ...............  ...............      22.7757      $903.92      $706.96      $180.78      $141.39
                   lingual tonsil.
42890...........  Partial removal of  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   pharynx.
42892...........  Revision of         ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   pharyngeal walls.
42900...........  Repair throat       ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   wound.
42950...........  Reconstruction of   ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   throat.
42955...........  Surgical opening    ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   of throat.
42960...........  Control throat      ...............  ...............  ...............       1.2021       $47.71       $60.85        $9.54       $12.17
                   bleeding.
42962...........  Control throat      ...............  ...............  ...............      37.7719    $1,499.09      $972.55      $299.82      $194.51
                   bleeding.
42970...........  Control nose/       Y..............  Y..............  ...............       1.2021       $47.71       $47.71        $9.54        $9.54
                   throat bleeding.
42972...........  Control nose/       ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   throat bleeding.
43030...........  Throat muscle       Y..............  ...............  ...............      16.4494      $652.85      $652.85      $130.57      $130.57
                   surgery.
43200...........  Esophagus           ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   endoscopy.
43201...........  Esoph scope w/      ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   submucous inj.
43202...........  Esophagus           ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   endoscopy, biopsy.
43204...........  Esoph scope w/      ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   sclerosis inj.
43205...........  Esophagus           ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   endoscopy/
                   ligation.
43215...........  Esophagus           ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   endoscopy.
43216...........  Esophagus           ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   endoscopy/lesion.
43217...........  Esophagus           ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   endoscopy.
43219...........  Esophagus           ...............  ...............  ...............      22.6777      $900.03      $616.52      $180.01      $123.30
                   endoscopy.
43220...........  Esoph endoscopy,    ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   dilation.
43226...........  Esoph endoscopy,    ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   dilation.
43227...........  Esoph endoscopy,    ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   repair.
43228...........  Esoph endoscopy,    ...............  ...............  ...............      27.5493    $1,093.38      $769.69      $218.68      $153.94
                   ablation.
43231...........  Esoph endoscopy w/  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   us exam.
43232...........  Esoph endoscopy w/  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   us fn bx.
43234...........  Upper gi            ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   endoscopy, exam.

[[Page 49910]]

 
43235...........  Uppr gi endoscopy,  ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   diagnosis.
43236...........  Uppr gi scope w/    ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   submuc inj.
43237...........  Endoscopic us       ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   exam, esoph.
43238...........  Uppr gi endoscopy   ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   w/us fn bx.
43239...........  Upper gi            ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   endoscopy, biopsy.
43240...........  Esoph endoscope w/  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   drain cyst.
43241...........  Upper gi endoscopy  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   with tube.
43242...........  Uppr gi endoscopy   ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   w/us fn bx.
43243...........  Upper gi endoscopy  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   & inject.
43244...........  Upper gi endoscopy/ ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   ligation.
43245...........  Uppr gi scope       ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   dilate strictr.
43246...........  Place gastrostomy   ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   tube.
43247...........  Operative upper gi  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   endoscopy.
43248...........  Uppr gi endoscopy/  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   guide wire.
43249...........  Esoph endoscopy,    ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   dilation.
43250...........  Upper gi endoscopy/ ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   tumor.
43251...........  Operative upper gi  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   endoscopy.
43255...........  Operative upper gi  ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   endoscopy.
43256...........  Uppr gi endoscopy   ...............  ...............  ...............      22.6777      $900.03      $705.02      $180.01      $141.00
                   w/stent.
43257...........  Uppr gi scope w/    Y..............  ...............  ...............      27.5493    $1,093.38    $1,093.38      $218.68      $218.68
                   thrml txmnt.
43258...........  Operative upper gi  ...............  ...............  ...............       8.3070      $329.69      $419.84       $65.94       $83.97
                   endoscopy.
43259...........  Endoscopic          ...............  ...............  ...............       8.3070      $329.69      $419.84       $65.94       $83.97
                   ultrasound exam.
43260...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.
43261...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.
43262...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.
43263...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.
43264...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.

[[Page 49911]]

 
43265...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.
43267...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.
43268...........  Endo                ...............  ...............  ...............      22.6777      $900.03      $673.02      $180.01      $134.60
                   cholangiopancreat
                   ograph.
43269...........  Endo                ...............  ...............  ...............      22.6777      $900.03      $673.02      $180.01      $134.60
                   cholangiopancreat
                   ograph.
43271...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.
43272...........  Endo                ...............  ...............  ...............      19.8125      $786.32      $616.16      $157.26      $123.23
                   cholangiopancreat
                   ograph.
43450...........  Dilate esophagus..  ...............  ...............  ...............       5.3134      $210.88      $268.96       $42.18       $53.79
43453...........  Dilate esophagus..  ...............  ...............  ...............       5.3134      $210.88      $268.96       $42.18       $53.79
43456...........  Dilate esophagus..  ...............  ...............  ...............       5.3134      $210.88      $268.96       $42.18       $53.79
43458...........  Dilate esophagus..  ...............  ...............  ...............       5.3134      $210.88      $268.96       $42.18       $53.79
43600...........  Biopsy of stomach.  ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
43653...........  Laparoscopy,        ...............  ...............  ...............      43.5124    $1,726.92    $1,532.96      $345.38      $306.59
                   gastrostomy.
43750...........  Place gastrostomy   ...............  ...............  ...............       8.3070      $329.69      $387.84       $65.94       $77.57
                   tube.
43760...........  Change gastrostomy  ...............  ...............  ...............       2.3431       $92.99      $118.61       $18.60       $23.72
                   tube.
43761...........  Reposition          Y..............  ...............  ...............       7.2859      $289.16      $289.16       $57.83       $57.83
                   gastrostomy tube.
43870...........  Repair stomach      ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
                   opening.
43886...........  Revise gastric      Y..............  ...............  ...............       5.0931      $202.14      $202.14       $40.43       $40.43
                   port, open.
43887...........  Remove gastric      Y..............  ...............  ...............       5.0931      $202.14      $202.14       $40.43       $40.43
                   port, open.
43888...........  Change gastric      Y..............  ...............  ...............      13.3433      $529.57      $529.57      $105.91      $105.91
                   port, open.
44100...........  Biopsy of bowel...  ...............  ...............  ...............       8.3070      $329.69      $331.34       $65.94       $66.27
44312...........  Revision of         ...............  ...............  ...............      21.2645      $843.95      $588.47      $168.79      $117.69
                   ileostomy.
44340...........  Revision of         ...............  ...............  ...............      21.2645      $843.95      $676.97      $168.79      $135.39
                   colostomy.
44360...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44361...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy/biopsy.
44363...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44364...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44365...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44366...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44369...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44370...........  Small bowel         ...............  ...............  ...............      22.6777      $900.03    $1,119.52      $180.01      $223.90
                   endoscopy/stent.
44372...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.

[[Page 49912]]

 
44373...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44376...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44377...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy/biopsy.
44378...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $409.29       $74.52       $81.86
                   endoscopy.
44379...........  Sbowel endoscope w/ ...............  ...............  ...............      22.6777      $900.03    $1,119.52      $180.01      $223.90
                   stent.
44380...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $352.79       $74.52       $70.56
                   endoscopy.
44382...........  Small bowel         ...............  ...............  ...............       9.3878      $372.58      $352.79       $74.52       $70.56
                   endoscopy.
44383...........  Ileoscopy w/stent.  ...............  ...............  ...............      22.6777      $900.03    $1,119.52      $180.01      $223.90
44385...........  Endoscopy of bowel  ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   pouch.
44386...........  Endoscopy, bowel    ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   pouch/biop.
44388...........  Colonoscopy.......  ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
44389...........  Colonoscopy with    ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   biopsy.
44390...........  Colonoscopy for     ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   foreign body.
44391...........  Colonoscopy for     ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   bleeding.
44392...........  Colonoscopy &       ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   polypectomy.
44393...........  Colonoscopy,        ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   lesion removal.
44394...........  Colonoscopy w/      ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   snare.
44397...........  Colonoscopy w/      ...............  ...............  ...............      22.6777      $900.03      $616.52      $180.01      $123.30
                   stent.
45000...........  Drainage of pelvic  ...............  ...............  ...............       4.8970      $194.35      $247.89       $38.87       $49.58
                   abscess.
45005...........  Drainage of rectal  ...............  ...............  ...............      12.8778      $511.10      $478.55      $102.22       $95.71
                   abscess.
45020...........  Drainage of rectal  ...............  ...............  ...............      12.8778      $511.10      $478.55      $102.22       $95.71
                   abscess.
45100...........  Biopsy of rectum..  ...............  ...............  ...............      22.2336      $882.41      $607.70      $176.48      $121.54
45108...........  Removal of          ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   anorectal lesion.
45150...........  Excision of rectal  ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   stricture.
45160...........  Excision of rectal  ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   lesion.
45170...........  Excision of rectal  ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   lesion.
45190...........  Destruction,        ...............  ...............  ...............      22.2336      $882.41    $1,110.70      $176.48      $222.14
                   rectal tumor.
45300...........  Proctosigmoidoscop  Y..............  Y..............  Y..............       1.5109       $59.96       $59.96       $11.99       $11.99
                   y dx.
45303...........  Proctosigmoidoscop  Y..............  Y..............  ...............       8.5644      $339.90      $339.90       $67.98       $67.98
                   y dilate.
45305...........  Proctosigmoidoscop  ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   y w/bx.
45307...........  Proctosigmoidoscop  ...............  ...............  ...............      20.4902      $813.22      $573.11      $162.64      $114.62
                   y fb.
45308...........  Proctosigmoidoscop  ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   y removal.

[[Page 49913]]

 
45309...........  Proctosigmoidoscop  ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   y removal.
45315...........  Proctosigmoidoscop  ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   y removal.
45317...........  Proctosigmoidoscop  ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   y bleed.
45320...........  Proctosigmoidoscop  ...............  ...............  ...............      20.4902      $813.22      $573.11      $162.64      $114.62
                   y ablate.
45321...........  Proctosigmoidoscop  ...............  ...............  ...............      20.4902      $813.22      $573.11      $162.64      $114.62
                   y volvul.
45327...........  Proctosigmoidoscop  ...............  ...............  ...............      22.6777      $900.03      $616.52      $180.01      $123.30
                   y w/stent.
45330...........  Diagnostic          Y..............  Y..............  Y..............       2.0624       $81.85       $81.85       $16.37       $16.37
                   sigmoidoscopy.
45331...........  Sigmoidoscopy and   ...............  ...............  ...............       4.8005      $190.52      $243.00       $38.10       $48.60
                   biopsy.
45332...........  Sigmoidoscopy w/fb  ...............  ...............  ...............       4.8005      $190.52      $243.00       $38.10       $48.60
                   removal.
45333...........  Sigmoidoscopy &     ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   polypectomy.
45334...........  Sigmoidoscopy for   ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   bleeding.
45335...........  Sigmoidoscopy w/    ...............  ...............  ...............       4.8005      $190.52      $243.00       $38.10       $48.60
                   submuc inj.
45337...........  Sigmoidoscopy &     ...............  ...............  ...............       4.8005      $190.52      $243.00       $38.10       $48.60
                   decompress.
45338...........  Sigmoidoscopy w/    ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   tumr remove.
45339...........  Sigmoidoscopy w/    ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   ablate tumr.
45340...........  Sig w/balloon       ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   dilation.
45341...........  Sigmoidoscopy w/    ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   ultrasound.
45342...........  Sigmoidoscopy w/us  ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   guide bx.
45345...........  Sigmoidoscopy w/    ...............  ...............  ...............      22.6777      $900.03      $616.52      $180.01      $123.30
                   stent.
45355...........  Surgical            ...............  ...............  ...............       8.8143      $349.82      $341.41       $69.96       $68.28
                   colonoscopy.
45378...........  Diagnostic          ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   colonoscopy.
45379...........  Colonoscopy w/fb    ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   removal.
45380...........  Colonoscopy and     ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   biopsy.
45381...........  Colonoscopy,        ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   submucous inj.
45382...........  Colonoscopy/        ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   control bleeding.
45383...........  Lesion removal      ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   colonoscopy.
45384...........  Lesion remove       ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   colonoscopy.
45385...........  Lesion removal      ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   colonoscopy.
45386...........  Colonoscopy dilate  ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   stricture.
45387...........  Colonoscopy w/      ...............  ...............  ...............      22.6777      $900.03      $616.52      $180.01      $123.30
                   stent.

[[Page 49914]]

 
45391...........  Colonoscopy w/      ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   endoscope us.
45392...........  Colonoscopy w/      ...............  ...............  ...............       8.8143      $349.82      $397.91       $69.96       $79.58
                   endoscopic fnb.
45500...........  Repair of rectum..  ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
45505...........  Repair of rectum..  ...............  ...............  ...............      29.4386    $1,168.36      $807.18      $233.67      $161.44
45520...........  Treatment of        Y..............  Y..............  ...............       1.1035       $43.80       $43.80        $8.76        $8.76
                   rectal prolapse.
45560...........  Repair of           ...............  ...............  ...............      29.4386    $1,168.36      $807.18      $233.67      $161.44
                   rectocele.
45900...........  Reduction of        ...............  ...............  ...............       4.8970      $194.35      $247.89       $38.87       $49.58
                   rectal prolapse.
45905...........  Dilation of anal    ...............  ...............  ...............      22.2336      $882.41      $607.70      $176.48      $121.54
                   sphincter.
45910...........  Dilation of rectal  ...............  ...............  ...............      22.2336      $882.41      $607.70      $176.48      $121.54
                   narrowing.
45915...........  Remove rectal       ...............  ...............  ...............       4.8970      $194.35      $247.89       $38.87       $49.58
                   obstruction.
45990...........  Surg dx exam,       ...............  ...............  ...............       4.8970      $194.35      $247.89       $38.87       $49.58
                   anorectal.
46020...........  Placement of seton  ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
46030...........  Removal of rectal   ...............  ...............  ...............       4.8970      $194.35      $247.89       $38.87       $49.58
                   marker.
46040...........  Incision of rectal  ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
                   abscess.
46045...........  Incision of rectal  ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   abscess.
46050...........  Incision of anal    ...............  ...............  ...............       4.8970      $194.35      $247.89       $38.87       $49.58
                   abscess.
46060...........  Incision of rectal  ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   abscess.
46070...........  Incision of anal    Y..............  ...............  ...............      12.8778      $511.10      $511.10      $102.22      $102.22
                   septum.
46080...........  Incision of anal    ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
                   sphincter.
46083...........  Incise external     Y..............  Y..............  Y..............       2.0708       $82.18       $82.18       $16.44       $16.44
                   hemorrhoid.
46200...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   fissure.
46210...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   crypt.
46211...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   crypts.
46220...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $607.70      $176.48      $121.54
                   tag.
46221...........  Ligation of         Y..............  Y..............  Y..............       2.7306      $108.37      $108.37       $21.67       $21.67
                   hemorrhoid(s).
46230...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $607.70      $176.48      $121.54
                   tags.
46250...........  Hemorrhoidectomy..  ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
46255...........  Hemorrhoidectomy..  ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
46257...........  Remove hemorrhoids  ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
                   & fissure.
46258...........  Remove hemorrhoids  ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
                   & fistula.
46260...........  Hemorrhoidectomy..  ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24

[[Page 49915]]

 
46261...........  Remove hemorrhoids  ...............  ...............  ...............      22.2336      $882.41      $756.20      $176.48      $151.24
                   & fissure.
46262...........  Remove hemorrhoids  ...............  ...............  ...............      22.2336      $882.41      $756.20      $176.48      $151.24
                   & fistula.
46270...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
                   fistula.
46275...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
                   fistula.
46280...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $756.20      $176.48      $151.24
                   fistula.
46285...........  Removal of anal     ...............  ...............  ...............      22.2336      $882.41      $607.70      $176.48      $121.54
                   fistula.
46288...........  Repair anal         ...............  ...............  ...............      22.2336      $882.41      $756.20      $176.48      $151.24
                   fistula.
46320...........  Removal of          Y..............  Y..............  Y..............       1.9331       $76.72       $76.72       $15.34       $15.34
                   hemorrhoid clot.
46500...........  Injection into      Y..............  Y..............  Y..............       2.4529       $97.35       $97.35       $19.47       $19.47
                   hemorrhoid(s).
46505...........  Chemodenervation    Y..............  ...............  ...............       4.8970      $194.35      $194.35       $38.87       $38.87
                   anal musc.
46600...........  Diagnostic          Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   anoscopy.
46604...........  Anoscopy and        Y..............  Y..............  ...............       8.5644      $339.90      $339.90       $67.98       $67.98
                   dilation.
46606...........  Anoscopy and        Y..............  Y..............  Y..............       3.3278      $132.07      $132.07       $26.41       $26.41
                   biopsy.
46608...........  Anoscopy, remove    ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
                   for body.
46610...........  Anoscopy, remove    ...............  ...............  ...............      20.4902      $813.22      $573.11      $162.64      $114.62
                   lesion.
46611...........  Anoscopy..........  ...............  ...............  ...............       8.5644      $339.90      $336.45       $67.98       $67.29
46612...........  Anoscopy, remove    ...............  ...............  ...............      20.4902      $813.22      $573.11      $162.64      $114.62
                   lesions.
46614...........  Anoscopy, control   Y..............  Y..............  Y..............       2.1904       $86.93       $86.93       $17.39       $17.39
                   bleeding.
46615...........  Anoscopy..........  ...............  ...............  ...............      20.4902      $813.22      $629.61      $162.64      $125.92
46700...........  Repair of anal      ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
                   stricture.
46706...........  Repr of anal        ...............  ...............  ...............      29.4386    $1,168.36      $750.68      $233.67      $150.14
                   fistula w/glue.
46750...........  Repair of anal      ...............  ...............  ...............      37.2425    $1,478.08      $994.04      $295.62      $198.81
                   sphincter.
46753...........  Reconstruction of   ...............  ...............  ...............      22.2336      $882.41      $696.20      $176.48      $139.24
                   anus.
46754...........  Removal of suture   ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   from anus.
46760...........  Repair of anal      ...............  ...............  ...............      37.2425    $1,478.08      $962.04      $295.62      $192.41
                   sphincter.
46761...........  Repair of anal      ...............  ...............  ...............      37.2425    $1,478.08      $994.04      $295.62      $198.81
                   sphincter.
46762...........  Implant artificial  ...............  ...............  ...............      37.2425    $1,478.08    $1,236.54      $295.62      $247.31
                   sphincter.
46900...........  Destruction, anal   Y..............  Y..............  ...............       2.6253      $104.19      $104.19       $20.84       $20.84
                   lesion(s).
46910...........  Destruction, anal   Y..............  Y..............  Y..............       2.9131      $115.62      $115.62       $23.12       $23.12
                   lesion(s).
46916...........  Cryosurgery, anal   Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
                   lesion(s).
46917...........  Laser surgery,      ...............  ...............  ...............      20.5802      $816.79      $574.89      $163.36      $114.98
                   anal lesions.
46922...........  Excision of anal    ...............  ...............  ...............      20.5802      $816.79      $574.89      $163.36      $114.98
                   lesion(s).

[[Page 49916]]

 
46924...........  Destruction, anal   ...............  ...............  ...............      20.5802      $816.79      $574.89      $163.36      $114.98
                   lesion(s).
46934...........  Destruction of      Y..............  Y..............  Y..............       4.4793      $177.78      $177.78       $35.56       $35.56
                   hemorrhoids.
46935...........  Destruction of      Y..............  Y..............  Y..............       3.0462      $120.90      $120.90       $24.18       $24.18
                   hemorrhoids.
46936...........  Destruction of      Y..............  Y..............  Y..............       4.7722      $189.40      $189.40       $37.88       $37.88
                   hemorrhoids.
46937...........  Cryotherapy of      ...............  ...............  ...............      22.2336      $882.41      $664.20      $176.48      $132.84
                   rectal lesion.
46938...........  Cryotherapy of      ...............  ...............  ...............      29.4386    $1,168.36      $807.18      $233.67      $161.44
                   rectal lesion.
46940...........  Treatment of anal   Y..............  Y..............  Y..............       2.0705       $82.17       $82.17       $16.43       $16.43
                   fissure.
46942...........  Treatment of anal   Y..............  Y..............  Y..............       1.9967       $79.25       $79.25       $15.85       $15.85
                   fissure.
46945...........  Ligation of         Y..............  Y..............  Y..............       3.4793      $138.09      $138.09       $27.62       $27.62
                   hemorrhoids.
46946...........  Ligation of         Y..............  Y..............  Y..............       3.6051      $143.08      $143.08       $28.62       $28.62
                   hemorrhoids.
46947...........  Hemorrhoidopexy by  ...............  ...............  ...............      29.4386    $1,168.36      $839.18      $233.67      $167.84
                   stapling.
47000...........  Needle biopsy of    ...............  ...............  ...............       6.0729      $241.02      $287.01       $48.20       $57.40
                   liver.
47382...........  Percut ablate       Y..............  ...............  ...............      39.0235    $1,548.77    $1,548.77      $309.75      $309.75
                   liver rf.
47510...........  Insert catheter,    ...............  ...............  ...............      19.4515      $771.99      $609.00      $154.40      $121.80
                   bile duct.
47511...........  Insert bile duct    ...............  ...............  ...............      19.4515      $771.99      $984.63      $154.40      $196.93
                   drain.
47525...........  Change bile duct    ...............  ...............  ...............      11.5220      $457.29      $395.14       $91.46       $79.03
                   catheter.
47530...........  Revise/reinsert     ...............  ...............  ...............      11.5220      $457.29      $395.14       $91.46       $79.03
                   bile tube.
47552...........  Biliary endoscopy   ...............  ...............  ...............      19.4515      $771.99      $609.00      $154.40      $121.80
                   thru skin.
47553...........  Biliary endoscopy   ...............  ...............  ...............      19.4515      $771.99      $641.00      $154.40      $128.20
                   thru skin.
47554...........  Biliary endoscopy   ...............  ...............  ...............      19.4515      $771.99      $641.00      $154.40      $128.20
                   thru skin.
47555...........  Biliary endoscopy   ...............  ...............  ...............      19.4515      $771.99      $641.00      $154.40      $128.20
                   thru skin.
47556...........  Biliary endoscopy   ...............  ...............  ...............      19.4515      $771.99      $984.63      $154.40      $196.93
                   thru skin.
47560...........  Laparoscopy w/      ...............  ...............  ...............      31.9353    $1,267.45      $888.73      $253.49      $177.75
                   cholangio.
47561...........  Laparo w/cholangio/ ...............  ...............  ...............      31.9353    $1,267.45      $888.73      $253.49      $177.75
                   biopsy.
47562...........  Laparoscopic        Y..............  ...............  ...............      43.5124    $1,726.92    $1,726.92      $345.38      $345.38
                   cholecystectomy.
47563...........  Laparo              Y..............  ...............  ...............      43.5124    $1,726.92    $1,726.92      $345.38      $345.38
                   cholecystectomy/
                   graph.
47630...........  Remove bile duct    ...............  ...............  ...............      19.4515      $771.99      $641.00      $154.40      $128.20
                   stone.
48102...........  Needle biopsy,      ...............  ...............  ...............       6.0729      $241.02      $287.01       $48.20       $57.40
                   pancreas.
49080...........  Puncture,           ...............  ...............  ...............       3.6425      $144.56      $184.38       $28.91       $36.88
                   peritoneal cavity.
49081...........  Removal of          ...............  ...............  ...............       3.6425      $144.56      $184.38       $28.91       $36.88
                   abdominal fluid.
49085...........  Remove abdomen      ...............  ...............  ...............      22.1758      $880.12      $663.06      $176.02      $132.61
                   foreign body.
49180...........  Biopsy, abdominal   ...............  ...............  ...............       6.0729      $241.02      $287.01       $48.20       $57.40
                   mass.

[[Page 49917]]

 
49250...........  Excision of         ...............  ...............  ...............      22.1758      $880.12      $755.06      $176.02      $151.01
                   umbilicus.
49320...........  Diag laparo         ...............  ...............  ...............      31.9353    $1,267.45      $888.73      $253.49      $177.75
                   separate proc.
49321...........  Laparoscopy,        ...............  ...............  ...............      31.9353    $1,267.45      $948.73      $253.49      $189.75
                   biopsy.
49322...........  Laparoscopy,        ...............  ...............  ...............      31.9353    $1,267.45      $948.73      $253.49      $189.75
                   aspiration.
49419...........  Insrt abdom cath    ...............  ...............  ...............      29.4757    $1,169.83      $751.42      $233.97      $150.28
                   for chemotx.
49420...........  Insert abdom        ...............  ...............  ...............      29.2259    $1,159.92      $746.46      $231.98      $149.29
                   drain, temp.
49421...........  Insert abdom        ...............  ...............  ...............      29.2259    $1,159.92      $746.46      $231.98      $149.29
                   drain, perm.
49422...........  Remove perm         ...............  ...............  ...............      23.4666      $931.34      $632.17      $186.27      $126.43
                   cannula/catheter.
49423...........  Exchange drainage   Y..............  ...............  ...............      11.5220      $457.29      $457.29       $91.46       $91.46
                   catheter.
49426...........  Revise abdomen-     ...............  ...............  ...............      22.1758      $880.12      $663.06      $176.02      $132.61
                   venous shunt.
49429...........  Removal of shunt..  Y..............  ...............  ...............      23.4666      $931.34      $931.34      $186.27      $186.27
49495...........  Rpr ing hernia      ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   baby, reduc.
49496...........  Rpr ing hernia      ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   baby, blocked.
49500...........  Rpr ing hernia,     ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   init, reduce.
49501...........  Rpr ing hernia,     ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   init blocked.
49505...........  Prp i/hern init     ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   reduc >5 yr.
49507...........  Prp i/hern init     ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   block >5 yr.
49520...........  Rerepair ing        ...............  ...............  ...............      29.1491    $1,156.87    $1,075.94      $231.37      $215.19
                   hernia, reduce.
49521...........  Rerepair ing        ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   hernia, blocked.
49525...........  Repair ing hernia,  ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   sliding.
49540...........  Repair lumbar       ...............  ...............  ...............      29.1491    $1,156.87      $801.44      $231.37      $160.29
                   hernia.
49550...........  Rpr rem hernia,     ...............  ...............  ...............      29.1491    $1,156.87      $936.94      $231.37      $187.39
                   init, reduce.
49553...........  Rpr fem hernia,     ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   init blocked.
49555...........  Rerepair fem        ...............  ...............  ...............      29.1491    $1,156.87      $936.94      $231.37      $187.39
                   hernia, reduce.
49557...........  Rerepair fem        ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   hernia, blocked.
49560...........  Rpr ventral hern    ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   init, reduc.
49561...........  Rpr ventral hern    ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   init, block.
49565...........  Rerepair ventrl     ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   hern, reduce.
49566...........  Rerepair ventrl     ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   hern, block.
49568...........  Hernia repair w/    ...............  ...............  ...............      29.1491    $1,156.87    $1,075.94      $231.37      $215.19
                   mesh.

[[Page 49918]]

 
49570...........  Rpr epigastric      ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   hern, reduce.
49572...........  Rpr epigastric      ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   hern, blocked.
49580...........  Rpr umbil hern,     ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   reduc < 5 yr.
49582...........  Rpr umbil hern,     ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   block < 5 yr.
49585...........  Rpr umbil hern,     ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   reduc > 5 yr.
49587...........  Rpr umbil hern,     ...............  ...............  ...............      29.1491    $1,156.87    $1,247.94      $231.37      $249.59
                   block > 5 yr.
49590...........  Repair spigelian    ...............  ...............  ...............      29.1491    $1,156.87      $833.44      $231.37      $166.69
                   hernia.
49600...........  Repair umbilical    ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   lesion.
49650...........  Laparo hernia       ...............  ...............  ...............      43.5124    $1,726.92    $1,178.46      $345.38      $235.69
                   repair initial.
49651...........  Laparo hernia       ...............  ...............  ...............      43.5124    $1,726.92    $1,360.96      $345.38      $272.19
                   repair recur.
50200...........  Biopsy of kidney..  ...............  ...............  ...............       6.0729      $241.02      $287.01       $48.20       $57.40
50382...........  Change ureter       Y..............  ...............  ...............      19.2766      $765.05      $765.05      $153.01      $153.01
                   stent, percut.
50384...........  Remove ureter       Y..............  ...............  ...............      19.2766      $765.05      $765.05      $153.01      $153.01
                   stent, percut.
50387...........  Change ext/int      Y..............  ...............  ...............       7.2859      $289.16      $289.16       $57.83       $57.83
                   ureter stent.
50389...........  Remove renal tube   Y..............  ...............  ...............       3.5688      $141.64      $141.64       $28.33       $28.33
                   w/fluoro.
50390...........  Drainage of kidney  ...............  ...............  ...............       6.0729      $241.02      $287.01       $48.20       $57.40
                   lesion.
50391...........  Instll rx agnt      Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   into rnal tub.
50392...........  Insert kidney       ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   drain.
50393...........  Insert ureteral     ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   tube.
50395...........  Create passage to   ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   kidney.
50396...........  Measure kidney      ...............  ...............  ...............       2.1159       $83.98      $107.11       $16.80       $21.42
                   pressure.
50398...........  Change kidney tube  ...............  ...............  ...............       7.2859      $289.16      $311.08       $57.83       $62.22
50551...........  Kidney endoscopy..  ...............  ...............  ...............       6.7325      $267.20      $300.10       $53.44       $60.02
50553...........  Kidney endoscopy..  ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
50555...........  Kidney endoscopy &  ...............  ...............  ...............       6.7325      $267.20      $300.10       $53.44       $60.02
                   biopsy.
50557...........  Kidney endoscopy &  ...............  ...............  ...............      23.8562      $946.81      $639.90      $189.36      $127.98
                   treatment.
50561...........  Kidney endoscopy &  ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   treatment.
50562...........  Renal scope w/      Y..............  ...............  ...............       6.7325      $267.20      $267.20       $53.44       $53.44
                   tumor resect.
50570...........  Kidney endoscopy..  Y..............  ...............  ...............       6.7325      $267.20      $267.20       $53.44       $53.44
50572...........  Kidney endoscopy..  Y..............  ...............  ...............       6.7325      $267.20      $267.20       $53.44       $53.44
50574...........  Kidney endoscopy &  Y..............  ...............  ...............       6.7325      $267.20      $267.20       $53.44       $53.44
                   biopsy.
50575...........  Kidney endoscopy..  Y..............  ...............  ...............      35.1024    $1,393.15    $1,393.15      $278.63      $278.63
50576...........  Kidney endoscopy &  Y..............  ...............  ...............      19.2766      $765.05      $765.05      $153.01      $153.01
                   treatment.

[[Page 49919]]

 
50590...........  Fragmenting of      Y..............  ...............  ...............      44.1144    $1,750.82    $1,750.82      $350.16      $350.16
                   kidney stone.
50592...........  Perc rf ablate      Y..............  ...............  ...............      39.0235    $1,548.77    $1,548.77      $309.75      $309.75
                   renal tumor.
50686...........  Measure ureter      Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   pressure.
50688...........  Change of ureter    ...............  ...............  ...............       7.2859      $289.16      $311.08       $57.83       $62.22
                   tube/stent.
50947...........  Laparo new ureter/  ...............  ...............  ...............      43.5124    $1,726.92    $1,532.96      $345.38      $306.59
                   bladder.
50948...........  Laparo new ureter/  ...............  ...............  ...............      43.5124    $1,726.92    $1,532.96      $345.38      $306.59
                   bladder.
50951...........  Endoscopy of        ...............  ...............  ...............       6.7325      $267.20      $300.10       $53.44       $60.02
                   ureter.
50953...........  Endoscopy of        ...............  ...............  ...............       6.7325      $267.20      $300.10       $53.44       $60.02
                   ureter.
50955...........  Ureter endoscopy &  ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   biopsy.
50957...........  Ureter endoscopy &  ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   treatment.
50961...........  Ureter endoscopy &  ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   treatment.
50970...........  Ureter endoscopy..  ...............  ...............  ...............       6.7325      $267.20      $300.10       $53.44       $60.02
50972...........  Ureter endoscopy &  ...............  ...............  ...............       6.7325      $267.20      $300.10       $53.44       $60.02
                   catheter.
50974...........  Ureter endoscopy &  ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   biopsy.
50976...........  Ureter endoscopy &  ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   treatment.
50980...........  Ureter endoscopy &  ...............  ...............  ...............      19.2766      $765.05      $549.03      $153.01      $109.81
                   treatment.
51000...........  Drainage of         Y..............  Y..............  Y..............       1.2446       $49.40       $49.40        $9.88        $9.88
                   bladder.
51005...........  Drainage of         Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   bladder.
51010...........  Drainage of         ...............  ...............  ...............      18.2333      $723.64      $528.32      $144.73      $105.66
                   bladder.
51020...........  Incise & treat      ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   bladder.
51030...........  Incise & treat      ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   bladder.
51040...........  Incise & drain      ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   bladder.
51045...........  Incise bladder/     ...............  ...............  ...............       6.7325      $267.20      $340.80       $53.44       $68.16
                   drain ureter.
51050...........  Removal of bladder  ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   stone.
51065...........  Remove ureter       ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   calculus.
51080...........  Drainage of         ...............  ...............  ...............      17.4686      $693.30      $513.15      $138.66      $102.63
                   bladder abscess.
51500...........  Removal of bladder  ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   cyst.
51520...........  Removal of bladder  ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   lesion.
51700...........  Irrigation of       Y..............  Y..............  Y..............       1.3433       $53.31       $53.31       $10.66       $10.66
                   bladder.
51701...........  Insert bladder      Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   catheter.
51702...........  Insert temp         Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   bladder cath.

[[Page 49920]]

 
51703...........  Insert bladder      Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   cath, complex.
51705...........  Change of bladder   Y..............  Y..............  Y..............       1.8609       $73.85       $73.85       $14.77       $14.77
                   tube.
51710...........  Change of bladder   ...............  ...............  ...............       7.2859      $289.16      $311.08       $57.83       $62.22
                   tube.
51715...........  Endoscopic          ...............  ...............  ...............      28.5971    $1,134.96      $822.48      $226.99      $164.50
                   injection/implant.
51720...........  Treatment of        Y..............  Y..............  Y..............       1.4579       $57.86       $57.86       $11.57       $11.57
                   bladder lesion.
51725...........  Simple              Y..............  Y..............  ...............       2.1159       $83.98       $83.98       $16.80       $16.80
                   cystometrogram.
51726...........  Complex             ...............  ...............  ...............       3.5688      $141.64      $180.65       $28.33       $36.13
                   cystometrogram.
51736...........  Urine flow          Y..............  Y..............  Y..............       0.6370       $25.28       $25.28        $5.06        $5.06
                   measurement.
51741...........  Electro-            Y..............  Y..............  Y..............       0.8854       $35.14       $35.14        $7.03        $7.03
                   uroflowmetry,
                   first.
51772...........  Urethra pressure    ...............  ...............  ...............       2.1159       $83.98      $107.11       $16.80       $21.42
                   profile.
51784...........  Anal/urinary        Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   muscle study.
51785...........  Anal/urinary        ...............  ...............  ...............       1.0844       $43.04       $54.89        $8.61       $10.98
                   muscle study.
51792...........  Urinary reflex      Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   study.
51795...........  Urine voiding       Y..............  Y..............  ...............       2.1159       $83.98       $83.98       $16.80       $16.80
                   pressure study.
51797...........  Intraabdominal      Y..............  Y..............  ...............       2.1159       $83.98       $83.98       $16.80       $16.80
                   pressure test.
51798...........  Us urine capacity   Y..............  Y..............  Y..............       0.4057       $16.10       $16.10        $3.22        $3.22
                   measure.
51880...........  Repair of bladder   ...............  ...............  ...............      23.8562      $946.81      $639.90      $189.36      $127.98
                   opening.
51992...........  Laparo sling        ...............  ...............  ...............      43.5124    $1,726.92    $1,221.96      $345.38      $244.39
                   operation.
52000...........  Cystoscopy........  ...............  ...............  ...............       6.7325      $267.20      $300.10       $53.44       $60.02
52001...........  Cystoscopy,         ...............  ...............  ...............       6.7325      $267.20      $340.80       $53.44       $68.16
                   removal of clots.
52005...........  Cystoscopy &        ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   ureter catheter.
52007...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   biopsy.
52010...........  Cystoscopy & duct   ...............  ...............  ...............       6.7325      $267.20      $340.80       $53.44       $68.16
                   catheter.
52204...........  Cystoscopy........  ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
52214...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   treatment.
52224...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   treatment.
52234...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   treatment.
52235...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   treatment.
52240...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   treatment.
52250...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   radiotracer.
52260...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   treatment.
52265...........  Cystoscopy and      Y..............  Y..............  ...............       6.7325      $267.20      $267.20       $53.44       $53.44
                   treatment.

[[Page 49921]]

 
52270...........  Cystoscopy &        ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   revise urethra.
52275...........  Cystoscopy &        ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   revise urethra.
52276...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $637.53      $153.01      $127.51
                   treatment.
52277...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   treatment.
52281...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   treatment.
52282...........  Cystoscopy,         ...............  ...............  ...............      35.1024    $1,393.15    $1,366.07      $278.63      $273.21
                   implant stent.
52283...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   treatment.
52285...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   treatment.
52290...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   treatment.
52300...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   treatment.
52301...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $637.53      $153.01      $127.51
                   treatment.
52305...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   treatment.
52310...........  Cystoscopy and      ...............  ...............  ...............       6.7325      $267.20      $340.80       $53.44       $68.16
                   treatment.
52315...........  Cystoscopy and      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   treatment.
52317...........  Remove bladder      ...............  ...............  ...............      23.8562      $946.81      $639.90      $189.36      $127.98
                   stone.
52318...........  Remove bladder      ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   stone.
52320...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $831.90      $189.36      $166.38
                   treatment.
52325...........  Cystoscopy, stone   ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   removal.
52327...........  Cystoscopy, inject  ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   material.
52330...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   treatment.
52332...........  Cystoscopy and      ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   treatment.
52334...........  Create passage to   ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   kidney.
52341...........  Cysto w/ureter      ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   stricture tx.
52342...........  Cysto w/up          ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   stricture tx.
52343...........  Cysto w/renal       ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   stricture tx.
52344...........  Cysto/uretero,      ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   stricture tx.
52345...........  Cysto/uretero w/up  ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   stricture.
52346...........  Cystouretero w/     ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   renal strict.
52351...........  Cystouretero & or   ...............  ...............  ...............      19.2766      $765.05      $637.53      $153.01      $127.51
                   pyeloscope.
52352...........  Cystouretero w/     ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   stone remove.
52353...........  Cystouretero w/     ...............  ...............  ...............      35.1024    $1,393.15    $1,011.57      $278.63      $202.31
                   lithotripsy.
52354...........  Cystouretero w/     ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   biopsy.
52355...........  Cystouretero w/     ...............  ...............  ...............      23.8562      $946.81      $788.40      $189.36      $157.68
                   excise tumor.
52400...........  Cystouretero w/     ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   congen repr.

[[Page 49922]]

 
52402...........  Cystourethro cut    ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   ejacul duct.
52450...........  Incision of         ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   prostate.
52500...........  Revision of         ...............  ...............  ...............      23.8562      $946.81      $728.40      $189.36      $145.68
                   bladder neck.
52510...........  Dilation prostatic  ...............  ...............  ...............      19.2766      $765.05      $637.53      $153.01      $127.51
                   urethra.
52601...........  Prostatectomy       ...............  ...............  ...............      35.1024    $1,393.15    $1,011.57      $278.63      $202.31
                   (turp).
52606...........  Control postop      ...............  ...............  ...............      23.8562      $946.81      $639.90      $189.36      $127.98
                   bleeding.
52612...........  Prostatectomy,      ...............  ...............  ...............      35.1024    $1,393.15      $919.57      $278.63      $183.91
                   first stage.
52614...........  Prostatectomy,      ...............  ...............  ...............      35.1024    $1,393.15      $863.07      $278.63      $172.61
                   second stage.
52620...........  Remove residual     ...............  ...............  ...............      35.1024    $1,393.15      $863.07      $278.63      $172.61
                   prostate.
52630...........  Remove prostate     ...............  ...............  ...............      35.1024    $1,393.15      $919.57      $278.63      $183.91
                   regrowth.
52640...........  Relieve bladder     ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   contracture.
52647...........  Laser surgery of    ...............  ...............  ...............      42.9327    $1,703.92    $1,521.46      $340.78      $304.29
                   prostate.
52648...........  Laser surgery of    ...............  ...............  ...............      42.9327    $1,703.92    $1,521.46      $340.78      $304.29
                   prostate.
52700...........  Drainage of         ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   prostate abscess.
53000...........  Incision of         ...............  ...............  ...............      18.5138      $734.78      $533.89      $146.96      $106.78
                   urethra.
53010...........  Incision of         ...............  ...............  ...............      18.5138      $734.78      $533.89      $146.96      $106.78
                   urethra.
53020...........  Incision of         ...............  ...............  ...............      18.5138      $734.78      $533.89      $146.96      $106.78
                   urethra.
53025...........  Incision of         Y..............  Y..............  Y..............       0.3551       $14.09       $14.09        $2.82        $2.82
                   urethra.
53040...........  Drainage of         ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   urethra abscess.
53060...........  Drainage of         Y..............  Y..............  Y..............       1.7500       $69.45       $69.45       $13.89       $13.89
                   urethra abscess.
53080...........  Drainage of         ...............  ...............  ...............      18.5138      $734.78      $622.39      $146.96      $124.48
                   urinary leakage.
53085...........  Drainage of         Y..............  ...............  ...............      18.5138      $734.78      $734.78      $146.96      $146.96
                   urinary leakage.
53200...........  Biopsy of urethra.  ...............  ...............  ...............      18.5138      $734.78      $533.89      $146.96      $106.78
53210...........  Removal of urethra  ...............  ...............  ...............      28.5971    $1,134.96      $925.98      $226.99      $185.20
53215...........  Removal of urethra  ...............  ...............  ...............      18.5138      $734.78      $725.89      $146.96      $145.18
53220...........  Treatment of        ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   urethra lesion.
53230...........  Removal of urethra  ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   lesion.
53235...........  Removal of urethra  ...............  ...............  ...............      18.5138      $734.78      $622.39      $146.96      $124.48
                   lesion.
53240...........  Surgery for         ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   urethra pouch.
53250...........  Removal of urethra  ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   gland.
53260...........  Treatment of        ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   urethra lesion.
53265...........  Treatment of        ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   urethra lesion.
53270...........  Removal of urethra  ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   gland.

[[Page 49923]]

 
53275...........  Repair of urethra   ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   defect.
53400...........  Revise urethra,     ...............  ...............  ...............      28.5971    $1,134.96      $822.48      $226.99      $164.50
                   stage 1.
53405...........  Revise urethra,     ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   stage 2.
53410...........  Reconstruction of   ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   urethra.
53420...........  Reconstruct         ...............  ...............  ...............      28.5971    $1,134.96      $822.48      $226.99      $164.50
                   urethra, stage 1.
53425...........  Reconstruct         ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   urethra, stage 2.
53430...........  Reconstruction of   ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   urethra.
53431...........  Reconstruct         ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   urethra/bladder.
53440...........  Male sling          ...............  ...............  ...............      79.3730    $3,150.16    $1,798.08      $630.03      $359.62
                   procedure.
53442...........  Remove/revise male  ...............  ...............  ...............      28.5971    $1,134.96      $733.98      $226.99      $146.80
                   sling.
53444...........  Insert tandem cuff  ...............  ...............  ...............      79.3730    $3,150.16    $1,798.08      $630.03      $359.62
53445...........  Insert uro/ves nck  ...............  ...............  ...............     135.7295    $5,386.84    $2,859.92    $1,077.37      $571.98
                   sphincter.
53446...........  Remove uro          ...............  ...............  ...............      28.5971    $1,134.96      $733.98      $226.99      $146.80
                   sphincter.
53447...........  Remove/replace ur   ...............  ...............  ...............     135.7295    $5,386.84    $2,859.92    $1,077.37      $571.98
                   sphincter.
53449...........  Repair uro          ...............  ...............  ...............      28.5971    $1,134.96      $733.98      $226.99      $146.80
                   sphincter.
53450...........  Revision of         ...............  ...............  ...............      28.5971    $1,134.96      $733.98      $226.99      $146.80
                   urethra.
53460...........  Revision of         ...............  ...............  ...............      18.5138      $734.78      $533.89      $146.96      $106.78
                   urethra.
53502...........  Repair of urethra   ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   injury.
53505...........  Repair of urethra   ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   injury.
53510...........  Repair of urethra   ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   injury.
53515...........  Repair of urethra   ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   injury.
53520...........  Repair of urethra   ...............  ...............  ...............      28.5971    $1,134.96      $790.48      $226.99      $158.10
                   defect.
53600...........  Dilate urethra      Y..............  Y..............  Y..............       0.9900       $39.29       $39.29        $7.86        $7.86
                   stricture.
53601...........  Dilate urethra      Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   stricture.
53605...........  Dilate urethra      ...............  ...............  ...............      19.2766      $765.05      $605.53      $153.01      $121.11
                   stricture.
53620...........  Dilate urethra      Y..............  Y..............  Y..............       1.6003       $63.51       $63.51       $12.70       $12.70
                   stricture.
53621...........  Dilate urethra      Y..............  Y..............  Y..............       1.6839       $66.83       $66.83       $13.37       $13.37
                   stricture.
53660...........  Dilation of         Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   urethra.
53661...........  Dilation of         Y..............  Y..............  ...............       1.0844       $43.04       $43.04        $8.61        $8.61
                   urethra.
53665...........  Dilation of         ...............  ...............  ...............      18.5138      $734.78      $533.89      $146.96      $106.78
                   urethra.
53850...........  Prostatic           Y..............  Y..............  ...............      42.3176    $1,679.50    $1,679.50      $335.90      $335.90
                   microwave
                   thermotx.
53852...........  Prostatic rf        Y..............  Y..............  ...............      42.3176    $1,679.50    $1,679.50      $335.90      $335.90
                   thermotx.

[[Page 49924]]

 
53853...........  Prostatic water     Y..............  Y..............  ...............      23.8562      $946.81      $946.81      $189.36      $189.36
                   thermother.
54000...........  Slitting of         ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   prepuce.
54001...........  Slitting of         ...............  ...............  ...............      18.5138      $734.78      $590.39      $146.96      $118.08
                   prepuce.
54015...........  Drain penis lesion  ...............  ...............  ...............      17.4686      $693.30      $661.65      $138.66      $132.33
54050...........  Destruction, penis  Y..............  Y..............  ...............       1.0876       $43.16       $43.16        $8.63        $8.63
                   lesion(s).
54055...........  Destruction, penis  Y..............  Y..............  Y..............       1.5372       $61.01       $61.01       $12.20       $12.20
                   lesion(s).
54056...........  Cryosurgery, penis  Y..............  Y..............  ...............       0.8076       $32.05       $32.05        $6.41        $6.41
                   lesion(s).
54057...........  Laser surg, penis   ...............  ...............  ...............      17.7392      $704.03      $518.52      $140.81      $103.70
                   lesion(s).
54060...........  Excision of penis   ...............  ...............  ...............      17.7392      $704.03      $518.52      $140.81      $103.70
                   lesion(s).
54065...........  Destruction, penis  ...............  ...............  ...............      20.5802      $816.79      $574.89      $163.36      $114.98
                   lesion(s).
54100...........  Biopsy of penis...  ...............  ...............  ...............      14.9563      $593.59      $463.29      $118.72       $92.66
54105...........  Biopsy of penis...  ...............  ...............  ...............      19.9760      $792.81      $562.90      $158.56      $112.58
54110...........  Treatment of penis  ...............  ...............  ...............      32.9991    $1,309.67      $877.84      $261.93      $175.57
                   lesion.
54111...........  Treat penis         ...............  ...............  ...............      32.9991    $1,309.67      $877.84      $261.93      $175.57
                   lesion, graft.
54112...........  Treat penis         ...............  ...............  ...............      32.9991    $1,309.67      $877.84      $261.93      $175.57
                   lesion, graft.
54115...........  Treatment of penis  ...............  ...............  ...............      17.4686      $693.30      $513.15      $138.66      $102.63
                   lesion.
54120...........  Partial removal of  ...............  ...............  ...............      32.9991    $1,309.67      $877.84      $261.93      $175.57
                   penis.
54150...........  Circumcision......  ...............  ...............  ...............      20.7418      $823.20      $578.10      $164.64      $115.62
54152...........  Circumcision......  ...............  ...............  ...............      20.7418      $823.20      $578.10      $164.64      $115.62
54160...........  Circumcision......  ...............  ...............  ...............      20.7418      $823.20      $634.60      $164.64      $126.92
54161...........  Circumcision......  ...............  ...............  ...............      20.7418      $823.20      $634.60      $164.64      $126.92
54162...........  Lysis penil         ...............  ...............  ...............      20.7418      $823.20      $634.60      $164.64      $126.92
                   circumic lesion.
54163...........  Repair of           ...............  ...............  ...............      20.7418      $823.20      $634.60      $164.64      $126.92
                   circumcision.
54164...........  Frenulotomy of      ...............  ...............  ...............      20.7418      $823.20      $634.60      $164.64      $126.92
                   penis.
54200...........  Treatment of penis  Y..............  Y..............  Y..............       1.6501       $65.49       $65.49       $13.10       $13.10
                   lesion.
54205...........  Treatment of penis  ...............  ...............  ...............      32.9991    $1,309.67      $969.84      $261.93      $193.97
                   lesion.
54220...........  Treatment of penis  ...............  ...............  ...............       2.1159       $83.98      $107.11       $16.80       $21.42
                   lesion.
54231...........  Dynamic             Y..............  Y..............  Y..............       1.3889       $55.12       $55.12       $11.02       $11.02
                   cavernosometry.
54235...........  Penile injection..  Y..............  Y..............  Y..............       1.0170       $40.36       $40.36        $8.07        $8.07
54240...........  Penis study.......  Y..............  Y..............  Y..............       1.0844       $43.04       $43.04        $8.61        $8.61
54250...........  Penis study.......  Y..............  Y..............  Y..............       0.9079       $36.03       $36.03        $7.21        $7.21
54300...........  Revision of penis.  ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
54304...........  Revision of penis.  ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
54308...........  Reconstruction of   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra.

[[Page 49925]]

 
54312...........  Reconstruction of   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra.
54316...........  Reconstruction of   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra.
54318...........  Reconstruction of   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra.
54322...........  Reconstruction of   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra.
54324...........  Reconstruction of   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra.
54326...........  Reconstruction of   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra.
54328...........  Revise penis/       ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra.
54340...........  Secondary urethral  ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   surgery.
54344...........  Secondary urethral  ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   surgery.
54348...........  Secondary urethral  ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   surgery.
54352...........  Reconstruct         ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   urethra/penis.
54360...........  Penis plastic       ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   surgery.
54380...........  Repair penis......  ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
54385...........  Repair penis......  ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
54400...........  Insert semi-rigid   ...............  ...............  ...............      79.3730    $3,150.16    $1,830.08      $630.03      $366.02
                   prosthesis.
54401...........  Insert self-contd   ...............  ...............  ...............     135.7295    $5,386.84    $2,948.42    $1,077.37      $589.68
                   prosthesis.
54405...........  Insert multi-comp   ...............  ...............  ...............     135.7295    $5,386.84    $2,948.42    $1,077.37      $589.68
                   penis pros.
54406...........  Remove muti-comp    ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   penis pros.
54408...........  Repair multi-comp   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   penis pros.
54410...........  Remove/replace      ...............  ...............  ...............     135.7295    $5,386.84    $2,948.42    $1,077.37      $589.68
                   penis prosth.
54415...........  Remove self-contd   ...............  ...............  ...............      32.9991    $1,309.67      $909.84      $261.93      $181.97
                   penis pros.
54416...........  Remv/repl penis     ...............  ...............  ...............     135.7295    $5,386.84    $2,948.42    $1,077.37      $589.68
                   contain pros.
54420...........  Revision of penis.  ...............  ...............  ...............      32.9991    $1,309.67      $969.84      $261.93      $193.97
54435...........  Revision of penis.  ...............  ...............  ...............      32.9991    $1,309.67      $969.84      $261.93      $193.97
54440...........  Repair of penis...  ...............  ...............  ...............      32.9991    $1,309.67      $969.84      $261.93      $193.97
54450...........  Preputial           ...............  ...............  ...............       3.5688      $141.64      $180.65       $28.33       $36.13
                   stretching.
54500...........  Biopsy of testis..  ...............  ...............  ...............      10.2616      $407.26      $370.13       $81.45       $74.03
54505...........  Biopsy of testis..  ...............  ...............  ...............      23.7072      $940.89      $636.95      $188.18      $127.39
54512...........  Excise lesion       ...............  ...............  ...............      23.7072      $940.89      $693.45      $188.18      $138.69
                   testis.
54520...........  Removal of testis.  ...............  ...............  ...............      23.7072      $940.89      $725.45      $188.18      $145.09
54522...........  Orchiectomy,        ...............  ...............  ...............      23.7072      $940.89      $725.45      $188.18      $145.09
                   partial.
54530...........  Removal of testis.  ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
54550...........  Exploration for     ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   testis.

[[Page 49926]]

 
54560...........  Exploration for     Y..............  ...............  ...............      23.7072      $940.89      $940.89      $188.18      $188.18
                   testis.
54600...........  Reduce testis       ...............  ...............  ...............      23.7072      $940.89      $785.45      $188.18      $157.09
                   torsion.
54620...........  Suspension of       ...............  ...............  ...............      23.7072      $940.89      $725.45      $188.18      $145.09
                   testis.
54640...........  Suspension of       ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   testis.
54660...........  Revision of testis  ...............  ...............  ...............      23.7072      $940.89      $693.45      $188.18      $138.69
54670...........  Repair testis       ...............  ...............  ...............      23.7072      $940.89      $725.45      $188.18      $145.09
                   injury.
54680...........  Relocation of       ...............  ...............  ...............      23.7072      $940.89      $725.45      $188.18      $145.09
                   testis(es).
54690...........  Laparoscopy,        ...............  ...............  ...............      43.5124    $1,726.92    $1,532.96      $345.38      $306.59
                   orchiectomy.
54700...........  Drainage of         ...............  ...............  ...............      23.7072      $940.89      $693.45      $188.18      $138.69
                   scrotum.
54800...........  Biopsy of           ...............  ...............  ...............       2.0863       $82.80      $105.61       $16.56       $21.12
                   epididymis.
54820...........  Exploration of      ...............  ...............  ...............      23.7072      $940.89      $636.95      $188.18      $127.39
                   epididymis.
54830...........  Remove epididymis   ...............  ...............  ...............      23.7072      $940.89      $725.45      $188.18      $145.09
                   lesion.
54840...........  Remove epididymis   ...............  ...............  ...............      23.7072      $940.89      $785.45      $188.18      $157.09
                   lesion.
54860...........  Removal of          ...............  ...............  ...............      23.7072      $940.89      $725.45      $188.18      $145.09
                   epididymis.
54861...........  Removal of          ...............  ...............  ...............      23.7072      $940.89      $785.45      $188.18      $157.09
                   epididymis.
54900...........  Fusion of           ...............  ...............  ...............      23.7072      $940.89      $785.45      $188.18      $157.09
                   spermatic ducts.
54901...........  Fusion of           ...............  ...............  ...............      23.7072      $940.89      $785.45      $188.18      $157.09
                   spermatic ducts.
55000...........  Drainage of         Y..............  Y..............  Y..............       1.6905       $67.09       $67.09       $13.42       $13.42
                   hydrocele.
55040...........  Removal of          ...............  ...............  ...............      29.1491    $1,156.87      $833.44      $231.37      $166.69
                   hydrocele.
55041...........  Removal of          ...............  ...............  ...............      29.1491    $1,156.87      $936.94      $231.37      $187.39
                   hydroceles.
55060...........  Repair of           ...............  ...............  ...............      23.7072      $940.89      $785.45      $188.18      $157.09
                   hydrocele.
55100...........  Drainage of         ...............  ...............  ...............      10.9184      $433.33      $383.17       $86.67       $76.63
                   scrotum abscess.
55110...........  Explore scrotum...  ...............  ...............  ...............      23.7072      $940.89      $693.45      $188.18      $138.69
55120...........  Removal of scrotum  ...............  ...............  ...............      23.7072      $940.89      $693.45      $188.18      $138.69
                   lesion.
55150...........  Removal of scrotum  ...............  ...............  ...............      23.7072      $940.89      $636.95      $188.18      $127.39
55175...........  Revision of         ...............  ...............  ...............      23.7072      $940.89      $636.95      $188.18      $127.39
                   scrotum.
55180...........  Revision of         ...............  ...............  ...............      23.7072      $940.89      $693.45      $188.18      $138.69
                   scrotum.
55200...........  Incision of sperm   ...............  ...............  ...............      23.7072      $940.89      $693.45      $188.18      $138.69
                   duct.
55250...........  Removal of sperm    ...............  ...............  ...............      23.7072      $940.89      $693.45      $188.18      $138.69
                   duct(s).
55400...........  Repair of sperm     ...............  ...............  ...............      23.7072      $940.89      $636.95      $188.18      $127.39
                   duct.
55450...........  Ligation of sperm   Y..............  Y..............  Y..............       5.6047      $222.44      $222.44       $44.49       $44.49
                   duct.
55500...........  Removal of          ...............  ...............  ...............      23.7072      $940.89      $725.45      $188.18      $145.09
                   hydrocele.
55520...........  Removal of sperm    ...............  ...............  ...............      23.7072      $940.89      $785.45      $188.18      $157.09
                   cord lesion.

[[Page 49927]]

 
55530...........  Revise spermatic    ...............  ...............  ...............      23.7072      $940.89      $785.45      $188.18      $157.09
                   cord veins.
55535...........  Revise spermatic    ...............  ...............  ...............      29.1491    $1,156.87      $893.44      $231.37      $178.69
                   cord veins.
55540...........  Revise hernia &     ...............  ...............  ...............      29.1491    $1,156.87      $936.94      $231.37      $187.39
                   sperm veins.
55550...........  Laparo ligate       ...............  ...............  ...............      43.5124    $1,726.92    $1,532.96      $345.38      $306.59
                   spermatic vein.
55559...........  Laparo proc,        Y..............  ...............  ...............      31.9353    $1,267.45    $1,267.45      $253.49      $253.49
                   spermatic cord.
55600...........  Incise sperm duct   Y..............  Y..............  Y..............       3.5462      $140.74      $140.74       $28.15       $28.15
                   pouch.
55680...........  Remove sperm pouch  ...............  ...............  ...............      23.7072      $940.89      $636.95      $188.18      $127.39
                   lesion.
55700...........  Biopsy of prostate  ...............  ...............  ...............       5.9892      $237.70      $303.17       $47.54       $60.63
55705...........  Biopsy of prostate  ...............  ...............  ...............       5.9892      $237.70      $303.17       $47.54       $60.63
55720...........  Drainage of         ...............  ...............  ...............      23.8562      $946.81      $639.90      $189.36      $127.98
                   prostate abscess.
55725...........  Drainage of         ...............  ...............  ...............      23.8562      $946.81      $696.40      $189.36      $139.28
                   prostate abscess.
55859...........  Percut/needle       ...............  ...............  ...............      35.1024    $1,393.15    $1,366.07      $278.63      $273.21
                   insert, pros.
55860...........  Surgical exposure,  Y..............  ...............  ...............      18.2333      $723.64      $723.64      $144.73      $144.73
                   prostate.
55870...........  Electroejaculation  Y..............  Y..............  Y..............       1.7213       $68.32       $68.32       $13.66       $13.66
55873...........  Cryoablate          ...............  ...............  ...............     107.8298    $4,279.56    $2,809.28      $855.91      $561.86
                   prostate.
56405...........  I & D of vulva/     Y..............  Y..............  Y..............       1.0685       $42.41       $42.41        $8.48        $8.48
                   perineum.
56420...........  Drainage of gland   Y..............  Y..............  ...............       1.4050       $55.76       $55.76       $11.15       $11.15
                   abscess.
56440...........  Surgery for vulva   ...............  ...............  ...............      20.5113      $814.05      $630.03      $162.81      $126.01
                   lesion.
56441...........  Lysis of labial     ...............  ...............  ...............      14.7958      $587.22      $460.11      $117.44       $92.02
                   lesion(s).
56501...........  Destroy, vulva      Y..............  Y..............  Y..............       1.4690       $58.30       $58.30       $11.66       $11.66
                   lesions, sim.
56515...........  Destroy vulva       ...............  ...............  ...............      20.5802      $816.79      $663.39      $163.36      $132.68
                   lesion/s compl.
56605...........  Biopsy of vulva/    Y..............  Y..............  Y..............       0.8450       $33.54       $33.54        $6.71        $6.71
                   perineum.
56606...........  Biopsy of vulva/    Y..............  Y..............  Y..............       0.3647       $14.47       $14.47        $2.89        $2.89
                   perineum.
56620...........  Partial removal of  ...............  ...............  ...............      28.7410    $1,140.68      $928.84      $228.14      $185.77
                   vulva.
56625...........  Complete removal    ...............  ...............  ...............      28.7410    $1,140.68    $1,067.84      $228.14      $213.57
                   of vulva.
56700...........  Partial removal of  ...............  ...............  ...............      20.5113      $814.05      $573.53      $162.81      $114.71
                   hymen.
56720...........  Incision of hymen.  ...............  ...............  ...............      14.7958      $587.22      $460.11      $117.44       $92.02
56740...........  Remove vagina       ...............  ...............  ...............      20.5113      $814.05      $662.03      $162.81      $132.41
                   gland lesion.
56800...........  Repair of vagina..  ...............  ...............  ...............      20.5113      $814.05      $662.03      $162.81      $132.41
56810...........  Repair of perineum  ...............  ...............  ...............      20.5113      $814.05      $765.53      $162.81      $153.11

[[Page 49928]]

 
56820...........  Exam of vulva w/    Y..............  Y..............  Y..............       1.0682       $42.39       $42.39        $8.48        $8.48
                   scope.
56821...........  Exam/biopsy of      Y..............  Y..............  Y..............       1.4089       $55.92       $55.92       $11.18       $11.18
                   vulva w/scope.
57000...........  Exploration of      ...............  ...............  ...............      14.7958      $587.22      $460.11      $117.44       $92.02
                   vagina.
57010...........  Drainage of pelvic  ...............  ...............  ...............      14.7958      $587.22      $516.61      $117.44      $103.32
                   abscess.
57020...........  Drainage of pelvic  ...............  ...............  ...............       6.9265      $274.90      $350.61       $54.98       $70.12
                   fluid.
57022...........  I & d vaginal       Y..............  ...............  ...............      10.9184      $433.33      $433.33       $86.67       $86.67
                   hematoma, pp.
57023...........  I& d vag hematoma,  ...............  ...............  ...............      17.4686      $693.30      $513.15      $138.66      $102.63
                   non-ob.
57061...........  Destroy vag         Y..............  Y..............  Y..............       1.3555       $53.80       $53.80       $10.76       $10.76
                   lesions, simple.
57065...........  Destroy vag         ...............  ...............  ...............      20.5113      $814.05      $573.53      $162.81      $114.71
                   lesions, complex.
57100...........  Biopsy of vagina..  Y..............  Y..............  Y..............       0.8573       $34.02       $34.02        $6.80        $6.80
57105...........  Biopsy of vagina..  ...............  ...............  ...............      20.5113      $814.05      $630.03      $162.81      $126.01
57130...........  Remove vagina       ...............  ...............  ...............      20.5113      $814.05      $630.03      $162.81      $126.01
                   lesion.
57135...........  Remove vagina       ...............  ...............  ...............      20.5113      $814.05      $630.03      $162.81      $126.01
                   lesion.
57150...........  Treat vagina        Y..............  Y..............  ...............       0.1501        $5.96        $5.96        $1.19        $1.19
                   infection.
57155...........  Insert uteri        ...............  ...............  ...............       6.9265      $274.90      $350.61       $54.98       $70.12
                   tandems/ovoids.
57160...........  Insert pessary/     Y..............  Y..............  Y..............       0.8815       $34.98       $34.98        $7.00        $7.00
                   other device.
57170...........  Fitting of          Y..............  Y..............  ...............       0.1501        $5.96        $5.96        $1.19        $1.19
                   diaphragm/cap.
57180...........  Treat vaginal       ...............  ...............  ...............       2.9902      $118.68      $151.36       $23.74       $30.27
                   bleeding.
57200...........  Repair of vagina..  ...............  ...............  ...............      20.5113      $814.05      $573.53      $162.81      $114.71
57210...........  Repair vagina/      ...............  ...............  ...............      20.5113      $814.05      $630.03      $162.81      $126.01
                   perineum.
57220...........  Revision of         ...............  ...............  ...............      42.8756    $1,701.65    $1,105.83      $340.33      $221.17
                   urethra.
57230...........  Repair of urethral  ...............  ...............  ...............      28.7410    $1,140.68      $825.34      $228.14      $165.07
                   lesion.
57240...........  Repair bladder &    ...............  ...............  ...............      28.7410    $1,140.68      $928.84      $228.14      $185.77
                   vagina.
57250...........  Repair rectum &     ...............  ...............  ...............      28.7410    $1,140.68      $928.84      $228.14      $185.77
                   vagina.
57260...........  Repair of vagina..  ...............  ...............  ...............      28.7410    $1,140.68      $928.84      $228.14      $185.77
57265...........  Extensive repair    ...............  ...............  ...............      42.8756    $1,701.65    $1,348.33      $340.33      $269.67
                   of vagina.
57268...........  Repair of bowel     ...............  ...............  ...............      28.7410    $1,140.68      $825.34      $228.14      $165.07
                   bulge.
57287...........  Revise/remove       Y..............  ...............  ...............      28.7410    $1,140.68    $1,140.68      $228.14      $228.14
                   sling repair.
57288...........  Repair bladder      ...............  ...............  ...............      42.8756    $1,701.65    $1,209.33      $340.33      $241.87
                   defect.
57289...........  Repair bladder &    ...............  ...............  ...............      28.7410    $1,140.68      $928.84      $228.14      $185.77
                   vagina.
57291...........  Construction of     ...............  ...............  ...............      28.7410    $1,140.68      $928.84      $228.14      $185.77
                   vagina.
57300...........  Repair rectum-      ...............  ...............  ...............      28.7410    $1,140.68      $825.34      $228.14      $165.07
                   vagina fistula.
57320...........  Repair bladder-     Y..............  ...............  ...............      28.7410    $1,140.68    $1,140.68      $228.14      $228.14
                   vagina lesion.

[[Page 49929]]

 
57400...........  Dilation of vagina  ...............  ...............  ...............      20.5113      $814.05      $630.03      $162.81      $126.01
57410...........  Pelvic examination  ...............  ...............  ...............      14.7958      $587.22      $516.61      $117.44      $103.32
57415...........  Remove vaginal      ...............  ...............  ...............      20.5113      $814.05      $630.03      $162.81      $126.01
                   foreign body.
57420...........  Exam of vagina w/   Y..............  Y..............  Y..............       1.1018       $43.73       $43.73        $8.75        $8.75
                   scope.
57421...........  Exam/biopsy of vag  Y..............  Y..............  Y..............       1.4710       $58.38       $58.38       $11.68       $11.68
                   w/scope.
57452...........  Examination of      Y..............  Y..............  Y..............       1.0518       $41.75       $41.75        $8.35        $8.35
                   vagina.
57454...........  Vagina examination  Y..............  Y..............  Y..............       1.2983       $51.53       $51.53       $10.31       $10.31
                   & biopsy.
57455...........  Biopsy of cervix w/ Y..............  Y..............  Y..............       1.3775       $54.67       $54.67       $10.93       $10.93
                   scope.
57456...........  Endocerv curettage  Y..............  Y..............  Y..............       1.3315       $52.85       $52.85       $10.57       $10.57
                   w/scope.
57460...........  Cervix excision...  Y..............  Y..............  Y..............       4.3623      $173.13      $173.13       $34.63       $34.63
57461...........  Conz of cervix w/   Y..............  Y..............  Y..............       4.6015      $182.62      $182.62       $36.52       $36.52
                   scope, leep.
57500...........  Biopsy of cervix..  Y..............  Y..............  Y..............       1.9587       $77.74       $77.74       $15.55       $15.55
57505...........  Endocervical        Y..............  Y..............  Y..............       1.1880       $47.15       $47.15        $9.43        $9.43
                   curettage.
57510...........  Cauterization of    Y..............  Y..............  Y..............       1.2257       $48.65       $48.65        $9.73        $9.73
                   cervix.
57511...........  Cryocautery of      Y..............  Y..............  ...............       1.4050       $55.76       $55.76       $11.15       $11.15
                   cervix.
57513...........  Laser surgery of    ...............  ...............  ...............      14.7958      $587.22      $516.61      $117.44      $103.32
                   cervix.
57520...........  Conization of       ...............  ...............  ...............      20.5113      $814.05      $630.03      $162.81      $126.01
                   cervix.
57522...........  Conization of       ...............  ...............  ...............      28.7410    $1,140.68      $793.34      $228.14      $158.67
                   cervix.
57530...........  Removal of cervix.  ...............  ...............  ...............      28.7410    $1,140.68      $825.34      $228.14      $165.07
57550...........  Removal of          ...............  ...............  ...............      28.7410    $1,140.68      $825.34      $228.14      $165.07
                   residual cervix.
57556...........  Remove cervix,      ...............  ...............  ...............      42.8756    $1,701.65    $1,209.33      $340.33      $241.87
                   repair bowel.
57700...........  Revision of cervix  ...............  ...............  ...............      20.5113      $814.05      $573.53      $162.81      $114.71
57720...........  Revision of cervix  ...............  ...............  ...............      20.5113      $814.05      $662.03      $162.81      $132.41
57800...........  Dilation of         Y..............  Y..............  Y..............       0.6280       $24.92       $24.92        $4.98        $4.98
                   cervical canal.
57820...........  D& c of residual    ...............  ...............  ...............      17.7635      $705.00      $607.50      $141.00      $121.50
                   cervix.
58100...........  Biopsy of uterus    Y..............  Y..............  Y..............       1.0495       $41.65       $41.65        $8.33        $8.33
                   lining.
58110...........  Bx done w/          Y..............  Y..............  Y..............       0.4041       $16.04       $16.04        $3.21        $3.21
                   colposcopy add-on.
58120...........  Dilation and        ...............  ...............  ...............      17.7635      $705.00      $575.50      $141.00      $115.10
                   curettage.
58145...........  Myomectomy vag      ...............  ...............  ...............      28.7410    $1,140.68      $928.84      $228.14      $185.77
                   method.
58301...........  Remove              Y..............  Y..............  Y..............       1.0140       $40.24       $40.24        $8.05        $8.05
                   intrauterine
                   device.
58321...........  Artificial          Y..............  Y..............  Y..............       0.9178       $36.42       $36.42        $7.28        $7.28
                   insemination.
58322...........  Artificial          Y..............  Y..............  Y..............       0.9612       $38.15       $38.15        $7.63        $7.63
                   insemination.
58323...........  Sperm washing.....  Y..............  Y..............  Y..............       0.2946       $11.69       $11.69        $2.34        $2.34
58345...........  Reopen fallopian    Y..............  Y..............  Y..............       1.9449       $77.19       $77.19       $15.44       $15.44
                   tube.

[[Page 49930]]

 
58346...........  Insert heyman       ...............  ...............  ...............      14.7958      $587.22      $516.61      $117.44      $103.32
                   uteri capsule.
58350...........  Reopen fallopian    ...............  ...............  ...............      28.7410    $1,140.68      $825.34      $228.14      $165.07
                   tube.
58353...........  Endometr ablate,    ...............  ...............  ...............      28.7410    $1,140.68      $885.34      $228.14      $177.07
                   thermal.
58356...........  Endometrial         Y..............  Y..............  ...............      42.8756    $1,701.65    $1,701.65      $340.33      $340.33
                   cryoablation.
58545...........  Laparoscopic        ...............  ...............  ...............      31.9353    $1,267.45    $1,303.23      $253.49      $260.65
                   myomectomy.
58546...........  Laparo-myomectomy,  ...............  ...............  ...............      43.5124    $1,726.92    $1,532.96      $345.38      $306.59
                   complex.
58550...........  Laparo-asst vag     ...............  ...............  ...............      70.8854    $2,813.31    $2,076.15      $562.66      $415.23
                   hysterectomy.
58552...........  Laparo-vag hyst     Y..............  ...............  ...............      43.5124    $1,726.92    $1,726.92      $345.38      $345.38
                   incl t/o.
58555...........  Hysteroscopy, dx,   ...............  ...............  ...............      21.4199      $850.11      $591.56      $170.02      $118.31
                   sep proc.
58558...........  Hysteroscopy,       ...............  ...............  ...............      21.4199      $850.11      $680.06      $170.02      $136.01
                   biopsy.
58559...........  Hysteroscopy,       ...............  ...............  ...............      21.4199      $850.11      $648.06      $170.02      $129.61
                   lysis.
58560...........  Hysteroscopy,       ...............  ...............  ...............      33.3029    $1,321.73      $915.86      $264.35      $183.17
                   resect septum.
58561...........  Hysteroscopy,       ...............  ...............  ...............      33.3029    $1,321.73      $915.86      $264.35      $183.17
                   remove myoma.
58562...........  Hysteroscopy,       ...............  ...............  ...............      21.4199      $850.11      $680.06      $170.02      $136.01
                   remove fb.
58563...........  Hysteroscopy,       ...............  ...............  ...............      33.3029    $1,321.73      $975.86      $264.35      $195.17
                   ablation.
58565...........  Hysteroscopy,       ...............  ...............  ...............      42.8756    $1,701.65    $1,165.83      $340.33      $233.17
                   sterilization.
58600...........  Division of         Y..............  ...............  ...............      28.7410    $1,140.68    $1,140.68      $228.14      $228.14
                   fallopian tube.
58615...........  Occlude fallopian   Y..............  ...............  ...............      20.5113      $814.05      $814.05      $162.81      $162.81
                   tube(s).
58660...........  Laparoscopy, lysis  ...............  ...............  ...............      43.5124    $1,726.92    $1,221.96      $345.38      $244.39
58661...........  Laparoscopy,        ...............  ...............  ...............      43.5124    $1,726.92    $1,221.96      $345.38      $244.39
                   remove adnexa.
58662...........  Laparoscopy,        ...............  ...............  ...............      43.5124    $1,726.92    $1,221.96      $345.38      $244.39
                   excise lesions.
58670...........  Laparoscopy, tubal  ...............  ...............  ...............      43.5124    $1,726.92    $1,118.46      $345.38      $223.69
                   cautery.
58671...........  Laparoscopy, tubal  ...............  ...............  ...............      43.5124    $1,726.92    $1,118.46      $345.38      $223.69
                   block.
58672...........  Laparoscopy,        ...............  ...............  ...............      43.5124    $1,726.92    $1,221.96      $345.38      $244.39
                   fimbrioplasty.
58673...........  Laparoscopy,        ...............  ...............  ...............      43.5124    $1,726.92    $1,221.96      $345.38      $244.39
                   salpingostomy.
58800...........  Drainage of         ...............  ...............  ...............      14.7958      $587.22      $548.61      $117.44      $109.72
                   ovarian cyst(s).
58820...........  Drain ovary         ...............  ...............  ...............      28.7410    $1,140.68      $825.34      $228.14      $165.07
                   abscess, open.
58900...........  Biopsy of ovary(s)  ...............  ...............  ...............      14.7958      $587.22      $548.61      $117.44      $109.72
58970...........  Retrieval of        ...............  ...............  ...............       4.4108      $175.06      $223.27       $35.01       $44.65
                   oocyte.
58974...........  Transfer of embryo  ...............  ...............  ...............       4.4108      $175.06      $223.27       $35.01       $44.65
58976...........  Transfer of embryo  ...............  ...............  ...............       4.4108      $175.06      $223.27       $35.01       $44.65
59000...........  Amniocentesis,      Y..............  Y..............  ...............       1.4026       $55.67       $55.67       $11.13       $11.13
                   diagnostic.

[[Page 49931]]

 
59001...........  Amniocentesis,      Y..............  Y..............  Y..............       1.0624       $42.16       $42.16        $8.43        $8.43
                   therapeutic.
59012...........  Fetal cord          Y..............  ...............  ...............       1.4026       $55.67       $55.67       $11.13       $11.13
                   puncture,prenatal.
59015...........  Chorion biopsy....  Y..............  Y..............  Y..............       1.2728       $50.52       $50.52       $10.10       $10.10
59020...........  Fetal contract      Y..............  Y..............  Y..............       0.7961       $31.60       $31.60        $6.32        $6.32
                   stress test.
59025...........  Fetal non-stress    Y..............  Y..............  Y..............       0.4581       $18.18       $18.18        $3.64        $3.64
                   test.
59070...........  Transabdom          Y..............  ...............  ...............       1.4026       $55.67       $55.67       $11.13       $11.13
                   amnioinfus w/us.
59072...........  Umbilical cord      Y..............  ...............  ...............       1.4026       $55.67       $55.67       $11.13       $11.13
                   occlud w/us.
59076...........  Fetal shunt         Y..............  ...............  ...............       1.4026       $55.67       $55.67       $11.13       $11.13
                   placement, w/us.
59100...........  Remove uterus       Y..............  Y..............  Y..............       5.2552      $208.57      $208.57       $41.71       $41.71
                   lesion.
59150...........  Treat ectopic       Y..............  ...............  ...............      43.5124    $1,726.92    $1,726.92      $345.38      $345.38
                   pregnancy.
59151...........  Treat ectopic       Y..............  ...............  ...............      43.5124    $1,726.92    $1,726.92      $345.38      $345.38
                   pregnancy.
59160...........  D& c after          ...............  ...............  ...............      17.7635      $705.00      $607.50      $141.00      $121.50
                   delivery.
59200...........  Insert cervical     Y..............  Y..............  Y..............       0.9139       $36.27       $36.27        $7.25        $7.25
                   dilator.
59300...........  Episiotomy or       Y..............  Y..............  Y..............       1.8766       $74.48       $74.48       $14.90       $14.90
                   vaginal repair.
59320...........  Revision of cervix  ...............  ...............  ...............      20.5113      $814.05      $573.53      $162.81      $114.71
59412...........  Antepartum          Y..............  ...............  ...............       2.8011      $111.17      $111.17       $22.23       $22.23
                   manipulation.
59812...........  Treatment of        ...............  ...............  ...............      18.5251      $735.23      $726.11      $147.05      $145.22
                   miscarriage.
59820...........  Care of             ...............  ...............  ...............      18.5251      $735.23      $726.11      $147.05      $145.22
                   miscarriage.
59821...........  Treatment of        ...............  ...............  ...............      18.5251      $735.23      $726.11      $147.05      $145.22
                   miscarriage.
59840...........  Abortion..........  ...............  ...............  ...............      17.2607      $685.04      $701.02      $137.01      $140.20
59841...........  Abortion..........  ...............  ...............  ...............      17.2607      $685.04      $701.02      $137.01      $140.20
59866...........  Abortion (mpr)....  Y..............  ...............  ...............       1.4026       $55.67       $55.67       $11.13       $11.13
59870...........  Evacuate mole of    ...............  ...............  ...............      18.5251      $735.23      $726.11      $147.05      $145.22
                   uterus.
59871...........  Remove cerclage     ...............  ...............  ...............      20.5113      $814.05      $765.53      $162.81      $153.11
                   suture.
60000...........  Drain thyroid/      ...............  ...............  ...............       7.7261      $306.63      $319.82       $61.33       $63.96
                   tongue cyst.
60001...........  Aspirate/inject     Y..............  Y..............  Y..............       1.4633       $58.08       $58.08       $11.62       $11.62
                   thyriod cyst.
60100...........  Biopsy of thyroid.  Y..............  Y..............  Y..............       1.1901       $47.23       $47.23        $9.45        $9.45
60200...........  Remove thyroid      ...............  ...............  ...............      37.1283    $1,473.55      $959.78      $294.71      $191.96
                   lesion.
60280...........  Remove thyroid      ...............  ...............  ...............      37.1283    $1,473.55    $1,051.78      $294.71      $210.36
                   duct lesion.
60281...........  Remove thyroid      ...............  ...............  ...............      37.1283    $1,473.55    $1,051.78      $294.71      $210.36
                   duct lesion.
61000...........  Remove cranial      Y..............  Y..............  Y..............       0.9167       $36.38       $36.38        $7.28        $7.28
                   cavity fluid.
61001...........  Remove cranial      Y..............  Y..............  Y..............       0.9655       $38.32       $38.32        $7.66        $7.66
                   cavity fluid.
61020...........  Remove brain        ...............  ...............  ...............       3.0383      $120.58      $153.80       $24.12       $30.76
                   cavity fluid.
61026...........  Injection into      ...............  ...............  ...............       3.0383      $120.58      $153.80       $24.12       $30.76
                   brain canal.

[[Page 49932]]

 
61050...........  Remove brain canal  ...............  ...............  ...............       3.0383      $120.58      $153.80       $24.12       $30.76
                   fluid.
61055...........  Injection into      ...............  ...............  ...............       3.0383      $120.58      $153.80       $24.12       $30.76
                   brain canal.
61070...........  Brain canal shunt   ...............  ...............  ...............       3.0383      $120.58      $153.80       $24.12       $30.76
                   procedure.
61215...........  Insert brain-fluid  ...............  ...............  ...............      45.6712    $1,812.60    $1,161.30      $362.52      $232.26
                   device.
61330...........  Decompress eye      Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   socket.
61334...........  Explore orbit/      Y..............  ...............  ...............      37.7719    $1,499.09    $1,499.09      $299.82      $299.82
                   remove object.
61790...........  Treat trigeminal    ...............  ...............  ...............      17.7609      $704.90      $607.45      $140.98      $121.49
                   nerve.
61791...........  Treat trigeminal    ...............  ...............  ...............       5.5439      $220.03      $280.63       $44.01       $56.13
                   tract.
61795...........  Brain surgery       Y..............  ...............  ...............       5.5005      $218.30      $218.30       $43.66       $43.66
                   using computer.
61880...........  Revise/remove       Y..............  ...............  ...............      17.1830      $681.96      $681.96      $136.39      $136.39
                   neuroelectrode.
61885...........  Insrt/redo          ...............  ...............  ...............     175.9328    $6,982.44    $3,714.22    $1,396.49      $742.84
                   neurostim 1 array.
61886...........  Implant neurostim   ...............  ...............  ...............     235.5774    $9,349.62    $4,929.81    $1,869.92      $985.96
                   arrays.
61888...........  Revise/remove       ...............  ...............  ...............      33.9521    $1,347.49      $840.25      $269.50      $168.05
                   neuroreceiver.
62194...........  Replace/irrigate    ...............  ...............  ...............      11.5220      $457.29      $395.14       $91.46       $79.03
                   catheter.
62225...........  Replace/irrigate    ...............  ...............  ...............      11.5220      $457.29      $395.14       $91.46       $79.03
                   catheter.
62230...........  Replace/revise      ...............  ...............  ...............      45.6712    $1,812.60    $1,129.30      $362.52      $225.86
                   brain shunt.
62252...........  Csf shunt           Y..............  Y..............  Y..............       1.1258       $44.68       $44.68        $8.94        $8.94
                   reprogram.
62263...........  Epidural lysis      ...............  ...............  ...............      12.4432      $493.85      $413.42       $98.77       $82.68
                   mult sessions.
62264...........  Epidural lysis on   ...............  ...............  ...............      12.4432      $493.85      $413.42       $98.77       $82.68
                   single day.
62268...........  Drain spinal cord   ...............  ...............  ...............       3.0383      $120.58      $153.80       $24.12       $30.76
                   cyst.
62269...........  Needle biopsy,      ...............  ...............  ...............       6.0729      $241.02      $287.01       $48.20       $57.40
                   spinal cord.
62270...........  Spinal fluid tap,   ...............  ...............  ...............       2.2491       $89.26      $113.85       $17.85       $22.77
                   diagnostic.
62272...........  Drain cerebro       ...............  ...............  ...............       2.2491       $89.26      $113.85       $17.85       $22.77
                   spinal fluid.
62273...........  Inject epidural     ...............  ...............  ...............       5.5439      $220.03      $276.51       $44.01       $55.30
                   patch.
62280...........  Treat spinal cord   ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   lesion.
62281...........  Treat spinal cord   ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   lesion.
62282...........  Treat spinal canal  ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   lesion.
62287...........  Percutaneous        ...............  ...............  ...............      33.3035    $1,321.75    $1,330.38      $264.35      $266.08
                   diskectomy.
62292...........  Injection into      Y..............  ...............  ...............       3.0383      $120.58      $120.58       $24.12       $24.12
                   disk lesion.
62294...........  Injection into      ...............  ...............  ...............       3.0383      $120.58      $153.80       $24.12       $30.76
                   spinal artery.
62310...........  Inject spine c/t..  ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
62311...........  Inject spine l/s    ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   (cd).

[[Page 49933]]

 
62318...........  Inject spine w/     ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   cath, c/t.
62319...........  Inject spine w/     ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   cath l/s (cd).
62350...........  Implant spinal      ...............  ...............  ...............      29.2931    $1,162.59      $804.29      $232.52      $160.86
                   canal cath.
62355...........  Remove spinal       ...............  ...............  ...............      12.4432      $493.85      $469.92       $98.77       $93.98
                   canal catheter.
62360...........  Insert spine        ...............  ...............  ...............     112.0147    $4,445.65    $2,445.82      $889.13      $489.16
                   infusion device.
62361...........  Implant spine       ...............  ...............  ...............     183.1974    $7,270.75    $3,858.38    $1,454.15      $771.68
                   infusion pump.
62362...........  Implant spine       ...............  ...............  ...............     183.1974    $7,270.75    $3,858.38    $1,454.15      $771.68
                   infusion pump.
62365...........  Remove spine        ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   infusion device.
62367...........  Analyze spine       Y..............  Y..............  Y..............       0.4369       $17.34       $17.34        $3.47        $3.47
                   infusion pump.
62368...........  Analyze spine       Y..............  Y..............  Y..............       0.5519       $21.90       $21.90        $4.38        $4.38
                   infusion pump.
63600...........  Remove spinal cord  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   lesion.
63610...........  Stimulation of      ...............  ...............  ...............      17.7609      $704.90      $518.95      $140.98      $103.79
                   spinal cord.
63615...........  Remove lesion of    Y..............  Y..............  Y..............       6.2719      $248.92      $248.92       $49.78       $49.78
                   spinal cord.
63650...........  Implant             ...............  ...............  ...............      56.3855    $2,237.83    $1,341.92      $447.57      $268.38
                   neuroelectrodes.
63655...........  Implant             Y..............  ...............  ...............      84.2373    $3,343.22    $3,343.22      $668.64      $668.64
                   neuroelectrodes.
63660...........  Revise/remove       ...............  ...............  ...............      17.1830      $681.96      $507.48      $136.39      $101.50
                   neuroelectrode.
63685...........  Insrt/redo spine n  ...............  ...............  ...............     178.1307    $7,069.67    $3,757.83    $1,413.93      $751.57
                   generator.
63688...........  Revise/remove       ...............  ...............  ...............      33.9521    $1,347.49      $840.25      $269.50      $168.05
                   neuroreceiver.
63744...........  Revision of spinal  ...............  ...............  ...............      36.1603    $1,435.13      $972.57      $287.03      $194.51
                   shunt.
63746...........  Removal of spinal   ...............  ...............  ...............      10.9541      $434.75      $440.37       $86.95       $88.07
                   shunt.
64400...........  N block inj,        Y..............  Y..............  Y..............       1.4194       $56.33       $56.33       $11.27       $11.27
                   trigeminal.
64402...........  N block inj,        Y..............  Y..............  Y..............       1.3219       $52.46       $52.46       $10.49       $10.49
                   facial.
64405...........  N block inj,        Y..............  Y..............  Y..............       1.1245       $44.63       $44.63        $8.93        $8.93
                   occipital.
64408...........  N block inj, vagus  Y..............  Y..............  Y..............       1.3388       $53.13       $53.13       $10.63       $10.63
64410...........  Nblock inj,         ...............  ...............  ...............       5.5439      $220.03      $276.51       $44.01       $55.30
                   phrenic.
64412...........  N block inj,        Y..............  Y..............  Y..............       2.0074       $79.67       $79.67       $15.93       $15.93
                   spinal accessor.
64413...........  N block inj,        Y..............  Y..............  Y..............       1.3483       $53.51       $53.51       $10.70       $10.70
                   cervical plexus.
64415...........  Nblock inj,         ...............  ...............  ...............       2.2491       $89.26      $113.85       $17.85       $22.77
                   brachial plexus.
64416...........  N block cont        Y..............  ...............  ...............       2.2491       $89.26       $89.26       $17.85       $17.85
                   infuse, b plex.
64417...........  Nblock inj,         ...............  ...............  ...............       2.2491       $89.26      $113.85       $17.85       $22.77
                   axillary.
64418...........  N block inj,        Y..............  Y..............  Y..............       1.9395       $76.98       $76.98       $15.40       $15.40
                   suprascapular.

[[Page 49934]]

 
64420...........  Nblock inj,         ...............  ...............  ...............       2.2491       $89.26      $113.85       $17.85       $22.77
                   intercost, sng.
64421...........  Nblock inj,         ...............  ...............  ...............       5.5439      $220.03      $276.51       $44.01       $55.30
                   intercost, mlt.
64425...........  N block inj ilio-   Y..............  Y..............  Y..............       1.2794       $50.78       $50.78       $10.16       $10.16
                   ing/hypogi.
64430...........  Nblock inj,         ...............  ...............  ...............       2.2491       $89.26      $113.85       $17.85       $22.77
                   pudendal.
64435...........  N block inj,        Y..............  Y..............  Y..............       1.9447       $77.18       $77.18       $15.44       $15.44
                   paracervical.
64445...........  Injection for       Y..............  Y..............  Y..............       1.8559       $73.66       $73.66       $14.73       $14.73
                   nerve block.
64450...........  N block, other      Y..............  Y..............  Y..............       1.0671       $42.35       $42.35        $8.47        $8.47
                   peripheral.
64470...........  Inj paravertebral   ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   c/t.
64472...........  Inj paravertebral   ...............  ...............  ...............       5.5439      $220.03      $276.51       $44.01       $55.30
                   c/t add-on.
64475...........  Inj paravertebral   ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   l/s.
64476...........  Inj paravertebral   ...............  ...............  ...............       5.5439      $220.03      $276.51       $44.01       $55.30
                   l/s add-on.
64479...........  Inj foramen         ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   epidural c/t.
64480...........  Inj foramen         ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   epidural add-on.
64483...........  Inj foramen         ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   epidural l/s.
64484...........  Inj foramen         ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   epidural add-on.
64505...........  N block,            Y..............  Y..............  Y..............       1.0101       $40.09       $40.09        $8.02        $8.02
                   spenopalatine
                   gangl.
64508...........  N block, carotid    Y..............  Y..............  Y..............       2.2491       $89.26       $89.26       $17.85       $17.85
                   sinus s/p.
64510...........  Nblock, stellate    ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   ganglion.
64517...........  Nblock inj,         ...............  ...............  ...............       2.2491       $89.26      $113.85       $17.85       $22.77
                   hypogas plxs.
64520...........  Nblock, lumbar/     ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   thoracic.
64530...........  Nblock inj, celiac  ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   pelus.
64553...........  Implant             ...............  ...............  ...............     234.1628    $9,293.47    $4,813.24    $1,858.69      $962.65
                   neuroelectrodes.
64555...........  Implant             Y..............  Y..............  Y..............       2.4298       $96.44       $96.44       $19.29       $19.29
                   neuroelectrodes.
64560...........  Implant             Y..............  ...............  ...............      56.3855    $2,237.83    $2,237.83      $447.57      $447.57
                   neuroelectrodes.
64561...........  Implant             ...............  ...............  ...............      56.3855    $2,237.83    $1,373.92      $447.57      $274.78
                   neuroelectrodes.
64565...........  Implant             Y..............  Y..............  Y..............       2.4267       $96.31       $96.31       $19.26       $19.26
                   neuroelectrodes.
64573...........  Implant             ...............  ...............  ...............     234.1628    $9,293.47    $4,813.24    $1,858.69      $962.65
                   neuroelectrodes.
64575...........  Implant             ...............  ...............  ...............      84.2373    $3,343.22    $1,838.11      $668.64      $367.62
                   neuroelectrodes.
64577...........  Implant             ...............  ...............  ...............      84.2373    $3,343.22    $1,838.11      $668.64      $367.62
                   neuroelectrodes.

[[Page 49935]]

 
64580...........  Implant             ...............  ...............  ...............      84.2373    $3,343.22    $1,838.11      $668.64      $367.62
                   neuroelectrodes.
64581...........  Implant             ...............  ...............  ...............      84.2373    $3,343.22    $1,926.61      $668.64      $385.32
                   neuroelectrodes.
64585...........  Revise/remove       ...............  ...............  ...............      17.1830      $681.96      $507.48      $136.39      $101.50
                   neuroelectrode.
64590...........  Insrt/redo perph n  ...............  ...............  ...............     178.1307    $7,069.67    $3,757.83    $1,413.93      $751.57
                   generator.
64595...........  Revise/remove       ...............  ...............  ...............      33.9521    $1,347.49      $840.25      $269.50      $168.05
                   neuroreceiver.
64600...........  Injection           ...............  ...............  ...............      12.4432      $493.85      $413.42       $98.77       $82.68
                   treatment of
                   nerve.
64605...........  Injection           ...............  ...............  ...............      12.4432      $493.85      $413.42       $98.77       $82.68
                   treatment of
                   nerve.
64610...........  Injection           ...............  ...............  ...............      12.4432      $493.85      $413.42       $98.77       $82.68
                   treatment of
                   nerve.
64612...........  Destroy nerve,      Y..............  Y..............  Y..............       1.7396       $69.04       $69.04       $13.81       $13.81
                   face muscle.
64613...........  Destroy nerve,      Y..............  Y..............  Y..............       1.8356       $72.85       $72.85       $14.57       $14.57
                   spine muscle.
64614...........  Destroy nerve,      Y..............  Y..............  Y..............       2.0569       $81.63       $81.63       $16.33       $16.33
                   extrem musc.
64620...........  Injection           ...............  ...............  ...............      12.4432      $493.85      $413.42       $98.77       $82.68
                   treatment of
                   nerve.
64622...........  Destr paravertebrl  ...............  ...............  ...............      12.4432      $493.85      $413.42       $98.77       $82.68
                   nerve l/s.
64623...........  Destr               ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   paravertebral n
                   add-on.
64626...........  Destr paravertebrl  ...............  ...............  ...............      12.4432      $493.85      $413.42       $98.77       $82.68
                   nerve c/t.
64627...........  Destr               ...............  ...............  ...............       6.3788      $253.16      $293.08       $50.63       $58.62
                   paravertebral n
                   add-on.
64630...........  Injection           ...............  ...............  ...............       5.5439      $220.03      $280.63       $44.01       $56.13
                   treatment of
                   nerve.
64640...........  Injection           Y..............  Y..............  Y..............       2.8054      $111.34      $111.34       $22.27       $22.27
                   treatment of
                   nerve.
64650...........  Chemodenerv         Y..............  ...............  ...............       2.2491       $89.26       $89.26       $17.85       $17.85
                   eccrine glands.
64653...........  Chemodenerv         Y..............  ...............  ...............       2.2491       $89.26       $89.26       $17.85       $17.85
                   eccrine glands.
64680...........  Injection           ...............  ...............  ...............       6.3788      $253.16      $322.89       $50.63       $64.58
                   treatment of
                   nerve.
64681...........  Injection           ...............  ...............  ...............      12.4432      $493.85      $469.92       $98.77       $93.98
                   treatment of
                   nerve.
64702...........  Revise finger/toe   ...............  ...............  ...............      17.7609      $704.90      $518.95      $140.98      $103.79
                   nerve.
64704...........  Revise hand/foot    ...............  ...............  ...............      17.7609      $704.90      $518.95      $140.98      $103.79
                   nerve.
64708...........  Revise arm/leg      ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64712...........  Revision of         ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   sciatic nerve.
64713...........  Revision of arm     ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve(s).
64714...........  Revise low back     ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve(s).
64716...........  Revision of         ...............  ...............  ...............      17.7609      $704.90      $607.45      $140.98      $121.49
                   cranial nerve.

[[Page 49936]]

 
64718...........  Revise ulnar nerve  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   at elbow.
64719...........  Revise ulnar nerve  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   at wrist.
64721...........  Carpal tunnel       ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   surgery.
64722...........  Relieve pressure    ...............  ...............  ...............      17.7609      $704.90      $518.95      $140.98      $103.79
                   on nerve(s).
64726...........  Release foot/toe    ...............  ...............  ...............      17.7609      $704.90      $518.95      $140.98      $103.79
                   nerve.
64727...........  Internal nerve      ...............  ...............  ...............      17.7609      $704.90      $518.95      $140.98      $103.79
                   revision.
64732...........  Incision of brow    ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64734...........  Incision of cheek   ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64736...........  Incision of chin    ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64738...........  Incision of jaw     ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64740...........  Incision of tongue  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64742...........  Incision of facial  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64744...........  Incise nerve, back  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   of head.
64746...........  Incise diaphragm    ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64761...........  Incision of pelvis  Y..............  ...............  ...............      17.7609      $704.90      $704.90      $140.98      $140.98
                   nerve.
64763...........  Incise hip/thigh    Y..............  ...............  ...............      17.7609      $704.90      $704.90      $140.98      $140.98
                   nerve.
64766...........  Incise hip/thigh    Y..............  ...............  ...............      33.3035    $1,321.75    $1,321.75      $264.35      $264.35
                   nerve.
64771...........  Sever cranial       ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64772...........  Incision of spinal  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerve.
64774...........  Remove skin nerve   ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   lesion.
64776...........  Remove digit nerve  ...............  ...............  ...............      17.7609      $704.90      $607.45      $140.98      $121.49
                   lesion.
64778...........  Digit nerve         ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   surgery add-on.
64782...........  Remove limb nerve   ...............  ...............  ...............      17.7609      $704.90      $607.45      $140.98      $121.49
                   lesion.
64783...........  Limb nerve surgery  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   add-on.
64784...........  Remove nerve        ...............  ...............  ...............      17.7609      $704.90      $607.45      $140.98      $121.49
                   lesion.
64786...........  Remove sciatic      ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   nerve lesion.
64787...........  Implant nerve end.  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
64788...........  Remove skin nerve   ...............  ...............  ...............      17.7609      $704.90      $607.45      $140.98      $121.49
                   lesion.
64790...........  Removal of nerve    ...............  ...............  ...............      17.7609      $704.90      $607.45      $140.98      $121.49
                   lesion.
64792...........  Removal of nerve    ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   lesion.
64795...........  Biopsy of nerve...  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
64802...........  Remove sympathetic  ...............  ...............  ...............      17.7609      $704.90      $575.45      $140.98      $115.09
                   nerves.
64820...........  Remove sympathetic  Y..............  ...............  ...............      17.7609      $704.90      $704.90      $140.98      $140.98
                   nerves.

[[Page 49937]]

 
64821...........  Remove sympathetic  ...............  ...............  ...............      25.8425    $1,025.64      $827.82      $205.13      $165.56
                   nerves.
64822...........  Remove sympathetic  Y..............  ...............  ...............      25.8425    $1,025.64    $1,025.64      $205.13      $205.13
                   nerves.
64823...........  Remove sympathetic  Y..............  ...............  ...............      25.8425    $1,025.64    $1,025.64      $205.13      $205.13
                   nerves.
64831...........  Repair of digit     ...............  ...............  ...............      33.3035    $1,321.75      $975.88      $264.35      $195.18
                   nerve.
64832...........  Repair nerve add-   ...............  ...............  ...............      33.3035    $1,321.75      $827.38      $264.35      $165.48
                   on.
64834...........  Repair of hand or   ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   foot nerve.
64835...........  Repair of hand or   ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   foot nerve.
64836...........  Repair of hand or   ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   foot nerve.
64837...........  Repair nerve add-   ...............  ...............  ...............      33.3035    $1,321.75      $827.38      $264.35      $165.48
                   on.
64840...........  Repair of leg       ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   nerve.
64856...........  Repair/transpose    ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   nerve.
64857...........  Repair arm/leg      ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   nerve.
64858...........  Repair sciatic      ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   nerve.
64859...........  Nerve surgery.....  ...............  ...............  ...............      33.3035    $1,321.75      $827.38      $264.35      $165.48
64861...........  Repair of arm       ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   nerves.
64862...........  Repair of low back  ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   nerves.
64864...........  Repair of facial    ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   nerve.
64865...........  Repair of facial    ...............  ...............  ...............      33.3035    $1,321.75      $975.88      $264.35      $195.18
                   nerve.
64870...........  Fusion of facial/   ...............  ...............  ...............      33.3035    $1,321.75      $975.88      $264.35      $195.18
                   other nerve.
64872...........  Subsequent repair   ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   of nerve.
64874...........  Repair & revise     ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   nerve add-on.
64876...........  Repair nerve/       ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   shorten bone.
64885...........  Nerve graft, head   ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   or neck.
64886...........  Nerve graft, head   ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   or neck.
64890...........  Nerve graft, hand   ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   or foot.
64891...........  Nerve graft, hand   ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   or foot.
64892...........  Nerve graft, arm    ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   or leg.
64893...........  Nerve graft, arm    ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   or leg.
64895...........  Nerve graft, hand   ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   or foot.
64896...........  Nerve graft, hand   ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   or foot.
64897...........  Nerve graft, arm    ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   or leg.
64898...........  Nerve graft, arm    ...............  ...............  ...............      33.3035    $1,321.75      $915.88      $264.35      $183.18
                   or leg.
64901...........  Nerve graft add-on  ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
64902...........  Nerve graft add-on  ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78

[[Page 49938]]

 
64905...........  Nerve pedicle       ...............  ...............  ...............      33.3035    $1,321.75      $883.88      $264.35      $176.78
                   transfer.
64907...........  Nerve pedicle       ...............  ...............  ...............      33.3035    $1,321.75      $827.38      $264.35      $165.48
                   transfer.
65091...........  Revise eye........  ...............  ...............  ...............      35.5217    $1,409.79      $959.89      $281.96      $191.98
65093...........  Revise eye with     ...............  ...............  ...............      35.5217    $1,409.79      $959.89      $281.96      $191.98
                   implant.
65101...........  Removal of eye....  ...............  ...............  ...............      35.5217    $1,409.79      $959.89      $281.96      $191.98
65103...........  Remove eye/insert   ...............  ...............  ...............      35.5217    $1,409.79      $959.89      $281.96      $191.98
                   implant.
65105...........  Remove eye/attach   ...............  ...............  ...............      35.5217    $1,409.79    $1,019.89      $281.96      $203.98
                   implant.
65110...........  Removal of eye....  ...............  ...............  ...............      35.5217    $1,409.79    $1,063.39      $281.96      $212.68
65112...........  Remove eye/revise   ...............  ...............  ...............      35.5217    $1,409.79    $1,202.39      $281.96      $240.48
                   socket.
65114...........  Remove eye/revise   ...............  ...............  ...............      35.5217    $1,409.79    $1,202.39      $281.96      $240.48
                   socket.
65125...........  Revise ocular       Y..............  ...............  ...............      17.0126      $675.20      $675.20      $135.04      $135.04
                   implant.
65130...........  Insert ocular       ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   implant.
65135...........  Insert ocular       ...............  ...............  ...............      24.8502      $986.26      $716.13      $197.25      $143.23
                   implant.
65140...........  Attach ocular       ...............  ...............  ...............      35.5217    $1,409.79      $959.89      $281.96      $191.98
                   implant.
65150...........  Revise ocular       ...............  ...............  ...............      24.8502      $986.26      $716.13      $197.25      $143.23
                   implant.
65155...........  Reinsert ocular     ...............  ...............  ...............      35.5217    $1,409.79      $959.89      $281.96      $191.98
                   implant.
65175...........  Removal of ocular   ...............  ...............  ...............      17.0126      $675.20      $504.10      $135.04      $100.82
                   implant.
65205...........  Remove foreign      Y..............  Y..............  Y..............       0.5328       $21.15       $21.15        $4.23        $4.23
                   body from eye.
65210...........  Remove foreign      Y..............  Y..............  Y..............       0.6756       $26.81       $26.81        $5.36        $5.36
                   body from eye.
65220...........  Remove foreign      Y..............  ...............  ...............       1.2244       $48.59       $48.59        $9.72        $9.72
                   body from eye.
65222...........  Remove foreign      Y..............  Y..............  Y..............       0.7394       $29.35       $29.35        $5.87        $5.87
                   body from eye.
65235...........  Remove foreign      ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   body from eye.
65260...........  Remove foreign      ...............  ...............  ...............      16.3433      $648.63      $579.32      $129.73      $115.86
                   body from eye.
65265...........  Remove foreign      ...............  ...............  ...............      26.9305    $1,068.82      $849.41      $213.76      $169.88
                   body from eye.
65270...........  Repair of eye       ...............  ...............  ...............      17.0126      $675.20      $560.60      $135.04      $112.12
                   wound.
65272...........  Repair of eye       ...............  ...............  ...............      22.9479      $910.76      $678.38      $182.15      $135.68
                   wound.
65275...........  Repair of eye       ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
                   wound.
65280...........  Repair of eye       ...............  ...............  ...............      16.3433      $648.63      $639.32      $129.73      $127.86
                   wound.
65285...........  Repair of eye       ...............  ...............  ...............      36.8820    $1,463.78    $1,046.89      $292.76      $209.38
                   wound.
65286...........  Repair of eye       Y..............  Y..............  ...............       5.9800      $237.33      $237.33       $47.47       $47.47
                   wound.
65290...........  Repair of eye       ...............  ...............  ...............      21.2885      $844.90      $677.45      $168.98      $135.49
                   socket wound.
65400...........  Removal of eye      ...............  ...............  ...............      14.9969      $595.20      $464.10      $119.04       $92.82
                   lesion.

[[Page 49939]]

 
65410...........  Biopsy of cornea..  ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
65420...........  Removal of eye      ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   lesion.
65426...........  Removal of eye      ...............  ...............  ...............      22.9479      $910.76      $813.88      $182.15      $162.78
                   lesion.
65430...........  Corneal smear.....  Y..............  Y..............  Y..............       1.0593       $42.04       $42.04        $8.41        $8.41
65435...........  Curette/treat       Y..............  Y..............  Y..............       0.8260       $32.78       $32.78        $6.56        $6.56
                   cornea.
65436...........  Curette/treat       Y..............  ...............  ...............      14.9969      $595.20      $595.20      $119.04      $119.04
                   cornea.
65450...........  Treatment of        Y..............  ...............  ...............       2.1934       $87.05       $87.05       $17.41       $17.41
                   corneal lesion.
65600...........  Revision of cornea  Y..............  Y..............  Y..............       4.1704      $165.51      $165.51       $33.10       $33.10
65710...........  Corneal transplant  ...............  ...............  ...............      37.9446    $1,505.95    $1,250.47      $301.19      $250.09
65730...........  Corneal transplant  ...............  ...............  ...............      37.9446    $1,505.95    $1,250.47      $301.19      $250.09
65750...........  Corneal transplant  ...............  ...............  ...............      37.9446    $1,505.95    $1,250.47      $301.19      $250.09
65755...........  Corneal transplant  ...............  ...............  ...............      37.9446    $1,505.95    $1,250.47      $301.19      $250.09
65770...........  Revise cornea with  ...............  ...............  ...............      50.6347    $2,009.59    $1,502.30      $401.92      $300.46
                   implant.
65772...........  Correction of       ...............  ...............  ...............      14.9969      $595.20      $612.60      $119.04      $122.52
                   astigmatism.
65775...........  Correction of       ...............  ...............  ...............      14.9969      $595.20      $612.60      $119.04      $122.52
                   astigmatism.
65780...........  Ocular reconst,     ...............  ...............  ...............      37.9446    $1,505.95    $1,111.47      $301.19      $222.29
                   transplant.
65781...........  Ocular reconst,     ...............  ...............  ...............      37.9446    $1,505.95    $1,111.47      $301.19      $222.29
                   transplant.
65782...........  Ocular reconst,     ...............  ...............  ...............      37.9446    $1,505.95    $1,111.47      $301.19      $222.29
                   transplant.
65800...........  Drainage of eye...  ...............  ...............  ...............      14.9969      $595.20      $464.10      $119.04       $92.82
65805...........  Drainage of eye...  ...............  ...............  ...............      14.9969      $595.20      $464.10      $119.04       $92.82
65810...........  Drainage of eye...  ...............  ...............  ...............      22.9479      $910.76      $710.38      $182.15      $142.08
65815...........  Drainage of eye...  ...............  ...............  ...............      22.9479      $910.76      $678.38      $182.15      $135.68
65820...........  Relieve inner eye   ...............  ...............  ...............       5.9800      $237.33      $285.17       $47.47       $57.03
                   pressure.
65850...........  Incision of eye...  ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
65855...........  Laser surgery of    Y..............  Y..............  Y..............       3.4882      $138.44      $138.44       $27.69       $27.69
                   eye.
65860...........  Incise inner eye    Y..............  Y..............  Y..............       3.2701      $129.78      $129.78       $25.96       $25.96
                   adhesions.
65865...........  Incise inner eye    ...............  ...............  ...............      14.9969      $595.20      $464.10      $119.04       $92.82
                   adhesions.
65870...........  Incise inner eye    ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
                   adhesions.
65875...........  Incise inner eye    ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
                   adhesions.
65880...........  Incise inner eye    ...............  ...............  ...............      14.9969      $595.20      $612.60      $119.04      $122.52
                   adhesions.
65900...........  Remove eye lesion.  ...............  ...............  ...............      14.9969      $595.20      $656.10      $119.04      $131.22
65920...........  Remove implant of   ...............  ...............  ...............      22.9479      $910.76      $952.88      $182.15      $190.58
                   eye.
65930...........  Remove blood clot   ...............  ...............  ...............      22.9479      $910.76      $813.88      $182.15      $162.78
                   from eye.
66020...........  Injection           ...............  ...............  ...............      14.9969      $595.20      $464.10      $119.04       $92.82
                   treatment of eye.
66030...........  Injection           ...............  ...............  ...............       5.9800      $237.33      $285.17       $47.47       $57.03
                   treatment of eye.
66130...........  Remove eye lesion.  ...............  ...............  ...............      22.9479      $910.76      $952.88      $182.15      $190.58
66150...........  Glaucoma surgery..  ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08

[[Page 49940]]

 
66155...........  Glaucoma surgery..  ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
66160...........  Glaucoma surgery..  ...............  ...............  ...............      22.9479      $910.76      $678.38      $182.15      $135.68
66165...........  Glaucoma surgery..  ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
66170...........  Glaucoma surgery..  ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
66172...........  Incision of eye...  ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
66180...........  Implant eye shunt.  ...............  ...............  ...............      37.3057    $1,480.59    $1,098.80      $296.12      $219.76
66185...........  Revise eye shunt..  ...............  ...............  ...............      37.3057    $1,480.59      $963.30      $296.12      $192.66
66220...........  Repair eye lesion.  ...............  ...............  ...............      36.8820    $1,463.78      $986.89      $292.76      $197.38
66225...........  Repair/graft eye    ...............  ...............  ...............      37.3057    $1,480.59    $1,055.30      $296.12      $211.06
                   lesion.
66250...........  Follow-up surgery   ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   of eye.
66500...........  Incision of iris..  ...............  ...............  ...............       5.9800      $237.33      $285.17       $47.47       $57.03
66505...........  Incision of iris..  ...............  ...............  ...............       5.9800      $237.33      $285.17       $47.47       $57.03
66600...........  Remove iris and     ...............  ...............  ...............      22.9479      $910.76      $710.38      $182.15      $142.08
                   lesion.
66605...........  Removal of iris...  ...............  ...............  ...............      22.9479      $910.76      $710.38      $182.15      $142.08
66625...........  Removal of iris...  ...............  ...............  ...............       5.9800      $237.33      $302.70       $47.47       $60.54
66630...........  Removal of iris...  ...............  ...............  ...............      22.9479      $910.76      $710.38      $182.15      $142.08
66635...........  Removal of iris...  ...............  ...............  ...............      22.9479      $910.76      $710.38      $182.15      $142.08
66680...........  Repair iris &       ...............  ...............  ...............      22.9479      $910.76      $710.38      $182.15      $142.08
                   ciliary body.
66682...........  Repair iris &       ...............  ...............  ...............      22.9479      $910.76      $678.38      $182.15      $135.68
                   ciliary body.
66700...........  Destruction,        ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   ciliary body.
66710...........  Ciliary             ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   transsleral
                   therapy.
66711...........  Ciliary endoscopic  ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   ablation.
66720...........  Destruction,        ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   ciliary body.
66740...........  Destruction,        ...............  ...............  ...............      22.9479      $910.76      $678.38      $182.15      $135.68
                   ciliary body.
66761...........  Revision of iris..  Y..............  Y..............  Y..............       4.6821      $185.82      $185.82       $37.16       $37.16
66762...........  Revision of iris..  Y..............  Y..............  Y..............       4.7458      $188.35      $188.35       $37.67       $37.67
66770...........  Removal of inner    Y..............  Y..............  Y..............       5.1266      $203.46      $203.46       $40.69       $40.69
                   eye lesion.
66820...........  Incision,           Y..............  ...............  ...............       5.9800      $237.33      $237.33       $47.47       $47.47
                   secondary
                   cataract.
66821...........  After cataract      ...............  ...............  ...............       5.1266      $203.46      $259.51       $40.69       $51.90
                   laser surgery.
66825...........  Reposition          ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
                   intraocular lens.
66830...........  Removal of lens     ...............  ...............  ...............       5.9800      $237.33      $302.70       $47.47       $60.54
                   lesion.
66840...........  Removal of lens     ...............  ...............  ...............      14.5427      $577.17      $603.59      $115.43      $120.72
                   material.
66850...........  Removal of lens     ...............  ...............  ...............      28.5043    $1,131.28    $1,063.14      $226.26      $212.63
                   material.
66852...........  Removal of lens     ...............  ...............  ...............      28.5043    $1,131.28      $880.64      $226.26      $176.13
                   material.
66920...........  Extraction of lens  ...............  ...............  ...............      28.5043    $1,131.28      $880.64      $226.26      $176.13
66930...........  Extraction of lens  ...............  ...............  ...............      28.5043    $1,131.28      $924.14      $226.26      $184.83

[[Page 49941]]

 
66940...........  Extraction of lens  ...............  ...............  ...............      14.5427      $577.17      $647.09      $115.43      $129.42
66982...........  Cataract surgery,   ...............  ...............  ...............      23.5664      $935.31      $954.15      $187.06      $190.83
                   complex.
66983...........  Cataract surg w/    ...............  ...............  ...............      23.5664      $935.31      $954.15      $187.06      $190.83
                   iol, 1 stage.
66984...........  Cataract surg w/    ...............  ...............  ...............      23.5664      $935.31      $954.15      $187.06      $190.83
                   iol, 1 stage.
66985...........  Insert lens         ...............  ...............  ...............      23.5664      $935.31      $880.65      $187.06      $176.13
                   prosthesis.
66986...........  Exchange lens       ...............  ...............  ...............      23.5664      $935.31      $880.65      $187.06      $176.13
                   prosthesis.
67005...........  Partial removal of  ...............  ...............  ...............      26.9305    $1,068.82      $849.41      $213.76      $169.88
                   eye fluid.
67010...........  Partial removal of  ...............  ...............  ...............      26.9305    $1,068.82      $849.41      $213.76      $169.88
                   eye fluid.
67015...........  Release of eye      ...............  ...............  ...............      26.9305    $1,068.82      $700.91      $213.76      $140.18
                   fluid.
67025...........  Replace eye fluid.  ...............  ...............  ...............      26.9305    $1,068.82      $700.91      $213.76      $140.18
67027...........  Implant eye drug    ...............  ...............  ...............      36.8820    $1,463.78    $1,046.89      $292.76      $209.38
                   system.
67028...........  Injection eye drug  Y..............  Y..............  Y..............       2.1499       $85.32       $85.32       $17.06       $17.06
67030...........  Incise inner eye    ...............  ...............  ...............      16.3433      $648.63      $490.82      $129.73       $98.16
                   strands.
67031...........  Laser surgery, eye  ...............  ...............  ...............       5.1266      $203.46      $259.51       $40.69       $51.90
                   strands.
67036...........  Removal of inner    ...............  ...............  ...............      36.8820    $1,463.78    $1,046.89      $292.76      $209.38
                   eye fluid.
67038...........  Strip retinal       ...............  ...............  ...............      36.8820    $1,463.78    $1,090.39      $292.76      $218.08
                   membrane.
67039...........  Laser treatment of  ...............  ...............  ...............      36.8820    $1,463.78    $1,229.39      $292.76      $245.88
                   retina.
67040...........  Laser treatment of  ...............  ...............  ...............      36.8820    $1,463.78    $1,229.39      $292.76      $245.88
                   retina.
67101...........  Repair detached     Y..............  Y..............  Y..............       7.7847      $308.96      $308.96       $61.79       $61.79
                   retina.
67105...........  Repair detached     Y..............  Y..............  ...............       5.0285      $199.57      $199.57       $39.91       $39.91
                   retina.
67107...........  Repair detached     ...............  ...............  ...............      36.8820    $1,463.78    $1,090.39      $292.76      $218.08
                   retina.
67108...........  Repair detached     ...............  ...............  ...............      36.8820    $1,463.78    $1,229.39      $292.76      $245.88
                   retina.
67110...........  Repair detached     Y..............  Y..............  Y..............       8.4635      $335.90      $335.90       $67.18       $67.18
                   retina.
67112...........  Rerepair detached   ...............  ...............  ...............      36.8820    $1,463.78    $1,229.39      $292.76      $245.88
                   retina.
67115...........  Release encircling  ...............  ...............  ...............      16.3433      $648.63      $547.32      $129.73      $109.46
                   material.
67120...........  Remove eye implant  ...............  ...............  ...............      16.3433      $648.63      $547.32      $129.73      $109.46
                   material.
67121...........  Remove eye implant  ...............  ...............  ...............      26.9305    $1,068.82      $757.41      $213.76      $151.48
                   material.
67141...........  Treatment of        ...............  ...............  ...............       4.0750      $161.73      $206.27       $32.35       $41.25
                   retina.
67145...........  Treatment of        Y..............  Y..............  Y..............       4.8836      $193.82      $193.82       $38.76       $38.76
                   retina.
67208...........  Treatment of        Y..............  Y..............  Y..............       5.2064      $206.63      $206.63       $41.33       $41.33
                   retinal lesion.
67210...........  Treatment of        Y..............  Y..............  ...............       5.0285      $199.57      $199.57       $39.91       $39.91
                   retinal lesion.
67218...........  Treatment of        ...............  ...............  ...............      16.3433      $648.63      $682.82      $129.73      $136.56
                   retinal lesion.
67220...........  Treatment of        Y..............  Y..............  ...............       4.0750      $161.73      $161.73       $32.35       $32.35
                   choroid lesion.

[[Page 49942]]

 
67221...........  Ocular              Y..............  Y..............  Y..............       3.3107      $131.39      $131.39       $26.28       $26.28
                   photodynamic ther.
67225...........  Eye photodynamic    Y..............  Y..............  Y..............       0.2131        $8.46        $8.46        $1.69        $1.69
                   ther add-on.
67227...........  Treatment of        ...............  ...............  ...............      26.9305    $1,068.82      $700.91      $213.76      $140.18
                   retinal lesion.
67228...........  Treatment of        Y..............  Y..............  ...............       5.0285      $199.57      $199.57       $39.91       $39.91
                   retinal lesion.
67250...........  Reinforce eye wall  ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
67255...........  Reinforce/graft     ...............  ...............  ...............      26.9305    $1,068.82      $789.41      $213.76      $157.88
                   eye wall.
67311...........  Revise eye muscle.  ...............  ...............  ...............      21.2885      $844.90      $677.45      $168.98      $135.49
67312...........  Revise two eye      ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   muscles.
67314...........  Revise eye muscle.  ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
67316...........  Revise two eye      ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   muscles.
67318...........  Revise eye          ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   muscle(s).
67320...........  Revise eye          ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   muscle(s) add-on.
67331...........  Eye surgery follow- ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   up add-on.
67332...........  Rerevise eye        ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   muscles add-on.
67334...........  Revise eye muscle   ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   w/suture.
67335...........  Eye suture during   ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   surgery.
67340...........  Revise eye muscle   ...............  ...............  ...............      21.2885      $844.90      $737.45      $168.98      $147.49
                   add-on.
67343...........  Release eye tissue  ...............  ...............  ...............      21.2885      $844.90      $919.95      $168.98      $183.99
67345...........  Destroy nerve of    Y..............  Y..............  Y..............       2.1183       $84.07       $84.07       $16.81       $16.81
                   eye muscle.
67350...........  Biopsy eye muscle.  ...............  ...............  ...............      13.9509      $553.68      $443.34      $110.74       $88.67
67400...........  Explore/biopsy eye  ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   socket.
67405...........  Explore/drain eye   ...............  ...............  ...............      24.8502      $986.26      $808.13      $197.25      $161.63
                   socket.
67412...........  Explore/treat eye   ...............  ...............  ...............      24.8502      $986.26      $851.63      $197.25      $170.33
                   socket.
67413...........  Explore/treat eye   ...............  ...............  ...............      24.8502      $986.26      $851.63      $197.25      $170.33
                   socket.
67414...........  Explr/decompress    Y..............  ...............  ...............      35.5217    $1,409.79    $1,409.79      $281.96      $281.96
                   eye socket.
67415...........  Aspiration,         ...............  ...............  ...............      17.0126      $675.20      $504.10      $135.04      $100.82
                   orbital contents.
67420...........  Explore/treat eye   ...............  ...............  ...............      35.5217    $1,409.79    $1,063.39      $281.96      $212.68
                   socket.
67430...........  Explore/treat eye   ...............  ...............  ...............      35.5217    $1,409.79    $1,063.39      $281.96      $212.68
                   socket.
67440...........  Explore/drain eye   ...............  ...............  ...............      35.5217    $1,409.79    $1,063.39      $281.96      $212.68
                   socket.
67445...........  Explr/decompress    ...............  ...............  ...............      35.5217    $1,409.79    $1,063.39      $281.96      $212.68
                   eye socket.

[[Page 49943]]

 
67450...........  Explore/biopsy eye  ...............  ...............  ...............      35.5217    $1,409.79    $1,063.39      $281.96      $212.68
                   socket.
67500...........  Inject/treat eye    Y..............  ...............  ...............       2.1934       $87.05       $87.05       $17.41       $17.41
                   socket.
67505...........  Inject/treat eye    Y..............  ...............  ...............       2.8099      $111.52      $111.52       $22.30       $22.30
                   socket.
67515...........  Inject/treat eye    Y..............  Y..............  Y..............       0.6151       $24.41       $24.41        $4.88        $4.88
                   socket.
67550...........  Insert eye socket   ...............  ...............  ...............      35.5217    $1,409.79    $1,019.89      $281.96      $203.98
                   implant.
67560...........  Revise eye socket   ...............  ...............  ...............      24.8502      $986.26      $716.13      $197.25      $143.23
                   implant.
67570...........  Decompress optic    ...............  ...............  ...............      35.5217    $1,409.79    $1,019.89      $281.96      $203.98
                   nerve.
67700...........  Drainage of eyelid  Y..............  Y..............  ...............       2.8099      $111.52      $111.52       $22.30       $22.30
                   abscess.
67710...........  Incision of eyelid  Y..............  Y..............  Y..............       4.0013      $158.80      $158.80       $31.76       $31.76
67715...........  Incision of eyelid  ...............  ...............  ...............      17.0126      $675.20      $504.10      $135.04      $100.82
                   fold.
67800...........  Remove eyelid       Y..............  Y..............  Y..............       1.3373       $53.08       $53.08       $10.62       $10.62
                   lesion.
67801...........  Remove eyelid       Y..............  Y..............  Y..............       1.6194       $64.27       $64.27       $12.85       $12.85
                   lesions.
67805...........  Remove eyelid       Y..............  Y..............  Y..............       2.0923       $83.04       $83.04       $16.61       $16.61
                   lesions.
67808...........  Remove eyelid       ...............  ...............  ...............      17.0126      $675.20      $560.60      $135.04      $112.12
                   lesion(s).
67810...........  Biopsy of eyelid..  Y..............  Y..............  ...............       2.8099      $111.52      $111.52       $22.30       $22.30
67820...........  Revise eyelashes..  Y..............  Y..............  Y..............       0.4905       $19.47       $19.47        $3.89        $3.89
67825...........  Revise eyelashes..  Y..............  Y..............  Y..............       1.3893       $55.14       $55.14       $11.03       $11.03
67830...........  Revise eyelashes..  ...............  ...............  ...............       6.9354      $275.25      $351.07       $55.05       $70.21
67835...........  Revise eyelashes..  ...............  ...............  ...............      17.0126      $675.20      $560.60      $135.04      $112.12
67840...........  Remove eyelid       Y..............  Y..............  Y..............       4.1405      $164.33      $164.33       $32.87       $32.87
                   lesion.
67850...........  Treat eyelid        Y..............  Y..............  Y..............       2.9051      $115.30      $115.30       $23.06       $23.06
                   lesion.
67875...........  Closure of eyelid   Y..............  ...............  ...............       6.9354      $275.25      $275.25       $55.05       $55.05
                   by suture.
67880...........  Revision of eyelid  ...............  ...............  ...............      14.9969      $595.20      $552.60      $119.04      $110.52
67882...........  Revision of eyelid  ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
67900...........  Repair brow defect  ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
67901...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $696.10      $135.04      $139.22
                   defect.
67902...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $696.10      $135.04      $139.22
                   defect.
67903...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   defect.
67904...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   defect.
67906...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $696.10      $135.04      $139.22
                   defect.
67908...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   defect.
67909...........  Revise eyelid       ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   defect.
67911...........  Revise eyelid       ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
                   defect.

[[Page 49944]]

 
67912...........  Correction eyelid   ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
                   w/implant.
67914...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
                   defect.
67915...........  Repair eyelid       Y..............  Y..............  Y..............       4.5979      $182.48      $182.48       $36.50       $36.50
                   defect.
67916...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   defect.
67917...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   defect.
67921...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
                   defect.
67922...........  Repair eyelid       Y..............  Y..............  Y..............       4.5261      $179.63      $179.63       $35.93       $35.93
                   defect.
67923...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   defect.
67924...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   defect.
67930...........  Repair eyelid       Y..............  Y..............  Y..............       4.4580      $176.93      $176.93       $35.39       $35.39
                   wound.
67935...........  Repair eyelid       ...............  ...............  ...............      17.0126      $675.20      $560.60      $135.04      $112.12
                   wound.
67938...........  Remove eyelid       Y..............  Y..............  ...............       1.2244       $48.59       $48.59        $9.72        $9.72
                   foreign body.
67950...........  Revision of eyelid  ...............  ...............  ...............      17.0126      $675.20      $560.60      $135.04      $112.12
67961...........  Revision of eyelid  ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
67966...........  Revision of eyelid  ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
67971...........  Reconstruction of   ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   eyelid.
67973...........  Reconstruction of   ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   eyelid.
67974...........  Reconstruction of   ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   eyelid.
67975...........  Reconstruction of   ...............  ...............  ...............      17.0126      $675.20      $592.60      $135.04      $118.52
                   eyelid.
68020...........  Incise/drain        Y..............  Y..............  Y..............       1.1738       $46.59       $46.59        $9.32        $9.32
                   eyelid lining.
68040...........  Treatment of        Y..............  Y..............  Y..............       0.5826       $23.12       $23.12        $4.62        $4.62
                   eyelid lesions.
68100...........  Biopsy of eyelid    Y..............  Y..............  Y..............       2.4727       $98.14       $98.14       $19.63       $19.63
                   lining.
68110...........  Remove eyelid       Y..............  Y..............  Y..............       3.1702      $125.82      $125.82       $25.16       $25.16
                   lining lesion.
68115...........  Remove eyelid       ...............  ...............  ...............      17.0126      $675.20      $560.60      $135.04      $112.12
                   lining lesion.
68130...........  Remove eyelid       ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   lining lesion.
68135...........  Remove eyelid       Y..............  Y..............  Y..............       1.5122       $60.01       $60.01       $12.00       $12.00
                   lining lesion.
68200...........  Treat eyelid by     Y..............  Y..............  Y..............       0.4396       $17.45       $17.45        $3.49        $3.49
                   injection.
68320...........  Revise/graft        ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   eyelid lining.
68325...........  Revise/graft        ...............  ...............  ...............      24.8502      $986.26      $808.13      $197.25      $161.63
                   eyelid lining.
68326...........  Revise/graft        ...............  ...............  ...............      24.8502      $986.26      $808.13      $197.25      $161.63
                   eyelid lining.
68328...........  Revise/graft        ...............  ...............  ...............      24.8502      $986.26      $808.13      $197.25      $161.63
                   eyelid lining.
68330...........  Revise eyelid       ...............  ...............  ...............      22.9479      $910.76      $770.38      $182.15      $154.08
                   lining.
68335...........  Revise/graft        ...............  ...............  ...............      24.8502      $986.26      $808.13      $197.25      $161.63
                   eyelid lining.
68340...........  Separate eyelid     ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   adhesions.

[[Page 49945]]

 
68360...........  Revise eyelid       ...............  ...............  ...............      22.9479      $910.76      $678.38      $182.15      $135.68
                   lining.
68362...........  Revise eyelid       ...............  ...............  ...............      22.9479      $910.76      $678.38      $182.15      $135.68
                   lining.
68371...........  Harvest eye         ...............  ...............  ...............      14.9969      $595.20      $520.60      $119.04      $104.12
                   tissue, alograft.
68400...........  Incise/drain tear   Y..............  Y..............  ...............       2.8099      $111.52      $111.52       $22.30       $22.30
                   gland.
68420...........  Incise/drain tear   Y..............  Y..............  Y..............       4.7254      $187.54      $187.54       $37.51       $37.51
                   sac.
68440...........  Incise tear duct    Y..............  Y..............  Y..............       1.4355       $56.97       $56.97       $11.39       $11.39
                   opening.
68500...........  Removal of tear     ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   gland.
68505...........  Partial removal,    ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   tear gland.
68510...........  Biopsy of tear      ...............  ...............  ...............      17.0126      $675.20      $504.10      $135.04      $100.82
                   gland.
68520...........  Removal of tear     ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   sac.
68525...........  Biopsy of tear sac  ...............  ...............  ...............      17.0126      $675.20      $504.10      $135.04      $100.82
68530...........  Clearance of tear   Y..............  Y..............  Y..............       6.0445      $239.89      $239.89       $47.98       $47.98
                   duct.
68540...........  Remove tear gland   ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   lesion.
68550...........  Remove tear gland   ...............  ...............  ...............      24.8502      $986.26      $748.13      $197.25      $149.63
                   lesion.
68700...........  Repair tear ducts.  ...............  ...............  ...............      24.8502      $986.26      $716.13      $197.25      $143.23
68705...........  Revise tear duct    Y..............  Y..............  ...............       2.8099      $111.52      $111.52       $22.30       $22.30
                   opening.
68720...........  Create tear sac     ...............  ...............  ...............      24.8502      $986.26      $808.13      $197.25      $161.63
                   drain.
68745...........  Create tear duct    ...............  ...............  ...............      24.8502      $986.26      $808.13      $197.25      $161.63
                   drain.
68750...........  Create tear duct    ...............  ...............  ...............      24.8502      $986.26      $808.13      $197.25      $161.63
                   drain.
68760...........  Close tear duct     Y..............  Y..............  ...............       2.1934       $87.05       $87.05       $17.41       $17.41
                   opening.
68761...........  Close tear duct     Y..............  Y..............  Y..............       1.8117       $71.90       $71.90       $14.38       $14.38
                   opening.
68770...........  Close tear system   ...............  ...............  ...............      17.0126      $675.20      $652.60      $135.04      $130.52
                   fistula.
68801...........  Dilate tear duct    Y..............  Y..............  ...............       1.2244       $48.59       $48.59        $9.72        $9.72
                   opening.
68810...........  Probe nasolacrimal  ...............  ...............  ...............       2.1934       $87.05      $111.03       $17.41       $22.21
                   duct.
68811...........  Probe nasolacrimal  ...............  ...............  ...............      17.0126      $675.20      $560.60      $135.04      $112.12
                   duct.
68815...........  Probe nasolacrimal  ...............  ...............  ...............      17.0126      $675.20      $560.60      $135.04      $112.12
                   duct.
68840...........  Explore/irrigate    Y..............  Y..............  ...............       1.2244       $48.59       $48.59        $9.72        $9.72
                   tear ducts.
69000...........  Drain external ear  Y..............  Y..............  ...............       1.4821       $58.82       $58.82       $11.76       $11.76
                   lesion.
69005...........  Drain external ear  Y..............  Y..............  Y..............       2.4802       $98.44       $98.44       $19.69       $19.69
                   lesion.
69020...........  Drain outer ear     Y..............  Y..............  ...............       1.4821       $58.82       $58.82       $11.76       $11.76
                   canal lesion.
69100...........  Biopsy of external  Y..............  Y..............  Y..............       1.5436       $61.26       $61.26       $12.25       $12.25
                   ear.
69105...........  Biopsy of external  Y..............  Y..............  Y..............       2.1216       $84.20       $84.20       $16.84       $16.84
                   ear canal.

[[Page 49946]]

 
69110...........  Remove external     ...............  ...............  ...............      14.9563      $593.59      $463.29      $118.72       $92.66
                   ear, partial.
69120...........  Removal of          ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   external ear.
69140...........  Remove ear canal    ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
                   lesion(s).
69145...........  Remove ear canal    ...............  ...............  ...............      14.9563      $593.59      $519.79      $118.72      $103.96
                   lesion(s).
69150...........  Extensive ear       ...............  ...............  ...............       7.7261      $306.63      $391.09       $61.33       $78.22
                   canal surgery.
69200...........  Clear outer ear     Y..............  Y..............  ...............       0.6211       $24.65       $24.65        $4.93        $4.93
                   canal.
69205...........  Clear outer ear     ...............  ...............  ...............      19.9760      $792.81      $562.90      $158.56      $112.58
                   canal.
69210...........  Remove impacted     Y..............  Y..............  Y..............       0.5077       $20.15       $20.15        $4.03        $4.03
                   ear wax.
69220...........  Clean out mastoid   Y..............  Y..............  ...............       0.8076       $32.05       $32.05        $6.41        $6.41
                   cavity.
69222...........  Clean out mastoid   Y..............  Y..............  Y..............       3.3054      $131.19      $131.19       $26.24       $26.24
                   cavity.
69300...........  Revise external     ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
                   ear.
69310...........  Rebuild outer ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   canal.
69320...........  Rebuild outer ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   canal.
69400...........  Inflate middle ear  Y..............  Y..............  Y..............       2.1026       $83.45       $83.45       $16.69       $16.69
                   canal.
69401...........  Inflate middle ear  Y..............  Y..............  Y..............       1.1906       $47.25       $47.25        $9.45        $9.45
                   canal.
69405...........  Catheterize middle  Y..............  Y..............  Y..............       3.0530      $121.17      $121.17       $24.23       $24.23
                   ear canal.
69420...........  Incision of         Y..............  Y..............  ...............       2.3768       $94.33       $94.33       $18.87       $18.87
                   eardrum.
69421...........  Incision of         ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   eardrum.
69424...........  Remove ventilating  Y..............  Y..............  Y..............       1.9136       $75.95       $75.95       $15.19       $15.19
                   tube.
69433...........  Create eardrum      Y..............  Y..............  Y..............       2.7076      $107.46      $107.46       $21.49       $21.49
                   opening.
69436...........  Create eardrum      ...............  ...............  ...............      16.4494      $652.85      $581.42      $130.57      $116.28
                   opening.
69440...........  Exploration of      ...............  ...............  ...............      23.1564      $919.03      $714.52      $183.81      $142.90
                   middle ear.
69450...........  Eardrum revision..  ...............  ...............  ...............      37.7719    $1,499.09      $916.05      $299.82      $183.21
69501...........  Mastoidectomy.....  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
69502...........  Mastoidectomy.....  ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
69505...........  Remove mastoid      ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   structures.
69511...........  Extensive mastoid   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   surgery.
69530...........  Extensive mastoid   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   surgery.
69540...........  Remove ear lesion.  Y..............  Y..............  Y..............       3.2334      $128.33      $128.33       $25.67       $25.67
69550...........  Remove ear lesion.  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
69552...........  Remove ear lesion.  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
69601...........  Mastoid surgery     ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   revision.
69602...........  Mastoid surgery     ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   revision.

[[Page 49947]]

 
69603...........  Mastoid surgery     ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   revision.
69604...........  Mastoid surgery     ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   revision.
69605...........  Mastoid surgery     ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   revision.
69610...........  Repair of eardrum.  Y..............  Y..............  Y..............       4.4163      $175.28      $175.28       $35.06       $35.06
69620...........  Repair of eardrum.  ...............  ...............  ...............      23.1564      $919.03      $682.52      $183.81      $136.50
69631...........  Repair eardrum      ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   structures.
69632...........  Rebuild eardrum     ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   structures.
69633...........  Rebuild eardrum     ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   structures.
69635...........  Repair eardrum      ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   structures.
69636...........  Rebuild eardrum     ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   structures.
69637...........  Rebuild eardrum     ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   structures.
69641...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   & mastoid.
69642...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   & mastoid.
69643...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   & mastoid.
69644...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   & mastoid.
69645...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   & mastoid.
69646...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   & mastoid.
69650...........  Release middle ear  ...............  ...............  ...............      23.1564      $919.03      $957.02      $183.81      $191.40
                   bone.
69660...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   bone.
69661...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   bone.
69662...........  Revise middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   bone.
69666...........  Repair middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   structures.
69667...........  Repair middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,064.55      $299.82      $212.91
                   structures.
69670...........  Remove mastoid air  ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   cells.
69676...........  Remove middle ear   ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   nerve.
69700...........  Close mastoid       ...............  ...............  ...............      37.7719    $1,499.09    $1,004.55      $299.82      $200.91
                   fistula.
69711...........  Remove/repair       ...............  ...............  ...............      37.7719    $1,499.09      $916.05      $299.82      $183.21
                   hearing aid.
69714...........  Implant temple      ...............  ...............  ...............      37.7719    $1,499.09    $1,419.05      $299.82      $283.81
                   bone w/stimul.
69715...........  Temple bne implnt   ...............  ...............  ...............      37.7719    $1,499.09    $1,419.05      $299.82      $283.81
                   w/stimulat.
69717...........  Temple bone         ...............  ...............  ...............      37.7719    $1,499.09    $1,419.05      $299.82      $283.81
                   implant revision.
69718...........  Revise temple bone  ...............  ...............  ...............      37.7719    $1,499.09    $1,419.05      $299.82      $283.81
                   implant.

[[Page 49948]]

 
69720...........  Release facial      ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   nerve.
69740...........  Repair facial       ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   nerve.
69745...........  Repair facial       ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   nerve.
69801...........  Incise inner ear..  ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
69802...........  Incise inner ear..  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
69805...........  Explore inner ear.  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
69806...........  Explore inner ear.  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
69820...........  Establish inner     ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   ear window.
69840...........  Revise inner ear    ...............  ...............  ...............      37.7719    $1,499.09    $1,108.05      $299.82      $221.61
                   window.
69905...........  Remove inner ear..  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
69910...........  Remove inner ear &  ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   mastoid.
69915...........  Incise inner ear    ...............  ...............  ...............      37.7719    $1,499.09    $1,247.05      $299.82      $249.41
                   nerve.
69930...........  Implant cochlear    ...............  ...............  ...............     406.8232   $16,146.03    $8,570.52    $3,229.21    $1,714.10
                   device.
G0104...........  CA screen;flexi     Y..............  Y..............  ...............       1.7292       $68.63       $68.63       $13.73       $13.73
                   sigmoidscope.
G0105...........  Colorectal scrn;    ...............  ...............  ...............       7.8134      $310.10      $378.05       $62.02       $75.61
                   hi risk ind.
G0121...........  Colon ca scrn; not  ...............  ...............  ...............       7.8134      $310.10      $378.05       $62.02       $75.61
                   high rsk.
G0127...........  Trim nail(s)......  Y..............  Y..............  ...............       0.2665       $10.58       $10.58        $2.12        $2.12
G0186...........  Dstry eye lesn,fdr  Y..............  Y..............  ...............       4.0750      $161.73      $161.73       $32.35       $32.35
                   vssl tech.
G0260...........  Inj for sacroiliac  ...............  ...............  ...............       5.5439      $220.03      $276.51       $44.01       $55.30
                   jt anesth.
G0268...........  Removal of          Y..............  Y..............  ...............       0.5409       $21.47       $21.47        $4.29        $4.29
                   impacted wax md.
G0364...........  Bone marrow         Y..............  Y..............  ...............       0.1293        $5.13        $5.13        $1.03        $1.03
                   aspirate & biops.
--------------------------------------------------------------------------------------------------------------------------------------------------------


ADDENDUM CC.--Proposed List of Procedures for CY 2008 Subject to Payment
                Limitation at the MPFS Nonfacility AMOUNT
------------------------------------------------------------------------
               HCPCS                          Short Description
------------------------------------------------------------------------
10021.............................  Fna w/o image
10040.............................  Acne surgery
10060.............................  Drainage of skin abscess
10061.............................  Drainage of skin abscess
10080.............................  Drainage of pilonidal cyst
10081.............................  Drainage of pilonidal cyst
10120.............................  Remove foreign body
10140.............................  Drainage of hematoma/fluid
10160.............................  Puncture drainage of lesion
11000.............................  Debride infected skin
11001.............................  Debride infected skin add-on
11040.............................  Debride skin, partial
11041.............................  Debride skin, full
11055.............................  Trim skin lesion
11056.............................  Trim skin lesions, 2 to 4
11057.............................  Trim skin lesions, over 4
11100.............................  Biopsy, skin lesion
11101.............................  Biopsy, skin add-on
11200.............................  Removal of skin tags
11201.............................  Remove skin tags add-on
11300.............................  Shave skin lesion
11301.............................  Shave skin lesion
11302.............................  Shave skin lesion
11303.............................  Shave skin lesion
11305.............................  Shave skin lesion
11306.............................  Shave skin lesion
11307.............................  Shave skin lesion
11308.............................  Shave skin lesion
11310.............................  Shave skin lesion
11311.............................  Shave skin lesion
11312.............................  Shave skin lesion
11313.............................  Shave skin lesion
11400.............................  Exc tr-ext b9+marg 0.5 < cm
11401.............................  Exc tr-ext b9+marg 0.6-1 cm
11402.............................  Exc tr-ext b9+marg 1.1-2 cm
11403.............................  Exc tr-ext b9+marg 2.1-3 cm
11420.............................  Exc h-f-nk-sp b9+marg 0.5 >
11421.............................  Exc h-f-nk-sp b9+marg 0.6-1
11422.............................  Exc h-f-nk-sp b9+marg 1.1-2
11423.............................  Exc h-f-nk-sp b9+marg 2.1-3
11440.............................  Exc face-mm b9+marg 0.5 < cm
11441.............................  Exc face-mm b9+marg 0.6-1 cm
11442.............................  Exc face-mm b9+marg 1.1-2 cm
11443.............................  Exc face-mm b9+marg 2.1-3 cm
11600.............................  Exc tr-ext mlg+marg 0.5 < cm

[[Page 49949]]

 
11601.............................  Exc tr-ext mlg+marg 0.6-1 cm
11602.............................  Exc tr-ext mlg+marg 1.1-2 cm
11603.............................  Exc tr-ext mlg+marg 2.1-3 cm
11620.............................  Exc h-f-nk-sp mlg+marg 0.5 >
11621.............................  Exc h-f-nk-sp mlg+marg 0.6-1
11622.............................  Exc h-f-nk-sp mlg+marg 1.1-2
11623.............................  Exc h-f-nk-sp mlg+marg 2.1-3
11640.............................  Exc face-mm malig+marg 0.5
11641.............................  Exc face-mm malig+marg 0.6-1
11642.............................  Exc face-mm malig+marg 1.1-2
11643.............................  Exc face-mm malig+marg 2.1-3
11719.............................  Trim nail(s)
11720.............................  Debride nail, 1-5
11721.............................  Debride nail, 6 or more
11730.............................  Removal of nail plate
11732.............................  Remove nail plate, add-on
11740.............................  Drain blood from under nail
11750.............................  Removal of nail bed
11752.............................  Remove nail bed/finger tip
11755.............................  Biopsy, nail unit
11762.............................  Reconstruction of nail bed
11765.............................  Excision of nail fold, toe
11900.............................  Injection into skin lesions
11901.............................  Added skin lesions injection
11920.............................  Correct skin color defects
11921.............................  Correct skin color defects
11922.............................  Correct skin color defects
11950.............................  Therapy for contour defects
11951.............................  Therapy for contour defects
11952.............................  Therapy for contour defects
11954.............................  Therapy for contour defects
11976.............................  Removal of contraceptive cap
11980.............................  Implant hormone pellet(s)
11981.............................  Insert drug implant device
11982.............................  Remove drug implant device
11983.............................  Remove/insert drug implant
12001.............................  Repair superficial wound(s)
12002.............................  Repair superficial wound(s)
12004.............................  Repair superficial wound(s)
12011.............................  Repair superficial wound(s)
12013.............................  Repair superficial wound(s)
12014.............................  Repair superficial wound(s)
12031.............................  Layer closure of wound(s)
12032.............................  Layer closure of wound(s)
12041.............................  Layer closure of wound(s)
12042.............................  Layer closure of wound(s)
12051.............................  Layer closure of wound(s)
12052.............................  Layer closure of wound(s)
12053.............................  Layer closure of wound(s)
13133.............................  Repair wound/lesion add-on
15340.............................  Apply cult skin substitute
15780.............................  Abrasion treatment of skin
15781.............................  Abrasion treatment of skin
15782.............................  Abrasion treatment of skin
15783.............................  Abrasion treatment of skin
15786.............................  Abrasion, lesion, single
15787.............................  Abrasion, lesions, add-on
15788.............................  Chemical peel, face, epiderm
15789.............................  Chemical peel, face, dermal
15792.............................  Chemical peel, nonfacial
15793.............................  Chemical peel, nonfacial
15851.............................  Removal of sutures
16000.............................  Initial treatment of burn(s)
16020.............................  Dress/debrid p-thick burn, s
17000.............................  Destroy benign/premlg lesion
17003.............................  Destroy lesions, 2-14
17004.............................  Destroy lesions, 15 or more
17106.............................  Destruction of skin lesions
17107.............................  Destruction of skin lesions
17108.............................  Destruction of skin lesions
17110.............................  Destruct lesion, 1-14
17111.............................  Destruct lesion, 15 or more
17250.............................  Chemical cautery, tissue
17260.............................  Destruction of skin lesions
17261.............................  Destruction of skin lesions
17262.............................  Destruction of skin lesions
17263.............................  Destruction of skin lesions
17264.............................  Destruction of skin lesions
17266.............................  Destruction of skin lesions
17270.............................  Destruction of skin lesions
17271.............................  Destruction of skin lesions
17272.............................  Destruction of skin lesions
17273.............................  Destruction of skin lesions
17274.............................  Destruction of skin lesions
17276.............................  Destruction of skin lesions
17280.............................  Destruction of skin lesions
17281.............................  Destruction of skin lesions
17282.............................  Destruction of skin lesions
17283.............................  Destruction of skin lesions
17284.............................  Destruction of skin lesions
17286.............................  Destruction of skin lesions
17304.............................  1 stage mohs, up to 5 spec
17305.............................  2 stage mohs, up to 5 spec
17306.............................  3 stage mohs, up to 5 spec
17307.............................  Mohs addl stage up to 5 spec
17310.............................  Mohs any stage > 5 spec each
17340.............................  Cryotherapy of skin
17360.............................  Skin peel therapy
17380.............................  Hair removal by electrolysis
19000.............................  Drainage of breast lesion
19001.............................  Drain breast lesion add-on
20000.............................  Incision of abscess
20500.............................  Injection of sinus tract
20520.............................  Removal of foreign body
20526.............................  Ther injection, carp tunnel
20550.............................  Inj tendon sheath/ligament
20551.............................  Inj tendon origin/insertion
20552.............................  Inj trigger point, 1/2 muscl
20553.............................  Inject trigger points, =/> 3
20600.............................  Drain/inject, joint/bursa
20605.............................  Drain/inject, joint/bursa
20610.............................  Drain/inject, joint/bursa
20612.............................  Aspirate/inj ganglion cyst
20615.............................  Treatment of bone cyst
20662.............................  Application of pelvis brace
20663.............................  Application of thigh brace
20973.............................  Bone/skin graft, great toe
20974.............................  Electrical bone stimulation
20979.............................  Us bone stimulation
21030.............................  Excise max/zygoma b9 tumor
21031.............................  Remove exostosis, mandible
21032.............................  Remove exostosis, maxilla
21048.............................  Remove maxilla cyst complex
21076.............................  Prepare face/oral prosthesis
21077.............................  Prepare face/oral prosthesis
21079.............................  Prepare face/oral prosthesis
21080.............................  Prepare face/oral prosthesis
21081.............................  Prepare face/oral prosthesis
21082.............................  Prepare face/oral prosthesis
21083.............................  Prepare face/oral prosthesis
21084.............................  Prepare face/oral prosthesis
21085.............................  Prepare face/oral prosthesis
21086.............................  Prepare face/oral prosthesis
21087.............................  Prepare face/oral prosthesis
21088.............................  Prepare face/oral prosthesis
21089.............................  Prepare face/oral prosthesis
21110.............................  Interdental fixation
21440.............................  Treat dental ridge fracture
21920.............................  Biopsy soft tissue of back
23065.............................  Biopsy shoulder tissues
23600.............................  Treat humerus fracture
23620.............................  Treat humerus fracture
24065.............................  Biopsy arm/elbow soft tissue
24200.............................  Removal of arm foreign body
24650.............................  Treat radius fracture
25065.............................  Biopsy forearm soft tissues
25500.............................  Treat fracture of radius
25530.............................  Treat fracture of ulna
25560.............................  Treat fracture radiusamp; ulna
25600.............................  Treat fracture radius/ulna
25622.............................  Treat wrist bone fracture
25630.............................  Treat wrist bone fracture
25650.............................  Treat wrist bone fracture
26010.............................  Drainage of finger abscess
26600.............................  Treat metacarpal fracture
26720.............................  Treat finger fracture, each
26725.............................  Treat finger fracture, each
26740.............................  Treat finger fracture, each
26750.............................  Treat finger fracture, each
27200.............................  Treat tail bone fracture
27613.............................  Biopsy lower leg soft tissue
28001.............................  Drainage of bursa of foot
28010.............................  Incision of toe tendon
28124.............................  Partial removal of toe
28190.............................  Removal of foot foreign body
28220.............................  Release of foot tendon
28230.............................  Incision of foot tendon(s)
28232.............................  Incision of toe tendon
28272.............................  Release of toe joint, each
28430.............................  Treatment of ankle fracture
28450.............................  Treat midfoot fracture, each
28455.............................  Treat midfoot fracture, each
28470.............................  Treat metatarsal fracture
28475.............................  Treat metatarsal fracture
28490.............................  Treat big toe fracture
28495.............................  Treat big toe fracture
28510.............................  Treatment of toe fracture
28515.............................  Treatment of toe fracture
28530.............................  Treat sesamoid bone fracture
28540.............................  Treat foot dislocation
28570.............................  Treat foot dislocation
28600.............................  Treat foot dislocation
29010.............................  Application of body cast
29015.............................  Application of body cast
29025.............................  Application of body cast
29049.............................  Application of figure eight
29055.............................  Application of shoulder cast
29058.............................  Application of shoulder cast
29065.............................  Application of long arm cast
29075.............................  Application of forearm cast
29085.............................  Apply hand/wrist cast
29086.............................  Apply finger cast
29105.............................  Apply long arm splint
29125.............................  Apply forearm splint
29126.............................  Apply forearm splint
29130.............................  Application of finger splint
29131.............................  Application of finger splint
29200.............................  Strapping of chest
29220.............................  Strapping of low back
29240.............................  Strapping of shoulder
29260.............................  Strapping of elbow or wrist

[[Page 49950]]

 
29280.............................  Strapping of hand or finger
29345.............................  Application of long leg cast
29355.............................  Application of long leg cast
29358.............................  Apply long leg cast brace
29365.............................  Application of long leg cast
29405.............................  Apply short leg cast
29425.............................  Apply short leg cast
29435.............................  Apply short leg cast
29440.............................  Addition of walker to cast
29445.............................  Apply rigid leg cast
29450.............................  Application of leg cast
29520.............................  Strapping of hip
29530.............................  Strapping of knee
29540.............................  Strapping of ankle and/or ft
29550.............................  Strapping of toes
29580.............................  Application of paste boot
29590.............................  Application of foot splint
29700.............................  Removal/revision of cast
29705.............................  Removal/revision of cast
29710.............................  Removal/revision of cast
29715.............................  Removal/revision of cast
29720.............................  Repair of body cast
29730.............................  Windowing of cast
29740.............................  Wedging of cast
29750.............................  Wedging of clubfoot cast
30000.............................  Drainage of nose lesion
30020.............................  Drainage of nose lesion
30100.............................  Intranasal biopsy
30110.............................  Removal of nose polyp(s)
30124.............................  Removal of nose lesion
30200.............................  Injection treatment of nose
30210.............................  Nasal sinus therapy
30300.............................  Remove nasal foreign body
30901.............................  Control of nosebleed
31000.............................  Irrigation, maxillary sinus
31002.............................  Irrigation, sphenoid sinus
31040.............................  Exploration behind upper jaw
31231.............................  Nasal endoscopy, dx
31505.............................  Diagnostic laryngoscopy
31575.............................  Diagnostic laryngoscopy
31579.............................  Diagnostic laryngoscopy
36425.............................  Vein access cutdown > 1 yr
36430.............................  Blood transfusion service
36440.............................  Bl push transfuse, 2 yr or lgt;
36468.............................  Injection(s), spider veins
36470.............................  Injection therapy of vein
36471.............................  Injection therapy of veins
36550.............................  Declot vascular device
36598.............................  Inj w/fluor, eval cv device
37765.............................  Phleb veins - extrem - to 20
37766.............................  Phleb veins - extrem 20+
38220.............................  Bone marrow aspiration
38221.............................  Bone marrow biopsy
38242.............................  Lymphocyte infuse transplant
40490.............................  Biopsy of lip
40702.............................  Repair cleft lip/nasal
40800.............................  Drainage of mouth lesion
40804.............................  Removal, foreign body, mouth
40805.............................  Removal, foreign body, mouth
40806.............................  Incision of lip fold
40808.............................  Biopsy of mouth lesion
40810.............................  Excision of mouth lesion
40812.............................  Excise/repair mouth lesion
40820.............................  Treatment of mouth lesion
41000.............................  Drainage of mouth lesion
41100.............................  Biopsy of tongue
41105.............................  Biopsy of tongue
41108.............................  Biopsy of floor of mouth
41110.............................  Excision of tongue lesion
41115.............................  Excision of tongue fold
41805.............................  Removal foreign body, gum
41806.............................  Removal foreign body,jawbone
41820.............................  Excision, gum, each quadrant
41822.............................  Excision of gum lesion
41823.............................  Excision of gum lesion
41825.............................  Excision of gum lesion
41826.............................  Excision of gum lesion
41828.............................  Excision of gum lesion
41830.............................  Removal of gum tissue
41850.............................  Treatment of gum lesion
41872.............................  Repair gum
41874.............................  Repair tooth socket
42100.............................  Biopsy roof of mouth
42104.............................  Excision lesion, mouth roof
42106.............................  Excision lesion, mouth roof
42160.............................  Treatment mouth roof lesion
42280.............................  Preparation, palate mold
42330.............................  Removal of salivary stone
42335.............................  Removal of salivary stone
42400.............................  Biopsy of salivary gland
42650.............................  Dilation of salivary duct
42660.............................  Dilation of salivary duct
42800.............................  Biopsy of throat
42970.............................  Control nose/throat bleeding
45300.............................  Proctosigmoidoscopy dx
45303.............................  Proctosigmoidoscopy dilate
45330.............................  Diagnostic sigmoidoscopy
45520.............................  Treatment of rectal prolapse
46083.............................  Incise external hemorrhoid
46221.............................  Ligation of hemorrhoid(s)
46320.............................  Removal of hemorrhoid clot
46500.............................  Injection into hemorrhoid(s)
46600.............................  Diagnostic anoscopy
46604.............................  Anoscopy and dilation
46606.............................  Anoscopy and biopsy
46614.............................  Anoscopy, control bleeding
46900.............................  Destruction, anal lesion(s)
46910.............................  Destruction, anal lesion(s)
46916.............................  Cryosurgery, anal lesion(s)
46934.............................  Destruction of hemorrhoids
46935.............................  Destruction of hemorrhoids
46936.............................  Destruction of hemorrhoids
46940.............................  Treatment of anal fissure
46942.............................  Treatment of anal fissure
46945.............................  Ligation of hemorrhoids
46946.............................  Ligation of hemorrhoids
50391.............................  Instll rx agnt into rnal tub
50686.............................  Measure ureter pressure
51000.............................  Drainage of bladder
51005.............................  Drainage of bladder
51700.............................  Irrigation of bladder
51701.............................  Insert bladder catheter
51702.............................  Insert temp bladder cath
51703.............................  Insert bladder cath, complex
51705.............................  Change of bladder tube
51720.............................  Treatment of bladder lesion
51725.............................  Simple cystometrogram
51736.............................  Urine flow measurement
51741.............................  Electro-uroflowmetry, first
51784.............................  Anal/urinary muscle study
51792.............................  Urinary reflex study
51795.............................  Urine voiding pressure study
51797.............................  Intraabdominal pressure test
51798.............................  Us urine capacity measure
52265.............................  Cystoscopy and treatment
53025.............................  Incision of urethra
53060.............................  Drainage of urethra abscess
53600.............................  Dilate urethra stricture
53601.............................  Dilate urethra stricture
53620.............................  Dilate urethra stricture
53621.............................  Dilate urethra stricture
53660.............................  Dilation of urethra
53661.............................  Dilation of urethra
53850.............................  Prostatic microwave thermotx
53852.............................  Prostatic rf thermotx
53853.............................  Prostatic water thermother
54050.............................  Destruction, penis lesion(s)
54055.............................  Destruction, penis lesion(s)
54056.............................  Cryosurgery, penis lesion(s)
54200.............................  Treatment of penis lesion
54231.............................  Dynamic cavernosometry
54235.............................  Penile injection
54240.............................  Penis study
54250.............................  Penis study
55000.............................  Drainage of hydrocele
55450.............................  Ligation of sperm duct
55600.............................  Incise sperm duct pouch
55870.............................  Electroejaculation
56405.............................  I & D of vulva/perineum
56420.............................  Drainage of gland abscess
56501.............................  Destroy, vulva lesions, sim
56605.............................  Biopsy of vulva/perineum
56606.............................  Biopsy of vulva/perineum
56820.............................  Exam of vulva w/scope
56821.............................  Exam/biopsy of vulva w/scope
57061.............................  Destroy vag lesions, simple
57100.............................  Biopsy of vagina
57150.............................  Treat vagina infection
57160.............................  Insert pessary/other device
57170.............................  Fitting of diaphragm/cap
57420.............................  Exam of vagina w/scope
57421.............................  Exam/biopsy of vag w/scope
57452.............................  Exam of cervix w/scope
57454.............................  Bx/curett of cervix w/scope
57455.............................  Biopsy of cervix w/scope
57456.............................  Endocerv curettage w/scope
57460.............................  Bx of cervix w/scope, leep
57461.............................  Conz of cervix w/scope, leep
57500.............................  Biopsy of cervix
57505.............................  Endocervical curettage
57510.............................  Cauterization of cervix
57511.............................  Cryocautery of cervix
57800.............................  Dilation of cervical canal
58100.............................  Biopsy of uterus lining
58110.............................  Bx done w/colposcopy add-on
58300.............................  Insert intrauterine device
58301.............................  Remove intrauterine device
58321.............................  Artificial insemination
58322.............................  Artificial insemination
58323.............................  Sperm washing
58345.............................  Reopen fallopian tube
58356.............................  Endometrial cryoablation
59000.............................  Amniocentesis, diagnostic
59001.............................  Amniocentesis, therapeutic
59015.............................  Chorion biopsy
59020.............................  Fetal contract stress test
59025.............................  Fetal non-stress test
59100.............................  Remove uterus lesion
59200.............................  Insert cervical dilator
59300.............................  Episiotomy or vaginal repair
60001.............................  Aspirate/inject thyriod cyst

[[Page 49951]]

 
60100.............................  Biopsy of thyroid
61000.............................  Remove cranial cavity fluid
61001.............................  Remove cranial cavity fluid
62252.............................  Csf shunt reprogram
62367.............................  Analyze spine infusion pump
62368.............................  Analyze spine infusion pump
63615.............................  Remove lesion of spinal cord
64400.............................  N block inj, trigeminal
64402.............................  N block inj, facial
64405.............................  N block inj, occipital
64408.............................  N block inj, vagus
64412.............................  N block inj, spinal accessor
64413.............................  N block inj, cervical plexus
64418.............................  N block inj, suprascapular
64425.............................  N block inj, ilio-ing/hypogi
64435.............................  N block inj, paracervical
64445.............................  N block inj, sciatic, sng
64450.............................  N block, other peripheral
64505.............................  N block, spenopalatine gangl
64508.............................  N block, carotid sinus s/p
64550.............................  Apply neurostimulator
64555.............................  Implant neuroelectrodes
64565.............................  Implant neuroelectrodes
64612.............................  Destroy nerve, face muscle
64613.............................  Destroy nerve, neck muscle
64614.............................  Destroy nerve, extrem musc
64640.............................  Injection treatment of nerve
65205.............................  Remove foreign body from eye
65210.............................  Remove foreign body from eye
65222.............................  Remove foreign body from eye
65286.............................  Repair of eye wound
65430.............................  Corneal smear
65435.............................  Curette/treat cornea
65600.............................  Revision of cornea
65855.............................  Laser surgery of eye
65860.............................  Incise inner eye adhesions
66761.............................  Revision of iris
66762.............................  Revision of iris
66770.............................  Removal of inner eye lesion
67028.............................  Injection eye drug
67101.............................  Repair detached retina
67105.............................  Repair detached retina
67110.............................  Repair detached retina
67145.............................  Treatment of retina
67208.............................  Treatment of retinal lesion
67210.............................  Treatment of retinal lesion
67220.............................  Treatment of choroid lesion
67221.............................  Ocular photodynamic ther
67225.............................  Eye photodynamic ther add-on
67228.............................  Treatment of retinal lesion
67345.............................  Destroy nerve of eye muscle
67515.............................  Inject/treat eye socket
67700.............................  Drainage of eyelid abscess
67710.............................  Incision of eyelid
67800.............................  Remove eyelid lesion
67801.............................  Remove eyelid lesions
67805.............................  Remove eyelid lesions
67810.............................  Biopsy of eyelid
67820.............................  Revise eyelashes
67825.............................  Revise eyelashes
67840.............................  Remove eyelid lesion
67850.............................  Treat eyelid lesion
67915.............................  Repair eyelid defect
67922.............................  Repair eyelid defect
67930.............................  Repair eyelid wound
67938.............................  Remove eyelid foreign body
68020.............................  Incise/drain eyelid lining
68040.............................  Treatment of eyelid lesions
68100.............................  Biopsy of eyelid lining
68110.............................  Remove eyelid lining lesion
68135.............................  Remove eyelid lining lesion
68200.............................  Treat eyelid by injection
68400.............................  Incise/drain tear gland
68420.............................  Incise/drain tear sac
68440.............................  Incise tear duct opening
68530.............................  Clearance of tear duct
68705.............................  Revise tear duct opening
68760.............................  Close tear duct opening
68761.............................  Close tear duct opening
68801.............................  Dilate tear duct opening
68840.............................  Explore/irrigate tear ducts
69000.............................  Drain external ear lesion
69005.............................  Drain external ear lesion
69020.............................  Drain outer ear canal lesion
69100.............................  Biopsy of external ear
69105.............................  Biopsy of external ear canal
69200.............................  Clear outer ear canal
69210.............................  Remove impacted ear wax
69220.............................  Clean out mastoid cavity
69222.............................  Clean out mastoid cavity
69399.............................  Outer ear surgery procedure
69400.............................  Inflate middle ear canal
69401.............................  Inflate middle ear canal
69405.............................  Catheterize middle ear canal
69410.............................  Inset middle ear (baffle)
69420.............................  Incision of eardrum
69424.............................  Remove ventilating tube
69433.............................  Create eardrum opening
69540.............................  Remove ear lesion
69610.............................  Repair of eardrum
------------------------------------------------------------------------


            Addendum D1.--Proposed Payment Status Indicators
------------------------------------------------------------------------
     Indicator          Item/code/service         OPPS payment status
------------------------------------------------------------------------
A.................  Services furnished to a    Not paid under OPPS. Paid
                     hospital outpatient that   by fiscal intermediaries
                     are paid under a fee       under a fee schedule or
                     schedule or payment        payment system other
                     system other than OPPS,    than OPPS.
                     for example:
                     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         Not paid under OPPS.
                     recognized by OPPS when    May be paid by
                     submitted on an            intermediaries when
                     outpatient hospital Part   submitted on a different
                     B bill type (12x and       bill type, for example,
                     13x).                      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 and 13x) may
                                                be available.
C.................  Inpatient Procedures.....  Not paid under OPPS.
                                                Admit patient. Bill as
                                                inpatient.
D.................  Discontinued Codes.......  Not paid under OPPS or
                                                any other Medicare
                                                payment system.
E.................  Items, Codes, and          Not paid under OPPS or
                     Services:                  any other Medicare
                     That are not       payment system.
                     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..

[[Page 49952]]

 
F.................  Corneal Tissue             Not paid under OPPS. Paid
                     Acquisition; Certain       at reasonable cost.
                     CRNA Services; and
                     Hepatitis B Vaccines.
G.................  Pass-Through Drugs and     Paid under OPPS; Separate
                     Biologicals.               APC payment includes
                                                pass-through amount.
H.................  Pass-Through Device        Separate cost-based pass-
                     Categories.                through payment; Not
                                                subject to coinsurance.
K.................  (1) Non-Pass-Through       (1) Paid under OPPS;
                     Drugs and Biologicals,     Separate APC payment.
                     and Radiopharmaceutical
                     Agents.
                    (2) Brachytherapy Sources  (2) Paid under OPPS;
                                                Separate APC payment.
                    (3) Blood and Blood        (3) Paid under OPPS;
                     Products.                  Separate APC payment.
L.................  Influenza Vaccine;         Not paid under OPPS. Paid
                     Pneumococcal Pneumonia     at reasonable cost; Not
                     Vaccine.                   subject to deductible or
                                                coinsurance.
M.................  Items and Services Not     Not paid under OPPS.
                     Billable to the Fiscal
                     Intermediary.
N.................  Items and Services         Paid under OPPS; Payment
                     Packaged into APC Rates.   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  Paid under OPPS; Addendum
                     to Separate Payment        B displays APC
                     Under OPPS Payment         assignments when
                     Criteria.                  services are separately
                                                payable.
                                               (1) Separate APC payment
                                                based on OPPS payment
                                                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 Procedure,     Paid under OPPS; Separate
                     Not Discounted when        APC payment.
                     Multiple.
T.................  Significant Procedure,     Paid under OPPS; Separate
                     Multiple Reduction         APC payment.
                     Applies.
V.................  Clinic or Emergency        Paid under OPPS; Separate
                     Department Visit.          APC payment.
Y.................  Non-Implantable Durable    Not paid under OPPS. All
                     Medical Equipment.         institutional providers
                                                other than home health
                                                agencies bill to DMERC.
X.................  Ancillary Services.......  Paid under OPPS; Separate
                                                APC payment.
------------------------------------------------------------------------


                Addendum D2.--Proposed 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.
CH....................  Active HCPCS codes in current year and next
                         calendar year; status indicator and/or APC
                         assignment have changed.
------------------------------------------------------------------------


    Addendum E.--CPT Codes That Are Paid Only as Inpatient Procedures
------------------------------------------------------------------------
                                                             CY 2007
                                                          Proposed Rule
           CPT/HCPCS                   Description            Status
                                                            Indicator
------------------------------------------------------------------------
00176..........................  Anesth, pharyngeal      C
                                  surgery.
00192..........................  Anesth, facial bone     C
                                  surgery.
00214..........................  Anesth, skull drainage  C
00215..........................  Anesth, skull repair/   C
                                  fract.
00404..........................  Anesth, surgery of      C
                                  breast.
00406..........................  Anesth, surgery of      C
                                  breast.
00452..........................  Anesth, surgery of      C
                                  shoulder.
00474..........................  Anesth, surgery of      C
                                  rib(s).
00524..........................  Anesth, chest drainage  C
00540..........................  Anesth, chest surgery.  C
00542..........................  Anesth, release of      C
                                  lung.
00546..........................  Anesth, lung, chest     C
                                  wall surg.
00560..........................  Anesth, heart surg w/o  C
                                  pump.
00561..........................  Anesth, heart surgry <  C
                                  age 1.
00562..........................  Anesth, heart surg w/   C
                                  pump.
00580..........................  Anesth, heart/lung      C
                                  transplnt.
00604..........................  Anesth, sitting         C
                                  procedure.
00622..........................  Anesth, removal of      C
                                  nerves.
00632..........................  Anesth, removal of      C
                                  nerves.
00670..........................  Anesth, spine, cord     C
                                  surgery.
00792..........................  Anesth, hemorr/excise   C
                                  liver.
00794..........................  Anesth, pancreas        C
                                  removal.
00796..........................  Anesth, for liver       C
                                  transplant.

[[Page 49953]]

 
00802..........................  Anesth, fat layer       C
                                  removal.
00844..........................  Anesth, pelvis surgery  C
00846..........................  Anesth, hysterectomy..  C
00848..........................  Anesth, pelvic organ    C
                                  surg.
00864..........................  Anesth, removal of      C
                                  bladder.
00865..........................  Anesth, removal of      C
                                  prostate.
00866..........................  Anesth, removal of      C
                                  adrenal.
00868..........................  Anesth, kidney          C
                                  transplant.
00882..........................  Anesth, major vein      C
                                  ligation.
00904..........................  Anesth, perineal        C
                                  surgery.
00908..........................  Anesth, removal of      C
                                  prostate.
00932..........................  Anesth, amputation of   C
                                  penis.
00934..........................  Anesth, penis, nodes    C
                                  removal.
00936..........................  Anesth, penis, nodes    C
                                  removal.
00944..........................  Anesth, vaginal         C
                                  hysterectomy.
01140..........................  Anesth, amputation at   C
                                  pelvis.
01150..........................  Anesth, pelvic tumor    C
                                  surgery.
01212..........................  Anesth, hip             C
                                  disarticulation.
01214..........................  Anesth, hip             C
                                  arthroplasty.
01232..........................  Anesth, amputation of   C
                                  femur.
01234..........................  Anesth, radical femur   C
                                  surg.
01272..........................  Anesth, femoral artery  C
                                  surg.
01274..........................  Anesth, femoral         C
                                  embolectomy.
01402..........................  Anesth, knee            C
                                  arthroplasty.
01404..........................  Anesth, amputation at   C
                                  knee.
01442..........................  Anesth, knee artery     C
                                  surg.
01444..........................  Anesth, knee artery     C
                                  repair.
01486..........................  Anesth, ankle           C
                                  replacement.
01502..........................  Anesth, lwr leg         C
                                  embolectomy.
01632..........................  Anesth, surgery of      C
                                  shoulder.
01634..........................  Anesth, shoulder joint  C
                                  amput.
01636..........................  Anesth, forequarter     C
                                  amput.
01638..........................  Anesth, shoulder        C
                                  replacement.
01652..........................  Anesth, shoulder        C
                                  vessel surg.
01654..........................  Anesth, shoulder        C
                                  vessel surg.
01656..........................  Anesth, arm-leg vessel  C
                                  surg.
01756..........................  Anesth, radical         C
                                  humerus surg.
01990..........................  Support for organ       C
                                  donor.
11004..........................  Debride genitalia &     C
                                  perineum.
11005..........................  Debride abdom wall....  C
11006..........................  Debride genit/per/      C
                                  abdom wall.
11008..........................  Remove mesh from abd    C
                                  wall.
15756..........................  Free myo/skin flap      C
                                  microvasc.
15757..........................  Free skin flap,         C
                                  microvasc.
15758..........................  Free fascial flap,      C
                                  microvasc.
16036..........................  Escharotomy; add'l      C
                                  incision.
19200..........................  Removal of breast.....  C
19220..........................  Removal of breast.....  C
19271..........................  Revision of chest wall  C
19272..........................  Extensive chest wall    C
                                  surgery.
19361..........................  Breast reconstruction.  C
19364..........................  Breast reconstruction.  C
19367..........................  Breast reconstruction.  C
19368..........................  Breast reconstruction.  C
19369..........................  Breast reconstruction.  C
20660..........................  Apply, rem fixation     C
                                  device.
20661..........................  Application of head     C
                                  brace.
20664..........................  Halo brace application  C
20802..........................  Replantation, arm,      C
                                  complete.
20805..........................  Replant forearm,        C
                                  complete.
20808..........................  Replantation hand,      C
                                  complete.
20816..........................  Replantation digit,     C
                                  complete.
20824..........................  Replantation thumb,     C
                                  complete.
20827..........................  Replantation thumb,     C
                                  complete.
20838..........................  Replantation foot,      C
                                  complete.
20930..........................  Spinal bone allograft.  C
20931..........................  Spinal bone allograft.  C
20936..........................  Spinal bone autograft.  C

[[Page 49954]]

 
20937..........................  Spinal bone autograft.  C
20938..........................  Spinal bone autograft.  C
20955..........................  Fibula bone graft,      C
                                  microvasc.
20956..........................  Iliac bone graft,       C
                                  microvasc.
20957..........................  Mt bone graft,          C
                                  microvasc.
20962..........................  Other bone graft,       C
                                  microvasc.
20969..........................  Bone/skin graft,        C
                                  microvasc.
20970..........................  Bone/skin graft, iliac  C
                                  crest.
21045..........................  Extensive jaw surgery.  C
21141..........................  Reconstruct midface,    C
                                  lefort.
21142..........................  Reconstruct midface,    C
                                  lefort.
21143..........................  Reconstruct midface,    C
                                  lefort.
21145..........................  Reconstruct midface,    C
                                  lefort.
21146..........................  Reconstruct midface,    C
                                  lefort.
21147..........................  Reconstruct midface,    C
                                  lefort.
21151..........................  Reconstruct midface,    C
                                  lefort.
21154..........................  Reconstruct midface,    C
                                  lefort.
21155..........................  Reconstruct midface,    C
                                  lefort.
21159..........................  Reconstruct midface,    C
                                  lefort.
21160..........................  Reconstruct midface,    C
                                  lefort.
21172..........................  Reconstruct orbit/      C
                                  forehead.
21179..........................  Reconstruct entire      C
                                  forehead.
21180..........................  Reconstruct entire      C
                                  forehead.
21182..........................  Reconstruct cranial     C
                                  bone.
21183..........................  Reconstruct cranial     C
                                  bone.
21184..........................  Reconstruct cranial     C
                                  bone.
21188..........................  Reconstruction of       C
                                  midface.
21193..........................  Reconst lwr jaw w/o     C
                                  graft.
21194..........................  Reconst lwr jaw w/      C
                                  graft.
21196..........................  Reconst lwr jaw w/      C
                                  fixation.
21247..........................  Reconstruct lower jaw   C
                                  bone.
21255..........................  Reconstruct lower jaw   C
                                  bone.
21256..........................  Reconstruction of       C
                                  orbit.
21268..........................  Revise eye sockets....  C
21343..........................  Treatment of sinus      C
                                  fracture.
21344..........................  Treatment of sinus      C
                                  fracture.
21346..........................  Treat nose/jaw          C
                                  fracture.
21347..........................  Treat nose/jaw          C
                                  fracture.
21348..........................  Treat nose/jaw          C
                                  fracture.
21360..........................  Treat cheek bone        C
                                  fracture.
21365..........................  Treat cheek bone        C
                                  fracture.
21366..........................  Treat cheek bone        C
                                  fracture.
21385..........................  Treat eye socket        C
                                  fracture.
21386..........................  Treat eye socket        C
                                  fracture.
21387..........................  Treat eye socket        C
                                  fracture.
21395..........................  Treat eye socket        C
                                  fracture.
21422..........................  Treat mouth roof        C
                                  fracture.
21423..........................  Treat mouth roof        C
                                  fracture.
21431..........................  Treat craniofacial      C
                                  fracture.
21432..........................  Treat craniofacial      C
                                  fracture.
21433..........................  Treat craniofacial      C
                                  fracture.
21435..........................  Treat craniofacial      C
                                  fracture.
21436..........................  Treat craniofacial      C
                                  fracture.
21510..........................  Drainage of bone        C
                                  lesion.
21615..........................  Removal of rib........  C
21616..........................  Removal of rib and      C
                                  nerves.
21620..........................  Partial removal of      C
                                  sternum.
21627..........................  Sternal debridement...  C
21630..........................  Extensive sternum       C
                                  surgery.
21632..........................  Extensive sternum       C
                                  surgery.
21705..........................  Revision of neck        C
                                  muscle/rib.
21740..........................  Reconstruction of       C
                                  sternum.
21750..........................  Repair of sternum       C
                                  separation.
21810..........................  Treatment of rib        C
                                  fracture(s).
21825..........................  Treat sternum fracture  C
22010..........................  I&d, p-spine, c/t/cerv- C
                                  thor.
22015..........................  I&d, p-spine, l/s/ls..  C
22110..........................  Remove part of neck     C
                                  vertebra.

[[Page 49955]]

 
22112..........................  Remove part, thorax     C
                                  vertebra.
22114..........................  Remove part, lumbar     C
                                  vertebra.
22116..........................  Remove extra spine      C
                                  segment.
22210..........................  Revision of neck spine  C
22212..........................  Revision of thorax      C
                                  spine.
22214..........................  Revision of lumbar      C
                                  spine.
22216..........................  Revise, extra spine     C
                                  segment.
22220..........................  Revision of neck spine  C
22224..........................  Revision of lumbar      C
                                  spine.
22226..........................  Revise, extra spine     C
                                  segment.
22318..........................  Treat odontoid fx w/o   C
                                  graft.
22319..........................  Treat odontoid fx w/    C
                                  graft.
22325..........................  Treat spine fracture..  C
22326..........................  Treat neck spine        C
                                  fracture.
22327..........................  Treat thorax spine      C
                                  fracture.
22328..........................  Treat each add spine    C
                                  fx.
22532..........................  Lat thorax spine        C
                                  fusion.
22533..........................  Lat lumbar spine        C
                                  fusion.
22534..........................  Lat thor/lumb, add'l    C
                                  seg.
22548..........................  Neck spine fusion.....  C
22554..........................  Neck spine fusion.....  C
22556..........................  Thorax spine fusion...  C
22558..........................  Lumbar spine fusion...  C
22585..........................  Additional spinal       C
                                  fusion.
22590..........................  Spine & skull spinal    C
                                  fusion.
22595..........................  Neck spinal fusion....  C
22600..........................  Neck spine fusion.....  C
22610..........................  Thorax spine fusion...  C
22630..........................  Lumbar spine fusion...  C
22632..........................  Spine fusion, extra     C
                                  segment.
22800..........................  Fusion of spine.......  C
22802..........................  Fusion of spine.......  C
22804..........................  Fusion of spine.......  C
22808..........................  Fusion of spine.......  C
22810..........................  Fusion of spine.......  C
22812..........................  Fusion of spine.......  C
22818..........................  Kyphectomy, 1-2         C
                                  segments.
22819..........................  Kyphectomy, 3 or more.  C
22830..........................  Exploration of spinal   C
                                  fusion.
22840..........................  Insert spine fixation   C
                                  device.
22841..........................  Insert spine fixation   C
                                  device.
22842..........................  Insert spine fixation   C
                                  device.
22843..........................  Insert spine fixation   C
                                  device.
22844..........................  Insert spine fixation   C
                                  device.
22845..........................  Insert spine fixation   C
                                  device.
22846..........................  Insert spine fixation   C
                                  device.
22847..........................  Insert spine fixation   C
                                  device.
22848..........................  Insert pelv fixation    C
                                  device.
22849..........................  Reinsert spinal         C
                                  fixation.
22850..........................  Remove spine fixation   C
                                  device.
22851..........................  Apply spine prosth      C
                                  device.
22852..........................  Remove spine fixation   C
                                  device.
22855..........................  Remove spine fixation   C
                                  device.
23200..........................  Removal of collar bone  C
23210..........................  Removal of shoulder     C
                                  blade.
23220..........................  Partial removal of      C
                                  humerus.
23221..........................  Partial removal of      C
                                  humerus.
23222..........................  Partial removal of      C
                                  humerus.
23332..........................  Remove shoulder         C
                                  foreign body.
23472..........................  Reconstruct shoulder    C
                                  joint.
23900..........................  Amputation of arm &     C
                                  girdle.
23920..........................  Amputation at shoulder  C
                                  joint.
24900..........................  Amputation of upper     C
                                  arm.
24920..........................  Amputation of upper     C
                                  arm.
24930..........................  Amputation follow-up    C
                                  surgery.
24931..........................  Amputate upper arm &    C
                                  implant.
24940..........................  Revision of upper arm.  C
25900..........................  Amputation of forearm.  C

[[Page 49956]]

 
25905..........................  Amputation of forearm.  C
25909..........................  Amputation follow-up    C
                                  surgery.
25915..........................  Amputation of forearm.  C
25920..........................  Amputate hand at wrist  C
25924..........................  Amputation follow-up    C
                                  surgery.
25927..........................  Amputation of hand....  C
25931..........................  Amputation follow-up    C
                                  surgery.
26551..........................  Great toe-hand          C
                                  transfer.
26553..........................  Single transfer, toe-   C
                                  hand.
26554..........................  Double transfer, toe-   C
                                  hand.
26556..........................  Toe joint transfer....  C
26992..........................  Drainage of bone        C
                                  lesion.
27005..........................  Incision of hip tendon  C
27006..........................  Incision of hip         C
                                  tendons.
27025..........................  Incision of hip/thigh   C
                                  fascia.
27030..........................  Drainage of hip joint.  C
27036..........................  Excision of hip joint/  C
                                  muscle.
27054..........................  Removal of hip joint    C
                                  lining.
27070..........................  Partial removal of hip  C
                                  bone.
27071..........................  Partial removal of hip  C
                                  bone.
27075..........................  Extensive hip surgery.  C
27076..........................  Extensive hip surgery.  C
27077..........................  Extensive hip surgery.  C
27078..........................  Extensive hip surgery.  C
27079..........................  Extensive hip surgery.  C
27090..........................  Removal of hip          C
                                  prosthesis.
27091..........................  Removal of hip          C
                                  prosthesis.
27120..........................  Reconstruction of hip   C
                                  socket.
27122..........................  Reconstruction of hip   C
                                  socket.
27125..........................  Partial hip             C
                                  replacement.
27130..........................  Total hip arthroplasty  C
27132..........................  Total hip arthroplasty  C
27134..........................  Revise hip joint        C
                                  replacement.
27137..........................  Revise hip joint        C
                                  replacement.
27138..........................  Revise hip joint        C
                                  replacement.
27140..........................  Transplant femur ridge  C
27146..........................  Incision of hip bone..  C
27147..........................  Revision of hip bone..  C
27151..........................  Incision of hip bones.  C
27156..........................  Revision of hip bones.  C
27158..........................  Revision of pelvis....  C
27161..........................  Incision of neck of     C
                                  femur.
27165..........................  Incision/fixation of    C
                                  femur.
27170..........................  Repair/graft femur      C
                                  head/neck.
27175..........................  Treat slipped           C
                                  epiphysis.
27176..........................  Treat slipped           C
                                  epiphysis.
27177..........................  Treat slipped           C
                                  epiphysis.
27178..........................  Treat slipped           C
                                  epiphysis.
27179..........................  Revise head/neck of     C
                                  femur.
27181..........................  Treat slipped           C
                                  epiphysis.
27185..........................  Revision of femur       C
                                  epiphysis.
27187..........................  Reinforce hip bones...  C
27215..........................  Treat pelvic            C
                                  fracture(s).
27217..........................  Treat pelvic ring       C
                                  fracture.
27218..........................  Treat pelvic ring       C
                                  fracture.
27222..........................  Treat hip socket        C
                                  fracture.
27226..........................  Treat hip wall          C
                                  fracture.
27227..........................  Treat hip fracture(s).  C
27228..........................  Treat hip fracture(s).  C
27232..........................  Treat thigh fracture..  C
27236..........................  Treat thigh fracture..  C
27240..........................  Treat thigh fracture..  C
27244..........................  Treat thigh fracture..  C
27245..........................  Treat thigh fracture..  C
27248..........................  Treat thigh fracture..  C
27253..........................  Treat hip dislocation.  C
27254..........................  Treat hip dislocation.  C
27258..........................  Treat hip dislocation.  C

[[Page 49957]]

 
27259..........................  Treat hip dislocation.  C
27280..........................  Fusion of sacroiliac    C
                                  joint.
27282..........................  Fusion of pubic bones.  C
27284..........................  Fusion of hip joint...  C
27286..........................  Fusion of hip joint...  C
27290..........................  Amputation of leg at    C
                                  hip.
27295..........................  Amputation of leg at    C
                                  hip.
27303..........................  Drainage of bone        C
                                  lesion.
27365..........................  Extensive leg surgery.  C
27445..........................  Revision of knee joint  C
27447..........................  Total knee              C
                                  arthroplasty.
27448..........................  Incision of thigh.....  C
27450..........................  Incision of thigh.....  C
27454..........................  Realignment of thigh    C
                                  bone.
27455..........................  Realignment of knee...  C
27457..........................  Realignment of knee...  C
27465..........................  Shortening of thigh     C
                                  bone.
27466..........................  Lengthening of thigh    C
                                  bone.
27468..........................  Shorten/lengthen        C
                                  thighs.
27470..........................  Repair of thigh.......  C
27472..........................  Repair/graft of thigh.  C
27477..........................  Surgery to stop leg     C
                                  growth.
27479..........................  Surgery to stop leg     C
                                  growth.
27485..........................  Surgery to stop leg     C
                                  growth.
27486..........................  Revise/replace knee     C
                                  joint.
27487..........................  Revise/replace knee     C
                                  joint.
27488..........................  Removal of knee         C
                                  prosthesis.
27495..........................  Reinforce thigh.......  C
27506..........................  Treatment of thigh      C
                                  fracture.
27507..........................  Treatment of thigh      C
                                  fracture.
27511..........................  Treatment of thigh      C
                                  fracture.
27513..........................  Treatment of thigh      C
                                  fracture.
27514..........................  Treatment of thigh      C
                                  fracture.
27519..........................  Treat thigh fx growth   C
                                  plate.
27535..........................  Treat knee fracture...  C
27536..........................  Treat knee fracture...  C
27540..........................  Treat knee fracture...  C
27556..........................  Treat knee dislocation  C
27557..........................  Treat knee dislocation  C
27558..........................  Treat knee dislocation  C
27580..........................  Fusion of knee........  C
27590..........................  Amputate leg at thigh.  C
27591..........................  Amputate leg at thigh.  C
27592..........................  Amputate leg at thigh.  C
27596..........................  Amputation follow-up    C
                                  surgery.
27598..........................  Amputate lower leg at   C
                                  knee.
27645..........................  Extensive lower leg     C
                                  surgery.
27646..........................  Extensive lower leg     C
                                  surgery.
27702..........................  Reconstruct ankle       C
                                  joint.
27703..........................  Reconstruction, ankle   C
                                  joint.
27712..........................  Realignment of lower    C
                                  leg.
27715..........................  Revision of lower leg.  C
27720..........................  Repair of tibia.......  C
27722..........................  Repair/graft of tibia.  C
27724..........................  Repair/graft of tibia.  C
27725..........................  Repair of lower leg...  C
27727..........................  Repair of lower leg...  C
27880..........................  Amputation of lower     C
                                  leg.
27881..........................  Amputation of lower     C
                                  leg.
27882..........................  Amputation of lower     C
                                  leg.
27886..........................  Amputation follow-up    C
                                  surgery.
27888..........................  Amputation of foot at   C
                                  ankle.
28800..........................  Amputation of midfoot.  C
28805..........................  Amputation thru         C
                                  metatarsal.
31225..........................  Removal of upper jaw..  C
31230..........................  Removal of upper jaw..  C
31290..........................  Nasal/sinus endoscopy,  C
                                  surg.
31291..........................  Nasal/sinus endoscopy,  C
                                  surg.

[[Page 49958]]

 
31360..........................  Removal of larynx.....  C
31365..........................  Removal of larynx.....  C
31367..........................  Partial removal of      C
                                  larynx.
31368..........................  Partial removal of      C
                                  larynx.
31370..........................  Partial removal of      C
                                  larynx.
31375..........................  Partial removal of      C
                                  larynx.
31380..........................  Partial removal of      C
                                  larynx.
31382..........................  Partial removal of      C
                                  larynx.
31390..........................  Removal of larynx &     C
                                  pharynx.
31395..........................  Reconstruct larynx &    C
                                  pharynx.
31584..........................  Treat larynx fracture.  C
31587..........................  Revision of larynx....  C
31725..........................  Clearance of airways..  C
31760..........................  Repair of windpipe....  C
31766..........................  Reconstruction of       C
                                  windpipe.
31770..........................  Repair/graft of         C
                                  bronchus.
31775..........................  Reconstruct bronchus..  C
31780..........................  Reconstruct windpipe..  C
31781..........................  Reconstruct windpipe..  C
31786..........................  Remove windpipe lesion  C
31800..........................  Repair of windpipe      C
                                  injury.
31805..........................  Repair of windpipe      C
                                  injury.
32035..........................  Exploration of chest..  C
32036..........................  Exploration of chest..  C
32095..........................  Biopsy through chest    C
                                  wall.
32100..........................  Exploration/biopsy of   C
                                  chest.
32110..........................  Explore/repair chest..  C
32120..........................  Re-exploration of       C
                                  chest.
32124..........................  Explore chest free      C
                                  adhesions.
32140..........................  Removal of lung         C
                                  lesion(s).
32141..........................  Remove/treat lung       C
                                  lesions.
32150..........................  Removal of lung         C
                                  lesion(s).
32151..........................  Remove lung foreign     C
                                  body.
32160..........................  Open chest heart        C
                                  massage.
32200..........................  Drain, open, lung       C
                                  lesion.
32215..........................  Treat chest lining....  C
32220..........................  Release of lung.......  C
32225..........................  Partial release of      C
                                  lung.
32310..........................  Removal of chest        C
                                  lining.
32320..........................  Free/remove chest       C
                                  lining.
32402..........................  Open biopsy chest       C
                                  lining.
32440..........................  Removal of lung.......  C
32442..........................  Sleeve pneumonectomy..  C
32445..........................  Removal of lung.......  C
32480..........................  Partial removal of      C
                                  lung.
32482..........................  Bilobectomy...........  C
32484..........................  Segmentectomy.........  C
32486..........................  Sleeve lobectomy......  C
32488..........................  Completion              C
                                  pneumonectomy.
32491..........................  Lung volume reduction.  C
32500..........................  Partial removal of      C
                                  lung.
32501..........................  Repair bronchus add-on  C
32503..........................  Resect apical lung      C
                                  tumor.
32504..........................  Resect apical lung tum/ C
                                  chest.
32540..........................  Removal of lung lesion  C
32650..........................  Thoracoscopy, surgical  C
32651..........................  Thoracoscopy, surgical  C
32652..........................  Thoracoscopy, surgical  C
32653..........................  Thoracoscopy, surgical  C
32654..........................  Thoracoscopy, surgical  C
32655..........................  Thoracoscopy, surgical  C
32656..........................  Thoracoscopy, surgical  C
32657..........................  Thoracoscopy, surgical  C
32658..........................  Thoracoscopy, surgical  C
32659..........................  Thoracoscopy, surgical  C
32660..........................  Thoracoscopy, surgical  C
32661..........................  Thoracoscopy, surgical  C
32662..........................  Thoracoscopy, surgical  C

[[Page 49959]]

 
32663..........................  Thoracoscopy, surgical  C
32664..........................  Thoracoscopy, surgical  C
32665..........................  Thoracoscopy, surgical  C
32800..........................  Repair lung hernia....  C
32810..........................  Close chest after       C
                                  drainage.
32815..........................  Close bronchial         C
                                  fistula.
32820..........................  Reconstruct injured     C
                                  chest.
32850..........................  Donor pneumonectomy...  C
32851..........................  Lung transplant,        C
                                  single.
32852..........................  Lung transplant with    C
                                  bypass.
32853..........................  Lung transplant,        C
                                  double.
32854..........................  Lung transplant with    C
                                  bypass.
32855..........................  Prepare donor lung,     C
                                  single.
32856..........................  Prepare donor lung,     C
                                  double.
32900..........................  Removal of rib(s).....  C
32905..........................  Revise & repair chest   C
                                  wall.
32906..........................  Revise & repair chest   C
                                  wall.
32940..........................  Revision of lung......  C
32997..........................  Total lung lavage.....  C
33015..........................  Incision of heart sac.  C
33020..........................  Incision of heart sac.  C
33025..........................  Incision of heart sac.  C
33030..........................  Partial removal of      C
                                  heart sac.
33031..........................  Partial removal of      C
                                  heart sac.
33050..........................  Removal of heart sac    C
                                  lesion.
33120..........................  Removal of heart        C
                                  lesion.
33130..........................  Removal of heart        C
                                  lesion.
33140..........................  Heart revascularize     C
                                  (tmr).
33141..........................  Heart tmr w/other       C
                                  procedure.
33200..........................  Insertion of heart      C
                                  pacemaker.
33201..........................  Insertion of heart      C
                                  pacemaker.
33236..........................  Remove electrode/       C
                                  thoracotomy.
33237..........................  Remove electrode/       C
                                  thoracotomy.
33238..........................  Remove electrode/       C
                                  thoracotomy.
33243..........................  Remove eltrd/           C
                                  thoracotomy.
33245..........................  Insert epic eltrd pace- C
                                  defib.
33246..........................  Insert epic eltrd/      C
                                  generator.
33250..........................  Ablate heart dysrhythm  C
                                  focus.
33251..........................  Ablate heart dysrhythm  C
                                  focus.
33253..........................  Reconstruct atria.....  C
33261..........................  Ablate heart dysrhythm  C
                                  focus.
33300..........................  Repair of heart wound.  C
33305..........................  Repair of heart wound.  C
33310..........................  Exploratory heart       C
                                  surgery.
33315..........................  Exploratory heart       C
                                  surgery.
33320..........................  Repair major blood      C
                                  vessel(s).
33321..........................  Repair major vessel...  C
33322..........................  Repair major blood      C
                                  vessel(s).
33330..........................  Insert major vessel     C
                                  graft.
33332..........................  Insert major vessel     C
                                  graft.
33335..........................  Insert major vessel     C
                                  graft.
33400..........................  Repair of aortic valve  C
33401..........................  Valvuloplasty, open...  C
33403..........................  Valvuloplasty, w/cp     C
                                  bypass.
33404..........................  Prepare heart-aorta     C
                                  conduit.
33405..........................  Replacement of aortic   C
                                  valve.
33406..........................  Replacement of aortic   C
                                  valve.
33410..........................  Replacement of aortic   C
                                  valve.
33411..........................  Replacement of aortic   C
                                  valve.
33412..........................  Replacement of aortic   C
                                  valve.
33413..........................  Replacement of aortic   C
                                  valve.
33414..........................  Repair of aortic valve  C
33415..........................  Revision, subvalvular   C
                                  tissue.
33416..........................  Revise ventricle        C
                                  muscle.
33417..........................  Repair of aortic valve  C
33420..........................  Revision of mitral      C
                                  valve.
33422..........................  Revision of mitral      C
                                  valve.
33425..........................  Repair of mitral valve  C

[[Page 49960]]

 
33426..........................  Repair of mitral valve  C
33427..........................  Repair of mitral valve  C
33430..........................  Replacement of mitral   C
                                  valve.
33460..........................  Revision of tricuspid   C
                                  valve.
33463..........................  Valvuloplasty,          C
                                  tricuspid.
33464..........................  Valvuloplasty,          C
                                  tricuspid.
33465..........................  Replace tricuspid       C
                                  valve.
33468..........................  Revision of tricuspid   C
                                  valve.
33470..........................  Revision of pulmonary   C
                                  valve.
33471..........................  Valvotomy, pulmonary    C
                                  valve.
33472..........................  Revision of pulmonary   C
                                  valve.
33474..........................  Revision of pulmonary   C
                                  valve.
33475..........................  Replacement, pulmonary  C
                                  valve.
33476..........................  Revision of heart       C
                                  chamber.
33478..........................  Revision of heart       C
                                  chamber.
33496..........................  Repair, prosth valve    C
                                  clot.
33500..........................  Repair heart vessel     C
                                  fistula.
33501..........................  Repair heart vessel     C
                                  fistula.
33502..........................  Coronary artery         C
                                  correction.
33503..........................  Coronary artery graft.  C
33504..........................  Coronary artery graft.  C
33505..........................  Repair artery w/tunnel  C
33506..........................  Repair artery,          C
                                  translocation.
33507..........................  Repair art, intramural  C
33510..........................  CABG, vein, single....  C
33511..........................  CABG, vein, two.......  C
33512..........................  CABG, vein, three.....  C
33513..........................  CABG, vein, four......  C
33514..........................  CABG, vein, five......  C
33516..........................  Cabg, vein, six or      C
                                  more.
33517..........................  CABG, artery-vein,      C
                                  single.
33518..........................  CABG, artery-vein, two  C
33519..........................  CABG, artery-vein,      C
                                  three.
33521..........................  CABG, artery-vein,      C
                                  four.
33522..........................  CABG, artery-vein,      C
                                  five.
33523..........................  Cabg, art-vein, six or  C
                                  more.
33530..........................  Coronary artery,        C
                                  bypass/reop.
33533..........................  CABG, arterial, single  C
33534..........................  CABG, arterial, two...  C
33535..........................  CABG, arterial, three.  C
33536..........................  Cabg, arterial, four    C
                                  or more.
33542..........................  Removal of heart        C
                                  lesion.
33545..........................  Repair of heart damage  C
33548..........................  Restore/remodel,        C
                                  ventricle.
33572..........................  Open coronary           C
                                  endarterectomy.
33600..........................  Closure of valve......  C
33602..........................  Closure of valve......  C
33606..........................  Anastomosis/artery-     C
                                  aorta.
33608..........................  Repair anomaly w/       C
                                  conduit.
33610..........................  Repair by enlargement.  C
33611..........................  Repair double           C
                                  ventricle.
33612..........................  Repair double           C
                                  ventricle.
33615..........................  Repair, modified        C
                                  fontan.
33617..........................  Repair single           C
                                  ventricle.
33619..........................  Repair single           C
                                  ventricle.
33641..........................  Repair heart septum     C
                                  defect.
33645..........................  Revision of heart       C
                                  veins.
33647..........................  Repair heart septum     C
                                  defects.
33660..........................  Repair of heart         C
                                  defects.
33665..........................  Repair of heart         C
                                  defects.
33670..........................  Repair of heart         C
                                  chambers.
33681..........................  Repair heart septum     C
                                  defect.
33684..........................  Repair heart septum     C
                                  defect.
33688..........................  Repair heart septum     C
                                  defect.
33690..........................  Reinforce pulmonary     C
                                  artery.
33692..........................  Repair of heart         C
                                  defects.
33694..........................  Repair of heart         C
                                  defects.
33697..........................  Repair of heart         C
                                  defects.

[[Page 49961]]

 
33702..........................  Repair of heart         C
                                  defects.
33710..........................  Repair of heart         C
                                  defects.
33720..........................  Repair of heart defect  C
33722..........................  Repair of heart defect  C
33730..........................  Repair heart-vein       C
                                  defect(s).
33732..........................  Repair heart-vein       C
                                  defect.
33735..........................  Revision of heart       C
                                  chamber.
33736..........................  Revision of heart       C
                                  chamber.
33737..........................  Revision of heart       C
                                  chamber.
33750..........................  Major vessel shunt....  C
33755..........................  Major vessel shunt....  C
33762..........................  Major vessel shunt....  C
33764..........................  Major vessel shunt &    C
                                  graft.
33766..........................  Major vessel shunt....  C
33767..........................  Major vessel shunt....  C
33768..........................  Cavopulmonary shunting  C
33770..........................  Repair great vessels    C
                                  defect.
33771..........................  Repair great vessels    C
                                  defect.
33774..........................  Repair great vessels    C
                                  defect.
33775..........................  Repair great vessels    C
                                  defect.
33776..........................  Repair great vessels    C
                                  defect.
33777..........................  Repair great vessels    C
                                  defect.
33778..........................  Repair great vessels    C
                                  defect.
33779..........................  Repair great vessels    C
                                  defect.
33780..........................  Repair great vessels    C
                                  defect.
33781..........................  Repair great vessels    C
                                  defect.
33786..........................  Repair arterial trunk.  C
33788..........................  Revision of pulmonary   C
                                  artery.
33800..........................  Aortic suspension.....  C
33802..........................  Repair vessel defect..  C
33803..........................  Repair vessel defect..  C
33813..........................  Repair septal defect..  C
33814..........................  Repair septal defect..  C
33820..........................  Revise major vessel...  C
33822..........................  Revise major vessel...  C
33824..........................  Revise major vessel...  C
33840..........................  Remove aorta            C
                                  constriction.
33845..........................  Remove aorta            C
                                  constriction.
33851..........................  Remove aorta            C
                                  constriction.
33852..........................  Repair septal defect..  C
33853..........................  Repair septal defect..  C
33860..........................  Ascending aortic graft  C
33861..........................  Ascending aortic graft  C
33863..........................  Ascending aortic graft  C
33870..........................  Transverse aortic arch  C
                                  graft.
33875..........................  Thoracic aortic graft.  C
33877..........................  Thoracoabdominal graft  C
33880..........................  Endovasc taa repr incl  C
                                  subcl.
33881..........................  Endovasc taa repr w/o   C
                                  subcl.
33883..........................  Insert endovasc         C
                                  prosth, taa.
33884..........................  Endovasc prosth, taa,   C
                                  add-on.
33886..........................  Endovasc prosth,        C
                                  delayed.
33889..........................  Artery transpose/       C
                                  endovas taa.
33891..........................  Car-car bp grft/        C
                                  endovas taa.
33910..........................  Remove lung artery      C
                                  emboli.
33915..........................  Remove lung artery      C
                                  emboli.
33916..........................  Surgery of great        C
                                  vessel.
33917..........................  Repair pulmonary        C
                                  artery.
33920..........................  Repair pulmonary        C
                                  atresia.
33922..........................  Transect pulmonary      C
                                  artery.
33924..........................  Remove pulmonary shunt  C
33925..........................  Rpr pul art unifocal w/ C
                                  o cpb.
33926..........................  Repr pul art, unifocal  C
                                  w/cpb.
33930..........................  Removal of donor heart/ C
                                  lung.
33933..........................  Prepare donor heart/    C
                                  lung.
33935..........................  Transplantation, heart/ C
                                  lung.
33940..........................  Removal of donor heart  C
33944..........................  Prepare donor heart...  C

[[Page 49962]]

 
33945..........................  Transplantation of      C
                                  heart.
33960..........................  External circulation    C
                                  assist.
33961..........................  External circulation    C
                                  assist.
33967..........................  Insert ia percut        C
                                  device.
33968..........................  Remove aortic assist    C
                                  device.
33970..........................  Aortic circulation      C
                                  assist.
33971..........................  Aortic circulation      C
                                  assist.
33973..........................  Insert balloon device.  C
33974..........................  Remove intra-aortic     C
                                  balloon.
33975..........................  Implant ventricular     C
                                  device.
33976..........................  Implant ventricular     C
                                  device.
33977..........................  Remove ventricular      C
                                  device.
33978..........................  Remove ventricular      C
                                  device.
33979..........................  Insert intracorporeal   C
                                  device.
33980..........................  Remove intracorporeal   C
                                  device.
34001..........................  Removal of artery clot  C
34051..........................  Removal of artery clot  C
34151..........................  Removal of artery clot  C
34401..........................  Removal of vein clot..  C
34451..........................  Removal of vein clot..  C
34502..........................  Reconstruct vena cava.  C
34800..........................  Endovas aaa repr w/sm   C
                                  tube.
34802..........................  Endovas aaa repr w/2-p  C
                                  part.
34803..........................  Endovas aaa repr w/3-p  C
                                  part.
34804..........................  Endovas aaa repr w/1-p  C
                                  part.
34805..........................  Endovas aaa repr w/     C
                                  long tube.
34808..........................  Endovas iliac a device  C
                                  addon.
34812..........................  Xpose for endoprosth,   C
                                  femorl.
34813..........................  Femoral endovas graft   C
                                  add-on.
34820..........................  Xpose for endoprosth,   C
                                  iliac.
34825..........................  Endovasc extend         C
                                  prosth, init.
34826..........................  Endovasc exten prosth,  C
                                  add'l.
34830..........................  Open aortic tube        C
                                  prosth repr.
34831..........................  Open aortoiliac prosth  C
                                  repr.
34832..........................  Open aortofemor prosth  C
                                  repr.
34833..........................  Xpose for endoprosth,   C
                                  iliac.
34834..........................  Xpose, endoprosth,      C
                                  brachial.
34900..........................  Endovasc iliac repr w/  C
                                  graft.
35001..........................  Repair defect of        C
                                  artery.
35002..........................  Repair artery rupture,  C
                                  neck.
35005..........................  Repair defect of        C
                                  artery.
35013..........................  Repair artery rupture,  C
                                  arm.
35021..........................  Repair defect of        C
                                  artery.
35022..........................  Repair artery rupture,  C
                                  chest.
35045..........................  Repair defect of arm    C
                                  artery.
35081..........................  Repair defect of        C
                                  artery.
35082..........................  Repair artery rupture,  C
                                  aorta.
35091..........................  Repair defect of        C
                                  artery.
35092..........................  Repair artery rupture,  C
                                  aorta.
35102..........................  Repair defect of        C
                                  artery.
35103..........................  Repair artery rupture,  C
                                  groin.
35111..........................  Repair defect of        C
                                  artery.
35112..........................  Repair artery           C
                                  rupture,spleen.
35121..........................  Repair defect of        C
                                  artery.
35122..........................  Repair artery rupture,  C
                                  belly.
35131..........................  Repair defect of        C
                                  artery.
35132..........................  Repair artery rupture,  C
                                  groin.
35141..........................  Repair defect of        C
                                  artery.
35142..........................  Repair artery rupture,  C
                                  thigh.
35151..........................  Repair defect of        C
                                  artery.
35152..........................  Repair artery rupture,  C
                                  knee.
35182..........................  Repair blood vessel     C
                                  lesion.
35189..........................  Repair blood vessel     C
                                  lesion.
35211..........................  Repair blood vessel     C
                                  lesion.
35216..........................  Repair blood vessel     C
                                  lesion.
35221..........................  Repair blood vessel     C
                                  lesion.
35241..........................  Repair blood vessel     C
                                  lesion.
35246..........................  Repair blood vessel     C
                                  lesion.

[[Page 49963]]

 
35251..........................  Repair blood vessel     C
                                  lesion.
35271..........................  Repair blood vessel     C
                                  lesion.
35276..........................  Repair blood vessel     C
                                  lesion.
35281..........................  Repair blood vessel     C
                                  lesion.
35301..........................  Rechanneling of artery  C
35311..........................  Rechanneling of artery  C
35331..........................  Rechanneling of artery  C
35341..........................  Rechanneling of artery  C
35351..........................  Rechanneling of artery  C
35355..........................  Rechanneling of artery  C
35361..........................  Rechanneling of artery  C
35363..........................  Rechanneling of artery  C
35371..........................  Rechanneling of artery  C
35372..........................  Rechanneling of artery  C
35381..........................  Rechanneling of artery  C
35390..........................  Reoperation, carotid    C
                                  add-on.
35400..........................  Angioscopy............  C
35450..........................  Repair arterial         C
                                  blockage.
35452..........................  Repair arterial         C
                                  blockage.
35454..........................  Repair arterial         C
                                  blockage.
35456..........................  Repair arterial         C
                                  blockage.
35480..........................  Atherectomy, open.....  C
35481..........................  Atherectomy, open.....  C
35482..........................  Atherectomy, open.....  C
35483..........................  Atherectomy, open.....  C
35501..........................  Artery bypass graft...  C
35506..........................  Artery bypass graft...  C
35507..........................  Artery bypass graft...  C
35508..........................  Artery bypass graft...  C
35509..........................  Artery bypass graft...  C
35510..........................  Artery bypass graft...  C
35511..........................  Artery bypass graft...  C
35512..........................  Artery bypass graft...  C
35515..........................  Artery bypass graft...  C
35516..........................  Artery bypass graft...  C
35518..........................  Artery bypass graft...  C
35521..........................  Artery bypass graft...  C
35522..........................  Artery bypass graft...  C
35525..........................  Artery bypass graft...  C
35526..........................  Artery bypass graft...  C
35531..........................  Artery bypass graft...  C
35533..........................  Artery bypass graft...  C
35536..........................  Artery bypass graft...  C
35541..........................  Artery bypass graft...  C
35546..........................  Artery bypass graft...  C
35548..........................  Artery bypass graft...  C
35549..........................  Artery bypass graft...  C
35551..........................  Artery bypass graft...  C
35556..........................  Artery bypass graft...  C
35558..........................  Artery bypass graft...  C
35560..........................  Artery bypass graft...  C
35563..........................  Artery bypass graft...  C
35565..........................  Artery bypass graft...  C
35566..........................  Artery bypass graft...  C
35571..........................  Artery bypass graft...  C
35583..........................  Vein bypass graft.....  C
35585..........................  Vein bypass graft.....  C
35587..........................  Vein bypass graft.....  C
35600..........................  Harvest artery for      C
                                  cabg.
35601..........................  Artery bypass graft...  C
35606..........................  Artery bypass graft...  C
35612..........................  Artery bypass graft...  C
35616..........................  Artery bypass graft...  C
35621..........................  Artery bypass graft...  C
35623..........................  Bypass graft, not vein  C
35626..........................  Artery bypass graft...  C
35631..........................  Artery bypass graft...  C
35636..........................  Artery bypass graft...  C

[[Page 49964]]

 
35641..........................  Artery bypass graft...  C
35642..........................  Artery bypass graft...  C
35645..........................  Artery bypass graft...  C
35646..........................  Artery bypass graft...  C
35647..........................  Artery bypass graft...  C
35650..........................  Artery bypass graft...  C
35651..........................  Artery bypass graft...  C
35654..........................  Artery bypass graft...  C
35656..........................  Artery bypass graft...  C
35661..........................  Artery bypass graft...  C
35663..........................  Artery bypass graft...  C
35665..........................  Artery bypass graft...  C
35666..........................  Artery bypass graft...  C
35671..........................  Artery bypass graft...  C
35681..........................  Composite bypass graft  C
35682..........................  Composite bypass graft  C
35683..........................  Composite bypass graft  C
35691..........................  Arterial transposition  C
35693..........................  Arterial transposition  C
35694..........................  Arterial transposition  C
35695..........................  Arterial transposition  C
35697..........................  Reimplant artery each.  C
35700..........................  Reoperation, bypass     C
                                  graft.
35701..........................  Exploration, carotid    C
                                  artery.
35721..........................  Exploration, femoral    C
                                  artery.
35741..........................  Exploration popliteal   C
                                  artery.
35800..........................  Explore neck vessels..  C
35820..........................  Explore chest vessels.  C
35840..........................  Explore abdominal       C
                                  vessels.
35870..........................  Repair vessel graft     C
                                  defect.
35901..........................  Excision, graft, neck.  C
35905..........................  Excision, graft,        C
                                  thorax.
35907..........................  Excision, graft,        C
                                  abdomen.
36660..........................  Insertion catheter,     C
                                  artery.
36822..........................  Insertion of            C
                                  cannula(s).
36823..........................  Insertion of            C
                                  cannula(s).
37140..........................  Revision of             C
                                  circulation.
37145..........................  Revision of             C
                                  circulation.
37160..........................  Revision of             C
                                  circulation.
37180..........................  Revision of             C
                                  circulation.
37181..........................  Splice spleen/kidney    C
                                  veins.
37182..........................  Insert hepatic shunt    C
                                  (tips).
37215..........................  Transcath stent, cca w/ C
                                  eps.
37216..........................  Transcath stent, cca w/ C
                                  o eps.
37616..........................  Ligation of chest       C
                                  artery.
37617..........................  Ligation of abdomen     C
                                  artery.
37618..........................  Ligation of extremity   C
                                  artery.
37660..........................  Revision of major vein  C
37788..........................  Revascularization,      C
                                  penis.
38100..........................  Removal of spleen,      C
                                  total.
38101..........................  Removal of spleen,      C
                                  partial.
38102..........................  Removal of spleen,      C
                                  total.
38115..........................  Repair of ruptured      C
                                  spleen.
38380..........................  Thoracic duct           C
                                  procedure.
38381..........................  Thoracic duct           C
                                  procedure.
38382..........................  Thoracic duct           C
                                  procedure.
38562..........................  Removal, pelvic lymph   C
                                  nodes.
38564..........................  Removal, abdomen lymph  C
                                  nodes.
38724..........................  Removal of lymph        C
                                  nodes, neck.
38746..........................  Remove thoracic lymph   C
                                  nodes.
38747..........................  Remove abdominal lymph  C
                                  nodes.
38765..........................  Remove groin lymph      C
                                  nodes.
38770..........................  Remove pelvis lymph     C
                                  nodes.
38780..........................  Remove abdomen lymph    C
                                  nodes.
39000..........................  Exploration of chest..  C
39010..........................  Exploration of chest..  C
39200..........................  Removal chest lesion..  C
39220..........................  Removal chest lesion..  C

[[Page 49965]]

 
39499..........................  Chest procedure.......  C
39501..........................  Repair diaphragm        C
                                  laceration.
39502..........................  Repair paraesophageal   C
                                  hernia.
39503..........................  Repair of diaphragm     C
                                  hernia.
39520..........................  Repair of diaphragm     C
                                  hernia.
39530..........................  Repair of diaphragm     C
                                  hernia.
39531..........................  Repair of diaphragm     C
                                  hernia.
39540..........................  Repair of diaphragm     C
                                  hernia.
39541..........................  Repair of diaphragm     C
                                  hernia.
39545..........................  Revision of diaphragm.  C
39560..........................  Resect diaphragm,       C
                                  simple.
39561..........................  Resect diaphragm,       C
                                  complex.
39599..........................  Diaphragm surgery       C
                                  procedure.
41130..........................  Partial removal of      C
                                  tongue.
41135..........................  Tongue and neck         C
                                  surgery.
41140..........................  Removal of tongue.....  C
41145..........................  Tongue removal, neck    C
                                  surgery.
41150..........................  Tongue, mouth, jaw      C
                                  surgery.
41153..........................  Tongue, mouth, neck     C
                                  surgery.
41155..........................  Tongue, jaw, & neck     C
                                  surgery.
42426..........................  Excise parotid gland/   C
                                  lesion.
42845..........................  Extensive surgery of    C
                                  throat.
42894..........................  Revision of pharyngeal  C
                                  walls.
42953..........................  Repair throat,          C
                                  esophagus.
42961..........................  Control throat          C
                                  bleeding.
42971..........................  Control nose/throat     C
                                  bleeding.
43045..........................  Incision of esophagus.  C
43100..........................  Excision of esophagus   C
                                  lesion.
43101..........................  Excision of esophagus   C
                                  lesion.
43107..........................  Removal of esophagus..  C
43108..........................  Removal of esophagus..  C
43112..........................  Removal of esophagus..  C
43113..........................  Removal of esophagus..  C
43116..........................  Partial removal of      C
                                  esophagus.
43117..........................  Partial removal of      C
                                  esophagus.
43118..........................  Partial removal of      C
                                  esophagus.
43121..........................  Partial removal of      C
                                  esophagus.
43122..........................  Partial removal of      C
                                  esophagus.
43123..........................  Partial removal of      C
                                  esophagus.
43124..........................  Removal of esophagus..  C
43135..........................  Removal of esophagus    C
                                  pouch.
43300..........................  Repair of esophagus...  C
43305..........................  Repair esophagus and    C
                                  fistula.
43310..........................  Repair of esophagus...  C
43312..........................  Repair esophagus and    C
                                  fistula.
43313..........................  Esophagoplasty          C
                                  congenital.
43314..........................  Tracheo-esophagoplasty  C
                                  cong.
43320..........................  Fuse esophagus &        C
                                  stomach.
43324..........................  Revise esophagus &      C
                                  stomach.
43325..........................  Revise esophagus &      C
                                  stomach.
43326..........................  Revise esophagus &      C
                                  stomach.
43330..........................  Repair of esophagus...  C
43331..........................  Repair of esophagus...  C
43340..........................  Fuse esophagus &        C
                                  intestine.
43341..........................  Fuse esophagus &        C
                                  intestine.
43350..........................  Surgical opening,       C
                                  esophagus.
43351..........................  Surgical opening,       C
                                  esophagus.
43352..........................  Surgical opening,       C
                                  esophagus.
43360..........................  Gastrointestinal        C
                                  repair.
43361..........................  Gastrointestinal        C
                                  repair.
43400..........................  Ligate esophagus veins  C
43401..........................  Esophagus surgery for   C
                                  veins.
43405..........................  Ligate/staple           C
                                  esophagus.
43410..........................  Repair esophagus wound  C
43415..........................  Repair esophagus wound  C
43420..........................  Repair esophagus        C
                                  opening.
43425..........................  Repair esophagus        C
                                  opening.
43460..........................  Pressure treatment      C
                                  esophagus.

[[Page 49966]]

 
43496..........................  Free jejunum flap,      C
                                  microvasc.
43500..........................  Surgical opening of     C
                                  stomach.
43501..........................  Surgical repair of      C
                                  stomach.
43502..........................  Surgical repair of      C
                                  stomach.
43520..........................  Incision of pyloric     C
                                  muscle.
43605..........................  Biopsy of stomach.....  C
43610..........................  Excision of stomach     C
                                  lesion.
43611..........................  Excision of stomach     C
                                  lesion.
43620..........................  Removal of stomach....  C
43621..........................  Removal of stomach....  C
43622..........................  Removal of stomach....  C
43631..........................  Removal of stomach,     C
                                  partial.
43632..........................  Removal of stomach,     C
                                  partial.
43633..........................  Removal of stomach,     C
                                  partial.
43634..........................  Removal of stomach,     C
                                  partial.
43635..........................  Removal of stomach,     C
                                  partial.
43640..........................  Vagotomy & pylorus      C
                                  repair.
43641..........................  Vagotomy & pylorus      C
                                  repair.
43644..........................  Lap gastric bypass/     C
                                  roux-en-y.
43645..........................  Lap gastr bypass incl   C
                                  smll i.
43770..........................  Lap, place gastr        C
                                  adjust band.
43771..........................  Lap, revise adjust      C
                                  gast band.
43772..........................  Lap, remove adjust      C
                                  gast band.
43773..........................  Lap, change adjust      C
                                  gast band.
43774..........................  Lap remov adj gast      C
                                  band/port.
43800..........................  Reconstruction of       C
                                  pylorus.
43810..........................  Fusion of stomach and   C
                                  bowel.
43820..........................  Fusion of stomach and   C
                                  bowel.
43825..........................  Fusion of stomach and   C
                                  bowel.
43832..........................  Place gastrostomy tube  C
43840..........................  Repair of stomach       C
                                  lesion.
43842..........................  V-band gastroplasty...  C
43843..........................  Gastroplasty w/o v-     C
                                  band.
43845..........................  Gastroplasty duodenal   C
                                  switch.
43846..........................  Gastric bypass for      C
                                  obesity.
43847..........................  Gastric bypass incl     C
                                  small i.
43848..........................  Revision gastroplasty.  C
43850..........................  Revise stomach-bowel    C
                                  fusion.
43855..........................  Revise stomach-bowel    C
                                  fusion.
43860..........................  Revise stomach-bowel    C
                                  fusion.
43865..........................  Revise stomach-bowel    C
                                  fusion.
43880..........................  Repair stomach-bowel    C
                                  fistula.
44005..........................  Freeing of bowel        C
                                  adhesion.
44010..........................  Incision of small       C
                                  bowel.
44015..........................  Insert needle cath      C
                                  bowel.
44020..........................  Explore small           C
                                  intestine.
44021..........................  Decompress small bowel  C
44025..........................  Incision of large       C
                                  bowel.
44050..........................  Reduce bowel            C
                                  obstruction.
44055..........................  Correct malrotation of  C
                                  bowel.
44110..........................  Excise intestine        C
                                  lesion(s).
44111..........................  Excision of bowel       C
                                  lesion(s).
44120..........................  Removal of small        C
                                  intestine.
44121..........................  Removal of small        C
                                  intestine.
44125..........................  Removal of small        C
                                  intestine.
44126..........................  Enterectomy w/o taper,  C
                                  cong.
44127..........................  Enterectomy w/taper,    C
                                  cong.
44128..........................  Enterectomy cong, add-  C
                                  on.
44130..........................  Bowel to bowel fusion.  C
44132..........................  Enterectomy, cadaver    C
                                  donor.
44133..........................  Enterectomy, live       C
                                  donor.
44135..........................  Intestine transplnt,    C
                                  cadaver.
44136..........................  Intestine transplant,   C
                                  live.
44137..........................  Remove intestinal       C
                                  allograft.
44139..........................  Mobilization of colon.  C
44140..........................  Partial removal of      C
                                  colon.
44141..........................  Partial removal of      C
                                  colon.
44143..........................  Partial removal of      C
                                  colon.

[[Page 49967]]

 
44144..........................  Partial removal of      C
                                  colon.
44145..........................  Partial removal of      C
                                  colon.
44146..........................  Partial removal of      C
                                  colon.
44147..........................  Partial removal of      C
                                  colon.
44150..........................  Removal of colon......  C
44151..........................  Removal of colon/       C
                                  ileostomy.
44152..........................  Removal of colon/       C
                                  ileostomy.
44153..........................  Removal of colon/       C
                                  ileostomy.
44155..........................  Removal of colon/       C
                                  ileostomy.
44156..........................  Removal of colon/       C
                                  ileostomy.
44160..........................  Removal of colon......  C
44187..........................  Lap, ileo/jejuno-stomy  C
44188..........................  Lap, colostomy........  C
44202..........................  Lap, enterectomy......  C
44203..........................  Lap resect s/           C
                                  intestine, addl.
44204..........................  Laparo partial          C
                                  colectomy.
44205..........................  Lap colectomy part w/   C
                                  ileum.
44210..........................  Laparo total            C
                                  proctocolectomy.
44211..........................  Laparo total            C
                                  proctocolectomy.
44212..........................  Laparo total            C
                                  proctocolectomy.
44227..........................  Lap, close enterostomy  C
44300..........................  Open bowel to skin....  C
44310..........................  Ileostomy/jejunostomy.  C
44314..........................  Revision of ileostomy.  C
44316..........................  Devise bowel pouch....  C
44320..........................  Colostomy.............  C
44322..........................  Colostomy with          C
                                  biopsies.
44345..........................  Revision of colostomy.  C
44346..........................  Revision of colostomy.  C
44602..........................  Suture, small           C
                                  intestine.
44603..........................  Suture, small           C
                                  intestine.
44604..........................  Suture, large           C
                                  intestine.
44605..........................  Repair of bowel lesion  C
44615..........................  Intestinal              C
                                  stricturoplasty.
44620..........................  Repair bowel opening..  C
44625..........................  Repair bowel opening..  C
44626..........................  Repair bowel opening..  C
44640..........................  Repair bowel-skin       C
                                  fistula.
44650..........................  Repair bowel fistula..  C
44660..........................  Repair bowel-bladder    C
                                  fistula.
44661..........................  Repair bowel-bladder    C
                                  fistula.
44680..........................  Surgical revision,      C
                                  intestine.
44700..........................  Suspend bowel w/        C
                                  prosthesis.
44715..........................  Prepare donor           C
                                  intestine.
44720..........................  Prep donor intestine/   C
                                  venous.
44721..........................  Prep donor intestine/   C
                                  artery.
44800..........................  Excision of bowel       C
                                  pouch.
44820..........................  Excision of mesentery   C
                                  lesion.
44850..........................  Repair of mesentery...  C
44899..........................  Bowel surgery           C
                                  procedure.
44900..........................  Drain app abscess,      C
                                  open.
44950..........................  Appendectomy..........  C
44955..........................  Appendectomy add-on...  C
44960..........................  Appendectomy..........  C
45110..........................  Removal of rectum.....  C
45111..........................  Partial removal of      C
                                  rectum.
45112..........................  Removal of rectum.....  C
45113..........................  Partial proctectomy...  C
45114..........................  Partial removal of      C
                                  rectum.
45116..........................  Partial removal of      C
                                  rectum.
45119..........................  Remove rectum w/        C
                                  reservoir.
45120..........................  Removal of rectum.....  C
45121..........................  Removal of rectum and   C
                                  colon.
45123..........................  Partial proctectomy...  C
45126..........................  Pelvic exenteration...  C
45130..........................  Excision of rectal      C
                                  prolapse.
45135..........................  Excision of rectal      C
                                  prolapse.
45136..........................  Excise ileoanal         C
                                  reservior.

[[Page 49968]]

 
45395..........................  Lap, removal of rectum  C
45397..........................  Lap, remove rectum w/   C
                                  pouch.
45400..........................  Laparoscopic            C
                                  proctopexy.
45402..........................  Lap proctopexy w/sig    C
                                  resect.
45540..........................  Correct rectal          C
                                  prolapse.
45550..........................  Repair rectum/remove    C
                                  sigmoid.
45562..........................  Exploration/repair of   C
                                  rectum.
45563..........................  Exploration/repair of   C
                                  rectum.
45800..........................  Repair rect/bladder     C
                                  fistula.
45805..........................  Repair fistula w/       C
                                  colostomy.
45820..........................  Repair rectourethral    C
                                  fistula.
45825..........................  Repair fistula w/       C
                                  colostomy.
46705..........................  Repair of anal          C
                                  stricture.
46710..........................  Repr per/vag pouch      C
                                  sngl proc.
46712..........................  Repr per/vag pouch dbl  C
                                  proc.
46715..........................  Rep perf anoper fistu.  C
46716..........................  Rep perf anoper/vestib  C
                                  fistu.
46730..........................  Construction of absent  C
                                  anus.
46735..........................  Construction of absent  C
                                  anus.
46740..........................  Construction of absent  C
                                  anus.
46742..........................  Repair of imperforated  C
                                  anus.
46744..........................  Repair of cloacal       C
                                  anomaly.
46746..........................  Repair of cloacal       C
                                  anomaly.
46748..........................  Repair of cloacal       C
                                  anomaly.
46751..........................  Repair of anal          C
                                  sphincter.
47010..........................  Open drainage, liver    C
                                  lesion.
47015..........................  Inject/aspirate liver   C
                                  cyst.
47100..........................  Wedge biopsy of liver.  C
47120..........................  Partial removal of      C
                                  liver.
47122..........................  Extensive removal of    C
                                  liver.
47125..........................  Partial removal of      C
                                  liver.
47130..........................  Partial removal of      C
                                  liver.
47133..........................  Removal of donor liver  C
47135..........................  Transplantation of      C
                                  liver.
47136..........................  Transplantation of      C
                                  liver.
47140..........................  Partial removal, donor  C
                                  liver.
47141..........................  Partial removal, donor  C
                                  liver.
47142..........................  Partial removal, donor  C
                                  liver.
47143..........................  Prep donor liver,       C
                                  whole.
47144..........................  Prep donor liver, 3-    C
                                  segment.
47145..........................  Prep donor liver, lobe  C
                                  split.
47146..........................  Prep donor liver/       C
                                  venous.
47147..........................  Prep donor liver/       C
                                  arterial.
47300..........................  Surgery for liver       C
                                  lesion.
47350..........................  Repair liver wound....  C
47360..........................  Repair liver wound....  C
47361..........................  Repair liver wound....  C
47362..........................  Repair liver wound....  C
47380..........................  Open ablate liver       C
                                  tumor rf.
47381..........................  Open ablate liver       C
                                  tumor cryo.
47400..........................  Incision of liver duct  C
47420..........................  Incision of bile duct.  C
47425..........................  Incision of bile duct.  C
47460..........................  Incise bile duct        C
                                  sphincter.
47480..........................  Incision of             C
                                  gallbladder.
47550..........................  Bile duct endoscopy     C
                                  add-on.
47570..........................  Laparo                  C
                                  cholecystoenterostomy.
47600..........................  Removal of gallbladder  C
47605..........................  Removal of gallbladder  C
47610..........................  Removal of gallbladder  C
47612..........................  Removal of gallbladder  C
47620..........................  Removal of gallbladder  C
47700..........................  Exploration of bile     C
                                  ducts.
47701..........................  Bile duct revision....  C
47711..........................  Excision of bile duct   C
                                  tumor.
47712..........................  Excision of bile duct   C
                                  tumor.
47715..........................  Excision of bile duct   C
                                  cyst.
47716..........................  Fusion of bile duct     C
                                  cyst.

[[Page 49969]]

 
47720..........................  Fuse gallbladder &      C
                                  bowel.
47721..........................  Fuse upper gi           C
                                  structures.
47740..........................  Fuse gallbladder &      C
                                  bowel.
47741..........................  Fuse gallbladder &      C
                                  bowel.
47760..........................  Fuse bile ducts and     C
                                  bowel.
47765..........................  Fuse liver ducts &      C
                                  bowel.
47780..........................  Fuse bile ducts and     C
                                  bowel.
47785..........................  Fuse bile ducts and     C
                                  bowel.
47800..........................  Reconstruction of bile  C
                                  ducts.
47801..........................  Placement, bile duct    C
                                  support.
47802..........................  Fuse liver duct &       C
                                  intestine.
47900..........................  Suture bile duct        C
                                  injury.
48000..........................  Drainage of abdomen...  C
48001..........................  Placement of drain,     C
                                  pancreas.
48005..........................  Resect/debride          C
                                  pancreas.
48020..........................  Removal of pancreatic   C
                                  stone.
48100..........................  Biopsy of pancreas,     C
                                  open.
48120..........................  Removal of pancreas     C
                                  lesion.
48140..........................  Partial removal of      C
                                  pancreas.
48145..........................  Partial removal of      C
                                  pancreas.
48146..........................  Pancreatectomy........  C
48148..........................  Removal of pancreatic   C
                                  duct.
48150..........................  Partial removal of      C
                                  pancreas.
48152..........................  Pancreatectomy........  C
48153..........................  Pancreatectomy........  C
48154..........................  Pancreatectomy........  C
48155..........................  Removal of pancreas...  C
48180..........................  Fuse pancreas and       C
                                  bowel.
48400..........................  Injection, intraop add- C
                                  on.
48500..........................  Surgery of pancreatic   C
                                  cyst.
48510..........................  Drain pancreatic        C
                                  pseudocyst.
48520..........................  Fuse pancreas cyst and  C
                                  bowel.
48540..........................  Fuse pancreas cyst and  C
                                  bowel.
48545..........................  Pancreatorrhaphy......  C
48547..........................  Duodenal exclusion....  C
48551..........................  Prep donor pancreas...  C
48552..........................  Prep donor pancreas/    C
                                  venous.
48554..........................  Transpl allograft       C
                                  pancreas.
48556..........................  Removal, allograft      C
                                  pancreas.
49000..........................  Exploration of abdomen  C
49002..........................  Reopening of abdomen..  C
49010..........................  Exploration behind      C
                                  abdomen.
49020..........................  Drain abdominal         C
                                  abscess.
49040..........................  Drain, open, abdom      C
                                  abscess.
49060..........................  Drain, open, retrop     C
                                  abscess.
49062..........................  Drain to peritoneal     C
                                  cavity.
49201..........................  Remove abdom lesion,    C
                                  complex.
49215..........................  Excise sacral spine     C
                                  tumor.
49220..........................  Multiple surgery,       C
                                  abdomen.
49255..........................  Removal of omentum....  C
49425..........................  Insert abdomen-venous   C
                                  drain.
49428..........................  Ligation of shunt.....  C
49605..........................  Repair umbilical        C
                                  lesion.
49606..........................  Repair umbilical        C
                                  lesion.
49610..........................  Repair umbilical        C
                                  lesion.
49611..........................  Repair umbilical        C
                                  lesion.
49900..........................  Repair of abdominal     C
                                  wall.
49904..........................  Omental flap, extra-    C
                                  abdom.
49905..........................  Omental flap, intra-    C
                                  abdom.
49906..........................  Free omental flap,      C
                                  microvasc.
50010..........................  Exploration of kidney.  C
50040..........................  Drainage of kidney....  C
50045..........................  Exploration of kidney.  C
50060..........................  Removal of kidney       C
                                  stone.
50065..........................  Incision of kidney....  C
50070..........................  Incision of kidney....  C
50075..........................  Removal of kidney       C
                                  stone.
50100..........................  Revise kidney blood     C
                                  vessels.

[[Page 49970]]

 
50120..........................  Exploration of kidney.  C
50125..........................  Explore and drain       C
                                  kidney.
50130..........................  Removal of kidney       C
                                  stone.
50135..........................  Exploration of kidney.  C
50205..........................  Biopsy of kidney......  C
50220..........................  Remove kidney, open...  C
50225..........................  Removal kidney open,    C
                                  complex.
50230..........................  Removal kidney open,    C
                                  radical.
50234..........................  Removal of kidney &     C
                                  ureter.
50236..........................  Removal of kidney &     C
                                  ureter.
50240..........................  Partial removal of      C
                                  kidney.
50250..........................  Cryoablate renal mass   C
                                  open.
50280..........................  Removal of kidney       C
                                  lesion.
50290..........................  Removal of kidney       C
                                  lesion.
50300..........................  Remove cadaver donor    C
                                  kidney.
50320..........................  Remove kidney, living   C
                                  donor.
50323..........................  Prep cadaver renal      C
                                  allograft.
50325..........................  Prep donor renal graft  C
50327..........................  Prep renal graft/       C
                                  venous.
50328..........................  Prep renal graft/       C
                                  arterial.
50329..........................  Prep renal graft/       C
                                  ureteral.
50340..........................  Removal of kidney.....  C
50360..........................  Transplantation of      C
                                  kidney.
50365..........................  Transplantation of      C
                                  kidney.
50370..........................  Remove transplanted     C
                                  kidney.
50380..........................  Reimplantation of       C
                                  kidney.
50400..........................  Revision of kidney/     C
                                  ureter.
50405..........................  Revision of kidney/     C
                                  ureter.
50500..........................  Repair of kidney wound  C
50520..........................  Close kidney-skin       C
                                  fistula.
50525..........................  Repair renal-abdomen    C
                                  fistula.
50526..........................  Repair renal-abdomen    C
                                  fistula.
50540..........................  Revision of horseshoe   C
                                  kidney.
50545..........................  Laparo radical          C
                                  nephrectomy.
50546..........................  Laparoscopic            C
                                  nephrectomy.
50547..........................  Laparo removal donor    C
                                  kidney.
50548..........................  Laparo remove w/ureter  C
50580..........................  Kidney endoscopy &      C
                                  treatment.
50600..........................  Exploration of ureter.  C
50605..........................  Insert ureteral         C
                                  support.
50610..........................  Removal of ureter       C
                                  stone.
50620..........................  Removal of ureter       C
                                  stone.
50630..........................  Removal of ureter       C
                                  stone.
50650..........................  Removal of ureter.....  C
50660..........................  Removal of ureter.....  C
50700..........................  Revision of ureter....  C
50715..........................  Release of ureter.....  C
50722..........................  Release of ureter.....  C
50725..........................  Release/revise ureter.  C
50727..........................  Revise ureter.........  C
50728..........................  Revise ureter.........  C
50740..........................  Fusion of ureter &      C
                                  kidney.
50750..........................  Fusion of ureter &      C
                                  kidney.
50760..........................  Fusion of ureters.....  C
50770..........................  Splicing of ureters...  C
50780..........................  Reimplant ureter in     C
                                  bladder.
50782..........................  Reimplant ureter in     C
                                  bladder.
50783..........................  Reimplant ureter in     C
                                  bladder.
50785..........................  Reimplant ureter in     C
                                  bladder.
50800..........................  Implant ureter in       C
                                  bowel.
50810..........................  Fusion of ureter &      C
                                  bowel.
50815..........................  Urine shunt to          C
                                  intestine.
50820..........................  Construct bowel         C
                                  bladder.
50825..........................  Construct bowel         C
                                  bladder.
50830..........................  Revise urine flow.....  C
50840..........................  Replace ureter by       C
                                  bowel.
50845..........................  Appendico-vesicostomy.  C
50860..........................  Transplant ureter to    C
                                  skin.

[[Page 49971]]

 
50900..........................  Repair of ureter......  C
50920..........................  Closure ureter/skin     C
                                  fistula.
50930..........................  Closure ureter/bowel    C
                                  fistula.
50940..........................  Release of ureter.....  C
51060..........................  Removal of ureter       C
                                  stone.
51525..........................  Removal of bladder      C
                                  lesion.
51530..........................  Removal of bladder      C
                                  lesion.
51535..........................  Repair of ureter        C
                                  lesion.
51550..........................  Partial removal of      C
                                  bladder.
51555..........................  Partial removal of      C
                                  bladder.
51565..........................  Revise bladder &        C
                                  ureter(s).
51570..........................  Removal of bladder....  C
51575..........................  Removal of bladder &    C
                                  nodes.
51580..........................  Remove bladder/revise   C
                                  tract.
51585..........................  Removal of bladder &    C
                                  nodes.
51590..........................  Remove bladder/revise   C
                                  tract.
51595..........................  Remove bladder/revise   C
                                  tract.
51596..........................  Remove bladder/create   C
                                  pouch.
51597..........................  Removal of pelvic       C
                                  structures.
51800..........................  Revision of bladder/    C
                                  urethra.
51820..........................  Revision of urinary     C
                                  tract.
51840..........................  Attach bladder/urethra  C
51841..........................  Attach bladder/urethra  C
51845..........................  Repair bladder neck...  C
51860..........................  Repair of bladder       C
                                  wound.
51865..........................  Repair of bladder       C
                                  wound.
51900..........................  Repair bladder/vagina   C
                                  lesion.
51920..........................  Close bladder-uterus    C
                                  fistula.
51925..........................  Hysterectomy/bladder    C
                                  repair.
51940..........................  Correction of bladder   C
                                  defect.
51960..........................  Revision of bladder &   C
                                  bowel.
51980..........................  Construct bladder       C
                                  opening.
53415..........................  Reconstruction of       C
                                  urethra.
53448..........................  Remov/replc ur          C
                                  sphinctr comp.
54125..........................  Removal of penis......  C
54130..........................  Remove penis & nodes..  C
54135..........................  Remove penis & nodes..  C
54332..........................  Revise penis/urethra..  C
54336..........................  Revise penis/urethra..  C
54390..........................  Repair penis and        C
                                  bladder.
54411..........................  Remov/replc penis       C
                                  pros, comp.
54417..........................  Remv/replc penis pros,  C
                                  compl.
54430..........................  Revision of penis.....  C
54535..........................  Extensive testis        C
                                  surgery.
54650..........................  Orchiopexy (Fowler-     C
                                  Stephens).
55605..........................  Incise sperm duct       C
                                  pouch.
55650..........................  Remove sperm duct       C
                                  pouch.
55801..........................  Removal of prostate...  C
55810..........................  Extensive prostate      C
                                  surgery.
55812..........................  Extensive prostate      C
                                  surgery.
55815..........................  Extensive prostate      C
                                  surgery.
55821..........................  Removal of prostate...  C
55831..........................  Removal of prostate...  C
55840..........................  Extensive prostate      C
                                  surgery.
55842..........................  Extensive prostate      C
                                  surgery.
55845..........................  Extensive prostate      C
                                  surgery.
55862..........................  Extensive prostate      C
                                  surgery.
55865..........................  Extensive prostate      C
                                  surgery.
55866..........................  Laparo radical          C
                                  prostatectomy.
56630..........................  Extensive vulva         C
                                  surgery.
56631..........................  Extensive vulva         C
                                  surgery.
56632..........................  Extensive vulva         C
                                  surgery.
56633..........................  Extensive vulva         C
                                  surgery.
56634..........................  Extensive vulva         C
                                  surgery.
56637..........................  Extensive vulva         C
                                  surgery.
56640..........................  Extensive vulva         C
                                  surgery.
57110..........................  Remove vagina wall,     C
                                  complete.
57111..........................  Remove vagina tissue,   C
                                  compl.

[[Page 49972]]

 
57112..........................  Vaginectomy w/nodes,    C
                                  compl.
57270..........................  Repair of bowel pouch.  C
57280..........................  Suspension of vagina..  C
57282..........................  Colpopexy,              C
                                  extraperitoneal.
57283..........................  Colpopexy,              C
                                  intraperitoneal.
57305..........................  Repair rectum-vagina    C
                                  fistula.
57307..........................  Fistula repair &        C
                                  colostomy.
57308..........................  Fistula repair,         C
                                  transperine.
57311..........................  Repair urethrovaginal   C
                                  lesion.
57531..........................  Removal of cervix,      C
                                  radical.
57540..........................  Removal of residual     C
                                  cervix.
57545..........................  Remove cervix/repair    C
                                  pelvis.
58140..........................  Myomectomy abdom        C
                                  method.
58146..........................  Myomectomy abdom        C
                                  complex.
58150..........................  Total hysterectomy....  C
58152..........................  Total hysterectomy....  C
58180..........................  Partial hysterectomy..  C
58200..........................  Extensive hysterectomy  C
58210..........................  Extensive hysterectomy  C
58240..........................  Removal of pelvis       C
                                  contents.
58260..........................  Vaginal hysterectomy..  C
58262..........................  Vag hyst including t/o  C
58263..........................  Vag hyst w/t/o & vag    C
                                  repair.
58267..........................  Vag hyst w/urinary      C
                                  repair.
58270..........................  Vag hyst w/enterocele   C
                                  repair.
58275..........................  Hysterectomy/revise     C
                                  vagina.
58280..........................  Hysterectomy/revise     C
                                  vagina.
58285..........................  Extensive hysterectomy  C
58290..........................  Vag hyst complex......  C
58291..........................  Vag hyst incl t/o,      C
                                  complex.
58292..........................  Vag hyst t/o & repair,  C
                                  compl.
58293..........................  Vag hyst w/uro repair,  C
                                  compl.
58294..........................  Vag hyst w/enterocele,  C
                                  compl.
58400..........................  Suspension of uterus..  C
58410..........................  Suspension of uterus..  C
58520..........................  Repair of ruptured      C
                                  uterus.
58540..........................  Revision of uterus....  C
58605..........................  Division of fallopian   C
                                  tube.
58611..........................  Ligate oviduct(s) add-  C
                                  on.
58700..........................  Removal of fallopian    C
                                  tube.
58720..........................  Removal of ovary/       C
                                  tube(s).
58740..........................  Revise fallopian        C
                                  tube(s).
58750..........................  Repair oviduct........  C
58752..........................  Revise ovarian tube(s)  C
58760..........................  Remove tubal            C
                                  obstruction.
58805..........................  Drainage of ovarian     C
                                  cyst(s).
58822..........................  Drain ovary abscess,    C
                                  percut.
58825..........................  Transposition,          C
                                  ovary(s).
58940..........................  Removal of ovary(s)...  C
58943..........................  Removal of ovary(s)...  C
58950..........................  Resect ovarian          C
                                  malignancy.
58951..........................  Resect ovarian          C
                                  malignancy.
58952..........................  Resect ovarian          C
                                  malignancy.
58953..........................  Tah, rad dissect for    C
                                  debulk.
58954..........................  Tah rad debulk/lymph    C
                                  remove.
58956..........................  Bso, omentectomy w/tah  C
58960..........................  Exploration of abdomen  C
59120..........................  Treat ectopic           C
                                  pregnancy.
59121..........................  Treat ectopic           C
                                  pregnancy.
59130..........................  Treat ectopic           C
                                  pregnancy.
59135..........................  Treat ectopic           C
                                  pregnancy.
59136..........................  Treat ectopic           C
                                  pregnancy.
59140..........................  Treat ectopic           C
                                  pregnancy.
59325..........................  Revision of cervix....  C
59350..........................  Repair of uterus......  C
59514..........................  Cesarean delivery only  C
59525..........................  Remove uterus after     C
                                  cesarean.
59620..........................  Attempted vbac          C
                                  delivery only.

[[Page 49973]]

 
59830..........................  Treat uterus infection  C
59850..........................  Abortion..............  C
59851..........................  Abortion..............  C
59852..........................  Abortion..............  C
59855..........................  Abortion..............  C
59856..........................  Abortion..............  C
59857..........................  Abortion..............  C
60254..........................  Extensive thyroid       C
                                  surgery.
60270..........................  Removal of thyroid....  C
60271..........................  Removal of thyroid....  C
60502..........................  Re-explore              C
                                  parathyroids.
60505..........................  Explore parathyroid     C
                                  glands.
60520..........................  Removal of thymus       C
                                  gland.
60521..........................  Removal of thymus       C
                                  gland.
60522..........................  Removal of thymus       C
                                  gland.
60540..........................  Explore adrenal gland.  C
60545..........................  Explore adrenal gland.  C
60600..........................  Remove carotid body     C
                                  lesion.
60605..........................  Remove carotid body     C
                                  lesion.
60650..........................  Laparoscopy             C
                                  adrenalectomy.
61105..........................  Twist drill hole......  C
61107..........................  Drill skull for         C
                                  implantation.
61108..........................  Drill skull for         C
                                  drainage.
61120..........................  Burr hole for puncture  C
61140..........................  Pierce skull for        C
                                  biopsy.
61150..........................  Pierce skull for        C
                                  drainage.
61151..........................  Pierce skull for        C
                                  drainage.
61154..........................  Pierce skull & remove   C
                                  clot.
61156..........................  Pierce skull for        C
                                  drainage.
61210..........................  Pierce skull, implant   C
                                  device.
61250..........................  Pierce skull & explore  C
61253..........................  Pierce skull & explore  C
61304..........................  Open skull for          C
                                  exploration.
61305..........................  Open skull for          C
                                  exploration.
61312..........................  Open skull for          C
                                  drainage.
61313..........................  Open skull for          C
                                  drainage.
61314..........................  Open skull for          C
                                  drainage.
61315..........................  Open skull for          C
                                  drainage.
61316..........................  Implt cran bone flap    C
                                  to abdo.
61320..........................  Open skull for          C
                                  drainage.
61321..........................  Open skull for          C
                                  drainage.
61322..........................  Decompressive           C
                                  craniotomy.
61323..........................  Decompressive           C
                                  lobectomy.
61332..........................  Explore/biopsy eye      C
                                  socket.
61333..........................  Explore orbit/remove    C
                                  lesion.
61340..........................  Subtemporal             C
                                  decompression.
61343..........................  Incise skull (press     C
                                  relief).
61345..........................  Relieve cranial         C
                                  pressure.
61440..........................  Incise skull for        C
                                  surgery.
61450..........................  Incise skull for        C
                                  surgery.
61458..........................  Incise skull for brain  C
                                  wound.
61460..........................  Incise skull for        C
                                  surgery.
61470..........................  Incise skull for        C
                                  surgery.
61480..........................  Incise skull for        C
                                  surgery.
61490..........................  Incise skull for        C
                                  surgery.
61500..........................  Removal of skull        C
                                  lesion.
61501..........................  Remove infected skull   C
                                  bone.
61510..........................  Removal of brain        C
                                  lesion.
61512..........................  Remove brain lining     C
                                  lesion.
61514..........................  Removal of brain        C
                                  abscess.
61516..........................  Removal of brain        C
                                  lesion.
61517..........................  Implt brain chemotx     C
                                  add-on.
61518..........................  Removal of brain        C
                                  lesion.
61519..........................  Remove brain lining     C
                                  lesion.
61520..........................  Removal of brain        C
                                  lesion.
61521..........................  Removal of brain        C
                                  lesion.
61522..........................  Removal of brain        C
                                  abscess.
61524..........................  Removal of brain        C
                                  lesion.

[[Page 49974]]

 
61526..........................  Removal of brain        C
                                  lesion.
61530..........................  Removal of brain        C
                                  lesion.
61531..........................  Implant brain           C
                                  electrodes.
61533..........................  Implant brain           C
                                  electrodes.
61534..........................  Removal of brain        C
                                  lesion.
61535..........................  Remove brain            C
                                  electrodes.
61536..........................  Removal of brain        C
                                  lesion.
61537..........................  Removal of brain        C
                                  tissue.
61538..........................  Removal of brain        C
                                  tissue.
61539..........................  Removal of brain        C
                                  tissue.
61540..........................  Removal of brain        C
                                  tissue.
61541..........................  Incision of brain       C
                                  tissue.
61542..........................  Removal of brain        C
                                  tissue.
61543..........................  Removal of brain        C
                                  tissue.
61544..........................  Remove & treat brain    C
                                  lesion.
61545..........................  Excision of brain       C
                                  tumor.
61546..........................  Removal of pituitary    C
                                  gland.
61548..........................  Removal of pituitary    C
                                  gland.
61550..........................  Release of skull seams  C
61552..........................  Release of skull seams  C
61556..........................  Incise skull/sutures..  C
61557..........................  Incise skull/sutures..  C
61558..........................  Excision of skull/      C
                                  sutures.
61559..........................  Excision of skull/      C
                                  sutures.
61563..........................  Excision of skull       C
                                  tumor.
61564..........................  Excision of skull       C
                                  tumor.
61566..........................  Removal of brain        C
                                  tissue.
61567..........................  Incision of brain       C
                                  tissue.
61570..........................  Remove foreign body,    C
                                  brain.
61571..........................  Incise skull for brain  C
                                  wound.
61575..........................  Skull base/brainstem    C
                                  surgery.
61576..........................  Skull base/brainstem    C
                                  surgery.
61580..........................  Craniofacial approach,  C
                                  skull.
61581..........................  Craniofacial approach,  C
                                  skull.
61582..........................  Craniofacial approach,  C
                                  skull.
61583..........................  Craniofacial approach,  C
                                  skull.
61584..........................  Orbitocranial approach/ C
                                  skull.
61585..........................  Orbitocranial approach/ C
                                  skull.
61586..........................  Resect nasopharynx,     C
                                  skull.
61590..........................  Infratemporal approach/ C
                                  skull.
61591..........................  Infratemporal approach/ C
                                  skull.
61592..........................  Orbitocranial approach/ C
                                  skull.
61595..........................  Transtemporal approach/ C
                                  skull.
61596..........................  Transcochlear approach/ C
                                  skull.
61597..........................  Transcondylar approach/ C
                                  skull.
61598..........................  Transpetrosal approach/ C
                                  skull.
61600..........................  Resect/excise cranial   C
                                  lesion.
61601..........................  Resect/excise cranial   C
                                  lesion.
61605..........................  Resect/excise cranial   C
                                  lesion.
61606..........................  Resect/excise cranial   C
                                  lesion.
61607..........................  Resect/excise cranial   C
                                  lesion.
61608..........................  Resect/excise cranial   C
                                  lesion.
61609..........................  Transect artery, sinus  C
61610..........................  Transect artery, sinus  C
61611..........................  Transect artery, sinus  C
61612..........................  Transect artery, sinus  C
61613..........................  Remove aneurysm, sinus  C
61615..........................  Resect/excise lesion,   C
                                  skull.
61616..........................  Resect/excise lesion,   C
                                  skull.
61618..........................  Repair dura...........  C
61619..........................  Repair dura...........  C
61624..........................  Transcath occlusion,    C
                                  cns.
61680..........................  Intracranial vessel     C
                                  surgery.
61682..........................  Intracranial vessel     C
                                  surgery.
61684..........................  Intracranial vessel     C
                                  surgery.
61686..........................  Intracranial vessel     C
                                  surgery.
61690..........................  Intracranial vessel     C
                                  surgery.
61692..........................  Intracranial vessel     C
                                  surgery.

[[Page 49975]]

 
61697..........................  Brain aneurysm repr,    C
                                  complx.
61698..........................  Brain aneurysm repr,    C
                                  complx.
61700..........................  Brain aneurysm repr,    C
                                  simple.
61702..........................  Inner skull vessel      C
                                  surgery.
61703..........................  Clamp neck artery.....  C
61705..........................  Revise circulation to   C
                                  head.
61708..........................  Revise circulation to   C
                                  head.
61710..........................  Revise circulation to   C
                                  head.
61711..........................  Fusion of skull         C
                                  arteries.
61735..........................  Incise skull/brain      C
                                  surgery.
61750..........................  Incise skull/brain      C
                                  biopsy.
61751..........................  Brain biopsy w/ct/mr    C
                                  guide.
61760..........................  Implant brain           C
                                  electrodes.
61770..........................  Incise skull for        C
                                  treatment.
61850..........................  Implant                 C
                                  neuroelectrodes.
61860..........................  Implant                 C
                                  neuroelectrodes.
61863..........................  Implant neuroelectrode  C
61864..........................  Implant neuroelectrde,  C
                                  addl.
61867..........................  Implant neuroelectrode  C
61868..........................  Implant neuroelectrde,  C
                                  add'l.
61870..........................  Implant                 C
                                  neuroelectrodes.
61875..........................  Implant                 C
                                  neuroelectrodes.
62005..........................  Treat skull fracture..  C
62010..........................  Treatment of head       C
                                  injury.
62100..........................  Repair brain fluid      C
                                  leakage.
62115..........................  Reduction of skull      C
                                  defect.
62116..........................  Reduction of skull      C
                                  defect.
62117..........................  Reduction of skull      C
                                  defect.
62120..........................  Repair skull cavity     C
                                  lesion.
62121..........................  Incise skull repair...  C
62140..........................  Repair of skull defect  C
62141..........................  Repair of skull defect  C
62142..........................  Remove skull plate/     C
                                  flap.
62143..........................  Replace skull plate/    C
                                  flap.
62145..........................  Repair of skull &       C
                                  brain.
62146..........................  Repair of skull with    C
                                  graft.
62147..........................  Repair of skull with    C
                                  graft.
62148..........................  Retr bone flap to fix   C
                                  skull.
62161..........................  Dissect brain w/scope.  C
62162..........................  Remove colloid cyst w/  C
                                  scope.
62163..........................  Neuroendoscopy w/fb     C
                                  removal.
62164..........................  Remove brain tumor w/   C
                                  scope.
62165..........................  Remove pituit tumor w/  C
                                  scope.
62180..........................  Establish brain cavity  C
                                  shunt.
62190..........................  Establish brain cavity  C
                                  shunt.
62192..........................  Establish brain cavity  C
                                  shunt.
62200..........................  Establish brain cavity  C
                                  shunt.
62201..........................  Brain cavity shunt w/   C
                                  scope.
62220..........................  Establish brain cavity  C
                                  shunt.
62223..........................  Establish brain cavity  C
                                  shunt.
62256..........................  Remove brain cavity     C
                                  shunt.
62258..........................  Replace brain cavity    C
                                  shunt.
63043..........................  Laminotomy, add'l       C
                                  cervical.
63044..........................  Laminotomy, add'l       C
                                  lumbar.
63050..........................  Cervical laminoplasty.  C
63051..........................  C-laminoplasty w/graft/ C
                                  plate.
63076..........................  Neck spine disk         C
                                  surgery.
63077..........................  Spine disk surgery,     C
                                  thorax.
63078..........................  Spine disk surgery,     C
                                  thorax.
63081..........................  Removal of vertebral    C
                                  body.
63082..........................  Remove vertebral body   C
                                  add-on.
63085..........................  Removal of vertebral    C
                                  body.
63086..........................  Remove vertebral body   C
                                  add-on.
63087..........................  Removal of vertebral    C
                                  body.
63088..........................  Remove vertebral body   C
                                  add-on.
63090..........................  Removal of vertebral    C
                                  body.
63091..........................  Remove vertebral body   C
                                  add-on.
63101..........................  Removal of vertebral    C
                                  body.

[[Page 49976]]

 
63102..........................  Removal of vertebral    C
                                  body.
63103..........................  Remove vertebral body   C
                                  add-on.
63170..........................  Incise spinal cord      C
                                  tract(s).
63172..........................  Drainage of spinal      C
                                  cyst.
63173..........................  Drainage of spinal      C
                                  cyst.
63180..........................  Revise spinal cord      C
                                  ligaments.
63182..........................  Revise spinal cord      C
                                  ligaments.
63185..........................  Incise spinal column/   C
                                  nerves.
63190..........................  Incise spinal column/   C
                                  nerves.
63191..........................  Incise spinal column/   C
                                  nerves.
63194..........................  Incise spinal column &  C
                                  cord.
63195..........................  Incise spinal column &  C
                                  cord.
63196..........................  Incise spinal column &  C
                                  cord.
63197..........................  Incise spinal column &  C
                                  cord.
63198..........................  Incise spinal column &  C
                                  cord.
63199..........................  Incise spinal column &  C
                                  cord.
63200..........................  Release of spinal cord  C
63250..........................  Revise spinal cord      C
                                  vessels.
63251..........................  Revise spinal cord      C
                                  vessels.
63252..........................  Revise spinal cord      C
                                  vessels.
63265..........................  Excise intraspinal      C
                                  lesion.
63266..........................  Excise intraspinal      C
                                  lesion.
63267..........................  Excise intraspinal      C
                                  lesion.
63268..........................  Excise intraspinal      C
                                  lesion.
63270..........................  Excise intraspinal      C
                                  lesion.
63271..........................  Excise intraspinal      C
                                  lesion.
63272..........................  Excise intraspinal      C
                                  lesion.
63273..........................  Excise intraspinal      C
                                  lesion.
63275..........................  Biopsy/excise spinal    C
                                  tumor.
63276..........................  Biopsy/excise spinal    C
                                  tumor.
63277..........................  Biopsy/excise spinal    C
                                  tumor.
63278..........................  Biopsy/excise spinal    C
                                  tumor.
63280..........................  Biopsy/excise spinal    C
                                  tumor.
63281..........................  Biopsy/excise spinal    C
                                  tumor.
63282..........................  Biopsy/excise spinal    C
                                  tumor.
63283..........................  Biopsy/excise spinal    C
                                  tumor.
63285..........................  Biopsy/excise spinal    C
                                  tumor.
63286..........................  Biopsy/excise spinal    C
                                  tumor.
63287..........................  Biopsy/excise spinal    C
                                  tumor.
63290..........................  Biopsy/excise spinal    C
                                  tumor.
63295..........................  Repair of laminectomy   C
                                  defect.
63300..........................  Removal of vertebral    C
                                  body.
63301..........................  Removal of vertebral    C
                                  body.
63302..........................  Removal of vertebral    C
                                  body.
63303..........................  Removal of vertebral    C
                                  body.
63304..........................  Removal of vertebral    C
                                  body.
63305..........................  Removal of vertebral    C
                                  body.
63306..........................  Removal of vertebral    C
                                  body.
63307..........................  Removal of vertebral    C
                                  body.
63308..........................  Remove vertebral body   C
                                  add-on.
63700..........................  Repair of spinal        C
                                  herniation.
63702..........................  Repair of spinal        C
                                  herniation.
63704..........................  Repair of spinal        C
                                  herniation.
63706..........................  Repair of spinal        C
                                  herniation.
63707..........................  Repair spinal fluid     C
                                  leakage.
63709..........................  Repair spinal fluid     C
                                  leakage.
63710..........................  Graft repair of spine   C
                                  defect.
63740..........................  Install spinal shunt..  C
64752..........................  Incision of vagus       C
                                  nerve.
64755..........................  Incision of stomach     C
                                  nerves.
64760..........................  Incision of vagus       C
                                  nerve.
64809..........................  Remove sympathetic      C
                                  nerves.
64818..........................  Remove sympathetic      C
                                  nerves.
64866..........................  Fusion of facial/other  C
                                  nerve.
64868..........................  Fusion of facial/other  C
                                  nerve.
65273..........................  Repair of eye wound...  C
69155..........................  Extensive ear/neck      C
                                  surgery.
69535..........................  Remove part of          C
                                  temporal bone.

[[Page 49977]]

 
69554..........................  Remove ear lesion.....  C
69950..........................  Incise inner ear nerve  C
69970..........................  Remove inner ear        C
                                  lesion.
75900..........................  Intravascular cath      C
                                  exchange.
75952..........................  Endovasc repair abdom   C
                                  aorta.
75953..........................  Abdom aneurysm endovas  C
                                  rpr.
75954..........................  Iliac aneurysm endovas  C
                                  rpr.
75956..........................  Xray, endovasc thor ao  C
                                  repr.
75957..........................  Xray, endovasc thor ao  C
                                  repr.
75958..........................  Xray, place prox ext    C
                                  thor ao.
75959..........................  Xray, place dist ext    C
                                  thor ao.
92970..........................  Cardioassist, internal  C
92971..........................  Cardioassist, external  C
92975..........................  Dissolve clot, heart    C
                                  vessel.
92992..........................  Revision of heart       C
                                  chamber.
92993..........................  Revision of heart       C
                                  chamber.
99190..........................  Special pump services.  C
99191..........................  Special pump services.  C
99192..........................  Special pump services.  C
99251..........................  Initial inpatient       C
                                  consult.
99252..........................  Initial inpatient       C
                                  consult.
99253..........................  Initial inpatient       C
                                  consult.
99254..........................  Initial inpatient       C
                                  consult.
99255..........................  Initial inpatient       C
                                  consult.
99293..........................  Ped critical care,      C
                                  initial.
99294..........................  Ped critical care,      C
                                  subseq.
99295..........................  Neonate crit care,      C
                                  initial.
99296..........................  Neonate critical care   C
                                  subseq.
99298..........................  Ic for lbw infant <     C
                                  1500 gm.
99299..........................  Ic, lbw infant 1500-    C
                                  2500 gm.
99356..........................  Prolonged service,      C
                                  inpatient.
99357..........................  Prolonged service,      C
                                  inpatient.
99433..........................  Normal newborn care/    C
                                  hospital.
0021T..........................  Fetal oximetry,         C
                                  trnsvag/cerv.
0024T..........................  Transcath cardiac       C
                                  reduction.
0048T..........................  Implant ventricular     C
                                  device.
0049T..........................  External circulation    C
                                  assist.
0050T..........................  Removal circulation     C
                                  assist.
0051T..........................  Implant total heart     C
                                  system.
0052T..........................  Replace component       C
                                  heart syst.
0053T..........................  Replace component       C
                                  heart syst.
0075T..........................  Perq stent/chest vert   C
                                  art.
0076T..........................  S&i stent/chest vert    C
                                  art.
0077T..........................  Cereb therm perfusion   C
                                  probe.
0078T..........................  Endovasc aort repr w/   C
                                  device.
0079T..........................  Endovasc visc extnsn    C
                                  repr.
0080T..........................  Endovasc aort repr rad  C
                                  s&i.
0081T..........................  Endovasc visc extnsn    C
                                  s&i.
0090T..........................  Cervical artific disc.  C
0091T..........................  Lumbar artific disc...  C
0092T..........................  Artific disc addl.....  C
0093T..........................  Cervical artific        C
                                  diskectomy.
0094T..........................  Lumbar artific          C
                                  diskectomy.
0095T..........................  Artific diskectomy      C
                                  addl.
0096T..........................  Rev cervical artific    C
                                  disc.
0097T..........................  Rev lumbar artific      C
                                  disc.
0098T..........................  Rev artific disc addl.  C
0153T..........................  Implant aneur sensor    C
                                  add-on.
G0341..........................  Percutaneous islet      C
                                  celltrans.
G0342..........................  Laparoscopy islet cell  C
                                  trans.
G0343..........................  Laparotomy islet cell   C
                                  transp.
------------------------------------------------------------------------

[FR Doc. 06-6846 Filed 8-8-06; 4:15 pm]
BILLING CODE 4120-01-P