[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]
[[Page 49505]]
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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
[[Page 49506]]
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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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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
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[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]]
[GRAPHIC] [TIFF OMITTED] TP23AU06.022
[[Page 49590]]
[GRAPHIC] [TIFF OMITTED] TP23AU06.023
[[Page 49591]]
[GRAPHIC] [TIFF OMITTED] TP23AU06.024
[[Page 49592]]
[GRAPHIC] [TIFF OMITTED] TP23AU06.025
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[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
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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
[[Page 49638]]
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
[[Page 49639]]
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.
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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.
[[Page 49647]]
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.
[[Page 49648]]
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
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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
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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
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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.
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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
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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
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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.
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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&or ........ 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&Lt heart ........ T....... 0080 37.1008 2,283.59 838.92 456.72
catheters.
93527......... Rt&Lt heart ........ T....... 0080 37.1008 2,283.59 838.92 456.72
catheters.
93528......... Rt&Lt 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.
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[FR Doc. 06-6846 Filed 8-8-06; 4:15 pm]
BILLING CODE 4120-01-P