[Federal Register Volume 72, Number 133 (Thursday, July 12, 2007)]
[Proposed Rules]
[Pages 38122-38395]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-3274]



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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 409, 410, et al.



Medicare Program; Proposed Revisions to Payment Policies Under the 
Physician Fee Schedule, and Other Part B Payment Policies for CY 2008; 
Proposed Revisions to the Payment Policies of Ambulance Services Under 
the Ambulance Fee Schedule for CY 2008; and the Proposed Elimination of 
the E-Prescribing Exemption for Computer-Generated Facsimile 
Transmissions; Proposed Rule

  Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / 
Proposed Rules  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 409, 410, 411, 413, 414, 415, 418, 423, 424, 482, 484, 
485, and 491

[CMS-1385-P]
RIN 0938-AO65


Medicare Program; Proposed Revisions to Payment Policies Under 
the Physician Fee Schedule, and Other Part B Payment Policies for CY 
2008; Proposed Revisions to the Payment Policies of Ambulance Services 
Under the Ambulance Fee Schedule for CY 2008; and the Proposed 
Elimination of the E-Prescribing Exemption for Computer-Generated 
Facsimile Transmissions

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

ACTION: Proposed rule.

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SUMMARY: This proposed rule would address certain provisions of the Tax 
Relief and Health Care Act of 2006, as well as make other proposed 
changes to Medicare Part B payment policy.
    We are proposing these changes to ensure that our payment systems 
are updated to reflect changes in medical practice and the relative 
value of services. This proposed rule also discusses refinements to 
resource-based practice expense (PE) relative value units (RVUs); 
geographic practice cost indices (GPCI) changes; malpractice RVUs; 
requests for additions to the list of telehealth services; several 
coding issues including additional codes from the 5-Year Review; 
payment for covered outpatient drugs and biologicals; the competitive 
acquisition program (CAP); clinical lab fee schedule issues; payment 
for renal dialysis services; performance standards for independent 
diagnostic testing facilities; expiration of the physician scarcity 
area (PSA) bonus payment authorized by section 413 of the Medicare 
Prescription Drug, Improvement and Modernization Act of 2003 (MMA); 
conforming and clarifying changes for comprehensive outpatient 
rehabilitation facilities (CORFs); a process for updating the drug 
compendia at section 1861(t)(2)(B) of the Social Security Act (the 
Act); physician self-referral issues; beneficiary signature for 
ambulance transport services; durable medical equipment (DME) update; 
the chiropractic services demonstration; a Medicare economic index 
(MEI) data change; technical corrections; issues related to therapy 
services; revisions to the ambulance fee schedule; the ambulance 
inflation factor for CY 2008; and the proposal to eliminate the 
exemption for computer-generated facsimile transmissions from the 
National Council for Prescription Drug Programs (NCPDP) SCRIPT standard 
for transmitting prescription and certain prescription-related 
information for Part D eligible individuals.

DATES: To be assured consideration, except for comments on section 
II.M.10 of the preamble, comments must be received at one of the 
adresses provided below, no later than 5 p.m. on Friday, August 31, 
2007.
    Comments on section II.M.10 ``Alternative Criteria for Satisfying 
Certain Exceptions'', of the preamble must be received by no later than 
5 p.m. on Friday, September 7, 2007.

ADDRESSES: In commenting, please refer to file code CMS-1385-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-1385-P, P.O. Box 8018, Baltimore, MD 21244-8018.
    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-1385-P, Mail Stop C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses. If you 
intend to deliver your comments to the Baltimore address, please call 
telephone number (410) 786-7195 in advance to schedule your arrival 
with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and 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: Pam West (410) 786-2302 for issues 
related to practice expense and changes to the comprehensive outpatient 
rehabilitation facility.
    Rick Ensor (410) 786-5617 for issues related to practice expense 
methodology.
    Stephanie Monroe (410) 786-6864 for issues related to the 
geographic practice cost index and malpractice RVUs.
    Craig Dobyski (410) 786-4584 for issues related to list of 
telehealth services.
    Ken Marsalek (410) 786-4502 for issues related to the DRA imaging 
cap.
    Catherine Jansto (410) 786-7762 for issues related to payment for 
covered outpatient drugs and biologicals.
    Edmund Kasaitis (410) 786-0477 for issues related to the 
Competitive Acquisition Program (CAP) for part B drugs.
    Anita Greenberg (410) 786-4601 for issues related to the clinical 
laboratory fee schedule.
    Henry Richter (410) 786-4562 for issues related to payments for 
end-stage renal disease facilities.
    August Nemec (410) 786-0612 for issues related to independent 
diagnostic testing facilities.
    Karen Rinker (410) 786-0189 for issues related to the drug 
compendia.
    David Walczak (410) 786-4475 for issues related to reassignment and

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physician self-referral rules for diagnostic tests and beneficiary 
signature for ambulance transport.
    Lisa Ohrin (410) 786-4565 for issues related to physician self-
referral rules.
    Bob Kuhl (410) 786-4597 for issues related to the DME update.
    Rachel Nelson (410) 786-1175 for issues related to the quality 
reporting system for physician payment for CY 2008.
    Mary Ciccanti (410) 786-3107 for issues related to the reporting of 
anemia quality indicators.
    James Menas (410) 786-4507 for issues related to payment for 
physician pathology services.
    Dorothy Shannon (410) 786-3396 for issues related to the outpatient 
therapy cap.
    Drew Morgan (410) 786-2543 for issues related to the E-Prescribing 
Exemption for Computer-Generated Facsimile Transmissions.
    Roechel Kujawa (410) 786-9111 or Anne Tayloe (410) 786-4546 for 
issues related to the ambulance fee schedule.
    Diane Milstead (410) 786-3355 or Gaysha Brooks (410) 786-9649 for 
all other issues.

SUPPLEMENTARY INFORMATION:
    Submitting Comments: We welcome comments from the public on all 
issues set forth in this rule to assist us in fully considering issues 
and developing policies. You can assist us by referencing the file code 
[CMS-1385-P] and the specific ``issue identifier'' that precedes the 
section on which you choose to comment.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. 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, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.
    To assist readers in referencing sections contained in this 
preamble, we are providing the following table of contents. Some of the 
issues discussed in this preamble affect the payment policies, but do 
not require changes to the regulations in the Code of Federal 
Regulations. Information on the regulation's impact appears throughout 
the preamble and is not exclusively in section VI.

Table of Contents

I. Background
    A. Development of the Relative Value System
    1. Work RVUs
    2. Practice Expense Relative Value Units (PE RVUs)
    3. Resource-Based Malpractice RVUs
    4. Refinements to the RVUs
    5. Adjustments to RVUs Are Budget Neutral
    B. Components of the Fee Schedule Payment Amounts
    C. Most Recent Changes to Fee Schedule
II. Provisions of the Proposed Regulation Related to the Physician 
Fee Schedule
    A. Resource-Based Practice Expense (PE) Relative Value Units 
(RVUs)
    1. Current Methodology
    2. PE Proposals for CY 2008
    B. Geographic Practice Cost Indices (GPCIs)
    1. GPCI Update
    2. Payment Localities
    C. Malpractice (MP) RVUs (TC/PC Issue)
    D. Medicare Telehealth Services
    1. Requests for Adding Services to the List of Medicare 
Telehealth Services
    2. Submitted Requests for Addition to the List of Telehealth 
Services
    E. Specific Coding Issues Related to PFS
    1. Reduction in the Technical Component (TC) for Imaging 
Services Under the PFS to the Outpatient Department (OPD) Payment 
Amount
    2. Application of Multiple Procedure Reduction for Mohs 
Micrographic Surgery (CPT Codes 17311 Through 17315)
    3. Payment for Intravenous Immune Globulin (IVIG) Add-On Code 
for Preadmission-Related Services
    4. Additional Codes From the 5-Year Review of Work RVUs
    5. Anesthesia Coding (Part of 5-Year Review)
    6. Reporting of Cardiac Rehabilitation Services
    F. Part B Drug Payment
    1. Average Sales Price (ASP) Issues
    2. Competitive Acquisition Program (CAP) Issues
    G. Issues Related to the Clinical Lab Fee Schedule
    1. Date of Service for the TC of Physician Pathology Services 
(Sec.  414.510)
    2. New Clinical Diagnostic Laboratory Test (Sec.  414.508)
    H. Proposed Revisions Related to Payment for Renal Dialysis 
Services Furnished by End-Stage Renal Disease (ESRD) Facilities
    1. CY 2005 Revisions
    2. CY 2006 Revisions
    3. CY 2007 Updates
    4. Provisions of This Proposed Rule
    I. Independent Diagnostic Testing Facility (IDTF) Issues
    1. Proposed Revisions of Existing IDTF Performance Standards
    2. Proposed New IDTF Standards
    J. Expiration of MMA Section 413 Provisions for Physician 
Scarcity Area (PSA)
    K. Comprehensive Outpatient Rehabilitation Facility (CORF) 
Issues
    1. Requirements for Coverage of CORF Services--Plan of Treatment 
(Sec.  410.105(c))
    2. Included Services (Sec.  410.100)
    3. Physician Services (Sec.  410.100(a))
    4. Clarifications of CORF Respiratory Therapy Services
    5. Social and Psychological Services
    6. Nursing Care Services
    7. Drugs and Biologicals
    8. Supplies and DME
    9. Clarifications and Payment Updates for Other CORF Services
    10. Cost-Based Payment (Sec.  413.1)
    11. Payment for Comprehensive Outpatient Rehabilitation Facility 
(CORF) Services
    12. Vaccines
    L. Compendia for Determination of Medically-Accepted Indications 
for Off-Label Uses of Drugs and Biologicals in an Anti-Cancer 
Chemotherapeutic Regimen (Sec.  414.930)
    1. Background
    2. Process for Determining Changes to the Compendia List
    M. Physician Self-Referral Issues
    1. Changes to Reassignment and Physician Self-Referral Rules 
Relating to Diagnostic Tests (Anti-Markup Provision)
    2. Burden of Proof
    3. In-Office Ancillary Services Exception
    4. Obstetrical Malpractice Insurance Subsidies
    5. Unit-of-Service (per click) Payments in Space and Equipment 
Leases
    6. Period of Disallowance for Noncompliant Financial 
Relationships
    7. Ownership or Investment Interest in Retirement Plans
    8. ``Set in Advance'' and Percentage-Based Compensation 
Arrangements
    9. Stand in the Shoes
    10. Alternative Criteria for Satisfying Certain Exceptions
    11. Services Furnished ``Under Arrangements''
    N. Beneficiary Signature for Ambulance Transport Services
    O. Update to Fee Schedules for Class III DME for CYs 2007 and 
2008
    1. Background
    2. Proposed Update to Fee Schedule
    P. Discussion of Chiropractic Services Demonstration
    Q. Technical Corrections
    1. Particular Services Excluded From Coverage (Sec.  411.15(a))
    2. Medical Nutrition Therapy (Sec.  410.132(a))
    3. Payment Exception: Pediatric Patient Mix (Sec.  413.84)
    4. Diagnostic X-Ray Tests, Diagnostic Laboratory Tests, and 
Other Diagnostic Tests: Conditions (Sec.  410.32(a)(1))
    R. Percentage Change in the Medicare Economic Index (MEI)
    S. Other Issues

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    1. Recalls and Replacement Devices
    2. Therapy Standards and Requirements
    3. Proposed Elimination of the Exemption for Computer-Generated 
Facsimile Transmission From the National Council for Prescription 
Drug Programs (NCPDP) SCRIPT Standard for Transmitting Prescription 
and Certain Prescription Related Information for Part D Eligible 
Individuals
    T. Division B of the Tax Relief and Health Care Act of 2006--
Medicare Improvements and Extension Act of 2006 (Pub. L. 109-432) 
(MIEA-TRHCA)
    1. Section 101(b)--Physician Quality Reporting Initiative (PQRI)
    2. Section 110--Reporting of Anemia Quality Indicators (Sec.  
414.707(b))
    3. Section 104--Extension of Treatment of Certain Physician 
Pathology Services Under Medicare
    4. Section 201--Extension of Therapy Cap Exception Process
    5. Section 101(d)--Physician Assistance and Quality Initiative 
(PAQI) Fund
    6. Section 108--Payment Process Under the Competitive 
Acquisition Program (CAP)
III. Fee Schedule for Payment of Ambulance Services Update for CY 
2007; Ambulance Inflation Factor Update for CY 2008; and Proposed 
Revisions to the Publication of the Ambulance Fee Schedule (Sec.  
414.620)
    A. History of Medicare Ambulance Services
    1. Statutory Coverage of Ambulance Services
    2. Medicare Regulations for Ambulance Services
    3. Transition to National Fee Schedule
    B. Ambulance Inflation Factor (AIF) During the Transition Period
    C. Ambulance Inflation Factor (AIF) for CY 2008
    D. Proposed Revisions to the Publication of the Ambulance Fee 
Schedule (Sec.  414.620)
IV. Collection of Information Requirements
V. Response to Comments
VI. Regulatory Impact Analysis
    Regulation Text
    Addendum A--Explanation and Use of Addendum B
    Addendum B--2008 Relative Value Units and Related Information 
Used in Determining Medicare Payments for 2008
    Addendum C--Codes for Which We Received PERC Recommendations on 
PE Direct Inputs
    Addendum D--Proposed 2008 Geographic Adjustment Factors (GAFs)
    Addendum E--Proposed 2008* Geographic Practice Cost Indices 
(GPCIs) by State and Medicare Locality
    Addendum F--CPT/HCPCS Imaging Codes Defined by Section 5102(b) 
of the DRA
    Addendum G--FY 2008 Wage Index for Urban Areas Based On CBSA 
Labor Market Areas
    Addendum H--FY 2008 Wage Index based on CBSA Labor Market Areas 
for Rural Areas

Acronyms

    In addition, because of the many organizations and terms to 
which we refer by acronym in this final rule with comment period, we 
are listing these acronyms and their corresponding terms in 
alphabetical order below:

AAA Abdominal aortic aneurysm
AAP Average acquisition price ?>
ACOTE Accreditation Council for Occupational Therapy Education
ACR American College of Radiology
AFROC Association of Freestanding Radiation Oncology Centers
AHFS-DI American Hospital Formulary Service-Drug Information
AHRQ Agency for Healthcare Research and Quality (HHS)
AIF Ambulance inflation factor
AMA American Medical Association
AMA-DE American Medical Association Drug Evaluations
AMP Average manufacturer price
AOTA American Occupational Therapy Association
APC Ambulatory payment classification
APTA American Physical Therapy Association
ASA American Society of Anesthesiologists
ASC Ambulatory surgical center
ASP Average sales price
ASTRO American Society for Therapeutic Radiology and Oncology
ATA American Telemedicine Association
AWP Average wholesale price
BBA Balanced Budget Act of 1997 (Pub. L. 105-33)
BBRA [Medicare, Medicaid and State Child Health Insurance Program] 
Balanced Budget Refinement Act of 1999 (Pub. L. 106-113)
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement Protection 
Act of 2000
BLS Bureau of Labor Statistics
BMD Bone mineral density
BMI Body mass index
BMM Bone mass measurement
BN Budget neutrality
BSA Body surface area
CAD Computer-aided detection
CAH Critical access hospital
CAP Competitive acquisition program
CBSA Core-Based Statistical Area
CEM Cardiac event monitoring
CF Conversion factor
CFR Code of Federal Regulations
CMA California Medical Association
CMS Centers for Medicare & Medicaid Services
CNS Clinical nurse specialist
CORF Comprehensive Outpatient Rehabilitation Facility
COTA Certified Occupational Therapy Assistant
CPEP Clinical Practice Expert Panel
CPI Consumer Price Index
CPI-U Consumer price index for urban customers
CPT (Physicians') Current Procedural Terminology (4th Edition, 2002, 
copyrighted by the American Medical Association)
CRT-D Cardiac resynchronization therapy defibrillator
CT Computed tomography
CTA Computed tomographic angiography
CY Calendar year
DEXA Dual energy x-ray absorptiometry
DHS Designated health services
DME Durable medical equipment
DMEPOS Durable medical equipment, prosthetics, orthotics, and 
supplies
DO Doctor of Osteopathy
DRA Deficit Reduction Act of 2005 (Pub. L. 109-432)
E/M Evaluation and management
ECI Employment cost index
EHR Electronic health record
EPC [Duke] Evidence-based Practice Centers
EPO Erythopoeitin
ESRD End stage renal disease
F&C Facts and Comparisons
FAW Furnish as written
FAX Facsimile
FDA Food and Drug Administration (HHS)
FMR Fair market rents
FQHC Federally qualified health center
FR Federal Register
GAF Geographic adjustment factor
GAO General Accounting Office
GII Global Insight, Inc.
GPO Group purchasing organization
GPCI Geographic practice cost index
HCPAC Health Care Professional Advisory Committee
HCPCS Healthcare Common Procedure Coding System
HCRIS Healthcare Cost Report Information System
HIPAA Health Insurance Portability and Accountability Act of 1996 
(Pub. L. 104-191)
HHA Home health agency
HHS [Department of] Health and Human Services
HIT Health information technology
HMO Health maintenance organization
HPSA Health Professional Shortage Area
HRSA Health Resources Services Administration (HHS)
HUD [Department of] Housing and Urban Development
ICD Implantable cardioverter-defibrillator
ICF Intermediate care facilities
IDTF Independent diagnostic testing facility
IFC Interim final rule with comment period
IOTED International Occupational Therapy Eligibility Determination
IPPE Initial preventive physical examination
IPPS Inpatient prospective payment system
IV Intravenous
IVIG Intravenous immune globulin
IWPUT Intra-service work per unit of time
JCAAI Joint Council of Allergy, Asthma, and Immunology
LPN Licensed practical nurse
MA Medicare Advantage
MA-PD Medicare Advantage-Prescription Drug Plans
MD Medical doctor
MedCAC Medicare Evidence Development and Coverage Advisory Committee 
(formerly the Medicare Coverage Advisory Committee (MCAC))
MedPAC Medicare Payment Advisory Commission
MEI Medicare Economic Index
MIEA-TRHCA Medicare Improvements and Extension Act of 2006 (That is, 
Division B of the Tax Relief and Health Care Act of 2006 (TRHCA))

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MMA Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 (Pub. L. 108-173)
MNT Medical nutrition therapy
MP Malpractice
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
MSA Metropolitan statistical area
MSP Medicare Secondary Payer
MSVP Multi-specialty visit package
NBCOT National Board for Certification in Occupational Therapy, Inc.
NCCN National Comprehensive Cancer Network
NCPDP National Council for Prescription Drug Programs
NCQDIS National Coalition of Quality Diagnostic Imaging Services
NDC National drug code
NEMC New England Medical Center
NISTA National Institute of Standards and Technology Act
NLA National limitation amount
NP Nurse practitioner
NPP Nonphysician practitioners
NQF National Quality Forum
NTTAA National Technology Transfer and Advancement Act of 1995 (Pub. 
L. 104-113)
OACT [CMS'] Office of the Actuary
OBRA Omnibus Budget Reconciliation Act
OIG Office of Inspector General
OMB Office of Management and Budget
OPD Outpatient Department
OPPS Outpatient prospective payment system
OPT Outpatient physical therapy
OSCAR Online Survey and Certification and Reporting
PA Physician assistant
PC Professional component
PCF Patient compensation fund
PDP Prescription Drug Plan
PE Practice Expense
PE/HR Practice expense per hour
PEAC Practice Expense Advisory Committee
PECOS Provider Enrollment, Chain, and Ownership System
PERC Practice Expense Review Committee
PET Positron emission tomography
PFS Physician Fee Schedule
PLI Professional liability insurance
PPI Producer price index
PPS Prospective payment system
PQRI Physician Quality Reporting Initiative
PRA Paperwork Reduction Act
PSA Physician scarcity areas
PT Physical therapy
PT/INR Prothrombin time, international normalized ratio
RFA Regulatory Flexibility Act
RHC Rural health clinic
RIA Regulatory impact analysis
RN Registered nurse
RT Respiratory therapist
RUC [AMA's Specialty Society] Relative (Value) Update Committee
RVU Relative value unit
SBA Small Business Administration
SGR Sustainable growth rate
SLP Speech-language pathology
SMS [AMA's] Socioeconomic Monitoring System
SNF Skilled nursing facility
STS Society of Thoracic Surgeons
TA Technology Assessment
TC Technical Component
TENS Transcutaneous electric nerve stimulator
TRHCA Tax Relief and Health Care Act of 2006 (Pub. L. 109-432)
USP-DI United States Pharmacopoeia-Drug Information
WAC Wholesale acquisition cost
WAMP Widely available market price
Wet AMD Exudative age-related macular degeneration
WFOT World Federation of Occupational Therapists

I. Background

    [If you choose to comment on issues in this section, please include 
the caption ``BACKGROUND'' at the beginning of your comments.]
    Since January 1, 1992, Medicare has paid for physicians' services 
under section 1848 of the Social Security Act (the Act), ``Payment for 
Physicians' Services.'' The Act requires that payments under the 
physician fee schedule (PFS) be based on national uniform relative 
value units (RVUs) based on the resources used in furnishing a service. 
Section 1848(c) of the Act requires that national RVUs be established 
for physician work, practice expense (PE), and malpractice expense. 
Before the establishment of the resource-based relative value system, 
Medicare payment for physicians' services was based on reasonable 
charges.

A. Development of the Relative Value System

1. Work RVUs
    The concepts and methodology underlying the PFS were enacted as 
part of the Omnibus Budget Reconciliation Act (OBRA) of 1989, Pub. L. 
101-239, and OBRA 1990, (Pub. L. 101-508). The final rule, published 
November 25, 1991 (56 FR 59502), set forth the fee schedule for payment 
for physicians' services beginning January 1, 1992. Initially, only the 
physician work RVUs were resource-based, and the PE and malpractice 
RVUs were based on average allowable charges.
    The physician work RVUs established for the implementation of the 
fee schedule in January 1992 were developed with extensive input from 
the physician community. A research team at the Harvard School of 
Public Health developed the original physician work RVUs for most codes 
in a cooperative agreement with the Department of Health and Human 
Services (HHS). In constructing the code-specific vignettes for the 
original physician work RVUs, Harvard worked with panels of experts, 
both inside and outside the Federal government, and obtained input from 
numerous physician specialty groups.
    Section 1848(b)(2)(B) of the Act specifies that the RVUs for 
anesthesia services are based on RVUs from a uniform relative value 
guide. We established a separate conversion factor (CF) for anesthesia 
services, and we continue to utilize time units as a factor in 
determining payment for these services. As a result, there is a 
separate payment methodology for anesthesia services.
    We establish physician work RVUs for new and revised codes based on 
recommendations received from the American Medical Association's (AMA) 
Specialty Society Relative Value Update Committee (RUC).
2. Practice Expense Relative Value Units (PE RVUs)
    Section 121 of the Social Security Act Amendments of 1994 (Pub. L. 
103-432), enacted on October 31, 1994, amended section 
1848(c)(2)(C)(ii) of the Act and required us to develop resource-based 
PE RVUs for each physician's service beginning in 1998. We were to 
consider general categories of expenses (such as office rent and wages 
of personnel, but excluding malpractice expenses) comprising PEs.
    Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L. 
105-33), amended section 1848(c)(2)(C)(ii) of the Act to delay 
implementation of the resource-based PE RVU system until January 1, 
1999. In addition, section 4505(b) of the BBA provided for a 4-year 
transition period from charge-based PE RVUs to resource-based RVUs.
    We established the resource-based PE RVUs for each physician's 
service in a final rule, published November 2, 1998 (63 FR 58814), 
effective for services furnished in 1999. Based on the requirement to 
transition to a resource-based system for PE over a 4-year period, 
resource-based PE RVUs did not become fully effective until 2002.
    This resource-based system was based on two significant sources of 
actual PE data: The Clinical Practice Expert Panel (CPEP) data and the 
AMA's Socioeconomic Monitoring System (SMS) data. The CPEP data were 
collected from panels of physicians, practice administrators, and 
nonphysicians (for example, registered nurses (RNs)) nominated by 
physician specialty societies and other groups. The CPEP panels 
identified the direct inputs required for each physician's service in 
both the office setting and out-of-office setting. We have since 
refined and revised these inputs based on recommendations from the RUC. 
The AMA's SMS data provided aggregate

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specialty-specific information on hours worked and PEs.
    Separate PE RVUs are established for procedures that can be 
performed in both a nonfacility setting, such as a physician's office, 
and a facility setting, such as a hospital outpatient department. The 
difference between the facility and nonfacility RVUs reflects the fact 
that a facility typically receives separate payment from Medicare for 
its costs of providing the service, apart from payment under the PFS. 
The nonfacility RVUs reflect all of the direct and indirect PEs of 
providing a particular service.
    Section 212 of the Balanced Budget Refinement Act of 1999 (BBRA) 
(Pub. L. 106-113) directed the Secretary of Health and Human Services 
(the Secretary) to establish a process under which we accept and use, 
to the maximum extent practicable and consistent with sound data 
practices, data collected or developed by entities and organizations to 
supplement the data we normally collect in determining the PE 
component. On May 3, 2000, we published the interim final rule (65 FR 
25664) that set forth the criteria for the submission of these 
supplemental PE survey data. The criteria were modified in response to 
comments received, and published in the Federal Register (65 FR 65376) 
as part of a November 1, 2000 final rule. The PFS final rules published 
in 2001 and 2003, respectively, (66 FR 55246 and 68 FR 63196) extended 
the period during which we would accept these supplemental data through 
March 1, 2005.
    In CY 2007 PFS final rule with comment period (71 FR 69624), we 
revised the methodology for calculating PE RVUs beginning in CY 2007 
and provided for a 4-year transition for the new PE RVUs under this new 
methodology. We will continue to evaluate this policy and proposed 
necessary revisions through future rulemaking.
3. Resource-Based Malpractice (MP) RVUs
    Section 4505(f) of the BBA amended section 1848(c) of the Act to 
require us to implement resource-based malpractice (MP) RVUs for 
services furnished on or after 2000. The resource-based MP RVUs were 
implemented in the PFS final rule published November 2, 1999 (64 FR 
59380). The MP RVUs were based on malpractice insurance premium data 
collected from commercial and physician-owned insurers from all the 
States, the District of Columbia, and Puerto Rico.
4. Refinements to the RVUs
    Section 1848(c)(2)(B)(i) of the Act requires that we review all 
RVUs no less often than every 5 years. The first 5-Year Review of the 
physician work RVUs was effective in 1997, published on November 22, 
1996 (61 FR 59489). The second 5-Year Review went into effect in 2002, 
published in the CY 2002 PFS final rule (66 FR 55246). The third 5-Year 
Review of physician work RVUs went into effect on January 1, 2007 and 
was published in the CY 2007 PFS final rule with comment period (71 FR 
69624) (although we note that this proposed rule contains certain 
additional proposals relating to the third 5-Year Review).
    In 1999, the AMA's RUC established the Practice Expense Advisory 
Committee (PEAC) for the purpose of refining the direct PE inputs. 
Through March 2004, the PEAC provided recommendations to CMS for over 
7,600 codes (all but a few hundred of the codes currently listed in the 
AMA's Current Procedural Terminology (CPT) codes). As part of the CY 
2007 PFS final rule with comment period (71 FR 69624), we implemented a 
new methodology for determining resource-based PE RVUs and are 
transitioning this over a 4-year period.
    In the CY 2005 PFS final rule with comment period (69 FR 66236), we 
implemented the first 5-Year Review of the malpractice RVUs (69 FR 
66263).
5. Adjustments to RVUs Are Budget Neutral
    Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments 
in RVUs for a year may not cause total PFS payments to differ by more 
than $20 million from what they would have been if the adjustments were 
not made. In accordance with section 1848(c)(2)(B)(ii)(II) of the Act, 
if adjustments to RVUs cause expenditures to change by more than $20 
million, we make adjustments to ensure that expenditures do not 
increase or decrease by more than $20 million.
    As explained in the CY 2007 PFS final rule with comment period (71 
FR 69624), due to the increase in work RVUs resulting from the third 5-
Year Review of physician work RVUs, we are applying a separate budget 
neutrality (BN) adjustor to the work RVUs for services furnished during 
2007. This approach is consistent with the method we use to make BN 
adjustments to the PE RVUs to reflect the changes in these PE RVUs.

B. Components of the Fee Schedule Payment Amounts

    To calculate the payment for every physician service, the 
components of the fee schedule (physician work, PE, and MP RVUs) are 
adjusted by a geographic practice cost index (GPCI). The GPCIs reflect 
the relative costs of physician work, PE, and malpractice insurance in 
an area compared to the national average costs for each component.
    Payments are converted to dollar amounts through the application of 
a CF, which is calculated by the Office of the Actuary (OACT) and is 
updated annually for inflation.
    The formula for calculating the Medicare fee schedule amount for a 
given service and fee schedule area can be expressed as:
    Payment = [(RVU work x budget neutrality adjuster x work GPCI) + 
(RVU PE x PE GPCI) + (MP RVU x MP GPCI)] x CF.

C. Most Recent Changes to the Fee Schedule

    The CY 2007 PFS final rule with comment period (71 FR 69624) 
addressed certain provisions of the Deficit Reduction Act of 2005 (Pub. 
L. 109-432) (DRA) and made other changes to Medicare Part B payment 
policy to ensure that our payment systems are updated to reflect 
changes in medical practice and the relative value of services. This 
final rule with comment period also discussed GPCI changes; requests 
for additions to the list of telehealth services; payment for covered 
outpatient drugs and biologicals; payment for renal dialysis services; 
policies related to private contracts and opt-out; policies related to 
bone mass measurement (BMM) services, independent diagnostic testing 
facilities (IDTFs), the physician self-referral prohibition; laboratory 
billing for the technical component (TC) of physician pathology 
services; the clinical laboratory fee schedule; certification of 
advanced practice nurses; health information technology, the health 
care information transparency initiative; updated the list of certain 
services subject to the physician self-referral prohibitions, finalized 
ASP reporting requirements, and codified Medicare's longstanding policy 
that payment of bad debts associated with services paid under a fee 
schedule/charge-based system is not allowable.
    We also finalized the CY 2006 interim RVUs and issued interim RVUs 
for new and revised procedure codes for CY 2007.

[[Page 38127]]

    In addition, the CY 2007 PFS final rule with comment period 
included revisions to payment policies under the fee schedule for 
ambulance services and announced the ambulance inflation factor (AIF) 
update for CY 2007.
    In accordance with section 1848(d)(1)(E)(i) of the Act, we also 
announced that the PFS update for CY 2007 is -5.0 percent, the initial 
estimate for the sustainable growth rate (SGR) for CY 2007 is 1.8 
percent and the CF for CY 2007 is $35.9848. However, subsequent to 
publication of the CY 2007 PFS final rule with comment period, section 
101(a) of Division B, Title I of the Tax Relief and Health Care Act of 
2006 (Pub. L. 109-432) (MIEA-TRHCA), which was enacted on December 22, 
2006, amended section 1848(d) of the Act. [Division B of the Tax Relief 
and Health Care Act of 2006 is entitled Medicare and Other Health 
Provisions and its short title is the Medicare Improvements and 
Extension Act of 2006. Therefore, it is hereinafter referred to as 
``MIEA-TRHCA''.] As a result of this statutory change the CF of 
$37.8975 was maintained for CY 2007.

II. Provisions of the Proposed Regulation Related to the Physician Fee 
Schedule

A. Resource-Based Practice Expense (PE) Relative Value Units (RVUs)

    [If you choose to comment on issues in this section, please include 
the caption ``RESOURCE-BASED PE RVUs'' at the beginning of your 
comments.]
    Practice expense (PE) is the portion of the resources used in 
furnishing the service that reflects the general categories of 
physician and practitioner expenses, such as office rent and personnel 
wages but excluding malpractice expenses, as specified in section 
1848(c)(1)(B) of the Act.
    Section 121 of the Social Security Amendments of 1994 (Pub. L. 103-
432), enacted on October 31, 1994, required CMS to develop a 
methodology for a resource-based system for determining PE RVUs for 
each physician's service. Until that time, PE RVUs were based on 
historical allowed charges. This legislation stated that the revised PE 
methodology must consider the staff, equipment, and supplies used in 
the provision of various medical and surgical services in various 
settings beginning in 1998. The Secretary has interpreted this to mean 
that Medicare payments for each service would be based on the relative 
PE resources typically involved with furnishing the service.
    The initial implementation of resource-based PE RVUs was delayed 
from January 1, 1998, until January 1, 1999, by section 4505(a) of the 
BBA. In addition, section 4505(b) of the BBA required that the new 
payment methodology be phased in over 4 years, effective for services 
furnished in CY 1999, and fully effective in CY 2002. The first step 
toward implementation of the statute was to adjust the PE values for 
certain services for CY 1998. Section 4505(d) of the BBA required that, 
in developing the resource-based PE RVUs, the Secretary must:
     Use, to the maximum extent possible, generally-accepted 
cost accounting principles that recognize all staff, equipment, 
supplies, and expenses, not solely those that can be linked to specific 
procedures and actual data on equipment utilization.
     Develop a refinement method to be used during the 
transition.
     Consider, in the course of notice and comment rulemaking, 
impact projections that compare new proposed payment amounts to data on 
actual physician PE.
    In CY 1999, we began the 4-year transition to resource-based PE 
RVUs utilizing a ``top-down'' methodology whereby we allocated 
aggregate specialty-specific practice costs to individual procedures. 
The specialty-specific PEs were derived from the American Medical 
Association's (AMA's) Socioeconomic Monitoring Survey (SMS). In 
addition, under section 212 of the BBRA, we established a process 
extending through March 2005 to supplement the SMS data with data 
submitted by a specialty. The aggregate PEs for a given specialty were 
then allocated to the services furnished by that specialty on the basis 
of the direct input data (that is, the staff time, equipment, and 
supplies) and work RVUs assigned to each CPT code.
    For CY 2007, we implemented a new methodology for calculating PE 
RVUs. Under this new methodology, we use the same data sources for 
calculating PE, but instead of using the ``top-down'' approach to 
calculate the direct PE RVUs, under which the aggregate direct and 
indirect costs for each specialty are allocated to each individual 
service, we now utilize a ``bottom-up'' approach to calculate the 
direct costs. Under the ``bottom up'' approach, we determine the direct 
PE by adding the costs of the resources (that is, the clinical staff, 
equipment, and supplies) typically required to provide each service. 
The costs of the resources are calculated using the refined direct PE 
inputs assigned to each CPT code in our PE database, which are based on 
our review of recommendations received from the AMA's Relative Value 
Update Committee (RUC). For a more detailed explanation of the PE 
methodology see the June 29, 2006 proposed notice (71 FR 37242) and the 
CY 2007 PFS final rule with comment period (71 FR 69629).
1. Current Methodology
a. Data Sources for Calculating Practice Expense
    The AMA's SMS survey data and supplemental survey data from the 
specialties of cardio-thoracic surgery, vascular surgery, physical and 
occupational therapy, independent laboratories, allergy/immunology, 
cardiology, dermatology, gastroenterology, radiology, independent 
diagnostic testing facilities (IDTFs), radiation oncology, and urology 
are used to develop the PE per hour (PE/HR) for each specialty. For 
those specialties for which we do not have PE/HR, the appropriate PE/HR 
is obtained from a crosswalk to a similar specialty.
    The AMA developed the SMS survey in 1981 and discontinued it in 
1999. Beginning in 2002, we incorporated the 1999 SMS survey data into 
our calculation of the PE RVUs, using a 5-year average of SMS survey 
data. (See the November 1, 2002 Revisions to Payment Policies and Five-
Year Review of and Adjustments to the Relative Value Units Under the 
Physician Fee Schedule for CY 2002 final rule (66 FR 55246) 
(hereinafter referred to as CY 2002 PFS final rule).) The SMS PE survey 
data are adjusted to a common year, 2005. The SMS data provide the 
following six categories of PE costs:
     Clinical payroll expenses, which are payroll expenses 
(including fringe benefits) for nonphysician clinical personnel.
     Administrative payroll expenses, which are payroll 
expenses (including fringe benefits) for nonphysician personnel 
involved in administrative, secretarial or clerical activities.
     Office expenses, which include expenses for rent, mortgage 
interest, depreciation on medical buildings, utilities and telephones.
     Medical material and supply expenses, which include 
expenses for drugs, x-ray films, and disposable medical products.
     Medical equipment expenses, which include expenses 
depreciation, leases, and rent of medical equipment used in the 
diagnosis or treatment of patients.
     All other expenses, which include expenses for legal 
services, accounting, office management, professional association 
memberships, and any

[[Page 38128]]

professional expenses not previously mentioned in this section.
    In accordance with section 212 of the BBRA, we established a 
process to supplement the SMS data for a specialty with data collected 
by entities and organizations other than the AMA (that is, the 
specialty itself). (See the Criteria for Submitting Supplemental 
Practice Expense Survey Data interim final rule with comment period (65 
FR 25664, May 3, 2000).) Originally, the deadline to submit 
supplementary survey data was through August 1, 2001. In the CY 2002 
PFS final rule (66 FR 55246), the deadline was extended through August 
1, 2003. To ensure maximum opportunity for specialties to submit 
supplementary survey data, we extended the deadline to submit surveys 
until March 1, 2005 in the Revisions to Payment Policies Under the 
Physician Fee Schedule for CY 2004 final rule (November 7, 2003; 68 FR 
63196) (hereinafter referred to as CY 2004 PFS final rule).
    The direct cost data for individual services were originally 
developed by the Clinical Practice Expert Panels (CPEP). The CPEP data 
include the supplies, equipment, and staff times specific to each 
procedure. The CPEPs consisted of panels of physicians, practice 
administrators, and nonphysicians (for example, RNs) who were nominated 
by physician specialty societies and other groups. There were 15 CPEPs 
consisting of 180 members from more than 61 specialties and 
subspecialties. Approximately 50 percent of the panelists were 
physicians.
    The CPEPs identified specific inputs involved in each physician's 
service provided in an office or facility setting. The inputs 
identified were the quantity and type of nonphysician labor, medical 
supplies, and medical equipment.
    In 1999, the AMA's RUC established the Practice Expense Advisory 
Committee (PEAC). From 1999 to March 2004, the PEAC, a multi-specialty 
committee, reviewed the original CPEP inputs and provided us with 
recommendations for refining these direct PE inputs for existing CPT 
codes. Through its last meeting in March 2004, the PEAC provided 
recommendations for over 7,600 codes which we have reviewed and 
accepted. As a result, the current PE inputs differ markedly from those 
originally recommended by the CPEPs. The PEAC has now been replaced by 
the Practice Expense Review Committee (PERC), which acts to assist the 
RUC in recommending PE inputs.
b. Allocation of PE to Services
    The aggregate level specialty-specific PEs are derived from the 
AMA's SMS survey and supplementary survey data. To establish PE RVUs 
for specific services, it is necessary to establish the direct and 
indirect PE associated with each service.
    (i) Direct costs. The direct costs are determined by adding the 
costs of the resources (that is, the clinical staff, equipment, and 
supplies) typically required to provide the service. The costs of these 
resources are calculated from the refined direct PE inputs in our PE 
database. These direct inputs are then scaled to the current aggregate 
pool of direct PE RVUs. The aggregate pool of direct PE RVUs can be 
derived using the following formula: (PE RVUs * physician CF) * 
(average direct percentage from SMS/(Supplemental PE/HR data)).
    (ii) Indirect costs. The SMS and supplementary survey data are the 
source for the specialty-specific aggregate indirect costs used in our 
PE calculations. We then allocate the indirect costs to the code level 
on the basis of the direct costs specifically associated with a code 
and the maximum of either the clinical labor costs or the physician 
work RVUs. For calculation of the 2008 PE RVUs, we are proposing to use 
the 2006 procedure-specific utilization data crosswalked to 2007 
services. To arrive at the indirect PE costs:
     We apply a specialty-specific indirect percentage factor 
to the direct expenses to recognize the varying proportion that 
indirect costs represent of total costs by specialty. For a given 
service, the specific indirect percentage factor to apply to the direct 
costs for the purpose of the indirect allocation is calculated as the 
weighted average of the ratio of the indirect to direct costs (based on 
the survey data) for the specialties that furnish the service. For 
example, if a service is furnished by a single specialty with indirect 
PEs that were 75 percent of total PEs, the indirect percentage factor 
to apply to the direct costs for the purposes of the indirect 
allocation would be (0.75/0.25) = 3.0. The indirect percentage factor 
is then applied to the service level adjusted indirect practice expense 
allocators.
     We use the specialty-specific PE/HR from the SMS survey 
data, as well as the supplemental surveys for cardio-thoracic surgery, 
vascular surgery, physical and occupational therapy, independent 
laboratories, allergy/immunology, cardiology, dermatology, radiology, 
gastroenterology, IDTFs, radiation oncology and urology.
    Note: For radiation oncology, the data represent the combined 
survey data from the American Society for Therapeutic Radiology and 
Oncology (ASTRO) and the Association of Freestanding Radiation Oncology 
Centers (AFROC).) We incorporate this PE/HR into the calculation of 
indirect costs using an index which reflects the relationship between 
each specialty's indirect scaling factor and the overall indirect 
scaling factor for the entire PFS. For example, if a specialty had an 
indirect practice cost index of 2.00, this specialty would have an 
indirect scaling factor that was twice the overall average indirect 
scaling factor. If a specialty had an indirect practice cost index of 
0.50, this specialty would have an indirect scaling factor that was 
half the overall average indirect scaling factor.
     When the clinical labor portion of the direct PE RVU is 
greater than the physician work RVU for a particular service, the 
indirect costs are allocated based upon the direct costs and the 
clinical labor costs. For example, if a service has no physician work 
and 1.10 direct PE RVUs, and the clinical labor portion of the direct 
PE RVUs is 0.65 RVUs, we would use the 1.10 direct PE RVUs and the 0.65 
clinical labor portions of the direct PE RVUs to allocate the indirect 
PE for that service.
c. Facility/Nonfacility Costs
    Procedures that can be furnished in a physician's office, as well 
as in a hospital or facility setting, have two PE RVUs: Facility and 
nonfacility. The nonfacility setting includes physicians' offices, 
patients' homes, freestanding imaging centers, and independent 
pathology labs. Facility settings include hospitals, ambulatory 
surgical centers (ASCs), and skilled nursing facilities (SNFs). The 
methodology for calculating PE RVUs is the same for both, facility and 
nonfacility RVUs, but is applied independently to yield two separate PE 
RVUs. Because the PEs for services provided in a facility setting are 
generally included in the payment to the facility (rather than the 
payment to the physician under the PFS), the PE RVUs are generally 
lower for services provided in the facility setting.
d. Services With Technical Components (TCs) and Professional Components 
(PCs)
    Diagnostic services are generally comprised of two components; a 
professional component (PC) and a technical component (TC), which may 
be performed independently or by different providers. When services 
have TC, PC, and global components that can be billed separately, the 
payment for the

[[Page 38129]]

global component equals the sum of the payment for the TC and PCs. This 
is a result of using a weighted average of the ratio of indirect to 
direct costs across all the specialties that furnish the global 
components, TCs, and PCs; that is, we apply the same weighted average 
indirect percentage factor to allocate indirect expenses to the global 
components, PC, and TCs for a service. (The direct PE RVUs for the TC 
and PCs sum to the global under the bottom-up methodology.)
e. Transition Period
    As discussed in the CY 2007 PFS final rule with comment period (71 
FR 69674), we are implementing the change in the methodology for 
calculating PE RVUs over a 4-year period. During this transition 
period, the PE RVUs will be calculated on the basis of a blend of RVUs 
calculated using our methodology described previously in this section 
(weighted by 25 percent during CY 2007, 50 percent during CY 2008, 75 
percent during CY 2009, and 100 percent thereinafter), and the CY 2006 
PE RVUs for each existing code. PE RVUs for codes that are new during 
this period will be calculated using only the current PE methodology, 
and will be paid at the fully transitioned rate.
f. PE RVU Methodology
    The following is a description of the PE RVU methodology.
(i) Setup File
    First, we create a setup file for the PE methodology. The setup 
file contains the direct cost inputs, the utilization for each 
procedure code at the specialty and facility/nonfacility place of 
service level, and the specialty-specific survey PE per physician hour 
data.
(ii) Calculate the Direct Cost PE RVUs
    Sum the costs of each direct input.
    Step 1: Sum the direct costs of the inputs for each service. The 
direct costs consist of the costs of the direct inputs for clinical 
labor, medical supplies, and medical equipment. The clinical labor cost 
is the sum of the cost of all the staff types associated with the 
service; it is the product of the time for each staff type and the wage 
rate for that staff type. The medical supplies cost is the sum of the 
supplies associated with the service; it is the product of the quantity 
of each supply and the cost of the supply. The medical equipment cost 
is the sum of the cost of the equipment associated with the service; it 
is the product of the number of minutes each piece of equipment is used 
in the service and the equipment cost per minute. The equipment cost 
per minute is calculated as described at the end of this section.
    Apply a BN adjustment to the direct inputs.
    Step 2: Calculate the current aggregate pool of direct PE costs. To 
do this, multiply the current aggregate pool of total direct and 
indirect PE costs (that is, the current aggregate PE RVUs multiplied by 
the CF) by the average direct PE percentage from the SMS and 
supplementary specialty survey data.
    Step 3: Calculate the aggregate pool of direct costs. To do this, 
for all PFS services, sum the product of the direct costs for each 
service from Step 1 and the utilization data for that service.
    Step 4: Using the results of Step 2 and Step 3 calculate a direct 
PE BN adjustment so that the proposed aggregate direct cost pool does 
not exceed the current aggregate direct cost pool and apply it to the 
direct costs from Step 1 for each service.
    Step 5: Convert the results of Step 4 to an RVU scale for each 
service. To do this, divide the results of Step 4 by the Medicare PFS 
CF.
(iii) Create the Indirect PE RVUs
    Create indirect allocators.
    Step 6: Based on the SMS and supplementary specialty survey data, 
calculate direct and indirect PE percentages for each physician 
specialty.
    Step 7: Calculate direct and indirect PE percentages at the service 
level by taking a weighted average of the results of Step 6 for the 
specialties that furnish the service. Note that for services with a TC 
and PCs we are calculating the direct and indirect percentages across 
the global components, PCs and TCs. That is, the direct and indirect 
percentages for a given service (for example, echocardiogram) do not 
vary by the PC, TC and global component.
    Step 8: Calculate the service level allocators for the indirect PEs 
based on the percentages calculated in Step 7. The indirect PEs are 
allocated based on the three components: The direct PE RVU, the 
clinical PE RVU and the work RVU.
    For most services the indirect allocator is:
    indirect percentage * (direct PE RVU/direct percentage) + work RVU.
    There are two situations where this formula is modified:
     If the service is a global service (that is, a service 
with global, professional and technical components), then the indirect 
allocator is: indirect percentage * (direct PERVU/direct percentage) + 
clinical PE RVU + work RVU.
     If the clinical labor PE RVU exceeds the work RVU (and the 
service is not a global service), then the indirect allocator is: 
indirect percentage * (direct PERVU/direct percentage) + clinical PE 
RVU.
    (Note that for global services the indirect allocator is based on 
both the work RVU and the clinical labor PE RVU. We do this to 
recognize that, for the professional service, indirect PEs will be 
allocated using the work RVUs, and for the TC service, indirect PEs 
will be allocated using the direct PE RVU and the clinical labor PE 
RVU. This also allows the global component RVUs to equal the sum of the 
PC and TC RVUs.)
    For presentation purposes in the examples in the Table 1, the 
formulas were divided into two parts for each service. The first part 
does not vary by service and is the indirect percentage * (direct PE 
RVU/direct percentage). The second part is either the work RVU, 
clinical PE RVU, or both depending on whether the service is a global 
service and whether the clinical PE RVU exceeds the work RVU (as 
described earlier in this step.)
    Apply a BN adjustment to the indirect allocators.
    Step 9: Calculate the current aggregate pool of indirect PE RVUs by 
multiplying the current aggregate pool of PE RVUs by the average 
indirect PE percentage from the physician specialty survey data. This 
is similar to the Step 2 calculation for the direct PE RVUs.
    Step 10: Calculate an aggregate pool of proposed indirect PE RVUs 
for all PFS services by adding the product of the indirect PE 
allocators for a service from Step 8 and the utilization data for that 
service. This is similar to the Step 3 calculation for the direct PE 
RVUs.
    Step 11: Using the results of Step 9 and Step 10, calculate an 
indirect PE adjustment so that the aggregate indirect allocation does 
not exceed the available aggregate indirect PE RVUs and apply it to 
indirect allocators calculated in Step 8. This is similar to the Step 4 
calculation for the direct PE RVUs.
    Calculate the Indirect Practice Cost Index.
    Step 12: Using the results of Step 11, calculate aggregate pools of 
specialty-specific adjusted indirect PE allocators for all PFS services 
for a specialty by adding the product of the adjusted indirect PE 
allocator for each service and the utilization data for that service.
    Step 13: Using the specialty-specific indirect PE/HR data, 
calculate specialty-specific aggregate pools of indirect PE for all PFS 
services for that specialty by adding the product of the indirect PE/HR 
for the specialty, the physician time for the service, and the 
specialty's utilization for the service.

[[Page 38130]]

    Step 14: Using the results of Step 12 and Step 13, calculate the 
specialty-specific indirect PE scaling factors as under the current 
methodology.
    Step 15: Using the results of Step 14, calculate an indirect 
practice cost index at the specialty level by dividing each specialty-
specific indirect scaling factor by the average indirect scaling factor 
for the entire PFS.
    Step 16: Calculate the indirect practice cost index at the service 
level to ensure the capture of all indirect costs. Calculate a weighted 
average of the practice cost index values for the specialties that 
furnish the service.

    Note: For services with TC and PCs, we calculate the indirect 
practice cost index across the global components, PCs and TCs. Under 
this method, the indirect practice cost index for a given service 
(for example, echocardiogram) does not vary by the PC, TC and global 
components.

    Step 17: Apply the service level indirect practice cost index 
calculated in Step 16 to the service level adjusted indirect allocators 
calculated in Step 11 to get the indirect PE RVU.
(iv) Calculate the Final PE RVUs
    Step 18: Add the direct PE RVUs from Step 6 to the indirect PE RVUs 
from Step 17.
    Step 19: Calculate and apply the final PE BN adjustment by 
comparing the results of Step 18 to the current pool of PE RVUs. This 
final BN adjustment is required primarily because certain specialties 
are excluded from the PE RVU calculation for rate-setting purposes, but 
all specialties are included for purposes of calculating the final BN 
adjustment. (See ``Specialties excluded from rate-setting calculation'' 
below in this section.)
(v) Setup File Information
     Specialties excluded from rate-setting calculation: For 
the purposes of calculating the PE RVUs, we exclude certain specialties 
such as midlevel practitioners paid at a percentage of the PFS, 
audiology, and low volume specialties from the calculation. These 
specialties are included for the purposes of calculating the BN 
adjustment.
     Crosswalk certain low volume physician specialties: 
Crosswalk the utilization of certain specialties with relatively low 
PFS utilization to the associated specialties.
     Physical therapy utilization: Crosswalk the utilization 
associated with all physical therapy services to the specialty of 
physical therapy.
     Identify professional and technical services not 
identified under the usual TC and 26 modifier: Flag the services that 
are PC and TC services, but do not use TC and 26 modifiers (for 
example, electrocardiograms). This flag associates the PC and TC with 
the associated global code for use in creating the indirect PE RVU. For 
example, the professional service code 93010 is associated with the 
global code 93000.
     Payment modifiers: Payment modifiers are accounted for in 
the creation of the file. For example, services billed with the 
assistant at surgery modifier are paid 16 percent of the PFS amount for 
that service; therefore, the utilization file is modified to only 
account for 16 percent of any service that contains the assistant at 
surgery modifier.
     Work RVUs: The setup file contains the work RVUs from this 
proposed rule.
(vi) Equipment Cost Per Minute =
    The equipment cost per minute is calculated as:

(1/(minutes per year * usage)) * price * ((interest rate/(1-(1/((1 + 
interest rate) * life of equipment)))) + maintenance)

Where:

minutes per year = maximum minutes per year if usage were continuous 
(that is, usage = 1); 150,000 minutes.
usage = equipment utilization assumption; 0.5.
price = price of the particular piece of equipment.
interest rate = 0.11.
life of equipment = useful life of the particular piece of 
equipment.
maintenance = factor for maintenance; 0.05.

[[Page 38131]]



                                                         Table 1.--Calculation of PE RVUs Under Proposed Methodology for Selected Codes
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                            99213         33533        71020       71020TC      7102026       93000        93005        93010
                                                                                      ----------------------------------------------------------------------------------------------------------
                                                                                                          CABG,
                                       Step             Source            Formula       Office visit,   arterial,   Chest x-ray  Chest x-ray  Chest x-ray      ECG,         ECG,     ECG, report
                                                                                             est          single                                             complete     tracing
                                                                                         nonfacility     facility   nonfacility  nonfacility  nonfacility  nonfacility  nonfacility  nonfacility
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(1) Labor cost (Lab)..........  Step 1...........  AMA.............  ................         $ 13.44      $ 77.74       $ 5.74       $ 5.65            $       $ 6.12       $ 6.12            $
(2) Supply cost (Sup).........  Step 1...........  AMA.............  ................          $ 2.94       $ 7.60       $ 3.39       $ 3.34            $       $ 1.19       $ 1.19            $
(3) Equipment cost (Eqp)......  Step 1...........  AMA.............  ................          $ 0.19       $ 0.64       $ 8.18       $ 8.05            $       $ 0.12       $ 0.12            $
(4) Direct cost (Dir).........  Step 1...........  ................  = (1) + (2) +            $ 16.37      $ 85.34      $ 17.31      $ 17.54            $       $ 7.60       $ 7.60            $
                                                                      (3).
(5) Direct adjustment (Dir      Steps 2-4........  See footnote*...  ................           0.584        0.584        0.584        0.584        0.584        0.584        0.584        0.584
 Adj).
(6) Adjusted labor............  Steps 2-4........  = Lab*Dir Adj...  = (1) * (5).....          $ 7.85      $ 45.40       $ 3.35       $ 3.30            $       $ 3.57       $ 3.57            $
(7) Adjusted supplies.........  Steps 2-4........  = Sup*Dir Adj...  = (2) * (5).....          $ 1.72       $ 4.44       $ 1.98       $ 1.95            $       $ 0.70       $ 0.70            $
(8) Adjusted equipment........  Steps 2-4........  = Eqp*Dir Adj...  = (3) * (5).....          $ 0.11       $ 0.37       $ 4.77       $ 4.70            $       $ 0.07       $ 0.07            $
(9) Adjusted direct...........  Steps 2-4........  ................  = (6) + (7) +              $9.56      $ 49.84      $ 10.11      $ 10.24            $       $ 4.44       $ 4.44            $
                                                                      (8).
(10) Conversion Factor (CF)...  Step 5...........  MFS.............  ................        $34.1350     $34.1350     $34.1350     $34.1350     $34.1350     $34.1350     $34.1350     $34.1350
(11) Adj. labor cost converted  Step 5...........  = (Lab*Dir Adj)/  = (6)/(10)......            0.23         1.33         0.10         0.10  ...........         0.10         0.10  ...........
                                                    CF.
(12) Adj. supply cost           Step 5...........  = (Sup*Dir Adj)/  = (7)/(10)......            0.05         0.13         0.06         0.06  ...........         0.02         0.02  ...........
 converted.                                         CF.
(13) Adj. equip cost converted  Step 5...........  = (Eqp*Dir Adj)/  = (8)/(10)......            0.00         0.01         0.14         0.14  ...........         0.00         0.00  ...........
                                                    CF.
(14) Adj. direct cost           Step 5...........  ................  = (11) + (12) +             0.28         1.46         0.30         0.30  ...........         0.13         0.13  ...........
 converted.                                                           (13).
(15) Wrk RVU* Wrk Scaler......  Setup File.......  MFS.............  ................            0.81        29.66         0.19  ...........         0.19         0.15  ...........         0.15
(16) Dir--pct.................  Steps 6, 7.......  Surveys.........  ................           33.8%        32.6%        40.7%        40.7%        40.7%        37.7%        37.7%        37.7%
(17) Ind--pct.................  Steps 6, 7.......  Surveys.........  ................           66.2%        67.4%        59.4%        59.4%        59.4%        62.3%        62.3%        62.3%
(18) Ind. Alloc. formula (1st   Step 8...........  See Step 8......  ................   ((14)/(16)) *  ((14)/(16))  ((14)/(16))  ((14)/(16))  ((14)/(16))  ((14)/(16))  ((14)/(16))  ((14)/(16))
 part).                                                                                          (17)       * (17)       * (17)       * (17)       * (17)       * (17)       * (17)       * (17)
(19) Ind. Alloc. (1st part)...  Step 8...........  ................  See (18)........            0.55         3.02         0.43         0.44  ...........         0.21         0.21  ...........
(20) Ind. Alloc. formulas (2nd  Step 8...........  See Step 8......  ................            (15)         (15)  (15) + (11)         (11)         (15)  (15) + (11)         (11)         (15)
 part).
(21) Ind. Alloc. (2nd part)...  Step 8...........  ................  See (20)........            0.81        29.66         0.29         0.10         0.19         0.25         0.10         0.15
(22) Indirect Allocator (1st +  Step 8...........  ................   = (19) + (21)..            1.36        32.68         0.72         0.53         0.19         0.47         0.32         0.15
 2nd).
(23) Indirect Adjustment (Ind   Steps 9-11.......  See footnote**..  ................           0.362        0.362        0.362        0.362        0.362        0.362        0.362        0.362
 Adj).
(24) Adjusted Indirect          Steps 9-11.......  = Ind Alloc* Ind  ................            0.49        11.83         0.26         0.19         0.07         0.17         0.12         0.05
 Allocator.                                         Adj.
(25) Ind. Practice Cost Index   Steps 12-16......  See Steps 12-16.  ................           0.966        0.941        1.060        1.060        1.060        1.237        1.237        1.237
 (PCI).
(26) Adjusted Indirect........  Step 17..........  = Adj. Ind        = (24) * (25)...            0.48        11.13         0.28         0.21         0.07         0.21         0.14         0.07
                                                    Alloc*PCI.
(27) PE RVU...................  Steps 18-19......  = (Adj Dir + Adj  = ((14) + (26))             0.75        12.56         0.57         0.50         0.07         0.34         0.27        0.07
                                                    Ind) *budn.       *budn.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* The direct adj = [current pe rvus * CF * avg dir pct] / [sum direct inputs] = [Step 2] / [Step 3].
** The indirect adj = [current pe rvus * avg ind pct] / [sum of ind allocators] = [Step 9] / [Step 10.


[[Page 38132]]

g. Discussion of Equipment Usage Percentage
    We continue to receive comments regarding our use of the equipment 
usage assumption of 50 percent. MedPAC continues to support an 
unspecified higher utilization rate. Several interested parties, 
including the AMA RUC, have requested that we refine this usage 
percentage to somewhere in the range of 70 to 80 percent. Other 
interested parties contend that the current utilization rate is too 
high at 50 percent and should be refined downward to a lower usage 
percentage. If the equipment usage percentage is set too high, the 
result would be insufficient allowance at the service level for the 
practice costs associated with equipment. If the equipment usage 
percentage is set too low, the result would be an excessive allowance 
for the PE costs of equipment at the service level. We do not want to 
create disincentives for the use of equipment by arbitrarily increasing 
the equipment usage percentage. Conversely, we do not want to create 
incentives for the acquisition and potential over-utilization of 
equipment by arbitrarily decreasing the equipment usage percentage.
    Although we acknowledge the across-the-board 50 percent usage rate 
we currently apply for all equipment does not capture the actual usage 
rates for all equipment, we do not believe that we have sufficient 
empirical evidence to justify an alternative proposal on this issue. We 
are interested in receiving comments relating to alternative 
percentages and approaches that differentially classify equipment into 
mutually exclusive categories with category-specific usage rate 
assumptions. We are committed to continuing our work with the physician 
community to examine equipment usage rate assumptions that ensure 
appropriate payments and encourage appropriate utilization of 
equipment. Additionally, we would welcome any empirical data that would 
assist us in these efforts.
h. Equipment Interest Rate (Discussion)
    As part of our calculation of the PE equipment costs, we take into 
consideration several factors, for example, the useful life of each 
piece of equipment and the typical interest that would be incurred in 
the purchase of the equipment. We updated the assigned useful life for 
all the equipment in our PE input database in the CY 2005 PFS final 
rule with comment period. However, we have used the same interest rate 
of 11 percent since the inception of the resource-based PE methodology 
in 1999. There has been much discussion regarding whether this is still 
the appropriate interest rate to utilize in the calculation of the 
equipment costs. The majority of comments on the CY 2007 PFS final rule 
with comment period requested an interest rate of prime plus 2 percent 
while a small number of commenters requested an interest rate 
significantly lower than prime plus 2 percent.
    The current interest rate of 11 percent was assigned in 1997 based 
upon information provided by the Small Business Administration (SBA). 
This prevailing rate was based upon data regarding prevailing loan 
rates for small businesses from both national and regional lending 
associations. Although the SBA offered various interest rates, we 
believed that the 11 percent interest rate was most relevant for fee 
schedule services as this rate was based on equipment cost of over 
$25,000 with a useful life of over 7 years.
    We have analyzed 2007 SBA data on loans and applicable interest 
rates. According to the SBA, loans are based on the prime rate plus a 
fixed percentage based upon the amount of the loan and the usable life 
of the equipment purchased. The prime plus rates ranged from 9.4 
percent to 13 percent. Using the same criteria as was used in 1997 
(that is, equipment cost over $25,000 with a useful life of over 7 
years), the interest rates ranged from 10.1 percent to 13 percent.
    Based upon our analysis of the revised SBA interest rate data, we 
believe 11 percent continues to be an appropriate assumption; 
therefore, we will retain the interest rate used in the calculation of 
equipment costs at 11 percent and no proposal is being made to adjust 
this rate.
2. PE Proposals for CY 2008
a. Radiology Practice Expense Per Hour
    The American College of Radiology (ACR) presented CMS with 
information regarding the PE/HR that was used in the PE methodology for 
radiology in the CY 2007 PFS final rule with comment period. ACR 
suggested that we change our methodology in a way that would weight the 
survey data to provide an alternative method of representing large and 
small practices. We agreed to take their approach to our contractor, 
the Lewin Group, for further analysis. (We note that the Lewin Group, 
in its initial analysis of the ACR survey data, had also raised 
concerns about the representation of small high cost entities in the 
ACR survey data.) The Lewin Group reviewed ACR's approach and concluded 
that weighting the ACR survey by practice size more appropriately 
accounts for the small high cost entities in the final PE/HR. After 
reviewing both the ACR inquiry and the Lewin response, we also agree 
that ACR's approach more appropriately identifies the PE/HR for 
radiology.
    For these reasons, we propose to revise the PE/HR associated with 
radiology using the survey data weighted by practice size. See Table 2 
which identifies the PE/HR for all specialties, as well as both the 
current and proposed revisions to the PE/HR for radiology.

                             Table 2.--2008 SMS and Supplemental Survey PE/HR Inflated to 2005 Based Upon MEI Growth Factors
                                                     [Includes proposed revision to radiology PE/HR]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 Clinical     Clerical      Office      Supplies    Equipment      Other        Total
                          Specialty                               labor       payroll      expense      expense      expense      expense      expense
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL PHYSICIANS...............................................        15.68        19.64        24.74         9.44         4.08        14.66        88.23
ALLERGY/IMMUNOLOGY...........................................        65.88        56.33        65.88        22.49         6.26        31.08       247.93
ANESTHESIOLOGY...............................................        14.41         4.72         7.52         0.51         0.51         7.52        35.19
CARDIAC/THORACIC SURGERY.....................................        24.38        22.50        21.50         2.63         2.63        17.75        91.38
CARDIOVASCULAR DISEASE.......................................        59.55        53.33        52.67        25.90        18.58        25.02       235.05
DERMATOLOGY..................................................        40.63        51.45        78.82        15.38        11.03        28.22       225.55
DIAGNOSTIC TESTING FACILITY..................................       111.57       155.49       121.18        54.96       302.47       189.48       935.15
EMERGENCY MEDICINE...........................................         4.21        19.64         2.55         0.89         0.13        14.66        42.08
GASTROENTEROLOGY.............................................        30.16        39.56        48.41         8.20         5.90        13.33       145.55
GENERAL INTERNAL MEDICINE....................................        11.99        18.36        22.82         7.78         2.68         8.42        72.04
GENERAL SURGERY..............................................         9.18        19.89        21.42         4.34         2.55        12.62        70.00
GENERAL/FAMILY PRACTICE......................................        18.87        19.00        22.57        10.07         3.95        11.22        85.68

[[Page 38133]]

 
INDEPENDENT LAB..............................................        84.79        25.76        19.09        19.84         8.83        21.60       179.93
NEUROLOGICAL SURGERY.........................................        10.97        32.64        36.47         2.30         1.79        20.53       104.68
NEUROLOGY....................................................        10.58        29.33        24.86         6.63         5.61        11.86        88.87
OBSTETRICS/GYNECOLOGY........................................        20.91        23.97        31.49         9.31         4.08        14.28       104.04
ONCOLOGY.....................................................        68.06        44.22        43.86        21.53         9.48        53.76       240.91
OPHTHALMOLOGY................................................        32.00        32.90        43.48        13.77        10.71        26.90       159.76
ORTHOPEDIC SURGERY...........................................        21.17        36.34        37.87        13.13         4.85        24.35       137.70
OTHER SPECIALTY..............................................        11.86        16.58        24.61         6.25         2.42        11.22        72.93
OTOLARYNGOLOGY...............................................        21.93        32.13        41.95         9.56         7.14        21.93       134.64
PATHOLOGY....................................................        14.28        17.85        15.17         8.67         2.55        26.78        85.30
PEDIATRICS...................................................        15.81        16.45        24.10        13.01         2.17        10.97        82.49
PHYS MED/RHEUMATOLOGY........................................        19.00        30.22        39.14         8.29         7.91        15.56       120.11
PHYSICAL THERAPY.............................................        13.25         8.21        17.11         3.05         2.70         9.85        54.15
PLASTIC SURGERY..............................................        19.13        25.88        41.31        23.59         7.27        32.13       149.30
PSYCHIATRY...................................................         2.17         6.50        13.39         0.51         0.51         9.18        32.26
PULMONARY DISEASE............................................         8.80        15.81        20.02         3.32         2.04         8.80        58.78
RADIATION ONCOLOGY...........................................        68.82        32.38        48.83         6.38        39.33        32.85       228.59
RADIOLOGY....................................................        29.07        37.81        23.93        11.26        27.32        44.80       174.18
*RADIOLOGY...................................................       *32.62       *42.29       *28.95       *14.15       *39.62       *47.24      *204.86
UROLOGICAL SURGERY...........................................        27.90        42.33        53.79        14.43        11.25        23.45       173.14
VASCULAR SURGERY.............................................        25.79        23.04        22.56         4.06         5.78        14.50        95.73
--------------------------------------------------------------------------------------------------------------------------------------------------------
*Proposed revision to radiology PE/HR.

b. RUC Recommendations for Direct PE Inputs and Other PE Input Issues
    The following discussions are proposals concerning direct PE 
inputs.
(i) RUC Recommendations
    In 2004, the AMA's Relative Value Update Committee (RUC) 
established a new committee, the Practice Expense Review Committee 
(PERC), to assist the RUC in recommending direct PE inputs (clinical 
staff, supplies, and equipment) for new and existing CPT codes.
    The PERC reviewed the PE inputs for nearly 300 existing codes at 
its meetings held in February 2007 and April 2007. (A list of these 
reviewed codes can be found in Addendum C.)
    In the CY 2007 PFS final rule with comment period, we addressed 
several issues concerning direct PE inputs and encouraged specialty 
societies to pursue further review of these inputs through the RUC/PERC 
process. The following discussions summarize the PERC recommendations 
regarding these issues:
Cardiac Catheterization Procedures
    At the recent April RUC meeting, the PERC considered 
recommendations for the family of CPT codes 93501 through 93556 for 
cardiac catheterization. The American College of Cardiology, in 
cooperation with the Society of Cardiac Angiography and Interventions 
and the Cardiovascular Outpatient Center Alliance, developed PE inputs 
for the nonfacility setting for 13 of the 28 CPT codes in this family. 
The PERC considered the proposed new or updated PE input 
recommendations for 13 cardiac catheterization CPT codes.
     Of these 13 codes, 8 were not previously valued in the 
nonfacility setting (as recommended at the January 2002 PEAC meeting), 
including CPT codes 93539, 93540, 93542, 93543, 93544, 93545, 93555, 
and 93556.
     The recommended revised PE inputs for the other 5 codes 
(last valued in the nonfacility setting at the January 2004 PEAC 
meeting), included CPT codes: 93501, 93505, 93508, 93510, and 93526.
    We are proposing to accept the PERC recommendations for the direct 
PE inputs for the nonfacility setting for the CPT codes 93501, 93505, 
93508, 93510, 93526, 93539, 93540, 93542, 93543, 93544, 93545, 93555, 
and 93556.
    The specialty societies recommended that the remaining 15 codes in 
the cardiac catheterization family remain carrier-priced, or be 
assigned an ``NA'' for the practice expense in the office setting. It 
was noted that these codes were rarely if ever performed in the office 
setting and the specialties recommended no direct PE inputs. Assigning 
these CPT codes as ``NA'' for PE in the nonfacility setting would 
conform to PFS policy for other services without PE inputs. Therefore, 
we are proposing that the PE for the following CPT codes will not be 
valued or applicable to the nonfacility setting: 93503, 93511, 93514, 
93524, 93527, 93528, 93529, 93530, 93531, 93532, 93533, 93561, 93562, 
93571, and 93572.
Obstetric/Gynecologic PE
    The PERC recommended changes to the content and the price of the 
pack, pelvic exam (supply code SA051) valued at $0.95. We agreed with 
the recommendation to add a non-sterile sheet (drape) 40 in by 60 in 
(supply code SB006) priced at $0.222 to the pelvic exam pack resulting 
in the new price of $1.172. This change affected 236 CPT codes for 
obstetric/gynecologic services containing the pelvic exam pack. In 
addition, we accepted the PERC recommendations to standardize the 
equipment used in post-operative visits to include both a power table 
and fiberoptic light in the PE database for 70 obstetric/gynecologic 
codes.
Dual Energy X-Ray Absorptiometry (DEXA)
    The PERC considered revisions to the direct PE inputs for CPT codes 
77080, 77081, and 77082 that contained recommendations established by 5 
distinct specialty organizations. These recommended inputs were revised 
to comply with established PERC standards, such as removing some labor 
inputs for CPT code 77082 because this procedure is always performed 
with CPT code 77081 and all revisions were agreed to by the presenting 
specialty. The resulting recommended inputs more appropriately reflect 
the resources used to furnish these services and were

[[Page 38134]]

adopted by the PERC. We agree with the PERC and have made adjustments 
to the PE database.
Computer-Aided Detection (CAD) Codes
    The specialty society for radiological services reviewed the direct 
inputs for CPT codes 77051 and 77052 and recommended that no changes to 
the PE inputs were needed. The PERC concurred with this decision and we 
are in agreement.
    In addition to the above, the PERC also addressed the following 
issues:
Nuclear Medicine Services
    The specialty society representing nuclear medicine recommended 
that the direct PE inputs for 2 CPT codes contained CPEP inputs and 
needed to be updated to agree with 2004 PEAC-approved inputs. The PERC 
recommended that the PE database reflect these changes and we agreed. 
However, we discovered that there were 4 other related codes which also 
had CPEP inputs. We made the appropriate adjustments to substitute the 
PEAC inputs for the CPEP for CPT codes 78600, 78607, 78206, 78647, 
78803 and 78807. The specialty society also noted that 7 CPT codes 
required the revision of x-ray related supplies, including the number 
of x-ray films, developer solution, and film jackets. The PERC 
forwarded these recommendations and we have made the appropriate 
changes to the PE database for the following CPT codes: 78600, 78601, 
78605, 78606, 78607, 78610 and 78615.
Transcatheter Placement of Stent(s)
    At the request of the specialty societies representing radiology 
and interventional radiology, the PERC agreed to consider the direct PE 
inputs for the nonfacility setting for 3 CPT codes, 37205, 37206, and 
75960, for transcatheter placement of stent(s). These PE inputs to 
value these procedures in the nonfacility setting were approved by the 
PERC. Among the supplies, a ``vascular stent deployment system'', 
valued at $1,645, was noted by the society as the typical stent used 
for CPT codes 37205 and 37206 requiring 2 such stents for the placement 
in the initial vessel and 1 stent for each subsequent vessel, 
respectively. We reviewed a published clinical research study which was 
forwarded by the specialty society that indicated that 1 stent was 
typical for the procedure of CPT code 37205. Absent any further 
verification from the specialty, we have, therefore, included only 1 
stent in this code.
    The complete PERC recommendations and the revised PE database can 
be found on the CMS Web site at http://cms.hhs.gov/PhysicianFeeSched/PFSFRN/ (under CMS-1385-P).
(ii) Remote Cardiac Event Monitoring
    As discussed in the CY 2007 PFS final rule with comment period, 
direct PE inputs for remote cardiac event monitoring (CEM) services 
represented by CPT codes 93012, 93225, 93226, 93231, 93232, 93270, 
93271, 93733, and 93736 were revised on an interim basis to reflect the 
unique circumstances surrounding the provision of these services. 
Unlike most physicians' services, CEM services are furnished primarily 
by specialized IDTFs that, due to the nature of CEM services, must 
operate on a 24/7 basis. The specialty group which represents suppliers 
that furnish CEM services believes that these services require 
additional direct PE inputs, such as telephone line charges associated 
with trans-telephonic transmissions and fees associated with providing 
Web access for storage and transmission of clinical information to the 
patient's physician. We continue to work with the specialty group 
regarding the specific direct PE inputs, as well as the components for 
the indirect PE allocation, based on surveys conducted by the specialty 
group. To clarify and further the results of our discussions with and 
information provided by the specialty group, we are asking for comments 
on the appropriateness of the above mentioned direct PE inputs. In 
addition, we invite comments on any additional direct inputs and 
components of the indirect PE allocations which would be appropriate 
for these services, along with supporting documentation to justify 
their inclusion for PE purposes.
(iii) Prothrombin Time, International Normalized Ratio (PT/INR)
    In the CEM discussion in the CY 2007 PFS final rule with comment 
period, we included some minor PE revisions on an interim basis for PT/
INR services represented by Healthcare Common Procedure Coding System 
(HCPCS) codes, G0248, Demonstration, at initial use, of home INR 
monitoring for patient with mechanical heart valve(s) who meets 
Medicare coverage criteria, under the direction of a physician; 
includes: Demonstrating use and care of the INR monitor, obtaining at 
least one blood sample, provision of instructions for reporting home 
INR test results, and documentation of patient ability to perform 
testing and G0249, Provision of test materials and equipment for home 
INR monitoring to patient with mechanical heart valve(s) who meets 
Medicare coverage criteria; includes provision of materials for use in 
the home and reporting pwiof [prothrombin] test results to physician; 
per four tests. Based on comments received and subsequent discussions 
with entities that furnish these PT/INR services, we have adjusted the 
time in use for the home monitor equipment for G0249 to 1440 minutes to 
reflect that the monitor is dedicated for use 24 hours a day and 
unavailable for others receiving this service. We invite comments on 
this change, as well as comments on any additional direct inputs which 
would be appropriate to this service, along with supporting 
documentation to justify their inclusion for PE purposes.
(iv) Positron Emission Tomography (PET) Codes Clinical Labor Time
    We received comments from the specialty society representing 
nuclear medicine regarding a discrepancy in the clinical labor time for 
CPT codes 78811, 78812, and 78813 which are PET codes for tumor 
imaging. The specialty noted that the clinical labor time indicated in 
the PE database differs by 7 minutes from the time that was previously 
recommended by the PERC in April 2004. We agree with the specialty 
society that the PE database labor inputs for these 3 PET codes are 
incorrect and have made the appropriate adjustments to the PE database.
(v) Nuclear Medicine PE Supplies
    The specialty society representing nuclear medicine commented that 
the PE database currently contains supply items that are inappropriate 
for certain procedures and provided the information to make the 
corrections. For respiratory imaging procedures represented by CPT 
codes 78587, 78591, 78593, 78594, 78630, 78660, 78291, and 78195, the 
specialty society noted specific IV supply items to be deleted from 
procedures where they are not required. For a thyroid imaging procedure 
represented by CPT code 78020, x-ray supply items were recommended for 
deletion. In addition, the society recommended adding supply items for 
respiratory imaging procedures, including nose clips, masks, and 
nebulizer kits, as appropriate, to CPT codes 78584, 78585, 78591, 
78593, 78594, 78586, 78587, 78588, and 78596. For a kidney function 
study represented by CPT code 78725, injection supply items were noted 
as missing and the specialty society requested that these be added. We 
propose to accept these direct PE input corrections and have revised 
our PE database accordingly.

[[Page 38135]]

(vi) Arthroscopic Procedure Nonfacility Inputs
    During the CY 2007 PFS rulemaking, we noted that at the October 
2006 RUC meeting a proposal was discussed for the establishment of 
nonfacility direct PE inputs for the arthroscopic procedures 
represented by CPT codes 29805, 29830, 29840, 29870, and 29900. At this 
October 2006 RUC meeting, the orthopedic specialty society declined to 
consider the valuation of these procedures for the nonfacility setting, 
based on the belief that these procedures are not safely performed in 
the physician office. The RUC agreed at that time and no 
recommendations were issued. Subsequent to the publication of the CY 
2007 PFS final rule with comment period in which we supported the RUC 
recommendation, we again discussed this valuation with physicians who 
are currently performing these procedures in the office. Because we 
believe that the RUC process is the most appropriate to provide these 
nonfacility inputs, we again referred the physicians providing these 
services to work with the RUC-represented orthopedic specialty society; 
however, they informed us that the orthopedic specialty society had 
recently again declined to support them in bringing the direct PE 
inputs to the April 2007 RUC/PERC meeting for consideration in valuing 
these services in the nonfacility setting.
    Absent specific recommendations from the RUC and because some 
physicians are already performing these procedures in the office 
setting, we are seeking comments regarding the appropriateness of 
establishing nonfacility PE inputs for these arthroscopic procedures 
when they are provided in the office setting. We also invite comments 
as to the specific direct PE inputs, following the RUC-approved 
standardized format, that are typical in the provision of each above 
listed arthroscopic procedure furnished in the physician's office. We 
will review these comments to determine whether or not it is 
appropriate to propose on an interim basis PE inputs for these codes in 
the nonfacility setting in our final rule.
(vii) Nonfacility Inputs for CPT Code 52327
    We received comments from the society representing urologists 
requesting that we remove all of the nonfacility PE inputs for CPT code 
52327, Cystourethroscopy (including ureteral catheterization); with 
subureteric injection of implant material. The specialty society 
reasoned that the nonfacility PE value is inappropriate since the 
procedure is never performed in the physician office; it is specific to 
the pediatric population; and, as such, is always performed with 
general anesthesia. We agree with the specialty society that this 
procedure is incorrectly valued for the nonfacility setting and propose 
to accept their recommendation to remove the nonfacility direct PE 
inputs and have revised the PE database accordingly.
(viii) Maxillofacial Prosthetics
    We have been working with the society representing maxillofacial 
prosthetists since 2005 to establish nonfacility direct inputs for the 
prosthetic services represented by the CPT code series, 21076 through 
21087. The current PE database reflects the labor, supplies, and 
equipment needed to perform each procedure. However, we do not have 
pricing information and documentation for many supply items. The 
society provided information and documentation for equipment prices, 
but because specific time-in-use information was not provided, we 
developed time-in-use in 2006 for each equipment item in each 
procedure. For CY 2007, these equipment inputs were utilized under the 
new PE methodology to calculate the nonfacility PE RVUs for these 
procedures. We have asked the specialty society to provide the supply 
pricing information with appropriate documentation and also to provide 
accurate time-in-use data for each equipment item for each procedure. 
However, we have not received the requested information to date. 
Consequently, unless such information is provided, the PE database will 
continue to have no prices associated with these supplies. For each 
equipment item, we propose to cap each time-in-use to 25 minutes until 
specific information is received regarding the actual time-in-use. See 
Table 3 for the outstanding supply prices and Table 4 for the equipment 
time-in-use information that is needed.

     Table 3.--Maxillofacial Prosthesis Supplies Needing Pricing and
                        Supporting Documentation
------------------------------------------------------------------------
         Supply item             CPT codes associated with supply item
------------------------------------------------------------------------
paper, articulating..........  21076, 21079, 21081, 21082, 21083, 21084,
                                and 21085.
paste, registration..........  21076, 21079, 21080, 21081, 21082, 21083,
                                21084, and 21085.
alloy framework, laboratory    21076, 21079, 21080, 21081, 21082, 21083,
 processing.                    21084, and 21085.
paste, pressure indicator....  21076, 21079, 21080, 21081, 21082, 21083,
                                21084, and 21085.
wax, boxing..................  21076, 21077, 21079, 21081, 21082, 21083,
                                21084, 21085, 21086 and 21087.
triad tray material..........  21076, 21082, 21083 and 21084.
wire, orthodontic............  21076, 21079, 21080 and 21085.
reline material, Trusoft.....  21076, 21079, 21081, 21082, 21083 and
                                21084.
silicone.....................  21077, 21086 and 21087.
adhesive, facial.............  21077, 21080, 21086 and 21087.
wax, baseplate...............  21077, 21079, 21080, 21081, 21082, 21083,
                                21084, 21085, 21086 and 21087.
impression material, final...  21077, 21080, 21081, 21082, 21083, 21084,
                                21085, 21086 and 21087.
monoplex eye.................  21077, 21080, 21086 and 21087.
syringe, impression..........  21077, 21079, 21080, 21081, 21082, 21083,
                                21084, 21085, 21086 and 21087.
acrylic, dental..............  21077, 21079, 21080, 21081, 21082, 21082,
                                21083, 21084, 21085, 21086 and 21087.
polyurethane sheets (quantity  21077, 21080, 21086, and 21087.
 as rolls).
burs, dental.................  21079, 21080, 21081, 21082, 21083, 21084
                                and 21085.
teeth set....................  21079, 21080 and 21081.
Greenstick compound..........  21080, 21081, 21082, 21083, 21084 and
                                21085.
------------------------------------------------------------------------
* CPT codes and descriptions only are copyright 2007 American Medical
  Association. All Rights Reserved. Applicable FARS/DFARS apply.


[[Page 38136]]


                 Table 4.--Equipment Time-in-Use Information Needed for Maxillofacial Prosthesis Codes Procedures Noted Below With an X
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                            CPT code  CPT code  CPT code  CPT code  CPT code  CPT code  CPT code  CPT code  CPT code  CPT code  CPT code
              Equipment Item                  21076     21077     21079     21080     21081     21082     21083     21084     21085     21086     21087
--------------------------------------------------------------------------------------------------------------------------------------------------------
Articulator...............................        X         X         X         X         X         X         X         X         X         X         X
Chair, dental w-upholstery................        X         X         X         X         X         X         X         X         X         X         X
Compressor air............................        X         X         X         X         X         X         X         X         X         X         X
Convection oven...........................  ........        X   ........  ........  ........  ........  ........  ........  ........        X         X
Delivery unit.............................        X         X         X         X         X         X         X         X         X         X         X
Dust collecting unit......................        X         X         X         X         X         X         X         X         X         X         X
Grinding and polishing unit...............        X         X         X         X         X         X         X         X         X         X         X
Handpiece, highspeed......................        X   ........        X         X         X         X         X         X         X   ........  ........
Handpiece, laboratory.....................        X         X         X         X         X         X         X         X         X         X         X
Handpiece, slow speed.....................        X   ........        X         X         X         X         X         X         X   ........  ........
Light curing unit.........................        X         X         X         X         X         X         X         X         X         X         X
Light, dental, ceiling mount..............        X         X         X         X         X         X         X         X         X         X         X
Steamer, portable.........................        X         X         X         X         X         X         X         X         X         X         X
Triad unit................................        X         X         X         X         X         X         X         X         X         X         X
Trimmer, dental model.....................        X         X         X         X         X         X         X         X         X         X         X
Ultrasonic cleaning unit..................        X   ........        X         X         X         X         X         X         X   ........  ........
Washout and curing unit...................        X   ........        X         X         X         X         X         X         X   ........  ........
Whip mix combo unit.......................        X         X         X         X         X         X         X         X         X         X         X
Whip mixer................................        X         X         X         X         X         X         X         X         X         X         X
--------------------------------------------------------------------------------------------------------------------------------------------------------
* CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

(ix) Requests for Increases in Supply Prices
    We received a request from the specialty society for obstetrics and 
gynecology to increase the price of supply item (kit, hysteroscopic 
tubal implant for sterilization) for CPT code 58565, Hysteroscopy, 
surgical; with bilateral fallopian tube cannulation to induce occlusion 
by placement of permanent implants for this code which was created for 
CY 2005. This hysteroscopic implant kit is priced at $980 and the 
specialty is now requesting a price of $1,245, providing an invoice for 
documentation. The specialty reports that the higher price is 
attributed to a manufacturer change in design and materials and 
submitted the manufacturer's documents supporting these changes that 
were used to secure FDA approval. Therefore, we are proposing to accept 
the new price of $1,245 for the hysteroscopic implant kit due to the 
changes made in the modified model and have made this change in the PE 
database.
(x) Supply and Equipment Items Needing Specialty Input
    We have identified certain supply and equipment items for which we 
were unable to verify the pricing information (see Table 5: Supply 
Items Needing Specialty Input for Pricing and Table 6: Equipment Items 
Needing Specialty Input for Pricing). During the CY 2007 PFS 
rulemaking, we listed both supply and equipment items for which pricing 
documentation was needed from the medical specialty societies and, for 
many of these items, we received sufficient documentation containing 
specific descriptors and pricing information in the form of catalog 
listings, vendor Web pages, invoices, and manufacturer quotes. We have 
accepted the documented prices for many of these items and these prices 
are reflected in the PE RVUs in Addendum B of this proposed rule. The 
items listed in Tables 6 and 7 represent the outstanding items from CY 
2007 and new items added from the current RUC recommendations. We are 
requesting that commenters provide pricing information on items in 
these tables along with acceptable documentation, as noted in the 
footnote to each table, to support recommended prices. We are also 
requesting that specialty societies review the direct inputs in PE 
database for the procedures performed by the specialty to verify that 
all supplies and equipment contain prices. For supplies or equipment 
that have previously appeared on this list, and for which we received 
no or inadequate documentation, we are proposing to delete these items 
unless we receive adequate information to support current pricing by 
the conclusion of the comment period for this proposed rule.

                                                                   Table 5.--Supply Items Needing Specialty Input for Pricing
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  Unit     Primary associated     Associated *CPT    Prior item status   Commenter response    2008 Item status
               Code                 2006/7 Description           Unit            price         specialties            code(s)             on table         and CMS action      refer to note(s)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
SC088............................  Fistula set,          item................  .........  Dermatology.........  36522..............  Yes..............  Specialty to submit  B
                                    dialysis, 17g.                                                                                                       asap.
SD140............................  pressure bag........  item................      8.925  Cardiology..........  93501, 93508,        Yes..............  Specialty to submit  B, C
                                                                                                                 93510, 93526.                           asap.
SL119............................  Sealant spray.......  oz..................  .........  Radiation Oncology..  77333..............  Yes..............  Specialty to submit  B
                                                                                                                                                         price per ounce,
                                                                                                                                                         asap.

[[Page 38137]]

 
SD213............................  tubing, sterile, non- item................       1.99  Cardiology..........  93501, 93508,        Yes..............  Specialty to submit  B, C
                                    vented (fluid                                                                93510, 93526.                           asap.
                                    administration).
                                   Stent, vascular,      Kit.................     $1,645  Radiology,            37205, 37206.......  No...............  Specialty to submit  A
                                    deployment system.                                     Interventional                                                price, kit
                                                                                           Radiology.                                                    contents and
                                                                                                                                                         typical quantity
                                                                                                                                                         needed.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
Note: Acceptable documentation includes--Detailed description (including system components), source, and current pricing information, such as copies of catalog pages, hard copy from specific
  web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distributors. Unacceptable documentation includes--phone numbers and addresses of manufacturer, vendors or
  distributors, website links without pricing information, etc.
Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including pricing per specified unit of measure in
  database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of manufacturer, vendors or distributors are not acceptable documentation.
Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly.
Note C: Submitted price accepted.
Note D: Deleted per comment or CMS.
Note E: 2007/8 price retained on an interim basis. Forward acceptable documentation promptly.


                                  Table 6.--Equipment Items Needing Specialty Input for Pricing and Proposed Deletions
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                    Primary
                                      2006/7         2007/8       specialties       * CPT code(s)    Prior status on      Commenter     2008 Item status
             Code                  Description        Price     associated with    associated with        table       response and CMS  refer to note(s)
                                                                      item              item                               Action
--------------------------------------------------------------------------------------------------------------------------------------------------------
EQ269.........................  Ambulatory blood         3000  Cardiology.......  93784, 93786,     Yes.............  Interim price of  A, E
                                 pressure monitor.                                 93788.                              $1920 basis
                                                                                                                       maintained,
                                                                                                                       pending receipt
                                                                                                                       of
                                                                                                                       documentation.
                                Camera mount-            2300  Dermatology......  96904...........  Yes.............  Specialty to      A, E
                                 floor.                                                                                submit, asap.
                                Cross slide               500  Dermatology......  96904...........  Yes.............  Specialty to      A, E
                                 attachment.                                                                           submit, asap.
                                Dermal imaging           4500  Dermatology......  96904...........  Yes.............  Specialty to      A, E
                                 software.                                                                             submit, asap.
                                Dermoscopy                650  Dermatology......  96904...........  Yes.............  Specialty to      A, E
                                 attachments.                                                                          submit, asap.
EQ008.........................  ECG signal              8,250  Cardiology, IM...  93278...........  Yes.............  Interim price of  A, E
                                 averaging system.                                                                     $17,900 basis
                                                                                                                       maintained,
                                                                                                                       pending receipt
                                                                                                                       of
                                                                                                                       documentation.
                                Lens, macro, 35-   ..........  Dermatology......  96904...........  Yes.............  Specialty to      A, E
                                 70mm.                                                                                 submit, asap.
                                plasma pheresis        37,900  Radiology,         36481, G0341....  Yes.............  Specialty to      A, E
                                 machine w/UV                   Dermatology.                                           submit, asap.
                                 light source.
ED039.........................  Psychology         ..........  Psychology.......  96101, 96102....  No..............  Specialty to      A, E
                                 Testing                                                                               submit, asap.
                                 Equipment.
ER070.........................  Portal imaging        377,319  Radiation          77421...........  Yes.............  Specialty to      A, E
                                 system (w/PC                   oncology.                                              submit, asap.
                                 work station and
                                 software).
                                Strobe, 400watts         1500  Dermatology......  96904...........  Yes.............  Specialty to      A, E
                                 (Studio)(2).                                                                          submit, asap.
--------------------------------------------------------------------------------------------------------------------------------------------------------
* CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
Note: Acceptable documentation includes--Detailed description (including system components), source, and current pricing information, such as copies of
  catalog pages, hard copy from specific web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distributors. Unacceptable
  documentation includes--phone numbers and addresses of manufacturer, vendors or distributors, website links without pricing information, etc.
Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including
  pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of
  manufacturer, vendors or distributors are not acceptable documentation.
Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly.
Note C: Submitted price accepted.
Note D: Deleted per comment or CMS.
Note E: 2007/8 price, where specified, retained on an interim basis. Forward acceptable documentation promptly.

B. Geographic Practice Cost Indices (GPCIs)

    [If you choose to comment on issues in this section, please include 
the caption ``GEOGRAPHIC PRACTICE COST INDICES (GPCIs)'' at the 
beginning of your comments.]
    We are required by section 1848(e)(1)(A) and (C) of the Act to 
develop separate Geographic Practice Cost Indices (GPCIs) to measure

[[Page 38138]]

resource cost differences among localities; and, to review and, if 
necessary, adjust the GPCIs at least every 3 years. We have completed 
the review of GPCIs for CY 2008 and are proposing new GPCIs. These 
proposed GPCIs are published in Addendum E. We note that the physician 
work GPCIs listed in Addendum E do not reflect the 1.000 floor that was 
in place during 2006 and 2007. This floor expires as of January 1, 2008 
in accordance with section 102 of the MIEA-TRHCA.
    In developing a GPCI, section 1848(e)(1)(A)(i) and (ii) of the Act 
require that the PE and malpractice (MP) GPCIs reflect the full 
relative cost difference while section 1848(e)(1)(A)(iii) of the Act 
requires that the physician work GPCIs reflect only one-quarter of the 
relative cost differences. Section 1848(e)(1)(C) of the Act also 
specifies that if more than 1 year has elapsed since the last GPCI 
revision, we must phase in the adjustment over 2 years, applying only 
one-half of any adjustment in each year. All GPCIs are developed 
through a comparison to a national average for each component, and the 
RVUs for different services uniformly weight each component.
1. GPCI Update
    A detailed description of the methodology used to develop and 
update the GPCIs can be found in the CY 2004 PFS proposed rule (68 FR 
49039, August 15, 2003). There are three components of the GPCIs 
(physician work, PE, and MP) and each relies on its own data source.
a. Physician Work
    The physician work GPCI is developed using the median hourly 
earnings from the 2000 Census of workers in six professional specialty 
occupation categories which we use as a proxy for physician wages and 
calculate to reflect one-quarter of the relative cost differences. 
Physician wages are not included in the occupation categories because 
Medicare payments are a key determinant of physicians' earnings; 
therefore, including physician wages in the physician work GPCI would, 
in effect, make the index dependent upon Medicare payments. The 
physician work GPCI was updated in 2001, 2003, and 2005 using data from 
the 2000 Census; the proposed CY 2008 physician work GPCI is also based 
on the 2000 Census data. Because all updates since 2001 have relied on 
the 2000 Census data, the changes observed in the physician work GPCI 
in the update years are due to minor changes in utilization and budget 
neutrality factors; for 2008, Addendum E shows that there have been 
small changes in the physician work GPCI. Section 102 of the MIEA-TRHCA 
required application of a 1.000 floor on the work GPCI in payment 
localities where the work GPCI was less than 1.000. This provision 
expires on December 31, 2006. The 2008 proposed physician work GPCI 
reflects the removal of this floor.
b. Practice Expense
    The PE GPCI is developed from three data sources:
    (i) Employee Wages: We use 2000 Census median hourly earnings of 
four occupation categories. The physician work GPCI was updated in 
2001, 2003, and 2005 using data from the 2000 Census.
    (ii) Office Rents: We use residential apartment rental data 
produced annually by the Department of Housing and Urban Development 
(HUD) as a proxy for physician office rents. In 2001, 2003, and 2005, 
we used rents in the HUD 40th percentile. In 2008, we have calculated 
the GPCI using rents in the 50th percentile for the physician office 
rent proxy. We are proposing to use the 50th percentile because 
although HUD generally allows payment for subsidized housing up to the 
40th percentile, in some areas it allows payment up to the 50th 
percentile. We made this change to reflect the trend toward higher 
rents across the country.
    Fair Market Rents (FMRs) are gross rent estimates including rent 
and utilities. HUD calculates the FMRs annually using: (1) Decennial 
Census data; (2) American Housing Surveys conducted by the Census 
Bureau for HUD to enable HUD to develop revisions between Census years; 
and (3) random-digit dial surveys to enable HUD to develop gross rent 
change factors. The American Housing Surveys cover 11 areas annually, 
rotating among the 44 largest metropolitan areas. The random-digit dial 
component surveys 60 FMR areas annually.
    The FMR is set as a percentile point in the distribution of rents 
for standard housing occupied by people who moved within the previous 
15 months. The current FMR definition is the 40th percentile rent (the 
amount below which 40 percent of units are rented). Each year, the 50th 
percentile rent is also calculated by HUD and available through the 
HUDUSER Web site.
    In 2000, HUD changed its FMR policy to increase access to housing 
for families receiving Section 8 rent subsidy vouchers (65 FR 58870). 
To do so, HUD increased FMRs from the 40th percentile to the 50th 
percentile in areas where subsidized families were highly concentrated 
in certain census tracts, given evidence that affordable housing was 
not well-distributed. Only metropolitan areas with more than 100 census 
tracts are considered for possible increase to the 50th percentile 
rent. FMRs can be moved from 40th to 50th percentile or back from 50th 
to 40th percentile.
    In the case of the office rent index for the PE GPCI, FMRs have 
been used to capture geographic differences in rental costs, in the 
absence of a consistent commercial rent index that covers all 
metropolitan and nonmetropolitan areas in the U.S. It has been used as 
a measure of the ``average rent'' in a market. However, since 2000, the 
FMRs have been a mixture of the 40th percentile and 50th percentile 
rents. FMR areas move between the two cutoffs. For example, in 
California, 9 counties had FMRs set at the 50th percentile in 2004. In 
2007, only 2 of these 9 counties were still at the 50th percentile 
level for the FMR, out of 4 total counties at the 50th percentile 
level.
    As described above in this section (and as detailed in 65 FR 
58870), the criteria for setting the FMR at the 40th or 50th percentile 
are based on concentrations of subsidized households. There is no 
reason to assume that commercial rents would follow the same patterns.
    Therefore, we believe the 50th percentile, or median, rents 
calculated by HUD will be a more consistent, fair measure of geographic 
differences for the purpose of proxying for commercial rents.
    Rent data produce the most significant changes because they are 
based on annual changes in HUD rents and are therefore more volatile 
than the wage (Census) data. While commenters have suggested that we 
explore sources of commercial rental data for use in the GPCI, we do 
not believe there is a national data source better than the HUD data.
    (iii) Equipment and Supplies: We assume that items such as medical 
equipment and supplies have a national market and that input prices do 
not vary among geographic areas. As mentioned in previous updates, some 
price differences may exist, but we believe these differences are more 
likely to be based on volume discounts rather than on geographic market 
differences. Equipment and supplies are factored into the GPCIs with a 
component index of 1.000.
c. Malpractice
    The MP GPCI is calculated based on insurer rate filings of premium 
data for

[[Page 38139]]

a $1 million to $3 million mature ``claims made'' policy along with 
premium or surcharge data for mandatory patient compensation funds 
(PCFs). The MP GPCI is the most volatile of the GPCIs. This GPCI was 
updated in 2001 and 2003 as scheduled with the physician work and PE 
GPCIs; but, there was an unscheduled update of the MP GPCI in 2004 (68 
FR 49043) to reflect increases in MP premiums nationwide. The 2008 MP 
update reflects the most recent premium data available. The physician 
work and PE GPCIs are being updated at the same time.
    The periodic review and adjustment of GPCIs is mandated by section 
1848(e)(1)(C) of the Act. At each update, the proposed GPCIs are 
published in our PFS proposed rule the year before they would take 
effect in order to provide an opportunity for public comment and 
further revisions in response to comments prior to implementation. As 
mentioned above, these proposed GPCIs are shown in Addendum D.
2. Payment Localities
a. Background
    The Medicare statute requires that PFS payments be adjusted for 
certain differences in the relative costs among areas. The statute 
requires an adjustment which reflects differences among areas for the 
relative costs of the mix of goods and services comprising PEs (other 
than MP expenses) compared to the national average. The statute also 
requires adjustment for the relative costs of MP expenses among areas 
compared to the national average. Finally, the statute requires 
adjustment for one-quarter of the difference between the relative value 
of physicians' work effort among areas and the national average of such 
work effort.
    The physician work component represents 52.466 percent of the 
national average fee schedule payment amount. Thus, the statutory 
requirement for geographic adjustment of only one-quarter of the 
differences in the physician work component means that, on average, 
only 13.117 percentage points of physician work are geographically 
adjusted, and, on average 39.349 percentage points of the physician 
work component are not adjusted and represent a national fee schedule 
amount.
    In addition, the PE component represents 43.669 percent of the 
national average fee schedule payment amount. PEs are comprised of 
nonphysician employee compensation, office expenses (including rent), 
medical equipment, drugs and supplies, and other expenses. As explained 
above in this section, we do not make a geographic adjustment relating 
to medical equipment, drugs, and supplies because there is a national 
marker for these items. Thus, only the categories of nonphysician 
employee compensation and rents are geographically adjusted. These 
categories represent, on average, 30.862 percentage points of the total 
PE, and 12.807 percentage points of PEs are not geographically 
adjusted.
    In total, more than half (52.156 percent) of the average PFS amount 
is a national payment that is the same in all areas of the country; 
that is, 52.156 percent of the average fee is not geographically 
adjusted.
    There are two additional points about the geographic indices that 
are important to note. First, as described above in this section, the 
data used to measure cost differences among localities are proxies for 
physician work, employee compensation and office rents. That is, wage 
data for various categories of employees are used to proxy the actual 
wages of physician employees. Second, the data used for such proxies 
are based on actual Census data only for a limited number of counties. 
The geographic adjustment factors (GAFs) for more than 90 percent of 
counties are developed using proxies based on larger geographic areas 
(for example, data for all rural areas in a State are combined and used 
to proxy the values for each rural county in a State). This aggregation 
is necessary for areas where county level data are not available. Thus, 
the underlying data are proxies for actual costs, and the resulting 
GPCIs do not measure perfectly the cost differences among localities.
    Currently, there are 89 Medicare physician payment localities to 
which GPCIs are applied. The payment locality structure under the PFS 
was established in 1996 and took effect January 1, 1997. The 
development of this structure is described in detail in both the CY 
1997 PFS proposed (61 FR 34615) and final rules (61 FR 59494). Before 
adoption of the current structure, there were 210 separate payment 
localities under the PFS. The 1997 payment locality revision was based 
and built upon the prior locality structure. The 22 then-existing 
statewide localities remained statewide localities. Localities were 
established in the remaining 28 States by comparing the area cost 
differences of the localities within these States. We ranked the 
existing localities within these remaining 28 States by costs in 
descending order. The GAF of the highest cost locality within a State 
was compared to the weighted average GAF of lower price localities. If 
the difference between these GAFs exceeded 5 percent, the highest 
locality remained a distinct locality. If the GAFs associated with all 
the localities in a State did not vary by at least 5 percent, the State 
became a statewide locality. If the highest-priced locality remained a 
distinct locality, the process was repeated for the second highest 
price locality and so on until the variation among remaining localities 
fell below the 5 percent threshold. This ensured that the statewide or 
residual State locality has relatively homogenous resource costs. 
Subsequent to this process, 3 additional States with multiple 
localities were converted to statewide localities. Currently, there are 
89 separate payment localities of which 34 are statewide. Recognizing 
that the GPCIs are necessarily proxies, this revision to the locality 
structure accomplished our major goals of appropriately paying for 
services furnished to Medicare beneficiaries, and simplifying payment 
areas.
b. Revision of Payment Localities
    Over time, changing demographics and local economic conditions may 
lead to increased variations in practice costs within payment locality 
boundaries. We are concerned about the potential impact of these 
variations and have been studying this issue and potential alternatives 
for a number of years. However, because changes to the GPCIs must be 
applied in a budget neutral manner (and under the current locality 
system, BN results in aggregate payments within each State remaining 
the same), there are significant redistributive effects to any change. 
Therefore, we are also concerned about the potential impact of locality 
revisions.
    For the past several years, we have been involved in discussions 
with California physicians and their representatives about recent 
shifts in relative demographics and economic conditions among a number 
of counties within the current California payment locality structure. 
The California Medical Association (CMA) suggested that we use our 
demonstration authority to adopt an alternative locality configuration 
and avoid certain redistributive effects, but such an approach was not 
feasible (as discussed in the CY 2005 PFS final rule with comment 
period (70 FR 70151)). In the CY 2006 PFS proposed rule (70 FR 45784), 
we proposed to remove two counties from the ``Rest of California'' 
payment locality and create a new payment locality for each county. 
These two counties were the ones with the

[[Page 38140]]

largest difference between the county and locality GAFs. However, there 
was much more opposition than support for this proposal, in large part 
because of its negative effect on payments for the counties that would 
have remained in the ``Rest of California'' locality. For example, the 
CMA commented on this proposal stating, ``a nationwide legislative 
solution that would provide additional funding * * * is the only 
solution we are supporting at this time.'' We did not finalize the 
proposal and described our reasons in the CY 2006 PFS final rule with 
comment period (70 FR 70151).
    As indicated previously, we recognize that changing demographics 
and local economic conditions may lead to increased variations in 
practice costs within payment locality boundaries. We are concerned 
about the potential impact of these variations. But, we are also 
concerned about the redistributive effects of locality changes since 
changes must be applied in a budget neutral manner (and under the 
current locality system, BN results in aggregate payments within each 
State remaining the same). In considering potential changes in payment 
localities, we believe it is important to evaluate both the potential 
impact of intralocality practice cost variations and the redistributive 
impacts. Therefore, we have identified and are soliciting comments on 
three possible locality reconfigurations, each of which strikes a 
different balance between intralocality variations and redistributive 
impacts. We are considering adopting one of these approaches for 
California in the final rule. Because of the importance of striking an 
appropriate balance with any such locality revisions, we want to 
proceed cautiously and evaluate the impacts in California before 
considering applying the policy more broadly in the future. We also 
seek comments about other potential approaches to locality revisions 
and about using a transition to phase-in changes in a new locality 
structure blending new and revised payments. We note that a transition 
could be complicated to administer, particularly with a concurrent 2-
year phase in of the new GPCI data. The three options are described as 
follows:
    Option 1: Using the existing locality structure, apply a rule 
whereby if a county GAF is more than 5 percent greater that GAF for the 
locality in which the county resides it would be removed from the 
current locality. A separate locality would be established for each 
county that is removed. Based on the new fully phased-in GPCI data 
(that is, for CY 2009), application of this approach in California 
would remove three counties (Santa Cruz, Monterey, and Sonoma) from the 
Rest of California payment locality and Marin county from the Marin/
Napa/Solano payment locality and create separate payment localities for 
each of these counties.
    This approach focuses on counties for which there is the biggest 
difference between the county GAF and the locality GAF. Since we are 
considering applying this approach initially in California, Table 7 
shows the impact for each of the counties and the Rest of California 
payment and Marin/Napa/Solano payment localities.

     TABLE 7.--Option 1--Apply 5 Percent Threshold To Remove Counties From Their Current Payment Localities,
                                                California Impact
----------------------------------------------------------------------------------------------------------------
                                                                           New CY 2009  New CY 2009    Percent
                                                                             GAF, no     GAF, with   change, due
               Locality name                         County name             locality     locality   to locality
                                                                              change       change       change
----------------------------------------------------------------------------------------------------------------
Santa Cruz................................  Santa Cruz...................        1.017        1.100        7.59%
Monterey..................................  Monterey.....................        1.017        1.080        5.83%
Sonoma....................................  Sonoma.......................        1.017        1.076        5.51%
Marin.....................................  Marin........................        1.112        1.173        5.19%
Napa/Solano...............................  Solano.......................        1.112        1.066       -4.33%
Napa/Solano...............................  Napa.........................        1.112        1.066       -4.33%
Rest of California........................  .............................        1.017        1.012       -0.49%
----------------------------------------------------------------------------------------------------------------

    This proposal is similar to the policy we previously proposed in 
the CY 2006 PFS proposed rule (70 FR 45784) (but, as discussed above in 
this section, we did not adopt in the final rule) to address the 
counties with GAFs that are most different from their current locality 
designation. At that time, we only considered the two counties with the 
greatest difference between the county and locality GAF--Santa Cruz and 
Sonoma. Given the new GAF data, we are again considering this approach 
to address locality issues, but we would make adjustments to any county 
in California in which the county GAF exceeds the locality GAF by more 
than 5 percent. Table 7 shows the impacts using fully phased-in CY 2009 
GPCIs that would apply using the new GPCI data discussed in this 
proposed rule. The table compares the changes that would occur in CY 
2009 under the current locality structure with those that would occur 
under option 1. The table shows that compared to the fully phased-in CY 
2009 GAFs that would occur under the current locality structure, under 
this option, the GAFs for Santa Cruz, Monterey and Sonoma would 
increase by 7.59 percent, 5.83 percent, and 5.51 percent respectively, 
and the GAF for the Rest of California locality would decrease by 0.49 
percent. The GAF for Marin would increase by 5.19 percent while the GAF 
for Napa/Solano would decrease by 4.33 percent. The GAFs for all other 
California localities would not change.
    Option 2: This approach is similar to option 1, but the new 
localities would be structured differently. We would use the same 5 
percent threshold methodology but instead of creating four new 
localities in which each county becomes its own new locality, the three 
counties that are removed from the Rest of California locality would 
become one new locality. Marin County would still be removed from the 
Marin/Napa/Solano locality to become its own locality. Application of 
this approach would remove three counties (Santa Cruz, Sonoma, and 
Monterey) from the Rest of California payment locality, and Marin 
County from the existing Marin/Napa/Solano payment locality. This 
approach groups together counties from the Rest of California locality 
that have the greatest difference between the county and locality GAF. 
These three counties have similar cost structures and grouping them 
together into one new locality is consistent with our goal of 
homogeneous resource costs within a locality. In addition, it creates 
fewer localities which is administratively simpler for both the 
Medicare program

[[Page 38141]]

and for physicians who might practice in multiple localities.
    Again, since we are considering applying this approach initially in 
California, Table 8 shows the impact, using fully phased-in CY 2009 
GPCIs, for each of the new localities and for the localities that would 
remain. The table shows that compared to the fully phased-in CY 2009 
GAFs that would occur under the current locality structure, under this 
option, the GAFs for the new Santa Cruz/Sonoma/Monterey locality would 
increase by 6.3 percent, and the GAF for the Marin County locality 
would increase by 5.19 percent. The GAFs would decrease by 0.49 percent 
for the Rest of California locality and by 4.33 percent for the Napa/
Solano locality.

   Table 8.--Option 2--Apply Five Percent Threshold To Remove Counties From Their Current Payment Localities,
                                  California Impact, Create Two New Localities
----------------------------------------------------------------------------------------------------------------
                                                                                                       Percent
                                                                             CY 2009      CY 2009     change, CY
                                                                CY 2009      GAF, no     GAF, with    2009 GAF,
            Locality name                   County name        county GAF    locality     locality       with
                                                                              change       change      locality
                                                                                                        change
----------------------------------------------------------------------------------------------------------------
Marin...............................  Marin.................        1.173        1.112        1.173         5.19
Napa/Solano.........................  Napa..................        1.080        1.112        1.066        -4.33
Napa/Solano.........................  Solano................        1.053        1.112        1.066        -4.33
Santa Cruz/Monterey/Sonoma..........  Santa Cruz............        1.100        1.017        1.082         6.03
Santa Cruz/Monterey/Sonoma..........  Sonoma................        1.076        1.017        1.082         6.03
Santa Cruz/Monterey/Sonoma..........  Monterey..............        1.080        1.017        1.082         6.03
Rest of California..................  ......................        1.017        1.017        1.012       -0.049
----------------------------------------------------------------------------------------------------------------

    Option 3: Apply a methodology similar to that used in the 1997 
locality revisions, but applied at the county level rather than the 
``existing locality'' level. That is, we sorted the counties by 
descending GAFs and compared the highest county to the second highest. 
If the difference is less than 5 percent, the counties were included in 
the same locality. The third highest is then compared to the highest 
county GAF. This iterative process continues until a county has a GAF 
difference that is more than 5 percent. When this occurs, that county 
becomes the highest county in a new payment locality and the process is 
repeated for all counties in the State. This methodology is also 
described in the CY 2006 PFS final rule with comment period (70 FR 
70151). This approach would group counties within a State into 
localities based on similarity of GAFs even if the counties were not 
geographically contiguous.
    This is a numerical organization of payment localities based on 
costs which will reduce the number of payment localities in California 
from 9 to 6 localities and will create a structure where areas with 
similar costs will be grouped together. This option alleviates the 
greatest variations in cost between counties in California. This 
proposal is unique in that the new localities are not contiguous. 
Currently, all localities encompass adjacent geographic areas. However, 
Table 9 shows that for most of the counties in California, geographic 
relationships are maintained within payment groups.
    While this option groups counties with similar costs together, it 
does not address the issue of a county or locality that has costs very 
different from those of an adjoining county or locality. Under this 
option, it will still be possible for neighboring counties or 
localities to have significantly different cost structures and the 
associated problems such as incentives to relocate across county lines 
would still exist.
    This option is the most administratively burdensome option for CMS 
to implement because of the significant systems changes and provider 
education that would be required to reconfigure the California 
localities in this manner. It will also place a greater burden on 
practicing physicians who are more likely to experience a change in his 
or her practice's locality. We are seeking comments on the extent of 
the administrative burden.
    Since we are considering applying this approach initially in 
California, Table 9 shows the impact, using fully phased-in CY 2009 
GPCIs, for each of the California counties. Table 9 shows that this 
approach would result in 6 total California payment localities. The 
changes would have a variety of impacts depending upon the counties 
involved. The changes are illustrated in Table 9.

                                                   Table 9.--Option 3--Revision of Payment Localities
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                     Proposed     Proposed     Current
                     County                           Current Medicare locality         Current      Medicare     locality     locality       Percent
                                                                                       county GAF    locality       GAF          GAF        difference
--------------------------------------------------------------------------------------------------------------------------------------------------------
San Mateo......................................  San Mateo, CA......................        1.204            1        1.197        1.204            -0.6
San Francisco..................................  San Francisco, CA..................        1.201            1        1.197        1.201            -0.3
Marin..........................................  Marin/Napa/Solano, CA..............        1.170            1        1.197        1.112             7.6
Santa Clara....................................  Santa Clara, CA....................        1.148            2        1.119        1.148            -2.5
Contra Costa...................................  Oakland/Berkeley, CA...............        1.134            2        1.119        1.131            -1.0
Alameda........................................  Oakland/Berkeley, CA...............        1.129            2        1.119        1.131            -1.0
Orange.........................................  Anaheim/Santa Ana, CA..............        1.128            2        1.119        1.128            -0.8
Ventura........................................  Ventura, CA........................        1.121            2        1.119        1.121            -0.2
Los Angeles....................................  Los Angeles, CA....................        1.112            2        1.119        1.112             0.6
Santa Cruz.....................................  Rest of California.................        1.098            3        1.061        1.012             4.9
Napa...........................................  Marin/Napa/Solano, CA..............        1.077            3        1.061        1.112            -4.6
Monterey.......................................  Rest of California.................        1.077            3        1.061        1.012             4.9
Sonoma.........................................  Rest of California.................        1.074            3        1.061        1.012             4.9
San Diego......................................  Rest of California.................        1.053            3        1.061        1.012             4.9

[[Page 38142]]

 
Santa Barbara..................................  Rest of California.................        1.053            3        1.061        1.012             4.9
Solano.........................................  Marin/Napa/Solano, CA..............        1.051            3        1.061        1.112            -4.6
Sacramento.....................................  Rest of California.................        1.047            4        1.023        1.012             1.2
El Dorado......................................  Rest of California.................        1.033            4        1.023        1.012             1.2
San Bernardino.................................  Rest of California.................        1.023            4        1.023        1.012             1.2
Placer.........................................  Rest of California.................        1.021            4        1.023        1.012             1.2
Riverside......................................  Rest of California.................        1.017            4        1.023        1.012             1.2
San Luis Obispo................................  Rest of California.................        1.015            4        1.023        1.012             1.2
San Joaquin....................................  Rest of California.................        1.006            4        1.023        1.012             1.2
Yolo...........................................  Rest of California.................        0.995            5        0.962        1.012            -4.9
Stanislaus.....................................  Rest of California.................        0.979            5        0.962        1.012            -4.9
Mono...........................................  Rest of California.................        0.977            5        0.962        1.012            -4.9
Nevada.........................................  Rest of California.................        0.975            5        0.962        1.012            -4.9
Kern...........................................  Rest of California.................        0.973            5        0.962        1.012            -4.9
San Benito.....................................  Rest of California.................        0.971            5        0.962        1.012            -4.9
Sierra.........................................  Rest of California.................        0.967            5        0.962        1.012            -4.9
Amador.........................................  Rest of California.................        0.967            5        0.962        1.012            -4.9
Fresno.........................................  Rest of California.................        0.963            5        0.962        1.012            -4.9
Mendocino......................................  Rest of California.................        0.960            5        0.962        1.012            -4.9
Madera.........................................  Rest of California.................        0.960            5        0.962        1.012            -4.9
Tuolumne.......................................  Rest of California.................        0.959            5        0.962        1.012            -4.9
Alpine.........................................  Rest of California.................        0.957            5        0.962        1.012            -4.9
Mariposa.......................................  Rest of California.................        0.956            5        0.962        1.012            -4.9
Tulare.........................................  Rest of California.................        0.950            5        0.962        1.012            -4.9
Butte..........................................  Rest of California.................        0.950            5        0.962        1.012            -4.9
Merced.........................................  Rest of California.................        0.949            5        0.962        1.012            -4.9
Calaveras......................................  Rest of California.................        0.949            5        0.962        1.012            -4.9
Humboldt.......................................  Rest of California.................        0.947            5        0.962        1.012            -4.9
Lake...........................................  Rest of California.................        0.947            5        0.962        1.012            -4.9
Imperial.......................................  Rest of California.................        0.945            5        0.962        1.012            -4.9
Plumas.........................................  Rest of California.................        0.945            6        0.938        1.012            -7.3
Lassen.........................................  Rest of California.................        0.944            6        0.938        1.012            -7.3
Sutter.........................................  Rest of California.................        0.942            6        0.938        1.012            -7.3
Yuba...........................................  Rest of California.................        0.942            6        0.938        1.012            -7.3
Colusa.........................................  Rest of California.................        0.940            6        0.938        1.012            -7.3
Del Norte......................................  Rest of California.................        0.940            6        0.938        1.012            -7.3
Modoc..........................................  Rest of California.................        0.938            6        0.938        1.012            -7.3
Shasta.........................................  Rest of California.................        0.937            6        0.938        1.012            -7.3
Kings..........................................  Rest of California.................        0.935            6        0.938        1.012            -7.3
Inyo...........................................  Rest of California.................        0.935            6        0.938        1.012            -7.3
Siskiyou.......................................  Rest of California.................        0.934            6        0.938        1.012            -7.3
Trinity........................................  Rest of California.................        0.933            6        0.938        1.012            -7.3
Tehama.........................................  Rest of California.................        0.932            6        0.938        1.012            -7.3
Glenn..........................................  Rest of California.................        0.930            6        0.938        1.012            -7.3
--------------------------------------------------------------------------------------------------------------------------------------------------------

    We are soliciting comments on these options, as well as other 
approaches to refining localities both from the perspective of 
implementing one of these approaches in California in CY 2008, and also 
from the perspective of their applicability more broadly.

C. Malpractice (MP) RVUs (TC/PC Issue)

    [If you choose to comment on issues in this section, please include 
the caption ``MALPRACTICE'' at the beginning of your comments.]
    In the CY 1992 PFS final rule (56 FR 59527), we described in detail 
how malpractice (MP) RVUs are calculated for CPT codes and, when 
professional liability insurance (PLI) is not available, how we 
crosswalk or assign RVU values to codes. Following the initial 
calculation of resource-based MP RVUs, the MP RVU are then subject to 
review by CMS at 5-year intervals. Reviewing the MP RVUs every 5 years 
ensures that MP RVU values reflect any marketplace changes in the 
physician community's ability to acquire PLI. Alternatively, there are 
some technical services which have assigned MP RVU values that have 
never been part of the review process. Consequently, the MP RVU values 
assigned to these technical services have not been revised since their 
initial assignment. The reason these services have never been reviewed 
is directly related to a lack of suitable data on the cost of PLI for 
technical staff or imaging centers.
    In response to our review of the MP RVUs of services, the RUC's PLI 
Workgroup brought to our attention the fact that there are 
approximately 600 services that have a technical component MP RVU that 
is greater than the professional component MP RVU. The RUC has asked 
CMS to change the technical component MP RVU values, stating that, as 
physicians have to pay the larger PLI premiums, there should be higher 
RVUs associated with the professional portions of these services. In 
the RUC's comments to CMS, the RUC made two alternative suggestions:
    1. CMS should ``flip'' the MP RVUs associated with each of the 
component parts, so the technical component MP RVUs are assigned the 
value of the professional component RVUs, and the professional 
component are assigned the MP RVUs of the technical component MP RVUs; 
or
    2. CMS should make the RVUs of the technical component MP RVUs 
equal to

[[Page 38143]]

the MP RVUs of the professional component.
    We are not accepting the first suggestion. The professional portion 
of the MP RVUs have undergone review and are derived from actual data, 
and are an integral part of our resource-based methodology. We do not 
believe, in the absence of evidence, that our data or conclusions for 
the professional MP RVUs are inaccurate. It would not be consistent 
with our resource-based fee schedule methodology to make changes in the 
professional RVUs that are not supported by actual data.
    Because no data have been offered to demonstrate that the 
malpractice costs for the technical portion of these services are the 
same as for the professional portion of these services, we also do not 
believe it would be appropriate to accept the second suggestion at this 
time. To ensure that any changes we make to any MP RVUs are resource-
based, we need more information from the affected community. 
Specifically, we would like to better understand how, and if, 
technicians employed by facilities purchase PLI or how their 
professional liability is insured. In addition, we are soliciting 
comments on what types of PLI are carried by facilities that perform 
technical services.
    We appreciate the RUC's recommendation and are interested in 
addressing their concerns. Ideally, we would like to develop a 
resource-based methodology for the technical portion of the MP RVUs. 
However, at this time we do not have data that would support such a 
change. Therefore, we are soliciting comments on how we could obtain 
the necessary data to create resource-based RVUs for these services.

D. Medicare Telehealth Services

    [If you choose to comment on issues in this section, please include 
the caption ``MEDICARE TELEHEALTH SERVICES'' at the beginning of your 
comments.]
1. Requests for Adding Services to the List of Medicare Telehealth 
Services
    Section 1834(m)(4)(F) of the Act defines telehealth services as 
professional consultations, office visits, and office psychiatry 
services, and any additional service specified by the Secretary. In 
addition, the statute required us to establish a process for adding 
services to or deleting services from the list of telehealth services 
on an annual basis.
    In the December 31, 2002 Federal Register (67 FR 79988), we 
established a process for adding services to or deleting services from 
the list of Medicare telehealth services. This process provides the 
public an ongoing opportunity to submit requests for adding services. 
We assign any request to make additions to the list of Medicare 
telehealth services to one of the following categories:
     Category 1: Services that are similar to office 
and other outpatient visits, consultation, and office psychiatry 
services. In reviewing these requests, we look for similarities between 
the proposed and existing telehealth services for the roles of, and 
interactions among, the beneficiary, the physician (or other 
practitioner) at the distant site and, if necessary, the telepresenter. 
We also look for similarities in the telecommunications system used to 
deliver the proposed service, for example, the use of interactive audio 
and video equipment.
     Category 2: Services that are not similar to the 
current list of telehealth services. Our review of these requests 
includes an assessment of whether the use of a telecommunications 
system to deliver the service produces similar diagnostic findings or 
therapeutic interventions as compared with the face-to-face ``hands 
on'' delivery of the same service. Requestors should submit evidence 
showing that the use of a telecommunications system does not affect the 
diagnosis or treatment plan as compared to a face-to-face delivery of 
the requested service.
    Since establishing the process, we have added the following to the 
list of Medicare telehealth services: Psychiatric diagnostic interview 
examination; ESRD services with two to three visits per month and four 
or more visits per month (although we require at least one visit a 
month, in person ``hands on'', by a physician, CNS, NP, or PA to 
examine the vascular access site); and individual medical nutrition 
therapy.
    Requests to add services to the list of Medicare telehealth 
services must be submitted and received no later than December 31 of 
each calendar year to be considered for the next rulemaking cycle. For 
example, requests submitted before the end of CY 2006 are considered 
for the CY 2008 proposed rule. For more information on submitting a 
request for an addition to the list of Medicare telehealth services, 
visit our Web site at www.cms.hhs.gov/telehealth/.
2. Submitted Requests for Addition to the List of Telehealth Services
    We received the following requests for additional approved services 
in CY 2006: (1) Subsequent hospital care; (2) neurobehavioral status 
exam; and (3) neuropsychological testing. The following is a discussion 
of the requests submitted in CY 2006.
a. Subsequent Hospital Care
    The American Telemedicine Association (ATA) submitted a request to 
add subsequent hospital care (as represented by HCPCS codes 99231 
through 99233). The ATA mentioned that the AMA CPT panel deleted the 
codes for follow-up inpatient consultation (as described by HCPCS codes 
99261 through 99263) and that the codes for subsequent hospital care 
are used instead of the deleted codes. The requestor described two 
scenarios in which subsequent hospital care services could be furnished 
as a telehealth service. The first scenario would involve a specialty 
physician who furnishes an inpatient consultation as a telehealth 
service and follows the specific problem (for which the consultation 
was requested) with subsequent hospital care (inpatient visits). The 
second scenario involves an attending or admitting physician who 
furnishes initial hospital care in-person (not as telehealth) and 
provides subsequent hospital care as a telehealth service. The 
requester explained that the ability to provide health care services 
when the practitioner is not onsite is critical to the survival of many 
rural and critical access hospitals (CAHs). The requestor believes that 
subsequent hospital care should be considered a category 1 service 
because it is similar to an inpatient consultation (which is currently 
on the list of telehealth services) and that an inpatient consultation 
is a more complex service than subsequent hospital care.
    Additionally, an individual practitioner explained that the 
complete diagnostic and therapeutic plan cannot be established for an 
infectious disease patient in a single consultation and noted that 
follow-up inpatient consultations were previously allowed as telehealth 
services. The practitioner believes that telehealth is appropriate for 
allowing the physician or practitioner at the distant site to be a 
``primary care giver'' (in the inpatient hospital setting); however, 
stated that supporting data is needed.
CMS Review
    As mentioned by the requestors, the AMA deleted follow-up inpatient 
consultation (as described by CPT codes 99261 through 99263). Effective 
January 1, 2006, these CPT codes no longer exist and were removed from 
the PFS. As such, a conforming change was made to remove these codes 
from the list of Medicare telehealth services. CPT

[[Page 38144]]

instructs physicians and practitioners to use subsequent hospital care 
instead of the deleted codes. However, subsequent hospital care 
describes a broader set of services than the deleted codes (follow-up 
inpatient consultation).
    In the CY 2005 PFS proposed rule (69 FR 47511), we discussed a 
previous request to add subsequent hospital care to the list of 
Medicare telehealth services. Given the potential acuity of the patient 
(patients tend to be more acutely ill in the hospital setting), we 
concluded that subsequent hospital care was not similar to existing 
telehealth services (for example, an office visit, office psychology, 
or consultation). Therefore, we indicated that we considered subsequent 
hospital care as a category 2 service. We were not able to approve 
subsequent hospital care for telehealth because no comparative analyses 
were submitted indicating that the use of a telecommunications system 
is an adequate substitute for subsequent hospital care furnished in-
person (which is a requirement for category 2 services).
    Given the potential acuity level of the patient in the hospital 
setting, we continue to believe that many services furnished within the 
scope of the subsequent hospital service codes are not similar to 
current telehealth services. We continue to have concerns about using a 
telecommunications system as a substitute for the on-going (in person) 
evaluation and management (E/M) of a hospital inpatient. Therefore, we 
propose to not add subsequent hospital care as described by HCPCS codes 
99231 through 99233 to the list of Medicare telehealth services.
    We recognize that in deleting the codes for follow-up inpatient 
consultation services, CPT instructs physicians to use the codes for 
subsequent hospital care instead of those for follow-up inpatient 
consultation. Therefore, we are considering the possibility of 
approving subsequent hospital care with specific limitations; for 
example, approving subsequent hospital care for telehealth only when 
the codes are used for follow-up inpatient consultation (and not for 
inpatient visits). As such, we are requesting specific comments as to 
what conditions (or requirements) we could apply to subsequent hospital 
care, so that subsequent hospital care reflects a follow-up inpatient 
consultation.
b. Neurobehavioral Status Exam and Neuropsychological Testing
    The ATA also submitted a request to add neurobehavioral status exam 
(as described by HCPCS code 96116) and neuropsychological testing 
(HCPCS codes 96118 through 96120) to the list of Medicare telehealth 
services. The requestor explained that these services are provided 
during testing of the cognitive function of the central nervous system 
(CNS). The requestor believes that the HCPCS codes currently approved 
for telehealth are not appropriate for reporting neurobehavioral status 
exam and neuropsychological testing, and that these services are 
category 1 services.
    The requestor also explained that the neurobehavioral status exam 
and neuropsychological testing are provided to patients located in a 
physician's or practitioner's office, CAH, rural health clinic (RHC), 
or Federally qualified health center (FQHC), and that physicians and 
clinical psychologists are typically the practitioners who furnish 
these services.
CMS Review
Neurobehavioral Status Exam
    The neurobehavioral status exam is furnished by a physician or 
psychologist and includes an initial assessment and evaluation of 
mental status for a psychiatric patient. In this regard, we believe the 
neurobehavioral status exam is similar to psychiatric diagnostic 
interview examination (which is currently approved as a Medicare 
telehealth service). Therefore, we propose to add neurobehavioral 
status exam as represented by HCPCS code 96116 to the list of Medicare 
telehealth services.
    We would revise Sec.  410.78 and Sec.  414.65 to include 
neurobehavioral status exam as a Medicare telehealth service.
Neuropsychological Testing
    We believe that neuropsychological testing services are category 2 
services because, as explained further below in this section, the roles 
of and interaction among the physician or practitioner at the distant 
site and beneficiary at the originating site are not similar to 
existing telehealth services (for example, office visits, consultation, 
and office psychiatry). We currently do not include the administration 
of other CNS tests on the list of telehealth services.
    Neuropsychological testing is typically used to predict the 
presence and possible causes of brain damage using a complex battery of 
tests such as the Halstead-Reitan Neuropsychological Battery, Wechsler 
Memory Scales, and Wisconsin Card Sorting Test. These are a unique 
series of test instruments that are not similar to other services on 
the list of telehealth services. For example, neuropsychological 
testing evaluates a broad range of brain and nervous system functioning 
such as attention span and memory; visual, auditory, and tactual input; 
verbal communication; spatial perception; the ability to analyze 
information, form mental concepts, and make judgments. The 
comprehensive evaluation and assessment of brain and nervous system 
functioning is typically not a component of the services currently on 
the list of telehealth services. Moreover, neuropsychological testing 
requires administration by a trained professional and involves a unique 
interactive dynamic between the physician, practitioner (or technician) 
who administers the test and the patient. For example, to assess 
tactual performance the patient may be blindfolded for portions of the 
test; to assess sensory perception, the practitioner who administers 
the test touches the patient's fingers, assigning a number to each 
finger. In some cases a significant amount of time is necessary to 
complete a neuropsychological test battery (for example, the Halstead-
Reitan Neuropsychological Battery could take up to 5 or 6 hours to 
complete).
    Because we consider neuropsychological testing to be a category 2 
service, we need to evaluate whether this is a service for which 
telehealth can be an adequate substitute for a face-to-face encounter. 
The requestor did not provide any comparative analyses illustrating 
that the use of a telecommunications system is an adequate substitute 
for the in-person administration of neuropsychological testing. 
Instead, the requestor submitted various summaries of studies and case 
reports addressing clinical consultation, psychotherapy, enrollment and 
consent of psychiatric research participants, health promotion, and 
health education. One comparison study between psychiatric services 
furnished in person and via an interactive audio and video 
telecommunications system was submitted. However, the study focused on 
the use of telehealth to furnish consultation and short-term 
psychotherapy (which are currently approved as Medicare telehealth 
services). Therefore, the information submitted was not sufficient to 
enable us to determine whether the use of a telecommunications system 
would affect the diagnosis or treatment plan as compared to a face-to-
face delivery of neuropsychological testing services.
    In furnishing neuropsychological testing as a telehealth service, 
it is our understanding that the physician, or practitioner (or 
technician) who actually administers the test would be located at

[[Page 38145]]

the distant site (rather than being present with the patient, in-
person, and ``hands on'' at the originating site). We are interested in 
receiving comments as to whether the administration of a 
neuropsychological test battery could be furnished adequately when the 
practitioner is not physically present with the patient.
    Moreover, we understand that in some cases neuropsychological 
testing is administered by a computer with a qualified health care 
professional present (for example, in administering the Wisconsin Card 
Sorting Test). However, we question whether a patient with suspected or 
confirmed brain damage or mental illness such as schizophrenia can be 
taught how to use a computer by a practitioner who is in a remote 
location. Therefore, we also request specific comments as to whether a 
neuropsychological patient could be instructed and supervised 
adequately to take the Wisconsin Card Sorting Test through an 
interactive audio and video telecommunications system. We are proposing 
not to add neuropsychological testing (as described by HCPCS codes 
96118 through and 99620) to the list of Medicare telehealth services.

E. Specific Coding Issues related to PFS

1. Reduction in the Technical Component (TC) for Imaging Services Under 
the PFS to the Outpatient Department (OPD) Payment Amount
    [If you choose to comment on issues in this section, please include 
the caption ``CODING--REDUCTION IN TC FOR IMAGING SERVICES'' at the 
beginning of your comments.]
    As we noted in the CY 2007 PFS final rule with comment period (71 
FR 69624), effective January 1, 2007, section 5102(b)(1) of the Deficit 
Reduction Act of 2005 (Pub. L. 109-171) (DRA) amended section 1848 of 
the Act to require that, for imaging services, if--``(i) The technical 
component (including the technical component portion of a global fee) 
of the service established for a year under the fee schedule * * * 
without application of the geographic adjustment factor * * *, exceeds 
(ii) The Medicare OPD fee schedule amount established under the 
prospective payment system for hospital outpatient department services 
* * * for such service for such year, determined without regard to 
geographic adjustment * * *, the Secretary shall substitute the amount 
described in clause (ii), adjusted by the geographic adjustment factor 
[under the PFS], for the fee schedule amount for such technical 
component for such year.''
    As required by the statute, for imaging services (described in this 
section) furnished on or after January 1, 2007, we cap the TC of the 
PFS payment amount for the year (prior to geographic adjustment) by the 
Outpatient Prospective Payment System (OPPS) payment amount for the 
service (prior to geographic adjustment). We then apply the PFS 
geographic adjustment to the capped payment amount.
    Section 5102(b)(2) of the DRA exempts the estimated reduced 
expenditures from this provision from the PFS BN requirement. Section 
5102(b)(1) of the DRA defines imaging services as ``imaging and 
computer-assisted imaging services, including X-ray, ultrasound 
(including echocardiography), nuclear medicine (including PET), 
magnetic resonance imaging (MRI), computed tomography (CT), and 
fluoroscopy, but excluding diagnostic and screening mammography.''
    To apply section 5102(b) of the DRA, we needed to determine the CPT 
and alpha-numeric HCPCS codes that fall within the scope of ``imaging 
services'' defined by the DRA provision. As we indicated in the CY 2007 
PFS final rule with comment period (71 FR 69659), in general, we 
believe that imaging services are those that provide visual information 
regarding areas of the body that are not normally visible, thereby 
assisting in the diagnosis or treatment of illness or injury. We began 
by considering the CPT 7XXXX series codes for radiology services, and 
then added other CPT codes and alpha-numeric HCPCS codes that describe 
imaging services. We then excluded nuclear medicine services that were 
non-imaging diagnostic or treatment services. We also excluded all 
codes for unlisted procedures since we would not know in advance of any 
specific clinical scenario whether or not the unlisted procedure was an 
imaging service.
    We excluded all mammography services, consistent with the statute. 
We excluded radiation oncology services that were not imaging or 
computer-assisted imaging services. We also excluded all HCPCS codes 
for imaging services that are not separately paid under the OPPS since 
there would be no corresponding OPPS payment to serve as a TC cap. We 
excluded any service where the CPT code describes a procedure for which 
fluoroscopy, ultrasound, or another imaging modality is included in the 
code whether or not it is used, or for which an imaging modality is 
employed peripherally in the performance of the main procedure, for 
example, CPT code 31622, bronchoscopy with or without fluoroscopic 
guidance and CPT code 43242, upper gastrointestinal endoscopy with 
transendoscopic ultrasound-guided intramural or transmural fine needle 
aspiration/biopsy(s). In these cases, we are unable to clearly 
distinguish imaging from non-imaging services because, for example, a 
specific procedure may or may not utilize an imaging modality, or the 
use of an imaging technology cannot be segregated from the performance 
of the main procedure. Note that we included carrier-priced services 
since these services are within the statutory definition of imaging 
services and are also within the statutory definition of PFS services 
(that is, carrier-priced TCs of PET scans).
    Upon further review, we have determined that certain ophthalmologic 
procedures meet the DRA definition of imaging procedures, but were not 
included in the original list of imaging services subject to the OPPS 
cap. Therefore, we propose to add the following procedures to the list 
of procedures subject to the OPPS cap, effective January 1, 2008:
     92135, Scanning computerized ophthalmic diagnostic imaging 
(e.g., scanning laser) with interpretation and report.
     92235, Fluorscein angioscopy (includes multiframe imaging) 
with interpretation and report.
     92240, Indocyanine-green angiography (includes multiframe 
imaging) with interpretation and report.
     92250, Fundus photography with interpretation and report.
     92285, External ocular photography with interpretation and 
report for documentation of medical progress (e.g., close-up 
photography, slit lamp photography, goniophotography, stereo-
photography).
     92286, Special anterior segment photography with 
interpretation and report; with specular endothelial microscopy and 
cell count.
    A complete list of codes that identify imaging services defined by 
the DRA OPPS cap provision was published in Addendum F of the CY 2007 
PFS proposed rule (71 FR 49249 through 49252). We will update the list 
through program instructions to our contractors. To the extent that the 
same imaging service is coded differently under the PFS and the OPPS, 
we crosswalked the code under the PFS to the appropriate code under the 
OPPS that could be reported for the same service provided in the 
hospital outpatient setting.

[[Page 38146]]

2. Application of Multiple Procedure Payment Reduction for Mohs 
Micrographic Surgery (CPT codes 17311 through 17315)
    [If you choose to comment on issues in this section, please include 
the caption ``CODING--MULTIPLE PROCEDURE PAYMENT REDUCTION FOR MOHS 
SURGERY'' at the beginning of your comments.]
    Under the multiple procedure payment reduction policy, 
reimbursement for subsequent surgical procedures performed during the 
same operative session by the same physician is reduced by 50 percent. 
The Mohs surgery codes have been exempt from the multiple procedure 
payment reduction rules since the inception of the PFS (56 FR 59602, 
November 25, 1991).
    The CPT Editorial Panel reviewed all of the codes on the -51 
modifier exempt list to identify which codes should be exempt from the 
multiple procedure payment reduction rules. Based on the revisions to 
the code descriptors and a clearer understanding regarding the 
technical elements of the procedure, the CPT Editorial Panel removed 
the Mohs procedure from the -51 modifier list. The code descriptors for 
Mohs surgery codes were developed to take into account the different 
level of physician work intensity based on anatomic site. The RVUs 
associated with the codes for each anatomic location were assigned, as 
they are for other procedures, after a thorough discussion by the RUC 
of all aspects of the service. RVUs were developed for each Mohs 
surgery base code based on an assumption that each code is performed 
separately. Because the RVUs for these services do not take into 
account the efficiencies that occur when multiple procedures are 
performed in one session, we do not believe that these codes should 
continue to be exempt from the multiple procedure payment reduction. 
Therefore, we are proposing to eliminate the modifier -51 exemption and 
apply the multiple procedure payment reduction rules to these codes.
3. Payment for Intravenous Immune Globulin (IVIG) Add-On Code for 
Preadmission-Related Services
    [If you choose to comment on issues in this section, please include 
the caption ``CODING--PAYMENT FOR IVIG ADD-ON CODE'' at the beginning 
of your comments.]
    Intravenous immune globulin (IVIG) is a unique product derived from 
blood plasma. Since its production depends on plasma collection, there 
may be constraints on the amount produced. There have been reported 
fluctuations in supply of this product and, in recent years, the demand 
for this product has grown because of off-label uses.
    We recognize the importance of IVIG to patients who require it and 
are concerned about reports of problems with IVIG access and 
availability. We have initiated several actions in response to the 
concerns about the supply of IVIG. We have continued to improve the 
codes for reporting IVIG, including creating four new codes for liquid 
non-lyophilized IVIG for use effective July 1, 2007. In addition, as 
noted below in this section, we established a temporary additional 
payment for IVIG preadministration services to compensate physicians 
for the extra resources required to be expended due to market 
conditions in order to locate and obtain the appropriate IVIG products 
and to schedule patient infusions.
    In 2006, we created the HCPCS code G0332, Preadministration-related 
services for intravenous infusion of immunoglobulin, per infusion 
encounter and established RVUs for the code based on the nonfacility PE 
RVUs for code G0319 (1.90 PE RVUs). Code G0319 describes ESRD-related 
services during the course of treatment, for patients 20 years of age 
and over; with one face-to-face physician visit per month.
    The rationale for the PE valuation was that we believed the 
additional physician practice resources expended for preadministration-
related services, particularly clinical labor, are comparable to the PE 
for the ESRD management code.
    In 2007, we established RVUs for code G0332 based on a blend of the 
PE RVUs for ESRD codes G0319 and G0318. The RVUs were set at 1.97, a 
slight increase in the PE RVUs assigned to the code. For a discussion 
of the RVUs established for these services, see the CY 2007 PFS final 
rule with comment period (71 FR 69679).
    The OIG recently published a report in April 2007 titled, 
``Intravenous Immune Globulin: Medicare Payment and Availability'' 
(OEI-03-05-00404). The CMS comments on this report were included in 
Appendix B. We believe this report provides information on the 
availability and pricing for this product and sets the stage for 
further review of key issues that can bring greater understanding of 
the marketplace for this product.
    We acknowledge the finding in the OIG report that increasing 
numbers of physicians are able to purchase IVIG below the Medicare 
ASP+6 percent payment rates. In the third quarter of 2006, 59 percent 
of sales to physicians were at prices lower than the Medicare payment 
rate, a substantial increase over the prior 3 quarters. We consider 
this to be an important development, as it suggests that although the 
OIG could not determine the underlying reasons that physicians have had 
issues with IVIG product availability, Medicare payment rates under the 
ASP+6 percent payment system have, over time, adjusted to substantial 
increases in IVIG market prices.
    We have also requested that the OIG further study some of the 
issues we raised in our comments so that we can better understand the 
IVIG market.
    We are concerned that the existence of the preadministration fee 
could further distort the market and provide inappropriate incentives 
for IVIG utilization. Despite these concerns, we want to ensure that 
beneficiaries continue to have access to IVIG. Therefore, we are 
proposing to continue payment for G0332 only through CY 2008 at the 
same level of PE RVUs as CY 2007. We invite comments on this policy.
4. Additional Codes from the 5-Year Review of Work RVUs
    [If you choose to comment on issues in this section, please include 
the caption ``CODING--ADDITIONAL CODES FROM 5-YEAR REVIEW'' at the 
beginning of your comments.]
    As discussed in the CY 2007 PFS final rule with comment period, we 
deferred the decisions on proposed changes to the work RVUs for a 
number of codes from the 5-Year Review for a year, either because we 
had not yet received the RUC recommendation or because we were 
suggesting that the RUC reevaluate the original recommendation. As we 
stated in that same rule, these additional codes are still considered 
part of the 5-Year Review. Table 10 shows the remaining codes, the 
requested and recommended RVUs, and CMS's proposal on the codes. We are 
proposing to accept all of the RUC recommendations, with the exception 
of CPT code 93325 which we are proposing to bundle (that is, work RVUs 
would be increasing for 33 codes, decreasing for 10 codes, and 
maintained for 15 codes).

[[Page 38147]]



                                      Table 10.--Remaining Codes From Five-Year Review of Work Relative Value Units
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                 2008
                                                                                2007  work   Requested                CMS  proposal  (agree/   Proposed
        CPT \1\/  HCPCS code                Mod              Descriptor            RVU       work  RVU     RUC  REC          disagree)        work  RVU
                                                                                                                                                 \2\
--------------------------------------------------------------------------------------------------------------------------------------------------------
19301..............................  ................  Partial mastectomy....         6.03        10.00        10.00  Agree................        10.00
33207..............................  ................  Insertion of heart             9.05         8.00         8.00  Agree................         8.00
                                                        pacemaker.
45300..............................  ................  Proctosigmoidoscopy dx         0.38         1.00         0.80  Agree................         0.80
45303..............................  ................  Proctosigmoidoscopy            0.44         1.50         1.50  Agree................         1.50
                                                        dilate.
45305..............................  ................  Proctosigmoidoscopy w/         1.01         1.25         1.25  Agree................         1.25
                                                        bx.
45307..............................  ................  Proctosigmoidoscopy fb         0.94         1.70         1.70  Agree................         1.70
45308..............................  ................  Proctosigmoidoscopy            0.83         1.40         1.40  Agree................         1.40
                                                        removal.
45309..............................  ................  Proctosigmoidoscopy            2.01         1.50         1.50  Agree................         1.50
                                                        removal.
45315..............................  ................  Proctosigmoidoscopy            1.40         1.80         1.80  Agree................         1.80
                                                        removal.
45317..............................  ................  Proctosigmoidoscopy            1.50         2.00         2.00  Agree................         2.00
                                                        bleed.
45320..............................  ................  Proctosigmoidoscopy            1.58         1.78         1.78  Agree................         1.78
                                                        ablate.
45321..............................  ................  Proctosigmoidoscopy            1.17         1.75         1.75  Agree................         1.75
                                                        volvul.
45327..............................  ................  Proctosigmoidoscopy w/         1.65         2.00         2.00  Agree................         2.00
                                                        stent.
46600..............................  ................  Diagnostic anoscopy...         0.50         0.79         0.55  Agree................         0.55
46604..............................  ................  Anoscopy and dilation.         1.31         1.25         1.03  Agree................         1.03
46606..............................  ................  Anoscopy and biopsy...         0.81         1.20         1.20  Agree................         1.20
46608..............................  ................  Anoscopy, remove for           1.51         1.30         1.30  Agree................         1.30
                                                        body.
46610..............................  ................  Anoscopy, remove               1.32         1.28         1.28  Agree................         1.28
                                                        lesion.
46611..............................  ................  Anoscopy..............         1.81         1.30         1.30  Agree................         1.30
46612..............................  ................  Anoscopy, remove               2.34         1.50         1.50  Agree................         1.50
                                                        lesions.
46614..............................  ................  Anoscopy, control              2.01         1.50         1.00  Agree................         1.00
                                                        bleeding.
46615..............................  ................  Anoscopy..............         2.68         1.50         1.50  Agree................         1.50
92002..............................  ................  Eye exam, new patient.         0.88         0.88         0.88  Agree................         0.88
92004..............................  ................  Eye exam, new patient.         1.67         1.82         1.82  Agree................         1.82
92012..............................  ................  Eye exam established           0.67         0.92         0.92  Agree................         0.92
                                                        pat.
92014..............................  ................  Eye exam & treatment..         1.10         1.42         1.42  Agree................         1.42
92557..............................  ................  Comprehensive hearing          0.00         0.60         0.60  Agree................         0.60
                                                        test.
92567..............................  ................  Tympanometry..........         0.00         0.20         0.20  Agree................         0.20
92568..............................  ................  Acoustic refl                  0.00         0.29         0.29  Agree................         0.29
                                                        threshold tst.
92569..............................  ................  Acoustic reflex decay          0.00         0.20         0.20  Agree................         0.20
                                                        test.
92579..............................  ................  Visual audiometry              0.00         0.70         0.70  Agree................         0.70
                                                        (vra).
92601..............................  ................  Cochlear implt f/up            0.00         2.30         2.30  Agree................         2.30
                                                        exam < 7.
92602..............................  ................  Reprogram cochlear             0.00         1.30         1.30  Agree................         1.30
                                                        implt < 7.
92603..............................  ................  Cochlear implt f/up            0.00         2.25         2.25  Agree................         2.25
                                                        exam 7 >.
92604..............................  ................  Reprogram cochlear             0.00         1.25         1.25  Agree................         1.25
                                                        implt 7 >.
93325..............................  ................  Doppler color flow add-        0.07         0.30          CPT  Disagree.............      Bundled
                                                        on.
99304..............................  ................  Nursing facility care,         1.20         1.88         1.61  Agree................         1.61
                                                        init.
99305..............................  ................  Nursing facility care,         1.61         2.56         2.30  Agree................         2.30
                                                        init.
99306..............................  ................  Nursing facility care,         2.01         3.60         3.00  Agree................         3.00
                                                        init.
99307..............................  ................  Nursing fac care,              0.60         0.76         0.76  Agree................         0.76
                                                        subseq.
99308..............................  ................  Nursing fac care,              1.00         1.39         1.16  Agree................         1.16
                                                        subseq.
99309..............................  ................  Nursing fac care,              1.42         2.00         1.55  Agree................         1.55
                                                        subseq.
99310..............................  ................  Nursing fac care,              1.77         2.35         2.35  Agree................         2.35
                                                        subseq.
99318..............................  ................  Annual nursing fac             1.20         1.88         1.71  Agree................         1.71
                                                        assessmnt.
99326..............................  ................  Domicil/r-home visit           2.27         2.85         2.27  Agree................         2.27
                                                        new pat.
99327..............................  ................  Domicil/r-home visit           3.03         3.75         3.03  Agree................         3.03
                                                        new pat.
99328..............................  ................  Domicil/r-home visit           3.78         4.26         3.78  Agree................         3.78
                                                        new pat.
99334..............................  ................  Domicil/r-home visit           0.76         1.25         0.76  Agree................         0.76
                                                        est pat.
99335..............................  ................  Domicil/r-home visit           1.26         2.00         1.26  Agree................         1.26
                                                        est pat.
99336..............................  ................  Domicil/r-home visit           2.02         2.75         2.02  Agree................         2.02
                                                        est pat.
99337..............................  ................  Domicil/r-home visit           3.03         4.05         3.03  Agree................         3.03
                                                        est pat.
99343..............................  ................  Home visit, new                2.27         2.65         2.27  Agree................         2.27
                                                        patient.
99344..............................  ................  Home visit, new                3.03         3.60         3.03  Agree................         3.03
                                                        patient.
99345..............................  ................  Home visit, new                3.78         4.26         3.78  Agree................         3.78
                                                        patient.

[[Page 38148]]

 
99347..............................  ................  Home visit, est                0.76         1.10         0.76  Agree................         0.76
                                                        patient.
99348..............................  ................  Home visit, est                1.26         1.70         1.26  Agree................         1.26
                                                        patient.
99349..............................  ................  Home visit, est                2.02         2.50         2.02  Agree................         2.02
                                                        patient.
99350..............................  ................  Home visit, est                3.03         3.45         3.03  Agree................         3.03
                                                        patient.
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
\2\ Proposed WRVU changes reflect E/M increases.

    In Table 10, work RVUs are being proposed for CPT codes 92557, 
92567, 92568, 92569, 92579, 92601, 92602, 92603 and 92604. These codes 
previously had no work RVUs assigned to them. However, based on surveys 
conducted by relevant specialty societies, the RUC recommended work 
RVUs as noted in the table, which we propose to accept.
    We note that CPT code 93325, Doppler echocardiography color flow 
velocity mapping (List separately in addition to codes for 
echocardiography), was submitted by CMS to the RUC as part of the third 
5-Year Review. The RUC 5-Year Review workgroup recommended sending the 
code to the CPT Editorial Panel so that it could bundle CPT code 93325 
into doppler echo code 93307. We believe that the technology of doppler 
imaging has evolved over the past 2 decades to enable color flow 
velocity and spectral analysis, both important components of doppler 
imaging, to be performed concurrently or in concert to obtain more 
accurate interpretation and documentation of the anatomy and 
physiologic function of the structure(s) and organ being evaluated. 
Therefore, we agree with the RUC and since the services described in 
93325 have become intrinsic to the performance of other 
echocardiography services, we are proposing to bundle 93325 into CPT 
codes 76825, 76826, 76827, 76828, 93303, 93304, 93307, 93308, 93312, 
93314, 93315, 93317, 93320, 93321, 93350 and assign CPT code 93325 a 
status indicator of ``B'' (Bundled).
5. Anesthesia Coding (Part of 5-Year Review)
    Although anesthesia services are paid under the PFS, under section 
1848(b)(2)(B) of the Act, they are paid on the basis of an anesthesia 
code-specific base unit and time units that vary based on the actual 
anesthesia time of the case. Since anesthesia services do not have a 
work RVU per code as do other medical and surgical services, a work 
value must be imputed for each anesthesia code. The imputed value is 
determined by multiplying the national average allowed charge for each 
anesthesia service by its anesthesia work share and dividing this 
amount by the general PFS conversion factor (CF). This places the work 
of the anesthesia service on the same relative value scale as all other 
physician services.
    In the second 5-Year Review of anesthesia work implemented in 2002, 
the AMA RUC and the American Society of Anesthesiologists (ASA) used a 
building block approach to estimate the value of anesthesia work and 
compared this value to the imputed work value to determine whether the 
work of anesthesia services is properly valued. Under the building 
block approach, each anesthesia code was uniformly divided into five 
components; pre-anesthesia, equipment and supply preparation, 
induction, post-induction anesthesia, and post-anesthesia. Work is 
determined for each of the five components and summed to calculate 
total anesthesia work for the anesthesia code. The imputed value for 
the anesthesia code is compared to the building block estimate of work 
in order to assess whether, and if so, to what extent, the anesthesia 
code is not properly valued.
    The most significant component of work for the anesthesia service 
is the intensity for the post-induction anesthesia time. The ASA 
thought that the RUC significantly misvalued this component in the 
second 5-Year Review. In addition, the ASA was dissatisfied that the 
RUC did not extend the analysis from the 19 high volume anesthesia 
codes reviewed by the RUC to all anesthesia codes.
    In the CY 2007 PFS final rule with comment period, we addressed the 
issue of the work of anesthesia services under the third 5-Year Review 
of work.
    As explained in that rule, we made very modest adjustments to the 
work of the 19 anesthesia codes surveyed and analyzed by the RUC in the 
second 5-Year Review of work. These adjustments were made recognizing 
that the work of the pre- and post-anesthesia service components as 
linked to certain E/M services. Since we accepted the AMA RUC's 
recommendations for increased work values for certain E/M codes for the 
third 5-Year Review of work, we recalculated the work of the 19 
anesthesia services to incorporate these higher work values. The 
adjustment in work was reflected by increasing the anesthesia CF by 
less than 1 percent.
    However, on the more significant issue of the valuation of work in 
the post-induction anesthesia period, we took no action. Rather, in the 
CY 2007 PFS final rule with comment period, we asked the RUC to review 
and consider this issue as part of the third 5-Year Review of work. We 
also asked the RUC to consider how increases in the work of pre- and 
post-anesthesia services could cause adjustments to the anesthesia 
services not specifically reviewed by the ASA and the RUC.
    In January 2007, the ASA requested the AMA RUC to review the 
undervaluation of the work of the post-induction anesthesia period and 
to consider also an analytic approach, based on linear regression 
analysis, which could be used to evaluate the work of the entire 
anesthesia service. The linear regression model relates the work of the 
post-induction period time and the work of the entire anesthesia 
service to the base unit value for the anesthesia code. Under this 
model, the work of anesthesia services is undervalued by approximately 
34 percent.
    The RUC established an anesthesia workgroup to examine this 
proposal. The workgroup discussed this proposal extensively at its two 
teleconferences, prior to the April RUC meeting, and at the April RUC 
meeting itself. In May 2007, the AMA RUC, based on the analyses and 
recommendations of its workgroup, submitted a recommendation to CMS for 
a 32 percent increase in the work of anesthesia services.
    The workgroup approved the ASA's use of the linear regression model 
to value only the work of the post-induction period time. In contrast 
to the ASA proposal, the workgroup

[[Page 38149]]

considered an analytic approach different from the regression model 
developed by the ASA. This approach is based on a building block 
approach that could be used to evaluate the work of all anesthesia 
service components other than the pos-induction period time. For 
example, for pre-anesthesia time, the methodology is as shown in Table 
11.

                     Table 11.--Pre-Anesthesia Time
------------------------------------------------------------------------
 
------------------------------------------------------------------------
All Anesthesia codes with 3 base units.  linked to the work of 99201.
All Anesthesia codes with 4 base units.  linked to the blend of work for
                                          99201 and 99202.
All Anesthesia codes with 5 to 15 base   linked to the work of 99202.
 units.
All Anesthesia codes with 16 to 30 base  linked to the work of 99252.
 units.
------------------------------------------------------------------------
Note: The source of the link for work is the pre-anesthesia valuation
  from the 19 surveyed anesthesia codes whose base units varied from 3
  units to 25 units.

    Similar approaches are used for each anesthesia component: 
preparation time, induction period time, and post-anesthesia time. 
Systematically, codes with lower anesthesia base unit values have lower 
work values for each component of the building block approach than do 
codes with higher anesthesia base unit values. For the given building 
block component, the work value of that component is the same for all 
anesthesia services that have the same base unit value.
    According to the workgroup's revised methodology which is extended 
from the 19 surveyed codes to all 271 anesthesia codes, the work of 
anesthesia services is undervalued by approximately 32 percent. Thus, 
based on the acceptance of the workgroup and the RUC's recommendation, 
an adjustment of approximately 25 percent would be applied to the 
anesthesia CF.
    Increases in the work of anesthesia services would have to be 
offset by additional adjustments to the PFS BN adjustor for work. We 
estimate that the increase in the anesthesia CF would result in an 
additional 1.0 percent increase in the BN adjuster for work.
    Other adjustments also affect the anesthesia CF. For example, an 
increase in anesthesia work may have implications for PE because 
indirect PEs are allocated based on the sum of work and direct PEs. 
When we ran the PE RVU program, there was no increase in the aggregate 
anesthesia PEs. Thus, no adjustment is being made to the PE share of 
the anesthesia service or to the anesthesia CF for this component.
    We are proposing to accept the RUC's recommendation and increase 
the work of anesthesia services by 32 percent.
    Due to the proposed work RVU changes for the codes listed in Table 
10 and the proposed increases in the work of anesthesia services, we 
are proposing to revise the work adjustor to maintain budget 
neutrality. Based upon the increases, the proposed revised work 
adjustor is approximately 0.8816, which is discussed further in the 
impact section of this proposed rule.
6. Reporting of Cardiac Rehabilitation Services
    For CY 2008, we are proposing to assign a status indicator of ``I'' 
(invalid for Medicare purposes, Medicare recognizes another code for 
the billing of this service) to the current CPT codes for cardiac 
rehabilitation services, CPT codes 93797, Physician services for 
outpatient cardiac rehabilitation; without continuous ECG monitoring 
(per session), and 93798, Physician services for outpatient cardiac 
rehabilitation; with continuous ECG monitoring (per session). (There is 
no definition of ``per session.'') Therefore, to clarify the coding and 
payment for these services, we propose to establish two new Level II 
HCPCS codes that we believe are more appropriate for specifically 
reporting cardiac rehabilitation services under the PFS. The proposed 
HCPCS codes are: Gxxx1, Physician services for outpatient cardiac 
rehabilitation; without continuous ECG monitoring (per hour), and 
Gxxx2, Physician services for outpatient cardiac rehabilitation; with 
continuous ECG monitoring (per hour). We believe the new codes that use 
a per hour descriptor will more accurately measure the services being 
provided and facilitate proper coding and payment. The current RVUs 
associated with CPT codes 93797 and 93798 will be crosswalked to HCPCS 
Codes Gxxx1 and Gxxx1, respectively, because 1 hour of service was 
assumed in establishing the current RVUs.

F. Part B Drug Payment

1. Average Sales Price (ASP) Issues
    [If you choose to comment on issues in this section, please include 
the caption ``ASP ISSUES'' at the beginning of your comments.]
    Medicare Part B covers a limited number of prescription drugs and 
biologicals. For the purposes of this proposed rule, the term ``drugs'' 
will hereafter refer to both drugs and biologicals, unless otherwise 
specified. Medicare Part B covered drugs not paid on a cost or 
prospective payment basis generally fall into the following three 
categories:
     Drugs furnished incident to a physician's service.
     DME drugs.
     Drugs specifically covered by statute (certain 
immunosuppressive drugs, for example).
    Beginning in CY 2005, the vast majority of Medicare Part B drugs 
not paid on a cost or prospective payment basis are paid under the ASP 
methodology. The ASP methodology is based on data submitted to us 
quarterly by manufacturers. In addition to the payment for the drug, 
Medicare currently pays a furnishing fee for blood clotting factors, a 
dispensing fee for inhalation drugs, and a supplying fee to pharmacies 
for certain Part B drugs.
    In January 2006, the drug coverage available to Medicare 
beneficiaries expanded with the implementation of Medicare Part D. The 
Medicare Part D program does not change Medicare Part B drug coverage.
    In this section, we discuss proposed changes and issues related to 
the determination of the payment amounts for covered Part B drugs and 
furnishing blood clotting factor. This section also discusses proposed 
changes to how manufacturers calculate and report ASP data to us.
a. ASP Payment
    Section 303(c) of the MMA amended Title XVIII of the Act by adding 
section 1847A. This section revised the payment methodology for the 
vast majority of drugs and biologicals not paid on a cost or 
prospective payment basis furnished on or after January 1, 2005. The 
ASP reporting requirements are set forth in section 1927(b) of the Act. 
Manufacturers must submit ASP data by 11-digit National Drug Code (NDC) 
to us quarterly. The manufacturers' submissions are due to us not later 
than 30 days after the last day of each calendar quarter. The 
methodology for developing Medicare drug payment allowances based on 
the manufacturers' submitted ASP data is specified in 42 CFR, part 414, 
subpart K.

[[Page 38150]]

We update the Part B drug payment amounts quarterly based on the data 
we receive.
    In this section of the preamble, we discuss our intent to establish 
further guidance regarding certain aspects of the calculation of 
manufacturers' ASP data, and seek comments on issues related to bundled 
price concessions.
    Further information on manufacturers' submission of ASP data for 
Medicare Part B drugs and biologicals is contained in prior rulemaking 
documents and other guidance accessible on the CMS Web page at (http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/). Specifically refer to the 
April 6, 2004 ASP interim final rule with comment period (IFC) (69 FR 
17935) and the CY 2007 PFS final rule with comment period (71 FR 
69624), which finalized the ASP calculation and reporting requirements 
of the April 6, 2004 IFC, and the Frequently Asked Questions available 
on the Web page.
b. Bundled Price Concessions
    In the CY 2007 PFS proposed rule and final rule with comment 
period, we solicited and responded to comments regarding the issue of 
how to allocate price concessions across drugs that are sold under 
bundling arrangements for purposes of calculating the ASP. We did not 
establish a specific methodology that manufacturers must use for the 
treatment of bundled price concessions for purposes of the ASP 
calculation in the CY 2007 PFS final rule with comment period. In the 
absence of specific guidance, we maintained existing guidance that 
manufacturers may make reasonable assumptions in its calculation of 
ASP, consistent with the general requirements and the intent of the 
Act, Federal regulations, and its customary business practices. Our 
intent in not being prescriptive in this area in the CY 2007 PFS final 
rule with comment period was to allow manufacturers the flexibility to 
adopt a methodology with regard to the treatment of bundled price 
concessions in the ASP calculation that, based on their particular 
circumstances, will best ensure the accuracy of the ASP calculation and 
not create inappropriate financial incentives. We also stated that we 
would be closely monitoring this issue and may provide more specific 
guidance in the future if we determine it is warranted. In addition, we 
encouraged stakeholders and the public to relay additional information 
or concerns to us on this issue. We specifically noted that MedPAC 
would be studying this issue, and that we looked forward to its work in 
this area.
    In its January 2007 Report to Congress, ``Impact of Changes in 
Medicare Payments for Part B Drugs'', MedPAC discusses the issue of how 
to allocate bundled price concessions for purposes of calculating the 
ASP, noting that ``some manufacturers offer provider discounts for one 
of their products contingent on purchases of one or more other 
products.'' The full report is posted on the MedPAC's Web site at 
(http://www.medpac.gov/publications/congressional_reports/Jan07_PartB_mandated_report.pdf). MedPAC's report illustrates the potential 
effects that certain methods for allocating bundled price concessions 
may have on Medicare payment rates, physicians' ability to choose a 
product based on clinical factors, and market availability of products. 
MedPAC notes that:

    Bundling arrangements take many forms. For example, some 
bundling arrangements may include only Part B drugs while others may 
include both Part B drugs and other products. Similarly, price 
concessions may be structured in numerous ways. For example, a 
discount on one or more drugs may be contingent on the purchase of 
other drugs or on meeting an aggregate expenditure target for a 
group of products. CMS's policy on reporting discounts may need to 
change over time to reflect changing market practices but that 
should not slow down action in this area. [MedPAC. 2007. Report to 
Congress: Impact of Changes in Medicare Payments for Part B Drugs. 
Washington, DC: MedPAC: page 8]

    In its report, MedPAC discusses two alternative approaches for 
allocating bundled price concessions. According to MedPAC, one option 
would be to require manufacturers to allocate bundled discounts in 
proportion to the sales of each drug sold under the bundled 
arrangement. For example, Drug A and Drug B are sold under a bundled 
arrangement and have a combined bundled discount equal to $200,000 on 
total sales of $1 million. If Drug A has sales of $600,000, the 
manufacturer would allocate 60 percent of the bundled discount to that 
drug when calculating ASP. Forty percent of the bundled discount would 
be allocated to Drug B. MedPAC states that this approach would parallel 
bundling requirements under Medicaid and would be simpler to 
administer. However, MedPAC notes that this method might not capture 
contingent discounts.
    The other approach discussed by MedPAC would be to require 
manufacturers to allocate bundled discounts to reflect the 
contingencies in the contract. That is, manufacturers would allocate 
any additional (or increased) discount to the sales of the drug (or 
drugs) that the discount is meant to increase. This approach would 
result in an ASP that more accurately reflects the transaction price of 
drugs when a discount for one drug or drugs is contingent in whole or 
in part on the purchase of another drug. For example, if a greater 
discount on the purchase price of Drug A is contingent on the purchase 
(or purchases) of Drug B, this additional discount would be allocated 
to sales of Drug B in the calculation of ASP.
    In its discussion of bundling, MedPAC states that the goal should 
be to ensure that ASP reflects the average transaction price for drugs. 
To that end, MedPAC recommends that the Secretary clarify the ASP 
reporting requirements for bundled products to ensure that ASP 
calculations allocate discounts to reflect the transaction price for 
each drug. Further, MedPAC states that we should ensure that the 
reporting requirements for allocating discounts are clear and that they 
can be implemented by manufacturers in a timely fashion.
    In the December 22, 2006 Medicaid Program: Prescription Drugs 
proposed rule (71 FR 77176), for purposes of calculating the average 
manufacturer price (AMP), we proposed that, the discounts associated 
with a bundled sale would be allocated proportionately according to the 
dollar value of the units of each drug sold under the bundled 
arrangement. For bundled sales where multiple drugs are discounted, the 
aggregate value of all the discounts would be proportionately allocated 
across all of the drugs in the bundle. For AMP purposes, a bundled sale 
would mean an arrangement regardless of physical packaging under which 
the rebate, discount, or other price concession is conditioned upon the 
purchase of the same drug or drugs of different types (that is, at the 
nine-digit NDC level) or some other performance requirement (for 
example, the achievement of market share, inclusion or tier placement 
on a formulary), or where the resulting discounts or other price 
concessions are greater than those which would have been available had 
the bundled drugs been purchased separately or outside of the bundled 
arrangement. In the December 22, 2006 Medicaid Program: Prescription 
Drugs proposed rule, we further proposed that the AMP should be 
adjusted for bundled sales by determining the total value of all the 
discounts on all drugs in the bundle and allocating those discounts 
proportionately to the respective AMP calculations. The aggregate 
discount is allocated proportionately to the dollar value of the units 
of each drug sold under the bundled arrangement. Where

[[Page 38151]]

discounts are offered on multiple products in a bundle, the aggregated 
value of all of the discounts should be proportionately allocated 
across all of the drugs in the bundle.
    We received many comments on the many aspects of the December 22, 
2006 Medicaid: Prescription Drugs proposed rule. However, our review of 
those comments and development of the final AMP calculation policies 
and rule are not complete, and therefore, we will respond to those 
comments in future rulemaking.
    In the CY 2007 PFS final rule with comment period, we stated that 
we may provide more specific guidance on bundled price concessions in 
the future if we determine it is warranted. In light of MedPAC's 
recommendation that we clarify the ASP reporting requirements for 
bundled products and our discussion of bundled price concessions in the 
CY 2007 PFS rulemaking, we believe specific guidance in the ASP context 
is warranted to provide for greater consistency in ASP reporting across 
manufacturers and enhancing the accuracy of the ASP payment system. We 
find MedPAC's suggestion to not defer further guidance in this area 
compelling with respect to the potential that manufacturers may make 
differing assumptions in the absence of specific guidance on how to 
allocate bundled price concessions in the context of ASP.
    As we noted in the CY 2007 PFS final rule with comment period, 
there is a potential for great variation in the structure of bundling 
arrangements and in the characteristics of drugs included in those 
arrangements. Thus, we believe that, in establishing a specific 
methodology for allocating bundled price concessions for purposes of 
calculating ASP, we should seek to balance the desirability of a 
consistent methodology across manufacturers' ASP calculations with the 
potential complexity that may be introduced by the designated approach. 
Our intention in proposing to adopt a specified approach for allocating 
bundled price concessions in the ASP context is to avoid greater 
computational complexity than necessary at this time primarily because 
it is unknown whether applicable data may be adequately known at 
quarterly reporting intervals for manufacturers to appropriately 
reflect the contingencies in purchasing contracts within their ASP 
calculations at the 11-digit NDC level.
    In addition, we believe that it is appropriate at this time to 
propose a specified method for treating bundled price concessions in 
the calculation of ASP which is consistent with our proposed approach 
for treating such discounts for purposes of the AMP calculation. 
Furthermore, because section 1847A(d) of the Act, as discussed 
elsewhere in this section, permits substitution of 103 percent of the 
AMP for the ASP-based payment limit in certain instances, we believe 
incorporating appropriate consistencies across the calculations of ASP 
and AMP, as allowable by statute, is rational. Although we are 
proceeding cautiously with such potential substitutions, we believe 
appropriate consistencies across the calculations of ASP and AMP will 
result in a lower potential for error and more accurate calculations of 
both prices.
    Although ASP and AMP serve similar, but not identical, purposes, 
differences between these calculations provide rationale for, and in 
some instances may require, minor differences between Medicaid and 
Medicare proposed regulations. For example, the Medicaid proposed rule 
proposes a definition of ``bundled sales'' whereas we believe ``bundled 
arrangement'' is more appropriate for purposes of the ASP context 
because, for ASP purposes, ``bundling'' is most applicable in the 
context of price concessions. Furthermore, based on our experience with 
manufacturers' ASP reporting, we believe other refinements are 
appropriate for purposes of ASP. We believe these differences are 
necessary to clarify certain aspects of a consistent approach for 
treatment of bundling, and will not result in significant policy 
differences on how bundling is addressed in the context of AMP and in 
the context of ASP.
    Therefore, for purposes of calculating the ASP (beginning with the 
reporting period for the first calendar quarter of 2008 and 
thereafter), we propose that the manufacturer must allocate the total 
value of all price concessions proportionately according to the dollar 
value of the units of each drug sold under a bundled arrangement to 
ensure that the ASP is adjusted for bundled arrangements as defined in 
the definition of bundled arrangement we are proposing at Sec.  
414.802. For bundled arrangement, where multiple drugs are discounted, 
the aggregate value of all the discounts would be proportionately 
allocated across all of the drugs sold under the bundled arrangement. 
We propose that a bundled arrangement, for ASP purposes, would mean an 
arrangement, regardless of physical packaging under which the rebate, 
discount, or other price concession is conditioned upon the purchase of 
the same drug or biological or other drugs or biologicals or some other 
performance requirement (for example, the achievement of market share, 
inclusion or tier placement on a formulary, purchasing patterns, prior 
purchases), or where the resulting discounts or other price concessions 
are greater than those that would have been available had the drugs or 
biologicals sold under the bundled arrangement been purchased 
separately or outside of the bundled arrangement. We propose to define 
bundled arrangement at Sec.  414.802, and to specify in proposed Sec.  
414.804(a)(2)(iii) that all price concessions on drugs sold under a 
bundled arrangement must be allocated proportionately to the dollar 
value of the units of each drug sold under the bundled arrangement.
    In making this proposal, we seek to establish a method for treating 
bundled price concessions for purposes of ASP that is consistent with 
the method proposed for AMP calculations while addressing existing 
program differences. We believe an overall consistent methodology for 
addressing bundling in both contexts will reduce the burden and the 
likelihood of errors for manufacturers calculating and reporting the 
ASP. We also believe that our proposed approach balances the need to 
provide clarification of how bundled price concessions are to be 
treated for purposes of calculating the ASP so that there is greater 
consistency across calculations of ASP with concerns that a more 
complex approach would present complicated implementation and 
monitoring challenges, as discussed by MedPAC and in our response to 
comments in the CY 2007 PFS final rule with comment period.
    As discussed previously in this section of the preamble, we propose 
to establish a method for the treatment of bundled price concessions 
that is appropriately consistent with proposed Medicaid policy for 
bundled sales, and we intend to remain consistent with the final policy 
adopted in the Medicaid final rule on this issue, as appropriate. 
However, we note that the final Medicaid AMP final rule is still under 
development, and the Medicaid policies on bundled sales may ultimately 
differ from our discussion of the topic in this section of the 
preamble. Because of the timing of the two proposed rules, the policy 
we ultimately adopt in this final rule may reflect the final Medicaid 
policy on bundled sales, but only to the extent that it is appropriate 
for ASP and the public has had the opportunity to comment on how the 
final Medicaid policy for bundled sales, if appropriately adopted for 
ASP purposes, would affect the calculation of ASP.

[[Page 38152]]

    We note that the comment period on the Medicaid proposed rule is 
closed. Therefore, comments received in response to this proposed rule 
on the topic of bundled sales for purposes of AMP will be considered 
untimely for the purposes of the Medicaid final rule and outside of the 
scope of this rulemaking.
    We are soliciting comments on our proposed approach for requiring 
manufacturers to allocate the total value of all price concessions on 
all drugs sold under a bundled arrangement proportionately according to 
the dollar value of the units of each drug sold under the bundled 
arrangement for purposes of the calculation of ASP, and on our proposal 
to specify the method for treatment of bundling in the ASP context that 
is appropriately consistent with the treatment of bundling in the AMP 
context. We are specifically soliciting comments on how our proposed 
approach for treatment of bundled price concessions for purposes of 
calculating ASP may impact the estimation of lagged price concessions, 
whether manufacturers believe additional guidance on this topic is 
needed, and the nature of the potential additional guidance. Further, 
we are soliciting comments on potential alternative approaches for the 
treatment of bundled price concessions that are appropriate for the 
calculation of ASP, including the alternative approach discussed by 
MedPAC in its recent report as noted previously in this section of the 
preamble. In addition, we seek comments on how our proposed approach or 
an alternative approach would result in clear reporting requirements 
for allocating discounts that can be implemented by manufacturers in a 
timely fashion.
c. Clotting Factor Furnishing Fee
    Section 303(e)(1) of the MMA added section 1842(o)(5) of the Act 
which requires the Secretary, beginning in CY 2005, to pay a furnishing 
fee, in an amount the Secretary determines to be appropriate, to 
hemophilia treatment centers and homecare companies for the items and 
services associated with the furnishing of blood clotting factor. 
Section 1842(o)(5)(C) of the Act specifies that the furnishing fee for 
clotting factor for CY 2006 and subsequent years will be equal to the 
fee for the previous year increased by the percentage increase in the 
consumer price index (CPI) for medical care for the 12-month period 
ending with June of the previous year. In the CY 2007 PFS final rule 
with comment period, we announced that the furnishing fee for CY 2007 
is $0.152 per unit clotting factor based on the percentage increase in 
the CPI of 4.1 percent for the 12-month period ending June 2006.
    The CPI data for the 12-month period ending in June 2007 is not yet 
available. In the CY 2008 PFS final rule with comment period, we will 
include the actual figure for the percent change in the CPI for medical 
care for the 12 month period ending June 2007, and the updated 
furnishing fee for CY 2008 calculated based on that figure.
    In the CY 2006 and CY 2007 PFS proposed and final rules, as well as 
in this proposed rule, we have included a discussion of the annual 
update of the blood clotting factor furnishing fee as specified in 
section 1842(o)(5)(C) of the Act. Because the update is based on the 
percentage increase in the CPI for medical care for the 12-month period 
ending with June of the previous year and the Bureau of Labor 
Statistics releases the applicable CPI data after our the proposed rule 
is published, we are not able to include the actual updated furnishing 
fee in the CY 2006 through CY 2008 proposed rules. Rather, we announced 
in these proposed rules that we intended to include the actual figure 
for the percent change in the applicable CPI, and the updated 
furnishing fee calculated based on that figure in the associated final 
rule. Given the timing of the availability of the applicable data and 
our timeframe for preparing proposed rules, this process is unavoidable 
and likely to remain unchanged in the future. We believe that including 
a discussion of the furnishing fee update in annual rulemaking does not 
provide an advantage over other means of announcing this information, 
so long as the current statutory update methodology continues in 
effect. We believe that the public's need for information and adequate 
notice regarding the updated furnishing fee can be better met by 
issuing program instructions which will eliminate the discussion of the 
furnishing fee update annually in rulemaking. In addition, by 
communicating the updated furnishing fee in program instruction, the 
actual figure for the percent change in the applicable CPI and the 
updated furnishing fee calculated based on that figure can be announced 
more timely than when included as part of the PFS final rulemaking 
process. Because the furnishing fee update process is statutorily 
determined and is based on an index which is not affected by 
administrative discretion or public comment, we do not believe a 
subregulatory means of communicating the update will adversely affect 
stakeholders or the public. Therefore, for CY 2009 and thereafter until 
such time as the update methodology may be modified, we propose to 
announce the blood clotting furnishing fee using applicable program 
instructions and posting on the CMS Web site. We are soliciting 
comments on our proposal to announce the updated furnishing fees via 
program instructions.
d. Widely Available Market Prices (WAMP) and AMP Threshold
    Section 1847A(d)(1) of the Act states that ``the Inspector General 
of HHS shall conduct studies, which may include surveys to determine 
the widely available market prices (WAMP) of drugs and biologicals to 
which this section applies, as the Inspector General, in consultation 
with the Secretary, determines to be appropriate.'' Section 1847A(d)(2) 
of the Act states that, ``Based upon such studies and other data for 
drugs and biologicals, the Inspector General shall compare the ASP 
under this section for drugs and biologicals with--
     The widely available market price (WAMP) for these drugs 
and biologicals (if any); and
     The AMP (as determined under section 1927(k)(1) of the Act 
for such drugs and biologicals.''
    Section 1847A(d)(3)(A) of the Act states that, ``The Secretary may 
disregard the ASP for a drug or biological that exceeds the WAMP or the 
AMP for such drug or biological by the applicable threshold percentage 
(as defined in subparagraph (B)).'' The applicable threshold is 
specified as 5 percent for CY 2005. For CY 2006 and subsequent years, 
section 1847A(d)(3)(B) of the Act establishes that the applicable 
threshold is ``the percentage applied under this subparagraph subject 
to such adjustment as the Secretary may specify for the WAMP or the 
AMP, or both.'' In CY 2006 and CY 2007, we specified an applicable 
threshold percentage of 5 percent for both the WAMP and AMP. We based 
this decision on the limited data available to support a change in the 
current threshold percentage.
    For CY 2008, we propose to specify an applicable threshold 
percentage of 5 percent for the WAMP and the AMP. At present, the OIG 
is continuing its comparison of both the WAMP and the AMP. Furthermore, 
information on how recent changes to the calculation of the AMP may 
affect the comparison of AMP to ASP is not available at this time. 
Since we do not have data that suggest another level is more 
appropriate at this time, we believe that continuing the 5 percent 
applicable threshold percentage

[[Page 38153]]

for both the WAMP and AMP is appropriate for CY 2008.
    As we noted in the CY 2007 PFS final rule with comment period (71 
FR 69680), we understand that there are complicated operational issues 
associated with potential payment substitutions. We will continue to 
proceed cautiously in this area and provide stakeholders, particularly 
manufacturers of drugs impacted by potential price substitutions with 
adequate notice of our intentions regarding such, including the 
opportunity to provide input with regard to the processes for 
substituting the WAMP or the AMP for the ASP. As part of our approach, 
we intend to develop a better understanding of the issues that may be 
related to certain drugs for which the WAMP and AMP may be lower than 
the ASP over time.
    We welcome comments on our proposal to continue the applicable 
threshold at 5 percent for both the WAMP and AMP for CY 2008.
2. Competitive Acquisition Program (CAP) Issues
    [If you choose to comment on issues in this section, please include 
the caption ``CAP ISSUES'' at the beginning of your comments.]
    In this section, we discuss the impact of new legislation on 
administrative and operational aspects of the CAP. Topics include the 
implementation of a post-payment review process and the corresponding 
changes to claims processing procedures. In subsequent subsections, we 
also seek comments regarding changes to other operational aspects of 
the CAP.
    This proposed rule will also be used to discuss comments related to 
transporting CAP drugs and the administrative burden of the CAP 
submitted in response to the Competitive Acquisition of Outpatient 
Drugs and Biologicals Under Part B; Interim Final Rule with Comment 
Period published in the July 6, 2005 Federal Register (hereinafter 
referred to as the July 6, 2005 IFC). We are addressing these comments 
in this proposed rule because we plan to ask for additional comments on 
these areas to explore areas that might be developed in future 
rulemaking efforts. In the upcoming PFS final rule with comment, we 
intend to finalize the portions of the July 6, 2005 IFC that were not 
finalized in the CY 2006 PFS final rule with comment period. We also 
will respond to the other timely comments we received on the July 6, 
2005 IFC that we have not responded to previously.
    This proposed rule implements conforming changes to the CAP 
regulations to reflect provisions of section 108 of the MIEA-TRHCA that 
made changes to the payment process of the CAP for Part B Drugs. 
Section 303(d) of the MMA required the implementation of a CAP for 
certain Medicare Part B drugs and biologicals not paid on a cost or PPS 
basis. The provisions for acquiring and billing drugs under the CAP 
were described in the Competitive Acquisition of Outpatient Drugs and 
Biologicals Under Part B proposed rule and July 6, 2005 IFC (70 FR 
10746 and 70 FR 39022, respectively), and certain provisions were 
finalized in the CY 2006 PFS final rule with comment period (70 FR 
70116). We specified a single CAP drug category to include a defined 
list of drugs furnished incident to a physician's service.
    The program began on July 1, 2006. At that time, physicians were 
given a choice between obtaining these drugs from vendors selected 
through a competitive bidding process and approved by CMS, or directly 
purchasing these drugs and being paid under the ASP system.
a. MMA Operational Provisions
    Prior to the enactment of the MIEA-TRHCA, section 1847B(a)(3)(A) of 
the Act set forth specific requirements that have a direct impact on 
the administrative and operational parameters for instituting a CAP. 
This section of the statute requires the following:
    (1) Approved CAP vendors bill the Medicare program for the drug or 
biological supplied, and collect any applicable deductibles and 
coinsurance from the Medicare beneficiary. (For purposes of the 
preamble, the term ``approved CAP vendor'' means the term 
``contractor'' as referred to in the statute.)
    (2) Any applicable deductible and coinsurance may not be collected 
unless the drug was administered to the beneficiary. (For purposes of 
the preamble, the term ``drug'' refers to drugs and biologicals 
furnished under the CAP, unless the context specifies otherwise.)
    (3) Medicare can make payments only to the approved CAP vendor, and 
these payments are conditioned upon the administration of the drug.
    Section 108 of the MIEA-TRHCA amended this third element.
b. MIEA-TRHCA
    Section 108 of the MIEA-TRHCA made changes to the CAP payment 
methodology. Section 108(a)(1) of the MIEA-TRHCA amended section 
1847B(a)(3)(A)(iii) of the Act by adding new language that requires 
that payment for drugs and biologicals shall be made upon receipt of a 
claim for a drug or biological supplied for administration to a 
beneficiary. This statutory change took effect on April 1, 2007.
    Section 108(a)(2) of the MIEA-TRHCA requires the Secretary to 
establish (by program instruction or otherwise) a post-payment review 
process (which may include the use of statistical sampling) to assure 
that payment is made for a drug or biological only if the drug or 
biological has been administered to a beneficiary. The Secretary shall 
recoup, offset, or collect any overpayments determined by the Secretary 
under this process.
    Section 108(b) of the MIEA-TRHCA states that nothing in this 
section shall be construed as requiring the conduct of any additional 
competition under section 1847B(b)(1) of the Act; or requiring an 
additional physician election process.
    Section 108(c) of the MIEA-TRHCA states that the amendments of this 
section apply to payments for drugs and biologicals supplied (1) on or 
after April 1, 2007, and (2) on or after July 1, 2006 and before April 
1, 2007, for claims that are unpaid as of April 1, 2007.
c. CAP Claims Processing
    In the July 6, 2005 IFC (70 FR 39042), we initially implemented a 
claims processing system that enables selected approved CAP vendors to 
bill the Medicare program directly, and to bill the Medicare 
beneficiary and his or her third party payer after verification that 
the physician has administered the drug. When a participating CAP 
physician elects to join the program, he or she must agree to obtain 
all drugs on the CAP list from the approved CAP vendor, with only a few 
exceptions. For example in furnish as written (FAW) situations (that 
is, where a beneficiary needs a particular formulation of a drug not 
available from the approved CAP vendor) the participating CAP physician 
would be allowed to obtain that drug outside of the CAP. In the case of 
Medicare Secondary Payer (MSP) (that is, where a Medicare beneficiary 
may have another payer primary to Medicare), the participating CAP 
physicians must obtain physician administered drugs from entities 
approved by the primary plan and bill the primary payer. Detailed MSP 
instructions have been issued by CMS that allow payment to the 
physician under the ASP methodology in this situation.
    Claims processing procedures for the approved CAP vendor and the 
participating CAP physician, which

[[Page 38154]]

remain largely unchanged under the new statutory provision, are as 
follows: Once a shipment is received from the approved CAP vendor, the 
participating CAP physician stores the drug until the date of drug 
administration. When the drug is administered to the beneficiary, the 
participating CAP physician places the prescription order number for 
each drug administered on the claim form submitted to his or her 
regular Part B carrier. Similarly, when the approved CAP vendor bills 
Medicare for the drug it shipped to the participating CAP physician, it 
places the relevant prescription order number on the claim form 
submitted to the designated carrier. The use of the prescription order 
number on both the participating CAP physician's claim and the approved 
CAP vendor's claim is intended to verify drug administration to the 
beneficiary. The participating CAP physician's claim and the approved 
CAP vendor's claim are matched in the Medicare claims processing system 
so that drug administration can be verified and payment to the approved 
CAP vendor can be made.
d. Required Changes to CAP Claims Processing
    As originally implemented, the claims matching process described 
above was completed before payment was made. However, as of April 1, 
2007, section 108 of the MIEA-TRHCA requires payment to be made to the 
CAP vendor for claims upon receipt. The statute also requires us to 
establish a post-payment review process to assure that payment is made 
for a drug only if the drug has been administered to a beneficiary. We 
are also charged with recouping, offsetting, or collecting any 
overpayments found. The statute also authorizes us to conduct post-
payment review using statistical sampling and to implement the post-
payment review process by program instruction or otherwise. We 
implemented the necessary changes to our claims processing system and 
initiated the post-payment review process on April 1, 2007 via 
instructions to the CAP designated claims processing contractor and 
questions and answers posted on the CMS competitive bidding Web site at 
http://www.cms.hhs.gov/CompetitiveAcquisforBios/15_Approved_Vendor.asp#TopOfPage.
    The post-payment review process uses statistical sampling to 
determine whether drugs were administered and if they were medically 
necessary. All Medicare claims are subject to medical necessity 
determinations; however, under the changes required by the MIEA-TRHCA, 
CAP claims may not all be reviewed for medical necessity before they 
are paid. Therefore, the post-payment review includes verification of 
drug administration and a medical necessity review of a statistically 
valid sample of CAP claims. We note that in conducting the post-payment 
review, we will continue to monitor for fraud, waste, and abuse. All 
CAP transactions will remain eligible for review for medical necessity 
and verification of administration. We also anticipate that the post-
payment review process will provide CMS with additional opportunities 
to monitor for the appropriate payment of drugs furnished under this 
program.
    As part of the post-payment review process, the CAP-designated 
carrier will use the CMS claims processing system to look for a match 
between the CAP prescription order number on the participating CAP 
physician's claim and the same prescription order number on the 
approved CAP vendor's claim to track drug administration on a dose-by-
dose basis. If the CAP designated carrier is able to find a match 
between the two claims, this assists the carrier in determining that 
the beneficiary did receive the drug being billed for. The 
participating CAP physician claim may also contain information on any 
determination of medical necessity and coverage made by the local 
carrier.
    To conduct post-payment review of claims, we may also ask for 
documentation of administration from the approved CAP vendor and for 
medical records from the participating CAP physician for any claim that 
is identified for review. While it is standard practice for Medicare 
providers to be required to submit medical records to assist in claims 
review, we reserve the right to also specifically request any other 
records that verify the administration of a CAP drug. Furthermore, we 
want to make it very clear to the participating CAP physician at the 
time he or she elects to join the program that he or she may be asked 
to supply medical records for post-payment review. Therefore, we are 
proposing to revise Sec.  414.908(a)(3)(xi) and the physician election 
agreement form to make clear that medical records and certain 
information may be requested from CAP physician during the post-payment 
review process. The procedures being used to verify valid claims and 
ensure proper payment for drugs supplied under the CAP are based on 
established post-payment review processes used in other parts of the 
Medicare program. The request for medical records as part of the claims 
payment process during CAP post-payment review is intended to work in 
conjunction with Item 12 on the Health Insurance Claim Form CMS-1500 
which, when signed by a beneficiary, authorizes the release of ``any 
medical information necessary to process a claim.''
    When a claim is selected for review we notify the approved CAP 
vendor and request its records to verify administration. We also notify 
the approved CAP vendor that we will be requesting medical records from 
the participating CAP physician and ask for his or her help in 
obtaining them. If the medical record is not received within 30 days, 
the claim is denied because we will not have sufficient information to 
verify drug administration and medical necessity. This review process 
is similar to those used elsewhere in the Medicare program such as 
clinical laboratory payment review or payment of radiology services. It 
is also consistent with our practice in reviewing claims for 
postoperative treatment. For example, if post-operative services have 
been provided by two physicians, and payment was denied to one 
physician, and that physician appeals, the Medicare contractor may 
request medical records from the other physician that treated the 
beneficiary to document that there was no overlap in the services 
provided by each physician. If the contractor does not receive the 
medical record of the other physician within a specified amount of time 
the appeal would be denied because there was no way to document the 
services provided. A similar process is used when durable medical 
equipment (DME) is provided through third party suppliers. In these 
cases, the physician ordering the DME is required to provide the 
suppler medical records to support the necessity of the equipment he or 
she ordered. If the supplier does not obtain the records, then payment 
is denied.
    As we specified in the CAP IFC (70 FR 39038), the local carrier's 
medical review policies and coverage determinations will continue to 
apply in the CAP. Under our previous claims processing methodology the 
local carrier made the coverage determination on the drug ordered by 
the participating CAP physician and provided by the approved CAP vendor 
as part of the claim matching process prior to payment of the approved 
CAP vendor's claim. Under the new methodology, the drug claim will be 
paid upon receipt unless the local carrier has already made a coverage 
or medical necessity determination on the drug, and the match has 
already occurred showing that the drug claim should be denied. As part 
of the post-payment review process, the CAP designated carrier will

[[Page 38155]]

check the CMS central claims processing system to determine whether the 
local carrier has made a coverage or medical necessity determination on 
the CAP drug indicated on the participating CAP physician's drug 
administration claim. If so, the CAP designated carrier will reflect 
this decision in its post-payment review of the claim. If the local 
carrier has not reviewed the drug administration portion of the 
participating CAP physician's claim as of the date that the designated 
carrier processes the approved CAP vendor's drug claim, the CAP 
designated carrier will use the local carrier's coverage determination 
policies when conducting medical review of the claim.
e. Provisions for Collection of Beneficiary Coinsurance
    In the CY 2006 PFS final rule with comment period, we specified 
Sec.  414.914(h)(1) that subsequent to receipt of final payment by 
Medicare, or the verification of drug administration by the 
participating CAP physician, the approved CAP vendor must bill any 
applicable supplemental insurance policies. If a balance remains after 
the supplemental insurer pays their share of the bill, or if there is 
no supplemental insurance, the approved CAP vendor may bill the 
beneficiary for the balance. In prior practice, a match in the claims 
system between the participating CAP physician's drug administration 
claim and the approved CAP vendor's drug claim and the subsequent 
payment by Medicare was used to indicate that the beneficiary received 
the drug. We also allowed voluntary information exchanges between the 
approved CAP vendor and the participating CAP physician's office have 
also been used to verify CAP drug administration. Additionally, we note 
that under the CAP regulations, the participating CAP physician has a 
responsibility to notify the approved CAP vendor when a drug is not 
administered or a smaller amount was administered than was originally 
ordered.
    Because section 108 of the MIEA-TRHCA requires the payment of CAP 
claims upon receipt, payment of a claim by Medicare may occur before 
administration of the drug has been verified. However, section 
1847B(a)(3)(A)(ii) of the Act, which states that deductible and 
coinsurance shall not be collected unless the drug or biological is 
administered, remains unchanged. Thus, because we have interpreted this 
provision as requiring verification of administration prior to the 
collection of applicable cost sharing amounts, the requirement for 
verification of administration similarly remains unchanged. However, 
because of the statutory change of section 108(a)(1) of the MIEA-TRHCA 
and its resulting impact on our claims processing methodology, the 
claims processing system no longer provides a way for CMS to verify 
administration on the approved CAP vendor's behalf before the approved 
CAP vendor collects coinsurance from the beneficiary or the 
supplemental insurer. Verification of CAP drug administration is also 
conducted in the post-payment review process. The approved CAP vendor 
is expected to make information available to verify administration for 
post-payment review as necessary.
    We believe that an approved CAP vendor can verify whether a CAP 
drug was administered in a variety of ways. For example, an approved 
CAP vendor may enter into a voluntary agreement with a participating 
CAP physician to exchange such information as described in the CY 2006 
PFS final rule with comment period (70 FR 70251). However, if a 
participating CAP physician is unwilling to enter into a voluntary 
agreement to verify administration, the approved CAP vendor may verify 
that the drug was administered by contacting the participating CAP 
physician's office to request verbal confirmation. In such an instance, 
the approved CAP vendor is expected to document the verbal confirmation 
of CAP drug administration, the identities of individuals who exchanged 
the information and the date and time that the information was 
obtained. In addition to verifying administration through contact with 
the physician's office, we also suggest that the approved CAP vendor 
place a statement on beneficiaries' bills informing them of the 
statutory requirement and suggesting that they contact their 
participating CAP physician to verify that they received the dose of 
the drug for which they are being billed prior to paying any cost 
sharing amount.
    For the reasons described above in this section, we believe that 
the verification of CAP drug administration remains a required element 
of the CAP and we are proposing to clarify Sec.  414.906(a)(6) by 
specifying that all of the following elements shall be required to 
document the verification of CAP drug administration:
     Beneficiary's name.
     Health insurance number.
     Expected date of administration.
     Actual date of administration.
     Identity of the participating CAP physician.
     Prescription order number.
     Identity of the individuals who supply and receive the 
information.
     Dosage supplied.
     Dosage administered.
    Also, as a result of changes mandated by section 108(a)(1) of the 
MIEA-TRHCA, we propose to revise Sec.  414.914(h)(1) to remove the 
reference to ``final payment by Medicare'' and revise this language to 
state, ``payment by Medicare.'' The original language was written to 
indicate that an approved CAP vendor could not bill a beneficiary's 
supplemental insurer for applicable amounts of cost sharing until the 
CAP drug claim had matched the corresponding physician's drug 
administration claim. Under the post-payment review process, the final 
payment would not occur until a statistical review of the claims was 
complete, a process that may take several months. Removing the word 
final from this section of the regulation will clarify that the 
approved CAP vendor may bill the supplemental insurer immediately after 
the designated CAP carrier makes the initial payment on a CAP drug 
claim. Under our current regulations, the approved CAP vendor may also 
bill the beneficiary if drug administration is verified by the 
participating CAP physician. This provision remains unchanged.
    Under the revised CAP claims payment process, the approved CAP 
vendor will bill Medicare for the CAP drug that has been provided. In 
most cases Medicare will pay the claim upon receipt. If the beneficiary 
has a supplemental insurance policy, and the supplemental insurer has a 
crossover agreement with Medicare, the claim automatically will cross 
over to the supplemental insurer for payment. The supplemental insurer 
will pay its share. Upon receipt of payment from the supplemental 
insurer the approved CAP vendor may bill the beneficiary for any 
residual amount. For beneficiaries who do not have a supplemental 
insurance policy, the approved CAP vendor may bill the beneficiary 
after payment by Medicare.
    However, in either case, the approved CAP vendor may not collect 
any coinsurance owed from the beneficiary or his or her supplemental 
insurer unless it has verified that the drug was administered. If the 
approved CAP vendor believes that the drug was administered but later 
learns that it was not, the approved CAP vendor must refund any 
coinsurance collected to the beneficiary and his or her supplemental 
insurer, as applicable. In addition, in Sec.  414.914(i)(2), we are 
proposing that the approved CAP vendor must promptly refund any payment 
made by

[[Page 38156]]

CMS if the vendor has been paid for drugs that were not administered. 
We are proposing that promptly is defined as 2 weeks so that the 
approved CAP vendor would have 2 weeks from the date that they were 
notified that they had been paid for a drug that had not been 
administered to the beneficiary to refund any payment for the claim 
made to the designated carrier and refund any cost sharing collected to 
the beneficiary and his or her supplemental insurer.
f. Approved CAP Vendor Appeals for Denied Drug Claims
    In the March 4, 2005 proposed rule (70 FR 10757 through 10758) and 
the July 6, 2005 IFC (70 FR 39054 through 39057), we discussed the 
development of the CAP dispute resolution process and the limited 
applicability of the traditional Medicare fee for service appeals 
process to an approved CAP vendor's dispute of CAP drugs claims that 
are denied by the CAP designated carrier. We stated that the approved 
CAP vendor could file appeals as a Medicare supplier consistent with 
the rules at 42 CFR Part 405, Subpart I. For the purposes of the 
appeals regulations at Part 405, Subpart I, we indicated that a local 
carrier's initial determination of the participating CAP physician's 
drug administration claim was an initial determination regarding 
payment of the approved CAP vendor's drug claim. Thus, the approved CAP 
vendor was to be considered a party to any redetermination of the drug 
administration claim by the local carrier. In addition, the approved 
CAP vendor would be considered a party to an initial determination on 
the claim for payment for the drug product the approved CAP vendor 
filed with the designated carrier. We also specified that appeals of 
either initial determination would be filed with the local carrier. We 
stated that the local carrier, rather than the designated carrier, 
possessed all information necessary to adjudicate an appeal in this 
situation. Such information included local coverage decisions, medical 
necessity determinations, and information regarding payment of drug 
administration claims. A dispute resolution process was set forth in 
Sec.  414.916.
    Under our initial implementation of the provision that authorized 
CAP, this alternative approach, which provided party status to the 
approved CAP vendor on the participating CAP physician's drug 
administration claim, was necessary because an approved CAP vendor was 
not permitted to receive payment for a CAP drug until the corresponding 
drug administration claim was submitted by a participating CAP 
physician, the approved CAP vendor's claim and the participating CAP 
physician's claim were matched in the system and the approved CAP 
vendor's claim was authorized for payment.
    However, changes to the claims processing requirements and the 
addition of a post-payment review process required by section 108(a)(2) 
of the MIEA-TRHCA (discussed above in this section) eliminates the 
approved CAP vendor's dependency on a participating CAP physician's 
filing of a drug administration claim before the approved CAP vendor 
may be paid for a CAP drug. Accordingly, there is no longer a need to 
afford party status to the approved CAP vendor for the drug 
administration claim submitted by the participating CAP physician. 
Instead, under the TRHCA legislation, the approved CAP vendor's drug 
claim may be paid by the designated carrier once received. This 
determination made on the claim constitutes an initial determination as 
defined in Sec.  405.924. The approved CAP vendor is considered a party 
to this initial determination, and thus, may request a redetermination 
and subsequent appeals consistent with the process established under 42 
CFR Part 405, Subpart I.
    The changes proposed to CAP claims processing in this proposed rule 
that conform to the TRHCA legislation result in two scenarios that 
create appeals rights for the approved CAP vendor with respect to their 
drug product claim: (1) Prepayment denials of the approved CAP vendor's 
claim made by the designated carrier (based on information from the 
local carrier that the payment for the drug should be denied as 
excluded or non-covered); and (2) post-payment denials by the 
designated carrier based on the post-payment review process established 
under TRHCA.
    Therefore, we are proposing the following clarifications regarding 
the CAP appeals process for an approved CAP vendor's denied drug 
claims:
     For prepayment denials, the approved CAP vendor, as a 
supplier, has a direct right to appeal the initial determination made 
by the designated carrier on its drug product claim. The local carrier 
will conduct the redetermination on prepayment denials. We acknowledge 
that this process differs from a traditional fee-for-service appeal 
since the redetermination will not be conducted by the contractor that 
issued the initial determination. However, we believe the local carrier 
is the most appropriate entity to review the prepayment denial since it 
is most familiar with the relevant coverage policies for that 
jurisdiction.
     For the postpayment review process, if the designated 
carrier selects the drug claim for review, this constitutes a reopening 
of the initial determination. If the designated carrier cannot verify 
administration or cannot determine that the drug is covered or 
medically reasonable and necessary, the designated carrier issues a 
revised determination to deny coverage of the drug product claim. The 
designated carrier then determines whether an overpayment exists, and 
if so, seeks recovery of the overpayment. The approved CAP vendor, as a 
supplier, would then have the right to request a redetermination of the 
revised coverage determination, and the overpayment assessment. The 
designated carrier will process the redetermination.
g. Definition of Exigent Circumstances
    Sections 1847B(a)(1)(A)(ii) and 1847B(a)(5)(A)(ii) of the Act 
require that each physician be given the opportunity annually to elect 
to obtain drugs and biologicals through the CAP and to select an 
approved CAP vendor. Section 1847B(a)(5)(A)(i) of the Act allows for 
selection of another approved CAP vendor more frequently than annually 
in exigent circumstances as defined by CMS.
    In the CY 2006 PFS final rule with comment period (70 FR 70258), we 
stated that participating CAP physicians would have the option of 
changing approved CAP vendors or opting out of the CAP program on an 
annual basis. We also provided the circumstances, as specified in Sec.  
414.908(a)(2), under which a participating CAP physician may choose a 
different approved CAP vendor mid-year or opt-out of the CAP. These 
circumstances are: (1) If the selected approved CAP vendor ceases to 
participate in the CAP; (2) if the participating CAP physician leaves 
the group practice that had selected the approved CAP vendor; (3) if 
the participating CAP physician relocates to another competitive 
acquisition area (if multiple CAP competitive areas are developed) or, 
(4) for other exigent circumstances defined by CMS. We also identified 
a separate exigent circumstance relating to instances in which an 
approved CAP vendor declines to ship CAP drugs (when the conditions of 
Sec.  414.914(h) are met) in Sec.  414.908(a)(5). We noted that in all 
these cases, while there is only one drug category for CAP, the 
participating CAP physician would be allowed to opt-out of the CAP 
altogether.
    The CAP became operational on July 1, 2006. Since that time, we 
have been

[[Page 38157]]

contacted by a few participating CAP physicians requesting that they be 
permitted to cancel their election agreement. Some of these requests 
have come from physician practices that misunderstood the program but 
found the program structure workable after further education about the 
CAP. Other requests have come from participating CAP physicians who 
identified significant concerns within the first few weeks of their 
participation that could not be resolved through provider education. 
When we initially implemented the CAP, we believed that most issues 
raised by participating CAP physicians would relate to quality and 
service issues that could be resolved through the approved CAP vendor's 
grievance process and the dispute resolution process conducted by the 
designated carrier. However, our experience with the initial operation 
of the CAP has demonstrated that there may be other business reasons a 
practice might wish to leave the program that are unrelated to the 
approved CAP vendor's performance. Examples of these include a 
demonstration of financial hardship due to participation in the CAP, 
the practice's inability to update its billing system despite a good 
faith effort, or that the practice relied on misleading information 
about the program from outside sources when making the decision to 
participate. Therefore, while we continue to believe that opportunities 
for leaving the CAP outside the annual election process should be 
limited because the CAP was designed as a program that physicians would 
make a decision to participate in on an annual basis, consistent with 
section 1847B(a)(5)(A) of the Act, we are proposing to define an 
additional exigent circumstance for opting out of the CAP. Under this 
proposed exigent circumstances exception, a participating CAP physician 
would be able to submit a written request to terminate his or her CAP 
physician election agreement within 30 days of its effective date, and 
CMS would grant such a request if the participating CAP physician could 
demonstrate that remaining in the CAP would be a significant burden.
    The participating CAP physician would be required to submit a 
written request to terminate his or her participation in the CAP, along 
with a reason for the request to leave the CAP, within 30 days of the 
effective date of the election agreement. Examples of a significant 
burden include, but are not limited to the following: A demonstration 
of financial hardship due to participation in the CAP, the practice's 
inability to update its billing system despite a good faith effort, or 
that the practice relied on misleading information about the program 
from outside sources when making the decision to participate and has 
proof of receiving such information. The request would be sent to the 
CAP-designated carrier under the dispute resolution process, and within 
1 business day the designated carrier would determine whether the 
request was related to the service provided by the approved CAP vendor. 
If so, the CAP designated carrier would refer the participating CAP 
physician to his or her approved CAP vendor's grievance process to 
further determine whether any appropriate and reasonable steps could be 
taken to resolve the issue the participating CAP physician had 
identified. The approved CAP vendor would have 2 business days to 
respond to the participating CAP physician's concern, consistent with 
our regulations at Sec.  414.914(f)(5). If the approved CAP vendor was 
unable to identify a solution, consistent with the CAP statute, 
regulations, contracts and guidance, and acceptable to the physician, 
for resolving the issue, the participating CAP physician would be 
referred back to the CAP designated carrier for assistance under the 
dispute resolution process.
    We propose that the participating CAP physician's request would be 
handled under the dispute resolution process because procedures and 
defined time frames for handling participating CAP physician and 
approved CAP vendor complaints are already developed under the CAP 
dispute resolution process. If the designated carrier did not believe 
the participating CAP physician's request was related to an issue that 
could be resolved by the approved CAP vendor, then the designated 
carrier would seek to resolve any other issues raised by the physician 
in the request to terminate CAP participation. The designated carrier 
would conduct an investigation into the physician's request to 
terminate his or her CAP election agreement and attempt to resolve any 
issues. If the designated carrier is unable to resolve the situation to 
the physician's satisfaction, within 2 business days, the designated 
carrier can either make a recommendation to CMS that the physician be 
permitted to terminate his or her CAP election agreement or request a 
2-day extension to continue an attempt to resolve the issue. We believe 
that 4 business days would be sufficient to conclude this process 
because it would give the carrier time to gather information from other 
affected parties, such as the participating CAP physician's carrier, 
but still prepare a speedy summary of the issues involved in the 
physician's request. After the 2-day or 4-day period, as applicable, 
the designated carrier would forward the physician's request, along 
with its recommendation, to CMS. We would then review the 
recommendation and make a final decision within 2 business days of the 
date we received the request.
    If we agree that the participating CAP physician has demonstrated 
that remaining in the CAP is a significant burden, we would allow that 
physician to terminate his or her participation in the program. We 
would inform the CAP-designated carrier of its decision and the 
decision would be communicated to the participating CAP physician in 
writing by the designated carrier. As part of this process, the 
physician's termination date for his or her CAP election agreement 
would be determined and communicated to the all parties involved, 
including the physician's local carrier. If we do not believe that the 
physician has demonstrated a significant burden, we would not allow the 
physician to terminate his or her participation in the CAP. We would 
inform the physician of such a decision and would include a 
recommendation for corrective action (such as education), and the right 
to request reconsideration as specified in Sec.  414.917.
    If we agree to terminate the participating CAP physician's CAP 
election agreement, the physician would be required to continue to 
cooperate in any post-payment review and appeals of claims for drugs 
that the approved CAP vendor had already provided to the physician and 
been paid for. The physician would also have to make arrangements with 
the approved CAP vendor for the return of any unused drugs that had not 
been administered to the beneficiary prior to the effective date of the 
physician's termination from the CAP. If the approved CAP vendor has 
inadvertently billed CMS for drugs that had not been administered to a 
beneficiary, the vendor would be required to correct the claim and 
return any overpayment.
h. Transporting CAP drugs
    Although section 1847B((b)(4)(E) of the Act provides for the 
shipment of CAP drugs to settings other than a participating CAP 
physician's office under certain conditions, we did not propose to 
implement the CAP in alternative settings. In the July 6, 2005 IFC, we 
described both comments that supported the idea of allowing 
participating CAP physicians to transport drugs to multiple office 
locations and comments that raised

[[Page 38158]]

concerns about the risk of damaging a drug that has not been kept under 
appropriate conditions while being transported.
    As stated in Sec.  414.906(a)(4), we implemented the CAP with a 
restriction that CAP drugs should be shipped directly to the location 
where they will be administered. However, we were aware that physicians 
may desire to administer drugs in alternative settings, especially in a 
home. We sought comment on how this could be accommodated under the CAP 
in a way that addresses the concerns about product integrity and damage 
to the approved CAP vendors' property expressed by the potential 
vendors.
    Several comments submitted in response to the July 6, 2005 IFC 
suggested either narrowing or removing the restriction on transporting 
drugs to other locations. Commenters believed that physicians were 
knowledgeable about drug stability and handling, and therefore, were 
capable of assuming this responsibility. Other commenters pointed out 
that transporting the drug to another office location may allow for 
flexibility in scheduling patient visits. It would allow practices with 
satellite operations that are not open every business day to receive 
shipments of CAP drugs at another practice location and then to 
administer the drugs in the satellite office.
    These comments and our experience with the CAP thus far, have 
caused us to consider changing our position. Therefore in this proposed 
rule, we are seeking comment on the potential feasibility of narrowing 
the restriction on transporting CAP drugs where this is permitted by 
State law and other applicable laws and regulations. We are asking 
commenters to consider how such a policy could be constructed so that 
the approved CAP vendor could retain control over how drugs that it 
owns are handled (we remind commenters that CAP drugs are the approved 
CAP vendor's property until they have been administered). We welcome 
comments on other issues that we should take into account as we 
consider the possibility of future changes to the regulation so that 
CAP drugs may be transported from one approved CAP physician's practice 
location to another office location that is listed on the physician's 
CAP election agreement form. We also welcome comments on how to 
structure requirements so that drugs are not subjected to conditions 
that will jeopardize their integrity, stability or sterility while 
being transported and steps to keep transportation activities 
consistent with all applicable laws and regulations. We are also 
seeking comments on whether any agreement allowing participating CAP 
physicians to transport CAP drugs to alternate practice locations 
should be voluntary, meaning that approved CAP vendors would not be 
required to offer such an agreement and physicians who participate in 
the CAP would not be required to accept such an offer. Finally, we are 
seeking comments on whether the agreement should be documented in 
writing, and whether it is necessary to create any restrictions on 
which CAP drugs could be transported. Again, we remind potential 
commenters that we are not making a specific proposal at this time, but 
we will use any information we receive to structure a future proposal, 
in the event we make one.
i. Alternatives to the CAP Prescription Order Number
    We received a number of comments that we responded to in the July 
6, 2005 IFC (70 FR 39043 and 39049,) about the administrative burden 
that the CAP ordering and claims payment process imposes upon 
participating CAP physicians; specifically, activities associated with 
using and tracking the prescription order number were mentioned. In 
response to the IFC, we have received additional comments on this 
issue. After the close of the comment period we also received an 
inquiry from the current approved CAP vendor about the potential length 
of the CAP prescription order number and whether it could present a 
burden to participating CAP physicians. A 30-byte field is currently 
available on the electronic claim form for prescription numbers; 
however, it is not necessary for the prescription order number to be 30 
bytes long. To meet national electronic standards for the automated 
transfer of certain health care data mandated by the Health Insurance 
Portability and Accountability Act of 1996 (Pub. L. 104-191) (HIPAA), 
Medicare claims that are submitted electronically must use a specific 
data format. Within this framework, the CAP prescription order number 
is captured in Loop 2410, REF02 (REF01=XZ) of the ANSI 4010A1 
electronic claims transaction. This segment is designed to capture the 
assigned prescription number. The requirements for developing the CAP 
prescription order number are as follows: the first 9 characters are 
the approved CAP vendor's ID and the HCPCS code of the drug that is 
being billed for; the approved CAP vendor sets the remaining 
characters. Typically, 15 or fewer total characters have been used by 
the approved CAP vendor.
    Each prescription order number is unique to a dose of a CAP drug 
that is being shipped for administration to a particular beneficiary. 
The approved CAP vendor is responsible for generating the prescription 
order number, and as stated in the July 6, 2005 IFC (70 FR 39042), each 
dose of a CAP drug is required to have a separate prescription order 
number to facilitate claim matching and approved CAP vendor payment. 
Although the CAP prescription order number on the approved CAP vendor's 
claim is no longer matched to the prescription order number on the 
participating CAP physician's claim prior to claims payment, the 
prescription order is still used to track each dose of a drug that is 
shipped by the approved CAP vendor to the participating CAP physician 
and administered to the beneficiary. Prior to paying the approved CAP 
vendor's claim for a drug the CAP designated carrier uses the 
prescription order number to check the claims processing system to 
ascertain whether the local carrier has adjudicated the drug 
administration claim. If so, the CAP designated carrier will look to 
see whether the local carrier determined that the CAP drug administered 
by the participating CAP physician is covered and is medically 
necessary. If the participating CAP physician's local carrier has not 
made a determination on the physician's claim and the CAP drug claim, 
the designated carrier will pay the approved CAP vendor's claim upon 
receipt and use the CAP prescription order number to help verify drug 
administration on a post-payment basis.
    The prescription order number accompanies each dose of drug that is 
sent to a participating CAP physician. After the drug is administered, 
the participating CAP physician's drug administration claim is 
submitted with a no-pay line containing the prescription order number. 
The approved CAP vendor's claim for the CAP drug also contains the 
prescription order number.
    Under the claims matching system used when the CAP was implemented, 
the prescription order number was used to match an approved CAP 
vendor's CAP drug claim to the participating CAP physician's drug 
administration claim in the claims processing system prior to payment. 
The presence of a drug administration claim with a matching 
prescription order number indicated that the drug on the corresponding 
approved CAP vendor's claim had been administered and a successful 
match

[[Page 38159]]

allowed the approved CAP vendor to be paid for that claim.
    At this time, section 108(a)(2) of the MIEA-TRHCA requires us to 
make payment upon receipt of an approved CAP vendor's drug claim and 
then to conduct a post-payment review of claims. As stated in the MIEA-
TRHCA, the post-payment review process is intended to ``assure that 
payment is made only for a drug or biological * * * if the drug or 
biological has been administered to a beneficiary.'' Under this new 
process, the prescription order number is still used to establish that 
the drug that is being billed for by the approved CAP vendor has been 
administered by the participating CAP physician and that the vendor's 
claim is payable. Situations such as the frequency of recurring cyclic 
drug treatment regimens, the possibility of temporary interruption to 
these regimens, and the lack of agreement between the approved CAP 
vendor's anticipated day of service and the actual date that the drug 
is administered make the use of an aid to assist accurate tracking of 
CAP drugs desirable. We believe that the prescription order remains an 
appropriate and necessary tool to track the administration of a 
specific dose of a drug and for the accurate execution of the post-
payment review process.
    Although we believe that the use of the prescription order number 
is necessary to facilitate accurate review of CAP claims, we are aware 
that it may be considered an inconvenience by some potential CAP-
participating physicians and approved CAP vendors. Therefore, we are 
seeking comment on alternative methods that could be used to accurately 
track the administration of specific doses of drugs in order to meet 
the requirements stated in section 108(a)(2) of the MIEA-TRHCA. We are 
not proposing to implement such a change at this time, but would like 
to receive comments on other methods that could be used to track CAP 
drug administration on a dose by dose basis. We may propose a change in 
future rulemaking.
j. Prefilled Syringes
    In the July 6, 2005 IFC (70 FR 39061), we described public comments 
that stated that participating CAP physicians could not vouch for the 
quality of products that were opened by an approved CAP vendor for 
repackaging, for mixing the drug with other drugs or injectable fluids 
(admixture), or for removing a part of the contents to supply the exact 
dose for a beneficiary. Several commenters recommended that approved 
CAP vendors deliver their products in the same form in which they are 
received from the manufacturer, without opening packaging or 
containers, mixing or reconstituting vials, or repackaging. 
Specifically, the commenters were concerned about the capabilities of 
individuals who mix the drug, as well as shipping conditions, storage, 
and stability.
    We responded by stating that the CAP is not intended to require 
approved CAP vendors to perform pharmacy admixture services, (for 
example, to furnish reconstituted or otherwise mixed drugs repackaged 
in IV bags, syringes, or other containers that are ready to be 
administered to a patient) when furnishing CAP drugs. Admixture 
services for injectable drugs require specialized staff, training, and 
equipment, and these services are subject to standards such as United 
States Pharmacopoeia Chapter 797, Pharmaceutical Compounding--Sterile 
Preparations. These requirements have significant impact on drug 
shipping, storage, and stability requirements, as well as system cost 
and complexity. As stated in Sec.  414.906(a)(4), the approved CAP 
vendor must deliver ``CAP drugs directly to the participating CAP 
physician in unopened vials or other original containers as supplied by 
the manufacturer or from a distributor that has acquired the products 
directly from the manufacturer.''
    Since issuing the July 6, 2005 IFC, we have become aware that 
bevacizumab (Avastin[supreg]) is being used for the treatment of 
exudative age-related macular degeneration (wet AMD) in very small 
doses. Although this is an off-label use, it is gaining acceptance 
among ophthalmologists who treat wet AMD and this use has been the 
subject of several carriers' local coverage determinations. Bevacizumab 
is considerably less expensive than certain other drugs used in the 
treatment of wet AMD.
    The smallest commercially available package of bevacizumab is a 
100mg single use vial, while a dose used to treat wet AMD is 
approximately 1mg. Some local carriers who have issued coverage 
instructions for the use of bevacizumab in the treatment of wet AMD 
allow physicians to obtain these small doses of drug from a pharmacy 
that is capable of preparing sterile products. We expect to issue 
instructions that will allow participating CAP physicians to use the 
furnish as written option, as appropriate, and to obtain small doses of 
bevacizumab outside of the CAP in prefilled syringes if their local 
carrier's coverage determinations allow such a practice and it is 
consistent with applicable laws and regulations. We believe that this 
approach will minimize the waste associated with using a 100mg single 
use vial for the treatment of wet AMD and will increase the flexibility 
for participating CAP physicians by making an alternative quantity of 
this drug available to participating CAP physicians whose carriers have 
applicable policies.
    However, this option is not available in all areas. Therefore, we 
are considering reassessing our policy on the use of prefilled syringes 
to determine whether it would be feasible to make the option of using 
prefilling syringes supplied by an approved CAP vendor available to all 
physicians who participate in the CAP, rather than requiring physicians 
to go outside the CAP in order to obtain CAP drugs in prefilled 
syringes. We are seeking comments on whether allowing approved CAP 
vendors to repackage CAP drugs in certain situations may be beneficial 
to beneficiaries, the program, and to the physicians who participate in 
it. We are not proposing to make a change to our regulations at this 
time, but we are seeking additional information that might allow us to 
consider making such a change in the future.
    In considering whether to propose a change to our regulations in 
the future, we seek comments on whether approved CAP vendors are likely 
to be pharmacies or have access to pharmacy services with trained 
personnel and facilities for the small scale preparation of sterile 
drug products in response to a specific prescription order for a 
specific patient. At this time there is no specific requirement for 
approved CAP vendors to be pharmacies. Also, please note we are 
describing a specialized pharmacy function; we are not contemplating 
manufacturing of drug products under this program.
    We are also seeking comments on whether an approved CAP vendor 
should be given an opportunity to supply bevacizumab under the CAP if 
it is repackaged in a patient-specific dose consistent with applicable 
state laws and regulations upon request from a participating CAP 
physician. Furthermore, we are seeking comments on whether this sort of 
activity should be restricted to bevacizumab, or possibly phased-in for 
other CAP drugs. If we were to apply this sort of policy to other CAP 
drugs, we would also have to determine how phasing-in might occur, 
which drugs it should apply to and whether the preparation of 
admixtures (including the preparation of sterile syringes, minibags, 
and mixing

[[Page 38160]]

of drugs and solutions intended for intravenous administration) should 
be allowed as well.
    We also seek comments on how this sort of service could be limited 
to participating CAP physicians who voluntarily agree to use it, and 
whether such an agreement should be made in writing between the 
approved CAP vendor and the participating CAP physician. We also seek 
comment on how such a program could be structured so that the service 
and staff engaged in providing the service would be required to meet 
all applicable laws (including Stark, Anti-kickback, and State pharmacy 
laws, as well as regulations for the preparation of sterile products, 
(including standards for product integrity and sterility). We also seek 
comments on whether the cost of preparing such product would be 
included in the CAP vendor's bid price. Finally, we seek comments on 
whether any other important elements should be evaluated if we consider 
changing CAP policy on prefilled syringes in the future.
k. Contractual Provisions
    Section 1847B of the Act is generally silent on the subject of 
disputes surrounding the delivery of drugs and the denial of drug 
claims. However, section 1847B(b)(2)(A)(ii)(II) of the Act states that 
a grievance process is a quality and service requirement expected of 
approved CAP vendors. In the July 6, 2005 IFC (70 FR 39055 through 
39058), we described the process for the resolution of approved CAP 
vendors' claims denials and the resolution of participating CAP 
physicians' drug quality and service complaints. We encouraged 
participating CAP physicians, beneficiaries, approved CAP vendors, and 
the designated carrier to use informal communication as a first step to 
resolve service-related administration issues. However, we recognized 
that certain disputes would require a more structured approach, and 
therefore, we established processes under Sec.  414.916 and Sec.  
414.917.
    Suspension and termination from the CAP were the only remedies 
described under the CAP dispute resolution processes. Having gained 
some experience with the CAP, we believe that having an intermediate 
level of remedy is desirable in order to bridge the gap between taking 
no action and suspension or termination of an approved CAP vendor for 
less serious but persistent problems.
    We believe that additional contractual obligations, such as 
additional reporting requirements could be useful, particularly if they 
provide an opportunity for the approved CAP vendor to come into 
compliance using objective goals and a set timeline. Therefore, we are 
seeking comments on what types of potential contractual provisions that 
could be used to encourage approved CAP vendors to comply with CAP 
requirements for less serious violations, such as missing reporting 
deadlines, or participation in inappropriate promotional strategies. 
Given that the CAP statute does not provide for the imposition of 
sanctions such as withholding payment or imposing other types of 
monetary penalties, we believe that building appropriate provisions 
into the approved CAP vendor's contract to address noncompliance or 
expanding the approved vendor's code of conduct by proposing more 
specific CMS requirements could be appropriate approaches. We are 
requesting comments on what type of contractual provisions would be 
suitable, for example, requests for specific or targeted reporting and 
monitoring activities in response to specific violations, etc. We are 
also looking for comments on whether an approved CAP vendor's code of 
conduct could be used to address these types of less serious situations 
and how that could be accomplished. Finally, we invite comments on 
whether the CAP physician election agreement should be revised to 
include provisions to address participating CAP physicians' 
noncompliance with CAP rules or the CAP election agreement. We will use 
any information that we receive on these issues to possibly develop a 
future proposal.

G. Issues Related to the Clinical Laboratory Fee Schedule

    [If you choose to comment on issues in this section, please include 
the caption ``CLINICAL LABORATORY ISSUES'' at the beginning of your 
comments.]
1. Date of Service for the Technical Component of Physician Pathology 
Services (Sec.  414.510)
    In the CY 2007 PFS final rule with comment period (71 FR 69787), we 
added Sec.  414.510 for the date of service of a clinical diagnostic 
laboratory test that uses a stored specimen. Generally, our policy 
states the date the specimen is collected is the date of service for 
claims review and adjudication. However, for a laboratory test that 
uses a stored specimen, the date of service is the date the specimen 
was obtained from the storage for a specimen that is stored for more 
than 30 days before testing. Specimens stored 30 days or less have a 
date of service of the date the test was performed only if--
    (a) The test is ordered by the patient's physician at least 14 days 
following the date of the patient's discharge from the hospital;
    (b) The specimen was collected while the patient was undergoing a 
hospital surgical procedure;
    (c) It would be medically inappropriate to have collected the 
sample other than during the hospital procedure for which the patient 
was admitted;
    (d) The results of the test do not guide treatment provided during 
the hospital stay; and
    (e) The test was reasonable and medically necessary for the 
treatment of an illness.

In addition, Sec.  414.510(b)(3) specifies the conditions for the date 
of service for a chemosensitivity test.
    When we added Sec.  414.510, we indicated the provision applies to 
clinical diagnostic laboratory tests. For outpatients, clinical 
diagnostic laboratory tests are paid under the Medicare Part B clinical 
laboratory fee schedule. Upon further review, we believe the provision 
should also apply to the technical component (TC) of physician 
pathology services. In practice, the collection date for both clinical 
laboratory services and the TC of physician pathology services is 
similar. Therefore, we believe Sec.  414.510 should apply to both types 
of services. This will improve claims processing and adjudication in 
relation to the clarity of dates of service, accuracy of payment, and 
detection of duplicate services. For outpatients, the TC of physician 
pathology services can be paid under the PFS or the hospital OPPS. As a 
result, for Sec.  414.510, we are proposing to revise the section 
heading and introductory sentence to specify the provision applies to 
both clinical laboratory and pathology specimens. We are also revising 
Sec.  415.130(d) to include a reference to Sec.  414.510.
2. New Clinical Diagnostic Laboratory Test (Sec.  414.508)
a. Background
    In the CY 2007 PFS final rule with comment period (71 FR 69701), we 
adopted a new subpart G under part 414 that implemented section 942(b) 
of the MMA requiring that we establish procedures for determining the 
basis for, and amount of payment for any clinical diagnostic laboratory 
test for which a new or substantially revised HCPCS code is assigned on 
or after January 1, 2005 (``new tests'').

[[Page 38161]]

    Under Sec.  414.508, we use one of two bases for payment to 
establish a payment amount for a new test. Under Sec.  414.508(a), the 
first basis, called ``crosswalking,'' is used if a new test is 
determined to be comparable to an existing test, multiple existing test 
codes, or a portion of an existing test code. If we use crosswalking, 
we assign the new test code the local fee schedule amounts and national 
limitation amount (NLA) of the existing test code or codes. If we 
crosswalk to multiple existing test codes, we determine the local fee 
schedule amounts and NLA based on a blend of payment amounts for the 
existing test codes. For example, we may pay based on 75 percent of the 
payment amounts for one existing test code and 25 percent of the 
payment amounts for another existing test code.
    The second basis for payment is ``gapfilling.'' Under Sec.  
414.508(b), we use gapfilling when no comparable existing test is 
available. We instruct each Medicare carrier to determine a carrier-
specific amount for use in the 1st year that the new code is effective. 
The sources of information that these carriers examine in determining 
carrier-specific amounts include:
     Charges for the test and routine discounts to charges;
     Resources required to perform the test;
     Payment amounts determined by other payers; and
     Charges, payment amounts, and resources required for other 
tests that may be comparable (although not similar enough to justify 
crosswalking) or otherwise relevant.
    After the first year, the carrier-specific amounts are used to 
calculate the NLA for subsequent years. Under Sec.  414.508(b)(2), the 
test code is paid at the NLA, rather than the lesser of the NLA and the 
carrier-specific amounts.
    In the CY 2007 PFS final rule with comment period, we also 
explained that we notify our carriers when to use the gapfill method 
described with a program instruction which lists the specific new test 
code and the timeframes to establish carrier-specific amounts. 
Contractors are required to establish carrier-specific amounts on or 
before March 31 of the year. Contractors may revise their payment 
amounts, if necessary, on or before September 1 of the year. In this 
manner, a carrier may revise its carrier-specific amount based on 
additional information during the 1st year.
    In the CY 2007 PFS final rule with comment period (71 FR 69702), we 
also described the timeframes for determining the amount of and basis 
for payment for new tests. Under 45 CFR Sec.  162.1003, a code for a 
new test may be developed either by the AMA's CPT Editorial Panel, 
which maintains and distributes the CPT codes, or HHS, which maintains 
and distributes the HCPCS codes. The codes to be included in the 
upcoming year's fee schedule (effective January 1) are available as 
early as May. We then list the new clinical laboratory tests codes on 
our Web site, usually in June, along with registration information for 
the public meeting.
    The public meeting is held no sooner than 30 days after we announce 
the meeting in the Federal Register. The public meeting is typically 
held in July. In September, we post our proposed determination of the 
basis for payment for each new code. We also seek public comment on 
these proposed determinations of the basis for payment. The updated 
clinical laboratory fee schedule is prepared in October for release to 
our contractors during the first week in November. Our contractors have 
many information system steps to complete during the months of November 
and December so that the updated clinical laboratory fee schedule is 
ready to pay claims effective January 1 of the following calendar year.
    In response to the CY 2007 PFS proposed rule, we received several 
comments regarding the level of detail of information presented during 
the public meeting process. We responded that we did not believe that 
opportunities for information gathering on new tests have been fully 
utilized within the public meeting process and that payment 
recommendations from the public have sometimes lacked charge, cost, and 
clinically detailed information for the new clinical laboratory tests. 
We also stated that when soliciting public input for the meeting we 
would recommend that all participants in the public meeting 
consultation process strive for transparency and try to provide as much 
supporting information as possible to assist us in evaluating their 
recommendations.
    We also received some comments that suggested that the method used 
by contractors to determine their price for gapfilled tests should be 
more specific. We responded that we would engage in discussions with 
our carrier contractors and laboratory industry representatives to 
explore their experiences with the gapfill process. We also agreed to 
host a forum to listen to suggestions from the public.
    We have discussed these issues with our contractors. We also plan 
to solicit comments on the gapfill process in the clinical laboratory 
public meeting scheduled on July 16, 2007. Although we encourage the 
public to suggest improvements to our gapfilling process at the 
upcoming clinical laboratory public meeting, we recommend that 
interested parties also submit written comments on the proposed changes 
for the gapfilling process contained in this rule. Written comments 
will be considered in the final rule to the extent that these comments 
relate to the issues discussed in this proposed rule.
    Discussions with our contractors and other interested parties 
revealed the length of time we allow for a contractor to establish a 
carrier-specific amount may sometimes be insufficient for obtaining 
additional sources and data on a new test. However, our contractors and 
other interested parties were also concerned that if procedures and 
determinations were permitted to extend over too long a time frame, the 
uncertainty of the final payment amount would be detrimental for 
laboratories, practitioners, and patients for incorporating new 
technology tests and improving patient care.
    In addition, in response to the CY 2007 PFS proposed rule, a 
commenter requested that we establish a formal review, or 
reconsideration process of a payment amount determination. In response 
to the comment, we revised Sec.  414.508(b)(3) to provide that if we 
gapfill a test, but determine after the 1st year of gapfilling that 
carrier-specific gapfilled amounts will not pay for the test 
appropriately, in the 2nd year we may use the crosswalk basis to 
establish fees for the test. We also stated that we expected to solicit 
comments on a potential reconsideration process in a future rulemaking.
    At Sec.  414.509, we are proposing a reconsideration process for 
determining the basis for and amount of payment for any new test for 
which a new or substantially revised HCPCS code is assigned on or after 
January 1, 2008. We have strived to balance additional opportunities 
for public input against the necessity for establishing final fees for 
new clinical laboratory test codes.
    Section 1833(h)(8)(A) of the Act provides broad authority to 
develop through regulation procedures for the method for determining 
the basis for and amount of payment for new tests. We believe that we 
have authority under section 1833(h)(8)(A) of the Act to establish 
procedures under which we may reconsider the basis for and amount of 
payment for a new test. Furthermore, under section 1833(h)(8)(D) of the 
Act, the Secretary may convene such other public meetings to receive 
public comments on payment amounts for new tests as the Secretary deems 
appropriate.

[[Page 38162]]

    We note that, under both section 1833(h)(8)(B)(v) of the Act and 
Sec.  414.506(d)(2), the Secretary must make available to the public a 
list of ``final determinations.'' We do not believe that these 
provisions preclude us from reconsidering our final determinations. It 
is not unusual for us to provide for discretionary reopening or 
reconsideration of final agency action. For example, under Sec.  
405.1885, we may reopen a final agency determination regarding payment 
to a provider of services.
b. Basis for Payment
    Under our existing procedures for determining the basis for payment 
of a new test, either to crosswalk or gapfill, we receive comments on 
the appropriate basis for payment for a new test both at the public 
meeting in July and after we announce our proposed determinations in 
September. In November, we post our determination for the basis for 
payment for the new test on the CMS Web site. This determination of the 
basis for payment is final, except in the case of a gapfilled test for 
which we later determine that gapfilling is not appropriate under Sec.  
414.508(b)(3).
    We are proposing to create a reconsideration process for 
determinations of the basis, either crosswalking or gapfilling, for 
payment of a new clinical diagnostic laboratory test. Consistent with 
our existing process, we would make a determination using the 
information gathered from the public meeting process and post a 
determination of the basis for payment, either to crosswalk or gapfill, 
on the CMS Web site, likely in November. Under Sec.  414.508, claims 
would be paid using this basis to calculate fees beginning January 1. 
We would accept written comments on this basis determination for 60 
days after we posted the determination on the CMS Web site. If a 
commenter recommended that we switch from gapfilling to crosswalking 
for a new code, the commenter would also have the opportunity to 
recommend the code or codes to which to crosswalk the new test code.
    In addition, those members of the public who submitted a written 
comment within the 60-day comment period would also have the 
opportunity to present their comment orally at the next clinical 
laboratory public meeting and hear other comments during the public 
meeting.
    After considering the comments received and the information of the 
public meeting, we would post our decision as to whether we elected to 
reconsider our determination of the basis for payment. If we elect to 
reconsider the basis for payment, we would post our determination as to 
whether we would change of the basis for payment on the CMS Web site on 
or before January 1 of the next year. Our decision regarding the basis 
for payment would be final and not subject to further reconsideration.
    If we change our prior determination of the basis for payment, the 
new determination would be effective the following January 1. We would 
not reopen or otherwise reprocess claims with dates of service prior to 
the effective date of the revised determination.
    We note that, under our proposed reconsideration processes (for 
both the basis for payment and amount of payment), we would make two 
separate decisions. First, we would decide whether to reconsider our 
prior determination. If we elect to reconsider our prior determination, 
we would then determine whether we should change our prior 
determination.
c. Amount of Payment
i. Crosswalking
    Under our existing procedures, commenters recommend the code or 
codes to which to crosswalk a new clinical laboratory test both at the 
public meeting in July and during the comment period after we issue our 
proposed determination in September. We consider the appropriate basis 
for payment and the amount of payment at the same time. Therefore, 
commenters that recommend crosswalking as the basis for payment for a 
new test also make recommendations concerning the code or codes to 
which to crosswalk the new test. In November, we post the code or codes 
to which we will crosswalk the test and the payment amount for the test 
on the CMS Web site. This determination is final.
    We are proposing to create a reconsideration process under which we 
may reevaluate the code or codes and their corresponding fees to which 
we crosswalk a new test's fees. After we posted our determination of 
the code or codes to which the test would be crosswalked on the CMS Web 
site, we would pay claims on the basis of this determination beginning 
January 1. We would accept written comments on the crosswalked code or 
codes and the resulting amount of payment for the new code for 60 days 
after we posted the determination on the CMS Web site. In addition, a 
commenter, who had submitted a written comment within the 60-day 
comment period, would also be given the opportunity to present their 
comment orally at the next public meeting.
    After considering the comments received and the information of the 
public meeting, we would post our decision as to whether we had elected 
to reconsider our determination of the crosswalked code or codes and 
the resulting amount of payment. If we elect to reconsider the amount 
of payment and had determined that we should revise the amount of 
payment, we would post a new determination of the code or codes to 
which we would crosswalk the test on or before January 1 of the next 
year. Our decision regarding the amount of payment would be final and 
not subject to further reconsideration.
    If we change our prior determination of the amount of payment, the 
new determination would be effective the following January 1. We would 
not reopen or otherwise reprocess claims with dates of service prior to 
the effective date of the revised determination.
    As discussed in section II.G.2.b., we may also change the basis for 
payment for a new test as the result of reconsideration. If we change 
the basis for payment from gapfilling to crosswalking, we would also 
determine the code or codes to which we would crosswalk the test. 
Because we believe it is important to establish final payment amounts 
within a reasonable amount of time, we are proposing that these 
determinations of crosswalked payment amounts would not be subject to 
reconsideration.
ii. Gapfilling
    As discussed in this preamble and in accordance with Sec.  
414.508(b), after we determine that gapfilling will be the basis for 
payment for a new clinical diagnostic laboratory test, we instruct our 
contractors to determine carrier-specific gapfill amounts by April 1 
and finalize carrier-specific amounts by September 30. We include the 
determinations of carrier-specific amounts and the NLA for the new test 
code in the clinical laboratory fee schedule the following November 
when we post our payment determinations on the CMS Web site. Except in 
the case of a gapfilled test for which we determine that gapfilling was 
not appropriate under Sec.  414.508(b)(3), these determinations are 
final.
    We are proposing to provide for a reconsideration process for 
gapfilled payment amounts. Under this process, by April 30, we would 
post the carrier-specific amounts on the CMS Web site. Interested 
parties would submit written comments to CMS on the carrier-

[[Page 38163]]

specific amounts within 60 days from the date of posting the carrier-
specific amounts. In addition, those commenters, who had submitted a 
written comment within the 60-day comment period, would be given the 
opportunity to present their comments orally at the next clinical 
laboratory public meeting.
    Carriers would finalize carrier-specific amounts by September 30 
and we would set the NLA be at the median of the carrier-specific 
amounts. However, based on the comments received, we would evaluate 
whether we should reconsider the carrier-specific amounts and NLA. If 
we elected no to reconsider the carrier-specific amounts and the NLA, 
we would post the carrier-specific amounts and NLA on the CMS Web site 
on or before January 1 of the next year. These amounts would be based 
on the carrier-specific amounts and NLA we had posted in September. 
Payment for the test would be made at the NLA on January 1 of the next 
year. This determination would be final and not subject to further 
reconsideration.
    If we elect to reconsider the carrier-specific amounts and decide 
to revise our prior determination, we would adjust the NLA based on 
comments received. We would post the revised NLA on the CMS Web site 
and payment for the test would be made at the NLA beginning January 1. 
This determination would be final and not subject to further 
reconsideration.
    We are also proposing that, if we change the basis of payment from 
crosswalking to gapfilling as the result of a reconsideration, the new 
gapfilled payment amount would be subject to reconsideration under 
proposed Sec.  414.509(b)(2). Unlike a crosswalked test, the payment 
amount for a gapfilled test is not established when we determine the 
basis for payment because it takes approximately 9 months for our 
contractors to establish carrier-specific amounts. Thus providing for 
reconsideration of gapfilled payment amounts would not lengthen the 
period of time it would take to determine a final payment amount.
    In addition, we are proposing to amend Sec.  414.508(b)(3) to 
provide that Sec.  414.508(b)(3) applies to new tests for which a new 
or substantially revised HCPCS code assigned on or before December 31, 
2007. We believe that the more comprehensive reconsideration procedures 
we are proposing should apply to new or substantially revised HCPCS 
codes assigned after December 31, 2007.
d. Jurisdiction for Reconsideration Decisions
    We are proposing that jurisdiction for reconsideration would rest 
exclusively with the Secretary. A decision whether to reconsider a 
determination would be committed to the discretion of the Secretary. 
Accordingly, a refusal to reconsider an initial determination would not 
be subject to administrative or judicial review. We recognize that 
parties dissatisfied with an initial determination as to the amount of 
payment for a particular claim for laboratory services may appeal the 
initial determination under part 405, subpart I of our regulations. 
Under our proposal, a party could challenge under part 405, subpart I a 
determination regarding the amount of payment for a new test--
regardless of whether the amount of payment was established as the 
result of a reconsideration--but a party could not challenge a decision 
not to reconsider.
3. Technical Revisions
    We are also proposing technical revisions to Sec.  414.502, Sec.  
414.506, and Sec.  414.508. Under section 1833(h)(8)(A) of the Act, the 
term ``new tests'' is defined as any clinical diagnostic laboratory 
test for which a new or substantially revised HCPCS code is assigned on 
or after January 1, 2005. However, our regulations do not define the 
term ``new test.'' Therefore, we are proposing to define the term ``new 
test'' under Sec.  414.502 using the statutory definition. In addition, 
under Sec.  414.506 and Sec.  414.508, we are proposing to replace 
references to ``new clinical diagnostic laboratory test that is 
assigned a new or substantially revised code on or after January 1, 
2005'' with references to ``new test.''

H. Proposed Provisions Related to Payment for Renal Dialysis Services 
Furnished by End-Stage Renal Disease (ESRD) Facilities

    [If you choose to comment on issues in this section, please include 
the caption ``ESRD PROVISIONS'' at the beginning of your comments.]
    Since August 1, 1983, payment for dialysis services furnished by 
ESRD facilities has been based on a composite rate payment system that 
provides a fixed, prospectively determined amount per dialysis 
treatment, adjusted for geographic differences in area wage levels. In 
accordance with section 1881(b)(7) of the Act, separate composite rates 
have been established for hospital-based and independent ESRD 
facilities. The composite rate is designed to cover a package of goods 
and services needed to furnish dialysis treatments that include, but 
not be limited to, certain routinely provided drugs, laboratory tests, 
supplies, and equipment. Unless specifically included in the composite 
rate, other injectable drugs and laboratory tests medically necessary 
for the care of the dialysis patient are separately billable. The base 
composite rates per treatment, effective on August 1, 1983, were $123 
for independent ESRD facilities and $127 for hospital-based ESRD 
facilities. The Congress has enacted a number of adjustments to the 
composite rate since that time. The current 2007 base composite rates 
are $132.49 for independent ESRD facilities and $136.68 for hospital-
based ESRD facilities.
    Section 623 of the MMA amended section 1881 of the Act to require 
changes to the composite rate payment methodology, as well as to the 
pricing methodology for separately billable drugs and biologicals 
furnished by ESRD facilities.
    Section 1881(b)(12) of the Act, as added by the MMA, required the 
establishment of a basic case-mix adjusted prospective payment system 
(PPS) that would include the services comprising the composite rate and 
an add-on to the composite rate component for the difference between 
current payments for separately billed drugs and the revised drug 
pricing specified in the statute. In addition, section 1881(b)(12) of 
the Act required that the composite rate be adjusted for a limited 
number of patient characteristics (case-mix) and section 1881(b)(12)(D) 
of the Act gave the Secretary discretion to revise the wage indices and 
the urban and rural definitions used to develop them. Finally, section 
1881(b)(12)(E) of the Act imposed a budget neutrality requirement, so 
that aggregate payments under the basic case-mix adjusted composite 
payment system for 2005 would equal the aggregate payments that would 
have been made for the same period if section 1881(b)(12) of the Act 
did not apply.
    Before January 1, 2005, payment to both independent and hospital-
based facilities for the anti-anemia drug, erythropoietin (EPO) was 
established under section 1881(b)(11) of the Act at $10.00 per 1,000 
units. For independent ESRD facilities, payment for all other 
separately billable drugs and biologicals was based on the lower of 
actual charges or 95 percent of the average wholesale price (AWP). 
Hospital-based ESRD facilities were paid based on the reasonable cost 
methodology for separately billed drugs and biologicals (other than 
EPO) furnished to dialysis

[[Page 38164]]

patients. Changes to the payment methodology for separately billed ESRD 
drugs and biologicals that were established by the MMA and were 
effective January 1, 2005 are described in sections II.H.1. and II.H.2. 
These changes affected payments in both CY 2005 and CY 2006.
    In addition, section 623(f)(1) of the MMA directs the Secretary to 
submit a Report to Congress detailing a bundled PPS for services 
furnished by ESRD facilities to Medicare beneficiaries. The bundled PPS 
would be a different way of paying for ESRD services since it will 
include not only composite rate services, but would also include 
separately billable drugs (including EPO), laboratory tests, and other 
separately billable items into one PPS payment rate. We expect to 
release the REPORT TO CONGRESS this summer.
1. CY 2005 Revisions
    In the CY 2005 PFS final rule with comment period (69 FR 66319 
through 66334), we implemented section 1881(b) of the Act, as amended 
by section 623 of the MMA, and revised payments to ESRD facilities. 
These revisions were effective January 1, 2005, included implementation 
of a case-mix adjusted payment system that incorporated services that 
comprise the composite rate; an update of 1.6 percent to the composite 
rate component of the payment system; and a drug add-on of 8.7 percent 
to the composite rate for the difference between current payments for 
separately billable drugs and payments based on the revised drug 
pricing for 2005 which used acquisition costs. The CY 2005 PFS final 
rule with comment period also implemented case-mix adjustments to the 
composite rate for a limited number of patient characteristics (that 
is, age, low body mass index (BMI), and body surface area (BSA)), 
effective April 1, 2005.
    In addition, to implement section 1881(b)(13) of the Act, we 
revised payments for drugs billed separately by independent ESRD 
facilities, paying for the top 10 ESRD drugs based on acquisition costs 
(as determined by the OIG) and for other separately billed drugs at the 
average sales price +6 percent (hereafter referred to as ASP+6 
percent). Hospital-based ESRD facilities continued to receive cost-
based payments for all separately billable drugs and biologicals except 
for EPO which was paid based on average acquisition costs.
2. CY 2006 Revisions
    In the CY 2006 PFS final rule with comment period (70 FR 70161), we 
implemented additional revisions to payments to ESRD facilities under 
section 623 of the MMA. For CY 2006, we further revised the drug 
payment methodology applicable to drugs furnished by ESRD facilities. 
All separately billed drugs and biologicals furnished by both hospital-
based and independent ESRD facilities are now paid based on ASP+6 
percent.
    We recalculated the 2005 drug add-on adjustment to reflect the 
difference in payments between the pre-MMA AWP pricing and the revised 
pricing based on ASP+6 percent. The recalculation did not affect the 
actual add-on adjustment applied to payments in 2005, but provided an 
estimate of what the adjustment would have been had the 2006 payment 
methodology been in effect in 2005. The drug add-on adjustment was then 
updated to reflect the expected growth in expenditures for separately 
billable drugs in CY 2006.
    As of January 1, 2006, we also implemented a revised geographic 
adjustment authorized by section 1881(b)(12) of the Act. As part of 
that change, we--
     Revised the labor market areas to incorporate the new CBSA 
designations established by the Office of Management and Budget (OMB);
     Eliminated the wage index ceiling and reduced the floor to 
0.8500; and
     Revised the labor portion of the composite rate to which 
the geographic adjustment is applied.
    We also provided a 4-year transition from the previous wage-
adjusted composite rates to the current wage-adjusted rates. For CY 
2006, only 25 percent of the payment is based on the revised geographic 
adjustments, and the remaining 75 percent of payment is based on the 
old metropolitan statistical area-based (MSA-based) payments.
    In addition, section 5106 of the DRA provided for a 1.6 percent 
update to the composite rate component of the basic case-mix adjusted 
payment system, effective January 1, 2006. As a result, the base 
composite rate was increased to $130.40 for independent ESRD facilities 
and $134.53 for hospital-based facilities. For 2006, the drug add-on 
adjustment (including the growth update) was 14.5 percent.
3. CY 2007 Updates
    In the CY 2007 PFS final rule with comment period (71 FR 69681), we 
implemented the following updates to the basic case-mix adjusted 
payment system:
     An update to the wage index adjustments to reflect the 
latest hospital wage data, including a BN adjustment of 1.052818 to the 
wage index for CY 2007.
     A method to annually calculate the growth update to the 
drug add-on adjustment required by section 1881(b)(12) of the Act, as 
well as growth update to the drug add-on adjustment of 0.5 percent for 
CY 2007. Therefore, effective January 1, 2007 the drug add-on 
adjustment was increased to 15.1 percent.
    In addition, section 103 of the MIEA-TRHCA established a 1.6 
percent update to the composite rate portion of the payment system, 
effective April 1, 2007. Therefore, the current base composite rate is 
$132.49 for independent facilities and $136.68 for hospital-based 
facilities. Also, the effect of this increase in the composite rate 
portion of the payment system was a reduction in the drug add-on 
adjustment to 14.9 percent, effective April 1, 2007. Since the 
statutory increase only applied to the composite rate, this adjustment 
to the drug add-on percent was needed to maintain the drug add-on 
amount constant.
4. Provisions of This Proposed Rule
    For CY 2008, we are proposing the following updates to the 
composite rate payment system:
     A growth update to the drug add-on adjustment to the 
composite rates; and
     An update to the wage adjustment to reflect the latest 
available wage data, and a revised budget neutrality adjustment.
a. Proposed Growth Update to the Drug Add-on Adjustment to the 
Composite Rates
    Section 623(d) of the MMA added section 1881(b)(12)(B)(ii) of the 
Act which required the establishment of an add-on to the composite rate 
to account for changes in the drug payment methodology stemming from 
enactment of the MMA. Section 1881(b)(12)(c) of the Act provides that 
the drug add-on must reflect the difference in aggregate payments 
between the revised drug payment methodology for separately billable 
ESRD drugs and the AWP payment methodology. In 2005, we generally paid 
for ESRD drugs based on average acquisition costs. Thus the difference 
from AWP pricing was calculated using acquisition costs. However, in 
2006 when we moved to ASP pricing for ESRD drugs, we recalculated the 
difference from AWP pricing using ASP prices.
    In addition, section 1881(b)(12)(F) of the Act requires that, 
beginning in CY 2006, we establish an annual update to the drug add-on 
to reflect estimated growth in expenditures for separately billable 
drugs and biologicals furnished by ESRD facilities. This growth update 
applies only to the drug add-on portion

[[Page 38165]]

of the case-mix adjusted payment system.
    The CY 2007 drug add-on adjustment to the composite rate is 14.9 
percent. The drug add-on adjustment for CY 2007 incorporates an 
inflation adjustment of 0.5 percent. This computation is explained in 
detail in the CY 2007 PFS final rule with comment period (71 FR 69682 
through 69684). We note that the drug add-on adjustment of 15.1 percent 
that was published in the CY 2007 PFS final rule with comment period 
did not account for the 1.6 percent update to the composite rate 
portion of the basic case-mix adjustment payment system that was 
subsequently enacted by the MIEA-TRHCA, effective April 1, 2007. Since 
we compute the drug add-on adjustment as a percentage of the weighted 
average base composite rate, the drug add-on percentage was decreased 
to account for the higher composite payment rate resulting in a 14.9 
percent add-on adjustment beginning April 1, 2007. This adjustment was 
necessary to ensure that the total drug add-on dollars remained 
constant.
(i) Estimating Growth in Expenditures for Drugs and Biologicals for CY 
2008
    Section 1881(b)(12)(F) of the Act specifies that the drug update 
must reflect ``the estimated growth in expenditures for drugs and 
biologicals (including erythropoietin) that are separately billable * * 
* '' By referring to ``expenditures'', we believe the statute 
contemplates that the update would account for both increases in drug 
prices, as well as increases in utilization of those drugs.
    In the CY 2007 PFS final rule with comment period (71 FR 69682), we 
established a methodology for annually estimating the growth in ESRD 
drugs and biological expenditures that uses the Producer Price Index 
(PPI) for pharmaceuticals as a proxy for pricing growth in conjunction 
with 2 years of ESRD drug data to estimate per patient utilization 
growth.
    For CY 2008, we are proposing to continue using this methodology to 
update the drug add-on adjustment. As we indicated in the CY 2007 PFS 
final rule with comment period, we believe the PPI is a reasonable 
measure of drug pricing growth, and when used in conjunction with an 
estimate of per patient growth in drug utilization, this measure 
provides a simple and accurate approach to updating the drug add-on 
that could be readily used in subsequent years. Moreover, using the PPI 
significantly reduces any data bias that is inherent in using 
historical drug expenditure data that do not reflect current drug 
payment methodologies.
    Therefore, we established a mechanism for estimating the annual 
growth in expenditures for ESRD drugs and biologicals using the PPI for 
prescription drugs as a measure of price increases in conjunction with 
2 years of historical data as a basis for estimating utilization growth 
at the per patient level.
    As discussed in detail below in this section, we are proposing to 
estimate growth in per patient utilization of drugs for CY 2008 by 
using historical drug expenditure data from CY 2005 and CY 2006. 
However, we are proposing to use only drug expenditures data from 
independent ESRD facilities because we are unable to determine 
utilization change in hospital-based dialysis facilities due to the 
changes in payment methodology for these types of dialysis facilities 
from 2005 to 2006. In 2005, payments to hospital-based facilities were 
based on cost (or a percentage of charges), whereas payments to 
hospital-based facilities in 2006 were based on ASP+6 percent. Because 
of the cost payment methodology, the ``drug unit'' fields on the 2005 
hospital-based ESRD facility bills were not used for payment purposes, 
and therefore, the data were not accurately reported on those bills. As 
such, we are unable to accurately isolate the per unit payment 
differential for hospital-based ESRD facility drug expenditures between 
2005 (cost payments) and 2006 (ASP payments) for purposes of estimating 
the residual utilization change between years. We considered applying 
the price differential factor for independent ESRD facilities between 
2005 and 2006 to the ESRD hospital-based facility data, but the result 
was a negative utilization growth. Because we have no way of accurately 
determining what portion of the change in drug expenditures for 
hospital-based facilities between 2005 and 2006 is attributable to 
price versus utilization, we do not believe it would be appropriate to 
assume that the same price differential applicable to independent ESRD 
facility data would be indicative of the price change for hospital-
based facilities between 2005 and 2006 where expenditures moved from 
cost-based to fee schedule payments. Given that the drug expenditure 
data for hospital-based ESRD facilities only represent about 9 percent 
of the total ESRD drug data, and we can more accurately measure the 
price difference between 2005 and 2006 for the independent ESRD 
facility expenditure data, we believe the best option would be to 
exclude the hospital-based ESRD facility data from the computation of 
utilization growth between 2005 and 2006. Under this option, we would 
impute the same utilization growth for hospital-based ESRD facilities 
as estimated for independent ESRD facilities.
(ii) Estimating Growth in Per Patient Drug Utilization
    To isolate and project the growth in per patient utilization of 
ESRD drugs for CY 2008, we need to remove the enrollment and price 
growth components from the historical drug expenditure data and 
consider the residual utilization growth. As discussed previously in 
this section, we propose to use independent ESRD facility drug 
expenditure data from CY 2005 and CY 2006 to estimate per patient 
utilization growth for CY 2008.
    We first needed to estimate the total drug expenditures for 
independent ESRD facilities. For this proposed rule, we used the final 
CY 2005 ESRD claims data and the latest available CY 2006 ESRD facility 
claims, updated through December 31, 2006 (that is, claims with dates 
of service from January 1 through December 31, 2006, that were 
received, processed, paid, and passed to the National Claims History 
File as of December 31, 2006). For the CY 2008 PFS final rule, we plan 
to use more updated CY 2006 claims with dates of service for the same 
time period. This updated CY 2006 data file will include claims that 
are received, processed, paid, and passed to the National Claims 
History File as of June 30, 2007.
    While the December 2006 update of CY 2006 claims used in this 
proposed rule is the most recently available claims data, we recognize 
that it is not a fully complete year as claims with dates of service 
towards the end of the year have not all been processed. To more 
accurately estimate the update to the drug add-on, we need aggregate 
drug expenditures. Based on an analysis of the 2005 claims data, we 
inflated the CY 2006 drug expenditures to estimate the June 30, 2007 
update of the 2006 claims file. We used the relationship between the 
December 2005 and the June 2006 versions of 2005 claims to estimate the 
more complete 2006 claims that will be available in June 2007. We 
applied that ratio to the 2006 claims data from the December 2006 
claims file. We did this separately for EPO, the other top ten 
separately billable drugs, and the remaining separately billable drugs 
for independent and hospital-based ESRD facilities. All components were 
then combined to estimate aggregate CY 2006 ESRD drug expenditures. The 
net adjustment to the CY 2006 claims data

[[Page 38166]]

was an increase of 12 percent to the 2006 expenditure data. This 
adjustment allows us to more accurately compare the 2005 and 2006 data 
to estimate utilization growth.
    The next step is to remove the enrollment and price growth 
components from that total. As discussed previously in this section, in 
developing the per patient utilization growth for this proposed rule, 
we limited our analysis to the latest 2 years of available independent 
ESRD facility drug data (that is, 2005 and 2006). We believe that per 
patient utilization growth between these years would be a better proxy 
for future growth, as it best represents current utilization trends.
    To calculate the per patient utilization growth, we removed the 
enrollment component by using the growth in enrollment data between 
2005 and 2006. This was approximately 3 percent. To remove the price 
effect we calculated the weighted difference between 2005 average 
acquisition price (AAP) and 2006 ASP pricing for the original top ten 
drugs for which we had average acquisition prices. We weighted the 
differences by 2006 independent ESRD facility drug expenditure data. 
Table 12 shows the 2006 weights for each of the top ten ESRD drugs 
billed by independent ESRD facilities.
    This process led to an overall 3 percent reduction in price between 
2005 and 2006.

       Table 12.--CY 2006 Drug Weights for Independent Facilities
------------------------------------------------------------------------
                                                                 2006
                      Independent drugs                         Weights
                                                               (percent)
------------------------------------------------------------------------
EPO.........................................................        75.2
Paricalcitol................................................        11.6
Sodium-ferric-glut..........................................         2.9
Iron-sucrose................................................         5.6
Levocarnitine...............................................         0.3
Doxercalciferol.............................................         3.1
Calcitriol..................................................         0.1
Iron-dextran................................................         0.0
Vancomycin..................................................         0.1
Alteplase...................................................         0.9
------------------------------------------------------------------------

    After removing the enrollment and price effects from the 
expenditure data, the residual growth would reflect the per patient 
utilization growth. To do this, we divided the product of the 
enrollment growth of 3 percent (1.03) and the price reduction of 3 
percent (1.00 - 0.03 = 0.97) into the total drug expenditure change 
between 2005 and 2006 of -0.2 percent (1.00 - 0.00 = 1.00). The result 
is a utilization factor equal to 1.00(1.00/(1.03 * 0.97) = 1.00).
    We observed no growth in per patient utilization of drugs between 
2005 and 2006. Therefore, we are projecting no growth in per patient 
utilization for all ESRD facilities in CY 2008.
b. Applying the Proposed Growth Update to the Drug Add-on Adjustment
    In CY 2006, we applied the projected growth update percentage to 
the total amount of drug add-on dollars established for CY 2005 to come 
up with a dollar amount for the CY 2006 growth update. In addition, we 
projected the growth in dialysis treatments for CY 2006 based on the 
projected growth in ESRD enrollment. We divided the projected total 
dialysis treatments for CY 2006 into the projected dollar amount of the 
CY 2006 growth to develop the per treatment growth update amount. This 
growth update amount, combined with the CY 2005 per treatment drug add-
on amount, resulted in an average drug add-on amount per treatment of 
$18.88 (or a 14.5 percent adjustment to the composite rate) for CY 
2006.
    In the CY 2007 PFS final rule with comment period (71 FR 69684), we 
revised our update methodology by applying the growth update to the per 
treatment drug add-on amount. That is, for CY 2007, we applied the 
growth update factor of 4.03 percent to the $18.88 per treatment drug 
add-on amount for an updated amount of $19.64 per treatment (71 FR 
69684).
    For CY 2008, we are proposing to update the per treatment drug add-
on amount of $19.64 established in CY 2007 and convert the update to an 
adjustment factor as specified in section 1881(b)(12)(F) of the Act. As 
explained in the CY 2007 PFS proposed rule (71 FR 49007) and adopted in 
the CY 2007 PFS final rule with comment period (71 FR 69683), we 
believe this approach is more accurate than using an estimate of growth 
in treatments to determine the per treatment add-on adjustment each 
year.
c. Proposed Update to the Drug Add-on Adjustment
    As discussed previously in this section, we estimate no growth in 
per patient utilization of ESRD drugs for CY 2008. Using the projected 
CY 2008 PPI for prescription drugs of 3.66 percent, we are projecting 
that the combined growth in per patient utilization and pricing for CY 
2008 would result in an update equal to 3.66 percent (1.0 * 1.0366 = 
1.0366). This update factor would be applied to the CY 2007 average per 
treatment drug add-on amount of $19.64 (reflecting a 14.9 percent 
adjustment in CY 2007), resulting in a proposed weighted average 
increase to the composite rate of $0.72 for CY 2008 or a 0.5 percent 
increase in the CY 2007 drug add-on percentage. Thus, the total 
proposed drug add-on adjustment to the composite rate for CY 2008, 
including the growth update, would be 15.5 percent (1.149 * 1.005 = 
1.155).
    We propose to continue to use this method to estimate the growth 
update to the drug add-on component of the case-mix adjusted payment 
system until we have at least 3 years worth of ASP-based historical 
drug expenditure data that could be used to conduct a trend analysis to 
estimate the growth in drug expenditures. Given the time lag in the 
availability of ASP drug expenditure data, we expect that the earliest 
we could consider using trend analysis to update the drug add-on 
adjustment would be CY 2010. We intend to reevaluate our methodology 
for estimating the growth update at that time.
d. Proposed Update to the Geographic Adjustments to the Composite Rates
    Section 1881(b)(12)(D) of the Act, as amended by section 623(d) of 
the MMA, gave the Secretary the authority to revise the wage indexes 
previously applied to the ESRD composite rates. The wage indexes are 
calculated for each urban and rural area. The purpose of the wage index 
is to adjust the composite rates for differing wage levels covering the 
areas in which ESRD facilities are located.
(i) Updates to Core-Based Statistical Area (CBSA) Definitions
    In the CY 2006 PFS final rule with comment period (70 FR 70167), we 
announced our adoption of the OMB's CBSA-based geographic area 
designations to develop revised urban/rural definitions and 
corresponding wage index values for purposes of calculating ESRD 
composite rates. OMB's CBSA-based geographic area designations were 
described in OMB Bulletin 03-04, originally issued June 6, 2003, and 
available online at www.whitehouse.gov/omb/bulletins/b03-04.html. In 
addition, OMB published subsequent bulletins regarding CBSA changes, 
including changes in CBSA numbers and titles. We wish to clarify that 
this and all subsequent ESRD rules and notices are considered to 
incorporate the CBSA changes published in the most recent OMB bulletin 
that applies to the hospital wage data used to determine the current 
ESRD wage index. The OMB bulletins may be accessed online at http://www.whitehouse.gov/omb/bulletins/index.html.

[[Page 38167]]

(ii) Updated Wage Index Values
    In the CY 2007 PFS final rule with comment period (71 FR 69685), we 
stated that we intend to update the ESRD wage index values annually. 
Current ESRD wage index values for CY 2007 were developed from FY 2003 
wage and employment data obtained from the Medicare hospital cost 
reports. The ESRD wage index values are calculated without regard to 
geographic reclassifications authorized under sections 1886(d)(8) and 
(d)(10) of the Act and utilize pre-floor hospital data that is 
unadjusted for occupational mix.
    The methodology for calculating the CY 2006 ESRD wage index values 
was described in the CY 2006 PFS final rule with comment period (70 FR 
70168). We propose to use the same methodology for CY 2008, with the 
exception that FY 2004 hospital data will be used to develop the CY 
2008 wage index values. For a detailed description of the development 
of the proposed CY 2008 wage index values based on FY 2004 hospital 
data, see the FY 2008 ``Proposed Changes to the Hospital Inpatient 
Prospective Payment Systems (IPPS) and Fiscal Year 2008 Rates'' 
proposed rule (72 FR 24680). Section III G. (Computation of the 
Proposed FY 2008 Unadjusted Wage Index) of the preamble to that 
proposed rule describes the cost report schedules, line items, data 
elements, adjustments, and wage index computations. The wage index data 
affecting ESRD composite rates for each urban and rural locale may also 
be accessed on the CMS Web site at http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp
    The wage data are located in the section entitled, ``FY 2008 
Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly 
Wage and Pre-reclassified Wage Index by CBSA''.
(A) Third Year of the Transition
    In the CY 2006 PFS final rule with comment period (70 FR 70169), we 
indicated that we would apply a 4-year transition period to mitigate 
the impact on composite rates resulting from our adoption of CBSA-based 
geographic designations. Beginning January 1, 2006, during each year of 
the transition, an ESRD facility's wage-adjusted composite rate (that 
is, without regard to any case-mix adjustments) will be a blend of its 
old MSA-based wage-adjusted payment rate and its new CBSA-based wage 
adjusted payment rate for the transition year involved. For each 
transition year, the share of the blended wage-adjusted base payment 
rate that is derived from the MSA-based and CBSA-based wage index 
values is shown in Table 13. In CY 2006, the first year of the 
transition, we implemented a 75/25 blend. In CY 2007, the second year 
of the transition, we implemented a 50/50 blend. Consistent with the 
transition blends announced in the CY 2006 PFS final rule with comment 
period (70 FR 70170), we are proposing a 25/75 blend between an ESRD 
facility's MSA-based composite rate, and its CY 2008 CBSA-based rate 
reflecting its revised wage index values.
    In CY 2006, we also eliminated the wage index cap of 1.30, and 
stated that we would implement a gradual reduction in the wage index 
floor of 0.90. Prior to January 1, 2006, the wage indexes were 
restricted to values no less than 0.90 and no greater than 1.30, 
meaning that payments to facilities in areas where labor costs fell 
below 90 percent of the national average, or exceeded 130 percent of 
that average, were not adjusted beyond the 90 percent or 130 percent 
level. Although we stated that the ESRD wage index values should not be 
constrained by the application of floors and ceilings, we also 
expressed concern that the immediate elimination of the floor could 
adversely affect ESRD beneficiary access to care. Therefore, we reduced 
the floor to 0.85 in CY 2006, and to 0.80 in CY 2007.
    For CY 2008, we are proposing to reduce the wage index floor to 
0.75. As we stated in the CY 2006 PFS final rule with comment period 
(70 FR 70169 through 70170), we intended to reassess the continuing 
need for a wage index floor in CY 2008 and CY 2009. For the third year 
of the transition, we believe that a reduction to 0.75 is appropriate 
as we continue to reassess the need for a wage index floor for future 
years. We believe that a gradual reduction to the wage index floor is 
needed to ensure patient access to dialysis in areas that have low wage 
index values, especially Puerto Rico, where payments would decrease 
significantly if the floor was eliminated.
    The proposed wage index floors, caps, and blended shares of the 
composite rates applicable to all ESRD facilities during CY 2008 
through CY 2009 are shown in Table 13. They are identical to the values 
shown in Table 4 of the CY 2007 PFS final rule with comment period (71 
FR 69686) for the applicable years.

                                      Table 13.--Wage Index Transition Blend
----------------------------------------------------------------------------------------------------------------
                                                                                          Old MSA      New CBSA
                CY payment                     Floor                Ceiling              (percent)    (percent)
----------------------------------------------------------------------------------------------------------------
2006......................................         0.85  None.........................           75           25
2007......................................         0.80  None.........................           50           50
2008......................................        *0.75  None.........................           25           75
2009......................................     Reassess  None.........................            0          100
----------------------------------------------------------------------------------------------------------------
*Each wage index floor is multiplied by a BN adjustment factor. For CY 2008, the BN adjustment is 1.054955
  resulting in an actual wage index floor of 0.7912.

    An example of how the wage-adjusted composite rates would be 
blended during CY 2008 and the additional subsequent transition year 
follows.
    Example: An ESRD facility has a wage-adjusted composite rate 
(without regard to any case-mix adjustments) of $135.00 per treatment 
in CY 2007. Using CBSA-based geographic area designations, the 
facility's CY 2008 wage-adjusted composite rate, reflecting its wage 
index value would be $145.00. During the remaining 2 years of the 4-
year transition period to the new CBSA based wage index values, this 
facility's blended rate through 2009 would be calculated as follows:

CY 2008 0.25 x $135.00 + 0.75 x $145.00 = $142.50
CY 2009 0 x $135.00 + 1.0 x $145.00 = $145.00

    We note that this hypothetical example assumes that the calculated 
wage-adjusted composite rate of $145.00 for CY 2008 does not change in 
CY 2009. In actuality, the wage-adjusted composite rate would change 
because of annual revisions to the wage index. However, the example 
serves only to demonstrate the effect on the composite rate of the 
CBSA-based wage index values which will be phased-in during the 
remaining 2 years of the transition period.

[[Page 38168]]

(B) Wage Index Values for Areas With No Hospital Data
    In CY 2006, while adopting the CBSA designations, we identified a 
small number of ESRD facilities in both urban and rural geographic 
areas where there is no hospital wage data on which to base the 
calculations of the CY 2006 ESRD wage index values. Our CY 2006 policy 
and CY 2007 proposals for each area are discussed separately below in 
this section.
    The first situation is rural Massachusetts. Because in CY 2006 we 
had not determined a reasonable proxy for rural data within 
Massachusetts, we used the prior year's acute care hospital wage index 
value for rural Massachusetts. For CY 2007, we continued to use this 
value and requested public input on an alternative methodology as 
described below in this section. We described an alternative 
methodology whereby we would impute a rural wage index value by using a 
simple average CBSA-based rural wage index value at the Census Division 
level.
    The second situation involves Puerto Rico. Rural Puerto Rico is 
similar to rural Massachusetts in that there are no acute care 
hospitals, and therefore, no hospital data. However, for ESRD 
facilities in rural Puerto Rico, the CY 2007 ESRD wage index floor 
value (0.8000) was applied to rural Puerto Rico ESRD facilities. All 
areas in Puerto Rico that have a wage index are eligible for the ESRD 
wage index floor because they have wage index values that are below 
0.8000. Accordingly, for CY 2007, we applied the ESRD wage index floor 
value to rural Puerto Rico.
    The third situation involves an urban area in Hinesville, GA (CBSA 
25980). As with the rural areas noted previously in this section, there 
are no available hospital wage index data as there are no urban 
hospitals within that CBSA. For CY 2007, we used a wage index value 
based on wage index values in all of the other urban areas within the 
same State to serve as a reasonable proxy for the urban areas without 
hospital wage index data. Specifically, for CY 2007, we used the 
average wage index value for all urban areas within the State of 
Georgia as the urban wage index for purposes of calculating the ESRD 
wage index value for Hinesville.
    In CY 2007, we received no comments on maintaining the policies 
used in CY 2006 for establishing ESRD wage index values for rural and 
urban areas without hospitals, or an alternative approach for 
developing wage index values for rural areas without hospitals for CY 
2007 and subsequent years. Therefore, for CY 2007, we maintained the 
policies used in CY 2006 for establishing ESRD wage index values for 
rural and urban areas without hospital data.
    For CY 2007, the Home Health PPS (71 FR 65884 through 65905) 
adopted an alternative approach using the average wage index from all 
contiguous CBSAs to represent a reasonable proxy for the rural areas 
without hospital wage index data. Because we have used the same wage 
index value (from CY 2005) for rural Massachusetts for both, CY 2006 
and CY 2007, we believe it is now appropriate to consider another 
methodology as a proxy for rural areas lacking hospital wage index 
data. We believe that use of contiguous areas is a valid proxy as it 
meets our criteria for imputing a wage index. This approach uses pre-
floor, pre-reclassified hospital wage data, is easy to evaluate, can be 
updated from year-to-year, and uses the most local data available.
    Therefore, in cases where there is a rural area without hospital 
wage data, we propose to use the average wage index from all contiguous 
CBSAs to represent a reasonable proxy for that rural area. As was the 
case in previous years, this proposed policy impacts rural 
Massachusetts.
    In determining an imputed rural wage index, we interpret the term 
``contiguous'' to mean sharing a border. For example, in the case of 
Massachusetts, the entire rural area consists of Dukes and Nantucket 
counties. We have determined that the borders of Dukes and Nantucket 
counties are ``contiguous'' with Barnstable and Bristol counties. Under 
the proposed methodology, the wage indexes for the counties of 
Barnstable (CBSA 12700, Barnstable Town, MA-(1.2539)) and Bristol (CBSA 
39300, Providence-New Bedford-Fall River, RI-MA-(1.0783)) are averaged, 
resulting in an imputed rural wage index of 1.1665 for rural 
Massachusetts for CY 2008. While we believe that this policy could be 
readily applied to other rural areas that lack hospital wage data 
(possibly due to hospitals converting to a different provider type, 
such as a CAH, that does not submit the appropriate wage data), should 
a similar situation arise in the future, we may reexamine this policy.
    As we stated previously in this section, rural Puerto Rico is 
similar to rural Massachusetts in that there are no acute care 
hospitals, and therefore, no hospital wage index data. However, for 
ESRD facilities in rural Puerto Rico we propose to use the proposed CY 
2008 ESRD wage index floor value (0.7500) as a proxy for the hospital 
wage index data. Accordingly, all areas in Puerto Rico that have a wage 
index are eligible for the ESRD wage index floor value because they 
have wage index values that are below 0.7500. We continue to believe 
that this approach is an appropriate proxy for rural Puerto Rico 
because it ensures a rural Puerto Rico wage index value consistent with 
all other areas in Puerto Rico. Thus, consistent with previous years, 
for CY 2008, we propose to continue to apply the ESRD wage index floor 
value (0.7500) to rural Puerto Rico.
    We also propose the following approach with regard to an urban area 
lacking hospital wage index data, specifically, Hinesville, GA (CBSA 
25980). Again, under CBSA designations there are no urban hospitals 
within that CBSA. For CY 2006 and CY 2007, we used all of the urban 
areas within the State to serve as a reasonable proxy for the urban 
area without specific hospital wage index data. Specifically, we used 
the average wage index value for all urban areas within the State of 
Georgia as the urban wage index for purposes of calculating the value 
for Hinesville for CY 2007.
    We propose to continue this approach for urban areas without 
specific hospital wage index data. Specifically, for CY 2008, we are 
proposing to continue using this method for Hinesville, GA (CBSA 
25980). Therefore, the wage index for urban CBSA (25980) Hinesville-
Fort Stewart, GA is calculated as the average wage index of all urban 
areas in Georgia.
    We solicit comments on these approaches to calculating the wage 
index values for areas without hospital wage index data for FY 2008 and 
subsequent years. We will also continue to evaluate existing hospital 
wage data and, possibly, wage data from other sources, such as the 
Bureau of Labor Statistics, to determine if other methodologies of 
imputing a wage index value where hospital wage data are not available 
may be feasible.
(iii) Budget Neutrality (BN) Adjustment
    Section 1881 (b)(12)(E)(i) of the Act, as added by section 623(d) 
of the MMA, requires that any revisions to the ESRD composite rate 
payment system as a result of the MMA provision (including the 
geographic adjustment) be made in a budget neutral manner. This means 
that aggregate payments to ESRD facilities in CY 2007 should be the 
same as aggregate payments that would have been made if we had not made 
any changes to the geographic adjusters. We note that this BN 
adjustment only addresses the impact of changes in the geographic 
adjustments. A separate BN adjustment was developed for the case-mix 
adjustments, currently in effect. As

[[Page 38169]]

we are not proposing any changes to the case-mix measures for CY 2008, 
the current case-mix BN adjustment will remain in effect for CY 2008. 
For CY 2008, we again propose to apply a BN adjustment factor 
(1.054955) directly to the ESRD wage index values, as we did in CY 
2007. As we explained in the CY 2007 PFS final rule with comment period 
(71 FR 69687 through 69688), we believe this is the simplest approach 
because it allows us to maintain our base composite rates during the 
transition from the current wage adjustments to the revised wage 
adjustments described previously in this section. Because the ESRD wage 
index is only applied to the labor-related portion of the composite 
rate, we computed the BN adjustment factor based on that proportion 
(53.711 percent).
    To compute the proposed CY 2008 wage index BN adjustment factor 
(1.054955), we used the wage index values in Addenda G and H, 2006 
outpatient claims (paid and processed as of December 31, 2006), and 
geographic location information for each facility which may be found 
through Dialysis Facility Compare Web page on the CMS Web site at 
http://www.cms.hhs.gov/DialysisFacilityCompare/.
    Using treatment counts from the 2006 claims and facility-specific 
CY 2007 composite rates, we computed the estimated total dollar amount 
each ESRD provider would have received in CY 2007 (the 2nd year of the 
4-year transition). The total of these payments became the target 
amount of expenditures for all ESRD facilities for CY 2008. Next, we 
computed the estimated dollar amount that would have been paid to the 
same ESRD facilities using the proposed ESRD wage index for CY 2008 
(the 3rd year of the 4-year transition). The total of these payments 
became the third year new amount of wage-adjusted composite rate 
expenditures for all ESRD facilities.
    After comparing these two dollar amounts (target amount divided by 
3rd year new amount), we calculated an adjustment factor that, when 
multiplied by the applicable CY 2008 ESRD wage index shown in Addenda G 
and H, will result in payments to each facility that will remain within 
the target amount of composite rate expenditures when totaled for all 
ESRD facilities. The proposed BN adjustment factor for the CY 2008 wage 
index is 1.054955.
    To ensure BN, we also must apply the BN adjustment factor to the 
proposed wage index floor of 0.7500 which results in a proposed 
adjusted wage index floor of 0.7912(0.7500 x 1.054955) for CY 2008.
(iv) ESRD Wage Index Tables
    The proposed 2008 wage index tables are located in Addenda G and H.

I. Independent Diagnostic Testing Facility (IDTF) Issues

    [If you choose to comment on issues in this section, please include 
the caption ``IDTF ISSUES'' at the beginning of your comments.]
    In the CY 2007 PFS final rule with comment period, we established 
14 performance standards and several other provisions at Sec.  
410.33(g) associated with independent diagnostic testing facilities 
(IDTFs). In this proposed rule, we are clarifying our interpretation of 
several of the performance standards at Sec.  410.33(g) to assist the 
public in understanding how we expect our designated contractors to 
implement these standards. In addition, we are proposing several new 
performance standards and other provisions associated with IDTFs.
1. Proposed Revisions of Existing IDTF Performance Standards
a. Sec.  410.33(g)(6)
    The supplier standard at Sec.  410.33(g)(6) states, ``Has a 
comprehensive liability insurance policy in the amount of at least 
$300,000 that covers both the supplier's place of business and all 
customers and employees of the supplier. The policy must be carried by 
a nonrelative-owned company.'' We are proposing to revise this standard 
to read, ``Has a comprehensive liability insurance policy in the amount 
of at least $300,000 per incident that covers both the supplier's place 
of business and all customers and employees of the supplier and ensures 
that this insurance policy must remain in force at all times. The 
policy must be carried by a nonrelative-owned company. The IDTF must 
list the Medicare contractor as a Certificate Holder on the policy and 
promptly notify the Medicare contractor in writing of any policy 
changes or cancellations. Failure to maintain required insurance at all 
times will result in revocation of the IDTF's billing privileges 
retroactive to the date the insurance lapsed. IDTF suppliers are 
responsible for providing the contact information for the issuing 
insurance agent and the underwriter.'' This proposed rule clarifies how 
we will verify whether an IDTF meets this standard to include the 
provision that IDTF suppliers are responsible for providing the contact 
information of an individual employed with the underwriter, who can 
verify coverage. This proposed revision will not preclude the use of 
self insurance to demonstrate compliance with the comprehensive 
liability insurance policy as long as CMS or our designated contractor 
can verify the policy and its coverage provisions with an independent 
underwriter.
    We believe that we should be able verify the issuance of a 
comprehensive liability insurance policy with an underwriter, as well 
as an insurance agent. This approach will allow our designated 
contractors to verify that a comprehensive liability insurance policy 
has been issued and is in effect at the time of enrollment and 
throughout the enrollment period. Moreover, since 90 days may pass 
before the underwriter receives notification the policy has been issued 
by the insurance agent or broker, we encourage IDTFs to obtain 
comprehensive liability insurance at least 90 days prior to filing its 
Medicare enrollment application. This will prevent delays in the 
enrollment process and will allow our designated contractors to verify 
the issuance of an IDTF's comprehensive liability insurance policy on 
the day an application is submitted for review.
    As a result, at Sec.  410.33(g)(6), we are proposing to revise this 
performance standard to include the requirement that an IDTF must list 
our designated contractor as a Certificate Holder on the policy. By 
listing our designated contractor as a Certificate Holder on the 
policy, our contractor will be able to verify coverage with the 
underwriter at the time of enrollment and as the need arises throughout 
the year.
    Therefore, we are also proposing to revise Sec.  410.33(g)(6) to 
state that it is the IDTF supplier's responsibility to: (1) Ensure that 
the insurance policy must remain in force at all times and provide 
coverage of at least $300,000 per incident; and (2) promptly notify the 
CMS designated contractor in writing of any policy changes and 
cancellations.
b. Sec.  410.33(g)(2)
    Based on feedback that we received after the implementation of 
Sec.  410.33(g)(2), we believe that several changes are necessary to 
ensure timely reporting of certain events and less frequent reporting 
of reportable events. Accordingly, we are proposing to change Sec.  
410.33(g)(2) from, ``Provides complete and accurate information on its 
enrollment application. Any change in enrollment information must be 
reported to the designated fee-for-service contractor on the Medicare 
enrollment application within 30 calendar days of the change,'' to

[[Page 38170]]

``Provides complete and accurate information on its enrollment 
application. Changes in ownership, changes of location, changes in 
general supervision, and adverse legal actions must be reported within 
30 calendar days of the change. All other reportable changes must be 
reported within 90 days.''
c. Sec.  410.33(g)(8)
    We are proposing to revise Sec.  410.33(g)(8) from ``Answer 
beneficiaries' questions and respond to their complaints,'' to, 
``Answer, document, and maintain documentation of beneficiaries' 
questions and responses to their complaints at the physical site of the 
IDTF.'' This change corrects an oversight in drafting of the initial 
performance standards for IDTFs. In the CY 2007 PFS final rule with 
comment period, we did not include a requirement for the documentation 
of the complaint process. Thus, by making this proposed change, we are 
proposing to require an IDTF to document its complaint process. We 
believe that this change is consistent with the established practice 
for durable medical equipment, prosthetics orthotics and supplies 
(DMEPOS) suppliers found in Sec.  424.57(c)(19). To meet this revised 
standard, an IDTF would be responsible for maintaining the following 
information on all written and oral beneficiary complaints, including 
telephone complaints, it receives:
     The name, address, telephone number, and health insurance 
claim number of the beneficiary.
     A summary of the complaint; the date it was received; the 
name of the person receiving the complaint; and a summary of actions 
taken to resolve the complaint.
     If an investigation was not conducted, the name of the 
person making the decision and the reason for the decision. For mobile 
IDTFs, this documentation would be stored at their home office.
d. Sec.  410.33(b)(1)
    At Sec.  410.33(b)(1), we are proposing to delete, ``The IDTF 
supervising physician is responsible for the overall operation and 
administration of the IDTFs, including the employment of personnel who 
are competent to perform test procedures, record and report test 
results promptly, accurately and proficiently, and for assuring 
compliance with the applicable regulations''. We believe that our 
earlier rulemaking effort had the unintended consequence of appearing 
to shift the overall administrative responsibility from owners or 
administrative staff employed by an IDTF to the supervising physician. 
This was not our intent. Moreover, we believe that this requirement can 
be interpreted as being too restrictive as it is currently written and 
may convey responsibilities to a general supervising physician who may 
not have the administrative authority or knowledge to make these 
decisions. We are proposing to clarify and expand on our meaning of 
what constitutes three IDTF sites found at Sec.  410.33(b)(1). We 
believe that limitation on sites applies to both fixed sites and mobile 
units. Accordingly, we believe that a physician providing general 
supervision as defined in Sec.  410.32(b)(3)(i) can oversee a maximum 
of three sites (that is, fixed or mobile) where concurrent operations 
can be performed. For example, we believe that a physician providing 
general supervision could oversee up to three individual IDTF mobile 
units or three individual fixed location IDTFs, or a combination of 
both that total up to three separate places which can concurrently run 
diagnostic tests. This does not change the requirements found at Sec.  
410.32(b)(3) for direct and personal supervision.
2. Proposed New IDTF Standards
    At Sec.  410.33(i), we are proposing to add a provision to state 
that Medicare will establish an initial enrollment date for IDTFs. 
Currently, IDTFs can retroactively bill Medicare for services that are 
rendered before they submitted a Medicare enrollment application or 
were approved to participate in the Medicare program. This means an 
IDTF is allowed to bill Medicare for services rendered on dates prior 
to the date the IDTF was enrolled in the Medicare program. For example, 
if an IDTF submits a Medicare enrollment application in November 2007 
and is enrolled in the Medicare program in December 2007, then a 
physician or supplier could retrospectively bill for services furnished 
to Medicare beneficiaries as far back as October 1, 2005; indeed, an 
IDTF may bill Medicare for services rendered up to 27 months prior to 
their Medicare enrollment date. This means that an IDTF in the example 
that is enrolled as meeting our program requirements in December 2007 
may not have met those same requirements prior to the date of 
enrollment, even though the IDTF could bill Medicare and receive 
payments for services rendered up to 27 months prior to their enrolling 
in the Medicare program.
    We are concerned that some IDTFs may bill Medicare for services 
when they do not meet all of the program requirements, including 
compliance with the performance standards at Sec.  410.33(g). Allowing 
an IDTF to bill Medicare for services furnished prior to being enrolled 
in the Medicare program, creates a significant risk for the Medicare 
program and its beneficiaries. Specifically, we believe that allowing 
an IDTF to bill for services furnished prior to enrolling in the 
Medicare program allows these facilities to potentially be reimbursed 
for services they are not qualified to perform or for which they 
otherwise may be precluded from billing to the Medicare program.
    Since Medicare FFS contractors verify enrollment information at the 
time an enrollment application is filed, not for prior periods, we do 
not believe that it is appropriate to continue the practice of allowing 
IDTFs to bill the Medicare program for services rendered in periods 
prior to their enrollment in the Medicare program. Therefore, we are 
proposing to add Sec.  410.33(i) to state that Medicare will establish 
an initial enrollment date for an IDTF that would be the later of: (1) 
The date of filing of a Medicare enrollment application that was 
subsequently approved by FFS contractor; or (2) the date an IDTF first 
started rendering services at its new practice location. We also 
propose to define the ``date of filing'' as the date that the Medicare 
FFS contractor receives a signed provider enrollment application that 
the Medicare FFS contractor is able to process for approval. If the 
contractor rejects or denies and enrollment application, the new date 
of filing would be established when an IDTF submits a new enrollment 
application that the contractor is able to process for approval. Please 
note that we expect to implement a Web-based enrollment process known 
as the Provider Enrollment, Chain, and Ownership System (PECOS) 
process, to be known as PECOS Web, in most States during the 2007 
calendar year. This internet enrollment process will permit IDTFs to 
complete and submit enrollment applications online. The date of filing 
for applications submitted through PECOS Web will be the date the 
Medicare FFS contractor receives all of the following: (1) A signed 
Certification Statement; (2) an electronic version of the enrollment 
application; and (3) a signature page that the Medicare FFS contractor 
processes to approval. Further, our proposed policy is consistent with 
current Medicare payment policy of precluding payment for services 
until the provider or supplier of service establishes that they meet 
enrollment and certification

[[Page 38171]]

requirements prior to being eligible to bill the Medicare program.
    While this change limits the retrospective payments that an IDTF 
may obtain from Medicare program, we believe that this approach is 
consistent with our existing requirements for those providers that 
require a State survey prior to being enrolled as specified in Sec.  
489.13 and the requirements followed by DMEPOS suppliers as established 
in section 1834(j)(1) of the Act and Sec.  424.57(b)(2). Moreover, this 
change would ensure that we are able to verify that an IDTF meets all 
program requirements at the time of filing, including the performance 
standards outlined in Sec.  410.33(g) before payment for service 
occurs.
    We are also proposing a new performance standard at Sec.  
410.33(g)(15), which states, ``Does not share space, equipment, or 
staff or sublease its operations to another individual or 
organization.'' We believe that it is inappropriate for a fixed-base 
(physical site) IDTF to commingle office space, staff, and equipment, 
and that commingling office space, staff and equipment or subleases its 
fixed-base (physical site) operation to another individual or 
organization constitutes a significant risk to the Medicare program 
because it prohibits CMS or our contractors from ensuring that each 
fixed-base (physical site) IDTF establishes and maintains Medicare 
billing privileges consistent with the provisions at Sec.  424.500 and 
each IDTF meets and maintains all performance standards and other 
requirements under Sec.  410.33. While we believe that this new 
performance standard should only apply to fixed-base (physical site) 
IDTF locations, we are seeking public comments on establishing a 
similar requirement for mobile IDTFs. This proposed standard, in 
conjunction with the existing IDTF performance standard three 
(concerning appropriate sites for an IDTF), expands the interpretation 
of these standards to state that a motel, or hotel is not an 
appropriate site for an IDTF. While we initially believed that this new 
performance standard should apply to only fixed-based (physical site) 
locations, we also believe it should apply to mobile IDTFs, but we are 
seeking public comment on establishing this requirement.
    We believe that allowing fixed-base (physical site) IDTFs to 
commingle office space (including waiting rooms), staff (including 
supervising physicians, nonphysician personnel, or receptionists), or 
equipment through subleasing agreements may allow an IDTF to circumvent 
Medicare enrollment and billing requirements. These types of 
arrangements also raise concerns because they may implicate the 
physician self-referral prohibition and the anti-kickback prohibition.

J. Expiration of MMA Section 413 Provisions for Physician Scarcity 
Areas (PSAs)

    [If you choose to comment on issues in this section, please include 
the caption ``PHYSICIAN SCARCITY AREAS'' at the beginning of your 
comments.]
    Section 413(a) of the MMA added a new section 1833(u) to the Act. 
That section provided a 5 percent incentive payment to physicians 
furnishing services in physician scarcity areas (PSAs) for physicians' 
services furnished on or after January 1, 2005, and before January 1, 
2008. Specifically, section 1833(u) of the Act provided for payment of 
an additional 5 percent of the payment amount for services furnished by 
primary care physicians in a primary care scarcity area and by non-
primary care physicians in a specialist care scarcity area.
    Because the provisions of section 1833(u) of the Act do not apply 
to services furnished after January 1, 2008, we are providing 
notification that these 5 percent incentive payments will no longer be 
made for services furnished on or after January 1, 2008.

K. Comprehensive Outpatient Rehabilitation Facility (CORF) Issues

    [If you choose to comment on issues in this section, please include 
the caption ``CORF ISSUES'' at the beginning of your comments.]
    Section 4541(a) of the Balanced Budget Act of 1997 (Pub. L. 105-33) 
(BBA), related to prospective payment for outpatient rehabilitation 
services, established section 1832(a)(2)(E) of the Act for all 
comprehensive outpatient rehabilitation facility (CORF) services, not 
just rehabilitation services of outpatient physical therapy services 
(including outpatient speech-language pathology (SLP) services), and 
outpatient occupational therapy services. The BBA also amended sections 
1833 and 1834 of the Act to provide that all CORF services (as defined 
under section 1861(cc)(1) of the Act) furnished on or after January 1, 
1999 would no longer be paid on a ``reasonable cost'' basis but instead 
would be paid based on the applicable fee schedule amount (or if less, 
based on the actual charge for the services). Where there is no 
applicable fee schedule amount, payment would be based on a comparable 
service or, if less, the CORF's actual charge for the service. 
Specifically, section 1834(k)(1)(B) of the Act states that the payment 
basis for outpatient physical therapy services (including outpatient 
SLP services), outpatient occupational therapy services, and all other 
CORF services provided on or after January 1, 1999 will be 80 percent 
of the lesser of: (i) The actual charge for the services; or (ii) the 
applicable fee schedule amount. The term ``applicable fee schedule 
amount'' is defined under section 1834(k)(3) of the Act to mean, for 
services furnished in a year, the payment amount determined under the 
PFS established under section 1848 of the Act for such services for the 
year ``or, if there is no such fee schedule established for such 
services, the amount determined under the fee schedule established for 
such comparable services as the Secretary specifies.''
    In the CY 1999 PFS final rule (63 FR 58860), we stated that we 
would base payment for a CORF service on the PFS amount for the service 
when the PFS established a payment amount for such service. We further 
explained that we would use the higher PFS amount applicable to 
services furnished in a nonfacility setting, rather than the facility 
payment amount, because no separate payment will be made for facility 
costs. The nonfacility payment rate includes, along with any physician 
work and MP RVUs, the PE RVUs representing nonfacility resources 
necessary for the physician to perform each service in the office 
setting, including both direct and indirect PE inputs, such as the 
costs of clinical labor, disposable supplies, personnel salaries, 
equipment, and overhead expenses. The facility payment rate is based 
primarily on the physician work and MP RVUs, although it contains RVUs 
for the indirect PE RVUs related to the primary providing specialties, 
but does not include the costs of the direct PE inputs (that is, 
clinical labor, disposable supplies, and equipment) that are utilized 
when the service is provided in the physician office or nonfacility 
setting. Payment at the higher nonfacility payment rate was already in 
place prior to CY 1999 for physical therapy, occupational therapy, and 
speech-language pathology (SLP) services provided in the physician's 
office and for the services of physical therapists (PTs) and 
occupational therapists (OTs) in private practice. Effective with the 
CY 1999 PFS final rule, we used the PFS nonfacility amount to make 
payment for outpatient Part B physical therapy, occupational therapy, 
and SLP services furnished in provider settings, including outpatient 
hospitals, SNFs, providers of outpatient

[[Page 38172]]

physical therapy (OPT) and SLP services, also known as rehabilitation 
agencies, CORFs, and home health agencies (HHAs) (for non-homebound 
patients), as discussed in the CY 1999 PFS final rule (63 FR 58860). 
Similarly, we used the PFS nonfacility amount for all other CORF 
services when the PFS established a payment amount for such service.
    In addition, in CY 1999, we established a fee schedule amount under 
the PFS for nursing services delivered within a CORF, and created a new 
HCPCS code (G0128) for such services. We defined this code as direct 
face-to-face skilled nursing services delivered to a CORF patient by a 
registered nurse (RN) as part of a rehabilitative therapy plan of 
treatment, billable in 10-minute intervals provided the initial 
interval is longer than 5 minutes. We stated that the HCPCS code G0128 
could be used for RN services that are not included in the work or PE 
of another therapy or physician service. The CORF conditions of 
participation at Sec.  485.58 provide that CORF services must be 
provided by personnel that meet the qualifications set forth in Sec.  
485.70. Sections 485.70(b) and (h) require, respectively, that as a 
condition of coverage of service a licensed practical nurse (LPN) be 
licensed as a LPN or vocational nurse by the State of practice, and 
that an RN be a graduate of an approved school of nursing and licensed 
as an RN by the State of practice. In creating the HCPCS code G0128 for 
CORF nursing services, we determined that a condition of coverage for 
the service is that it be furnished by an individual who meets the 
personnel requirements for an RN because we believe only an RN 
possesses the necessary training to provide the clinical nursing 
services that are medically necessary and appropriate for CORF patients 
as they relate to the therapy plan of treatment.
    Finally, in the CY 1999 PFS final rule (63 FR 58860), we explained 
that we interpret section 1834(k)(3) of the Act, defining the term 
``applicable fee schedule amount,'' as requiring us to use the payment 
amount established by an existing fee schedule other than the PFS when 
the PFS does not establish a payment amount for the CORF service. 
Specifically, we stated that we would use the existing fee schedules 
for prosthetic and orthotic devices, DME and supplies, and drugs and 
biologicals for covered prosthetics and orthotics devices, durable 
medical equipment (DME) and supplies, and drugs and biologicals, 
respectively, provided by CORFs. Covered DME, orthotic and prosthetic 
devices, and supplies provided by a CORF are paid under the DMEPOS fee 
schedule.
    Drugs and biologicals that are not considered to be self-
administered are specified as CORF services at section 1861(cc)(1)(F) 
of the Act. However, as discussed in section II.K.7., we believe that 
drugs and biologicals provided to CORF patients are not appropriately 
provided as part of a rehabilitation plan of treatment and, as such, we 
propose to remove drugs and biologicals from the scope of CORF services 
as defined at Sec.  410.100. In addition, because we believe it is 
appropriate for pneumococcal, influenza, and hepatitis B vaccines to be 
administered to CORF patients in the CORF setting, even though such 
vaccines fall outside the scope of CORF services, we propose to revise 
the conditions of participation at Sec.  485.51(a) to permit CORFs to 
provide to their patients pneumococcal, influenza, and hepatitis B 
vaccines in addition to CORF services.
    Because the regulations under 42 CFR parts 410 and 413 were never 
updated to reflect the change in CORF payment methodology from a 
``reasonable cost'' basis to 80 percent if the lesser of a payment 
amount under an existing fee schedule or the CORF's actual charge, we 
are proposing to add a new subpart M to 42 CFR Part 414 to reflect the 
change in CORF payment methodology. In addition, we propose to revise 
the following sections of the Medicare regulations to clarify the CORF 
benefit.
1. Requirements for Coverage of CORF services--Plan of Treatment (Sec.  
410.105(c))
    In accordance with section 1861(cc)(1) of the Act, requiring that 
CORF services be furnished ``under a plan (for furnishing such items 
and services to such individual) established and periodically reviewed 
by a physician,'' Sec.  410.105(c) provides that CORF services as 
defined under Sec.  410.100 are covered only if furnished under a 
written plan of treatment. Specifically, the plan of treatment must: 
(1) Be established and signed by a physician prior to the commencement 
of treatment in the CORF setting; and (2) Indicate the diagnosis and 
anticipated rehabilitation goals, and prescribe the type, amount, 
frequency, and duration of the services to be furnished. We interpret 
these provisions as requiring that the services furnished under the 
plan of treatment must relate directly to the rehabilitation of 
injured, disabled, or sick patients. Services provided in the CORF 
setting that do not relate directly to such rehabilitation goals are 
not covered as CORF services.
    We propose to revise Sec.  410.105(c) to clarify our policy that 
CORF services are covered only if they relate directly to the 
rehabilitation of injured, disabled, or sick patients. We believe our 
policy is consistent with the statutory requirements under section 
1861(cc) of the Act. Section 1861(cc)(1) of the Act specifies that CORF 
services must be furnished under a plan of treatment. Section 
1861(cc)(1)(H) of the Act further states that ``other items and 
services'' are considered CORF services only if ``medically necessary 
for the rehabilitation of the patient.'' We believe the implication of 
this limitation for ``other items of services'' is that all other CORF 
services (that is, those listed under sections 1861(cc)(1)(A) through 
(G) of the Act) also must be necessary for the rehabilitation of the 
patient. In addition, we note that section 1861(cc)(2)(A) of the Act 
specifies that a CORF facility is a facility ``primarily engaged in 
providing * * * diagnostic, therapeutic, and restorative services to 
outpatients for the rehabilitation of injured, disabled, or sick 
persons'' (emphasis added). We believe this requirement further signals 
the Congress's intent that the services provided in a CORF setting be 
covered as CORF services only if such services relate directly to the 
rehabilitation of the patient.
2. Included Services (Sec.  410.100)
    Section 410.100 establishes the services that are covered under the 
CORF services benefit, consistent with section 1861(cc)(1) of the Act. 
Because of the change in payment methodology from that based on cost to 
payment under the PFS and other existing fee schedules beginning in CY 
1999, this section does not reflect our current payment policies. 
Therefore, we propose to clarify our payment policy in the introductory 
paragraph of this section by including a cross-reference to proposed 
Sec.  414.1101, which sets forth the payment methodology for CORF 
services, including identifying the applicable fee schedule for each 
CORF service. In addition, we propose to revise our definitions of 
physician services to reflect the change in payment methodology for 
CORF services. We also propose to revise the definitions of physician 
services, respiratory therapy services, social and psychological 
services, and nursing services to ensure that these definitions include 
only those services appropriately provided by qualified nonphysician 
and physician personnel and related to the rehabilitation plan of 
treatment established under Sec.  410.105(c). In addition, we propose

[[Page 38173]]

revisions to the definition of supplies, equipment, and appliances to 
conform to the statutory provision at section 1861(cc)(1)(G) of the 
Act. Finally, we propose to remove the provision for drugs and 
biologicals. Although vaccines are not included in the definition of 
CORF services at section 1861(cc)(1) and Sec.  410.100, we propose to 
make revisions to the CORF conditions of participation at Sec.  485.51 
to reflect current coverage and payment policy for vaccines provided in 
the CORF setting.
3. Physician services (Sec.  410.100(a))
    Section 410.100(a) defines the physician services included within 
the scope of CORF services. Specifically, those services of a CORF 
physician described as administrative in nature are considered CORF 
services, to the exclusion of diagnostic and therapeutic services, 
which are physician services under section 1861(q) of the Act and 
separately billable as physician services under 42 CFR part 414, 
subpart B. Section 1861(cc)(1) of the Act excludes from the definition 
of CORF services any item or service that, if furnished to an inpatient 
of a hospital, would be excluded under section 1861(b) of the Act. 
Section 1861(b)(4) of the Act excludes from the definition of 
``inpatient hospital services'' the ``medical or surgical services 
provided by a physician,'' which would include the diagnostic and 
therapeutic services of a physician. Consequently, diagnostic and 
therapeutic services provided in the CORF setting by a physician are 
not considered CORF services. In contrast, because those services of a 
CORF physician that are of an administrative nature are not ``medical'' 
services, such services are included in the definition of CORF 
services.
    In accordance with section 1861(cc)(2)(B)(i) of the Act and Sec.  
485.70(a)(1), the CORF physician must be either a medical doctor (MD) 
or a Doctor of Osteopathy (DO); and the conditions of participation at 
Sec.  485.70(a)(2) and (3) further require that the physician have 
training or experience in the medical management of patients requiring 
rehabilitation services. The conditions of participation at Sec.  
485.58(a)(1)(i) also require the CORF facility physician to provide, in 
accordance with accepted principles of medical practice, medical 
direction, medical supervision, medical care services and consultation. 
We are proposing to revise Sec.  410.100(a) to clarify that only those 
physician services required and provided by the CORF facility physician 
that are administrative in nature are considered CORF services, whereas 
diagnostic and therapeutic services provided by a physician to CORF 
patients are considered physician services under section 1861(q) of 
that Act. Specifically, we propose to define CORF physician services as 
those services provided by a CORF facility physician that are 
administrative in nature, such as consultation with and medical 
supervision of nonphysician staff, patient case review conferences, 
utilization review, and the review of the therapy plan of treatment, as 
appropriate.
    Services provided to a CORF patient by the CORF facility physician 
or other physician that are not administrative in nature but that are 
diagnostic or therapeutic services are considered physician services 
under section 1861(q) of the Act. Where these services are covered, 
they are separately payable to the physician as physician services 
under the PFS at the nonfacility payment amount. The physician bills 
the carrier in the same manner as if the services were provided in the 
physician office setting and notes the CORF as the place of service.
    In addition, Sec.  410.100(a) currently provides that physician 
services included within the definition of CORF services are reimbursed 
on a reasonable cost basis under part 413, and that physician services 
to CORF patients not included within the definition of CORF services 
but billed as physician services are paid by the carrier on a 
reasonable charge basis subject to the provisions of subpart E of part 
405 of this chapter. This description of the payment methodology for 
physician services provided in the CORF setting under Sec.  410.100(a) 
is inconsistent with the payment methodology set forth under section 
1834(k)(1) of the Act for CORF services and section 1848 of the Act for 
physician services, as well as the preamble discussion in the CY 1999 
PFS final rule (63 FR 58860). In the CY 1999 PFS final rule, we stated 
that we would base payment for diagnostic and therapeutic physician 
services provided to individuals in the CORF setting on the PFS amount 
for the services. Therefore, we are proposing to revise Sec.  
410.100(a) to remove the reference to reasonable cost-based payments 
for CORF physician services and the reference to reasonable charge 
based payments for non-CORF physician services. In place of these 
references, we propose to revise Sec.  410.100(a) to add a reference to 
42 CFR part 414, subpart B, setting forth the payment methodology for 
non-CORF physician services.
4. Clarifications of CORF Respiratory Therapy Services
    Section 1861(cc)(1)(B) of the Act states that CORF services include 
respiratory therapy services along with physical therapy, occupational 
therapy, and SLP services. Because respiratory therapists (RTs) are not 
recognized as independent practitioners in the Act or regulations, and 
respiratory therapy services do not have a statutory benefit category 
except as specified in the CORF services benefit at section 
1861(cc)(1)(B) of the Act, separate payment is not made for services 
provided by RTs. Instead, RTs are most often employed in physician 
offices and in facility settings, such as hospitals and SNFs, where 
payment is made to the RT employer.
    The description of CORF respiratory therapy services currently 
includes some services that should be provided by a physician, and not 
an RT, and thus are inappropriate to include in a respiratory therapy 
plan of care. Therefore, we are proposing to remove these services from 
the description of CORF respiratory therapy services under Sec.  
410.100(e), and to limit these services to those provided by RTs under 
a respiratory therapy plan of treatment. Section 410.105(c) requires a 
physician, and not the RT, to provide the clinical diagnosis; establish 
and sign the respiratory therapy plan of treatment for each patient 
that includes the type, amount, frequency and duration of the services 
to be furnished; and indicate the diagnosis and the patient's 
rehabilitation goals. The physician must also recertify this plan for 
medical necessity every 60 days or sooner if appropriate. However, the 
description of respiratory therapy services under Sec.  410.100(e) 
includes these services, as well as other services that under current 
clinical standards should not be provided by RTs, but rather should be 
entrusted to the physician.
    Therefore, we are proposing to revise Sec.  410.100(e) to limit 
respiratory therapy services to those services appropriately provided 
to CORF patients by RTs under a physician-established respiratory 
therapy plan of treatment in accordance with current medical and 
clinical standards. Specifically, we propose to remove from the 
definition of CORF respiratory therapy services the services of 
establishing the medical and therapy-related diagnosis and the 
provision of E/M services because these services are provided by the 
physician, as necessary, to establish the respiratory therapy plan of 
treatment. These services may be provided by either the CORF facility 
physician, as CORF

[[Page 38174]]

physician services or as non-CORF physician services, or by the 
patient's referring physician, as appropriate. We also propose to 
remove diagnostic tests from the description of CORF respiratory 
therapy services since diagnostic tests are covered under the physician 
services benefit category at section 1861(s)(2)(C) of the Act when 
provided by the physician to a CORF patient, and accordingly are 
separately billable by the physician under the PFS as previously 
discussed.
    In addition to RTs, we note that the conditions of participation 
also recognize respiratory therapy technicians as CORF personnel; 
however, during the CY 1999 PFS rulemaking to recognize the 1997 BBA 
payment requirements, we did not include services performed by 
respiratory therapy technicians because we believed that current 
medical standards for skilled respiratory therapy services provided to 
patients in the CORF setting required the educational requirements 
possessed by RTs. This determination to only recognize the services of 
RTs, and not those provided by respiratory therapy technicians in 
carrying out the therapy plan of treatment was further supported in the 
CY 2002 and CY 2003 rulemaking (66 FR 55311 and 67 FR 79999), when we 
developed and discussed G-codes for certain CORF respiratory therapy 
services and specifically recognized the RT as the appropriate level of 
personnel to provide these CORF services. These G-codes were created to 
differentiate between the CORF services provided under a respiratory 
therapy plan of treatment from those services provided under physical 
and occupational therapy plans of treatment by PTs and OTs, 
respectively, under benefit sections 1861(p) and (g) of the Act in the 
97XXX CPT code series. Because physical and occupational therapy 
services are subject to the therapy caps, the services provided under a 
CORF respiratory therapy plan of treatment needed to be identified by 
procedure codes specific to these services so as not to be attributed 
to the therapy caps. The three HCPCS codes G0237, G0238, and G0239 are 
specific to services provided under the respiratory therapy treatment 
plan and, as such, are not designated as subject to the therapy caps. 
We are proposing to revise the description of respiratory therapy 
services to remove those services appropriately provided by the 
physician establishing the respiratory therapy plan of treatment. In 
addition, we have determined that a condition of coverage for the 
respiratory therapy service is that it be provided by an individual 
meeting the educational and training level of the RT, rather than the 
RT technician. For these reasons, we will accept comments on the 
service description at Sec.  410.100(e), and the personnel 
qualifications at Sec.  485.70(j) and (k) for a respiratory therapist 
and a respiratory therapy technician, respectively.
5. Social and Psychological Services
    In accordance with section 1861(cc)(1)(D) of the Act, social and 
psychological services are included within the definition of CORF 
services under Sec.  410.100(h) and (i), respectively. In addition, 
Sec.  485.58 specifies that the CORF must provide a coordinated 
rehabilitation program that includes, at a minimum, social or 
psychological services, along with physical therapy services and 
physician services, and that these services must be consistent with the 
therapy plan of treatment.
    Currently, the description of social work services considered CORF 
services under Sec.  410.100(h) includes (1) Assessment of the social 
and emotional factors related to the individual's illness, need for 
care, response to treatment, and adjustment to care furnished by the 
facility; (2) casework services to assist in resolving social and 
emotional problems that may have an adverse effect on the beneficiary's 
ability to respond to treatment; and (3) assessment of the relationship 
of the individual's medical and nursing requirements to his or her home 
situation, financial resources, and the community resources available 
upon discharge from facility care. The current description of CORF 
psychological services under Sec.  410.100(h) includes: (1) Assessment 
diagnosis and treatment of an individual's mental and emotional 
functioning as it relates to the individual's rehabilitation; (2) 
Psychological evaluations of the individual's response to and rate of 
progression under the treatment plan; and (3) Assessment of those 
aspects of an individual's family and home situation that affect the 
individual's rehabilitation treatment. We believe the current 
definitions of CORF social and psychological services are too broad. As 
discussed above in this section, we propose to revise Sec.  410.105 to 
clarify our policy that CORF services are covered only if they are 
provided under the rehabilitation plan of treatment and relate directly 
to the rehabilitation of the patient. As such, we are concerned that 
the current descriptions of CORF social and psychological services may 
be misconstrued to include social and psychological services for the 
treatment of mental illness, which we believe is outside the scope of 
coverage for CORF social and psychological services because these 
services do not relate directly to a rehabilitation plan of treatment 
and the associated rehabilitation goals.
    In addition, we believe it unnecessary to distinguish between CORF 
social services and CORF psychological services given their 
similarities, and therefore, we propose to merge the two definitions 
into a single definition of CORF social and psychological services. As 
noted at section 1861(cc)(2)(B) of the Act, we believe that CORFs are 
required to provide either social services or psychological services, 
and not both types of services. We believe that merging the regulations 
at Sec.  410.100(h) and (i) into a single definition of CORF social and 
psychological services is warranted to clarify the similarities between 
them.
    Therefore, we are proposing to clarify the description of social 
and psychological services at Sec.  410.100(h) to include only those 
services that address the patient's response and adjustment to the 
treatment plan; rate of improvement and progress towards the 
rehabilitation goals, or other services as they directly relate to the 
physical therapy, occupational therapy, SLP, or respiratory therapy 
plan of treatment. In addition, we propose to change the heading at 
Sec.  410.100(h) from ``social services'' to ``social and psychological 
services,'' and to eliminate the separate definition for psychological 
services under Sec.  410.100(i).
    Because we are proposing to revise the description of social and 
psychological services in Sec.  410.100(h), we are interested in 
receiving comments concerning the CORF personnel qualifications in the 
conditions of participation at Sec.  485.70(l) and (g) for social 
workers and psychologists, respectively, and comments relating to the 
appropriate CPT codes to represent these CORF services.
    Due to the specificity of the purpose of CORF social and 
psychological services requiring these covered services to directly 
relate to the patient's rehabilitation treatment plan, we are inviting 
comments on which CPT codes would be appropriate for CORF social and 
psychological services. We believe that the procedure codes for health 
and behavior assessment and treatment, represented by CPT codes 96150 
through 96154, specific to the patient's physical health problems, best 
describe the social and psychological services required in the CORF 
setting.

[[Page 38175]]

6. Nursing Care Services
    Because the PFS does not contain a CPT code for nursing services, 
we established in the CY 1999 PFS final rule a new HCPCS code (G0128) 
for direct face-to-face skilled nursing services delivered to a CORF 
patient by an RN as part of a rehabilitative therapy plan of treatment. 
In the CORF conditions of participation at Sec.  485.70(b) and (h), 
qualified personnel for nursing services include an LPN or vocational 
nurse and an RN, respectively. However, when the HCPCS code G0128 was 
created for CORF nursing services we determined that a condition for 
coverage is that the nursing service be provided by an individual 
meeting the qualifications of an RN, rather than the LPN, for CORF 
clinical nursing services as they relate, or are part of, the therapy 
plan of treatment. Because we established coverage for CORF nursing 
services only when provided by an RN, we are proposing to revise new 
Sec.  410.100(i) (that is, the current Sec.  410.100(j) is redesignated 
as Sec.  410.100(i)) to specifically reflect this coverage decision. 
Consequently, in addition to the above proposal, we are also asking for 
comments on the appropriateness of the personnel qualification 
standards at Sec.  485.79(b) and (h) for the LPN and for the RN, 
respectively.
7. Drugs and Biologicals
    Section 410.100(k) currently provides that drugs and biologicals 
included within the definition of CORF services includes drugs and 
biologicals that are prescribed by a physician and administered by a 
physician or a CORF RN and not otherwise excluded from Medicare Part B 
payment under section Sec.  410.29 (relating to self-administered 
drugs). In addition, in accordance with Sec.  410.105(c), drugs and 
biologicals administered to a CORF patient will be covered as CORF 
services only if included as part of the rehabilitation plan of 
treatment. However, we are unable to identify any physician prescribed 
drugs or biologicals that are not self-administered that would be 
appropriately provided under a patient's rehabilitation treatment plan.
    In addition, we are concerned about duplicate payment for drugs and 
biologicals provided to CORF patients in the CORF setting. Drugs and 
biologicals provided to CORF patients by CORF physicians or RNs under 
the supervision of a physician are considered services and supplies 
furnished incident to a physician's professional services under section 
1861(s)(2)(A) of the Act, and therefore, may be paid to the physician 
in accordance with section 1847(A) of the Act. Physicians bill the 
carrier for such incident to services. If such drugs and biologicals 
also considered CORF services, the CORF could submit a claim for the 
same drugs and biologicals to the fiscal intermediary for payment. If 
physicians and CORFs each were able to bill for drugs and biologicals 
that are provided in the CORF setting, we believe there is a risk of 
duplicative payments for the same drugs and biologicals--one payment to 
the CORF and one payment to the physician by the carrier. Such 
duplicative billing would be difficult for us to detect given that 
CORFs bill the fiscal intermediary for CORF services while physicians 
bill the carrier for physician services.
    While we recognize that drugs and biologicals are enumerated as 
CORF services at section 1861(cc)(1) of the Act, we do not believe that 
drugs and biologicals are appropriately provided under rehabilitation 
therapy plans of treatment. Therefore, we propose to remove Sec.  
410.100(k).
    We invite comments on this proposal. We are especially interested 
in receiving comments on the appropriateness of including drugs and 
biologicals under a CORF patient's rehabilitation plan of treatment.
8. Supplies and DME
    Payment for supplies and DME as part of CORF services is specified 
at Sec.  410.100(l) as ``[s]upplies, appliances and equipment'' and 
includes nonreusable supplies, medical equipment and appliances, and 
DME as defined in Sec.  410.38 (except for renal dialysis systems), is 
a CORF covered service when provided for the patient's use outside the 
CORF whether purchased or rented, and is paid under the DMEPOS fee 
schedule. We believe that the provision at Sec.  410.100(l) is too 
broad, out of date, and inconsistent with current terminology used for 
covered services or items. The CORF provision at section 1861(cc)(1)(G) 
of the Act applies only to supplies and DME, yet the regulatory 
provision also encompasses medical equipment and appliances. Because we 
believe the requirements of Sec.  410.100(l) are inconsistent with 
those of section 1861(cc)(1)(G) of the Act, we are proposing to revise 
both the title and description at new Sec.  410.100(k) (that is, the 
current Sec.  410.100(l) is redesignated as Sec.  410.100(k)) by 
deleting reference to medical equipment and appliances to reflect the 
CORF statutory provision by including only the items specified under 
section 1861(cc)(1)(G) of the Act. We also note that DME, as well as 
prosthetics, orthotics, and supplies, provided in the CORF setting 
requires the CORF's participation in the competitive bidding, where 
applicable, in accordance with 42 CFR part 414 subpart F.
9. Clarifications and Payment Updates for Other CORF Services
    Section 4078 in the Omnibus Budget Reconciliation Act of 1987 (Pub. 
L. 100-203) (OBRA) amended section 1861(cc)(1) of the Act to provide 
that there is no requirement that any item or service furnished by a 
CORF in connection with physical therapy, occupational therapy, and 
speech pathology services under the plan of treatment be furnished at a 
single fixed location; however, such items and services are covered as 
CORF services only if payment is not otherwise made under Medicare. We 
note that such items and services may be covered under the Medicare 
home health benefit established under sections 1861(g), (m), and (p) of 
the Act. Accordingly, physical therapy, occupational therapy, and SLP 
services provided in the home are not covered as CORF services if such 
services and related items are covered under the Medicare home health 
benefit. Because the CORF regulations were not revised to reflect these 
changes in coverage and payment methodology, we propose to do so now.
    Therefore, we are proposing to clarify the regulations at new Sec.  
410.100(l) (that is, the current Sec.  410.100(m) is redesignated as 
Sec.  410.100(l)) and Sec.  410.105(b)(3) to reflect these 
requirements.
    In Sec.  410.105(b)(3), we propose to clarify that physical 
therapy, occupational therapy and SLP services can be furnished in the 
patient's home when payment for these therapy services is not otherwise 
made under the Medicare home health benefit.
    In addition, we propose to revise Sec.  410.100(l) to clarify that 
the patient must be present during the home environment evaluation that 
is performed by the PT, OT or speech-language pathologist, as 
appropriate, because we believe that the patient's presence is 
necessary to fully evaluate the potential impact of the home situation 
on the patient's rehabilitation goals.
10. Cost-Based Payment (Sec.  413.1)
    Section 413.1(a)(2)(iv) currently provides for cost-based payment 
for CORF services, which reflects the payment methodology provided for 
under section 1833(a) of the Act, requiring payment on the basis of the 
lesser of the provider's reasonable costs

[[Page 38176]]

or customary charges. As discussed above, this payment methodology is 
inconsistent with section 1834(k) of the Act, requiring that the 
payment basis for outpatient physical therapy services (including 
outpatient SLP services), outpatient occupational therapy services, and 
all other CORF services provided on or after January 1, 1999 be 80 
percent of the lesser of: (i) The actual charge for the services; or 
(ii) the applicable fee schedule amount. Therefore, we are proposing to 
remove Sec.  413.1(a)(2)(iv) to clarify that cost-based payment is not 
applicable to services provided in the CORF setting. We are also 
proposing to remove Sec.  413.1(a)(2)(vi) for OPTs or rehabilitation 
agencies as referenced at section 1861(p) of the Act, because these 
providers were also affected by the same payment changes required by 
the 1997 BBA for physical therapy, occupational therapy, and SLP 
services effective for CY 1999.
11. Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) 
Services
    We are proposing to establish a new regulatory subpart M at 42 CFR 
Part 414 to specify the payment methodology for comprehensive 
outpatient rehabilitation services covered under Part B of Title XVIII 
of the Act that are described at section 1861(cc)(1) of the Act. 
Specifically, this proposed subpart would identify and describe how 
payment is determined for services included as CORF services under 
Sec.  410.100.
    Proposed Sec.  414.1100 sets forth the basis and scope for payment 
for CORF services. Proposed Sec.  414.1101 sets forth the payment 
methodology for CORF services, including identifying the applicable fee 
schedule for each type of CORF service identified in Sec.  410.100.
    Section 1834(k)(1)(B) of the Act provides that the payment basis 
for CORF services is 80 percent of the lesser of: (i) The actual charge 
for the services; or (ii) the applicable fee schedule amount. The term 
``applicable fee schedule amount'' is defined under section 1834(k)(3) 
of the Act to mean, for services furnished in a year, the payment 
amount determined under the PFS established under section 1848 of the 
Act for such services for the year ``or, if there is no such fee 
schedule established for such services, the amount determined under the 
fee schedule established for such comparable services as the Secretary 
specifies.'' Accordingly, we propose at new Sec.  414.1101(a) to base 
payment for a CORF service on 80 percent of the lesser of the actual 
charge or the PFS amount for the service when the PFS establishes a 
payment amount for such service. Payment for CORF services under the 
PFS is made for physical therapy, occupational therapy, SLP, and 
respiratory therapy services, as well as the related nursing and social 
and psychological services. In the CY 1999 PFS final rule (63 FR 
58860), we explained that we interpret section 1834(k)(3) of the Act, 
defining the term ``applicable fee schedule amount,'' as requiring us 
to use the payment amount established by an existing fee schedule other 
than the PFS when the PFS does not establish a payment amount for the 
CORF service. Therefore, we propose at new Sec.  414.1101(c) that we 
use the existing fee schedules for prosthetic and orthotic devices, DME 
and supplies for covered DMEPOS provided by CORFs. Specifically, we 
propose that payment for covered DME, orthotic and prosthetic devices 
and supplies provided by a CORF be based on the lesser of 80 percent of 
actual charges or the payment amount established under the DMEPOS fee 
schedule under sections 1834 and 1847 of the Act and in 42 CFR part 
414, subparts D and F. Finally, we propose at new Sec.  414.1101(d) 
that if there is no fee schedule amount established for a CORF service, 
payment shall be based on the lesser of 80 percent of actual charges or 
the amount determined under the fee schedule established for a 
comparable service, as specified by the Secretary.
    As discussed in sections II.K.7. and II.K.12., we propose to remove 
drugs and biologicals from the scope of CORF services as defined under 
Sec.  410.100. Therefore, we propose not to include payment for drugs 
and biologicals under Sec.  414.1101.
    As discussed in section II.K.3., physician services included within 
the definition of CORF services under Sec.  410.100(a) are limited to 
those services of a CORF physician described as administrative in 
nature, to the exclusion of diagnostic and therapeutic services which 
are considered separately billable physician services. Medicare 
generally does not permit providers to separately bill for their 
administrative costs; rather, such costs typically are subsumed in the 
payment amounts for covered medical services and items furnished to 
Medicare beneficiaries. Under the PFS these costs are included in the 
payment amount as part of the indirect practice expenses that are 
reflected in the PE RVUs for each service and also captured as part of 
the post-visit work RVU component. Similarly, we believe payment to 
CORFs for the administrative duties of a CORF physician, required as a 
condition of participation at Sec.  485.58(a), such as participating in 
patient case review conferences is subsumed within PFS payments to 
CORFs for physical therapy, occupational therapy, SLP, and respiratory 
therapy services, and the related nursing, and social and psychological 
services. Generally, administrative costs associated with the provision 
of such services is incorporated into payment amounts established under 
the PFS through the PE RVUs representing the resources necessary to 
perform each service in the physician office or nonfacility setting. 
Therefore, we believe it unnecessary to separately compensate CORFs for 
CORF physician services given that such services are administrative in 
nature, and propose at Sec.  414.1001(b) not to separately pay CORFs 
for CORF physician services.
    To ensure that CORFs are not paid twice for CORF services, we 
propose at new Sec.  414.1101 to base payment for a CORF service on the 
applicable fee schedule amount only to the extent that payment for such 
service is not included in the payment amount for other CORF services. 
For example, under the PFS, disposable supplies generally are included 
in the PE RVUs representing the resources necessary to perform the 
service in the nonfacility setting, and thus are included in the 
payment amount for each service and cannot be billed separately. 
Accordingly, under proposed Sec.  414.1001(c) a CORF could not bill 
separately for supplies included in the PE RVU component of the payment 
amount established for a service under the PFS. However, we note that 
CORFs could bill separately for certain splint and cast supplies for 
the application of casts and strapping because these supplies have been 
removed from the payment amounts established under the PFS. These 
splint and cast supplies are currently paid using the HCPCS code series 
Q4001 through Q4051 which were established to make separate payment 
under section 1861(s)(5) of the Act for surgical dressings, and splint 
and cast materials. In the CORF setting, the splint and cast supplies 
may be applicable for certain cast/strapping application procedures in 
the CPT code series 29000 through 29750. We would note that Medicare 
makes separate payment for surgical dressings, which are also 
referenced at section 1861(s)(5) of the Act, only when used by the 
beneficiary in his or her home. No separate payment is made when these 
surgical dressings are used in the CORF setting; rather the dressings 
costs are bundled into the payment amount

[[Page 38177]]

established under the PFS for the provided services.
    For CORF services based on the payment amount determined under the 
PFS, we propose at new Sec.  414.1101(a)(2) to use the PFS amount 
applicable to services furnished in a nonfacility setting, with no 
separate payment made for facility costs. The nonfacility payment rate 
includes, along with any physician work and malpractice RVUs, the PE 
RVUs representing the resources necessary to perform each service in 
the nonfacility setting, such as overhead expenses and personnel 
salaries and the direct costs of clinical labor, disposable supplies, 
and equipment. In contrast, the facility payment rate is based 
primarily on the physician work and malpractice RVUs, as well as RVUs 
for indirect PE incurred by the physician, and does not include the 
cost of the direct PE associated with providing each service in the 
physician office or nonfacility setting. We propose to use the PFS 
nonfacility amount for CORF services in order to offset any costs of 
providing such services in the CORF setting.
12. Vaccines
    Section 485.51(a) defines a CORF as a nonresidential facility that 
``is established and operated exclusively for the purpose of 
providing'' rehabilitation services by or under the supervision of a 
physician. Because vaccines administered in the CORF setting are not 
rehabilitation services furnished under a plan of treatment relating 
directly to the rehabilitation of the patient (or, presumably, even 
medically necessary for the rehabilitation of the patient), in 
accordance with Sec.  485.51(a), a CORF may not administer vaccines to 
its patients. However, we note that nothing in the Medicare statute 
would prohibit a CORF from providing pneumococcal, influenza, and 
hepatitis B vaccines to its patients provided the facility is 
``primarily engaged in providing * * * diagnostic, therapeutic, and 
restorative services to outpatients for the rehabilitation of injured, 
disabled, or sick persons'' (section 1861(cc)(2)(A) of the Act). 
Accordingly, under the statute, such vaccines may be covered separately 
from the CORF services benefit under section 1861(s)(10) of the Act--
defining the term ``medical and other health services'' to include the 
pneumococcal, influenza, and hepatitis B vaccines--provided the 
applicable conditions of coverage under Sec.  410.58 and Sec.  410.63 
are met. In order to include coverage and payment for these vaccines 
when provided to CORF patients in the CORF setting, we propose to amend 
the CORF conditions of participation at Sec.  485.51 to permit CORFs to 
provide vaccines to their patients in addition to rehabilitation 
services. Such vaccines would be covered in the CORF setting provided 
the conditions of coverage under Sec.  410.58 and Sec.  410.63 are met. 
In accordance with sections 1833(a)(1) and 1842(o)(1) of the Act, 
payment for covered pneumococcal, influenza, and hepatitis B vaccines 
provided in the CORF setting is based on 95 percent of the average 
wholesale price (AWP).
    We are interested in receiving comments on this proposal.

L. Compendia for Determination of Medically-Accepted Indications for 
Off-Label Uses of Drugs and Biologicals in an Anti-cancer 
Chemotherapeutic Regimen (Sec.  414.930)

    [If you choose to comment on issues in this section, please include 
the caption ``DRUG COMPENDIA'' at the beginning of your comments.]
1. Background
a. Statutory Requirements
    Section 1861(t)(2)(B)(ii)(I) of the Act lists three drug compendia 
that may be used in determining the medically-accepted indications of 
drugs and biologicals used in an anti-cancer chemotherapeutic regimen. 
The three drug compendia listed are:
     American Hospital Formulary Service-Drug Information 
(AHFS-DI)
     American Medical Association Drug Evaluations (AMA-DE)
     United States Pharmacopoeia-Drug Information (USP-DI)
    Section 1861(t)(2) of the Act provides the Secretary the authority 
to revise the list of compendia for determining medically-accepted 
indications for drugs. Due to changes in the pharmaceutical reference 
industry, fewer of the statutorily named compendia are available for 
our reference. (That is, AMA-DE is no longer in publication; USP-DI has 
been purchased by Thomson Micromedex and it is our understanding that 
the name ``USP-DI'' may not be used after 2007.)
    Section 6001(f)(1) of the DRA amends both ``sections 
1927(g)(1)(B)(i)(II) and 1861(t)(2)(B)(ii)(I) of the Act by inserting 
`(or its successor publications)' after `United States Pharmacopeia-
Drug Information'.'' We interpret this DRA provision as explicitly 
authorizing the Secretary to continue recognition of the compendium 
currently known as USP-DI after its name change if the Secretary 
determines that it is in fact a successor publication rather than a 
substitute publication.
b. Requests To Amend the Compendia Listings
    We received requests from the stakeholder community for recognition 
of additional compendia under the following authorities:
     Section 1861(t)(2)(B) of the Act which allows the 
Secretary to identify additional authoritative compendia; and
     Section 1873 of the Act which allows the Secretary to 
recognize a successor publication if one of the statutorily named 
compendia changes its name.
    In contrast, others have suggested that the Secretary consider 
elimination of certain listed compendia. However, there is no 
established regulatory process by which the agency can currently accept 
and act definitively on such requests. In addition, there is currently 
no transparency about the criteria upon which we could base a decision. 
Therefore, we are seeking public input on this topic.
c. Technology Assessment of Drug Compendia Used to Determine Medically-
Accepted Uses of Drugs and Biologicals in an Anti-cancer 
Chemotherapeutic Regimen
    We commissioned a technology assessment (TA) from the Agency for 
Healthcare Research and Quality (AHRQ) on the currently listed 
compendia (AHFS and USP-DI), as well as other compendia (that is, 
National Comprehensive Cancer Network (NCCN), ClinPharm, DrugDex, Facts 
& Comparisons (F&C)) which might provide comparable information. AHRQ 
contracted the TA to the New England Medical Center (NEMC) and Duke 
Evidence-based Practice Centers (EPCs) and found little agreement in 
the evidence cited among drug compendia. In addition, the TA found 
little agreement between the EPC's independent identification of 
evidence on 14 example off-label indications and evidence cited in the 
drug compendia. The TA can be found at http://www.cms.hhs.gov/mcd/viewtechassess.asp?where=index&tid=46.
d. Medicare Evidence Development and Coverage Advisory Committee 
(MedCAC)
    On March 30, 2006, the MedCAC (formerly the Medicare Coverage 
Advisory Committee (MCAC)) met in public session to advise CMS on the 
evidence about the desirable characteristics of compendia to determine 
medically-accepted indications of drugs and biologicals in anti-cancer 
therapy and the degree to which the currently listed and other

[[Page 38178]]

available compendia display those characteristics. All information on 
this MedCAC meeting can be found on the CMS Web site at http://www.cms.hhs.gov/mcd/viewmcac.asp?where=index∣=33. The agenda 
included a presentation of the TA performed for AHRQ by staff of the 
NEMC and Duke EPCs, scheduled stakeholder presentations, as well as an 
opportunity to hear testimony from members of the audience. As is 
customary, the MedCAC panelists elicited additional information from 
the presenters and discussed the evidence in preparation for a formal 
vote.
    The MedCAC identified the following desirable characteristics:
     Extensive breadth of listings.
     Quick throughput from application for inclusion to 
listing.
     Detailed description of the evidence reviewed for every 
individual listing.
     Use of pre-specified published criteria for weighing 
evidence.
     Use of prescribed published process for making 
recommendations.
     Publicly transparent process for evaluating therapies.
     Explicit ``Not recommended'' listing when validated 
evidence is appropriate.
     Explicit listing and recommendations regarding therapies, 
including sequential use or combination in relation to other therapies.
     Explicit ``Equivocal'' listing when validated evidence is 
equivocal.
     Process for public identification and notification of 
potential conflicts of interest of the compendia's parent and sibling 
organizations, reviewers, and committee members, with an established 
procedure to manage recognized conflicts.
    The MedCAC concluded that none of the compendia fully display the 
desirable characteristics. The voting results can be viewed at the same 
Web site provided previously for the MedCAC meeting. In addition the 
MedCAC noted significant variability among the compendia. There was no 
agreement among the panel members that any particular predetermined 
number of compendia was desirable.
    Participants in the meeting also discussed the clinical usefulness 
of drug compendia in the treatment of cancer. It was reported that 
oncologists do not rely on compendia when making treatment decisions, 
relying instead on published treatment guidelines, clinical trial 
protocols, or consultation with peers.
    Prior to this proposed rule, we received and reviewed unsolicited 
comments from professional societies regarding additions and deletions 
to the listing of compendia for purposes of section 1861(t) of the Act. 
We believe that the notice and comment period of this proposed rule 
will provide the opportunity for the public to present its concerns 
regarding this process. We encourage all interested parties to submit 
their comments via the process mentioned in the SUPPLEMENTARY 
INFORMATION section of this proposed rule.
2. Process for Determining Changes to the Compendia List
    A compendium for the purpose of this section is defined as a 
comprehensive listing of FDA-approved drugs and biologicals or a 
comprehensive listing of a specific subset of drugs and biologicals in 
a specialty compendium, for example, a compendium of anti-cancer 
treatment. A compendium: (1) Includes a summary of the pharmacologic 
characteristics of each drug or biological and may include information 
on dosage, as well as recommended or endorsed uses in specific 
diseases; (2) is indexed by drug or biological; (3) differs from a 
disease treatment guideline, which is indexed by disease. We believe 
that the use of compendia to determine medically-accepted indications 
of drugs and biologicals in the manner specified in section 
1861(t)(2)(B)(ii)(I) of the Act is more efficiently accomplished if the 
information contained is organized by the drug or biological and if the 
listings are comprehensive.
    We propose to create a process incorporating public notice and 
comment to receive and make determinations regarding requests for 
changes to the list of compendia used to determine medically-accepted 
indications for drugs and biologicals used in anti-cancer treatment as 
described in section 1861(t)(2)(B)(ii)(I) of the Act. Requests may be 
for addition or deletion of a compendium from the list.
    We will use the following process to receive and make 
determinations regarding requests for changes to the list of compendia:
     For the purposes of this section, the notice may be 
accomplished by posting the information on the CMS Web site. This does 
not preclude us from using other reasonable means at our discretion. We 
believe this will facilitate a timely and efficient consideration of 
requests.
     We will issue annually a notice for requests to revise the 
list of compendia. This notice will be published and will specify a 30-
day time period within which we will accept any external requests that 
are complete, as defined in this section. To allow sufficient time for 
the public to be notified, we will begin the acceptance process for 
external requests no sooner than 45 days after publication of the 
notice. We believe that this will enhance the administrative efficiency 
of this process without placing a significant burden on the public.
     We will publish a listing of the timely complete 
request(s) received and allow the public 30 days to submit comments on 
the request(s). The listing will identify the requestor and the 
requested addition or deletion to the list of compendia.
     A complete request must include the following:
    + The full name and contact information (including the mailing 
address, e-mail address, and telephone number) of the requestor. If the 
requestor is not an individual person, the information shall identify 
the officer or other representative who is authorized to act for the 
requestor on all matters related to the request.
    + Full identification of the compendium that is the subject of the 
request, including name, publisher, edition if applicable, date of 
publication, and any other information needed for the accurate and 
precise identification of the specific compendium.
    + A complete written copy of the compendium that is the subject of 
the request. If the complete compendium is available electronically, it 
may be submitted electronically in place of hard copy. If the 
compendium is available online, the requestor may provide us with 
electronic access by furnishing at no cost to the Federal government 
sufficient accounts for the purposes and duration of the review of the 
application in place of hard copy.
    + The specific action that the requestor wishes CMS to take, for 
example to add or delete a specific compendium.
    + Detailed, specific documentation that the compendium that is the 
subject of the request does or does not comply with the conditions of 
this rule. Broad, nonspecific claims without supporting documentation 
cannot be efficiently reviewed; therefore, they will not be accepted.
    + A request may have only a single compendium as its subject. This 
will provide greater clarity on the scope of the agency's review of a 
given request. A requestor may submit multiple requests, each 
requesting a different action.
    + Requests must be in writing as opposed to verbal.
     Requests may be submitted in two ways (no duplicates 
please). Electronic

[[Page 38179]]

submissions are encouraged to facilitate administrative efficiency. We 
will, in our solicitation of requests, identify the electronic address 
to be used for submissions. Hard copy requests can be sent to the 
Centers for Medicare & Medicaid Services, Coverage and Analysis Group, 
Mailstop C1-09-06, 7500 Security Boulevard, Baltimore, MD, 21244. 
Please allow sufficient time for hard copies to be received prior to 
the close of the solicitation period. We may internally generate a 
request to change the list of compendia at any time. We believe that 
this preserves the agency's ability to act quickly if we determine that 
urgent action is needed to protect the interests of the Medicare 
program and its beneficiaries.
     We will consider a compendium's attainment of the MedCAC-
recommended desirable characteristics of compendia, listed above in 
this section, in reviewing requests. We may consider additional 
reasonable factors in making a determination. (For example, we may 
consider factors that are likely to impact the compendium's suitability 
for this use, such as a change in ownership or affiliation, the 
standards applicable to the evidence considered by the compendium, and 
any relevant conflicts of interest. We may consider that broad 
accessibility by the general public to the information contained in the 
compendium may assist beneficiaries, their treating physicians or both 
in choosing among treatment options.)
     We will also consider a compendium's grading of evidence 
used in making recommendations regarding off-label uses and the process 
by which the compendium grades the evidence.
     We may, at our discretion, combine and consider multiple 
requests that refer to the same compendium, even if those requests are 
for different actions. This facilitates administrative efficiency in 
our review of requests.
     We will publish our decision within 120 days after the 
close of the public comment period.
     For each compendium that we determine should be included 
on the list, the publisher or its designee must notify CMS, within 45 
days from the publication date of each new edition or revision of the 
compendium, that a new edition or version is available. This will 
ensure that we have the most current information for each compendium. 
This may be provided electronically or via online access. We believe 
that this is necessary to permit us to efficiently ensure that the 
listed compendia continue to meet the conditions set forth in this 
rule.
     In addition to the annual process, we may generate a 
request for changes to the list of compendia at any time.

M. Physician Self-Referral Provisions

    [If you choose to comment on issues in this section, please include 
the caption ``PHYSICIAN SELF-REFERRAL PROVISIONS'' at the beginning of 
your comments.]
1. Changes to Reassignment and Physician Self-Referral Rules Relating 
to Diagnostic Tests (Anti-Markup Provision)
    Medicare rules currently prohibit the markup of the technical 
component of certain diagnostic tests that are performed by outside 
suppliers and billed to Medicare by a different individual or entity 
(Sec.  414.50). In addition, Medicare program instructions restrict who 
may bill for the professional component (the interpretation) of 
diagnostic tests (CMS Pub. 100-04, Chapter 1, 30.2.9.1).
    In the CY 2007 PFS proposed rule (71 FR 48982), we stated that 
recent changes to our rules on reassignment concerning the right to 
receive Medicare payment may have led to some confusion as to whether 
the anti-markup and purchased interpretation requirements apply to 
certain situations where a reassignment has occurred under a 
contractual arrangement. In addition, we expressed concern about the 
existence of certain arrangements that we believe are not within the 
intended purpose of the physician self-referral rules, which permit 
physician group practices to bill for certain services furnished by a 
contractor physician in a ``centralized building.'' We also expressed 
concern that allowing physician group practices or other suppliers to 
purchase or otherwise contract for the provision of diagnostic testing 
services and to then realize a profit when billing Medicare may lead to 
patient and program abuse in the form of overutilization of services 
and result in higher costs to the Medicare program (71 FR 49054).
    In the CY 2007 PFS proposed rule (71 FR 48982), we proposed to 
amend Sec.  424.80 to provide that if the TC of a diagnostic test 
(other than clinical diagnostic laboratory tests paid under section 
1833(a)(2)(D) of the Act, which are subject to the special rules set 
forth in section 1833(h)(5)(A) of the Act) is billed by a physician or 
medical group (the ``billing entity'') under a reassignment involving a 
contractual arrangement with a physician or other supplier who performs 
the service, the amount billed to Medicare by the billing entity, less 
the applicable deductibles and coinsurance, may not exceed the lowest 
of the following amounts:
     The physician or other supplier's net charge to the 
billing physician or medical group.
     The billing physician's or medical group's actual charge.
     The fee schedule amount for the service that would be 
allowed if the physician or other supplier billed directly.
    We also proposed that, to bill for the TC, the billing entity would 
be required to perform the interpretation. In addition, we considered 
imposing certain conditions on when a physician or medical group can 
bill for a reassigned PC of a diagnostic test. We stated that we were 
considering the following conditions (which currently appear in manual 
provisions and are known as the purchased interpretation rules):
     The test must be ordered by a physician who is financially 
independent of the person or entity performing the test and also of the 
physician or medical group performing the interpretation.
     The physician or medical group performing the 
interpretation does not see the patient.
     The physician or medical group billing for the 
interpretation must have performed the TC of the test.
    We stated that, although we welcomed comments on all aspects of our 
proposals, we were particularly interested in receiving comments on 
whether: diagnostic imaging tests should be excepted from any of our 
proposed provisions; the proposal in whole or in part should apply only 
to pathology services; any of the proposed provisions should apply to 
services performed on the premises of the billing entity and if so, how 
to define the premises appropriately. We also requested comments as to 
whether an anti-markup provision should apply to the reassignment of 
the PC of diagnostic tests performed under a contractual arrangement, 
and if so, how to determine the correct amount that should be billed to 
the Medicare program.
    For our physician self-referral rules, we proposed to modify the 
definition of ``centralized building'' at Sec.  411.351 to require a 
centralized building to consist of at least 350 square feet. We further 
proposed that the proposed minimum square footage requirement would not 
apply to space owned or rented in a building in which no more than 
three group practices own or lease space in the ``same building,'' as 
defined at Sec.  411.351 (that is, in a building with the same street 
address) and share the same

[[Page 38180]]

``physician in the group practice'' (as defined at Sec.  411.351). We 
also proposed that a centralized building must contain, on a permanent 
basis, the necessary equipment to perform substantially all of the 
designated health services (DHS) that are performed in the space in 
order to meet the definition of a centralized building. We solicited 
comments as to whether a centralized building should have a minimum 
square foot requirement, and if so, whether the minimum should be 350 
square feet or an amount more or less than that. In addition, we sought 
comments regarding whether there should be an exception to any minimum 
square foot requirement, and if so, the circumstances under which an 
exception should apply.
    For our proposal that the centralized building permanently contain 
the necessary equipment to perform substantially all of the DHS that is 
furnished in the centralized building, we sought comments on whether 
this test should be imposed, and whether at least 90 percent or some 
other minimum percentage or measurement would be appropriate. We stated 
that we were also considering whether to require that, for space to 
qualify as a centralized building, the group practice must employ, in 
that space, a nonphysician employee or independent contractor who will 
perform services exclusively for the group for at least 35 hours per 
week. Finally, we sought comments on whether a group practice should be 
allowed to maintain a centralized building in a State different from 
the State(s) in which it has an office that meets the criteria in Sec.  
411.355(b)(2)(i), and if so, whether space that is located in a 
different State must be within a certain number of miles from an office 
of the group practice that meets the criteria in Sec.  411.355(b)(2)(i) 
in order to qualify as a centralized building.
    We received numerous comments on these proposals. As a result, we 
did not finalize our proposals in the CY 2007 PFS final rule with 
comment period. Based on the comments received and other information 
that we considered, we are proposing to impose an anti-markup provision 
on the TC and PC of diagnostic tests. We would apply the anti-markup 
provision irrespective of whether the billing physician or medical 
group outright purchases the PC or the TC, or whether the physician or 
other supplier performing the TC or PC reassigns his or her right to 
bill to the billing physician or medical group (unless the performing 
supplier is a full-time employee of the billing entity). To prevent 
gaming, whereby the performing physician's or other supplier's net 
charge to the billing entity is inflated to cover the cost of equipment 
or space that is leased to the performing physician or other supplier, 
we would define ``net charge'' as exclusive of any amount that takes 
into consideration such charges. For example, consider the following 
hypothetical:
     The fee schedule amount for the PC of a particular 
diagnostic test is $100.
     Performing Physician A rents office space and equipment 
from Group B for $50 per test interpretation performed.
     Physician A charges Group B $100 per test. In this 
example, pursuant to our proposal, Physician A's charge of $100 would 
be deemed to take into account the $50 rental fee imposed by Group B 
(simply by virtue of the rental arrangement). Therefore, Group B would 
not be allowed to bill the full fee schedule amount of $100, but 
rather, would be limited to the lesser of Physician A's net charge 
determined exclusive of the amount that is deemed to have taken into 
consideration the lease expense, that is $50, or Group B's actual 
charge for the PC. We are also concerned that overutilization of 
diagnostic tests could continue despite our proposal to apply an anti-
markup provision to TCs that are reassigned to, or outright purchased 
by, group practices. That is, our proposal in the CY 2007 PFS proposed 
rule to impose an anti-markup provision would not have addressed the 
situation in which the TC is performed by a part-time or leased 
employee of the group practice in a centralized building, and the group 
neither receives a reassignment from the employee technician (if the 
technician is not able to bill for the TC in his or her own right), nor 
purchases the TC outright from the technician. Therefore, we are 
proposing to apply an anti-markup provision to TCs that are performed 
in a centralized building, and are seeking comments on whether we 
should have such a provision and, if so, how we should effect such a 
provision (for example, through amending the definition of 
``centralized building'' or through some other means. We would except 
the anti-markup provision for PCs ordered by independent laboratories 
because we do not believe that PCs ordered by independent laboratories 
pose a significant risk of program abuse because the independent lab is 
not ordering the TC. In States where the corporate practice of medicine 
doctrine is in effect, independent labs that are organized as 
corporations are prevented from hiring physicians as employees to 
perform PCs of diagnostic tests.
    In addition, we are proposing in Sec.  414.50 that--(1) The PC of a 
purchased test be subject to an anti-markup provision; (2) the anti-
markup provision for the TC and PC apply to all arrangements not 
involving a reassignment from a full-time employee of the billing 
entity; (3) the performing physician's or other supplier's net charge 
be calculated exclusive of any charge that reflects the cost of space 
or equipment leased to the performing physician or other supplier by 
the billing entity; and (4) the anti-markup provision not apply to 
independent labs that have not ordered the TC.
    At this time, we are not proposing to make changes to the 
definition of ``centralized building'' (with the one possible exception 
noted below in this section). We believe that changes to the definition 
may be unnecessary in light of our proposals for an anti-markup 
provision on the TC and PC of diagnostic tests (although if we decide 
to impose an anti-markup for TCs performed by technicians in a 
centralized building, we may accomplish that through amending the 
definition of ``centralized building''). If an anti-markup provision is 
finalized, we may evaluate at a later time whether to make any 
revisions to the definition of ``centralized building.'' We also are 
not proposing to adopt the purchased test interpretation rules in the 
context of reassignments because this provision may be unnecessary if 
we impose an anti-markup provision and because the purchased test 
interpretation rules may be problematic for multi-specialty group 
practices. Finally, in the CY 2007 PFS proposed rule, we proposed that, 
in order to bill for the TC of the diagnostic test, the billing 
physician or medical group must directly perform the PC. However, we 
believe this provision may be unnecessary if we impose an anti-markup 
provision and also would be problematic for independent labs that 
cannot employ physicians due to corporate practice of medicine 
restrictions.
2. Burden of Proof
    We are proposing to add Sec.  411.353(g) to clarify that, 
consistent with our policy with respect to claims denials, in any 
appeal of a denial of payment for a DHS that was made on the basis that 
the service was furnished pursuant to a prohibited referral, the burden 
is on the entity submitting the claim for payment to establish that the 
service was not furnished pursuant to a prohibited referral. That is, 
the burden of proof is not on CMS or our contractors to establish that 
the service was furnished pursuant to a prohibited referral.

[[Page 38181]]

3. In-Office Ancillary Services Exception
    One of the most important exceptions to the physician self-referral 
prohibition, applicable to services furnished by group practices and 
sole practitioners, is the in-office ancillary services exception. 
Section 1877(b)(2) of the Act sets forth an exception for certain 
services (other than durable medical equipment and parenteral and 
enteral nutrients) that are provided ancillary to medical services 
provided by a physician or group practice and that meet certain 
conditions. The in-office ancillary services exception is codified in 
Sec.  411.355(b).
    Among other things, the exception allows patients of a sole 
practitioner or physician in a group practice to receive ancillary 
services in the same building in which the referring physician or his 
or her group practice furnishes medical services, including some 
services unrelated to the furnishing of DHS. The exception provides 
additional flexibility for patients seen by a physician in a group 
practice by allowing these patients to receive a test or procedure in 
another building in space owned or leased on a full-time, exclusive 
basis by a group practice (that is, a ``centralized building'' as 
defined at Sec.  411.351).
    The in-office ancillary services exception does not contain certain 
requirements that are found in other compensation exceptions. For 
example, the exception for personal service arrangements in Sec.  
411.357(d), like many of the compensation exceptions, requires that 
compensation be set in advance, consistent with fair market value, and 
not determined in a manner that takes into account the volume or value 
of referrals or other business generated by the referring physician. 
These requirements are not present in the in-office ancillary services 
exception. Also, under the ``special rule for productivity bonuses and 
profit shares'' in Sec.  411.352(i), a physician in a group practice 
may receive a share of profits or a productivity bonus for referred 
ancillary services, provided that the payment is not directly related 
to the volume or value of referrals.
    We believe that the Congress included an exception for in-office 
ancillary services to allow for the provision of certain services 
necessary to the diagnosis or treatment of the medical condition that 
brought the patient to the physician's office. At the time of 
enactment, a typical in-office ancillary services arrangement might 
have involved a clinical laboratory owned by physicians located on one 
floor of a small medical office building. Under such an arrangement, a 
staff member would take a urine or blood sample to the clinical 
laboratory, create a slide, perform the test, and obtain the results 
for the physician while the patient waited.
    However, services furnished today purportedly under the in-office 
ancillary services exception are often not as closely connected to the 
physician practice. For example, pathology services may be furnished in 
a building that is not physically close to any of the group practice's 
other offices, and the professional component of the pathology services 
may be furnished by contractor pathologists who have virtually no 
relationship with the group practice (in some cases, the technical 
component of the pathology services is furnished by laboratory 
technologists who are employed by an entity unrelated to the group 
practice). In other words, the core members of the group practice and 
their staff are never physically present in the contractor 
pathologist's office. Similarly, the contractor pathologists do not 
participate in any group practice activities; they attend no meetings 
(except for phone calls about individual patients), and do not obtain 
retirement or health benefits from the group practice. In sum, these 
types of arrangements appear to be nothing more than enterprises 
established for the self-referral of DHS.
    Even in the case of ancillary services furnished in the same 
building, there may be very little interaction between the physicians 
who treat patients and the staff that provide the ancillary services. 
For example, an entity with its own staff located in a large medical 
office building next to a hospital may furnish an array of diagnostic 
services, including clinical laboratory services and radiology 
services, to patients of physicians who practice in the building and 
own either the equipment or the entity.
    Comments received on the Phase I and Phase II physician self-
referral rules (66 FR 856 and 69 FR 16055, respectively) stated that 
the in-office ancillary services exception is susceptible to abuse. For 
example, in response to the 1998 physician self-referral proposed rule 
(66 FR 892), a commenter asserted that the Congress did not intend for 
a group practice to have multiple centralized office locations, except 
for the provision of clinical laboratory services. This sentiment was 
reiterated in response to the Phase I final rule when several 
commenters objected to the decision to allow group practices to have 
more than one centralized facility (69 FR 16075). In response to Phase 
II, we received hundreds of letters from physical therapists and 
occupational therapists stating that the in-office ancillary services 
exception encourages physicians to create physical and occupational 
therapy practices. In addition, we have been informed by a number of 
physician specialists that the in-office ancillary services exception 
enables physicians to order and then subsequently perform ancillary 
services instead of making a referral to a specialist.
    In the CY 2007 PFS proposed rule (71 FR 48982), we stated our 
intent to address certain types of potentially abusive arrangements in 
which group practice physicians make a referral for a DHS to a 
specialist who is an independent contractor of the group practice. The 
specialist then performs the service for the group practice in a 
``centralized building'' and reassigns his or her right to Medicare 
payment to the group (which then bills Medicare at a profit).
    Comments received on the CY 2007 PFS proposed rule stated that, 
although our proposal addressed potential abuses arising from referrals 
to independent contractors who perform services in a centralized 
building, it failed to address abusive arrangements within the 
physician's office. Our review of industry trade articles and 
discussions with trade associations has heightened our awareness of the 
proliferation of in-office laboratories and the migration of 
sophisticated and expensive imaging or other equipment to physician 
offices. ``Turn-key'' operations, such as the arrangements described in 
this section for in-office laboratories and other ventures, are being 
marketed to physicians over the internet.
    At this time, we decline to issue a specific proposal for amending 
the in-office ancillary services exception. Rather, we are soliciting 
comments as to whether changes are necessary and, if so, what changes 
should be made. We are interested in receiving comments on: (1) Whether 
certain services should not qualify for the exception (for example, any 
therapy services that are not provided on an incident to basis, and 
services that are not needed at the time of the office visit in order 
to assist the physician in his or her diagnosis or plan of treatment, 
or complex laboratory services); (2) whether and, if so, how we should 
make changes to our definitions of same building and centralized 
building; (3) whether nonspecialist physicians should be able to use 
the exception to refer patients for specialized services involving the 
use of equipment owned by the nonspecialists;

[[Page 38182]]

and (4) any other restrictions on the ownership or investment in 
services that would curtail program or patient abuse.
4. Obstetrical Malpractice Insurance Subsidies
    We are concerned that our exception for obstetrical malpractice 
insurance subsidies is unnecessarily restrictive; that is, that our 
exception does not allow for certain obstetrical malpractice insurance 
subsidies that may be provided without a risk of program or patient 
abuse. The exception in Sec.  411.357(r) incorporates by reference the 
conditions in the anti-kickback safe harbor in Sec.  1001.952(o). We 
have received accounts, through advisory opinion requests and 
anecdotally, of patient difficulty obtaining obstetrical care in some 
communities in States in which obstetrical malpractice insurance 
premiums are relatively high. We have also been informed that 
obstetricians have left these States for other practice locations where 
obstetrical malpractice insurance premiums are less expensive, 
requiring patients to drive long distances to receive obstetrical care. 
We are seeking comments describing such problems and recommendations 
for how the exception should be changed without creating a risk of 
program or patient abuse. For example, the exception requires that the 
physician practice in a primary care HPSA and that 75 percent of the 
physician's obstetrical patients treated under the coverage of the 
malpractice insurance will either reside in a HPSA or a medically-
underserved area or be part of a medically-underserved population. We 
are interested in whether the exception would more effectively ensure 
beneficiary access to obstetrical care without risking program abuse if 
any of the requirements were changed. In addition, to the extent 
possible, we would like to establish bright-line requirements in the 
exception.
    We are proposing to revise the exception in Sec.  411.357(r) to 
specifically list the conditions that we believe are appropriate to 
safeguard against program or patient abuse when remuneration is 
provided by a hospital to a physician in the form of an obstetrical 
malpractice insurance subsidy. As noted previously, the current 
exception incorporates the conditions in the anti-kickback safe harbor 
in Sec.  1001.952(o). We are seeking comments with respect to 
requirements, such as the following, that would be appropriate to 
include in the exception for obstetrical malpractice insurance 
subsidies:
     A requirement for a written agreement between the parties.
     Physician certification (or, in subsequent years, actual 
data indicating) that a specified percent of the physician's 
obstetrical patients treated under the coverage of the subsidized 
malpractice insurance will either reside in a HPSA or medically-
underserved area or be part of a medically-underserved population.
     Location of the entity making the malpractice insurance 
premium subsidy payment.
     Location of the medical practice of the physician 
receiving the malpractice insurance subsidy payment.
     A requirement that the payment not be conditioned on the 
physician making referrals to, or otherwise generating business for, 
the entity.
     No restriction on the physician establishing staff 
privileges at, referring any service to, or otherwise generating any 
business for any other entity.
     A requirement that the amount of the payment may not vary 
based on the volume or value of any previous or expected referrals to 
or business otherwise generated for the entity by the physician.
     A requirement that the physician must treat obstetrical 
patients who receive medical benefits or assistance under any Federal 
health care program in a nondiscriminatory manner.
     A requirement that the insurance is a bona fide 
malpractice insurance policy or program, and the premium, if any, is 
calculated based on a bona fide assessment of the liability risk 
covered under the insurance.
    In addition, we would include the requirement that the arrangement 
not violate the anti-kickback statute (section 1128B(b) of the Act) or 
any Federal or State law or regulation governing billing or claims 
submission (which is a requirement of our other compensation exceptions 
issued under our authority under section 1877(b)(4) of the Act).
5. Unit-of-Service (Per-Click) Payments in Space and Equipment Leases
    Section 1877(e)(1) of the Act provides an exception to the 
prohibition of physician referrals for space and equipment leases, 
provided that certain requirements are met. Among the requirements, 
which are incorporated in our regulations in Sec.  411.357(a) and (b), 
are that the lease be commercially reasonable even if no referrals were 
made between the parties, and that the rental charges be set in 
advance, be consistent with market value, and not be determined in a 
manner that takes into account the volume or value of any referrals or 
other business generated between the parties. The statute also requires 
that the lease arrangement meet such other requirements as the 
Secretary may impose by regulation as needed to safeguard against 
program or patient abuse. We are concerned with lease arrangements that 
are structured so that a physician is rewarded for each referral he or 
she makes for DHS. Such arrangements could take the form of a physician 
leasing equipment that he or she owns to a hospital, and receiving a 
per-use (per-click) fee each time a patient is referred by the 
physician-owner to the hospital for the use of the equipment. We are 
also concerned about arrangements where the physician is the lessee and 
rents space or equipment from a hospital or other DHS entity on a per-
click basis. For example, if a physician rents an MRI machine from a 
hospital only when the physician refers a patient for an MRI and then 
provides the facility portion of the MRI service under arrangements 
with the hospital, the physician benefits financially and the 
arrangement could provide an incentive for overutilization or other 
program abuse.
    In the 1998 proposed rule (63 FR 1714), we noted that we had been 
asked about situations in which a physician rents equipment (such as a 
magnetic resonance imaging (MRI) machine) to an entity that furnishes a 
DHS, such as a hospital, with the physician receiving rental payments 
on a per-click basis (that is, total rental payments increase each time 
the machine is used). We stated that we believed that this arrangement 
would not prohibit the physician from otherwise referring to the 
entity, provided that these kinds of arrangements were typical and 
complied with the fair market value and other requirements included 
under the rental exception. However, we added that, because a 
physician's compensation under this exception may not reflect the 
volume or value of the physician's own referrals, the rental payments 
may not reflect per-click payments for patients who are referred for 
the service by the lessor physician.
    In the Phase I rulemaking, we stated that we were substantially 
revising the proposed rule with respect to ``the volume or value 
standard.'' We stated:

    Most importantly, we are permitting time-based or unit-of-
service-based payments, even when the physician receiving the 
payment has generated the payment through a DHS referral. We have 
reviewed the legislative history with respect to the exception for 
space and equipment leases and concluded that the Congress intended 
that time-based or unit-of-service-based payments be protected, so 
long as the payment per unit is at fair market value at

[[Page 38183]]

inception and does not subsequently change during the lease term in 
any manner that takes into account DHS referrals. (66 FR 876)

    After reconsidering the issue, we are proposing that space and 
equipment leases may not include unit-of-service-based payments to a 
physician lessor for services rendered by an entity lessee to patients 
who are referred by a physician lessor to the entity. We believe that 
such arrangements are inherently susceptible to abuse because the 
physician lessor has an incentive to profit from referring a higher 
volume of patients to the lessee, and we would disallow such per-click 
payments, using our authority under section 1877(e)(1) of the Act, even 
if the statute does not expressly forbid per-click payments to a lessor 
for patient referred to the lessee.
    Finally, we are soliciting comments on whether, using our authority 
under section 1877(e)(1) of the Act, we should prohibit time-based or 
unit-of-service-based payments to an entity lessor by a physician 
lessee, to the extent that such payments reflect services rendered to 
patients sent to the physician lessee by the entity lessor.
6. Period of Disallowance for Noncompliant Financial Relationships
    In response to the Phase II interim final rule with comment period 
(69 FR 16054), we received several comments that questioned what the 
period would be for which the physician could not refer DHS to the 
entity and the entity could not bill Medicare for the situation in 
which a financial arrangement between a referring physician and an 
entity failed to satisfy the requirements of an exception to the 
general prohibition on self-referrals.
    At this time, we are not making proposals for prescribing the 
period of disallowance for various types of noncompliance, but rather 
are seeking comments on how we might, to the extent practicable, set 
forth the period of disallowance for arrangements that implicate, but 
fail to satisfy the requirements of, one or more of the various 
exceptions. As a general matter, we believe that the statute 
contemplates that the period of disallowance should begin with the date 
that a financial arrangement failed to comply with the statute and the 
regulations and end with the date that the arrangement came into 
compliance or ended. However, in some instances it may not be clear 
when a financial arrangement has ended. For example, where an entity 
leases space to a physician at a rental price that is substantially 
below fair market value, it may raise the inference that the below 
market rent was in exchange for future referrals, including referrals 
made beyond the expiration of the lease. We are seeking comment 
whether, with respect to types of noncompliance for which it is not 
clear when a financial relationship ended, we should always employ a 
case-by-case approach, or deem certain types of financial relationships 
to continue for a prescribed period of time.
    We are also soliciting comment as to whether we should allow the 
period of disallowance to terminate where the parties have returned, or 
paid back the value of, the consideration. For example, if we were to 
impose a period of disallowance for a prescribed period of time because 
it would not be clear when a noncompliant compensation arrangement 
ended, we might allow the parties to terminate the period of 
disqualification sooner than the prescribed period if the prohibited 
compensation were returned. We caution that we do not envision allowing 
such an option where the parties knew or, in our judgment, reasonably 
should have known that the arrangement did not satisfy the requirements 
of an exception.
    We are also seeking comment as to whether we should impose a period 
of disqualification from using an exception where an arrangement has 
failed to satisfy the requirements of that exception. For example, 
suppose non-monetary compensation is given by an entity to a physician 
that greatly exceeds the permissible limit prescribed in Sec.  
411.357(k). In addition to whatever period of disallowance that would 
apply, we are considering whether the parties should be disqualified, 
for a period of time, from relying on this exception. For example, if 
an entity gives a piece of equipment to a physician that has a fair 
market value of $900, we may--
     Prohibit one or both of the parties from relying on this 
exception for a period of time;
     Require the parties to ``spend down'' in order to use the 
exception again (for example, if the permissible year limit is $300 
(not taking into account adjustment for inflation) and the parties 
exceeded this limit by $600, the parties would be precluded from using 
the exception during the next 2 years (not taking into account 
adjustment for inflation); or
     Require the physician to return or pay back the value of 
the excess compensation in order for one or both of the parties to use 
the exception again.
7. Ownership or Investment Interest in Retirement Plans
    In the 1998 proposed rule (63 FR 1708), we noted that we had 
received questions concerning whether stock options and other nonvested 
interests (such as an interest in retirement funds that vests after a 
certain number of years worked) in an entity constitutes ownership in 
that entity. We replied that it was our view that options and nonvested 
interests are inchoate or partial ownership interests that qualify as 
``ownership'' for purposes of the physician self-referral law. In 
response to a comment to the 1998 proposed rule, however, we stated in 
the Phase I final rule with comment period that we were withdrawing the 
statement in the 1998 proposed rule that an interest in a retirement 
plan might be treated as an ownership or investment interest for 
purposes of section 1877 of the Act and that, instead, we would 
consider contributions (including employer contributions) to retirement 
plans to be part of an employee's overall compensation arrangement with 
his or her employer (66 FR 870). As part of the Phase I rule, we 
promulgated Sec.  411.354(b)(3)(i), which excludes ``[a]n interest in a 
retirement plan'' from the definition of ownership and investment 
interests. We made no changes to this provision in Phase II (69 FR 
16054).
    We received a comment in response to the Phase II interim final 
rule (69 FR 16054) concerning the exclusion from an ownership or 
investment interest for retirement plans as specified in Sec.  
411.354(b)(3)(i). The commenter stated that, contrary to our intent, 
some physicians are using retirement plans to purchase DHS entities to 
which they refer patients for DHS. We agree with the commenter that it 
was not our intent to exclude from the definition of an ownership or 
investment interest an interest in a DHS entity that results from a 
physician's (or family member's) participation in a retirement plan 
that purchases an interest in that DHS entity. That is, where a 
physician has an interest in a retirement plan offered by Entity A, 
through the physician's (or an immediate family member's) employment 
with Entity A, we intended to except from the definition of ownership 
or investment interests any interest the physician would have in Entity 
A by virtue of his or her interest in the retirement plan; we did not 
intend to exclude from the definition of ownership or investment 
interests any interest the physician may have in Entity B through the 
retirement plan's purchase of an interest in Entity B.
    Accordingly we are proposing to revise Sec.  411.354(b)(3)(i) to 
provide that ownership and investment interests do not include an 
interest in a retirement plan offered by the entity to the physician or 
immediate family member

[[Page 38184]]

as a result of the physician's or immediate family member's employment 
with the entity.
8. ``Set in Advance'' and Percentage-Based Compensation Arrangements
    Several of the compensation exceptions in section 1877 of the Act 
require that the compensation be ``set in advance'' (or ``fixed in 
advance''). This requirement has been carried over in our regulations 
implementing those statutory exceptions, and we have also included a 
``set in advance'' requirement in some of our regulatory exceptions 
(that is, exceptions promulgated pursuant to our authority in section 
1877(b)(4) of the Act to create additional exceptions that pose no risk 
of program or patient abuse). In Sec.  411.354(d), Special Rules on 
Compensation, we state that compensation will be considered ``set in 
advance'' if the aggregate compensation, a time-based or per unit-of-
service-based amount, or a specific formula for calculating the 
compensation, is set forth in an agreement between the parties before 
the furnishing of the items or services for which the compensation is 
to be paid. Under Phase I (66 FR 959), the last sentence of Sec.  
411.354(d)(1) read,

    Percentage compensation arrangements do not constitute 
compensation that is `set in advance' in which the percentage 
compensation is based on fluctuating or indeterminate measures or in 
which the arrangement results in the seller receiving different 
payment amounts for the same service from the same purchaser.

We had explained in that rule, in response to a public comment, that 
``[p]ercentage compensation that is determined by calculating a 
percentage of a fluctuating or indeterminate amount, such as revenues, 
collections or expenses, is not fixed in advance'' (66 FR 878). 
Following publication of the Phase I rule, however, we received 
anecdotal accounts about contracts for physician services under which 
payment was calculated based on a percentage of the revenue raised by a 
physician's own professional services. Therefore, we delayed the 
effective date of the final sentence of Sec.  411.354(d)(1) through 
four Federal Register notices, to allow us to revise the provision ``to 
avoid unnecessarily disrupting existing contractual arrangements for 
physician services'' (68 FR 74491, December 24, 2003; 68 FR 20347, 
April 25, 2003; 67 FR 70322, November 22, 2002; 66 FR 60154 and 60155, 
December 3, 2001).
    In the Phase II interim final rule with comment period, in the 
section on physician compensation, we explained that percentage 
compensation arrangements were of particular concern to academic 
medical centers and to hospitals ``which argued that percentage 
compensation is commonplace in their physician compensation 
arrangements'' (69 FR 16068). We were persuaded that our original 
position was overly restrictive, and accordingly, we deleted the last 
sentence in Sec.  411.354(d)(1) and clarified that the specific formula 
must be set forth in sufficient detail before the furnishing of the 
items or services and the formula may not be modified within the time 
period in any manner that reflects the volume or value of referrals or 
any other business generated between the parties.
    Despite our intent that percentage compensation arrangements could 
be used only for compensating physicians for the physician services 
they perform, it has come to our attention that percentage compensation 
arrangements are being used for the provision of other services and 
items, such as equipment and office space that is leased on the basis 
of a percentage of the revenues raised by the equipment or in the 
medical office space. We are concerned that percentage compensation 
arrangements in the context of equipment and office space rentals are 
potentially abusive. We note that section 1877(e)(1)(A)(vi) of the Act, 
with respect to office space rentals, and section 1877(e)(1)(B)(vi) of 
the Act, with respect to equipment rentals, allow us to impose 
requirements on office space and equipment rental arrangements as 
needed to protect against program or patient abuse. Although we are 
concerned primarily with percentage compensation arrangements in the 
context of equipment and office space rentals, we believe there is the 
potential for percentage compensation to be utilized in other areas as 
well. Therefore, relying on our authority in sections 
1877(e)(1)(A)(vi), 1877(e)(1)(B)(vi), and 1877(b)(4) of the Act, we are 
proposing to clarify that percentage compensation arrangements: (1) May 
be used only for paying for personally performed physician services; 
and (2) must be based on the revenues directly resulting from the 
physician services rather than based on some other factor such as a 
percentage of the savings by a hospital department (which is not 
directly or indirectly related to the physician services provided).
9. Stand in the Shoes
    Commenters to the Phase I final rule with comment period proposed 
that we permit physicians to stand in the shoes of their group 
practices, thereby requiring analysis of certain indirect compensation 
arrangements as direct compensation arrangements. In the Phase II 
interim final rule, we solicited comments on this issue, and we may be 
addressing this issue in an upcoming final rule. In this proposed rule, 
we are focusing on the DHS entity side of physician-DHS entity 
financial relationships. We propose to amend Sec.  411.354(c) to 
provide that, where a DHS entity owns or controls an entity to which a 
physician refers Medicare patients for DHS, the DHS entity would stand 
in the shoes of the entity that it owns or controls and would be deemed 
to have the same compensation arrangements with the same parties and on 
the same terms as does the entity that it owns or controls. For 
example, a hospital would stand in the shoes of a medical foundation 
that it owns or controls (such as where the hospital is the sole member 
of a non-profit corporation). Thus, if a hospital owns or controls a 
medical foundation that contracts with a physician to provide physician 
services at a clinic owned by the medical foundation, the hospital 
would stand in the shoes of the medical foundation, and would be deemed 
to have a direct compensation relationship with the contractor 
physician.
    We believe that it is necessary to collapse the type of 
relationship discussed above to safeguard against program abuse by 
parties who endeavor to avoid the application of the physician self-
referral requirements by simply inserting an entity or contract into a 
chain of financial relationships linking a DHS entity and a referring 
physician. We are soliciting comments as to whether and how we would 
employ a stand in the shoes approach for the type of relationship 
discussed above, as well as for other types of financial relationships. 
In submitting comments, commenters should be mindful that we finalize 
(or may already have finalized) a provision that treats physicians as 
standing on the shoes of their group practices or other physician 
practices.
10. Alternative Criteria for Satisfying Certain Exceptions
    We received several comments in response to the Phase II rulemaking 
that asserted that even innocent and trivial violations of the 
physician self-referral statute may result in huge penalties to an 
entity that submits claims to Medicare. For example, the failure of a 
hospital to obtain a signature on a lease or a personal services 
arrangement with a physician could result in the hospital being 
required to make repayment for all services for which it billed 
Medicare as a result of prohibited referrals from the physician. One 
commenter stated that we should exercise our discretion

[[Page 38185]]

in pursuing minor violations and the failure to meet the procedural 
requirements of an exception (such as obtaining all required signatures 
prior to commencement of the agreement for personal services) and 
technical violations. Another commenter stated that we should consider 
adding an exception that would permit physicians to refer for DHS, and 
entities to submit and receive payment for DHS, if, in our sole 
discretion, we determined that there was no abuse. The commenter 
suggested that such an exception be available only after (1) receipt by 
the entity of a favorable advisory opinion, or (2) a voluntary 
disclosure by the entity or upon audit or investigation by the 
government.
    Although we do not have discretion to waive violations of the 
physician self-referral statute, we are considering whether to amend 
certain of the exceptions that appear in Sec.  411.355 through Sec.  
411.357 to provide an alternate method for satisfying the exception. We 
caution that our proposal is intended to address only inadvertent, 
violations in which an agreement fails to satisfy the procedural of 
``form'' requirements of an exception of the statute or regulations. We 
do not intend to apply the alternative method for compliance to other 
requirements such as compensation that is fair market value, not 
related to volume or value of referrals, or set in advance. What we 
have in mind, for example, is a situation in which parties are missing 
a signature but every other requirement of the exception for personal 
service arrangements is satisfied. In such a case, provided that there 
is full disclosure, the missing signature is inadvertent, and other 
conditions for alternative compliance described here are satisfied, the 
alternative method for compliance would be met and the parties would 
comply with the exception.
    The alternative method for compliance with the physician self-
referral prohibition would provide that, if an arrangement does not 
meet all of the existing prescribed criteria of an exception, the 
arrangement nevertheless would meet the exception if: (1) The facts and 
circumstances of the arrangement are self-disclosed by the parties to 
us; (2) we determine that the arrangement satisfied all but the 
prescribed procedural or ``form'' requirements of the exception at the 
time of the referral for DHS at issue and at the time of the claim for 
such DHS; (3) the failure to meet all the prescribed criteria of the 
exception was inadvertent; (4) the referral for DHS and the claim for 
DHS were not made with knowledge that one or more of the prescribed 
criteria of the exception were not met (consistent with other 
exceptions, we would apply the same knowledge standard as that 
applicable under the False Claims Act; (5) the parties have brought (or 
will bring as soon as possible) the arrangement into complete 
compliance with the prescribed criteria of the exception or have 
terminated (or will terminate as soon as possible) the financial 
relationship between or among them; (6) the arrangement did not pose a 
risk of program or patient abuse; (7) no more than a set amount of time 
had passed since the time of the original noncompliance with the 
prescribed criteria; and (8) the arrangement at issue is not the 
subject of an ongoing Federal investigation or other proceeding 
(including, but not limited to, an enforcement matter). We would 
consider there to be an ``inadvertent'' failure to meet all of the 
prescribed criteria in an exception only where there was an innocent or 
unintentional mistake. We would rely on our authority under section 
1877(b)(4) of the Act to implement an alternative compliance policy, 
and we would include requirements that are contained in all exceptions 
that we promulgate under that authority (including, but not limited to, 
the requirement that the arrangement not violate the anti-kickback 
statute).
    We believe that if we were to adopt an alternative compliance 
method policy for certain exceptions, with the criteria specified 
above, the determination of whether an arrangement meets the terms of 
an exception despite not meeting all of the prescribed criteria of an 
exception should be at our sole discretion and not subject to further 
administrative or judicial review. We caution that we would retain the 
discretion as to whether to make such a determination; parties would 
have no right to receive such a determination and no time period by 
which we would be required to issue a determination. We further caution 
that, because we would retain sole authority to determine that an 
arrangement that failed to satisfy all of the prescribed procedural or 
``form'' criteria of an exception that meets the conditions for the 
alternative method of compliance, and because of the proposed 
requirements that: (1) The failure to meet all of the prescribed 
criteria of the exception was inadvertent; and (2) the referral for DHS 
and the claim for DHS were not made with knowledge that one or more of 
the prescribed criteria of the exception were not met, parties to an 
arrangement would not be able to refer or bill for DHS with the 
knowledge that the arrangement did not comply with all of the 
prescribed criteria of an exception and then later claim in response to 
an enforcement action that they believed that their conduct was proper 
because, in their view, the arrangement would have met the criteria for 
the alternative method for compliance with the prescribed criteria of 
an exception. In fact, if our proposal were to be adopted and a DHS 
entity were to submit a claim for Medicare payment with the knowledge 
that its financial relationship with the referring physician (or his or 
her immediate family member) did not meet the prescribed criteria of 
any exception, and did so in advance of any determination from us that 
the arrangement met the alternative method of compliance, it could be 
found liable under the False Claims Act.
    We are especially interested in comments regarding: whether we 
should adopt an alternative compliance method policy, and if so, the 
exceptions for which the policy should be applicable; the conditions 
that must be met in order to obtain a favorable determination that an 
arrangement that does not meet all of the prescribed criteria of an 
exception nevertheless satisfies the alternative method of compliance 
with the exception; the manner (for example, advisory opinion) for 
making such a determination; the length of time during which the 
alternative method option would be available (that is, the length of 
time that a party would have to discover that an arrangement was out of 
compliance with the prescribed criteria of an exception and seek 
protection under the alternative compliance method policy); and, 
whether, having received a favorable determination that an arrangement 
satisfied the alternative method of compliance (essentially, that the 
arrangement was deemed to have met the prescribed criteria of an 
exception), an entity should be precluded for a period of time from 
receiving another favorable determination with respect to an 
arrangement that (1) failed to meet the prescribed criteria of the same 
exception (or similar criteria of another exception) and (2) that was 
entered into after the date the arrangement that received the favorable 
determination was entered into by the entity. We are also interested in 
comments as to whether each eligible exception should specify which 
criterion or criteria an arrangement can fail to meet and nevertheless 
still qualify under the alternative method criteria as satisfying the 
exception (for

[[Page 38186]]

example, specifying in several exceptions that an arrangement that is 
missing a signature can nevertheless qualify for the alternative 
compliance method), or whether, in addition to or in lieu thereof, we 
should provide that an arrangement may qualify for the alternative 
compliance method if we make a determination that the arrangement 
substantially complied with the prescribed criteria and met all of the 
other alternative criteria. We are specifically seeking comment on 
what, if any, additional requirements or standards should be met where 
an arrangement fails to satisfy a procedural of ``form'' requirement of 
an exception. For example, we would like comments on whether we should 
require other documentary proof of the parties' intent to contract 
(through memoranda, electronic mail, or otherwise) in the case where 
the parties failed to obtain a necessary signature to effect the 
contractual arrangement.
    We reiterate that we do not have the authority to waive violations 
of the physician self-referral statute or regulations. We do not mean 
to suggest that, for financial relationships that implicate the general 
prohibition, anything less than full compliance with one or more of the 
exceptions is sufficient; rather, we are proposing to provide 
additional and alternative criteria for some of the exceptions 
themselves so that some arrangements that otherwise would be 
noncompliant as a result of an inadvertent mistake might satisfy an 
exception. In effect, we are merely proposing to expand the scope of 
some exceptions to provide more flexibility.
    Finally, we note that our proposal for an alternative compliance 
method policy is intended to complement, and not replace, the 
provisions in Sec.  411.353(f) for certain arrangements involving 
temporary noncompliance. Among other requirements, in order to qualify 
for protection under Sec.  411.353(f), the financial relationship 
between the entity and the referring physician must have been in 
compliance with an exception for at least 180 consecutive calendar days 
immediately preceding the date on which the financial relationship 
became noncompliant, and the financial relationship must have fallen 
out of compliance due to reasons beyond the control of the entity. In 
addition, claims are payable only for DHS rendered during a maximum of 
90 consecutive calendar days following the date on which the financial 
relationship became noncompliant; the exception may be used by an 
entity only once every 3 years for the same referring physician; and 
the exception may not be used for temporary noncompliance with the 
exception for nonmonetary compensation or medical staff incidental 
benefits.
11. Services Furnished ``Under Arrangements''
    Our physician self-referral rules prohibit a physician from making 
referrals for DHS to an entity with which the physician (or an 
immediate family member) has a financial relationship, and prohibits 
the entity from billing Medicare for the DHS, unless an exception 
applies. In the 1998 proposed rule, we stated that we had received 
questions about which entities are the relevant ones for purposes of 
the prohibition on referrals, given that some entities only bill for 
services, whereas others actually directly ``furnish'' the services. We 
noted that, for example, in an ``under arrangements'' situation, a 
hospital, rural primary care hospital, SNF, HHA, or hospice program 
contracts with a separate provider to furnish services to the 
hospital's, SNF's, or other contracting entity's patients, for which 
the hospital, SNF or other contracting entity ultimately bills. 
Sections 1832, 1835(b)(1), 1861(e), and 1861(w)(1) of the Act and Sec.  
413.65(i) provide for Medicare payment to providers for services 
furnished ``under arrangements.'' The Internet-Only Manual (IOM) manual 
100-01, Medicare General Information, Eligibility and Entitlement 
Manual, Pub. 100-01, at Chapter 5, section 10.3 requires that the 
provider must exercise professional responsibility over an arranged-for 
service, using the same quality controls as applied to services 
furnished by the provider's salaried employees. Under Sec.  413.65(i), 
a provider-based hospital department may not provide all of its 
services under arrangements. Therefore, a hospital department may not 
contract out all of its patient care services.
    We stated in the 1998 proposed rule that, absent an exception, the 
referral prohibition applies to a physician's DHS referrals to any 
entity that directly furnishes DHS to Medicare or Medicaid patients. We 
stated that a physician can have an incentive to overutilize services 
if he or she has a financial relationship with the entity that directly 
furnishes DHS, even if this is not the entity ultimately billing for 
the services. In these situations, the physician can potentially 
recognize a profit from each referral based on the fact that the DHS 
will, in essence, be sold to the entity that bills (63 FR 1707). 
Notwithstanding our statements in the 1998 proposed rule, we have 
interpreted the definition of ``entity'' at Sec.  411.351 as including 
only the person or entity that bills Medicare for the DHS, and not the 
person or entity that performs the DHS (where the person or entity 
performing the DHS is not the person or entity billing for it).
    We continue to have concerns with services provided under 
arrangements to hospitals and other providers. We believe that the risk 
of overutilization that we identified in the 1998 proposed rule has 
continued, particularly with hospital outpatient services for which 
Medicare pays on a per-service basis. That is, we pay a hospital 
separately for each clinical laboratory test, for each therapy service, 
and for the vast majority of radiology and other imaging services. We 
have received anecdotal reports of hospital and physician joint 
ventures that provide hospital imaging services formerly provided by 
the hospital directly. There appears to be no legitimate reason for 
these arranged for services other than to allow referring physicians an 
opportunity to make money on referrals for separately payable services. 
Many of the services furnished by the joint venture were previously 
furnished directly by the hospitals, and in most cases, could continue 
to be furnished directly by hospitals.
    We are also concerned that the services furnished under 
arrangements to a hospital are furnished in a less medically-intensive 
setting than the hospital, but billed at higher outpatient hospital PPS 
rates, which not only costs the Medicare program more, but also costs 
Medicare beneficiaries more in the form of higher deductibles and 
coinsurance. Often, physician specialists who order services for their 
hospital patients set up joint ventures, frequently including as an 
owner a hospital to which the physicians refer patients. The joint 
venture often owns an entity that furnishes medically less intensive 
services than a hospital, such as an ASC, an IDTF, or a physician 
office. The entity may even be located in a hospital building in space 
leased by the hospital to the joint venture, whether owned by 
physicians alone or with the hospital. It appears that the use of these 
arrangements may be little more than a method to share hospital 
revenues with referring physicians in spite of unnecessary costs to the 
program and to beneficiaries.
    We believe that more and more procedures are being performed as 
arranged for hospital services. The provider community is well aware 
that, effective for services furnished on or after January 1, 2008, 
Medicare may pay more for all hospital outpatient surgical procedures 
than for the same procedures billed by ASCs under the

[[Page 38187]]

revised ASC payment system required by section 626(b) of the MMA. (In 
the CY 2007 OPPS/ASC proposed rule (71 FR 49635), we proposed that 
payment for an ASC surgical procedure would be made at 62 percent of 
the payment for the same procedure under the OPPS (71 FR 49656).)
    After the close of the Phase II comment period, the Medicare 
Payment Advisory Commission (MedPAC), in its March 2005 Report to 
Congress, recommended that the Secretary ``should expand the definition 
of physician ownership in the physician self-referral law to include 
interests in an entity that derives a substantial proportion of its 
revenue from a provider of designated health services.'' Specifically, 
MedPAC wrote:

    Physician ownership of entities that provide services and 
equipment to imaging centers and other providers creates financial 
incentives for physicians to refer patients to these providers, 
which could lead to higher use of services. Prohibiting these 
arrangements should help ensure that referrals are based on 
clinical, rather than financial, considerations. It would also help 
ensure that competition among health care facilities is based on 
quality and cost, rather than financial arrangements with entities 
owned by physicians who refer patients to the facility.

(See http://www.medpac.gov/publications/congressional_reports/Mar05_EntireReport.pdf, at page 170.) We agree with the concerns of MedPAC 
and a commenter to the Phase II interim final rule that arrangements 
structured so that referring physicians own leasing, staffing, and 
similar entities that furnish items and services to entities furnishing 
DHS but do not submit claims, raise significant concerns under the 
fraud and abuse laws. We believe such arrangements to be contrary to 
the plain intent of the physician self-referral law. Arrangements so 
structured are particularly problematic because referrals by physician-
owners of leasing, staffing, and similar entities to a contracting DHS 
entity can significantly increase the physician-owned entity's profits 
and investor returns, creating incentives for overutilization and 
corrupting medical decision-making.
    We are attempting to determine the best approach to prohibit 
certain arrangements under which physicians supply items and services 
to DHS entities. We note that some of the arrangements described by 
MedPAC are subject to the physician self-referral prohibition and more 
may become subject to the physician self-referral prohibition through 
provisions we may implement in the upcoming Phase III final rule.
    Although MedPAC recommended that the definition of physician 
ownership subject to the physician self-referral prohibition be 
expanded to include any entity that derives a substantial proportion of 
its revenue from a provider of DHS, we are proposing what we believe is 
a more straightforward approach to addressing the issue. That is, we 
propose to revise our definition of entity at Sec.  411.351 so that a 
DHS entity includes both the person or entity that performs the DHS, as 
well as the person or entity that submits claims or causes claims to be 
submitted to Medicare for the DHS. Our proposal is not meant to exclude 
any persons or entities that presently are considered to be DHS 
entities. (In this regard, we note that we propose to reorganize and 
delete some of the material in the current definition and are seeking 
comment on our proposed changes to the regulatory text.) Although we 
believe our proposed approach is sufficient to address abusive 
arrangements, we solicit comments on whether we should implement the 
MedPAC approach, either in some combination with our proposed approach 
or instead of our proposed approach. We would be particularly 
interested in comments related to what should constitute a 
``substantial'' proportion of revenue derived from providing DHS.

N. Beneficiary Signature for Ambulance Transport Services

    [If you choose to comment on issues in this section, please include 
the caption ``BENEFICIARY SIGNATURE'' at the beginning of your 
comments.]
    Section 424.36 requires that a beneficiary's signature must appear 
on all claims submitted for Medicare services, unless the beneficiary 
has died, or another exception applies. For example, if a beneficiary 
is physically or mentally incapable of signing the claim, the claim may 
be signed on the beneficiary's behalf by another individual listed in 
Sec.  424.36(b). Ambulance suppliers and providers have stated that, in 
emergency situations, it is impossible or impractical for ambulance 
providers or suppliers to obtain a beneficiary's or other authorized 
person's signature on a claim to properly bill Medicare for ambulance 
transport services because: (1) Many beneficiaries are incapable of 
signing claims due to their medical condition at the time of transport; 
and (2) another person authorized to sign the claim under Sec.  
424.36(b) is not available, or is unwilling to sign the claim at the 
time of transport; and (3) if an individual listed in Sec.  424.36(b) 
is not available or willing to sign a claim on behalf of the 
beneficiary at the time of transport, it is impractical later to locate 
the beneficiary (or the beneficiary's authorized representative) to 
obtain a signature on the claim form before submitting it to Medicare 
for payment.
    We are sympathetic to the concerns of ambulance providers and 
suppliers insofar as emergency transport services are involved. 
Therefore, at Sec.  424.36, we are proposing that, for emergency 
ambulance transport services, where the ambulance provider or supplier 
documents that the beneficiary was physically or mentally incapable of 
signing a claim form at the time the service was provided and that none 
of the individuals listed in Sec.  424.36(b)(1) through (5) was 
available or willing to sign a claim on behalf of the beneficiary, the 
ambulance provider or supplier may submit the claim without a 
beneficiary signature. Such claim submission would be permitted only 
if: (1) The beneficiary was physically or mentally incapable of signing 
the claim form at the time the service was provided; (2) none of the 
individuals listed in Sec.  424.36(b)(1) through (5) was available or 
willing to sign the claim form on behalf of the beneficiary at the time 
the service was provided; and (3) the ambulance provider or supplier 
maintains in its files for a period of at least 4 years from the date 
of service certain documentation. Required documentation would include: 
(1) A signed contemporaneous statement, made by an ambulance employee 
present during the trip to the receiving facility, that the beneficiary 
was physically or mentally incapable of signing a claim form and that 
none of the individuals listed in Sec.  424.36(b)(1) through (5) was 
available or willing to sign the claim form on behalf of the 
beneficiary at the time the service was provided; (2) the date and time 
the beneficiary was transported, and the name and location of the 
facility where the beneficiary was received; and (3) a signed 
contemporaneous statement from a representative of the facility that 
received the beneficiary, which documents the name of the beneficiary 
and the time and date that the beneficiary was received by that 
facility.
    For non-emergency ambulance transport services, the ambulance 
provider or supplier would continue to be required to obtain a 
beneficiary's signature on a claim form (or the signature of someone 
who is authorized to sign on behalf of the beneficiary under Sec.  
424.36(b)(1) through (5) prior to submitting claims to Medicare.

[[Page 38188]]

O. Update to Fee Schedules for Class III DME for CYs 2007 and 2008

    [If you choose to comment on issues in this section, please include 
the caption ``DME UPDATE'' at the beginning of your comments.]
1. Background
a. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies 
(DMEPOS) Classifications
    Under Sec.  414.210, for Medicare payment purposes, fee schedules 
are determined for the following classes of equipment and devices:
     Inexpensive or routinely purchased items as specified in 
Sec.  414.220.
     Items requiring frequent and substantial servicing, as 
specified in Sec.  414.222.
     Certain customized items, as specified in Sec.  414.224.
     Oxygen and oxygen equipment, as specified in Sec.  
414.226.
     Prosthetic and orthotic devices, as specified in Sec.  
414.228.
     Other DME (capped rental items), as specified in Sec.  
414.229.
     Transcutaneous electric nerve stimulators (TENS), as 
specified in Sec.  414.232.
    We designate the items in each class of equipment or device through 
our program instructions.
    Under section 513 of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 360c), the Food and Drug Administration (FDA) must classify 
devices into one of three regulatory classes: class I, class II, or 
class III. FDA classification of a device is determined by the amount 
of regulation necessary to provide a reasonable assurance of safety and 
effectiveness; class III devices typically posing the greatest risk. 
Devices are to be classified into class I if there is information 
showing that the general controls of the act are sufficient to assure 
safety and effectiveness. General controls apply to all medical devices 
and include provisions that relate to adulteration, misbranding, device 
registration and listing, notification, including repair, replacement, 
or refund, records and reports, and good manufacturing practices. 
Examples of class I devices are canes and crutches.
    Class II devices are those for which general controls, by 
themselves, are insufficient to provide reasonable assurance of safety 
and effectiveness, but there is sufficient information to establish 
special controls to provide such assurance. Special controls include 
performance standards, postmarket surveillance, patient registries, 
development and dissemination of guidelines, recommendations, and any 
other appropriate action the FDA deems necessary (section 513(a)(1)(B) 
of the act). Examples of class II devices are blood glucose test 
systems and infusion pumps.
    Class III devices are those for which there is insufficient 
information to support classifying a device into class I or class II 
and the device is a life-sustaining or life-supporting device or is for 
a use which is of substantial importance in preventing impairment of 
human health, or presents a potential unreasonable risk of illness or 
injury. Class III devices paid in accordance with the DME fee schedule 
payment methodology include osteogenesis or bone growth stimulators, 
implantable infusion pumps, and stair-climbing wheelchairs (standard 
power wheelchair function only). This is not an inclusive list of class 
III devices. The Medicare DMEPOS suppliers should specify on the 
Medicare claim form whether the device furnished to a beneficiary is a 
class III device as described in section 513(a)(1)(C) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 360c(a)(1)(C)).
b. DMEPOS Payment
    Section 302(b)(1) of the MMA amended section 1847 of the Act to 
require the Secretary to establish and implement competitive 
acquisition programs for the furnishing under Medicare Part B of 
certain types of DMEPOS. Section 1847(a)(2)(A) of the Act provides that 
devices determined by the FDA to be class III devices under the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 301) cannot be included in the 
competitive acquisition programs. As part of the transition to 
competitive acquisition, the Congress mandated in sections 
1847(a)(14)(G) through (I) of the Act that the fee schedule amounts for 
DME, other than class III devices, be frozen at 2003 levels through 
2008.
    For class III devices, section 1834(a)(14)(G)(i) of the Act 
mandates that an annual update factor based on the percentage change in 
the consumer price index for urban customers (CPI-U) be applied to the 
fee schedule amounts for CYs 2004 through 2006. Section 
1834(a)(14)(H)(i) of the Act, as added by section 302 of the MMA, gives 
the Secretary discretion in determining the appropriate fee schedule 
update percentage for CY 2007 for DME which are class III medical 
devices described in section 513(a)(1)(C) of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C.360c(a)(1)(C)).\1\ Specifically, for 2007, 
the 2006 fee schedule amounts for class III devices are to be updated 
by the percentage change determined to be appropriate by the Secretary, 
taking into account recommendations contained in a report of the 
Comptroller General of the United States under section 302(c)(1)(B) of 
the MMA. Also mandated by section 1834(a)(14)(I)(i) of the Act, for 
2008, the 2007 fee schedule amounts for class III devices are to be 
increased by an annual factor based on the percentage change in the 
CPI-U, as applied to the 2007 payment amount determined after 
application of the percentage change under section 1834(a)(14)(H)(i) of 
the Act.
---------------------------------------------------------------------------

    \1\ Section 513(a)(1)(C) of the Federal Food, Drug, and Cosmetic 
Act has been codified as 21 U.S.C. 360c(a)(1)(C). Accordingly, we 
believe that the reference to 21 U.S.C. 360 (c)(1)(C) in sections 
1834(a)(14)(G)(i), (H)(i), and (I)(i) of the Act is a scrivener's 
error.
---------------------------------------------------------------------------

    As stated above, section 1834(a)(14)(H)(i) of the Act mandated that 
the Secretary take into account recommendations by the Comptroller 
General of the United States, who is the head of the Government 
Accountability Office (GAO), when determining the appropriate update 
percentage for class III devices for 2007. On March 1, 2006, the GAO 
published a report, ``Class III Devices do not Warrant a Distinct 
Annual Payment Update'' (GAO-06-62). The GAO concluded in that report, 
``because the initial payment rates for all classes of devices on the 
Medicare DME fee schedule are based on retail prices or an equivalent 
measure, they account for the costs of class III and similar class II 
devices in a consistent manner. Distinct updates for two different 
classes of devices are unwarranted.'' The GAO recommended that the 
Secretary establish a uniform payment update to the DME fee schedule 
for 2007 for class II and class III devices.
    In the May 1, 2006 Federal Register, we published the Competitive 
Acquisition for Certain Durable Medical Equipment, Prosthetics, 
Orthotics, and Supplies (DMEPOS) and Other Issues proposed rule (71 FR 
25660). We solicited comments on how to determine the appropriate fee 
schedule percentage change for class III devices for 2007 and 2008. We 
stated that we would consider the comments received in conjunction with 
the recommendations in the GAO report in determining the appropriate 
update percentage for these devices for 2007 and 2008.
    A majority of the submitted public comments indicated that the GAO 
report was flawed since it did not recommend a specific update factor 
or take into account changes over time in the costs of producing, 
supplying and

[[Page 38189]]

servicing class III devices. Several commenters recommended that we 
continue to use the CPI-U to adjust fee schedule amounts for class III 
devices, but offered no substantive information that would otherwise 
support a distinct update factor for class III devices. Another 
commenter recommended that the class III proposal be included in a 
separate rulemaking procedure because it is not related to competitive 
acquisition.
2. Proposed Update to Fee Schedule
    We believe that the GAO has done a thorough job in reviewing 
Medicare payment rules and methods and issues associated with the costs 
of furnishing class III devices. Accordingly, we agree with the finding 
in the report that the costs of furnishing class II and class III DME 
devices have been factored into the fee schedule amounts calculated for 
these devices. We also agree with the GAO recommendation that a uniform 
payment update be established to the DME fee schedule for 2007 for 
class II and class III devices. For class II devices, the MMA provided 
for a zero percent payment update from 2004 through 2008. Accordingly, 
for 2007, we are proposing a zero percent update for class III devices. 
Also, in accordance with the MMA, we are proposing to use the percent 
change in the CPI-U to update the class III device 2007 fee schedule 
amounts for 2008.

P. Discussion of Chiropractic Services Demonstration

    [If you choose to comment on issues in this section, please include 
the caption ``CHIROPRACTIC SERVICES DEMONSTRATION'' at the beginning of 
your comments.]
    In the CY 2006 PFS final rule with comment period (70 FR 70266) and 
the CY 2007 PFS final rule with comment period (71 FR 69707), we 
included a discussion of the 2-year chiropractic services demonstration 
that ended on March 31, 2007. This demonstration was authorized by 
section 651 of the MMA to evaluate the feasibility and advisability of 
covering chiropractic services under Medicare. These services extended 
beyond the current coverage for manipulation to care for 
neuromusculoskeletal conditions typical among eligible beneficiaries, 
and covered diagnostic and other services that a chiropractor was 
legally authorized to perform by the State or jurisdiction in which the 
treatment was provided. The demonstration was conducted in four sites, 
two rural and two urban. The demonstration was required to be budget 
neutral as the statute requires the Secretary to ensure that the 
aggregate payment made under the Medicare program does not exceed the 
amount which would be paid in the absence of the demonstration.
    Ensuring budget neutrality requires that the Secretary develop a 
strategy for recouping funds should the demonstration result in costs 
higher than those that would occur in the absence of the demonstration. 
As we stated in the CY 2006 and CY 2007 PFS final rules with comment 
period, we would make adjustments to the chiropractor fees under the 
Medicare PFS to recover aggregate payments under the demonstration in 
excess of the amount estimated to yield budget neutrality. We will 
assess budget neutrality by determining the change in costs based on a 
pre- and post-comparison of aggregate payments and the rate of change 
for specific diagnoses that were treated by chiropractors and 
physicians in the demonstration sites and control sites. Because the 
aggregate payments under the expanded chiropractor services may have an 
impact on other Medicare expenditures, we will not limit our analysis 
to reviewing only chiropractor claims.
    Any needed reduction to chiropractor fees under the PFS would be 
made in the CY 2010 and CY 2011 physician fee schedules as it will take 
approximately 2 years after the demonstration ends to complete the 
claims analysis. If we determine that the adjustment for BN is greater 
than 2 percent of spending for the chiropractor fee schedule codes 
(comprised of the 3 currently covered CPT codes 98940, 98941, and 
98942), we would implement the adjustment over a 2-year period. 
However, if the adjustment is less than 2 percent of spending under the 
chiropractor fee schedule codes, we would implement the adjustment over 
a 1-year period. We will include the detailed analysis of budget 
neutrality and the proposed offset during the CY 2009 PFS rulemaking 
process.

Q. Technical Corrections

    [If you choose to comment on issues in this section, please include 
the caption ``TECHNICAL CORRECTIONS'' at the beginning of your 
comments.]
1. Particular Services Excluded From Coverage (Sec.  411.15(a))
    Prior to January 1, 2005, Medicare did not pay for routine physical 
examinations or checkups. Section 1862(a)(7) of the Act states that 
routine physical checkups are excluded services. This exclusion is 
described in Sec.  411.15(a), Particular services excluded from 
coverage. In addition, we had interpreted section 1862(a)(1)(A) of the 
Act to exclude coverage for cardiovascular disease screening tests and 
diabetes screening tests. This section provides that items or services 
must be reasonable and necessary for the diagnosis or treatment of 
illness or injury, or to improve the functioning of a malformed body 
member as stated in Sec.  411.15(k). Since preventive services are not 
provided for diagnosis or treatment of illness, injury, or 
malformation, we determined that these services are not reasonable and 
necessary within the meaning of the statute.
    Effective January 1, 2005, Part B coverage was expanded to include 
an initial preventative physical examination (IPPE) for certain 
individuals. Our regulations governing the IPPEs are primarily set 
forth in Sec.  410.16. Additional conforming changes were made at that 
time to Sec.  411.15 to reflect this expansion in coverage.
    Sections 612 and 613 of the MMA added coverage under Part B for 
cardiovascular disease screening tests and diabetes screening tests, 
effective for services furnished on or after January 1, 2005, subject 
to certain eligibility and other limitations. These provisions were 
implemented in the CY 2005 PFS final rule with comment period (69 FR 
66236). Those rules are codified in Sec.  410.17 and Sec.  410.18, 
respectively. However, at the time we neglected to make additional 
conforming changes to Sec.  411.15 to reflect this expansion in 
coverage.
    To conform the regulations to the MMA provisions, we are proposing 
a technical correction to the provisions in Sec.  411.15 by specifying 
additional exceptions to provide payment for cardiovascular disease 
screening tests and diabetes screening tests that meet the eligibility 
limitation and the conditions for coverage that we specified under 
Sec.  410.17, Cardiovascular Disease Screening Tests, and Sec.  410.18, 
Diabetes Screening Tests.
2. Medical Nutrition Therapy (MNT) (Sec.  410.132)
    In the CY 2006 PFS final rule with comment period (70 FR 70160), we 
added individual medical nutrition therapy, as represented by HCPCS 
codes G0270, 97802 and 97803, to the list of telehealth services. We 
are making a technical correction to Sec.  410.132(a) to conform the 
regulations to include an exception for services provided at Sec.  
410.78. This revised paragraph reads as follows:
    ``(a) Conditions for coverage of MNT services. Medicare Part B pays 
for MNT services provided by a registered

[[Page 38190]]

dietitian or nutrition professional as defined in Sec.  410.134 when 
the beneficiary is referred for the service by the treating physician. 
Except as provided at Sec.  410.78, services covered consist of face-
to-face nutritional assessments and interventions in accordance with 
nationally-accepted dietary or nutritional protocols.''
3. Payment Exception: Pediatric Patient Mix (Sec.  413.184)
    In the CY 2006 PFS final rule with comment period (70 FR 70214), we 
revised Sec.  413.180 through Sec.  413.192 regarding criteria and the 
application procedures for requesting an exception to the ESRD 
composite rate payment. As part of the revisions we intended to amend 
the section heading of Sec.  413.184 to reflect that, as specified in 
the statute, this exception only pertains to a pediatric ESRD facility. 
However, this change was not made. Therefore, we are proposing to 
revise the section heading of Sec.  413.184 to read as follows: 
``Payment exception: Pediatric patient mix.''
4. Diagnostic X-ray Tests, Diagnostic Laboratory Tests, and Other 
Diagnostic Tests: Conditions (Sec.  410.32(a)(1))
    Section 1861(r)(5) of the Act was amended by section 4513(a) of the 
BBA to allow Medicare payment for a chiropractor's manual manipulation 
of the spine to correct subluxation, without requiring the subluxation 
to be demonstrated by an x-ray. The BBA provision was effective for 
services furnished on or after January 1, 2000. Prior to this statutory 
change, the subluxation was required to be demonstrated by an x-ray. 
Because chiropractors are limited by statute with respect to the 
services they can provide under Medicare, it had been necessary to 
create an exception to the requirement that diagnostic services 
(including x-rays) must be ordered by the treating physician as 
provided in Sec.  410.32(a). This exception, which permits a physician 
who is not a treating physician to order and receive payment for an x-
ray that is used by a chiropractor, is specified in Sec.  410.32(a)(1).
    We revised Sec.  410.22 to reflect the BBA change in the CY 2000 
PFS final rule (64 FR 59439). (Note: Sec.  410.22 was redesignated as 
Sec.  410.21 in the CY 2001 PFS final rule.) However, we neglected to 
remove the chiropractic exception at Sec.  410.32 (a)(1). Because of 
the BBA change, which removed the requirement that subluxation must be 
demonstrated by an x-ray, the chiropractic exception is no longer 
warranted. We do not believe it would be necessary or appropriate to 
continue to permit payment for an x-ray ordered by a non-treating 
physician when a chiropractor, not the ordering physician, will use 
that x-ray. Therefore, we are proposing to revise Sec.  410.32 by 
removing paragraph (a)(1) and by redesignating paragraphs (a)(2) and 
(a)(3) as (a)(1) and (a)(2), respectively.

R. The Percentage Change in the Medicare Economic Index (MEI)

    [If you choose to comment on issues in this section, please include 
the caption ``MEI'' at the beginning of your comments.]
    The Medicare Economic Index (MEI) is authorized by section 
1842(b)(3) of the Act, which states that prevailing charge levels 
beginning after June 30, 1973 may not exceed the level from the 
previous year except to the extent that the Secretary finds, on the 
basis of appropriate economic index data, that the higher level is 
justified by year-to-year economic changes.
    The MEI measures the weighted-average annual price change for 
various inputs needed to produce physicians' services. The MEI is a 
fixed-weight input price index, with an adjustment for the change in 
economy-wide multifactor productivity. This index, which has CY 2000 
base year weights, is comprised of two broad categories: (1) 
Physician's own time; and (2) physician's PE.
    The physician's own time component represents the net income 
portion of business receipts and primarily reflects the input of the 
physician's own time into the production of physicians' services in 
physicians' offices. This category consists of two subcomponents: (1) 
Wages and salaries; and (2) fringe benefits.
    The physician's PE category represents nonphysician inputs used in 
the production of services in physicians' offices. This category 
consists of wages and salaries and fringe benefits for nonphysician 
staff and other nonlabor inputs. The physician's PE component also 
includes the following categories of nonlabor inputs: office expense; 
medical materials and supplies; professional liability insurance; 
medical equipment; prescription drugs; and other expenses. The 
components are adjusted to reflect productivity growth in physicians' 
offices by the 10-year moving average of productivity in the private 
nonfarm business sector. Table 14 presents a listing of the MEI cost 
categories with the associated weights.

  Table 14.--Medicare Economic Index Expenditure Categories and Weights
------------------------------------------------------------------------
                                                                 2000
                    Expenditure category                        Expense
                                                                weight
------------------------------------------------------------------------
Physician Compensation......................................      52.466
    Wages and Salaries......................................      42.730
    Benefits................................................       9.735
Practice Expense............................................      47.534
    Nonphysician Compensation...............................      18.653
        Nonphysician wages..................................      13.808
            Prof/Tech Wages.................................       5.887
            Manager Wages...................................       3.333
            Clerical Wages..................................       3.892
            Services Wages..................................       0.696
            Employee Benefits...............................       4.845
        Other Practice Expense..............................      18.129
            Office Expenses.................................      12.209
            Prof. Liability Insurance.......................       3.865
            Medical equipment...............................       2.055
        Drugs and Supplies..................................       4.319
            Medical material and supplies...................       2.011
            Prescription Drugs..............................       2.308
        Other Expenses......................................       6.433
            All Other.......................................       6.433
------------------------------------------------------------------------

    Beginning in April 2007, with their March 2007 publication, the 
Bureau of Labor Statistics (BLS) will discontinue production and 
publication of the white collar occupation employment cost index (ECI) 
series.
    The white collar benefit ECI for private workers has been used as 
the price proxy for nonphysician benefits in the MEI. There is no other 
comparable, published series that is a suitable replacement for the 
white collar benefit ECI. Consequently, Global Insight, Inc. (GII) and 
CMS jointly developed a composite series which is composed of four 
published ECI series and weighted by November 2004 National Industry--
Specific Occupational Employment and Wage Estimates for NAICS 6211, 
Office of Physicians. Global Insight Inc. is a nationally recognized 
economic and financial forecasting firm that contracts with CMS to 
forecast the components of the market baskets.
    Table 15 lists the four ECI series and corresponding weights used 
to construct the new composite benefit index. We are proposing to 
replace the ECI white collar benefit series with this composite benefit 
index effective for the CY 2008 MEI update.

     Table 15.--CMS Composite Price Index for Non-Physician Employee
                                Benefits
------------------------------------------------------------------------
                          ECI series                             Weight
------------------------------------------------------------------------
Benefits, Private, Professional, Scientific, Technical.......       59.0

[[Page 38191]]

 
Benefits, Private, Management, Business, Financial...........        6.3
Benefits, Private, Office & Administrative Support...........       32.6
Benefits, Private, Service Occupations.......................        2.1
------------------------------------------------------------------------

    We compared the historical 4-quarter moving average percent changes 
of the MEI using the ECI white collar benefit index and the proposed 
ECI composite benefit series and in the 5 most recent calendar years, 
the difference in the overall MEI update is no greater than 0.1 
percentage point. This analysis shows that the new composite benefit 
index would be expected to have little material impact on the aggregate 
MEI updates; and therefore, we believe the use of this composite 
benefit index is the most technically accurate index for capturing 
nonphysician benefits price pressures.
    Although we have not done so in the past, we believe it would be 
beneficial to publish a preliminary estimate of the expected MEI 
update. For CY 2008, the forecasted increase in the MEI is 1.9 percent, 
which includes a forecasted 1.5 percent productivity offset based on 
the 10-year moving average of multifactor productivity. This forecast 
is based on GII's 1st quarter 2007 forecast of the MEI market basket. 
The final update will be based on historical data through 2nd quarter 
2007.

S. Other Issues

1. Recalls and Replacement Devices
    [If you choose to comment on issues in this section, please include 
the caption ``RECALLS AND REPLACEMENT DEVICES'' at the beginning of 
your comments.]
    Recently, there has been a recall of 73,000 implantable 
cardioverter-defibrillators (ICDs) and cardiac resynchronization 
therapy defibrillators (CRT-Ds) because of a faulty capacitor that can 
cause the batteries to deplete sooner than expected. (See the FDA Web 
site at www.fda.gov/cdrh/news for Questions and Answers posted April 
20, 2007 on this recall). This follows upon the recall of thousands of 
ICDs and pacemakers in CY 2004 and CY 2005. These recalls raise issues 
both with regard to the additional costs of replacement devices and 
with regard to the additional physicians' services and diagnostic tests 
that beneficiaries who have these devices often need.
    For outpatient hospital costs of the replacement devices, effective 
for services furnished on or after January 1, 2007, we reduce the 
ambulatory payment classification (APC) payment we make to hospitals 
when the hospital receives a replacement device without cost or with 
full credit for the device.
    We also proposed a reduction to Medicare payment for inpatient 
hospital services in the FY 2008 IPPS proposed rule (72 FR 26479). This 
proposed rule would reduce payments for hospital inpatients when 
hospitals use a recalled or replacement device at no cost or with 
partial credit.
    While these regulations address hospital payment for the devices 
involved, there are also costs associated with physician monitoring of 
patients treated with recalled devices. Specifically, the manufacturer 
of the devices that have been most recently recalled recommends that 
patients with the recalled device consult with their physicians in each 
case and, in some cases, begin a routine of monthly evaluations. We 
would expect that not only could extra visits to physicians' offices or 
hospital outpatient departments be necessary, but additional diagnostic 
tests may also be needed to care for the beneficiaries who have the 
recalled devices. Thus, even when immediate replacement of the device 
is not required, we are concerned that the potential greater costs to 
Medicare and to the beneficiary for these unforeseen extra services may 
be substantial and burdensome.
    We will be actively assessing ways to identify the additional 
health care costs and Medicare expenditures associated with device 
recall actions and exploring what actions would be appropriate in the 
case of these additional monitoring and related expenses as they relate 
to both the hospital outpatient and physician payment systems. We 
welcome public comments on this issue to inform our future review and 
analyses.
2. Therapy Standards and Requirements
    [If you choose to comment on issues in this section, please include 
the caption ``THERAPY STANDARDS AND REQUIREMENTS'' at the beginning of 
your comments.]
a. Revisions to Personnel Qualification Standards for Therapy Services
    In the CY 2005 PFS final rule with comment period (69 FR 66354), we 
amended Sec.  410.59, Sec.  410.60, and Sec.  410.62 to refer to the 
qualifications for physical therapists (PTs), occupational therapists 
(OTs) and speech-language pathologists at Sec.  484.4, which sets the 
personnel qualifications required under the HHA Conditions of 
Participation.
    Section 484.4 contains requirements for persons furnishing services 
in HHAs that include physical therapists (PTs), physical therapist 
assistants (PTAs), occupational therapists (OTs), occupational therapy 
assistants (OTAs) and speech-language pathologists (SLPs). The CY 2005 
PFS final rule with comment period clarified that the personnel 
qualifications in Sec.  484.4 are applicable to all outpatient PT, OT, 
and SLP services ``in order to create consistent requirements for 
therapists and therapy assistants'' (69 FR 66345).
    We propose to update the personnel qualifications in Sec.  484.4 
for PTs, PTAs, OTs, and OTAs. We also propose to revise the 
qualifications for SLPs to remove a reference to audiologists in the 
definition for speech-language pathologists because a speech-language 
pathologist would not have a Certificate of Clinical Competence in 
audiology, as implied by the regulation, unless that person was dually 
qualified as an audiologist. Otherwise, we are not proposing to update 
the qualifications for SLPs because we believe the qualifications in 
Sec.  484.4 are currently appropriate and address the issues of 
continuing education and internationally trained SLPs.
    We are proposing these changes for the following several reasons.
     The current regulations at Sec.  484.4 contain outdated 
terminology relating to several of the relevant professional 
organizations.
     The standards that now exist in the fields of physical 
therapy and occupational therapy have changed since a substantial 
portion of these qualification requirements were developed.
     Some of the current qualification requirements do not 
address individuals who have been trained outside of the United States, 
or refer to outdated requirements.
     These revisions would have the benefit of establishing 
consistent standards across provider/supplier lines.
    Although all States license PTs, some States have no licensing 
provisions for PTAs, OTs, OTAs, and SLPs. In particular, the 
qualifications for PTAs vary widely among States. According to the 
Federation of State Boards of Physical Therapy Web site (accessed on 
March 29, 2007), the ``Number of states that grandfathered PTAs prior 
to regulation = 41.'' Under the title ``What method does your state use 
to regulate PTAs?'' the field contains the word ``Licensed,'' or 
``Certified'', or is blank. Therefore, we believe PTAs who have

[[Page 38192]]

been licensed and practicing for many years may not meet the current 
education requirements in Sec.  484.4. We believe the same is true of 
occupational therapy assistants who obtained their training prior to 
application of the requirements of the certification examination for 
Certified Occupational Therapy Assistant (COTA) developed and 
administered by the National Board for Certification in Occupational 
Therapy, Inc. (NBCOT). Additionally, we believe some States permitted 
licensure or certification of PTs and OTs without successful completion 
of a curriculum in physical therapy or occupational therapy after 1977 
(the date currently specified under the ``grandfather clause'' in Sec.  
484.4 before which a practicing PT or OT need not have completed a 
curriculum in physical therapy or occupational therapy). We believe 
there may also be licensed or certified PTAs and OTAs who do not meet 
the educational requirements in Sec.  484.4.
    Therefore, we believe it would be appropriate to broaden the 
current grandfathering clauses for practicing PTs, OTs, PTAs, and OTAs. 
We propose to revise our requirements to recognize PTs, OTs, PTAs, or 
OTAs who meet their respective State qualifications (or have received 
State recognition as PTs, OTs, PTAs or OTAs) before January 1, 2008. 
Individuals who furnish physical or occupational therapy services but 
have not met State qualifications (or received State recognition as 
PTs, OTs, PTAs and OTAs) before January 1, 2008, would be required to 
meet the updated qualifications in Sec.  484.4.
    We are not proposing to change the current grandfathering 
provisions relating to the qualifications for PTs, OTs, PTAs, and OTAs 
furnishing services under the Home Health PPS or the Hospice PPS 
because the current regulations in Sec.  484.4 (that is, occupational 
therapist (paragraph (c)), OTA (paragraph (b)), physical therapist 
(paragraph (c) or (d)), or PTA (paragraph (2)) have applied to those 
settings consistently for almost 20 years. We do not expect that there 
are therapists furnishing services in a HHA or hospice that do not meet 
either the current or proposed revised qualifications. Therefore, we 
will retain the current grandfathering clauses for personnel providing 
services in those settings before 1977. We would not apply to Home 
Health and Hospice settings the proposed new grandfathering clause that 
would permit those qualified professionals who are licensed, certified, 
registered or otherwise regulated by a State and are furnishing 
services in other settings before January 1, 2008 to continue providing 
services without updating their education to meet the new requirements.
    We are seeking comment on appropriate grandfathering provisions 
relating to qualifications of therapists and assistants to assure that 
skilled therapists and assistants with comparable and appropriate 
education and training treat Medicare beneficiaries in all settings. We 
propose these grandfathering provisions to Sec.  409.16, Sec.  409.23, 
Sec.  410.43, Sec.  410.59, Sec.  410.60, Sec.  482.56, Sec.  485.70, 
Sec.  485.705, Sec.  491.9.
    The proposed revised personnel qualifications in Sec.  484.4 for 
therapists and assistants must address minimum requirements for the 
provision of therapy services by qualified personnel who have attained 
the skills of therapists with education and training in the specific 
discipline in which they are practicing, but who are not licensed. 
Also, for therapists and assistants trained outside the United States 
or trained by the United States military, we want to consider 
developing standards comparable to those applied to therapists and 
assistants trained in the United States. By ``comparable'' we mean that 
we would refer to and base our standard on a process whereby it is 
determined (either by the State or by another credentialing authority 
such as the NBCOT) that the education, training, or testing standards 
obtained outside the United States or in the military are so similar as 
to be substantially indistinguishable from standards applied to those 
who meet the qualifications for therapists and assistants trained in 
the United States. However, we note that we intend to establish 
standards comparable to those we establish for PTs, OTs, PTAs, OTAs, 
and speech-language pathologists, and not to recognize as qualified 
therapists or therapy assistants individuals trained in other 
disciplines for purposes of furnishing PT, OT, or SLP services to 
Medicare beneficiaries. It is not our intention to modify the policy 
that requires physical therapy, occupational therapy, and SLP services 
furnished incident to a physicians service to meet all the standards 
and conditions (except licensure) that apply to therapists, as this 
policy is based on the section 1862(a)(20) of the Act. Rather, it is 
our intention to assure that Medicare payment is made only for physical 
therapy, occupational therapy, and SLP services provided by personnel 
who meet qualifications, including consistent and appropriate education 
and training relevant to the discipline, so that they are adequately 
prepared to safely and effectively treat Medicare beneficiaries.
    In this proposal, we refer to persons who are licensed, certified, 
and otherwise regulated by a State. We interpret ``otherwise 
regulated'' to mean that, while a State may not regulate a profession 
by granting a license or certifying educational or training 
credentials, it may nevertheless regulate the practice of a profession 
by application of certain other requirements. For example the use of 
the title physical therapy assistant might be limited to those who have 
passed a course for PTAs in a State-approved college, even when the 
State does not grant graduates a license or certificate to practice. By 
``otherwise regulated,'' we do not mean to refer to State regulations 
that are generally applicable to all health care or other professionals 
regarding, for example, business practices, employment or hygiene. 
Rather, we mean to refer to the specific qualifications one must have 
in order to practice within a particular discipline or use a particular 
title.
    We propose to require that OT's beginning their practice after 
January 1, 2008, must be licensed, certified, registered or otherwise 
regulated as an OT, and have graduated from an occupational therapist 
curriculum accredited by the Accreditation Council for Occupational 
Therapy Education (ACOTE) of the American Occupational Therapy 
Association (AOTA), and also have successfully completed the 
certification examination developed and administered by the NBCOT. By 
``successfully completed'' we mean the individual must perform 
sufficiently well on the exam to receive (or be eligible to receive) 
certification. For services incident to a physician's or nonphysician 
practitioner's service where the licensure requirement does not apply, 
the education requirements continue to apply.
    We propose that after January 1, 2008, OTAs must be licensed, 
certified, registered or otherwise regulated as an OTA and have 
graduated from an OTA curriculum accredited by the nationally 
recognized organization for accreditation of occupational therapists, 
the ACOTE of the AOTA, and successfully completed the certification 
examination for Certified Occupational Therapy Assistant (COTA) 
developed and administered by the NBCOT.
    We are proposing that OTs who are educated outside the United 
States or by the U.S. Military-- (1) Be graduates of an occupational 
therapy curriculum accredited by the World Federation of Occupational 
Therapists (WFOT); (2) have successfully completed the NBCOT 
International Occupational Therapy Eligibility Determination

[[Page 38193]]

(IOTED) review; and (3) have successfully completed the certification 
examination for Registered Occupational Therapist. We propose to adopt 
similar standards for OTAs (but with an OTA curriculum) and seek 
comments on qualifications for internationally educated occupational 
therapy assistants.
    For PTs, we propose the therapist must be licensed as a physical 
therapist by the State in which practicing and accredited by the 
Commission on Accreditation in Physical Therapy Education (CAPTE) based 
on American Physical Therapy Association (APTA) guidelines. When the 
licensure requirement is not applicable (that is, for services 
furnished incident to the services of physicians and NPPs), we propose 
to require that PTs must have been accredited by the CAPTE. We seek 
comment on qualifications for PTs that include a curriculum and a 
national examination each approved by the APTA.
    We propose that licensure or certification, registration or other 
regulation by the State in which services are furnished would be 
required for PTAs under our regulations. We also propose that PTAs be 
accredited by the CAPTE. We seek comment on appropriate qualifications 
for PTAs.
b. Application of Consistent Therapy Standards
(1) Personnel Qualifications
    We believe therapy services should be provided according to the 
same standards and policies in all settings, to the extent possible and 
consistent with statute. For example, personnel qualifications for 
therapists and assistants should apply equally to all settings in which 
Medicare pays for physical therapy, occupational therapy and SLP 
services. Therefore, we propose to revise our regulations to cross-
reference the personnel qualifications for therapists in Sec.  484.4 to 
the personnel requirements for PTs, OTs, PTAs, OTAs, and SLPs in the 
following sections:
     Sec.  409.10 and Sec.  409.16 (Inpatient hospital services 
and inpatient critical access hospital services).
     Sec.  409.23 (Posthospital SNF care).
     Sec.  410.43 (Partial hospitalization services).
     Sec.  410.59 (Outpatient occupational therapy services).
     Sec.  410.60 (Outpatient physical therapy services).
     Sec.  410.62 (Outpatient SLP services).
     Sec.  418.92 (Hospice).
     Sec.  482.56 (Optional hospital services, Rehabilitation 
services).
     Sec.  485.70 (Specialized providers).
     Sec.  485.705 (Clinics, Rehabilitation agencies, Public 
health agencies).
     Sec.  491.9 (Rural health clinics and Federally qualified 
health centers (FQHCs)).
    We also welcome comments on whether the personnel qualifications at 
Sec.  484.4 should be made applicable in other settings.
    It is our intention that when Medicare policies describe physical 
therapists, physical therapist assistants, occupational therapists, 
occupational therapy assistants and speech-language pathologists, the 
qualifications for those professions would be the same in all settings, 
without exception.
(2) Application of Consistent Therapy Standards
    In tandem with cross-referencing Part A and Part B therapy 
personnel requirements in the regulations, we believe it would be 
appropriate to clarify our policies to improve consistency in the 
standards and conditions for Part A and Part B therapy services. Many, 
but not all, of the policies described for therapy services in Part B 
settings are also appropriate to Part A settings.
    In Sec.  409.17, we propose to clarify that hospital services 
include physical therapy, occupational therapy and SLP. We propose to 
add regulations for inpatient hospital services to include a plan of 
treatment for therapy services consistent with the plan required for 
outpatient therapy services. We invite comment on PT, OT, and SLP plan 
of treatment policies that are appropriately applied to all therapy 
services, whether provided under Medicare Part A or B.
    Since inpatient hospital services are always provided under the 
care of a physician, we believe that the physician's review and 
certification of the therapy plan of treatment is implied by the 
physician's review and approval of a facility plan that includes 
therapy services and, therefore, we are not proposing additional 
therapy certification requirements for the hospital setting.
c. Outpatient Therapy Certification Requirements
    The signature of a physician or NPP in the medical record 
indicating approval of the plan of care for outpatient therapy services 
certifies the initial need for therapy services furnished under Part B. 
For other covered medical and health services furnished by providers 
and suppliers of outpatient services, certification is required only 
once, either at the beginning or at the end of a series of visits. 
Recertification is not required for most health services. In 1988, in 
an attempt to control the expanding utilization of therapy services, we 
added a 30-day recertification requirement for outpatient therapy 
services to our regulation at Sec.  424.24. This requires that a 
physician certifies a plan of care for 30 days, regardless of the 
appropriate length of treatment. To continue treatment past 30 days, 
the physician is required to recertify the plan. After many years of 
experience with the current recertification requirements, we now 
believe that requiring recertification at 30-day intervals may not 
always provide sufficient flexibility to the physician to order the 
correct amount of therapy for the patient's needs. In some cases, it 
may impact utilization by encouraging reevaluations at intervals based 
on certification timing, rather than on necessity. Since the 30-day 
recertification requirement was initiated in 1988, many other means of 
ensuring appropriate utilization of therapy services have been 
developed. Medicare policies have been clarified to define skilled 
services, reasonable and necessary services, and appropriate 
documentation. Payments for therapy services are now limited by annual 
per beneficiary caps, and there are many local medical review policies 
and system edits to monitor extended treatment. Therapy services are 
now identified as such on claims, making it easier to analyze and 
review overutilization of services. Three studies on utilization of 
therapy services are published and available to medical reviewers and 
providers or suppliers of services to help identify typical episodes of 
care. Taken together, these changes may have improved appropriate 
utilization and limit errors in billing for therapy services, as 
evidenced in the Improper Medicare Fee-for-Service Payment Report of 
May 2007.
    In 2004 and again in 2006, we engaged a contractor to perform an 
extensive analysis of the utilization of therapy services. The analyses 
indicated that the 30-day recertification requirement has not had the 
anticipated impact on utilization of services and does not serve to 
limit therapy services payments. About 70 percent of episodes are 
completed before the first 30-day recertification interval. Although 
CORFs have a 60-day recertification period, and SNFs and ORFs have 30-
day recertification periods, the average number of treatment days is 
similar in these settings. This suggests that the interval of the 
recertification requirement does not affect professional decisions 
regarding the duration of treatment. In fact, contrary to the pattern

[[Page 38194]]

expected if certification impacted duration of treatment, the number of 
physical therapy treatment days is higher in a SNF (30-day 
recertification interval) than in a CORF (60-day recertification 
interval).
    For these reasons, we do not believe there is a continued need for 
recertification at the 30-day interval. We propose that review of the 
plan of care continue to be required at certification and 
recertification. Since the plan of care may be established by a nurse 
practitioner, a clinical nurse specialist, or a physician assistant 
(nonphysician practitioners) as well as a physician, we propose to 
modify the language in Sec.  410.61 to include those professionals 
among those who shall review the plan. Since the certification and 
recertification of the plan requires a signature, we propose to remove 
the current redundant requirement at Sec.  410.61(e) to date and sign a 
review at the same time as the plan is certified.
    We propose to change the plan of treatment recertification schedule 
in Sec.  424.24. Currently, the physician must initially certify a plan 
of treatment at the time the plan is established or as soon thereafter 
as possible. If the need for treatment continues beyond 30 days, the 
plan of treatment must be recertified every 30 days until discharge. We 
propose that the physician (or NPP, as appropriate) would continue to 
review and certify the initial plan of care as soon as possible, but 
that the certification would apply for an episode length based on the 
patient's needs, not to exceed 90 days and would be recertified every 
90 days thereafter. Payment would continue to be denied if services 
were provided without a certified plan of care. Overutilization of 
services would continue to be monitored, as it is now, by Medicare 
contractors based on data analysis assisted by system edits.
    We believe adjusting the first recertification interval from 30 to 
90 days would allow the physician to approve a plan of care that 
represents the clinically appropriate length of treatment, discourage 
routine 30-day plans, encourage professional determination of an 
appropriate length of treatment at the time of the initial 
certification, protect the patient's access to needed treatment when 
the certifying physician or NPP is not available at the 30-day 
interval, reduce the administrative burden on providers, suppliers, 
physicians, NPPs and Medicare contractors, and provide an appropriate 
timeline for monitoring the necessity of continuing therapy services. 
Therefore, we are proposing to amend Sec.  424.24 to require 
recertification every 90 days after beginning treatment.
    We propose to revise Sec.  424.24 to remove reference to a 
certification ``statement'' and to require that the continuing need for 
therapy services be documented in the medical record, for example, the 
plan of treatment. Since each plan must include the duration of 
treatment, the current requirement for an estimate of how much longer 
the services will be needed is proposed to be omitted as redundant.
    We propose to continue to review the utilization of therapy 
services to assess any changes in practice that might be related to the 
proposed changes in our regulations regarding certification of a plan 
of care for an appropriate length of treatment. After 2 years, if we 
determine that there are changes in practice that suggest inappropriate 
utilization of therapy services based on the certification timing, we 
will consider whether to reinstate the 30-day recertification 
requirement.
3. Proposed Elimination of the Exemption for Computer-Generated 
Facsimile Transmission from the National Council for Prescription Drug 
Programs (NCPDP) SCRIPT Standard for Transmitting Prescription and 
Certain Prescription Related Information for Part D Eligible 
Individuals
    [If you choose to comment on issues in this section, please include 
the caption ``PROPOSED ELIMINATION OF EXEMPTION FOR COMPUTER-GENERATED 
FACSIMILES'' at the beginning of your comments.]
a. Legislative History
    Section 101 of the MMA amended title XVIII of the Act to establish 
a voluntary prescription drug benefit program. Prescription Drug Plan 
(PDP) sponsors, Medicare Advantage (MA) organizations offering Medicare 
Advantage-Prescription Drug Plans (MA-PD), and other Part D sponsors 
are required to establish electronic prescription drug programs to 
provide for electronic transmittal of certain information to the 
prescribing provider and dispensing pharmacy and pharmacist. This would 
include information about eligibility, benefits (including drugs 
included in the applicable formulary, any tiered formulary structure 
and any requirements for prior authorization), the drug being 
prescribed or dispensed and other drugs listed in the medication 
history, as well as the availability of lower cost, therapeutically 
appropriate alternatives (if any) for the drug prescribed. The MMA 
directed the Secretary to issue uniform standards for the electronic 
transmission of such data.
    There is no requirement that prescribers or dispensers implement e-
prescribing. However, prescribers and dispensers who electronically 
transmit prescription and certain other information for covered drugs 
prescribed for Medicare Part D eligible beneficiaries, directly or 
through an intermediary, would be required to comply with any 
applicable final standards that are in effect.
    Section 1860D-4(e) of the Act required the Secretary to conduct a 
pilot project to test initial standards recognized under section 1860D-
4(e)(A) of the Act, prior to issuing the final standards in accordance 
with section 1860D-4(e)(D) of the Act. Initial standards were 
recognized by the Secretary in 2005 and then tested in a pilot project 
during CY 2006. The MMA created an exception to the requirement for 
pilot testing of standards where, after consultation with the National 
Committee on Vital and Health Statistics (NCVHS), the Secretary 
determined that there already was adequate industry experience with the 
standard(s). Such ``foundation standards'' were recognized and adopted 
through notice and comment rulemaking as final standards without pilot 
testing.
    Based upon the evaluation of the pilot project, and not later than 
April 1, 2008, the Secretary is required to issue final uniform 
standards. These final standards must be effective not later than 1 
year after the date of their issuance.
    For a complete discussion of the statutory bases for the e-
prescribing portions of this proposed rule and the statutory 
requirements at section 1860D-4 of the Act, please refer to the 
``Background'' section of the E-Prescribing and the Prescription Drug 
Program proposed rule published in the February 4, 2005 Federal 
Register (70 FR 6256).
b. Regulatory History
i. Foundation Standards
    After consulting with the NCVHS, the Secretary found that there was 
adequate industry experience with several potential e-prescribing 
standards. Upon adoption through notice and comment rulemaking, these 
standards were called ``foundation'' standards, because they would be 
the first set of final standards adopted for an electronic prescription 
drug program. Three standards were adopted in the E-Prescribing and the 
Prescription Drug Program final rule

[[Page 38195]]

published in the November 7, 2005 Federal Register (70 FR 67568).
    The foundation standards are as follows:
     For the exchange of eligibility information between 
prescribers and Part D sponsors: ASC X12N-270/271--Health Care 
Eligibility Benefit Inquiry and Response, Version 4010, May 2000, 
Washington Publishing Company, 004010X092 and Addenda to Health Care 
Eligibility Benefit Inquiry and Response, Version 4010, A1, October 
2002, Washington Publishing Company, 004010X092A1 (hereafter referred 
to as the ASC X12N 270/271 transaction).
     For the exchange of eligibility information between 
dispensers and Part D sponsors: The National Council for Prescription 
Drug Programs (NCPDP) Telecommunication Standard Guide, Version 5, 
Release 1 (Version 5.1), September 1999, and equivalent NCPDP Batch 
Standard Batch Implementation Guide, Version 1, Release 1 (Version 
1.1), January 2000 supporting Telecommunications Standard, September 
1999, Implementation Guide Version 5, Release 1 (Version 5.1) for NCPDP 
Data Record in the Detail Data Record (hereafter referred to as the 
NCPDP Telecommunication Standard).
     For the exchange of new prescriptions, changes, renewals, 
cancellations and certain other transactions between prescribers and 
dispensers: NCPDP SCRIPT Standard, Implementation Guide, Version 5, 
Release 0 (Version 5.0), May 12, 2004 (hereafter referred to as NCPDP 
SCRIPT Standard).
ii. Exemption to Foundation Standard Requirements for Computer-
Generated Facsimiles
    The November 7, 2005 final rule included an exemption for entities 
that transmit prescriptions or prescription-related information by 
means of computer-generated facsimile (faxes) from the requirement to 
use the adopted NCPDP SCRIPT standard. ``Electronic media'' was already 
defined by the HIPAA, so e-prescribing utilized the same definition. As 
a result, faxes that were generated by a prescriber's/dispenser's 
computer and sent to a provider's/dispenser's fax machine which prints 
out a hard copy of the original computer-generated fax (that is, 
``computer-generated'' faxes) fell within the definition of 
``electronic media'' for e-prescribing. Absent an exemption, entities 
transmitting computer-generated faxes would be required to comply with 
the adopted foundation standards. Comments received from the health 
care industry indicated that this would cause computer-generated faxers 
to revert to paper prescribing. As the Secretary believed that 
prescribers/dispensers using computer fax capabilities would eventually 
migrate to fully functional e-prescribing, possibly at the same time as 
they implemented electronic health record (EHR) systems, the November 
7, 2005 final rule exempted entities transmitting computer-generated 
faxes from having to comply with the NCPDP SCRIPT standard.
c. Proposal of Elimination of Exemption
    We propose to revise Sec.  423.160(a)(3)(i) to eliminate the 
computer-generated facsimiles (faxes) exemption to the NCPDP SCRIPT 
Standard for the communication of prescription or certain prescription-
related information between prescribers and dispensers for the 
transactions listed at Sec.  423.160(b)(1)(i) through (xii). In the 
November 7, 2005 final rule (70 FR 67571), we explained that faxes 
generated by one computer and electronically transmitted to another 
computer or fax machine would be included under the e-prescribing 
definition of electronic media. This computer-generated fax technology 
is used in some e-prescribing software products and under the 
definition of electronic media, providers and dispensers who utilize 
these products would be required to comply with adopted e-prescribing 
standards. Our discussion of computer-generated faxing distinguished 
between cases where the prescriber's/dispenser's software has the 
ability to generate SCRIPT transactions, but the feature is not 
activated because the prescriber has not activated the feature on their 
software, and other cases where software (such as a word processing 
program) is used that creates and sends a fax that results in a paper 
prescription or response at the receiving end, but does not have true 
e-prescribing (electronic data interchange using the SCRIPT standard) 
capabilities.
    We believed that requiring prescribers/dispensers who already use 
electronic media to e-prescribe to modify or change their software and 
hardware products to be compliant with the foundation standards would 
likely result in their simply reverting to paper prescribing and would 
be counterproductive to achieving standardized use of non-fax 
electronic data interchange for prescribing. Also, we believed that 
prescribers and dispensers would begin to migrate to true e-prescribing 
in time, and therefore, adopted an exemption that permitted prescribers 
and dispensers to continue to use computer-generated faxes for 
transmitting certain prescriptions and prescription-related 
information. However, at the same time we encouraged all prescribers 
and dispensers using fax technology to move as quickly as possible to 
computer-to-computer data interchange via the NCPDP SCRIPT standard.
    Since January 2006, we have seen little reduction in the use of 
computer-generated fax technology. Based on data provided to CMS by 
SureScripts, which operates the Pharmacy Health Information Exchange, 
the largest network to link electronic communications between 
pharmacies and physicians, serving more than 95 percent of all 
pharmacies and all major physician technology vendors in the United 
States, it estimates that of the 150,000 prescribers now using software 
that is capable of generating SCRIPT transactions, only 15 percent are 
doing so. The remaining 85 percent are still generating paper faxes. 
The costs to convert to e-prescribing using NCPDP SCRIPT for these 
prescribers would in most cases be included in the annual maintenance 
fee they pay their software vendor. However, the cost of conversion for 
prescribers using e-prescribing software that cannot generate SCRIPT 
transactions would be higher, as these prescribers would have to 
purchase and install other software products. Therefore, we are 
specifically soliciting comments on the impact to providers and 
pharmacies.
    Pharmacy implementation of e-prescribing is considerably more 
widespread. SureScripts reports that all chain drug stores and 20 
percent of independent pharmacies are capable of sending and receiving 
SCRIPT transactions. Independent pharmacies are less likely to perceive 
a return on investment for e-prescribing due to low numbers of 
practices seeking to move to e-prescribing using the SCRIPT 
transaction.
    Since computer-generated faxing retains some of the disadvantages 
of paper prescribing (for example, the administrative cost of keying 
the prescription into the pharmacy system and the related potential for 
data entry errors that may impact patient safety), we believe it is 
important to take steps to encourage prescribers and dispensers to move 
toward use of the SCRIPT standard.
    One concrete step we could take to increase the use of the SCRIPT 
transaction would be to eliminate the exemption for computer-generated 
faxing. This would move prescribers and dispensers using this 
technology to upgrade to software products or to new versions of the 
products they currently use, that would enable electronic

[[Page 38196]]

transmission of SCRIPT transactions. Because this requirement would 
fall on prescribers that already use e-prescribing software, it would 
increase the number of SCRIPT transactions fairly significantly in a 
relatively short time period, and this could in turn create a ``tipping 
point'' that could create an economic incentive for independent 
pharmacies to adopt software to begin to exchange SCRIPT transactions 
with their prescriber partners.
    Therefore, we propose to eliminate the computer-generated fax 
exemption for all provider/dispenser transactions. We anticipate having 
this change effective 1 year after the effective date of the CY 2008 
PFS final rule. This will provide notice to prescribers and dispensers 
seeking to implement or upgrade e-prescribing software to look for 
products and upgrades that are capable of generating and receiving 
NCPDP SCRIPT transactions. It also affords current e-prescribers time 
to work with their trading partners to eventually eliminate computer to 
fax machine transactions.
    We now believe that, with the additional phase-in period allotted 
to allow for this transition, with improved and more readily available 
standards-based e-prescribing products, and the apparent ability of e-
prescribing networks to now identify which prescribers and dispensers 
are capable of making SCRIPT enabled transactions and which use this 
information to facilitate successful SCRIPT enabled transactions, this 
elimination of the exemption for computer-generated faxing will 
encourage e-prescribers and dispensers to move as quickly as possible 
to use of the SCRIPT standard with what we perceive to be minimal 
impact.
    We are soliciting comments on the impact of the proposed 
elimination of this exemption, including the total number of affected 
practices and pharmacies and the time required for them to implement 
SCRIPT-enabled software. Specifically, we are soliciting information 
regarding the number of practices that currently use legacy versions of 
software that are not capable of generating SCRIPT transactions and the 
amount of lead time they would need to comply. We are also soliciting 
comments regarding the extent to which eliminating the exemption would 
cause entities using fax technology to revert to paper prescribing 
rather than update current software.

T. Division B of the Tax Relief and Health Care Act of 2006--Medicare 
Improvements and Extension Act of 2006 (Pub. L. 109-432) (MIEA-TRHCA)

    In addition to the provisions of the MIEA-TRHCA discussed in 
section II.B. (GPCIs), additional provisions of the MIEA-TRHCA are 
discussed in this section of the proposed rule.
1. Section 101(b)--Physician Quality Reporting Initiative (PQRI)
    [If you choose to comment on issues in this section, please include 
the caption ``TRHCA--SECTION 101(b): PQRI'' at the beginning of your 
comments.]
a. Background
    Section 101(b) of the MIEA-TRHCA amended section 1848 of the Act by 
adding subsection (k). Section 1848(k)(1) of the Act requires the 
Secretary to implement a system for the reporting by eligible 
professionals of data on quality measures as described in section 
1848(k)(2) of the Act. As specified in section 1848(k)(3)(B) of the 
Act, for the purpose of the quality reporting system, eligible 
professionals include physicians, other practitioners as described in 
section 1842(b)(18)(C) of the Act, physical and occupational 
therapists, and qualified speech-language pathologists. Section 101(c) 
of the MIEA-TRHCA authorizes ``Transitional Bonus Incentive Payments 
for Quality Reporting'' in 2007, specifically for satisfactory 
reporting of quality data, as defined by section 101(c)(2) of the MIEA-
TRHCA. We have named this quality reporting system for 2007, including 
the 2007 bonus payment, the ``Physician Quality Reporting Initiative 
(PQRI)'' for ease of reference.
    For 2007, section 1848(k)(2)(A)(i) of the Act, as added by the 
MIEA-TRHCA, provides that the quality measures for the PQRI shall be 
the physician quality measures published as 2007 Physician Voluntary 
Reporting Program (PVRP) quality measures on the CMS Web site as of the 
date of enactment of this subsection, except as may be changed based on 
the results of a consensus-based process in January 2007. The 2007 PVRP 
quality measures consist of the 66 measures that we had identified and 
posted on the CMS Web site on December 5, 2006 (see ``Transition from 
2006 PVRP'' below in this section). The statute also allowed for 
additional quality measures to be added to the original set as the 
result of a consensus-based process in January 2007. As allowed under 
the statute, and based on actions approved at the AQA Alliance 
(formerly the Ambulatory Care Quality Alliance) meeting on January 22, 
2007, 8 quality measures were added to the 66 measures identified and 
originally posted to the CMS Web site on December 5, 2006. The final 
result is 74 ``2007 PQRI Quality Measures.'' A list and description of 
these 74 measures is available for download from the PQRI Measures/
Codes page of the PQRI section of the CMS Web site at www.cms.hhs.gov/PQRI.
    Although section 1848(k)(2)(A)(ii) of the Act does not allow for 
any further additions to or deletions from the 2007 PQRI Quality 
Measures after January 2007, the statute does allow modifications or 
refinements (such as code additions, corrections, or revisions) to the 
detailed specifications for the 2007 PQRI quality measures until the 
beginning date of the reporting period (that is, July 1, 2007). After 
this date, no further revisions to the specifications for 2007 PQRI 
measures are allowed by section 1848(k) of the Act. The specifications 
for the 2007 PQRI quality measures are available as a download from the 
Measures/Codes page of the PQRI section of the CMS Web site at http://www.cms.hhs.gov/pqri. Additional materials containing information on 
the 2007 PQRI, including but not limited to the calculation of 
eligibility for and amount of bonus payment for satisfactory reporting, 
are also available on this section of the CMS Web site.
    Section 1848(k)(2)(B) of the Act requires that the Secretary 
publish in the Federal Register not later than August 15, 2007, 
proposed quality measures that would be appropriate for eligible 
professionals to use to submit data to the Secretary in 2008. The final 
2008 PQRI quality measures must be determined and published by November 
15, 2007, as specified in section 1848(k)(2)(B) of the Act as amended 
by the MIEA-TRHCA.
b. MIEA-TRHCA Requirements for Measures Included in the 2008 PQRI
(i) Overview of MIEA-TRHCA Requirements for 2008 PQRI Quality Measures
    Section 1848(k)(2)(B)(i) of the Act requires, ``for purposes of 
reporting data on quality measures for covered professional services 
furnished during 2008, the quality measures specified under this 
paragraph for covered professional services shall be measures that have 
been adopted or endorsed by a consensus organization (such as the 
National Quality Forum or AQA), that include measures that have been 
submitted by a physician specialty, and

[[Page 38197]]

that the Secretary identifies as having used a consensus-based process 
for developing such measures. Such measures shall include structural 
measures, such as the use of EHRs and electronic prescribing 
technology.''
    Section 1848(k)(2)(B)(ii) of the Act requires, that ``[n]ot later 
than August 15, 2007, the Secretary shall publish in the Federal 
Register a proposed set of quality measures that the Secretary 
determines are described in clause (i) and would be appropriate for 
eligible professionals to use to submit data to the Secretary in 2008. 
The Secretary shall provide for a period of public comment on such set 
of measures.''
    In examining the statutory requirements of section 1848(k)(2)(B)(i) 
of the Act, we believe that the requirement that measures be endorsed 
or adopted by a consensus organization applies to each measure that 
would be included in the measures set for submitting quality data on 
covered professional services furnished during 2008. Likewise, the 
requirement for measures to have been developed using a consensus-based 
process (as identified by the Secretary) applies to each measure. By 
contrast, we do not interpret the provision requiring inclusion of 
measures submitted by a specialty to apply to each measure. Rather, we 
believe this requirement means that in endorsing or adopting measures, 
a consensus organization must include in its consideration process at 
least some measures submitted by one physician or organization 
representing a particular specialty. Similarly, we interpret the 
requirement that 2008 measures include structural measures, such as the 
use of EHRs and electronic prescribing technology, to mean that the 
2008 measure set must include at least 2 structural measures.
    In examining sections 1848(k)(2)(B)(ii through iii) of the Act, we 
believe that the Secretary is given broad discretion to determine which 
quality measures meet the statutory requirements and are appropriate 
for inclusion in the final set of measures for 2008. We do not 
interpret the Act to require that all measures that meet the basic 
requirements of section 1848(k)(2)(B)(i) of the Act must be included in 
the 2008 set of quality measures.
    We discuss in the following section the statutory requirements for 
consensus organizations and the use of a consensus-based process for 
developing quality measures as they relate to the requirements for the 
set of measures for 2008 in the context of other applicable Federal law 
and policy. We also discuss the policies used in proposing the initial 
set of quality measures for eligible professionals for use in 2008 and 
the policies we propose to apply in publishing the final set.
(ii) Consensus Organizations and Consensus-Based Process for Developing 
Measures
    The MIEA-TRHCA requires that measures used for 2008 be identified 
by the Secretary as having been endorsed or adopted by a consensus 
organization and having been developed through the use of a consensus-
based process. We believe that these requirements should be interpreted 
in the context of the National Institute of Standards and Technology 
Act (NISTA) (15 U.S.C. 271 et seq.) as amended by the National 
Technology Transfer and Advancement Act of 1995 (Pub. L. 104-113) 
(NTTAA) and implemented by OMB Circular No. A-119 (OMB A-119) dated 
February 10, 1998.
    Per the NTTAA, except when it is inconsistent with applicable law 
or otherwise impractical, all Federal agencies and departments shall 
use technical standards that are developed or adopted by voluntary 
consensus standards bodies and shall also participate with such bodies 
in the development of technical standards when such participation is in 
the public interest and compatible with the agency and departmental 
missions, authorities, priorities, and budget resources.
    OMB A-119 provides specific policy guidance to agencies on the 
appropriate interpretation of agency responsibilities under the NTTAA. 
Specifically, OMB A-119 establishes as government-wide policy that 
agencies ``must use voluntary consensus standards, both domestic and 
international, in its regulatory and procurement activities in lieu of 
government-unique standards, unless use of such standards would be 
inconsistent with applicable law or otherwise impractical.'' OMB A-119 
explains that in determining whether use of existing voluntary 
consensus standards in its regulatory and procurement activities is 
otherwise impractical, `` `Impractical' includes circumstances in which 
such use would fail to serve the agency's program needs; would be 
infeasible; would be inadequate, ineffectual, inefficient, or 
inconsistent with agency mission; or would impose more burdens, or be 
less useful, than the use of another standard.''
    OMB A-119 further provides that ``voluntary consensus standards'' 
are standards developed or adopted by voluntary consensus standards 
bodies. OMB A-119 defines ``voluntary consensus standards body'' as 
maintaining the following attributes: (1) Openness; (2) Balance of 
interest; (3) Due process; (4) An appeals process; (5) Consensus; which 
is defined as general agreement, but not necessarily unanimity, and 
also includes a process for attempting to resolve objections by 
interested parties. The process requires that, as long as all comments 
have been fairly considered, each objector is advised of the 
disposition of his or her objection(s) and the reasons for the 
disposition, and the consensus body members are given an opportunity to 
change their votes after reviewing the comments. Voluntary consensus 
standards must include provisions requiring that owners of relevant 
intellectual property have agreed to make that intellectual property 
available to all interested parties on a nondiscriminatory, royalty-
free, or reasonable royalty basis.
    Other types of standards, that are distinct from voluntary 
consensus standards include the following: (1) Industry standards, 
company standards, non-consensus standards, or de facto standards which 
are developed in the private sector but not in the full consensus 
process of a voluntary consensus standards body; (2) Government-unique 
standards which are developed by the government for its own uses; (3) 
Standards mandated by statute such as those contained in the United 
States Pharmacopeia and the National Formulary, as referenced in 21 
U.S.C. 351.
    The term ``technical standards'' under 12(d)(4) of the NTTAA, means 
``performance-based or design-specific technical specifications and 
related management systems practices''. When healthcare quality 
measures are used in a regulatory framework such as contemplated for 
the 2008 PQRI quality measures under the MIEA-TRHCA, we believe that 
such measures constitute ``technical standards'' as used in the NTTAA 
and that NTTAA applies to such measures.
    Two consensus organizations are referenced in MIEA-TRHCA: the 
National Quality Forum (NQF) and the AQA. The NQF has a formal 
organizational structure and established processes that are 
intentionally designed to comply with the NTTAA and OMB A-119. 
Membership is open and includes physicians and other providers, 
hospital organizations, purchasers, researchers, payers, and employers. 
In achieving its determination of whether or not to endorse a standard, 
the NQF uses a formal process that consists of five principal steps 
that follow a project's conceptualization, prioritization, and

[[Page 38198]]

planning. The steps are: (1) Consensus Standard Development; (2) 
Widespread Review; (3) Member Voting and Member Council Approval; (4) 
Board of Directors Action; and (5) Evaluation that includes an appeals 
process. The NQF meets the NTTAA requirements for a voluntary consensus 
standards body within the meaning of the NTTAA and its endorsed 
healthcare quality measures constitute voluntary consensus standards 
within the meaning of NTTAA.
    The AQA, also referenced in section 1848(k)(2) of the Act as a 
consensus organization for the purpose of identifying measures that 
have successfully completed review by a consensus organization, 
utilizes certain essential practices of a voluntary consensus standards 
body under NTTAA and the OMB A-119 relating to openness, balance of 
interest, and consensus. Of particular note is the breadth of formal 
participation among stakeholders that have an interest in healthcare 
quality measures dealing with physician care. Participants at AQA may 
vote without limitation as to which stakeholder category into which 
they may fall. Voting participation, for example, includes physicians, 
other providers, purchasers, payers, consumers, accrediting 
organizations, and employers. However, the AQA does not have a defined 
organizational structure intended to meet the requirements of the NTTAA 
and the OMB A-119 and has no formal due process or appeals structure. 
Therefore, the AQA does not meet the requirements of the NTTAA for a 
``voluntary consensus standards body''.
    By citing AQA as an example of an acceptable consensus 
organization, section 1848(k)(2)(B) of the Act establishes that AQA 
adoption satisfies the requirement of section 1848(k)(2)(B) of the Act 
that PQRI quality measures be adopted or endorsed by a consensus 
organization. We believe it follows that the Congress did not intend to 
require all 2008 quality measures under section 1848(k)(2)(B) of the 
Act to meet the requirements to be considered voluntary consensus 
standards under the NTTAA. However, by giving NQF and AQA as examples 
of consensus organizations, we believe the Congress intended that 
consensus organizations should, in the context of section 1848(k)(2)(B) 
of the Act, have a breadth of stakeholder involvement and voting 
participation substantially comparable to that of the NQF or AQA.
    Inasmuch as we are unaware of any other organizations that engage 
in endorsement or adoption of healthcare quality measures for physician 
services that have the level of openness, balance of interest, and 
consensus based on voting participation, that is comparable to NQF or 
AQA, we propose to limit measures for inclusion as 2008 PQRI to 
measures that are endorsed or adopted by NQF or AQA. However, as 
elaborated in the policies we set forth below in this section, we 
invite comment as to other consensus organizations that may have a 
comparable level of consensus organization characteristics.
    Given the overlap of NQF and AQA as consensus organizations under 
the MIEA-TRHCA, it is important to distinguish their roles. As 
currently established, the principal purpose of AQA for physician 
quality measures is to select among NQF endorsed measures for 
coordinated implementation. Unlike NQF, AQA is not established to serve 
as a ``voluntary consensus standards body'' under NTTAA. Therefore, the 
AQA is not established as an alternative or substitute for NQF 
endorsement processes as an entity organized to comply with the NTTAA 
and OMB A-119 requirements for a voluntary consensus standards body. 
However, during a time of rapid physician quality measures development 
and implementation, it is impractical to delay implementation of 
physician quality measures until the formal processes of NQF are 
completed. Therefore, AQA has been able to facilitate incorporation of 
new measures into the quality reporting system by providing consensus 
review acceptable under MIEA-TRHCA for implementation of a measure 
prior to actual NQF endorsement. In the event of a determination by NQF 
to decline endorsement of a particular measure after it had been 
adopted by AQA, we anticipate that AQA would withdraw its adoption of 
such a measure.
    Turning to the requirement of a consensus-based process for 
developing quality measures, we propose to interpret this requirement 
in light of the NTTAA and the importance of broad consensus for health 
care quality measures used for regulatory purposes. In this context we 
will outline the process of health care quality measurement development 
and distinguish basic development steps from the completion of a 
consensus-based development process as required under MIEA-TRHCA.
    Many organizations are involved in the development of health care 
quality measures including physician organizations, health care 
providers, Federal agencies, accreditation organizations, disease-
focused not-for-profit organizations, research organizations, and 
health plans. The basic development processes of leading health care 
quality measure developers generally use standardized methods that 
include identification of a quality goal or gap, literature and 
evidence review, expert and technical evaluation, specification 
development, testing, organizational review, and that may include 
public comment.
    In the framework of the NTTAA, upon completion of the basic 
development work, healthcare quality measures do not constitute 
voluntary consensus standards, even though they may have utilized 
consensus as a mechanism of achieving agreement among the developer's 
participants or within the developer's organizational structure. 
Rather, to achieve the status as a voluntary consensus standard under 
NTTAA, the measure must go through the additional development that 
occurs through the broader consensus process of consensus endorsement. 
During this process, based on the need to achieve agreement, quality 
measures are often modified in order to achieve the necessary broad 
consensus.
    Consistent with this in concept but without proposing that 2008 
PQRI measures be limited to those meeting the definition of a voluntary 
consensus standard under NTTAA, we interpret ``consensus-based process 
for developing measures'' as used in MIEA-TRHCA to encompass not only 
the basic development work of the formal measure developer, but also to 
include the achievement of consensus among stakeholders in the health 
care system based on at least a level of openness, balance of interest, 
and consensus reflected in the structures and processes of the NQF and 
AQA as of the date of enactment of MIEA-TRHCA and the date of 
publication of this proposed rule.
    Based on the considerations previously discussed, we propose to 
apply the following policies in identifying measures that meet the 
MIEA-TRHCA requirements for having used a consensus-based process for 
development and the requirement for having been endorsed or adopted by 
a consensus organization such as the NQF or AQA, and that are 
appropriate for inclusion as 2008 measures:
    (1) We interpret ``a consensus-based development process'' as 
meaning that in addition to the measure development, the measure has 
achieved adoption or endorsement by a consensus organization having at 
least the basic characteristics of the AQA as a consensus organization 
as of December 2006, when the MIEA-TRHCA incorporating reference to AQA 
was passed and signed into law. Those basic characteristics include a 
comparable

[[Page 38199]]

level of openness, balance of interest, and consensus based on voting 
participation. As discussed above and further clarified in points (3) 
and (5), we do not interpret ``consensus-based development process'' 
per section 1848(k)(2)(B) of the Act to require that the consensus 
organization or process meet all of the criteria of the NTTAA and OMB 
A-119 definition of a voluntary consensus standards body.
    (2) ``Voluntary consensus standard'' is interpreted to mean a 
voluntary consensus standard that has been endorsed as such by a 
consensus organization that meets the requirements of the NTTAA, as 
implemented by OMB A-119, for a voluntary consensus standards body.
    (3) Where there are available quality measures, and some of these 
measures meet the definition of ``voluntary consensus standards'' while 
others do not, those measures that meet the definition of ``voluntary 
consensus standards'' are preferred to other measures not meeting the 
requirements of the NTTAA.
    (4) In view of the preference for voluntary consensus standards, if 
a measure has been specifically considered by NQF for possible 
endorsement but NQF has declined to endorse it as of November 15, 2007, 
we propose not to include it in the final set of 2008 PQRI Quality 
Measures.
    (5) Although the AQA does not meet the requirements of the NTTAA 
for a voluntary consensus standards body, it is a consensus 
organization per section 1848(k)(2)(B) of the Act. In circumstances 
where no voluntary consensus standard (NQF-endorsed) measure is 
available, a quality measure that has been adopted by the AQA (or 
another consensus organization with comparable consensus-organization 
characteristics, will meet the requirements of MIEA-TRHCA is we 
determine that it is appropriate for eligible professionals to use to 
submit data.
    (6) We are unaware of other consensus organizations that are 
comparable to the NQF in terms of meeting the formal requirements of 
the NTTAA or of organizations other than AQA that do not strictly meet 
the requirements of the NISTA as amended by the NTTAA but that feature 
the breadth of stakeholder involvement in the consensus process 
necessary to meet the intent of the MIEA-TRHCA. However, the MIEA-TRHCA 
does not limit consensus organizations to the NQF or the AQA, nor 
restrict the field of potential consensus organizations. The MIEA-
TRHCA, thereby, maintains flexibility in potential sources of measure 
consensus review, which is, like having multiple sources of measure 
development, key to maintaining a robust marketplace for development 
and review of quality measures.
    (7) The basic steps for developing the physician level measures may 
be carried out by a variety of different organizations. We do not 
interpret the MIEA-TRHCA to place special restrictions on the type or 
make up of the organizations carrying out this basic development of 
physician measures, such as restricting the initial development to 
physician-controlled organizations. Any such restriction would unduly 
limit the basic development of physician quality measures and the scope 
and utility of measures that may be considered for endorsement as 
voluntary consensus standards.
    (8) The policies we propose are based on the preference as 
articulated in NTTAA and OMB A-119 for ``voluntary consensus 
standards'' to government standards, and a preference for quality 
measures that have achieved broad consensus among stakeholders in the 
health care system. However, the MIEA-TRHCA does not require that 
quality measures meet the NTTAA or OMB A-119 definition of ``voluntary 
consensus standards'' in order to be used for PQRI. Thus, though we 
prefer to use quality measures meeting the NTTAA and OMB A-119 criteria 
for voluntary consensus standards, neither this CMS preference nor the 
NTTA or OMB A-119 preclude CMS from selecting measures for PQRI based 
upon a lesser degree of consensus when necessary to meet CMS' program 
needs as determined by the Secretary.
c. Proposed 2008 PQRI Quality Measures
    The identified measures we propose for 2008 would be made final as 
of the effective date of the final rule, and no changes (no additions 
or deletions of measures) will be made after that date. However, as was 
done for 2007, we may make modifications or refinements, such as code 
additions, corrections, or revisions, to the detailed specifications 
for the 2008 measures until the beginning of the reporting period. Such 
specification modifications may be made through the last day preceding 
the beginning of the reporting period. The 2008 measures specifications 
will be available on the PQRI section of the CMS Web site at http://www.cms.hhs.gov/pqri when they are sufficiently developed or finalized 
but in no event later than December 31, 2007. These detailed 
specifications will include instructions for reporting and identify the 
circumstances in which each measure is applicable.
    For 2008, we propose PQRI Quality measures selected from measures 
listed in Tables 16 through 22, which fall into 7 broad categories as 
set forth below in this section. We welcome comments on the 
implications of including any given measure or measures proposed herein 
in the final 2008 PQRI quality measures.
(i) Measures Selected From the 2007 PQRI Quality Measures
    We propose to retain and include in the final 2008 PQRI measures 
the following 2007 PQRI measures in Table 16 contingent on NQF 
endorsement of each such included measure by November 15, 2007. All 
2007 PQRI measures have been considered or are under consideration for 
endorsement under NQF projects. Those 2007 PQRI measures that have been 
declined for endorsement are not included in the list of proposed 
measures for 2008. The measures in Table 16 include measures submitted 
by specialties, in compliance with section 1848(k)(2)(B) of the Act, 
for example, the measures for diabetic retinopathy (ophthalmology).

                      Table 16.--2007 PQRI Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus.
Low Density Lipoprotein Control in Type 1 or 2 Diabetes Mellitus.
High Blood Pressure Control in Type 1 or 2 Diabetes Mellitus.
Screening for Future Fall Risk.
Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or
 Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular
 Systolic Dysfunction (LVSD).
Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery
 Disease.
Beta-blocker Therapy for Coronary Artery Disease Patients with Prior
 Myocardial Infarction (MI).
Heart Failure: Beta-blocker Therapy for Left Ventricular Systolic
 Dysfunction.
Antidepressant Medication During Acute Phase for Patients with New
 Episode of Major Depression.

[[Page 38200]]

 
Medication Reconciliation.
Assessment of Presence or Absence of Urinary Incontinence in Women Aged
 65 Years and Older.
Characterization of Urinary Incontinence in Women Aged 65 Years and
 Older.
Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older.
Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation.
Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy.
Asthma: Pharmacologic Therapy.
Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic
 Resonance Imaging (MRI) Reports.
Stroke and Stroke Rehabilitation: Carotid Imaging Reports.
Primary Open Angle Glaucoma: Optic Nerve Evaluation.
Diabetic Retinopathy: Documentation of Presence or Absence of Macular
 Edema and Level of Severity of Retinopathy.
Diabetic Retinopathy: Communication with the Physician Managing Ongoing
 Diabetes Care.
Perioperative Care: Timing of Antibiotic Prophylaxis--Ordering
 Physician.
Perioperative Care: Selection of Prophylactic Antibiotic--First or
 Second Generation Cephalosporin.
Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-
 Cardiac Procedures).
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (when
 indicated in All patients).
Osteoporosis: Management Following Fracture.
Osteoporosis: Communication with the Physician Managing Ongoing Care
 Post-Fracture.
Aspirin at Arrival for Acute Myocardial Infarction (AMI).
Electrocardiogram Performed for Non-Traumatic Chest Pain.
Electrocardiogram Performed for Syncope.
Vital Signs for Community-Acquired Bacterial Pneumonia.
Assessment of Oxygen Saturation for Community-Acquired Bacterial
 Pneumonia.
Assessment of Mental Status for Community-Acquired Bacterial Pneumonia.
Empiric Antibiotic for Community-Acquired Bacterial Pneumonia.
Asthma Assessment.
Perioperative Care: Timing of Prophylactic Antibiotics--Administering
 Physician.
Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT)
 for Ischemic Stroke or Intracranial Hemorrhage.
Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy.
Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for
 Atrial Fibrillation at Discharge.
Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA)
 Considered.
Stroke and Stroke Rehabilitation: Screening for Dysphagia.
Stroke and Stroke Rehabilitation: Consideration of Rehabilitation
 Services.
Dialysis Dose in End Stage Renal Disease (ESRD) Patients.
Hematocrit Level in ESRD Patients.
Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older.
Osteoporosis: Pharmacologic Therapy.
Use of Internal Mammary Artery (IMA) in Coronary Artery Bypass Graft
 (CABG) Surgery.
Preoperative Beta-blocker in Patients with Isolated Coronary Artery
 Bypass Graft (CABG) Surgery.
Perioperative Care: Discontinuation of Prophylactic Antibiotics (Cardiac
 Procedures).
Appropriate Treatment for Children with Upper Respiratory Infection
 (URI).
Appropriate Testing for Children with Pharyngitis.
Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic
 Testing Performed on Bone Marrow.
Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients
 Receiving Erythropoietin Therapy.
Multiple Myeloma: Treatment with Bisphosphonates.
Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry.
Hormonal Therapy for Stage IC-III ER/PR Positive Breast Cancer.
Chemotherapy for Stage III Colon Cancer Patients.
Plan for Chemotherapy Documented Before Chemotherapy Administered.
Radiation Therapy Recommended for Invasive Breast Cancer Patients Who
 Have Undergone Breast Conserving Surgery.
Advance Care Plan.
------------------------------------------------------------------------

    Please note that measures specifications for 2007 PQRI measures may 
be updated or modified during the NQF endorsement process or may 
otherwise be modified prior to 2008. The 2008 PQRI measure 
specifications for any given measure may, therefore, be different from 
specifications for the same measure used for 2007. All specifications 
for 2008 measures must be obtained from the specifications document for 
2008 measures, which will be available on the CMS PQRI Web site on or 
before December 31, 2007.
(ii) AMA-PCPI Measures
    We propose to include measures in the final 2008 PQRI selected from 
those listed in Table 17 that are currently under development via the 
AMA-Physicians Consortium for Performance Improvement (PCPI) provided 
that they achieve NQF endorsement or AQA adoption by November 15, 2007. 
We propose to select from among these measures based upon development 
completion in a sufficiently timely manner that implementation for 2008 
would be practical, their importance in relation to quality goals, 
their meaningfulness as measures of quality, their utility in the PQRI 
program such as through augmenting the scope of services provided by 
eligible practitioners to which PQRI measures apply, the degree to 
which they meet the needs of the Medicare program, and their 
functionality in terms of their ability to be collected and calculated 
in the PQRI program.

                      Table 17.--AMA/PCPI Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Prevention of Ventilator-Associated Pneumonia--Head elevation.

[[Page 38201]]

 
Stress Ulcer Disease (SUD) Prophylaxis in Ventilated patients.
Prevention of Catheter-Related Bloodstream Infections in Ventilated
 patients--Catheter Insertion Protocol.
Perioperative Temperature Management for Surgical Procedures Under
 General Anesthesia.
Assessment of Thromboembolic Risk Factors in patients with Atrial
 Fibrillation.
Chronic Anticoagulation in patients with Atrial Fibrillation.
Monthly INR Measurements in patients with Atrial Fibrillation.
GFR Calculation in patients with Chronic Kidney Disease (CKD).
Blood Pressure Measurement in patients with CKD.
Plan of Care for patients with CKD and Elevated Blood Pressure.
ACE Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy in patients
 with CKD.
Calcium, Phosphorus and Intact Parathyroid Hormone Measurement in
 patients with CKD.
Lipid Profile in patients with CKD.
Hemoglobin Monitoring in patients with CKD.
Erythropoietin Overuse in patients with CKD and normal Hemoglobin.
Influenza Vaccination in patients with End Stage Renal Disease (ESRD).
Vascular Access for patients Undergoing Hemodialysis.
Permanent Catheter Vascular Access for patients Receiving Hemodialysis.
Plan of Care for ESRD patients with Anemia.
Plan of Care for Inadequate Hemodialysis in ESRD patients.
Plan of Care for Inadequate Peritoneal Dialysis.
Assessment of GERD Symptoms in Patients Receiving Chronic Medication for
 GERD.
Testing of patients with Chronic Hepatitis C (HCV) for Hepatitis C
 Viremia.
Initial Hepatitis C RNA Testing.
HCV Genotype Testing Prior to Therapy.
Consideration for Antiviral Therapy in HCV Patients.
HCV RNA Testing at Week 12 of Therapy.
Hepatitis A and B Vaccination in patients with HCV.
Counseling patients with HCV Regarding Use of Alcohol.
Counseling of patients Regarding Use of Contraception Prior to Starting
 Antiviral Therapy.
Patients who have Major Depression Disorder who meet DSM IV Criteria.
Patients who have Major Depression Disorder who are assessed for suicide
 risks.
Patients with Osteoarthritis who receive Anti-Inflammatory or Analgesia
 Medication.
Patients with Osteoarthritis who have an assessment of their pain and
 function.
Patients with Acute Otitis Externa (AOE) or Otitis Media with Effusion
 (OME) who receive Topical Therapy.
Patients with AOE/OME who have a pain assessment.
Patients with AOE/OME who are inappropriately prescribed antimicrobials.
Patients with AOE/OME who have an assessment of tympanic membrane
 mobility.
Patients with AOE/OME who undergo hearing testing.
Patients with AOE/OME who inappropriately receive antihistamines/
 decongestants.
Patients with AOE/OME who inappropriately receive systemic
 antimicrobials.
Patients with AOE/OME who inappropriately receive systemic steroids.
Breast cancer patients who have a pT and pN category and histologic
 grade for their cancer.
Colorectal cancer patients who have a pT and pN category and histologic
 grade for their cancer.
Documentation of hydration status in Pediatric Patients with Acute
 Gastroenteritis (PAG).
Weight measurement in patients with PAG.
Recommendation of appropriate oral rehydration solution in PAG patients.
Education parents of PAG patients.
Perioperative Cardiac risk assessment (history).
Perioperative Cardiac risk assessment (current symptoms).
Perioperative Cardiac risk assessment (physical examination).
Perioperative Cardiac risk assessment (electrocardiogram).
Perioperative Cardiac risk assessment (continuation of Beta Blockers).
Appropriate initial evaluation of patients with Prostate Cancer.
Inappropriate use of Bone Scan for staging Low-Risk Prostate Cancer
 patients.
Review of treatment options in patients with clinically localized
 Prostate Cancer.
Adjuvant Hormonal therapy for High-risk Prostate Cancer patients.
Three-dimensional radiotherapy for patients with Prostate Cancer
------------------------------------------------------------------------

(iii) Nonphysician Measures Currently Under Development
    We propose to include measures in the final 2008 PQRI quality 
measures selected from those listed in Table 18 that are currently 
under development by Quality Insights of Pennsylvania (under the 
Medicare Quality Improvement Organization (QIO) contract for the State 
of Pennsylvania) and that achieve NQF endorsement or AQA adoption by 
November 15, 2007. We propose to select from among these measures based 
upon: Development completion in a sufficiently timely manner that 
implementation for 2008 would be practical; their importance in 
relation to quality goals; their meaningfulness as measures of quality; 
their utility in the PQRI program such as through augmenting the scope 
of services provided by eligible professionals to which PQRI measures 
apply; the degree to which they meet the needs of the Medicare program 
and their functionality in terms of ability to be collected and 
calculated in the PQRI program.

    Table 18.--Quality Insights of Pennsylvania Nonphysician Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Universal Weight Screening (BMI).
Universal Weight Screening Follow-up (BMI).
Universal Hypertension Screening.
Universal Hypertension Screening Follow-up.

[[Page 38202]]

 
Universal Influenza Vaccine Screening and Counseling.
Universal Documentation and Verification of Current Medications in the
 Medical Record.
Screening for Clinical Depression.
Screening for Cognitive Impairment.
Patient Co-development of Treatment Plan.
Patient Co-development of Plan of Care.
Pain Assessment Prior to Initiation of Patient Treatment.
------------------------------------------------------------------------

(iv) Structural Measures Currently Under Development
    We propose to include measures in the final 2008 PQRI measures 
selected from the structural measures listed in Table 19 that are 
currently under development by Quality Insights of Pennsylvania (under 
the Medicare QIO contract for the State of Pennsylvania) and that 
achieve NQF endorsement or AQA adoption by November 15, 2007. These 
measures meet the requirement of section 1848 (k)(2)(B)(i) of the Act 
that the quality reporting system for 2008 include structural measures.

     Table 19.--Quality Insights of Pennsylvania Structural Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
HIT--Adoption/Use of E-Prescribing
HIT--Adoption/Use of Health Information Technology (Electronic Health
 Records)
------------------------------------------------------------------------

(v) Additional AQA Starter-Set Measures
    We propose to include measures in the final 2008 PQRI measures 
selected from the AQA starter set that were not included in the 2007 
PQRI quality measures but that are relevant to Medicare beneficiaries. 
Specifications necessary for PQRI reporting of these measures will be 
completed for such measures by November 15, 2007, and posted on the CMS 
Web site. Each of the AQA starter-set measures that is identified in 
Table 20 we propose to include in the 2008 PQRI quality measures 
provided it retains NQF endorsement and AQA adoption as of November 15, 
2007.

             Table 20.--Additional AQA Starter-Set Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Dilated eye exam in diabetic patient.
Beta-Blocker Therapy (persistent for 6 months or more)--Post MI.
Screening Mammography.
Colorectal Cancer Screening.
Inquiry regarding Tobacco Use.
Advising Smokers to Quit.
------------------------------------------------------------------------

(vi) Other NQF-Endorsed Measures
    We propose to include in the final 2008 PQRI measures other 
measures endorsed by the NQF that were not included in the 2007 PQRI 
quality measures but that are relevant to Medicare beneficiaries, 
address overuse/misuse of pharmacologic therapy, and that expand the 
specialty applicability and patient population. Specifications 
necessary for PQRI reporting of these measures will be completed for 
such measures by November 15, 2007, and posted on the CMS Web site. We 
propose to include in the 2008 PQRI quality measures each of the NQF-
endorsed measures identified in Table 21 provided it retains NQF 
endorsement as of November 15, 2007.

                 Table 21.--Other NQF-Endorsed Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Inappropriate antibiotic treatment for adults with acute bronchitis.
Disease Modifying Anti-rheumatic Drug Therapy in Rheumatoid Arthritis.
Angiotensin Converting Enzyme Inhibitor (ACE) or Angiotensin Receptor
 Blocker (ARB) Therapy for patients with coronary artery disease and
 diabetes and/or left ventricular systolic dysfunction (LSVD).
Urine screening for microalbumin or medical attention for nephropathy in
 diabetic patients.
Annual Therapeutic monitoring for patients on the following persistent
 medications:
     Angiotensin Converting Enzyme Inhibitor (ACE)/Angiotensis
     Receptor Blocker (ARB);
     Digoxin;
     Diuretics;
     Anticonvulsants; and
     Statins.
Influenza vaccination for patients [gteqt] 50 years old.
Pneumonia vaccination for patients 65 years and older.
------------------------------------------------------------------------

(vii) Podiatric Measures
    We propose to include measures in the final 2008 PQRI quality 
measures selected from those listed in Table 22 that are currently 
under development by the American Podiatric Medical Association and 
that achieve NQF endorsement or AQA adoption by November 15, 2007. We 
propose to select from among these measures based upon development 
completion of the measures in a sufficiently timely manner that 
implementation for 2008 would be practical.

                      Table 22.--Podiatric Measures
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
Diabetic Foot and Ankle Care, Peripheral Neuropathy: Neurological
 Evaluation.
Diabetic Foot and Ankle Care, Peripheral Arterial Disease: Ankle
 Brachial Index (ABI) Measurement.
Diabetic Foot and Ankle Care, Ulcer Prevention: Evaluation of Footwear.
------------------------------------------------------------------------

d. Addressing a Mechanism for Submission of Data on Quality Measures 
Via a Medical Registry or Electronic Health Record
    Section 1848(k)(4) of the Act, as amended by the MIEA-TRHCA, 
requires that ``as part of the publication of proposed and final 
quality measures for 2008 under clauses (i) and (iii) of paragraph 
(2)(B), the Secretary shall address a mechanism whereby an eligible 
professional may provide data on quality measures through an 
appropriate medical registry''.
    A medical registry, which is also often referred to as a ``clinical 
registry'' or ``clinical data registry'', henceforth ``registry'', may 
be broadly defined as a file of documents containing uniform 
information about a defined population of individual persons or events, 
collected using an observational study design in a systematic way, in 
order to serve a predetermined scientific, clinical, or policy purpose. 
It is generally agreed that clinical data registries are one potential 
means to measure and report physician and other eligible professionals' 
performance for purposes of quality improvement, public reporting, 
quality based payment, continuous certification, and credentialing. 
Other possible uses of

[[Page 38203]]

data collected by a registry include satisfying requirements for 
maintenance of professional or specialty board certification status, 
and ongoing improvement of professional performance.
    The MIEA-TRHCA lists the Society of Thoracic Surgeons (STS) 
National Database registry as an example of a registry. The STS 
registry collects outcomes and quality data on cardiac surgeries. The 
data output provides an analysis of the participant's adult cardiac 
surgery outcomes, resulting in a benchmarking of each participant's 
data against regional and national outcomes. The STS registry currently 
collects data on two PQRI quality measures that have been adapted from 
existing STS measures. These two measures are: Use of Internal Mammary 
Artery (IMA) in Coronary Artery Bypass Graft (CABG) Surgery; and Pre-
operative Beta-blocker in Patient with Isolated Coronary Artery Bypass 
Graft (CABG) Surgery.
    To be eligible for the incentive payment under MIEA-TRHCA, cardiac 
and thoracic surgeons who report data to the STS registry will in 2007 
and 2008 still find it necessary under PQRI to report quality data with 
reference to those same measures through the claims process. To avoid 
duplication of data submission and to support the use of registries, 
generally, we believe that it would be desirable to establish a 
mechanism whereby the quality data relevant to PQRI measures could be 
reported from the registries, on behalf of eligible professionals.
    At this point, it is unclear which registries currently collect or 
plan to collect data for PRQI quality measures and which approach or 
approaches should be utilized to allow registries to report quality 
data to PQRI. For this reason, in 2008, we anticipate evaluating and 
testing the mechanisms to use registries for the reporting of PQRI 
quality data. We plan to use the results of this evaluation and testing 
to determine whether and how to implement the use of registries for the 
reporting of quality data in the future.
    In concept, we anticipate that upon implementation of registry-
based quality data reporting, eligible professionals would be able to 
provide data on PQRI quality measures through an appropriate medical 
registry by authorizing or instructing the registry to submit data on 
their behalf. Thus, the registry would act as a data submission vendor 
for the eligible professional. A ``data submission vendor'' is defined 
as an entity that has permission from the eligible professional to 
provide medical registry data to the Quality Reporting System developed 
per the statute. The registry, acting as such a data submission vendor, 
would submit data to the CMS clinical data warehouse component of the 
Quality Reporting System, using a CMS-specified record layout based on 
the quality measures' specifications as published by CMS. For purposes 
of this proposed rule, the term, ``CMS clinical data warehouse,'' is 
defined as a clinical data warehouse designated by CMS.
    For 2008, we expect to explore at least the five different data 
submission options described below, and to test in CY 2008 one or more 
of these options. There are several data formats and analytical options 
that we see as potentially available to fulfill the objectives of 
registry inclusion in PQRI. These options vary with regard to whether 
individual beneficiary-level data is submitted by the registry, as well 
as to the number and type of data elements needed from the registry.
    Option 1: Registries provide the quality-data codes required for a 
particular PQRI measure plus beneficiary/service identifier information 
needed to link the registry data to Medicare Part B claims. The 
beneficiary/service identifiers would be used to pull in the 
denominator data by CMS. All non-registry analytics payment information 
and diagnosis would come from claims. Reporting/performing rates would 
be calculated from the registry-submitted data.
    Examples of data elements needed from a registry are:
     Beneficiary HIC Number
     Beneficiary Date of Birth
     Date of Service
     NPI and Tax ID
     CPT category II and G codes and modifiers
     Clinical data elements required to compute the appropriate 
CPT category II codes, G codes and modifiers
    Option 2: Registries provide the quality codes and diagnosis codes. 
We would use claims to capture the payment information at the NPI/Tax 
ID level. The beneficiary-specific information is de-identified. All 
PQRI reporting and performance calculations would be performed using 
registry data. Payment information would be extracted from Medicare 
claims. The registries would be required to add data elements to the 
database to allow collection of appropriate codes.
    Examples of data elements needed from a registry:
     Beneficiary/procedure level data (ICD-9 and CPT codes)
     HCPCS codes (G-codes and CPT category II codes and 
modifiers)
     NPI and Tax ID
    Option 3: Registries calculate the reporting and performance rates 
for Medicare beneficiaries only, and submit these rates to CMS (that 
is, aggregate information by NPI within a Tax ID). We assume no 
beneficiary-level information will be shared. Registries would be 
required to add data elements to the database to allow collection of 
appropriate quality-data codes or clinical data needed to compute the 
quality-data codes. Registries would be required to perform the 
necessary calculations to be able to submit completed numerator/
denominators for both reporting and performance rates.
    Option 4: Registries provide all of the claims data elements as 
submitted using the Part B claims process. We perform all rate 
calculations.
    Examples of data elements needed from a registry include the 
following:
     Line Item TIN
     Line Item Individual NPI
     Line Item Group NPI
     Claim Beneficiary Claim Account Number (CAN)
     Claim Beneficiary Identification Code (BIC)
     Claim Date of Birth
     Line Item First Expense Date
     Line Item Last Expense Date
     Line Item Diagnosis Code
     Line Item HCPCS (HCPCS Level 1, CPT Category I, CPT 
Category II, HCPCS Level 2 G Codes)
     Line Item Initial Modifier Code
     Line Item Secondary Modifier Code
     Claim CMS Claims Processing Date
     Claim Overall Allowable Charges
     Line Item Allowable Charges
     Claim Gender
     Claim Carrier Number
     Claim Control Number
     Claim Final Action Status
     Claim Carrier Claim Receipt Date
     Claim Payment Denial Code
     Line Item Procedure Indicator Code
     Line Item Carrier Locality Code
     Line Item Provider State Code
     Line Item Place of Service
     Line Processing Indicator Code
    Option 5: Registry data dump for Medicare beneficiaries only; for 
all information in the registry for the service period of interest. 
There is an assumption that the registry is able to submit either: (1) 
the ICD-9, HCPCS, and CPT category II codes and exclusions as stated in 
the measures specifications; or (2) supply the clinical information 
needed for CMS to make those judgments (eligibility and quality of 
care). We would be required to use a series of linkage algorithms to 
attempt to connect the registry data with the matching claims.
    Examples for linkage of registry data to the corresponding Medicare 
Part B claims include some combination of:

[[Page 38204]]

     Beneficiary-level identifiers: HIC (or SSN), DOB, gender
     Procedure-level identifiers: date of service (or procedure 
date)
     Provider identifiers: NPI, Tax ID, or even UPIN
    For CMS to maintain compliance with applicable statutes, including 
but not limited to HIPAA, the registry must maintain compliance with 
HIPAA requirements for processing, storing, and transmitting data. To 
be considered an appropriate registry from which we can accept and 
process data for the purposes of calculating PQRI measures, a registry 
must also comply with the Consolidated Health Informatics Initiative 
(CHI) standards adopted by the Federal government, and therefore, 
applicable to the HHS. A description of the CHI, including its purpose, 
Federal member agencies, and the specific standards adopted by the 
Federal government, is available on the HHS Office of the National 
Coordinator for Health Information Technology (ONC) Web site at http://www.hhs.gov/healthit/chiinitiative.html.
    Upon determination of the preferred option and conclusion of the 
testing phase for registry-based reporting to PQRI, we anticipate that 
all necessary information and instructions will be made available on 
the PQRI section of the CMS Web site at http://www.cms.hhs.gov/pqri. 
This information will include at a minimum: (a) The exact data elements 
needed and the CMS-specified record layout for transmitting the data to 
the CMS clinical data warehouse; and (b) a detailed description of the 
proposed CMS infrastructure for accepting registry-based submission of 
PQRI quality data, including, but not limited to, electronic data 
exchange specifications, and applicable processes for authenticating 
registry users for access to the warehouse submission interface.
    We anticipate requesting that registries interested in 
participating in the testing of the registry-based quality data 
submission mechanism will be invited to self-nominate via a simple 
process that will be published on the PQRI section of the CMS Web site, 
and via one or more additional CMS communication venues, in the fourth 
quarter of 2007. We propose and expect to begin testing with the 
registries in the first quarter of 2008.
    We plan to select for testing, from the self nominees, a group of 
registries that are HIPAA and CHI compliant and technically capable of 
interfacing with the CMS clinical warehouse electronic data exchange 
interface (EDI). The number of registries selected for testing may be 
all that are technically capable or may need to be limited to some or 
all of those that already contain key minimum data elements on at least 
a test basis, depending on the number of registries falling into these 
categories and on the actual level of complexity and effort required 
for the testing from the CMS data infrastructure. (Experience with 
other initiatives has suggested that some data submission vendors and 
their software are more easily interfaced and tested with the CMS data 
warehouse EDI than others.)
    We invite comments on these plans for evaluation and testing 
mechanisms for registry-based quality-data reporting to PQRI with 
reference to the 5 data submission options described. We also invite 
comments on appropriate validation methodologies for reporting and 
performance rates.
    In addition to the testing of registry-based submission of quality 
data, CMS is considering for 2008 the feasibility and utility of 
accepting clinical quality data submitted from EHRs. For 2008, we plan 
to consider accepting EHR-extracted clinical data for a limited number 
of ambulatory-care PQRI measures for which data may also be submitted 
under the current Doctors Office Quality-Information Technology (DOQ-
IT) Project. The listing of and specifications for DOQ-IT ambulatory-
care measures are available at http://www.qualitynet.org, under the 
subsidiary headings Physician Offices, Doctors Office Quality 
Information Technology (DOQ-IT), Ambulatory-Care Measures. If 
implemented in 2008, the EHR-based submission of PQRI/DOQ-IT 
overlapping ambulatory-care measures would serve as an alternative 
method to claims-based reporting of submitting quality data for those 
measures, not a required method.
2. Section 110--Reporting of Anemia Quality Indicators (Sec.  
414.707(b))
    [If you choose to comment on issues in this section, please include 
the caption ``TRHCA--SECTION 110: ANEMIA QUALITY INDICATORS'' at the 
beginning of your comments.]
    Medicare Part B provides payment for certain drugs used to treat 
anemia. Anemia is common in cancer patients and may be caused by the 
cancer itself or by various anti-cancer treatments, including 
chemotherapy, radiation therapy and surgical therapy. Anemia occurs 
when the number of red blood cells is reduced by an anti-cancer 
treatment. This happens due to the effect of chemotherapy or radiation 
therapy on the bone marrow, wherein red blood cells are produced by 
dividing precursor cells. This chemotherapy effect is commonly referred 
to as ``bone marrow suppression.'' Anemia may also result from blood 
loss in association with surgical therapy for the cancer.
    Anemia adversely impacts the quality of life for beneficiaries 
being treated for cancer. Fatigue and reduced performance capacity are 
the side effects of anemia that cancer patients report as the most 
disabling and contributing to poor quality of life. The treatment of 
anemia in cancer patients commonly includes the use of drugs, 
specifically erythropoiesis stimulating agents (ESAs) such as 
recombinant erythropoietin and darbepoietin. Although other 
pharmacologic interventions are available, ESAs have received the 
greatest attention. Notably, recent research has raised concerns that 
these drugs may be associated with significant adverse effects 
including a higher risk of mortality in some populations, possibly 
related to the amount of drug administered.
    In 2006, we implemented a revised ESA claims monitoring policy 
based on the last hemoglobin or hematocrit value from the preceding 
month on Medicare claims for payment of ESAs administered to 
beneficiaries with anemia due to ESRD receiving dialysis treatments in 
facilities. For many years prior, we have required the reporting of 
these red blood cell indicators by ESRD facilities to ensure that the 
beneficiaries' anemia was addressed.
    Section 110 of the MIEA-TRHCA amends section 1842 of the Act by 
adding a new subsection (u) that reads as follows: ``Each request for 
payment, or bill submitted, for a drug furnished to an individual for 
the treatment of anemia in connection with the treatment of cancer 
shall include (in a form and manner specified by the Secretary) 
information on the hemoglobin or hematocrit levels for the 
individual.'' Section 110 of the MIEA-TRHCA requires such reporting for 
drugs furnished on or after January 1, 2008. In addition, subsection 
(b) directs the Secretary to use the rulemaking process under section 
1848 of the Act to address the implementation of this requirement.
    By requiring the reporting of the anemia quality indicators in 
cancer patients undergoing treatment for anemia, we will facilitate 
assessment of the quality of care for this condition. We will use the 
information reported to help determine the prevalence and severity of 
anemia associated with cancer therapy, the clinical and hematologic 
responses to the institution of anti-anemia therapy, and the outcomes 
associated with various doses of anti-anemia therapy.

[[Page 38205]]

    While not specifically addressing other indications, the recent 
research on the adverse effects of ESAs in patients with cancer does 
raise concerns as to whether patients receiving ESAs for other 
conditions, such as in the treatment of HIV-AIDS and for some surgical 
patients, are also at higher risk. While not required by this statute, 
we are requesting public comment on the potential of expanding this 
regulation to include all uses of ESAs.
3. Section 104--Extension of Treatment of Certain Physician Pathology 
Services Under Medicare
    [If you choose to comment on issues in this section, please include 
the caption ``TRHCA--SECTION 104: PHYSICIAN PATHOLOGY SERVICES'' at the 
beginning of your comments.]
    The TC of physician pathology services refers to the preparation of 
the slide involving tissue or cells that a pathologist will interpret. 
(In contrast, the pathologist's interpretation of the slide is the PC 
service. If this service is furnished by the hospital pathologist for a 
hospital patient, it is separately billable. If the independent 
laboratory's pathologist furnishes the PC service, it is usually billed 
with the TC service as a combined service.)
    In the CY 2000 PFS final rule, we stated that we would implement a 
policy to pay only the hospital for the TC of physician pathology 
services furnished to hospital patients. Before that provision, any 
independent laboratory could bill the carrier under the PFS for the TC 
of physician pathology services for hospital patients. As stated in the 
CY 2000 PFS final rule, this policy has contributed to the Medicare 
program paying twice for the TC service, first through the inpatient 
prospective payment rate to the hospital where the patient is an 
inpatient and again to the independent laboratory that bills the 
carrier, instead of the hospital, for the TC service.
    Therefore, in the CY 2000 PFS final rule, in Sec.  415.130 we 
specified that for services furnished on or after January 1, 2001, the 
carriers would no longer pay claims to the independent laboratory under 
the PFS for the TC of physician pathology services for hospital 
patients.
    Ordinarily, the provisions in the PFS final rule are implemented in 
the following year. However, in this case, the change to Sec.  415.130 
was delayed one year (until January 1, 2001), at the request of the 
industry, to allow independent laboratories and hospitals sufficient 
time to negotiate arrangements. Moreover, our full implementation of 
Sec.  415.130 was further delayed through CY 2006.
    In the CY 2007 PFS final rule with comment period (71 FR 69700), we 
announced that beginning January 1, 2007, we would no longer allow the 
carriers to pay the independent laboratory for the TC of physician 
pathology services to hospital patients. In effect, we would be 
implementing the provisions of the CY 2000 PFS final rule whose 
implementation had been delayed by section 542 of the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 
(Pub. L. 106-554) (BIPA) and section 732 of the MMA.
    Subsequent to publication of the CY 2007 PFS final rule with 
comment period, the MIEA-TRHCA was enacted. Section 104 of the MIEA-
TRHCA provided for an additional 1 year extension to allow carriers to 
continue to pay independent laboratories under the PFS for the TC 
portion of physician pathology services furnished to patients of a 
covered hospital.
    Consistent with this legislative change we are amending Sec.  
415.130(d) to reflect that for services furnished after December 31, 
2007, an independent laboratory may not bill the carrier for physician 
pathology services furnished to a hospital inpatient or outpatient.
4. Section 201--Extension of Therapy Cap Exception Process
    [If you choose to comment on issues in this section, please include 
the caption ``TRHCA--SECTION 201: THERAPY CAPS'' at the beginning of 
your comments.]
    Section 1833(g)(1) of the Act applies an annual per beneficiary 
combined cap beginning January 1, 1999, on outpatient physical therapy 
and speech-language pathology services, and a similar separate cap on 
outpatient occupational therapy services. These caps apply to expenses 
incurred for the respective therapy services under Medicare Part B, 
with the exception of outpatient hospital services. The caps were 
implemented from January 1, 1999 through December 31, 1999, from 
September 1, 2003 through December 7, 2003, and beginning January 1, 
2006 (with an exception process). In CY 2000 through CY 2002, and from 
December 8, 2003 through December 31, 2005, the Congress placed 
moratoria on implementation of the caps. Section 1833(g)(2) of the Act 
provides that, for CY 1999 through CY 2001, the caps were $1500, and 
for the calendar years after 2001, the caps are equal to the preceding 
year's cap increased by the percentage increase in the Medicare 
Economic Index (MEI) (except that if an increase for a year is not a 
multiple of $10, it is rounded to the nearest multiple of $10).
    Section 5107(a) of the DRA required the Secretary to develop an 
exceptions process for the therapy caps effective for expenses incurred 
during CY 2006. Details of the CY 2006 exceptions process were 
published in a manual change on February 13, 2006 (CR4364 consists of 
Transmittal 855, Transmittal 47, and Transmittal 140). Section 201 of 
the MIEA-TRHCA extended the exceptions process to apply for expenses 
incurred through December 31, 2007. Therapy cap exception policies for 
2007 were specified in Change Request 5478 which consists of three 
transmittals with current numbers of--
     Transmittal 1145CP, Pub. 100-04;
     Transmittal 63BP, Pub. 100-02; and
     Transmittal 181PI, Pub. 100-08.
    The transmittals are incorporated into the Internet Only Manuals 
available at http://www.cms.hhs.gov/Manuals and are also available on 
our Web site at http://www.cms.hhs.gov/Transmittals/.
    In accordance with the statute as amended by the MIEA-TRHCA, we 
will continue to implement therapy caps, but the exceptions process 
will no longer be applicable, for expenses incurred beginning on 
January 1, 2008. The dollar amount of the therapy caps in CY 2008 will 
be the CY 2007 rate ($1,780) increased by the percentage increase in 
the MEI.
    As noted previously in this section, under current law therapy caps 
will continue to apply to expenses incurred for therapy services after 
December 31, 2007, with one exception. That is, the therapy caps will 
remain inapplicable to expenses incurred for therapy services furnished 
in the outpatient hospital setting as provided in section 1833(g) of 
the Act.
5. Section 101(d)--Physician Assistance and Quality Initiative (PAQI) 
Fund
    [If you choose to comment on issues in this section, please include 
the caption ``TRHCA--SECTION 101(d): PAQI'' at the beginning of your 
comments.]
    Section 1848(1) of the Act, as added by section 101(d) of the MIEA-
TRHCA requires the Secretary to establish a Physician Assistance and 
Quality Initiative Fund (PAQI) which shall be available for physician 
payment and quality improvement initiatives, which may include 
application of an adjustment to the update of the PFS CF. The provision 
makes available $1.35 billion to the Fund for services furnished during 
2008. Specifically, the provision directs the Secretary to provide for 
expenditures from the Fund

[[Page 38206]]

in a manner designed to provide (to the maximum extent feasible) for 
the obligation of the entire $1.35 billion for payment for physicians' 
services furnished during CY 2008. The provision also requires that if 
expenditures from the Fund are applied to, or otherwise affect, a 
conversion factor for a year, the conversion factor for a subsequent 
year shall be computed as if the adjustment to the conversion factor 
had never occurred.
    As the legislation indicates, this Fund can be used to either buy 
down the negative update to the fee schedule or for quality improvement 
initiatives. We believe it is essential that Medicare continue to 
encourage improvement in the efficiency and quality of health care 
delivered to Medicare beneficiaries. Therefore, we are proposing that 
the $1.35 billion be used to fund bonus payments to be made during 2009 
for physician reporting of measures during 2008. Specifically, we 
propose that the physician quality initiative for 2008 be structured 
and implemented in the same manner as the 2007 PQRI with regard to the 
professionals eligible to participate in the program, reporting quality 
measures via claims submission, and the standards for satisfactory 
reporting. If, as discussed in section II.T.1 of this proposed rule, we 
determine that a quality measure reporting mechanism based on EHRs can 
be effectively implemented in 2008, we would plan to also offer 
eligible professionals the option of reporting quality measures via 
such EHR-based mechanism based in lieu of claims-based reporting. If 
the EHR-based reporting mechanism is implemented for 2008, we would 
expect to apply to professionals opting to report via that mechanism 
the same standards for satisfactory reporting as are applicable to 
professionals reporting quality measures via claims.
    The differences between 2007 and 2008 that we currently anticipate 
are noted below in this section. As we monitor the implementation of 
the 2007 PQRI and possibly make refinements to the 2007 program, we 
anticipate that such refinements would also apply under the 2008 
program. Such refinements, should they be needed, will be noted with 
guidance linked from the CMS quality reporting Web site at http://www.cms.hhs.gov/PQRI/01_Overview.asp#TopOfPage.
    As with the 2007 PQRI, we are proposing that eligible professionals 
who successfully report a designated set of quality measures in 2008 
may earn a bonus payment of a percentage of total allowed charges for 
covered Medicare services, subject to a cap based on the volume of 
quality reporting. In contrast to 2007, we propose that physicians 
could report applicable measures for services furnished from January 1, 
2008 through December 31, 2008, and allowed charges during such period 
would be the basis for calculating the bonus payments. We propose that 
the 2008 measures that we finalize in the PFS final rule would apply 
for 2008. We also propose to estimate all of the bonus payments that 
would be payable to physicians using the same method as the one used 
for reporting during 2007 and to calculate the amount of the bonus 
payment, after the close of 2008 reporting period. Given that we are 
proposing to use the PAQI Fund for the 2008 PQRI program, we also 
propose that the bonus payments to individual physicians be subject to 
an aggregate cap of $1.35 billion. Because we are proposing to scale 
aggregate payments to physicians in a manner such that Medicare would 
pay $1.35 billion during 2009 for measures reported for services 
furnished during 2008, we are unable to provide an exact percentage for 
the bonus payment at this time. However, we anticipate that the bonus 
payments will be approximately 1.5 percent of allowed charges for 
participating professionals (and we do not expect that the ultimate 
percentage amount will exceed 2 percent).
    Medicare payment systems need to encourage reliable, high quality 
and efficient care, rather than making payment simply based on the 
quantity of services provided and resources consumed. This approach 
allows CMS to fully expend the $1.35 billion fund and further the goal 
of improving quality and efficiency by utilizing the infrastructure 
that both physicians and Medicare have invested in for the 2007 PQRI. 
We believe implementing this Fund through an extension of the PQRI 
program is the best way to ensure physicians get the greatest benefit 
from the Fund's resources while ensuring that the Fund is being used to 
increase quality and efficiency of care for Medicare beneficiaries.
    We recognize that there is an alternative approach to using this 
fund. That is, the $1.35 billion could be used in some manner to reduce 
the update to the PFS of -9.9 percent that is projected for 2008. 
However, there are fundamental legal and operational problems with this 
approach that make it not feasible. The $1.35 billion is a fixed dollar 
amount. Once the amount is reached, there is no authority to pay any 
more than that amount. Medicare is an entitlement program that covers 
medically necessary services for eligible beneficiaries, but such 
coverage is not limited to a fixed dollar amount for a year. While we 
estimate that the $1.35 billion would reduce the negative update by 
approximately two percentage points, actual spending could be above or 
below the estimate. To insure that we do not exceed the Fund amount, we 
would have to estimate an amount to reduce the update by that is low 
enough to ensure the $1.35 billion funding cap is not exceeded. While 
this approach might reduce the 2008 negative update, it could still 
leave money in the Fund, and we would be faced with the same problem of 
how to spend such remaining funds in the future. Therefore, as 
previously stated, we believe the best use of the Fund is to apply it 
to extend PQRI into 2008.
6. Section 108--Payment Process Under the Competitive Acquisition 
Program (CAP)
    [If you choose to comment on issues in this section, please include 
the caption ``TRHCA--SECTION 108: CAP'' at the beginning of your 
comments.]
    Section 108 of the MIEA-TRHCA made changes to the CAP Payment 
methodology. Section 108(a)(1) of the MIEA-TRHCA amended section 
1847B(a)(3)(A)(iii) of the Act by adding new language which requires 
that payment for drugs and biologicals shall be made upon receipt of a 
claim for a drug or biological supplied for administration to a 
beneficiary.
    Section 108(a)(2) of the MIEA-TRHCA required the Secretary to 
establish (by program instruction or otherwise) a post-payment review 
process (which may include the use of statistical sampling) to assure 
that payment is made for a drug or biological only if the drug or 
biological has been administered to a beneficiary. The Secretary shall 
recoup, offset, or collect any overpayments determined by the Secretary 
under this process.
    Section 108(b) of the MIEA-TRHCA, Construction, states that nothing 
in this section shall be construed as requiring the conduct of any 
additional competition under section 1847B(b)(1) of the Act; or 
requiring an additional physician election process.
    Section 108(c) of the MIEA-TRHCA states that the amendments of this 
section apply to payments for drugs and biologicals supplied (1) on or 
after April 1, 2007, and (2) on or after July 1, 2006 and before April 
1, 2007, for claims that are unpaid as of April 1, 2007.

[[Page 38207]]

III. Fee Schedule for Payment of Ambulance Services Update for CY 2007; 
Ambulance Inflation Factor Update for CY 2008; and Proposed Revisions 
to the Publication of the Ambulance Fee Schedule (Sec.  414.620)

    [If you choose to comment on issues in this section, please include 
the caption ``AMBULANCE SERVICES'' at the beginning of your comments.]
    Under the ambulance fee schedule, the Medicare program pays for 
transportation services for Medicare beneficiaries when other means of 
transportation are contraindicated. Ambulance services are classified 
into different levels of ground (including water) and air ambulance 
services based on the medically necessary treatment provided during 
transport. These services include the following levels of service:
    For Ground--
     Basic Life Support (BLS)
     Advanced Life Support, Level 1 (ALS1)
     Advanced Life Support, Level 2 (ALS2)
     Specialty Care Transport (SCT)
     Paramedic ALS Intercept (PI)
    For Air--
     Fixed Wing Air Ambulance (FW)
     Rotary Wing Air Ambulance (RW)

A. History of Medicare Ambulance Services

1. Statutory Coverage of Ambulance Services
    Under sections 1834(l) and 1861(s)(7) of the Act, Medicare Part B 
covers and pays for ambulance services, to the extent prescribed in 
regulations, when the use of other methods of transportation would be 
contraindicated by the beneficiary's medical condition. The House Ways 
and Means Committee and Senate Finance Committee Reports that 
accompanied the 1965 Social Security Amendments suggest that the 
Congress intended that--
     The ambulance benefit cover transportation services only 
if other means of transportation are contraindicated by the 
beneficiary's medical condition; and
     Only ambulance service to local facilities be covered 
unless necessary services are not available locally, in which case, 
transportation to the nearest facility furnishing those services is 
covered (H.R. Rep. No. 213, 89th Cong., 1st Sess. 37 and Rep. No. 404, 
89th Cong., 1st Sess. Pt 1, 43 (1965)).
    The reports indicate that transportation may also be provided from 
one hospital to another, to the beneficiary's home, or to an extended 
care facility.
2. Medicare Regulations for Ambulance Services
    Our regulations relating to ambulance services are set forth at 42 
CFR part 410, subpart B and 42 CFR part 414, subpart H. Section 
410.10(i) lists ambulance services as one of the covered medical and 
other health services under Medicare Part B. Therefore, ambulance 
services are subject to basic conditions and limitations set forth at 
Sec.  410.12 and to specific conditions and limitations as specified in 
Sec.  410.40. Part 414, subpart H, describes how payment is made for 
ambulance services covered by Medicare.
3. Transition to National Fee Schedule
    The national fee schedule for ambulance services was phased in over 
a 5-year transitional period beginning April 1, 2002, as specified in 
Sec.  414.615. As of January 1, 2006, the total payment amount for air 
ambulance providers and suppliers is based on 100 percent of the 
national ambulance fee schedule. In accordance with section 414 of the 
MMA, we added Sec.  414.617 which specifies that for ambulance services 
furnished during the period July 1, 2004, through December 31, 2009, 
the ground ambulance base rate is subject to a floor amount, which is 
determined by establishing nine fee schedules based on each of the nine 
census divisions and using the same methodology as was used to 
establish the national fee schedule. If the regional fee schedule 
methodology for a given census division results in an amount that is 
lower than or equal to the national ground base rate, then it is not 
used, and the national fee schedule amount applies for all providers 
and suppliers in the census division. If the regional fee schedule 
methodology for a given census division results in an amount that is 
greater than the national ground base rate, then the fee schedule 
portion of the base rate for that census division is equal to a blend 
of the national rate and the regional rate through CY 2009. Thus, as of 
January 1, 2007, the total payment amount for ground ambulance 
providers and suppliers is based on either 100 percent of the national 
ambulance fee schedule amount, or a combination of 80 percent of the 
national ambulance fee schedule and 20 percent of the regional 
ambulance fee schedule.

B. Ambulance Inflation Factor (AIF) During the Transition Period

    As we noted in the previous section, the national fee schedule for 
ambulance services was phased in over a 5-year transition period 
beginning April 1, 2002, as specified in Sec.  414.615. During the 
transition period, the ambulance inflation factor (AIF) was applied 
separately to both the fee schedule portion of the blended payment 
amount (regardless of whether a national or regional fee schedule 
applied) and to the supplier's reasonable charge or provider's 
reasonable cost portion of the blended payment amount, respectively, 
for each ambulance provider or supplier. Then, the two amounts were 
added together to determine the total payment amount for each provider 
or supplier.

C. Ambulance Inflation Factor (AIF) for CY 2008

    Section 1834(l)(3)(B) of the Act provides the basis for updating 
payment amounts for ambulance services. Section 414.610(f) specifies 
that certain components of the ambulance fee schedule are updated by 
the AIF annually, based on the consumer price index for all urban 
consumers (CPI-U) (U.S. city average) for the 12-month period ending 
with June of the previous year. At this time, the CPI-U for the 12-
month period ending with June 2007 is not available. We will announce 
the AIF for CY 2008 in the final rule which will be published in the 
Federal Register later this year. In addition, as set forth in Section 
III.D., we propose to announce the AIF for CY 2009 and subsequent years 
via CMS instruction and on the CMS Web site.

D. Proposed Revisions to the Publication of the Ambulance Fee Schedule 
(Sec.  414.620)

    Currently, section 414.620 specifies that changes in payment rates 
resulting from incorporation of the AIF will be announced by notice in 
the Federal Register without opportunity for prior comment. We believe 
it is unnecessary to undertake notice and comment rulemaking to update 
the AIF because the statute and regulations specify the methods of 
computation of annual inflation updates, and we have no discretion in 
that matter. Thus, the annual AIF notice does not change or establish 
policy, but merely applies the update methods specified in the statute 
and regulations.
    By mid-July of each year, we have the CPI-U for the 12-month period 
ending with June of such year. Therefore, we know what the AIF for the 
upcoming calendar year will be by mid-July of each year. However, the 
AIF is not published by CMS until November because Sec.  414.620 
currently states that the AIF will be announced in the Federal 
Register. Each document published in the Federal Register requires 
scheduling and a thorough

[[Page 38208]]

review by CMS, HHS, and OMB prior to publication. Therefore, even 
though we know the AIF by mid-July of each year, the final rule 
announcing the AIF is not published until November. This publication 
timeframe does not allow Medicare contractors the optimal amount of 
time to update their systems so that they can effectuate the proper 
payment on Medicare ambulance claims timely. In addition, it does not 
provide an optimal amount of time for either the Medicare contractors 
or the ambulance industry to take advantage of testing practices to 
make sure that the update is working properly as implemented. We 
believe that announcing the AIF via CMS instructions and on the CMS Web 
site would enable the AIF to be released earlier in the calendar year, 
allowing the Medicare contractors to test their data systems, and to 
timely effectuate and provide accurate payments on Medicare ambulance 
claims.
    Therefore, we are proposing to revise Sec.  414.620 to state that 
we will announce the AIF via CMS instruction and on the CMS Web site 
and to remove the language that states that we will announce the AIF by 
notice in the Federal Register.

IV. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995, we are required to 
provide 60-day notice in the Federal Register and solicit public 
comment before a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. 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.
    We are soliciting public comment on each of these issues for the 
following sections of this document that contain information collection 
requirements.

Section 410.33 Independent diagnostic testing facility

    Section 410.33(g)(2) states that an independent diagnostic testing 
facility (IDTF) should provide complete and accurate information on its 
Medicare enrollment application. In addition, an IDTF is required to 
notify its designated fee-for-service contractor within 30 days of any 
changes in ownership, location, general supervision, and any adverse 
legal actions. The notification must be made on the Medicare enrollment 
application. All of the changes to the enrollment application must be 
reported within 90 days.
    The aforementioned requirements are not new. The burden associated 
with completing the Medicare enrollment application is currently 
approved under OMB control number 0938-0685. The collection has an 
expiration date of April 30, 2009.
    Section 410.33(g)(6) states the comprehensive liability insurance 
requirements for IDTFs. Specifically, Sec.  410.33(g)(6)(1) states that 
must have a comprehensive insurance policy or notify the CMS designated 
contractor, in writing, of any policy changes or cancellations. The 
burden associated with this requirement is the time and effort 
necessary to draft and submit the written notification to the CMS 
designated contractor. While this requirement is subject to the PRA, we 
believe it is exempt from the PRA as stipulated under 5 CFR 
1320.3(h)(6). This information will be collected on a case-by-case 
basis.
    Section 410.33(g)(8) requires an IDTF to answer, document, maintain 
documentation of beneficiaries questions, and responses to beneficiary 
complaints at the physical site of the IDTF. Sections 410.33(g)(8)(i) 
through (iii) list the minimum amount of documentation needed to comply 
with this requirement. The burden associated with these requirements is 
the time and effort associated with responding to beneficiary questions 
and complaints, documenting the actions taken in response to the 
questions and complaints, and maintaining the documentation. While this 
requirement is subject to the PRA, we believe the associated burden is 
exempt under 5 CFR 1320.3(b)(2). The burden associated with documenting 
and maintaining the documentation of the corrective actions is a usual 
and customary business practice. The time, effort, and financial 
resources necessary to comply this information collection requirement 
would be incurred by persons in the normal course of their activities 
(for example, in compiling and maintaining business records) is not 
subject to the PRA.

Section 414.707 Basis of payment

    Section 414.707(c) states that effective January 1, 2008, each 
request for payment for anti-anemia drugs furnished to treat anemia 
resulting from the treatment of cancer must report the beneficiary's 
most recent hemoglobin or hematocrit level. The burden associated with 
this requirement is the time and effort associated with obtaining the 
most recent hemoglobin or hematocrit levels and documenting it on the 
request for payment. The requirement and its associated burden are not 
subject to the PRA under 5 CFR 1320.3(h)(5). The interpretation of 
biological analyses of body fluids, tissues, or other specimens, or the 
identification or classification of such specimens is not subject to 
the PRA.

Section 414.914 Term of contract

    Section 414.914(h) states that the approved CAP vendor must verify 
drug administration prior to the collection of any applicable cost 
sharing amount. As part of the verification process, Sec.  
414.914(h)(1) through (2) lists the documentation that is required as 
part of the verification process. Section 414.914(h)(3) states that the 
approved CAP vendor must provide this information to CMS or the 
beneficiary upon request.
    The burden associated with the requirements in Sec.  414.914(1) 
through (3) is the time and effort needed to verify the drug 
administration. When obtaining written verification, the CAP vendor 
must document the elements listed in Sec.  414.914(h)(1)(i) though 
(vi). When obtaining verbal verification, the CAP vendor must document 
the elements listed in Sec.  414.914(h)(2)(i) though (ii). We believe 
the requirements and their associated burden are not subject to the 
PRA; they are part of the CAP vendor's usual and customary business 
practices as stipulated under 5 CFR 1320.3(h)(5).
    In addition, Sec.  414.914(h)(3) imposes both recordkeeping and 
reporting requirements. We believe that the burden associated with the 
recordkeeping requirement imposed by Sec.  414.914(h)(3) is not subject 
to the PRA under 5 CFR 1320.3(c)(4) because it would affect less than 
10 persons.
    The reporting requirement places burden on the CAP vendor to 
provide the information listed in Sec.  414.914(h)(1) through (2) to a 
beneficiary upon request. We estimate that the CAP vendor will receive 
72 requests per year from beneficiaries. We believe it will take 15 
minutes per request for the vendor to provide this information to the 
beneficiary. The total annual burden associated with this requirement 
is 1080 minutes or 18 burden hours. However, we believe this 
information collection requirement and the associated burden is not 
subject to the PRA as defined in

[[Page 38209]]

5 CFR 1320.3(c)(4) because it would affect less than 10 persons.

Section 414.930 Compendia for Determination of Medically-Accepted 
Indications for Off-Label Uses of Drugs and Biologicals in an Anti-
Cancer Chemotherapeutic Regimen

    Section 414.930(b) states the process for listing compendia for 
determining medically-accepted uses of drugs and biologicals in anti-
cancer treatment. We will annually solicit requests for changes to the 
list of compendia. As stated in Sec.  414.930(c)(1), we will review a 
complete written request that is submitted in writing, electronically, 
or via hard copy. A complete written request must contain the following 
information as stated in Sec.  414.930(c)(1)(i) through (vi):
     Full name and contact information for the requestor;
     Full identification of the compendium in question;
     A complete written copy of the compendium in question;
     The specific action requested of CMS;
     Supporting documentation for the requested action;
     Address a single compendium per request.
    Section 414.930(d) states that for each compendium that is 
determined by CMS to be included on the list, the publisher or its 
designee must notify CMS, within 45 days of any update or revision, 
that a new edition or version is available.
    The burden associated with the requirements contained in Sec.  
414.930(b) through (d) is the time and effort required to draft and 
submit to CMS a complete written request for changes to the list of 
compendia. In addition, there is additional time and effort for each 
compendium that is determined by CMS to be included on the list; the 
publisher or its designee must furnish to CMS, within 45 days of 
listing and within 45 days of any update or revision, a written copy of 
the current edition or version of the compendia, including updates. 
While these requirements are subject to the PRA, we believe the burden 
is exempt under 5 CFR 1320.3(c)(4) because it would affect less than 10 
persons or entities. There are currently only 6 compendia that could 
reasonably be expected to be the subject of a request, so 6 requests is 
a likely maximum.

Section 424.36 Signature Requirements

    Section 424.36(a) requires the beneficiary's signature on a claim 
for payment of services unless the beneficiary has died or the 
provisions of Sec.  424.36(b), (c), or (d) apply. Section 424.36(b) 
states that if the beneficiary is physically or mentally incapable of 
signing the claim, the claim may be signed by one of the persons 
specified in Sec.  424.36(b)(1) through (5). Proposed Sec.  
424.36(b)(6) states that, for emergency ambulance transport services, 
if certain conditions and documentation requirements are met, an 
ambulance provider or supplier would be permitted to sign the claim on 
behalf of the beneficiary. Specifically, Sec.  424.36(b)(6)(ii)(A) 
through (C) lists the documentation that would be required, all of 
which would have to be maintained by the ambulance provider or supplier 
in its files for a period of at least 4 years from the date of service. 
An ambulance provider or supplier would be required to obtain a signed, 
contemporaneous statement from an ambulance employee present during 
transport of the patient that, at the time the service was provided, 
the beneficiary was physically or mentally incapable of signing the 
claim and that none of the other qualified persons listed in Sec.  
424.36(b)(1) through (5) were available or willing to sign the claim on 
behalf of the beneficiary.
    The ambulance provider or supplier would also be required to 
maintain documentation of the date and time that the beneficiary was 
transported and the name and location of the facility that received the 
beneficiary. In addition, the ambulance provider or supplier would be 
required to obtain and maintain a signed contemporaneous statement from 
a representative of the facility that received the beneficiary. The 
statement would have to contain the name of the beneficiary and the 
date and time the beneficiary was received at the facility.
    The burden associated with the recordkeeping requirements contained 
in Sec.  424.36(b)(6) is the time and effort associated with drafting, 
obtaining, and maintaining written statements from both employees of 
the ambulance provider or supplier transporting the beneficiary and 
employees of the facility receiving the beneficiary. We estimate that 
approximately 9,000 ambulance providers or suppliers will comply with 
these requirements. We estimate that it will take no more than 5 
minutes for each provider or supplier to comply with the recordkeeping 
requirements. Based on the best available data at this time, we 
estimate the total annual burden associated with the requirements in 
Sec.  424.36(b)(6) to be 541,667 hours nationwide. The annual total 
number of burden hours was arrived at by multiplying 5 minutes by the 
total estimated number of emergency ambulance transports of 6,500,000. 
We note that the total number of burden hours may be overstated, 
because not every beneficiary who receives emergency ambulance 
transport services is unable to sign the claim. However, we also note 
that the 6.5 million figure for emergency transports is the estimated 
number of ALS1-emergency and BLS-emergency ambulance claims processed 
by Part B carriers, incurred in 2006 and processed through April 2007, 
and thus, does not include the number of emergency ambulance transport 
services billed to fiscal intermediaries by ambulance providers (this 
number is not available to us). In any event, we believe our proposal 
will benefit ambulance providers and suppliers by allowing them an 
alternative procedure for submitting claims to Medicare. In the absence 
of the proposed procedure for signing claims on behalf of beneficiaries 
for emergency ambulance transport services, ambulance suppliers and 
providers would be required to track down beneficiaries after the 
emergency transport services have been rendered, in an attempt to have 
the beneficiary sign the claim. Moreover, such attempts may prove 
fruitless, thereby preventing the ambulance suppliers and providers 
from submitting the claim to Medicare.

Additional Information Collection Requirements

    This proposed rule imposes collection of information requirements 
as outlined in the regulation text and specified above. However, this 
proposed rule also makes reference to several associated information 
collections that are not discussed in the regulation text. The 
following is a discussion of these collections, which have already 
received OMB approval.

Part B Drug Payment

    Section II.F.1 of the preamble of this proposed rule discusses 
payment for Medicare Part B drugs and biologicals under the ASP 
methodology. Drug manufacturers are required to submit ASP data to us 
on a quarterly basis. As stated in section II.F.1.a. of the preamble, 
the ASP reporting requirements are set forth in section 1927(b) of the 
Act.
    The collection of ASP data imposes a reporting requirement on the 
public. The burden associated with this requirement is the time and 
effort required by manufacturers of Medicare Part B drugs and 
biologicals to calculate, record, and submit the required data to CMS. 
While the burden associated with this requirement is subject to the 
PRA, it is currently approved under OMB

[[Page 38210]]

control number 0938-0921, with an expiration date of May 31, 2009.

Competitive Acquisition Program (CAP)

    In section II.F.2.c. of the preamble, we propose to revise the CAP 
physician election agreement. In conjunction with post-payment review 
process, we are revising the CAP physician election agreement to 
reflect the physician's obligation to provide medical records to assist 
with claims review. The CAP physician election agreement is currently 
approved under 0938-0955 with an expiration date of August 31, 2009. 
Under a separate notice, we will make the revised instrument available 
for public comment prior to submitting the revised information 
collection request to OMB for approval.
    Section II.F.2.e. of the preamble discusses details of the CAP. 
Each year, physicians are given the option to elect to obtain Medicare 
Part B drugs and biologicals through the CAP. In addition, physicians 
are also given an opportunity to select an approved CAP vendor. The 
burden associated with these election requirements is the time and 
effort necessary for a physician to make an election and notify CMS. 
The burden associated with election requirements for participating in 
the CAP and selecting an approved CAP vendor is subject to the PRA. 
However, it is currently approved under OMB control numbers 0938-0955 
and 0938-0987 with expiration dates of August 31, 2009 and April 30, 
2009, respectively.
    Section II.F.2.e. of the preamble also discusses the exigent 
circumstances exception for leaving the CAP outside of the annual 
election process. A physician may request a release from the CAP within 
the first 30 days of its participation if it can prove that staying in 
the program would impose a significant burden. Specifically, the 
physician must submit a release request to the CAP designated carrier.
    While this burden is subject to the PRA, we believe it is exempt 
under 5 CFR 1320.3(h)(6). Facts or opinions collected from a single 
person or entity are not subject to the PRA. The aforementioned 
information collection request will be reviewed individually on a case-
by-case basis.
    Once the CAP-designated carrier receives a removal request, they 
are required to refer the physician to their approved CAP vendor. As 
part of the grievance process, the CAP vendor will try to work with the 
physician to address their concerns for participation in the program. 
Then, the CAP vendor has 2 business days to address the physician's 
concerns. If the CAP vendor and the physician cannot resolve the 
outstanding issues within 2 business days, the CAP vendor may submit a 
request to CMS for an extension to allow for an additional 2 business 
days to resolve the physician's issues.
    The burden associated with this requirement is the time and effort 
necessary to submit an extension request to CMS. While this burden is 
subject to the PRA, we currently have no way to quantify how many 
requests of this type we will receive. Requests from physicians will be 
reviewed by CAP vendors on an individual case-by-case basis. Similarly, 
requests for extensions from the CAP vendors will be reviewed 
individually, on a case-by-case basis. We will continue to monitor the 
process. If we believe that we will receive 10 or more requests, we 
will submit an information collection request to OMB.

Physician Quality Reporting Initiative (PQRI)

    Section II.T.1.a. of the preamble discusses the background of the 
reporting initiative and provides information about the measures 
available to eligible professionals who choose to participate in PQRI. 
Section 1848(k)(1) of the Act requires the Secretary to implement a 
system for eligible professionals to submit data pertaining to certain 
quality measures. As stated in section II.T.1.a., eligible 
professionals, for the purpose of the quality reporting system, include 
physicians, other practitioners as described in section 1842(b)(18)(c) 
of the Act, physical and occupational therapists, and qualified speech-
language pathologists. As also stated in section II.T.1.a, this is a 
voluntary initiative. Eligible professionals may choose whether to 
participate and, to the extent they satisfactorily submit data on 
quality measures applicable to covered professional services they 
furnish to Medicare beneficiaries, they can qualify to receive a bonus 
incentive payment.
    Specifically, to qualify to receive a bonus incentive payment for 
satisfactory reporting of quality data on covered professional services 
furnished in 2007, an eligible professional must submit data on at 
least 1, 2, or 3 measures selected from the 74 PQRI 2007 quality 
measures. The minimum number of measures each professional must report 
to qualify for the bonus payment is determined by how many available 
measures are applicable to the services that professional furnishes to 
Medicare beneficiaries. For a majority of the eligible professionals, 
three or more available measures will be applicable to their practice, 
and thus, the MIEA-TRHCA requires that they report on at least three 
measures at a rate of at least 80 percent for each of those three 
measures to meet statutory criteria for satisfactory reporting and 
qualify for the bonus payment. An eligible professional could meet the 
satisfactory reporting requirement, and thus be eligible for the bonus 
incentive payment, by reporting fewer than three measures only if his 
or her practice has fewer than three applicable measures available. The 
quality measures are posted and available for download on the CMS Web 
site at http://www.cms.hhs.gov/pqri.
    The burden associated with this requirement is the time and effort 
associated with eligible professionals identifying applicable PQRI 
quality measures for which they can report the necessary information. 
In addition, they must gather the required information, select the 
appropriate quality-data codes, and include the appropriate quality-
data codes on the claims they submit for payment.
    In 2007, the PQRI will collect quality-data codes exclusively as 
additional (optional) line items on the existing HIPAA transaction 837-
P and CMS Form 1500. There will be no new forms and no modifications to 
the existing transaction or form in support of 2007 PQRI. We also do 
not anticipate changes to the 837-P or CMS Form 1500 for 2008.
    Because this is a voluntary program, it is impossible to estimate 
with any degree of accuracy how many eligible professionals will opt to 
participate in the PQRI in 2007. Moreover, the time needed for an 
eligible professional to review the quality measures and other 
information, select measures applicable to his or her patients and the 
services he or she furnishes to them, and incorporate the use of 
quality data codes into the office work flows is expected to vary along 
with the number of measures that are potentially applicable to a given 
professional's practice. We estimate that the additional time required 
to put quality data codes on each claim is not a material increment to 
the time required to code the claim for payment. The total estimated 
annual burden for this requirement will also vary along with the volume 
of claims on which quality data is reported.

[[Page 38211]]



                         TABLE 23.--Estimated Annual Reporting and Recordkeeping Burden
----------------------------------------------------------------------------------------------------------------
                                                    OMB control                                    Total annual
              Regulation section(s)                   number        Respondents      Responses    burden (hours)
----------------------------------------------------------------------------------------------------------------
Preamble section II.F.1.........................       0938-0921             120             480          17,760
Preamble section II.F.2.f.......................       0938-0955              12              12             480
                                                       0938-0987          10,000          10,000          20,000
Sec.   410.33...................................       0938-0685         400,000         400,000       1,000,000
Sec.   424.36...................................        0938-New           9,000       6,500,000         541,667
ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½
    Total.......................................  ..............  ..............  ..............       1,579,907
----------------------------------------------------------------------------------------------------------------

    If you comment on these information collection and recordkeeping 
requirements, please mail copies directly to the following:
    Centers for Medicare & Medicaid Services, Office of Strategic 
Operations and Regulatory Affairs, Regulations Development Group, Attn: 
William N. Parham, III, CMS-1385-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-1385-P], [email protected]. Fax (202) 
395-6974.

V. 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, we will respond to the 
comments in the preamble to that document.

VI. Regulatory Impact Analysis

    [If you choose to comment on issues in this section, please include 
the caption ``IMPACT'' at the beginning of your comments.]
    We have examined the impact of this 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.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibilities of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, when 
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 must be prepared for proposed rules with 
economically significant effects (that is, a proposed rule that would 
have an annual effect on the economy of $100 million or more in any one 
year, or would adversely affect in a material way the economy, a sector 
of the economy, productivity, competition, jobs, the environment, 
public health or safety, or State, local, or tribal governments or 
communities). As indicated in more detail below in this regulatory 
impact analysis, we estimate that the PFS provisions included in this 
proposed rule will redistribute more than $100 million in 1 year. We 
are considering this proposed rule to be economically significant 
because its provisions are estimated to result in an increase, decrease 
or aggregate redistribution of Medicare spending that will exceed $100 
million. Therefore, this proposed rule is a major rule and we have 
prepared a regulatory impact analysis.
    The RFA requires agencies to analyze options for regulatory relief 
of small entities. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having revenues of 
$6.5 million to $31.5 million in any 1 year. (For further information, 
see the Small Business Administration's regulation at 70 FR 72577, 
December 6, 2003.) Individuals and States are not included in the 
definition of a small entity. The RFA requires that we analyze 
regulatory options for small businesses and other entities. We prepare 
a regulatory flexibility analysis unless we certify that a rule would 
not have a significant economic impact on a substantial number of small 
entities. The analysis must include a justification concerning the 
reason action is being taken, the kinds and number of small entities 
the rule affects, and an explanation of any meaningful options that 
achieve the objectives with less significant adverse economic impact on 
the small entities.
    For purposes of the RFA, physicians, NPPs, and suppliers, including 
IDTFs, are considered small businesses if they generate revenues of 
$6.5 million or less. Approximately 95 percent of physicians are 
considered to be small entities. There are about 980,000 physicians, 
other practitioners and medical suppliers that receive Medicare payment 
under the PFS.
    The CAP provides alternatives to physicians who do not wish to 
purchase drugs directly or collect coinsurance. The impact of the CAP 
provisions on an individual physician is dependent on whether the drugs 
they provide to Medicare beneficiaries are included in the list of CAP 
drugs, whether the physician chooses to obtain drugs administered to 
Medicare beneficiaries through the CAP. The proposed CAP provisions in 
this proposed rule will also have a potential impact on entities that 
are involved in the dispensing or distribution of drugs, plan to become 
approved CAP vendors, or are approved CAP vendors.
    For purposes of the RFA, approximately 80 percent of clinical 
diagnostic laboratories are considered small businesses according to 
the Small Business Administration's size standards. Ambulance providers 
and suppliers for purposes of the RFA are also considered to be small 
entities.
    In addition, most ESRD facilities are considered small entities, 
either based on nonprofit status or by having revenues of $31.5 million 
or less in any year. We consider a substantial number of entities to be 
affected if the proposed rule is estimated to impact more than 5 
percent of the total number of small entities. Based on our analysis of 
the 930 nonprofit ESRD facilities considered small entities in 
accordance with the above definitions, we estimate that the combined 
impact of the proposed changes to payment for renal dialysis services 
included in this proposed rule would have a 0.8 percent increase in 
overall payments relative to current overall payments. The analysis

[[Page 38212]]

and discussion provided in this section, as well as elsewhere in this 
proposed rule, complies with the RFA requirements.
    For the e-prescribing provisions, physician practices and 
independent pharmacies are considered small entities.
    Because we acknowledge that many of the affected entities are small 
entities, the analysis discussed throughout the preamble of this 
proposed rule constitutes our initial regulatory flexibility analysis 
for the remaining provisions. Therefore, we are soliciting comments on 
our estimates and analysis of the impact of this proposed rule on those 
small entities.
    Section 1102(b) of the Act requires us to prepare a regulatory 
impact analysis for any proposed rule that 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. For purposes of section 1102(b) of the Act, we define a 
small rural hospital as a hospital that is located outside a 
Metropolitan Statistical Area and has fewer than 100 beds. We have 
determined that this proposed rule would have minimal impact on small 
hospitals located in rural areas. Of the 202 hospital-based ESRD 
facilities located in rural areas, only 40 are affiliated with 
hospitals with fewer than 100 beds.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in expenditures in any year by State, 
local, or tribal governments, in the aggregate, or by the private 
sector, of $120 million. This proposed rule will not mandate any 
requirements for State, local, or tribal governments. Medicare 
beneficiaries are considered to be part of the private sector for this 
purpose. A discussion concerning the impact of this rule on 
beneficiaries is found later in this section.
    We have examined this proposed rule in accordance with Executive 
Order 13132 and have determined that this regulation would not have any 
significant impact on the rights, roles, or responsibilities of State, 
local, or tribal governments.
    We have prepared the following analysis, which, together with the 
information provided in the rest of this preamble, meets all assessment 
requirements. The analysis explains the rationale for and purposes of 
this proposed rule; details the costs and benefits of the rule; 
analyzes alternatives; and presents the measures we propose to use to 
minimize the burden on small entities. As indicated elsewhere in this 
proposed rule, we propose a variety of changes to our regulations, 
payments, or payment policies to ensure that our payment systems 
reflect changes in medical practice and the relative value of services. 
We provide information for each of the policy changes in the relevant 
sections of this proposed rule. We are unaware of any relevant Federal 
rules that duplicate, overlap or conflict with this proposed rule. The 
relevant sections of this proposed rule contain a description of 
significant alternatives if applicable.

A. RVU Impacts

1. Resource-Based Work and PE RVUs
    Section 1848(c)(2)(B)(ii) of the Act requires that increases or 
decreases in RVUs may not cause the amount of expenditures for the year 
to differ by more than $20 million from what expenditures would have 
been in the absence of these changes. If this threshold is exceeded, we 
make adjustments to preserve BN. In the CY 2007 PFS final rule with 
comment period, the $4 billion impact of changes in work RVUs resulting 
from the 5-Year Review required that a BN adjustment be made.
    As discussed in section IV.D.3 of the CY 2007 PFS final rule with 
comment period (71 FR 69735), we carefully reviewed the comments 
received concerning the BN adjustment needed to offset the $4 billion 
impact of changes in work RVUs resulting from the 5-Year Review. To 
meet the requirements set forth in section 1848(c)(2)(B)(ii)(II) of the 
Act, we implemented a BN adjustor of 0.8994 or 10.1 percent to be 
applied to the work RVUs.
    Subsequent to the publication of the CY 2007 PFS final rule with 
comment period and the announcement of the 0.8994 BN adjustment to the 
work RVUs, the AMA RUC supplied work RVU recommendations on additional 
CPT codes from the 5-Year Review and recommendations for an increase in 
the work of anesthesia services. See Table 10 in Section II.E. for a 
listing of the RUC recommendations and CMS decisions on these 
additional codes reviewed for the 5-Year Review. As stated in the CY 
2007 PFS final rule with comment period, these additional codes are 
still considered part of the 5-Year Review. The impact of these 
additional recommendations and increases in the work of anesthesia 
services on the BN adjustment must be accounted for by revising the 
current work adjustor of 0.8994. The proposed revised work adjustor for 
2008, based upon the proposed work RVUs for these additional CPT codes 
and proposed increases in the work of anesthesia services, is 
approximately 0.8816. Table 24 shows the specialty-level impact of the 
work and PE RVU changes.
    Our estimates of changes in Medicare revenues for PFS services 
compare payment rates for CY 2007 with proposed payment rates for CY 
2008 using CY 2006 Medicare utilization for all years. We are using CY 
2006 Medicare claims processed and paid through March 30, 2007, that we 
estimate are 98 percent complete. To the extent that there are year-to-
year changes in the volume and mix of services provided by physicians, 
the actual impact on total Medicare revenues will be different than 
those shown in Table 24. The payment impacts reflect averages for each 
specialty based on Medicare utilization. The payment impact for an 
individual physician would be different from the average, based on the 
mix of services the physician provides. The average change in total 
revenues would be less than the impact displayed here because 
physicians furnish services to both Medicare and non-Medicare patients 
and specialties may receive substantial Medicare revenues for services 
that are not paid under the PFS. For instance, independent laboratories 
receive approximately 80 percent of their Medicare revenues from 
clinical laboratory services that are not paid under the PFS.
    Table 24 shows only the payment impact on PFS services. The 
following is an explanation of the information represented in Table 24. 
Note that Table 24 does not include the impact of the estimated CY 2008 
update.
     Specialty: The physician specialty or type of 
practitioner/supplier.
     Allowed Charges: Allowed charges are the Medicare Fee 
Schedule amounts for covered services and include coinsurance and 
deductibles (which are the financial responsibility of the 
beneficiary.) These amounts have been summed across all services 
provided by physicians, practitioners, or suppliers with a specialty to 
arrive at the total allowed charges for the specialty.
     Impact of Work RVU Changes for additional proposed changes 
in work RVUs from the 5-Year Review.
     Impact of PE RVU changes. The impact is shown for both 
2008 which is the second year of the 4-year transition using the new 
methodology and the fully implemented 2010 PE RVUs.
     Combined impact of the proposed work RVUs and PE RVUs for 
both 2008

[[Page 38213]]

and the fully implemented 2010 PE RVUs.

        Table 24.--Proposed Combined Total Allowed Charge Impact for Work and Practice Expense RVU Changes
----------------------------------------------------------------------------------------------------------------
                                                     Impact of PE RVU changes     Combined impact of PE and work
                                  Impact of work             (percent)                  changes* (percent)
            Specialty               RVU changes  ---------------------------------------------------------------
                                  2008 (percent)     2008 (PE      2010 (PE full     2008 (PE      2010 (PE full
                                                  trans. year 2)    implement.)   trans. year 2)    implement.)
----------------------------------------------------------------------------------------------------------------
TOTAL...........................               0               0               0               0               0
ALLERGY/IMMUNOLOGY..............               0               1               2               1               3
ANESTHESIOLOGY..................              15              -1              -3              14              13
CARDIAC SURGERY.................              -1              -1              -2              -2              -3
CARDIOLOGY......................              -1               0               0              -1              -1
COLON AND RECTAL SURGERY........              -1               1               2               0               1
CRITICAL CARE...................              -1               0              -1              -1              -2
DERMATOLOGY.....................              -1               2               7               2               6
EMERGENCY MEDICINE..............              -1               0              -1              -2              -2
ENDOCRINOLOGY...................              -1               0               0              -1              -2
FAMILY PRACTICE.................               0               0               0               0               0
GASTROENTEROLOGY................              -1               1               4               0               3
GENERAL PRACTICE................               0               0              -1               0              -1
GENERAL SURGERY.................              -1               0               0              -1              -1
GERIATRICS......................               2               0               0               2               3
HAND SURGERY....................              -1              -1              -3              -2              -4
HEMATOLOGY/ONCOLOGY.............              -1               0              -1              -1              -2
INFECTIOUS DISEASE..............              -1               0               1              -1               0
INTERNAL MEDICINE...............               0               0               0               0              -1
INTERVENTIONAL RADIOLOGY........              -1              -1              -4              -2              -4
NEPHROLOGY......................              -1              -1              -4              -2              -5
NEUROLOGY.......................              -1               0              -1              -1              -2
NEUROSURGERY....................              -1              -1              -2              -2              -3
NUCLEAR MEDICINE................              -1               4              13               4              12
OBSTETRICS/GYNECOLOGY...........              -1               0              -1              -1              -2
OPHTHALMOLOGY...................               2              -1              -3               1              -1
ORTHOPEDIC SURGERY..............              -1              -1              -2              -1              -2
OTOLARNGOLOGY...................               2              -1              -4               1              -2
PATHOLOGY.......................              -1              -1              -3              -2              -4
PEDIATRICS......................               0               0               0               0              -1
PHYSICAL MEDICINE...............               0              -1              -2              -1              -2
PLASTIC SURGERY.................              -1               0               1              -1               0
PSYCHIATRY......................              -1               0               1               0               1
PULMONARY DISEASE...............              -1               0               1              -1               0
RADIATION ONCOLOGY..............              -1               0               1               0               1
RADIOLOGY.......................              -1               1               2               0               1
RHEUMATOLOGY....................              -1              -1              -2              -2              -3
THORACIC SURGERY................              -1              -1              -2              -2              -3
UROLOGY.........................              -1               0               0              -1              -1
VASCULAR SURGERY................              -1               0              -1              -1              -1
AUDIOLOGIST.....................              26             -14             -43              12             -17
CHIROPRACTOR....................              -1              -1              -2              -2              -3
CLINICAL PSYCHOLOGIST...........              -1              -2              -6              -3              -7
CLINICAL SOCIAL WORKER..........              -1              -2              -5              -3              -6
NURSE ANESTHETIST...............              22               0               0              22              22
NURSE PRACTITIONER..............               1               0               1               2               2
OPTOMETRY.......................               4               0              -1               4               3
ORAL/MAXILLOFACIAL SURGERY......              -1               1               3               0               3
PHYSICAL/OCCUPATIONAL THERAPY...              -1               1               4               1               4
PHYSICIAN ASSISTANT.............              -1               0               0               0               0
PODIATRY........................              -1               1               4               1               3
DIAGNOSTIC TESTING FACILITY.....               0               0               0               0               0
INDEPENDENT LABORATORY..........               0               3               9               3               9
PORTABLE X-RAY SUPPLIER.........               0               2               6               2               6
----------------------------------------------------------------------------------------------------------------
*Components may not sum to total due to rounding.


[[Page 38214]]

2. Adjustments for Payments for Imaging Services
    Section 5102 of the Deficit Reduction Act of 2005 (Pub. L. 109-171) 
(DRA) exempts the estimated savings from the application of the OPPS-
based payment limitation on PFS imaging services from the PFS BN 
requirement. We estimate that the combined impact of the current BN 
exemptions instituted by section 5102 of the DRA, the proposed addition 
of 6 codes to the list of services subject to the DRA OPPS cap 
(discussed in section II.E.1.), and the proposed payment revisions to 
OPPS cap amounts would result in no measurable changes in the specialty 
specific impacts of the DRA provisions with the exception of vascular 
surgery in CY 2008.
3. Combined Impact
    Table 25 shows the specialty-level impact of the proposed work and 
PE RVU changes, section 5102 of the DRA (including the additional 6 
services that were added to the list of services subject to the DRA 
OPPS cap and the proposed revision to OPPS payment amounts), and our 
most recent estimate (-9.9 percent) of the CY 2008 Medicare PFS update. 
Additionally, the impacts in this proposed rule reflect the use of 
updated physician time data from the AMA-RUC.
    As indicated in Table 25, our estimates of changes in Medicare 
revenues for PFS services compare payment rates for CY 2007 with 
proposed payment rates for CY 2008 using CY 2006 Medicare utilization 
crosswalked to 2007 services. To the extent that there are year-to-year 
changes in the volume and mix of services provided by physicians, the 
actual impact on total Medicare revenues will be different than those 
shown in Table 25. The payment impacts reflect averages for each 
specialty based on Medicare utilization. The payment impact for an 
individual physician would be different from the average, based on the 
mix of services the physician provides.
    Table 25 shows only the payment impact on PFS services. The 
following is an explanation of the information represented in Table 25.
     Specialty: The physician specialty or type of 
practitioner/supplier.
     Allowed Charges: Allowed charges are the Medicare Fee 
Schedule amounts for covered services and include copayments and 
deductibles (which are the financial responsibility of the 
beneficiary.) These amounts have been summed across all services 
provided by physicians, practitioners, or suppliers with a specialty to 
arrive at the total allowed charges for the specialty.
     Impact of the 2008 Work and PE RVU proposed changes using 
the methodology finalized in the CY 2007 PFS final rule with comment 
period and the revised data sources discussed in this proposed rule.
     Impact of section 5102 of the DRA: The CY 2008 percentage 
decrease in allowed charges attributed to section 5102 of the DRA with 
the proposed addition of six codes to the OPPS cap list.
     Combined impact of the proposed work and PE RVUs, section 
5102 of the DRA and the proposed addition of six codes to the OPPS cap 
list, and the proposed revisions to OPPS payment amounts.
     CY 2008 Update: The percentage decrease in allowed charges 
attributed to the estimated CY 2008 PFS conversion factor update (-9.9 
percent).
     Combined impact with CY 2008 update: The CY 2008 
percentage decrease in allowed charges attributed to the impact of the 
work and PE RVU changes, section 5102 of the DRA (plus six proposed 
additions to OPPS cap list), and the proposed revisions to OPPS payment 
amounts, and the CY 2008 update.

    Table 25.--Combined CY 2008 Total Allowed Charge Impact for the Remaining 5-Year Review of Work RVUs and
                       Practice Expense Changes, OPPS Imaging Cap, and the CY 2008 Update
----------------------------------------------------------------------------------------------------------------
                                                  Impact of                  Combined                  Combined
                                      Allowed    work and PE   Impact of    impact RVU    CY 2008    impact with
             Specialty                charges        RVU        DRA 5102     and DRA       update      CY 2008
                                       (mil)       changes*    (percent)      5102**     (percent)     update**
                                                  (percent)                 (percent)                 (percent)
----------------------------------------------------------------------------------------------------------------
TOTAL.............................      $75,819            0            0            0          -10          -10
ALLERGY/IMMUNOLOGY................          172            1            0            1          -10           -9
ANESTHESIOLOGY....................        1,600           14            0           14          -10            4
CARDIAC SURGERY...................          393           -2            0           -2          -10          -12
CARDIOLOGY........................        7,447           -1            0           -1          -10          -11
COLON AND RECTAL SURGERY..........          121            0            0            0          -10          -10
CRITICAL CARE.....................          197           -1            0           -1          -10          -11
DERMATOLOGY.......................        2,237            2            0            2          -10           -8
EMERGENCY MEDICINE................        2,170           -2            0           -2          -10          -12
ENDOCRINOLOGY.....................          347           -1            0           -1          -10          -11
FAMILY PRACTICE...................        5,011            0            0            0          -10          -10
GASTROENTEROLOGY..................        1,737            0            0            0          -10          -10
GENERAL PRACTICE..................          964            0            0            0          -10          -10
GENERAL SURGERY...................        2,282           -1            0           -1          -10          -11
GERIATRICS........................          145            2            0            2          -10           -8
HAND SURGERY......................           79           -2            0           -2          -10          -12
HEMATOLOGY/ONCOLOGY...............        1,905           -1            0           -1          -10          -11
INFECTIOUS DISEASE................          499           -1            0           -1          -10          -11
INTERNAL MEDICINE.................        9,867            0            0           -1          -10          -11
INTERVENTIONAL RADIOLOGY..........          241           -2            0           -2          -10          -12
NEPHROLOGY........................        1,649           -2            0           -2          -10          -12
NEUROLOGY.........................        1,385           -1            0           -1          -10          -11
NEUROSURGERY......................          568           -2            0           -2          -10          -12
NUCLEAR MEDICINE..................           77            4            0            4          -10           -6
OBSTETRICS/GYNECOLOGY.............          621           -1            0           -1          -10          -11
OPHTHALMOLOGY.....................        4,642            1            0            1          -10           -9
ORTHOPEDIC SURGERY................        3,221           -1            0           -1          -10          -11
OTOLARNGOLOGY.....................          906            1            0            0          -10          -10

[[Page 38215]]

 
PATHOLOGY.........................          939           -2            0           -2          -10          -12
PEDIATRICS........................           72            0            0           -1          -10          -11
PHYSICAL MEDICINE.................          775           -1            0           -1          -10          -11
PLASTIC SURGERY...................          268           -1            0           -1          -10          -11
PSYCHIATRY........................        1,076            0            0            0          -10          -10
PULMONARY DISEASE.................        1,679           -1            0           -1          -10          -11
RADIATION ONCOLOGY................        1,599            0            0            0          -10          -10
RADIOLOGY.........................        5,197            0            0            0          -10          -10
RHEUMATOLOGY......................          491           -2            0           -2          -10          -12
THORACIC SURGERY..................          432           -2            0           -2          -10          -12
UROLOGY...........................        2,021           -1            0            0          -10          -10
VASCULAR SURGERY..................          634           -1           -1           -2          -10          -12
AUDIOLOGIST.......................           31           12            0           12          -10            2
CHIROPRACTOR......................          717           -2            0           -2          -10          -12
CLINICAL PSYCHOLOGIST.............          521           -3            0           -3          -10          -13
CLINICAL SOCIAL WORKER............          347           -3            0           -3          -10          -13
NURSE ANESTHETIST.................          605           22            0           22          -10           12
NURSE PRACTITIONER................          783            2            0            2          -10           -8
OPTOMETRY.........................          782            4            0            4          -10           -6
ORAL/MAXILLOFACIAL SURGERY........           36            0            0            0          -10          -10
PHYSICAL/OCCUPATIONAL THERAPY.....        1,371            1            0            1          -10           -9
PHYSICIAN ASSISTANT...............          591            0            0            0          -10          -10
PODIATRY..........................        1,554            1            0            1          -10           -9
DIAGNOSTIC TESTING FACILITY.......        1,162            0            0            0          -10          -10
INDEPENDENT LABORATORY............        1,081            3            0            3          -10           -7
PORTABLE X-RAY SUPPLIER...........           80            2            0            2          -10          -8
----------------------------------------------------------------------------------------------------------------
* PE changes are CY 2008 second year transition changes. For fully implemented CY 2010 PE changes see Table 1.
** Components may not sum to total due to rounding.

    Table 26 shows the estimated impact on total payments for selected 
high-volume procedures of all of the changes discussed previously. We 
selected these procedures because they are the most commonly provided 
by a broad spectrum of physician specialties. There are separate 
columns that show the change in the facility rates and the nonfacility 
rates. For an explanation of facility and nonfacility PE refer to 
Addendum A of this proposed rule.

                   Table 26.--Impact of Proposed Rule and Estimated Physician Update on Proposed 2008 Payment for Selected Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                               Facility                           Nonfacility
                                                                                 -----------------------------------------------------------------------
               CPT/HCPCS                   MOD             Description                         Proposed     Percent                Proposed     Percent
                                                                                     2007        2008       change       2007        2008       change
--------------------------------------------------------------------------------------------------------------------------------------------------------
11721..................................  ......  Debride nail, 6 or more........      $28.80      $24.92         -13      $39.03      $35.50          -9
17000..................................  ......  Destruct premalg lesion........       44.72       41.64          -7       63.29       60.42          -5
27130..................................  ......  Total hip arthroplasty.........    1,360.52    1,199.16         -12          NA          NA          NA
27244..................................  ......  Treat thigh fracture...........    1,100.92      967.04         -12          NA          NA          NA
27447..................................  ......  Total knee arthroplasty........    1,464.74    1,288.25         -12          NA          NA          NA
33533..................................  ......  CABG, arterial, single.........    1,908.52    1,664.76         -13          NA          NA          NA
35301..................................  ......  Rechanneling of artery.........    1,071.74      938.37         -12          NA          NA          NA
43239..................................  ......  Upper GI endoscopy, biopsy.....      155.00      140.98          -9      325.16      293.90         -10
66821..................................  ......  After cataract laser surgery...      253.53      224.61         -11      270.97      239.63         -12
66984..................................  ......  Cataract surg w/iol, 1 stage...      641.98      563.91         -12          NA          NA          NA
67210..................................  ......  Treatment of retinal lesion....      556.34      491.54         -12      580.59      511.68         -12
71010..................................  ......  Chest x-ray....................          NA          NA          NA       26.15       22.87         -13
71010..................................      26  Chest x-ray....................        8.72        7.85         -10        8.72        7.85         -10
77056..................................  ......  Mammogram, both breasts........          NA          NA          NA       97.40       90.46          -7
77056..................................      26  Mammogram, both breasts........       41.31       37.55          -9       41.31       37.55          -9
77057..................................  ......  Mammogram, screening...........          NA          NA          NA       81.86       74.07         -10
77057..................................      26  Mammogram, screening...........       33.35       30.38          -9       33.35       30.38          -9
77427..................................  ......  Radiation tx management, x5....      176.22      159.07         -10      176.22      159.07         -10
78465..................................      26  Heart image (3d), multiple.....       73.14       66.56          -9       73.14       66.56          -9
88305..................................      26  Tissue exam by pathologist.....       37.90       32.77         -14       37.90       32.77         -14
90801..................................  ......  Psy dx interview...............      129.99      112.65         -13      145.15      131.76          -9
90862..................................  ......  Medication management..........       44.72       39.60         -11       50.40       46.76          -7
90935..................................  ......  Hemodialysis, one evaluation...       67.46       59.05         -12          NA          NA          NA

[[Page 38216]]

 
92012..................................  ......  Eye exam established pat.......       34.11       38.23          12       61.77       62.47           1
92014..................................  ......  Eye exam & treatment...........       55.71       59.39           7       91.33       91.14           0
92980..................................  ......  Insert intracoronary stent.....      795.85      721.61          -9          NA          NA          NA
93000..................................  ......  Electrocardiogram, complete....       24.63       20.48         -17       24.63       20.48         -17
93010..................................  ......  Electrocardiogram report.......        8.34        7.51         -10        8.34        7.51         -10
93015..................................  ......  Cardiovascular stress test.....      104.22       92.51         -11      104.22       92.51         -11
93307..................................      26  Echo exam of heart.............       46.99       42.33         -10       46.99       42.33         -10
93510..................................      26  Left heart catheterization.....      242.92      215.73         -11      242.92      215.73         -11
98941..................................  ......  Chiropractic manipulation......       28.80       25.60         -11       33.35       29.36         -12
99203..................................  ......  Office/outpatient visit, new...       67.08       59.05         -12       91.71       81.58         -11
99213..................................  ......  Office/outpatient visit, est...       42.07       37.55         -11       59.50       53.59         -10
99214..................................  ......  Office/outpatient visit, est...       66.32       59.05         -11       90.20       80.56         -11
99222..................................  ......  Initial hospital care..........      119.00      105.48         -11          NA          NA          NA
99223..................................  ......  Initial hospital care..........      173.57      154.29         -11          NA          NA          NA
99231..................................  ......  Subsequent hospital care.......       35.62       31.75         -11          NA          NA          NA
99232..................................  ......  Subsequent hospital care.......       63.67       57.01         -10          NA          NA          NA
99233..................................  ......  Subsequent hospital care.......       90.95       81.24         -11          NA          NA          NA
99236..................................  ......  Observ/hosp same date..........      205.40      180.57         -12          NA          NA          NA
99239..................................  ......  Hospital discharge day.........       94.74       83.63         -12          NA          NA          NA
99243..................................  ......  Office consultation............       93.23       83.29         -11      122.41      109.57         -10
99244..................................  ......  Office consultation............      145.91      130.74         -10      179.26      160.43         -10
99253..................................  ......  Inpatient consultation.........      108.77       97.63         -10          NA          NA          NA
99254..................................  ......  Inpatient consultation.........      156.52      140.64         -10          NA          NA          NA
99283..................................  ......  Emergency dept visit...........       60.64       52.91         -13          NA          NA          NA
99284..................................  ......  Emergency dept visit...........      110.28       97.97         -11          NA          NA          NA
99291..................................  ......  Critical care, first hour......      208.82      183.65         -12      256.19      224.95         -12
99292..................................  ......  Critical care, add'l 30 min....      104.60       92.16         -12      114.45      100.70         -12
99348..................................  ......  Home visit, est patient........          NA          NA          NA       66.32       58.03         -13
99350..................................  ......  Home visit, est patient........          NA          NA          NA      150.83      131.42         -13
G0008..................................  ......  Admin influenza virus vac......          NA          NA          NA       18.95       18.43          -3
G0317..................................  ......  ESRD related svs 4+mo 20+yrs...      283.09      246.45         -13      283.09      246.45         -13
--------------------------------------------------------------------------------------------------------------------------------------------------------

B. Geographic Practice Cost Index Changes

    Section 1848(e)(1)(A) of the Act requires that payments under the 
Medicare PFS vary among payment areas only to the extent that area 
costs vary as reflected by the area GPCIs. The GPCIs measure area cost 
differences in the three components of the PFS: Physician work; PEs 
(employee wages, rent, medical supplies, and equipment); and 
malpractice insurance. Section 1848(e)(1)(C) of the Act requires that 
GPCIs be reviewed and, if necessary, revised at least every 3 years. 
The first GPCI revision was implemented in 1993. The second revision 
was implemented in 1998, the next in 2001, and the last in 2005. In 
section II.C. of this proposed rule, we are proposing the next GPCI 
update. The proposed GPCI values are shown in Addendum E. These values 
reflect the expiration of the 1.000 floor on physician work as provided 
under section 102 of the MIEA-TRHCA. Section 1848(e)(1)(c) of the Act 
also requires that the GPCI revisions be phased-in equally over a 2-
year period if more than 1 year has elapsed since the last adjustment.
    An estimate of the overall effects of proposed GPCI changes on fee 
schedule area payments can be demonstrated by a comparison of area 
geographic adjustment factors (GAFs). The GAFs are a weighted composite 
of each area's work, PE, and malpractice expense GPCIs using the 
national GPCI cost share weights. While we do not actually use the GAFs 
in computing the fee schedule payment for a specific service, they are 
useful in comparing overall area costs and payments. The actual effect 
on payment for any actual service will deviate from the GAF to the 
extent that the proportions of work, PE, and malpractice expense RVUs 
for the service differ from those of the GAF. Addendum D shows the 
estimated effects of the revised GPCIs on area GAFs in descending 
order. The GAFs reflect the expiration of the 1.000 floor on physician 
work as provided under section 102 of the MIEA-TRHCA.
    The effects of the 2008 transition year will be only one-half of 
the total amount of the revisions associated with the updated GPCI 
values. As required by law, the GPCIs would be phased in over a 2 year 
period. The total impact of the GPCI revisions is shown in the 2009 
GPCI values of Addendum E.
    The most significant changes occur in 11 payment localities where 
the GAF moves up by 1 or more percent or down by more than 2 percent.

C. Telehealth

    In section II.D of this rule, we are proposing to add 
neurobehavioral status exam as represented by HCPCS code 96116 to the 
list of telehealth services. To date, Medicare expenditures for 
telehealth services have been extremely low. For instance, in CY 2006, 
the total Medicare payment amount for telehealth services (including 
the originating site facility fee) was approximately $2 million. 
Moreover, previous additions to the list of Medicare telehealth 
services have not resulted in a significant increase in Medicare 
program expenditures. For example, the psychiatric diagnostic interview 
examination (as described by CPT code 90801) was added to the list of 
Medicare telehealth services in CY 2003. The addition of CPT code 90801 
resulted in an increase in Medicare payment amounts of approximately 
$100,000 in CY 2006.

[[Page 38217]]

    The neurobehavioral status exam (CPT code 96116) includes an 
initial assessment and evaluation of the mental status for a 
psychiatric patient. In this regard, the neurobehavioral status exam is 
similar to the psychiatric diagnostic interview examination (CPT code 
90801). However, the utilization rate of psychiatric diagnostic 
interview examination is much greater than the neurobehavioral status 
exam. For instance, in CY 2006, the total allowed services for CPT code 
90801 was approximately 1.3 million while total allowed services for 
neurobehavioral status exam in CY 2006 was approximately 105,000. 
Because utilization of neurobehavioral status exam is substantially 
less than the psychiatric diagnostic interview examination, we believe 
the budgetary impact of adding neurobehavioral status exam to the list 
of Medicare telehealth services will be even less than the previously 
added psychiatric diagnostic interview examination.
    While we believe that addition of this service to the telehealth 
service list will enable more beneficiaries to access to these 
services, we do not anticipate that this proposed change will have a 
significant budgetary impact on the Medicare program.

D. Payment for Covered Outpatient Drugs and Biologicals

1. ASP Issues
    The proposed changes discussed in section II.F.1. with respect to 
payment for covered outpatient drugs and biologicals, are estimated to 
have no impact on Medicare expenditures. However, we believe the 
changes will assist in clarifying existing policy with respect to ASP 
payment.
2. CAP Issues
    This proposed rule describes a significant change in how CAP drug 
claims are paid due to the implementation of section 108(a)(2) of the 
MIEA-TRHCA. This rule also contains proposals and seeks comment on 
certain approaches to refining the CAP seek to improve service by 
improving compliance, increasing flexibility, and increasing choices 
available to participating CAP physicians. The proposed CAP provisions 
will also have a potential impact on entities that are involved in the 
dispensing or distribution of drugs, plan to become approved CAP 
vendors, or are approved CAP vendors. Changes associated with section 
108(a)(2) of the MIEA-TRHCA, especially the provision for payment to 
vendors upon receipt of a claim, will almost certainly be perceived as 
a positive step. Other changes which are proposed or are being 
contemplated seek to improve service by improving compliance, and 
increasing the services that an approved CAP vendor may offer to 
participating CAP physicians. At this time we anticipate these changes 
will result in no significant additional cost savings or increases 
associated with the CAP, relative to the ASP payment system.

E. Clinical Laboratory Fee Schedule issues

    As discussed in section II.G. of this preamble, we have proposed 
two additions to Sec.  410.508 for determining payment for a new 
clinical diagnostic laboratory paid under the Medicare Part B clinical 
laboratory fee schedule. These proposals will not increase or decrease 
payment amounts for existing clinical diagnostic laboratory tests 
because the payment amounts are not subject to these regulatory 
changes. For new tests, the proposals would primarily permit additional 
comment opportunity for establishing a payment amount for a new test 
but not result in an increase or decrease in payment amounts. Because 
any new laboratory tests to undergo a reconsideration request of a 
payment amount are unknown to us at the current time, we do not have 
any data to estimate the impact of our proposal to establish a 
reconsideration process. By improving the comment opportunities and 
timeframes for establishing payment amount for new tests, we expect 
less than five tests per year to undergo a subsequent reconsideration 
process with the resulting adjustments in payment amounts to be very 
modest if any.

F. Provisions Related to Payment for Renal Dialysis Services Furnished 
by End State Renal Disease (ESRD) Facilities

    The ESRD-related provisions in this proposed rule are discussed in 
section II.H. To understand the impact of the proposed changes 
affecting payments to different categories of ESRD facilities, it is 
necessary to compare estimated payments under the current year (CY 2007 
payments) to estimated payments under the revisions to the composite 
rate payment system (CY 2008 payments) as discussed in II.H. of this 
proposed rule. To estimate the impact among various classes of ESRD 
facilities, it is imperative that the estimates of current payments and 
proposed payments contain similar inputs. Therefore, we simulated 
payments only for those ESRD facilities that we are able to calculate 
both current 2006 payments and proposed 2007 payments.
    ESRD providers were grouped into the categories based on 
characteristics provided in the Online Survey and Certification and 
Reporting (OSCAR) file and the most recent cost report data from the 
Healthcare Cost Report Information System (HCRIS). We also used the 
December 2006 update of CY 2006 National Claims History file as a basis 
for Medicare dialysis treatments and separately billable drugs and 
biologicals. While the December 2006 update of the 2006 claims is not 
complete, we wanted to use the most recent data available, and plan to 
use an updated version of the 2006 claims file for the final rule. Due 
to data limitations, we are unable to estimate current and proposed 
payments for 168 of the 4,712 ESRD facilities that bill for ESRD 
dialysis treatments.
    Table 27 shows the impact of this year's proposed changes to CY 
2008 payments to hospital-based and independent ESRD facilities. The 
first column of Table 27 identifies the type of ESRD provider, the 
second column indicates the number of ESRD facilities for each type, 
and the third column indicates the number of dialysis treatments.
    The fourth column shows the effect of the proposed change to the 
wage index floor as it affects the composite rate payments to ESRD 
facilities for CY 2008. The fourth column compares aggregate ESRD wage 
adjusted composite rate payments in the third year of the transition 
(CY 2008) using the CY 2008 wage index with a 0.80 floor compared to 
aggregate ESRD wage adjusted composite rate payments in the third year 
of the transition (CY 2008) using the CY 2008 wage index with a 0.75 
floor. Note that the fourth column only includes the effect of the 
proposed change to the wage index floor and does not include the 
effects of other wage index changes, such as, moving from the second to 
third year of the transition and updated wage index values from CY 2007 
to CY 2008.
    The fifth column shows the effect of all proposed changes to the 
ESRD wage index for CY 2008 as it affects the composite rate payments 
to ESRD facilities. It is inclusive of the changes in the fourth 
column. The fifth column compares aggregate ESRD wage adjusted 
composite rate payments in the third year of the transition (CY 2008) 
to aggregate ESRD wage adjusted composite rate payments in the second 
year of the transition (CY 2007). In the third year of the transition 
(CY 2008), ESRD facilities receive 75 percent of the CBSA wage adjusted 
composite rate and

[[Page 38218]]

25 percent of the MSA wage adjusted composite rate. In the second year 
of the transition, ESRD facilities receive 50 percent of the CBSA wage 
adjusted composite rate and 50 percent of the MSA wage adjusted 
composite rate. The overall effect to all ESRD providers in aggregate 
is zero because the proposed CY 2008 ESRD wage index has been 
multiplied by a BN adjustment factor to comply with the statutory 
requirement that any wage index revisions be done in a manner that 
results in the same aggregate amount of expenditures as would have been 
made without any changes in the wage index. The decreases shown among 
census regions is primarily due to reducing the wage index floor, as 
there were areas in these areas with wage index values below the 
proposed floor.
    The sixth column shows the overall effect of the proposed changes 
in composite rate payments to ESRD providers. The overall effect is 
measured as the difference between the proposed CY 2008 payment with 
all changes as proposed in this rule and current CY 2007 payment. This 
payment amount is computed by multiplying the wage adjusted composite 
rate with the drug add-on for each provider times the number of 
dialysis treatments from the CY 2006 claims. The CY 2008 proposed 
payment is the transition year 3 wage-adjusted composite rate for each 
provider (with the 15.5 percent drug add-on) times dialysis treatments 
from CY 2006 claims. The CY 2007 current payment is the transition year 
2 wage-adjusted composite rate for each provider (with the current 14.9 
percent drug add-on) times dialysis treatments from CY 2006 claims.
    The overall impact to ESRD providers in aggregate is 0.5 percent. 
This increase corresponds to the proposed 0.5 percent increase to the 
drug add-on. The variation shown in column 6 is due to variation in 
changes in the wage index (column 5). All provider types receive the 
same 0.5 percent increase to the drug add-on.

                       Table 27.--Impact of CY 2008 Proposed Changes in Payments to Hospital-Based and Independent ESRD Facilities
                             [Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                      Number of
                                                                    Number of         dialysis          Effect of         Effect of      Overall effect
                         ESRD provider                             facilities      treatments (in   changes in floor   changes in Wage         \3\
                                                                                      millions)         only \1\          Index \2\
--------------------------------------------------------------------------------------------------------------------------------------------------------
All Providers:................................................             4,541              31.4               0.0               0.0               0.5
    Independent...............................................             3,958              28.1               0.0              -0.1               0.5
    Hospital-Based............................................               583               3.3               0.0               0.5               1.0
By Facility Size:
    Less than 5000 treatments.................................             1,821               5.4              -0.1              -0.2               0.3
    5000 to 9999 treatments...................................             1,805              13.0               0.0               0.0               0.6
    Greater than 9999 treatments..............................               915              13.0               0.0               0.1               0.6
Type of Ownership:
    Profit....................................................             3,611              25.6               0.0              -0.1               0.4
    Nonprofit.................................................               930               5.9               0.0               0.3               0.8
By Geographic Location:
    Rural.....................................................             1,227               6.5              -0.3              -0.5               0.0
    Urban.....................................................             3,314              25.0               0.1               0.1               0.6
By Region:
    New England...............................................               154               1.1               0.1               1.6               2.2
    Middle Atlantic...........................................               549               4.0               0.1               0.4               1.0
    East North Central........................................               717               5.1               0.1              -0.7              -0.2
    West North Central........................................               343               1.7               0.0              -0.3               0.3
    South Atlantic............................................             1,023               7.3               0.0               0.1               0.6
    East South Central........................................               357               2.3              -0.3              -1.1              -0.6
    West South Central........................................               622               4.4              -0.1              -0.6              -0.1
    Mountain..................................................               248               1.4               0.1               0.5               1.0
    Pacific...................................................               498               3.9               0.1               1.3               1.8
    Puerto Rico...............................................                30               0.4              -2.1              -3.1             -2.6
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ This column only shows the effect of the proposed wage index floor changes on ESRD providers for CY 2008. Composite rate payments computed using the
  CY 2008 wage index with a 0.80 floor are compared to composite rate payments using the CY 2008 wage index with a 0.75 floor.
\2\ This column shows the overall effect of wage index changes on ESRD providers. Composite rate payments computed using the current wage index are
  compared to composite rate payments using the CY 2008 wage index changes.
\3\ This column shows the percent change between CY 2008 and CY 2007 composite rate payments to ESRD facilities. The CY 2008 payments include the CY
  2008 wage adjusted composite rate, and the 15.5 percent drug add-on times treatments. The CY 2007 payments to ESRD facilities includes the CY 2007
  wage adjusted composite rate and the 14.9 percent drug add-on times treatments.

G. IDTF Changes

    We believe that our proposals regarding IDTFs as discussed in 
section II.I. of this proposed rule would have no budgetary impact. 
However, we believe that these changes are necessary to ensure that 
only legitimate IDTFs are enrolled into the program. In addition, we 
believe that the proposed IDTF provisions contained in this rule will 
help ensure that beneficiaries receive quality care. Therefore, we 
expect to have an impact on an unknown number of persons and entities 
who will be denied enrollment into the Medicare program.

H. CORF Issues

    The revisions to the CORF regulations discussed in section II.K. 
update the regulations for consistency with the PFS payment rules. 
These revisions will help to clarify payment for CORF services and are 
expected to have minimal impact on Medicare expenditures.

[[Page 38219]]

I. Compendia for Determination of Medically-Accepted Indications for 
Off-Label Use of Drugs and Biologicals in an Anti-Cancer 
Chemotherapeutic Regimen

    We anticipate that the proposals related to the compendia discussed 
in section II.L. of this proposed rule will have a negligible cost to 
the Medicare program. The proposed changes will enable CMS to respond 
quickly should changes in the number and quality of the compendia 
indicate a need to amend the list.

J. Physician Self-referral Provisions

    We anticipate that our proposals in section II.M. of this proposed 
rule for the reassignment and anti-markup provisions, and the physician 
self-referral provisions would result in savings to the program by 
reducing overutilization and anti-competitive business arrangements. We 
cannot gauge with any certainty the extent of these savings to the 
Medicare program.

K. Beneficiary Signature for Ambulance Transport Services

    We believe that our proposal in section II.N. of this proposed rule 
for allowing the ambulance provider or supplier to sign the claim on 
behalf of the beneficiary with respect to emergency transport services, 
provided that certain conditions are satisfied, will have no budget 
impact.

L. Update to Fee Schedules for Class III DME for CYs 2007 and 2008

    In section II.O. of this proposed rule, we discuss the proposed 
update to the fee schedules for class III DME for CYs 2007 and 2008. 
Total allowed charges for class III devices in 2005 were $71 million. 
Accordingly, with a zero percent increase for DME, other than class III 
devices, for 2005 and 2006 and with the proposed establishment of an 
update for 2007 of zero percent for class III devices, rather than 4.3 
percent based on the CPI-U, this would result in a savings to the 
Medicare program of approximately $2 million in FY 2007, $4 million in 
FY 2008, $4 million in FY 2009, $5 million in FY 2010, $5 million in FY 
2011, and $5 million in FY 2012.

M. Therapy Services

    In section II.S.2., we proposed to change the certification the 
plan of care, for outpatient physical therapy, occupational therapy and 
speech-language pathology services from every 30 days to an appropriate 
length, based on the patient's needs, limited to 90 days. Analysis of 
Medicare claims data shows negative or no impact for this change. In 
most cases, the appropriate length of treatment will be less than 30 
days. Certification of the appropriate length of treatment will 
discourage the practice of billing for re-evaluations prior to 
recertification regardless of need.
    The 30-day recertification allows treatment under a plan of care 
for 30 days after initial certification, regardless of the appropriate 
length of treatment. The initial certification cannot assure that a 
physician reviews the plan or follows the patient's progress.
    In 2004 and again in 2006, we received an extensive analysis of the 
utilization of therapy services. The analysis indicates that the 
recertification has no impact on utilization of services and does not 
limit payment. About 70 percent of episodes are completed before the 
first 30-day recertification interval. Although CORFs have a 60-day 
certification period, and SNFs and outpatient rehabilitation facilities 
(ORFs) have 30-day certification periods, the average number of 
treatment days is similar in these settings. Contrary to the pattern 
expected if certification impacted length of care, the number of 
physical therapy treatment days is higher in SNF than in CORF.
    We propose to review the utilization of therapy services after a 2-
year trial to assess any changes that might be related to certification 
of a plan of care for an appropriate length of treatment. At that time, 
if we determine that this change has caused an increase in 
inappropriate utilization, we will reconsider the 30-day certification 
requirement.

N. TRHCA 101(b) Physician Quality Reporting Initiative

    As discussed in section II.T.1. of this proposed rule, the proposed 
2008 PQRI measures satisfy the requirement of section 1848(k)(2)(B)(ii) 
of the Act that the Secretary publish in the Federal Register by August 
15, 2007 a proposed set of measures that the Secretary determines would 
be appropriate for eligible professionals to use to submit data to the 
Secretary in 2008. We also expect to address registry-based data 
submission on a test basis in 2008. As discussed in section II.T.1. of 
this proposed rule, we will also explore and may offer an option in 
2008 for reporting some of the 2008 PQRI measures via submission of 
clinical data extracted from EHRs. Although there may be some cost 
incurred for maintaining the measures and their associated code sets, 
and for expanding an existing clinical data warehouse to accommodate 
registry-based data submission, we do not anticipate a significant cost 
impact on the Medicare program.

O. TRHCA 101(d) Physician Assistance and Quality Initiative Fund

    As discussed in section II.T.5. of this proposed rule, section 
101(d) of the MIEA-TRHCA created the Physician Assistance and Quality 
Initiative Fund (PAQI) which provides $1.35 billion for physician 
payment and quality improvement initiatives. The legislation directs 
the Secretary to provide for expenditures from the Fund in a manner 
designed to provide (to the maximum extent feasible) for the obligation 
of the entire $1.35 billion for payment for physician's services 
furnished during 2008.

P. TRHCA 110 Reporting of Anemia Quality Indicators

    As discussed in section II.T.2. of this proposed rule, there are no 
program cost savings or increased expenditure associated with this 
proposed change; however, we expect that the regulation will have a 
positive impact on patient care.

Q. Proposed Elimination of Exemption From NCPDP SCRIPT Standard for 
Computer-Generated Facsimile Transmissions Under Medicare Part D

    The proposed elimination of the exemption for computer-generated 
fax transactions under Medicare Part D is discussed in section II.S.3. 
of this proposed rule. E-prescribing is voluntary for providers and 
pharmacies. This proposal would affect only providers and pharmacies 
that already conduct e-prescribing using products that generate faxes 
rather than SCRIPT transactions.
    We believe that providers and pharmacies that are now e-prescribing 
using products that generate faxes generally already possess the 
hardware necessary to e-prescribe. Many would need to obtain software 
upgrades to send and receive the SCRIPT transaction. This software will 
generally be available to providers through automatic version upgrades 
built into annual software vendor maintenance fees. However, providers 
currently using software that cannot be upgraded to generate SCRIPT 
transactions would need to purchase and install new e-prescribing 
software or revert to sending paper fax transactions to pharmacies.
    Dispensers that currently e-prescribe but have not established the 
connectivity necessary to receive and send SCRIPT transactions would 
need to connect to a network, and may need to install software 
upgrades, which will generally be covered under annual fees. Because 
pharmacies customarily bear

[[Page 38220]]

the cost of transaction fees for the SCRIPT transactions they receive 
and send, these costs would increase as the rate of e-prescribing 
increases.
    The proposed elimination of this exemption will have indirect 
benefits in that it will help to encourage e-prescribing using 
electronic data interchange, which will ultimately result in improved 
patient safety.
    Because of the voluntary nature of e-prescribing for physicians and 
pharmacies, the relatively small number of entities currently e-
prescribing, and the minimal nature of the anticipated costs, we 
believe this provision does not constitute a major rule for purposes of 
this analysis. However, we specifically solicit comments on the impact 
to providers and pharmacies.

R. Revisions to Payment Policies Under the Ambulance Fee Schedule and 
the Ambulance Inflation Factor Update for CY 2008

    Ambulance providers and suppliers for purposes of the RFA are 
considered to be small entities. The proposal to remove the requirement 
that the AIF be published annually via Federal Register notice, as 
discussed in Section III. of this proposed rule has no monetary impact 
on small entities, or small businesses. It merely allows for the 
earlier dissemination of necessary information to the ambulance 
industry, the Medicare contractors, and the general public.

S. Alternatives Considered

    This proposed rule contains a range of policies, including some 
provisions related to specific MMA provisions. The preamble provides 
descriptions of the statutory provisions that are addressed, identifies 
those policies when discretion has been exercised, presents rationale 
for our decisions and, where relevant, alternatives that were 
considered.

T. Impact on Beneficiaries

    There are a number of changes made in this proposed rule that would 
have an effect on beneficiaries. In general, we believe these changes, 
particularly the implementation of the PQRI with its continuing focus 
on measuring, submitting, and analyzing quality data, will have a 
positive impact and improve the quality and value of care provided to 
Medicare beneficiaries.
    We do not believe that beneficiaries will experience drug access 
issues as a result of the proposed changes with respect to Part B drugs 
and CAP.
    As explained in more detail subsequently in this section, the 
regulatory provisions may affect beneficiary liability in some cases. 
Most changes in aggregate beneficiary liability from a particular 
provision would be a function of the coinsurance (20 percent if 
applicable for the particular provision after the beneficiary has met 
the deductible) and the effect of the aggregate cost (savings) of the 
provision on the calculation of the Medicare Part B premium rate 
(generally 25 percent of the provision's cost or savings). In 2008, 
total cost sharing (coinsurance and deductible) per Part B enrollee 
associated with physician fee schedule services is estimated to be 
$590. In addition, the portion of the 2008 standard monthly Part B 
premium attributable to PFS services is estimated to be $38.60.
    To illustrate this point, as shown in Table 26, the 2007 national 
payment amount in the nonfacility setting for CPT code 99203 (Office/
outpatient visit, new), is 91.71 which means that currently a 
beneficiary is responsible for 20 percent of this amount, or 18.34. 
Based on this proposed rule, the 2008 national payment amount in the 
nonfacility setting for CPT code 99203, as shown in Table 26, is $81.58 
which means that, in 2008, the beneficiary coinsurance for this service 
would be $16.32.
    Proposed policies discussed in this rule that do affect overall 
spending, such as the proposed additions to the list of codes that are 
subject to section 5102 of the DRA imaging provisions, would similarly 
impact beneficiaries' coinsurance.

U. Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table 28, we have 
prepared an accounting statement showing the classification of the 
expenditures associated with this proposed rule. This estimate includes 
the incurred benefit impact associated with the estimated CY 2008 PFS 
update, shown in this proposed rule, based on the 2007 Trustees Report 
baseline. All estimated impacts are classified as transfers.

      Table 28.--Accounting Statement: Classification of Estimated
                  Expenditures From CY 2007 to CY 2008
------------------------------------------------------------------------
           Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized           Estimated decrease in expenditures of $
 Transfers.                     5.9 billion.
From Whom To Whom?...........  Physicians, other practitioners and
                                suppliers who receive payment under the
                                Medicare Physician Fee Schedule; ESRD
                                Medicare Providers; ambulance suppliers,
                                DME suppliers, and Medicare suppliers
                                billing for Part B drugs to Federal
                                Government.
------------------------------------------------------------------------

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

List of Subjects

42 CFR Part 409

    Health facilities, Medicare.

42 CFR Part 410

    Health facilities, Health professions, Kidney diseases, 
Laboratories, Medicare, Reporting and recordkeeping requirements, Rural 
areas, X-rays.

42 CFR Part 411

    Kidney diseases, Medicare, Physician Referral, Reporting and 
recordkeeping requirements.

42 CFR Part 413

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

42 CFR Part 414

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

42 CFR Part 415

    Health facilities, Health professions, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 418

    Health facilities, Hospice care, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 423

    Administrative practice and procedure, Emergency medical services, 
Health facilities, Health maintenance organizations (HMO), Health 
Professionals, Medicare, Penalties,

[[Page 38221]]

Privacy, Reporting and recordkeeping requirements.

42 CFR Part 424

    Emergency medical services, Health facilities, Health professions, 
Medicare, Reporting and recordkeeping requirements.

42 CFR Part 482

    Grant programs-health, Hospitals, Medicaid, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 484

    Grant programs-health, Health facilities, Health professions, 
Health records, Medicaid, Medicare, Nursing homes, Nutrition, Reporting 
and recordkeeping requirements, Safety.

42 CFR Part 485

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

42 CFR Part 491

    Grant programs-health, Health facilities, Medicaid, Medicare, 
Reporting and recordkeeping requirements, Rural areas.
    For the reasons set forth in the preamble, the Centers for Medicare 
& Medicaid Services proposes to amend 42 CFR chapter IV as set forth 
below:

PART 409--HOSPITAL INSURANCE BENEFITS

    1. The authority citation for part 409 continues to read as 
follows:

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

Subpart B--Inpatient Hospital Services and Inpatient Critical 
Access Hospital Services

    2. A new Sec.  409.17 is added to read as follows:


Sec.  409.17  Physical therapy, occupational therapy, and speech-
language pathology services.

    (a) General rules. (1)(i) Except as specified in paragraph 
(a)(1)(ii) of this section, physical therapy, occupational therapy or 
speech-language pathology services must be furnished by qualified 
physical therapists, physical therapist assistants, occupational 
therapists, occupational therapy assistants or speech-language 
pathologists who meet the requirements specified in Sec.  484.4 of this 
chapter.
    (ii) Physical therapy, occupational therapy or speech-language 
pathology services may be furnished by qualified physical therapists, 
physical therapist assistants, occupational therapists, or occupational 
therapy assistants who have been licensed, certified, registered or 
otherwise regulated as physical therapists, physical therapist 
assistants, occupational therapists, or occupational therapy assistants 
by the State in which practicing before January 1, 2008 and continue to 
furnish Medicare services at least part time without an interruption in 
furnishing services of more than 2 years.
    (2) Physical therapy, occupational therapy or speech-language 
pathology services must be furnished under a plan of treatment that 
meets the requirements of paragraphs (b) through (e) of this section.
    (b) Establishment of the plan. The plan must be established before 
treatment begins by one of the following:
    (1) A physician.
    (2) A nurse practitioner, a clinical nurse specialist or a 
physician assistant.
    (3) The physical therapist furnishing the physical therapy 
services.
    (4) A speech-language pathologist furnishing the speech-language 
pathology services.
    (5) An occupational therapist furnishing the occupational therapy 
services.
    (c) Content of the plan. The plan must--
    (1) Prescribe the type, amount, frequency, and duration of the 
physical therapy, occupational therapy, or speech-language pathology 
services to be furnished to the individual; and
    (2) Indicate the diagnosis and anticipated goals.
    (d) Changes in the plan. Any changes in the plan must be made in 
writing, incorporated immediately, and signed by one of the following:
    (1) A physician.
    (2) A nurse practitioner, clinical nurse specialist, or a physician 
assistant.
    (3) The physical therapist furnishing the physical therapy 
services.
    (4) The speech-language pathologist furnishing the speech-language 
pathology services.
    (5) The occupational therapist furnishing the occupational therapy 
services.
    (6) A registered professional nurse or a staff physician, in 
accordance with verbal orders from one the practitioners listed in 
paragraphs (1) through (5) of this section.
    (e) Review of the plan. The physician, nurse practitioner, clinical 
nurse special or physician assistant reviews the plan as often as the 
individual's condition requires, but at least prior to certification.

Subpart C--Posthospital SNF Care

    3. Section 409.23 is amended by adding paragraph (c) to read as 
follows:


Sec.  409.23  Physical, occupational, and speech therapy.

* * * * *
    (c) Except as specified in paragraph (c)(1)(ii) of this section, 
physical therapy, occupational therapy or speech-language pathology 
services must be furnished--
    (1)(i) By qualified physical therapists, physical therapist 
assistants, occupational therapists, occupational therapy assistants or 
speech-language pathologists as defined in Sec.  484.4; or
    (ii) By qualified physical therapists, physical therapist 
assistants, occupational therapists, or occupational therapy assistants 
who have been licensed, certified, registered or otherwise recognized 
by the State in which practicing before January 1, 2008 and continue to 
furnish Medicare physical therapy or occupational therapy services at 
least part time without an interruption in furnishing services of more 
than 2 years.
    (2) In accordance with a plan of treatment that meets the 
requirements of Sec.  409.16(b) through (e) of this part.

PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

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

    Authority: Secs. 1102, 1834, 1871, and 1893 of the Social 
Security Act (42 U.S.C. 1302, 1395m, 1395hh, and 1395ddd).

Subpart B--Medical and Other Health Services


Sec.  410.32  [Amended]

    5. Section 410.32 is amended by--
    A. Removing paragraph (a)(1).
    B. Redesignating paragraphs (a)(2) and (a)(3) as paragraphs (a)(1) 
and (a)(2).
    6. Section 410.33 is amended by--
    A. Removing the phrase, ``and (h)'' in the introductory text of 
paragraph (a)(2) and adding in its place, ``and (i)''.
    B. Revising paragraphs (b)(1), (g)(2), (g)(6), and (g)(8).
    C. Adding paragraphs (g)(15) and (i).
    The revisions and additions read as follows:


Sec.  410.33  Independent diagnostic testing facility.

* * * * *
    (b) * * *
    (1) Each supervising physician must be limited to providing 
supervision to no more than three IDTF sites. This applies to both 
fixed sites and mobile

[[Page 38222]]

units where three concurrent operations are capable of performing 
tests.
* * * * *
    (g) * * *
    (2) Provides complete and accurate information on its enrollment 
application. Changes in ownership, changes of location, changes in 
general supervision, and adverse legal actions must be reported to the 
designated fee-for-service contractor on the Medicare enrollment 
application within 30 calendar days of the change. All other changes to 
the enrollment application must be reported within 90 days.
* * * * *
    (6) Have a comprehensive liability insurance policy of at least 
$300,000 per location that covers both the place of business and all 
customers and employees of the IDTF. The policy must be carried by a 
nonrelative-owned company. Failure to maintain required insurance at 
all times will result in revocation of the IDTF's billing privileges 
retroactive to the date the insurance lapsed. IDTF suppliers are 
responsible for providing the contact information for the issuing 
insurance agent and the underwriter. In addition, the IDTF must--
    (i) Ensure that the insurance policy must remain in force at all 
times and provide coverage of at least $300,000 per incident;
    (ii) Notify the CMS designated contractor in writing of any policy 
changes or cancellations; and
    (iii) List the CMS designated contractor as a Certificate Holder on 
the policy.
* * * * *
    (8) Answer, document, and maintain documentation of all 
beneficiaries' questions and responses to their complaints at the 
physical site of the IDTF. This includes, but is not limited to, the 
following:
    (i) The name, address, telephone number, and health insurance claim 
number of the beneficiary.
    (ii) A summary of the complaint; the date it was received; the name 
of the person receiving the complaint; and a summary of actions taken 
to resolve the complaint.
    (iii) If an investigation was not conducted, the name of the person 
making the decision and the reason for the decision. For mobile IDTFs, 
this documentation would be stored at their home office.
* * * * *
    (15) Does not share space, equipment, or staff or sublease its 
operations to another individual or organization.
* * * * *
    (i) Effective date of billing privileges. The effective date of 
billing privileges for a newly enrolled IDTF is the later of the 
following:
    (1) The filing date of the Medicare enrollment application that was 
subsequently approved by a fee-for-service contractor;
    (2) The date the IDTF first furnished services at its new practice 
location; or
    (3) The filing date of the Medicare enrollment application or the 
date that the Medicare fee-for-service contractor receives a signed 
provider enrollment application that it is able to process for 
approval.
    7. Section 410.43 is amended by revising paragraph (a)(3)(ii) to 
read as follows:


Sec.  410.43  Partial hospitalization services: Conditions and 
exclusions.

    (a) * * *
    (3) * * *
    (ii) Occupational therapy requiring the skills of a qualified 
occupational therapist, provided by an occupational therapist, or under 
appropriate supervision of a qualified occupational therapist by an 
occupational therapy assistant--
    (A) As specified in Sec.  484.4 of this chapter; or
    (B) Who has been licensed, certified, registered or otherwise 
recognized as an occupational therapist or occupational therapy 
assistant by the State in which practicing before January 1, 2008 and 
continues to furnish Medicare occupational therapy services at least 
part time without an interruption in furnishing services of more than 2 
years.
* * * * *
    8. Section 410.59 is amended by--
    A. Removing the phrase ``paragraph (a)(3)(iii)'' in the 
introductory text to paragraph (a) and adding the phrase, ``paragraphs 
(a)(3)(iii) and (iv)'' in its place.
    B. Adding a new paragraph (a)(3)(iv).
    The addition reads as follows:


Sec.  410.59  Outpatient occupational therapy services: Conditions.

    (a) * * *
    (3) * * *
    (iv) By qualified occupational therapists or appropriately 
supervised occupational therapy assistants who meet the qualifications 
in Sec.  484.4 of this chapter or who have been licensed, certified, 
registered or otherwise recognized by the State in which practicing 
before January 1, 2008 and continue to furnish Medicare occupational 
therapy services at least part time without an interruption in 
furnishing services of more than 2 years;
* * * * *
    9. Section 410.60 is amended by--
    A. Removing the phrase ``paragraph (a)(3)(iii)'' in the 
introductory text to paragraph (a) and adding the phrase, ``paragraphs 
(a)(3)(iii) and (iv)'' in its place.
    B. Adding a new paragraph (a)(3)(iv).
    The addition reads as follows:


Sec.  410.60  Outpatient physical therapy services: Conditions.

    (a) * * *
    (3) * * *
    (iv) By qualified physical therapists or appropriately supervised 
physical therapist assistants who meet the qualifications in Sec.  
484.4 of this chapter or who have been licensed, certified, registered 
or otherwise recognized by the State in which practicing before January 
1, 2008 and continue to furnish Medicare physical therapy services at 
least part time without an interruption in furnishing services of more 
than 2 years;
* * * * *
    10. Section 410.61 is amended by revising paragraph (e)(1) to read 
as follows:


Sec.  410.61  Plan of treatment requirements for outpatient 
rehabilitation services.

* * * * *
    (e) * * *
    (1) The physician, nurse practitioner, clinical nurse specialist or 
physician's assistant reviews the plan as often as the individual's 
condition requires, but at least at every certification and 
recertification.
* * * * *
    11. Section 410.78 is amended by revising the introductory text of 
paragraph (b) to read as follows:


Sec.  410.78  Telehealth services.

* * * * *
    (b) General rule. Medicare Part B pays for office and other 
outpatient visits, professional consultation, psychiatric diagnostic 
interview examination, individual psychotherapy, pharmacologic 
management, end stage renal disease related services included in the 
monthly capitation payment (except for one visit per month to examine 
the access site), individual medical nutrition therapy, and 
neurobehavioral status exam furnished by an interactive 
telecommunications system if the following conditions are met:
* * * * *

Subpart D--Comprehensive Outpatient Rehabilitation Facility (CORF) 
Services

    12. Section 410.100 is amended by--
    A. Revising the introductory text and paragraphs (a), (e), and (h).

[[Page 38223]]

    B. Removing paragraphs (i) and (k).
    C. Redesignating paragraphs (j), (l), and (m) to (i), (j), and (k), 
respectively.
    D. Revising new paragraphs (i), (j), and (k).
    The revisions read as follows:


Sec.  410.100  Included services.

    Subject to the conditions and limitations set forth in Sec.  
410.102 and Sec.  410.105, CORF services means the following services 
furnished to an outpatient of the CORF by personnel that meet the 
qualifications set forth in Sec.  485.70 of this chapter. Payment for 
CORF services are made in accordance with Sec.  414.1101 of this 
chapter.
    (a) Physician's services. CORF facility physician services are 
administrative in nature and include consultation with and medical 
supervision of nonphysician staff, participate in plan of treatment 
reviews and patient care review conferences, and other medical and 
facility administration activities. Diagnostic and therapeutic services 
furnished to an individual CORF patient by a physician in a CORF 
facility are not CORF physician services. These services, if covered, 
are physician services under Sec.  410.20 with payment for these 
services made to the physician in accordance with part 414 subpart B of 
this chapter.
* * * * *
    (e) Respiratory therapy services. (1) Respiratory therapy services 
are for the treatment, and monitoring of patients with deficiencies or 
abnormalities of cardiopulmonary function.
    (2) Respiratory therapy services include the following:
    (i) Application of techniques for support of oxygenation and 
ventilation of the patient.
    (ii) Therapeutic use and monitoring of gases, mists, and aerosols 
and related equipment.
    (iii) Bronchial hygiene therapy.
    (iv) Pulmonary rehabilitation techniques to develop strength and 
endurance of respiratory muscles and other techniques to increase 
respiratory function, such as graded activity services; these services 
include physiologic monitoring and patient education.
* * * * *
    (h) Social and psychological services. Social and psychological 
services include the assessment and treatment of an individual's mental 
and emotional functioning and the response to and rate of progress as 
it relates to the individual's rehabilitation plan of treatment, 
including physical therapy services, occupational therapy services, 
speech-language pathology services and respiratory therapy services.
    (i) Nursing care services. Nursing care services include nursing 
services provided by a registered nurse that are prescribed by a 
physician and are specified in or directly related to the 
rehabilitation treatment plan and necessary for the attainment of the 
rehabilitation goals of the physical therapy, occupational therapy, 
speech-language pathology, or respiratory therapy plan of treatment.
    (j) Supplies and durable medical equipment. Supplies and durable 
medical equipment include the following:
    (1) Disposable supplies.
    (2) Durable medical equipment of the type specified in Sec.  410.38 
(except for renal dialysis systems) for a patient's use outside the 
CORF, whether purchased or rented.
    (k) Home environment evaluation. A home environment evaluation--
    (1) Is a single home visit to evaluate the potential impact of the 
home situation on the patient's rehabilitation goals.
    (2) Requires the presence of the patient and the physical 
therapist, occupational therapist, or speech-language pathologist, as 
appropriate.
    13. Section 410.105 is amended by revising paragraphs (b)(3)(i) and 
(ii), (c)(1) introductory text, and (c)(1)(ii) to read as follows:


Sec.  410.105  Requirements for coverage of CORF services.

* * * * *
    (b) * * *
    (3) * * *
    (i) Physical therapy, occupational therapy, and speech-language 
pathology services may be furnished away from the premises of the CORF 
including the individual's home when payment is not otherwise made 
under Title XVIII of the Act.
    (ii) The single home environment evaluation visit specified in 
Sec.  410.100(m) is also covered.
    (c) * * *
    (1) The service must be furnished under a written rehabilitation 
plan of treatment that--
    (i) * * *
    (ii) Indicates the diagnosis and rehabilitation goals, and 
prescribes the type, amount, frequency, and duration of the services to 
be furnished that relate directly to such rehabilitation goals.
* * * * *

Subpart G--Medical Nutrition Therapy

    14. Section 410.132 is amended by revising paragraph (a) to read as 
follows:


Sec.  410.132  Medical nutrition therapy.

    (a) Conditions for coverage of MNT services. Medicare Part B pays 
for MNT services provided by a registered dietitian or nutrition 
professional as defined in Sec.  410.134 when the beneficiary is 
referred for the service by the treating physician. Except as provided 
at Sec.  410.78, services covered consist of face-to-face nutritional 
assessments and interventions in accordance with nationally-accepted 
dietary or nutritional protocols.
* * * * *

PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE 
PAYMENT

    15. The authority citation for part 411 continues to read as 
follows:

    Authority: Secs. 1102, 1860D-1 through 1860D-42, 1871, and 1877 
of the Social Security Act (42 U.S.C. 1302, 1395w-101 through 1395w-
152, 1395hh, and 1395nn).

Subpart A--General Exclusions and Exclusion of Particular Services

    16. Section 411.15 is amended by--
    A. Revising paragraph (a)(1).
    B. Adding paragraphs (k)(13) and (k)(14).
    The revision and additions read as follows:


Sec.  411.15  Particular services excluded from coverage.

* * * * *
    (a) * * *
    (1) Examinations performed for a purpose other than treatment or 
diagnosis of a specific illness, symptoms, complaint, or injury, except 
for screening mammography, colorectal cancer screening tests, screening 
pelvic exams, prostate cancer screening tests, glaucoma screening 
exams, initial preventive physical exams, ultrasound screening for 
abdominal aortic aneurysms (AAA), cardiovascular disease screening 
tests, or diabetes screening tests that meet the criteria specified in 
paragraphs (k)(6) through (k)(14) of this section.
* * * * *
    (k) * * *
    (13) In the case of cardiovascular disease screening tests for the 
early detection of cardiovascular disease or abnormalities associated 
with an elevated risk for that disease, subject to the conditions 
specified in Sec.  410.17 of this chapter.
    (14) In the case of diabetes screening tests furnished to an 
individual at risk for diabetes for the purpose of the early detection 
of that disease, subject to the conditions specified in Sec.  410.18 of 
this chapter.
* * * * *

[[Page 38224]]

Subpart J--Financial Relationships Between Physicians and Entities 
Furnishing Designated Health Services

    17. Section 411.351 is amended by revising the definition of 
``entity'' to read as follows:


Sec.  411.351  Definitions.

* * * * *
    Entity means--
    (1) A physician's sole practice or a practice of multiple 
physicians or any other person, sole proprietorship, public or private 
agency or trust, corporation, partnership, limited liability company, 
foundation, nonprofit corporation, or unincorporated association that 
furnishes DHS. An entity does not include the referring physician 
himself or herself, but does include his or her medical practice. A 
person or entity is considered to be furnishing DHS if it--
    (i) Is the person or entity that has performed the DHS, or
    (ii) Presented a claim or caused a claim to be presented for 
Medicare benefits for the DHS.
    (2) For purposes of this subpart, ``entity'' includes a health 
plan, managed care organization (MCO), provider sponsored organization 
(PSO), or independent practice association (IPA) that employs a 
supplier or operates a facility that could accept reassignment from a 
supplier pursuant to Sec.  424.80 of this chapter, with respect to any 
designated health services provided by that supplier; ``entity'' does 
not include a health care delivery system that is a health plan (as 
defined in Sec.  1001.952(l) of this title), or any MCO, PSO or IPA 
with which a health plan contracts for services provided to plan 
enrollees.
    (3) For purposes of this subpart, ``entity'' does not include a 
physician's practice when it bills Medicare for a diagnostic testing 
accordance with Sec.  414.50 of this chapter (Physician billing for 
purchased diagnostic tests) and section 30.2.9 of the Internet-Only 
Manual, Pub.100-04, Chapter 1, General Billing Requirements.
* * * * *
    18. Section 411.353 is amended by adding paragraph (g) to read as 
follows:


Sec.  411.353  Prohibition on certain referrals by physicians and 
limitations on billing.

* * * * *
    (g) Denial of payment for services furnished under a prohibited 
referral. When payment for a designated health service is denied on the 
basis that the service was furnished pursuant to a prohibited referral, 
and such payment denial is appealed, the burden is on the entity 
submitting the claim for payment to establish that the service was not 
furnished pursuant to a prohibited referral (and not on CMS or its 
contractors to establish that the service was furnished pursuant to a 
prohibited referral).
    19. Section 411.354 is amended by revising paragraphs (b)(3)(i) and 
(d)(1) to read as follows:


Sec.  411.354  Financial relationship, compensation, and ownership or 
investment interest.

* * * * *
    (b) * * *
    (3) * * *
    (i) An interest in an entity that arises from a retirement plan 
offered by that entity to the physician or immediate family member 
through the physician's or immediate family member's employment with 
that entity;
* * * * *
    (d) * * *
    (1) Compensation will be considered ``set in advance'' if the 
aggregate compensation, a time-based or per unit of service based 
(whether per-use or per-service) amount, or a specific formula for 
calculating the compensation is set in an agreement between the parties 
before the furnishing of the items or services for which the 
compensation is to be paid. The formula for determining the 
compensation must be set forth in sufficient detail so that it can be 
objectively verified, and the formula may not be changed or modified 
during the course of the agreement in any manner that reflects the 
volume or value of referrals or other business generated by the 
referring physician. Percentage-based compensation, other than 
compensation based on revenues directly resulting from personally 
performed physician services (as defined in Sec.  410.20(a)), is not 
considered set in advance.
* * * * *
    20. Section 411.357 is amended by revising paragraphs (a)(5) and 
(b)(4) to read as follows:


Sec.  411.357  Exceptions to the referral prohibition related to 
compensation arrangements.

* * * * *
    (a) * * *
    (5) The rental charges over the term of the agreement are not 
determined in a manner that takes into account the volume or value of 
any referrals or other business generated between the parties. Per 
unit-of-service rental charges are not allowed to the extent that such 
charges reflect services provided to patients referred by the lessor to 
the lessee.
* * * * *
    (b) * * *
    (4) The rental charges over the term of the agreement are set in 
advance, are consistent with fair market value, and are not determined 
in a manner that takes into account the volume or value of any 
referrals or other business generated between the parties. Per unit-of-
service rental charges are not allowed to the extent that such payments 
reflect services provided to patients referred by the lessor to the 
lessee.
* * * * *

PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR 
END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT 
RATES FOR SKILLED NURSING FACILITIES

    21. The authority citation for part 413 continues to read as 
follows:

    Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and 
(n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act 
(42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 
1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww); and sec. 124 of Pub. 
L. 106-133 (113 Stat. 1501A-332).

Subpart A--Introduction and General Rules


Sec.  413.1  [Amended]

    22. Section 413.1 is amended by--
    A. Removing paragraphs (a)(2)(iv) and (vi).
    B. Redesignating paragraphs (a)(2)(v) and (vii) as paragraphs 
(a)(2)(iv) and (v), respectively.

Subpart H--Payment for End-Stage Renal Disease (ESRD) Services and 
Organ Procurement Costs

    23. Section 413.184 is amended by revising the section heading as 
set forth below:


Sec.  413.184  Payment exception: Pediatric patient mix.

* * * * *

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

    24. The authority citation for part 414 is revised to read as 
follows:

    Authority: Secs. 1102, 1871, and 1881(b)(l) of the Social 
Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(l)).

Subpart B--Physicians and Other Practitioners

    25. Section 414.50 is revised to read as follows:

[[Page 38225]]

Sec.  414.50  Physician billing for purchased diagnostic tests.

    (a) General rule. (1) For services covered under section 1861(s)(3) 
of the Act and paid for under part 414 of this chapter (other than 
clinical diagnostic laboratory tests paid under section 1833(a)(2)(D) 
of the Act, which are subject to the special rules set forth in section 
1833(h)(5)(A) of the Act), if a physician or medical group bills for 
the technical or professional component of a diagnostic test that was 
performed by an outside supplier, the payment to the physician or the 
medical group (less the applicable deductibles and coinsurance) for the 
technical or professional component of the test may not exceed the 
lowest of the following amounts:
    (i) The supplier's net charge to the physician or medical group.
    (ii) The physician's or medical group's actual charge.
    (iii) The fee schedule amount for the test that would be allowed if 
the supplier billed directly.
    (2) This provision applies regardless of whether the test or its 
interpretation was purchased by the physician or medical group billing 
for the test or the interpretation, or whether the right to bill for 
the test or its interpretation was reassigned to the physician or 
medical group billing for the test or the interpretation.
    (3) For purposes of paragraph (a) of this section--
    (i) The physician's or other supplier's net charge must be 
determined without regard to any charge that is intended to reflect the 
cost of equipment or space leased to the outside supplier by or through 
the billing physician or medical group.
    (ii) An outside supplier is someone other than a full-time employee 
of the billing physician or medical group.
    (b) Restriction on payment. (1) The physician or medical group must 
identify the supplier and indicate the supplier's net charge for the 
test. If the physician or medical group fails to provide this 
information, CMS makes no payment to the physician or medical group and 
the physician or medical group may not bill the beneficiary.
    (2) Physicians and medical groups that accept Medicare assignment 
may bill beneficiaries for only the applicable deductibles and co-
insurance.
    (3) Physicians and medical groups that do not accept Medicare 
assignment may not bill the beneficiary more than the payment amount 
described in paragraph (a) of this section.
    26. Section 414.65 is amended by revising paragraph (a)(1) to read 
as follows:


Sec.  414.65  Payment for telehealth services.

    (a) * * *
    (1) The Medicare payment amount for office or other outpatient 
visits, consultation, individual psychotherapy, psychiatric diagnostic 
interview examination, pharmacologic management, end stage renal 
disease related services included in the monthly capitation payment 
(except for one visit per month to examine the access site), individual 
medical nutrition therapy, and neurobehavioral status exam furnished 
via an interactive telecommunications system is equal to the current 
fee schedule amount applicable for the service of the physician or 
practitioner.
* * * * *

Subpart G--Payment for New Clinical Diagnostic Laboratory Tests

    27. Section Sec.  414.502 is amended by adding the definition, 
``New test'' in alphabetical order to read as follows:


Sec.  414.502  Definitions.

* * * * *
    New test means any clinical diagnostic laboratory test for which a 
new or substantially revised Healthcare Common Procedure Coding System 
Code is assigned on or after January 1, 2005.
* * * * *
    28. Section 414.506 is amended by revising the introductory text to 
read as follows:


Sec.  414.506  Procedures for public consultation for payment for a new 
clinical diagnostic laboratory test.

    For a new test, CMS determines the basis for and amount of payment 
after performance of the following:
* * * * *
    29. Section 414.508 is amended by revising paragraph (b)(3) to read 
as follows:.


Sec.  414.508  Payment for a new clinical diagnostic laboratory test.

* * * * *
    (b) * * *
    (3) For a new test for which a new or substantially revised HCPCS 
code was assigned on or before December 31, 2007, after the first year 
of gapfilling, CMS determines whether the carrier-specific amounts will 
pay for the test appropriately. If CMS determines that the carrier-
specific amounts will not pay for the test appropriately, CMS may 
crosswalk the test.
    30. Section 414.509 is added to read as follows:


Sec.  414.509  Reconsideration of basis for and amount of payment for a 
new clinical diagnostic laboratory test.

    For a new test for which a new or substantially revised HCPCS code 
was assigned on or after January 1, 2008, the following reconsideration 
procedures apply:
    (a) Reconsideration of basis for payment. (1) CMS will receive 
public comments in written format for 60 days after making a 
determination of the basis for payment under Sec.  414.506(d)(2) 
regarding whether CMS should reconsider the basis for payment and why a 
different basis for payment would be more appropriate. If a commenter 
recommends that the basis for payment should be changed from gapfilling 
to crosswalking, the commenter may also recommend the code or codes to 
which to crosswalk the new test.
    (2) At the meeting convened under Sec.  414.506(c), those 
commenters who submitted comments within the 60-day comment period may 
present their comments.
    (3) Considering comments received, CMS may reconsider its 
determination of the basis for payment. As the result of such a 
reconsideration, CMS may change the basis for payment from crosswalking 
to gapfilling or from gapfilling to crosswalking.
    (4) If the basis for payment is revised as the result of a 
reconsideration, the new basis for payment is final and is not subject 
to further reconsideration.
    (b) Reconsideration of amount of payment--(1) Crosswalking. (i) For 
60 days after making a determination under Sec.  414.506(d)(2) of the 
code or codes to which a new test will be crosswalked, CMS receives 
public comments in written format regarding whether CMS should 
reconsider its determination and the recommended code or codes to which 
to crosswalk the new test.
    (ii) At the meeting convened under Sec.  414.506(c), those 
commenters who submitted comments within the 60-day comment period may 
present their comments.
    (iii) Considering comments received, CMS may reconsider its 
determination of the amount of payment. As the result of such a 
reconsideration, CMS may change the code or codes to which the new test 
is crosswalked.
    (iv) If CMS changes the basis for payment from gapfilling to 
crosswalking as a result of a reconsideration, the crosswalked amount 
of payment is not subject to reconsideration.
    (2) Gapfilling. (i) By April 30 of the year after CMS makes a 
determination under Sec.  414.506(d)(2) or Sec.  414.509(a)(3) that the 
basis for payment for a new test will be gapfilling, CMS posts interim

[[Page 38226]]

carrier-specific amounts on the CMS Web site.
    (ii) For 60 days after CMS posts interim carrier-specific amounts 
on the CMS Web site, CMS will receive public comments in written format 
regarding whether CMS should reconsider the interim payment amounts and 
the appropriate national limitation amount for the new test.
    (iii) Considering comments received, CMS may reconsider its 
determination of the amount of payment. As the result of a 
reconsideration, CMS may revise the national limitation amount for the 
new test.
    (3) For both gapfilled and crosswalked new tests, if CMS revises 
the amount of payment as the result of a reconsideration, the new 
amount of payment is final and is not subject to further 
reconsideration.
    (c) Effective date. If CMS changes a determination as the result of 
a reconsideration, the new determination regarding the basis for or 
amount of payment is effective January 1 of the year following 
reconsideration. Claims for services with dates of service prior to the 
effective date will not be reopened or otherwise reprocessed.
    (d) Jurisdiction for Reconsideration Decisions. Jurisdiction for 
reconsidering a determination rests exclusively with the Secretary. A 
decision whether to reconsider a determination is committed to the 
discretion of the Secretary. A decision not to reconsider an initial 
determination is not subject to administrative or judicial review.
    31. Section 414.510 is amended by--
    A. Revising the section heading to read as set forth below.
    B. Revising the introductory text.
    The revisions read as follows:


Sec.  414.510  Laboratory date of service for clinical laboratory and 
pathology specimens.

    The date of service for either a clinical laboratory test or the 
technical component of physician pathology service is as follows:
* * * * *

Subpart H--Fee Schedule for Ambulance Services


Sec.  414.620  [Amended]

    32. In Sec.  414.620, the phrase ``notice in the Federal Register 
without opportunity for prior comment'' is removed and the phrase ``CMS 
by instruction and on the CMS Web site'' is added in its place.

Subpart I--Payment for Drugs and Biologicals

    33. Section 414.707 is amended by adding paragraph (c) to read as 
follows:


Sec.  414.707  Basis of payment.

* * * * *
    (c) Mandatory reporting of anemia quality indicators for Medicare 
part B cancer anti-anemia drugs. Effective January 1, 2008, each 
request for payment for anti-anemia drugs furnished to treat anemia 
resulting from the treatment of cancer must report the beneficiary's 
most recent hemoglobin or hematocrit level in a manner specified by the 
Secretary.

Subpart J--Submission of Manufacturer's Average Sales Price Data

    34. Section 414.802 is amended by adding the definition of 
``bundled arrangement'' in alphabetical order to read as follows:


Sec.  414.802  Definitions.

* * * * *
    Bundled arrangement means an arrangement regardless of physical 
packaging under which the rebate, discount, or other price concession 
is conditioned upon the purchase of the same drug or biological or 
other drugs or biologicals or some other performance requirement (for 
example, the achievement of market share, inclusion or tier placement 
on a formulary, purchasing patterns, prior purchases), or where the 
resulting discounts or other price concessions are greater than those 
that would have been available had the bundled drugs or biologicals 
been purchased separately or outside of the bundled arrangement.
* * * * *
    35. Section 414.804 is amended by adding paragraph (a)(2)(iii) to 
read as follows:


Sec.  414.804  Basis of payment.

    (a) * * *
    (2) * * *
    (iii) For the purposes of paragraph (a)(2)(i) of this section, the 
total value of all price concessions on all drugs sold under a bundled 
arrangement must be allocated proportionately according to the dollar 
value of the units of each drug sold under the bundled arrangement.
* * * * *

Subpart K--Payment for Drugs and Biologicals Under Part B

    36. Section 414.904 is amended by revising paragraph (d)(3) to read 
as follows:


Sec.  414.904  Average sales price as the basis for payment.

* * * * *
    (d) * * *
    (3) Widely available market price and average manufacturer price. 
If the Inspector General finds that the average sales price exceeds the 
widely available market price or the average manufacturer price by 5 
percent or more in calendar year 2008, the payment limit in the quarter 
following the transmittal of this information to the Secretary is the 
lesser of the widely available market price or 103 percent of the 
average manufacturer price.
* * * * *
    37. Section 414.908 is amended by--
    A. Revising paragraph (a)(2)(iv).
    B. Revising paragraph (a)(3)(xi).
    C. Removing paragraph (a)(5).
    The revision reads as follows:


Sec.  414.908  Competitive acquisition program.

    (a) * * *
    (2) * * *
    (iv) For other exigent circumstances defined by CMS, including--
    (A) If the approved CAP vendor refuses to ship to the participating 
CAP physician because the conditions of Sec.  414.914(h) have been met, 
the physician can withdraw from the CAP category for the remainder of 
the year immediately upon notice to CMS and the approved CAP vendor.
    (B) If, during the first 30 days of participation in the CAP, the 
participating physician can document significant burden to the practice 
and the physician has attempted resolution through the vendor's 
grievance process, the CAP dispute resolution process, and the request 
has been approved by CMS.
    (3) * * *
    (xi) Agrees to submit documentation such as medical records or 
certification, as necessary, to support payment for a CAP drug;
* * * * *
    38. Section 414.914 is amended by--
    A. Redesignating paragraph (h) as (i)
    B. Adding new paragraph (h).
    C. Revising new paragraphs (i)(1) and (2).
    The addition and revision reads as follows:


Sec.  414.914  Terms of contract.

* * * * *
    (h) The approved CAP vendor must verify drug administration prior 
to collection of any applicable cost sharing amount.
    (1) The approved CAP vendor is expected to document, in writing, 
the following information necessary to verify drug administration:

[[Page 38227]]

    (i) Beneficiary's name.
    (ii) Medicare health insurance number (HIC).
    (iii) Expected date of service.
    (iv) Actual date of service.
    (v) Name of the CAP physician.
    (vi) CAP prescription order number.
    (2) If the information is obtained verbally, the approved CAP 
vendor must also maintain the following information:
    (i) The identities of individuals who exchanged the information.
    (ii) The date and time that the information was obtained.
    (3) The approved CAP vendor must provide this information to CMS or 
the beneficiary upon request.
    (i) * * *
    (1) Subsequent to receipt of payment by Medicare, or the 
verification of drug administration by the participating CAP physician, 
the approved CAP vendor must bill any applicable supplemental insurance 
policies.
    (2) An approved CAP vendor that has received payment for the CAP-
designated carrier for CAP drugs that have not been administered must 
promptly refund payment for such drugs to the CAP-designated carrier 
and must refund any coinsurance and deductible collected from the 
beneficiary and his or her supplemental insurer.
* * * * *
    39. Section 414.917 is amended by--
    A. Revising the section heading.
    B. Adding paragraph (d).
    The revision and addition reads as follows:


Sec.  414.917  Dispute resolution and process for suspension or 
termination of approved CAP contract and termination of physician 
participation under exigent circumstances.

* * * * *
    (d) CAP participating physicians' exigent circumstances provision. 
The following process must be completed for CAP participating 
physicians' requesting to terminate their participation in the program 
under exigent circumstances provisions described in Sec.  
414.908(a)(2)(iv):
    (1) The designated carrier must--
    (i) Determine whether a request to terminate CAP participation was 
related to approved CAP vendor service and whether to forward the issue 
to the approved CAP vendor's grievance process within 1 business day of 
the receipt of the request; or,
    (ii) Continue to investigate and within 2 business days of receipt, 
and may do any of the following:
    (A) Request a single, 2-business day extension.
    (B) Recommend to CMS that the requesting physician be permitted to 
terminate his or her participation in the CAP.
    (C) Recommend to CMS that the physician not be permitted to 
terminate his or her participation in the CAP and refer to the CAP 
designated carrier's dispute resolution process.
    (2) As a result of the findings as specified in paragraph (d)(1) of 
the section, CMS will--:
    (i) Consider the designated carrier's recommendation and approve or 
deny the request to terminate participation in the CAP within 2 
business days of receipt of the recommendation. A denial of the 
participating CAP physician's request to terminate participation in the 
CAP and will include notification of the right to request 
reconsideration under this section.
    (ii) Communicate the decision to the appropriate Medicare 
contractors and the participating CAP physician.
    (3) Upon termination of participation in the CAP a physician must 
agree to the following:
    (i) Continue to submit claims for drugs supplied and administered 
under the CAP prior to the effective date of the physician's 
termination consistent with Sec.  414.908(a) until all such claims are 
timely submitted.
    (ii) Return any unused CAP drugs that had not been administered to 
the beneficiary prior to the effective date of the physician's 
termination from the CAP to the approved CAP vendor consistent with 
applicable law and regulation and any agreement with the approved CAP 
vendor.
    (iii) Cooperate in any post-payment review activities on claims 
submitted under the CAP, as required under section 1847B(a)(3) of the 
Act.
    (4) An approved CAP vendor that has billed and been paid for CAP 
drugs that have not been administered must refund any payments made by 
CMS or the beneficiary and his or her supplemental insurer in 
accordance with Sec.  414.914(h)(3)(i)(2).
    40. Section 414.930 is added to subpart K to read as follows:


Sec.  414.930  Compendia for determination of medically-accepted 
indications for off-label uses of drugs and biologicals in an anti-
cancer chemotherapeutic regimen.

    (a) Definition. For purposes of this section, compendium means a 
comprehensive listing of FDA-approved drugs and biologicals or a 
comprehensive listing of a specific subset of drugs and biologicals in 
a specialty compendium, for example a compendium of anti-cancer 
treatment. A compendium includes a summary of the pharmacologic 
characteristics of each drug or biological and may include information 
on dosage, as well as recommended or endorsed uses in specific 
diseases. A compendium is indexed by drug or biological.
    (b) Process for listing compendia for determining medically-
accepted uses of drugs and biologicals in anti-cancer treatment. (1) 
The process states that CMS--
    (i) Solicits requests annually for changes to the list of 
compendia. This solicitation specifies a 30-day time period within 
which CMS receives requests, to begin no earlier than 45 days after 
publication of the solicitation.
    (ii) Publishes a listing of the timely complete requests received 
and solicit public comment on the requests for 30 days. The listing 
identifies the requestor and the requested action.
    (iii) Considers a compendium's attainment of the MedCAC (Medicare 
Evidence Development and Coverage Advisory Committee, previously known 
as the MCAC-Medicare Coverage Advisory Committee) recommended desirable 
characteristics of compendia in reviewing requests. CMS may consider 
additional reasonable factors.
    (iv) Considers a compendium's grading of evidence used in making 
recommendations regarding off-label uses and the process by which the 
compendium grades the evidence.
    (v) Publishes its decision no later than 120 days after the close 
of the public comment period.
    (2) Exception. In addition to the annual process outlined in 
paragraph (b)(1) of this section, CMS may generate a request for 
changes to the list of compendia at any time.
    (c) Written request for review. (1) CMS will review a complete, 
written request that is submitted in writing, electronically or via 
hard copy (no duplicate submissions) and includes the following:
    (i) The full name and contact information of the requestor.
    (ii) The full identification of the compendium that is the subject 
of the request, including name, publisher, edition if applicable, date 
of publication, and any other information needed for the accurate and 
precise identification of the specific compendium.
    (iii) A complete written copy of the compendium that is the subject 
of the request.
    (iv) The specific action that is requested of CMS.
    (v) Materials that the requestor must submit for CMS review in 
support of the requested action.
    (vi) A single compendium as its subject.

[[Page 38228]]

    (2) CMS may at its discretion combine and consider multiple 
requests that refer to the same compendium.
    (d) Other provisions. (1) For each compendium that is determined by 
CMS to be included on the list, the publisher or its designee must 
notify CMS, within 45 days of any update or revision that a new edition 
or version is available. Failure to meet this requirement may result in 
removal of the compendium from the list.
    (2) For the purposes of this section, publication by CMS may be 
accomplished by posting on the CMS Web site.
    41. Subpart M is added to read as follows:

Subpart M--Payment for Comprehensive Outpatient Rehabilitation 
Facility (CORF) Services


Sec.  414.1100  Basis and Scope.

    This subpart implements sections 1834(k)(1) and (k)(3) of the Act 
by specifying the payment methodology for comprehensive outpatient 
rehabilitation facility services covered under Part B of Title XVIII of 
the Act that are described at section 1861(cc)(1) of the Act.


Sec.  414.1105  Payment for Comprehensive Outpatient Rehabilitation 
Facility (CORF) Services.

    (a) Payment under the physician fee schedule. Except as otherwise 
specified under paragraphs (b), (c), and (d) of this section payment 
for CORF services, as defined under Sec.  410.100 of this chapter, is 
paid the lesser of 80 percent of the following:
    (1) The actual charge for the item or service; or
    (2) The nonfacility amount determined under the physician fee 
schedule established under section 1848(b) of the Act for the item or 
service.
    (b) Payment for physician services. No separate payment for 
physician services that are CORF services under Sec.  410.100(a) of 
this chapter will be made.
    (c) Payment for supplies and durable medical equipment, and 
prosthetic and orthotic devices. Supplies and durable medical equipment 
that are CORF services under Sec.  410.100(l) of this chapter, 
prosthetic device services that are CORF services under Sec.  
410.100(f) and orthotic devices that are CORF services under Sec.  
410.100(g) of this chapter are paid the lesser of 80 percent of the 
following:
    (1) The actual charge for the service provided that payment for 
such item is not included in the payment amount for other CORF services 
paid under paragraph (a) of this section; or
    (2) The amount determined under the DMEPOS fee schedule established 
under part 414 Subparts D and F for the item, provided that payment for 
such item is not included in the payment amount for other CORF services 
paid under paragraph (a) of this section.
    (d) Payment for CORF services when no fee schedule amount for the 
service. If there is no fee schedule amount established for a CORF 
service, payment for the item or service will be the lesser of 80 
percent of:
    (i) The actual charge for the service provided that payment for 
such item or service is not included in the payment amount for other 
CORF services paid under paragraphs (a) or (c) of this section.
    (ii) The amount determined under the fee schedule established for a 
comparable service as specified by the Secretary provided that payment 
for such item or service is not included in the payment amount for 
other CORF services paid under paragraphs (a) or (c) of this section.

PART 415--SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, 
SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN 
CERTAIN SETTINGS

    42. The authority citation for part 415 continues to read as 
follows:

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

Subpart C--Part B Carrier Payments for Physician Services to 
Beneficiaries in Providers

    43. Section 415.130 is amended by revising paragraph (d) to read as 
follows:


Sec.  415.130  Conditions for payment: Physician pathology services.

* * * * *
    (d) Physician pathology services furnished by an independent 
laboratory. The technical component of physician pathology services 
furnished by an independent laboratory to a hospital inpatient or 
outpatient on or before December 31, 2007, may be paid to the 
laboratory by the carrier under the physician fee schedule if the 
Medicare beneficiary is a patient of a covered hospital as defined in 
paragraph (a)(1) of this section. For services furnished after December 
31, 2007, an independent laboratory may not bill the carrier for the 
technical component of physician pathology services furnished to a 
hospital inpatient or outpatient. For services furnished on or after 
January 1, 2008, the date of service policy in Sec.  414.510 of this 
chapter applies for the technical component of specimens for physician 
pathology services.

PART 418--HOSPICE CARE

    44. The authority citation for part 418 continues to read as 
follows:

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

Subpart E--Condition of Participation: Other Services

    45. Section 418.92 is amended by revising paragraph (a) to read as 
follows:


Sec.  418.92  Condition of participation--Physical therapy, 
occupational therapy, and speech-language pathology.

    (a) Physical therapy, occupational therapy, and speech-language 
pathology services must be--
    (1) Available, and when provided, offered in a manner consistent 
with accepted standards of practice; and
    (2) Furnished by personnel who meet the qualifications specified in 
Sec.  484.4 of this chapter.
* * * * *

PART 423--VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT

    46. The authority citation for part 423 continues to read as 
follows:

    Authority: Secs 1102, 1860D'1 through 1860D'42, and 1871 of the 
Social Security Act (42 U.S.C. 1302, 1395w'101 through 1395w'152, 
and 1395hh).

Subpart D--Cost Control and Quality Improvement Requirements


Sec.  423.160  [Amended]

    47. Section 423.160 is amended by--
    A. Removing paragraph (a)(3)(i).
    B. Redesignating paragraphs (a)(3)(ii) and (iii) to (a)(3)(i) and 
(ii), respectively.

PART 424--CONDITIONS FOR MEDICARE PAYMENT

    48. The authority citation for part 424 continues to read as 
follows:

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

Subpart B--Certification and Plan of Treatment Requirements

    49. Section 424.24 is amended by revising paragraphs (c)(2) and 
(c)(4) to read as follows:


Sec.  424.24  Requirements for medical and other health services 
furnished by providers under Medicare Part B.

* * * * *
    (c) * * *

[[Page 38229]]

    (2) Timing. The certification must be obtained at the time the plan 
of treatment is established or as soon thereafter as possible.
    (4) Recertification--(i) Timing. Recertification is required at 
least every 90 days.
    (ii) Content. When it is recertified, the plan or other 
documentation in the patient's record must indicate the continuing need 
for physical therapy, occupational therapy or speech-language pathology 
services.
    (iii) Signature. The physician, nurse practitioner, clinical nurse 
specialist, or physician assistant who reviews the plan of treatment 
must recertify the plan by signing the medical record.
* * * * *

Subpart C--Claims for Payment

    50. Section 424.36 is amended by adding paragraph (b)(6) to read as 
follows:


Sec.  424.36  Signature requirements.

* * * * *
    (b) * * *
    (6) An ambulance provider or supplier with respect to emergency 
ambulance transport services, if the following conditions and 
documentation requirements are met.
    (i) None of the individuals listed in paragraphs (b)(1) through 
(b)(5) of this section was available or willing to sign the claim on 
behalf of the beneficiary at the time the service was provided;
    (ii) The ambulance provider or supplier maintains in its files the 
following information and documentation for a period of at least 4 
years from the date of service:
    (A) A contemporaneous statement, signed by an ambulance employee 
present during the trip to the receiving facility, that at the time the 
service was provided the beneficiary was physically or mentally 
incapable of signing the claim and that none of the individuals listed 
in paragraphs (b)(1) through (5) of this section were available or 
willing to sign the claim on behalf of the beneficiary.
    (B) Documentation with the date and time the beneficiary was 
transported, and the name and location of the facility that received 
the beneficiary.
    (C) A signed contemporaneous statement from a representative of the 
facility that received the beneficiary, which documents the name of the 
beneficiary and the date and time the beneficiary was received by that 
facility.
* * * * *


Sec.  424.37  [Amended]

    51. Section 424.37(a) is amended by removing the reference to 
``Sec.  424.36(b)'' and adding in its place the reference ``Sec.  
424.36(b)(1) through (5).''

Subpart F--Limitations on Assignment and Reassignment of Claims

    52. Section 424.80 is amended by adding paragraph (d)(3) to read as 
follows:


Sec.  424.80  Prohibition of reassignment of claims by suppliers.

* * * * *
    (d) * * *
    (3) Reassignment of the technical or professional component of 
diagnostic test services. If a physician or medical group bills for the 
technical or professional component of a diagnostic test covered under 
section 1861(s)(3) of the Act and paid for under part 414 of this 
chapter (other than clinical diagnostic laboratory tests paid under 
section 1833(a)(2)(D) of the Act, which are subject to the special 
rules set forth in section 1833(h)(5)(A) of the Act), following a 
reassignment from a physician or other supplier who performed the 
technical or professional component and who was not a full-time 
employee of the billing physician or medical group at the time the 
service was performed, each of the following conditions must be met:
    (i) The payment to the billing physician, or medical group, less 
the applicable deductibles and coinsurance, may not exceed the lowest 
of the following amounts:
    (A) The physician's or other supplier's net charge to the billing 
physician or medical group. The physician's or other supplier's net 
charge must be determined without regard to any charge that is intended 
to cover or address the cost of equipment or space leased to the 
physician or the other supplier by or through the billing physician or 
medical group.
    (B) The billing physician's or medical group's actual charge.
    (C) The fee schedule amount for the service that would be allowed 
if the physician or other supplier billed directly.
    (ii) The physician or medical group billing for the test must 
identify the physician or other supplier that performed the test and 
indicate the supplier's net charge for the test. If the physician or 
medical group billing for the test fails to provide this information, 
CMS will not make any payment to the physician or medical group billing 
for the test and the billing physician or medical group can not bill 
the beneficiary.
    (iii) To bill for the technical component of the service, the 
physician or medical group must directly perform the professional 
component of the service.

PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS

    53. The authority citation for part 482 continues to read as 
follows:

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

Subpart D--Optional Hospital Services

    54. Section 482.56 is amended by revising paragraphs (a)(2) and (b) 
to read as follows:


Sec.  482.56  Condition of participation: Rehabilitation services.

    (a) * * *
    (2) Services must be given in accordance with orders of 
practitioners who are authorized by the medical staff to order the 
services, and the orders must be incorporated in the patient's record.
    (b) Standard: Delivery of services. (1) Except as specified in 
paragraph (c)(1)(ii) of this section, physical therapy, occupational 
therapy, or speech-language pathology services must be furnished--
    (i) By qualified physical therapists, physical therapist 
assistants, occupational therapists, occupational therapist assistants, 
speech-language pathologists, or audiologists as defined in Sec.  484.4 
of this chapter; or
    (ii) By qualified physical therapists, physical therapist 
assistants, occupational therapists, or occupational therapy assistants 
who have been licensed, certified, registered, or otherwise recognized 
by the State in which practicing before January 1, 2008 and continue to 
furnish Medicare services at least part time without an interruption in 
furnishing services of more than 2 years.
    (2) The physical therapy, occupational therapy, or speech-language 
pathology must be in accordance with a written plan of treatment that 
meets the requirements of paragraphs (b)(3)(i) through (b)(3)(iv) of 
this section.
    (3) Plan of treatment requirements--(i) Establishment of the plan. 
The plan must be established by one of the following before treatment 
begins:
    (A) A physician.
    (B) A nurse practitioner, a clinical nurse specialist, or a 
physician assistant.
    (C) The physical therapist furnishing the physical therapy 
services.
    (D) The speech-language pathologist furnishing the speech-language 
pathology services.

[[Page 38230]]

    (E) The occupational therapist furnishing the occupational therapy 
services.
    (ii) Content of the plan. The plan must--
    (A) Prescribe the type, amount, frequency, and duration of the 
physical therapy, occupational therapy, or speech-language pathology 
services to be furnished to the individual; and
    (B) Indicate the diagnosis and anticipated goals.
    (iii) Changes in the plan. Any changes in the plan must be made in 
writing, incorporated immediately, and signed by one of the following:
    (A) A physician.
    (B) A nurse practitioner, clinical nurse specialist, or a physician 
assistant.
    (C) The physical therapist furnishing the physical therapy 
services.
    (D) The speech-language pathologist furnishing the speech-language 
pathology services.
    (E) The occupational therapist furnishing the occupational therapy 
services.
    (F) A registered professional nurse or a staff physician, in 
accordance with verbal orders from one the practitioners listed in 
paragraphs (b)(3)(iii)(A) through (iii)(E) of this section.
    (iv) Review of the plan. The physician, nurse practitioner, 
clinical nurse specialist, or physician assistant reviews the plan as 
often as the individual's condition requires, but at least at the time 
of certification and at recertification, if applicable.

PART 484--HOME HEALTH SERVICES

    55. The authority citation for part 484 continues to read as 
follows:

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

Subpart A--General Provisions

    56. Section 484.4 is amended by revising the definitions of 
``Occupational therapist,'' ``Occupational therapy assistant,'' 
``Physical therapist,'' ``Physical therapist assistant'' and ``Speech-
language pathologist'' to read as follows:


Sec.  484.4  Personnel Qualifications.

* * * * *
    Occupational therapist. A person who meets one of the one of the 
following requirements:
    (1) Requirements for individuals beginning their practice on or 
after January 1, 2008. Meets all practice requirements set forth by the 
State in which occupational therapy services are furnished and meets 
one of the following educational/training requirements on or after 
January 1, 2008:
    (i)(A) Graduated after successful completion of an occupational 
therapist curriculum accredited by the Accreditation Council for 
Occupational Therapy Education (ACOTE) of the American Occupational 
Therapy Association, Inc. (AOTA); and
    (B) Successfully completed the National Registration Examination 
for occupational therapists developed and administered by the National 
Board for Certification in Occupational Therapy, Inc. (NBCOT).
    (ii) If educated outside the United States, or trained by the 
United States military--
    (A) Graduated after successful completion of an occupational 
therapist curriculum accredited by the World Federation of Occupational 
Therapists, (WFOT));
    (B) Is deemed eligible to test as a result of completing the NBCOT 
International Occupational Therapy Eligibility Determination (IOTED) 
review; and
    (C) Successfully completed the National Registration Examination 
developed and administered by the National Board for Certification in 
Occupational Therapy, Inc. (NBCOT)).
    (2) Requirements for individuals beginning their practice after 
December 31, 1977 and before January 1, 2008. Meets the one following 
requirements after December 31, 1977 and before January 1, 2008:
    (i) Is a graduate of an occupational therapy curriculum accredited 
jointly by the Committee on Allied Health Education and Accreditation 
of the American Medical Association and the American Occupational 
Therapy Association.
    (ii) Is eligible for the National Registration Examination of the 
American Occupational Therapy Association.
    (3) Requirements for individuals beginning their practice on or 
before December 31, 1977. (i) Has 2 years of appropriate experience as 
an occupational therapist; and
    (ii) Has achieved a satisfactory grade on a proficiency examination 
conducted, approved, or sponsored by the U.S. Public Health Service on 
or before December 31, 1977.
    Occupational therapy assistant. A person who meets one of the 
following requirements:
    (1) Requirements for individuals beginning their practice on or 
after January 1, 2008. Provides certain occupational therapy services 
under the supervision of a qualified occupational therapist, continues 
to meet all practice requirements set forth by the State in which 
occupational therapy services are furnished, and meets one of the 
educational/training requirements if his or her professional practice 
begins on or after January 1, 2008:
    (i)(A) Graduated after successful completion of coursework and 
clinical field work from an occupational therapy assistant curriculum 
accredited by the Accreditation Council for Occupational Therapy 
Education (ACOTE) of the American Occupational Therapy Association, 
Inc. (AOTA); and
    (B) Successfully completed the certification examination for 
Certified Occupational Therapy Assistant developed and administered by 
the National Board for Certification in Occupational Therapy, Inc. 
(NBCOT).
    (ii) If educated outside the United States or trained in the United 
States military, graduated after successful completion of an 
occupational therapy assistant curriculum that by credentials 
evaluation conducted or approved by the American Occupational Therapy 
Association is determined to be comparable, with respect to 
occupational therapy assistant entry level education in the United 
States.
    (2) Requirements for individuals beginning their practice after 
December 31, 1977 and before January 1, 2008. Meets the requirements 
for certification as an occupational therapy assistant established by 
the American Occupational Therapy Association after December 31, 1977 
and before January 1, 2008.
    (3) Requirements for individuals beginning their practice on or 
before December 31, 1977. Has 2 years of appropriate experience as an 
occupational therapy assistant, and has achieved a satisfactory grade 
on a proficiency examination conducted, approved, or sponsored by the 
U.S. Public Health Service on or before December 31, 1977.
    Physical therapist. A person who is licensed by the State in which 
practicing and meets one of the following requirements:
    (1) Requirements for individuals beginning their practice on or 
after January 1, 2008. Meets all practice requirements set forth by the 
State in which the physical therapy services are furnished and meets 
one of the following educational/training requirements on or after 
January 1, 2008:
    (i)(A) Graduated after successful completion of a college or 
university physical therapy curriculum approved by the Commission on 
Accreditation in

[[Page 38231]]

Physical Therapy Education (CAPTE); and
    (B) Passed the National Examination approved by the American 
Physical Therapy Association.
    (ii) If educated outside the United States or trained by the United 
States military--
    (A) Graduated after successful completion of an education program 
that, by a credentials evaluation process approved by the American 
Physical Therapy Association, is determined to be comparable with 
respect to physical therapist entry level education in the United 
States; and
    (B) Passed the National Examination approved by the American 
Physical Therapy Association.
    (2) Requirements for individuals beginning their practice after 
December 31, 1977 and before January 1, 2008. Has graduated from a 
physical therapy curriculum approved by one of the following after 
December 31, 1977 and before January 1, 2008:
    (i) The American Physical Therapy Association.
    (ii) The Committee on Allied Health Education and Accreditation of 
the American Medical Association.
    (iii) The Council on Medical Education of the American Medical 
Association and the American Physical Therapy Association.
    (3) Requirements for individuals beginning their practice on or 
after January 1, 1966 and on or before December 31, 1977. Had 2 years 
of appropriate experience as a physical therapist, and has achieved a 
satisfactory grade on a proficiency examination conducted, approved, or 
sponsored by the U.S. Public Health Service on or before December 31, 
1977.
    (4) Requirements for individuals beginning their practice before 
January 1, 1966. Meets one of the following requirements before January 
1, 1966:
    (i) Was admitted to membership by the American Physical Therapy 
Association.
    (ii) Was admitted to registration by the American Registry of 
Physical Therapists.
    (iii) Graduated from a physical therapy curriculum in a 4-year 
college or university approved by a State department of education.
    (iv) Was licensed or registered prior to January 1, 1966, and prior 
to January 1, 1970, had 15 years of full-time experience in the 
treatment of illness or injury through the practice of physical therapy 
in which services were rendered under the order and direction of 
attending and referring doctors of medicine or osteopathy.
    (5) Requirements for individuals trained outside of the United 
States before January 1, 2008. If trained outside the United States 
before January 1, 2008 meets the following requirements:
    (i) Was graduated since 1928 from a physical therapy curriculum 
approved in the country in which the curriculum was located and in 
which there is a member organization of the World Confederation for 
Physical Therapy.
    (ii) Meets the requirements for membership in a member organization 
of the World Confederation for Physical Therapy.
    Physical therapist assistant. A person who meets one of the 
following requirements:
    (1) Requirements for individuals beginning their practice on or 
after January 1, 2008. A person who provides certain physical therapy 
services under the supervision of a qualified physical therapist and is 
licensed, registered, certified or otherwise recognized as a physical 
therapist assistant, if applicable, by the State in which practicing, 
continues to meet all practice requirements set forth by the State in 
which physical therapy services are furnished, and meets one of the 
following educational/training requirements:
    (i) Graduated after successful completion of a physical therapist 
assistant curriculum approved by the Commission on Accreditation in 
Physical Therapy Education of the American Physical Therapy 
Association.
    (ii) If educated outside the United States or trained in the United 
States military, graduated after successful completion of an education 
program that by a credentials evaluation process approved by the 
American Physical Therapy Association, is determined to be comparable 
with respect to physical therapist assistant entry level education in 
the United States.
    (2) Requirements for individuals beginning their practice before 
January 1, 2008. Is licensed as a physical therapist assistant, if 
applicable, by the State in which practicing, meets either of the 
following requirements:
    (i) Has graduated from a 2-year college-level program approved by 
the American Physical Therapy Association.
    (ii) Has 2 years of appropriate experience as a physical therapist 
assistant, and has achieved a satisfactory grade on a proficiency 
examination conducted, approved, or sponsored by the U.S. Public Health 
Service, except that these determinations of proficiency do not apply 
with respect to persons initially licensed by a State or seeking 
initial qualification as a physical therapist assistant after December 
31, 1977.
* * * * *
    Speech-language pathologist. A person who meets either of the 
following requirements:
    (1) The education and experience requirements for a Certificate of 
Clinical Competence in speech-language pathology granted by the 
American Speech-Language Hearing Association.
    (2) The educational requirements for certification and is in the 
process of accumulating the supervised experience required for 
certification.

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

    57. 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 1395(hh)).

Subpart B--Conditions of Participation: Comprehensive Outpatient 
Rehabilitation Facilities

    58. Section 485.51 is amended by--
    A. Revising paragraph (a).
    B. Adding paragraph (c).
    The revision and addition read as follows:


Sec.  485.51  Definition.

* * * * *
    (a) Is established and operated exclusively for the purpose of 
providing diagnostic, therapeutic, and restorative services to 
outpatients for the rehabilitation of injured, disabled, or sick 
persons, at a single fixed location, by or under the supervision of a 
physician except as provided in paragraph (c) of this section;
* * * * *
    (c) Exception. May provide influenza, pneumococcal and Hepatitis B 
vaccines provided the applicable conditions of coverage under Sec.  
410.58 and Sec.  410.63 of this chapter are met.
    59. Section 485.70 is amended by revising paragraphs (c), (e), and 
(m) to read as follows:


Sec.  485.70  Personnel qualifications.

* * * * *
    (c) An occupational therapist and an occupational therapy assistant 
must meet one of the following qualifications:
    (1) As set forth in Sec.  484.4 of this chapter.
    (2) Occupational therapists or occupational therapy assistants must 
have been licensed, certified, registered, or otherwise recognized as 
occupational

[[Page 38232]]

therapists or occupational therapy assistants by the State in which 
practicing before January 1, 2008, and continue to furnish Medicare 
services at least part time without an interruption in furnishing 
services of more than 2 years.
* * * * *
    (e) A physical therapist and a physical therapist assistant must 
meet one of the following qualifications:
    (1) As set forth in Sec.  484.4 of this chapter.
    (2) Qualified physical therapists or physical therapist assistants 
must have been licensed, certified, registered, or otherwise recognized 
as physical therapists or physical therapist assistants by the State in 
which practicing before January 1, 2008, and continue to furnish 
Medicare services at least part time without an interruption in 
furnishing services of more than 2 years.
* * * * *
    (m) A speech-language pathologist must meet the qualifications set 
forth in Sec.  484.4 of this chapter.

Subpart H--Conditions of Participation for Clinics, Rehabilitation 
Agencies, and Public Health Agencies as Providers of Outpatient 
Physical Therapy and Speech-Language Pathology Services

    60. Section 485.705 is amended by revising paragraph (a) to read as 
follows:


Sec.  485.705  Personnel qualifications.

    (a) General qualification requirements. Except as specified in 
paragraphs (b) and (c) of this section, all personnel who are involved 
in the furnishing of outpatient physical therapy, occupational therapy 
and speech-language pathology services directly by or under 
arrangements with an organization must--
    (1) Be legally authorized (licensed or, if applicable, certified or 
registered) to practice by the State in which they perform the 
functions or actions.
    (2) Act only within the scope of their State license or State 
certification or registration.
    (3) Meet one of the following requirements:
    (i) Meet the qualifications specified in Sec.  484.4 of this 
chapter.
    (ii) Physical therapy, occupational therapy or speech-language 
pathology services may be furnished by qualified physical therapists, 
physical therapist assistants, occupational therapists, or occupational 
therapy assistants who have been licensed, certified, registered or 
otherwise recognized as physical therapists, physical therapist 
assistants, occupational therapists, or occupational therapy assistants 
by the State in which practicing before January 1, 2008 and continue to 
furnish Medicare services at least part time without an interruption in 
furnishing services of more than 2 years.
* * * * *

PART 491--CERTIFICATION OF CERTAIN HEALTH FACILITIES

    61. The authority citation for part 491 continues to read as 
follows:

    Authority: Sec. 1102 of the Social Security Act (42 U.S.C. 
1302); and sec. 353 of the Public Health Service Act (42 U.S.C. 
263a).

Subpart A--Rural Health Clinics: Conditions for Certification; and 
FQHCs Conditions for Coverage

    62. Section 491.9 is amended by adding paragraph (c)(4) to read as 
follows:


Sec.  491.9  Provision of services.

* * * * *
    (c) * * *
    (4) Physical therapy, occupational therapy or speech-language 
pathology services, if provided, must be furnished--
    (i) By clinicians who meet either of the following qualifications:
    (A) The qualifications specified in Sec.  484.4 of this subchapter.
    (B) Physical therapists, physical therapist assistants, 
occupational therapists, or occupational therapy assistants who have 
been licensed, certified, registered or otherwise recognized as 
physical therapists, physical therapist assistants, occupational 
therapists, or occupational therapy assistants by the State in which 
practicing before January 1, 2008 and continue to furnish Medicare 
services at least part time without an interruption in furnishing 
services of more than 2 years.
    (ii) In accordance with a written plan of treatment as described in 
Sec.  410.61 of this chapter.
* * * * *

Authority

    (Catalog of Federal Domestic Assistance Program No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: May 24, 2007.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Approved: June 28, 2007.
Michael O. Leavitt,
Secretary.

    Note: These addenda will not appear in the Code of Federal 
Regulations.

    The addenda on the following pages provide various data pertaining 
to the Medicare fee schedule for physicians' services furnished in 
2008.

Addendum A: Explanation and Use of Addendum B

    Addendum B contains the RVUs for work, non-facility PE, facility 
PE, and malpractice expense, and other information for all services 
included in the PFS.
    In previous years, we have listed many services in Addendum B that 
are not paid under the PFS. To avoid publishing as many pages of codes 
for these services, we are not including clinical laboratory codes or 
the alphanumeric codes (Healthcare Common Procedure Coding System 
(HCPCS) codes not included in CPT) not paid under the PFS in Addendum 
B.
    Addendum B contains the following information for each CPT code and 
alphanumeric HCPCS code, except for: alphanumeric codes beginning with 
B (enteral and parenteral therapy), E (durable medical equipment), K 
(temporary codes for nonphysicians' services or items), or L 
(orthotics); and codes for anesthesiology. Please also note the 
following:
     An ``NA'' in the ``Non-facility PE RVUs'' column of 
Addendum B means that CMS has not developed a PE RVU in the nonfacility 
setting for the service because it is typically performed in the 
hospital (for example, an open heart surgery is generally performed in 
the hospital setting and not a physician's office). If there is an 
``NA'' in the nonfacility PE RVU column, and the contractor determines 
that this service can be performed in the nonfacility setting, the 
service will be paid at the facility PE RVU rate.
     Services that have an ``NA'' in the ``Facility PE RVUs'' 
column of Addendum B are typically not paid using the PFS when provided 
in a facility setting. These services (which include ``incident to'' 
services and the technical portion of diagnostic tests) are generally 
paid under either the outpatient hospital prospective payment system or 
bundled into the hospital inpatient prospective payment system payment.
    1. CPT/HCPCS code. This is the CPT or alphanumeric HCPCS number for 
the service. Alphanumeric HCPCS codes are included at the end of this 
addendum.
    2. Modifier. A modifier is shown if there is a technical component 
(modifier TC) and a professional component (PC) (modifier -26) for the 
service. If there is a PC and a TC for the service, Addendum B contains 
three entries for the code. A code for: the global values

[[Page 38233]]

(both professional and technical); modifier -26 (PC); and, modifier TC. 
The global service is not designated by a modifier, and physicians must 
bill using the code without a modifier if the physician furnishes both 
the PC and the TC of the service.
    Modifier-53 is shown for a discontinued procedure, for example, a 
colonoscopy that is not completed. There will be RVUs for a code with 
this modifier.
    3. Status indicator. This indicator shows whether the CPT/HCPCS 
code is in the PFS and whether it is separately payable if the service 
is covered.
    A = Active code. These codes are separately payable under the PFS 
if covered. There will be RVUs for codes with this status. The presence 
of an ``A'' indicator does not mean that Medicare has made a national 
coverage determination regarding the service. Carriers remain 
responsible for coverage decisions in the absence of a national 
Medicare policy.
    B = Bundled code. Payments for covered services are always bundled 
into payment for other services not specified. If RVUs are shown, they 
are not used for Medicare payment. If these services are covered, 
payment for them is subsumed by the payment for the services to which 
they are incident (an example is a telephone call from a hospital nurse 
regarding care of a patient).
    C = Carriers price the code. Carriers will establish RVUs and 
payment amounts for these services, generally on an individual case 
basis following review of documentation, such as an operative report.
    D* = Deleted/discontinued code.
    E = Excluded from the PFS by regulation. These codes are for items 
and services that CMS chose to exclude from the fee schedule payment by 
regulation. No RVUs are shown, and no payment may be made under the PFS 
for these codes. Payment for them, when covered, continues under 
reasonable charge procedures.
    F = Deleted/discontinued codes. (Code not subject to a 90-day grace 
period.) These codes are deleted effective with the beginning of the 
year and are never subject to a grace period. This indicator is no 
longer effective beginning with the CY 2005 PFS as of January 1, 2005.
    G = Code not valid for Medicare purposes. Medicare uses another 
code for reporting of, and payment for, these services. (Codes subject 
to a 90-day grace period.) This indicator is no longer effective with 
the 2005 PFS as of January 1, 2005.
    H* = Deleted modifier. For 2000 and later years, either the TC or 
PC component shown for the code has been deleted and the deleted 
component is shown in the database with the H status indicator.
    I = Not valid for Medicare purposes. Medicare uses another code for 
the reporting of, and the payment for these services. (Codes not 
subject to a 90-day grace period.)
    L = Local codes. Carriers will apply this status to all local codes 
in effect on January 1, 1998 or subsequently approved by central office 
for use. Carriers will complete the RVUs and payment amounts for these 
codes.
    M = Measurement codes, used for reporting purposes only. There are 
no RVUs and no payment amounts for these codes. Medicare uses them to 
aid with performance measurement.
    N = Noncovered service. These codes are noncovered services. 
Medicare payment may not be made for these codes. If RVUs are shown, 
they are not used for Medicare payment.
    R = Restricted coverage. Special coverage instructions apply. If 
the service is covered and no RVUs are shown, it is carrier-priced.
    T = There are RVUs for these services, but they are only paid if 
there are no other services payable under the PFS billed on the same 
date by the same provider. If any other services payable under the PFS 
are billed on the same date by the same provider, these services are 
bundled into the service(s) for which payment is made.
    X = Statutory exclusion. These codes represent an item or service 
that is not within the statutory definition of ``physicians' services'' 
for PFS payment purposes. No RVUs are shown for these codes, and no 
payment may be made under the PFS. (Examples are ambulance services and 
clinical diagnostic laboratory services.)
    4. Description of code. This is an abbreviated version of the 
narrative description of the code.
    5. Physician work RVUs. These are the RVUs for the physician work 
for this service in 2008.

    Note: The separate BN adjustor is not reflected in these 
physician work RVUs.

    6. Fully implemented nonfacility practice expense RVUs. These are 
the fully implemented resource-based PE RVUs for nonfacility settings.
    7. Year 2008 Transitional Nonfacility practice expense RVUs. These 
are the 2008 resource-based PE RVUs for nonfacility settings.
    8. Fully implemented facility practice expense RVUs. These are the 
fully implemented resource-based PE RVUs for facility settings.
    9. Year 2008 Transitional facility practice expense RVUs. These are 
the 2008 resource-based PE RVUs for facility settings.
    10. Malpractice expense RVUs. These are the RVUs for the 
malpractice expense for the service for 2006.
    11. Global period. This indicator shows the number of days in the 
global period for the code (0, 10, or 90 days).
    An explanation of the alpha codes follows:
    MMM = Code describes a service furnished in uncomplicated maternity 
cases including antepartum care, delivery, and postpartum care. The 
usual global surgical concept does not apply. See the 1999 Physicians' 
Current Procedural Terminology for specific definitions.
    XXX = The global concept does not apply.
    YYY = The global period is to be set by the carrier (for example, 
unlisted surgery codes).
    ZZZ = Code related to another service that is always included in 
the global period of the other service. (Note: Physician work and PE 
are associated with intra-service time and in some instances in the 
post-service time.)
    *Codes with these indicators had a 90-day grace period before 
January 1, 2005.

[[Page 38234]]







    --------------------
\1\ CPT codes and descriptions are copyright 2007 American Medical 
Association.

\2\ Copyright 2007 American Dental Association. All rights reserved.

\3\ If values are reflected for codes not payable by Medicare, please 
note that these values have been established as a courtesy to the 
general public and are not used for Medicare payment.

[[Page 38234]]



                      Addendum B.--2008 Relative Value Units and Related Information Used in Determining Medicare Payments for 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                          Fully
                                                            Physician  implemented    Year 2008      Fully       Year 2008
CPT \1\/HCPCS      Mod        Status       Description      work RVUs      non-     transitional  implemented  transitional  Malpractice      Global
     \2\                                                       \3\     facility PE  non-facility  facility PE   facility PE    RVUs \3\
                                                                         RVUs \3\    PE RVUs \3\    RVUs \3\     RVUs \3\
--------------------------------------------------------------------------------------------------------------------------------------------------------
0016T........  ...........  C.........  Thermotx choroid         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vasc lesion.
0017T........  ...........  C.........  Photocoagulat            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         macular drusen.
0019T........  ...........  C.........  Extracorp shock          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         wv tx,ms nos.
0026T........  ...........  C.........  Measure remnant          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         lipoproteins.
0027T........  ...........  C.........  Endoscopic               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         epidural lysis.
0028T........  ...........  C.........  Dexa body                0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         composition
                                         study.
0029T........  ...........  C.........  Magnetic tx for          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         incontinence.
0030T........  ...........  C.........  Antiprothrombin          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         antibody.
0031T........  ...........  C.........  Speculoscopy.....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0032T........  ...........  C.........  Speculoscopy w/          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         direct sample.
0041T........  ...........  C.........  Detect ur infect         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         agnt w/cpas.
0042T........  ...........  C.........  Ct perfusion w/          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         contrast, cbf.
0043T........  ...........  C.........  Co expired gas           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         analysis.
0046T........  ...........  C.........  Cath lavage,             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         mammary duct(s).
0047T........  ...........  C.........  Cath lavage,             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         mammary duct(s).
0048T........  ...........  C.........  Implant                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ventricular
                                         device.
0049T........  ...........  C.........  External                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         circulation
                                         assist.
0050T........  ...........  C.........  Removal                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         circulation
                                         assist.
0051T........  ...........  C.........  Implant total            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         heart system.
0052T........  ...........  C.........  Replace component        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         heart syst.
0053T........  ...........  C.........  Replace component        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         heart syst.
0054T........  ...........  C.........  Bone surgery             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         using computer.
0055T........  ...........  C.........  Bone surgery             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         using computer.
0056T........  ...........  C.........  Bone surgery             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         using computer.
0058T........  ...........  C.........  Cryopreservation,        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ovary tiss.
0059T........  ...........  C.........  Cryopreservation,        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         oocyte.
0060T........  ...........  C.........  Electrical               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         impedance scan.
0061T........  ...........  C.........  Destruction of           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         tumor, breast.
0062T........  ...........  C.........  Rep intradisc            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         annulus;1 lev.
0063T........  ...........  C.........  Rep intradisc            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         annulus;>1lev.
0064T........  ...........  C.........  Spectroscop eval         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         expired gas.
0065T........  ...........  C.........  Ocular                   0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         photoscreen
                                         bilat.
0067T........  ...........  C.........  Ct                       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         colonography;dx.
0067T........  26.........  C.........  Ct                       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         colonography;dx.
0067T........  TC.........  C.........  Ct                       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         colonography;dx.
0068T........  ...........  C.........  Interp/rept heart        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         sound.
0069T........  ...........  C.........  Analysis only            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         heart sound.
0070T........  ...........  C.........  Interp only heart        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         sound.
0071T........  ...........  C.........  U/s leiomyomata          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ablate <200.
0072T........  ...........  C.........  U/s leiomyomata          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ablate >200.
0073T........  ...........  A.........  Delivery, comp           0.00        13.04        15.55            NA           NA          0.13  XXX
                                         imrt.
0075T........  ...........  C.........  Perq stent/chest         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vert art.
0075T........  26.........  C.........  Perq stent/chest         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vert art.
0075T........  TC.........  C.........  Perq stent/chest         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vert art.
0076T........  ...........  C.........  S&i stent/chest          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vert art.
0076T........  26.........  C.........  S&i stent/chest          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vert art.
0076T........  TC.........  C.........  S&i stent/chest          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vert art.
0077T........  ...........  C.........  Cereb therm              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         perfusion probe.
0078T........  ...........  C.........  Endovasc aort            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         repr w/device.
0079T........  ...........  C.........  Endovasc visc            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         extnsn repr.
0080T........  ...........  C.........  Endovasc aort            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         repr rad s&i.
0081T........  ...........  C.........  Endovasc visc            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         extnsn s&i.
0084T........  ...........  C.........  Temp prostate            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         urethral stent.
0085T........  ...........  C.........  Breath test heart        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         reject.
0086T........  ...........  C.........  L ventricle fill         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         pressure.
0087T........  ...........  C.........  Sperm eval               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         hyaluronan.
0088T........  ...........  C.........  Rf tongue base           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vol reduxn.
0089T........  ...........  C.........  Actigraphy               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         testing, 3-day.
0090T........  ...........  C.........  Cervical artific         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         disc.
0092T........  ...........  C.........  Artific disc addl        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0093T........  ...........  C.........  Cervical artific         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         diskectomy.
0095T........  ...........  C.........  Artific                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         diskectomy addl.
0096T........  ...........  C.........  Rev cervical             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         artific disc.
0098T........  ...........  C.........  Rev artific disc         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         addl.
0099T........  ...........  C.........  Implant corneal          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ring.
0100T........  ...........  C.........  Prosth retina            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         receive&gen.
0101T........  ...........  C.........  Extracorp shockwv        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         tx,hi enrg.
0102T........  ...........  C.........  Extracorp shockwv        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         tx,anesth.
0103T........  ...........  C.........  Holotranscobalami        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         n.
0104T........  ...........  C.........  At rest cardio           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         gas rebreathe.
0105T........  ...........  C.........  Exerc cardio gas         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         rebreathe.
0106T........  ...........  C.........  Touch quant              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         sensory test.
0107T........  ...........  C.........  Vibrate quant            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         sensory test.

[[Page 38235]]

 
0108T........  ...........  C.........  Cool quant               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         sensory test.
0109T........  ...........  C.........  Heat quant               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         sensory test.
0110T........  ...........  C.........  Nos quant sensory        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         test.
0111T........  ...........  C.........  Rbc membranes            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         fatty acids.
0123T........  ...........  C.........  Scleral                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         fistulization.
0126T........  ...........  C.........  Chd risk imt             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         study.
0130T........  ...........  C.........  Chron care drug          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         investigatn.
0135T........  ...........  C.........  Perq cryoablate          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         renal tumor.
0137T........  ...........  C.........  Prostate                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         saturation
                                         sampling.
0140T........  ...........  C.........  Exhaled breath           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         condensate ph.
0144T........  ...........  C.........  CT heart wo dye;         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         qual calc.
0144T........  26.........  C.........  CT heart wo dye;         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         qual calc.
0144T........  TC.........  C.........  CT heart wo dye;         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         qual calc.
0145T........  ...........  C.........  CT heart w/wo dye        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         funct.
0145T........  26.........  C.........  CT heart w/wo dye        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         funct.
0145T........  TC.........  C.........  CT heart w/wo dye        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         funct.
0146T........  ...........  C.........  CCTA w/wo dye....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0146T........  26.........  C.........  CCTA w/wo dye....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0146T........  TC.........  C.........  CCTA w/wo dye....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0147T........  ...........  C.........  CCTA w/wo, quan          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         calcium.
0147T........  26.........  C.........  CCTA w/wo, quan          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         calcium.
0147T........  TC.........  C.........  CCTA w/wo, quan          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         calcium.
0148T........  ...........  C.........  CCTA w/wo, strxr.        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0148T........  26.........  C.........  CCTA w/wo, strxr.        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0148T........  TC.........  C.........  CCTA w/wo, strxr.        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0149T........  ...........  C.........  CCTA w/wo, strxr         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         quan calc.
0149T........  26.........  C.........  CCTA w/wo, strxr         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         quan calc.
0149T........  TC.........  C.........  CCTA w/wo, strxr         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         quan calc.
0150T........  ...........  C.........  CCTA w/wo,               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         disease strxr.
0150T........  26.........  C.........  CCTA w/wo,               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         disease strxr.
0150T........  TC.........  C.........  CCTA w/wo,               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         disease strxr.
0151T........  ...........  C.........  CT heart funct           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         add-on.
0151T........  26.........  C.........  CT heart funct           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         add-on.
0151T........  TC.........  C.........  CT heart funct           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         add-on.
0153T........  ...........  C.........  Tcath sensor             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         aneurysm sac.
0154T........  ...........  C.........  Study sensor             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         aneurysm sac.
0155T........  ...........  C.........  Lap impl gast            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         curve electrd.
0156T........  ...........  C.........  Lap remv gast            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         curve electrd.
0157T........  ...........  C.........  Open impl gast           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         curve electrd.
0158T........  ...........  C.........  Open remv gast           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         curve electrd.
0159T........  ...........  C.........  Cad breast mri...        0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
0159T........  26.........  C.........  Cad breast mri...        0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
0159T........  TC.........  C.........  Cad breast mri...        0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
0160T........  ...........  C.........  Tcranial magn            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         stim tx plan.
0161T........  ...........  C.........  Tcranial magn            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         stim tx deliv.
0162T........  ...........  C.........  Anal program gast        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         neurostim.
0163T........  ...........  C.........  Lumb artif               0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         diskectomy addl.
0164T........  ...........  C.........  Remove lumb artif        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         disc addl.
0165T........  ...........  C.........  Revise lumb artif        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         disc addl.
0166T........  ...........  C.........  Tcath vsd close w/       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         o bypass.
0167T........  ...........  C.........  Tcath vsd close w        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         bypass.
0168T........  ...........  C.........  Rhinophototx             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         light app bilat.
0169T........  ...........  C.........  Place stereo cath        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         brain.
0170T........  ...........  C.........  Anorectal fistula        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         plug rpr.
0171T........  ...........  C.........  Lumbar spine             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         proces distract.
0172T........  ...........  C.........  Lumbar spine             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         proces addl.
0173T........  ...........  C.........  Iop monit io             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         pressure.
0174T........  ...........  C.........  Cad cxr with             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         interp.
0175T........  ...........  C.........  Cad cxr remote...        0.00         0.00         0.00          0.00         0.00          0.00  XXX
0176T........  ...........  C.........  Aqu canal dilat w/       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         o retent.
0177T........  ...........  C.........  Aqu canal dilat w        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         retent.
10021........  ...........  A.........  Fna w/o image....        1.27         2.17         2.15          0.38         0.46          0.10  XXX
10022........  ...........  A.........  Fna w/image......        1.27         2.14         2.32          0.41         0.40          0.08  XXX
10040........  ...........  A.........  Acne surgery.....        1.19         1.34         1.17          0.98         0.89          0.05  010
10060........  ...........  A.........  Drainage of skin         1.19         1.48         1.35          1.06         1.00          0.12  010
                                         abscess.
10061........  ...........  A.........  Drainage of skin         2.42         2.03         1.94          1.48         1.50          0.26  010
                                         abscess.
10080........  ...........  A.........  Drainage of              1.19         2.65         2.88          1.10         1.11          0.11  010
                                         pilonidal cyst.
10081........  ...........  A.........  Drainage of              2.47         3.45         3.76          1.44         1.47          0.24  010
                                         pilonidal cyst.
10120........  ...........  A.........  Remove foreign           1.23         1.92         2.05          0.93         0.96          0.12  010
                                         body.
10121........  ...........  A.........  Remove foreign           2.71         3.45         3.49          1.63         1.71          0.33  010
                                         body.
10140........  ...........  A.........  Drainage of              1.55         2.21         2.00          1.27         1.28          0.19  010
                                         hematoma/fluid.
10160........  ...........  A.........  Puncture drainage        1.22         1.82         1.71          1.06         1.07          0.14  010
                                         of lesion.

[[Page 38236]]

 
10180........  ...........  A.........  Complex drainage,        2.27         3.22         3.11          1.79         1.89          0.35  010
                                         wound.
11000........  ...........  A.........  Debride infected         0.60         0.71         0.65          0.16         0.19          0.07  000
                                         skin.
11001........  ...........  A.........  Debride infected         0.30         0.23         0.23          0.08         0.09          0.04  ZZZ
                                         skin add-on.
11004........  ...........  A.........  Debride genitalia       10.80           NA           NA          3.23         3.56          0.67  000
                                         & perineum.
11005........  ...........  A.........  Debride abdom           14.24           NA           NA          3.80         4.75          0.96  000
                                         wall.
11006........  ...........  A.........  Debride genit/per/      13.10           NA           NA          4.00         4.39          1.28  000
                                         abdom wall.
11008........  ...........  A.........  Remove mesh from         5.00           NA           NA          1.29         1.67          0.61  ZZZ
                                         abd wall.
11010........  ...........  A.........  Debride skin, fx.        4.19         6.75         6.80          2.34         2.48          0.66  010
11011........  ...........  A.........  Debride skin/            4.94         6.98         7.58          2.02         2.19          0.74  000
                                         muscle, fx.
11012........  ...........  A.........  Debride skin/            6.87         8.95        10.53          3.12         3.49          1.16  000
                                         muscle/bone, fx.
11040........  ...........  A.........  Debride skin,            0.50         0.66         0.59          0.16         0.19          0.06  000
                                         partial.
11041........  ...........  A.........  Debride skin,            0.60         0.70         0.69          0.18         0.26          0.10  000
                                         full.
11042........  ...........  A.........  Debride skin/            0.80         0.94         0.96          0.24         0.34          0.13  000
                                         tissue.
11043........  ...........  A.........  Debride tissue/          3.04         3.46         3.45          2.57         2.60          0.32  010
                                         muscle.
11044........  ...........  A.........  Debride tissue/          4.11         4.78         4.65          3.54         3.67          0.43  010
                                         muscle/bone.
11055........  ...........  R.........  Trim skin lesion.        0.43         0.78         0.68          0.11         0.14          0.05  000
11056........  ...........  R.........  Trim skin                0.61         0.86         0.75          0.15         0.20          0.07  000
                                         lesions, 2 to 4.
11057........  ...........  R.........  Trim skin                0.79         0.96         0.86          0.20         0.25          0.10  000
                                         lesions, over 4.
11100........  ...........  A.........  Biopsy, skin             0.81         1.88         1.57          0.39         0.38          0.03  000
                                         lesion.
11101........  ...........  A.........  Biopsy, skin add-        0.41         0.41         0.37          0.20         0.20          0.02  ZZZ
                                         on.
11200........  ...........  A.........  Removal of skin          0.79         1.23         1.14          0.90         0.83          0.04  010
                                         tags.
11201........  ...........  A.........  Remove skin tags         0.29         0.16         0.16          0.11         0.12          0.02  ZZZ
                                         add-on.
11300........  ...........  A.........  Shave skin lesion        0.51         1.19         1.09          0.21         0.21          0.03  000
11301........  ...........  A.........  Shave skin lesion        0.85         1.50         1.31          0.39         0.38          0.04  000
11302........  ...........  A.........  Shave skin lesion        1.05         1.77         1.54          0.49         0.48          0.05  000
11303........  ...........  A.........  Shave skin lesion        1.24         2.03         1.80          0.56         0.54          0.07  000
11305........  ...........  A.........  Shave skin lesion        0.67         1.04         0.95          0.20         0.24          0.07  000
11306........  ...........  A.........  Shave skin lesion        0.99         1.41         1.26          0.38         0.40          0.07  000
11307........  ...........  A.........  Shave skin lesion        1.14         1.70         1.50          0.48         0.49          0.07  000
11308........  ...........  A.........  Shave skin lesion        1.41         1.69         1.58          0.50         0.55          0.13  000
11310........  ...........  A.........  Shave skin lesion        0.73         1.38         1.25          0.32         0.32          0.04  000
11311........  ...........  A.........  Shave skin lesion        1.05         1.64         1.44          0.49         0.49          0.05  000
11312........  ...........  A.........  Shave skin lesion        1.20         1.92         1.67          0.57         0.56          0.06  000
11313........  ...........  A.........  Shave skin lesion        1.62         2.19         2.00          0.74         0.73          0.10  000
11400........  ...........  A.........  Exc tr-ext               0.87         1.87         1.93          0.93         0.91          0.06  010
                                         b9+marg 0.5 < cm.
11401........  ...........  A.........  Exc tr-ext               1.25         2.18         2.11          1.15         1.08          0.10  010
                                         b9+marg 0.6-1 cm.
11402........  ...........  A.........  Exc tr-ext               1.42         2.39         2.30          1.21         1.14          0.13  010
                                         b9+marg 1.1-2 cm.
11403........  ...........  A.........  Exc tr-ext               1.81         2.54         2.47          1.57         1.44          0.17  010
                                         b9+marg 2.1-3 cm.
11404........  ...........  A.........  Exc tr-ext               2.08         2.84         2.77          1.63         1.52          0.21  010
                                         b9+marg 3.1-4 cm.
11406........  ...........  A.........  Exc tr-ext               3.47         3.51         3.28          2.09         1.87          0.32  010
                                         b9+marg > 4.0 cm.
11420........  ...........  A.........  Exc h-f-nk-sp            1.00         1.80         1.79          0.92         0.93          0.09  010
                                         b9+marg 0.5 <.
11421........  ...........  A.........  Exc h-f-nk-sp            1.44         2.20         2.13          1.16         1.14          0.13  010
                                         b9+marg 0.6-1.
11422........  ...........  A.........  Exc h-f-nk-sp            1.65         2.42         2.33          1.53         1.43          0.16  010
                                         b9+marg 1.1-2.
11423........  ...........  A.........  Exc h-f-nk-sp            2.03         2.65         2.62          1.65         1.55          0.20  010
                                         b9+marg 2.1-3.
11424........  ...........  A.........  Exc h-f-nk-sp            2.45         2.96         2.88          1.77         1.69          0.25  010
                                         b9+marg 3.1-4.
11426........  ...........  A.........  Exc h-f-nk-sp            4.04         3.57         3.53          2.30         2.21          0.44  010
                                         b9+marg > 4 cm.
11440........  ...........  A.........  Exc face-mm              1.02         1.99         2.10          1.31         1.31          0.08  010
                                         b9+marg 0.5 < cm.
11441........  ...........  A.........  Exc face-mm              1.50         2.37         2.36          1.55         1.52          0.13  010
                                         b9+marg 0.6-1 cm.
11442........  ...........  A.........  Exc face-mm              1.74         2.63         2.58          1.66         1.61          0.16  010
                                         b9+marg 1.1-2 cm.
11443........  ...........  A.........  Exc face-mm              2.31         2.88         2.89          1.85         1.83          0.22  010
                                         b9+marg 2.1-3 cm.
11444........  ...........  A.........  Exc face-mm              3.16         3.31         3.38          2.11         2.14          0.30  010
                                         b9+marg 3.1-4 cm.
11446........  ...........  A.........  Exc face-mm              4.75         4.09         4.06          2.69         2.73          0.43  010
                                         b9+marg > 4 cm.
11450........  ...........  A.........  Removal, sweat           3.14         5.07         5.06          2.39         2.21          0.34  090
                                         gland lesion.
11451........  ...........  A.........  Removal, sweat           4.35         6.32         6.43          2.90         2.70          0.53  090
                                         gland lesion.
11462........  ...........  A.........  Removal, sweat           2.92         5.27         5.20          2.45         2.24          0.32  090
                                         gland lesion.
11463........  ...........  A.........  Removal, sweat           4.35         6.47         6.67          2.93         2.82          0.54  090
                                         gland lesion.
11470........  ...........  A.........  Removal, sweat           3.66         5.43         5.27          2.62         2.45          0.40  090
                                         gland lesion.
11471........  ...........  A.........  Removal, sweat           4.81         6.45         6.58          2.99         2.88          0.58  090
                                         gland lesion.
11600........  ...........  A.........  Exc tr-ext               1.58         2.73         2.68          1.14         1.06          0.10  010
                                         mlg+marg 0.5 <
                                         cm.
11601........  ...........  A.........  Exc tr-ext               2.02         3.43         3.07          1.51         1.37          0.12  010
                                         mlg+marg 0.6-1
                                         cm.
11602........  ...........  A.........  Exc tr-ext               2.22         3.84         3.33          1.70         1.49          0.12  010
                                         mlg+marg 1.1-2
                                         cm.
11603........  ...........  A.........  Exc tr-ext               2.77         4.04         3.56          1.88         1.61          0.16  010
                                         mlg+marg 2.1-3
                                         cm.
11604........  ...........  A.........  Exc tr-ext               3.12         4.33         3.86          1.94         1.67          0.20  010
                                         mlg+marg 3.1-4
                                         cm.
11606........  ...........  A.........  Exc tr-ext               4.97         5.47         4.77          2.47         2.10          0.36  010
                                         mlg+marg > 4 cm.
11620........  ...........  A.........  Exc h-f-nk-sp            1.59         2.84         2.72          1.20         1.07          0.09  010
                                         mlg+marg 0.5 <.
11621........  ...........  A.........  Exc h-f-nk-sp            2.03         3.49         3.10          1.54         1.39          0.12  010
                                         mlg+marg 0.6-1.
11622........  ...........  A.........  Exc h-f-nk-sp            2.36         3.89         3.43          1.76         1.58          0.14  010
                                         mlg+marg 1.1-2.
11623........  ...........  A.........  Exc h-f-nk-sp            3.06         4.11         3.72          1.97         1.78          0.20  010
                                         mlg+marg 2.1-3.
11624........  ...........  A.........  Exc h-f-nk-sp            3.57         4.42         4.09          2.10         1.94          0.27  010
                                         mlg+marg 3.1-4.
11626........  ...........  A.........  Exc h-f-nk-sp            4.56         4.95         4.79          2.34         2.37          0.45  010
                                         mlg+mar > 4 cm.
11640........  ...........  A.........  Exc face-mm              1.62         3.04         2.85          1.29         1.20          0.11  010
                                         malig+marg 0.5 <.
11641........  ...........  A.........  Exc face-mm              2.12         3.62         3.33          1.62         1.58          0.16  010
                                         malig+marg 0.6-1.

[[Page 38237]]

 
11642........  ...........  A.........  Exc face-mm              2.57         4.04         3.72          1.86         1.79          0.19  010
                                         malig+marg 1.1-2.
11643........  ...........  A.........  Exc face-mm              3.37         4.28         4.04          2.12         2.04          0.26  010
                                         malig+marg 2.1-3.
11644........  ...........  A.........  Exc face-mm              4.29         5.07         4.88          2.48         2.47          0.37  010
                                         malig+marg 3.1-4.
11646........  ...........  A.........  Exc face-mm              6.21         5.90         5.82          3.15         3.31          0.61  010
                                         mlg+marg > 4 cm.
11719........  ...........  R.........  Trim nail(s).....        0.17         0.37         0.31          0.04         0.06          0.02  000
11720........  ...........  A.........  Debride nail, 1-5        0.32         0.45         0.40          0.08         0.10          0.04  000
11721........  ...........  A.........  Debride nail, 6          0.54         0.53         0.49          0.14         0.18          0.07  000
                                         or more.
11730........  ...........  A.........  Removal of nail          1.10         1.29         1.17          0.27         0.36          0.14  000
                                         plate.
11732........  ...........  A.........  Remove nail              0.57         0.53         0.49          0.14         0.18          0.07  ZZZ
                                         plate, add-on.
11740........  ...........  A.........  Drain blood from         0.37         0.78         0.67          0.42         0.39          0.04  000
                                         under nail.
11750........  ...........  A.........  Removal of nail          2.40         2.88         2.54          1.83         1.80          0.22  010
                                         bed.
11752........  ...........  A.........  Remove nail bed/         3.48         3.97         3.51          2.72         2.87          0.35  010
                                         finger tip.
11755........  ...........  A.........  Biopsy, nail unit        1.31         1.98         1.79          0.74         0.76          0.14  000
11760........  ...........  A.........  Repair of nail           1.60         3.34         3.00          1.41         1.60          0.21  010
                                         bed.
11762........  ...........  A.........  Reconstruction of        2.91         3.61         3.27          1.64         2.01          0.36  010
                                         nail bed.
11765........  ...........  A.........  Excision of nail         0.71         2.60         2.21          0.98         0.88          0.08  010
                                         fold, toe.
11770........  ...........  A.........  Removal of               2.63         3.43         3.46          1.51         1.51          0.33  010
                                         pilonidal lesion.
11771........  ...........  A.........  Removal of               5.98         6.57         6.12          3.66         3.49          0.74  090
                                         pilonidal lesion.
11772........  ...........  A.........  Removal of               7.23         7.97         7.74          5.51         5.29          0.89  090
                                         pilonidal lesion.
11900........  ...........  A.........  Injection into           0.52         0.92         0.79          0.25         0.23          0.02  000
                                         skin lesions.
11901........  ...........  A.........  Added skin               0.80         1.02         0.84          0.40         0.38          0.03  000
                                         lesions
                                         injection.
11920........  ...........  R.........  Correct skin             1.61         2.34         3.03          1.10         1.11          0.24  000
                                         color defects.
11921........  ...........  R.........  Correct skin             1.93         2.65         3.32          1.26         1.27          0.29  000
                                         color defects.
11922........  ...........  R.........  Correct skin             0.49         0.92         1.03          0.22         0.24          0.07  ZZZ
                                         color defects.
11950........  ...........  R.........  Therapy for              0.84         0.89         1.01          0.36         0.37          0.06  000
                                         contour defects.
11951........  ...........  R.........  Therapy for              1.19         0.88         1.24          0.35         0.46          0.11  000
                                         contour defects.
11952........  ...........  R.........  Therapy for              1.69         1.63         1.76          0.77         0.74          0.16  000
                                         contour defects.
11954........  ...........  R.........  Therapy for              1.85         1.78         2.11          0.77         0.84          0.25  000
                                         contour defects.
11960........  ...........  A.........  Insert tissue           11.01           NA           NA         10.53        10.50          1.31  090
                                         expander(s).
11970........  ...........  A.........  Replace tissue           7.86           NA           NA          6.17         6.18          1.05  090
                                         expander.
11971........  ...........  A.........  Remove tissue            3.21         7.35         8.25          4.00         3.91          0.32  090
                                         expander(s).
11975........  ...........  N.........  Insert                   1.48         1.52         1.47          0.34         0.45          0.17  XXX
                                         contraceptive
                                         cap.
11976........  ...........  R.........  Removal of               1.78         1.72         1.72          0.48         0.58          0.21  000
                                         contraceptive
                                         cap.
11977........  ...........  N.........  Removal/reinsert         3.30         1.97         2.12          0.76         1.01          0.37  XXX
                                         contra cap.
11980........  ...........  A.........  Implant hormone          1.48         1.07         1.09          0.49         0.53          0.13  000
                                         pellet(s).
11981........  ...........  A.........  Insert drug              1.48         1.90         1.81          0.59         0.64          0.12  XXX
                                         implant device.
11982........  ...........  A.........  Remove drug              1.78         2.02         1.99          0.71         0.78          0.17  XXX
                                         implant device.
11983........  ...........  A.........  Remove/insert            3.30         2.65         2.47          1.34         1.41          0.23  XXX
                                         drug implant.
12001........  ...........  A.........  Repair                   1.72         1.72         1.85          0.73         0.75          0.15  010
                                         superficial
                                         wound(s).
12002........  ...........  A.........  Repair                   1.88         1.78         1.91          0.84         0.87          0.17  010
                                         superficial
                                         wound(s).
12004........  ...........  A.........  Repair                   2.26         2.06         2.19          0.92         0.97          0.21  010
                                         superficial
                                         wound(s).
12005........  ...........  A.........  Repair                   2.88         2.50         2.67          1.06         1.13          0.27  010
                                         superficial
                                         wound(s).
12006........  ...........  A.........  Repair                   3.68         3.03         3.21          1.29         1.40          0.35  010
                                         superficial
                                         wound(s).
12007........  ...........  A.........  Repair                   4.13         3.33         3.58          1.46         1.64          0.45  010
                                         superficial
                                         wound(s).
12011........  ...........  A.........  Repair                   1.78         1.89         2.01          0.75         0.77          0.16  010
                                         superficial
                                         wound(s).
12013........  ...........  A.........  Repair                   2.01         2.04         2.16          0.88         0.91          0.18  010
                                         superficial
                                         wound(s).
12014........  ...........  A.........  Repair                   2.48         2.27         2.42          0.97         1.02          0.23  010
                                         superficial
                                         wound(s).
12015........  ...........  A.........  Repair                   3.21         2.76         2.95          1.11         1.18          0.29  010
                                         superficial
                                         wound(s).
12016........  ...........  A.........  Repair                   3.94         3.14         3.35          1.27         1.40          0.37  010
                                         superficial
                                         wound(s).
12017........  ...........  A.........  Repair                   4.72           NA           NA          1.52         1.70          0.47  010
                                         superficial
                                         wound(s).
12018........  ...........  A.........  Repair                   5.54           NA           NA          1.94         2.11          0.64  010
                                         superficial
                                         wound(s).
12020........  ...........  A.........  Closure of split         2.64         3.66         3.75          1.74         1.84          0.30  010
                                         wound.
12021........  ...........  A.........  Closure of split         1.86         1.83         1.83          1.32         1.37          0.24  010
                                         wound.
12031........  ...........  A.........  Layer closure of         2.17         3.88         3.09          1.78         1.37          0.17  010
                                         wound(s).
12032........  ...........  A.........  Layer closure of         2.49         5.21         4.53          2.29         2.04          0.16  010
                                         wound(s).
12034........  ...........  A.........  Layer closure of         2.94         4.59         3.89          2.00         1.73          0.25  010
                                         wound(s).
12035........  ...........  A.........  Layer closure of         3.44         5.26         5.23          2.11         2.13          0.39  010
                                         wound(s).
12036........  ...........  A.........  Layer closure of         4.06         5.36         5.46          2.22         2.39          0.55  010
                                         wound(s).
12037........  ...........  A.........  Layer closure of         4.68         5.95         6.02          2.63         2.80          0.66  010
                                         wound(s).
12041........  ...........  A.........  Layer closure of         2.39         3.86         3.20          1.78         1.45          0.19  010
                                         wound(s).
12042........  ...........  A.........  Layer closure of         2.76         4.49         3.88          2.14         1.80          0.17  010
                                         wound(s).
12044........  ...........  A.........  Layer closure of         3.16         5.38         4.29          1.96         1.78          0.27  010
                                         wound(s).
12045........  ...........  A.........  Layer closure of         3.65         4.99         5.14          2.05         2.17          0.41  010
                                         wound(s).
12046........  ...........  A.........  Layer closure of         4.26         5.67         6.08          2.31         2.53          0.54  010
                                         wound(s).
12047........  ...........  A.........  Layer closure of         4.66         6.44         6.35          2.66         2.85          0.58  010
                                         wound(s).
12051........  ...........  A.........  Layer closure of         2.49         4.11         3.69          1.94         1.69          0.20  010
                                         wound(s).
12052........  ...........  A.........  Layer closure of         2.81         4.86         4.05          2.57         2.00          0.17  010
                                         wound(s).
12053........  ...........  A.........  Layer closure of         3.14         5.37         4.30          2.13         1.83          0.23  010
                                         wound(s).
12054........  ...........  A.........  Layer closure of         3.47         5.40         4.48          2.06         1.85          0.30  010
                                         wound(s).
12055........  ...........  A.........  Layer closure of         4.44         5.96         5.23          2.09         2.12          0.45  010
                                         wound(s).
12056........  ...........  A.........  Layer closure of         5.25         6.57         6.60          2.61         2.80          0.59  010
                                         wound(s).
12057........  ...........  A.........  Layer closure of         5.97         7.71         6.88          2.93         3.33          0.56  010
                                         wound(s).

[[Page 38238]]

 
13100........  ...........  A.........  Repair of wound          3.14         4.42         4.24          2.47         2.39          0.26  010
                                         or lesion.
13101........  ...........  A.........  Repair of wound          3.93         5.94         5.31          2.99         2.84          0.26  010
                                         or lesion.
13102........  ...........  A.........  Repair wound/            1.24         1.35         1.26          0.53         0.56          0.13  ZZZ
                                         lesion add-on.
13120........  ...........  A.........  Repair of wound          3.32         4.58         4.37          2.59         2.47          0.26  010
                                         or lesion.
13121........  ...........  A.........  Repair of wound          4.36         6.71         5.78          3.66         3.23          0.25  010
                                         or lesion.
13122........  ...........  A.........  Repair wound/            1.44         1.37         1.44          0.59         0.62          0.15  ZZZ
                                         lesion add-on.
13131........  ...........  A.........  Repair of wound          3.80         5.01         4.69          2.89         2.79          0.26  010
                                         or lesion.
13132........  ...........  A.........  Repair of wound          6.48         7.90         6.91          4.98         4.58          0.32  010
                                         or lesion.
13133........  ...........  A.........  Repair wound/            2.19         1.88         1.77          0.99         1.01          0.18  ZZZ
                                         lesion add-on.
13150........  ...........  A.........  Repair of wound          3.82         4.72         4.79          2.74         2.75          0.34  010
                                         or lesion.
13151........  ...........  A.........  Repair of wound          4.46         5.52         5.17          3.24         3.19          0.31  010
                                         or lesion.
13152........  ...........  A.........  Repair of wound          6.34         7.56         6.80          3.95         4.00          0.40  010
                                         or lesion.
13153........  ...........  A.........  Repair wound/            2.38         2.05         1.99          1.04         1.09          0.24  ZZZ
                                         lesion add-on.
13160........  ...........  A.........  Late closure of         11.84           NA           NA          7.00         7.10          1.54  090
                                         wound.
14000........  ...........  A.........  Skin tissue              6.83         8.93         8.40          6.05         5.77          0.59  090
                                         rearrangement.
14001........  ...........  A.........  Skin tissue              9.60        11.01        10.24          7.51         7.32          0.82  090
                                         rearrangement.
14020........  ...........  A.........  Skin tissue              7.66        10.02         9.33          6.90         6.73          0.64  090
                                         rearrangement.
14021........  ...........  A.........  Skin tissue             11.18        12.48        11.25          8.70         8.51          0.81  090
                                         rearrangement.
14040........  ...........  A.........  Skin tissue              8.44        10.19         9.51          7.01         7.12          0.62  090
                                         rearrangement.
14041........  ...........  A.........  Skin tissue             12.67        13.60        12.11          9.40         9.05          0.73  090
                                         rearrangement.
14060........  ...........  A.........  Skin tissue              9.07         9.70         9.25          7.21         7.33          0.68  090
                                         rearrangement.
14061........  ...........  A.........  Skin tissue             13.67        14.87        13.26         10.24         9.89          0.76  090
                                         rearrangement.
14300........  ...........  A.........  Skin tissue             13.26        13.53        12.36          9.49         9.35          1.16  090
                                         rearrangement.
14350........  ...........  A.........  Skin tissue             10.82           NA           NA          6.82         7.02          1.34  090
                                         rearrangement.
15002........  ...........  A.........  Wnd prep, ch/inf,        3.65         4.18         4.14          1.69         1.66          0.49  000
                                         trk/arm/lg.
15003........  ...........  A.........  Wnd prep, ch/inf         0.80         0.90         0.91          0.27         0.28          0.11  ZZZ
                                         addl 100 cm.
15004........  ...........  A.........  Wnd prep ch/inf,         4.58         4.84         4.79          2.02         1.99          0.62  000
                                         f/n/hf/g.
15005........  ...........  A.........  Wnd prep, f/n/hf/        1.60         1.23         1.26          0.53         0.55          0.22  ZZZ
                                         g, addl cm.
15040........  ...........  A.........  Harvest cultured         2.00         3.89         4.22          1.05         1.09          0.24  000
                                         skin graft.
15050........  ...........  A.........  Skin pinch graft.        5.37         7.52         7.25          4.94         5.05          0.57  090
15100........  ...........  A.........  Skin splt grft,          9.74         9.72        11.18          6.67         7.27          1.28  090
                                         trnk/arm/leg.
15101........  ...........  A.........  Skin splt grft t/        1.72         2.46         3.11          0.85         1.02          0.24  ZZZ
                                         a/l, add-on.
15110........  ...........  A.........  Epidrm autogrft         10.88         8.72         9.75          6.36         6.72          1.31  090
                                         trnk/arm/leg.
15111........  ...........  A.........  Epidrm autogrft t/       1.85         0.87         1.08          0.62         0.71          0.26  ZZZ
                                         a/l add-on.
15115........  ...........  A.........  Epidrm a-grft           11.19         9.22         9.23          6.75         7.06          1.15  090
                                         face/nck/hf/g.
15116........  ...........  A.........  Epidrm a-grft f/n/       2.50         1.20         1.40          0.87         1.00          0.33  ZZZ
                                         hf/g addl.
15120........  ...........  A.........  Skn splt a-grft         10.96        11.31        11.02          7.46         7.63          1.16  090
                                         fac/nck/hf/g.
15121........  ...........  A.........  Skn splt a-grft f/       2.67         3.41         3.96          1.30         1.58          0.36  ZZZ
                                         n/hf/g add.
15130........  ...........  A.........  Derm autograft,          7.41         7.91         8.92          5.56         5.97          0.97  090
                                         trnk/arm/leg.
15131........  ...........  A.........  Derm autograft t/        1.50         0.65         0.87          0.48         0.57          0.21  ZZZ
                                         a/l add-on.
15135........  ...........  A.........  Derm autograft          10.91         9.47         9.68          7.06         7.61          1.23  090
                                         face/nck/hf/g.
15136........  ...........  A.........  Derm autograft, f/       1.50         0.66         0.78          0.52         0.60          0.20  ZZZ
                                         n/hf/g add.
15150........  ...........  A.........  Cult epiderm grft        9.30         7.02         7.79          5.75         6.14          1.14  090
                                         t/arm/leg.
15151........  ...........  A.........  Cult epiderm grft        2.00         0.88         1.10          0.68         0.77          0.28  ZZZ
                                         t/a/l addl.
15152........  ...........  A.........  Cult epiderm             2.50         1.07         1.32          0.86         0.97          0.35  ZZZ
                                         graft t/a/l +%.
15155........  ...........  A.........  Cult epiderm            10.05         7.65         7.75          6.31         6.65          1.05  090
                                         graft, f/n/hf/g.
15156........  ...........  A.........  Cult epidrm grft         2.75         1.15         1.36          0.95         1.10          0.36  ZZZ
                                         f/n/hfg add.
15157........  ...........  A.........  Cult epiderm grft        3.00         1.34         1.57          1.04         1.21          0.39  ZZZ
                                         f/n/hfg +%.
15170........  ...........  A.........  Acell graft trunk/       5.99         3.99         3.86          2.60         2.45          0.55  090
                                         arms/legs.
15171........  ...........  A.........  Acell graft t/arm/       1.55         0.60         0.65          0.47         0.56          0.19  ZZZ
                                         leg add-on.
15175........  ...........  A.........  Acellular graft,         7.99         4.40         5.07          3.10         3.67          0.82  090
                                         f/n/hf/g.
15176........  ...........  A.........  Acell graft, f/n/        2.45         1.04         1.08          0.79         0.90          0.29  ZZZ
                                         hf/g add-on.
15200........  ...........  A.........  Skin full graft,         8.97         9.89         9.66          6.37         6.30          0.98  090
                                         trunk.
15201........  ...........  A.........  Skin full graft          1.32         2.00         2.30          0.47         0.56          0.19  ZZZ
                                         trunk add-on.
15220........  ...........  A.........  Skin full graft          7.95        10.45         9.82          6.72         6.70          0.84  090
                                         sclp/arm/leg.
15221........  ...........  A.........  Skin full graft          1.19         2.00         2.17          0.51         0.54          0.16  ZZZ
                                         add-on.
15240........  ...........  A.........  Skin full grft          10.15        12.02        11.11          8.92         8.44          0.92  090
                                         face/genit/hf.
15241........  ...........  A.........  Skin full graft          1.86         2.53         2.49          0.82         0.87          0.23  ZZZ
                                         add-on.
15260........  ...........  A.........  Skin full graft         11.39        13.03        11.63          9.38         8.99          0.69  090
                                         een & lips.
15261........  ...........  A.........  Skin full graft          2.23         2.98         2.83          1.17         1.28          0.21  ZZZ
                                         add-on.
15300........  ...........  A.........  Apply                    4.65         3.42         3.31          2.15         2.19          0.49  090
                                         skinallogrft, t/
                                         arm/lg.
15301........  ...........  A.........  Apply sknallogrft        1.00         0.45         0.46          0.32         0.37          0.14  ZZZ
                                         t/a/l addl.
15320........  ...........  A.........  Apply skin               5.36         3.73         3.68          2.33         2.44          0.58  090
                                         allogrft f/n/hf/
                                         g.
15321........  ...........  A.........  Aply sknallogrft         1.50         0.69         0.69          0.51         0.55          0.21  ZZZ
                                         f/n/hfg add.
15330........  ...........  A.........  Aply acell               3.99         3.48         3.28          2.14         2.15          0.49  090
                                         alogrft t/arm/
                                         leg.
15331........  ...........  A.........  Aply acell grft t/       1.00         0.49         0.47          0.36         0.38          0.14  ZZZ
                                         a/l add-on.
15335........  ...........  A.........  Apply acell              4.50         3.28         3.40          1.99         2.23          0.55  090
                                         graft, f/n/hf/g.
15336........  ...........  A.........  Aply acell grft f/       1.43         0.72         0.71          0.49         0.53          0.20  ZZZ
                                         n/hf/g add.
15340........  ...........  A.........  Apply cult skin          3.76         3.62         3.84          2.60         2.70          0.41  010
                                         substitute.
15341........  ...........  A.........  Apply cult skin          0.50         0.63         0.64          0.13         0.17          0.06  ZZZ
                                         sub add-on.
15360........  ...........  A.........  Apply cult derm          3.93         4.81         4.58          3.51         3.26          0.43  090
                                         sub, t/a/l.
15361........  ...........  A.........  Aply cult derm           1.15         0.50         0.55          0.32         0.40          0.14  ZZZ
                                         sub t/a/l add.

[[Page 38239]]

 
15365........  ...........  A.........  Apply cult derm          4.21         4.11         4.37          3.02         3.14          0.46  090
                                         sub f/n/hf/g.
15366........  ...........  A.........  Apply cult derm f/       1.45         0.67         0.69          0.47         0.53          0.17  ZZZ
                                         hf/g add.
15400........  ...........  A.........  Apply skin               4.38         4.92         4.47          3.71         3.87          0.47  090
                                         xenograft, t/a/l.
15401........  ...........  A.........  Apply skn                1.00         1.00         1.45          0.33         0.39          0.14  ZZZ
                                         xenogrft t/a/l
                                         add.
15420........  ...........  A.........  Apply skin               4.89         5.36         5.03          4.13         3.93          0.52  090
                                         xgraft, f/n/hf/g.
15421........  ...........  A.........  Apply skn xgrft f/       1.50         1.15         1.24          0.48         0.56          0.21  ZZZ
                                         n/hf/g add.
15430........  ...........  A.........  Apply acellular          5.93         6.51         6.80          5.97         6.38          0.66  090
                                         xenograft.
15431........  ...........  C.........  Apply acellular          0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         xgraft add.
15570........  ...........  A.........  Form skin pedicle       10.00        10.03        10.74          6.26         6.56          1.34  090
                                         flap.
15572........  ...........  A.........  Form skin pedicle        9.94         9.77         9.65          6.68         6.58          1.20  090
                                         flap.
15574........  ...........  A.........  Form skin pedicle       10.52        10.54        10.61          7.06         7.42          1.20  090
                                         flap.
15576........  ...........  A.........  Form skin pedicle        9.24         9.68         9.72          6.55         6.72          0.87  090
                                         flap.
15600........  ...........  A.........  Skin graft.......        1.95         5.28         6.45          2.74         2.90          0.27  090
15610........  ...........  A.........  Skin graft.......        2.46         5.52         5.12          3.03         3.23          0.35  090
15620........  ...........  A.........  Skin graft.......        3.62         6.43         7.10          3.89         3.88          0.35  090
15630........  ...........  A.........  Skin graft.......        3.95         7.05         7.04          4.31         4.23          0.34  090
15650........  ...........  A.........  Transfer skin            4.64         7.26         7.18          4.39         4.28          0.42  090
                                         pedicle flap.
15731........  ...........  A.........  Forehead flap w/        14.12        11.92        12.06          9.38         9.50          1.28  090
                                         vasc pedicle.
15732........  ...........  A.........  Muscle-skin             19.70        14.70        16.41         11.17        11.73          2.00  090
                                         graft, head/neck.
15734........  ...........  A.........  Muscle-skin             19.62        15.67        16.94         11.87        12.17          2.62  090
                                         graft, trunk.
15736........  ...........  A.........  Muscle-skin             16.92        13.37        15.90          9.61        10.51          2.46  090
                                         graft, arm.
15738........  ...........  A.........  Muscle-skin             18.92        13.75        15.94         10.21        11.04          2.66  090
                                         graft, leg.
15740........  ...........  A.........  Island pedicle          11.57        13.59        11.87          9.47         8.88          0.63  090
                                         flap graft.
15750........  ...........  A.........  Neurovascular           12.73           NA           NA          8.87         8.98          1.42  090
                                         pedicle graft.
15756........  ...........  A.........  Free myo/skin           36.74           NA           NA         18.66        19.65          4.62  090
                                         flap microvasc.
15757........  ...........  A.........  Free skin flap,         36.95           NA           NA         17.98        19.63          3.90  090
                                         microvasc.
15758........  ...........  A.........  Free fascial            36.70           NA           NA         17.66        19.49          4.24  090
                                         flap, microvasc.
15760........  ...........  A.........  Composite skin           9.68        10.42        10.21          7.09         7.17          0.85  090
                                         graft.
15770........  ...........  A.........  Derma-fat-fascia         8.73           NA           NA          6.65         6.67          1.05  090
                                         graft.
15775........  ...........  R.........  Hair transplant          3.95         2.86         3.65          1.23         1.35          0.52  000
                                         punch grafts.
15776........  ...........  R.........  Hair transplant          5.53         4.84         4.94          2.15         2.38          0.72  000
                                         punch grafts.
15780........  ...........  A.........  Abrasion                 8.50        11.44        11.55          6.70         7.51          0.67  090
                                         treatment of
                                         skin.
15781........  ...........  A.........  Abrasion                 4.91         8.67         7.79          5.65         5.51          0.34  090
                                         treatment of
                                         skin.
15782........  ...........  A.........  Abrasion                 4.36         8.65         9.42          4.94         5.85          0.34  090
                                         treatment of
                                         skin.
15783........  ...........  A.........  Abrasion                 4.33         7.93         7.44          4.99         4.61          0.28  090
                                         treatment of
                                         skin.
15786........  ...........  A.........  Abrasion, lesion,        2.05         3.89         3.61          1.25         1.29          0.11  010
                                         single.
15787........  ...........  A.........  Abrasion,                0.33         0.82         0.96          0.08         0.13          0.04  ZZZ
                                         lesions, add-on.
15788........  ...........  R.........  Chemical peel,           2.09         9.40         7.91          4.11         3.53          0.11  090
                                         face, epiderm.
15789........  ...........  R.........  Chemical peel,           4.91         9.43         8.73          5.85         5.31          0.20  090
                                         face, dermal.
15792........  ...........  R.........  Chemical peel,           1.86         8.88         7.65          4.54         4.32          0.13  090
                                         nonfacial.
15793........  ...........  A.........  Chemical peel,           3.82         8.08         6.76          4.91         4.38          0.19  090
                                         nonfacial.
15819........  ...........  A.........  Plastic surgery,        10.45           NA           NA          6.71         6.96          0.97  090
                                         neck.
15820........  ...........  A.........  Revision of lower        6.09         6.43         6.72          5.24         5.41          0.40  090
                                         eyelid.
15821........  ...........  A.........  Revision of lower        6.66         6.61         7.01          5.33         5.54          0.45  090
                                         eyelid.
15822........  ...........  A.........  Revision of upper        4.51         5.24         5.56          4.11         4.32          0.37  090
                                         eyelid.
15823........  ...........  A.........  Revision of upper        8.12         7.42         7.67          6.15         6.32          0.50  090
                                         eyelid.
15830........  ...........  R.........  Exc skin abd.....       16.90           NA           NA          9.82        10.04          2.93  090
15832........  ...........  A.........  Excise excessive        12.65           NA           NA          8.31         8.34          1.66  090
                                         skin tissue.
15833........  ...........  A.........  Excise excessive        11.70           NA           NA          7.42         7.77          1.49  090
                                         skin tissue.
15834........  ...........  A.........  Excise excessive        11.97           NA           NA          8.13         7.86          1.61  090
                                         skin tissue.
15835........  ...........  A.........  Excise excessive        12.79           NA           NA          7.83         7.70          1.60  090
                                         skin tissue.
15836........  ...........  A.........  Excise excessive        10.41           NA           NA          6.88         6.87          1.34  090
                                         skin tissue.
15837........  ...........  A.........  Excise excessive         9.37         8.61         8.61          5.75         6.57          1.18  090
                                         skin tissue.
15838........  ...........  A.........  Excise excessive         8.07           NA           NA          5.45         5.68          0.58  090
                                         skin tissue.
15839........  ...........  A.........  Excise excessive        10.32         9.70         9.21          6.44         6.39          1.22  090
                                         skin tissue.
15840........  ...........  A.........  Graft for face          14.76           NA           NA          8.97         9.44          1.32  090
                                         nerve palsy.
15841........  ...........  A.........  Graft for face          25.69           NA           NA         13.62        14.26          2.55  090
                                         nerve palsy.
15842........  ...........  A.........  Flap for face           40.68           NA           NA         20.89        22.02          4.94  090
                                         nerve palsy.
15845........  ...........  A.........  Skin and muscle         14.04           NA           NA          8.43         8.94          0.81  090
                                         repair, face.
15847........  ...........  C.........  Exc skin abd add-        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         on.
15850........  ...........  B.........  Removal of               0.78         1.19         1.38          0.18         0.24          0.05  XXX
                                         sutures.
15851........  ...........  A.........  Removal of               0.86         1.32         1.50          0.24         0.27          0.06  000
                                         sutures.
15852........  ...........  A.........  Dressing change          0.86           NA           NA          0.26         0.29          0.09  000
                                         not for burn.
15860........  ...........  A.........  Test for blood           1.95           NA           NA          0.64         0.72          0.27  000
                                         flow in graft.
15920........  ...........  A.........  Removal of tail          8.15           NA           NA          5.32         5.53          1.04  090
                                         bone ulcer.
15922........  ...........  A.........  Removal of tail         10.23           NA           NA          7.20         7.19          1.42  090
                                         bone ulcer.
15931........  ...........  A.........  Remove sacrum            9.96           NA           NA          5.54         5.61          1.25  090
                                         pressure sore.
15933........  ...........  A.........  Remove sacrum           11.60           NA           NA          7.29         7.59          1.52  090
                                         pressure sore.
15934........  ...........  A.........  Remove sacrum           13.54           NA           NA          7.70         7.87          1.79  090
                                         pressure sore.
15935........  ...........  A.........  Remove sacrum           15.58           NA           NA          9.15         9.94          2.10  090
                                         pressure sore.
15936........  ...........  A.........  Remove sacrum           13.04           NA           NA          7.42         7.85          1.77  090
                                         pressure sore.
15937........  ...........  A.........  Remove sacrum           15.00           NA           NA          8.96         9.42          2.07  090
                                         pressure sore.

[[Page 38240]]

 
15940........  ...........  A.........  Remove hip              10.11           NA           NA          5.78         6.00          1.31  090
                                         pressure sore.
15941........  ...........  A.........  Remove hip              12.24           NA           NA          8.43         8.98          1.66  090
                                         pressure sore.
15944........  ...........  A.........  Remove hip              12.27           NA           NA          8.12         8.41          1.65  090
                                         pressure sore.
15945........  ...........  A.........  Remove hip              13.57           NA           NA          8.81         9.32          1.85  090
                                         pressure sore.
15946........  ...........  A.........  Remove hip              23.80           NA           NA         13.73        14.14          3.17  090
                                         pressure sore.
15950........  ...........  A.........  Remove thigh             7.91           NA           NA          5.38         5.41          1.04  090
                                         pressure sore.
15951........  ...........  A.........  Remove thigh            11.41           NA           NA          7.31         7.72          1.49  090
                                         pressure sore.
15952........  ...........  A.........  Remove thigh            12.14           NA           NA          7.47         7.68          1.60  090
                                         pressure sore.
15953........  ...........  A.........  Remove thigh            13.39           NA           NA          8.22         8.78          1.80  090
                                         pressure sore.
15956........  ...........  A.........  Remove thigh            16.59           NA           NA          9.54        10.20          2.22  090
                                         pressure sore.
15958........  ...........  A.........  Remove thigh            16.55           NA           NA         10.48        10.76          2.26  090
                                         pressure sore.
15999........  ...........  C.........  Removal of               0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         pressure sore.
16000........  ...........  A.........  Initial treatment        0.89         0.72         0.79          0.23         0.25          0.08  000
                                         of burn(s).
16020........  ...........  A.........  Dress/debrid p-          0.80         1.10         1.20          0.56         0.57          0.08  000
                                         thick burn, s.
16025........  ...........  A.........  Dress/debrid p-          1.85         1.56         1.67          0.85         0.91          0.19  000
                                         thick burn, m.
16030........  ...........  A.........  Dress/debrid p-          2.08         2.07         2.10          1.02         1.06          0.24  000
                                         thick burn, l.
16035........  ...........  A.........  Incision of burn         3.74           NA           NA          1.22         1.41          0.46  090
                                         scab, initi.
16036........  ...........  A.........  Escharotomy;             1.50           NA           NA          0.45         0.53          0.20  ZZZ
                                         add[boxHu]l
                                         incision.
17000........  ...........  A.........  Destruct premalg         0.62         1.41         1.19          0.74         0.64          0.03  010
                                         lesion.
17003........  ...........  A.........  Destruct premalg         0.07         0.10         0.11          0.03         0.05          0.01  ZZZ
                                         les, 2-14.
17004........  ...........  A.........  Destroy premlg           1.82         2.45         2.37          1.39         1.49          0.11  010
                                         lesions 15+.
17106........  ...........  A.........  Destruction of           4.62         4.70         4.65          3.30         3.32          0.35  090
                                         skin lesions.
17107........  ...........  A.........  Destruction of           9.19         7.01         7.16          4.99         5.27          0.63  090
                                         skin lesions.
17108........  ...........  A.........  Destruction of          13.22         8.91         9.20          6.45         7.14          0.54  090
                                         skin lesions.
17110........  ...........  A.........  Destruct b9              0.67         1.77         1.70          0.88         0.79          0.05  010
                                         lesion, 1-14.
17111........  ...........  A.........  Destruct lesion,         0.94         2.24         1.97          1.11         0.96          0.05  010
                                         15 or more.
17250........  ...........  A.........  Chemical cautery,        0.50         1.30         1.27          0.38         0.36          0.06  000
                                         tissue.
17260........  ...........  A.........  Destruction of           0.93         1.41         1.35          0.71         0.70          0.04  010
                                         skin lesions.
17261........  ...........  A.........  Destruction of           1.19         2.49         2.06          1.07         0.96          0.05  010
                                         skin lesions.
17262........  ...........  A.........  Destruction of           1.60         2.83         2.36          1.28         1.15          0.06  010
                                         skin lesions.
17263........  ...........  A.........  Destruction of           1.81         3.07         2.56          1.38         1.24          0.07  010
                                         skin lesions.
17264........  ...........  A.........  Destruction of           1.96         3.27         2.75          1.45         1.29          0.08  010
                                         skin lesions.
17266........  ...........  A.........  Destruction of           2.36         3.50         3.01          1.60         1.42          0.09  010
                                         skin lesions.
17270........  ...........  A.........  Destruction of           1.34         2.43         2.07          1.10         0.99          0.05  010
                                         skin lesions.
17271........  ...........  A.........  Destruction of           1.51         2.66         2.22          1.23         1.11          0.06  010
                                         skin lesions.
17272........  ...........  A.........  Destruction of           1.79         2.97         2.48          1.38         1.25          0.07  010
                                         skin lesions.
17273........  ...........  A.........  Destruction of           2.07         3.21         2.71          1.50         1.36          0.08  010
                                         skin lesions.
17274........  ...........  A.........  Destruction of           2.61         3.61         3.10          1.76         1.61          0.10  010
                                         skin lesions.
17276........  ...........  A.........  Destruction of           3.22         3.89         3.42          1.99         1.84          0.16  010
                                         skin lesions.
17280........  ...........  A.........  Destruction of           1.19         2.36         1.99          1.04         0.93          0.05  010
                                         skin lesions.
17281........  ...........  A.........  Destruction of           1.74         2.74         2.33          1.34         1.22          0.07  010
                                         skin lesions.
17282........  ...........  A.........  Destruction of           2.06         3.15         2.66          1.51         1.38          0.08  010
                                         skin lesions.
17283........  ...........  A.........  Destruction of           2.66         3.56         3.06          1.79         1.64          0.11  010
                                         skin lesions.
17284........  ...........  A.........  Destruction of           3.23         3.98         3.46          2.05         1.91          0.13  010
                                         skin lesions.
17286........  ...........  A.........  Destruction of           4.45         4.46         4.07          2.51         2.48          0.23  010
                                         skin lesions.
17311........  ...........  A.........  Mohs, 1 stage, h/        6.20        10.71        10.76          3.10         3.14          0.24  000
                                         n/hf/g.
17312........  ...........  A.........  Mohs addl stage..        3.30         6.88         6.91          1.65         1.67          0.13  ZZZ
17313........  ...........  A.........  Mohs, 1 stage, t/        5.56         9.88         9.93          2.78         2.81          0.22  000
                                         a/l.
17314........  ...........  A.........  Mohs, addl stage,        3.06         6.37         6.40          1.53         1.54          0.12  ZZZ
                                         t/a/l.
17315........  ...........  A.........  Mohs surg, addl          0.87         1.14         1.15          0.43         0.44          0.03  ZZZ
                                         block.
17340........  ...........  A.........  Cryotherapy of           0.76         0.35         0.36          0.38         0.37          0.05  010
                                         skin.
17360........  ...........  A.........  Skin peel therapy        1.44         1.86         1.65          1.02         0.95          0.06  010
17999........  ...........  C.........  Skin tissue              0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
19000........  ...........  A.........  Drainage of              0.84         1.89         1.92          0.27         0.28          0.08  000
                                         breast lesion.
19001........  ...........  A.........  Drain breast             0.42         0.26         0.25          0.14         0.14          0.04  ZZZ
                                         lesion add-on.
19020........  ...........  A.........  Incision of              3.74         6.57         6.45          3.02         2.85          0.45  090
                                         breast lesion.
19030........  ...........  A.........  Injection for            1.53         2.65         2.72          0.55         0.50          0.09  000
                                         breast x-ray.
19100........  ...........  A.........  Bx breast percut         1.27         2.06         2.07          0.33         0.38          0.16  000
                                         w/o image.
19101........  ...........  A.........  Biopsy of breast,        3.20         4.33         4.41          1.77         1.84          0.39  010
                                         open.
19102........  ...........  A.........  Bx breast percut         2.00         3.44         3.60          0.69         0.66          0.14  000
                                         w/image.
19103........  ...........  A.........  Bx breast percut         3.69        10.02        10.68          1.20         1.19          0.30  000
                                         w/device.
19105........  ...........  A.........  Cryosurg ablate          3.69        45.89        45.89          0.99         0.99          0.30  000
                                         fa, each.
19110........  ...........  A.........  Nipple                   4.35         6.15         6.00          3.14         3.02          0.57  090
                                         exploration.
19112........  ...........  A.........  Excise breast            3.72         6.16         6.12          3.10         2.90          0.48  090
                                         duct fistula.
19120........  ...........  A.........  Removal of breast        5.84         5.04         4.79          3.35         3.21          0.73  090
                                         lesion.
19125........  ...........  A.........  Excision, breast         6.59         5.51         5.15          3.63         3.46          0.80  090
                                         lesion.
19126........  ...........  A.........  Excision, addl           2.93           NA           NA          0.75         0.88          0.38  ZZZ
                                         breast lesion.
19260........  ...........  A.........  Removal of chest        17.60           NA           NA         10.08        10.65          2.14  090
                                         wall lesion.
19271........  ...........  A.........  Revision of chest       21.86           NA           NA         15.73        16.86          2.63  090
                                         wall.
19272........  ...........  A.........  Extensive chest         24.82           NA           NA         16.86        17.92          3.00  090
                                         wall surgery.
19290........  ...........  A.........  Place needle             1.27         2.87         2.83          0.45         0.42          0.07  000
                                         wire, breast.
19291........  ...........  A.........  Place needle             0.63         1.13         1.16          0.22         0.21          0.04  ZZZ
                                         wire, breast.

[[Page 38241]]

 
19295........  ...........  A.........  Place breast             0.00         2.25         2.46          0.00         1.35          0.01  ZZZ
                                         clip, percut.
19296........  ...........  A.........  Place po breast          3.63        84.88       104.91          1.19         1.36          0.36  000
                                         cath for rad.
19297........  ...........  A.........  Place breast cath        1.72           NA           NA          0.44         0.55          0.17  ZZZ
                                         for rad.
19298........  ...........  A.........  Place breast rad         6.00        21.81        32.20          2.14         2.29          0.43  000
                                         tube/caths.
19300........  ...........  A.........  Removal of breast        5.20         7.97         7.43          3.83         3.54          0.69  090
                                         tissue.
19301........  ...........  A.........  Partial                 10.00           NA           NA          4.61         3.82          0.79  090
                                         mastectomy.
19302........  ...........  A.........  P-mastectomy w/ln       13.88           NA           NA          6.12         6.27          1.80  090
                                         removal.
19303........  ...........  A.........  Mast, simple,           15.67           NA           NA          6.97         5.68          1.18  090
                                         complete.
19304........  ...........  A.........  Mast, subq.......        7.81           NA           NA          4.91         4.81          1.04  090
19305........  ...........  A.........  Mast, radical....       17.23           NA           NA          8.09         8.02          1.93  090
19306........  ...........  A.........  Mast, rad, urban        17.85           NA           NA          8.68         8.39          2.08  090
                                         type.
19307........  ...........  A.........  Mast, mod rad....       17.95           NA           NA          8.72         8.39          2.13  090
19316........  ...........  A.........  Suspension of           10.98           NA           NA          6.96         7.29          1.64  090
                                         breast.
19318........  ...........  A.........  Reduction of            15.91           NA           NA          9.94        10.61          2.93  090
                                         large breast.
19324........  ...........  A.........  Enlarge breast...        6.65           NA           NA          4.45         4.71          0.84  090
19325........  ...........  A.........  Enlarge breast           8.52           NA           NA          6.42         6.51          1.33  090
                                         with implant.
19328........  ...........  A.........  Removal of breast        6.35           NA           NA          4.98         5.03          0.91  090
                                         implant.
19330........  ...........  A.........  Removal of               8.39           NA           NA          5.94         6.05          1.26  090
                                         implant material.
19340........  ...........  A.........  Immediate breast         6.32           NA           NA          2.83         2.99          1.06  ZZZ
                                         prosthesis.
19342........  ...........  A.........  Delayed breast          12.40           NA           NA          8.94         8.98          1.84  090
                                         prosthesis.
19350........  ...........  A.........  Breast                   8.99         9.86        11.89          6.60         6.91          1.41  090
                                         reconstruction.
19355........  ...........  A.........  Correct inverted         8.37         7.41         8.90          4.69         4.75          0.92  090
                                         nipple(s).
19357........  ...........  A.........  Breast                  20.57           NA           NA         15.40        15.59          2.94  090
                                         reconstruction.
19361........  ...........  A.........  Breast reconstr w/      23.17           NA           NA         16.83        14.71          2.93  090
                                         lat flap.
19364........  ...........  A.........  Breast                  42.40           NA           NA         22.28        23.13          6.24  090
                                         reconstruction.
19366........  ...........  A.........  Breast                  21.70           NA           NA          9.91        10.81          3.25  090
                                         reconstruction.
19367........  ...........  A.........  Breast                  26.59           NA           NA         15.24        16.05          4.04  090
                                         reconstruction.
19368........  ...........  A.........  Breast                  33.61           NA           NA         18.12        18.63          5.54  090
                                         reconstruction.
19369........  ...........  A.........  Breast                  31.02           NA           NA         16.41        17.40          4.51  090
                                         reconstruction.
19370........  ...........  A.........  Surgery of breast        8.99           NA           NA          6.79         6.88          1.29  090
                                         capsule.
19371........  ...........  A.........  Removal of breast       10.42           NA           NA          7.69         7.80          1.62  090
                                         capsule.
19380........  ...........  A.........  Revise breast           10.21           NA           NA          7.62         7.70          1.44  090
                                         reconstruction.
19396........  ...........  A.........  Design custom            2.17         4.50         2.80          1.29         1.14          0.30  000
                                         breast implant.
19499........  ...........  C.........  Breast surgery           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
20000........  ...........  A.........  Incision of              2.14         2.74         2.72          1.51         1.62          0.25  010
                                         abscess.
20005........  ...........  A.........  Incision of deep         3.55         3.62         3.57          1.99         2.13          0.46  010
                                         abscess.
20100........  ...........  A.........  Explore wound,          10.33           NA           NA          3.59         4.04          1.21  010
                                         neck.
20101........  ...........  A.........  Explore wound,           3.22         6.53         6.20          1.53         1.57          0.44  010
                                         chest.
20102........  ...........  A.........  Explore wound,           3.95         6.88         7.17          1.83         1.87          0.49  010
                                         abdomen.
20103........  ...........  A.........  Explore wound,           5.31         7.72         8.15          2.77         3.08          0.75  010
                                         extremity.
20150........  ...........  A.........  Excise epiphyseal       14.60           NA           NA          7.67         7.38          2.04  090
                                         bar.
20200........  ...........  A.........  Muscle biopsy....        1.46         3.06         3.06          0.69         0.72          0.23  000
20205........  ...........  A.........  Deep muscle              2.35         3.79         3.84          1.10         1.15          0.33  000
                                         biopsy.
20206........  ...........  A.........  Needle biopsy,           0.99         5.17         5.80          0.57         0.59          0.07  000
                                         muscle.
20220........  ...........  A.........  Bone biopsy,             1.27         2.69         3.61          0.68         0.73          0.08  000
                                         trocar/needle.
20225........  ...........  A.........  Bone biopsy,             1.87        11.89        18.29          1.03         1.08          0.22  000
                                         trocar/needle.
20240........  ...........  A.........  Bone biopsy,             3.25           NA           NA          2.02         2.30          0.44  010
                                         excisional.
20245........  ...........  A.........  Bone biopsy,             8.77           NA           NA          5.73         6.16          1.31  010
                                         excisional.
20250........  ...........  A.........  Open bone biopsy.        5.16           NA           NA          3.63         3.58          1.02  010
20251........  ...........  A.........  Open bone biopsy.        5.69           NA           NA          3.86         4.02          1.15  010
20500........  ...........  A.........  Injection of             1.25         1.32         1.78          0.87         1.20          0.12  010
                                         sinus tract.
20501........  ...........  A.........  Inject sinus             0.76         2.35         2.61          0.28         0.25          0.04  000
                                         tract for x-ray.
20520........  ...........  A.........  Removal of               1.87         2.58         2.75          1.44         1.60          0.21  010
                                         foreign body.
20525........  ...........  A.........  Removal of               3.51         7.03         8.09          2.19         2.41          0.51  010
                                         foreign body.
20526........  ...........  A.........  Ther injection,          0.94         0.81         0.89          0.41         0.47          0.13  000
                                         carp tunnel.
20550........  ...........  A.........  Inj tendon sheath/       0.75         0.62         0.67          0.28         0.26          0.09  000
                                         ligament.
20551........  ...........  A.........  Inj tendon origin/       0.75         0.64         0.66          0.29         0.31          0.08  000
                                         insertion.
20552........  ...........  A.........  Inj trigger              0.66         0.58         0.65          0.25         0.22          0.05  000
                                         point, 1/2 muscl.
20553........  ...........  A.........  Inject trigger           0.75         0.64         0.73          0.27         0.24          0.04  000
                                         points, =/> 3.
20600........  ...........  A.........  Drain/inject,            0.66         0.65         0.66          0.31         0.33          0.08  000
                                         joint/bursa.
20605........  ...........  A.........  Drain/inject,            0.68         0.73         0.75          0.32         0.34          0.08  000
                                         joint/bursa.
20610........  ...........  A.........  Drain/inject,            0.79         1.06         1.01          0.40         0.41          0.11  000
                                         joint/bursa.
20612........  ...........  A.........  Aspirate/inj             0.70         0.69         0.70          0.32         0.34          0.10  000
                                         ganglion cyst.
20615........  ...........  A.........  Treatment of bone        2.30         2.68         3.10          1.41         1.62          0.20  010
                                         cyst.
20650........  ...........  A.........  Insert and remove        2.25         2.41         2.40          1.42         1.50          0.31  010
                                         bone pin.
20660........  ...........  A.........  Apply, rem               2.51         3.30         3.19          1.49         1.56          0.59  000
                                         fixation device.
20661........  ...........  A.........  Application of           5.14           NA           NA          6.05         5.48          1.14  090
                                         head brace.
20662........  ...........  A.........  Application of           6.26           NA           NA          4.91         5.21          0.56  090
                                         pelvis brace.
20663........  ...........  A.........  Application of           5.62           NA           NA          4.84         4.89          0.94  090
                                         thigh brace.
20664........  ...........  A.........  Halo brace               9.86           NA           NA          7.83         7.50          1.75  090
                                         application.
20665........  ...........  A.........  Removal of               1.33         1.37         1.78          0.98         1.17          0.19  010
                                         fixation device.
20670........  ...........  A.........  Removal of               1.76         6.54         9.06          1.65         1.88          0.28  010
                                         support implant.

[[Page 38242]]

 
20680........  ...........  A.........  Removal of               5.90         8.07         8.44          4.05         3.90          0.56  090
                                         support implant.
20690........  ...........  A.........  Apply bone               3.67           NA           NA          2.24         2.39          0.59  090
                                         fixation device.
20692........  ...........  A.........  Apply bone               6.40           NA           NA          3.18         3.49          1.05  090
                                         fixation device.
20693........  ...........  A.........  Adjust bone              5.97           NA           NA          4.45         4.96          0.98  090
                                         fixation device.
20694........  ...........  A.........  Remove bone              4.20         5.27         6.22          3.51         3.78          0.71  090
                                         fixation device.
20802........  ...........  A.........  Replantation,           42.30           NA           NA         13.20        19.01          3.82  090
                                         arm, complete.
20805........  ...........  A.........  Replant forearm,        51.14           NA           NA         23.87        29.46          4.85  090
                                         complete.
20808........  ...........  A.........  Replantation            62.77           NA           NA         37.05        40.08          6.88  090
                                         hand, complete.
20816........  ...........  A.........  Replantation            31.74           NA           NA         25.24        31.41          4.53  090
                                         digit, complete.
20822........  ...........  A.........  Replantation            26.42           NA           NA         23.69        28.95          4.19  090
                                         digit, complete.
20824........  ...........  A.........  Replantation            31.74           NA           NA         24.76        30.85          4.62  090
                                         thumb, complete.
20827........  ...........  A.........  Replantation            27.24           NA           NA         23.43        30.06          3.67  090
                                         thumb, complete.
20838........  ...........  A.........  Replantation            42.56           NA           NA         14.01        18.06          1.12  090
                                         foot, complete.
20900........  ...........  A.........  Removal of bone          5.77         9.15         8.82          4.88         5.29          0.94  090
                                         for graft.
20902........  ...........  A.........  Removal of bone          7.98           NA           NA          5.97         6.41          1.30  090
                                         for graft.
20910........  ...........  A.........  Remove cartilage         5.41           NA           NA          4.55         4.89          0.71  090
                                         for graft.
20912........  ...........  A.........  Remove cartilage         6.42           NA           NA          4.96         5.34          0.69  090
                                         for graft.
20920........  ...........  A.........  Removal of fascia        5.42           NA           NA          4.35         4.30          0.66  090
                                         for graft.
20922........  ...........  A.........  Removal of fascia        6.84         7.56         7.55          5.02         4.95          0.70  090
                                         for graft.
20924........  ...........  A.........  Removal of tendon        6.59           NA           NA          4.94         5.43          1.04  090
                                         for graft.
20926........  ...........  A.........  Removal of tissue        5.70           NA           NA          4.49         4.61          0.87  090
                                         for graft.
20931........  ...........  A.........  Spinal bone              1.81           NA           NA          0.69         0.81          0.43  ZZZ
                                         allograft.
20937........  ...........  A.........  Spinal bone              2.79           NA           NA          1.09         1.28          0.54  ZZZ
                                         autograft.
20938........  ...........  A.........  Spinal bone              3.02           NA           NA          1.16         1.37          0.64  ZZZ
                                         autograft.
20950........  ...........  A.........  Fluid pressure,          1.26         4.18         5.51          0.88         0.93          0.20  000
                                         muscle.
20955........  ...........  A.........  Fibula bone             40.02           NA           NA         18.61        21.42          4.90  090
                                         graft, microvasc.
20956........  ...........  A.........  Iliac bone graft,       40.93           NA           NA         20.42        22.67          7.03  090
                                         microvasc.
20957........  ...........  A.........  Mt bone graft,          42.33           NA           NA         15.50        17.91          7.07  090
                                         microvasc.
20962........  ...........  A.........  Other bone graft,       39.21           NA           NA         21.53        24.02          6.57  090
                                         microvasc.
20969........  ...........  A.........  Bone/skin graft,        45.11           NA           NA         21.25        23.86          4.80  090
                                         microvasc.
20970........  ...........  A.........  Bone/skin graft,        44.26           NA           NA         21.03        23.12          6.62  090
                                         iliac crest.
20972........  ...........  A.........  Bone/skin graft,        44.19           NA           NA         14.42        18.07          5.32  090
                                         metatarsal.
20973........  ...........  A.........  Bone/skin graft,        46.95           NA           NA         14.14        19.83          5.56  090
                                         great toe.
20974........  ...........  A.........  Electrical bone          0.62         0.97         0.84          0.48         0.51          0.11  000
                                         stimulation.
20975........  ...........  A.........  Electrical bone          2.60           NA           NA          1.46         1.59          0.51  000
                                         stimulation.
20979........  ...........  A.........  Us bone                  0.62         0.60         0.70          0.20         0.27          0.09  000
                                         stimulation.
20982........  ...........  A.........  Ablate, bone             7.27        79.27        94.26          2.71         2.78          0.69  000
                                         tumor(s) perq.
20999........  ...........  C.........  Musculoskeletal          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
21010........  ...........  A.........  Incision of jaw         10.90           NA           NA          6.42         6.68          1.11  090
                                         joint.
21015........  ...........  A.........  Resection of             5.59           NA           NA          4.30         4.67          0.70  090
                                         facial tumor.
21025........  ...........  A.........  Excision of bone,       11.07        12.59        12.41          8.80         9.07          1.32  090
                                         lower jaw.
21026........  ...........  A.........  Excision of              5.54         8.82         8.33          5.94         6.12          0.60  090
                                         facial bone(s).
21029........  ...........  A.........  Contour of face          8.26         9.60         9.44          6.59         6.76          0.94  090
                                         bone lesion.
21030........  ...........  A.........  Excise max/zygoma        4.80         7.19         6.76          4.70         4.87          0.54  090
                                         b9 tumor.
21031........  ...........  A.........  Remove exostosis,        3.26         5.91         5.55          3.48         3.56          0.48  090
                                         mandible.
21032........  ...........  A.........  Remove exostosis,        3.28         6.04         5.69          3.37         3.44          0.47  090
                                         maxilla.
21034........  ...........  A.........  Excise max/zygoma       17.17        13.98        14.84         10.19        11.34          1.72  090
                                         mlg tumor.
21040........  ...........  A.........  Excise mandible          4.80         7.21         6.81          4.66         4.70          0.54  090
                                         lesion.
21044........  ...........  A.........  Removal of jaw          12.61           NA           NA          8.14         8.67          1.12  090
                                         bone lesion.
21045........  ...........  A.........  Extensive jaw           18.13           NA           NA         10.87        11.50          1.52  090
                                         surgery.
21046........  ...........  A.........  Remove mandible         13.97           NA           NA         11.59        11.77          1.86  090
                                         cyst complex.
21047........  ...........  A.........  Excise lwr jaw          19.83           NA           NA         10.32        11.81          2.13  090
                                         cyst w/repair.
21048........  ...........  A.........  Remove maxilla          14.47           NA           NA         11.45        11.80          1.77  090
                                         cyst complex.
21049........  ...........  A.........  Excis uppr jaw          19.08           NA           NA         10.36        11.51          1.59  090
                                         cyst w/repair.
21050........  ...........  A.........  Removal of jaw          11.54           NA           NA          8.21         8.84          1.47  090
                                         joint.
21060........  ...........  A.........  Remove jaw joint        10.91           NA           NA          7.24         7.99          1.38  090
                                         cartilage.
21070........  ...........  A.........  Remove coronoid          8.50           NA           NA          6.30         6.69          1.27  090
                                         process.
21076........  ...........  A.........  Prepare face/oral       13.40         7.83        10.12          4.78         7.41          2.00  010
                                         prosthesis.
21077........  ...........  A.........  Prepare face/oral       33.70        18.06        24.81         11.99        19.09          4.56  090
                                         prosthesis.
21079........  ...........  A.........  Prepare face/oral       22.31        13.62        17.61          8.24        12.73          3.16  090
                                         prosthesis.
21080........  ...........  A.........  Prepare face/oral       25.06        15.78        20.19          9.17        14.30          3.75  090
                                         prosthesis.
21081........  ...........  A.........  Prepare face/oral       22.85        14.72        18.53          8.55        13.04          3.21  090
                                         prosthesis.
21082........  ...........  A.........  Prepare face/oral       20.84        14.77        17.10          8.38        12.09          3.12  090
                                         prosthesis.
21083........  ...........  A.........  Prepare face/oral       19.27        14.58        16.72          7.89        11.19          2.89  090
                                         prosthesis.
21084........  ...........  A.........  Prepare face/oral       22.48        16.52        19.45          9.08        13.37          2.19  090
                                         prosthesis.
21085........  ...........  A.........  Prepare face/oral        8.99         6.80         7.56          3.57         5.19          1.27  010
                                         prosthesis.
21086........  ...........  A.........  Prepare face/oral       24.88        12.65        18.24          8.58        14.05          3.72  090
                                         prosthesis.
21087........  ...........  A.........  Prepare face/oral       24.88        12.80        18.10          8.70        14.00          3.45  090
                                         prosthesis.
21088........  ...........  C.........  Prepare face/oral        0.00         0.00         0.00          0.00         0.00          0.00  090
                                         prosthesis.
21089........  ...........  C.........  Prepare face/oral        0.00         0.00         0.00          0.00         0.00          0.00  090
                                         prosthesis.
21100........  ...........  A.........  Maxillofacial            4.56        14.76        12.98          5.52         5.06          0.34  090
                                         fixation.
21110........  ...........  A.........  Interdental              5.80        13.02        11.33          9.72         9.07          0.72  090
                                         fixation.

[[Page 38243]]

 
21116........  ...........  A.........  Injection, jaw           0.81         2.50         3.39          0.23         0.28          0.06  000
                                         joint x-ray.
21120........  ...........  A.........  Reconstruction of        4.99         9.59        10.17          6.62         7.11          0.60  090
                                         chin.
21121........  ...........  A.........  Reconstruction of        7.70        10.67        10.20          7.63         7.72          0.90  090
                                         chin.
21122........  ...........  A.........  Reconstruction of        8.59           NA           NA          8.45         8.42          1.07  090
                                         chin.
21123........  ...........  A.........  Reconstruction of       11.22           NA           NA          6.98         9.42          1.40  090
                                         chin.
21125........  ...........  A.........  Augmentation,           10.68        63.67        60.26          6.47         7.51          0.79  090
                                         lower jaw bone.
21127........  ...........  A.........  Augmentation,           12.24        84.66        64.16          7.56         8.58          1.52  090
                                         lower jaw bone.
21137........  ...........  A.........  Reduction of            10.12           NA           NA          7.45         7.42          1.32  090
                                         forehead.
21138........  ...........  A.........  Reduction of            12.73           NA           NA          7.71         8.81          1.75  090
                                         forehead.
21139........  ...........  A.........  Reduction of            14.90           NA           NA          6.95         9.26          1.18  090
                                         forehead.
21141........  ...........  A.........  Reconstruct             19.27           NA           NA         12.00        12.77          2.36  090
                                         midface, lefort.
21142........  ...........  A.........  Reconstruct             19.98           NA           NA         10.06        11.54          2.39  090
                                         midface, lefort.
21143........  ...........  A.........  Reconstruct             20.75           NA           NA         11.86        12.57          1.66  090
                                         midface, lefort.
21145........  ...........  A.........  Reconstruct             23.64           NA           NA         13.11        13.44          2.85  090
                                         midface, lefort.
21146........  ...........  A.........  Reconstruct             24.54           NA           NA          9.15        12.24          3.10  090
                                         midface, lefort.
21147........  ...........  A.........  Reconstruct             26.14           NA           NA         15.48        14.98          1.85  090
                                         midface, lefort.
21150........  ...........  A.........  Reconstruct             25.78           NA           NA         16.97        16.21          2.56  090
                                         midface, lefort.
21151........  ...........  A.........  Reconstruct             28.84           NA           NA         11.56        17.26          2.31  090
                                         midface, lefort.
21154........  ...........  A.........  Reconstruct             31.05           NA           NA         18.20        21.26          2.49  090
                                         midface, lefort.
21155........  ...........  A.........  Reconstruct             34.98           NA           NA         18.27        20.25          6.66  090
                                         midface, lefort.
21159........  ...........  A.........  Reconstruct             42.90           NA           NA         15.08        22.09          8.20  090
                                         midface, lefort.
21160........  ...........  A.........  Reconstruct             46.95           NA           NA         23.29        25.52          4.14  090
                                         midface, lefort.
21172........  ...........  A.........  Reconstruct orbit/      28.07           NA           NA         13.87        13.81          3.56  090
                                         forehead.
21175........  ...........  A.........  Reconstruct orbit/      33.43           NA           NA         13.63        15.64          4.84  090
                                         forehead.
21179........  ...........  A.........  Reconstruct             22.53           NA           NA         11.33        12.70          2.81  090
                                         entire forehead.
21180........  ...........  A.........  Reconstruct             25.46           NA           NA         13.14        14.20          3.49  090
                                         entire forehead.
21181........  ...........  A.........  Contour cranial         10.18           NA           NA          6.85         7.20          1.32  090
                                         bone lesion.
21182........  ...........  A.........  Reconstruct             32.45           NA           NA         15.45        17.10          2.81  090
                                         cranial bone.
21183........  ...........  A.........  Reconstruct             35.57           NA           NA         19.33        19.46          4.48  090
                                         cranial bone.
21184........  ...........  A.........  Reconstruct             38.49           NA           NA         15.78        19.80          5.72  090
                                         cranial bone.
21188........  ...........  A.........  Reconstruction of       22.97           NA           NA         15.69        17.16          1.70  090
                                         midface.
21193........  ...........  A.........  Reconst lwr jaw w/      18.65           NA           NA          9.92        11.29          2.24  090
                                         o graft.
21194........  ...........  A.........  Reconst lwr jaw w/      21.54           NA           NA         12.22        12.86          2.03  090
                                         graft.
21195........  ...........  A.........  Reconst lwr jaw w/      18.88           NA           NA         13.15        14.04          1.64  090
                                         o fixation.
21196........  ...........  A.........  Reconst lwr jaw w/      20.55           NA           NA         14.03        14.76          2.08  090
                                         fixation.
21198........  ...........  A.........  Reconstr lwr jaw        15.48           NA           NA         11.92        12.19          1.44  090
                                         segment.
21199........  ...........  A.........  Reconstr lwr jaw        16.62           NA           NA          7.63         8.26          1.39  090
                                         w/advance.
21206........  ...........  A.........  Reconstruct upper       15.36           NA           NA         10.92        11.83          1.33  090
                                         jaw bone.
21208........  ...........  A.........  Augmentation of         11.15        33.03        27.58          8.06         8.78          1.09  090
                                         facial bones.
21209........  ...........  A.........  Reduction of             7.58        12.17        11.52          7.41         7.76          0.90  090
                                         facial bones.
21210........  ...........  A.........  Face bone graft..       11.40        43.32        34.16          7.68         8.54          1.30  090
21215........  ...........  A.........  Lower jaw bone          11.94        85.72        63.87          8.02         8.71          1.53  090
                                         graft.
21230........  ...........  A.........  Rib cartilage           11.06           NA           NA          7.00         7.51          1.29  090
                                         graft.
21235........  ...........  A.........  Ear cartilage            7.31        10.10         9.93          6.20         6.28          0.61  090
                                         graft.
21240........  ...........  A.........  Reconstruction of       15.77           NA           NA          9.55        10.82          2.25  090
                                         jaw joint.
21242........  ...........  A.........  Reconstruction of       14.32           NA           NA          9.13        10.29          1.79  090
                                         jaw joint.
21243........  ...........  A.........  Reconstruction of       24.03           NA           NA         14.33        15.86          3.26  090
                                         jaw joint.
21244........  ...........  A.........  Reconstruction of       13.35           NA           NA         11.55        11.74          1.25  090
                                         lower jaw.
21245........  ...........  A.........  Reconstruction of       12.88        14.20        14.18          8.65         9.16          1.19  090
                                         jaw.
21246........  ...........  A.........  Reconstruction of       12.78           NA           NA          7.48         8.15          1.35  090
                                         jaw.
21247........  ...........  A.........  Reconstruct lower       24.05           NA           NA         12.79        14.96          2.84  090
                                         jaw bone.
21248........  ...........  A.........  Reconstruction of       12.54        12.62        12.38          7.57         8.49          1.55  090
                                         jaw.
21249........  ...........  A.........  Reconstruction of       18.57        15.81        16.34          9.72        11.27          2.49  090
                                         jaw.
21255........  ...........  A.........  Reconstruct lower       18.14           NA           NA         13.78        14.91          2.39  090
                                         jaw bone.
21256........  ...........  A.........  Reconstruction of       17.42           NA           NA          9.68        10.80          1.50  090
                                         orbit.
21260........  ...........  A.........  Revise eye              17.74           NA           NA         12.98        12.27          0.97  090
                                         sockets.
21261........  ...........  A.........  Revise eye              33.78           NA           NA         14.67        19.46          3.43  090
                                         sockets.
21263........  ...........  A.........  Revise eye              30.72           NA           NA         13.97        16.52          2.63  090
                                         sockets.
21267........  ...........  A.........  Revise eye              20.45           NA           NA         16.17        18.00          1.71  090
                                         sockets.
21268........  ...........  A.........  Revise eye              26.78           NA           NA         13.06        17.13          3.66  090
                                         sockets.
21270........  ...........  A.........  Augmentation,           10.52        11.19        11.43          5.96         6.61          0.72  090
                                         cheek bone.
21275........  ...........  A.........  Revision,               11.65           NA           NA          7.19         7.74          1.29  090
                                         orbitofacial
                                         bones.
21280........  ...........  A.........  Revision of              6.92           NA           NA          5.68         5.84          0.42  090
                                         eyelid.
21282........  ...........  A.........  Revision of              4.11           NA           NA          4.17         4.35          0.26  090
                                         eyelid.
21295........  ...........  A.........  Revision of jaw          1.82           NA           NA          2.22         2.44          0.16  090
                                         muscle/bone.
21296........  ...........  A.........  Revision of jaw          4.67           NA           NA          4.12         4.75          0.34  090
                                         muscle/bone.
21299........  ...........  C.........  Cranio/                  0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         maxillofacial
                                         surgery.
21310........  ...........  A.........  Treatment of nose        0.58         1.97         2.12          0.11         0.13          0.05  000
                                         fracture.
21315........  ...........  A.........  Treatment of nose        1.78         4.68         4.42          1.77         1.81          0.14  010
                                         fracture.
21320........  ...........  A.........  Treatment of nose        1.86         4.27         4.06          1.36         1.47          0.18  010
                                         fracture.
21325........  ...........  A.........  Treatment of nose        4.07           NA           NA          6.91         7.74          0.31  090
                                         fracture.
21330........  ...........  A.........  Treatment of nose        5.68           NA           NA          7.59         8.64          0.56  090
                                         fracture.

[[Page 38244]]

 
21335........  ...........  A.........  Treatment of nose        8.91           NA           NA          8.47         8.94          0.74  090
                                         fracture.
21336........  ...........  A.........  Treat nasal              6.56           NA           NA          8.64         9.06          0.55  090
                                         septal fracture.
21337........  ...........  A.........  Treat nasal              3.26         6.11         6.08          3.54         3.53          0.28  090
                                         septal fracture.
21338........  ...........  A.........  Treat nasoethmoid        6.76           NA           NA          9.89        11.93          0.82  090
                                         fracture.
21339........  ...........  A.........  Treat nasoethmoid        8.39           NA           NA          9.78        12.01          0.96  090
                                         fracture.
21340........  ...........  A.........  Treatment of nose       11.33           NA           NA          7.28         7.83          1.15  090
                                         fracture.
21343........  ...........  A.........  Treatment of            14.11           NA           NA         12.76        14.10          1.47  090
                                         sinus fracture.
21344........  ...........  A.........  Treatment of            21.36           NA           NA         13.12        14.85          2.44  090
                                         sinus fracture.
21345........  ...........  A.........  Treat nose/jaw           8.87        10.33         9.99          6.48         6.76          0.92  090
                                         fracture.
21346........  ...........  A.........  Treat nose/jaw          11.29           NA           NA         10.85        11.53          1.21  090
                                         fracture.
21347........  ...........  A.........  Treat nose/jaw          13.37           NA           NA         11.79        13.98          1.47  090
                                         fracture.
21348........  ...........  A.........  Treat nose/jaw          17.36           NA           NA         11.03        10.28          2.49  090
                                         fracture.
21355........  ...........  A.........  Treat cheek bone         4.32         5.89         6.02          3.25         3.33          0.34  010
                                         fracture.
21356........  ...........  A.........  Treat cheek bone         4.70         6.96         7.02          4.07         4.30          0.46  010
                                         fracture.
21360........  ...........  A.........  Treat cheek bone         7.03           NA           NA          5.41         5.66          0.74  090
                                         fracture.
21365........  ...........  A.........  Treat cheek bone        16.52           NA           NA          9.16         9.99          1.70  090
                                         fracture.
21366........  ...........  A.........  Treat cheek bone        18.44           NA           NA         10.42        10.88          2.50  090
                                         fracture.
21385........  ...........  A.........  Treat eye socket         9.46           NA           NA          7.13         7.68          0.97  090
                                         fracture.
21386........  ...........  A.........  Treat eye socket         9.46           NA           NA          6.05         6.53          0.97  090
                                         fracture.
21387........  ...........  A.........  Treat eye socket        10.00           NA           NA          7.47         8.20          1.08  090
                                         fracture.
21390........  ...........  A.........  Treat eye socket        11.07           NA           NA          7.05         7.44          0.90  090
                                         fracture.
21395........  ...........  A.........  Treat eye socket        14.62           NA           NA          8.33         8.62          1.44  090
                                         fracture.
21400........  ...........  A.........  Treat eye socket         1.44         2.70         2.66          1.96         1.92          0.15  090
                                         fracture.
21401........  ...........  A.........  Treat eye socket         3.57         7.03         7.54          3.06         3.29          0.38  090
                                         fracture.
21406........  ...........  A.........  Treat eye socket         7.31           NA           NA          5.34         5.68          0.73  090
                                         fracture.
21407........  ...........  A.........  Treat eye socket         8.91           NA           NA          5.94         6.41          0.94  090
                                         fracture.
21408........  ...........  A.........  Treat eye socket        12.67           NA           NA          7.42         8.26          1.44  090
                                         fracture.
21421........  ...........  A.........  Treat mouth roof         5.80        12.43        10.83          9.20         8.73          0.73  090
                                         fracture.
21422........  ...........  A.........  Treat mouth roof         8.62           NA           NA          7.05         7.54          0.99  090
                                         fracture.
21423........  ...........  A.........  Treat mouth roof        10.71           NA           NA          7.43         8.37          1.27  090
                                         fracture.
21431........  ...........  A.........  Treat                    7.74           NA           NA         10.80         9.93          0.70  090
                                         craniofacial
                                         fracture.
21432........  ...........  A.........  Treat                    8.76           NA           NA          6.83         7.52          0.81  090
                                         craniofacial
                                         fracture.
21433........  ...........  A.........  Treat                   26.13           NA           NA         12.30        14.39          2.79  090
                                         craniofacial
                                         fracture.
21435........  ...........  A.........  Treat                   20.02           NA           NA         11.15        11.86          1.99  090
                                         craniofacial
                                         fracture.
21436........  ...........  A.........  Treat                   30.01           NA           NA         13.27        15.94          3.10  090
                                         craniofacial
                                         fracture.
21440........  ...........  A.........  Treat dental             3.28        10.03         8.61          7.43         6.83          0.38  090
                                         ridge fracture.
21445........  ...........  A.........  Treat dental             6.04        12.27        11.05          8.47         8.45          0.78  090
                                         ridge fracture.
21450........  ...........  A.........  Treat lower jaw          3.55        10.48         8.91          7.70         7.28          0.33  090
                                         fracture.
21451........  ...........  A.........  Treat lower jaw          5.46        12.94        11.15          9.66         9.03          0.63  090
                                         fracture.
21452........  ...........  A.........  Treat lower jaw          2.29        11.86        12.42          5.97         5.28          0.27  090
                                         fracture.
21453........  ...........  A.........  Treat lower jaw          6.40        14.78        12.76         11.65        11.19          0.74  090
                                         fracture.
21454........  ...........  A.........  Treat lower jaw          7.17           NA           NA          5.77         6.02          0.82  090
                                         fracture.
21461........  ...........  A.........  Treat lower jaw          9.07        41.49        32.92         12.79        12.70          0.98  090
                                         fracture.
21462........  ...........  A.........  Treat lower jaw         10.77        42.89        35.16         13.44        13.05          1.27  090
                                         fracture.
21465........  ...........  A.........  Treat lower jaw         12.88           NA           NA          8.18         9.03          1.50  090
                                         fracture.
21470........  ...........  A.........  Treat lower jaw         17.24           NA           NA         10.25        11.14          1.97  090
                                         fracture.
21480........  ...........  A.........  Reset dislocated         0.61         1.50         1.63          0.18         0.19          0.06  000
                                         jaw.
21485........  ...........  A.........  Reset dislocated         4.58        12.06        10.16          9.09         8.39          0.51  090
                                         jaw.
21490........  ...........  A.........  Repair dislocated       12.71           NA           NA          8.23         8.92          1.97  090
                                         jaw.
21495........  ...........  A.........  Treat hyoid bone         6.55           NA           NA         10.43         9.30          0.46  090
                                         fracture.
21497........  ...........  A.........  Interdental              4.45        12.20        10.29          9.34         8.47          0.50  090
                                         wiring.
21499........  ...........  C.........  Head surgery             0.00         0.00         1.58          0.00         0.17          0.00  YYY
                                         procedure.
21501........  ...........  A.........  Drain neck/chest         3.87         6.51         6.44          3.50         3.65          0.43  090
                                         lesion.
21502........  ...........  A.........  Drain chest              7.43           NA           NA          4.55         5.13          0.97  090
                                         lesion.
21510........  ...........  A.........  Drainage of bone         6.06           NA           NA          4.77         5.21          0.80  090
                                         lesion.
21550........  ...........  A.........  Biopsy of neck/          2.08         4.33         3.94          1.79         1.74          0.16  010
                                         chest.
21555........  ...........  A.........  Remove lesion,           4.40         5.74         5.63          3.42         3.31          0.56  090
                                         neck/chest.
21556........  ...........  A.........  Remove lesion,           5.63           NA           NA          4.12         4.09          0.65  090
                                         neck/chest.
21557........  ...........  A.........  Remove tumor,            8.91           NA           NA          4.51         4.92          1.08  090
                                         neck/chest.
21600........  ...........  A.........  Partial removal          7.14           NA           NA          5.92         5.81          0.99  090
                                         of rib.
21610........  ...........  A.........  Partial removal         15.76           NA           NA          8.90         8.77          3.08  090
                                         of rib.
21615........  ...........  A.........  Removal of rib...       10.31           NA           NA          5.17         5.98          1.45  090
21616........  ...........  A.........  Removal of rib          12.54           NA           NA          6.48         7.36          1.87  090
                                         and nerves.
21620........  ...........  A.........  Partial removal          7.16           NA           NA          4.75         5.38          0.98  090
                                         of sternum.
21627........  ...........  A.........  Sternal                  7.18           NA           NA          5.51         5.93          1.02  090
                                         debridement.
21630........  ...........  A.........  Extensive sternum       19.01           NA           NA         10.35        11.16          2.59  090
                                         surgery.
21632........  ...........  A.........  Extensive sternum       19.51           NA           NA          9.28        10.25          2.66  090
                                         surgery.
21685........  ...........  A.........  Hyoid myotomy &         14.89           NA           NA          8.80         9.25          1.06  090
                                         suspension.
21700........  ...........  A.........  Revision of neck         6.23           NA           NA          4.41         4.36          0.32  090
                                         muscle.
21705........  ...........  A.........  Revision of neck         9.83           NA           NA          4.35         5.02          1.43  090
                                         muscle/rib.
21720........  ...........  A.........  Revision of neck         5.72           NA           NA          4.02         3.30          0.91  090
                                         muscle.
21725........  ...........  A.........  Revision of neck         7.10           NA           NA          5.14         5.20          1.21  090
                                         muscle.

[[Page 38245]]

 
21740........  ...........  A.........  Reconstruction of       17.47           NA           NA          8.04         8.41          2.37  090
                                         sternum.
21742........  ...........  C.........  Repair stern/nuss        0.00         0.00         0.00          0.00         0.00          0.00  090
                                         w/o scope.
21743........  ...........  C.........  Repair sternum/          0.00         0.00         0.00          0.00         0.00          0.00  090
                                         nuss w/scope.
21750........  ...........  A.........  Repair of sternum       11.35           NA           NA          5.30         5.73          1.63  090
                                         separation.
21800........  ...........  A.........  Treatment of rib         0.98         1.35         1.34          1.41         1.36          0.09  090
                                         fracture.
21805........  ...........  A.........  Treatment of rib         2.80           NA           NA          3.27         3.28          0.38  090
                                         fracture.
21810........  ...........  A.........  Treatment of rib         6.92           NA           NA          5.34         5.13          0.94  090
                                         fracture(s).
21820........  ...........  A.........  Treat sternum            1.31         1.81         1.82          1.88         1.81          0.16  090
                                         fracture.
21825........  ...........  A.........  Treat sternum            7.65           NA           NA          5.35         5.89          1.11  090
                                         fracture.
21899........  ...........  C.........  Neck/chest               0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery
                                         procedure.
21920........  ...........  A.........  Biopsy soft              2.08         4.42         3.85          1.89         1.68          0.14  010
                                         tissue of back.
21925........  ...........  A.........  Biopsy soft              4.54         5.30         5.26          3.34         3.31          0.60  090
                                         tissue of back.
21930........  ...........  A.........  Remove lesion,           5.06         6.00         5.86          3.75         3.58          0.66  090
                                         back or flank.
21935........  ...........  A.........  Remove tumor,           18.38           NA           NA          8.45         9.06          2.48  090
                                         back.
22010........  ...........  A.........  I&d, p-spine, c/t/      12.57           NA           NA          8.35         8.54          1.74  090
                                         cerv-thor.
22015........  ...........  A.........  I&d, p-spine, l/s/      12.46           NA           NA          8.35         8.50          1.72  090
                                         ls.
22100........  ...........  A.........  Remove part of          10.80           NA           NA          8.20         7.85          2.14  090
                                         neck vertebra.
22101........  ...........  A.........  Remove part,            10.88           NA           NA          8.10         7.91          1.91  090
                                         thorax vertebra.
22102........  ...........  A.........  Remove part,            10.88           NA           NA          7.96         7.92          1.88  090
                                         lumbar vertebra.
22103........  ...........  A.........  Remove extra             2.34           NA           NA          0.91         1.06          0.44  ZZZ
                                         spine segment.
22110........  ...........  A.........  Remove part of          13.80           NA           NA          9.12         9.15          2.77  090
                                         neck vertebra.
22112........  ...........  A.........  Remove part,            13.87           NA           NA          9.03         9.15          2.53  090
                                         thorax vertebra.
22114........  ...........  A.........  Remove part,            13.87           NA           NA          8.99         9.14          2.64  090
                                         lumbar vertebra.
22116........  ...........  A.........  Remove extra             2.32           NA           NA          0.90         1.03          0.50  ZZZ
                                         spine segment.
22210........  ...........  A.........  Revision of neck        25.13           NA           NA         14.61        15.05          5.46  090
                                         spine.
22212........  ...........  A.........  Revision of             20.74           NA           NA         12.48        12.89          3.91  090
                                         thorax spine.
22214........  ...........  A.........  Revision of             20.77           NA           NA         12.58        13.21          3.92  090
                                         lumbar spine.
22216........  ...........  A.........  Revise, extra            6.03           NA           NA          2.35         2.75          1.29  ZZZ
                                         spine segment.
22220........  ...........  A.........  Revision of neck        22.69           NA           NA         13.42        13.55          5.08  090
                                         spine.
22222........  ...........  A.........  Revision of             22.84           NA           NA         10.60        11.15          4.13  090
                                         thorax spine.
22224........  ...........  A.........  Revision of             22.84           NA           NA         12.98        13.65          4.19  090
                                         lumbar spine.
22226........  ...........  A.........  Revise, extra            6.03           NA           NA          2.30         2.67          1.29  ZZZ
                                         spine segment.
22305........  ...........  A.........  Treat spine              2.08         2.14         2.23          1.80         1.86          0.39  090
                                         process fracture.
22310........  ...........  A.........  Treat spine              3.69         2.98         2.89          2.50         2.43          0.50  090
                                         fracture.
22315........  ...........  A.........  Treat spine              9.91         9.88         9.77          7.45         7.39          1.86  090
                                         fracture.
22318........  ...........  A.........  Treat odontoid fx       22.54           NA           NA         13.35        13.38          5.30  090
                                         w/o graft.
22319........  ...........  A.........  Treat odontoid fx       25.15           NA           NA         13.54        14.23          6.05  090
                                         w/graft.
22325........  ...........  A.........  Treat spine             19.62           NA           NA         12.18        12.11          3.88  090
                                         fracture.
22326........  ...........  A.........  Treat neck spine        20.64           NA           NA         12.11        12.43          4.43  090
                                         fracture.
22327........  ...........  A.........  Treat thorax            20.52           NA           NA         12.38        12.37          3.99  090
                                         spine fracture.
22328........  ...........  A.........  Treat each add           4.60           NA           NA          1.78         2.03          0.94  ZZZ
                                         spine fx.
22505........  ...........  A.........  Manipulation of          1.87           NA           NA          1.11         1.02          0.36  010
                                         spine.
22520........  ...........  A.........  Percut                   9.17        43.46        52.37          4.61         4.76          1.72  010
                                         vertebroplasty
                                         thor.
22521........  ...........  A.........  Percut                   8.60        44.62        50.12          4.38         4.59          1.60  010
                                         vertebroplasty
                                         lumb.
22522........  ...........  A.........  Percut                   4.30           NA           NA          1.52         1.57          0.82  ZZZ
                                         vertebroplasty
                                         add[boxHU]l.
22523........  ...........  A.........  Percut                   9.21           NA           NA          4.70         5.30          1.72  010
                                         kyphoplasty,
                                         thor.
22524........  ...........  A.........  Percut                   8.81           NA           NA          4.55         5.12          1.60  010
                                         kyphoplasty,
                                         lumbar.
22525........  ...........  A.........  Percut                   4.47           NA           NA          1.71         1.98          0.82  ZZZ
                                         kyphoplasty, add-
                                         on.
22526........  ...........  A.........  Idet, single             6.07        46.11        46.38          2.04         2.07          1.16  010
                                         level.
22527........  ...........  A.........  Idet, 1 or more          3.03        39.85        39.88          0.70         0.70          0.58  ZZZ
                                         levels.
22532........  ...........  A.........  Lat thorax spine        25.81           NA           NA         13.50        14.23          4.35  090
                                         fusion.
22533........  ...........  A.........  Lat lumbar spine        24.61           NA           NA         13.63        13.59          3.16  090
                                         fusion.
22534........  ...........  A.........  Lat thor/lumb,           5.99           NA           NA          2.30         2.67          1.25  ZZZ
                                         add[boxHu]l seg.
22548........  ...........  A.........  Neck spine fusion       26.86           NA           NA         15.03        15.46          5.61  090
22554........  ...........  A.........  Neck spine fusion       17.54           NA           NA         10.70        11.55          4.46  090
22556........  ...........  A.........  Thorax spine            24.50           NA           NA         13.03        13.90          4.35  090
                                         fusion.
22558........  ...........  A.........  Lumbar spine            23.33           NA           NA         11.47        12.40          3.16  090
                                         fusion.
22585........  ...........  A.........  Additional spinal        5.52           NA           NA          2.08         2.44          1.25  ZZZ
                                         fusion.
22590........  ...........  A.........  Spine & skull           21.56           NA           NA         13.16        13.25          4.79  090
                                         spinal fusion.
22595........  ...........  A.........  Neck spinal             20.44           NA           NA         12.73        12.78          4.41  090
                                         fusion.
22600........  ...........  A.........  Neck spine fusion       17.20           NA           NA         11.24        11.24          3.73  090
22610........  ...........  A.........  Thorax spine            17.08           NA           NA         10.86        11.15          3.53  090
                                         fusion.
22612........  ...........  A.........  Lumbar spine            23.38           NA           NA         12.56        13.41          4.47  090
                                         fusion.
22614........  ...........  A.........  Spine fusion,            6.43           NA           NA          2.48         2.93          1.38  ZZZ
                                         extra segment.
22630........  ...........  A.........  Lumbar spine            21.89           NA           NA         12.60        13.13          4.73  090
                                         fusion.
22632........  ...........  A.........  Spine fusion,            5.22           NA           NA          2.01         2.34          1.16  ZZZ
                                         extra segment.
22800........  ...........  A.........  Fusion of spine..       19.30           NA           NA         11.19        11.98          3.76  090
22802........  ...........  A.........  Fusion of spine..       31.91           NA           NA         16.07        17.86          6.17  090
22804........  ...........  A.........  Fusion of spine..       37.30           NA           NA         18.23        20.48          7.00  090
22808........  ...........  A.........  Fusion of spine..       27.31           NA           NA         14.12        15.18          4.93  090
22810........  ...........  A.........  Fusion of spine..       31.30           NA           NA         15.01        16.68          5.15  090
22812........  ...........  A.........  Fusion of spine..       34.00           NA           NA         17.46        18.67          5.30  090

[[Page 38246]]

 
22818........  ...........  A.........  Kyphectomy, 1-2         34.18           NA           NA         16.71        17.80          6.47  090
                                         segments.
22819........  ...........  A.........  Kyphectomy, 3 or        39.18           NA           NA         18.99        19.62          7.67  090
                                         more.
22830........  ...........  A.........  Exploration of          11.13           NA           NA          7.08         7.53          2.30  090
                                         spinal fusion.
22840........  ...........  A.........  Insert spine            12.52           NA           NA          4.83         5.68          2.79  ZZZ
                                         fixation device.
22842........  ...........  A.........  Insert spine            12.56           NA           NA          4.85         5.69          2.75  ZZZ
                                         fixation device.
22843........  ...........  A.........  Insert spine            13.44           NA           NA          5.21         5.92          2.86  ZZZ
                                         fixation device.
22844........  ...........  A.........  Insert spine            16.42           NA           NA          6.47         7.62          3.19  ZZZ
                                         fixation device.
22845........  ...........  A.........  Insert spine            11.94           NA           NA          4.54         5.32          2.86  ZZZ
                                         fixation device.
22846........  ...........  A.........  Insert spine            12.40           NA           NA          4.72         5.54          2.96  ZZZ
                                         fixation device.
22847........  ...........  A.........  Insert spine            13.78           NA           NA          5.26         6.17          3.00  ZZZ
                                         fixation device.
22848........  ...........  A.........  Insert pelv              5.99           NA           NA          2.36         2.77          1.15  ZZZ
                                         fixation device.
22849........  ...........  A.........  Reinsert spinal         19.08           NA           NA         10.22        11.00          3.90  090
                                         fixation.
22850........  ...........  A.........  Remove spine             9.74           NA           NA          6.43         6.73          2.05  090
                                         fixation device.
22851........  ...........  A.........  Apply spine              6.70           NA           NA          2.57         2.98          1.49  ZZZ
                                         prosth device.
22852........  ...........  A.........  Remove spine             9.29           NA           NA          6.19         6.50          1.90  090
                                         fixation device.
22855........  ...........  A.........  Remove spine            15.77           NA           NA          9.23         9.47          3.52  090
                                         fixation device.
22857........  ...........  R.........  Lumbar artif            26.93           NA           NA         16.22        11.27          3.56  090
                                         diskectomy.
22862........  ...........  R.........  Revise lumbar           32.43           NA           NA         10.05        10.06          5.36  090
                                         artif disc.
22865........  ...........  R.........  Remove lumb artif       31.55           NA           NA          9.85         9.86          5.18  090
                                         disc.
22899........  ...........  C.........  Spine surgery            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
22900........  ...........  A.........  Remove abdominal         6.14           NA           NA          3.51         3.37          0.76  090
                                         wall lesion.
22999........  ...........  C.........  Abdomen surgery          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
23000........  ...........  A.........  Removal of               4.40         7.83         8.17          3.72         4.07          0.68  090
                                         calcium deposits.
23020........  ...........  A.........  Release shoulder         9.24           NA           NA          6.48         7.03          1.54  090
                                         joint.
23030........  ...........  A.........  Drain shoulder           3.44         6.24         6.82          2.40         2.65          0.57  010
                                         lesion.
23031........  ...........  A.........  Drain shoulder           2.76         6.46         7.16          2.21         2.47          0.46  010
                                         bursa.
23035........  ...........  A.........  Drain shoulder           9.04           NA           NA          7.02         7.65          1.47  090
                                         bone lesion.
23040........  ...........  A.........  Exploratory              9.63           NA           NA          6.74         7.31          1.60  090
                                         shoulder surgery.
23044........  ...........  A.........  Exploratory              7.48           NA           NA          5.51         5.98          1.24  090
                                         shoulder surgery.
23065........  ...........  A.........  Biopsy shoulder          2.28         2.95         2.72          1.74         1.68          0.20  010
                                         tissues.
23066........  ...........  A.........  Biopsy shoulder          4.21         7.69         7.67          3.59         3.78          0.63  090
                                         tissues.
23075........  ...........  A.........  Removal of               2.41         3.67         3.67          1.71         1.75          0.34  010
                                         shoulder lesion.
23076........  ...........  A.........  Removal of               7.77           NA           NA          5.30         5.43          1.13  090
                                         shoulder lesion.
23077........  ...........  A.........  Remove tumor of         18.08           NA           NA          9.61         9.95          2.34  090
                                         shoulder.
23100........  ...........  A.........  Biopsy of                6.09           NA           NA          4.98         5.35          1.04  090
                                         shoulder joint.
23101........  ...........  A.........  Shoulder joint           5.63           NA           NA          4.52         4.93          0.96  090
                                         surgery.
23105........  ...........  A.........  Remove shoulder          8.36           NA           NA          6.09         6.62          1.42  090
                                         joint lining.
23106........  ...........  A.........  Incision of              6.02           NA           NA          4.77         5.21          0.99  090
                                         collarbone joint.
23107........  ...........  A.........  Explore treat            8.75           NA           NA          6.25         6.83          1.49  090
                                         shoulder joint.
23120........  ...........  A.........  Partial removal,         7.23           NA           NA          5.46         5.97          1.23  090
                                         collar bone.
23125........  ...........  A.........  Removal of collar        9.52           NA           NA          6.38         6.97          1.62  090
                                         bone.
23130........  ...........  A.........  Remove shoulder          7.63           NA           NA          6.07         6.61          1.30  090
                                         bone, part.
23140........  ...........  A.........  Removal of bone          7.01           NA           NA          4.88         5.04          1.08  090
                                         lesion.
23145........  ...........  A.........  Removal of bone          9.28           NA           NA          6.49         6.86          1.49  090
                                         lesion.
23146........  ...........  A.........  Removal of bone          7.96           NA           NA          5.90         6.52          1.35  090
                                         lesion.
23150........  ...........  A.........  Removal of               8.79           NA           NA          6.25         6.56          1.32  090
                                         humerus lesion.
23155........  ...........  A.........  Removal of              10.72           NA           NA          7.25         7.81          1.81  090
                                         humerus lesion.
23156........  ...........  A.........  Removal of               8.99           NA           NA          6.29         6.86          1.50  090
                                         humerus lesion.
23170........  ...........  A.........  Remove collar            7.10           NA           NA          4.99         5.52          1.12  090
                                         bone lesion.
23172........  ...........  A.........  Remove shoulder          7.20           NA           NA          5.51         5.82          1.01  090
                                         blade lesion.
23174........  ...........  A.........  Remove humerus           9.90           NA           NA          7.16         7.79          1.65  090
                                         lesion.
23180........  ...........  A.........  Remove collar            8.85           NA           NA          7.00         8.01          1.47  090
                                         bone lesion.
23182........  ...........  A.........  Remove shoulder          8.47           NA           NA          6.97         7.75          1.37  090
                                         blade lesion.
23184........  ...........  A.........  Remove humerus           9.76           NA           NA          7.49         8.41          1.63  090
                                         lesion.
23190........  ...........  A.........  Partial removal          7.36           NA           NA          5.30         5.76          1.17  090
                                         of scapula.
23195........  ...........  A.........  Removal of head         10.24           NA           NA          6.91         7.30          1.71  090
                                         of humerus.
23200........  ...........  A.........  Removal of collar       12.69           NA           NA          7.09         7.98          1.94  090
                                         bone.
23210........  ...........  A.........  Removal of              13.16           NA           NA          7.82         8.48          2.03  090
                                         shoulder blade.
23220........  ...........  A.........  Partial removal         15.36           NA           NA          9.15         9.98          2.49  090
                                         of humerus.
23221........  ...........  A.........  Partial removal         18.41           NA           NA         10.64        10.51          3.06  090
                                         of humerus.
23222........  ...........  A.........  Partial removal         25.44           NA           NA         13.39        14.63          3.95  090
                                         of humerus.
23330........  ...........  A.........  Remove shoulder          1.87         3.32         3.51          1.50         1.70          0.24  010
                                         foreign body.
23331........  ...........  A.........  Remove shoulder          7.51           NA           NA          5.82         6.32          1.27  090
                                         foreign body.
23332........  ...........  A.........  Remove shoulder         12.23           NA           NA          7.96         8.66          2.03  090
                                         foreign body.
23350........  ...........  A.........  Injection for            1.00         2.71         3.06          0.36         0.33          0.06  000
                                         shoulder x-ray.
23395........  ...........  A.........  Muscle                  18.29           NA           NA         11.21        12.06          2.94  090
                                         transfer,shoulde
                                         r/arm.
23397........  ...........  A.........  Muscle transfers.       16.62           NA           NA          9.55        10.50          2.74  090
23400........  ...........  A.........  Fixation of             13.73           NA           NA          8.55         9.32          2.30  090
                                         shoulder blade.
23405........  ...........  A.........  Incision of              8.43           NA           NA          5.92         6.43          1.45  090
                                         tendon & muscle.
23406........  ...........  A.........  Incise tendon(s)        10.90           NA           NA          6.91         7.64          1.88  090
                                         & muscle(s).
23410........  ...........  A.........  Repair rotator          12.63           NA           NA          7.79         8.61          2.17  090
                                         cuff, acute.
23412........  ...........  A.........  Repair rotator          13.55           NA           NA          8.17         9.05          2.32  090
                                         cuff, chronic.

[[Page 38247]]

 
23415........  ...........  A.........  Release of              10.09           NA           NA          6.59         7.30          1.74  090
                                         shoulder
                                         ligament.
23420........  ...........  A.........  Repair of               14.75           NA           NA          9.71        10.30          2.32  090
                                         shoulder.
23430........  ...........  A.........  Repair biceps           10.05           NA           NA          6.78         7.45          1.74  090
                                         tendon.
23440........  ...........  A.........  Remove/transplant       10.53           NA           NA          6.78         7.53          1.83  090
                                         tendon.
23450........  ...........  A.........  Repair shoulder         13.58           NA           NA          8.19         9.02          2.33  090
                                         capsule.
23455........  ...........  A.........  Repair shoulder         14.55           NA           NA          8.57         9.52          2.50  090
                                         capsule.
23460........  ...........  A.........  Repair shoulder         15.68           NA           NA          9.37        10.38          2.67  090
                                         capsule.
23462........  ...........  A.........  Repair shoulder         15.60           NA           NA          9.09         9.93          2.60  090
                                         capsule.
23465........  ...........  A.........  Repair shoulder         16.16           NA           NA          9.52        10.37          2.77  090
                                         capsule.
23466........  ...........  A.........  Repair shoulder         15.55           NA           NA         10.00        10.71          2.47  090
                                         capsule.
23470........  ...........  A.........  Reconstruct             17.75           NA           NA         10.14        11.21          2.99  090
                                         shoulder joint.
23472........  ...........  A.........  Reconstruct             22.47           NA           NA         12.17        13.32          3.67  090
                                         shoulder joint.
23480........  ...........  A.........  Revision of             11.42           NA           NA          7.29         8.05          1.95  090
                                         collar bone.
23485........  ...........  A.........  Revision of             13.79           NA           NA          8.21         9.08          2.34  090
                                         collar bone.
23490........  ...........  A.........  Reinforce               12.04           NA           NA          6.77         7.70          1.47  090
                                         clavicle.
23491........  ...........  A.........  Reinforce               14.40           NA           NA          8.73         9.76          2.47  090
                                         shoulder bones.
23500........  ...........  A.........  Treat clavicle           2.13         2.63         2.75          2.70         2.60          0.30  090
                                         fracture.
23505........  ...........  A.........  Treat clavicle           3.74         3.99         4.20          3.60         3.73          0.61  090
                                         fracture.
23515........  ...........  A.........  Treat clavicle           7.47           NA           NA          5.56         6.07          1.28  090
                                         fracture.
23520........  ...........  A.........  Treat clavicle           2.21         2.75         2.78          2.82         2.75          0.34  090
                                         dislocation.
23525........  ...........  A.........  Treat clavicle           3.67         4.15         4.40          3.63         3.84          0.46  090
                                         dislocation.
23530........  ...........  A.........  Treat clavicle           7.37           NA           NA          5.31         5.62          1.20  090
                                         dislocation.
23532........  ...........  A.........  Treat clavicle           8.08           NA           NA          6.01         6.50          1.38  090
                                         dislocation.
23540........  ...........  A.........  Treat clavicle           2.28         2.65         2.75          2.72         2.53          0.29  090
                                         dislocation.
23545........  ...........  A.........  Treat clavicle           3.32         3.72         3.96          3.24         3.31          0.35  090
                                         dislocation.
23550........  ...........  A.........  Treat clavicle           7.48           NA           NA          5.53         5.95          1.25  090
                                         dislocation.
23552........  ...........  A.........  Treat clavicle           8.70           NA           NA          6.25         6.79          1.46  090
                                         dislocation.
23570........  ...........  A.........  Treat shoulder           2.28         2.77         2.90          2.91         2.88          0.36  090
                                         blade fx.
23575........  ...........  A.........  Treat shoulder           4.12         4.57         4.69          4.07         4.16          0.59  090
                                         blade fx.
23585........  ...........  A.........  Treat scapula            9.15           NA           NA          6.49         7.08          1.54  090
                                         fracture.
23600........  ...........  A.........  Treat humerus            3.00         4.05         4.30          3.63         3.60          0.48  090
                                         fracture.
23605........  ...........  A.........  Treat humerus            4.94         5.36         5.77          4.58         4.85          0.84  090
                                         fracture.
23615........  ...........  A.........  Treat humerus           10.93           NA           NA          8.27         8.56          1.62  090
                                         fracture.
23616........  ...........  A.........  Treat humerus           21.68           NA           NA         11.47        12.83          3.70  090
                                         fracture.
23620........  ...........  A.........  Treat humerus            2.46         3.39         3.50          3.13         3.06          0.40  090
                                         fracture.
23625........  ...........  A.........  Treat humerus            3.99         4.43         4.69          3.90         4.09          0.67  090
                                         fracture.
23630........  ...........  A.........  Treat humerus            7.47           NA           NA          5.64         6.15          1.27  090
                                         fracture.
23650........  ...........  A.........  Treat shoulder           3.44         3.26         3.52          2.80         2.78          0.30  090
                                         dislocation.
23655........  ...........  A.........  Treat shoulder           4.64           NA           NA          4.13         4.16          0.69  090
                                         dislocation.
23660........  ...........  A.........  Treat shoulder           7.55           NA           NA          5.68         6.03          1.29  090
                                         dislocation.
23665........  ...........  A.........  Treat dislocation/       4.54         4.83         5.08          4.25         4.49          0.71  090
                                         fracture.
23670........  ...........  A.........  Treat dislocation/       8.02           NA           NA          5.89         6.36          1.36  090
                                         fracture.
23675........  ...........  A.........  Treat dislocation/       6.13         6.10         6.47          5.11         5.48          1.01  090
                                         fracture.
23680........  ...........  A.........  Treat dislocation/      10.30           NA           NA          6.92         7.53          1.76  090
                                         fracture.
23700........  ...........  A.........  Fixation of              2.54           NA           NA          1.90         2.04          0.44  010
                                         shoulder.
23800........  ...........  A.........  Fusion of               14.59           NA           NA          8.75         9.40          2.36  090
                                         shoulder joint.
23802........  ...........  A.........  Fusion of               18.17           NA           NA         11.21        10.67          2.71  090
                                         shoulder joint.
23900........  ...........  A.........  Amputation of arm       20.57           NA           NA         10.44        11.13          3.19  090
                                         & girdle.
23920........  ...........  A.........  Amputation at           16.03           NA           NA          9.14         9.61          2.47  090
                                         shoulder joint.
23921........  ...........  A.........  Amputation follow-       5.61           NA           NA          4.84         4.97          0.78  090
                                         up surgery.
23929........  ...........  C.........  Shoulder surgery         0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
23930........  ...........  A.........  Drainage of arm          2.96         4.93         5.63          1.97         2.14          0.43  010
                                         lesion.
23931........  ...........  A.........  Drainage of arm          1.81         4.32         5.11          1.75         1.96          0.28  010
                                         bursa.
23935........  ...........  A.........  Drain arm/elbow          6.27           NA           NA          5.08         5.51          1.05  090
                                         bone lesion.
24000........  ...........  A.........  Exploratory elbow        5.99           NA           NA          4.74         5.09          0.97  090
                                         surgery.
24006........  ...........  A.........  Release elbow            9.62           NA           NA          6.58         7.19          1.50  090
                                         joint.
24065........  ...........  A.........  Biopsy arm/elbow         2.10         4.14         3.68          1.92         1.83          0.17  010
                                         soft tissue.
24066........  ...........  A.........  Biopsy arm/elbow         5.26         8.20         8.57          3.91         4.02          0.80  090
                                         soft tissue.
24075........  ...........  A.........  Remove arm/elbow         3.96         7.12         7.24          3.25         3.33          0.56  090
                                         lesion.
24076........  ...........  A.........  Remove arm/elbow         6.36           NA           NA          4.57         4.72          0.95  090
                                         lesion.
24077........  ...........  A.........  Remove tumor of         11.95           NA           NA          6.86         7.33          1.73  090
                                         arm/elbow.
24100........  ...........  A.........  Biopsy elbow             4.98           NA           NA          4.08         4.33          0.85  090
                                         joint lining.
24101........  ...........  A.........  Explore/treat            6.19           NA           NA          5.03         5.49          1.03  090
                                         elbow joint.
24102........  ...........  A.........  Remove elbow             8.15           NA           NA          5.80         6.34          1.33  090
                                         joint lining.
24105........  ...........  A.........  Removal of elbow         3.67           NA           NA          4.01         4.20          0.61  090
                                         bursa.
24110........  ...........  A.........  Remove humerus           7.46           NA           NA          5.64         6.16          1.28  090
                                         lesion.
24115........  ...........  A.........  Remove/graft bone       10.00           NA           NA          4.30         6.18          1.68  090
                                         lesion.
24116........  ...........  A.........  Remove/graft bone       12.11           NA           NA          7.69         8.38          2.06  090
                                         lesion.
24120........  ...........  A.........  Remove elbow             6.71           NA           NA          5.17         5.56          1.10  090
                                         lesion.
24125........  ...........  A.........  Remove/graft bone        8.02           NA           NA          5.99         6.08          1.06  090
                                         lesion.
24126........  ...........  A.........  Remove/graft bone        8.50           NA           NA          5.99         6.55          1.16  090
                                         lesion.
24130........  ...........  A.........  Removal of head          6.31           NA           NA          5.12         5.57          1.04  090
                                         of radius.

[[Page 38248]]

 
24134........  ...........  A.........  Removal of arm          10.10           NA           NA          7.46         8.17          1.64  090
                                         bone lesion.
24136........  ...........  A.........  Remove radius            8.29           NA           NA          5.77         6.48          1.38  090
                                         bone lesion.
24138........  ...........  A.........  Remove elbow bone        8.33           NA           NA          6.47         7.17          1.34  090
                                         lesion.
24140........  ...........  A.........  Partial removal          9.43           NA           NA          7.13         8.14          1.51  090
                                         of arm bone.
24145........  ...........  A.........  Partial removal          7.70           NA           NA          6.20         7.15          1.25  090
                                         of radius.
24147........  ...........  A.........  Partial removal          7.69           NA           NA          6.83         7.73          1.30  090
                                         of elbow.
24149........  ...........  A.........  Radical resection       15.92           NA           NA         10.74        11.21          2.35  090
                                         of elbow.
24150........  ...........  A.........  Extensive humerus       13.70           NA           NA          8.50         9.26          2.33  090
                                         surgery.
24151........  ...........  A.........  Extensive humerus       16.08           NA           NA          9.71        10.63          2.60  090
                                         surgery.
24152........  ...........  A.........  Extensive radius        10.24           NA           NA          6.19         6.99          1.48  090
                                         surgery.
24153........  ...........  A.........  Extensive radius        11.73           NA           NA          4.86         5.22          0.74  090
                                         surgery.
24155........  ...........  A.........  Removal of elbow        11.97           NA           NA          7.40         7.94          1.93  090
                                         joint.
24160........  ...........  A.........  Remove elbow             7.89           NA           NA          5.81         6.36          1.30  090
                                         joint implant.
24164........  ...........  A.........  Remove radius            6.34           NA           NA          4.88         5.33          1.03  090
                                         head implant.
24200........  ...........  A.........  Removal of arm           1.78         2.72         3.07          1.36         1.50          0.20  010
                                         foreign body.
24201........  ...........  A.........  Removal of arm           4.61         7.76         8.80          3.66         3.95          0.72  090
                                         foreign body.
24220........  ...........  A.........  Injection for            1.31         2.65         3.12          0.47         0.44          0.08  000
                                         elbow x-ray.
24300........  ...........  A.........  Manipulate elbow         3.86           NA           NA          5.13         5.43          0.65  090
                                         w/anesth.
24301........  ...........  A.........  Muscle/tendon           10.26           NA           NA          6.83         7.52          1.66  090
                                         transfer.
24305........  ...........  A.........  Arm tendon               7.51           NA           NA          5.63         6.18          1.15  090
                                         lengthening.
24310........  ...........  A.........  Revision of arm          6.03           NA           NA          4.72         5.17          0.96  090
                                         tendon.
24320........  ...........  A.........  Repair of arm           10.74           NA           NA          7.03         7.30          1.74  090
                                         tendon.
24330........  ...........  A.........  Revision of arm          9.67           NA           NA          6.63         7.26          1.60  090
                                         muscles.
24331........  ...........  A.........  Revision of arm         10.83           NA           NA          6.95         7.75          1.78  090
                                         muscles.
24332........  ...........  A.........  Tenolysis,               7.77           NA           NA          5.91         6.32          1.23  090
                                         triceps.
24340........  ...........  A.........  Repair of biceps         7.96           NA           NA          5.96         6.48          1.36  090
                                         tendon.
24341........  ...........  A.........  Repair arm tendon/       9.24           NA           NA          7.50         7.72          1.36  090
                                         muscle.
24342........  ...........  A.........  Repair of               10.74           NA           NA          7.06         7.81          1.86  090
                                         ruptured tendon.
24343........  ...........  A.........  Repr elbow lat           8.99           NA           NA          6.97         7.58          1.43  090
                                         ligmnt w/tiss.
24344........  ...........  A.........  Reconstruct elbow       14.97           NA           NA          9.95        10.76          2.37  090
                                         lat ligmnt.
24345........  ...........  A.........  Repr elbw med            8.99           NA           NA          6.92         7.49          1.44  090
                                         ligmnt w/tissu.
24346........  ...........  A.........  Reconstruct elbow       14.97           NA           NA         10.01        10.69          2.34  090
                                         med ligmnt.
24350........  ...........  A.........  Repair of tennis         5.32           NA           NA          4.85         5.22          0.87  090
                                         elbow.
24351........  ...........  A.........  Repair of tennis         5.97           NA           NA          4.98         5.46          1.02  090
                                         elbow.
24352........  ...........  A.........  Repair of tennis         6.49           NA           NA          5.19         5.70          1.10  090
                                         elbow.
24354........  ...........  A.........  Repair of tennis         6.54           NA           NA          5.20         5.69          1.07  090
                                         elbow.
24356........  ...........  A.........  Revision of              6.74           NA           NA          5.29         5.81          1.11  090
                                         tennis elbow.
24360........  ...........  A.........  Reconstruct elbow       12.53           NA           NA          7.87         8.70          2.06  090
                                         joint.
24361........  ...........  A.........  Reconstruct elbow       14.27           NA           NA          8.75         9.68          2.19  090
                                         joint.
24362........  ...........  A.........  Reconstruct elbow       15.18           NA           NA          5.71         8.48          2.61  090
                                         joint.
24363........  ...........  A.........  Replace elbow           22.47           NA           NA         12.18        12.97          3.02  090
                                         joint.
24365........  ...........  A.........  Reconstruct head         8.51           NA           NA          5.96         6.58          1.41  090
                                         of radius.
24366........  ...........  A.........  Reconstruct head         9.25           NA           NA          6.29         6.92          1.52  090
                                         of radius.
24400........  ...........  A.........  Revision of             11.19           NA           NA          7.50         8.20          1.93  090
                                         humerus.
24410........  ...........  A.........  Revision of             14.96           NA           NA          9.26         9.81          2.58  090
                                         humerus.
24420........  ...........  A.........  Revision of             13.58           NA           NA          8.48         9.58          2.18  090
                                         humerus.
24430........  ...........  A.........  Repair of humerus       15.07           NA           NA          9.24         9.51          2.22  090
24435........  ...........  A.........  Repair humerus          14.74           NA           NA          9.81        10.36          2.28  090
                                         with graft.
24470........  ...........  A.........  Revision of elbow        8.81           NA           NA          5.73         6.84          1.48  090
                                         joint.
24495........  ...........  A.........  Decompression of         8.30           NA           NA          6.36         7.60          1.18  090
                                         forearm.
24498........  ...........  A.........  Reinforce humerus       12.16           NA           NA          7.67         8.48          2.07  090
24500........  ...........  A.........  Treat humerus            3.29         4.42         4.64          3.79         3.74          0.50  090
                                         fracture.
24505........  ...........  A.........  Treat humerus            5.25         5.81         6.22          4.86         5.13          0.89  090
                                         fracture.
24515........  ...........  A.........  Treat humerus           11.97           NA           NA          8.04         8.73          2.03  090
                                         fracture.
24516........  ...........  A.........  Treat humerus           12.07           NA           NA          7.65         8.40          2.03  090
                                         fracture.
24530........  ...........  A.........  Treat humerus            3.57         4.71         4.96          3.99         4.02          0.57  090
                                         fracture.
24535........  ...........  A.........  Treat humerus            6.96         6.80         7.33          5.85         6.24          1.18  090
                                         fracture.
24538........  ...........  A.........  Treat humerus            9.63           NA           NA          7.18         7.95          1.64  090
                                         fracture.
24545........  ...........  A.........  Treat humerus           10.88           NA           NA          7.19         7.84          1.83  090
                                         fracture.
24546........  ...........  A.........  Treat humerus           15.99           NA           NA          9.43        10.40          2.74  090
                                         fracture.
24560........  ...........  A.........  Treat humerus            2.87         4.08         4.27          3.41         3.30          0.44  090
                                         fracture.
24565........  ...........  A.........  Treat humerus            5.64         5.90         6.25          5.02         5.27          0.93  090
                                         fracture.
24566........  ...........  A.........  Treat humerus            8.86           NA           NA          6.83         7.52          1.30  090
                                         fracture.
24575........  ...........  A.........  Treat humerus           11.02           NA           NA          7.18         7.81          1.87  090
                                         fracture.
24576........  ...........  A.........  Treat humerus            2.94         4.38         4.58          3.69         3.71          0.46  090
                                         fracture.
24577........  ...........  A.........  Treat humerus            5.87         6.00         6.47          5.06         5.45          0.95  090
                                         fracture.
24579........  ...........  A.........  Treat humerus           11.96           NA           NA          7.83         8.34          2.03  090
                                         fracture.
24582........  ...........  A.........  Treat humerus            9.89           NA           NA          8.15         8.64          1.48  090
                                         fracture.
24586........  ...........  A.........  Treat elbow             15.64           NA           NA          9.33        10.30          2.65  090
                                         fracture.
24587........  ...........  A.........  Treat elbow             15.65           NA           NA          9.32        10.19          2.53  090
                                         fracture.
24600........  ...........  A.........  Treat elbow              4.28         3.84         4.35          3.26         3.39          0.50  090
                                         dislocation.
24605........  ...........  A.........  Treat elbow              5.50           NA           NA          4.89         5.14          0.89  090
                                         dislocation.

[[Page 38249]]

 
24615........  ...........  A.........  Treat elbow              9.72           NA           NA          6.55         7.20          1.60  090
                                         dislocation.
24620........  ...........  A.........  Treat elbow              7.07           NA           NA          5.46         5.86          1.07  090
                                         fracture.
24635........  ...........  A.........  Treat elbow             13.56           NA           NA          8.36        11.52          2.29  090
                                         fracture.
24640........  ...........  A.........  Treat elbow              1.22         1.51         1.67          0.82         0.81          0.12  010
                                         dislocation.
24650........  ...........  A.........  Treat radius             2.22         3.41         3.60          2.98         2.87          0.35  090
                                         fracture.
24655........  ...........  A.........  Treat radius             4.48         5.15         5.56          4.37         4.59          0.70  090
                                         fracture.
24665........  ...........  A.........  Treat radius             8.22           NA           NA          6.50         7.01          1.41  090
                                         fracture.
24666........  ...........  A.........  Treat radius             9.74           NA           NA          6.94         7.52          1.62  090
                                         fracture.
24670........  ...........  A.........  Treat ulnar              2.60         3.70         3.91          3.13         3.10          0.41  090
                                         fracture.
24675........  ...........  A.........  Treat ulnar              4.79         5.35         5.67          4.55         4.76          0.81  090
                                         fracture.
24685........  ...........  A.........  Treat ulnar              8.92           NA           NA          6.43         6.99          1.52  090
                                         fracture.
24800........  ...........  A.........  Fusion of elbow         11.27           NA           NA          6.86         7.94          1.63  090
                                         joint.
24802........  ...........  A.........  Fusion/graft of         14.18           NA           NA          8.03         9.30          2.38  090
                                         elbow joint.
24900........  ...........  A.........  Amputation of           10.04           NA           NA          6.40         6.75          1.53  090
                                         upper arm.
24920........  ...........  A.........  Amputation of           10.02           NA           NA          6.01         6.56          1.61  090
                                         upper arm.
24925........  ...........  A.........  Amputation follow-       7.19           NA           NA          4.93         5.51          1.14  090
                                         up surgery.
24930........  ...........  A.........  Amputation follow-      10.72           NA           NA          6.15         6.66          1.68  090
                                         up surgery.
24931........  ...........  A.........  Amputate upper          13.32           NA           NA          5.06         5.95          1.90  090
                                         arm & implant.
24935........  ...........  A.........  Revision of             16.30           NA           NA         10.49         8.99          2.14  090
                                         amputation.
24940........  ...........  C.........  Revision of upper        0.00         0.00         0.00          0.00         0.00          0.00  090
                                         arm.
24999........  ...........  C.........  Upper arm/elbow          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
25000........  ...........  A.........  Incision of              3.44           NA           NA          5.03         5.96          0.55  090
                                         tendon sheath.
25001........  ...........  A.........  Incise flexor            3.68           NA           NA          3.92         4.07          0.55  090
                                         carpi radialis.
25020........  ...........  A.........  Decompress               5.97           NA           NA          6.89         8.23          0.93  090
                                         forearm 1 space.
25023........  ...........  A.........  Decompress              13.69           NA           NA         11.36        13.18          2.04  090
                                         forearm 1 space.
25024........  ...........  A.........  Decompress              10.62           NA           NA          7.07         7.30          1.36  090
                                         forearm 2 spaces.
25025........  ...........  A.........  Decompress              17.77           NA           NA          9.63         9.72          1.83  090
                                         forearm 2 spaces.
25028........  ...........  A.........  Drainage of              5.30           NA           NA          6.15         7.17          0.81  090
                                         forearm lesion.
25031........  ...........  A.........  Drainage of              4.18           NA           NA          5.42         6.68          0.63  090
                                         forearm bursa.
25035........  ...........  A.........  Treat forearm            7.54           NA           NA          8.74        11.19          1.24  090
                                         bone lesion.
25040........  ...........  A.........  Explore/treat            7.41           NA           NA          5.85         6.59          1.15  090
                                         wrist joint.
25065........  ...........  A.........  Biopsy forearm           2.01         4.32         3.77          1.98         1.94          0.15  010
                                         soft tissues.
25066........  ...........  A.........  Biopsy forearm           4.18           NA           NA          5.45         6.26          0.64  090
                                         soft tissues.
25075........  ...........  A.........  Removal forearm          3.78           NA           NA          4.87         5.38          0.55  090
                                         lesion subcu.
25076........  ...........  A.........  Removal forearm          4.97           NA           NA          6.84         8.20          0.74  090
                                         lesion deep.
25077........  ...........  A.........  Remove tumor,            9.90           NA           NA          8.81        10.47          1.42  090
                                         forearm/wrist.
25085........  ...........  A.........  Incision of wrist        5.55           NA           NA          5.38         6.27          0.85  090
                                         capsule.
25100........  ...........  A.........  Biopsy of wrist          3.94           NA           NA          4.22         4.76          0.59  090
                                         joint.
25101........  ...........  A.........  Explore/treat            4.74           NA           NA          4.80         5.35          0.75  090
                                         wrist joint.
25105........  ...........  A.........  Remove wrist             5.91           NA           NA          5.75         6.54          0.92  090
                                         joint lining.
25107........  ...........  A.........  Remove wrist             7.50           NA           NA          7.00         7.71          0.99  090
                                         joint cartilage.
25109........  ...........  A.........  Excise tendon            6.81           NA           NA          5.26         5.30          0.96  090
                                         forearm/wrist.
25110........  ...........  A.........  Remove wrist             3.96           NA           NA          5.22         6.15          0.62  090
                                         tendon lesion.
25111........  ...........  A.........  Remove wrist             3.44           NA           NA          4.06         4.39          0.53  090
                                         tendon lesion.
25112........  ...........  A.........  Reremove wrist           4.58           NA           NA          4.52         4.89          0.70  090
                                         tendon lesion.
25115........  ...........  A.........  Remove wrist/            9.89           NA           NA         10.13        12.10          1.31  090
                                         forearm lesion.
25116........  ...........  A.........  Remove wrist/            7.38           NA           NA          8.98        11.08          1.11  090
                                         forearm lesion.
25118........  ...........  A.........  Excise wrist             4.42           NA           NA          4.60         5.18          0.68  090
                                         tendon sheath.
25119........  ...........  A.........  Partial removal          6.10           NA           NA          5.83         6.72          0.96  090
                                         of ulna.
25120........  ...........  A.........  Removal of               6.16           NA           NA          7.90         9.99          1.00  090
                                         forearm lesion.
25125........  ...........  A.........  Remove/graft             7.55           NA           NA          8.68        10.77          1.06  090
                                         forearm lesion.
25126........  ...........  A.........  Remove/graft             7.62           NA           NA          8.69        10.87          1.27  090
                                         forearm lesion.
25130........  ...........  A.........  Removal of wrist         5.32           NA           NA          5.17         5.80          0.80  090
                                         lesion.
25135........  ...........  A.........  Remove & graft           6.96           NA           NA          6.06         6.81          1.02  090
                                         wrist lesion.
25136........  ...........  A.........  Remove & graft           6.03           NA           NA          5.53         6.06          1.03  090
                                         wrist lesion.
25145........  ...........  A.........  Remove forearm           6.43           NA           NA          8.01        10.06          1.01  090
                                         bone lesion.
25150........  ...........  A.........  Partial removal          7.27           NA           NA          6.30         7.27          1.14  090
                                         of ulna.
25151........  ...........  A.........  Partial removal          7.57           NA           NA          8.45        10.60          1.18  090
                                         of radius.
25170........  ...........  A.........  Extensive forearm       11.34           NA           NA         10.36        12.79          1.78  090
                                         surgery.
25210........  ...........  A.........  Removal of wrist         6.01           NA           NA          5.49         6.16          0.88  090
                                         bone.
25215........  ...........  A.........  Removal of wrist         8.02           NA           NA          6.79         7.78          1.19  090
                                         bones.
25230........  ...........  A.........  Partial removal          5.28           NA           NA          4.94         5.55          0.79  090
                                         of radius.
25240........  ...........  A.........  Partial removal          5.22           NA           NA          5.23         6.10          0.81  090
                                         of ulna.
25246........  ...........  A.........  Injection for            1.45         2.72         3.05          0.53         0.49          0.09  000
                                         wrist x-ray.
25248........  ...........  A.........  Remove forearm           5.20           NA           NA          6.57         7.54          0.72  090
                                         foreign body.
25250........  ...........  A.........  Removal of wrist         6.66           NA           NA          5.25         5.70          1.01  090
                                         prosthesis.
25251........  ...........  A.........  Removal of wrist         9.70           NA           NA          6.72         7.33          1.26  090
                                         prosthesis.
25259........  ...........  A.........  Manipulate wrist         3.86           NA           NA          5.12         5.43          0.62  090
                                         w/anesthes.
25260........  ...........  A.........  Repair forearm           7.89           NA           NA          9.13        11.24          1.19  090
                                         tendon/muscle.
25263........  ...........  A.........  Repair forearm           7.90           NA           NA          8.93        11.11          1.18  090
                                         tendon/muscle.
25265........  ...........  A.........  Repair forearm           9.96           NA           NA          9.89        12.13          1.47  090
                                         tendon/muscle.
25270........  ...........  A.........  Repair forearm           6.06           NA           NA          7.73         9.91          0.95  090
                                         tendon/muscle.

[[Page 38250]]

 
25272........  ...........  A.........  Repair forearm           7.10           NA           NA          8.30        10.56          1.11  090
                                         tendon/muscle.
25274........  ...........  A.........  Repair forearm           8.82           NA           NA          9.19        11.42          1.36  090
                                         tendon/muscle.
25275........  ...........  A.........  Repair forearm           8.82           NA           NA          6.46         7.04          1.31  090
                                         tendon sheath.
25280........  ...........  A.........  Revise wrist/            7.28           NA           NA          8.36        10.52          1.08  090
                                         forearm tendon.
25290........  ...........  A.........  Incise wrist/            5.34           NA           NA          9.03        12.03          0.82  090
                                         forearm tendon.
25295........  ...........  A.........  Release wrist/           6.61           NA           NA          8.09        10.14          1.00  090
                                         forearm tendon.
25300........  ...........  A.........  Fusion of tendons        8.88           NA           NA          7.09         7.80          1.26  090
                                         at wrist.
25301........  ...........  A.........  Fusion of tendons        8.47           NA           NA          6.64         7.38          1.29  090
                                         at wrist.
25310........  ...........  A.........  Transplant               8.26           NA           NA          8.74        10.91          1.21  090
                                         forearm tendon.
25312........  ...........  A.........  Transplant               9.70           NA           NA          9.52        11.75          1.41  090
                                         forearm tendon.
25315........  ...........  A.........  Revise palsy hand       10.56           NA           NA          9.89        12.18          1.58  090
                                         tendon(s).
25316........  ...........  A.........  Revise palsy hand       12.76           NA           NA         10.53        13.47          1.75  090
                                         tendon(s).
25320........  ...........  A.........  Repair/revise           12.38           NA           NA         10.29        10.87          1.61  090
                                         wrist joint.
25332........  ...........  A.........  Revise wrist            11.60           NA           NA          7.60         8.42          1.84  090
                                         joint.
25335........  ...........  A.........  Realignment of          13.25           NA           NA          9.11        10.01          1.93  090
                                         hand.
25337........  ...........  A.........  Reconstruct ulna/       11.44           NA           NA          9.38        10.24          1.61  090
                                         radioulnar.
25350........  ...........  A.........  Revision of              8.97           NA           NA          9.14        11.58          1.46  090
                                         radius.
25355........  ...........  A.........  Revision of             10.41           NA           NA          9.79        12.25          1.74  090
                                         radius.
25360........  ...........  A.........  Revision of ulna.        8.62           NA           NA          9.05        11.47          1.41  090
25365........  ...........  A.........  Revise radius &         12.77           NA           NA         11.01        13.34          2.16  090
                                         ulna.
25370........  ...........  A.........  Revise radius or        13.93           NA           NA         11.86        13.98          2.29  090
                                         ulna.
25375........  ...........  A.........  Revise radius &         13.41           NA           NA         11.22        13.84          2.27  090
                                         ulna.
25390........  ...........  A.........  Shorten radius or       10.58           NA           NA          9.88        12.25          1.65  090
                                         ulna.
25391........  ...........  A.........  Lengthen radius         14.14           NA           NA         11.47        14.05          2.22  090
                                         or ulna.
25392........  ...........  A.........  Shorten radius &        14.44           NA           NA         11.70        13.86          2.11  090
                                         ulna.
25393........  ...........  A.........  Lengthen radius &       16.42           NA           NA         12.42        15.17          2.77  090
                                         ulna.
25394........  ...........  A.........  Repair carpal           10.71           NA           NA          6.94         7.49          1.59  090
                                         bone, shorten.
25400........  ...........  A.........  Repair radius or        11.16           NA           NA         10.08        12.65          1.83  090
                                         ulna.
25405........  ...........  A.........  Repair/graft            14.87           NA           NA         11.75        14.54          2.33  090
                                         radius or ulna.
25415........  ...........  A.........  Repair radius &         13.66           NA           NA         11.23        13.84          2.18  090
                                         ulna.
25420........  ...........  A.........  Repair/graft            16.89           NA           NA         12.74        15.52          2.62  090
                                         radius & ulna.
25425........  ...........  A.........  Repair/graft            13.58           NA           NA         14.21        17.80          2.09  090
                                         radius or ulna.
25426........  ...........  A.........  Repair/graft            16.31           NA           NA         11.95        14.34          2.55  090
                                         radius & ulna.
25430........  ...........  A.........  Vasc graft into          9.57           NA           NA          7.01         7.19          1.27  090
                                         carpal bone.
25431........  ...........  A.........  Repair nonunion         10.75           NA           NA          7.13         7.80          1.91  090
                                         carpal bone.
25440........  ...........  A.........  Repair/graft            10.56           NA           NA          7.33         8.40          1.63  090
                                         wrist bone.
25441........  ...........  A.........  Reconstruct wrist       13.15           NA           NA          8.07         9.13          2.08  090
                                         joint.
25442........  ...........  A.........  Reconstruct wrist       10.98           NA           NA          7.46         8.17          1.53  090
                                         joint.
25443........  ...........  A.........  Reconstruct wrist       10.52           NA           NA          7.21         7.90          1.37  090
                                         joint.
25444........  ...........  A.........  Reconstruct wrist       11.28           NA           NA          7.44         8.29          1.72  090
                                         joint.
25445........  ...........  A.........  Reconstruct wrist        9.76           NA           NA          6.67         7.35          1.55  090
                                         joint.
25446........  ...........  A.........  Wrist replacement       17.16           NA           NA          9.96        10.95          2.48  090
25447........  ...........  A.........  Repair wrist            10.95           NA           NA          7.83         8.26          1.61  090
                                         joint(s).
25449........  ...........  A.........  Remove wrist            14.80           NA           NA          8.94         9.85          2.22  090
                                         joint implant.
25450........  ...........  A.........  Revision of wrist        7.94           NA           NA          5.85         8.26          1.36  090
                                         joint.
25455........  ...........  A.........  Revision of wrist        9.57           NA           NA          9.69         9.73          0.96  090
                                         joint.
25490........  ...........  A.........  Reinforce radius.        9.61           NA           NA          9.33        11.56          1.43  090
25491........  ...........  A.........  Reinforce ulna...       10.03           NA           NA          9.63        12.06          1.60  090
25492........  ...........  A.........  Reinforce radius        12.52           NA           NA         11.08        13.11          2.15  090
                                         and ulna.
25500........  ...........  A.........  Treat fracture of        2.51         3.29         3.44          2.85         2.79          0.35  090
                                         radius.
25505........  ...........  A.........  Treat fracture of        5.30         5.81         6.18          4.97         5.20          0.90  090
                                         radius.
25515........  ...........  A.........  Treat fracture of        9.37           NA           NA          6.69         7.09          1.59  090
                                         radius.
25520........  ...........  A.........  Treat fracture of        6.35         5.66         6.32          5.12         5.64          1.08  090
                                         radius.
25525........  ...........  A.........  Treat fracture of       12.69           NA           NA          8.67         9.35          2.13  090
                                         radius.
25526........  ...........  A.........  Treat fracture of       13.43           NA           NA         10.14        11.84          2.20  090
                                         radius.
25530........  ...........  A.........  Treat fracture of        2.15         3.46         3.61          2.96         2.91          0.34  090
                                         ulna.
25535........  ...........  A.........  Treat fracture of        5.22         5.54         5.80          4.82         5.08          0.89  090
                                         ulna.
25545........  ...........  A.........  Treat fracture of        9.09           NA           NA          6.61         7.14          1.53  090
                                         ulna.
25560........  ...........  A.........  Treat fracture           2.50         3.34         3.52          2.83         2.72          0.35  090
                                         radius & ulna.
25565........  ...........  A.........  Treat fracture           5.71         5.88         6.31          4.91         5.18          0.93  090
                                         radius & ulna.
25574........  ...........  A.........  Treat fracture           7.47           NA           NA          6.58         6.90          1.21  090
                                         radius & ulna.
25575........  ...........  A.........  Treat fracture          12.02           NA           NA          8.92         9.23          1.82  090
                                         radius/ulna.
25600........  ...........  A.........  Treat fracture           2.69         3.66         3.88          3.15         3.06          0.42  090
                                         radius/ulna.
25605........  ...........  A.........  Treat fracture           7.02         6.84         7.05          6.12         6.18          1.00  090
                                         radius/ulna.
25606........  ...........  A.........  Treat fx distal          8.10           NA           NA          6.68         8.22          1.26  090
                                         radial.
25607........  ...........  A.........  Treat fx rad             9.35           NA           NA          7.18         7.23          1.36  090
                                         extra-articul.
25608........  ...........  A.........  Treat fx rad            10.86           NA           NA          7.78         7.85          1.84  090
                                         intra-articul.
25609........  ...........  A.........  Treat fx radial         14.12           NA           NA          9.65         9.73          2.38  090
                                         3+ frag.
25622........  ...........  A.........  Treat wrist bone         2.68         3.88         4.08          3.33         3.22          0.41  090
                                         fracture.
25624........  ...........  A.........  Treat wrist bone         4.62         5.59         5.94          4.75         4.91          0.76  090
                                         fracture.
25628........  ...........  A.........  Treat wrist bone         9.50           NA           NA          7.29         7.57          1.37  090
                                         fracture.
25630........  ...........  A.........  Treat wrist bone         2.94         3.73         3.96          3.23         3.09          0.45  090
                                         fracture.

[[Page 38251]]

 
25635........  ...........  A.........  Treat wrist bone         4.47         5.07         5.56          4.31         4.15          0.74  090
                                         fracture.
25645........  ...........  A.........  Treat wrist bone         7.31           NA           NA          5.74         6.20          1.20  090
                                         fracture.
25650........  ...........  A.........  Treat wrist bone         3.12         3.82         4.07          3.43         3.30          0.45  090
                                         fracture.
25651........  ...........  A.........  Pin ulnar styloid        5.68           NA           NA          5.11         5.30          0.86  090
                                         fracture.
25652........  ...........  A.........  Treat fracture           7.92           NA           NA          6.14         6.59          1.21  090
                                         ulnar styloid.
25660........  ...........  A.........  Treat wrist              4.84           NA           NA          4.29         4.54          0.58  090
                                         dislocation.
25670........  ...........  A.........  Treat wrist              7.98           NA           NA          6.00         6.50          1.28  090
                                         dislocation.
25671........  ...........  A.........  Pin radioulnar           6.32           NA           NA          5.47         5.82          1.00  090
                                         dislocation.
25675........  ...........  A.........  Treat wrist              4.75         4.68         5.20          3.97         4.34          0.62  090
                                         dislocation.
25676........  ...........  A.........  Treat wrist              8.17           NA           NA          6.33         6.81          1.34  090
                                         dislocation.
25680........  ...........  A.........  Treat wrist              6.08           NA           NA          4.36         4.56          0.78  090
                                         fracture.
25685........  ...........  A.........  Treat wrist              9.97           NA           NA          6.80         7.29          1.60  090
                                         fracture.
25690........  ...........  A.........  Treat wrist              5.58           NA           NA          4.89         5.19          0.88  090
                                         dislocation.
25695........  ...........  A.........  Treat wrist              8.40           NA           NA          6.19         6.65          1.32  090
                                         dislocation.
25800........  ...........  A.........  Fusion of wrist          9.95           NA           NA          7.25         8.18          1.57  090
                                         joint.
25805........  ...........  A.........  Fusion/graft of         11.59           NA           NA          8.14         9.21          1.81  090
                                         wrist joint.
25810........  ...........  A.........  Fusion/graft of         11.75           NA           NA          8.49         9.22          1.68  090
                                         wrist joint.
25820........  ...........  A.........  Fusion of hand           7.52           NA           NA          6.28         7.07          1.22  090
                                         bones.
25825........  ...........  A.........  Fuse hand bones          9.54           NA           NA          7.50         8.39          1.41  090
                                         with graft.
25830........  ...........  A.........  Fusion,                 10.69           NA           NA         10.40        12.42          1.55  090
                                         radioulnar jnt/
                                         ulna.
25900........  ...........  A.........  Amputation of            9.46           NA           NA          9.44        10.97          1.30  090
                                         forearm.
25905........  ...........  A.........  Amputation of            9.48           NA           NA          8.74        10.47          1.40  090
                                         forearm.
25907........  ...........  A.........  Amputation follow-       7.98           NA           NA          8.53        10.02          1.10  090
                                         up surgery.
25909........  ...........  A.........  Amputation follow-       9.20           NA           NA          9.07        10.67          1.44  090
                                         up surgery.
25915........  ...........  A.........  Amputation of           17.38           NA           NA          8.12        13.50          2.94  090
                                         forearm.
25920........  ...........  A.........  Amputate hand at         8.92           NA           NA          6.45         7.20          1.35  090
                                         wrist.
25922........  ...........  A.........  Amputate hand at         7.54           NA           NA          6.12         6.66          1.12  090
                                         wrist.
25924........  ...........  A.........  Amputation follow-       8.70           NA           NA          6.02         7.18          1.32  090
                                         up surgery.
25927........  ...........  A.........  Amputation of            8.98           NA           NA          8.50        10.11          1.27  090
                                         hand.
25929........  ...........  A.........  Amputation follow-       7.71           NA           NA          5.66         5.73          1.14  090
                                         up surgery.
25931........  ...........  A.........  Amputation follow-       7.93           NA           NA          8.20         9.89          1.15  090
                                         up surgery.
25999........  ...........  C.........  Forearm or wrist         0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
26010........  ...........  A.........  Drainage of              1.56         4.02         4.79          1.51         1.57          0.18  010
                                         finger abscess.
26011........  ...........  A.........  Drainage of              2.21         6.20         7.51          1.95         2.14          0.33  010
                                         finger abscess.
26020........  ...........  A.........  Drain hand tendon        4.97           NA           NA          4.71         5.04          0.73  090
                                         sheath.
26025........  ...........  A.........  Drainage of palm         4.99           NA           NA          4.44         4.79          0.76  090
                                         bursa.
26030........  ...........  A.........  Drainage of palm         6.16           NA           NA          4.98         5.36          0.92  090
                                         bursa(s).
26034........  ...........  A.........  Treat hand bone          6.49           NA           NA          5.55         5.96          1.01  090
                                         lesion.
26035........  ...........  A.........  Decompress              11.14           NA           NA          8.12         7.99          1.47  090
                                         fingers/hand.
26037........  ...........  A.........  Decompress               7.48           NA           NA          5.49         5.92          1.13  090
                                         fingers/hand.
26040........  ...........  A.........  Release palm             3.38           NA           NA          3.56         3.82          0.53  090
                                         contracture.
26045........  ...........  A.........  Release palm             5.62           NA           NA          4.87         5.26          0.93  090
                                         contracture.
26055........  ...........  A.........  Incise finger            3.00         8.95        11.66          3.80         3.88          0.43  090
                                         tendon sheath.
26060........  ...........  A.........  Incision of              2.85           NA           NA          3.03         3.28          0.45  090
                                         finger tendon.
26070........  ...........  A.........  Explore/treat            3.73           NA           NA          3.04         3.20          0.48  090
                                         hand joint.
26075........  ...........  A.........  Explore/treat            3.83           NA           NA          3.35         3.58          0.53  090
                                         finger joint.
26080........  ...........  A.........  Explore/treat            4.36           NA           NA          4.29         4.58          0.66  090
                                         finger joint.
26100........  ...........  A.........  Biopsy hand joint        3.71           NA           NA          3.65         3.88          0.54  090
                                         lining.
26105........  ...........  A.........  Biopsy finger            3.75           NA           NA          3.66         3.96          0.59  090
                                         joint lining.
26110........  ...........  A.........  Biopsy finger            3.57           NA           NA          3.59         3.82          0.53  090
                                         joint lining.
26115........  ...........  A.........  Removal hand             3.92         9.75        11.43          4.21         4.50          0.59  090
                                         lesion subcut.
26116........  ...........  A.........  Removal hand             5.61           NA           NA          5.28         5.65          0.84  090
                                         lesion, deep.
26117........  ...........  A.........  Remove tumor,            8.62           NA           NA          6.16         6.63          1.26  090
                                         hand/finger.
26121........  ...........  A.........  Release palm             7.61           NA           NA          5.90         6.45          1.17  090
                                         contracture.
26123........  ...........  A.........  Release palm            10.63           NA           NA          8.18         8.54          1.43  090
                                         contracture.
26125........  ...........  A.........  Release palm             4.60           NA           NA          1.88         2.17          0.70  ZZZ
                                         contracture.
26130........  ...........  A.........  Remove wrist             5.48           NA           NA          4.88         5.11          0.94  090
                                         joint lining.
26135........  ...........  A.........  Revise finger            7.02           NA           NA          5.44         5.97          1.07  090
                                         joint, each.
26140........  ...........  A.........  Revise finger            6.23           NA           NA          5.13         5.60          0.92  090
                                         joint, each.
26145........  ...........  A.........  Tendon excision,         6.38           NA           NA          5.16         5.62          0.97  090
                                         palm/finger.
26160........  ...........  A.........  Remove tendon            3.46         8.94        10.67          3.91         4.02          0.49  090
                                         sheath lesion.
26170........  ...........  A.........  Removal of palm          4.82           NA           NA          4.35         4.66          0.69  090
                                         tendon, each.
26180........  ...........  A.........  Removal of finger        5.24           NA           NA          4.68         5.07          0.78  090
                                         tendon.
26185........  ...........  A.........  Remove finger            6.32           NA           NA          5.69         5.88          0.81  090
                                         bone.
26200........  ...........  A.........  Remove hand bone         5.56           NA           NA          4.53         4.95          0.88  090
                                         lesion.
26205........  ...........  A.........  Remove/graft bone        7.82           NA           NA          5.83         6.37          1.20  090
                                         lesion.
26210........  ...........  A.........  Removal of finger        5.21           NA           NA          4.71         5.08          0.79  090
                                         lesion.
26215........  ...........  A.........  Remove/graft             7.16           NA           NA          5.51         5.92          0.98  090
                                         finger lesion.
26230........  ...........  A.........  Partial removal          6.38           NA           NA          4.93         5.44          1.01  090
                                         of hand bone.
26235........  ...........  A.........  Partial removal,         6.24           NA           NA          4.92         5.38          0.95  090
                                         finger bone.
26236........  ...........  A.........  Partial removal,         5.37           NA           NA          4.55         4.94          0.81  090
                                         finger bone.
26250........  ...........  A.........  Extensive hand           7.61           NA           NA          5.69         5.98          1.07  090
                                         surgery.

[[Page 38252]]

 
26255........  ...........  A.........  Extensive hand          12.80           NA           NA          8.22         8.85          1.69  090
                                         surgery.
26260........  ...........  A.........  Extensive finger         7.09           NA           NA          5.45         5.81          1.01  090
                                         surgery.
26261........  ...........  A.........  Extensive finger         9.28           NA           NA          6.73         6.50          1.14  090
                                         surgery.
26262........  ...........  A.........  Partial removal          5.72           NA           NA          4.73         5.02          0.88  090
                                         of finger.
26320........  ...........  A.........  Removal of               4.02           NA           NA          3.77         4.05          0.59  090
                                         implant from
                                         hand.
26340........  ...........  A.........  Manipulate finger        2.62           NA           NA          4.57         4.74          0.39  090
                                         w/anesth.
26350........  ...........  A.........  Repair finger/           6.07           NA           NA          9.35        12.00          0.93  090
                                         hand tendon.
26352........  ...........  A.........  Repair/graft hand        7.75           NA           NA          9.89        12.65          1.13  090
                                         tendon.
26356........  ...........  A.........  Repair finger/          10.22           NA           NA         13.51        15.98          1.21  090
                                         hand tendon.
26357........  ...........  A.........  Repair finger/           8.65           NA           NA         10.19        12.92          1.33  090
                                         hand tendon.
26358........  ...........  A.........  Repair/graft hand        9.22           NA           NA         10.77        13.72          1.38  090
                                         tendon.
26370........  ...........  A.........  Repair finger/           7.17           NA           NA          9.35        12.26          1.12  090
                                         hand tendon.
26372........  ...........  A.........  Repair/graft hand        8.89           NA           NA         10.36        13.47          1.40  090
                                         tendon.
26373........  ...........  A.........  Repair finger/           8.29           NA           NA          9.98        13.05          1.23  090
                                         hand tendon.
26390........  ...........  A.........  Revise hand/             9.31           NA           NA          9.04        11.17          1.40  090
                                         finger tendon.
26392........  ...........  A.........  Repair/graft hand       10.38           NA           NA         10.98        13.87          1.57  090
                                         tendon.
26410........  ...........  A.........  Repair hand              4.68           NA           NA          7.49         9.73          0.73  090
                                         tendon.
26412........  ...........  A.........  Repair/graft hand        6.37           NA           NA          8.46        10.88          0.97  090
                                         tendon.
26415........  ...........  A.........  Excision, hand/          8.40           NA           NA          7.35         9.46          0.98  090
                                         finger tendon.
26416........  ...........  A.........  Graft hand or            9.44           NA           NA          8.90        11.71          0.79  090
                                         finger tendon.
26418........  ...........  A.........  Repair finger            4.33           NA           NA          7.98        10.17          0.67  090
                                         tendon.
26420........  ...........  A.........  Repair/graft             6.83           NA           NA          8.64        11.15          1.07  090
                                         finger tendon.
26426........  ...........  A.........  Repair finger/           6.21           NA           NA          8.40        10.81          0.95  090
                                         hand tendon.
26428........  ...........  A.........  Repair/graft             7.28           NA           NA          9.07        11.50          1.09  090
                                         finger tendon.
26432........  ...........  A.........  Repair finger            4.07           NA           NA          6.63         8.46          0.64  090
                                         tendon.
26433........  ...........  A.........  Repair finger            4.61           NA           NA          6.86         8.84          0.72  090
                                         tendon.
26434........  ...........  A.........  Repair/graft             6.15           NA           NA          7.79         9.68          0.93  090
                                         finger tendon.
26437........  ...........  A.........  Realignment of           5.88           NA           NA          7.64         9.62          0.89  090
                                         tendons.
26440........  ...........  A.........  Release palm/            5.07           NA           NA          8.31        10.89          0.75  090
                                         finger tendon.
26442........  ...........  A.........  Release palm &           9.50           NA           NA         11.63        13.79          1.20  090
                                         finger tendon.
26445........  ...........  A.........  Release hand/            4.36           NA           NA          8.05        10.60          0.65  090
                                         finger tendon.
26449........  ...........  A.........  Release forearm/         8.34           NA           NA         11.18        13.50          1.06  090
                                         hand tendon.
26450........  ...........  A.........  Incision of palm         3.71           NA           NA          5.04         6.20          0.59  090
                                         tendon.
26455........  ...........  A.........  Incision of              3.68           NA           NA          5.00         6.15          0.58  090
                                         finger tendon.
26460........  ...........  A.........  Incise hand/             3.50           NA           NA          4.97         6.06          0.55  090
                                         finger tendon.
26471........  ...........  A.........  Fusion of finger         5.79           NA           NA          7.63         9.44          0.88  090
                                         tendons.
26474........  ...........  A.........  Fusion of finger         5.38           NA           NA          7.44         9.43          0.76  090
                                         tendons.
26476........  ...........  A.........  Tendon                   5.24           NA           NA          7.17         9.09          0.79  090
                                         lengthening.
26477........  ...........  A.........  Tendon shortening        5.21           NA           NA          7.40         9.25          0.81  090
26478........  ...........  A.........  Lengthening of           5.86           NA           NA          7.62         9.73          0.90  090
                                         hand tendon.
26479........  ...........  A.........  Shortening of            5.80           NA           NA          7.60         9.60          0.92  090
                                         hand tendon.
26480........  ...........  A.........  Transplant hand          6.76           NA           NA          9.47        12.28          1.02  090
                                         tendon.
26483........  ...........  A.........  Transplant/graft         8.36           NA           NA         10.06        12.81          1.26  090
                                         hand tendon.
26485........  ...........  A.........  Transplant palm          7.77           NA           NA          9.90        12.64          1.15  090
                                         tendon.
26489........  ...........  A.........  Transplant/graft         9.74           NA           NA         10.64        11.29          1.26  090
                                         palm tendon.
26490........  ...........  A.........  Revise thumb             8.48           NA           NA          8.71        10.80          1.21  090
                                         tendon.
26492........  ...........  A.........  Tendon transfer          9.70           NA           NA          9.66        11.66          1.40  090
                                         with graft.
26494........  ...........  A.........  Hand tendon/             8.54           NA           NA          9.05        11.00          1.28  090
                                         muscle transfer.
26496........  ...........  A.........  Revise thumb             9.66           NA           NA          9.40        11.33          1.45  090
                                         tendon.
26497........  ...........  A.........  Finger tendon            9.64           NA           NA          9.38        11.49          1.41  090
                                         transfer.
26498........  ...........  A.........  Finger tendon           14.07           NA           NA         11.46        13.83          2.11  090
                                         transfer.
26499........  ...........  A.........  Revision of              9.05           NA           NA          8.66        10.87          1.35  090
                                         finger.
26500........  ...........  A.........  Hand tendon              6.02           NA           NA          7.60         9.56          0.90  090
                                         reconstruction.
26502........  ...........  A.........  Hand tendon              7.20           NA           NA          8.18        10.13          1.13  090
                                         reconstruction.
26508........  ...........  A.........  Release thumb            6.07           NA           NA          7.64         9.68          0.98  090
                                         contracture.
26510........  ...........  A.........  Thumb tendon             5.49           NA           NA          7.47         9.42          0.79  090
                                         transfer.
26516........  ...........  A.........  Fusion of knuckle        7.21           NA           NA          8.13        10.20          1.10  090
                                         joint.
26517........  ...........  A.........  Fusion of knuckle        8.96           NA           NA          8.86        11.25          1.41  090
                                         joints.
26518........  ...........  A.........  Fusion of knuckle        9.15           NA           NA          8.79        11.16          1.35  090
                                         joints.
26520........  ...........  A.........  Release knuckle          5.36           NA           NA          8.69        11.31          0.80  090
                                         contracture.
26525........  ...........  A.........  Release finger           5.39           NA           NA          8.71        11.36          0.81  090
                                         contracture.
26530........  ...........  A.........  Revise knuckle           6.76           NA           NA          5.39         5.78          1.04  090
                                         joint.
26531........  ...........  A.........  Revise knuckle           7.99           NA           NA          6.12         6.64          1.17  090
                                         with implant.
26535........  ...........  A.........  Revise finger            5.30           NA           NA          4.03         3.90          0.71  090
                                         joint.
26536........  ...........  A.........  Revise/implant           6.44           NA           NA          9.05         9.37          0.96  090
                                         finger joint.
26540........  ...........  A.........  Repair hand joint        6.49           NA           NA          7.89         9.90          0.99  090
26541........  ...........  A.........  Repair hand joint        8.69           NA           NA          8.95        11.19          1.28  090
                                         with graft.
26542........  ...........  A.........  Repair hand joint        6.84           NA           NA          8.04        10.05          1.02  090
                                         with graft.
26545........  ...........  A.........  Reconstruct              6.99           NA           NA          8.30        10.23          1.05  090
                                         finger joint.
26546........  ...........  A.........  Repair nonunion         10.53           NA           NA         11.33        13.20          1.44  090
                                         hand.
26548........  ...........  A.........  Reconstruct              8.10           NA           NA          8.64        10.78          1.20  090
                                         finger joint.
26550........  ...........  A.........  Construct thumb         21.54           NA           NA         14.40        16.17          2.46  090
                                         replacement.

[[Page 38253]]

 
26551........  ...........  A.........  Great toe-hand          48.23           NA           NA         17.12        25.55          7.98  090
                                         transfer.
26553........  ...........  A.........  Single transfer,        47.92           NA           NA         27.43        23.93          2.42  090
                                         toe-hand.
26554........  ...........  A.........  Double transfer,        56.73           NA           NA         36.06        34.01          9.44  090
                                         toe-hand.
26555........  ...........  A.........  Positional change       16.94           NA           NA         13.85        16.03          2.49  090
                                         of finger.
26556........  ...........  A.........  Toe joint               49.43           NA           NA         17.98        25.63          2.58  090
                                         transfer.
26560........  ...........  A.........  Repair of web            5.43           NA           NA          6.52         8.26          0.85  090
                                         finger.
26561........  ...........  A.........  Repair of web           10.98           NA           NA          9.36        10.87          1.45  090
                                         finger.
26562........  ...........  A.........  Repair of web           16.40           NA           NA          8.64        13.81          2.24  090
                                         finger.
26565........  ...........  A.........  Correct                  6.80           NA           NA          7.99         9.99          1.00  090
                                         metacarpal flaw.
26567........  ...........  A.........  Correct finger           6.88           NA           NA          7.96         9.99          1.04  090
                                         deformity.
26568........  ...........  A.........  Lengthen                 9.15           NA           NA         10.50        12.91          1.49  090
                                         metacarpal/
                                         finger.
26580........  ...........  A.........  Repair hand             19.50           NA           NA          9.66        11.93          2.29  090
                                         deformity.
26587........  ...........  A.........  Reconstruct extra       14.36           NA           NA          7.95         8.67          1.53  090
                                         finger.
26590........  ...........  A.........  Repair finger           18.51           NA           NA         12.27        12.82          2.78  090
                                         deformity.
26591........  ...........  A.........  Repair muscles of        3.30           NA           NA          6.07         7.88          0.48  090
                                         hand.
26593........  ...........  A.........  Release muscles          5.38           NA           NA          7.64         9.41          0.78  090
                                         of hand.
26596........  ...........  A.........  Excision                 9.02           NA           NA          7.36         8.11          1.43  090
                                         constricting
                                         tissue.
26600........  ...........  A.........  Treat metacarpal         2.48         3.81         3.72          3.47         3.06          0.30  090
                                         fracture.
26605........  ...........  A.........  Treat metacarpal         2.92         4.06         4.31          3.48         3.57          0.49  090
                                         fracture.
26607........  ...........  A.........  Treat metacarpal         5.40           NA           NA          4.87         5.58          0.87  090
                                         fracture.
26608........  ...........  A.........  Treat metacarpal         5.43           NA           NA          5.21         5.74          0.88  090
                                         fracture.
26615........  ...........  A.........  Treat metacarpal         5.38           NA           NA          4.70         5.01          0.86  090
                                         fracture.
26641........  ...........  A.........  Treat thumb              4.01         4.02         4.32          3.39         3.48          0.39  090
                                         dislocation.
26645........  ...........  A.........  Treat thumb              4.47         4.58         4.88          3.90         4.05          0.67  090
                                         fracture.
26650........  ...........  A.........  Treat thumb              5.80           NA           NA          5.07         5.98          0.94  090
                                         fracture.
26665........  ...........  A.........  Treat thumb              7.72           NA           NA          5.84         6.24          0.90  090
                                         fracture.
26670........  ...........  A.........  Treat hand               3.74         3.59         3.92          3.01         2.97          0.39  090
                                         dislocation.
26675........  ...........  A.........  Treat hand               4.71         5.22         5.29          4.49         4.43          0.77  090
                                         dislocation.
26676........  ...........  A.........  Pin hand                 5.60           NA           NA          5.54         6.13          0.91  090
                                         dislocation.
26685........  ...........  A.........  Treat hand               7.09           NA           NA          5.35         5.76          1.09  090
                                         dislocation.
26686........  ...........  A.........  Treat hand               8.06           NA           NA          6.05         6.50          1.24  090
                                         dislocation.
26700........  ...........  A.........  Treat knuckle            3.74         3.27         3.52          2.91         2.90          0.35  090
                                         dislocation.
26705........  ...........  A.........  Treat knuckle            4.26         4.73         5.04          4.03         4.18          0.66  090
                                         dislocation.
26706........  ...........  A.........  Pin knuckle              5.19           NA           NA          4.68         4.89          0.81  090
                                         dislocation.
26715........  ...........  A.........  Treat knuckle            5.79           NA           NA          4.86         5.20          0.91  090
                                         dislocation.
26720........  ...........  A.........  Treat finger             1.70         2.56         2.67          2.29         2.18          0.24  090
                                         fracture, each.
26725........  ...........  A.........  Treat finger             3.39         4.06         4.42          3.39         3.45          0.53  090
                                         fracture, each.
26727........  ...........  A.........  Treat finger             5.30           NA           NA          5.15         5.70          0.84  090
                                         fracture, each.
26735........  ...........  A.........  Treat finger             6.03           NA           NA          4.94         5.26          0.95  090
                                         fracture, each.
26740........  ...........  A.........  Treat finger             1.99         2.98         3.05          2.69         2.69          0.31  090
                                         fracture, each.
26742........  ...........  A.........  Treat finger             3.90         4.24         4.63          3.55         3.73          0.58  090
                                         fracture, each.
26746........  ...........  A.........  Treat finger             5.86           NA           NA          4.91         5.25          0.91  090
                                         fracture, each.
26750........  ...........  A.........  Treat finger             1.74         2.23         2.36          2.24         2.13          0.22  090
                                         fracture, each.
26755........  ...........  A.........  Treat finger             3.15         3.72         4.09          2.92         2.97          0.42  090
                                         fracture, each.
26756........  ...........  A.........  Pin finger               4.46           NA           NA          4.83         5.28          0.71  090
                                         fracture, each.
26765........  ...........  A.........  Treat finger             4.21           NA           NA          4.00         4.20          0.66  090
                                         fracture, each.
26770........  ...........  A.........  Treat finger             3.07         2.90         3.17          2.53         2.47          0.27  090
                                         dislocation.
26775........  ...........  A.........  Treat finger             3.78         4.60         4.89          3.86         3.83          0.54  090
                                         dislocation.
26776........  ...........  A.........  Pin finger               4.87           NA           NA          4.95         5.49          0.77  090
                                         dislocation.
26785........  ...........  A.........  Treat finger             4.25           NA           NA          4.03         4.29          0.68  090
                                         dislocation.
26820........  ...........  A.........  Thumb fusion with        8.33           NA           NA          8.81        11.02          1.30  090
                                         graft.
26841........  ...........  A.........  Fusion of thumb..        7.21           NA           NA          8.61        10.94          1.18  090
26842........  ...........  A.........  Thumb fusion with        8.37           NA           NA          8.87        11.14          1.32  090
                                         graft.
26843........  ...........  A.........  Fusion of hand           7.67           NA           NA          8.40        10.34          1.15  090
                                         joint.
26844........  ...........  A.........  Fusion/graft of          8.86           NA           NA          9.01        11.22          1.33  090
                                         hand joint.
26850........  ...........  A.........  Fusion of knuckle        7.03           NA           NA          8.20        10.22          1.06  090
26852........  ...........  A.........  Fusion of knuckle        8.59           NA           NA          9.06        10.99          1.22  090
                                         with graft.
26860........  ...........  A.........  Fusion of finger         4.76           NA           NA          7.47         9.34          0.73  090
                                         joint.
26861........  ...........  A.........  Fusion of finger         1.74           NA           NA          0.70         0.82          0.27  ZZZ
                                         jnt, add-on.
26862........  ...........  A.........  Fusion/graft of          7.44           NA           NA          8.59        10.49          1.10  090
                                         finger joint.
26863........  ...........  A.........  Fuse/graft added         3.89           NA           NA          1.59         1.86          0.56  ZZZ
                                         joint.
26910........  ...........  A.........  Amputate                 7.67           NA           NA          8.23         9.74          1.16  090
                                         metacarpal bone.
26951........  ...........  A.........  Amputation of            5.85           NA           NA          8.33         9.25          0.71  090
                                         finger/thumb.
26952........  ...........  A.........  Amputation of            6.37           NA           NA          7.86         9.78          0.95  090
                                         finger/thumb.
26989........  ...........  C.........  Hand/finger              0.00         0.00         8.41          0.00         8.41          0.00  YYY
                                         surgery.
26990........  ...........  A.........  Drainage of              7.84           NA           NA          6.19         6.72          1.22  090
                                         pelvis lesion.
26991........  ...........  A.........  Drainage of              6.97         8.57         9.86          4.87         5.15          1.11  090
                                         pelvis bursa.
26992........  ...........  A.........  Drainage of bone        13.37           NA           NA          8.42         9.44          2.17  090
                                         lesion.
27000........  ...........  A.........  Incision of hip          5.66           NA           NA          4.51         4.90          0.98  090
                                         tendon.
27001........  ...........  A.........  Incision of hip          7.05           NA           NA          5.22         5.66          1.24  090
                                         tendon.
27003........  ...........  A.........  Incision of hip          7.70           NA           NA          5.72         6.12          1.12  090
                                         tendon.
27005........  ...........  A.........  Incision of hip          9.96           NA           NA          6.52         7.22          1.73  090
                                         tendon.

[[Page 38254]]

 
27006........  ...........  A.........  Incision of hip          9.99           NA           NA          6.77         7.39          1.70  090
                                         tendons.
27025........  ...........  A.........  Incision of hip/        12.66           NA           NA          8.23         8.37          1.85  090
                                         thigh fascia.
27030........  ...........  A.........  Drainage of hip         13.54           NA           NA          8.05         8.86          2.27  090
                                         joint.
27033........  ...........  A.........  Exploration of          13.99           NA           NA          8.40         9.17          2.33  090
                                         hip joint.
27035........  ...........  A.........  Denervation of          17.23           NA           NA          8.56        10.09          2.16  090
                                         hip joint.
27036........  ...........  A.........  Excision of hip         14.18           NA           NA          8.93         9.48          2.27  090
                                         joint/muscle.
27040........  ...........  A.........  Biopsy of soft           2.89         5.16         5.17          1.87         1.92          0.27  010
                                         tissues.
27041........  ...........  A.........  Biopsy of soft          10.07           NA           NA          5.74         6.19          1.35  090
                                         tissues.
27047........  ...........  A.........  Remove hip/pelvis        7.51         6.97         7.06          4.48         4.64          1.03  090
                                         lesion.
27048........  ...........  A.........  Remove hip/pelvis        6.44           NA           NA          4.59         4.70          0.92  090
                                         lesion.
27049........  ...........  A.........  Remove tumor, hip/      15.20           NA           NA          8.17         8.30          2.07  090
                                         pelvis.
27050........  ...........  A.........  Biopsy of                4.65           NA           NA          3.00         3.84          0.60  090
                                         sacroiliac joint.
27052........  ...........  A.........  Biopsy of hip            7.27           NA           NA          5.64         5.77          1.08  090
                                         joint.
27054........  ...........  A.........  Removal of hip           9.09           NA           NA          6.49         6.92          1.47  090
                                         joint lining.
27060........  ...........  A.........  Removal of               5.78           NA           NA          4.36         4.38          0.80  090
                                         ischial bursa.
27062........  ...........  A.........  Remove femur             5.66           NA           NA          4.59         4.90          0.93  090
                                         lesion/bursa.
27065........  ...........  A.........  Removal of hip           6.44           NA           NA          4.99         5.24          1.01  090
                                         bone lesion.
27066........  ...........  A.........  Removal of hip          11.06           NA           NA          7.43         7.94          1.80  090
                                         bone lesion.
27067........  ...........  A.........  Remove/graft hip        14.57           NA           NA          8.85         9.76          1.85  090
                                         bone lesion.
27070........  ...........  A.........  Partial removal         11.44           NA           NA          8.03         8.57          1.75  090
                                         of hip bone.
27071........  ...........  A.........  Partial removal         12.25           NA           NA          8.47         9.31          1.93  090
                                         of hip bone.
27075........  ...........  A.........  Extensive hip           36.77           NA           NA         16.17        17.78          5.66  090
                                         surgery.
27076........  ...........  A.........  Extensive hip           24.25           NA           NA         12.89        13.69          3.71  090
                                         surgery.
27077........  ...........  A.........  Extensive hip           42.54           NA           NA         20.04        21.36          6.14  090
                                         surgery.
27078........  ...........  A.........  Extensive hip           14.54           NA           NA          8.78         9.37          2.23  090
                                         surgery.
27079........  ...........  A.........  Extensive hip           14.91           NA           NA          8.00         8.69          1.95  090
                                         surgery.
27080........  ...........  A.........  Removal of tail          6.80           NA           NA          4.56         4.73          0.93  090
                                         bone.
27086........  ...........  A.........  Remove hip               1.89         3.58         4.09          1.46         1.65          0.25  010
                                         foreign body.
27087........  ...........  A.........  Remove hip               8.72           NA           NA          5.64         6.15          1.35  090
                                         foreign body.
27090........  ...........  A.........  Removal of hip          11.57           NA           NA          7.41         8.10          1.95  090
                                         prosthesis.
27091........  ...........  A.........  Removal of hip          24.15           NA           NA         12.95        13.50          3.85  090
                                         prosthesis.
27093........  ...........  A.........  Injection for hip        1.30         3.13         3.77          0.48         0.47          0.13  000
                                         x-ray.
27095........  ...........  A.........  Injection for hip        1.50         3.69         4.69          0.51         0.51          0.14  000
                                         x-ray.
27096........  ...........  A.........  Inject sacroiliac        1.40         2.50         3.42          0.33         0.33          0.08  000
                                         joint.
27097........  ...........  A.........  Revision of hip          9.16           NA           NA          6.33         6.38          1.57  090
                                         tendon.
27098........  ...........  A.........  Transfer tendon          9.20           NA           NA          4.92         5.97          0.95  090
                                         to pelvis.
27100........  ...........  A.........  Transfer of             11.21           NA           NA          7.39         8.03          1.86  090
                                         abdominal muscle.
27105........  ...........  A.........  Transfer of             11.90           NA           NA          7.35         8.36          1.73  090
                                         spinal muscle.
27110........  ...........  A.........  Transfer of             13.63           NA           NA          8.28         8.76          2.19  090
                                         iliopsoas muscle.
27111........  ...........  A.........  Transfer of             12.46           NA           NA          8.08         8.62          1.95  090
                                         iliopsoas muscle.
27120........  ...........  A.........  Reconstruction of       19.10           NA           NA         10.83        11.34          3.09  090
                                         hip socket.
27122........  ...........  A.........  Reconstruction of       15.95           NA           NA          9.45        10.26          2.62  090
                                         hip socket.
27125........  ...........  A.........  Partial hip             16.46           NA           NA          9.61        10.14          2.55  090
                                         replacement.
27130........  ...........  A.........  Total hip               21.61           NA           NA         11.80        12.57          3.51  090
                                         arthroplasty.
27132........  ...........  A.........  Total hip               25.49           NA           NA         13.47        14.58          4.05  090
                                         arthroplasty.
27134........  ...........  A.........  Revise hip joint        30.13           NA           NA         14.75        16.30          4.95  090
                                         replacement.
27137........  ...........  A.........  Revise hip joint        22.55           NA           NA         11.77        12.87          3.68  090
                                         replacement.
27138........  ...........  A.........  Revise hip joint        23.55           NA           NA         12.15        13.30          3.85  090
                                         replacement.
27140........  ...........  A.........  Transplant femur        12.66           NA           NA          7.88         8.64          2.12  090
                                         ridge.
27146........  ...........  A.........  Incision of hip         18.72           NA           NA         10.70        11.43          2.97  090
                                         bone.
27147........  ...........  A.........  Revision of hip         21.87           NA           NA         12.04        12.65          3.58  090
                                         bone.
27151........  ...........  A.........  Incision of hip         23.92           NA           NA         12.92        10.37          3.92  090
                                         bones.
27156........  ...........  A.........  Revision of hip         26.03           NA           NA         13.76        14.89          4.22  090
                                         bones.
27158........  ...........  A.........  Revision of             20.89           NA           NA         11.55        10.52          3.17  090
                                         pelvis.
27161........  ...........  A.........  Incision of neck        17.74           NA           NA         10.38        11.25          2.95  090
                                         of femur.
27165........  ...........  A.........  Incision/fixation       20.06           NA           NA         11.60        12.29          3.11  090
                                         of femur.
27170........  ...........  A.........  Repair/graft            17.46           NA           NA          9.78        10.55          2.82  090
                                         femur head/neck.
27175........  ...........  A.........  Treat slipped            9.29           NA           NA          5.16         6.03          1.46  090
                                         epiphysis.
27176........  ...........  A.........  Treat slipped           12.78           NA           NA          8.19         8.62          2.23  090
                                         epiphysis.
27177........  ...........  A.........  Treat slipped           15.94           NA           NA          9.65        10.28          2.62  090
                                         epiphysis.
27178........  ...........  A.........  Treat slipped           12.78           NA           NA          7.98         8.25          2.09  090
                                         epiphysis.
27179........  ...........  A.........  Revise head/neck        13.83           NA           NA          8.58         9.29          2.26  090
                                         of femur.
27181........  ...........  A.........  Treat slipped           15.98           NA           NA          9.76        10.00          1.57  090
                                         epiphysis.
27185........  ...........  A.........  Revision of femur        9.67           NA           NA          6.64         7.09          2.40  090
                                         epiphysis.
27187........  ...........  A.........  Reinforce hip           14.09           NA           NA          8.70         9.52          2.38  090
                                         bones.
27193........  ...........  A.........  Treat pelvic ring        5.98         4.62         4.86          4.75         4.90          0.96  090
                                         fracture.
27194........  ...........  A.........  Treat pelvic ring       10.08           NA           NA          6.63         7.14          1.65  090
                                         fracture.
27200........  ...........  A.........  Treat tail bone          1.87         2.06         2.15          2.21         2.16          0.28  090
                                         fracture.
27202........  ...........  A.........  Treat tail bone          7.25           NA           NA         10.28        13.71          1.06  090
                                         fracture.
27215........  ...........  A.........  Treat pelvic            10.45           NA           NA          6.58         6.83          1.98  090
                                         fracture(s).
27216........  ...........  A.........  Treat pelvic ring       15.73           NA           NA          9.17         9.40          2.64  090
                                         fracture.
27217........  ...........  A.........  Treat pelvic ring       14.65           NA           NA          8.64         9.41          2.42  090
                                         fracture.

[[Page 38255]]

 
27218........  ...........  A.........  Treat pelvic ring       20.93           NA           NA         11.36        11.39          3.49  090
                                         fracture.
27220........  ...........  A.........  Treat hip socket         6.72         5.23         5.48          5.14         5.39          1.07  090
                                         fracture.
27222........  ...........  A.........  Treat hip socket        13.97           NA           NA          8.52         9.25          2.20  090
                                         fracture.
27226........  ...........  A.........  Treat hip wall          15.45           NA           NA          8.94         8.39          2.49  090
                                         fracture.
27227........  ...........  A.........  Treat hip               25.21           NA           NA         13.42        14.43          4.06  090
                                         fracture(s).
27228........  ...........  A.........  Treat hip               29.13           NA           NA         14.90        16.29          4.67  090
                                         fracture(s).
27230........  ...........  A.........  Treat thigh              5.69         4.92         5.23          4.85         4.99          0.95  090
                                         fracture.
27232........  ...........  A.........  Treat thigh             11.66           NA           NA          6.11         6.62          1.86  090
                                         fracture.
27235........  ...........  A.........  Treat thigh             12.88           NA           NA          7.99         8.74          2.12  090
                                         fracture.
27236........  ...........  A.........  Treat thigh             17.43           NA           NA         10.15        10.62          2.72  090
                                         fracture.
27238........  ...........  A.........  Treat thigh              5.64           NA           NA          4.64         4.90          0.89  090
                                         fracture.
27240........  ...........  A.........  Treat thigh             13.66           NA           NA          8.21         8.82          2.17  090
                                         fracture.
27244........  ...........  A.........  Treat thigh             17.08           NA           NA          9.64        10.49          2.78  090
                                         fracture.
27245........  ...........  A.........  Treat thigh             21.09           NA           NA         11.37        12.58          3.53  090
                                         fracture.
27246........  ...........  A.........  Treat thigh              4.75         3.90         4.19          3.94         4.18          0.81  090
                                         fracture.
27248........  ...........  A.........  Treat thigh             10.80           NA           NA          6.94         7.59          1.82  090
                                         fracture.
27250........  ...........  A.........  Treat hip                7.21           NA           NA          4.26         4.45          0.62  090
                                         dislocation.
27252........  ...........  A.........  Treat hip               10.92           NA           NA          6.48         6.97          1.66  090
                                         dislocation.
27253........  ...........  A.........  Treat hip               13.46           NA           NA          8.18         9.00          2.25  090
                                         dislocation.
27254........  ...........  A.........  Treat hip               18.80           NA           NA         10.56        11.30          3.18  090
                                         dislocation.
27256........  ...........  A.........  Treat hip                4.25         2.50         2.99          1.40         1.74          0.46  010
                                         dislocation.
27257........  ...........  A.........  Treat hip                5.35           NA           NA          2.48         2.66          0.69  010
                                         dislocation.
27258........  ...........  A.........  Treat hip               16.04           NA           NA          9.50        10.19          2.65  090
                                         dislocation.
27259........  ...........  A.........  Treat hip               23.03           NA           NA         12.81        13.49          3.75  090
                                         dislocation.
27265........  ...........  A.........  Treat hip                5.12           NA           NA          3.92         4.37          0.63  090
                                         dislocation.
27266........  ...........  A.........  Treat hip                7.67           NA           NA          5.50         5.93          1.29  090
                                         dislocation.
27275........  ...........  A.........  Manipulation of          2.29           NA           NA          1.85         1.98          0.39  010
                                         hip joint.
27280........  ...........  A.........  Fusion of               14.49           NA           NA          8.89         9.61          2.54  090
                                         sacroiliac joint.
27282........  ...........  A.........  Fusion of pubic         11.71           NA           NA          7.78         7.91          1.87  090
                                         bones.
27284........  ...........  A.........  Fusion of hip           24.91           NA           NA         12.00        13.53          3.93  090
                                         joint.
27286........  ...........  A.........  Fusion of hip           24.97           NA           NA         12.65        14.37          3.13  090
                                         joint.
27290........  ...........  A.........  Amputation of leg       24.38           NA           NA         12.14        13.17          3.44  090
                                         at hip.
27295........  ...........  A.........  Amputation of leg       19.54           NA           NA          9.61        10.50          2.96  090
                                         at hip.
27299........  ...........  C.........  Pelvis/hip joint         0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
27301........  ...........  A.........  Drain thigh/knee         6.67         8.15         9.12          4.64         4.89          1.04  090
                                         lesion.
27303........  ...........  A.........  Drainage of bone         8.52           NA           NA          5.99         6.50          1.43  090
                                         lesion.
27305........  ...........  A.........  Incise thigh             6.09           NA           NA          4.68         4.92          1.01  090
                                         tendon & fascia.
27306........  ...........  A.........  Incision of thigh        4.66           NA           NA          4.07         4.40          0.85  090
                                         tendon.
27307........  ...........  A.........  Incision of thigh        5.97           NA           NA          4.73         5.07          1.04  090
                                         tendons.
27310........  ...........  A.........  Exploration of           9.88           NA           NA          6.78         7.19          1.61  090
                                         knee joint.
27323........  ...........  A.........  Biopsy, thigh            2.30         4.17         3.83          1.93         1.90          0.24  010
                                         soft tissues.
27324........  ...........  A.........  Biopsy, thigh            4.95           NA           NA          3.81         4.00          0.75  090
                                         soft tissues.
27325........  ...........  A.........  Neurectomy,              7.09           NA           NA          4.97         4.96          1.09  090
                                         hamstring.
27326........  ...........  A.........  Neurectomy,              6.36           NA           NA          5.11         5.20          1.06  090
                                         popliteal.
27327........  ...........  A.........  Removal of thigh         4.52         5.98         5.99          3.55         3.64          0.64  090
                                         lesion.
27328........  ...........  A.........  Removal of thigh         5.62           NA           NA          4.05         4.21          0.84  090
                                         lesion.
27329........  ...........  A.........  Remove tumor,           15.68           NA           NA          8.47         8.76          2.15  090
                                         thigh/knee.
27330........  ...........  A.........  Biopsy, knee             5.02           NA           NA          4.25         4.39          0.86  090
                                         joint lining.
27331........  ...........  A.........  Explore/treat            5.93           NA           NA          4.79         5.16          1.02  090
                                         knee joint.
27332........  ...........  A.........  Removal of knee          8.34           NA           NA          6.12         6.63          1.43  090
                                         cartilage.
27333........  ...........  A.........  Removal of knee          7.43           NA           NA          5.68         6.19          1.26  090
                                         cartilage.
27334........  ...........  A.........  Remove knee joint        9.07           NA           NA          6.43         6.94          1.51  090
                                         lining.
27335........  ...........  A.........  Remove knee joint       10.43           NA           NA          7.02         7.63          1.75  090
                                         lining.
27340........  ...........  A.........  Removal of               4.23           NA           NA          4.02         4.29          0.72  090
                                         kneecap bursa.
27345........  ...........  A.........  Removal of knee          5.98           NA           NA          4.87         5.25          1.00  090
                                         cyst.
27347........  ...........  A.........  Remove knee cyst.        6.58           NA           NA          5.24         5.33          0.98  090
27350........  ...........  A.........  Removal of               8.54           NA           NA          6.24         6.75          1.41  090
                                         kneecap.
27355........  ...........  A.........  Remove femur             7.89           NA           NA          5.81         6.30          1.32  090
                                         lesion.
27356........  ...........  A.........  Remove femur             9.97           NA           NA          6.83         7.35          1.65  090
                                         lesion/graft.
27357........  ...........  A.........  Remove femur            11.02           NA           NA          7.48         8.11          1.96  090
                                         lesion/graft.
27358........  ...........  A.........  Remove femur             4.73           NA           NA          1.81         2.18          0.82  ZZZ
                                         lesion/fixation.
27360........  ...........  A.........  Partial removal,        11.34           NA           NA          8.04         8.81          1.84  090
                                         leg bone(s).
27365........  ...........  A.........  Extensive leg           17.93           NA           NA         10.43        11.08          2.80  090
                                         surgery.
27370........  ...........  A.........  Injection for            0.96         2.98         3.31          0.36         0.33          0.08  000
                                         knee x-ray.
27372........  ...........  A.........  Removal of               5.12         8.25         9.16          4.03         4.36          0.84  090
                                         foreign body.
27380........  ...........  A.........  Repair of kneecap        7.34           NA           NA          6.04         6.67          1.24  090
                                         tendon.
27381........  ...........  A.........  Repair/graft            10.64           NA           NA          7.56         8.33          1.80  090
                                         kneecap tendon.
27385........  ...........  A.........  Repair of thigh          8.00           NA           NA          6.30         6.98          1.36  090
                                         muscle.
27386........  ...........  A.........  Repair/graft of         10.99           NA           NA          7.92         8.73          1.86  090
                                         thigh muscle.
27390........  ...........  A.........  Incision of thigh        5.44           NA           NA          4.46         4.81          0.92  090
                                         tendon.
27391........  ...........  A.........  Incision of thigh        7.38           NA           NA          5.54         6.05          1.23  090
                                         tendons.
27392........  ...........  A.........  Incision of thigh        9.51           NA           NA          6.67         7.14          1.57  090
                                         tendons.

[[Page 38256]]

 
27393........  ...........  A.........  Lengthening of           6.50           NA           NA          4.95         5.40          1.10  090
                                         thigh tendon.
27394........  ...........  A.........  Lengthening of           8.68           NA           NA          6.14         6.69          1.47  090
                                         thigh tendons.
27395........  ...........  A.........  Lengthening of          12.10           NA           NA          7.93         8.64          2.05  090
                                         thigh tendons.
27396........  ...........  A.........  Transplant of            8.04           NA           NA          5.83         6.44          1.34  090
                                         thigh tendon.
27397........  ...........  A.........  Transplants of          12.46           NA           NA          8.35         8.71          1.83  090
                                         thigh tendons.
27400........  ...........  A.........  Revise thigh             9.21           NA           NA          6.49         6.82          1.31  090
                                         muscles/tendons.
27403........  ...........  A.........  Repair of knee           8.51           NA           NA          6.02         6.61          1.44  090
                                         cartilage.
27405........  ...........  A.........  Repair of knee           8.96           NA           NA          6.38         6.95          1.51  090
                                         ligament.
27407........  ...........  A.........  Repair of knee          10.71           NA           NA          6.84         7.56          1.79  090
                                         ligament.
27409........  ...........  A.........  Repair of knee          13.57           NA           NA          8.26         9.14          2.25  090
                                         ligaments.
27412........  ...........  A.........  Autochondrocyte         24.53           NA           NA         13.69        14.25          4.36  090
                                         implant knee.
27415........  ...........  A.........  Osteochondral           19.79           NA           NA         11.80        12.19          4.36  090
                                         knee allograft.
27418........  ...........  A.........  Repair                  11.46           NA           NA          7.57         8.25          1.89  090
                                         degenerated
                                         kneecap.
27420........  ...........  A.........  Revision of             10.14           NA           NA          6.91         7.52          1.72  090
                                         unstable kneecap.
27422........  ...........  A.........  Revision of             10.09           NA           NA          6.88         7.51          1.71  090
                                         unstable kneecap.
27424........  ...........  A.........  Revision/removal        10.12           NA           NA          6.90         7.50          1.71  090
                                         of kneecap.
27425........  ...........  A.........  Lat retinacular          5.28           NA           NA          4.69         5.11          0.90  090
                                         release open.
27427........  ...........  A.........  Reconstruction,          9.67           NA           NA          6.69         7.25          1.63  090
                                         knee.
27428........  ...........  A.........  Reconstruction,         15.33           NA           NA         10.04        10.66          2.43  090
                                         knee.
27429........  ...........  A.........  Reconstruction,         17.24           NA           NA         11.27        11.86          2.71  090
                                         knee.
27430........  ...........  A.........  Revision of thigh       10.04           NA           NA          6.84         7.43          1.70  090
                                         muscles.
27435........  ...........  A.........  Incision of knee        10.68           NA           NA          7.58         8.05          1.70  090
                                         joint.
27437........  ...........  A.........  Revise kneecap...        8.82           NA           NA          6.19         6.72          1.49  090
27438........  ...........  A.........  Revise kneecap          11.77           NA           NA          7.51         8.04          1.96  090
                                         with implant.
27440........  ...........  A.........  Revision of knee        10.97           NA           NA          7.01         6.53          1.82  090
                                         joint.
27441........  ...........  A.........  Revision of knee        11.42           NA           NA          7.35         7.06          1.89  090
                                         joint.
27442........  ...........  A.........  Revision of knee        12.25           NA           NA          7.65         8.31          2.10  090
                                         joint.
27443........  ...........  A.........  Revision of knee        11.29           NA           NA          7.35         8.05          1.91  090
                                         joint.
27445........  ...........  A.........  Revision of knee        18.52           NA           NA         10.44        11.42          3.09  090
                                         joint.
27446........  ...........  A.........  Revision of knee        16.26           NA           NA          9.30        10.31          2.81  090
                                         joint.
27447........  ...........  A.........  Total knee              23.04           NA           NA         12.61        13.63          3.80  090
                                         arthroplasty.
27448........  ...........  A.........  Incision of thigh       11.48           NA           NA          7.32         7.99          1.95  090
27450........  ...........  A.........  Incision of thigh       14.47           NA           NA          8.85         9.72          2.43  090
27454........  ...........  A.........  Realignment of          18.97           NA           NA         10.74        11.63          3.13  090
                                         thigh bone.
27455........  ...........  A.........  Realignment of          13.24           NA           NA          8.31         9.12          2.25  090
                                         knee.
27457........  ...........  A.........  Realignment of          13.92           NA           NA          8.24         9.09          2.35  090
                                         knee.
27465........  ...........  A.........  Shortening of           18.44           NA           NA         10.31        10.28          2.48  090
                                         thigh bone.
27466........  ...........  A.........  Lengthening of          17.13           NA           NA         10.08        10.97          2.78  090
                                         thigh bone.
27468........  ...........  A.........  Shorten/lengthen        19.82           NA           NA         11.20        11.80          3.31  090
                                         thighs.
27470........  ...........  A.........  Repair of thigh..       16.97           NA           NA         10.18        11.00          2.80  090
27472........  ...........  A.........  Repair/graft of         18.57           NA           NA         10.66        11.69          3.08  090
                                         thigh.
27475........  ...........  A.........  Surgery to stop          8.82           NA           NA          6.20         6.82          1.36  090
                                         leg growth.
27477........  ...........  A.........  Surgery to stop         10.03           NA           NA          6.60         7.18          1.74  090
                                         leg growth.
27479........  ...........  A.........  Surgery to stop         13.04           NA           NA          8.90         8.63          2.79  090
                                         leg growth.
27485........  ...........  A.........  Surgery to stop          9.02           NA           NA          6.19         6.81          1.53  090
                                         leg growth.
27486........  ...........  A.........  Revise/replace          20.92           NA           NA         11.66        12.60          3.37  090
                                         knee joint.
27487........  ...........  A.........  Revise/replace          26.91           NA           NA         14.02        15.32          4.40  090
                                         knee joint.
27488........  ...........  A.........  Removal of knee         17.40           NA           NA         10.27        11.00          2.75  090
                                         prosthesis.
27495........  ...........  A.........  Reinforce thigh..       16.40           NA           NA          9.61        10.53          2.72  090
27496........  ...........  A.........  Decompression of         6.66           NA           NA          4.95         5.29          0.99  090
                                         thigh/knee.
27497........  ...........  A.........  Decompression of         7.70           NA           NA          4.97         5.15          1.15  090
                                         thigh/knee.
27498........  ...........  A.........  Decompression of         8.54           NA           NA          5.21         5.61          1.24  090
                                         thigh/knee.
27499........  ...........  A.........  Decompression of         9.31           NA           NA          5.97         6.38          1.47  090
                                         thigh/knee.
27500........  ...........  A.........  Treatment of             6.21         5.34         5.75          4.57         4.80          1.02  090
                                         thigh fracture.
27501........  ...........  A.........  Treatment of             6.34         5.00         5.41          4.91         5.16          1.03  090
                                         thigh fracture.
27502........  ...........  A.........  Treatment of            11.24           NA           NA          6.86         7.50          1.79  090
                                         thigh fracture.
27503........  ...........  A.........  Treatment of            11.13           NA           NA          7.21         7.76          1.85  090
                                         thigh fracture.
27506........  ...........  A.........  Treatment of            19.42           NA           NA         11.38        12.06          3.04  090
                                         thigh fracture.
27507........  ...........  A.........  Treatment of            14.39           NA           NA          8.15         9.01          2.43  090
                                         thigh fracture.
27508........  ...........  A.........  Treatment of             6.08         5.67         6.07          5.04         5.27          0.97  090
                                         thigh fracture.
27509........  ...........  A.........  Treatment of             8.02           NA           NA          6.53         7.25          1.34  090
                                         thigh fracture.
27510........  ...........  A.........  Treatment of             9.68           NA           NA          6.27         6.82          1.53  090
                                         thigh fracture.
27511........  ...........  A.........  Treatment of            13.94           NA           NA          9.04        10.13          2.38  090
                                         thigh fracture.
27513........  ...........  A.........  Treatment of            19.45           NA           NA         11.75        12.84          3.13  090
                                         thigh fracture.
27514........  ...........  A.........  Treatment of            19.09           NA           NA         11.87        12.64          3.01  090
                                         thigh fracture.
27516........  ...........  A.........  Treat thigh fx           5.45         5.69         6.02          5.05         5.28          0.81  090
                                         growth plate.
27517........  ...........  A.........  Treat thigh fx           8.98           NA           NA          6.41         6.88          1.22  090
                                         growth plate.
27519........  ...........  A.........  Treat thigh fx          15.80           NA           NA          9.80        10.71          2.56  090
                                         growth plate.
27520........  ...........  A.........  Treat kneecap            2.93         4.07         4.31          3.51         3.48          0.47  090
                                         fracture.
27524........  ...........  A.........  Treat kneecap           10.25           NA           NA          6.94         7.59          1.75  090
                                         fracture.
27530........  ...........  A.........  Treat knee               3.97         4.80         5.06          4.24         4.33          0.65  090
                                         fracture.
27532........  ...........  A.........  Treat knee               7.43         6.38         6.88          5.62         6.05          1.26  090
                                         fracture.

[[Page 38257]]

 
27535........  ...........  A.........  Treat knee              11.80           NA           NA          8.20         9.17          2.01  090
                                         fracture.
27536........  ...........  A.........  Treat knee              17.19           NA           NA         10.21        10.93          2.74  090
                                         fracture.
27538........  ...........  A.........  Treat knee               4.95         5.49         5.82          4.87         5.04          0.84  090
                                         fracture(s).
27540........  ...........  A.........  Treat knee              13.45           NA           NA          7.97         8.76          2.28  090
                                         fracture.
27550........  ...........  A.........  Treat knee               5.84         5.20         5.63          4.50         4.73          0.76  090
                                         dislocation.
27552........  ...........  A.........  Treat knee               8.04           NA           NA          6.08         6.53          1.36  090
                                         dislocation.
27556........  ...........  A.........  Treat knee              14.95           NA           NA          9.27        10.48          2.51  090
                                         dislocation.
27557........  ...........  A.........  Treat knee              17.31           NA           NA         10.50        11.83          2.98  090
                                         dislocation.
27558........  ...........  A.........  Treat knee              18.01           NA           NA         10.37        11.76          3.09  090
                                         dislocation.
27560........  ...........  A.........  Treat kneecap            3.88         4.21         4.48          3.68         3.39          0.40  090
                                         dislocation.
27562........  ...........  A.........  Treat kneecap            5.86           NA           NA          4.59         4.66          0.94  090
                                         dislocation.
27566........  ...........  A.........  Treat kneecap           12.59           NA           NA          7.89         8.60          2.13  090
                                         dislocation.
27570........  ...........  A.........  Fixation of knee         1.76           NA           NA          1.61         1.69          0.30  010
                                         joint.
27580........  ...........  A.........  Fusion of knee...       20.90           NA           NA         12.21        13.54          3.38  090
27590........  ...........  A.........  Amputate leg at         13.35           NA           NA          6.00         6.35          1.75  090
                                         thigh.
27591........  ...........  A.........  Amputate leg at         13.82           NA           NA          7.35         8.01          2.03  090
                                         thigh.
27592........  ...........  A.........  Amputate leg at         10.86           NA           NA          5.44         5.81          1.45  090
                                         thigh.
27594........  ...........  A.........  Amputation follow-       7.17           NA           NA          4.71         4.95          1.02  090
                                         up surgery.
27596........  ...........  A.........  Amputation follow-      11.15           NA           NA          5.95         6.40          1.57  090
                                         up surgery.
27598........  ...........  A.........  Amputate lower          11.08           NA           NA          6.18         6.63          1.65  090
                                         leg at knee.
27599........  ...........  C.........  Leg surgery              0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
27600........  ...........  A.........  Decompression of         5.94           NA           NA          3.78         4.17          0.86  090
                                         lower leg.
27601........  ...........  A.........  Decompression of         5.94           NA           NA          4.13         4.51          0.80  090
                                         lower leg.
27602........  ...........  A.........  Decompression of         7.71           NA           NA          4.27         4.72          1.10  090
                                         lower leg.
27603........  ...........  A.........  Drain lower leg          5.12         6.97         7.24          3.88         4.03          0.74  090
                                         lesion.
27604........  ...........  A.........  Drain lower leg          4.51         6.40         6.25          3.39         3.68          0.69  090
                                         bursa.
27605........  ...........  A.........  Incision of              2.89         5.06         6.41          1.71         2.03          0.41  010
                                         achilles tendon.
27606........  ...........  A.........  Incision of              4.15           NA           NA          2.62         3.00          0.69  010
                                         achilles tendon.
27607........  ...........  A.........  Treat lower leg          8.51           NA           NA          5.68         5.95          1.31  090
                                         bone lesion.
27610........  ...........  A.........  Explore/treat            9.01           NA           NA          6.08         6.56          1.40  090
                                         ankle joint.
27612........  ...........  A.........  Exploration of           8.01           NA           NA          5.10         5.65          1.13  090
                                         ankle joint.
27613........  ...........  A.........  Biopsy lower leg         2.19         3.87         3.55          1.76         1.78          0.20  010
                                         soft tissue.
27614........  ...........  A.........  Biopsy lower leg         5.71         7.66         7.43          3.90         4.19          0.78  090
                                         soft tissue.
27615........  ...........  A.........  Remove tumor,           12.93           NA           NA          7.93         8.69          1.84  090
                                         lower leg.
27618........  ...........  A.........  Remove lower leg         5.14         6.37         6.19          3.77         3.88          0.72  090
                                         lesion.
27619........  ...........  A.........  Remove lower leg         8.47         9.91         9.74          5.24         5.61          1.25  090
                                         lesion.
27620........  ...........  A.........  Explore/treat            6.04           NA           NA          4.54         5.01          0.97  090
                                         ankle joint.
27625........  ...........  A.........  Remove ankle             8.37           NA           NA          5.45         5.98          1.28  090
                                         joint lining.
27626........  ...........  A.........  Remove ankle             8.98           NA           NA          5.73         6.37          1.48  090
                                         joint lining.
27630........  ...........  A.........  Removal of tendon        4.85         7.88         7.73          3.77         4.08          0.74  090
                                         lesion.
27635........  ...........  A.........  Remove lower leg         7.91           NA           NA          5.61         6.19          1.31  090
                                         bone lesion.
27637........  ...........  A.........  Remove/graft leg        10.17           NA           NA          6.96         7.67          1.66  090
                                         bone lesion.
27638........  ...........  A.........  Remove/graft leg        10.87           NA           NA          7.04         7.66          1.85  090
                                         bone lesion.
27640........  ...........  A.........  Partial removal         12.10           NA           NA          8.13         9.24          1.89  090
                                         of tibia.
27641........  ...........  A.........  Partial removal          9.73           NA           NA          6.71         7.54          1.46  090
                                         of fibula.
27645........  ...........  A.........  Extensive lower         14.78           NA           NA          9.42        10.75          2.42  090
                                         leg surgery.
27646........  ...........  A.........  Extensive lower         13.21           NA           NA          8.25         9.68          2.06  090
                                         leg surgery.
27647........  ...........  A.........  Extensive ankle/        12.85           NA           NA          6.44         7.07          1.76  090
                                         heel surgery.
27648........  ...........  A.........  Injection for            0.96         2.85         3.15          0.34         0.33          0.08  000
                                         ankle x-ray.
27650........  ...........  A.........  Repair achilles          9.94           NA           NA          6.13         6.86          1.59  090
                                         tendon.
27652........  ...........  A.........  Repair/graft            10.64           NA           NA          6.37         7.22          1.72  090
                                         achilles tendon.
27654........  ...........  A.........  Repair of               10.32           NA           NA          5.93         6.55          1.58  090
                                         achilles tendon.
27656........  ...........  A.........  Repair leg fascia        4.62         7.88         8.23          3.56         3.69          0.69  090
                                         defect.
27658........  ...........  A.........  Repair of leg            5.03           NA           NA          3.85         4.22          0.79  090
                                         tendon, each.
27659........  ...........  A.........  Repair of leg            6.99           NA           NA          4.62         5.18          1.09  090
                                         tendon, each.
27664........  ...........  A.........  Repair of leg            4.64           NA           NA          3.84         4.21          0.76  090
                                         tendon, each.
27665........  ...........  A.........  Repair of leg            5.46           NA           NA          4.28         4.66          0.89  090
                                         tendon, each.
27675........  ...........  A.........  Repair lower leg         7.24           NA           NA          4.61         5.20          1.11  090
                                         tendons.
27676........  ...........  A.........  Repair lower leg         8.61           NA           NA          5.68         6.23          1.37  090
                                         tendons.
27680........  ...........  A.........  Release of lower         5.79           NA           NA          4.12         4.66          0.93  090
                                         leg tendon.
27681........  ...........  A.........  Release of lower         6.94           NA           NA          5.07         5.44          1.15  090
                                         leg tendons.
27685........  ...........  A.........  Revision of lower        6.57         8.62         7.99          4.50         5.01          0.97  090
                                         leg tendon.
27686........  ...........  A.........  Revise lower leg         7.64           NA           NA          5.25         5.90          1.24  090
                                         tendons.
27687........  ...........  A.........  Revision of calf         6.30           NA           NA          4.42         4.89          1.00  090
                                         tendon.
27690........  ...........  A.........  Revise lower leg         8.96           NA           NA          5.30         5.87          1.33  090
                                         tendon.
27691........  ...........  A.........  Revise lower leg        10.28           NA           NA          6.63         7.22          1.64  090
                                         tendon.
27692........  ...........  A.........  Revise additional        1.87           NA           NA          0.71         0.82          0.32  ZZZ
                                         leg tendon.
27695........  ...........  A.........  Repair of ankle          6.58           NA           NA          4.83         5.38          1.05  090
                                         ligament.
27696........  ...........  A.........  Repair of ankle          8.46           NA           NA          5.19         5.86          1.28  090
                                         ligaments.
27698........  ...........  A.........  Repair of ankle          9.49           NA           NA          5.81         6.40          1.47  090
                                         ligament.
27700........  ...........  A.........  Revision of ankle        9.54           NA           NA          5.10         5.41          1.30  090
                                         joint.
27702........  ...........  A.........  Reconstruct ankle       14.28           NA           NA          8.65         9.58          2.38  090
                                         joint.

[[Page 38258]]

 
27703........  ...........  A.........  Reconstruction,         16.79           NA           NA          9.78        10.53          2.77  090
                                         ankle joint.
27704........  ...........  A.........  Removal of ankle         7.69           NA           NA          5.59         5.61          1.27  090
                                         implant.
27705........  ...........  A.........  Incision of tibia       10.74           NA           NA          6.94         7.56          1.81  090
27707........  ...........  A.........  Incision of              4.67           NA           NA          4.46         4.71          0.76  090
                                         fibula.
27709........  ...........  A.........  Incision of tibia       17.32           NA           NA          9.99         9.06          1.74  090
                                         & fibula.
27712........  ...........  A.........  Realignment of          15.67           NA           NA          9.63        10.12          2.48  090
                                         lower leg.
27715........  ...........  A.........  Revision of lower       15.36           NA           NA          9.08         9.92          2.50  090
                                         leg.
27720........  ...........  A.........  Repair of tibia..       12.22           NA           NA          7.92         8.67          2.05  090
27722........  ...........  A.........  Repair/graft of         12.31           NA           NA          7.88         8.54          2.06  090
                                         tibia.
27724........  ...........  A.........  Repair/graft of         19.18           NA           NA         10.31        11.35          3.17  090
                                         tibia.
27725........  ...........  A.........  Repair of lower         17.15           NA           NA         10.58        11.25          2.72  090
                                         leg.
27727........  ...........  A.........  Repair of lower         14.69           NA           NA          9.07         9.64          2.44  090
                                         leg.
27730........  ...........  A.........  Repair of tibia          7.59           NA           NA          5.30         5.87          1.73  090
                                         epiphysis.
27732........  ...........  A.........  Repair of fibula         5.37           NA           NA          4.12         4.62          0.77  090
                                         epiphysis.
27734........  ...........  A.........  Repair lower leg         8.72           NA           NA          6.16         6.23          1.35  090
                                         epiphyses.
27740........  ...........  A.........  Repair of leg            9.49           NA           NA          6.60         7.31          1.62  090
                                         epiphyses.
27742........  ...........  A.........  Repair of leg           10.49           NA           NA          4.58         5.29          1.80  090
                                         epiphyses.
27745........  ...........  A.........  Reinforce tibia..       10.37           NA           NA          6.99         7.59          1.76  090
27750........  ...........  A.........  Treatment of             3.26         4.30         4.53          3.72         3.79          0.55  090
                                         tibia fracture.
27752........  ...........  A.........  Treatment of             6.15         5.92         6.29          5.09         5.39          1.01  090
                                         tibia fracture.
27756........  ...........  A.........  Treatment of             7.33           NA           NA          5.75         6.11          1.17  090
                                         tibia fracture.
27758........  ...........  A.........  Treatment of            12.40           NA           NA          8.02         8.61          2.04  090
                                         tibia fracture.
27759........  ...........  A.........  Treatment of            14.31           NA           NA          8.68         9.51          2.39  090
                                         tibia fracture.
27760........  ...........  A.........  Treatment of             3.09         4.25         4.47          3.65         3.63          0.48  090
                                         ankle fracture.
27762........  ...........  A.........  Treatment of             5.33         5.44         5.91          4.63         4.97          0.85  090
                                         ankle fracture.
27766........  ...........  A.........  Treatment of             8.73           NA           NA          6.24         6.74          1.44  090
                                         ankle fracture.
27780........  ...........  A.........  Treatment of             2.72         3.84         4.02          3.29         3.26          0.41  090
                                         fibula fracture.
27781........  ...........  A.........  Treatment of             4.47         4.85         5.19          4.24         4.46          0.73  090
                                         fibula fracture.
27784........  ...........  A.........  Treatment of             7.41           NA           NA          5.56         6.03          1.23  090
                                         fibula fracture.
27786........  ...........  A.........  Treatment of             2.91         4.02         4.25          3.41         3.38          0.46  090
                                         ankle fracture.
27788........  ...........  A.........  Treatment of             4.52         4.94         5.30          4.21         4.44          0.74  090
                                         ankle fracture.
27792........  ...........  A.........  Treatment of             7.91           NA           NA          5.90         6.44          1.32  090
                                         ankle fracture.
27808........  ...........  A.........  Treatment of             2.91         4.37         4.59          3.68         3.69          0.46  090
                                         ankle fracture.
27810........  ...........  A.........  Treatment of             5.20         5.37         5.82          4.53         4.86          0.82  090
                                         ankle fracture.
27814........  ...........  A.........  Treatment of            11.10           NA           NA          7.23         7.91          1.86  090
                                         ankle fracture.
27816........  ...........  A.........  Treatment of             2.96         3.96         4.18          3.31         3.37          0.43  090
                                         ankle fracture.
27818........  ...........  A.........  Treatment of             5.57         5.38         5.89          4.42         4.81          0.82  090
                                         ankle fracture.
27822........  ...........  A.........  Treatment of            12.12           NA           NA          8.84         9.75          1.92  090
                                         ankle fracture.
27823........  ...........  A.........  Treatment of            14.26           NA           NA          9.40        10.46          2.26  090
                                         ankle fracture.
27824........  ...........  A.........  Treat lower leg          3.20         3.63         3.86          3.44         3.52          0.45  090
                                         fracture.
27825........  ...........  A.........  Treat lower leg          6.60         5.76         6.20          4.75         5.08          1.02  090
                                         fracture.
27826........  ...........  A.........  Treat lower leg          8.97           NA           NA          7.00         7.91          1.47  090
                                         fracture.
27827........  ...........  A.........  Treat lower leg         15.75           NA           NA         10.75        11.77          2.44  090
                                         fracture.
27828........  ...........  A.........  Treat lower leg         18.19           NA           NA         12.22        13.11          2.82  090
                                         fracture.
27829........  ...........  A.........  Treat lower leg          5.68           NA           NA          5.47         6.14          0.95  090
                                         joint.
27830........  ...........  A.........  Treat lower leg          3.85         4.06         4.27          3.54         3.73          0.54  090
                                         dislocation.
27831........  ...........  A.........  Treat lower leg          4.62           NA           NA          4.04         4.25          0.73  090
                                         dislocation.
27832........  ...........  A.........  Treat lower leg          6.67           NA           NA          5.11         5.58          1.03  090
                                         dislocation.
27840........  ...........  A.........  Treat ankle              4.65           NA           NA          3.62         3.69          0.46  090
                                         dislocation.
27842........  ...........  A.........  Treat ankle              6.34           NA           NA          4.84         4.99          1.00  090
                                         dislocation.
27846........  ...........  A.........  Treat ankle             10.16           NA           NA          6.75         7.36          1.71  090
                                         dislocation.
27848........  ...........  A.........  Treat ankle             11.56           NA           NA          7.70         8.71          1.95  090
                                         dislocation.
27860........  ...........  A.........  Fixation of ankle        2.36           NA           NA          1.68         1.83          0.39  010
                                         joint.
27870........  ...........  A.........  Fusion of ankle         15.21           NA           NA          9.06         9.82          2.37  090
                                         joint, open.
27871........  ...........  A.........  Fusion of                9.42           NA           NA          6.52         7.05          1.59  090
                                         tibiofibular
                                         joint.
27880........  ...........  A.........  Amputation of           15.24           NA           NA          6.63         6.90          1.76  090
                                         lower leg.
27881........  ...........  A.........  Amputation of           13.32           NA           NA          7.36         8.12          1.99  090
                                         lower leg.
27882........  ...........  A.........  Amputation of            9.67           NA           NA          5.47         5.98          1.29  090
                                         lower leg.
27884........  ...........  A.........  Amputation follow-       8.64           NA           NA          5.08         5.42          1.22  090
                                         up surgery.
27886........  ...........  A.........  Amputation follow-       9.88           NA           NA          5.63         6.09          1.40  090
                                         up surgery.
27888........  ...........  A.........  Amputation of           10.23           NA           NA          5.96         6.78          1.51  090
                                         foot at ankle.
27889........  ...........  A.........  Amputation of           10.72           NA           NA          5.41         5.93          1.46  090
                                         foot at ankle.
27892........  ...........  A.........  Decompression of         7.82           NA           NA          5.10         5.31          1.10  090
                                         leg.
27893........  ...........  A.........  Decompression of         7.78           NA           NA          5.10         5.29          1.10  090
                                         leg.
27894........  ...........  A.........  Decompression of        12.42           NA           NA          7.33         7.56          1.65  090
                                         leg.
27899........  ...........  C.........  Leg/ankle surgery        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
28001........  ...........  A.........  Drainage of bursa        2.75         3.89         3.46          1.56         1.77          0.33  010
                                         of foot.
28002........  ...........  A.........  Treatment of foot        5.78         6.52         5.80          3.49         3.66          0.61  010
                                         infection.
28003........  ...........  A.........  Treatment of foot        8.95         7.62         6.97          4.47         4.88          1.12  090
                                         infection.
28005........  ...........  A.........  Treat foot bone          9.30           NA           NA          5.27         5.70          1.16  090
                                         lesion.
28008........  ...........  A.........  Incision of foot         4.50         6.03         5.32          2.93         3.09          0.57  090
                                         fascia.
28010........  ...........  A.........  Incision of toe          2.89         2.79         2.60          2.29         2.34          0.36  090
                                         tendon.

[[Page 38259]]

 
28011........  ...........  A.........  Incision of toe          4.19         3.71         3.53          2.96         3.15          0.59  090
                                         tendons.
28020........  ...........  A.........  Exploration of           5.06         7.22         6.67          3.52         3.86          0.72  090
                                         foot joint.
28022........  ...........  A.........  Exploration of           4.72         6.77         6.01          3.25         3.57          0.62  090
                                         foot joint.
28024........  ...........  A.........  Exploration of           4.43         6.40         5.86          3.05         3.52          0.58  090
                                         toe joint.
28035........  ...........  A.........  Decompression of         5.14         7.13         6.56          3.48         3.83          0.70  090
                                         tibia nerve.
28043........  ...........  A.........  Excision of foot         3.58         4.67         4.27          2.67         2.94          0.46  090
                                         lesion.
28045........  ...........  A.........  Excision of foot         4.77         6.86         6.16          3.17         3.41          0.63  090
                                         lesion.
28046........  ...........  A.........  Resection of            10.55        10.19         9.53          5.67         6.11          1.36  090
                                         tumor, foot.
28050........  ...........  A.........  Biopsy of foot           4.30         6.81         5.87          3.23         3.42          0.60  090
                                         joint lining.
28052........  ...........  A.........  Biopsy of foot           3.98         6.16         5.59          2.81         3.15          0.53  090
                                         joint lining.
28054........  ...........  A.........  Biopsy of toe            3.49         6.10         5.43          2.73         3.00          0.46  090
                                         joint lining.
28055........  ...........  A.........  Neurectomy, foot.        6.20           NA           NA          3.34         3.55          0.74  090
28060........  ...........  A.........  Partial removal,         5.29         6.90         6.23          3.45         3.69          0.70  090
                                         foot fascia.
28062........  ...........  A.........  Removal of foot          6.58         7.61         7.12          3.71         3.90          0.83  090
                                         fascia.
28070........  ...........  A.........  Removal of foot          5.15         7.21         6.22          3.47         3.65          0.73  090
                                         joint lining.
28072........  ...........  A.........  Removal of foot          4.63         7.46         6.52          3.56         3.95          0.68  090
                                         joint lining.
28080........  ...........  A.........  Removal of foot          4.65         7.49         6.34          4.09         3.92          0.47  090
                                         lesion.
28086........  ...........  A.........  Excise foot              4.83         7.75         7.88          3.77         4.24          0.76  090
                                         tendon sheath.
28088........  ...........  A.........  Excise foot              3.90         6.89         6.34          3.15         3.53          0.61  090
                                         tendon sheath.
28090........  ...........  A.........  Removal of foot          4.46         6.61         5.92          3.10         3.30          0.59  090
                                         lesion.
28092........  ...........  A.........  Removal of toe           3.69         6.32         5.81          2.92         3.24          0.49  090
                                         lesions.
28100........  ...........  A.........  Removal of ankle/        5.72         7.96         8.01          3.94         4.35          0.82  090
                                         heel lesion.
28102........  ...........  A.........  Remove/graft foot        7.80           NA           NA          4.76         5.39          1.14  090
                                         lesion.
28103........  ...........  A.........  Remove/graft foot        6.56           NA           NA          3.94         4.32          0.91  090
                                         lesion.
28104........  ...........  A.........  Removal of foot          5.17         7.08         6.32          3.40         3.68          0.70  090
                                         lesion.
28106........  ...........  A.........  Remove/graft foot        7.23           NA           NA          4.12         4.34          0.97  090
                                         lesion.
28107........  ...........  A.........  Remove/graft foot        5.62         7.52         7.09          3.57         3.92          0.74  090
                                         lesion.
28108........  ...........  A.........  Removal of toe           4.21         6.18         5.43          2.91         3.10          0.53  090
                                         lesions.
28110........  ...........  A.........  Part removal of          4.13         6.77         6.03          2.99         3.13          0.54  090
                                         metatarsal.
28111........  ...........  A.........  Part removal of          5.06         6.95         6.68          3.13         3.43          0.67  090
                                         metatarsal.
28112........  ...........  A.........  Part removal of          4.54         7.03         6.46          3.17         3.40          0.61  090
                                         metatarsal.
28113........  ...........  A.........  Part removal of          5.88         8.16         7.16          4.49         4.44          0.63  090
                                         metatarsal.
28114........  ...........  A.........  Removal of              11.61        13.18        12.44          8.18         8.31          1.42  090
                                         metatarsal heads.
28116........  ...........  A.........  Revision of foot.        8.94         9.24         8.07          5.23         5.24          1.03  090
28118........  ...........  A.........  Removal of heel          6.02         7.77         7.04          3.95         4.17          0.84  090
                                         bone.
28119........  ...........  A.........  Removal of heel          5.45         7.03         6.27          3.48         3.63          0.70  090
                                         spur.
28120........  ...........  A.........  Part removal of          5.64         7.94         7.65          3.90         4.17          0.77  090
                                         ankle/heel.
28122........  ...........  A.........  Partial removal          7.56         8.27         7.60          4.67         5.00          0.98  090
                                         of foot bone.
28124........  ...........  A.........  Partial removal          4.88         6.59         5.84          3.36         3.53          0.60  090
                                         of toe.
28126........  ...........  A.........  Partial removal          3.56         5.81         5.04          2.59         2.81          0.45  090
                                         of toe.
28130........  ...........  A.........  Removal of ankle         9.30           NA           NA          6.06         6.37          1.26  090
                                         bone.
28140........  ...........  A.........  Removal of               7.03         7.66         7.48          4.04         4.43          0.92  090
                                         metatarsal.
28150........  ...........  A.........  Removal of toe...        4.14         6.20         5.56          2.90         3.12          0.53  090
28153........  ...........  A.........  Partial removal          3.71         6.05         5.21          2.81         2.76          0.47  090
                                         of toe.
28160........  ...........  A.........  Partial removal          3.79         6.15         5.40          2.85         3.12          0.49  090
                                         of toe.
28171........  ...........  A.........  Extensive foot           9.85           NA           NA          4.98         5.27          1.33  090
                                         surgery.
28173........  ...........  A.........  Extensive foot           9.05         8.55         8.13          4.51         4.89          1.12  090
                                         surgery.
28175........  ...........  A.........  Extensive foot           6.17         6.95         6.37          3.52         3.64          0.73  090
                                         surgery.
28190........  ...........  A.........  Removal of foot          1.98         3.92         3.67          1.31         1.40          0.22  010
                                         foreign body.
28192........  ...........  A.........  Removal of foot          4.69         6.56         6.05          3.11         3.40          0.61  090
                                         foreign body.
28193........  ...........  A.........  Removal of foot          5.79         7.17         6.42          3.55         3.76          0.73  090
                                         foreign body.
28200........  ...........  A.........  Repair of foot           4.65         6.72         5.95          3.16         3.38          0.61  090
                                         tendon.
28202........  ...........  A.........  Repair/graft of          6.96         7.53         7.46          3.81         4.20          0.91  090
                                         foot tendon.
28208........  ...........  A.........  Repair of foot           4.42         6.54         5.71          3.11         3.22          0.58  090
                                         tendon.
28210........  ...........  A.........  Repair/graft of          6.41         7.42         6.85          3.82         3.95          0.81  090
                                         foot tendon.
28220........  ...........  A.........  Release of foot          4.58         6.24         5.49          2.99         3.23          0.57  090
                                         tendon.
28222........  ...........  A.........  Release of foot          5.67         6.74         6.03          3.25         3.71          0.69  090
                                         tendons.
28225........  ...........  A.........  Release of foot          3.70         5.86         5.11          2.64         2.79          0.46  090
                                         tendon.
28226........  ...........  A.........  Release of foot          4.58         6.74         5.81          3.19         3.50          0.58  090
                                         tendons.
28230........  ...........  A.........  Incision of foot         4.28         6.10         5.43          2.80         3.26          0.55  090
                                         tendon(s).
28232........  ...........  A.........  Incision of toe          3.43         5.77         5.18          2.60         2.97          0.44  090
                                         tendon.
28234........  ...........  A.........  Incision of foot         3.43         6.14         5.44          2.98         3.19          0.44  090
                                         tendon.
28238........  ...........  A.........  Revision of foot         7.85         8.21         7.76          4.28         4.63          1.06  090
                                         tendon.
28240........  ...........  A.........  Release of big           4.40         6.19         5.46          2.87         3.20          0.58  090
                                         toe.
28250........  ...........  A.........  Revision of foot         5.97         7.40         6.53          3.75         3.95          0.82  090
                                         fascia.
28260........  ...........  A.........  Release of               8.08         8.28         7.37          4.53         4.80          1.14  090
                                         midfoot joint.
28261........  ...........  A.........  Revision of foot        12.91        10.42         9.59          6.18         6.79          1.57  090
                                         tendon.
28262........  ...........  A.........  Revision of foot        17.01        15.42        14.52          9.71        10.34          2.60  090
                                         and ankle.
28264........  ...........  A.........  Release of              10.53        10.12         8.99          5.85         6.61          1.54  090
                                         midfoot joint.
28270........  ...........  A.........  Release of foot          4.82         6.75         5.86          3.36         3.57          0.62  090
                                         contracture.
28272........  ...........  A.........  Release of toe           3.84         5.67         4.96          2.57         2.73          0.46  090
                                         joint, each.
28280........  ...........  A.........  Fusion of toes...        5.24         7.14         6.73          3.47         4.00          0.73  090

[[Page 38260]]

 
28285........  ...........  A.........  Repair of                4.65         6.54         5.74          3.26         3.37          0.59  090
                                         hammertoe.
28286........  ...........  A.........  Repair of                4.61         6.35         5.60          2.97         3.13          0.57  090
                                         hammertoe.
28288........  ...........  A.........  Partial removal          5.81         8.42         7.22          4.60         4.77          0.65  090
                                         of foot bone.
28289........  ...........  A.........  Repair hallux            8.11         9.25         8.66          5.24         5.53          1.02  090
                                         rigidus.
28290........  ...........  A.........  Correction of            5.72         8.02         7.17          3.89         4.33          0.82  090
                                         bunion.
28292........  ...........  A.........  Correction of            8.72        10.08         8.83          6.00         5.81          0.91  090
                                         bunion.
28293........  ...........  A.........  Correction of           11.10        14.07        12.50          6.72         6.47          1.13  090
                                         bunion.
28294........  ...........  A.........  Correction of            8.63         9.21         8.32          4.64         4.68          1.09  090
                                         bunion.
28296........  ...........  A.........  Correction of            9.31         9.33         8.80          4.67         5.08          1.19  090
                                         bunion.
28297........  ...........  A.........  Correction of            9.31        10.29         9.66          5.25         5.78          1.32  090
                                         bunion.
28298........  ...........  A.........  Correction of            8.01         9.07         8.18          4.48         4.77          1.05  090
                                         bunion.
28299........  ...........  A.........  Correction of           11.39        10.29         9.59          5.58         5.87          1.37  090
                                         bunion.
28300........  ...........  A.........  Incision of heel         9.61           NA           NA          5.99         6.54          1.54  090
                                         bone.
28302........  ...........  A.........  Incision of ankle        9.62           NA           NA          6.18         6.47          1.42  090
                                         bone.
28304........  ...........  A.........  Incision of              9.29         9.38         8.70          4.99         5.39          1.27  090
                                         midfoot bones.
28305........  ...........  A.........  Incise/graft            10.63           NA           NA          5.68         6.21          1.27  090
                                         midfoot bones.
28306........  ...........  A.........  Incision of              5.91         8.26         7.57          3.82         4.01          0.84  090
                                         metatarsal.
28307........  ...........  A.........  Incision of              6.39         9.12        10.14          4.27         4.82          0.90  090
                                         metatarsal.
28308........  ...........  A.........  Incision of              5.36         7.73         6.78          3.74         3.73          0.70  090
                                         metatarsal.
28309........  ...........  A.........  Incision of             13.96           NA           NA          7.62         7.83          2.05  090
                                         metatarsals.
28310........  ...........  A.........  Revision of big          5.48         7.35         6.58          3.33         3.46          0.70  090
                                         toe.
28312........  ...........  A.........  Revision of toe..        4.60         7.19         6.35          3.16         3.41          0.63  090
28313........  ...........  A.........  Repair deformity         5.06         7.13         6.24          3.54         4.21          0.73  090
                                         of toe.
28315........  ...........  A.........  Removal of               4.91         6.51         5.74          3.14         3.26          0.63  090
                                         sesamoid bone.
28320........  ...........  A.........  Repair of foot           9.25           NA           NA          5.63         6.20          1.43  090
                                         bones.
28322........  ...........  A.........  Repair of                8.41         9.61         9.46          5.26         5.84          1.27  090
                                         metatarsals.
28340........  ...........  A.........  Resect enlarged          7.04         7.90         7.21          3.98         4.14          0.84  090
                                         toe tissue.
28341........  ...........  A.........  Resect enlarged          8.60         8.36         7.71          4.29         4.60          1.01  090
                                         toe.
28344........  ...........  A.........  Repair extra             4.31         6.28         6.10          2.87         3.30          0.51  090
                                         toe(s).
28345........  ...........  A.........  Repair webbed            5.98         7.45         6.88          3.70         4.23          0.80  090
                                         toe(s).
28360........  ...........  A.........  Reconstruct cleft       14.67           NA           NA          6.31         8.40          2.29  090
                                         foot.
28400........  ...........  A.........  Treatment of heel        2.22         3.33         3.49          2.89         2.98          0.35  090
                                         fracture.
28405........  ...........  A.........  Treatment of heel        4.63         4.36         4.63          3.62         4.15          0.73  090
                                         fracture.
28406........  ...........  A.........  Treatment of heel        6.44           NA           NA          5.52         6.19          1.11  090
                                         fracture.
28415........  ...........  A.........  Treat heel              17.54           NA           NA         10.92        12.11          2.67  090
                                         fracture.
28420........  ...........  A.........  Treat/graft heel        17.07           NA           NA          9.59        11.36          2.81  090
                                         fracture.
28430........  ...........  A.........  Treatment of             2.14         3.09         3.25          2.55         2.56          0.31  090
                                         ankle fracture.
28435........  ...........  A.........  Treatment of             3.45         3.94         3.89          3.22         3.46          0.55  090
                                         ankle fracture.
28436........  ...........  A.........  Treatment of             4.78           NA           NA          4.65         5.34          0.81  090
                                         ankle fracture.
28445........  ...........  A.........  Treat ankle             17.07           NA           NA          9.72        10.39          2.59  090
                                         fracture.
28450........  ...........  A.........  Treat midfoot            1.95         2.87         3.00          2.38         2.43          0.28  090
                                         fracture, each.
28455........  ...........  A.........  Treat midfoot            3.15         3.69         3.56          3.06         3.24          0.44  090
                                         fracture, each.
28456........  ...........  A.........  Treat midfoot            2.75           NA           NA          3.51         3.85          0.44  090
                                         fracture.
28465........  ...........  A.........  Treat midfoot            7.13           NA           NA          5.04         5.69          1.10  090
                                         fracture, each.
28470........  ...........  A.........  Treat metatarsal         1.99         2.77         2.96          2.34         2.40          0.30  090
                                         fracture.
28475........  ...........  A.........  Treat metatarsal         2.97         3.08         3.22          2.47         2.86          0.44  090
                                         fracture.
28476........  ...........  A.........  Treat metatarsal         3.46           NA           NA          4.27         4.64          0.54  090
                                         fracture.
28485........  ...........  A.........  Treat metatarsal         5.77           NA           NA          4.48         4.98          0.83  090
                                         fracture.
28490........  ...........  A.........  Treat big toe            1.12         2.05         2.04          1.64         1.65          0.14  090
                                         fracture.
28495........  ...........  A.........  Treat big toe            1.62         2.41         2.30          1.82         1.95          0.20  090
                                         fracture.
28496........  ...........  A.........  Treat big toe            2.39         7.31         7.76          2.95         3.06          0.36  090
                                         fracture.
28505........  ...........  A.........  Treat big toe            3.86         7.23         7.71          3.15         3.55          0.56  090
                                         fracture.
28510........  ...........  A.........  Treatment of toe         1.12         1.65         1.60          1.58         1.56          0.14  090
                                         fracture.
28515........  ...........  A.........  Treatment of toe         1.50         2.17         2.04          1.78         1.85          0.18  090
                                         fracture.
28525........  ...........  A.........  Treat toe                3.37         6.82         7.18          2.89         3.17          0.49  090
                                         fracture.
28530........  ...........  A.........  Treat sesamoid           1.08         1.58         1.52          1.31         1.38          0.14  090
                                         bone fracture.
28531........  ...........  A.........  Treat sesamoid           2.51         6.42         6.75          2.38         2.18          0.34  090
                                         bone fracture.
28540........  ...........  A.........  Treat foot               2.10         2.68         2.56          2.25         2.34          0.26  090
                                         dislocation.
28545........  ...........  A.........  Treat foot               2.51         3.42         2.87          2.80         2.56          0.37  090
                                         dislocation.
28546........  ...........  A.........  Treat foot               3.28         7.91         7.37          3.58         3.97          0.52  090
                                         dislocation.
28555........  ...........  A.........  Repair foot              6.42         9.38         9.71          4.75         5.25          1.04  090
                                         dislocation.
28570........  ...........  A.........  Treat foot               1.70         2.43         2.46          1.87         2.12          0.23  090
                                         dislocation.
28575........  ...........  A.........  Treat foot               3.38         4.37         4.05          3.68         3.70          0.56  090
                                         dislocation.
28576........  ...........  A.........  Treat foot               4.48           NA           NA          4.01         4.10          0.69  090
                                         dislocation.
28585........  ...........  A.........  Repair foot              8.17         9.70         8.55          5.10         5.51          1.25  090
                                         dislocation.
28600........  ...........  A.........  Treat foot               1.94         2.98         2.91          2.34         2.52          0.27  090
                                         dislocation.
28605........  ...........  A.........  Treat foot               2.78         3.90         3.49          3.29         3.18          0.40  090
                                         dislocation.
28606........  ...........  A.........  Treat foot               4.97           NA           NA          4.10         4.43          0.82  090
                                         dislocation.
28615........  ...........  A.........  Repair foot              8.96           NA           NA          6.87         7.48          1.30  090
                                         dislocation.
28630........  ...........  A.........  Treat toe                1.72         1.81         1.72          0.90         0.96          0.20  010
                                         dislocation.
28635........  ...........  A.........  Treat toe                1.93         2.21         2.13          1.30         1.42          0.26  010
                                         dislocation.
28636........  ...........  A.........  Treat toe                2.77         4.33         4.10          2.03         2.33          0.43  010
                                         dislocation.

[[Page 38261]]

 
28645........  ...........  A.........  Repair toe               4.27         6.72         5.87          3.13         3.22          0.57  090
                                         dislocation.
28660........  ...........  A.........  Treat toe                1.25         1.28         1.27          0.77         0.78          0.13  010
                                         dislocation.
28665........  ...........  A.........  Treat toe                1.94         1.79         1.62          1.30         1.37          0.26  010
                                         dislocation.
28666........  ...........  A.........  Treat toe                2.66           NA           NA          1.80         2.21          0.43  010
                                         dislocation.
28675........  ...........  A.........  Repair of toe            2.97         6.61         6.89          2.84         3.10          0.45  090
                                         dislocation.
28705........  ...........  A.........  Fusion of foot          20.12           NA           NA         10.61        11.56          3.09  090
                                         bones.
28715........  ...........  A.........  Fusion of foot          14.40           NA           NA          8.45         9.12          2.17  090
                                         bones.
28725........  ...........  A.........  Fusion of foot          11.97           NA           NA          6.77         7.54          1.87  090
                                         bones.
28730........  ...........  A.........  Fusion of foot          12.21           NA           NA          7.68         8.11          1.71  090
                                         bones.
28735........  ...........  A.........  Fusion of foot          12.03           NA           NA          6.90         7.39          1.69  090
                                         bones.
28737........  ...........  A.........  Revision of foot        10.83           NA           NA          5.99         6.43          1.47  090
                                         bones.
28740........  ...........  A.........  Fusion of foot           9.09        10.71        10.83          5.91         6.22          1.22  090
                                         bones.
28750........  ...........  A.........  Fusion of big toe        8.37        10.62        11.31          5.82         6.27          1.13  090
                                         joint.
28755........  ...........  A.........  Fusion of big toe        4.79         7.10         6.63          3.28         3.53          0.65  090
                                         joint.
28760........  ...........  A.........  Fusion of big toe        8.94         9.63         8.87          5.14         5.37          1.05  090
                                         joint.
28800........  ...........  A.........  Amputation of            8.65           NA           NA          4.93         5.39          1.15  090
                                         midfoot.
28805........  ...........  A.........  Amputation thru         12.55           NA           NA          5.83         5.77          1.18  090
                                         metatarsal.
28810........  ...........  A.........  Amputation toe &         6.52           NA           NA          4.01         4.26          0.86  090
                                         metatarsal.
28820........  ...........  A.........  Amputation of toe        4.89         7.51         7.57          3.49         3.66          0.61  090
28825........  ...........  A.........  Partial                  3.71         7.00         7.03          3.07         3.29          0.50  090
                                         amputation of
                                         toe.
28890........  ...........  A.........  High energy eswt,        3.36         4.43         5.13          2.13         2.14          0.41  090
                                         plantar f.
28899........  ...........  C.........  Foot/toes surgery        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
29000........  ...........  A.........  Application of           2.25         3.94         3.58          1.63         1.72          0.41  000
                                         body cast.
29010........  ...........  A.........  Application of           2.06         4.35         3.65          1.62         1.65          0.45  000
                                         body cast.
29015........  ...........  A.........  Application of           2.41         3.58         3.24          1.56         1.57          0.28  000
                                         body cast.
29020........  ...........  A.........  Application of           2.11         3.79         3.49          1.41         1.43          0.28  000
                                         body cast.
29025........  ...........  A.........  Application of           2.40         4.02         3.51          1.77         1.78          0.44  000
                                         body cast.
29035........  ...........  A.........  Application of           1.77         3.67         3.64          1.47         1.52          0.28  000
                                         body cast.
29040........  ...........  A.........  Application of           2.22         3.25         2.92          1.34         1.45          0.36  000
                                         body cast.
29044........  ...........  A.........  Application of           2.12         3.83         3.92          1.65         1.84          0.35  000
                                         body cast.
29046........  ...........  A.........  Application of           2.41         4.46         3.80          1.91         1.98          0.42  000
                                         body cast.
29049........  ...........  A.........  Application of           0.89         1.11         1.21          0.59         0.56          0.13  000
                                         figure eight.
29055........  ...........  A.........  Application of           1.78         2.79         2.90          1.22         1.36          0.30  000
                                         shoulder cast.
29058........  ...........  A.........  Application of           1.31         1.25         1.40          0.67         0.70          0.17  000
                                         shoulder cast.
29065........  ...........  A.........  Application of           0.87         1.27         1.30          0.70         0.73          0.15  000
                                         long arm cast.
29075........  ...........  A.........  Application of           0.77         1.23         1.24          0.66         0.67          0.13  000
                                         forearm cast.
29085........  ...........  A.........  Apply hand/wrist         0.87         1.25         1.27          0.68         0.66          0.14  000
                                         cast.
29086........  ...........  A.........  Apply finger cast        0.62         1.07         1.01          0.55         0.52          0.07  000
29105........  ...........  A.........  Apply long arm           0.87         1.08         1.16          0.53         0.52          0.12  000
                                         splint.
29125........  ...........  A.........  Apply forearm            0.59         0.96         0.99          0.42         0.41          0.07  000
                                         splint.
29126........  ...........  A.........  Apply forearm            0.77         1.01         1.11          0.48         0.47          0.07  000
                                         splint.
29130........  ...........  A.........  Application of           0.50         0.43         0.45          0.18         0.18          0.06  000
                                         finger splint.
29131........  ...........  A.........  Application of           0.55         0.59         0.67          0.24         0.25          0.03  000
                                         finger splint.
29200........  ...........  A.........  Strapping of             0.65         0.60         0.66          0.34         0.34          0.04  000
                                         chest.
29220........  ...........  A.........  Strapping of low         0.64         0.64         0.67          0.38         0.38          0.04  000
                                         back.
29240........  ...........  A.........  Strapping of             0.71         0.68         0.77          0.40         0.38          0.06  000
                                         shoulder.
29260........  ...........  A.........  Strapping of             0.55         0.67         0.70          0.37         0.34          0.05  000
                                         elbow or wrist.
29280........  ...........  A.........  Strapping of hand        0.51         0.66         0.73          0.37         0.34          0.03  000
                                         or finger.
29305........  ...........  A.........  Application of           2.03         3.26         3.32          1.55         1.66          0.35  000
                                         hip cast.
29325........  ...........  A.........  Application of           2.32         3.32         3.49          1.59         1.80          0.40  000
                                         hip casts.
29345........  ...........  A.........  Application of           1.40         1.65         1.71          0.94         1.00          0.24  000
                                         long leg cast.
29355........  ...........  A.........  Application of           1.53         1.61         1.66          0.93         1.03          0.26  000
                                         long leg cast.
29358........  ...........  A.........  Apply long leg           1.43         1.99         2.04          0.91         1.00          0.25  000
                                         cast brace.
29365........  ...........  A.........  Application of           1.18         1.57         1.62          0.85         0.90          0.20  000
                                         long leg cast.
29405........  ...........  A.........  Apply short leg          0.86         1.18         1.21          0.65         0.68          0.14  000
                                         cast.
29425........  ...........  A.........  Apply short leg          1.01         1.20         1.22          0.65         0.70          0.15  000
                                         cast.
29435........  ...........  A.........  Apply short leg          1.18         1.52         1.54          0.81         0.87          0.20  000
                                         cast.
29440........  ...........  A.........  Addition of              0.57         0.63         0.66          0.26         0.27          0.08  000
                                         walker to cast.
29445........  ...........  A.........  Apply rigid leg          1.78         1.54         1.69          0.88         0.93          0.27  000
                                         cast.
29450........  ...........  A.........  Application of           2.08         1.56         1.51          0.88         0.99          0.27  000
                                         leg cast.
29505........  ...........  A.........  Application, long        0.69         1.06         1.12          0.45         0.45          0.08  000
                                         leg splint.
29515........  ...........  A.........  Application lower        0.73         0.94         0.91          0.45         0.46          0.09  000
                                         leg splint.
29520........  ...........  A.........  Strapping of hip.        0.54         0.65         0.76          0.37         0.42          0.03  000
29530........  ...........  A.........  Strapping of knee        0.57         0.65         0.72          0.36         0.35          0.05  000
29540........  ...........  A.........  Strapping of             0.51         0.53         0.48          0.30         0.31          0.06  000
                                         ankle and/or ft.
29550........  ...........  A.........  Strapping of toes        0.47         0.54         0.49          0.29         0.29          0.06  000
29580........  ...........  A.........  Application of           0.55         0.70         0.68          0.33         0.34          0.07  000
                                         paste boot.
29590........  ...........  A.........  Application of           0.76         0.58         0.55          0.25         0.28          0.09  000
                                         foot splint.
29700........  ...........  A.........  Removal/revision         0.57         0.94         0.92          0.25         0.27          0.08  000
                                         of cast.
29705........  ...........  A.........  Removal/revision         0.76         0.76         0.79          0.36         0.37          0.13  000
                                         of cast.
29710........  ...........  A.........  Removal/revision         1.34         1.30         1.44          0.55         0.64          0.20  000
                                         of cast.
29715........  ...........  A.........  Removal/revision         0.94         1.21         1.18          0.44         0.41          0.09  000
                                         of cast.

[[Page 38262]]

 
29720........  ...........  A.........  Repair of body           0.68         1.16         1.16          0.35         0.37          0.12  000
                                         cast.
29730........  ...........  A.........  Windowing of cast        0.75         0.73         0.78          0.33         0.34          0.12  000
29740........  ...........  A.........  Wedging of cast..        1.12         1.03         1.10          0.47         0.48          0.18  000
29750........  ...........  A.........  Wedging of               1.26         1.05         1.04          0.52         0.54          0.21  000
                                         clubfoot cast.
29799........  ...........  C.........  Casting/strapping        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
29800........  ...........  A.........  Jaw arthroscopy/         6.73           NA           NA          4.64         5.86          0.99  090
                                         surgery.
29804........  ...........  A.........  Jaw arthroscopy/         8.71           NA           NA          5.77         6.68          1.38  090
                                         surgery.
29805........  ...........  A.........  Shoulder                 5.94           NA           NA          4.70         5.19          1.02  090
                                         arthroscopy, dx.
29806........  ...........  A.........  Shoulder                14.95           NA           NA          9.37        10.28          2.50  090
                                         arthroscopy/
                                         surgery.
29807........  ...........  A.........  Shoulder                14.48           NA           NA          9.21        10.12          2.42  090
                                         arthroscopy/
                                         surgery.
29819........  ...........  A.........  Shoulder                 7.68           NA           NA          5.62         6.21          1.32  090
                                         arthroscopy/
                                         surgery.
29820........  ...........  A.........  Shoulder                 7.12           NA           NA          5.18         5.71          1.22  090
                                         arthroscopy/
                                         surgery.
29821........  ...........  A.........  Shoulder                 7.78           NA           NA          5.65         6.24          1.33  090
                                         arthroscopy/
                                         surgery.
29822........  ...........  A.........  Shoulder                 7.49           NA           NA          5.57         6.14          1.28  090
                                         arthroscopy/
                                         surgery.
29823........  ...........  A.........  Shoulder                 8.24           NA           NA          6.04         6.64          1.41  090
                                         arthroscopy/
                                         surgery.
29824........  ...........  A.........  Shoulder                 8.82           NA           NA          6.53         7.04          1.42  090
                                         arthroscopy/
                                         surgery.
29825........  ...........  A.........  Shoulder                 7.68           NA           NA          5.63         6.20          1.32  090
                                         arthroscopy/
                                         surgery.
29826........  ...........  A.........  Shoulder                 9.05           NA           NA          6.18         6.87          1.55  090
                                         arthroscopy/
                                         surgery.
29827........  ...........  A.........  Arthroscop              15.44           NA           NA          9.33        10.45          2.67  090
                                         rotator cuff
                                         repr.
29830........  ...........  A.........  Elbow arthroscopy        5.80           NA           NA          4.48         4.92          0.99  090
29834........  ...........  A.........  Elbow arthroscopy/       6.33           NA           NA          4.85         5.35          1.08  090
                                         surgery.
29835........  ...........  A.........  Elbow arthroscopy/       6.53           NA           NA          4.96         5.43          1.13  090
                                         surgery.
29836........  ...........  A.........  Elbow arthroscopy/       7.61           NA           NA          5.58         6.19          1.22  090
                                         surgery.
29837........  ...........  A.........  Elbow arthroscopy/       6.92           NA           NA          5.06         5.61          1.19  090
                                         surgery.
29838........  ...........  A.........  Elbow arthroscopy/       7.77           NA           NA          5.65         6.28          1.30  090
                                         surgery.
29840........  ...........  A.........  Wrist arthroscopy        5.59           NA           NA          4.60         4.97          0.84  090
29843........  ...........  A.........  Wrist arthroscopy/       6.06           NA           NA          4.78         5.23          0.92  090
                                         surgery.
29844........  ...........  A.........  Wrist arthroscopy/       6.42           NA           NA          4.86         5.36          1.04  090
                                         surgery.
29845........  ...........  A.........  Wrist arthroscopy/       7.58           NA           NA          5.58         6.02          0.99  090
                                         surgery.
29846........  ...........  A.........  Wrist arthroscopy/       6.80           NA           NA          5.09         5.58          1.07  090
                                         surgery.
29847........  ...........  A.........  Wrist arthroscopy/       7.13           NA           NA          5.24         5.71          1.08  090
                                         surgery.
29848........  ...........  A.........  Wrist endoscopy/         6.24           NA           NA          5.25         5.44          0.86  090
                                         surgery.
29850........  ...........  A.........  Knee arthroscopy/        8.18           NA           NA          4.71         4.97          1.25  090
                                         surgery.
29851........  ...........  A.........  Knee arthroscopy/       13.08           NA           NA          8.23         9.02          2.35  090
                                         surgery.
29855........  ...........  A.........  Tibial                  10.60           NA           NA          7.28         8.04          1.85  090
                                         arthroscopy/
                                         surgery.
29856........  ...........  A.........  Tibial                  14.12           NA           NA          8.71         9.70          2.40  090
                                         arthroscopy/
                                         surgery.
29860........  ...........  A.........  Hip arthroscopy,         8.85           NA           NA          6.25         6.60          1.36  090
                                         dx.
29861........  ...........  A.........  Hip arthroscopy/         9.95           NA           NA          6.39         6.91          1.59  090
                                         surgery.
29862........  ...........  A.........  Hip arthroscopy/        10.97           NA           NA          7.58         8.08          1.62  090
                                         surgery.
29863........  ...........  A.........  Hip arthroscopy/        10.97           NA           NA          7.51         8.02          1.42  090
                                         surgery.
29866........  ...........  A.........  Autgrft implnt,         14.48           NA           NA          9.48        10.43          2.40  090
                                         knee w/scope.
29867........  ...........  A.........  Allgrft implnt,         18.18           NA           NA         11.16        12.21          2.79  090
                                         knee w/scope.
29868........  ...........  A.........  Meniscal trnspl,        24.89           NA           NA         13.83        15.34          4.36  090
                                         knee w/scpe.
29870........  ...........  A.........  Knee arthroscopy,        5.11           NA           NA          4.17         4.54          0.85  090
                                         dx.
29871........  ...........  A.........  Knee arthroscopy/        6.60           NA           NA          5.05         5.46          1.14  090
                                         drainage.
29873........  ...........  A.........  Knee arthroscopy/        6.09           NA           NA          5.58         6.08          1.04  090
                                         surgery.
29874........  ...........  A.........  Knee arthroscopy/        7.10           NA           NA          5.08         5.59          1.11  090
                                         surgery.
29875........  ...........  A.........  Knee arthroscopy/        6.36           NA           NA          4.88         5.37          1.09  090
                                         surgery.
29876........  ...........  A.........  Knee arthroscopy/        8.72           NA           NA          6.19         6.62          1.37  090
                                         surgery.
29877........  ...........  A.........  Knee arthroscopy/        8.15           NA           NA          5.98         6.37          1.28  090
                                         surgery.
29879........  ...........  A.........  Knee arthroscopy/        8.84           NA           NA          6.23         6.68          1.39  090
                                         surgery.
29880........  ...........  A.........  Knee arthroscopy/        9.30           NA           NA          6.43         6.90          1.47  090
                                         surgery.
29881........  ...........  A.........  Knee arthroscopy/        8.56           NA           NA          6.14         6.56          1.34  090
                                         surgery.
29882........  ...........  A.........  Knee arthroscopy/        9.45           NA           NA          6.46         6.86          1.50  090
                                         surgery.
29883........  ...........  A.........  Knee arthroscopy/       11.61           NA           NA          7.59         8.34          1.93  090
                                         surgery.
29884........  ...........  A.........  Knee arthroscopy/        8.13           NA           NA          5.96         6.34          1.27  090
                                         surgery.
29885........  ...........  A.........  Knee arthroscopy/       10.03           NA           NA          7.03         7.51          1.58  090
                                         surgery.
29886........  ...........  A.........  Knee arthroscopy/        8.34           NA           NA          6.03         6.45          1.30  090
                                         surgery.
29887........  ...........  A.........  Knee arthroscopy/        9.98           NA           NA          6.96         7.46          1.57  090
                                         surgery.
29888........  ...........  A.........  Knee arthroscopy/       14.14           NA           NA          8.28         9.26          2.42  090
                                         surgery.
29889........  ...........  A.........  Knee arthroscopy/       17.15           NA           NA         10.63        11.56          2.79  090
                                         surgery.
29891........  ...........  A.........  Ankle arthroscopy/       9.47           NA           NA          6.62         7.08          1.39  090
                                         surgery.
29892........  ...........  A.........  Ankle arthroscopy/      10.07           NA           NA          6.35         7.09          1.41  090
                                         surgery.
29893........  ...........  A.........  Scope, plantar           6.08         8.59         7.49          4.53         4.30          0.63  090
                                         fasciotomy.
29894........  ...........  A.........  Ankle arthroscopy/       7.26           NA           NA          4.68         5.09          1.15  090
                                         surgery.
29895........  ...........  A.........  Ankle arthroscopy/       7.04           NA           NA          4.47         4.99          1.11  090
                                         surgery.
29897........  ...........  A.........  Ankle arthroscopy/       7.23           NA           NA          4.79         5.37          1.17  090
                                         surgery.
29898........  ...........  A.........  Ankle arthroscopy/       8.38           NA           NA          5.19         5.72          1.28  090
                                         surgery.
29899........  ...........  A.........  Ankle arthroscopy/      15.21           NA           NA          9.21         9.90          2.41  090
                                         surgery.
29900........  ...........  A.........  Mcp joint                5.74           NA           NA          4.67         5.29          0.94  090
                                         arthroscopy, dx.
29901........  ...........  A.........  Mcp joint                6.45           NA           NA          5.05         5.74          1.06  090
                                         arthroscopy,
                                         surg.
29902........  ...........  A.........  Mcp joint                7.02           NA           NA          4.72         5.46          1.12  090
                                         arthroscopy,
                                         surg.

[[Page 38263]]

 
29999........  ...........  C.........  Arthroscopy of           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         joint.
30000........  ...........  A.........  Drainage of nose         1.45         3.98         3.98          1.34         1.35          0.12  010
                                         lesion.
30020........  ...........  A.........  Drainage of nose         1.45         4.15         3.66          1.39         1.41          0.12  010
                                         lesion.
30100........  ...........  A.........  Intranasal biopsy        0.94         2.57         2.24          0.75         0.78          0.07  000
30110........  ...........  A.........  Removal of nose          1.65         3.88         3.52          1.45         1.49          0.14  010
                                         polyp(s).
30115........  ...........  A.........  Removal of nose          4.38           NA           NA          5.97         5.79          0.41  090
                                         polyp(s).
30117........  ...........  A.........  Removal of               3.20        18.04        15.41          4.90         4.71          0.26  090
                                         intranasal
                                         lesion.
30118........  ...........  A.........  Removal of               9.81           NA           NA          8.55         8.76          0.78  090
                                         intranasal
                                         lesion.
30120........  ...........  A.........  Revision of nose.        5.31         7.06         6.75          5.09         5.52          0.52  090
30124........  ...........  A.........  Removal of nose          3.14           NA           NA          3.68         3.64          0.25  090
                                         lesion.
30125........  ...........  A.........  Removal of nose          7.21           NA           NA          7.40         7.80          0.63  090
                                         lesion.
30130........  ...........  A.........  Excise inferior          3.41           NA           NA          5.62         5.55          0.31  090
                                         turbinate.
30140........  ...........  A.........  Resect inferior          3.48           NA           NA          7.07         6.55          0.35  090
                                         turbinate.
30150........  ...........  A.........  Partial removal          9.44           NA           NA          9.03         9.96          0.93  090
                                         of nose.
30160........  ...........  A.........  Removal of nose..        9.88           NA           NA          8.88         9.43          0.88  090
30200........  ...........  A.........  Injection                0.78         2.01         1.80          0.67         0.70          0.06  000
                                         treatment of
                                         nose.
30210........  ...........  A.........  Nasal sinus              1.10         2.50         2.27          1.27         1.28          0.09  010
                                         therapy.
30220........  ...........  A.........  Insert nasal             1.56         5.78         4.95          1.43         1.46          0.12  010
                                         septal button.
30300........  ...........  A.........  Remove nasal             1.06         4.27         4.43          1.86         1.87          0.08  010
                                         foreign body.
30310........  ...........  A.........  Remove nasal             1.98           NA           NA          2.90         2.97          0.16  010
                                         foreign body.
30320........  ...........  A.........  Remove nasal             4.56           NA           NA          6.33         6.63          0.39  090
                                         foreign body.
30400........  ...........  R.........  Reconstruction of       10.58           NA           NA         13.86        14.67          1.04  090
                                         nose.
30410........  ...........  R.........  Reconstruction of       13.72           NA           NA         15.27        16.68          1.42  090
                                         nose.
30420........  ...........  R.........  Reconstruction of       16.62           NA           NA         15.79        16.70          1.46  090
                                         nose.
30430........  ...........  R.........  Revision of nose.        7.96           NA           NA         13.20        14.55          0.77  090
30435........  ...........  R.........  Revision of nose.       12.45           NA           NA         15.34        17.27          1.22  090
30450........  ...........  R.........  Revision of nose.       19.38           NA           NA         16.88        19.30          1.97  090
30460........  ...........  A.........  Revision of nose.       10.24           NA           NA          7.49         8.68          1.03  090
30462........  ...........  A.........  Revision of nose.       20.12           NA           NA         14.68        17.44          2.54  090
30465........  ...........  A.........  Repair nasal            12.20           NA           NA         11.07        11.41          1.06  090
                                         stenosis.
30520........  ...........  A.........  Repair of nasal          6.85           NA           NA          8.03         7.24          0.46  090
                                         septum.
30540........  ...........  A.........  Repair nasal             7.81           NA           NA          8.53         8.66          0.67  090
                                         defect.
30545........  ...........  A.........  Repair nasal            11.50           NA           NA         11.08        11.33          1.71  090
                                         defect.
30560........  ...........  A.........  Release of nasal         1.28         5.25         4.96          2.02         2.05          0.10  010
                                         adhesions.
30580........  ...........  A.........  Repair upper jaw         6.76         8.17         7.98          4.73         5.26          0.89  090
                                         fistula.
30600........  ...........  A.........  Repair mouth/nose        6.07         7.67         7.57          4.20         4.59          0.70  090
                                         fistula.
30620........  ...........  A.........  Intranasal               6.04           NA           NA          8.64         8.65          0.57  090
                                         reconstruction.
30630........  ...........  A.........  Repair nasal             7.18           NA           NA          7.72         7.74          0.61  090
                                         septum defect.
30801........  ...........  A.........  Ablate inf               1.11         4.27         4.16          2.11         1.99          0.09  010
                                         turbinate,
                                         superf.
30802........  ...........  A.........  Cauterization,           2.05         4.95         4.72          2.51         2.40          0.16  010
                                         inner nose.
30901........  ...........  A.........  Control of               1.21         1.27         1.30          0.31         0.31          0.11  000
                                         nosebleed.
30903........  ...........  A.........  Control of               1.54         3.26         2.95          0.43         0.46          0.13  000
                                         nosebleed.
30905........  ...........  A.........  Control of               1.97         3.91         3.68          0.51         0.63          0.17  000
                                         nosebleed.
30906........  ...........  A.........  Repeat control of        2.45         4.27         4.03          0.77         0.97          0.20  000
                                         nosebleed.
30915........  ...........  A.........  Ligation, nasal          7.36           NA           NA          6.46         6.48          0.58  090
                                         sinus artery.
30920........  ...........  A.........  Ligation, upper         11.03           NA           NA          8.97         8.85          0.80  090
                                         jaw artery.
30930........  ...........  A.........  Ther fx, nasal           1.28           NA           NA          1.64         1.61          0.12  010
                                         inf turbinate.
30999........  ...........  C.........  Nasal surgery            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
31000........  ...........  A.........  Irrigation,              1.17         3.19         2.98          1.33         1.35          0.09  010
                                         maxillary sinus.
31002........  ...........  A.........  Irrigation,              1.93           NA           NA          2.67         2.93          0.15  010
                                         sphenoid sinus.
31020........  ...........  A.........  Exploration,             2.99         8.56         8.47          5.52         5.29          0.29  090
                                         maxillary sinus.
31030........  ...........  A.........  Exploration,             5.95        10.38        10.84          6.44         6.49          0.60  090
                                         maxillary sinus.
31032........  ...........  A.........  Explore sinus,           6.61           NA           NA          7.00         7.04          0.59  090
                                         remove polyps.
31040........  ...........  A.........  Exploration              9.66           NA           NA          7.38         8.59          0.87  090
                                         behind upper jaw.
31050........  ...........  A.........  Exploration,             5.31           NA           NA          6.50         6.37          0.49  090
                                         sphenoid sinus.
31051........  ...........  A.........  Sphenoid sinus           7.16           NA           NA          8.31         8.18          0.62  090
                                         surgery.
31070........  ...........  A.........  Exploration of           4.32           NA           NA          6.17         5.98          0.38  090
                                         frontal sinus.
31075........  ...........  A.........  Exploration of           9.40           NA           NA          9.29         9.40          0.75  090
                                         frontal sinus.
31080........  ...........  A.........  Removal of              12.54           NA           NA         10.75        12.10          1.23  090
                                         frontal sinus.
31081........  ...........  A.........  Removal of              13.99           NA           NA         15.48        14.63          2.47  090
                                         frontal sinus.
31084........  ...........  A.........  Removal of              14.75           NA           NA         12.88        13.04          1.19  090
                                         frontal sinus.
31085........  ...........  A.........  Removal of              15.44           NA           NA         14.48        13.98          1.73  090
                                         frontal sinus.
31086........  ...........  A.........  Removal of              14.16           NA           NA         12.78        12.87          1.07  090
                                         frontal sinus.
31087........  ...........  A.........  Removal of              14.39           NA           NA         11.66        11.96          1.44  090
                                         frontal sinus.
31090........  ...........  A.........  Exploration of          10.88           NA           NA         13.38        12.80          0.94  090
                                         sinuses.
31200........  ...........  A.........  Removal of               5.03           NA           NA          7.44         8.33          0.29  090
                                         ethmoid sinus.
31201........  ...........  A.........  Removal of               8.49           NA           NA          8.99         8.97          0.82  090
                                         ethmoid sinus.
31205........  ...........  A.........  Removal of              10.47           NA           NA          9.55        10.72          0.67  090
                                         ethmoid sinus.
31225........  ...........  A.........  Removal of upper        26.44           NA           NA         17.94        17.65          1.59  090
                                         jaw.
31230........  ...........  A.........  Removal of upper        30.56           NA           NA         19.56        19.08          1.78  090
                                         jaw.
31231........  ...........  A.........  Nasal endoscopy,         1.10         3.57         3.44          0.77         0.82          0.09  000
                                         dx.
31233........  ...........  A.........  Nasal/sinus              2.18         4.25         4.22          1.13         1.29          0.20  000
                                         endoscopy, dx.

[[Page 38264]]

 
31235........  ...........  A.........  Nasal/sinus              2.64         4.63         4.72          1.27         1.48          0.26  000
                                         endoscopy, dx.
31237........  ...........  A.........  Nasal/sinus              2.98         4.89         4.98          1.40         1.61          0.28  000
                                         endoscopy, surg.
31238........  ...........  A.........  Nasal/sinus              3.26         4.81         4.96          1.49         1.76          0.27  000
                                         endoscopy, surg.
31239........  ...........  A.........  Nasal/sinus              9.23           NA           NA          6.46         7.21          0.62  010
                                         endoscopy, surg.
31240........  ...........  A.........  Nasal/sinus              2.61           NA           NA          1.27         1.48          0.24  000
                                         endoscopy, surg.
31254........  ...........  A.........  Revision of              4.64           NA           NA          1.95         2.36          0.45  000
                                         ethmoid sinus.
31255........  ...........  A.........  Removal of               6.95           NA           NA          2.72         3.37          0.73  000
                                         ethmoid sinus.
31256........  ...........  A.........  Exploration              3.29           NA           NA          1.50         1.78          0.33  000
                                         maxillary sinus.
31267........  ...........  A.........  Endoscopy,               5.45           NA           NA          2.22         2.71          0.55  000
                                         maxillary sinus.
31276........  ...........  A.........  Sinus endoscopy,         8.84           NA           NA          3.35         4.17          0.92  000
                                         surgical.
31287........  ...........  A.........  Nasal/sinus              3.91           NA           NA          1.71         2.05          0.39  000
                                         endoscopy, surg.
31288........  ...........  A.........  Nasal/sinus              4.57           NA           NA          1.93         2.34          0.46  000
                                         endoscopy, surg.
31290........  ...........  A.........  Nasal/sinus             18.50           NA           NA          9.11        10.43          1.40  010
                                         endoscopy, surg.
31291........  ...........  A.........  Nasal/sinus             19.45           NA           NA          9.60        10.90          1.69  010
                                         endoscopy, surg.
31292........  ...........  A.........  Nasal/sinus             15.79           NA           NA          8.11         9.24          1.21  010
                                         endoscopy, surg.
31293........  ...........  A.........  Nasal/sinus             17.36           NA           NA          8.74         9.94          1.28  010
                                         endoscopy, surg.
31294........  ...........  A.........  Nasal/sinus             20.20           NA           NA          9.74        11.17          1.53  010
                                         endoscopy, surg.
31299........  ...........  C.........  Sinus surgery            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
31300........  ...........  A.........  Removal of larynx       15.71           NA           NA         14.58        14.61          1.17  090
                                         lesion.
31320........  ...........  A.........  Diagnostic               5.62           NA           NA         10.11        10.06          0.46  090
                                         incision, larynx.
31360........  ...........  A.........  Removal of larynx       29.57           NA           NA         20.13        18.12          1.38  090
31365........  ...........  A.........  Removal of larynx       38.47           NA           NA         23.08        21.36          1.98  090
31367........  ...........  A.........  Partial removal         30.23           NA           NA         22.55        21.88          1.79  090
                                         of larynx.
31368........  ...........  A.........  Partial removal         33.85           NA           NA         24.64        24.70          2.21  090
                                         of larynx.
31370........  ...........  A.........  Partial removal         27.23           NA           NA         22.16        21.91          1.75  090
                                         of larynx.
31375........  ...........  A.........  Partial removal         25.73           NA           NA         21.16        20.49          1.63  090
                                         of larynx.
31380........  ...........  A.........  Partial removal         25.23           NA           NA         20.80        20.43          1.71  090
                                         of larynx.
31382........  ...........  A.........  Partial removal         28.23           NA           NA         22.72        21.83          1.68  090
                                         of larynx.
31390........  ...........  A.........  Removal of larynx       42.17           NA           NA         26.07        24.82          2.24  090
                                         & pharynx.
31395........  ...........  A.........  Reconstruct             43.46           NA           NA         28.60        28.01          2.49  090
                                         larynx & pharynx.
31400........  ...........  A.........  Revision of             11.48           NA           NA         12.47        12.96          0.83  090
                                         larynx.
31420........  ...........  A.........  Removal of              11.32           NA           NA          8.59         8.96          0.83  090
                                         epiglottis.
31500........  ...........  A.........  Insert emergency         2.33           NA           NA          0.42         0.49          0.17  000
                                         airway.
31502........  ...........  A.........  Change of                0.65           NA           NA          0.21         0.24          0.05  000
                                         windpipe airway.
31505........  ...........  A.........  Diagnostic               0.61         1.42         1.42          0.59         0.60          0.05  000
                                         laryngoscopy.
31510........  ...........  A.........  Laryngoscopy with        1.92         3.21         3.22          1.01         1.12          0.16  000
                                         biopsy.
31511........  ...........  A.........  Remove foreign           2.16         2.92         2.99          1.03         1.03          0.19  000
                                         body, larynx.
31512........  ...........  A.........  Removal of larynx        2.07         2.95         3.04          1.06         1.19          0.18  000
                                         lesion.
31513........  ...........  A.........  Injection into           2.10           NA           NA          1.09         1.26          0.17  000
                                         vocal cord.
31515........  ...........  A.........  Laryngoscopy for         1.80         3.17         3.34          0.88         0.97          0.14  000
                                         aspiration.
31520........  ...........  A.........  Dx laryngoscopy,         2.56           NA           NA          1.22         1.37          0.20  000
                                         newborn.
31525........  ...........  A.........  Dx laryngoscopy          2.63         3.44         3.51          1.24         1.43          0.21  000
                                         excl nb.
31526........  ...........  A.........  Dx laryngoscopy w/       2.57           NA           NA          1.26         1.47          0.21  000
                                         oper scope.
31527........  ...........  A.........  Laryngoscopy for         3.27           NA           NA          1.39         1.62          0.26  000
                                         treatment.
31528........  ...........  A.........  Laryngoscopy and         2.37           NA           NA          1.10         1.26          0.19  000
                                         dilation.
31529........  ...........  A.........  Laryngoscopy and         2.68           NA           NA          1.26         1.46          0.22  000
                                         dilation.
31530........  ...........  A.........  Laryngoscopy w/fb        3.38           NA           NA          1.46         1.68          0.29  000
                                         removal.
31531........  ...........  A.........  Laryngoscopy w/fb        3.58           NA           NA          1.60         1.91          0.29  000
                                         & op scope.
31535........  ...........  A.........  Laryngoscopy w/          3.16           NA           NA          1.45         1.70          0.26  000
                                         biopsy.
31536........  ...........  A.........  Laryngoscopy w/bx        3.55           NA           NA          1.59         1.89          0.29  000
                                         & op scope.
31540........  ...........  A.........  Laryngoscopy w/          4.12           NA           NA          1.77         2.12          0.33  000
                                         exc of tumor.
31541........  ...........  A.........  Larynscop w/tumr         4.52           NA           NA          1.91         2.31          0.37  000
                                         exc + scope.
31545........  ...........  A.........  Remove vc lesion         6.30           NA           NA          2.54         2.96          0.37  000
                                         w/scope.
31546........  ...........  A.........  Remove vc lesion         9.73           NA           NA          3.47         4.27          0.78  000
                                         scope/graft.
31560........  ...........  A.........  Laryngoscop w/           5.45           NA           NA          2.17         2.62          0.43  000
                                         arytenoidectom.
31561........  ...........  A.........  Larynscop, remve         5.99           NA           NA          2.35         2.82          0.49  000
                                         cart + scop.
31570........  ...........  A.........  Laryngoscope w/vc        3.86         4.25         4.91          1.66         1.99          0.31  000
                                         inj.
31571........  ...........  A.........  Laryngoscop w/vc         4.26           NA           NA          1.83         2.18          0.35  000
                                         inj + scope.
31575........  ...........  A.........  Diagnostic               1.10         1.69         1.78          0.76         0.81          0.09  000
                                         laryngoscopy.
31576........  ...........  A.........  Laryngoscopy with        1.97         3.50         3.55          1.05         1.16          0.14  000
                                         biopsy.
31577........  ...........  A.........  Remove foreign           2.47         3.36         3.54          1.17         1.34          0.21  000
                                         body, larynx.
31578........  ...........  A.........  Removal of larynx        2.84         3.98         4.08          1.35         1.41          0.23  000
                                         lesion.
31579........  ...........  A.........  Diagnostic               2.26         2.86         3.29          1.15         1.30          0.18  000
                                         laryngoscopy.
31580........  ...........  A.........  Revision of             14.46           NA           NA         13.81        14.81          1.00  090
                                         larynx.
31582........  ...........  A.........  Revision of             22.87           NA           NA         22.55        23.84          1.76  090
                                         larynx.
31584........  ...........  A.........  Treat larynx            20.35           NA           NA         15.29        16.56          1.72  090
                                         fracture.
31587........  ...........  A.........  Revision of             15.12           NA           NA          8.67         8.86          0.97  090
                                         larynx.
31588........  ...........  A.........  Revision of             14.62           NA           NA         12.51        12.88          1.06  090
                                         larynx.
31590........  ...........  A.........  Reinnervate              7.63           NA           NA         12.73        14.02          0.84  090
                                         larynx.
31595........  ...........  A.........  Larynx nerve             8.75           NA           NA          9.62         9.97          0.68  090
                                         surgery.
31599........  ...........  C.........  Larynx surgery           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
31600........  ...........  A.........  Incision of              7.17           NA           NA          2.30         2.73          0.80  000
                                         windpipe.

[[Page 38265]]

 
31601........  ...........  A.........  Incision of              4.44           NA           NA          1.76         2.06          0.40  000
                                         windpipe.
31603........  ...........  A.........  Incision of              4.14           NA           NA          1.20         1.45          0.44  000
                                         windpipe.
31605........  ...........  A.........  Incision of              3.57           NA           NA          0.82         1.01          0.40  000
                                         windpipe.
31610........  ...........  A.........  Incision of              9.29           NA           NA          7.72         7.90          0.79  090
                                         windpipe.
31611........  ...........  A.........  Surgery/speech           5.92           NA           NA          7.06         6.97          0.46  090
                                         prosthesis.
31612........  ...........  A.........  Puncture/clear           0.91         1.08         1.09          0.26         0.31          0.08  000
                                         windpipe.
31613........  ...........  A.........  Repair windpipe          4.63           NA           NA          6.11         6.00          0.42  090
                                         opening.
31614........  ...........  A.........  Repair windpipe          8.47           NA           NA          9.56         9.03          0.58  090
                                         opening.
31615........  ...........  A.........  Visualization of         2.09         2.37         2.46          1.05         1.11          0.16  000
                                         windpipe.
31620........  ...........  A.........  Endobronchial us         1.40         5.96         5.81          0.33         0.44          0.11  ZZZ
                                         add-on.
31622........  ...........  A.........  Dx bronchoscope/         2.78         5.19         5.43          0.90         0.98          0.18  000
                                         wash.
31623........  ...........  A.........  Dx bronchoscope/         2.88         5.92         6.19          0.90         0.98          0.13  000
                                         brush.
31624........  ...........  A.........  Dx bronchoscope/         2.88         5.29         5.54          0.90         0.98          0.13  000
                                         lavage.
31625........  ...........  A.........  Bronchoscopy w/          3.36         5.43         5.63          1.02         1.12          0.18  000
                                         biopsy(s).
31628........  ...........  A.........  Bronchoscopy/lung        3.80         6.90         6.98          1.11         1.21          0.18  000
                                         bx, each.
31629........  ...........  A.........  Bronchoscopy/            4.09        11.90        13.10          1.18         1.29          0.16  000
                                         needle bx, each.
31630........  ...........  A.........  Bronchoscopy             3.81           NA           NA          1.27         1.50          0.32  000
                                         dilate/fx repr.
31631........  ...........  A.........  Bronchoscopy,            4.36           NA           NA          1.42         1.59          0.34  000
                                         dilate w/stent.
31632........  ...........  A.........  Bronchoscopy/lung        1.03         0.85         0.84          0.24         0.28          0.18  ZZZ
                                         bx, add[boxHu]l.
31633........  ...........  A.........  Bronchoscopy/            1.32         0.98         0.95          0.31         0.36          0.16  ZZZ
                                         needle bx
                                         add[boxHu]l.
31635........  ...........  A.........  Bronchoscopy w/fb        3.67         5.16         5.64          1.14         1.29          0.24  000
                                         removal.
31636........  ...........  A.........  Bronchoscopy,            4.30           NA           NA          1.35         1.56          0.31  000
                                         bronch stents.
31637........  ...........  A.........  Bronchoscopy,            1.58           NA           NA          0.41         0.49          0.13  ZZZ
                                         stent add-on.
31638........  ...........  A.........  Bronchoscopy,            4.88           NA           NA          1.54         1.76          0.22  000
                                         revise stent.
31640........  ...........  A.........  Bronchoscopy w/          4.93           NA           NA          1.54         1.81          0.46  000
                                         tumor excise.
31641........  ...........  A.........  Bronchoscopy,            5.02           NA           NA          1.50         1.69          0.35  000
                                         treat blockage.
31643........  ...........  A.........  Diag bronchoscope/       3.49           NA           NA          1.04         1.14          0.20  000
                                         catheter.
31645........  ...........  A.........  Bronchoscopy,            3.16         4.69         4.93          0.97         1.05          0.16  000
                                         clear airways.
31646........  ...........  A.........  Bronchoscopy,            2.72         4.38         4.63          0.85         0.93          0.14  000
                                         reclear airway.
31656........  ...........  A.........  Bronchoscopy, inj        2.17         5.69         6.42          0.69         0.76          0.15  000
                                         for x-ray.
31715........  ...........  A.........  Injection for            1.11           NA           NA          0.25         0.30          0.07  000
                                         bronchus x-ray.
31717........  ...........  A.........  Bronchial brush          2.12         5.78         7.03          0.72         0.77          0.14  000
                                         biopsy.
31720........  ...........  A.........  Clearance of             1.06           NA           NA          0.27         0.30          0.07  000
                                         airways.
31725........  ...........  A.........  Clearance of             1.96           NA           NA          0.41         0.50          0.14  000
                                         airways.
31730........  ...........  A.........  Intro, windpipe          2.85        25.45        13.80          0.75         0.88          0.21  000
                                         wire/tube.
31750........  ...........  A.........  Repair of               15.19           NA           NA         17.43        17.29          1.05  090
                                         windpipe.
31755........  ...........  A.........  Repair of               17.19           NA           NA         23.90        23.95          1.29  090
                                         windpipe.
31760........  ...........  A.........  Repair of               23.36           NA           NA          9.75        10.23          2.95  090
                                         windpipe.
31766........  ...........  A.........  Reconstruction of       31.58           NA           NA         11.72        12.64          4.53  090
                                         windpipe.
31770........  ...........  A.........  Repair/graft of         23.48           NA           NA          8.55         9.44          2.84  090
                                         bronchus.
31775........  ...........  A.........  Reconstruct             24.51           NA           NA          9.46        10.53          3.02  090
                                         bronchus.
31780........  ...........  A.........  Reconstruct             19.70           NA           NA          8.84         9.83          1.65  090
                                         windpipe.
31781........  ...........  A.........  Reconstruct             24.77           NA           NA          9.67        10.83          2.25  090
                                         windpipe.
31785........  ...........  A.........  Remove windpipe         18.29           NA           NA          7.75         8.61          1.59  090
                                         lesion.
31786........  ...........  A.........  Remove windpipe         25.34           NA           NA          9.65        11.40          3.30  090
                                         lesion.
31800........  ...........  A.........  Repair of                8.10           NA           NA          8.64         8.89          0.79  090
                                         windpipe injury.
31805........  ...........  A.........  Repair of               13.34           NA           NA          6.21         6.73          1.83  090
                                         windpipe injury.
31820........  ...........  A.........  Closure of               4.58         5.83         5.68          3.27         3.42          0.38  090
                                         windpipe lesion.
31825........  ...........  A.........  Repair of                6.98         7.43         7.45          4.49         4.86          0.53  090
                                         windpipe defect.
31830........  ...........  A.........  Revise windpipe          4.54         5.91         5.79          3.55         3.74          0.44  090
                                         scar.
31899........  ...........  C.........  Airways surgical         0.00         0.00         1.44          0.00         0.45          0.00  YYY
                                         procedure.
32000........  ...........  A.........  Drainage of chest        1.54         2.39         2.70          0.47         0.46          0.08  000
32002........  ...........  A.........  Treatment of             2.19         2.86         3.01          1.04         1.03          0.12  000
                                         collapsed lung.
32005........  ...........  A.........  Treat lung lining        2.19         5.01         5.74          0.59         0.64          0.23  000
                                         chemically.
32019........  ...........  A.........  Insert pleural           4.17        15.00        17.51          1.52         1.57          0.42  000
                                         catheter.
32020........  ...........  A.........  Insertion of             3.29           NA           NA          0.97         1.16          0.43  000
                                         chest tube.
32035........  ...........  A.........  Exploration of          11.20           NA           NA          6.04         5.95          1.26  090
                                         chest.
32036........  ...........  A.........  Exploration of          12.21           NA           NA          6.29         6.38          1.43  090
                                         chest.
32095........  ...........  A.........  Biopsy through          10.06           NA           NA          5.08         5.24          1.22  090
                                         chest wall.
32100........  ...........  A.........  Exploration/            16.08           NA           NA          6.99         7.42          2.24  090
                                         biopsy of chest.
32110........  ...........  A.........  Explore/repair          25.15           NA           NA          9.86        10.32          3.22  090
                                         chest.
32120........  ...........  A.........  Re-exploration of       14.27           NA           NA          6.76         6.93          1.63  090
                                         chest.
32124........  ...........  A.........  Explore chest           15.33           NA           NA          6.95         7.10          1.90  090
                                         free adhesions.
32140........  ...........  A.........  Removal of lung         16.54           NA           NA          7.37         7.54          1.97  090
                                         lesion(s).
32141........  ...........  A.........  Remove/treat lung       27.10           NA           NA         10.18         8.89          2.01  090
                                         lesions.
32150........  ...........  A.........  Removal of lung         16.70           NA           NA          7.49         7.55          2.01  090
                                         lesion(s).
32151........  ...........  A.........  Remove lung             16.82           NA           NA          7.86         8.08          2.04  090
                                         foreign body.
32160........  ...........  A.........  Open chest heart        13.02           NA           NA          5.83         5.55          1.31  090
                                         massage.
32200........  ...........  A.........  Drain, open, lung       18.48           NA           NA          8.76         8.69          2.14  090
                                         lesion.
32201........  ...........  A.........  Drain, percut,           3.99        19.70        20.04          1.45         1.32          0.24  000
                                         lung lesion.
32215........  ...........  A.........  Treat chest             12.93           NA           NA          6.20         6.58          1.69  090
                                         lining.
32220........  ...........  A.........  Release of lung..       26.41           NA           NA         11.88        12.45          3.57  090

[[Page 38266]]

 
32225........  ...........  A.........  Partial release         16.63           NA           NA          7.43         7.56          2.07  090
                                         of lung.
32310........  ...........  A.........  Removal of chest        15.16           NA           NA          6.93         7.16          2.00  090
                                         lining.
32320........  ...........  A.........  Free/remove chest       27.04           NA           NA         11.44        11.82          3.52  090
                                         lining.
32400........  ...........  A.........  Needle biopsy            1.76         2.14         2.11          0.57         0.54          0.10  000
                                         chest lining.
32402........  ...........  A.........  Open biopsy chest        8.89           NA           NA          4.68         4.91          1.07  090
                                         lining.
32405........  ...........  A.........  Biopsy, lung or          1.93         0.70         0.66          0.70         0.64          0.11  000
                                         mediastinum.
32420........  ...........  A.........  Puncture/clear           2.18           NA           NA          0.72         0.68          0.12  000
                                         lung.
32440........  ...........  A.........  Removal of lung..       27.17           NA           NA         10.91        11.93          3.69  090
32442........  ...........  A.........  Sleeve                  56.37           NA           NA         18.84        16.75          3.85  090
                                         pneumonectomy.
32445........  ...........  A.........  Removal of lung..       63.60           NA           NA         22.86        18.49          3.72  090
32480........  ...........  A.........  Partial removal         25.71           NA           NA         10.19        11.15          3.50  090
                                         of lung.
32482........  ...........  A.........  Bilobectomy......       27.28           NA           NA         11.08        12.01          3.67  090
32484........  ...........  A.........  Segmentectomy....       25.30           NA           NA          9.58        10.49          3.04  090
32486........  ...........  A.........  Sleeve lobectomy.       42.80           NA           NA         14.66        14.04          3.52  090
32488........  ...........  A.........  Completion              42.83           NA           NA         15.59        14.70          3.81  090
                                         pneumonectomy.
32491........  ...........  R.........  Lung volume             25.09           NA           NA         10.44        11.57          2.99  090
                                         reduction.
32500........  ...........  A.........  Partial removal         24.48           NA           NA         10.26        11.33          3.26  090
                                         of lung.
32501........  ...........  A.........  Repair bronchus          4.68           NA           NA          1.35         1.45          0.65  ZZZ
                                         add-on.
32503........  ...........  A.........  Resect apical           31.61           NA           NA         12.10        13.61          4.38  090
                                         lung tumor.
32504........  ...........  A.........  Resect apical           36.41           NA           NA         13.49        15.12          5.09  090
                                         lung tum/chest.
32540........  ...........  A.........  Removal of lung         30.22           NA           NA         11.49        10.68          2.08  090
                                         lesion.
32601........  ...........  A.........  Thoracoscopy,            5.45           NA           NA          2.07         2.22          0.80  000
                                         diagnostic.
32602........  ...........  A.........  Thoracoscopy,            5.95           NA           NA          2.23         2.38          0.87  000
                                         diagnostic.
32603........  ...........  A.........  Thoracoscopy,            7.80           NA           NA          2.75         2.93          1.14  000
                                         diagnostic.
32604........  ...........  A.........  Thoracoscopy,            8.77           NA           NA          3.05         3.25          1.25  000
                                         diagnostic.
32605........  ...........  A.........  Thoracoscopy,            6.92           NA           NA          2.58         2.73          1.00  000
                                         diagnostic.
32606........  ...........  A.........  Thoracoscopy,            8.39           NA           NA          2.97         3.16          1.22  000
                                         diagnostic.
32650........  ...........  A.........  Thoracoscopy,           10.77           NA           NA          5.23         6.00          1.58  090
                                         surgical.
32651........  ...........  A.........  Thoracoscopy,           18.70           NA           NA          7.69         7.47          1.87  090
                                         surgical.
32652........  ...........  A.........  Thoracoscopy,           29.00           NA           NA         11.14        10.65          2.73  090
                                         surgical.
32653........  ...........  A.........  Thoracoscopy,           18.09           NA           NA          7.45         7.22          1.89  090
                                         surgical.
32654........  ...........  A.........  Thoracoscopy,           20.44           NA           NA          7.96         7.75          1.63  090
                                         surgical.
32655........  ...........  A.........  Thoracoscopy,           16.09           NA           NA          6.87         7.08          1.90  090
                                         surgical.
32656........  ...........  A.........  Thoracoscopy,           13.18           NA           NA          5.96         6.96          1.90  090
                                         surgical.
32657........  ...........  A.........  Thoracoscopy,           12.85           NA           NA          5.96         6.84          2.00  090
                                         surgical.
32658........  ...........  A.........  Thoracoscopy,           11.65           NA           NA          5.48         6.44          1.70  090
                                         surgical.
32659........  ...........  A.........  Thoracoscopy,           11.86           NA           NA          5.78         6.64          1.62  090
                                         surgical.
32660........  ...........  A.........  Thoracoscopy,           17.69           NA           NA          7.58         8.51          2.09  090
                                         surgical.
32661........  ...........  A.........  Thoracoscopy,           13.27           NA           NA          6.04         6.94          1.93  090
                                         surgical.
32662........  ...........  A.........  Thoracoscopy,           14.91           NA           NA          6.64         7.74          2.18  090
                                         surgical.
32663........  ...........  A.........  Thoracoscopy,           24.56           NA           NA          9.41        10.10          2.73  090
                                         surgical.
32664........  ...........  A.........  Thoracoscopy,           14.22           NA           NA          5.62         6.75          2.33  090
                                         surgical.
32665........  ...........  A.........  Thoracoscopy,           21.45           NA           NA          8.54         8.35          2.16  090
                                         surgical.
32800........  ...........  A.........  Repair lung             15.59           NA           NA          6.86         7.17          1.99  090
                                         hernia.
32810........  ...........  A.........  Close chest after       14.83           NA           NA          6.98         7.27          1.94  090
                                         drainage.
32815........  ...........  A.........  Close bronchial         49.79           NA           NA         18.63        14.86          3.28  090
                                         fistula.
32820........  ...........  A.........  Reconstruct             22.33           NA           NA         10.56        11.57          2.53  090
                                         injured chest.
32851........  ...........  A.........  Lung transplant,        40.94           NA           NA         20.18        24.04          5.58  090
                                         single.
32852........  ...........  A.........  Lung transplant         44.65           NA           NA         22.54        28.05          6.02  090
                                         with bypass.
32853........  ...........  A.........  Lung transplant,        50.11           NA           NA         22.79        27.36          7.07  090
                                         double.
32854........  ...........  A.........  Lung transplant         53.88           NA           NA         25.79        30.38          7.22  090
                                         with bypass.
32855........  ...........  C.........  Prepare donor            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         lung, single.
32856........  ...........  C.........  Prepare donor            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         lung, double.
32900........  ...........  A.........  Removal of rib(s)       23.69           NA           NA          9.62         9.78          2.94  090
32905........  ...........  A.........  Revise & repair         23.17           NA           NA          9.54         9.85          3.16  090
                                         chest wall.
32906........  ...........  A.........  Revise & repair         29.18           NA           NA         11.04        11.60          3.98  090
                                         chest wall.
32940........  ...........  A.........  Revision of lung.       21.22           NA           NA          8.50         9.01          2.89  090
32960........  ...........  A.........  Therapeutic              1.84         1.61         1.66          0.69         0.62          0.16  000
                                         pneumothorax.
32997........  ...........  A.........  Total lung lavage        7.31           NA           NA          1.85         1.88          0.55  000
32998........  ...........  A.........  Perq rf ablate           5.68        69.54        68.94          2.00         1.85          0.36  000
                                         tx, pul tumor.
32999........  ...........  C.........  Chest surgery            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
33010........  ...........  A.........  Drainage of heart        2.24           NA           NA          1.00         0.90          0.14  000
                                         sac.
33011........  ...........  A.........  Repeat drainage          2.24           NA           NA          1.09         0.96          0.15  000
                                         of heart sac.
33015........  ...........  A.........  Incision of heart        8.44           NA           NA          5.04         5.00          0.65  090
                                         sac.
33020........  ...........  A.........  Incision of heart       14.87           NA           NA          6.36         6.59          1.80  090
                                         sac.
33025........  ...........  A.........  Incision of heart       13.65           NA           NA          5.83         6.11          1.81  090
                                         sac.
33030........  ...........  A.........  Partial removal         22.27           NA           NA          9.11         9.34          2.84  090
                                         of heart sac.
33031........  ...........  A.........  Partial removal         25.30           NA           NA          9.58         9.87          3.14  090
                                         of heart sac.
33050........  ...........  A.........  Removal of heart        16.85           NA           NA          7.37         7.64          2.15  090
                                         sac lesion.
33120........  ...........  A.........  Removal of heart        27.33           NA           NA         10.56        11.10          3.70  090
                                         lesion.
33130........  ...........  A.........  Removal of heart        24.05           NA           NA          9.39         9.76          3.01  090
                                         lesion.
33140........  ...........  A.........  Heart                   28.26           NA           NA         10.32        10.65          2.86  090
                                         revascularize
                                         (tmr).

[[Page 38267]]

 
33141........  ...........  A.........  Heart tmr w/other        2.54           NA           NA          0.78         1.19          0.69  ZZZ
                                         procedure.
33202........  ...........  A.........  Insert epicard          13.15           NA           NA          6.03         6.16          1.71  090
                                         eltrd, open.
33203........  ...........  A.........  Insert epicard          13.92           NA           NA          6.09         6.22          1.39  090
                                         eltrd, endo.
33206........  ...........  A.........  Insertion of             7.31           NA           NA          4.96         4.75          0.52  090
                                         heart pacemaker.
33207........  ...........  A.........  Insertion of             8.00           NA           NA          5.06         4.99          0.59  090
                                         heart pacemaker.
33208........  ...........  A.........  Insertion of             8.72           NA           NA          5.47         5.12          0.56  090
                                         heart pacemaker.
33210........  ...........  A.........  Insertion of             3.30           NA           NA          1.60         1.45          0.18  000
                                         heart electrode.
33211........  ...........  A.........  Insertion of             3.39           NA           NA          1.54         1.45          0.21  000
                                         heart electrode.
33212........  ...........  A.........  Insertion of             5.51           NA           NA          3.59         3.50          0.43  090
                                         pulse generator.
33213........  ...........  A.........  Insertion of             6.36           NA           NA          4.07         3.94          0.45  090
                                         pulse generator.
33214........  ...........  A.........  Upgrade of               7.78           NA           NA          5.19         5.08          0.58  090
                                         pacemaker system.
33215........  ...........  A.........  Reposition pacing-       4.89           NA           NA          3.36         3.30          0.37  090
                                         defib lead.
33216........  ...........  A.........  Insert lead pace-        5.81           NA           NA          4.38         4.33          0.36  090
                                         defib, one.
33217........  ...........  A.........  Insert lead pace-        5.78           NA           NA          4.29         4.30          0.39  090
                                         defib, dual.
33218........  ...........  A.........  Repair lead pace-        5.97           NA           NA          4.66         4.51          0.37  090
                                         defib, one.
33220........  ...........  A.........  Repair lead pace-        6.05           NA           NA          4.62         4.50          0.37  090
                                         defib, dual.
33222........  ...........  A.........  Revise pocket,           5.01           NA           NA          4.18         4.27          0.42  090
                                         pacemaker.
33223........  ...........  A.........  Revise pocket,           6.49           NA           NA          4.71         4.70          0.45  090
                                         pacing-defib.
33224........  ...........  A.........  Insert pacing            9.04           NA           NA          4.73         4.43          0.54  000
                                         lead & connect.
33225........  ...........  A.........  L ventric pacing         8.33           NA           NA          4.18         3.77          0.45  ZZZ
                                         lead add-on.
33226........  ...........  A.........  Reposition l             8.68           NA           NA          4.57         4.26          0.59  000
                                         ventric lead.
33233........  ...........  A.........  Removal of               3.33           NA           NA          3.16         3.25          0.22  090
                                         pacemaker system.
33234........  ...........  A.........  Removal of               7.85           NA           NA          5.30         5.15          0.56  090
                                         pacemaker system.
33235........  ...........  A.........  Removal pacemaker        9.93           NA           NA          7.01         6.98          0.73  090
                                         electrode.
33236........  ...........  A.........  Remove electrode/       12.64           NA           NA          6.36         6.95          1.69  090
                                         thoracotomy.
33237........  ...........  A.........  Remove electrode/       13.75           NA           NA          7.80         7.77          1.59  090
                                         thoracotomy.
33238........  ...........  A.........  Remove electrode/       15.28           NA           NA          7.98         8.15          2.03  090
                                         thoracotomy.
33240........  ...........  A.........  Insert pulse             7.61           NA           NA          5.06         4.88          0.41  090
                                         generator.
33241........  ...........  A.........  Remove pulse             3.26           NA           NA          2.89         2.96          0.18  090
                                         generator.
33243........  ...........  A.........  Remove eltrd/           23.42           NA           NA         10.84        11.18          2.10  090
                                         thoracotomy.
33244........  ...........  A.........  Remove eltrd,           13.84           NA           NA          9.12         9.09          0.99  090
                                         transven.
33249........  ...........  A.........  Eltrd/insert pace-      15.02           NA           NA          9.78         9.19          0.77  090
                                         defib.
33250........  ...........  A.........  Ablate heart            25.78           NA           NA         10.80        10.80          3.19  090
                                         dysrhythm focus.
33251........  ...........  A.........  Ablate heart            28.80           NA           NA         10.97        11.34          3.60  090
                                         dysrhythm focus.
33254........  ...........  A.........  Ablate atria,           23.58           NA           NA          9.76         9.88          3.35  090
                                         lmtd.
33255........  ...........  A.........  Ablate atria w/o        28.91           NA           NA         11.36        11.50          3.94  090
                                         bypass, ext.
33256........  ...........  A.........  Ablate atria w/         34.77           NA           NA         13.11        13.28          4.95  090
                                         bypass, exten.
33261........  ...........  A.........  Ablate heart            28.80           NA           NA         11.63        11.64          3.46  090
                                         dysrhythm focus.
33265........  ...........  A.........  Ablate atria w/         23.58           NA           NA          9.76         9.88          3.35  090
                                         bypass, endo.
33266........  ...........  A.........  Ablate atria w/o        32.91           NA           NA         12.55        12.72          4.80  090
                                         bypass endo.
33282........  ...........  A.........  Implant pat-             4.70           NA           NA          4.08         4.09          0.23  090
                                         active ht record.
33284........  ...........  A.........  Remove pat-active        3.04           NA           NA          3.26         3.42          0.14  090
                                         ht record.
33300........  ...........  A.........  Repair of heart         44.89           NA           NA         15.08        12.25          2.66  090
                                         wound.
33305........  ...........  A.........  Repair of heart         76.85           NA           NA         25.16        17.89          3.13  090
                                         wound.
33310........  ...........  A.........  Exploratory heart       20.22           NA           NA          8.36         9.05          2.59  090
                                         surgery.
33315........  ...........  A.........  Exploratory heart       26.05           NA           NA         10.35        10.63          3.28  090
                                         surgery.
33320........  ...........  A.........  Repair major            18.46           NA           NA          7.93         8.20          2.08  090
                                         blood vessel(s).
33321........  ...........  A.........  Repair major            20.71           NA           NA          8.38         9.40          2.91  090
                                         vessel.
33322........  ...........  A.........  Repair major            24.30           NA           NA          9.55        10.00          2.86  090
                                         blood vessel(s).
33330........  ...........  A.........  Insert major            25.17           NA           NA          9.49         9.92          2.82  090
                                         vessel graft.
33332........  ...........  A.........  Insert major            24.46           NA           NA          9.47        10.01          3.03  090
                                         vessel graft.
33335........  ...........  A.........  Insert major            33.79           NA           NA         12.50        12.99          4.28  090
                                         vessel graft.
33400........  ...........  A.........  Repair of aortic        41.37           NA           NA         14.60        15.23          4.11  090
                                         valve.
33401........  ...........  A.........  Valvuloplasty,          24.41           NA           NA         10.28        11.81          3.57  090
                                         open.
33403........  ...........  A.........  Valvuloplasty, w/       25.39           NA           NA         12.17        12.96          3.55  090
                                         cp bypass.
33404........  ...........  A.........  Prepare heart-          31.25           NA           NA         12.02        13.31          4.33  090
                                         aorta conduit.
33405........  ...........  A.........  Replacement of          41.19           NA           NA         15.12        16.76          5.33  090
                                         aortic valve.
33406........  ...........  A.........  Replacement of          52.55           NA           NA         18.40        18.82          5.45  090
                                         aortic valve.
33410........  ...........  A.........  Replacement of          46.28           NA           NA         16.57        16.63          4.69  090
                                         aortic valve.
33411........  ...........  A.........  Replacement of          61.94           NA           NA         21.16        20.01          5.48  090
                                         aortic valve.
33412........  ...........  A.........  Replacement of          43.77           NA           NA         16.27        18.37          6.39  090
                                         aortic valve.
33413........  ...........  A.........  Replacement of          59.74           NA           NA         23.31        21.60          6.53  090
                                         aortic valve.
33414........  ...........  A.........  Repair of aortic        39.29           NA           NA         14.29        14.36          4.57  090
                                         valve.
33415........  ...........  A.........  Revision,               37.19           NA           NA         13.15        12.56          4.14  090
                                         subvalvular
                                         tissue.
33416........  ...........  A.........  Revise ventricle        36.43           NA           NA         13.26        13.43          4.57  090
                                         muscle.
33417........  ...........  A.........  Repair of aortic        29.17           NA           NA         11.69        12.72          4.10  090
                                         valve.
33420........  ...........  A.........  Revision of             25.67           NA           NA          9.47         9.44          1.82  090
                                         mitral valve.
33422........  ...........  A.........  Revision of             29.61           NA           NA         11.36        12.69          3.94  090
                                         mitral valve.
33425........  ...........  A.........  Repair of mitral        49.83           NA           NA         17.63        15.38          4.07  090
                                         valve.
33426........  ...........  A.........  Repair of mitral        43.15           NA           NA         15.75        16.49          5.03  090
                                         valve.
33427........  ...........  A.........  Repair of mitral        44.70           NA           NA         15.72        17.59          6.09  090
                                         valve.
33430........  ...........  A.........  Replacement of          50.75           NA           NA         18.57        18.00          5.10  090
                                         mitral valve.

[[Page 38268]]

 
33460........  ...........  A.........  Revision of             44.62           NA           NA         14.77        13.16          3.45  090
                                         tricuspid valve.
33463........  ...........  A.........  Valvuloplasty,          56.95           NA           NA         19.74        16.33          3.87  090
                                         tricuspid.
33464........  ...........  A.........  Valvuloplasty,          44.49           NA           NA         15.85        14.75          4.15  090
                                         tricuspid.
33465........  ...........  A.........  Replace tricuspid       50.59           NA           NA         17.67        15.33          4.39  090
                                         valve.
33468........  ...........  A.........  Revision of             32.82           NA           NA         14.95        14.37          4.07  090
                                         tricuspid valve.
33470........  ...........  A.........  Revision of             21.32           NA           NA          7.93         9.44          1.03  090
                                         pulmonary valve.
33471........  ...........  A.........  Valvotomy,              22.83           NA           NA         11.33         9.94          3.39  090
                                         pulmonary valve.
33472........  ...........  A.........  Revision of             22.90           NA           NA          8.80        10.07          3.55  090
                                         pulmonary valve.
33474........  ...........  A.........  Revision of             39.27           NA           NA         13.25        12.73          3.22  090
                                         pulmonary valve.
33475........  ...........  A.........  Replacement,            42.27           NA           NA         15.11        15.34          4.93  090
                                         pulmonary valve.
33476........  ...........  A.........  Revision of heart       26.41           NA           NA         10.39        11.35          2.42  090
                                         chamber.
33478........  ...........  A.........  Revision of heart       27.38           NA           NA         11.02        12.03          3.89  090
                                         chamber.
33496........  ...........  A.........  Repair, prosth          29.71           NA           NA         11.12        11.99          4.13  090
                                         valve clot.
33500........  ...........  A.........  Repair heart            27.82           NA           NA         11.00        11.24          3.87  090
                                         vessel fistula.
33501........  ...........  A.........  Repair heart            19.43           NA           NA          8.17         8.24          1.91  090
                                         vessel fistula.
33502........  ...........  A.........  Coronary artery         21.69           NA           NA          9.31        10.18          3.00  090
                                         correction.
33503........  ...........  A.........  Coronary artery         22.29           NA           NA         11.18        10.37          1.78  090
                                         graft.
33504........  ...........  A.........  Coronary artery         25.30           NA           NA         10.57        11.12          3.36  090
                                         graft.
33505........  ...........  A.........  Repair artery w/        38.35           NA           NA         14.84        13.45          2.19  090
                                         tunnel.
33506........  ...........  A.........  Repair artery,          37.80           NA           NA         12.76        14.13          4.66  090
                                         translocation.
33507........  ...........  A.........  Repair art,             31.35           NA           NA         11.10        12.48          4.06  090
                                         intramural.
33508........  ...........  A.........  Endoscopic vein          0.31           NA           NA          0.09         0.10          0.04  ZZZ
                                         harvest.
33510........  ...........  A.........  CABG, vein,             34.87           NA           NA         12.91        14.67          4.41  090
                                         single.
33511........  ...........  A.........  CABG, vein, two..       38.34           NA           NA         14.16        15.67          4.56  090
33512........  ...........  A.........  CABG, vein, three       43.87           NA           NA         15.94        16.82          4.67  090
33513........  ...........  A.........  CABG, vein, four.       45.26           NA           NA         16.36        17.15          4.88  090
33514........  ...........  A.........  CABG, vein, five.       47.97           NA           NA         17.32        17.74          4.77  090
33516........  ...........  A.........  Cabg, vein, six         49.65           NA           NA         17.93        18.47          5.13  090
                                         or more.
33517........  ...........  A.........  CABG, artery-            3.61           NA           NA          1.08         0.97          0.39  ZZZ
                                         vein, single.
33518........  ...........  A.........  CABG, artery-            7.93           NA           NA          2.37         1.98          0.73  ZZZ
                                         vein, two.
33519........  ...........  A.........  CABG, artery-           10.49           NA           NA          3.15         2.74          1.04  ZZZ
                                         vein, three.
33521........  ...........  A.........  CABG, artery-           12.59           NA           NA          3.78         3.44          1.37  ZZZ
                                         vein, four.
33522........  ...........  A.........  CABG, artery-           14.14           NA           NA          4.25         4.04          1.78  ZZZ
                                         vein, five.
33523........  ...........  A.........  Cabg, art-vein,         16.08           NA           NA          4.80         4.69          2.13  ZZZ
                                         six or more.
33530........  ...........  A.........  Coronary artery,        10.13           NA           NA          2.96         2.46          0.88  ZZZ
                                         bypass/reop.
33533........  ...........  A.........  CABG, arterial,         33.64           NA           NA         12.56        14.55          4.56  090
                                         single.
33534........  ...........  A.........  CABG, arterial,         39.77           NA           NA         14.74        16.27          4.70  090
                                         two.
33535........  ...........  A.........  CABG, arterial,         44.64           NA           NA         16.28        17.26          5.03  090
                                         three.
33536........  ...........  A.........  Cabg, arterial,         48.32           NA           NA         17.31        17.84          5.44  090
                                         four or more.
33542........  ...........  A.........  Removal of heart        48.08           NA           NA         16.91        15.05          4.38  090
                                         lesion.
33545........  ...........  A.........  Repair of heart         56.93           NA           NA         20.10        17.93          5.21  090
                                         damage.
33548........  ...........  A.........  Restore/remodel,        53.96           NA           NA         19.36        19.44          5.53  090
                                         ventricle.
33572........  ...........  A.........  Open coronary            4.44           NA           NA          1.32         1.39          0.65  ZZZ
                                         endarterectomy.
33600........  ...........  A.........  Closure of valve.       30.15           NA           NA         12.08        12.36          4.42  090
33602........  ...........  A.........  Closure of valve.       29.18           NA           NA         11.26        12.24          3.82  090
33606........  ...........  A.........  Anastomosis/            31.37           NA           NA         11.94        12.83          4.41  090
                                         artery-aorta.
33608........  ...........  A.........  Repair anomaly w/       31.72           NA           NA         12.80        13.55          4.74  090
                                         conduit.
33610........  ...........  A.........  Repair by               31.24           NA           NA         13.56        13.20          4.56  090
                                         enlargement.
33611........  ...........  A.........  Repair double           35.49           NA           NA         12.41        13.30          4.37  090
                                         ventricle.
33612........  ...........  A.........  Repair double           36.49           NA           NA         14.19        14.46          5.30  090
                                         ventricle.
33615........  ...........  A.........  Repair, modified        35.76           NA           NA         13.70        13.23          4.32  090
                                         fontan.
33617........  ...........  A.........  Repair single           38.96           NA           NA         14.02        15.41          5.66  090
                                         ventricle.
33619........  ...........  A.........  Repair single           48.60           NA           NA         18.07        19.46          6.46  090
                                         ventricle.
33641........  ...........  A.........  Repair heart            29.50           NA           NA         10.89        10.25          3.23  090
                                         septum defect.
33645........  ...........  A.........  Revision of heart       27.98           NA           NA         10.71        11.28          3.79  090
                                         veins.
33647........  ...........  A.........  Repair heart            29.37           NA           NA         12.61        13.14          3.32  090
                                         septum defects.
33660........  ...........  A.........  Repair of heart         31.75           NA           NA         11.76        12.57          4.49  090
                                         defects.
33665........  ...........  A.........  Repair of heart         34.77           NA           NA         12.23        13.06          4.00  090
                                         defects.
33670........  ...........  A.........  Repair of heart         36.58           NA           NA         15.34        13.74          4.65  090
                                         chambers.
33675........  ...........  A.........  Close mult vsd...       35.87           NA           NA         15.47        17.04          4.95  090
33676........  ...........  A.........  Close mult vsd w/       36.87           NA           NA         15.78        17.37          5.44  090
                                         resection.
33677........  ...........  A.........  Cl mult vsd w/rem       38.37           NA           NA         16.34        17.99          5.68  090
                                         pul band.
33681........  ...........  A.........  Repair heart            32.16           NA           NA         12.88        13.84          4.45  090
                                         septum defect.
33684........  ...........  A.........  Repair heart            34.29           NA           NA         13.45        14.57          3.39  090
                                         septum defect.
33688........  ...........  A.........  Repair heart            34.67           NA           NA         11.68        10.70          4.73  090
                                         septum defect.
33690........  ...........  A.........  Reinforce               20.20           NA           NA          8.64         9.39          1.97  090
                                         pulmonary artery.
33692........  ...........  A.........  Repair of heart         31.38           NA           NA         18.79        14.76          4.58  090
                                         defects.
33694........  ...........  A.........  Repair of heart         35.49           NA           NA         10.04        12.13          5.28  090
                                         defects.
33697........  ...........  A.........  Repair of heart         37.49           NA           NA         16.62        16.63          4.09  090
                                         defects.
33702........  ...........  A.........  Repair of heart         27.11           NA           NA         10.54        11.71          3.68  090
                                         defects.
33710........  ...........  A.........  Repair of heart         30.28           NA           NA         11.28        12.68          4.43  090
                                         defects.
33720........  ...........  A.........  Repair of heart         27.13           NA           NA         10.68        11.55          3.84  090
                                         defect.

[[Page 38269]]

 
33722........  ...........  A.........  Repair of heart         29.05           NA           NA         10.66        11.92          1.30  090
                                         defect.
33724........  ...........  A.........  Repair venous           27.55           NA           NA         10.37        10.50          4.00  090
                                         anomaly.
33726........  ...........  A.........  Repair pul venous       37.04           NA           NA         13.22        13.38          5.03  090
                                         stenosis.
33730........  ...........  A.........  Repair heart-vein       36.01           NA           NA         12.82        13.55          5.03  090
                                         defect(s).
33732........  ...........  A.........  Repair heart-vein       28.80           NA           NA         12.55        13.34          3.68  090
                                         defect.
33735........  ...........  A.........  Revision of heart       22.04           NA           NA         10.86         9.67          1.92  090
                                         chamber.
33736........  ...........  A.........  Revision of heart       24.16           NA           NA         11.91        11.68          3.09  090
                                         chamber.
33737........  ...........  A.........  Revision of heart       22.34           NA           NA          9.14         9.77          3.25  090
                                         chamber.
33750........  ...........  A.........  Major vessel            22.06           NA           NA          9.61        10.21          1.16  090
                                         shunt.
33755........  ...........  A.........  Major vessel            22.44           NA           NA          7.77         8.29          3.26  090
                                         shunt.
33762........  ...........  A.........  Major vessel            22.44           NA           NA          8.72         9.17          3.14  090
                                         shunt.
33764........  ...........  A.........  Major vessel            22.44           NA           NA          8.94         9.63          3.01  090
                                         shunt & graft.
33766........  ...........  A.........  Major vessel            23.41           NA           NA          8.46        10.08          3.70  090
                                         shunt.
33767........  ...........  A.........  Major vessel            25.14           NA           NA          8.52        10.27          3.82  090
                                         shunt.
33768........  ...........  A.........  Cavopulmonary            8.00           NA           NA          1.84         2.31          1.19  ZZZ
                                         shunting.
33770........  ...........  A.........  Repair great            39.02           NA           NA         11.91        13.07          5.74  090
                                         vessels defect.
33771........  ...........  A.........  Repair great            40.58           NA           NA         13.14        12.33          5.68  090
                                         vessels defect.
33774........  ...........  A.........  Repair great            31.54           NA           NA         12.22        13.47          4.81  090
                                         vessels defect.
33775........  ...........  A.........  Repair great            32.83           NA           NA         10.09        12.54          4.99  090
                                         vessels defect.
33776........  ...........  A.........  Repair great            34.53           NA           NA         10.22        13.53          5.09  090
                                         vessels defect.
33777........  ...........  A.........  Repair great            33.95           NA           NA          9.91        12.76          5.49  090
                                         vessels defect.
33778........  ...........  A.........  Repair great            42.62           NA           NA         14.99        15.98          6.20  090
                                         vessels defect.
33779........  ...........  A.........  Repair great            43.15           NA           NA         12.50        13.75          2.92  090
                                         vessels defect.
33780........  ...........  A.........  Repair great            43.85           NA           NA         13.14        15.87          3.68  090
                                         vessels defect.
33781........  ...........  A.........  Repair great            43.16           NA           NA         11.13        12.74          5.97  090
                                         vessels defect.
33786........  ...........  A.........  Repair arterial         41.74           NA           NA         14.15        14.98          5.71  090
                                         trunk.
33788........  ...........  A.........  Revision of             27.26           NA           NA          8.23        10.34          4.03  090
                                         pulmonary artery.
33800........  ...........  A.........  Aortic suspension       17.23           NA           NA          6.84         7.55          2.46  090
33802........  ...........  A.........  Repair vessel           18.24           NA           NA          7.96         8.52          2.27  090
                                         defect.
33803........  ...........  A.........  Repair vessel           20.18           NA           NA          6.38         8.33          3.20  090
                                         defect.
33813........  ...........  A.........  Repair septal           21.23           NA           NA          8.82         9.89          3.13  090
                                         defect.
33814........  ...........  A.........  Repair septal           26.41           NA           NA         10.41        11.53          3.85  090
                                         defect.
33820........  ...........  A.........  Revise major            16.61           NA           NA          6.98         7.91          2.35  090
                                         vessel.
33822........  ...........  A.........  Revise major            17.63           NA           NA          5.92         7.44          2.68  090
                                         vessel.
33824........  ...........  A.........  Revise major            20.10           NA           NA          8.47         9.24          2.89  090
                                         vessel.
33840........  ...........  A.........  Remove aorta            21.21           NA           NA          9.36         9.76          2.16  090
                                         constriction.
33845........  ...........  A.........  Remove aorta            22.77           NA           NA          9.39        10.40          3.22  090
                                         constriction.
33851........  ...........  A.........  Remove aorta            21.85           NA           NA          8.88         9.82          3.18  090
                                         constriction.
33852........  ...........  A.........  Repair septal           24.28           NA           NA         14.27        12.08          2.16  090
                                         defect.
33853........  ...........  A.........  Repair septal           32.35           NA           NA         12.28        13.67          4.48  090
                                         defect.
33860........  ...........  A.........  Ascending aortic        59.33           NA           NA         20.24        18.40          5.76  090
                                         graft.
33861........  ...........  A.........  Ascending aortic        43.94           NA           NA         15.73        16.78          6.37  090
                                         graft.
33863........  ...........  A.........  Ascending aortic        58.71           NA           NA         19.64        19.22          6.59  090
                                         graft.
33870........  ...........  A.........  Transverse aortic       45.93           NA           NA         16.30        17.40          6.62  090
                                         arch graft.
33875........  ...........  A.........  Thoracic aortic         35.68           NA           NA         12.91        13.54          4.89  090
                                         graft.
33877........  ...........  A.........  Thoracoabdominal        68.85           NA           NA         21.04        18.79          5.94  090
                                         graft.
33880........  ...........  A.........  Endovasc taa repr       34.48           NA           NA         10.90        12.12          2.75  090
                                         incl subcl.
33881........  ...........  A.........  Endovasc taa repr       29.48           NA           NA          9.65        10.74          2.33  090
                                         w/o subcl.
33883........  ...........  A.........  Insert endovasc         20.99           NA           NA          7.21         8.15          2.11  090
                                         prosth, taa.
33884........  ...........  A.........  Endovasc prosth,         8.20           NA           NA          2.09         2.32          0.86  ZZZ
                                         taa, add-on.
33886........  ...........  A.........  Endovasc prosth,        17.99           NA           NA          6.29         7.24          1.80  090
                                         delayed.
33889........  ...........  A.........  Artery transpose/       15.92           NA           NA          3.97         4.60          2.18  000
                                         endovas taa.
33891........  ...........  A.........  Car-car bp grft/        20.00           NA           NA          5.80         6.47          2.73  000
                                         endovas taa.
33910........  ...........  A.........  Remove lung             29.59           NA           NA         11.34        11.37          3.70  090
                                         artery emboli.
33915........  ...........  A.........  Remove lung             24.83           NA           NA          9.16         9.44          1.44  090
                                         artery emboli.
33916........  ...........  A.........  Surgery of great        28.30           NA           NA         10.90        11.11          3.67  090
                                         vessel.
33917........  ...........  A.........  Repair pulmonary        25.14           NA           NA         10.04        11.17          3.70  090
                                         artery.
33920........  ...........  A.........  Repair pulmonary        32.58           NA           NA          9.46        11.95          4.38  090
                                         atresia.
33922........  ...........  A.........  Transect                24.09           NA           NA         10.19        10.76          3.10  090
                                         pulmonary artery.
33924........  ...........  A.........  Remove pulmonary         5.49           NA           NA          1.61         1.82          0.82  ZZZ
                                         shunt.
33925........  ...........  A.........  Rpr pul art             31.25           NA           NA         15.94        14.34          4.61  090
                                         unifocal w/o cpb.
33926........  ...........  A.........  Repr pul art,           44.68           NA           NA         14.86        16.18          6.22  090
                                         unifocal w/cpb.
33933........  ...........  C.........  Prepare donor            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         heart/lung.
33935........  ...........  R.........  Transplantation,        61.68           NA           NA         22.99        25.92          9.06  090
                                         heart/lung.
33944........  ...........  C.........  Prepare donor            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         heart.
33945........  ...........  R.........  Transplantation         89.08           NA           NA         30.44        25.97          6.26  090
                                         of heart.
33960........  ...........  A.........  External                19.33           NA           NA          5.42         5.20          2.67  000
                                         circulation
                                         assist.
33961........  ...........  A.........  External                10.91           NA           NA          2.97         3.29          0.88  ZZZ
                                         circulation
                                         assist.
33967........  ...........  A.........  Insert ia percut         4.84           NA           NA          2.32         2.11          0.35  000
                                         device.
33968........  ...........  A.........  Remove aortic            0.64           NA           NA          0.25         0.24          0.07  000
                                         assist device.
33970........  ...........  A.........  Aortic                   6.74           NA           NA          2.49         2.40          0.82  000
                                         circulation
                                         assist.
33971........  ...........  A.........  Aortic                  11.91           NA           NA          5.92         5.99          1.25  090
                                         circulation
                                         assist.

[[Page 38270]]

 
33973........  ...........  A.........  Insert balloon           9.75           NA           NA          3.85         3.59          1.26  000
                                         device.
33974........  ...........  A.........  Remove intra-           14.93           NA           NA          7.59         7.77          1.74  090
                                         aortic balloon.
33975........  ...........  A.........  Implant                 20.97           NA           NA          6.33         6.36          3.07  XXX
                                         ventricular
                                         device.
33976........  ...........  A.........  Implant                 22.97           NA           NA          7.59         7.62          3.26  XXX
                                         ventricular
                                         device.
33977........  ...........  A.........  Remove                  20.07           NA           NA          9.40        10.23          2.81  090
                                         ventricular
                                         device.
33978........  ...........  A.........  Remove                  22.51           NA           NA         10.41        11.09          3.31  090
                                         ventricular
                                         device.
33979........  ...........  A.........  Insert                  45.93           NA           NA         13.34        14.31          6.97  XXX
                                         intracorporeal
                                         device.
33980........  ...........  A.........  Remove                  64.86           NA           NA         23.15        24.50          8.59  090
                                         intracorporeal
                                         device.
33999........  ...........  C.........  Cardiac surgery          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
34001........  ...........  A.........  Removal of artery       17.78           NA           NA          6.35         6.58          1.85  090
                                         clot.
34051........  ...........  A.........  Removal of artery       16.91           NA           NA          7.39         7.50          2.21  090
                                         clot.
34101........  ...........  A.........  Removal of artery       10.85           NA           NA          4.29         4.84          1.41  090
                                         clot.
34111........  ...........  A.........  Removal of arm          10.85           NA           NA          4.27         4.84          1.40  090
                                         artery clot.
34151........  ...........  A.........  Removal of artery       26.41           NA           NA          8.66         9.55          3.56  090
                                         clot.
34201........  ...........  A.........  Removal of artery       19.38           NA           NA          6.53         6.01          1.45  090
                                         clot.
34203........  ...........  A.........  Removal of leg          17.73           NA           NA          6.36         7.24          2.36  090
                                         artery clot.
34401........  ...........  A.........  Removal of vein         26.41           NA           NA          9.28        10.02          3.10  090
                                         clot.
34421........  ...........  A.........  Removal of vein         13.29           NA           NA          5.17         5.74          1.55  090
                                         clot.
34451........  ...........  A.........  Removal of vein         28.41           NA           NA          9.39        10.46          3.84  090
                                         clot.
34471........  ...........  A.........  Removal of vein         21.00           NA           NA          7.81         6.53          1.18  090
                                         clot.
34490........  ...........  A.........  Removal of vein         10.83           NA           NA          4.34         4.90          1.41  090
                                         clot.
34501........  ...........  A.........  Repair valve,           16.74           NA           NA          6.41         7.54          2.35  090
                                         femoral vein.
34502........  ...........  A.........  Reconstruct vena        27.86           NA           NA         10.51        11.44          3.63  090
                                         cava.
34510........  ...........  A.........  Transposition of        19.80           NA           NA          7.55         8.43          2.33  090
                                         vein valve.
34520........  ...........  A.........  Cross-over vein         19.05           NA           NA          7.00         8.10          2.29  090
                                         graft.
34530........  ...........  A.........  Leg vein fusion..       17.77           NA           NA          6.75         7.87          1.74  090
34800........  ...........  A.........  Endovas aaa repr        21.46           NA           NA          7.23         8.22          2.46  090
                                         w/sm tube.
34802........  ...........  A.........  Endovas aaa repr        23.71           NA           NA          8.14         8.97          2.33  090
                                         w/2-p part.
34803........  ...........  A.........  Endovas aaa repr        24.74           NA           NA          8.00         9.12          2.01  090
                                         w/3-p part.
34804........  ...........  A.........  Endovas aaa repr        23.71           NA           NA          8.04         8.93          2.30  090
                                         w/1-p part.
34805........  ...........  A.........  Endovas aaa repr        22.59           NA           NA          7.25         8.44          2.01  090
                                         w/long tube.
34808........  ...........  A.........  Endovas iliac a          4.12           NA           NA          1.05         1.22          0.59  ZZZ
                                         device addon.
34812........  ...........  A.........  Xpose for                6.74           NA           NA          1.67         1.96          1.18  000
                                         endoprosth,
                                         femorl.
34813........  ...........  A.........  Femoral endovas          4.79           NA           NA          1.16         1.37          0.67  ZZZ
                                         graft add-on.
34820........  ...........  A.........  Xpose for                9.74           NA           NA          2.46         2.85          1.50  000
                                         endoprosth,
                                         iliac.
34825........  ...........  A.........  Endovasc extend         12.72           NA           NA          5.12         5.63          1.28  090
                                         prosth, init.
34826........  ...........  A.........  Endovasc exten           4.12           NA           NA          1.13         1.25          0.44  ZZZ
                                         prosth, add-l.
34830........  ...........  A.........  Open aortic tube        35.10           NA           NA         10.35        12.09          4.55  090
                                         prosth repr.
34831........  ...........  A.........  Open aortoiliac         37.85           NA           NA         11.29        11.64          4.89  090
                                         prosth repr.
34832........  ...........  A.........  Open aortofemor         37.85           NA           NA         11.78        13.17          4.85  090
                                         prosth repr.
34833........  ...........  A.........  Xpose for               11.98           NA           NA          3.29         3.86          1.70  000
                                         endoprosth,
                                         iliac.
34834........  ...........  A.........  Xpose,                   5.34           NA           NA          1.55         1.88          0.76  000
                                         endoprosth,
                                         brachial.
34900........  ...........  A.........  Endovasc iliac          16.77           NA           NA          6.04         6.84          2.00  090
                                         repr w/graft.
35001........  ...........  A.........  Repair defect of        20.70           NA           NA          7.69         8.61          2.81  090
                                         artery.
35002........  ...........  A.........  Repair artery           22.12           NA           NA          7.44         8.63          3.00  090
                                         rupture, neck.
35005........  ...........  A.........  Repair defect of        19.18           NA           NA          8.58         8.54          1.77  090
                                         artery.
35011........  ...........  A.........  Repair defect of        18.50           NA           NA          6.29         7.16          2.55  090
                                         artery.
35013........  ...........  A.........  Repair artery           23.10           NA           NA          7.73         8.74          3.10  090
                                         rupture, arm.
35021........  ...........  A.........  Repair defect of        22.09           NA           NA          8.44         8.97          2.87  090
                                         artery.
35022........  ...........  A.........  Repair artery           25.62           NA           NA         10.45         9.98          3.17  090
                                         rupture, chest.
35045........  ...........  A.........  Repair defect of        17.94           NA           NA          6.26         6.93          2.45  090
                                         arm artery.
35081........  ...........  A.........  Repair defect of        33.37           NA           NA         10.70        11.14          4.01  090
                                         artery.
35082........  ...........  A.........  Repair artery           41.93           NA           NA         12.78        14.09          5.44  090
                                         rupture, aorta.
35091........  ...........  A.........  Repair defect of        35.35           NA           NA         10.00        11.85          5.14  090
                                         artery.
35092........  ...........  A.........  Repair artery           50.81           NA           NA         14.51        16.16          6.40  090
                                         rupture, aorta.
35102........  ...........  A.........  Repair defect of        36.37           NA           NA         11.29        11.88          4.48  090
                                         artery.
35103........  ...........  A.........  Repair artery           43.49           NA           NA         12.64        14.34          5.76  090
                                         rupture, groin.
35111........  ...........  A.........  Repair defect of        26.17           NA           NA          8.50         9.49          3.47  090
                                         artery.
35112........  ...........  A.........  Repair artery           32.44           NA           NA         10.07        11.08          4.08  090
                                         rupture,spleen.
35121........  ...........  A.........  Repair defect of        31.41           NA           NA          9.96        11.25          4.30  090
                                         artery.
35122........  ...........  A.........  Repair artery           37.76           NA           NA         11.57        12.77          4.75  090
                                         rupture, belly.
35131........  ...........  A.........  Repair defect of        26.29           NA           NA          8.63         9.73          3.80  090
                                         artery.
35132........  ...........  A.........  Repair artery           32.44           NA           NA         10.30        11.33          4.30  090
                                         rupture, groin.
35141........  ...........  A.........  Repair defect of        20.83           NA           NA          6.92         7.95          2.90  090
                                         artery.
35142........  ...........  A.........  Repair artery           25.03           NA           NA          8.23         9.32          3.36  090
                                         rupture, thigh.
35151........  ...........  A.........  Repair defect of        23.61           NA           NA          7.63         8.85          3.24  090
                                         artery.
35152........  ...........  A.........  Repair artery           27.53           NA           NA          9.09        10.22          3.61  090
                                         rupture, knee.
35180........  ...........  A.........  Repair blood            15.01           NA           NA          6.28         6.52          1.00  090
                                         vessel lesion.
35182........  ...........  A.........  Repair blood            31.58           NA           NA         10.85        11.97          4.36  090
                                         vessel lesion.
35184........  ...........  A.........  Repair blood            18.72           NA           NA          6.48         7.46          2.53  090
                                         vessel lesion.
35188........  ...........  A.........  Repair blood            15.05           NA           NA          6.19         6.92          2.16  090
                                         vessel lesion.
35189........  ...........  A.........  Repair blood            29.85           NA           NA         10.56        11.18          4.01  090
                                         vessel lesion.

[[Page 38271]]

 
35190........  ...........  A.........  Repair blood            13.33           NA           NA          5.22         5.86          1.80  090
                                         vessel lesion.
35201........  ...........  A.........  Repair blood            16.84           NA           NA          6.31         7.17          2.34  090
                                         vessel lesion.
35206........  ...........  A.........  Repair blood            13.76           NA           NA          5.29         5.94          1.87  090
                                         vessel lesion.
35207........  ...........  A.........  Repair blood            10.85           NA           NA          6.62         7.00          1.48  090
                                         vessel lesion.
35211........  ...........  A.........  Repair blood            24.50           NA           NA          9.70        10.22          3.20  090
                                         vessel lesion.
35216........  ...........  A.........  Repair blood            36.47           NA           NA         13.56        11.32          2.65  090
                                         vessel lesion.
35221........  ...........  A.........  Repair blood            26.54           NA           NA          8.35         9.17          3.37  090
                                         vessel lesion.
35226........  ...........  A.........  Repair blood            15.22           NA           NA          5.77         6.62          2.02  090
                                         vessel lesion.
35231........  ...........  A.........  Repair blood            21.08           NA           NA          7.72         8.74          2.89  090
                                         vessel lesion.
35236........  ...........  A.........  Repair blood            17.94           NA           NA          6.29         7.12          2.43  090
                                         vessel lesion.
35241........  ...........  A.........  Repair blood            25.50           NA           NA         10.02        10.55          3.53  090
                                         vessel lesion.
35246........  ...........  A.........  Repair blood            28.15           NA           NA         10.14        11.09          3.86  090
                                         vessel lesion.
35251........  ...........  A.........  Repair blood            31.83           NA           NA          9.45        10.68          4.13  090
                                         vessel lesion.
35256........  ...........  A.........  Repair blood            18.98           NA           NA          6.36         7.40          2.63  090
                                         vessel lesion.
35261........  ...........  A.........  Repair blood            18.88           NA           NA          6.94         7.52          2.61  090
                                         vessel lesion.
35266........  ...........  A.........  Repair blood            15.75           NA           NA          5.46         6.27          2.10  090
                                         vessel lesion.
35271........  ...........  A.........  Repair blood            24.50           NA           NA          9.67        10.09          3.16  090
                                         vessel lesion.
35276........  ...........  A.........  Repair blood            25.72           NA           NA          9.76        10.45          3.49  090
                                         vessel lesion.
35281........  ...........  A.........  Repair blood            29.93           NA           NA          9.27        10.57          3.97  090
                                         vessel lesion.
35286........  ...........  A.........  Repair blood            17.06           NA           NA          6.30         7.20          2.35  090
                                         vessel lesion.
35301........  ...........  A.........  Rechanneling of         19.53           NA           NA          6.68         7.59          2.68  090
                                         artery.
35302........  ...........  A.........  Rechanneling of         21.27           NA           NA          6.90         7.06          2.98  090
                                         artery.
35303........  ...........  A.........  Rechanneling of         23.52           NA           NA          7.45         7.63          3.26  090
                                         artery.
35304........  ...........  A.........  Rechanneling of         24.52           NA           NA          7.70         7.88          3.41  090
                                         artery.
35305........  ...........  A.........  Rechanneling of         23.52           NA           NA          7.45         7.63          3.26  090
                                         artery.
35306........  ...........  A.........  Rechanneling of          9.25           NA           NA          2.28         2.35          1.34  ZZZ
                                         artery.
35311........  ...........  A.........  Rechanneling of         28.52           NA           NA          9.63        10.69          3.42  090
                                         artery.
35321........  ...........  A.........  Rechanneling of         16.51           NA           NA          5.77         6.61          2.25  090
                                         artery.
35331........  ...........  A.........  Rechanneling of         27.61           NA           NA          8.81        10.05          3.83  090
                                         artery.
35341........  ...........  A.........  Rechanneling of         26.10           NA           NA          8.23         9.60          3.78  090
                                         artery.
35351........  ...........  A.........  Rechanneling of         24.53           NA           NA          7.65         8.67          3.35  090
                                         artery.
35355........  ...........  A.........  Rechanneling of         19.78           NA           NA          6.35         7.24          2.67  090
                                         artery.
35361........  ...........  A.........  Rechanneling of         30.11           NA           NA          9.60        10.67          4.15  090
                                         artery.
35363........  ...........  A.........  Rechanneling of         32.22           NA           NA         10.45        11.53          4.33  090
                                         artery.
35371........  ...........  A.........  Rechanneling of         15.23           NA           NA          5.32         6.16          2.14  090
                                         artery.
35372........  ...........  A.........  Rechanneling of         18.50           NA           NA          6.12         7.11          2.63  090
                                         artery.
35390........  ...........  A.........  Reoperation,             3.19           NA           NA          0.82         0.95          0.46  ZZZ
                                         carotid add-on.
35400........  ...........  A.........  Angioscopy.......        3.00           NA           NA          0.72         0.92          0.43  ZZZ
35450........  ...........  A.........  Repair arterial         10.05           NA           NA          2.96         3.30          1.25  000
                                         blockage.
35452........  ...........  A.........  Repair arterial          6.90           NA           NA          2.06         2.34          0.94  000
                                         blockage.
35454........  ...........  A.........  Repair arterial          6.03           NA           NA          1.76         2.05          0.87  000
                                         blockage.
35456........  ...........  A.........  Repair arterial          7.34           NA           NA          2.12         2.47          1.04  000
                                         blockage.
35458........  ...........  A.........  Repair arterial          9.48           NA           NA          2.80         3.15          1.26  000
                                         blockage.
35459........  ...........  A.........  Repair arterial          8.62           NA           NA          2.63         2.88          1.21  000
                                         blockage.
35460........  ...........  A.........  Repair venous            6.03           NA           NA          1.75         2.02          0.83  000
                                         blockage.
35470........  ...........  A.........  Repair arterial          8.62        59.93        74.50          3.39         3.38          0.69  000
                                         blockage.
35471........  ...........  A.........  Repair arterial         10.05        64.34        82.51          4.56         4.27          0.67  000
                                         blockage.
35472........  ...........  A.........  Repair arterial          6.90        46.58        55.56          2.77         2.76          0.58  000
                                         blockage.
35473........  ...........  A.........  Repair arterial          6.03        45.57        52.79          2.46         2.44          0.51  000
                                         blockage.
35474........  ...........  A.........  Repair arterial          7.35        59.20        73.53          2.93         2.91          0.57  000
                                         blockage.
35475........  ...........  R.........  Repair arterial          9.48        48.02        51.97          3.38         3.45          0.62  000
                                         blockage.
35476........  ...........  A.........  Repair venous            6.03        36.79        40.56          2.25         2.26          0.34  000
                                         blockage.
35480........  ...........  A.........  Atherectomy, open       11.06           NA           NA          3.98         4.01          1.28  000
35481........  ...........  A.........  Atherectomy, open        7.60           NA           NA          2.58         2.71          1.13  000
35482........  ...........  A.........  Atherectomy, open        6.64           NA           NA          2.01         2.30          0.89  000
35483........  ...........  A.........  Atherectomy, open        8.09           NA           NA          2.55         2.82          1.15  000
35484........  ...........  A.........  Atherectomy, open       10.42           NA           NA          2.90         3.36          1.27  000
35485........  ...........  A.........  Atherectomy, open        9.48           NA           NA          2.86         3.22          1.35  000
35490........  ...........  A.........  Atherectomy,            11.06           NA           NA          5.04         5.09          0.71  000
                                         percutaneous.
35491........  ...........  A.........  Atherectomy,             7.60           NA           NA          3.74         3.55          0.74  000
                                         percutaneous.
35492........  ...........  A.........  Atherectomy,             6.64           NA           NA          3.40         3.33          0.43  000
                                         percutaneous.
35493........  ...........  A.........  Atherectomy,             8.09           NA           NA          3.87         3.88          0.56  000
                                         percutaneous.
35494........  ...........  A.........  Atherectomy,            10.42           NA           NA          5.01         4.76          0.59  000
                                         percutaneous.
35495........  ...........  A.........  Atherectomy,             9.48           NA           NA          4.35         4.42          0.69  000
                                         percutaneous.
35500........  ...........  A.........  Harvest vein for         6.44           NA           NA          1.60         1.83          0.93  ZZZ
                                         bypass.
35501........  ...........  A.........  Artery bypass           28.99           NA           NA         11.04         9.83          4.10  090
                                         graft.
35506........  ...........  A.........  Artery bypass           25.23           NA           NA          8.34         8.92          2.87  090
                                         graft.
35508........  ...........  A.........  Artery bypass           25.99           NA           NA          8.77         9.16          2.78  090
                                         graft.
35509........  ...........  A.........  Artery bypass           27.99           NA           NA         10.74         9.74          3.92  090
                                         graft.
35510........  ...........  A.........  Artery bypass           24.29           NA           NA          7.68         8.94          2.12  090
                                         graft.
35511........  ...........  A.........  Artery bypass           22.12           NA           NA          7.58         8.41          2.91  090
                                         graft.
35512........  ...........  A.........  Artery bypass           23.79           NA           NA          7.47         8.74          2.12  090
                                         graft.

[[Page 38272]]

 
35515........  ...........  A.........  Artery bypass           25.99           NA           NA          9.09         9.07          2.78  090
                                         graft.
35516........  ...........  A.........  Artery bypass           24.11           NA           NA          7.46         7.18          2.34  090
                                         graft.
35518........  ...........  A.........  Artery bypass           22.57           NA           NA          7.36         8.19          3.03  090
                                         graft.
35521........  ...........  A.........  Artery bypass           24.00           NA           NA          7.96         8.92          3.13  090
                                         graft.
35522........  ...........  A.........  Artery bypass           23.05           NA           NA          7.40         8.59          2.12  090
                                         graft.
35525........  ...........  A.........  Artery bypass           21.59           NA           NA          7.03         8.22          2.12  090
                                         graft.
35526........  ...........  A.........  Artery bypass           31.47           NA           NA         13.81        13.92          3.63  090
                                         graft.
35531........  ...........  A.........  Artery bypass           38.98           NA           NA         11.47        13.04          5.18  090
                                         graft.
35533........  ...........  A.........  Artery bypass           29.79           NA           NA          9.50        10.69          3.85  090
                                         graft.
35536........  ...........  A.........  Artery bypass           33.60           NA           NA          9.50        11.39          4.62  090
                                         graft.
35537........  ...........  A.........  Artery bypass           41.75           NA           NA         13.08        13.17          5.72  090
                                         graft.
35538........  ...........  A.........  Artery bypass           46.82           NA           NA         14.44        14.55          6.39  090
                                         graft.
35539........  ...........  A.........  Artery bypass           43.98           NA           NA         13.48        13.65          6.02  090
                                         graft.
35540........  ...........  A.........  Artery bypass           49.20           NA           NA         14.82        15.01          6.76  090
                                         graft.
35548........  ...........  A.........  Artery bypass           22.57           NA           NA          7.73         8.60          2.98  090
                                         graft.
35549........  ...........  A.........  Artery bypass           24.34           NA           NA          8.74         9.63          3.30  090
                                         graft.
35551........  ...........  A.........  Artery bypass           27.72           NA           NA          9.39        10.52          3.75  090
                                         graft.
35556........  ...........  A.........  Artery bypass           26.62           NA           NA          8.63         9.22          3.10  090
                                         graft.
35558........  ...........  A.........  Artery bypass           23.00           NA           NA          7.85         8.73          3.00  090
                                         graft.
35560........  ...........  A.........  Artery bypass           33.90           NA           NA         10.63        11.99          4.75  090
                                         graft.
35563........  ...........  A.........  Artery bypass           25.99           NA           NA          8.84         9.63          3.52  090
                                         graft.
35565........  ...........  A.........  Artery bypass           25.00           NA           NA          8.15         9.19          3.30  090
                                         graft.
35566........  ...........  A.........  Artery bypass           32.22           NA           NA          9.84        10.66          3.83  090
                                         graft.
35571........  ...........  A.........  Artery bypass           25.39           NA           NA          8.08         9.51          3.43  090
                                         graft.
35572........  ...........  A.........  Harvest                  6.81           NA           NA          1.92         2.07          0.99  ZZZ
                                         femoropopliteal
                                         vein.
35583........  ...........  A.........  Vein bypass graft       27.62           NA           NA          8.64         9.45          3.17  090
35585........  ...........  A.........  Vein bypass graft       32.22           NA           NA         10.10        11.19          4.02  090
35587........  ...........  A.........  Vein bypass graft       26.08           NA           NA          8.48         9.99          3.52  090
35600........  ...........  A.........  Harvest artery           4.94           NA           NA          1.53         1.58          0.73  ZZZ
                                         for cabg.
35601........  ...........  A.........  Artery bypass           26.99           NA           NA         10.38         9.52          3.72  090
                                         graft.
35606........  ...........  A.........  Artery bypass           22.36           NA           NA          7.30         8.21          2.70  090
                                         graft.
35612........  ...........  A.........  Artery bypass           16.71           NA           NA          6.29         7.10          2.09  090
                                         graft.
35616........  ...........  A.........  Artery bypass           21.74           NA           NA          7.09         7.60          2.20  090
                                         graft.
35621........  ...........  A.........  Artery bypass           20.95           NA           NA          6.77         7.76          2.92  090
                                         graft.
35623........  ...........  A.........  Bypass graft, not       25.79           NA           NA          8.43         9.49          3.46  090
                                         vein.
35626........  ...........  A.........  Artery bypass           29.06           NA           NA         10.20        11.09          4.08  090
                                         graft.
35631........  ...........  A.........  Artery bypass           35.90           NA           NA         10.54        12.26          4.96  090
                                         graft.
35636........  ...........  A.........  Artery bypass           31.62           NA           NA          9.72        11.03          4.10  090
                                         graft.
35637........  ...........  A.........  Artery bypass           32.92           NA           NA         10.65        10.83          4.44  090
                                         graft.
35638........  ...........  A.........  Artery bypass           33.47           NA           NA         10.79        10.97          4.52  090
                                         graft.
35642........  ...........  A.........  Artery bypass           18.85           NA           NA          6.20         7.69          2.28  090
                                         graft.
35645........  ...........  A.........  Artery bypass           18.34           NA           NA          7.86         7.97          2.50  090
                                         graft.
35646........  ...........  A.........  Artery bypass           32.84           NA           NA         10.44        11.82          4.44  090
                                         graft.
35647........  ...........  A.........  Artery bypass           29.62           NA           NA          9.65        10.73          3.99  090
                                         graft.
35650........  ...........  A.........  Artery bypass           20.08           NA           NA          6.90         7.61          2.72  090
                                         graft.
35651........  ...........  A.........  Artery bypass           25.97           NA           NA          8.75         9.74          3.36  090
                                         graft.
35654........  ...........  A.........  Artery bypass           26.17           NA           NA          8.34         9.53          3.53  090
                                         graft.
35656........  ...........  A.........  Artery bypass           20.39           NA           NA          6.83         7.75          2.80  090
                                         graft.
35661........  ...........  A.........  Artery bypass           20.22           NA           NA          7.03         8.02          2.72  090
                                         graft.
35663........  ...........  A.........  Artery bypass           23.80           NA           NA          7.92         8.97          3.11  090
                                         graft.
35665........  ...........  A.........  Artery bypass           22.22           NA           NA          7.35         8.44          3.01  090
                                         graft.
35666........  ...........  A.........  Artery bypass           23.53           NA           NA          8.48         9.60          3.16  090
                                         graft.
35671........  ...........  A.........  Artery bypass           20.64           NA           NA          7.61         8.54          2.78  090
                                         graft.
35681........  ...........  A.........  Composite bypass         1.60           NA           NA          0.40         0.47          0.23  ZZZ
                                         graft.
35682........  ...........  A.........  Composite bypass         7.19           NA           NA          1.70         2.05          1.03  ZZZ
                                         graft.
35683........  ...........  A.........  Composite bypass         8.49           NA           NA          1.96         2.41          1.20  ZZZ
                                         graft.
35685........  ...........  A.........  Bypass graft             4.04           NA           NA          0.96         1.16          0.58  ZZZ
                                         patency/patch.
35686........  ...........  A.........  Bypass graft/av          3.34           NA           NA          0.84         0.99          0.47  ZZZ
                                         fist patency.
35691........  ...........  A.........  Arterial                18.32           NA           NA          5.88         7.21          2.59  090
                                         transposition.
35693........  ...........  A.........  Arterial                15.64           NA           NA          6.10         6.90          2.22  090
                                         transposition.
35694........  ...........  A.........  Arterial                19.19           NA           NA          6.32         7.50          2.70  090
                                         transposition.
35695........  ...........  A.........  Arterial                19.97           NA           NA          6.70         7.61          2.74  090
                                         transposition.
35697........  ...........  A.........  Reimplant artery         3.00           NA           NA          0.74         0.89          0.41  ZZZ
                                         each.
35700........  ...........  A.........  Reoperation,             3.08           NA           NA          0.77         0.90          0.44  ZZZ
                                         bypass graft.
35701........  ...........  A.........  Exploration,             9.11           NA           NA          4.31         4.72          1.12  090
                                         carotid artery.
35721........  ...........  A.........  Exploration,             7.66           NA           NA          3.79         4.10          1.03  090
                                         femoral artery.
35741........  ...........  A.........  Exploration              8.61           NA           NA          3.86         4.28          1.12  090
                                         popliteal artery.
35761........  ...........  A.........  Exploration of           5.84           NA           NA          3.42         3.73          0.75  090
                                         artery/vein.
35800........  ...........  A.........  Explore neck             7.99           NA           NA          3.94         4.30          0.95  090
                                         vessels.
35820........  ...........  A.........  Explore chest           36.81           NA           NA         12.92        10.11          1.95  090
                                         vessels.
35840........  ...........  A.........  Explore abdominal       10.87           NA           NA          4.79         5.05          1.34  090
                                         vessels.
35860........  ...........  A.........  Explore limb             6.72           NA           NA          3.36         3.71          0.78  090
                                         vessels.

[[Page 38273]]

 
35870........  ...........  A.........  Repair vessel           24.39           NA           NA          7.90         8.88          3.01  090
                                         graft defect.
35875........  ...........  A.........  Removal of clot         10.64           NA           NA          4.27         4.74          1.41  090
                                         in graft.
35876........  ...........  A.........  Removal of clot         17.74           NA           NA          5.94         6.75          2.40  090
                                         in graft.
35879........  ...........  A.........  Revise graft w/         17.28           NA           NA          5.96         6.85          2.28  090
                                         vein.
35881........  ...........  A.........  Revise graft w/         19.22           NA           NA          6.45         7.60          2.56  090
                                         vein.
35883........  ...........  A.........  Revise graft w/         23.07           NA           NA          8.45         8.79          3.19  090
                                         nonauto graft.
35884........  ...........  A.........  Revise graft w/         24.57           NA           NA          8.89         9.25          3.41  090
                                         vein.
35901........  ...........  A.........  Excision, graft,         8.26           NA           NA          4.23         4.78          1.15  090
                                         neck.
35903........  ...........  A.........  Excision, graft,         9.44           NA           NA          4.58         5.39          1.30  090
                                         extremity.
35905........  ...........  A.........  Excision, graft,        33.39           NA           NA         10.65        11.93          4.44  090
                                         thorax.
35907........  ...........  A.........  Excision, graft,        37.14           NA           NA         10.89        12.59          4.92  090
                                         abdomen.
36000........  ...........  A.........  Place needle in          0.18         0.45         0.51          0.06         0.05          0.01  XXX
                                         vein.
36002........  ...........  A.........  Pseudoaneurysm           1.96         2.23         2.53          0.86         0.90          0.17  000
                                         injection trt.
36005........  ...........  A.........  Injection ext            0.95         8.31         7.97          0.38         0.34          0.05  000
                                         venography.
36010........  ...........  A.........  Place catheter in        2.43        10.97        15.10          0.79         0.78          0.20  XXX
                                         vein.
36011........  ...........  A.........  Place catheter in        3.14        19.38        23.54          1.01         1.02          0.27  XXX
                                         vein.
36012........  ...........  A.........  Place catheter in        3.51        20.00        19.39          1.28         1.21          0.23  XXX
                                         vein.
36013........  ...........  A.........  Place catheter in        2.52        18.38        19.98          0.91         0.81          0.25  XXX
                                         artery.
36014........  ...........  A.........  Place catheter in        3.02        18.75        19.33          1.12         1.05          0.19  XXX
                                         artery.
36015........  ...........  A.........  Place catheter in        3.51        18.34        20.87          1.05         1.10          0.21  XXX
                                         artery.
36100........  ...........  A.........  Establish access         3.02        10.95        11.54          1.18         1.15          0.26  XXX
                                         to artery.
36120........  ...........  A.........  Establish access         2.01         9.11         9.90          0.60         0.62          0.14  XXX
                                         to artery.
36140........  ...........  A.........  Establish access         2.01        10.28        11.53          0.70         0.67          0.16  XXX
                                         to artery.
36145........  ...........  A.........  Artery to vein           2.01        10.19        11.31          0.66         0.65          0.11  XXX
                                         shunt.
36160........  ...........  A.........  Establish access         2.52        11.30        12.43          1.04         0.89          0.26  XXX
                                         to aorta.
36200........  ...........  A.........  Place catheter in        3.02        13.45        14.95          1.01         1.00          0.24  XXX
                                         aorta.
36215........  ...........  A.........  Place catheter in        4.67        25.46        26.21          1.87         1.72          0.27  XXX
                                         artery.
36216........  ...........  A.........  Place catheter in        5.27        27.57        28.24          2.07         1.90          0.31  XXX
                                         artery.
36217........  ...........  A.........  Place catheter in        6.29        45.25        50.18          2.43         2.26          0.44  XXX
                                         artery.
36218........  ...........  A.........  Place catheter in        1.01         3.72         4.39          0.39         0.36          0.07  ZZZ
                                         artery.
36245........  ...........  A.........  Place catheter in        4.67        28.07        30.14          2.06         1.87          0.31  XXX
                                         artery.
36246........  ...........  A.........  Place catheter in        5.27        26.94        28.43          1.97         1.88          0.38  XXX
                                         artery.
36247........  ...........  A.........  Place catheter in        6.29        44.33        46.92          2.33         2.22          0.47  XXX
                                         artery.
36248........  ...........  A.........  Place catheter in        1.01         3.12         3.58          0.38         0.36          0.07  ZZZ
                                         artery.
36260........  ...........  A.........  Insertion of             9.82           NA           NA          4.63         4.79          1.29  090
                                         infusion pump.
36261........  ...........  A.........  Revision of              5.55           NA           NA          3.04         3.37          0.70  090
                                         infusion pump.
36262........  ...........  A.........  Removal of               4.05           NA           NA          2.69         2.72          0.54  090
                                         infusion pump.
36299........  ...........  C.........  Vessel injection         0.00         0.00         6.30          0.00         6.30          0.00  YYY
                                         procedure.
36400........  ...........  A.........  Bl draw < 3 yrs          0.38         0.28         0.29          0.09         0.10          0.03  XXX
                                         fem/jugular.
36405........  ...........  A.........  Bl draw < 3 yrs          0.31         0.27         0.27          0.08         0.08          0.03  XXX
                                         scalp vein.
36406........  ...........  A.........  Bl draw < 3 yrs          0.18         0.24         0.27          0.04         0.05          0.01  XXX
                                         other vein.
36410........  ...........  A.........  Non-routine bl           0.18         0.31         0.30          0.05         0.05          0.01  XXX
                                         draw > 3 yrs.
36420........  ...........  A.........  Vein access              1.01           NA           NA          0.21         0.24          0.07  XXX
                                         cutdown < 1 yr.
36425........  ...........  A.........  Vein access              0.76           NA           NA          0.20         0.21          0.06  XXX
                                         cutdown > 1 yr.
36430........  ...........  A.........  Blood transfusion        0.00         0.93         0.97          0.00         0.51          0.06  XXX
                                         service.
36440........  ...........  A.........  Bl push                  1.03           NA           NA          0.25         0.30          0.10  XXX
                                         transfuse, 2 yr
                                         or <.
36450........  ...........  A.........  Bl exchange/             2.23           NA           NA          0.77         0.74          0.21  XXX
                                         transfuse, nb.
36455........  ...........  A.........  Bl exchange/             2.43           NA           NA          0.67         0.86          0.15  XXX
                                         transfuse non-nb.
36460........  ...........  A.........  Transfusion              6.58           NA           NA          1.84         2.01          0.79  XXX
                                         service, fetal.
36470........  ...........  A.........  Injection therapy        1.09         2.38         2.54          0.64         0.69          0.12  010
                                         of vein.
36471........  ...........  A.........  Injection therapy        1.60         2.54         2.81          0.79         0.88          0.19  010
                                         of veins.
36475........  ...........  A.........  Endovenous rf,           6.72        35.43        43.52          1.88         2.22          0.37  000
                                         1st vein.
36476........  ...........  A.........  Endovenous rf,           3.38         6.09         6.96          0.83         1.00          0.18  ZZZ
                                         vein add-on.
36478........  ...........  A.........  Endovenous laser,        6.72        26.65        36.69          2.05         2.29          0.37  000
                                         1st vein.
36479........  ...........  A.........  Endovenous laser         3.38         6.29         7.16          0.95         1.05          0.18  ZZZ
                                         vein addon.
36481........  ...........  A.........  Insertion of             6.98           NA           NA          2.35         2.42          0.55  000
                                         catheter, vein.
36500........  ...........  A.........  Insertion of             3.51           NA           NA          1.26         1.30          0.20  000
                                         catheter, vein.
36510........  ...........  A.........  Insertion of             1.09         1.05         2.48          0.29         0.46          0.10  000
                                         catheter, vein.
36511........  ...........  A.........  Apheresis wbc....        1.74           NA           NA          0.58         0.65          0.08  000
36512........  ...........  A.........  Apheresis rbc....        1.74           NA           NA          0.61         0.68          0.08  000
36513........  ...........  A.........  Apheresis                1.74           NA           NA          0.55         0.64          0.17  000
                                         platelets.
36514........  ...........  A.........  Apheresis plasma.        1.74        10.41        13.69          0.54         0.63          0.08  000
36515........  ...........  A.........  Apheresis, adsorp/       1.74        45.00        55.61          0.48         0.58          0.08  000
                                         reinfuse.
36516........  ...........  A.........  Apheresis,               1.22        48.74        66.49          0.39         0.44          0.08  000
                                         selective.
36522........  ...........  A.........  Photopheresis....        1.67        37.04        34.36          0.94         0.94          0.13  000
36550........  ...........  A.........  Declot vascular          0.00         0.32         0.35          0.06         0.23          0.37  XXX
                                         device.
36555........  ...........  A.........  Insert non-tunnel        2.68         3.77         4.82          0.59         0.70          0.11  000
                                         cv cath.
36556........  ...........  A.........  Insert non-tunnel        2.50         2.83         4.23          0.56         0.65          0.19  000
                                         cv cath.
36557........  ...........  A.........  Insert tunneled          5.11        14.84        17.90          2.26         2.45          0.57  010
                                         cv cath.
36558........  ...........  A.........  Insert tunneled          4.81        14.71        17.82          2.36         2.43          0.57  010
                                         cv cath.
36560........  ...........  A.........  Insert tunneled          6.26        21.07        25.32          2.69         2.83          0.57  010
                                         cv cath.
36561........  ...........  A.........  Insert tunneled          6.01        22.02        25.76          2.64         2.78          0.57  010
                                         cv cath.

[[Page 38274]]

 
36563........  ...........  A.........  Insert tunneled          6.21        22.86        24.79          2.59         2.79          0.84  010
                                         cv cath.
36565........  ...........  A.........  Insert tunneled          6.01        17.33        21.04          2.47         2.71          0.57  010
                                         cv cath.
36566........  ...........  A.........  Insert tunneled          6.51       110.45        68.26          2.59         2.86          0.57  010
                                         cv cath.
36568........  ...........  A.........  Insert picc cath.        1.92         5.81         6.62          0.60         0.58          0.11  000
36569........  ...........  A.........  Insert picc cath.        1.82         4.44         5.85          0.67         0.60          0.19  000
36570........  ...........  A.........  Insert picvad            5.33        20.99        27.31          2.10         2.44          0.57  010
                                         cath.
36571........  ...........  A.........  Insert picvad            5.31        24.25        28.75          2.44         2.56          0.57  010
                                         cath.
36575........  ...........  A.........  Repair tunneled          0.67         3.27         3.65          0.23         0.24          0.20  000
                                         cv cath.
36576........  ...........  A.........  Repair tunneled          3.21         5.86         6.37          1.56         1.69          0.19  010
                                         cv cath.
36578........  ...........  A.........  Replace tunneled         3.51         9.10        10.05          2.00         2.12          0.19  010
                                         cv cath.
36580........  ...........  A.........  Replace cvad cath        1.31         3.93         5.42          0.43         0.42          0.19  000
36581........  ...........  A.........  Replace tunneled         3.45        15.37        17.34          1.74         1.80          0.19  010
                                         cv cath.
36582........  ...........  A.........  Replace tunneled         5.21        21.33        23.45          2.46         2.62          0.19  010
                                         cv cath.
36583........  ...........  A.........  Replace tunneled         5.26        21.33        23.46          2.49         2.65          0.19  010
                                         cv cath.
36584........  ...........  A.........  Replace picc cath        1.20         3.94         5.42          0.62         0.57          0.19  000
36585........  ...........  A.........  Replace picvad           4.81        22.31        24.96          2.44         2.54          0.19  010
                                         cath.
36589........  ...........  A.........  Removal tunneled         2.27         1.85         2.04          1.23         1.30          0.24  010
                                         cv cath.
36590........  ...........  A.........  Removal tunneled         3.32         3.60         3.48          1.60         1.65          0.44  010
                                         cv cath.
36595........  ...........  A.........  Mech remov               3.59        10.76        13.92          1.39         1.39          0.21  000
                                         tunneled cv cath.
36596........  ...........  A.........  Mech remov               0.75         2.56         3.11          0.43         0.46          0.05  000
                                         tunneled cv cath.
36597........  ...........  A.........  Reposition venous        1.21         2.03         2.20          0.46         0.44          0.07  000
                                         catheter.
36598........  ...........  T.........  Inj w/fluor, eval        0.74         2.19         2.41          0.27         1.45          0.05  000
                                         cv device.
36600........  ...........  A.........  Withdrawal of            0.32         0.49         0.49          0.07         0.08          0.02  XXX
                                         arterial blood.
36620........  ...........  A.........  Insertion                1.15           NA           NA          0.15         0.20          0.07  000
                                         catheter, artery.
36625........  ...........  A.........  Insertion                2.11           NA           NA          0.51         0.52          0.26  000
                                         catheter, artery.
36640........  ...........  A.........  Insertion                2.10           NA           NA          0.91         0.98          0.21  000
                                         catheter, artery.
36660........  ...........  A.........  Insertion                1.40           NA           NA          0.40         0.39          0.14  000
                                         catheter, artery.
36680........  ...........  A.........  Insert needle,           1.20           NA           NA          0.28         0.39          0.11  000
                                         bone cavity.
36800........  ...........  A.........  Insertion of             2.43           NA           NA          1.52         1.67          0.25  000
                                         cannula.
36810........  ...........  A.........  Insertion of             3.96           NA           NA          1.32         1.51          0.45  000
                                         cannula.
36815........  ...........  A.........  Insertion of             2.62           NA           NA          1.04         1.11          0.35  000
                                         cannula.
36818........  ...........  A.........  Av fuse, uppr           11.81           NA           NA          4.48         5.31          1.90  090
                                         arm, cephalic.
36819........  ...........  A.........  Av fuse, uppr           14.39           NA           NA          5.11         5.76          1.96  090
                                         arm, basilic.
36820........  ...........  A.........  Av fusion/forearm       14.39           NA           NA          5.24         5.82          1.95  090
                                         vein.
36821........  ...........  A.........  Av fusion direct         9.15           NA           NA          3.93         4.30          1.23  090
                                         any site.
36822........  ...........  A.........  Insertion of             5.51           NA           NA          3.73         4.06          0.79  090
                                         cannula(s).
36823........  ...........  A.........  Insertion of            22.82           NA           NA          8.63         9.03          2.89  090
                                         cannula(s).
36825........  ...........  A.........  Artery-vein             10.00           NA           NA          4.21         4.65          1.35  090
                                         autograft.
36830........  ...........  A.........  Artery-vein             12.00           NA           NA          4.12         4.69          1.66  090
                                         nonautograft.
36831........  ...........  A.........  Open thrombect av        8.01           NA           NA          3.18         3.57          1.09  090
                                         fistula.
36832........  ...........  A.........  Av fistula              10.50           NA           NA          3.74         4.25          1.44  090
                                         revision, open.
36833........  ...........  A.........  Av fistula              11.95           NA           NA          4.11         4.68          1.65  090
                                         revision.
36834........  ...........  A.........  Repair A-V              11.11           NA           NA          4.20         4.52          1.37  090
                                         aneurysm.
36835........  ...........  A.........  Artery to vein           7.43           NA           NA          3.73         4.05          0.98  090
                                         shunt.
36838........  ...........  A.........  Dist revas              21.59           NA           NA          7.03         8.22          3.02  090
                                         ligation, hemo.
36860........  ...........  A.........  External cannula         2.01         3.33         2.55          0.63         0.66          0.11  000
                                         declotting.
36861........  ...........  A.........  Cannula                  2.52           NA           NA          1.22         1.35          0.27  000
                                         declotting.
36870........  ...........  A.........  Percut thrombect         5.17        40.42        46.50          2.77         2.92          0.29  090
                                         av fistula.
37140........  ...........  A.........  Revision of             25.12           NA           NA          8.95         9.70          2.02  090
                                         circulation.
37145........  ...........  A.........  Revision of             26.13           NA           NA         10.29        10.37          3.26  090
                                         circulation.
37160........  ...........  A.........  Revision of             23.13           NA           NA          7.87         8.60          2.82  090
                                         circulation.
37180........  ...........  A.........  Revision of             26.13           NA           NA          9.32         9.75          3.35  090
                                         circulation.
37181........  ...........  A.........  Splice spleen/          28.26           NA           NA          8.83        10.00          3.41  090
                                         kidney veins.
37182........  ...........  A.........  Insert hepatic          16.97           NA           NA          6.41         6.02          1.00  000
                                         shunt (tips).
37183........  ...........  A.........  Remove hepatic           7.99           NA           NA          3.12         2.97          0.47  000
                                         shunt (tips).
37184........  ...........  A.........  Prim art mech            8.66        49.36        60.20          3.24         3.22          0.55  000
                                         thrombectomy.
37185........  ...........  A.........  Prim art m-              3.28        16.17        19.40          1.12         1.09          0.21  ZZZ
                                         thrombect add-on.
37186........  ...........  A.........  Sec art m-               4.92        34.32        41.56          1.78         1.66          0.32  ZZZ
                                         thrombect add-on.
37187........  ...........  A.........  Venous mech              8.03        47.81        58.74          3.02         3.01          0.51  000
                                         thrombectomy.
37188........  ...........  A.........  Venous m-                5.71        41.84        51.67          2.20         2.23          0.37  000
                                         thrombectomy add-
                                         on.
37195........  ...........  C.........  Thrombolytic             0.00         0.00         4.03          0.00         4.03          0.00  XXX
                                         therapy, stroke.
37200........  ...........  A.........  Transcatheter            4.55           NA           NA          1.67         1.53          0.27  000
                                         biopsy.
37201........  ...........  A.........  Transcatheter            4.99           NA           NA          2.33         2.40          0.33  000
                                         therapy infuse.
37202........  ...........  A.........  Transcatheter            5.67           NA           NA          3.28         3.18          0.43  000
                                         therapy infuse.
37203........  ...........  A.........  Transcatheter            5.02        29.76        31.17          2.08         2.01          0.29  000
                                         retrieval.
37204........  ...........  A.........  Transcatheter           18.11           NA           NA          6.29         5.93          1.48  000
                                         occlusion.
37205........  ...........  A.........  Transcath iv             8.27        73.69        27.08          3.20         3.58          0.60  000
                                         stent, percut.
37206........  ...........  A.........  Transcath iv             4.12        62.08        21.67          1.55         1.49          0.31  ZZZ
                                         stent/perc addl.
37207........  ...........  A.........  Transcath iv             8.27           NA           NA          2.38         2.78          1.17  000
                                         stent, open.
37208........  ...........  A.........  Transcath iv             4.12           NA           NA          1.01         1.20          0.59  ZZZ
                                         stent/open addl.
37209........  ...........  A.........  Change iv cath at        2.27           NA           NA          0.78         0.74          0.15  000
                                         thromb tx.
37210........  ...........  A.........  Embolization            10.60        82.44        80.73          3.71         3.32          0.60  000
                                         uterine fibroid.

[[Page 38275]]

 
37215........  ...........  R.........  Transcath stent,        19.58           NA           NA          9.70         9.46          1.09  090
                                         cca w/eps.
37216........  ...........  N.........  Transcath stent,        18.85           NA           NA          5.75         7.28          1.04  090
                                         cca w/o eps.
37250........  ...........  A.........  Iv us first              2.10           NA           NA          0.75         0.76          0.21  ZZZ
                                         vessel add-on.
37251........  ...........  A.........  Iv us each add           1.60           NA           NA          0.49         0.52          0.19  ZZZ
                                         vessel add-on.
37500........  ...........  A.........  Endoscopy ligate        11.54           NA           NA          5.34         6.11          1.54  090
                                         perf veins.
37501........  ...........  C.........  Vascular                 0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         endoscopy
                                         procedure.
37565........  ...........  A.........  Ligation of neck        11.97           NA           NA          5.15         5.38          1.33  090
                                         vein.
37600........  ...........  A.........  Ligation of neck        12.34           NA           NA          4.92         5.76          1.41  090
                                         artery.
37605........  ...........  A.........  Ligation of neck        14.20           NA           NA          5.48         6.21          1.99  090
                                         artery.
37606........  ...........  A.........  Ligation of neck         8.72           NA           NA          4.85         4.71          1.23  090
                                         artery.
37607........  ...........  A.........  Ligation of a-v          6.19           NA           NA          3.01         3.30          0.85  090
                                         fistula.
37609........  ...........  A.........  Temporal artery          3.02         4.17         4.34          1.82         1.89          0.36  010
                                         procedure.
37615........  ...........  A.........  Ligation of neck         7.72           NA           NA          4.10         4.09          0.68  090
                                         artery.
37616........  ...........  A.........  Ligation of chest       18.89           NA           NA          7.92         8.00          2.33  090
                                         artery.
37617........  ...........  A.........  Ligation of             23.71           NA           NA          7.91         8.54          2.98  090
                                         abdomen artery.
37618........  ...........  A.........  Ligation of              5.95           NA           NA          3.35         3.48          0.67  090
                                         extremity artery.
37620........  ...........  A.........  Revision of major       11.49           NA           NA          5.45         5.50          0.91  090
                                         vein.
37650........  ...........  A.........  Revision of major        8.41           NA           NA          3.99         4.37          1.01  090
                                         vein.
37660........  ...........  A.........  Revision of major       22.20           NA           NA          7.63         8.40          2.49  090
                                         vein.
37700........  ...........  A.........  Revise leg vein..        3.76           NA           NA          2.37         2.59          0.53  090
37718........  ...........  A.........  Ligate/strip             7.05           NA           NA          3.46         3.77          0.14  090
                                         short leg vein.
37722........  ...........  A.........  Ligate/strip long        8.08           NA           NA          3.67         4.06          0.86  090
                                         leg vein.
37735........  ...........  A.........  Removal of leg          10.81           NA           NA          4.67         5.08          1.48  090
                                         veins/lesion.
37760........  ...........  A.........  Ligation, leg           10.69           NA           NA          4.47         4.92          1.44  090
                                         veins, open.
37765........  ...........  A.........  Phleb veins--            7.63           NA           NA          3.57         4.10          0.48  090
                                         extrem--to 20.
37766........  ...........  A.........  Phleb veins--            9.58           NA           NA          4.12         4.71          0.48  090
                                         extrem 20+.
37780........  ...........  A.........  Revision of leg          3.87           NA           NA          2.37         2.63          0.53  090
                                         vein.
37785........  ...........  A.........  Ligate/divide/           3.87         4.87         5.04          2.56         2.65          0.54  090
                                         excise vein.
37788........  ...........  A.........  Revascularization       23.21           NA           NA         12.19        10.63          2.26  090
                                         , penis.
37790........  ...........  A.........  Penile venous            8.37           NA           NA          5.16         4.76          0.59  090
                                         occlusion.
37799........  ...........  C.........  Vascular surgery         0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
38100........  ...........  A.........  Removal of              19.47           NA           NA          6.83         6.51          1.92  090
                                         spleen, total.
38101........  ...........  A.........  Removal of              19.47           NA           NA          6.93         6.79          2.05  090
                                         spleen, partial.
38102........  ...........  A.........  Removal of               4.79           NA           NA          1.23         1.44          0.63  ZZZ
                                         spleen, total.
38115........  ...........  A.........  Repair of               21.80           NA           NA          7.43         7.06          2.09  090
                                         ruptured spleen.
38120........  ...........  A.........  Laparoscopy,            16.97           NA           NA          6.91         7.15          2.25  090
                                         splenectomy.
38129........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         spleen.
38200........  ...........  A.........  Injection for            2.64           NA           NA          1.11         0.98          0.14  000
                                         spleen x-ray.
38204........  ...........  B.........  Bl donor search          2.00         0.46         0.76          0.46         0.76          0.06  XXX
                                         management.
38205........  ...........  R.........  Harvest allogenic        1.50           NA           NA          0.54         0.61          0.07  000
                                         stem cells.
38206........  ...........  R.........  Harvest auto stem        1.50           NA           NA          0.55         0.61          0.07  000
                                         cells.
38207........  ...........  I.........  Cryopreserve stem        0.89         0.40         0.41          0.40         0.41          0.01  XXX
                                         cells.
38208........  ...........  I.........  Thaw preserved           0.56         0.25         0.25          0.25         0.25          0.02  XXX
                                         stem cells.
38209........  ...........  I.........  Wash harvest stem        0.24         0.11         0.11          0.11         0.11          0.01  XXX
                                         cells.
38210........  ...........  I.........  T-cell depletion         1.57         0.71         0.72          0.71         0.72          0.03  XXX
                                         of harvest.
38211........  ...........  I.........  Tumor cell               1.42         0.65         0.65          0.65         0.65          0.02  XXX
                                         deplete of
                                         harvst.
38212........  ...........  I.........  Rbc depletion of         0.94         0.43         0.43          0.43         0.43          0.02  XXX
                                         harvest.
38213........  ...........  I.........  Platelet deplete         0.24         0.11         0.11          0.11         0.11          0.01  XXX
                                         of harvest.
38214........  ...........  I.........  Volume deplete of        0.81         0.37         0.37          0.37         0.37          0.01  XXX
                                         harvest.
38215........  ...........  I.........  Harvest stem cell        0.94         0.43         0.43          0.43         0.43          0.02  XXX
                                         concentrte.
38220........  ...........  A.........  Bone marrow              1.08         2.66         3.19          0.45         0.48          0.05  XXX
                                         aspiration.
38221........  ...........  A.........  Bone marrow              1.37         2.77         3.35          0.58         0.61          0.07  XXX
                                         biopsy.
38230........  ...........  R.........  Bone marrow              4.80           NA           NA          3.14         3.13          0.48  010
                                         collection.
38240........  ...........  R.........  Bone marrow/stem         2.24           NA           NA          0.95         0.99          0.11  XXX
                                         transplant.
38241........  ...........  R.........  Bone marrow/stem         2.24           NA           NA          0.95         1.00          0.11  XXX
                                         transplant.
38242........  ...........  A.........  Lymphocyte infuse        1.71           NA           NA          0.69         0.74          0.08  000
                                         transplant.
38300........  ...........  A.........  Drainage, lymph          2.28         4.18         4.14          2.02         1.99          0.25  010
                                         node lesion.
38305........  ...........  A.........  Drainage, lymph          6.55           NA           NA          4.19         4.18          0.88  090
                                         node lesion.
38308........  ...........  A.........  Incision of lymph        6.73           NA           NA          3.53         3.64          0.85  090
                                         channels.
38380........  ...........  A.........  Thoracic duct            8.34           NA           NA          5.04         5.31          0.74  090
                                         procedure.
38381........  ...........  A.........  Thoracic duct           13.32           NA           NA          6.07         6.48          1.85  090
                                         procedure.
38382........  ...........  A.........  Thoracic duct           10.51           NA           NA          5.43         5.60          1.37  090
                                         procedure.
38500........  ...........  A.........  Biopsy/removal,          3.76         3.72         3.71          2.02         2.05          0.49  010
                                         lymph nodes.
38505........  ...........  A.........  Needle biopsy,           1.14         2.10         2.06          0.74         0.75          0.09  000
                                         lymph nodes.
38510........  ...........  A.........  Biopsy/removal,          6.69         5.36         5.43          3.09         3.27          0.72  010
                                         lymph nodes.
38520........  ...........  A.........  Biopsy/removal,          6.95           NA           NA          3.74         3.89          0.84  090
                                         lymph nodes.
38525........  ...........  A.........  Biopsy/removal,          6.35           NA           NA          3.45         3.37          0.80  090
                                         lymph nodes.
38530........  ...........  A.........  Biopsy/removal,          8.26           NA           NA          4.09         4.24          1.12  090
                                         lymph nodes.
38542........  ...........  A.........  Explore deep             6.08           NA           NA          3.97         4.19          0.60  090
                                         node(s), neck.
38550........  ...........  A.........  Removal, neck/           6.99           NA           NA          4.25         4.08          0.88  090
                                         armpit lesion.
38555........  ...........  A.........  Removal, neck/          15.42           NA           NA          7.45         7.96          1.76  090
                                         armpit lesion.
38562........  ...........  A.........  Removal, pelvic         10.92           NA           NA          5.77         5.77          1.20  090
                                         lymph nodes.

[[Page 38276]]

 
38564........  ...........  A.........  Removal, abdomen        11.29           NA           NA          5.21         5.23          1.32  090
                                         lymph nodes.
38570........  ...........  A.........  Laparoscopy,             9.28           NA           NA          4.06         4.01          1.13  010
                                         lymph node biop.
38571........  ...........  A.........  Laparoscopy,            14.70           NA           NA          6.90         6.28          1.15  010
                                         lymphadenectomy.
38572........  ...........  A.........  Laparoscopy,            16.86           NA           NA          5.99         6.57          1.91  010
                                         lymphadenectomy.
38589........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         lymphatic.
38700........  ...........  A.........  Removal of lymph        12.68           NA           NA          6.54         6.30          0.72  090
                                         nodes, neck.
38720........  ...........  A.........  Removal of lymph        21.72           NA           NA         10.23         9.65          1.20  090
                                         nodes, neck.
38724........  ...........  A.........  Removal of lymph        23.72           NA           NA         11.00        10.25          1.28  090
                                         nodes, neck.
38740........  ...........  A.........  Remove armpit           10.57           NA           NA          4.98         4.97          1.32  090
                                         lymph nodes.
38745........  ...........  A.........  Remove armpit           13.71           NA           NA          6.04         6.06          1.74  090
                                         lymph nodes.
38746........  ...........  A.........  Remove thoracic          4.88           NA           NA          1.43         1.52          0.72  ZZZ
                                         lymph nodes.
38747........  ...........  A.........  Remove abdominal         4.88           NA           NA          1.27         1.47          0.64  ZZZ
                                         lymph nodes.
38760........  ...........  A.........  Remove groin            13.49           NA           NA          5.91         6.03          1.72  090
                                         lymph nodes.
38765........  ...........  A.........  Remove groin            21.78           NA           NA          8.38         8.64          2.48  090
                                         lymph nodes.
38770........  ...........  A.........  Remove pelvis           13.98           NA           NA          6.77         6.29          1.40  090
                                         lymph nodes.
38780........  ...........  A.........  Remove abdomen          17.56           NA           NA          8.03         8.12          1.89  090
                                         lymph nodes.
38790........  ...........  A.........  Inject for               1.29           NA           NA          0.75         0.75          0.13  000
                                         lymphatic x-ray.
38792........  ...........  A.........  Identify sentinel        0.52           NA           NA          0.49         0.46          0.06  000
                                         node.
38794........  ...........  A.........  Access thoracic          4.51           NA           NA          3.18         3.26          0.32  090
                                         lymph duct.
38999........  ...........  C.........  Blood/lymph              0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         system procedure.
39000........  ...........  A.........  Exploration of           7.49           NA           NA          4.26         4.47          0.89  090
                                         chest.
39010........  ...........  A.........  Exploration of          13.11           NA           NA          5.99         6.79          1.76  090
                                         chest.
39200........  ...........  A.........  Removal chest           15.04           NA           NA          6.20         6.87          2.03  090
                                         lesion.
39220........  ...........  A.........  Removal chest           19.47           NA           NA          8.00         8.69          2.46  090
                                         lesion.
39400........  ...........  A.........  Visualization of         8.00           NA           NA          4.14         4.50          0.82  010
                                         chest.
39499........  ...........  C.........  Chest procedure..        0.00         0.00         0.00          0.00         0.00          0.00  YYY
39501........  ...........  A.........  Repair diaphragm        13.89           NA           NA          5.81         6.15          1.78  090
                                         laceration.
39502........  ...........  A.........  Repair                  17.09           NA           NA          6.57         6.86          2.17  090
                                         paraesophageal
                                         hernia.
39503........  ...........  A.........  Repair of              108.67           NA           NA         26.87        30.78         10.98  090
                                         diaphragm hernia.
39520........  ...........  A.........  Repair of               16.63           NA           NA          6.79         7.44          2.24  090
                                         diaphragm hernia.
39530........  ...........  A.........  Repair of               16.22           NA           NA          6.22         6.71          2.11  090
                                         diaphragm hernia.
39531........  ...........  A.........  Repair of               17.23           NA           NA          6.58         6.98          2.22  090
                                         diaphragm hernia.
39540........  ...........  A.........  Repair of               14.51           NA           NA          5.73         5.96          1.80  090
                                         diaphragm hernia.
39541........  ...........  A.........  Repair of               15.67           NA           NA          6.05         6.34          1.93  090
                                         diaphragm hernia.
39545........  ...........  A.........  Revision of             14.58           NA           NA          6.87         7.26          1.84  090
                                         diaphragm.
39560........  ...........  A.........  Resect diaphragm,       12.97           NA           NA          5.52         5.91          1.59  090
                                         simple.
39561........  ...........  A.........  Resect diaphragm,       19.75           NA           NA          9.30         9.33          2.45  090
                                         complex.
39599........  ...........  C.........  Diaphragm surgery        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
40490........  ...........  A.........  Biopsy of lip....        1.22         2.09         1.86          0.59         0.60          0.05  000
40500........  ...........  A.........  Partial excision         4.35         7.88         7.37          4.36         4.33          0.38  090
                                         of lip.
40510........  ...........  A.........  Partial excision         4.74         6.73         6.64          3.63         3.80          0.49  090
                                         of lip.
40520........  ...........  A.........  Partial excision         4.71         6.98         7.25          3.82         3.96          0.52  090
                                         of lip.
40525........  ...........  A.........  Reconstruct lip          7.61           NA           NA          5.35         5.82          0.85  090
                                         with flap.
40527........  ...........  A.........  Reconstruct lip          9.20           NA           NA          6.16         6.73          0.97  090
                                         with flap.
40530........  ...........  A.........  Partial removal          5.45         7.57         7.66          4.27         4.40          0.55  090
                                         of lip.
40650........  ...........  A.........  Repair lip.......        3.69         5.93         6.36          3.15         3.22          0.38  090
40652........  ...........  A.........  Repair lip.......        4.32         7.23         7.46          4.11         4.18          0.52  090
40654........  ...........  A.........  Repair lip.......        5.37         8.06         8.34          4.68         4.81          0.60  090
40700........  ...........  A.........  Repair cleft lip/       13.97           NA           NA          8.71         8.99          0.95  090
                                         nasal.
40701........  ...........  A.........  Repair cleft lip/       17.03           NA           NA          7.83        10.18          1.65  090
                                         nasal.
40702........  ...........  A.........  Repair cleft lip/       14.09           NA           NA          5.83         7.29          1.23  090
                                         nasal.
40720........  ...........  A.........  Repair cleft lip/       14.54           NA           NA          9.55         9.66          1.80  090
                                         nasal.
40761........  ...........  A.........  Repair cleft lip/       15.69           NA           NA          9.32         9.75          1.94  090
                                         nasal.
40799........  ...........  C.........  Lip surgery              0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
40800........  ...........  A.........  Drainage of mouth        1.19         3.83         3.40          1.88         1.83          0.13  010
                                         lesion.
40801........  ...........  A.........  Drainage of mouth        2.57         4.88         4.45          2.59         2.66          0.31  010
                                         lesion.
40804........  ...........  A.........  Removal, foreign         1.26         3.77         3.56          1.83         1.83          0.11  010
                                         body, mouth.
40805........  ...........  A.........  Removal, foreign         2.73         5.12         4.79          2.66         2.73          0.32  010
                                         body, mouth.
40806........  ...........  A.........  Incision of lip          0.31         2.41         2.12          0.51         0.50          0.04  000
                                         fold.
40808........  ...........  A.........  Biopsy of mouth          0.98         3.59         3.11          1.62         1.55          0.10  010
                                         lesion.
40810........  ...........  A.........  Excision of mouth        1.33         3.67         3.26          1.72         1.68          0.13  010
                                         lesion.
40812........  ...........  A.........  Excise/repair            2.33         4.54         4.13          2.29         2.34          0.28  010
                                         mouth lesion.
40814........  ...........  A.........  Excise/repair            3.45         5.69         5.30          3.70         3.79          0.41  090
                                         mouth lesion.
40816........  ...........  A.........  Excision of mouth        3.70         5.90         5.52          3.78         3.88          0.40  090
                                         lesion.
40818........  ...........  A.........  Excise oral              2.72         5.81         5.48          3.74         3.85          0.21  090
                                         mucosa for graft.
40819........  ...........  A.........  Excise lip or            2.45         4.93         4.50          3.11         3.10          0.29  090
                                         cheek fold.
40820........  ...........  A.........  Treatment of             1.30         5.28         4.58          2.93         2.67          0.11  010
                                         mouth lesion.
40830........  ...........  A.........  Repair mouth             1.78         4.01         3.88          1.99         2.04          0.19  010
                                         laceration.
40831........  ...........  A.........  Repair mouth             2.50         5.21         4.96          2.69         2.88          0.30  010
                                         laceration.
40840........  ...........  R.........  Reconstruction of        9.03        10.03         9.91          5.63         6.30          1.08  090
                                         mouth.
40842........  ...........  R.........  Reconstruction of        9.03        10.35        10.11          5.81         6.23          1.08  090
                                         mouth.
40843........  ...........  R.........  Reconstruction of       12.62        11.36        11.73          5.81         6.86          1.39  090
                                         mouth.

[[Page 38277]]

 
40844........  ...........  R.........  Reconstruction of       16.57        15.45        15.51          9.34        10.37          2.00  090
                                         mouth.
40845........  ...........  R.........  Reconstruction of       19.13        16.03        16.44         10.26        11.65          2.01  090
                                         mouth.
40899........  ...........  C.........  Mouth surgery            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
41000........  ...........  A.........  Drainage of mouth        1.32         2.55         2.42          1.33         1.37          0.12  010
                                         lesion.
41005........  ...........  A.........  Drainage of mouth        1.28         4.30         3.80          1.77         1.74          0.12  010
                                         lesion.
41006........  ...........  A.........  Drainage of mouth        3.28         5.46         5.10          2.85         3.00          0.35  090
                                         lesion.
41007........  ...........  A.........  Drainage of mouth        3.14         5.34         5.24          2.73         2.88          0.31  090
                                         lesion.
41008........  ...........  A.........  Drainage of mouth        3.40         5.52         5.09          2.87         3.03          0.42  090
                                         lesion.
41009........  ...........  A.........  Drainage of mouth        3.63         5.85         5.40          3.17         3.37          0.47  090
                                         lesion.
41010........  ...........  A.........  Incision of              1.08         3.86         3.56          1.56         1.55          0.07  010
                                         tongue fold.
41015........  ...........  A.........  Drainage of mouth        4.00         6.30         5.84          4.00         4.06          0.46  090
                                         lesion.
41016........  ...........  A.........  Drainage of mouth        4.11         6.23         5.91          4.08         4.15          0.53  090
                                         lesion.
41017........  ...........  A.........  Drainage of mouth        4.11         6.38         6.00          4.14         4.21          0.53  090
                                         lesion.
41018........  ...........  A.........  Drainage of mouth        5.14         6.77         6.42          4.51         4.52          0.68  090
                                         lesion.
41100........  ...........  A.........  Biopsy of tongue.        1.39         2.68         2.53          1.18         1.29          0.15  010
41105........  ...........  A.........  Biopsy of tongue.        1.44         2.67         2.47          1.20         1.25          0.13  010
41108........  ...........  A.........  Biopsy of floor          1.07         2.51         2.27          1.08         1.10          0.10  010
                                         of mouth.
41110........  ...........  A.........  Excision of              1.53         3.64         3.28          1.64         1.63          0.13  010
                                         tongue lesion.
41112........  ...........  A.........  Excision of              2.77         5.25         4.84          3.24         3.22          0.28  090
                                         tongue lesion.
41113........  ...........  A.........  Excision of              3.23         5.52         5.11          3.40         3.43          0.34  090
                                         tongue lesion.
41114........  ...........  A.........  Excision of              8.71           NA           NA          6.33         6.71          0.83  090
                                         tongue lesion.
41115........  ...........  A.........  Excision of              1.76         4.19         3.75          1.73         1.80          0.18  010
                                         tongue fold.
41116........  ...........  A.........  Excision of mouth        2.47         5.54         4.91          2.80         2.78          0.23  090
                                         lesion.
41120........  ...........  A.........  Partial removal         10.91           NA           NA         14.29        14.64          0.79  090
                                         of tongue.
41130........  ...........  A.........  Partial removal         15.51           NA           NA         15.88        15.83          0.93  090
                                         of tongue.
41135........  ...........  A.........  Tongue and neck         29.83           NA           NA         21.89        22.26          1.89  090
                                         surgery.
41140........  ...........  A.........  Removal of tongue       28.81           NA           NA         23.58        24.79          2.27  090
41145........  ...........  A.........  Tongue removal,         37.59           NA           NA         28.85        29.32          2.55  090
                                         neck surgery.
41150........  ...........  A.........  Tongue, mouth,          29.52           NA           NA         23.06        23.60          1.95  090
                                         jaw surgery.
41153........  ...........  A.........  Tongue, mouth,          33.28           NA           NA         23.98        24.19          2.01  090
                                         neck surgery.
41155........  ...........  A.........  Tongue, jaw, &          43.96           NA           NA         27.67        26.88          2.34  090
                                         neck surgery.
41250........  ...........  A.........  Repair tongue            1.93         3.83         3.28          1.60         1.39          0.18  010
                                         laceration.
41251........  ...........  A.........  Repair tongue            2.29         3.47         3.32          1.77         1.64          0.22  010
                                         laceration.
41252........  ...........  A.........  Repair tongue            2.99         4.57         4.20          2.13         2.16          0.29  010
                                         laceration.
41500........  ...........  A.........  Fixation of              3.74           NA           NA          7.49         7.31          0.30  090
                                         tongue.
41510........  ...........  A.........  Tongue to lip            3.45           NA           NA          6.42         7.28          0.20  090
                                         surgery.
41520........  ...........  A.........  Reconstruction,          2.77         5.77         5.19          3.25         3.43          0.27  090
                                         tongue fold.
41599........  ...........  C.........  Tongue and mouth         0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
41800........  ...........  A.........  Drainage of gum          1.21         4.77         3.68          2.11         1.70          0.12  010
                                         lesion.
41805........  ...........  A.........  Removal foreign          1.28         4.61         3.66          2.69         2.46          0.13  010
                                         body, gum.
41806........  ...........  A.........  Removal foreign          2.73         5.82         4.71          3.35         3.20          0.37  010
                                         body,jawbone.
41822........  ...........  R.........  Excision of gum          2.35         4.80         4.32          1.86         1.85          0.31  010
                                         lesion.
41823........  ...........  R.........  Excision of gum          3.63         6.41         6.00          3.71         3.87          0.47  090
                                         lesion.
41825........  ...........  A.........  Excision of gum          1.35         3.68         3.36          1.47         1.85          0.15  010
                                         lesion.
41826........  ...........  A.........  Excision of gum          2.35         5.09         3.76          2.58         2.35          0.30  010
                                         lesion.
41827........  ...........  A.........  Excision of gum          3.72         6.63         6.07          3.39         3.52          0.35  090
                                         lesion.
41828........  ...........  R.........  Excision of gum          3.11         4.10         3.95          1.66         2.31          0.44  010
                                         lesion.
41830........  ...........  R.........  Removal of gum           3.38         5.98         5.48          3.13         3.38          0.44  010
                                         tissue.
41872........  ...........  R.........  Repair gum.......        2.90         6.02         5.50          3.30         3.38          0.30  090
41874........  ...........  R.........  Repair tooth             3.13         5.67         5.27          2.73         2.96          0.45  090
                                         socket.
41899........  ...........  C.........  Dental surgery           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
42000........  ...........  A.........  Drainage mouth           1.25         2.47         2.50          1.20         1.22          0.12  010
                                         roof lesion.
42100........  ...........  A.........  Biopsy roof of           1.33         2.27         2.16          1.26         1.31          0.13  010
                                         mouth.
42104........  ...........  A.........  Excision lesion,         1.66         3.56         3.03          1.67         1.60          0.16  010
                                         mouth roof.
42106........  ...........  A.........  Excision lesion,         2.12         4.45         3.83          2.08         2.26          0.25  010
                                         mouth roof.
42107........  ...........  A.........  Excision lesion,         4.48         6.53         6.09          3.70         3.81          0.44  090
                                         mouth roof.
42120........  ...........  A.........  Remove palate/          11.70           NA           NA         12.27        11.90          0.52  090
                                         lesion.
42140........  ...........  A.........  Excision of uvula        1.65         4.55         4.08          2.11         2.08          0.13  090
42145........  ...........  A.........  Repair palate,           9.63           NA           NA          7.50         7.39          0.65  090
                                         pharynx/uvula.
42160........  ...........  A.........  Treatment mouth          1.82         3.77         3.99          1.69         1.98          0.17  010
                                         roof lesion.
42180........  ...........  A.........  Repair palate....        2.52         3.36         3.19          1.86         1.97          0.21  010
42182........  ...........  A.........  Repair palate....        3.84         3.99         3.94          2.41         2.72          0.40  010
42200........  ...........  A.........  Reconstruct cleft       12.41           NA           NA          8.64         9.36          1.27  090
                                         palate.
42205........  ...........  A.........  Reconstruct cleft       13.57           NA           NA          7.37         8.76          1.58  090
                                         palate.
42210........  ...........  A.........  Reconstruct cleft       14.91           NA           NA         10.29        10.80          2.17  090
                                         palate.
42215........  ...........  A.........  Reconstruct cleft        8.88           NA           NA          7.43         8.24          1.31  090
                                         palate.
42220........  ...........  A.........  Reconstruct cleft        7.07           NA           NA          7.20         6.93          0.73  090
                                         palate.
42225........  ...........  A.........  Reconstruct cleft        9.66           NA           NA         12.28        14.65          0.86  090
                                         palate.
42226........  ...........  A.........  Lengthening of          10.24           NA           NA         11.88        13.22          1.01  090
                                         palate.
42227........  ...........  A.........  Lengthening of           9.81           NA           NA         11.19        13.13          0.98  090
                                         palate.
42235........  ...........  A.........  Repair palate....        7.92           NA           NA         10.31        11.09          0.72  090
42260........  ...........  A.........  Repair nose to          10.10         9.75         9.96          6.08         6.55          1.26  090
                                         lip fistula.

[[Page 38278]]

 
42280........  ...........  A.........  Preparation,             1.56         2.23         2.10          0.84         0.99          0.19  010
                                         palate mold.
42281........  ...........  A.........  Insertion, palate        1.95         3.02         2.79          1.69         1.76          0.17  010
                                         prosthesis.
42299........  ...........  C.........  Palate/uvula             0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
42300........  ...........  A.........  Drainage of              1.95         3.12         2.94          1.74         1.75          0.16  010
                                         salivary gland.
42305........  ...........  A.........  Drainage of              6.23           NA           NA          4.00         4.31          0.51  090
                                         salivary gland.
42310........  ...........  A.........  Drainage of              1.58         2.28         2.25          1.39         1.46          0.13  010
                                         salivary gland.
42320........  ...........  A.........  Drainage of              2.37         3.73         3.47          1.88         1.97          0.21  010
                                         salivary gland.
42330........  ...........  A.........  Removal of               2.23         3.40         3.24          1.74         1.77          0.19  010
                                         salivary stone.
42335........  ...........  A.........  Removal of               3.35         5.75         5.28          2.85         2.97          0.29  090
                                         salivary stone.
42340........  ...........  A.........  Removal of               4.64         6.69         6.30          3.49         3.67          0.42  090
                                         salivary stone.
42400........  ...........  A.........  Biopsy of                0.78         1.99         1.80          0.65         0.68          0.06  000
                                         salivary gland.
42405........  ...........  A.........  Biopsy of                3.31         3.96         3.95          2.16         2.28          0.28  010
                                         salivary gland.
42408........  ...........  A.........  Excision of              4.58         6.41         6.11          3.28         3.41          0.45  090
                                         salivary cyst.
42409........  ...........  A.........  Drainage of              2.85         5.30         4.87          2.54         2.63          0.27  090
                                         salivary cyst.
42410........  ...........  A.........  Excise parotid           9.46           NA           NA          5.38         5.73          0.91  090
                                         gland/lesion.
42415........  ...........  A.........  Excise parotid          17.99           NA           NA          8.68         9.63          1.43  090
                                         gland/lesion.
42420........  ...........  A.........  Excise parotid          20.87           NA           NA          9.64        10.85          1.65  090
                                         gland/lesion.
42425........  ...........  A.........  Excise parotid          13.31           NA           NA          6.87         7.62          1.05  090
                                         gland/lesion.
42426........  ...........  A.........  Excise parotid          22.54           NA           NA         10.09        11.36          1.81  090
                                         gland/lesion.
42440........  ...........  A.........  Excise                   7.05           NA           NA          3.88         4.28          0.59  090
                                         submaxillary
                                         gland.
42450........  ...........  A.........  Excise sublingual        4.66         6.37         6.06          4.03         4.08          0.42  090
                                         gland.
42500........  ...........  A.........  Repair salivary          4.34         6.11         5.85          3.87         3.99          0.41  090
                                         duct.
42505........  ...........  A.........  Repair salivary          6.23         7.27         7.12          4.73         4.99          0.55  090
                                         duct.
42507........  ...........  A.........  Parotid duct             6.16           NA           NA          6.33         6.37          0.49  090
                                         diversion.
42508........  ...........  A.........  Parotid duct             9.22           NA           NA          8.07         8.12          1.04  090
                                         diversion.
42509........  ...........  A.........  Parotid duct            11.65           NA           NA          8.93         9.53          0.93  090
                                         diversion.
42510........  ...........  A.........  Parotid duct             8.26           NA           NA          6.95         7.28          0.66  090
                                         diversion.
42550........  ...........  A.........  Injection for            1.25         2.27         2.71          0.45         0.42          0.07  000
                                         salivary x-ray.
42600........  ...........  A.........  Closure of               4.86         6.55         6.56          3.43         3.77          0.43  090
                                         salivary fistula.
42650........  ...........  A.........  Dilation of              0.77         1.28         1.18          0.66         0.68          0.07  000
                                         salivary duct.
42660........  ...........  A.........  Dilation of              1.13         1.46         1.40          0.75         0.80          0.09  000
                                         salivary duct.
42665........  ...........  A.........  Ligation of              2.57         4.98         4.53          2.40         2.47          0.23  090
                                         salivary duct.
42699........  ...........  C.........  Salivary surgery         0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
42700........  ...........  A.........  Drainage of              1.64         2.96         2.77          1.65         1.66          0.13  010
                                         tonsil abscess.
42720........  ...........  A.........  Drainage of              6.31         4.72         4.71          3.20         3.45          0.44  010
                                         throat abscess.
42725........  ...........  A.........  Drainage of             12.28           NA           NA          7.07         7.58          0.91  090
                                         throat abscess.
42800........  ...........  A.........  Biopsy of throat.        1.41         2.46         2.29          1.30         1.33          0.11  010
42802........  ...........  A.........  Biopsy of throat.        1.56         4.11         4.39          1.67         1.84          0.12  010
42804........  ...........  A.........  Biopsy of upper          1.26         3.56         3.61          1.49         1.59          0.10  010
                                         nose/throat.
42806........  ...........  A.........  Biopsy of upper          1.60         3.81         3.90          1.61         1.75          0.13  010
                                         nose/throat.
42808........  ...........  A.........  Excise pharynx           2.32         3.22         3.12          1.61         1.75          0.19  010
                                         lesion.
42809........  ...........  A.........  Remove pharynx           1.83         2.22         2.26          1.31         1.31          0.16  010
                                         foreign body.
42810........  ...........  A.........  Excision of neck         3.30         6.19         5.88          3.72         3.58          0.29  090
                                         cyst.
42815........  ...........  A.........  Excision of neck         7.23           NA           NA          6.25         6.25          0.61  090
                                         cyst.
42820........  ...........  A.........  Remove tonsils           4.17           NA           NA          2.86         3.03          0.31  090
                                         and adenoids.
42821........  ...........  A.........  Remove tonsils           4.31           NA           NA          3.00         3.21          0.35  090
                                         and adenoids.
42825........  ...........  A.........  Removal of               3.45           NA           NA          2.90         2.96          0.25  090
                                         tonsils.
42826........  ...........  A.........  Removal of               3.40           NA           NA          2.69         2.82          0.27  090
                                         tonsils.
42830........  ...........  A.........  Removal of               2.60           NA           NA          2.43         2.46          0.20  090
                                         adenoids.
42831........  ...........  A.........  Removal of               2.75           NA           NA          2.66         2.71          0.22  090
                                         adenoids.
42835........  ...........  A.........  Removal of               2.33           NA           NA          1.76         2.11          0.21  090
                                         adenoids.
42836........  ...........  A.........  Removal of               3.21           NA           NA          2.65         2.77          0.26  090
                                         adenoids.
42842........  ...........  A.........  Extensive surgery       12.02           NA           NA         12.03        11.35          0.71  090
                                         of throat.
42844........  ...........  A.........  Extensive surgery       17.57           NA           NA         15.48        15.64          1.16  090
                                         of throat.
42845........  ...........  A.........  Extensive surgery       32.35           NA           NA         21.21        21.88          1.99  090
                                         of throat.
42860........  ...........  A.........  Excision of              2.25           NA           NA          2.30         2.32          0.18  090
                                         tonsil tags.
42870........  ...........  A.........  Excision of              5.44           NA           NA          8.68         8.51          0.44  090
                                         lingual tonsil.
42890........  ...........  A.........  Partial removal         18.92           NA           NA         15.27        14.50          1.05  090
                                         of pharynx.
42892........  ...........  A.........  Revision of             25.77           NA           NA         19.24        17.93          1.28  090
                                         pharyngeal walls.
42894........  ...........  A.........  Revision of             33.61           NA           NA         23.59        22.44          1.87  090
                                         pharyngeal walls.
42900........  ...........  A.........  Repair throat            5.26           NA           NA          2.96         3.27          0.50  010
                                         wound.
42950........  ...........  A.........  Reconstruction of        8.16           NA           NA         11.04        11.33          0.72  090
                                         throat.
42953........  ...........  A.........  Repair throat,           9.33           NA           NA         13.73        15.40          0.88  090
                                         esophagus.
42955........  ...........  A.........  Surgical opening         7.92           NA           NA         10.07        10.25          0.80  090
                                         of throat.
42960........  ...........  A.........  Control throat           2.35           NA           NA          1.72         1.82          0.19  010
                                         bleeding.
42961........  ...........  A.........  Control throat           5.69           NA           NA          4.50         4.67          0.45  090
                                         bleeding.
42962........  ...........  A.........  Control throat           7.31           NA           NA          5.19         5.48          0.58  090
                                         bleeding.
42970........  ...........  A.........  Control nose/            5.76           NA           NA          3.57         3.87          0.39  090
                                         throat bleeding.
42971........  ...........  A.........  Control nose/            6.54           NA           NA          4.52         4.76          0.51  090
                                         throat bleeding.
42972........  ...........  A.........  Control nose/            7.53           NA           NA          5.00         5.27          0.62  090
                                         throat bleeding.
42999........  ...........  C.........  Throat surgery           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
43020........  ...........  A.........  Incision of              8.14           NA           NA          4.55         4.95          0.87  090
                                         esophagus.

[[Page 38279]]

 
43030........  ...........  A.........  Throat muscle            7.91           NA           NA          4.53         4.96          0.70  090
                                         surgery.
43045........  ...........  A.........  Incision of             21.70           NA           NA          9.31        10.13          2.59  090
                                         esophagus.
43100........  ...........  A.........  Excision of              9.55           NA           NA          5.21         5.70          0.93  090
                                         esophagus lesion.
43101........  ...........  A.........  Excision of             16.99           NA           NA          7.17         7.54          2.32  090
                                         esophagus lesion.
43107........  ...........  A.........  Removal of              43.97           NA           NA         16.27        17.32          5.24  090
                                         esophagus.
43108........  ...........  A.........  Removal of              82.66           NA           NA         24.57        19.58          4.08  090
                                         esophagus.
43112........  ...........  A.........  Removal of              47.27           NA           NA         17.03        18.20          5.81  090
                                         esophagus.
43113........  ...........  A.........  Removal of              79.85           NA           NA         25.44        20.67          4.43  090
                                         esophagus.
43116........  ...........  A.........  Partial removal         92.78           NA           NA         30.90        23.47          3.06  090
                                         of esophagus.
43117........  ...........  A.........  Partial removal         43.52           NA           NA         15.19        16.25          5.19  090
                                         of esophagus.
43118........  ...........  A.........  Partial removal         66.86           NA           NA         21.59        17.65          4.11  090
                                         of esophagus.
43121........  ...........  A.........  Partial removal         51.22           NA           NA         18.33        15.99          3.91  090
                                         of esophagus.
43122........  ...........  A.........  Partial removal         43.97           NA           NA         15.61        16.52          5.42  090
                                         of esophagus.
43123........  ...........  A.........  Partial removal         82.91           NA           NA         25.88        19.99          4.16  090
                                         of esophagus.
43124........  ...........  A.........  Removal of              68.83           NA           NA         24.51        18.70          3.74  090
                                         esophagus.
43130........  ...........  A.........  Removal of              12.41           NA           NA          6.40         6.91          1.16  090
                                         esophagus pouch.
43135........  ...........  A.........  Removal of              26.09           NA           NA          9.93         9.02          2.34  090
                                         esophagus pouch.
43200........  ...........  A.........  Esophagus                1.59         3.70         3.89          0.98         1.02          0.13  000
                                         endoscopy.
43201........  ...........  A.........  Esoph scope w/           2.09         5.58         5.10          1.20         1.15          0.15  000
                                         submucous inj.
43202........  ...........  A.........  Esophagus                1.89         5.14         5.34          0.99         0.96          0.15  000
                                         endoscopy,
                                         biopsy.
43204........  ...........  A.........  Esoph scope w/           3.76           NA           NA          2.02         1.76          0.30  000
                                         sclerosis inj.
43205........  ...........  A.........  Esophagus                3.78           NA           NA          2.07         1.80          0.28  000
                                         endoscopy/
                                         ligation.
43215........  ...........  A.........  Esophagus                2.60           NA           NA          1.29         1.24          0.22  000
                                         endoscopy.
43216........  ...........  A.........  Esophagus                2.40         3.10         2.07          1.28         1.16          0.20  000
                                         endoscopy/lesion.
43217........  ...........  A.........  Esophagus                2.90         6.53         6.74          1.39         1.30          0.26  000
                                         endoscopy.
43219........  ...........  A.........  Esophagus                2.80           NA           NA          1.56         1.45          0.24  000
                                         endoscopy.
43220........  ...........  A.........  Esoph endoscopy,         2.10           NA           NA          1.13         1.05          0.17  000
                                         dilation.
43226........  ...........  A.........  Esoph endoscopy,         2.34           NA           NA          1.29         1.16          0.19  000
                                         dilation.
43227........  ...........  A.........  Esoph endoscopy,         3.59           NA           NA          1.77         1.62          0.28  000
                                         repair.
43228........  ...........  A.........  Esoph endoscopy,         3.76           NA           NA          1.90         1.72          0.34  000
                                         ablation.
43231........  ...........  A.........  Esoph endoscopy w/       3.19           NA           NA          1.77         1.54          0.23  000
                                         us exam.
43232........  ...........  A.........  Esoph endoscopy w/       4.47           NA           NA          2.40         2.11          0.34  000
                                         us fn bx.
43234........  ...........  A.........  Upper GI                 2.01         4.94         5.13          1.02         0.95          0.17  000
                                         endoscopy, exam.
43235........  ...........  A.........  Uppr gi                  2.39         5.26         5.21          1.36         1.19          0.19  000
                                         endoscopy,
                                         diagnosis.
43236........  ...........  A.........  Uppr gi scope w/         2.92         6.67         6.54          1.66         1.44          0.21  000
                                         submuc inj.
43237........  ...........  A.........  Endoscopic us            3.98           NA           NA          2.18         1.89          0.43  000
                                         exam, esoph.
43238........  ...........  A.........  Uppr gi endoscopy        5.02           NA           NA          2.59         2.27          0.43  000
                                         w/us fn bx.
43239........  ...........  A.........  Upper GI                 2.87         6.01         5.86          1.56         1.38          0.22  000
                                         endoscopy,
                                         biopsy.
43240........  ...........  A.........  Esoph endoscope w/       6.85           NA           NA          3.30         2.98          0.56  000
                                         drain cyst.
43241........  ...........  A.........  Upper GI                 2.59           NA           NA          1.41         1.26          0.21  000
                                         endoscopy with
                                         tube.
43242........  ...........  A.........  Uppr gi endoscopy        7.30           NA           NA          3.70         3.22          0.53  000
                                         w/us fn bx.
43243........  ...........  A.........  Upper gi                 4.56           NA           NA          2.37         2.08          0.33  000
                                         endoscopy &
                                         inject.
43244........  ...........  A.........  Upper GI                 5.04           NA           NA          2.66         2.31          0.37  000
                                         endoscopy/
                                         ligation.
43245........  ...........  A.........  Uppr gi scope            3.18           NA           NA          1.64         1.47          0.26  000
                                         dilate strictr.
43246........  ...........  A.........  Place gastrostomy        4.32           NA           NA          2.12         1.91          0.34  000
                                         tube.
43247........  ...........  A.........  Operative upper          3.38           NA           NA          1.79         1.58          0.27  000
                                         GI endoscopy.
43248........  ...........  A.........  Uppr gi endoscopy/       3.15           NA           NA          1.78         1.55          0.23  000
                                         guide wire.
43249........  ...........  A.........  Esoph endoscopy,         2.90           NA           NA          1.63         1.42          0.22  000
                                         dilation.
43250........  ...........  A.........  Upper GI                 3.20           NA           NA          1.62         1.47          0.26  000
                                         endoscopy/tumor.
43251........  ...........  A.........  Operative upper          3.69           NA           NA          1.93         1.71          0.29  000
                                         GI endoscopy.
43255........  ...........  A.........  Operative upper          4.81           NA           NA          2.54         2.21          0.35  000
                                         GI endoscopy.
43256........  ...........  A.........  Uppr gi endoscopy        4.34           NA           NA          2.27         1.99          0.32  000
                                         w/stent.
43257........  ...........  A.........  Uppr gi scope w/         5.50           NA           NA          2.15         2.16          0.36  000
                                         thrml txmnt.
43258........  ...........  A.........  Operative upper          4.54           NA           NA          2.38         2.09          0.33  000
                                         GI endoscopy.
43259........  ...........  A.........  Endoscopic               5.19           NA           NA          2.71         2.35          0.35  000
                                         ultrasound exam.
43260........  ...........  A.........  Endo                     5.95           NA           NA          3.08         2.69          0.43  000
                                         cholangiopancrea
                                         tograph.
43261........  ...........  A.........  Endo                     6.26           NA           NA          3.23         2.82          0.46  000
                                         cholangiopancrea
                                         tograph.
43262........  ...........  A.........  Endo                     7.38           NA           NA          3.76         3.27          0.54  000
                                         cholangiopancrea
                                         tograph.
43263........  ...........  A.........  Endo                     7.28           NA           NA          3.66         3.23          0.54  000
                                         cholangiopancrea
                                         tograph.
43264........  ...........  A.........  Endo                     8.89           NA           NA          4.47         3.90          0.65  000
                                         cholangiopancrea
                                         tograph.
43265........  ...........  A.........  Endo                    10.00           NA           NA          5.02         4.36          0.73  000
                                         cholangiopancrea
                                         tograph.
43267........  ...........  A.........  Endo                     7.38           NA           NA          3.41         3.14          0.54  000
                                         cholangiopancrea
                                         tograph.
43268........  ...........  A.........  Endo                     7.38           NA           NA          3.91         3.40          0.54  000
                                         cholangiopancrea
                                         tograph.
43269........  ...........  A.........  Endo                     8.20           NA           NA          4.13         3.61          0.60  000
                                         cholangiopancrea
                                         tograph.
43271........  ...........  A.........  Endo                     7.38           NA           NA          3.73         3.26          0.54  000
                                         cholangiopancrea
                                         tograph.
43272........  ...........  A.........  Endo                     7.38           NA           NA          3.80         3.30          0.54  000
                                         cholangiopancrea
                                         tograph.
43280........  ...........  A.........  Laparoscopy,            18.00           NA           NA          6.64         6.97          2.28  090
                                         fundoplasty.
43289........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         esoph.
43300........  ...........  A.........  Repair of                9.21           NA           NA          5.38         5.85          1.12  090
                                         esophagus.
43305........  ...........  A.........  Repair esophagus        17.98           NA           NA          8.39         9.42          1.54  090
                                         and fistula.
43310........  ...........  A.........  Repair of               26.18           NA           NA          9.83        10.49          3.61  090
                                         esophagus.
43312........  ...........  A.........  Repair esophagus        29.23           NA           NA         10.28        11.03          4.01  090
                                         and fistula.

[[Page 38280]]

 
43313........  ...........  A.........  Esophagoplasty          48.17           NA           NA         17.46        18.11          5.47  090
                                         congenital.
43314........  ...........  A.........  Tracheo-                53.15           NA           NA         17.17        18.38          6.65  090
                                         esophagoplasty
                                         cong.
43320........  ...........  A.........  Fuse esophagus &        23.18           NA           NA          8.66         8.96          2.74  090
                                         stomach.
43324........  ...........  A.........  Revise esophagus        22.86           NA           NA          8.33         8.56          2.76  090
                                         & stomach.
43325........  ...........  A.........  Revise esophagus        22.47           NA           NA          8.29         8.55          2.60  090
                                         & stomach.
43326........  ...........  A.........  Revise esophagus        22.15           NA           NA          9.19         9.26          2.85  090
                                         & stomach.
43330........  ...........  A.........  Repair of               22.06           NA           NA          8.09         8.34          2.63  090
                                         esophagus.
43331........  ...........  A.........  Repair of               22.93           NA           NA          9.83         9.76          2.94  090
                                         esophagus.
43340........  ...........  A.........  Fuse esophagus &        22.86           NA           NA          9.29         9.09          2.46  090
                                         intestine.
43341........  ...........  A.........  Fuse esophagus &        24.10           NA           NA          9.63         9.90          2.92  090
                                         intestine.
43350........  ...........  A.........  Surgical opening,       19.31           NA           NA          8.77         8.48          1.42  090
                                         esophagus.
43351........  ...........  A.........  Surgical opening,       21.87           NA           NA         10.81        10.10          2.47  090
                                         esophagus.
43352........  ...........  A.........  Surgical opening,       17.68           NA           NA          7.94         8.20          2.06  090
                                         esophagus.
43360........  ...........  A.........  Gastrointestinal        39.90           NA           NA         14.92        15.15          4.97  090
                                         repair.
43361........  ...........  A.........  Gastrointestinal        45.50           NA           NA         17.70        17.15          4.50  090
                                         repair.
43400........  ...........  A.........  Ligate esophagus        25.47           NA           NA         13.65        11.56          1.96  090
                                         veins.
43401........  ...........  A.........  Esophagus surgery       26.36           NA           NA          9.56         9.50          3.05  090
                                         for veins.
43405........  ...........  A.........  Ligate/staple           24.55           NA           NA         10.62        10.06          2.84  090
                                         esophagus.
43410........  ...........  A.........  Repair esophagus        16.28           NA           NA          7.67         7.63          1.72  090
                                         wound.
43415........  ...........  A.........  Repair esophagus        28.70           NA           NA         11.82        11.80          3.53  090
                                         wound.
43420........  ...........  A.........  Repair esophagus        16.65           NA           NA          7.52         7.37          1.43  090
                                         opening.
43425........  ...........  A.........  Repair esophagus        24.91           NA           NA         10.47        10.20          3.03  090
                                         opening.
43450........  ...........  A.........  Dilate esophagus.        1.38         2.66         2.65          0.93         0.81          0.11  000
43453........  ...........  A.........  Dilate esophagus.        1.51         6.26         6.17          1.01         0.87          0.11  000
43456........  ...........  A.........  Dilate esophagus.        2.57        12.90        13.33          1.46         1.29          0.20  000
43458........  ...........  A.........  Dilate esophagus.        3.06         6.88         6.77          1.60         1.45          0.24  000
43460........  ...........  A.........  Pressure                 3.79           NA           NA          1.77         1.62          0.31  000
                                         treatment
                                         esophagus.
43496........  ...........  C.........  Free jejunum             2.20         0.00         0.00          0.00         0.00          0.00  090
                                         flap, microvasc.
43499........  ...........  C.........  Esophagus surgery        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
43500........  ...........  A.........  Surgical opening        12.71           NA           NA          5.27         5.12          1.45  090
                                         of stomach.
43501........  ...........  A.........  Surgical repair         22.47           NA           NA          8.08         8.20          2.65  090
                                         of stomach.
43502........  ...........  A.........  Surgical repair         25.56           NA           NA          8.95         9.21          3.10  090
                                         of stomach.
43510........  ...........  A.........  Surgical opening        15.01           NA           NA          9.10         7.47          1.48  090
                                         of stomach.
43520........  ...........  A.........  Incision of             11.21           NA           NA          4.82         5.04          1.36  090
                                         pyloric muscle.
43600........  ...........  A.........  Biopsy of stomach        1.91           NA           NA          0.78         0.73          0.14  000
43605........  ...........  A.........  Biopsy of stomach       13.64           NA           NA          5.35         5.33          1.58  090
43610........  ...........  A.........  Excision of             16.26           NA           NA          6.02         6.09          1.94  090
                                         stomach lesion.
43611........  ...........  A.........  Excision of             20.25           NA           NA          7.47         7.53          2.36  090
                                         stomach lesion.
43620........  ...........  A.........  Removal of              33.91           NA           NA         11.10        11.45          3.96  090
                                         stomach.
43621........  ...........  A.........  Removal of              39.40           NA           NA         12.41        12.20          4.04  090
                                         stomach.
43622........  ...........  A.........  Removal of              39.90           NA           NA         12.51        12.56          4.30  090
                                         stomach.
43631........  ...........  A.........  Removal of              24.38           NA           NA          8.58         8.87          2.99  090
                                         stomach, partial.
43632........  ...........  A.........  Removal of              35.01           NA           NA         11.27        10.22          2.99  090
                                         stomach, partial.
43633........  ...........  A.........  Removal of              33.01           NA           NA         10.75        10.06          3.06  090
                                         stomach, partial.
43634........  ...........  A.........  Removal of              36.51           NA           NA         11.81        10.96          3.33  090
                                         stomach, partial.
43635........  ...........  A.........  Removal of               2.06           NA           NA          0.52         0.61          0.27  ZZZ
                                         stomach, partial.
43640........  ...........  A.........  Vagotomy &              19.43           NA           NA          7.33         7.30          2.26  090
                                         pylorus repair.
43641........  ...........  A.........  Vagotomy &              19.68           NA           NA          7.60         7.50          2.25  090
                                         pylorus repair.
43644........  ...........  A.........  Lap gastric             29.24           NA           NA         10.09        10.68          3.16  090
                                         bypass/roux-en-y.
43645........  ...........  A.........  Lap gastr bypass        31.37           NA           NA         10.46        11.35          3.54  090
                                         incl smll i.
43647........  ...........  C.........  Lap impl                 0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         electrode,
                                         antrum.
43648........  ...........  C.........  Lap revise/remv          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         eltrd antrum.
43651........  ...........  A.........  Laparoscopy,            10.13           NA           NA          4.60         4.69          1.33  090
                                         vagus nerve.
43652........  ...........  A.........  Laparoscopy,            12.13           NA           NA          5.20         5.47          1.55  090
                                         vagus nerve.
43653........  ...........  A.........  Laparoscopy,             8.38           NA           NA          4.44         4.30          1.01  090
                                         gastrostomy.
43659........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         stom.
43750........  ...........  A.........  Place gastrostomy        4.62           NA           NA          2.03         2.09          0.43  010
                                         tube.
43752........  ...........  A.........  Nasal/orogastric         0.81           NA           NA          0.27         0.26          0.02  000
                                         w/stent.
43760........  ...........  A.........  Change                   1.10        12.86         7.47          0.40         0.43          0.09  000
                                         gastrostomy tube.
43761........  ...........  A.........  Reposition               2.01         1.04         1.09          0.71         0.66          0.13  000
                                         gastrostomy tube.
43770........  ...........  A.........  Lap, place gastr        17.85           NA           NA          7.38         7.56          2.19  090
                                         adjust band.
43771........  ...........  A.........  Lap, revise             20.64           NA           NA          8.10         8.35          2.55  090
                                         adjust gast band.
43772........  ...........  A.........  Lap, remove             15.62           NA           NA          5.98         6.20          1.93  090
                                         adjust gast band.
43773........  ...........  A.........  Lap, change             20.64           NA           NA          8.09         8.35          2.56  090
                                         adjust gast band.
43774........  ...........  A.........  Lap remov adj           15.66           NA           NA          6.17         6.36          1.85  090
                                         gast band/port.
43800........  ...........  A.........  Reconstruction of       15.35           NA           NA          5.80         5.86          1.82  090
                                         pylorus.
43810........  ...........  A.........  Fusion of stomach       16.80           NA           NA          6.14         6.18          1.94  090
                                         and bowel.
43820........  ...........  A.........  Fusion of stomach       22.40           NA           NA          8.06         7.25          2.04  090
                                         and bowel.
43825........  ...........  A.........  Fusion of stomach       21.63           NA           NA          7.89         7.96          2.54  090
                                         and bowel.
43830........  ...........  A.........  Place gastrostomy       10.75           NA           NA          5.15         5.00          1.25  090
                                         tube.
43831........  ...........  A.........  Place gastrostomy        8.38           NA           NA          4.90         4.75          1.03  090
                                         tube.
43832........  ...........  A.........  Place gastrostomy       17.26           NA           NA          7.06         6.97          1.98  090
                                         tube.

[[Page 38281]]

 
43840........  ...........  A.........  Repair of stomach       22.70           NA           NA          8.13         7.46          2.06  090
                                         lesion.
43842........  ...........  N.........  V-band                  20.90           NA           NA          6.74         7.27          2.45  090
                                         gastroplasty.
43843........  ...........  A.........  Gastroplasty w/o        21.08           NA           NA          7.82         7.79          2.46  090
                                         v-band.
43845........  ...........  A.........  Gastroplasty            33.12           NA           NA         12.93        11.77          4.06  090
                                         duodenal switch.
43846........  ...........  A.........  Gastric bypass          27.23           NA           NA          9.95        10.00          3.19  090
                                         for obesity.
43847........  ...........  A.........  Gastric bypass          30.10           NA           NA         10.50        10.73          3.56  090
                                         incl small i.
43848........  ...........  A.........  Revision                32.57           NA           NA         11.28        11.56          3.88  090
                                         gastroplasty.
43850........  ...........  A.........  Revise stomach-         27.45           NA           NA          9.50         9.65          3.28  090
                                         bowel fusion.
43855........  ...........  A.........  Revise stomach-         28.56           NA           NA          9.69        10.02          3.47  090
                                         bowel fusion.
43860........  ...........  A.........  Revise stomach-         27.76           NA           NA          9.46         9.72          3.31  090
                                         bowel fusion.
43865........  ...........  A.........  Revise stomach-         28.92           NA           NA          9.72        10.18          3.51  090
                                         bowel fusion.
43870........  ...........  A.........  Repair stomach          11.36           NA           NA          4.94         4.74          1.27  090
                                         opening.
43880........  ...........  A.........  Repair stomach-         27.05           NA           NA          9.26         9.59          3.27  090
                                         bowel fistula.
43881........  ...........  C.........  Impl/redo                0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         electrd, antrum.
43882........  ...........  C.........  Revise/remove            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         electrd antrum.
43886........  ...........  A.........  Revise gastric           4.54           NA           NA          3.43         3.27          0.25  090
                                         port, open.
43887........  ...........  A.........  Remove gastric           4.24           NA           NA          3.04         2.89          0.51  090
                                         port, open.
43888........  ...........  A.........  Change gastric           6.34           NA           NA          4.00         3.86          0.70  090
                                         port, open.
43999........  ...........  C.........  Stomach surgery          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
44005........  ...........  A.........  Freeing of bowel        18.38           NA           NA          6.57         6.65          2.15  090
                                         adhesion.
44010........  ...........  A.........  Incision of small       14.18           NA           NA          5.52         5.49          1.64  090
                                         bowel.
44015........  ...........  A.........  Insert needle            2.62           NA           NA          0.68         0.78          0.35  ZZZ
                                         cath bowel.
44020........  ...........  A.........  Explore small           16.14           NA           NA          6.00         5.97          1.86  090
                                         intestine.
44021........  ...........  A.........  Decompress small        16.23           NA           NA          6.14         6.08          1.87  090
                                         bowel.
44025........  ...........  A.........  Incision of large       16.43           NA           NA          6.04         6.05          1.90  090
                                         bowel.
44050........  ...........  A.........  Reduce bowel            15.44           NA           NA          5.81         5.89          1.86  090
                                         obstruction.
44055........  ...........  A.........  Correct                 25.53           NA           NA          8.50         8.62          2.91  090
                                         malrotation of
                                         bowel.
44100........  ...........  A.........  Biopsy of bowel..        2.01           NA           NA          0.92         0.81          0.17  000
44110........  ...........  A.........  Excise intestine        13.96           NA           NA          5.51         5.38          1.55  090
                                         lesion(s).
44111........  ...........  A.........  Excision of bowel       16.44           NA           NA          6.09         6.11          1.87  090
                                         lesion(s).
44120........  ...........  A.........  Removal of small        20.74           NA           NA          7.14         7.12          2.25  090
                                         intestine.
44121........  ...........  A.........  Removal of small         4.44           NA           NA          1.12         1.33          0.58  ZZZ
                                         intestine.
44125........  ...........  A.........  Removal of small        19.93           NA           NA          7.02         7.15          2.27  090
                                         intestine.
44126........  ...........  A.........  Enterectomy w/o         42.02           NA           NA         13.59        13.90          4.69  090
                                         taper, cong.
44127........  ...........  A.........  Enterectomy w/          49.09           NA           NA         15.65        15.54          5.77  090
                                         taper, cong.
44128........  ...........  A.........  Enterectomy cong,        4.44           NA           NA          1.22         1.35          0.61  ZZZ
                                         add-on.
44130........  ...........  A.........  Bowel to bowel          21.98           NA           NA          7.96         7.09          1.88  090
                                         fusion.
44137........  ...........  C.........  Remove intestinal        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         allograft.
44139........  ...........  A.........  Mobilization of          2.23           NA           NA          0.56         0.66          0.28  ZZZ
                                         colon.
44140........  ...........  A.........  Partial removal         22.46           NA           NA          8.06         8.37          2.71  090
                                         of colon.
44141........  ...........  A.........  Partial removal         29.75           NA           NA         11.81        10.94          2.53  090
                                         of colon.
44143........  ...........  A.........  Partial removal         27.63           NA           NA         10.27        10.49          3.05  090
                                         of colon.
44144........  ...........  A.........  Partial removal         29.75           NA           NA         10.61        10.12          2.86  090
                                         of colon.
44145........  ...........  A.........  Partial removal         28.45           NA           NA          9.49        10.16          3.29  090
                                         of colon.
44146........  ...........  A.........  Partial removal         35.14           NA           NA         13.35        13.11          3.41  090
                                         of colon.
44147........  ...........  A.........  Partial removal         33.56           NA           NA         10.79         9.78          2.56  090
                                         of colon.
44150........  ...........  A.........  Removal of colon.       29.99           NA           NA         12.57        12.32          3.04  090
44151........  ...........  A.........  Removal of colon/       34.73           NA           NA         13.89        13.68          3.49  090
                                         ileostomy.
44155........  ...........  A.........  Removal of colon/       34.23           NA           NA         13.44        13.39          3.28  090
                                         ileostomy.
44156........  ...........  A.........  Removal of colon/       37.23           NA           NA         14.45        14.80          3.95  090
                                         ileostomy.
44157........  ...........  A.........  Colectomy w/            35.49           NA           NA         17.13        16.16          3.93  090
                                         ileoanal anast.
44158........  ...........  A.........  Colectomy w/neo-        36.49           NA           NA         17.47        16.47          4.06  090
                                         rectum pouch.
44160........  ...........  A.........  Removal of colon.       20.78           NA           NA          7.51         7.64          2.37  090
44180........  ...........  A.........  Lap, enterolysis.       15.19           NA           NA          5.79         5.99          1.86  090
44186........  ...........  A.........  Lap, jejunostomy.       10.30           NA           NA          4.57         4.66          1.27  090
44187........  ...........  A.........  Lap, ileo/jejuno-       17.27           NA           NA          8.10         8.20          1.96  090
                                         stomy.
44188........  ...........  A.........  Lap, colostomy...       19.20           NA           NA          8.65         8.76          2.24  090
44202........  ...........  A.........  Lap, enterectomy.       23.26           NA           NA          8.30         8.62          2.85  090
44203........  ...........  A.........  Lap resect s/            4.44           NA           NA          1.12         1.31          0.57  ZZZ
                                         intestine, addl.
44204........  ...........  A.........  Laparo partial          26.29           NA           NA          8.88         9.43          3.11  090
                                         colectomy.
44205........  ...........  A.........  Lap colectomy           22.86           NA           NA          7.81         8.34          2.75  090
                                         part w/ileum.
44206........  ...........  A.........  Lap part                29.63           NA           NA         10.46        10.87          3.46  090
                                         colectomy w/
                                         stoma.
44207........  ...........  A.........  L colectomy/            31.79           NA           NA         10.12        10.82          3.67  090
                                         coloproctostomy.
44208........  ...........  A.........  L colectomy/            33.86           NA           NA         12.02        12.60          3.88  090
                                         coloproctostomy.
44210........  ...........  A.........  Laparo total            29.88           NA           NA         11.17        11.54          3.42  090
                                         proctocolectomy.
44211........  ...........  A.........  Lap colectomy w/        36.87           NA           NA         13.56        14.17          4.17  090
                                         proctectomy.
44212........  ...........  A.........  Laparo total            34.37           NA           NA         13.04        13.40          3.78  090
                                         proctocolectomy.
44213........  ...........  A.........  Lap, mobil               3.50           NA           NA          0.87         1.05          0.44  ZZZ
                                         splenic fl add-
                                         on.
44227........  ...........  A.........  Lap, close              28.49           NA           NA          9.49        10.07          3.38  090
                                         enterostomy.
44238........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         intestine.
44300........  ...........  A.........  Open bowel to           13.65           NA           NA          5.54         5.52          1.60  090
                                         skin.
44310........  ...........  A.........  Ileostomy/              17.49           NA           NA          6.40         6.55          1.99  090
                                         jejunostomy.

[[Page 38282]]

 
44312........  ...........  A.........  Revision of              9.33           NA           NA          4.66         4.33          0.92  090
                                         ileostomy.
44314........  ...........  A.........  Revision of             16.61           NA           NA          6.77         6.68          1.75  090
                                         ileostomy.
44316........  ...........  A.........  Devise bowel            23.46           NA           NA          8.89         8.79          2.38  090
                                         pouch.
44320........  ...........  A.........  Colostomy........       19.75           NA           NA          7.58         7.63          2.26  090
44322........  ...........  A.........  Colostomy with          13.15           NA           NA          9.04         8.87          1.54  090
                                         biopsies.
44340........  ...........  A.........  Revision of              9.12           NA           NA          4.91         4.60          0.99  090
                                         colostomy.
44345........  ...........  A.........  Revision of             17.06           NA           NA          6.91         6.90          1.97  090
                                         colostomy.
44346........  ...........  A.........  Revision of             19.47           NA           NA          7.51         7.46          2.13  090
                                         colostomy.
44360........  ...........  A.........  Small bowel              2.59           NA           NA          1.50         1.31          0.19  000
                                         endoscopy.
44361........  ...........  A.........  Small bowel              2.87           NA           NA          1.63         1.42          0.21  000
                                         endoscopy/biopsy.
44363........  ...........  A.........  Small bowel              3.49           NA           NA          1.87         1.64          0.27  000
                                         endoscopy.
44364........  ...........  A.........  Small bowel              3.73           NA           NA          1.99         1.75          0.27  000
                                         endoscopy.
44365........  ...........  A.........  Small bowel              3.31           NA           NA          1.75         1.56          0.24  000
                                         endoscopy.
44366........  ...........  A.........  Small bowel              4.40           NA           NA          2.39         2.06          0.32  000
                                         endoscopy.
44369........  ...........  A.........  Small bowel              4.51           NA           NA          2.38         2.07          0.33  000
                                         endoscopy.
44370........  ...........  A.........  Small bowel              4.79           NA           NA          2.57         2.27          0.37  000
                                         endoscopy/stent.
44372........  ...........  A.........  Small bowel              4.40           NA           NA          2.14         1.94          0.35  000
                                         endoscopy.
44373........  ...........  A.........  Small bowel              3.49           NA           NA          1.78         1.59          0.27  000
                                         endoscopy.
44376........  ...........  A.........  Small bowel              5.25           NA           NA          2.49         2.26          0.42  000
                                         endoscopy.
44377........  ...........  A.........  Small bowel              5.52           NA           NA          2.78         2.47          0.40  000
                                         endoscopy/biopsy.
44378........  ...........  A.........  Small bowel              7.12           NA           NA          3.60         3.15          0.52  000
                                         endoscopy.
44379........  ...........  A.........  S bowel endoscope        7.46           NA           NA          3.95         3.33          0.62  000
                                         w/stent.
44380........  ...........  A.........  Small bowel              1.05           NA           NA          0.75         0.65          0.08  000
                                         endoscopy.
44382........  ...........  A.........  Small bowel              1.27           NA           NA          0.84         0.73          0.12  000
                                         endoscopy.
44383........  ...........  A.........  Ileoscopy w/stent        2.94           NA           NA          1.63         1.45          0.21  000
44385........  ...........  A.........  Endoscopy of             1.82         4.86         4.11          0.89         0.82          0.15  000
                                         bowel pouch.
44386........  ...........  A.........  Endoscopy, bowel         2.12         6.60         6.64          1.02         0.96          0.20  000
                                         pouch/biop.
44388........  ...........  A.........  Colonoscopy......        2.82         6.08         5.59          1.36         1.26          0.26  000
44389........  ...........  A.........  Colonoscopy with         3.13         7.06         6.84          1.58         1.43          0.27  000
                                         biopsy.
44390........  ...........  A.........  Colonoscopy for          3.82         8.29         7.64          1.93         1.69          0.32  000
                                         foreign body.
44391........  ...........  A.........  Colonoscopy for          4.31         8.88         8.81          2.23         1.96          0.34  000
                                         bleeding.
44392........  ...........  A.........  Colonoscopy &            3.81         7.31         6.96          1.72         1.61          0.34  000
                                         polypectomy.
44393........  ...........  A.........  Colonoscopy,             4.83         7.99         7.42          2.15         1.99          0.42  000
                                         lesion removal.
44394........  ...........  A.........  Colonoscopy w/           4.42         8.45         8.13          2.09         1.90          0.38  000
                                         snare.
44397........  ...........  A.........  Colonoscopy w/           4.70           NA           NA          2.17         2.01          0.39  000
                                         stent.
44500........  ...........  A.........  Intro,                   0.49           NA           NA          0.17         0.16          0.03  000
                                         gastrointestinal
                                         tube.
44602........  ...........  A.........  Suture, small           24.64           NA           NA          7.62         7.02          2.12  090
                                         intestine.
44603........  ...........  A.........  Suture, small           28.03           NA           NA          8.97         8.14          2.42  090
                                         intestine.
44604........  ...........  A.........  Suture, large           18.06           NA           NA          6.07         6.27          2.12  090
                                         intestine.
44605........  ...........  A.........  Repair of bowel         22.00           NA           NA          7.82         8.13          2.52  090
                                         lesion.
44615........  ...........  A.........  Intestinal              18.08           NA           NA          6.53         6.62          2.07  090
                                         stricturoplasty.
44620........  ...........  A.........  Repair bowel            14.35           NA           NA          5.50         5.42          1.51  090
                                         opening.
44625........  ...........  A.........  Repair bowel            17.20           NA           NA          6.14         6.23          1.86  090
                                         opening.
44626........  ...........  A.........  Repair bowel            27.82           NA           NA          8.89         9.37          3.27  090
                                         opening.
44640........  ...........  A.........  Repair bowel-skin       24.12           NA           NA          8.01         8.31          2.78  090
                                         fistula.
44650........  ...........  A.........  Repair bowel            25.04           NA           NA          8.30         8.61          2.93  090
                                         fistula.
44660........  ...........  A.........  Repair bowel-           23.83           NA           NA          9.84         9.08          2.14  090
                                         bladder fistula.
44661........  ...........  A.........  Repair bowel-           27.27           NA           NA          9.43         9.50          2.81  090
                                         bladder fistula.
44680........  ...........  A.........  Surgical                17.88           NA           NA          6.66         6.54          2.00  090
                                         revision,
                                         intestine.
44700........  ...........  A.........  Suspend bowel w/        17.40           NA           NA          6.17         6.44          1.84  090
                                         prosthesis.
44701........  ...........  A.........  Intraop colon            3.10           NA           NA          0.76         0.91          0.37  ZZZ
                                         lavage add-on.
44715........  ...........  C.........  Prepare donor            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         intestine.
44720........  ...........  A.........  Prep donor               5.00           NA           NA          1.27         1.49          0.37  XXX
                                         intestine/venous.
44721........  ...........  A.........  Prep donor               7.00           NA           NA          1.77         2.09          0.97  XXX
                                         intestine/artery.
44799........  ...........  C.........  Unlisted                 0.00         0.00         7.75          0.00         7.75          0.00  YYY
                                         procedure
                                         intestine.
44800........  ...........  A.........  Excision of bowel       11.94           NA           NA          5.48         5.44          1.47  090
                                         pouch.
44820........  ...........  A.........  Excision of             13.63           NA           NA          5.56         5.53          1.59  090
                                         mesentery lesion.
44850........  ...........  A.........  Repair of               12.03           NA           NA          5.00         5.01          1.39  090
                                         mesentery.
44899........  ...........  C.........  Bowel surgery            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
44900........  ...........  A.........  Drain app               12.44           NA           NA          5.01         4.86          1.33  090
                                         abscess, open.
44901........  ...........  A.........  Drain app                3.37        19.64        23.62          1.21         1.12          0.22  000
                                         abscess, percut.
44950........  ...........  A.........  Appendectomy.....       10.52           NA           NA          4.03         4.18          1.31  090
44955........  ...........  A.........  Appendectomy add-        1.53           NA           NA          0.40         0.47          0.20  ZZZ
                                         on.
44960........  ...........  A.........  Appendectomy.....       14.39           NA           NA          5.39         5.37          1.63  090
44970........  ...........  A.........  Laparoscopy,             9.35           NA           NA          4.18         4.13          1.14  090
                                         appendectomy.
44979........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         app.
45000........  ...........  A.........  Drainage of              6.20           NA           NA          3.56         3.25          0.52  090
                                         pelvic abscess.
45005........  ...........  A.........  Drainage of              2.00         3.95         4.00          1.58         1.58          0.25  010
                                         rectal abscess.
45020........  ...........  A.........  Drainage of              8.43           NA           NA          4.54         3.90          0.55  090
                                         rectal abscess.
45100........  ...........  A.........  Biopsy of rectum.        3.96           NA           NA          2.80         2.59          0.44  090
45108........  ...........  A.........  Removal of               5.04           NA           NA          3.09         2.92          0.59  090
                                         anorectal lesion.
45110........  ...........  A.........  Removal of rectum       30.57           NA           NA         11.84        12.14          3.36  090

[[Page 38283]]

 
45111........  ...........  A.........  Partial removal         17.89           NA           NA          6.99         7.08          2.07  090
                                         of rectum.
45112........  ...........  A.........  Removal of rectum       33.05           NA           NA         10.33        11.06          3.43  090
45113........  ...........  A.........  Partial                 33.09           NA           NA         11.59        12.10          3.49  090
                                         proctectomy.
45114........  ...........  A.........  Partial removal         30.63           NA           NA         10.29        10.60          3.36  090
                                         of rectum.
45116........  ...........  A.........  Partial removal         27.56           NA           NA          9.58         9.78          2.88  090
                                         of rectum.
45119........  ...........  A.........  Remove rectum w/        33.35           NA           NA         11.55        12.04          3.36  090
                                         reservoir.
45120........  ...........  A.........  Removal of rectum       26.25           NA           NA          9.24         9.72          2.90  090
45121........  ...........  A.........  Removal of rectum       28.93           NA           NA         10.04        10.62          3.25  090
                                         and colon.
45123........  ...........  A.........  Partial                 18.70           NA           NA          6.95         6.93          1.86  090
                                         proctectomy.
45126........  ...........  A.........  Pelvic                  48.89           NA           NA         18.00        18.50          4.33  090
                                         exenteration.
45130........  ...........  A.........  Excision of             18.37           NA           NA          6.67         6.74          1.80  090
                                         rectal prolapse.
45135........  ...........  A.........  Excision of             22.15           NA           NA          8.62         8.64          2.36  090
                                         rectal prolapse.
45136........  ...........  A.........  Excise ileoanal         30.63           NA           NA         11.94        12.23          2.82  090
                                         reservior.
45150........  ...........  A.........  Excision of              5.77           NA           NA          3.34         3.17          0.61  090
                                         rectal stricture.
45160........  ...........  A.........  Excision of             16.17           NA           NA          6.43         6.56          1.68  090
                                         rectal lesion.
45170........  ...........  A.........  Excision of             12.48           NA           NA          5.35         5.30          1.35  090
                                         rectal lesion.
45190........  ...........  A.........  Destruction,            10.29           NA           NA          5.51         5.08          1.13  090
                                         rectal tumor.
45300........  ...........  A.........  Proctosigmoidosco        0.80         1.95         1.74          0.45         0.35          0.04  000
                                         py dx.
45303........  ...........  A.........  Proctosigmoidosco        1.50        19.71        19.14          0.66         0.45          0.05  000
                                         py dilate.
45305........  ...........  A.........  Proctosigmoidosco        1.25         3.16         2.91          0.59         0.54          0.11  000
                                         py w/bx.
45307........  ...........  A.........  Proctosigmoidosco        1.70         3.22         3.14          0.70         0.56          0.11  000
                                         py fb.
45308........  ...........  A.........  Proctosigmoidosco        1.40         3.37         2.66          0.63         0.51          0.09  000
                                         py removal.
45309........  ...........  A.........  Proctosigmoidosco        1.50         3.49         3.20          0.67         0.78          0.22  000
                                         py removal.
45315........  ...........  A.........  Proctosigmoidosco        1.80         3.79         3.29          0.88         0.72          0.15  000
                                         py removal.
45317........  ...........  A.........  Proctosigmoidosco        2.00         3.35         2.91          0.77         0.70          0.15  000
                                         py bleed.
45320........  ...........  A.........  Proctosigmoidosco        1.78         3.37         3.24          0.80         0.75          0.16  000
                                         py ablate.
45321........  ...........  A.........  Proctosigmoidosco        1.75           NA           NA          0.86         0.67          0.13  000
                                         py volvul.
45327........  ...........  A.........  Proctosigmoidosco        2.00           NA           NA          0.91         0.78          0.16  000
                                         py w/stent.
45330........  ...........  A.........  Diagnostic               0.96         2.50         2.39          0.62         0.56          0.08  000
                                         sigmoidoscopy.
45331........  ...........  A.........  Sigmoidoscopy and        1.15         3.25         3.16          0.79         0.69          0.09  000
                                         biopsy.
45332........  ...........  A.........  Sigmoidoscopy w/         1.79         5.49         5.26          1.00         0.91          0.16  000
                                         fb removal.
45333........  ...........  A.........  Sigmoidoscopy &          1.79         5.62         5.25          0.99         0.90          0.15  000
                                         polypectomy.
45334........  ...........  A.........  Sigmoidoscopy for        2.73           NA           NA          1.55         1.34          0.20  000
                                         bleeding.
45335........  ...........  A.........  Sigmoidoscopy w/         1.46         5.30         4.26          0.90         0.80          0.11  000
                                         submuc inj.
45337........  ...........  A.........  Sigmoidoscopy &          2.36           NA           NA          1.25         1.12          0.21  000
                                         decompress.
45338........  ...........  A.........  Sigmoidoscopy w/         2.34         5.86         5.53          1.28         1.14          0.19  000
                                         tumr remove.
45339........  ...........  A.........  Sigmoidoscopy w/         3.14         5.70         4.59          1.67         1.48          0.26  000
                                         ablate tumr.
45340........  ...........  A.........  Sig w/balloon            1.89        10.17         8.18          1.04         0.94          0.15  000
                                         dilation.
45341........  ...........  A.........  Sigmoidoscopy w/         2.60           NA           NA          1.48         1.27          0.19  000
                                         ultrasound.
45342........  ...........  A.........  Sigmoidoscopy w/         4.05           NA           NA          2.18         1.87          0.30  000
                                         us guide bx.
45345........  ...........  A.........  Sigmoidoscopy w/         2.92           NA           NA          1.51         1.34          0.23  000
                                         stent.
45355........  ...........  A.........  Surgical                 3.51           NA           NA          1.59         1.48          0.36  000
                                         colonoscopy.
45378........  ...........  A.........  Diagnostic               3.69         6.35         6.25          1.83         1.66          0.30  000
                                         colonoscopy.
45378........  53.........  A.........  Diagnostic               0.96         2.50         2.39          0.62         0.56          0.08  000
                                         colonoscopy.
45379........  ...........  A.........  Colonoscopy w/fb         4.68         8.03         7.86          2.18         2.01          0.39  000
                                         removal.
45380........  ...........  A.........  Colonoscopy and          4.43         7.71         7.46          2.25         2.00          0.35  000
                                         biopsy.
45381........  ...........  A.........  Colonoscopy,             4.19         7.68         7.40          2.17         1.92          0.30  000
                                         submucous inj.
45382........  ...........  A.........  Colonoscopy/             5.68        10.30        10.13          2.90         2.55          0.41  000
                                         control bleeding.
45383........  ...........  A.........  Lesion removal           5.86         8.51         8.22          2.65         2.44          0.48  000
                                         colonoscopy.
45384........  ...........  A.........  Lesion remove            4.69         7.15         6.98          2.19         2.02          0.38  000
                                         colonoscopy.
45385........  ...........  A.........  Lesion removal           5.30         8.33         8.07          2.60         2.32          0.42  000
                                         colonoscopy.
45386........  ...........  A.........  Colonoscopy              4.57        12.27        12.34          2.19         1.99          0.39  000
                                         dilate stricture.
45387........  ...........  A.........  Colonoscopy w/           5.90           NA           NA          2.81         2.60          0.48  000
                                         stent.
45391........  ...........  A.........  Colonoscopy w/           5.09           NA           NA          2.62         2.29          0.42  000
                                         endoscope us.
45392........  ...........  A.........  Colonoscopy w/           6.54           NA           NA          3.23         2.84          0.42  000
                                         endoscopic fnb.
45395........  ...........  A.........  Lap, removal of         32.79           NA           NA         12.94        13.32          3.63  090
                                         rectum.
45397........  ...........  A.........  Lap, remove             36.29           NA           NA         13.40        13.87          3.67  090
                                         rectum w/pouch.
45400........  ...........  A.........  Laparoscopic proc       19.31           NA           NA          7.09         7.48          2.03  090
45402........  ...........  A.........  Lap proctopexy w/       26.38           NA           NA          8.76         9.39          2.82  090
                                         sig resect.
45499........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         rectum.
45500........  ...........  A.........  Repair of rectum.        7.64           NA           NA          4.45         3.98          0.75  090
45505........  ...........  A.........  Repair of rectum.        8.20           NA           NA          5.02         4.45          0.86  090
45520........  ...........  A.........  Treatment of             0.55         2.83         2.27          0.38         0.38          0.05  000
                                         rectal prolapse.
45540........  ...........  A.........  Correct rectal          18.02           NA           NA          5.83         6.31          1.85  090
                                         prolapse.
45541........  ...........  A.........  Correct rectal          14.72           NA           NA          6.58         6.27          1.55  090
                                         prolapse.
45550........  ...........  A.........  Repair rectum/          24.67           NA           NA          8.96         9.10          2.62  090
                                         remove sigmoid.
45560........  ...........  A.........  Repair of               11.42           NA           NA          5.55         5.30          1.13  090
                                         rectocele.
45562........  ...........  A.........  Exploration/            17.82           NA           NA          8.12         7.56          1.84  090
                                         repair of rectum.
45563........  ...........  A.........  Exploration/            26.22           NA           NA         10.74        10.66          3.11  090
                                         repair of rectum.
45800........  ...........  A.........  Repair rect/            20.18           NA           NA          9.24         8.34          1.86  090
                                         bladder fistula.
45805........  ...........  A.........  Repair fistula w/       23.19           NA           NA          9.94         9.61          2.03  090
                                         colostomy.
45820........  ...........  A.........  Repair                  20.24           NA           NA          9.14         8.42          1.58  090
                                         rectourethral
                                         fistula.

[[Page 38284]]

 
45825........  ...........  A.........  Repair fistula w/       24.01           NA           NA          9.49         9.91          2.32  090
                                         colostomy.
45900........  ...........  A.........  Reduction of             2.96           NA           NA          1.65         1.58          0.30  010
                                         rectal prolapse.
45905........  ...........  A.........  Dilation of anal         2.32           NA           NA          1.60         1.53          0.27  010
                                         sphincter.
45910........  ...........  A.........  Dilation of              2.82           NA           NA          1.85         1.75          0.30  010
                                         rectal narrowing.
45915........  ...........  A.........  Remove rectal            3.16         4.18         4.26          2.01         2.06          0.30  010
                                         obstruction.
45990........  ...........  A.........  Surg dx exam,            1.80           NA           NA          0.72         0.77          0.17  000
                                         anorectal.
45999........  ...........  C.........  Rectum surgery           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
46020........  ...........  A.........  Placement of             2.94         3.24         2.79          2.33         2.10          0.31  010
                                         seton.
46030........  ...........  A.........  Removal of rectal        1.24         1.87         1.61          0.81         0.76          0.14  010
                                         marker.
46040........  ...........  A.........  Incision of              5.26         6.48         5.99          3.96         3.77          0.62  090
                                         rectal abscess.
46045........  ...........  A.........  Incision of              5.79           NA           NA          3.92         3.41          0.54  090
                                         rectal abscess.
46050........  ...........  A.........  Incision of anal         1.21         3.16         2.85          0.97         0.91          0.14  010
                                         abscess.
46060........  ...........  A.........  Incision of              6.24           NA           NA          4.39         3.82          0.67  090
                                         rectal abscess.
46070........  ...........  A.........  Incision of anal         2.74           NA           NA          2.33         2.08          0.36  090
                                         septum.
46080........  ...........  A.........  Incision of anal         2.50         3.04         2.70          1.12         1.13          0.30  010
                                         sphincter.
46083........  ...........  A.........  Incise external          1.42         2.34         2.43          0.95         0.94          0.15  010
                                         hemorrhoid.
46200........  ...........  A.........  Removal of anal          3.48         6.24         5.05          3.70         3.29          0.39  090
                                         fissure.
46210........  ...........  A.........  Removal of anal          2.73         5.77         5.47          3.27         2.96          0.31  090
                                         crypt.
46211........  ...........  A.........  Removal of anal          4.31         7.79         6.48          4.64         3.98          0.48  090
                                         crypts.
46220........  ...........  A.........  Removal of anal          1.58         2.99         2.64          1.09         1.02          0.17  010
                                         tag.
46221........  ...........  A.........  Ligation of              2.31         3.70         3.17          1.99         1.87          0.23  010
                                         hemorrhoid(s).
46230........  ...........  A.........  Removal of anal          2.59         3.48         3.28          1.33         1.31          0.30  010
                                         tags.
46250........  ...........  A.........  Hemorrhoidectomy.        4.17         5.90         5.61          2.82         2.72          0.48  090
46255........  ...........  A.........  Hemorrhoidectomy.        4.88         6.28         6.07          3.05         2.95          0.58  090
46257........  ...........  A.........  Remove                   5.68           NA           NA          3.83         3.35          0.64  090
                                         hemorrhoids &
                                         fissure.
46258........  ...........  A.........  Remove                   6.28           NA           NA          3.94         3.62          0.68  090
                                         hemorrhoids &
                                         fistula.
46260........  ...........  A.........  Hemorrhoidectomy.        6.65           NA           NA          4.04         3.61          0.76  090
46261........  ...........  A.........  Remove                   7.63           NA           NA          4.28         3.95          0.79  090
                                         hemorrhoids &
                                         fissure.
46262........  ...........  A.........  Remove                   7.80           NA           NA          4.62         4.19          0.83  090
                                         hemorrhoids &
                                         fistula.
46270........  ...........  A.........  Removal of anal          4.81         6.33         5.65          3.88         3.35          0.46  090
                                         fistula.
46275........  ...........  A.........  Removal of anal          5.31         6.57         5.60          3.95         3.46          0.52  090
                                         fistula.
46280........  ...........  A.........  Removal of anal          6.28           NA           NA          4.25         3.76          0.66  090
                                         fistula.
46285........  ...........  A.........  Removal of anal          5.31         6.49         5.13          3.94         3.35          0.44  090
                                         fistula.
46288........  ...........  A.........  Repair anal              7.68           NA           NA          4.66         4.17          0.79  090
                                         fistula.
46320........  ...........  A.........  Removal of               1.62         2.39         2.26          0.88         0.87          0.18  010
                                         hemorrhoid clot.
46500........  ...........  A.........  Injection into           1.64         3.58         2.85          1.24         1.20          0.16  010
                                         hemorrhoid(s).
46505........  ...........  A.........  Chemodenervation         3.13         3.26         3.15          2.27         2.12          0.14  010
                                         anal musc.
46600........  ...........  A.........  Diagnostic               0.55         1.36         1.47          0.38         0.36          0.05  000
                                         anoscopy.
46604........  ...........  A.........  Anoscopy and             1.03        12.39        10.78          0.51         0.58          0.12  000
                                         dilation.
46606........  ...........  A.........  Anoscopy and             1.20         3.84         3.82          0.58         0.49          0.09  000
                                         biopsy.
46608........  ...........  A.........  Anoscopy, remove         1.30         3.73         4.10          0.58         0.62          0.16  000
                                         for body.
46610........  ...........  A.........  Anoscopy, remove         1.28         3.76         3.95          0.59         0.62          0.15  000
                                         lesion.
46611........  ...........  A.........  Anoscopy.........        1.30         2.52         2.97          0.57         0.70          0.19  000
46612........  ...........  A.........  Anoscopy, remove         1.50         4.66         5.02          0.72         0.89          0.28  000
                                         lesions.
46614........  ...........  A.........  Anoscopy, control        1.00         1.92         2.23          0.52         0.73          0.20  000
                                         bleeding.
46615........  ...........  A.........  Anoscopy.........        1.50         1.76         2.21          0.64         0.91          0.33  000
46700........  ...........  A.........  Repair of anal           9.68           NA           NA          5.14         4.68          0.94  090
                                         stricture.
46705........  ...........  A.........  Repair of anal           7.32           NA           NA          4.04         3.86          0.91  090
                                         stricture.
46706........  ...........  A.........  Repr of anal             2.41           NA           NA          1.48         1.36          0.28  010
                                         fistula w/glue.
46710........  ...........  A.........  Repr per/vag            17.01           NA           NA          7.54         7.69          1.38  090
                                         pouch sngl proc.
46712........  ...........  A.........  Repr per/vag            36.32           NA           NA         14.06        14.59          3.67  090
                                         pouch dbl proc.
46715........  ...........  A.........  Rep perf anoper          7.54           NA           NA          3.73         3.65          0.92  090
                                         fistu.
46716........  ...........  A.........  Rep perf anoper/        17.14           NA           NA          9.53         8.76          1.58  090
                                         vestib fistu.
46730........  ...........  A.........  Construction of         30.17           NA           NA         12.51        12.10          2.47  090
                                         absent anus.
46735........  ...........  A.........  Construction of         35.66           NA           NA         14.95        14.02          3.21  090
                                         absent anus.
46740........  ...........  A.........  Construction of         33.42           NA           NA         15.36        14.16          2.42  090
                                         absent anus.
46742........  ...........  A.........  Repair of               39.66           NA           NA         13.72        15.95          3.20  090
                                         imperforated
                                         anus.
46744........  ...........  A.........  Repair of cloacal       58.46           NA           NA         18.11        20.16          6.40  090
                                         anomaly.
46746........  ...........  A.........  Repair of cloacal       64.93           NA           NA         19.65        22.40          7.70  090
                                         anomaly.
46748........  ...........  A.........  Repair of cloacal       70.91           NA           NA         21.03        22.34          3.37  090
                                         anomaly.
46750........  ...........  A.........  Repair of anal          12.02           NA           NA          5.77         5.42          1.10  090
                                         sphincter.
46751........  ...........  A.........  Repair of anal           9.19           NA           NA          5.04         5.12          0.94  090
                                         sphincter.
46753........  ...........  A.........  Reconstruction of        8.81           NA           NA          4.57         4.22          0.94  090
                                         anus.
46754........  ...........  A.........  Removal of suture        2.88         3.60         3.61          2.20         1.95          0.19  010
                                         from anus.
46760........  ...........  A.........  Repair of anal          17.21           NA           NA          7.87         7.54          1.59  090
                                         sphincter.
46761........  ...........  A.........  Repair of anal          15.16           NA           NA          6.48         6.25          1.43  090
                                         sphincter.
46762........  ...........  A.........  Implant                 14.66           NA           NA          7.09         6.26          1.24  090
                                         artificial
                                         sphincter.
46900........  ...........  A.........  Destruction, anal        1.91         3.63         3.10          1.31         1.29          0.17  010
                                         lesion(s).
46910........  ...........  A.........  Destruction, anal        1.88         3.85         3.38          1.20         1.13          0.19  010
                                         lesion(s).
46916........  ...........  A.........  Cryosurgery, anal        1.88         3.76         3.46          1.59         1.50          0.11  010
                                         lesion(s).
46917........  ...........  A.........  Laser surgery,           1.88         8.72         8.91          1.22         1.17          0.21  010
                                         anal lesions.
46922........  ...........  A.........  Excision of anal         1.88         4.10         3.69          1.19         1.13          0.22  010
                                         lesion(s).

[[Page 38285]]

 
46924........  ...........  A.........  Destruction, anal        2.78         9.50         9.11          1.52         1.44          0.26  010
                                         lesion(s).
46934........  ...........  A.........  Destruction of           3.79         5.53         5.28          2.87         2.90          0.32  090
                                         hemorrhoids.
46935........  ...........  A.........  Destruction of           2.44         3.84         3.63          1.11         1.16          0.23  010
                                         hemorrhoids.
46936........  ...........  A.........  Destruction of           3.70         6.20         5.53          2.65         2.56          0.34  090
                                         hemorrhoids.
46937........  ...........  A.........  Cryotherapy of           2.70         3.39         3.21          1.43         1.40          0.14  010
                                         rectal lesion.
46938........  ...........  A.........  Cryotherapy of           4.70         5.58         4.82          3.53         3.31          0.58  090
                                         rectal lesion.
46940........  ...........  A.........  Treatment of anal        2.33         2.83         2.41          1.04         1.07          0.23  010
                                         fissure.
46942........  ...........  A.........  Treatment of anal        2.05         2.78         2.31          0.96         0.99          0.19  010
                                         fissure.
46945........  ...........  A.........  Ligation of              2.13         4.76         4.02          2.96         2.72          0.19  090
                                         hemorrhoids.
46946........  ...........  A.........  Ligation of              2.60         4.60         4.17          2.63         2.52          0.27  090
                                         hemorrhoids.
46947........  ...........  A.........  Hemorrhoidopexy          5.49           NA           NA          3.09         2.90          0.75  090
                                         by stapling.
46999........  ...........  C.........  Anus surgery             0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
47000........  ...........  A.........  Needle biopsy of         1.90         7.61         5.28          0.71         0.65          0.12  000
                                         liver.
47001........  ...........  A.........  Needle biopsy,           1.90           NA           NA          0.49         0.57          0.25  ZZZ
                                         liver add-on.
47010........  ...........  A.........  Open drainage,          19.27           NA           NA          8.31         8.32          1.81  090
                                         liver lesion.
47011........  ...........  A.........  Percut drain,            3.69           NA           NA          1.33         1.22          0.22  000
                                         liver lesion.
47015........  ...........  A.........  Inject/aspirate         18.37           NA           NA          8.16         7.76          1.84  090
                                         liver cyst.
47100........  ...........  A.........  Wedge biopsy of         12.78           NA           NA          6.29         6.17          1.53  090
                                         liver.
47120........  ...........  A.........  Partial removal         38.82           NA           NA         14.07        14.61          4.66  090
                                         of liver.
47122........  ...........  A.........  Extensive removal       59.35           NA           NA         18.78        20.12          7.21  090
                                         of liver.
47125........  ...........  A.........  Partial removal         52.91           NA           NA         17.18        18.33          6.47  090
                                         of liver.
47130........  ...........  A.........  Partial removal         57.06           NA           NA         18.14        19.54          6.96  090
                                         of liver.
47135........  ...........  R.........  Transplantation         83.29           NA           NA         27.72        29.63          9.96  090
                                         of liver.
47136........  ...........  R.........  Transplantation         70.39           NA           NA         24.50        25.63          8.44  090
                                         of liver.
47140........  ...........  A.........  Partial removal,        59.22           NA           NA         21.57        21.95          5.19  090
                                         donor liver.
47141........  ...........  A.........  Partial removal,        71.27           NA           NA         25.30        26.13          5.19  090
                                         donor liver.
47142........  ...........  A.........  Partial removal,        79.21           NA           NA         27.31        28.42          5.19  090
                                         donor liver.
47143........  ...........  C.........  Prep donor liver,        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         whole.
47144........  ...........  C.........  Prep donor liver,        0.00         0.00         0.00          0.00         0.00          0.00  090
                                         3-segment.
47145........  ...........  C.........  Prep donor liver,        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         lobe split.
47146........  ...........  A.........  Prep donor liver/        6.00           NA           NA          1.52         1.79          0.83  XXX
                                         venous.
47147........  ...........  A.........  Prep donor liver/        7.00           NA           NA          1.78         2.09          0.97  XXX
                                         arterial.
47300........  ...........  A.........  Surgery for liver       18.01           NA           NA          7.72         7.46          1.99  090
                                         lesion.
47350........  ...........  A.........  Repair liver            22.36           NA           NA          8.75         8.83          2.59  090
                                         wound.
47360........  ...........  A.........  Repair liver            31.18           NA           NA         11.23        11.42          3.38  090
                                         wound.
47361........  ...........  A.........  Repair liver            52.47           NA           NA         17.43        17.87          5.87  090
                                         wound.
47362........  ...........  A.........  Repair liver            23.41           NA           NA          9.28         9.00          2.51  090
                                         wound.
47370........  ...........  A.........  Laparo ablate           20.67           NA           NA          7.67         7.90          2.56  090
                                         liver tumor rf.
47371........  ...........  A.........  Laparo ablate           20.67           NA           NA          7.90         8.06          2.61  090
                                         liver cryosurg.
47379........  ...........  C.........  Laparoscope              0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure, liver.
47380........  ...........  A.........  Open ablate liver       24.43           NA           NA          8.60         8.96          2.87  090
                                         tumor rf.
47381........  ...........  A.........  Open ablate liver       24.72           NA           NA          9.34         9.41          2.85  090
                                         tumor cryo.
47382........  ...........  A.........  Percut ablate           15.19           NA           NA          6.26         5.97          0.96  010
                                         liver rf.
47399........  ...........  C.........  Liver surgery            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
47400........  ...........  A.........  Incision of liver       36.23           NA           NA         13.02        13.24          3.08  090
                                         duct.
47420........  ...........  A.........  Incision of bile        21.92           NA           NA          8.53         8.66          2.63  090
                                         duct.
47425........  ...........  A.........  Incision of bile        22.20           NA           NA          8.63         8.71          2.62  090
                                         duct.
47460........  ...........  A.........  Incise bile duct        20.41           NA           NA          9.13         8.72          2.21  090
                                         sphincter.
47480........  ...........  A.........  Incision of             13.12           NA           NA          6.61         6.26          1.42  090
                                         gallbladder.
47490........  ...........  A.........  Incision of              8.05           NA           NA          5.31         5.32          0.43  090
                                         gallbladder.
47500........  ...........  A.........  Injection for            1.96           NA           NA          0.72         0.65          0.12  000
                                         liver x-rays.
47505........  ...........  A.........  Injection for            0.76           NA           NA          0.28         0.25          0.04  000
                                         liver x-rays.
47510........  ...........  A.........  Insert catheter,         7.94           NA           NA          4.65         4.72          0.46  090
                                         bile duct.
47511........  ...........  A.........  Insert bile duct        10.74           NA           NA          5.08         4.94          0.62  090
                                         drain.
47525........  ...........  A.........  Change bile duct         5.55        14.76        14.79          2.71         2.68          0.33  010
                                         catheter.
47530........  ...........  A.........  Revise/reinsert          5.96        30.34        31.82          3.46         3.51          0.37  090
                                         bile tube.
47550........  ...........  A.........  Bile duct                3.02           NA           NA          0.78         0.90          0.40  ZZZ
                                         endoscopy add-on.
47552........  ...........  A.........  Biliary endoscopy        6.03           NA           NA          2.50         2.37          0.42  000
                                         thru skin.
47553........  ...........  A.........  Biliary endoscopy        6.34           NA           NA          2.28         2.10          0.37  000
                                         thru skin.
47554........  ...........  A.........  Biliary endoscopy        9.05           NA           NA          3.31         3.26          0.96  000
                                         thru skin.
47555........  ...........  A.........  Biliary endoscopy        7.55           NA           NA          2.78         2.53          0.45  000
                                         thru skin.
47556........  ...........  A.........  Biliary endoscopy        8.55           NA           NA          3.13         2.84          0.50  000
                                         thru skin.
47560........  ...........  A.........  Laparoscopy w/           4.88           NA           NA          1.24         1.46          0.65  000
                                         cholangio.
47561........  ...........  A.........  Laparo w/                5.17           NA           NA          1.59         1.74          0.66  000
                                         cholangio/biopsy.
47562........  ...........  A.........  Laparoscopic            11.63           NA           NA          5.25         5.12          1.46  090
                                         cholecystectomy.
47563........  ...........  A.........  Laparo                  12.03           NA           NA          5.05         5.18          1.58  090
                                         cholecystectomy/
                                         graph.
47564........  ...........  A.........  Laparo                  14.21           NA           NA          5.40         5.68          1.89  090
                                         cholecystectomy/
                                         explr.
47570........  ...........  A.........  Laparo                  12.56           NA           NA          4.95         5.17          1.65  090
                                         cholecystoentero
                                         stomy.
47579........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         biliary.
47600........  ...........  A.........  Removal of              17.35           NA           NA          7.20         6.67          1.80  090
                                         gallbladder.
47605........  ...........  A.........  Removal of              15.90           NA           NA          6.37         6.44          1.95  090
                                         gallbladder.
47610........  ...........  A.........  Removal of              20.84           NA           NA          7.64         7.79          2.49  090
                                         gallbladder.

[[Page 38286]]

 
47612........  ...........  A.........  Removal of              21.13           NA           NA          7.66         7.78          2.48  090
                                         gallbladder.
47620........  ...........  A.........  Removal of              22.99           NA           NA          8.15         8.34          2.74  090
                                         gallbladder.
47630........  ...........  A.........  Remove bile duct         9.57           NA           NA          4.75         4.72          0.65  090
                                         stone.
47700........  ...........  A.........  Exploration of          16.39           NA           NA          7.28         7.34          2.07  090
                                         bile ducts.
47701........  ...........  A.........  Bile duct               28.62           NA           NA         10.62        10.96          3.68  090
                                         revision.
47711........  ...........  A.........  Excision of bile        25.77           NA           NA          9.64         9.77          3.05  090
                                         duct tumor.
47712........  ...........  A.........  Excision of bile        33.59           NA           NA         11.65        12.02          3.93  090
                                         duct tumor.
47715........  ...........  A.........  Excision of bile        21.42           NA           NA          8.58         8.50          2.49  090
                                         duct cyst.
47719........  ...........  A.........  Fusion of bile          19.07           NA           NA          7.93         7.86          2.15  090
                                         duct cyst.
47720........  ...........  A.........  Fuse gallbladder        18.21           NA           NA          7.71         7.59          2.11  090
                                         & bowel.
47721........  ...........  A.........  Fuse upper gi           21.86           NA           NA          8.53         8.56          2.53  090
                                         structures.
47740........  ...........  A.........  Fuse gallbladder        21.10           NA           NA          8.31         8.37          2.42  090
                                         & bowel.
47741........  ...........  A.........  Fuse gallbladder        24.08           NA           NA          9.23         9.26          2.83  090
                                         & bowel.
47760........  ...........  A.........  Fuse bile ducts         38.14           NA           NA         13.03        11.95          3.42  090
                                         and bowel.
47765........  ...........  A.........  Fuse liver ducts        52.01           NA           NA         16.94        13.87          3.30  090
                                         & bowel.
47780........  ...........  A.........  Fuse bile ducts         42.14           NA           NA         14.11        12.66          3.50  090
                                         and bowel.
47785........  ...........  A.........  Fuse bile ducts         56.01           NA           NA         17.87        15.40          4.10  090
                                         and bowel.
47800........  ...........  A.........  Reconstruction of       26.04           NA           NA          9.75         9.90          3.08  090
                                         bile ducts.
47801........  ...........  A.........  Placement, bile         17.47           NA           NA          8.47         8.16          1.16  090
                                         duct support.
47802........  ...........  A.........  Fuse liver duct &       24.80           NA           NA          9.66         9.63          2.86  090
                                         intestine.
47900........  ...........  A.........  Suture bile duct        22.31           NA           NA          8.83         8.83          2.65  090
                                         injury.
47999........  ...........  C.........  Bile tract               0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery
                                         procedure.
48000........  ...........  A.........  Drainage of             31.82           NA           NA         10.86        11.18          3.48  090
                                         abdomen.
48001........  ...........  A.........  Placement of            39.56           NA           NA         12.77        13.31          4.69  090
                                         drain, pancreas.
48020........  ...........  A.........  Removal of              18.96           NA           NA          7.57         7.44          2.13  090
                                         pancreatic stone.
48100........  ...........  A.........  Biopsy of               14.38           NA           NA          5.95         5.76          1.62  090
                                         pancreas, open.
48102........  ...........  A.........  Needle biopsy,           4.68         9.56         8.66          1.93         1.88          0.28  010
                                         pancreas.
48105........  ...........  A.........  Resect/debride          49.05           NA           NA         15.77        16.32          5.56  090
                                         pancreas.
48120........  ...........  A.........  Removal of              18.33           NA           NA          6.85         6.86          2.10  090
                                         pancreas lesion.
48140........  ...........  A.........  Partial removal         26.19           NA           NA          9.37         9.45          3.03  090
                                         of pancreas.
48145........  ...........  A.........  Partial removal         27.26           NA           NA          9.54         9.71          3.18  090
                                         of pancreas.
48146........  ...........  A.........  Pancreatectomy...       30.42           NA           NA         11.91        11.94          3.50  090
48148........  ...........  A.........  Removal of              20.26           NA           NA          8.20         7.88          2.30  090
                                         pancreatic duct.
48150........  ...........  A.........  Partial removal         52.63           NA           NA         18.02        18.77          6.32  090
                                         of pancreas.
48152........  ...........  A.........  Pancreatectomy...       48.47           NA           NA         16.83        17.48          5.80  090
48153........  ...........  A.........  Pancreatectomy...       52.61           NA           NA         17.90        18.73          6.31  090
48154........  ...........  A.........  Pancreatectomy...       48.70           NA           NA         17.05        17.62          5.84  090
48155........  ...........  A.........  Removal of              29.27           NA           NA         11.93        11.80          3.27  090
                                         pancreas.
48400........  ...........  A.........  Injection,               1.95           NA           NA          0.67         0.68          0.15  ZZZ
                                         intraop add-on.
48500........  ...........  A.........  Surgery of              18.03           NA           NA          7.64         7.55          2.03  090
                                         pancreatic cyst.
48510........  ...........  A.........  Drain pancreatic        17.06           NA           NA          7.58         7.50          1.83  090
                                         pseudocyst.
48511........  ...........  A.........  Drain pancreatic         3.99        20.03        20.30          1.45         1.33          0.24  000
                                         pseudocyst.
48520........  ...........  A.........  Fuse pancreas           18.07           NA           NA          6.82         6.75          2.06  090
                                         cyst and bowel.
48540........  ...........  A.........  Fuse pancreas           21.86           NA           NA          7.79         7.94          2.61  090
                                         cyst and bowel.
48545........  ...........  A.........  Pancreatorrhaphy.       22.10           NA           NA          8.40         8.14          2.38  090
48547........  ...........  A.........  Duodenal                30.25           NA           NA         10.28        10.38          3.42  090
                                         exclusion.
48548........  ...........  A.........  Fuse pancreas and       27.96           NA           NA          9.88        10.07          3.28  090
                                         bowel.
48551........  ...........  C.........  Prep donor               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         pancreas.
48552........  ...........  A.........  Prep donor               4.30           NA           NA          1.15         1.30          0.31  XXX
                                         pancreas/venous.
48554........  ...........  R.........  Transpl allograft       37.03           NA           NA         20.43        19.36          4.19  090
                                         pancreas.
48556........  ...........  A.........  Removal,                19.24           NA           NA          9.18         8.66          2.08  090
                                         allograft
                                         pancreas.
48999........  ...........  C.........  Pancreas surgery         0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
49000........  ...........  A.........  Exploration of          12.44           NA           NA          5.20         5.29          1.52  090
                                         abdomen.
49002........  ...........  A.........  Reopening of            17.55           NA           NA          6.38         5.71          1.37  090
                                         abdomen.
49010........  ...........  A.........  Exploration             15.98           NA           NA          6.21         6.07          1.51  090
                                         behind abdomen.
49020........  ...........  A.........  Drain abdominal         26.46           NA           NA          9.88        10.03          2.85  090
                                         abscess.
49021........  ...........  A.........  Drain abdominal          3.37        19.48        20.11          1.23         1.12          0.20  000
                                         abscess.
49040........  ...........  A.........  Drain, open,            16.41           NA           NA          6.50         6.46          1.70  090
                                         abdom abscess.
49041........  ...........  A.........  Drain, percut,           3.99        19.76        19.47          1.45         1.33          0.24  000
                                         abdom abscess.
49060........  ...........  A.........  Drain, open,            18.42           NA           NA          7.25         7.32          1.75  090
                                         retrop abscess.
49061........  ...........  A.........  Drain, percut,           3.69        19.59        19.45          1.34         1.23          0.22  000
                                         retroper absc.
49062........  ...........  A.........  Drain to                12.12           NA           NA          5.12         5.29          1.39  090
                                         peritoneal
                                         cavity.
49080........  ...........  A.........  Puncture,                1.35         2.71         3.32          0.49         0.46          0.08  000
                                         peritoneal
                                         cavity.
49081........  ...........  A.........  Removal of               1.26         2.92         2.74          0.47         0.44          0.09  000
                                         abdominal fluid.
49180........  ...........  A.........  Biopsy, abdominal        1.73         2.47         2.75          0.63         0.58          0.10  000
                                         mass.
49200........  ...........  A.........  Removal of              10.94           NA           NA          4.85         4.94          1.24  090
                                         abdominal lesion.
49201........  ...........  A.........  Remove abdom            15.67           NA           NA          6.42         6.73          1.88  090
                                         lesion, complex.
49215........  ...........  A.........  Excise sacral           37.66           NA           NA         12.75        13.40          4.38  090
                                         spine tumor.
49220........  ...........  A.........  Multiple surgery,       15.70           NA           NA          6.48         6.51          1.89  090
                                         abdomen.
49250........  ...........  A.........  Excision of              8.93           NA           NA          4.34         4.29          1.08  090
                                         umbilicus.
49255........  ...........  A.........  Removal of              12.41           NA           NA          5.61         5.61          1.43  090
                                         omentum.
49320........  ...........  A.........  Diag laparo              5.09           NA           NA          2.44         2.54          0.65  010
                                         separate proc.

[[Page 38287]]

 
49321........  ...........  A.........  Laparoscopy,             5.39           NA           NA          2.56         2.60          0.70  010
                                         biopsy.
49322........  ...........  A.........  Laparoscopy,             5.96           NA           NA          2.63         2.81          0.71  010
                                         aspiration.
49323........  ...........  A.........  Laparo drain            10.13           NA           NA          4.68         4.59          1.20  090
                                         lymphocele.
49324........  ...........  A.........  Lap insertion            6.27           NA           NA          2.78         2.79          0.73  010
                                         perm ip cath.
49325........  ...........  A.........  Lap revision perm        6.77           NA           NA          2.90         2.92          0.86  010
                                         ip cath.
49326........  ...........  A.........  Lap w/omentopexy         3.50           NA           NA          0.92         0.92          0.44  ZZZ
                                         add-on.
49329........  ...........  C.........  Laparo proc, abdm/       0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         per/oment.
49400........  ...........  A.........  Air injection            1.88         2.46         2.74          0.62         0.61          0.15  000
                                         into abdomen.
49402........  ...........  A.........  Remove foreign          14.01           NA           NA          5.51         5.51          1.62  090
                                         body, adbomen.
49419........  ...........  A.........  Insrt abdom cath         7.03           NA           NA          3.44         3.49          0.81  090
                                         for chemotx.
49420........  ...........  A.........  Insert abdom             2.22           NA           NA          1.19         1.14          0.21  000
                                         drain, temp.
49421........  ...........  A.........  Insert abdom             5.87           NA           NA          3.10         3.13          0.74  090
                                         drain, perm.
49422........  ...........  A.........  Remove perm              6.26           NA           NA          2.60         2.75          0.83  010
                                         cannula/catheter.
49423........  ...........  A.........  Exchange drainage        1.46        12.97        13.44          0.57         0.53          0.09  000
                                         catheter.
49424........  ...........  A.........  Assess cyst,             0.76         3.06         3.36          0.31         0.29          0.04  000
                                         contrast inject.
49425........  ...........  A.........  Insert abdomen-         12.13           NA           NA          5.29         5.44          1.54  090
                                         venous drain.
49426........  ...........  A.........  Revise abdomen-         10.33           NA           NA          4.55         4.65          1.28  090
                                         venous shunt.
49427........  ...........  A.........  Injection,               0.89           NA           NA          0.32         0.30          0.07  000
                                         abdominal shunt.
49428........  ...........  A.........  Ligation of shunt        6.79           NA           NA          2.99         3.47          0.80  010
49429........  ...........  A.........  Removal of shunt.        7.41           NA           NA          2.99         3.20          1.02  010
49435........  ...........  A.........  Insert subq exten        2.25           NA           NA          0.62         0.61          0.28  ZZZ
                                         to ip cath.
49436........  ...........  A.........  Embedded ip cath         2.69           NA           NA          1.66         1.64          0.28  010
                                         exit-site.
49491........  ...........  A.........  Rpr hern preemie        12.42           NA           NA          4.60         4.97          1.40  090
                                         reduc.
49492........  ...........  A.........  Rpr ing hern            15.32           NA           NA          6.21         6.10          1.81  090
                                         premie, blocked.
49495........  ...........  A.........  Rpr ing hernia           6.15           NA           NA          3.04         2.99          0.74  090
                                         baby, reduc.
49496........  ...........  A.........  Rpr ing hernia           9.32           NA           NA          4.42         4.33          1.07  090
                                         baby, blocked.
49500........  ...........  A.........  Rpr ing hernia,          5.76           NA           NA          3.69         3.39          0.71  090
                                         init, reduce.
49501........  ...........  A.........  Rpr ing hernia,          9.28           NA           NA          4.25         4.22          1.12  090
                                         init blocked.
49505........  ...........  A.........  Prp i/hern init          7.88           NA           NA          3.86         3.81          1.03  090
                                         reduc >5 yr.
49507........  ...........  A.........  Prp i/hern init          9.97           NA           NA          4.43         4.45          1.27  090
                                         block >5 yr.
49520........  ...........  A.........  Rerepair ing             9.91           NA           NA          4.36         4.40          1.28  090
                                         hernia, reduce.
49521........  ...........  A.........  Rerepair ing            12.36           NA           NA          4.97         5.11          1.59  090
                                         hernia, blocked.
49525........  ...........  A.........  Repair ing               8.85           NA           NA          4.10         4.09          1.13  090
                                         hernia, sliding.
49540........  ...........  A.........  Repair lumbar           10.66           NA           NA          4.56         4.67          1.37  090
                                         hernia.
49550........  ...........  A.........  Rpr rem hernia,          8.91           NA           NA          4.09         4.11          1.14  090
                                         init, reduce.
49553........  ...........  A.........  Rpr fem hernia,          9.84           NA           NA          4.39         4.40          1.24  090
                                         init blocked.
49555........  ...........  A.........  Rerepair fem             9.31           NA           NA          4.19         4.23          1.20  090
                                         hernia, reduce.
49557........  ...........  A.........  Rerepair fem            11.54           NA           NA          4.81         4.90          1.47  090
                                         hernia, blocked.
49560........  ...........  A.........  Rpr ventral hern        11.84           NA           NA          4.86         5.01          1.52  090
                                         init, reduc.
49561........  ...........  A.........  Rpr ventral hern        15.30           NA           NA          5.78         5.93          1.89  090
                                         init, block.
49565........  ...........  A.........  Rerepair ventrl         12.29           NA           NA          5.07         5.15          1.52  090
                                         hern, reduce.
49566........  ...........  A.........  Rerepair ventrl         15.45           NA           NA          5.83         5.98          1.91  090
                                         hern, block.
49568........  ...........  A.........  Hernia repair w/         4.88           NA           NA          1.25         1.46          0.64  ZZZ
                                         mesh.
49570........  ...........  A.........  Rpr epigastric           5.97           NA           NA          3.36         3.26          0.75  090
                                         hern, reduce.
49572........  ...........  A.........  Rpr epigastric           7.79           NA           NA          3.81         3.64          0.88  090
                                         hern, blocked.
49580........  ...........  A.........  Rpr umbil hern,          4.39           NA           NA          2.91         2.76          0.54  090
                                         reduc < 5 yr.
49582........  ...........  A.........  Rpr umbil hern,          7.05           NA           NA          3.67         3.56          0.88  090
                                         block < 5 yr.
49585........  ...........  A.........  Rpr umbil hern,          6.51           NA           NA          3.49         3.40          0.82  090
                                         reduc > 5 yr.
49587........  ...........  A.........  Rpr umbil hern,          7.96           NA           NA          3.84         3.79          0.99  090
                                         block > 5 yr.
49590........  ...........  A.........  Repair spigelian         8.82           NA           NA          4.07         4.08          1.13  090
                                         hernia.
49600........  ...........  A.........  Repair umbilical        11.47           NA           NA          5.39         5.32          1.32  090
                                         lesion.
49605........  ...........  A.........  Repair umbilical        86.85           NA           NA         26.29        27.42          9.39  090
                                         lesion.
49606........  ...........  A.........  Repair umbilical        18.92           NA           NA          6.77         7.20          2.46  090
                                         lesion.
49610........  ...........  A.........  Repair umbilical        10.83           NA           NA          5.31         5.15          1.07  090
                                         lesion.
49611........  ...........  A.........  Repair umbilical         9.26           NA           NA          4.24         5.51          0.78  090
                                         lesion.
49650........  ...........  A.........  Laparo hernia            6.30           NA           NA          3.32         3.26          0.93  090
                                         repair initial.
49651........  ...........  A.........  Laparo hernia            8.29           NA           NA          4.21         4.13          1.14  090
                                         repair recur.
49659........  ...........  C.........  Laparo proc,             0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         hernia repair.
49900........  ...........  A.........  Repair of               12.26           NA           NA          6.26         6.25          1.62  090
                                         abdominal wall.
49904........  ...........  A.........  Omental flap,           22.16           NA           NA         11.89        13.62          2.70  090
                                         extra-abdom.
49905........  ...........  A.........  Omental flap,            6.54           NA           NA          1.71         2.01          0.75  ZZZ
                                         intra-abdom.
49906........  ...........  C.........  Free omental             2.08         0.00         0.00          0.00         0.00          0.00  090
                                         flap, microvasc.
49999........  ...........  C.........  Abdomen surgery          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
50010........  ...........  A.........  Exploration of          12.13           NA           NA          6.79         6.02          0.93  090
                                         kidney.
50020........  ...........  A.........  Renal abscess,          17.88           NA           NA          8.52         8.13          1.34  090
                                         open drain.
50021........  ...........  A.........  Renal abscess,           3.37        20.92        21.13          1.23         1.12          0.20  000
                                         percut drain.
50040........  ...........  A.........  Drainage of             16.48           NA           NA          8.94         7.87          1.03  090
                                         kidney.
50045........  ...........  A.........  Exploration of          16.67           NA           NA          8.19         7.45          1.24  090
                                         kidney.
50060........  ...........  A.........  Removal of kidney       20.80           NA           NA         10.95         9.44          1.36  090
                                         stone.
50065........  ...........  A.........  Incision of             22.17           NA           NA         11.67         8.90          1.59  090
                                         kidney.
50070........  ...........  A.........  Incision of             21.70           NA           NA         11.47         9.87          1.44  090
                                         kidney.
50075........  ...........  A.........  Removal of kidney       26.91           NA           NA         13.67        11.83          1.81  090
                                         stone.

[[Page 38288]]

 
50080........  ...........  A.........  Removal of kidney       15.61           NA           NA          8.65         7.47          1.04  090
                                         stone.
50081........  ...........  A.........  Removal of kidney       23.32           NA           NA         12.33        10.56          1.54  090
                                         stone.
50100........  ...........  A.........  Revise kidney           17.30           NA           NA          6.37         7.22          2.07  090
                                         blood vessels.
50120........  ...........  A.........  Exploration of          17.06           NA           NA          9.22         7.94          1.21  090
                                         kidney.
50125........  ...........  A.........  Explore and drain       17.67           NA           NA          9.83         8.42          1.43  090
                                         kidney.
50130........  ...........  A.........  Removal of kidney       18.67           NA           NA         10.17         8.68          1.22  090
                                         stone.
50135........  ...........  A.........  Exploration of          20.44           NA           NA         10.81         9.32          1.33  090
                                         kidney.
50200........  ...........  A.........  Biopsy of kidney.        2.63           NA           NA          1.19         1.22          0.16  000
50205........  ...........  A.........  Biopsy of kidney.       12.19           NA           NA          5.52         5.28          1.30  090
50220........  ...........  A.........  Remove kidney,          18.53           NA           NA          9.62         8.45          1.35  090
                                         open.
50225........  ...........  A.........  Removal kidney          21.73           NA           NA         11.15         9.66          1.50  090
                                         open, complex.
50230........  ...........  A.........  Removal kidney          23.68           NA           NA         11.80        10.21          1.55  090
                                         open, radical.
50234........  ...........  A.........  Removal of kidney       23.90           NA           NA         12.19        10.54          1.59  090
                                         & ureter.
50236........  ...........  A.........  Removal of kidney       26.74           NA           NA         14.08        12.19          1.77  090
                                         & ureter.
50240........  ...........  A.........  Partial removal         24.01           NA           NA         12.76        10.91          1.55  090
                                         of kidney.
50250........  ...........  A.........  Cryoablate renal        22.06           NA           NA         11.63        10.25          1.39  090
                                         mass open.
50280........  ...........  A.........  Removal of kidney       16.94           NA           NA          9.15         7.96          1.19  090
                                         lesion.
50290........  ...........  A.........  Removal of kidney       16.00           NA           NA          7.78         7.20          1.41  090
                                         lesion.
50320........  ...........  A.........  Remove kidney,          22.28           NA           NA         12.27        11.49          2.36  090
                                         living donor.
50323........  ...........  C.........  Prep cadaver             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         renal allograft.
50325........  ...........  C.........  Prep donor renal         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         graft.
50327........  ...........  A.........  Prep renal graft/        4.00           NA           NA          1.10         1.23          0.29  XXX
                                         venous.
50328........  ...........  A.........  Prep renal graft/        3.50           NA           NA          0.99         1.08          0.26  XXX
                                         arterial.
50329........  ...........  A.........  Prep renal graft/        3.34           NA           NA          1.07         1.08          0.25  XXX
                                         ureteral.
50340........  ...........  A.........  Removal of kidney       13.86           NA           NA          7.86         7.14          1.65  090
50360........  ...........  A.........  Transplantation         40.45           NA           NA         18.64        17.09          3.82  090
                                         of kidney.
50365........  ...........  A.........  Transplantation         45.68           NA           NA         19.28        18.78          4.43  090
                                         of kidney.
50370........  ...........  A.........  Remove                  18.68           NA           NA          9.18         8.18          1.68  090
                                         transplanted
                                         kidney.
50380........  ...........  A.........  Reimplantation of       29.66           NA           NA         16.13        14.12          2.51  090
                                         kidney.
50382........  ...........  A.........  Change ureter            5.50        26.17        30.92          2.08         1.90          0.34  000
                                         stent, percut.
50384........  ...........  A.........  Remove ureter            5.00        20.53        27.71          1.88         1.73          0.31  000
                                         stent, percut.
50387........  ...........  A.........  Change ext/int           2.00        12.51        15.28          0.74         0.68          0.12  000
                                         ureter stent.
50389........  ...........  A.........  Remove renal tube        1.10         6.63         9.64          0.41         0.38          0.07  000
                                         w/fluoro.
50390........  ...........  A.........  Drainage of              1.96           NA           NA          0.72         0.65          0.12  000
                                         kidney lesion.
50391........  ...........  A.........  Instll rx agnt           1.96         1.39         1.50          0.73         0.69          0.14  000
                                         into rnal tub.
50392........  ...........  A.........  Insert kidney            3.37           NA           NA          1.53         1.48          0.20  000
                                         drain.
50393........  ...........  A.........  Insert ureteral          4.15           NA           NA          1.82         1.75          0.25  000
                                         tube.
50394........  ...........  A.........  Injection for            0.76         1.86         2.25          0.58         0.61          0.05  000
                                         kidney x-ray.
50395........  ...........  A.........  Create passage to        3.37           NA           NA          1.58         1.51          0.21  000
                                         kidney.
50396........  ...........  A.........  Measure kidney           2.09           NA           NA          1.09         1.06          0.13  000
                                         pressure.
50398........  ...........  A.........  Change kidney            1.46        11.74        13.95          0.57         0.53          0.09  000
                                         tube.
50400........  ...........  A.........  Revision of             21.12           NA           NA         11.08         9.51          1.38  090
                                         kidney/ureter.
50405........  ...........  A.........  Revision of             25.68           NA           NA         13.07        11.09          1.79  090
                                         kidney/ureter.
50500........  ...........  A.........  Repair of kidney        21.07           NA           NA          8.75         8.66          2.02  090
                                         wound.
50520........  ...........  A.........  Close kidney-skin       18.73           NA           NA          9.33         8.41          1.49  090
                                         fistula.
50525........  ...........  A.........  Repair renal-           24.21           NA           NA         11.91        10.31          1.84  090
                                         abdomen fistula.
50526........  ...........  A.........  Repair renal-           26.13           NA           NA          8.14         9.00          1.97  090
                                         abdomen fistula.
50540........  ...........  A.........  Revision of             20.95           NA           NA         10.74         9.56          1.36  090
                                         horseshoe kidney.
50541........  ...........  A.........  Laparo ablate           16.76           NA           NA          8.81         7.66          1.13  090
                                         renal cyst.
50542........  ...........  A.........  Laparo ablate           21.18           NA           NA         11.32         9.73          1.39  090
                                         renal mass.
50543........  ...........  A.........  Laparo partial          27.18           NA           NA         14.27        12.25          1.81  090
                                         nephrectomy.
50544........  ...........  A.........  Laparoscopy,            23.27           NA           NA         11.59        10.07          1.58  090
                                         pyeloplasty.
50545........  ...........  A.........  Laparo radical          24.93           NA           NA         12.31        10.78          1.71  090
                                         nephrectomy.
50546........  ...........  A.........  Laparoscopic            21.69           NA           NA         11.42         9.91          1.57  090
                                         nephrectomy.
50547........  ...........  A.........  Laparo removal          26.24           NA           NA         12.54        11.85          2.77  090
                                         donor kidney.
50548........  ...........  A.........  Laparo remove w/        25.26           NA           NA         12.29        10.76          1.73  090
                                         ureter.
50549........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         renal.
50551........  ...........  A.........  Kidney endoscopy.        5.59         4.62         4.38          2.69         2.33          0.40  000
50553........  ...........  A.........  Kidney endoscopy.        5.98         4.51         4.40          2.66         2.39          0.39  000
50555........  ...........  A.........  Kidney endoscopy         6.52         5.13         4.97          3.07         2.70          0.45  000
                                         & biopsy.
50557........  ...........  A.........  Kidney endoscopy         6.61         5.30         4.94          3.12         2.71          0.47  000
                                         & treatment.
50561........  ...........  A.........  Kidney endoscopy         7.58         5.84         5.45          3.46         3.05          0.54  000
                                         & treatment.
50562........  ...........  A.........  Renal scope w/          10.90           NA           NA          5.43         4.88          0.73  090
                                         tumor resect.
50570........  ...........  A.........  Kidney endoscopy.        9.53           NA           NA          4.21         3.73          0.68  000
50572........  ...........  A.........  Kidney endoscopy.       10.33           NA           NA          4.38         3.99          0.85  000
50574........  ...........  A.........  Kidney endoscopy        11.00           NA           NA          4.87         4.30          0.77  000
                                         & biopsy.
50575........  ...........  A.........  Kidney endoscopy.       13.96           NA           NA          6.05         5.36          0.99  000
50576........  ...........  A.........  Kidney endoscopy        10.97           NA           NA          4.85         4.27          0.78  000
                                         & treatment.
50580........  ...........  A.........  Kidney endoscopy        11.84           NA           NA          5.17         4.58          0.83  000
                                         & treatment.
50590........  ...........  A.........  Fragmenting of           9.64        17.08        14.76          6.18         5.16          0.65  090
                                         kidney stone.
50592........  ...........  A.........  Perc rf ablate           6.77        74.72       111.68          3.03         2.94          0.43  010
                                         renal tumor.
50600........  ...........  A.........  Exploration of          17.04           NA           NA          8.60         7.65          1.13  090
                                         ureter.

[[Page 38289]]

 
50605........  ...........  A.........  Insert ureteral         16.66           NA           NA          7.94         7.35          1.45  090
                                         support.
50610........  ...........  A.........  Removal of ureter       17.12           NA           NA          9.01         8.02          1.43  090
                                         stone.
50620........  ...........  A.........  Removal of ureter       16.30           NA           NA          8.98         7.67          1.07  090
                                         stone.
50630........  ...........  A.........  Removal of ureter       16.08           NA           NA          8.24         7.28          1.09  090
                                         stone.
50650........  ...........  A.........  Removal of ureter       18.67           NA           NA         10.11         8.69          1.23  090
50660........  ...........  A.........  Removal of ureter       20.87           NA           NA         10.85         9.42          1.38  090
50684........  ...........  A.........  Injection for            0.76         3.94         4.47          0.63         0.55          0.05  000
                                         ureter x-ray.
50686........  ...........  A.........  Measure ureter           1.51         2.28         2.82          0.82         0.80          0.11  000
                                         pressure.
50688........  ...........  A.........  Change of ureter         1.18           NA           NA          0.95         0.99          0.07  010
                                         tube/stent.
50690........  ...........  A.........  Injection for            1.16         1.45         1.62          0.75         0.72          0.07  000
                                         ureter x-ray.
50700........  ...........  A.........  Revision of             16.54           NA           NA          8.86         7.91          1.27  090
                                         ureter.
50715........  ...........  A.........  Release of ureter       20.49           NA           NA          8.63         8.70          2.14  090
50722........  ...........  A.........  Release of ureter       17.80           NA           NA          7.32         7.68          1.91  090
50725........  ...........  A.........  Release/revise          20.05           NA           NA          8.89         8.61          1.52  090
                                         ureter.
50727........  ...........  A.........  Revise ureter....        8.17           NA           NA          5.76         5.02          0.61  090
50728........  ...........  A.........  Revise ureter....       12.00           NA           NA          6.79         6.25          1.00  090
50740........  ...........  A.........  Fusion of ureter        19.92           NA           NA          8.99         8.38          1.97  090
                                         & kidney.
50750........  ...........  A.........  Fusion of ureter        21.07           NA           NA         11.22         9.38          1.38  090
                                         & kidney.
50760........  ...........  A.........  Fusion of ureters       19.92           NA           NA          9.98         8.81          1.55  090
50770........  ...........  A.........  Splicing of             21.07           NA           NA         11.01         9.46          1.45  090
                                         ureters.
50780........  ...........  A.........  Reimplant ureter        19.80           NA           NA         10.22         8.91          1.51  090
                                         in bladder.
50782........  ...........  A.........  Reimplant ureter        19.51           NA           NA         10.19         9.20          1.61  090
                                         in bladder.
50783........  ...........  A.........  Reimplant ureter        20.52           NA           NA         10.31         9.23          1.99  090
                                         in bladder.
50785........  ...........  A.........  Reimplant ureter        22.08           NA           NA         11.33         9.81          1.45  090
                                         in bladder.
50800........  ...........  A.........  Implant ureter in       16.23           NA           NA          9.25         7.88          1.19  090
                                         bowel.
50810........  ...........  A.........  Fusion of ureter        22.38           NA           NA         10.64         9.69          2.32  090
                                         & bowel.
50815........  ...........  A.........  Urine shunt to          22.06           NA           NA         11.59        10.04          1.54  090
                                         intestine.
50820........  ...........  A.........  Construct bowel         23.89           NA           NA         11.97        10.33          1.90  090
                                         bladder.
50825........  ...........  A.........  Construct bowel         30.48           NA           NA         15.08        13.13          2.08  090
                                         bladder.
50830........  ...........  A.........  Revise urine flow       33.57           NA           NA         15.78        14.03          2.38  090
50840........  ...........  A.........  Replace ureter by       22.19           NA           NA         12.06        10.25          1.47  090
                                         bowel.
50845........  ...........  A.........  Appendico-              22.21           NA           NA         12.35        10.66          1.57  090
                                         vesicostomy.
50860........  ...........  A.........  Transplant ureter       16.93           NA           NA          9.31         7.94          1.29  090
                                         to skin.
50900........  ...........  A.........  Repair of ureter.       14.89           NA           NA          8.06         7.11          1.14  090
50920........  ...........  A.........  Closure ureter/         15.66           NA           NA          8.60         7.57          1.01  090
                                         skin fistula.
50930........  ...........  A.........  Closure ureter/         20.04           NA           NA          9.56         8.90          1.28  090
                                         bowel fistula.
50940........  ...........  A.........  Release of ureter       15.78           NA           NA          7.85         7.20          1.26  090
50945........  ...........  A.........  Laparoscopy             17.87           NA           NA          9.40         8.13          1.36  090
                                         ureterolithotomy.
50947........  ...........  A.........  Laparo new ureter/      25.63           NA           NA         12.42        11.09          2.17  090
                                         bladder.
50948........  ...........  A.........  Laparo new ureter/      23.69           NA           NA         11.31        10.14          1.71  090
                                         bladder.
50949........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         ureter.
50951........  ...........  A.........  Endoscopy of             5.83         4.85         4.58          2.80         2.43          0.41  000
                                         ureter.
50953........  ...........  A.........  Endoscopy of             6.23         4.95         4.69          3.25         2.82          0.43  000
                                         ureter.
50955........  ...........  A.........  Ureter endoscopy         6.74         5.17         5.80          3.49         3.09          0.48  000
                                         & biopsy.
50957........  ...........  A.........  Ureter endoscopy         6.78         5.41         4.98          3.19         2.78          0.48  000
                                         & treatment.
50961........  ...........  A.........  Ureter endoscopy         6.04         4.77         4.57          2.82         2.49          0.41  000
                                         & treatment.
50970........  ...........  A.........  Ureter endoscopy.        7.13           NA           NA          3.29         2.88          0.52  000
50972........  ...........  A.........  Ureter endoscopy         6.88           NA           NA          3.10         2.77          0.49  000
                                         & catheter.
50974........  ...........  A.........  Ureter endoscopy         9.16           NA           NA          3.82         3.49          0.64  000
                                         & biopsy.
50976........  ...........  A.........  Ureter endoscopy         9.03           NA           NA          3.91         3.45          0.66  000
                                         & treatment.
50980........  ...........  A.........  Ureter endoscopy         6.84           NA           NA          3.17         2.76          0.48  000
                                         & treatment.
51000........  ...........  A.........  Drainage of              0.78         0.92         1.43          0.27         0.26          0.05  000
                                         bladder.
51005........  ...........  A.........  Drainage of              1.02         2.40         3.55          0.35         0.34          0.10  000
                                         bladder.
51010........  ...........  A.........  Drainage of              4.27         4.75         5.18          2.39         2.13          0.28  010
                                         bladder.
51020........  ...........  A.........  Incise & treat           7.56           NA           NA          5.42         4.63          0.47  090
                                         bladder.
51030........  ...........  A.........  Incise & treat           7.68           NA           NA          4.78         4.39          0.58  090
                                         bladder.
51040........  ...........  A.........  Incise & drain           4.43           NA           NA          3.71         3.24          0.31  090
                                         bladder.
51045........  ...........  A.........  Incise bladder/          7.68           NA           NA          5.18         4.57          0.52  090
                                         drain ureter.
51050........  ...........  A.........  Removal of               7.87           NA           NA          5.37         4.52          0.49  090
                                         bladder stone.
51060........  ...........  A.........  Removal of ureter        9.82           NA           NA          6.48         5.49          0.62  090
                                         stone.
51065........  ...........  A.........  Remove ureter            9.82           NA           NA          6.30         5.35          0.63  090
                                         calculus.
51080........  ...........  A.........  Drainage of              6.61           NA           NA          4.67         4.04          0.43  090
                                         bladder abscess.
51500........  ...........  A.........  Removal of              10.92           NA           NA          5.76         5.40          1.03  090
                                         bladder cyst.
51520........  ...........  A.........  Removal of              10.08           NA           NA          6.37         5.56          0.69  090
                                         bladder lesion.
51525........  ...........  A.........  Removal of              15.29           NA           NA          8.56         7.37          0.99  090
                                         bladder lesion.
51530........  ...........  A.........  Removal of              13.58           NA           NA          7.45         6.58          1.05  090
                                         bladder lesion.
51535........  ...........  A.........  Repair of ureter        13.77           NA           NA          7.43         6.80          1.23  090
                                         lesion.
51550........  ...........  A.........  Partial removal         17.10           NA           NA          8.79         7.79          1.31  090
                                         of bladder.
51555........  ...........  A.........  Partial removal         23.03           NA           NA         11.48        10.09          1.70  090
                                         of bladder.
51565........  ...........  A.........  Revise bladder &        23.50           NA           NA         12.26        10.60          1.63  090
                                         ureter(s).
51570........  ...........  A.........  Removal of              27.31           NA           NA         13.65        11.68          1.72  090
                                         bladder.
51575........  ...........  A.........  Removal of              34.00           NA           NA         16.66        14.40          2.17  090
                                         bladder & nodes.

[[Page 38290]]

 
51580........  ...........  A.........  Remove bladder/         35.14           NA           NA         17.81        15.16          2.25  090
                                         revise tract.
51585........  ...........  A.........  Removal of              39.41           NA           NA         19.51        16.67          2.49  090
                                         bladder & nodes.
51590........  ...........  A.........  Remove bladder/         36.15           NA           NA         17.48        15.08          2.28  090
                                         revise tract.
51595........  ...........  A.........  Remove bladder/         41.12           NA           NA         19.85        17.02          2.60  090
                                         revise tract.
51596........  ...........  A.........  Remove bladder/         44.01           NA           NA         21.49        18.38          2.78  090
                                         create pouch.
51597........  ...........  A.........  Removal of pelvic       42.61           NA           NA         20.44        17.62          2.82  090
                                         structures.
51600........  ...........  A.........  Injection for            0.88         4.21         4.61          0.33         0.30          0.06  000
                                         bladder x-ray.
51605........  ...........  A.........  Preparation for          0.64           NA           NA          0.43         0.39          0.04  000
                                         bladder xray.
51610........  ...........  A.........  Injection for            1.05         1.91         2.09          0.71         0.65          0.07  000
                                         bladder x-ray.
51700........  ...........  A.........  Irrigation of            0.88         1.50         1.55          0.35         0.32          0.06  000
                                         bladder.
51701........  ...........  A.........  Insert bladder           0.50         1.03         1.31          0.25         0.22          0.04  000
                                         catheter.
51702........  ...........  A.........  Insert temp              0.50         1.52         1.80          0.34         0.29          0.04  000
                                         bladder cath.
51703........  ...........  A.........  Insert bladder           1.47         2.26         2.50          0.81         0.69          0.10  000
                                         cath, complex.
51705........  ...........  A.........  Change of bladder        1.03         2.02         2.15          0.85         0.73          0.07  010
                                         tube.
51710........  ...........  A.........  Change of bladder        1.50         2.72         3.03          1.18         0.98          0.11  010
                                         tube.
51715........  ...........  A.........  Endoscopic               3.73         4.42         4.17          1.75         1.56          0.29  000
                                         injection/
                                         implant.
51720........  ...........  A.........  Treatment of             1.50         1.62         1.69          0.75         0.72          0.14  000
                                         bladder lesion.
51725........  ...........  A.........  Simple                   1.51         4.22         4.91          4.22         4.91          0.16  000
                                         cystometrogram.
51725........  26.........  A.........  Simple                   1.51         0.56         0.53          0.56         0.53          0.12  000
                                         cystometrogram.
51725........  TC.........  A.........  Simple                   0.00         3.66         4.39          3.66         4.39          0.04  000
                                         cystometrogram.
51726........  ...........  A.........  Complex                  1.71         7.08         7.30          7.08         7.30          0.18  000
                                         cystometrogram.
51726........  26.........  A.........  Complex                  1.71         0.65         0.61          0.65         0.61          0.13  000
                                         cystometrogram.
51726........  TC.........  A.........  Complex                  0.00         6.43         6.69          6.43         6.69          0.05  000
                                         cystometrogram.
51736........  ...........  A.........  Urine flow               0.61         0.94         0.76          0.94         0.76          0.06  000
                                         measurement.
51736........  26.........  A.........  Urine flow               0.61         0.24         0.22          0.24         0.22          0.05  000
                                         measurement.
51736........  TC.........  A.........  Urine flow               0.00         0.70         0.54          0.70         0.54          0.01  000
                                         measurement.
51741........  ...........  A.........  Electro-                 1.14         1.28         1.03          1.28         1.03          0.11  000
                                         uroflowmetry,
                                         first.
51741........  26.........  A.........  Electro-                 1.14         0.45         0.41          0.45         0.41          0.09  000
                                         uroflowmetry,
                                         first.
51741........  TC.........  A.........  Electro-                 0.00         0.82         0.62          0.82         0.62          0.02  000
                                         uroflowmetry,
                                         first.
51772........  ...........  A.........  Urethra pressure         1.61         5.03         5.30          5.03         5.30          0.20  000
                                         profile.
51772........  26.........  A.........  Urethra pressure         1.61         0.55         0.55          0.55         0.55          0.15  000
                                         profile.
51772........  TC.........  A.........  Urethra pressure         0.00         4.48         4.75          4.48         4.75          0.05  000
                                         profile.
51784........  ...........  A.........  Anal/urinary             1.53         4.11         4.00          4.11         4.00          0.16  000
                                         muscle study.
51784........  26.........  A.........  Anal/urinary             1.53         0.57         0.53          0.57         0.53          0.12  000
                                         muscle study.
51784........  TC.........  A.........  Anal/urinary             0.00         3.54         3.47          3.54         3.47          0.04  000
                                         muscle study.
51785........  ...........  A.........  Anal/urinary             1.53         4.54         4.49          4.54         4.49          0.15  000
                                         muscle study.
51785........  26.........  A.........  Anal/urinary             1.53         0.57         0.54          0.57         0.54          0.11  000
                                         muscle study.
51785........  TC.........  A.........  Anal/urinary             0.00         3.97         3.95          3.97         3.95          0.04  000
                                         muscle study.
51792........  ...........  A.........  Urinary reflex           1.10         5.07         5.52          5.07         5.52          0.20  000
                                         study.
51792........  26.........  A.........  Urinary reflex           1.10         0.40         0.41          0.40         0.41          0.07  000
                                         study.
51792........  TC.........  A.........  Urinary reflex           0.00         4.67         5.11          4.67         5.11          0.13  000
                                         study.
51795........  ...........  A.........  Urine voiding            1.53         6.69         7.00          6.69         7.00          0.22  000
                                         pressure study.
51795........  26.........  A.........  Urine voiding            1.53         0.58         0.54          0.58         0.54          0.12  000
                                         pressure study.
51795........  TC.........  A.........  Urine voiding            0.00         6.11         6.46          6.11         6.46          0.10  000
                                         pressure study.
51797........  ...........  A.........  Intraabdominal           1.60         4.82         5.31          4.82         5.31          0.17  000
                                         pressure test.
51797........  26.........  A.........  Intraabdominal           1.60         0.60         0.57          0.60         0.57          0.12  000
                                         pressure test.
51797........  TC.........  A.........  Intraabdominal           0.00         4.22         4.74          4.22         4.74          0.05  000
                                         pressure test.
51798........  ...........  A.........  Us urine capacity        0.00         0.59         0.46            NA           NA          0.08  XXX
                                         measure.
51800........  ...........  A.........  Revision of             18.74           NA           NA          9.83         8.76          1.32  090
                                         bladder/urethra.
51820........  ...........  A.........  Revision of             19.41           NA           NA          9.75         9.16          1.75  090
                                         urinary tract.
51840........  ...........  A.........  Attach bladder/         11.28           NA           NA          5.80         5.68          1.06  090
                                         urethra.
51841........  ...........  A.........  Attach bladder/         13.60           NA           NA          6.95         6.65          1.24  090
                                         urethra.
51845........  ...........  A.........  Repair bladder          10.07           NA           NA          5.94         5.34          0.79  090
                                         neck.
51860........  ...........  A.........  Repair of bladder       12.49           NA           NA          6.76         6.27          1.16  090
                                         wound.
51865........  ...........  A.........  Repair of bladder       15.69           NA           NA          8.41         7.56          1.23  090
                                         wound.
51880........  ...........  A.........  Repair of bladder        7.81           NA           NA          4.75         4.35          0.72  090
                                         opening.
51900........  ...........  A.........  Repair bladder/         14.48           NA           NA          8.07         7.07          1.21  090
                                         vagina lesion.
51920........  ...........  A.........  Close bladder-          13.26           NA           NA          8.12         6.83          1.18  090
                                         uterus fistula.
51925........  ...........  A.........  Hysterectomy/           17.35           NA           NA         11.93        10.01          2.04  090
                                         bladder repair.
51940........  ...........  A.........  Correction of           30.48           NA           NA         11.80        11.89          2.15  090
                                         bladder defect.
51960........  ...........  A.........  Revision of             25.20           NA           NA         13.02        11.37          1.63  090
                                         bladder & bowel.
51980........  ...........  A.........  Construct bladder       12.44           NA           NA          7.12         6.29          0.86  090
                                         opening.
51990........  ...........  A.........  Laparo urethral         13.26           NA           NA          5.97         6.06          1.39  090
                                         suspension.
51992........  ...........  A.........  Laparo sling            14.77           NA           NA          6.57         6.40          1.41  090
                                         operation.
51999........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         bla.
52000........  ...........  A.........  Cystoscopy.......        2.23         3.66         3.49          1.33         1.05          0.14  000
52001........  ...........  A.........  Cystoscopy,              5.44         5.07         5.08          2.60         2.24          0.39  000
                                         removal of clots.
52005........  ...........  A.........  Cystoscopy &             2.37         5.72         5.65          1.38         1.14          0.17  000
                                         ureter catheter.
52007........  ...........  A.........  Cystoscopy and           3.02        10.67        13.56          1.63         1.40          0.22  000
                                         biopsy.
52010........  ...........  A.........  Cystoscopy & duct        3.02         8.02         9.41          1.63         1.40          0.21  000
                                         catheter.
52204........  ...........  A.........  Cystoscopy w/            2.59         8.28        11.41          1.39         1.15          0.17  000
                                         biopsy(s).
52214........  ...........  A.........  Cystoscopy and           3.70        19.80        28.97          1.85         1.60          0.26  000
                                         treatment.

[[Page 38291]]

 
52224........  ...........  A.........  Cystoscopy and           3.14        18.98        27.73          1.62         1.39          0.22  000
                                         treatment.
52234........  ...........  A.........  Cystoscopy and           4.62           NA           NA          2.30         1.99          0.33  000
                                         treatment.
52235........  ...........  A.........  Cystoscopy and           5.44           NA           NA          2.67         2.31          0.39  000
                                         treatment.
52240........  ...........  A.........  Cystoscopy and           9.71           NA           NA          4.41         3.87          0.69  000
                                         treatment.
52250........  ...........  A.........  Cystoscopy and           4.49           NA           NA          2.33         2.00          0.32  000
                                         radiotracer.
52260........  ...........  A.........  Cystoscopy and           3.91           NA           NA          1.96         1.70          0.28  000
                                         treatment.
52265........  ...........  A.........  Cystoscopy and           2.94         7.47        10.44          1.48         1.31          0.22  000
                                         treatment.
52270........  ...........  A.........  Cystoscopy &             3.36         7.01         9.03          1.76         1.51          0.24  000
                                         revise urethra.
52275........  ...........  A.........  Cystoscopy &             4.69         9.28        12.43          2.30         1.99          0.33  000
                                         revise urethra.
52276........  ...........  A.........  Cystoscopy and           4.99           NA           NA          2.48         2.13          0.35  000
                                         treatment.
52277........  ...........  A.........  Cystoscopy and           6.16           NA           NA          2.94         2.58          0.44  000
                                         treatment.
52281........  ...........  A.........  Cystoscopy and           2.80         5.28         6.19          1.56         1.33          0.20  000
                                         treatment.
52282........  ...........  A.........  Cystoscopy,              6.39           NA           NA          3.00         2.63          0.45  000
                                         implant stent.
52283........  ...........  A.........  Cystoscopy and           3.73         4.08         4.02          1.89         1.64          0.26  000
                                         treatment.
52285........  ...........  A.........  Cystoscopy and           3.60         4.33         4.18          1.85         1.60          0.26  000
                                         treatment.
52290........  ...........  A.........  Cystoscopy and           4.58           NA           NA          2.29         1.98          0.32  000
                                         treatment.
52300........  ...........  A.........  Cystoscopy and           5.30           NA           NA          2.59         2.26          0.38  000
                                         treatment.
52301........  ...........  A.........  Cystoscopy and           5.50           NA           NA          2.72         2.26          0.46  000
                                         treatment.
52305........  ...........  A.........  Cystoscopy and           5.30           NA           NA          2.52         2.19          0.38  000
                                         treatment.
52310........  ...........  A.........  Cystoscopy and           2.81         4.01         4.36          1.45         1.24          0.20  000
                                         treatment.
52315........  ...........  A.........  Cystoscopy and           5.20         6.63         7.66          2.50         2.17          0.37  000
                                         treatment.
52317........  ...........  A.........  Remove bladder           6.71        17.02        23.00          3.04         2.67          0.48  000
                                         stone.
52318........  ...........  A.........  Remove bladder           9.18           NA           NA          4.10         3.61          0.65  000
                                         stone.
52320........  ...........  A.........  Cystoscopy and           4.69           NA           NA          2.24         1.94          0.33  000
                                         treatment.
52325........  ...........  A.........  Cystoscopy, stone        6.15           NA           NA          2.82         2.48          0.44  000
                                         removal.
52327........  ...........  A.........  Cystoscopy,              5.18        18.03        24.89          2.41         2.11          0.37  000
                                         inject material.
52330........  ...........  A.........  Cystoscopy and           5.03        20.33        29.60          2.38         2.07          0.36  000
                                         treatment.
52332........  ...........  A.........  Cystoscopy and           2.83        12.37         9.07          1.57         1.32          0.21  000
                                         treatment.
52334........  ...........  A.........  Create passage to        4.82           NA           NA          2.36         2.05          0.35  000
                                         kidney.
52341........  ...........  A.........  Cysto w/ureter           6.11           NA           NA          3.08         2.65          0.43  000
                                         stricture tx.
52342........  ...........  A.........  Cysto w/up               6.61           NA           NA          3.30         2.83          0.46  000
                                         stricture tx.
52343........  ...........  A.........  Cysto w/renal            7.31           NA           NA          3.53         3.07          0.51  000
                                         stricture tx.
52344........  ...........  A.........  Cysto/uretero,           7.81           NA           NA          3.95         3.38          0.55  000
                                         stricture tx.
52345........  ...........  A.........  Cysto/uretero w/         8.31           NA           NA          4.16         3.57          0.58  000
                                         up stricture.
52346........  ...........  A.........  Cystouretero w/          9.34           NA           NA          4.57         3.94          0.65  000
                                         renal strict.
52351........  ...........  A.........  Cystouretero & or        5.85           NA           NA          2.99         2.57          0.41  000
                                         pyeloscope.
52352........  ...........  A.........  Cystouretero w/          6.87           NA           NA          3.51         3.02          0.49  000
                                         stone remove.
52353........  ...........  A.........  Cystouretero w/          7.96           NA           NA          3.95         3.41          0.57  000
                                         lithotripsy.
52354........  ...........  A.........  Cystouretero w/          7.33           NA           NA          3.69         3.19          0.52  000
                                         biopsy.
52355........  ...........  A.........  Cystouretero w/          8.81           NA           NA          4.30         3.73          0.63  000
                                         excise tumor.
52400........  ...........  A.........  Cystouretero w/         10.06           NA           NA          5.45         4.60          0.68  090
                                         congen repr.
52402........  ...........  A.........  Cystourethro cut         5.27           NA           NA          2.19         1.96          0.40  000
                                         ejacul duct.
52450........  ...........  A.........  Incision of              7.63           NA           NA          5.52         4.61          0.54  090
                                         prostate.
52500........  ...........  A.........  Revision of              9.39           NA           NA          6.23         5.09          0.60  090
                                         bladder neck.
52510........  ...........  A.........  Dilation                 7.49           NA           NA          4.94         4.03          0.48  090
                                         prostatic
                                         urethra.
52601........  ...........  A.........  Prostatectomy           15.13           NA           NA          8.52         6.83          0.87  090
                                         (TURP).
52606........  ...........  A.........  Control postop           8.84           NA           NA          5.53         4.56          0.57  090
                                         bleeding.
52612........  ...........  A.........  Prostatectomy,           9.07           NA           NA          5.93         4.84          0.56  090
                                         first stage.
52614........  ...........  A.........  Prostatectomy,           7.81           NA           NA          5.41         4.39          0.48  090
                                         second stage.
52620........  ...........  A.........  Remove residual          7.19           NA           NA          4.66         3.83          0.47  090
                                         prostate.
52630........  ...........  A.........  Remove prostate          7.65           NA           NA          4.84         4.03          0.51  090
                                         regrowth.
52640........  ...........  A.........  Relieve bladder          6.89           NA           NA          4.45         3.72          0.47  090
                                         contracture.
52647........  ...........  A.........  Laser surgery of        11.15        41.80        57.91          6.96         5.76          0.73  090
                                         prostate.
52648........  ...........  A.........  Laser surgery of        12.00        42.34        58.18          7.29         6.06          0.79  090
                                         prostate.
52700........  ...........  A.........  Drainage of              7.39           NA           NA          4.94         4.08          0.48  090
                                         prostate abscess.
53000........  ...........  A.........  Incision of              2.30           NA           NA          1.78         1.67          0.16  010
                                         urethra.
53010........  ...........  A.........  Incision of              4.35           NA           NA          3.85         3.38          0.24  090
                                         urethra.
53020........  ...........  A.........  Incision of              1.77           NA           NA          0.96         0.82          0.13  000
                                         urethra.
53025........  ...........  A.........  Incision of              1.13           NA           NA          0.82         0.67          0.08  000
                                         urethra.
53040........  ...........  A.........  Drainage of              6.49           NA           NA          4.43         3.94          0.45  090
                                         urethra abscess.
53060........  ...........  A.........  Drainage of              2.65         2.10         2.07          1.55         1.44          0.28  010
                                         urethra abscess.
53080........  ...........  A.........  Drainage of              6.82           NA           NA          5.00         5.47          0.52  090
                                         urinary leakage.
53085........  ...........  A.........  Drainage of             11.05           NA           NA          4.43         5.94          0.92  090
                                         urinary leakage.
53200........  ...........  A.........  Biopsy of urethra        2.59         1.71         1.52          1.31         1.15          0.20  000
53210........  ...........  A.........  Removal of              13.59           NA           NA          7.76         6.81          0.89  090
                                         urethra.
53215........  ...........  A.........  Removal of              16.72           NA           NA          9.23         7.94          1.10  090
                                         urethra.
53220........  ...........  A.........  Treatment of             7.53           NA           NA          5.03         4.38          0.49  090
                                         urethra lesion.
53230........  ...........  A.........  Removal of              10.31           NA           NA          6.43         5.59          0.73  090
                                         urethra lesion.
53235........  ...........  A.........  Removal of              10.86           NA           NA          6.97         5.95          0.72  090
                                         urethra lesion.
53240........  ...........  A.........  Surgery for              6.98           NA           NA          4.90         4.20          0.52  090
                                         urethra pouch.
53250........  ...........  A.........  Removal of               6.42           NA           NA          4.41         3.91          0.49  090
                                         urethra gland.
53260........  ...........  A.........  Treatment of             3.00         2.46         2.35          1.85         1.64          0.25  010
                                         urethra lesion.

[[Page 38292]]

 
53265........  ...........  A.........  Treatment of             3.14         2.95         2.84          2.00         1.71          0.24  010
                                         urethra lesion.
53270........  ...........  A.........  Removal of               3.11         2.47         2.31          1.86         1.68          0.30  010
                                         urethra gland.
53275........  ...........  A.........  Repair of urethra        4.54           NA           NA          2.79         2.52          0.32  010
                                         defect.
53400........  ...........  A.........  Revise urethra,         13.98           NA           NA          8.28         7.15          0.98  090
                                         stage 1.
53405........  ...........  A.........  Revise urethra,         15.51           NA           NA          8.78         7.59          1.10  090
                                         stage 2.
53410........  ...........  A.........  Reconstruction of       17.53           NA           NA          9.77         8.44          1.16  090
                                         urethra.
53415........  ...........  A.........  Reconstruction of       20.55           NA           NA         10.88         9.15          1.37  090
                                         urethra.
53420........  ...........  A.........  Reconstruct             15.04           NA           NA          7.07         6.60          0.96  090
                                         urethra, stage 1.
53425........  ...........  A.........  Reconstruct             16.94           NA           NA          9.10         8.05          1.13  090
                                         urethra, stage 2.
53430........  ...........  A.........  Reconstruction of       17.30           NA           NA          8.92         7.94          1.15  090
                                         urethra.
53431........  ...........  A.........  Reconstruct             21.03           NA           NA         11.11         9.60          1.41  090
                                         urethra/bladder.
53440........  ...........  A.........  Male sling              15.34           NA           NA          9.27         7.64          0.96  090
                                         procedure.
53442........  ...........  A.........  Remove/revise           13.29           NA           NA          8.43         6.95          0.82  090
                                         male sling.
53444........  ...........  A.........  Insert tandem           14.06           NA           NA          8.11         7.00          0.94  090
                                         cuff.
53445........  ...........  A.........  Insert uro/ves          15.21           NA           NA          8.85         7.98          0.99  090
                                         nck sphincter.
53446........  ...........  A.........  Remove uro              10.89           NA           NA          7.06         6.15          0.72  090
                                         sphincter.
53447........  ...........  A.........  Remove/replace ur       14.15           NA           NA          8.46         7.46          0.95  090
                                         sphincter.
53448........  ...........  A.........  Remov/replc ur          23.26           NA           NA         12.47        10.79          1.50  090
                                         sphinctr comp.
53449........  ...........  A.........  Repair uro              10.43           NA           NA          6.67         5.71          0.68  090
                                         sphincter.
53450........  ...........  A.........  Revision of              6.67           NA           NA          4.79         4.05          0.43  090
                                         urethra.
53460........  ...........  A.........  Revision of              7.65           NA           NA          5.08         4.41          0.50  090
                                         urethra.
53500........  ...........  A.........  Urethrlys,              12.87           NA           NA          7.49         6.85          0.90  090
                                         transvag w/
                                         scope.
53502........  ...........  A.........  Repair of urethra        8.16           NA           NA          5.11         4.54          0.62  090
                                         injury.
53505........  ...........  A.........  Repair of urethra        8.16           NA           NA          5.42         4.65          0.54  090
                                         injury.
53510........  ...........  A.........  Repair of urethra       10.83           NA           NA          6.88         6.01          0.74  090
                                         injury.
53515........  ...........  A.........  Repair of urethra       14.09           NA           NA          8.04         6.97          1.05  090
                                         injury.
53520........  ...........  A.........  Repair of urethra        9.35           NA           NA          6.25         5.36          0.61  090
                                         defect.
53600........  ...........  A.........  Dilate urethra           1.21         1.16         1.15          0.58         0.51          0.09  000
                                         stricture.
53601........  ...........  A.........  Dilate urethra           0.98         1.36         1.32          0.52         0.45          0.07  000
                                         stricture.
53605........  ...........  A.........  Dilate urethra           1.28           NA           NA          0.52         0.47          0.09  000
                                         stricture.
53620........  ...........  A.........  Dilate urethra           1.62         1.70         1.85          0.84         0.72          0.11  000
                                         stricture.
53621........  ...........  A.........  Dilate urethra           1.35         1.81         1.94          0.68         0.59          0.10  000
                                         stricture.
53660........  ...........  A.........  Dilation of              0.71         1.32         1.31          0.46         0.39          0.05  000
                                         urethra.
53661........  ...........  A.........  Dilation of              0.72         1.29         1.30          0.42         0.36          0.05  000
                                         urethra.
53665........  ...........  A.........  Dilation of              0.76           NA           NA          0.27         0.26          0.06  000
                                         urethra.
53850........  ...........  A.........  Prostatic                9.98        49.02        71.59          5.93         4.95          0.67  090
                                         microwave
                                         thermotx.
53852........  ...........  A.........  Prostatic rf            10.68        46.18        67.53          6.72         5.56          0.70  090
                                         thermotx.
53853........  ...........  A.........  Prostatic water          5.54        28.96        42.18          4.37         3.62          0.37  090
                                         thermother.
53899........  ...........  C.........  Urology surgery          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
54000........  ...........  A.........  Slitting of              1.56         2.70         2.81          1.49         1.21          0.11  010
                                         prepuce.
54001........  ...........  A.........  Slitting of              2.21         3.06         3.12          1.68         1.40          0.15  010
                                         prepuce.
54015........  ...........  A.........  Drain penis              5.33           NA           NA          3.24         2.89          0.38  010
                                         lesion.
54050........  ...........  A.........  Destruction,             1.26         2.09         1.88          1.40         1.21          0.08  010
                                         penis lesion(s).
54055........  ...........  A.........  Destruction,             1.23         1.97         1.78          1.24         1.03          0.08  010
                                         penis lesion(s).
54056........  ...........  A.........  Cryosurgery,             1.26         2.37         2.03          1.54         1.33          0.06  010
                                         penis lesion(s).
54057........  ...........  A.........  Laser surg, penis        1.26         2.62         2.41          1.37         1.10          0.09  010
                                         lesion(s).
54060........  ...........  A.........  Excision of penis        1.95         3.09         3.10          1.64         1.35          0.13  010
                                         lesion(s).
54065........  ...........  A.........  Destruction,             2.44         3.30         2.97          2.01         1.62          0.13  010
                                         penis lesion(s).
54100........  ...........  A.........  Biopsy of penis..        1.90         3.35         3.08          1.38         1.10          0.10  000
54105........  ...........  A.........  Biopsy of penis..        3.51         3.98         4.14          2.45         2.20          0.25  010
54110........  ...........  A.........  Treatment of            10.79           NA           NA          6.78         5.75          0.72  090
                                         penis lesion.
54111........  ...........  A.........  Treat penis             14.29           NA           NA          8.12         6.96          0.96  090
                                         lesion, graft.
54112........  ...........  A.........  Treat penis             16.83           NA           NA          9.41         8.12          1.11  090
                                         lesion, graft.
54115........  ...........  A.........  Treatment of             6.82         5.78         5.09          4.97         4.23          0.43  090
                                         penis lesion.
54120........  ...........  A.........  Partial removal         10.88           NA           NA          6.79         5.75          0.68  090
                                         of penis.
54125........  ...........  A.........  Removal of penis.       14.43           NA           NA          8.16         7.02          0.95  090
54130........  ...........  A.........  Remove penis &          21.66           NA           NA         11.72         9.92          1.52  090
                                         nodes.
54135........  ...........  A.........  Remove penis &          27.99           NA           NA         14.29        12.26          1.88  090
                                         nodes.
54150........  ...........  A.........  Circumcision w/          1.90         2.40         3.38          0.75         0.73          0.16  000
                                         regionl block.
54160........  ...........  A.........  Circumcision,            2.50         3.80         3.95          1.49         1.29          0.19  010
                                         neonate.
54161........  ...........  A.........  Circum 28 days or        3.29           NA           NA          2.22         1.89          0.23  010
                                         older.
54162........  ...........  A.........  Lysis penil              3.27         4.01         4.33          2.28         1.86          0.21  010
                                         circumic lesion.
54163........  ...........  A.........  Repair of                3.27           NA           NA          2.86         2.44          0.21  010
                                         circumcision.
54164........  ...........  A.........  Frenulotomy of           2.77           NA           NA          2.66         2.25          0.18  010
                                         penis.
54200........  ...........  A.........  Treatment of             1.08         2.01         1.90          1.31         1.14          0.08  010
                                         penis lesion.
54205........  ...........  A.........  Treatment of             8.84           NA           NA          6.10         5.41          0.56  090
                                         penis lesion.
54220........  ...........  A.........  Treatment of             2.42         3.32         3.59          1.36         1.16          0.17  000
                                         penis lesion.
54230........  ...........  A.........  Prepare penis            1.34         1.41         1.24          0.91         0.77          0.09  000
                                         study.
54231........  ...........  A.........  Dynamic                  2.04         1.98         1.66          1.26         1.05          0.16  000
                                         cavernosometry.
54235........  ...........  A.........  Penile injection.        1.19         1.39         1.18          0.90         0.74          0.08  000
54240........  ...........  A.........  Penis study......        1.31         1.51         1.28          1.51         1.28          0.17  000
54240........  26.........  A.........  Penis study......        1.31         0.49         0.46          0.49         0.46          0.11  000

[[Page 38293]]

 
54240........  TC.........  A.........  Penis study......        0.00         1.02         0.81          1.02         0.81          0.06  000
54250........  ...........  A.........  Penis study......        2.22         1.23         1.08          1.23         1.08          0.18  000
54250........  26.........  A.........  Penis study......        2.22         0.87         0.80          0.87         0.80          0.16  000
54250........  TC.........  A.........  Penis study......        0.00         0.37         0.28          0.37         0.28          0.02  000
54300........  ...........  A.........  Revision of penis       11.07           NA           NA          6.76         6.18          0.76  090
54304........  ...........  A.........  Revision of penis       13.15           NA           NA          7.87         7.12          0.88  090
54308........  ...........  A.........  Reconstruction of       12.49           NA           NA          4.74         5.83          0.84  090
                                         urethra.
54312........  ...........  A.........  Reconstruction of       14.36           NA           NA          9.28         8.03          1.24  090
                                         urethra.
54316........  ...........  A.........  Reconstruction of       17.90           NA           NA         10.05         9.02          1.21  090
                                         urethra.
54318........  ...........  A.........  Reconstruction of       12.28           NA           NA          4.81         5.54          1.39  090
                                         urethra.
54322........  ...........  A.........  Reconstruction of       13.85           NA           NA          8.02         7.23          0.92  090
                                         urethra.
54324........  ...........  A.........  Reconstruction of       17.40           NA           NA          9.85         8.92          1.14  090
                                         urethra.
54326........  ...........  A.........  Reconstruction of       16.87           NA           NA          9.24         8.59          1.11  090
                                         urethra.
54328........  ...........  A.........  Revise penis/           16.74           NA           NA          9.58         8.46          0.98  090
                                         urethra.
54332........  ...........  A.........  Revise penis/           18.22           NA           NA         10.18         8.97          1.21  090
                                         urethra.
54336........  ...........  A.........  Revise penis/           21.44           NA           NA          7.29         9.58          2.21  090
                                         urethra.
54340........  ...........  A.........  Secondary                9.58           NA           NA          6.41         5.74          0.63  090
                                         urethral surgery.
54344........  ...........  A.........  Secondary               16.91           NA           NA          9.64         8.74          1.54  090
                                         urethral surgery.
54348........  ...........  A.........  Secondary               18.17           NA           NA         10.24         8.64          1.23  090
                                         urethral surgery.
54352........  ...........  A.........  Reconstruct             25.95           NA           NA         14.13        12.61          2.25  090
                                         urethra/penis.
54360........  ...........  A.........  Penis plastic           12.65           NA           NA          7.52         6.79          0.84  090
                                         surgery.
54380........  ...........  A.........  Repair penis.....       14.03           NA           NA          8.04         6.93          0.93  090
54385........  ...........  A.........  Repair penis.....       16.38           NA           NA         11.34         9.31          0.86  090
54390........  ...........  A.........  Repair penis and        22.59           NA           NA          7.40         8.40          1.54  090
                                         bladder.
54400........  ...........  A.........  Insert semi-rigid        9.09           NA           NA          5.80         5.08          0.64  090
                                         prosthesis.
54401........  ...........  A.........  Insert self-contd       10.26           NA           NA          8.20         6.97          0.73  090
                                         prosthesis.
54405........  ...........  A.........  Insert multi-comp       14.39           NA           NA          8.20         7.07          0.95  090
                                         penis pros.
54406........  ...........  A.........  Remove muti-comp        12.76           NA           NA          7.68         6.57          0.86  090
                                         penis pros.
54408........  ...........  A.........  Repair multi-comp       13.73           NA           NA          8.32         7.03          0.90  090
                                         penis pros.
54410........  ...........  A.........  Remove/replace          16.48           NA           NA          9.45         8.05          1.10  090
                                         penis prosth.
54411........  ...........  A.........  Remov/replc penis       18.14           NA           NA         10.51         8.79          1.13  090
                                         pros, comp.
54415........  ...........  A.........  Remove self-contd        8.75           NA           NA          6.05         5.13          0.58  090
                                         penis pros.
54416........  ...........  A.........  Remv/repl penis         11.87           NA           NA          7.96         6.67          0.77  090
                                         contain pros.
54417........  ...........  A.........  Remv/replc penis        15.94           NA           NA          9.19         7.70          1.00  090
                                         pros, compl.
54420........  ...........  A.........  Revision of penis       12.26           NA           NA          7.46         6.55          0.81  090
54430........  ...........  A.........  Revision of penis       10.93           NA           NA          7.04         6.07          0.72  090
54435........  ...........  A.........  Revision of penis        6.71           NA           NA          5.03         4.32          0.43  090
54440........  ...........  C.........  Repair of penis..        0.42           NA           NA          0.00         0.00          0.00  090
54450........  ...........  A.........  Preputial                1.12         0.86         0.91          0.49         0.46          0.08  000
                                         stretching.
54500........  ...........  A.........  Biopsy of testis.        1.31           NA           NA          0.77         0.67          0.10  000
54505........  ...........  A.........  Biopsy of testis.        3.47           NA           NA          2.46         2.18          0.27  010
54512........  ...........  A.........  Excise lesion            9.23           NA           NA          5.72         4.93          0.67  090
                                         testis.
54520........  ...........  A.........  Removal of testis        5.25           NA           NA          3.74         3.27          0.50  090
54522........  ...........  A.........  Orchiectomy,            10.15           NA           NA          5.59         5.26          0.89  090
                                         partial.
54530........  ...........  A.........  Removal of testis        9.31           NA           NA          6.11         5.18          0.66  090
54535........  ...........  A.........  Extensive testis        13.06           NA           NA          6.95         6.36          0.95  090
                                         surgery.
54550........  ...........  A.........  Exploration for          8.31           NA           NA          5.24         4.55          0.59  090
                                         testis.
54560........  ...........  A.........  Exploration for         11.97           NA           NA          6.92         5.94          0.90  090
                                         testis.
54600........  ...........  A.........  Reduce testis            7.54           NA           NA          5.15         4.36          0.51  090
                                         torsion.
54620........  ...........  A.........  Suspension of            5.16           NA           NA          3.25         2.85          0.37  010
                                         testis.
54640........  ...........  A.........  Suspension of            7.57           NA           NA          5.38         4.58          0.62  090
                                         testis.
54650........  ...........  A.........  Orchiopexy              12.24           NA           NA          5.68         5.89          1.16  090
                                         (Fowler-
                                         Stephens).
54660........  ...........  A.........  Revision of              5.64           NA           NA          4.37         3.70          0.44  090
                                         testis.
54670........  ...........  A.........  Repair testis            6.57           NA           NA          4.81         4.18          0.47  090
                                         injury.
54680........  ...........  A.........  Relocation of           13.91           NA           NA          7.74         6.96          1.16  090
                                         testis(es).
54690........  ...........  A.........  Laparoscopy,            11.60           NA           NA          5.60         5.37          1.02  090
                                         orchiectomy.
54692........  ...........  A.........  Laparoscopy,            13.64           NA           NA          7.64         6.55          1.30  090
                                         orchiopexy.
54699........  ...........  C.........  Laparoscope proc,        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         testis.
54700........  ...........  A.........  Drainage of              3.44           NA           NA          2.39         2.16          0.28  010
                                         scrotum.
54800........  ...........  A.........  Biopsy of                2.33           NA           NA          1.24         1.03          0.23  000
                                         epididymis.
54830........  ...........  A.........  Remove epididymis        5.91           NA           NA          4.46         3.75          0.41  090
                                         lesion.
54840........  ...........  A.........  Remove epididymis        5.22           NA           NA          3.82         3.31          0.37  090
                                         lesion.
54860........  ...........  A.........  Removal of               6.85           NA           NA          4.91         4.12          0.45  090
                                         epididymis.
54861........  ...........  A.........  Removal of               9.57           NA           NA          6.30         5.31          0.63  090
                                         epididymis.
54865........  ...........  A.........  Explore                  5.67           NA           NA          4.28         3.39          0.40  090
                                         epididymis.
54900........  ...........  A.........  Fusion of               14.05           NA           NA          5.23         5.50          0.93  090
                                         spermatic ducts.
54901........  ...........  A.........  Fusion of               18.92           NA           NA         10.63         8.40          1.83  090
                                         spermatic ducts.
55000........  ...........  A.........  Drainage of              1.43         1.85         1.96          0.92         0.79          0.11  000
                                         hydrocele.
55040........  ...........  A.........  Removal of               5.39           NA           NA          3.97         3.44          0.43  090
                                         hydrocele.
55041........  ...........  A.........  Removal of               8.41           NA           NA          5.72         4.85          0.60  090
                                         hydroceles.
55060........  ...........  A.........  Repair of                6.05           NA           NA          4.48         3.78          0.46  090
                                         hydrocele.
55100........  ...........  A.........  Drainage of              2.40         3.49         3.58          2.11         1.84          0.17  010
                                         scrotum abscess.

[[Page 38294]]

 
55110........  ...........  A.........  Explore scrotum..        6.23           NA           NA          4.51         3.82          0.43  090
55120........  ...........  A.........  Removal of               5.62           NA           NA          4.23         3.60          0.39  090
                                         scrotum lesion.
55150........  ...........  A.........  Removal of               8.01           NA           NA          5.49         4.67          0.56  090
                                         scrotum.
55175........  ...........  A.........  Revision of              5.77           NA           NA          4.36         3.69          0.37  090
                                         scrotum.
55180........  ...........  A.........  Revision of             11.63           NA           NA          7.33         6.36          0.90  090
                                         scrotum.
55200........  ...........  A.........  Incision of sperm        4.50         7.99        10.19          3.34         2.87          0.33  090
                                         duct.
55250........  ...........  A.........  Removal of sperm         3.32         7.83         9.63          3.08         2.63          0.25  090
                                         duct(s).
55300........  ...........  A.........  Prepare, sperm           3.50           NA           NA          1.77         1.52          0.25  000
                                         duct x-ray.
55400........  ...........  A.........  Repair of sperm          8.53           NA           NA          5.46         4.77          0.64  090
                                         duct.
55450........  ...........  A.........  Ligation of sperm        4.38         5.46         6.31          2.58         2.27          0.29  010
                                         duct.
55500........  ...........  A.........  Removal of               6.12           NA           NA          4.21         3.66          0.55  090
                                         hydrocele.
55520........  ...........  A.........  Removal of sperm         6.56           NA           NA          3.80         3.53          0.75  090
                                         cord lesion.
55530........  ...........  A.........  Revise spermatic         5.69           NA           NA          4.11         3.57          0.45  090
                                         cord veins.
55535........  ...........  A.........  Revise spermatic         7.09           NA           NA          4.86         4.13          0.47  090
                                         cord veins.
55540........  ...........  A.........  Revise hernia &          8.20           NA           NA          4.23         4.02          0.94  090
                                         sperm veins.
55550........  ...........  A.........  Laparo ligate            7.10           NA           NA          4.57         3.94          0.57  090
                                         spermatic vein.
55559........  ...........  C.........  Laparo proc,             0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         spermatic cord.
55600........  ...........  A.........  Incise sperm duct        6.91           NA           NA          4.94         4.14          0.62  090
                                         pouch.
55605........  ...........  A.........  Incise sperm duct        8.63           NA           NA          4.60         4.50          0.64  090
                                         pouch.
55650........  ...........  A.........  Remove sperm duct       12.52           NA           NA          7.47         6.35          0.92  090
                                         pouch.
55680........  ...........  A.........  Remove sperm             5.59           NA           NA          3.95         3.45          0.47  090
                                         pouch lesion.
55700........  ...........  A.........  Biopsy of                2.58         3.71         3.96          1.34         0.99          0.11  000
                                         prostate.
55705........  ...........  A.........  Biopsy of                4.58           NA           NA          2.88         2.59          0.32  010
                                         prostate.
55720........  ...........  A.........  Drainage of              7.67           NA           NA          4.93         4.36          0.95  090
                                         prostate abscess.
55725........  ...........  A.........  Drainage of              9.90           NA           NA          6.32         5.41          0.70  090
                                         prostate abscess.
55801........  ...........  A.........  Removal of              19.62           NA           NA         10.44         9.08          1.34  090
                                         prostate.
55810........  ...........  A.........  Extensive               24.14           NA           NA         12.49        10.74          1.60  090
                                         prostate surgery.
55812........  ...........  A.........  Extensive               29.69           NA           NA         14.55        12.88          2.05  090
                                         prostate surgery.
55815........  ...........  A.........  Extensive               32.75           NA           NA         16.40        14.19          2.17  090
                                         prostate surgery.
55821........  ...........  A.........  Removal of              15.63           NA           NA          8.77         7.50          1.01  090
                                         prostate.
55831........  ...........  A.........  Removal of              17.06           NA           NA          9.35         8.02          1.10  090
                                         prostate.
55840........  ...........  A.........  Extensive               24.45           NA           NA         12.84        11.07          1.61  090
                                         prostate surgery.
55842........  ...........  A.........  Extensive               26.31           NA           NA         13.64        11.77          1.73  090
                                         prostate surgery.
55845........  ...........  A.........  Extensive               30.52           NA           NA         15.06        13.03          2.03  090
                                         prostate surgery.
55860........  ...........  A.........  Surgical                15.71           NA           NA          8.64         7.55          1.02  090
                                         exposure,
                                         prostate.
55862........  ...........  A.........  Extensive               19.89           NA           NA         10.82         9.35          1.49  090
                                         prostate surgery.
55865........  ...........  A.........  Extensive               24.39           NA           NA         12.56        11.00          1.63  090
                                         prostate surgery.
55866........  ...........  A.........  Laparo radical          32.25           NA           NA         16.16        13.97          2.17  090
                                         prostatectomy.
55870........  ...........  A.........  Electroejaculatio        2.58         2.49         2.01          1.47         1.28          0.16  000
                                         n.
55873........  ...........  A.........  Cryoablate              20.25           NA           NA         11.41        10.20          1.38  090
                                         prostate.
55875........  ...........  A.........  Transperi needle        13.31           NA           NA          7.91         6.54          0.89  090
                                         place, pros.
55876........  ...........  A.........  Place rt device/         1.73         2.07         2.05          1.06         1.04          0.28  000
                                         marker, pros.
55899........  ...........  C.........  Genital surgery          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
56405........  ...........  A.........  I & D of vulva/          1.46         1.17         1.25          1.16         1.15          0.17  010
                                         perineum.
56420........  ...........  A.........  Drainage of gland        1.41         1.51         1.89          0.78         0.91          0.16  010
                                         abscess.
56440........  ...........  A.........  Surgery for vulva        2.86           NA           NA          1.57         1.64          0.34  010
                                         lesion.
56441........  ...........  A.........  Lysis of labial          1.99         1.71         1.76          1.56         1.49          0.20  010
                                         lesion(s).
56442........  ...........  A.........  Hymenotomy.......        0.68           NA           NA          0.52         0.51          0.08  000
56501........  ...........  A.........  Destroy, vulva           1.55         1.63         1.70          1.22         1.23          0.18  010
                                         lesions, sim.
56515........  ...........  A.........  Destroy vulva            3.03         2.39         2.46          1.74         1.77          0.33  010
                                         lesion/s compl.
56605........  ...........  A.........  Biopsy of vulva/         1.10         0.92         0.99          0.35         0.40          0.13  000
                                         perineum.
56606........  ...........  A.........  Biopsy of vulva/         0.55         0.36         0.43          0.15         0.18          0.07  ZZZ
                                         perineum.
56620........  ...........  A.........  Partial removal          8.44           NA           NA          4.41         4.60          0.90  090
                                         of vulva.
56625........  ...........  A.........  Complete removal         9.55           NA           NA          4.83         5.06          1.02  090
                                         of vulva.
56630........  ...........  A.........  Extensive vulva         14.67           NA           NA          6.32         6.57          1.49  090
                                         surgery.
56631........  ...........  A.........  Extensive vulva         18.81           NA           NA          7.83         8.30          1.96  090
                                         surgery.
56632........  ...........  A.........  Extensive vulva         21.61           NA           NA          9.36         9.43          2.39  090
                                         surgery.
56633........  ...........  A.........  Extensive vulva         19.47           NA           NA          7.87         8.22          1.98  090
                                         surgery.
56634........  ...........  A.........  Extensive vulva         20.48           NA           NA          8.25         8.83          2.17  090
                                         surgery.
56637........  ...........  A.........  Extensive vulva         24.57           NA           NA          9.38        10.21          2.61  090
                                         surgery.
56640........  ...........  A.........  Extensive vulva         24.65           NA           NA          8.91         9.79          2.89  090
                                         surgery.
56700........  ...........  A.........  Partial removal          2.79           NA           NA          1.77         1.80          0.30  010
                                         of hymen.
56740........  ...........  A.........  Remove vagina            4.83           NA           NA          2.34         2.45          0.56  010
                                         gland lesion.
56800........  ...........  A.........  Repair of vagina.        3.90           NA           NA          1.97         2.08          0.44  010
56805........  ...........  A.........  Repair clitoris..       19.75           NA           NA          7.75         8.84          2.15  090
56810........  ...........  A.........  Repair of                4.26           NA           NA          2.05         2.17          0.49  010
                                         perineum.
56820........  ...........  A.........  Exam of vulva w/         1.50         1.19         1.25          0.53         0.59          0.18  000
                                         scope.
56821........  ...........  A.........  Exam/biopsy of           2.05         1.53         1.64          0.69         0.80          0.25  000
                                         vulva w/scope.
57000........  ...........  A.........  Exploration of           2.99           NA           NA          1.77         1.74          0.31  010
                                         vagina.
57010........  ...........  A.........  Drainage of              6.74           NA           NA          3.80         3.81          0.71  090
                                         pelvic abscess.
57020........  ...........  A.........  Drainage of              1.50         0.78         0.85          0.46         0.52          0.18  000
                                         pelvic fluid.
57022........  ...........  A.........  I & d vaginal            2.70           NA           NA          1.43         1.46          0.26  010
                                         hematoma, pp.

[[Page 38295]]

 
57023........  ...........  A.........  I & d vag                5.13           NA           NA          2.38         2.48          0.58  010
                                         hematoma, non-ob.
57061........  ...........  A.........  Destroy vag              1.27         1.52         1.58          1.11         1.12          0.15  010
                                         lesions, simple.
57065........  ...........  A.........  Destroy vag              2.63         2.03         2.16          1.50         1.59          0.31  010
                                         lesions, complex.
57100........  ...........  A.........  Biopsy of vagina.        1.20         0.95         1.01          0.37         0.42          0.14  000
57105........  ...........  A.........  Biopsy of vagina.        1.71         1.59         1.69          1.33         1.38          0.20  010
57106........  ...........  A.........  Remove vagina            7.35           NA           NA          4.28         4.23          0.73  090
                                         wall, partial.
57107........  ...........  A.........  Remove vagina           24.43           NA           NA          9.14         9.79          2.72  090
                                         tissue, part.
57109........  ...........  A.........  Vaginectomy             28.25           NA           NA         10.36        10.81          3.22  090
                                         partial w/nodes.
57110........  ...........  A.........  Remove vagina           15.38           NA           NA          6.24         6.75          1.74  090
                                         wall, complete.
57111........  ...........  A.........  Remove vagina           28.25           NA           NA         10.53        11.52          3.18  090
                                         tissue, compl.
57112........  ...........  A.........  Vaginectomy w/          30.37           NA           NA         10.71        11.56          3.08  090
                                         nodes, compl.
57120........  ...........  A.........  Closure of vagina        8.18           NA           NA          4.21         4.40          0.89  090
57130........  ...........  A.........  Remove vagina            2.44         1.96         2.06          1.47         1.51          0.29  010
                                         lesion.
57135........  ...........  A.........  Remove vagina            2.68         2.03         2.14          1.54         1.59          0.31  010
                                         lesion.
57150........  ...........  A.........  Treat vagina             0.55         0.58         0.84          0.15         0.18          0.07  000
                                         infection.
57155........  ...........  A.........  Insert uteri             6.79           NA           NA          3.52         4.04          0.43  090
                                         tandems/ovoids.
57160........  ...........  A.........  Insert pessary/          0.89         1.04         1.03          0.26         0.30          0.10  000
                                         other device.
57170........  ...........  A.........  Fitting of               0.91         0.57         1.02          0.25         0.29          0.11  000
                                         diaphragm/cap.
57180........  ...........  A.........  Treat vaginal            1.60         1.85         2.00          0.93         1.10          0.19  010
                                         bleeding.
57200........  ...........  A.........  Repair of vagina.        4.34           NA           NA          3.00         2.93          0.46  090
57210........  ...........  A.........  Repair vagina/           5.63           NA           NA          3.28         3.35          0.62  090
                                         perineum.
57220........  ...........  A.........  Revision of              4.77           NA           NA          3.01         3.06          0.51  090
                                         urethra.
57230........  ...........  A.........  Repair of                6.22           NA           NA          3.66         3.55          0.54  090
                                         urethral lesion.
57240........  ...........  A.........  Repair bladder &        11.42           NA           NA          5.53         4.66          0.62  090
                                         vagina.
57250........  ...........  A.........  Repair rectum &         11.42           NA           NA          5.07         4.31          0.65  090
                                         vagina.
57260........  ...........  A.........  Repair of vagina.       14.36           NA           NA          5.90         5.35          0.97  090
57265........  ...........  A.........  Extensive repair        15.86           NA           NA          6.37         6.19          1.32  090
                                         of vagina.
57267........  ...........  A.........  Insert mesh/             4.88           NA           NA          1.52         1.75          0.64  ZZZ
                                         pelvic flr addon.
57268........  ...........  A.........  Repair of bowel          7.47           NA           NA          4.35         4.26          0.79  090
                                         bulge.
57270........  ...........  A.........  Repair of bowel         13.57           NA           NA          5.89         6.03          1.42  090
                                         pouch.
57280........  ...........  A.........  Suspension of           16.62           NA           NA          7.03         7.19          1.68  090
                                         vagina.
57282........  ...........  A.........  Colpopexy,               7.84           NA           NA          4.51         4.49          1.02  090
                                         extraperitoneal.
57283........  ...........  A.........  Colpopexy,              11.58           NA           NA          5.15         5.54          1.02  090
                                         intraperitoneal.
57284........  ...........  A.........  Repair                  13.51           NA           NA          6.92         7.00          1.41  090
                                         paravaginal
                                         defect.
57287........  ...........  A.........  Revise/remove           11.49           NA           NA          6.40         5.95          0.90  090
                                         sling repair.
57288........  ...........  A.........  Repair bladder          14.01           NA           NA          7.09         6.50          1.12  090
                                         defect.
57289........  ...........  A.........  Repair bladder &        12.69           NA           NA          6.72         6.29          1.21  090
                                         vagina.
57291........  ...........  A.........  Construction of          8.54           NA           NA          4.91         4.82          0.93  090
                                         vagina.
57292........  ...........  A.........  Construct vagina        13.91           NA           NA          5.95         6.46          1.58  090
                                         with graft.
57295........  ...........  A.........  Revise vag graft         7.74           NA           NA          4.11         4.26          0.91  090
                                         via vagina.
57296........  ...........  A.........  Revise vag graft,       16.46           NA           NA          6.73         6.74          1.68  090
                                         open abd.
57300........  ...........  A.........  Repair rectum-           8.58           NA           NA          4.44         4.37          0.87  090
                                         vagina fistula.
57305........  ...........  A.........  Repair rectum-          15.24           NA           NA          6.19         6.22          1.73  090
                                         vagina fistula.
57307........  ...........  A.........  Fistula repair &        17.02           NA           NA          6.91         6.97          2.02  090
                                         colostomy.
57308........  ...........  A.........  Fistula repair,         10.48           NA           NA          4.97         5.02          1.14  090
                                         transperine.
57310........  ...........  A.........  Repair                   7.55           NA           NA          5.03         4.44          0.54  090
                                         urethrovaginal
                                         lesion.
57311........  ...........  A.........  Repair                   8.81           NA           NA          5.56         4.78          0.65  090
                                         urethrovaginal
                                         lesion.
57320........  ...........  A.........  Repair bladder-          8.78           NA           NA          5.32         4.85          0.69  090
                                         vagina lesion.
57330........  ...........  A.........  Repair bladder-         13.11           NA           NA          7.28         6.49          1.06  090
                                         vagina lesion.
57335........  ...........  A.........  Repair vagina....       19.87           NA           NA          7.89         8.65          1.92  090
57400........  ...........  A.........  Dilation of              2.27           NA           NA          1.01         1.06          0.26  000
                                         vagina.
57410........  ...........  A.........  Pelvic                   1.75           NA           NA          0.92         0.91          0.18  000
                                         examination.
57415........  ...........  A.........  Remove vaginal           2.44           NA           NA          1.50         1.46          0.24  010
                                         foreign body.
57420........  ...........  A.........  Exam of vagina w/        1.60         1.23         1.29          0.56         0.62          0.19  000
                                         scope.
57421........  ...........  A.........  Exam/biopsy of           2.20         1.59         1.72          0.73         0.84          0.27  000
                                         vag w/scope.
57425........  ...........  A.........  Laparoscopy,            16.93           NA           NA          6.97         6.80          1.76  090
                                         surg, colpopexy.
57452........  ...........  A.........  Exam of cervix w/        1.50         1.18         1.23          0.74         0.75          0.18  000
                                         scope.
57454........  ...........  A.........  Bx/curett of             2.33         1.39         1.52          0.95         1.05          0.28  000
                                         cervix w/scope.
57455........  ...........  A.........  Biopsy of cervix         1.99         1.50         1.61          0.66         0.77          0.24  000
                                         w/scope.
57456........  ...........  A.........  Endocerv                 1.85         1.45         1.55          0.63         0.72          0.22  000
                                         curettage w/
                                         scope.
57460........  ...........  A.........  Bx of cervix w/          2.83         4.26         5.05          1.10         1.24          0.34  000
                                         scope, leep.
57461........  ...........  A.........  Conz of cervix w/        3.43         4.55         5.32          1.06         1.27          0.41  000
                                         scope, leep.
57500........  ...........  A.........  Biopsy of cervix.        1.20         2.00         2.27          0.64         0.63          0.12  000
57505........  ...........  A.........  Endocervical             1.16         1.32         1.39          1.06         1.08          0.14  010
                                         curettage.
57510........  ...........  A.........  Cauterization of         1.90         1.31         1.44          0.90         0.97          0.23  010
                                         cervix.
57511........  ...........  A.........  Cryocautery of           1.92         1.60         1.71          1.27         1.32          0.23  010
                                         cervix.
57513........  ...........  A.........  Laser surgery of         1.92         1.57         1.64          1.28         1.34          0.23  010
                                         cervix.
57520........  ...........  A.........  Conization of            4.06         3.37         3.65          2.51         2.69          0.49  090
                                         cervix.
57522........  ...........  A.........  Conization of            3.62         2.77         2.96          2.25         2.35          0.41  090
                                         cervix.
57530........  ...........  A.........  Removal of cervix        5.19           NA           NA          3.11         3.24          0.58  090
57531........  ...........  A.........  Removal of              29.77           NA           NA         10.96        12.03          3.35  090
                                         cervix, radical.
57540........  ...........  A.........  Removal of              13.19           NA           NA          5.47         5.88          1.49  090
                                         residual cervix.

[[Page 38296]]

 
57545........  ...........  A.........  Remove cervix/          14.00           NA           NA          5.74         6.29          1.52  090
                                         repair pelvis.
57550........  ...........  A.........  Removal of               6.24           NA           NA          3.62         3.72          0.67  090
                                         residual cervix.
57555........  ...........  A.........  Remove cervix/           9.84           NA           NA          4.78         4.93          1.09  090
                                         repair vagina.
57556........  ...........  A.........  Remove cervix,           9.26           NA           NA          4.64         4.75          0.92  090
                                         repair bowel.
57558........  ...........  A.........  D&c of cervical          1.69         1.34         1.43          1.05         1.11          0.20  010
                                         stump.
57700........  ...........  A.........  Revision of              4.22           NA           NA          3.27         3.18          0.41  090
                                         cervix.
57720........  ...........  A.........  Revision of              4.53           NA           NA          2.94         3.01          0.49  090
                                         cervix.
57800........  ...........  A.........  Dilation of              0.77         0.72         0.74          0.41         0.44          0.09  000
                                         cervical canal.
58100........  ...........  A.........  Biopsy of uterus         1.53         1.14         1.23          0.58         0.65          0.18  000
                                         lining.
58110........  ...........  A.........  Bx done w/               0.77         0.40         0.47          0.21         0.26          0.09  ZZZ
                                         colposcopy add-
                                         on.
58120........  ...........  A.........  Dilation and             3.54         2.70         2.50          1.66         1.77          0.39  010
                                         curettage.
58140........  ...........  A.........  Myomectomy abdom        15.69           NA           NA          6.21         6.66          1.82  090
                                         method.
58145........  ...........  A.........  Myomectomy vag           8.81           NA           NA          4.25         4.52          0.97  090
                                         method.
58146........  ...........  A.........  Myomectomy abdom        20.24           NA           NA          7.40         8.19          2.33  090
                                         complex.
58150........  ...........  A.........  Total                   17.21           NA           NA          6.61         7.04          1.85  090
                                         hysterectomy.
58152........  ...........  A.........  Total                   21.73           NA           NA          8.10         8.98          2.48  090
                                         hysterectomy.
58180........  ...........  A.........  Partial                 16.50           NA           NA          6.38         6.91          1.64  090
                                         hysterectomy.
58200........  ...........  A.........  Extensive               23.00           NA           NA          8.23         9.10          2.55  090
                                         hysterectomy.
58210........  ...........  A.........  Extensive               30.76           NA           NA         10.82        12.00          3.38  090
                                         hysterectomy.
58240........  ...........  A.........  Removal of pelvis       49.02           NA           NA         17.79        17.70          4.23  090
                                         contents.
58260........  ...........  A.........  Vaginal                 14.02           NA           NA          5.82         6.25          1.57  090
                                         hysterectomy.
58262........  ...........  A.........  Vag hyst                15.81           NA           NA          6.28         6.83          1.80  090
                                         including t/o.
58263........  ...........  A.........  Vag hyst w/t/o &        17.10           NA           NA          6.69         7.28          1.95  090
                                         vag repair.
58267........  ...........  A.........  Vag hyst w/             18.23           NA           NA          7.02         7.69          2.07  090
                                         urinary repair.
58270........  ...........  A.........  Vag hyst w/             15.20           NA           NA          5.98         6.51          1.74  090
                                         enterocele
                                         repair.
58275........  ...........  A.........  Hysterectomy/           16.90           NA           NA          6.66         7.21          1.92  090
                                         revise vagina.
58280........  ...........  A.........  Hysterectomy/           18.20           NA           NA          7.01         7.64          2.07  090
                                         revise vagina.
58285........  ...........  A.........  Extensive               23.30           NA           NA          8.01         8.98          2.71  090
                                         hysterectomy.
58290........  ...........  A.........  Vag hyst complex.       20.17           NA           NA          7.41         8.26          2.30  090
58291........  ...........  A.........  Vag hyst incl t/        21.96           NA           NA          7.89         8.87          2.53  090
                                         o, complex.
58292........  ...........  A.........  Vag hyst t/o &          23.25           NA           NA          8.29         9.32          2.68  090
                                         repair, compl.
58293........  ...........  A.........  Vag hyst w/uro          24.23           NA           NA          8.60         9.61          2.79  090
                                         repair, compl.
58294........  ...........  A.........  Vag hyst w/             21.45           NA           NA          7.57         8.50          2.40  090
                                         enterocele,
                                         compl.
58300........  ...........  N.........  Insert                   1.01         0.63         1.02          0.23         0.30          0.12  XXX
                                         intrauterine
                                         device.
58301........  ...........  A.........  Remove                   1.27         1.04         1.18          0.35         0.42          0.15  000
                                         intrauterine
                                         device.
58321........  ...........  A.........  Artificial               0.92         0.93         1.04          0.23         0.30          0.10  000
                                         insemination.
58322........  ...........  A.........  Artificial               1.10         1.03         1.12          0.31         0.36          0.13  000
                                         insemination.
58323........  ...........  A.........  Sperm washing....        0.23         0.16         0.35          0.07         0.08          0.03  000
58340........  ...........  A.........  Catheter for             0.88         2.14         2.65          0.57         0.61          0.09  000
                                         hysterography.
58345........  ...........  A.........  Reopen fallopian         4.67           NA           NA          2.13         2.26          0.41  010
                                         tube.
58346........  ...........  A.........  Insert heyman            7.48           NA           NA          3.76         3.85          0.56  090
                                         uteri capsule.
58350........  ...........  A.........  Reopen fallopian         1.03         1.35         1.42          0.88         0.90          0.12  010
                                         tube.
58353........  ...........  A.........  Endometr ablate,         3.57        22.66        29.16          1.72         1.89          0.43  010
                                         thermal.
58356........  ...........  A.........  Endometrial              6.36        43.03        52.21          1.88         2.28          0.82  010
                                         cryoablation.
58400........  ...........  A.........  Suspension of            7.06           NA           NA          3.88         3.89          0.75  090
                                         uterus.
58410........  ...........  A.........  Suspension of           13.70           NA           NA          5.61         6.06          1.45  090
                                         uterus.
58520........  ...........  A.........  Repair of               13.38           NA           NA          5.53         5.77          1.47  090
                                         ruptured uterus.
58540........  ...........  A.........  Revision of             15.61           NA           NA          6.19         6.57          1.79  090
                                         uterus.
58541........  ...........  A.........  Lsh, uterus 250 g       14.57           NA           NA          6.17         6.15          1.68  090
                                         or less.
58542........  ...........  A.........  Lsh w/t/o ut 250        16.43           NA           NA          6.68         6.67          1.69  090
                                         g or less.
58543........  ...........  A.........  Lsh uterus above        16.74           NA           NA          6.76         6.74          1.73  090
                                         250 g.
58544........  ...........  A.........  Lsh w/t/o uterus        18.24           NA           NA          7.18         7.17          1.89  090
                                         above 250 g.
58545........  ...........  A.........  Laparoscopic            15.45           NA           NA          5.91         6.55          1.78  090
                                         myomectomy.
58546........  ...........  A.........  Laparo-                 19.84           NA           NA          7.12         8.01          2.31  090
                                         myomectomy,
                                         complex.
58548........  ...........  A.........  Lap radical hyst.       31.45           NA           NA         12.62        12.70          3.52  090
58550........  ...........  A.........  Laparo-asst vag         14.97           NA           NA          6.17         6.73          1.73  090
                                         hysterectomy.
58552........  ...........  A.........  Laparo-vag hyst         16.78           NA           NA          6.61         7.31          1.73  090
                                         incl t/o.
58553........  ...........  A.........  Laparo-vag hyst,        19.96           NA           NA          7.15         8.03          2.31  090
                                         complex.
58554........  ...........  A.........  Laparo-vag hyst w/      22.98           NA           NA          8.33         9.36          2.28  090
                                         t/o, compl.
58555........  ...........  A.........  Hysteroscopy, dx,        3.33         2.75         2.46          1.24         1.39          0.40  000
                                         sep proc.
58558........  ...........  A.........  Hysteroscopy,            4.74         3.62         2.89          1.67         1.92          0.57  000
                                         biopsy.
58559........  ...........  A.........  Hysteroscopy,            6.16           NA           NA          2.06         2.39          0.74  000
                                         lysis.
58560........  ...........  A.........  Hysteroscopy,            6.99           NA           NA          2.34         2.70          0.84  000
                                         resect septum.
58561........  ...........  A.........  Hysteroscopy,            9.99           NA           NA          3.15         3.72          1.21  000
                                         remove myoma.
58562........  ...........  A.........  Hysteroscopy,            5.20         3.53         2.93          1.77         2.06          0.63  000
                                         remove fb.
58563........  ...........  A.........  Hysteroscopy,            6.16        36.96        46.57          2.06         2.41          0.74  000
                                         ablation.
58565........  ...........  A.........  Hysteroscopy,            7.06        41.68        44.35          3.39         3.64          1.19  090
                                         sterilization.
58578........  ...........  C.........  Laparo proc,             0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         uterus.
58579........  ...........  C.........  Hysteroscope             0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
58600........  ...........  A.........  Division of              5.86           NA           NA          2.93         3.13          0.66  090
                                         fallopian tube.
58605........  ...........  A.........  Division of              5.25           NA           NA          2.72         2.91          0.59  090
                                         fallopian tube.
58611........  ...........  A.........  Ligate oviduct(s)        1.45           NA           NA          0.40         0.49          0.18  ZZZ
                                         add-on.

[[Page 38297]]

 
58615........  ...........  A.........  Occlude fallopian        3.91           NA           NA          2.04         2.36          0.47  010
                                         tube(s).
58660........  ...........  A.........  Laparoscopy,            11.54           NA           NA          4.52         4.89          1.40  090
                                         lysis.
58661........  ...........  A.........  Laparoscopy,            11.30           NA           NA          4.02         4.57          1.34  010
                                         remove adnexa.
58662........  ...........  A.........  Laparoscopy,            12.08           NA           NA          4.79         5.28          1.43  090
                                         excise lesions.
58670........  ...........  A.........  Laparoscopy,             5.86           NA           NA          2.96         3.11          0.67  090
                                         tubal cautery.
58671........  ...........  A.........  Laparoscopy,             5.86           NA           NA          2.95         3.11          0.68  090
                                         tubal block.
58672........  ...........  A.........  Laparoscopy,            12.88           NA           NA          4.82         5.49          1.60  090
                                         fimbrioplasty.
58673........  ...........  A.........  Laparoscopy,            13.99           NA           NA          5.16         5.87          1.70  090
                                         salpingostomy.
58679........  ...........  C.........  Laparo proc,             0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         oviduct-ovary.
58700........  ...........  A.........  Removal of              12.84           NA           NA          5.50         5.75          1.51  090
                                         fallopian tube.
58720........  ...........  A.........  Removal of ovary/       12.08           NA           NA          5.11         5.44          1.39  090
                                         tube(s).
58740........  ...........  A.........  Revise fallopian        14.79           NA           NA          6.08         6.61          1.72  090
                                         tube(s).
58750........  ...........  A.........  Repair oviduct...       15.56           NA           NA          6.09         6.72          1.85  090
58752........  ...........  A.........  Revise ovarian          15.56           NA           NA          5.97         6.46          1.81  090
                                         tube(s).
58760........  ...........  A.........  Remove tubal            13.85           NA           NA          5.62         6.17          1.80  090
                                         obstruction.
58770........  ...........  A.........  Create new tubal        14.69           NA           NA          5.79         6.34          1.74  090
                                         opening.
58800........  ...........  A.........  Drainage of              4.54         3.21         3.41          2.69         2.78          0.43  090
                                         ovarian cyst(s).
58805........  ...........  A.........  Drainage of              6.34           NA           NA          3.50         3.49          0.69  090
                                         ovarian cyst(s).
58820........  ...........  A.........  Drain ovary              4.62           NA           NA          2.90         3.09          0.52  090
                                         abscess, open.
58822........  ...........  A.........  Drain ovary             11.71           NA           NA          5.16         5.17          1.16  090
                                         abscess, percut.
58823........  ...........  A.........  Drain pelvic             3.37        19.80        20.43          1.17         1.11          0.24  000
                                         abscess, percut.
58825........  ...........  A.........  Transposition,          11.70           NA           NA          4.86         5.35          1.32  090
                                         ovary(s).
58900........  ...........  A.........  Biopsy of                6.51           NA           NA          3.55         3.54          0.69  090
                                         ovary(s).
58920........  ...........  A.........  Partial removal         11.87           NA           NA          5.08         5.35          1.43  090
                                         of ovary(s).
58925........  ...........  A.........  Removal of              12.33           NA           NA          5.26         5.47          1.41  090
                                         ovarian cyst(s).
58940........  ...........  A.........  Removal of               8.12           NA           NA          4.04         4.07          0.91  090
                                         ovary(s).
58943........  ...........  A.........  Removal of              19.42           NA           NA          7.22         7.93          2.23  090
                                         ovary(s).
58950........  ...........  A.........  Resect ovarian          18.24           NA           NA          7.30         7.85          2.05  090
                                         malignancy.
58951........  ...........  A.........  Resect ovarian          24.15           NA           NA          8.67         9.55          2.64  090
                                         malignancy.
58952........  ...........  A.........  Resect ovarian          27.15           NA           NA          9.90        10.82          3.03  090
                                         malignancy.
58953........  ...........  A.........  Tah, rad dissect        33.97           NA           NA         11.75        13.14          3.84  090
                                         for debulk.
58954........  ...........  A.........  Tah rad debulk/         36.97           NA           NA         12.63        14.16          4.18  090
                                         lymph remove.
58956........  ...........  A.........  Bso, omentectomy        22.65           NA           NA          8.65         9.48          4.01  090
                                         w/tah.
58957........  ...........  A.........  Resect recurrent        26.06           NA           NA          9.58         9.61          2.95  090
                                         gyn mal.
58958........  ...........  A.........  Resect recur gyn        29.06           NA           NA         10.39        10.42          3.29  090
                                         mal w/lym.
58960........  ...........  A.........  Exploration of          15.68           NA           NA          6.29         6.82          1.80  090
                                         abdomen.
58970........  ...........  A.........  Retrieval of             3.52         1.85         2.08          1.28         1.38          0.43  000
                                         oocyte.
58974........  ...........  C.........  Transfer of              0.00         0.00         0.00          0.00         0.00          0.00  000
                                         embryo.
58976........  ...........  A.........  Transfer of              3.82         1.93         2.30          1.20         1.51          0.47  000
                                         embryo.
58999........  ...........  C.........  Genital surgery          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
59000........  ...........  A.........  Amniocentesis,           1.30         1.74         1.90          0.55         0.61          0.31  000
                                         diagnostic.
59001........  ...........  A.........  Amniocentesis,           3.00           NA           NA          1.08         1.25          0.71  000
                                         therapeutic.
59012........  ...........  A.........  Fetal cord               3.44           NA           NA          1.14         1.34          0.82  000
                                         puncture,prenata
                                         l.
59015........  ...........  A.........  Chorion biopsy...        2.20         1.43         1.49          0.80         0.92          0.52  000
59020........  ...........  A.........  Fetal contract           0.66         1.07         0.92          1.07         0.92          0.26  000
                                         stress test.
59020........  26.........  A.........  Fetal contract           0.66         0.18         0.22          0.18         0.22          0.16  000
                                         stress test.
59020........  TC.........  A.........  Fetal contract           0.00         0.88         0.70          0.88         0.70          0.10  000
                                         stress test.
59025........  ...........  A.........  Fetal non-stress         0.53         0.63         0.54          0.63         0.54          0.15  000
                                         test.
59025........  26.........  A.........  Fetal non-stress         0.53         0.15         0.18          0.15         0.18          0.13  000
                                         test.
59025........  TC.........  A.........  Fetal non-stress         0.00         0.48         0.35          0.48         0.35          0.02  000
                                         test.
59030........  ...........  A.........  Fetal scalp blood        1.99           NA           NA          0.46         0.63          0.47  000
                                         sample.
59050........  ...........  A.........  Fetal monitor w/         0.89           NA           NA          0.27         0.31          0.21  XXX
                                         report.
59051........  ...........  A.........  Fetal monitor/           0.74           NA           NA          0.20         0.25          0.17  XXX
                                         interpret only.
59070........  ...........  A.........  Transabdom               5.24         4.38         4.76          1.78         2.04          0.28  000
                                         amnioinfus w/us.
59072........  ...........  A.........  Umbilical cord           8.99           NA           NA          2.39         2.84          0.16  000
                                         occlud w/us.
59074........  ...........  A.........  Fetal fluid              5.24         3.58         4.12          1.53         1.95          0.28  000
                                         drainage w/us.
59076........  ...........  A.........  Fetal shunt              8.99           NA           NA          2.39         2.76          0.16  000
                                         placement, w/us.
59100........  ...........  A.........  Remove uterus           13.26           NA           NA          5.57         6.05          2.95  090
                                         lesion.
59120........  ...........  A.........  Treat ectopic           12.56           NA           NA          5.43         5.84          2.73  090
                                         pregnancy.
59121........  ...........  A.........  Treat ectopic           12.64           NA           NA          5.38         5.85          2.79  090
                                         pregnancy.
59130........  ...........  A.........  Treat ectopic           14.98           NA           NA          6.74         5.65          3.39  090
                                         pregnancy.
59135........  ...........  A.........  Treat ectopic           14.82           NA           NA          5.07         6.14          3.31  090
                                         pregnancy.
59136........  ...........  A.........  Treat ectopic           14.15           NA           NA          4.92         5.89          3.14  090
                                         pregnancy.
59140........  ...........  A.........  Treat ectopic            5.86           NA           NA          3.31         2.69          1.29  090
                                         pregnancy.
59150........  ...........  A.........  Treat ectopic           12.19           NA           NA          5.27         5.62          2.79  090
                                         pregnancy.
59151........  ...........  A.........  Treat ectopic           12.01           NA           NA          4.90         5.47          2.74  090
                                         pregnancy.
59160........  ...........  A.........  D & c after              2.73         1.99         2.64          1.18         1.65          0.64  010
                                         delivery.
59200........  ...........  A.........  Insert cervical          0.79         0.94         1.07          0.22         0.26          0.19  000
                                         dilator.
59300........  ...........  A.........  Episiotomy or            2.41         2.19         2.18          1.01         0.99          0.57  000
                                         vaginal repair.
59320........  ...........  A.........  Revision of              2.48           NA           NA          1.01         1.12          0.59  000
                                         cervix.
59325........  ...........  A.........  Revision of              4.06           NA           NA          1.45         1.64          0.88  000
                                         cervix.
59350........  ...........  A.........  Repair of uterus.        4.94           NA           NA          1.22         1.57          1.17  000

[[Page 38298]]

 
59400........  ...........  A.........  Obstetrical care.       26.80           NA           NA         14.13        14.75          5.50  MMM
59409........  ...........  A.........  Obstetrical care.       13.48           NA           NA          3.75         4.52          3.22  MMM
59410........  ...........  A.........  Obstetrical care.       15.29           NA           NA          4.97         5.63          3.52  MMM
59412........  ...........  A.........  Antepartum               1.71           NA           NA          0.65         0.73          0.40  MMM
                                         manipulation.
59414........  ...........  A.........  Deliver placenta.        1.61           NA           NA          0.44         0.54          0.38  MMM
59425........  ...........  A.........  Antepartum care          6.22         4.24         4.22          1.70         1.77          1.14  MMM
                                         only.
59426........  ...........  A.........  Antepartum care         11.04         7.78         7.66          3.03         3.12          1.98  MMM
                                         only.
59430........  ...........  A.........  Care after               2.13         1.08         1.15          0.72         0.83          0.50  MMM
                                         delivery.
59510........  ...........  A.........  Cesarean delivery       30.34           NA           NA         16.03        16.62          6.25  MMM
59514........  ...........  A.........  Cesarean delivery       15.95           NA           NA          4.49         5.35          3.80  MMM
                                         only.
59515........  ...........  A.........  Cesarean delivery       18.26           NA           NA          6.20         7.02          4.13  MMM
59525........  ...........  A.........  Remove uterus            8.53           NA           NA          2.28         2.81          1.95  ZZZ
                                         after cesarean.
59610........  ...........  A.........  Vbac delivery....       28.21           NA           NA         14.99        15.34          5.87  MMM
59612........  ...........  A.........  Vbac delivery           15.04           NA           NA          4.25         5.15          3.59  MMM
                                         only.
59614........  ...........  A.........  Vbac care after         16.59           NA           NA          5.18         6.05          3.89  MMM
                                         delivery.
59618........  ...........  A.........  Attempted vbac          31.78           NA           NA         16.40        17.29          6.61  MMM
                                         delivery.
59620........  ...........  A.........  Attempted vbac          17.50           NA           NA          4.70         5.75          4.17  MMM
                                         delivery only.
59622........  ...........  A.........  Attempted vbac          19.70           NA           NA          6.76         7.68          4.50  MMM
                                         after care.
59812........  ...........  A.........  Treatment of             4.39         3.10         2.82          2.36         2.45          0.95  090
                                         miscarriage.
59820........  ...........  A.........  Care of                  4.68         4.07         4.24          3.46         3.51          0.95  090
                                         miscarriage.
59821........  ...........  A.........  Treatment of             4.97         3.91         4.07          3.24         3.31          1.06  090
                                         miscarriage.
59830........  ...........  A.........  Treat uterus             6.51           NA           NA          3.45         3.72          1.44  090
                                         infection.
59840........  ...........  R.........  Abortion.........        3.01         2.00         2.06          1.77         1.95          0.71  010
59841........  ...........  R.........  Abortion.........        5.57         3.12         3.31          2.56         2.77          1.24  010
59850........  ...........  R.........  Abortion.........        5.90           NA           NA          2.44         2.88          1.28  090
59851........  ...........  R.........  Abortion.........        5.92           NA           NA          3.30         3.52          1.28  090
59852........  ...........  R.........  Abortion.........        8.23           NA           NA          3.80         4.42          1.81  090
59855........  ...........  R.........  Abortion.........        6.38           NA           NA          3.09         3.30          1.45  090
59856........  ...........  R.........  Abortion.........        7.74           NA           NA          3.33         3.78          1.79  090
59857........  ...........  R.........  Abortion.........        9.30           NA           NA          3.67         4.10          2.02  090
59866........  ...........  R.........  Abortion (mpr)...        3.99           NA           NA          1.37         1.61          0.87  000
59870........  ...........  A.........  Evacuate mole of         6.40           NA           NA          4.38         4.41          1.42  090
                                         uterus.
59871........  ...........  A.........  Remove cerclage          2.13           NA           NA          0.91         1.02          0.50  000
                                         suture.
59897........  ...........  C.........  Fetal invas px w/        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         us.
59898........  ...........  C.........  Laparo proc, ob          0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         care/deliver.
59899........  ...........  C.........  Maternity care           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
60000........  ...........  A.........  Drain thyroid/           1.78         2.04         1.98          1.66         1.69          0.15  010
                                         tongue cyst.
60001........  ...........  A.........  Aspirate/inject          0.97         1.93         1.66          0.31         0.32          0.07  000
                                         thyriod cyst.
60100........  ...........  A.........  Biopsy of thyroid        1.56         1.32         1.34          0.53         0.52          0.10  000
60200........  ...........  A.........  Remove thyroid           9.91           NA           NA          5.50         5.70          1.01  090
                                         lesion.
60210........  ...........  A.........  Partial thyroid         11.15           NA           NA          5.23         5.40          1.23  090
                                         excision.
60212........  ...........  A.........  Partial thyroid         16.32           NA           NA          6.95         7.28          1.95  090
                                         excision.
60220........  ...........  A.........  Partial removal         12.29           NA           NA          5.67         5.86          1.32  090
                                         of thyroid.
60225........  ...........  A.........  Partial removal         14.67           NA           NA          6.92         7.12          1.64  090
                                         of thyroid.
60240........  ...........  A.........  Removal of              16.18           NA           NA          6.41         6.96          1.86  090
                                         thyroid.
60252........  ...........  A.........  Removal of              21.88           NA           NA          8.85         9.40          2.30  090
                                         thyroid.
60254........  ...........  A.........  Extensive thyroid       28.29           NA           NA         11.28        12.57          2.61  090
                                         surgery.
60260........  ...........  A.........  Repeat thyroid          18.18           NA           NA          7.43         7.97          1.94  090
                                         surgery.
60270........  ...........  A.........  Removal of              23.07           NA           NA          9.31         9.82          2.33  090
                                         thyroid.
60271........  ...........  A.........  Removal of              17.54           NA           NA          7.17         7.82          1.75  090
                                         thyroid.
60280........  ...........  A.........  Remove thyroid           6.05           NA           NA          4.48         4.51          0.54  090
                                         duct lesion.
60281........  ...........  A.........  Remove thyroid           8.71           NA           NA          5.33         5.47          0.73  090
                                         duct lesion.
60500........  ...........  A.........  Explore                 16.69           NA           NA          6.85         7.10          2.01  090
                                         parathyroid
                                         glands.
60502........  ...........  A.........  Re-explore              21.01           NA           NA          8.61         8.96          2.54  090
                                         parathyroids.
60505........  ...........  A.........  Explore                 22.91           NA           NA          9.40        10.13          2.65  090
                                         parathyroid
                                         glands.
60512........  ...........  A.........  Autotransplant           4.44           NA           NA          1.21         1.41          0.53  ZZZ
                                         parathyroid.
60520........  ...........  A.........  Removal of thymus       17.07           NA           NA          7.00         7.63          2.20  090
                                         gland.
60521........  ...........  A.........  Removal of thymus       19.11           NA           NA          8.13         8.86          2.82  090
                                         gland.
60522........  ...........  A.........  Removal of thymus       23.37           NA           NA          9.61        10.46          3.27  090
                                         gland.
60540........  ...........  A.........  Explore adrenal         17.91           NA           NA          8.28         7.91          1.75  090
                                         gland.
60545........  ...........  A.........  Explore adrenal         20.82           NA           NA          8.96         8.73          2.08  090
                                         gland.
60600........  ...........  A.........  Remove carotid          24.99           NA           NA          8.84         9.89          2.20  090
                                         body lesion.
60605........  ...........  A.........  Remove carotid          31.86           NA           NA         12.12        12.21          2.50  090
                                         body lesion.
60650........  ...........  A.........  Laparoscopy             20.63           NA           NA          8.12         8.07          2.29  090
                                         adrenalectomy.
60659........  ...........  C.........  Laparo proc,             0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         endocrine.
60699........  ...........  C.........  Endocrine surgery        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
61000........  ...........  A.........  Remove cranial           1.58           NA           NA          1.23         1.09          0.13  000
                                         cavity fluid.
61001........  ...........  A.........  Remove cranial           1.49           NA           NA          1.06         1.09          0.16  000
                                         cavity fluid.
61020........  ...........  A.........  Remove brain             1.51           NA           NA          1.63         1.48          0.34  000
                                         cavity fluid.
61026........  ...........  A.........  Injection into           1.69           NA           NA          1.30         1.38          0.33  000
                                         brain canal.
61050........  ...........  A.........  Remove brain             1.51           NA           NA          1.15         1.20          0.11  000
                                         canal fluid.
61055........  ...........  A.........  Injection into           2.10           NA           NA          1.33         1.36          0.17  000
                                         brain canal.

[[Page 38299]]

 
61070........  ...........  A.........  Brain canal shunt        0.89           NA           NA          1.15         1.08          0.17  000
                                         procedure.
61105........  ...........  A.........  Twist drill hole.        5.40           NA           NA          4.95         4.44          1.32  090
61107........  ...........  A.........  Drill skull for          4.99           NA           NA          1.86         2.20          1.29  000
                                         implantation.
61108........  ...........  A.........  Drill skull for         11.51           NA           NA          8.40         7.79          2.64  090
                                         drainage.
61120........  ...........  A.........  Burr hole for            9.52           NA           NA          6.81         6.39          2.10  090
                                         puncture.
61140........  ...........  A.........  Pierce skull for        17.10           NA           NA         10.49        10.19          4.12  090
                                         biopsy.
61150........  ...........  A.........  Pierce skull for        18.80           NA           NA         10.75        10.58          4.32  090
                                         drainage.
61151........  ...........  A.........  Pierce skull for        13.41           NA           NA          8.49         8.17          3.01  090
                                         drainage.
61154........  ...........  A.........  Pierce skull &          16.92           NA           NA         10.90        10.19          4.21  090
                                         remove clot.
61156........  ...........  A.........  Pierce skull for        17.37           NA           NA          9.79         9.85          4.23  090
                                         drainage.
61210........  ...........  A.........  Pierce skull,            5.83           NA           NA          2.18         2.55          1.50  000
                                         implant device.
61215........  ...........  A.........  Insert brain-            5.77           NA           NA          5.47         4.74          1.26  090
                                         fluid device.
61250........  ...........  A.........  Pierce skull &          11.41           NA           NA          7.43         7.18          2.77  090
                                         explore.
61253........  ...........  A.........  Pierce skull &          13.41           NA           NA          7.63         7.72          2.62  090
                                         explore.
61304........  ...........  A.........  Open skull for          23.31           NA           NA         12.63        12.76          5.63  090
                                         exploration.
61305........  ...........  A.........  Open skull for          28.51           NA           NA         15.08        15.23          6.09  090
                                         exploration.
61312........  ...........  A.........  Open skull for          30.07           NA           NA         15.38        15.24          6.36  090
                                         drainage.
61313........  ...........  A.........  Open skull for          27.94           NA           NA         15.49        15.18          6.45  090
                                         drainage.
61314........  ...........  A.........  Open skull for          25.77           NA           NA         14.29        13.68          6.28  090
                                         drainage.
61315........  ...........  A.........  Open skull for          29.52           NA           NA         15.63        15.85          7.16  090
                                         drainage.
61316........  ...........  A.........  Implt cran bone          1.39           NA           NA          0.52         0.56          0.35  ZZZ
                                         flap to abdo.
61320........  ...........  A.........  Open skull for          27.32           NA           NA         14.37        14.58          6.62  090
                                         drainage.
61321........  ...........  A.........  Open skull for          30.40           NA           NA         16.21        15.88          7.14  090
                                         drainage.
61322........  ...........  A.........  Decompressive           34.08           NA           NA         17.72        16.75          7.63  090
                                         craniotomy.
61323........  ...........  A.........  Decompressive           34.93           NA           NA         17.48        16.75          8.03  090
                                         lobectomy.
61330........  ...........  A.........  Decompress eye          25.17           NA           NA         11.70        12.77          2.32  090
                                         socket.
61332........  ...........  A.........  Explore/biopsy          28.50           NA           NA         13.06        14.43          4.83  090
                                         eye socket.
61333........  ...........  A.........  Explore orbit/          29.17           NA           NA         13.09        14.41          3.92  090
                                         remove lesion.
61334........  ...........  A.........  Explore orbit/          19.50           NA           NA          9.15         9.91          1.75  090
                                         remove object.
61340........  ...........  A.........  Subtemporal             20.01           NA           NA         11.77        11.41          4.84  090
                                         decompression.
61343........  ...........  A.........  Incise skull            31.73           NA           NA         16.12        16.51          7.64  090
                                         (press relief).
61345........  ...........  A.........  Relieve cranial         29.10           NA           NA         14.98        15.27          7.04  090
                                         pressure.
61440........  ...........  A.........  Incise skull for        28.53           NA           NA         15.37        14.60          6.90  090
                                         surgery.
61450........  ...........  A.........  Incise skull for        27.59           NA           NA         14.38        14.08          5.79  090
                                         surgery.
61458........  ...........  A.........  Incise skull for        28.71           NA           NA         15.02        15.30          7.03  090
                                         brain wound.
61460........  ...........  A.........  Incise skull for        30.11           NA           NA         14.70        15.67          6.04  090
                                         surgery.
61470........  ...........  A.........  Incise skull for        27.52           NA           NA         14.18        13.87          5.90  090
                                         surgery.
61480........  ...........  A.........  Incise skull for        27.95           NA           NA          8.13        11.70          6.73  090
                                         surgery.
61490........  ...........  A.........  Incise skull for        27.12           NA           NA         14.36        14.37          6.92  090
                                         surgery.
61500........  ...........  A.........  Removal of skull        19.05           NA           NA         10.77        10.78          4.11  090
                                         lesion.
61501........  ...........  A.........  Remove infected         16.22           NA           NA          9.53         9.39          3.22  090
                                         skull bone.
61510........  ...........  A.........  Removal of brain        30.63           NA           NA         17.09        16.93          7.35  090
                                         lesion.
61512........  ...........  A.........  Remove brain            36.99           NA           NA         18.64        19.19          9.08  090
                                         lining lesion.
61514........  ...........  A.........  Removal of brain        27.10           NA           NA         14.53        14.52          6.54  090
                                         abscess.
61516........  ...........  A.........  Removal of brain        26.45           NA           NA         14.16        14.27          6.35  090
                                         lesion.
61517........  ...........  A.........  Implt brain              1.38           NA           NA          0.52         0.58          0.35  ZZZ
                                         chemotx add-on.
61518........  ...........  A.........  Removal of brain        39.69           NA           NA         20.49        20.84          9.65  090
                                         lesion.
61519........  ...........  A.........  Remove brain            43.28           NA           NA         20.91        21.82         10.63  090
                                         lining lesion.
61520........  ...........  A.........  Removal of brain        56.89           NA           NA         26.23        28.26         11.21  090
                                         lesion.
61521........  ...........  A.........  Removal of brain        46.84           NA           NA         22.38        23.32         11.39  090
                                         lesion.
61522........  ...........  A.........  Removal of brain        31.41           NA           NA         15.95        16.15          7.62  090
                                         abscess.
61524........  ...........  A.........  Removal of brain        29.76           NA           NA         15.84        15.78          7.16  090
                                         lesion.
61526........  ...........  A.........  Removal of brain        53.90           NA           NA         22.68        25.99          7.07  090
                                         lesion.
61530........  ...........  A.........  Removal of brain        45.43           NA           NA         19.69        22.19          6.15  090
                                         lesion.
61531........  ...........  A.........  Implant brain           16.28           NA           NA         10.52         9.80          3.79  090
                                         electrodes.
61533........  ...........  A.........  Implant brain           21.36           NA           NA         11.88        11.71          5.12  090
                                         electrodes.
61534........  ...........  A.........  Removal of brain        22.88           NA           NA         13.23        12.68          5.44  090
                                         lesion.
61535........  ...........  A.........  Remove brain            13.05           NA           NA          8.89         8.18          3.02  090
                                         electrodes.
61536........  ...........  A.........  Removal of brain        37.59           NA           NA         18.72        19.26          9.21  090
                                         lesion.
61537........  ...........  A.........  Removal of brain        36.35           NA           NA         17.21        16.08          6.94  090
                                         tissue.
61538........  ...........  A.........  Removal of brain        39.35           NA           NA         18.56        17.03          6.94  090
                                         tissue.
61539........  ...........  A.........  Removal of brain        34.15           NA           NA         16.98        17.17          8.32  090
                                         tissue.
61540........  ...........  A.........  Removal of brain        31.30           NA           NA         16.45        16.80          8.32  090
                                         tissue.
61541........  ...........  A.........  Incision of brain       30.81           NA           NA         16.23        16.24          6.60  090
                                         tissue.
61542........  ...........  A.........  Removal of brain        33.03           NA           NA         16.94        17.30          8.03  090
                                         tissue.
61543........  ...........  A.........  Removal of brain        31.18           NA           NA         13.94        15.60          7.56  090
                                         tissue.
61544........  ...........  A.........  Remove & treat          27.26           NA           NA         14.41        14.15          5.97  090
                                         brain lesion.
61545........  ...........  A.........  Excision of brain       46.23           NA           NA         23.05        23.58         10.63  090
                                         tumor.
61546........  ...........  A.........  Removal of              33.31           NA           NA         16.90        17.19          7.67  090
                                         pituitary gland.
61548........  ...........  A.........  Removal of              23.27           NA           NA         11.74        12.23          3.43  090
                                         pituitary gland.
61550........  ...........  A.........  Release of skull        15.44           NA           NA          5.63         6.28          0.98  090
                                         seams.
61552........  ...........  A.........  Release of skull        20.27           NA           NA         12.24         9.74          1.06  090
                                         seams.

[[Page 38300]]

 
61556........  ...........  A.........  Incise skull/           24.00           NA           NA         13.40        12.31          4.65  090
                                         sutures.
61557........  ...........  A.........  Incise skull/           23.16           NA           NA         13.74        13.71          5.80  090
                                         sutures.
61558........  ...........  A.........  Excision of skull/      26.35           NA           NA         14.82        13.39          1.36  090
                                         sutures.
61559........  ...........  A.........  Excision of skull/      33.82           NA           NA         18.54        19.07          8.51  090
                                         sutures.
61563........  ...........  A.........  Excision of skull       28.35           NA           NA         13.20        14.45          5.17  090
                                         tumor.
61564........  ...........  A.........  Excision of skull       34.59           NA           NA         18.07        17.92          8.78  090
                                         tumor.
61566........  ...........  A.........  Removal of brain        32.32           NA           NA         16.79        17.30          6.94  090
                                         tissue.
61567........  ...........  A.........  Incision of brain       36.84           NA           NA         19.25        19.60          6.54  090
                                         tissue.
61570........  ...........  A.........  Remove foreign          26.38           NA           NA         14.11        14.06          5.88  090
                                         body, brain.
61571........  ...........  A.........  Incise skull for        28.29           NA           NA         14.77        15.06          6.79  090
                                         brain wound.
61575........  ...........  A.........  Skull base/             36.43           NA           NA         16.33        17.91          5.34  090
                                         brainstem
                                         surgery.
61576........  ...........  A.........  Skull base/             55.11           NA           NA         28.10        31.11          5.58  090
                                         brainstem
                                         surgery.
61580........  ...........  A.........  Craniofacial            34.34           NA           NA         22.87        23.92          3.37  090
                                         approach, skull.
61581........  ...........  A.........  Craniofacial            38.88           NA           NA         27.92        25.23          3.92  090
                                         approach, skull.
61582........  ...........  A.........  Craniofacial            34.93           NA           NA         30.64        28.97          7.21  090
                                         approach, skull.
61583........  ...........  A.........  Craniofacial            38.41           NA           NA         26.05        25.59          9.21  090
                                         approach, skull.
61584........  ...........  A.........  Orbitocranial           37.61           NA           NA         26.18        25.29          8.18  090
                                         approach/skull.
61585........  ...........  A.........  Orbitocranial           42.46           NA           NA         25.17        25.83          7.03  090
                                         approach/skull.
61586........  ...........  A.........  Resect                  27.28           NA           NA         22.71        22.89          4.37  090
                                         nasopharynx,
                                         skull.
61590........  ...........  A.........  Infratemporal           46.87           NA           NA         24.91        26.54          5.31  090
                                         approach/skull.
61591........  ...........  A.........  Infratemporal           46.87           NA           NA         24.75        27.05          5.66  090
                                         approach/skull.
61592........  ...........  A.........  Orbitocranial           42.98           NA           NA         27.05        26.92         10.07  090
                                         approach/skull.
61595........  ...........  A.........  Transtemporal           33.57           NA           NA         21.25        21.52          3.98  090
                                         approach/skull.
61596........  ...........  A.........  Transcochlear           39.31           NA           NA         20.95        22.34          3.40  090
                                         approach/skull.
61597........  ...........  A.........  Transcondylar           40.73           NA           NA         23.27        23.11          8.84  090
                                         approach/skull.
61598........  ...........  A.........  Transpetrosal           36.41           NA           NA         22.34        22.61          5.70  090
                                         approach/skull.
61600........  ...........  A.........  Resect/excise           29.84           NA           NA         19.82        19.59          3.79  090
                                         cranial lesion.
61601........  ...........  A.........  Resect/excise           31.04           NA           NA         22.47        21.50          6.63  090
                                         cranial lesion.
61605........  ...........  A.........  Resect/excise           32.40           NA           NA         19.52        20.47          2.86  090
                                         cranial lesion.
61606........  ...........  A.........  Resect/excise           41.94           NA           NA         23.89        24.64          8.97  090
                                         cranial lesion.
61607........  ...........  A.........  Resect/excise           40.82           NA           NA         21.22        22.45          6.90  090
                                         cranial lesion.
61608........  ...........  A.........  Resect/excise           45.45           NA           NA         26.57        26.63         10.75  090
                                         cranial lesion.
61609........  ...........  A.........  Transect artery,         9.88           NA           NA          3.30         4.16          2.56  ZZZ
                                         sinus.
61610........  ...........  A.........  Transect artery,        29.63           NA           NA         11.23        12.22          7.68  ZZZ
                                         sinus.
61611........  ...........  A.........  Transect artery,         7.41           NA           NA          1.71         2.96          1.89  ZZZ
                                         sinus.
61612........  ...........  A.........  Transect artery,        27.84           NA           NA          6.42        10.19          4.31  ZZZ
                                         sinus.
61613........  ...........  A.........  Remove aneurysm,        44.94           NA           NA         27.55        26.96          8.45  090
                                         sinus.
61615........  ...........  A.........  Resect/excise           35.63           NA           NA         21.37        21.75          4.73  090
                                         lesion, skull.
61616........  ...........  A.........  Resect/excise           46.60           NA           NA         27.46        27.97          8.26  090
                                         lesion, skull.
61618........  ...........  A.........  Repair dura......       18.58           NA           NA         10.51        10.43          3.72  090
61619........  ...........  A.........  Repair dura......       22.01           NA           NA         11.76        11.90          3.95  090
61623........  ...........  A.........  Endovasc tempory         9.95           NA           NA          3.77         3.82          1.05  000
                                         vessel occl.
61624........  ...........  A.........  Transcath               20.12           NA           NA          7.39         6.96          1.96  000
                                         occlusion, cns.
61626........  ...........  A.........  Transcath               16.60           NA           NA          6.05         5.59          1.24  000
                                         occlusion, non-
                                         cns.
61630........  ...........  N.........  Intracranial            22.07           NA           NA          6.43         9.46          2.02  090
                                         angioplasty.
61635........  ...........  N.........  Intracran               24.28           NA           NA          6.94        10.24          2.21  090
                                         angioplsty w/
                                         stent.
61640........  ...........  N.........  Dilate ic               12.32           NA           NA          2.84         2.85          0.71  000
                                         vasospasm, init.
61641........  ...........  N.........  Dilate ic                4.33           NA           NA          1.00         1.00          0.25  ZZZ
                                         vasospasm add-on.
61642........  ...........  N.........  Dilate ic                8.66           NA           NA          2.00         2.00          0.50  ZZZ
                                         vasospasm add-on.
61680........  ...........  A.........  Intracranial            32.40           NA           NA         16.89        17.20          7.95  090
                                         vessel surgery.
61682........  ...........  A.........  Intracranial            63.31           NA           NA         27.86        30.03         15.90  090
                                         vessel surgery.
61684........  ...........  A.........  Intracranial            41.49           NA           NA         20.58        21.33         10.31  090
                                         vessel surgery.
61686........  ...........  A.........  Intracranial            67.32           NA           NA         30.81        32.76         16.71  090
                                         vessel surgery.
61690........  ...........  A.........  Intracranial            31.18           NA           NA         16.67        16.60          6.94  090
                                         vessel surgery.
61692........  ...........  A.........  Intracranial            54.43           NA           NA         24.63        26.12         13.43  090
                                         vessel surgery.
61697........  ...........  A.........  Brain aneurysm          63.22           NA           NA         28.96        28.54         12.85  090
                                         repr, complx.
61698........  ...........  A.........  Brain aneurysm          69.45           NA           NA         31.15        28.97         12.54  090
                                         repr, complx.
61700........  ...........  A.........  Brain aneurysm          50.44           NA           NA         24.27        26.06         13.02  090
                                         repr, simple.
61702........  ...........  A.........  Inner skull             59.86           NA           NA         27.80        27.02         10.79  090
                                         vessel surgery.
61703........  ...........  A.........  Clamp neck artery       18.70           NA           NA         10.17        10.45          4.06  090
61705........  ...........  A.........  Revise                  37.97           NA           NA         18.51        18.78          8.87  090
                                         circulation to
                                         head.
61708........  ...........  A.........  Revise                  37.07           NA           NA         15.03        14.73          2.51  090
                                         circulation to
                                         head.
61710........  ...........  A.........  Revise                  31.19           NA           NA         13.90        13.58          4.52  090
                                         circulation to
                                         head.
61711........  ...........  A.........  Fusion of skull         38.10           NA           NA         18.79        19.31          9.42  090
                                         arteries.
61720........  ...........  A.........  Incise skull/           17.52           NA           NA          7.97         9.02          2.79  090
                                         brain surgery.
61735........  ...........  A.........  Incise skull/           22.22           NA           NA          9.22        11.07          2.73  090
                                         brain surgery.
61750........  ...........  A.........  Incise skull/           19.73           NA           NA         11.03        10.84          4.72  090
                                         brain biopsy.
61751........  ...........  A.........  Brain biopsy w/ct/      18.64           NA           NA         11.45        11.16          4.56  090
                                         mr guide.
61760........  ...........  A.........  Implant brain           22.24           NA           NA         12.15        10.42          5.42  090
                                         electrodes.
61770........  ...........  A.........  Incise skull for        23.09           NA           NA         10.05        11.15          3.55  090
                                         treatment.
61790........  ...........  A.........  Treat trigeminal        11.50           NA           NA          7.74         6.85          2.82  090
                                         nerve.
61791........  ...........  A.........  Treat trigeminal        15.31           NA           NA          8.27         8.50          3.40  090
                                         tract.

[[Page 38301]]

 
61793........  ...........  A.........  Focus radiation         17.75           NA           NA          9.62         9.93          4.46  090
                                         beam.
61795........  ...........  A.........  Brain surgery            4.03           NA           NA          1.45         1.73          0.79  ZZZ
                                         using computer.
61850........  ...........  A.........  Implant                 13.26           NA           NA          7.94         7.42          3.22  090
                                         neuroelectrodes.
61860........  ...........  A.........  Implant                 22.16           NA           NA         11.71        11.83          4.95  090
                                         neuroelectrodes.
61863........  ...........  A.........  Implant                 20.56           NA           NA         12.51        12.16          5.43  090
                                         neuroelectrode.
61864........  ...........  A.........  Implant                  4.49           NA           NA          1.70         1.99          5.43  ZZZ
                                         neuroelectrde,
                                         addl.
61867........  ...........  A.........  Implant                 32.88           NA           NA         16.50        17.33          5.43  090
                                         neuroelectrode.
61868........  ...........  A.........  Implant                  7.91           NA           NA          2.98         3.50          5.43  ZZZ
                                         neuroelectrde,
                                         add[boxHu]l.
61870........  ...........  A.........  Implant                 16.24           NA           NA          9.76         9.57          3.87  090
                                         neuroelectrodes.
61875........  ...........  A.........  Implant                 16.36           NA           NA          5.32         6.95          2.95  090
                                         neuroelectrodes.
61880........  ...........  A.........  Revise/remove            6.87           NA           NA          5.19         4.94          1.66  090
                                         neuroelectrode.
61885........  ...........  A.........  Insrt/redo               7.37           NA           NA          7.07         6.26          1.59  090
                                         neurostim 1
                                         array.
61886........  ...........  A.........  Implant neurostim        9.73           NA           NA          8.53         7.49          1.97  090
                                         arrays.
61888........  ...........  A.........  Revise/remove            5.20           NA           NA          3.48         3.60          1.33  010
                                         neuroreceiver.
62000........  ...........  A.........  Treat skull             13.83           NA           NA          7.69         6.53          1.06  090
                                         fracture.
62005........  ...........  A.........  Treat skull             17.53           NA           NA          9.67         9.22          3.87  090
                                         fracture.
62010........  ...........  A.........  Treatment of head       21.30           NA           NA         11.91        11.84          5.14  090
                                         injury.
62100........  ...........  A.........  Repair brain            23.40           NA           NA         12.18        12.46          4.84  090
                                         fluid leakage.
62115........  ...........  A.........  Reduction of            22.71           NA           NA         13.99        12.84          5.51  090
                                         skull defect.
62116........  ...........  A.........  Reduction of            24.90           NA           NA         13.45        13.40          6.11  090
                                         skull defect.
62117........  ...........  A.........  Reduction of            28.26           NA           NA         12.86        14.46          4.53  090
                                         skull defect.
62120........  ...........  A.........  Repair skull            24.39           NA           NA         17.26        17.65          3.00  090
                                         cavity lesion.
62121........  ...........  A.........  Incise skull            22.93           NA           NA         14.26        14.85          4.17  090
                                         repair.
62140........  ...........  A.........  Repair of skull         14.45           NA           NA          8.70         8.51          3.47  090
                                         defect.
62141........  ...........  A.........  Repair of skull         15.97           NA           NA          9.41         9.23          3.76  090
                                         defect.
62142........  ...........  A.........  Remove skull            11.73           NA           NA          7.84         7.41          2.73  090
                                         plate/flap.
62143........  ...........  A.........  Replace skull           14.05           NA           NA          8.79         8.43          3.37  090
                                         plate/flap.
62145........  ...........  A.........  Repair of skull &       19.99           NA           NA         10.33        10.62          4.50  090
                                         brain.
62146........  ...........  A.........  Repair of skull         17.18           NA           NA          9.59         9.55          3.62  090
                                         with graft.
62147........  ...........  A.........  Repair of skull         20.57           NA           NA         11.07        11.13          4.32  090
                                         with graft.
62148........  ...........  A.........  Retr bone flap to        2.00           NA           NA          0.75         0.81          0.48  ZZZ
                                         fix skull.
62160........  ...........  A.........  Neuroendoscopy           3.00           NA           NA          1.12         1.33          0.77  ZZZ
                                         add-on.
62161........  ...........  A.........  Dissect brain w/        21.10           NA           NA         12.25        12.18          5.19  090
                                         scope.
62162........  ...........  A.........  Remove colloid          26.67           NA           NA         14.77        14.69          5.91  090
                                         cyst w/scope.
62163........  ...........  A.........  Neuroendoscopy w/       16.40           NA           NA          9.31         9.84          4.01  090
                                         fb removal.
62164........  ...........  A.........  Remove brain            29.27           NA           NA         16.35        15.45          5.38  090
                                         tumor w/scope.
62165........  ...........  A.........  Remove pituit           23.10           NA           NA         11.86        12.59          3.01  090
                                         tumor w/scope.
62180........  ...........  A.........  Establish brain         22.45           NA           NA         12.63        12.38          4.98  090
                                         cavity shunt.
62190........  ...........  A.........  Establish brain         12.07           NA           NA          7.59         7.36          2.80  090
                                         cavity shunt.
62192........  ...........  A.........  Establish brain         13.25           NA           NA          8.06         7.91          3.02  090
                                         cavity shunt.
62194........  ...........  A.........  Replace/irrigate         5.68           NA           NA          3.17         2.90          0.92  010
                                         catheter.
62200........  ...........  A.........  Establish brain         19.19           NA           NA         10.79        10.82          4.65  090
                                         cavity shunt.
62201........  ...........  A.........  Brain cavity            15.89           NA           NA         10.41         9.96          3.68  090
                                         shunt w/scope.
62220........  ...........  A.........  Establish brain         14.00           NA           NA          8.68         8.30          3.35  090
                                         cavity shunt.
62223........  ...........  A.........  Establish brain         13.90           NA           NA          9.41         8.84          3.14  090
                                         cavity shunt.
62225........  ...........  A.........  Replace/irrigate         6.11           NA           NA          5.50         4.80          1.39  090
                                         catheter.
62230........  ...........  A.........  Replace/revise          11.35           NA           NA          7.26         6.89          2.71  090
                                         brain shunt.
62252........  ...........  A.........  Csf shunt                0.74         1.76         1.62            NA           NA          0.21  XXX
                                         reprogram.
62252........  26.........  A.........  Csf shunt                0.74         0.27         0.32          0.27         0.32          0.19  XXX
                                         reprogram.
62252........  TC.........  A.........  Csf shunt                0.00         1.49         1.30            NA           NA          0.02  XXX
                                         reprogram.
62256........  ...........  A.........  Remove brain             7.30           NA           NA          5.92         5.31          1.72  090
                                         cavity shunt.
62258........  ...........  A.........  Replace brain           15.54           NA           NA          9.37         9.04          3.74  090
                                         cavity shunt.
62263........  ...........  A.........  Epidural lysis           6.41         9.42        10.99          2.99         3.07          0.41  010
                                         mult sessions.
62264........  ...........  A.........  Epidural lysis on        4.42         5.61         6.67          1.26         1.34          0.27  010
                                         single day.
62268........  ...........  A.........  Drain spinal cord        4.73         6.65         9.06          1.82         1.95          0.43  000
                                         cyst.
62269........  ...........  A.........  Needle biopsy,           5.01         6.24        10.53          1.50         1.75          0.37  000
                                         spinal cord.
62270........  ...........  A.........  Spinal fluid tap,        1.37         2.38         2.67          0.58         0.56          0.08  000
                                         diagnostic.
62272........  ...........  A.........  Drain cerebro            1.35         3.11         3.35          0.62         0.66          0.18  000
                                         spinal fluid.
62273........  ...........  A.........  Inject epidural          2.15         1.66         2.19          0.58         0.65          0.13  000
                                         patch.
62280........  ...........  A.........  Treat spinal cord        2.63         4.62         5.71          1.16         1.07          0.30  010
                                         lesion.
62281........  ...........  A.........  Treat spinal cord        2.66         4.05         4.79          1.03         0.94          0.19  010
                                         lesion.
62282........  ...........  A.........  Treat spinal             2.33         4.06         6.19          1.12         1.01          0.17  010
                                         canal lesion.
62284........  ...........  A.........  Injection for            1.54         3.77         4.34          0.72         0.69          0.13  000
                                         myelogram.
62287........  ...........  A.........  Percutaneous             8.88           NA           NA          4.30         4.89          0.58  090
                                         diskectomy.
62290........  ...........  A.........  Inject for spine         3.00         4.48         5.78          1.16         1.26          0.23  000
                                         disk x-ray.
62291........  ...........  A.........  Inject for spine         2.91         4.20         5.05          1.09         1.15          0.26  000
                                         disk x-ray.
62292........  ...........  A.........  Injection into           9.14           NA           NA          2.90         3.73          0.82  090
                                         disk lesion.
62294........  ...........  A.........  Injection into          12.77           NA           NA          6.54         5.90          1.24  090
                                         spinal artery.
62310........  ...........  A.........  Inject spine c/t.        1.91         2.98         3.89          0.57         0.61          0.12  000
62311........  ...........  A.........  Inject spine l/s         1.54         2.64         3.78          0.53         0.56          0.09  000
                                         (cd).
62318........  ...........  A.........  Inject spine w/          2.04         3.07         4.42          0.43         0.55          0.12  000
                                         cath, c/t.
62319........  ...........  A.........  Inject spine w/          1.87         2.78         3.89          0.44         0.53          0.11  000
                                         cath l/s (cd).

[[Page 38302]]

 
62350........  ...........  A.........  Implant spinal           8.04           NA           NA          4.01         4.00          1.02  090
                                         canal cath.
62351........  ...........  A.........  Implant spinal          11.54           NA           NA          7.66         7.41          2.25  090
                                         canal cath.
62355........  ...........  A.........  Remove spinal            6.60           NA           NA          3.54         3.36          0.71  090
                                         canal catheter.
62360........  ...........  A.........  Insert spine             3.68           NA           NA          3.15         2.96          0.34  090
                                         infusion device.
62361........  ...........  A.........  Implant spine            6.59           NA           NA          4.06         3.98          0.80  090
                                         infusion pump.
62362........  ...........  A.........  Implant spine            8.58           NA           NA          4.68         4.53          1.18  090
                                         infusion pump.
62365........  ...........  A.........  Remove spine             6.57           NA           NA          3.73         3.68          0.86  090
                                         infusion device.
62367........  ...........  A.........  Analyze spine            0.48         0.42         0.51          0.12         0.11          0.03  XXX
                                         infusion pump.
62368........  ...........  A.........  Analyze spine            0.75         0.58         0.64          0.18         0.17          0.06  XXX
                                         infusion pump.
63001........  ...........  A.........  Removal of spinal       17.51           NA           NA          9.83         9.70          3.77  090
                                         lamina.
63003........  ...........  A.........  Removal of spinal       17.64           NA           NA          9.78         9.84          3.73  090
                                         lamina.
63005........  ...........  A.........  Removal of spinal       16.28           NA           NA          9.78         9.89          3.35  090
                                         lamina.
63011........  ...........  A.........  Removal of spinal       15.78           NA           NA          9.05         8.70          3.38  090
                                         lamina.
63012........  ...........  A.........  Removal of spinal       16.72           NA           NA          9.81         9.99          3.49  090
                                         lamina.
63015........  ...........  A.........  Removal of spinal       20.70           NA           NA         11.94        11.94          4.76  090
                                         lamina.
63016........  ...........  A.........  Removal of spinal       21.90           NA           NA         11.72        11.81          4.59  090
                                         lamina.
63017........  ...........  A.........  Removal of spinal       17.18           NA           NA         10.41        10.42          3.64  090
                                         lamina.
63020........  ...........  A.........  Neck spine disk         16.05           NA           NA          9.94         9.83          3.72  090
                                         surgery.
63030........  ...........  A.........  Low back disk           13.03           NA           NA          8.64         8.55          3.01  090
                                         surgery.
63035........  ...........  A.........  Spinal disk              3.15           NA           NA          1.21         1.40          0.79  ZZZ
                                         surgery add-on.
63040........  ...........  A.........  Laminotomy,             20.18           NA           NA         11.11        11.32          4.68  090
                                         single cervical.
63042........  ...........  A.........  Laminotomy,             18.61           NA           NA         10.64        11.01          4.26  090
                                         single lumbar.
63043........  ...........  C.........  Laminotomy,              0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         add[boxHu]l
                                         cervical.
63044........  ...........  C.........  Laminotomy,              0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         add[boxHu]lumbar.
63045........  ...........  A.........  Removal of spinal       17.82           NA           NA         10.40        10.40          3.99  090
                                         lamina.
63046........  ...........  A.........  Removal of spinal       17.12           NA           NA          9.83        10.03          3.56  090
                                         lamina.
63047........  ...........  A.........  Removal of spinal       15.22           NA           NA          9.38         9.65          3.24  090
                                         lamina.
63048........  ...........  A.........  Remove spinal            3.47           NA           NA          1.33         1.50          0.72  ZZZ
                                         lamina add-on.
63050........  ...........  A.........  Cervical                21.88           NA           NA         11.89        11.37          4.67  090
                                         laminoplasty.
63051........  ...........  A.........  C-laminoplasty w/       25.38           NA           NA         13.15        13.08          4.67  090
                                         graft/plate.
63055........  ...........  A.........  Decompress spinal       23.42           NA           NA         12.55        12.84          5.29  090
                                         cord.
63056........  ...........  A.........  Decompress spinal       21.73           NA           NA         11.46        12.03          4.76  090
                                         cord.
63057........  ...........  A.........  Decompress spine         5.25           NA           NA          2.01         2.32          1.22  ZZZ
                                         cord add-on.
63064........  ...........  A.........  Decompress spinal       26.09           NA           NA         13.30        13.91          5.71  090
                                         cord.
63066........  ...........  A.........  Decompress spine         3.26           NA           NA          1.23         1.45          0.69  ZZZ
                                         cord add-on.
63075........  ...........  A.........  Neck spine disk         19.47           NA           NA         11.07        11.60          4.63  090
                                         surgery.
63076........  ...........  A.........  Neck spine disk          4.04           NA           NA          1.53         1.80          0.96  ZZZ
                                         surgery.
63077........  ...........  A.........  Spine disk              22.75           NA           NA         11.15        11.99          3.99  090
                                         surgery, thorax.
63078........  ...........  A.........  Spine disk               3.28           NA           NA          1.22         1.43          0.66  ZZZ
                                         surgery, thorax.
63081........  ...........  A.........  Removal of              25.97           NA           NA         13.59        13.99          5.56  090
                                         vertebral body.
63082........  ...........  A.........  Remove vertebral         4.36           NA           NA          1.66         1.95          1.02  ZZZ
                                         body add-on.
63085........  ...........  A.........  Removal of              29.34           NA           NA         13.64        14.60          4.49  090
                                         vertebral body.
63086........  ...........  A.........  Remove vertebral         3.19           NA           NA          1.18         1.39          0.59  ZZZ
                                         body add-on.
63087........  ...........  A.........  Removal of              37.38           NA           NA         16.74        18.14          6.22  090
                                         vertebral body.
63088........  ...........  A.........  Remove vertebral         4.32           NA           NA          1.61         1.90          0.82  ZZZ
                                         body add-on.
63090........  ...........  A.........  Removal of              30.78           NA           NA         14.47        15.21          4.22  090
                                         vertebral body.
63091........  ...........  A.........  Remove vertebral         3.03           NA           NA          1.15         1.30          0.48  ZZZ
                                         body add-on.
63101........  ...........  A.........  Removal of              33.92           NA           NA         17.17        18.26          5.71  090
                                         vertebral body.
63102........  ...........  A.........  Removal of              33.92           NA           NA         16.94        18.13          5.71  090
                                         vertebral body.
63103........  ...........  A.........  Remove vertebral         4.82           NA           NA          1.77         2.14          0.69  ZZZ
                                         body add-on.
63170........  ...........  A.........  Incise spinal           22.08           NA           NA         10.52        11.57          4.87  090
                                         cord tract(s).
63172........  ...........  A.........  Drainage of             19.66           NA           NA         11.15        10.94          4.49  090
                                         spinal cyst.
63173........  ...........  A.........  Drainage of             24.18           NA           NA         13.68        13.22          5.70  090
                                         spinal cyst.
63180........  ...........  A.........  Revise spinal           20.40           NA           NA         11.04        11.00          3.96  090
                                         cord ligaments.
63182........  ...........  A.........  Revise spinal           22.69           NA           NA          7.17         9.06          5.32  090
                                         cord ligaments.
63185........  ...........  A.........  Incise spinal           16.36           NA           NA         10.19         9.14          2.80  090
                                         column/nerves.
63190........  ...........  A.........  Incise spinal           18.76           NA           NA          9.66         9.99          3.25  090
                                         column/nerves.
63191........  ...........  A.........  Incise spinal           18.79           NA           NA          4.14         8.43          6.36  090
                                         column/nerves.
63194........  ...........  A.........  Incise spinal           21.97           NA           NA         11.28        11.10          3.27  090
                                         column & cord.
63195........  ...........  A.........  Incise spinal           21.54           NA           NA         12.20        11.65          4.88  090
                                         column & cord.
63196........  ...........  A.........  Incise spinal           25.14           NA           NA         13.90        13.67          5.78  090
                                         column & cord.
63197........  ...........  A.........  Incise spinal           23.95           NA           NA          7.46        10.85          5.38  090
                                         column & cord.
63198........  ...........  A.........  Incise spinal           29.75           NA           NA          8.91         8.68          6.45  090
                                         column & cord.
63199........  ...........  A.........  Incise spinal           31.32           NA           NA          9.27        12.16          1.40  090
                                         column & cord.
63200........  ...........  A.........  Release of spinal       21.31           NA           NA         12.18        11.69          4.97  090
                                         cord.
63250........  ...........  A.........  Revise spinal           43.73           NA           NA         21.13        20.58          9.04  090
                                         cord vessels.
63251........  ...........  A.........  Revise spinal           44.49           NA           NA         21.75        22.16         10.44  090
                                         cord vessels.
63252........  ...........  A.........  Revise spinal           44.48           NA           NA         21.08        21.74         10.67  090
                                         cord vessels.
63265........  ...........  A.........  Excise                  23.69           NA           NA         13.11        12.96          5.45  090
                                         intraspinal
                                         lesion.
63266........  ...........  A.........  Excise                  24.55           NA           NA         13.27        13.25          5.56  090
                                         intraspinal
                                         lesion.
63267........  ...........  A.........  Excise                  19.32           NA           NA         11.20        11.16          4.38  090
                                         intraspinal
                                         lesion.
63268........  ...........  A.........  Excise                  19.89           NA           NA         10.93        10.65          3.70  090
                                         intraspinal
                                         lesion.

[[Page 38303]]

 
63270........  ...........  A.........  Excise                  29.67           NA           NA         15.49        15.56          6.84  090
                                         intraspinal
                                         lesion.
63271........  ...........  A.........  Excise                  29.79           NA           NA         15.44        15.52          6.92  090
                                         intraspinal
                                         lesion.
63272........  ...........  A.........  Excise                  27.37           NA           NA         14.42        14.57          6.20  090
                                         intraspinal
                                         lesion.
63273........  ...........  A.........  Excise                  26.34           NA           NA         14.16        14.22          5.76  090
                                         intraspinal
                                         lesion.
63275........  ...........  A.........  Biopsy/excise           25.73           NA           NA         13.84        13.77          5.82  090
                                         spinal tumor.
63276........  ...........  A.........  Biopsy/excise           25.56           NA           NA         13.62        13.69          5.85  090
                                         spinal tumor.
63277........  ...........  A.........  Biopsy/excise           22.26           NA           NA         12.21        12.38          5.03  090
                                         spinal tumor.
63278........  ...........  A.........  Biopsy/excise           21.99           NA           NA         11.99        12.22          4.56  090
                                         spinal tumor.
63280........  ...........  A.........  Biopsy/excise           30.14           NA           NA         16.01        16.20          7.29  090
                                         spinal tumor.
63281........  ...........  A.........  Biopsy/excise           29.84           NA           NA         16.00        16.09          7.19  090
                                         spinal tumor.
63282........  ...........  A.........  Biopsy/excise           28.00           NA           NA         15.13        15.26          6.78  090
                                         spinal tumor.
63283........  ...........  A.........  Biopsy/excise           26.61           NA           NA         14.80        14.65          6.28  090
                                         spinal tumor.
63285........  ...........  A.........  Biopsy/excise           37.90           NA           NA         18.24        19.27          9.21  090
                                         spinal tumor.
63286........  ...........  A.........  Biopsy/excise           37.47           NA           NA         18.87        19.42          9.24  090
                                         spinal tumor.
63287........  ...........  A.........  Biopsy/excise           39.93           NA           NA         19.80        20.11          9.42  090
                                         spinal tumor.
63290........  ...........  A.........  Biopsy/excise           40.67           NA           NA         19.44        20.17          9.05  090
                                         spinal tumor.
63295........  ...........  A.........  Repair of                5.25           NA           NA          1.99         1.96          1.03  ZZZ
                                         laminectomy
                                         defect.
63300........  ...........  A.........  Removal of              26.67           NA           NA         13.92        14.07          5.99  090
                                         vertebral body.
63301........  ...........  A.........  Removal of              31.42           NA           NA         14.24        15.05          5.41  090
                                         vertebral body.
63302........  ...........  A.........  Removal of              31.00           NA           NA         13.91        15.05          5.55  090
                                         vertebral body.
63303........  ...........  A.........  Removal of              33.42           NA           NA         15.03        15.92          4.69  090
                                         vertebral body.
63304........  ...........  A.........  Removal of              33.70           NA           NA         17.74        17.43          6.43  090
                                         vertebral body.
63305........  ...........  A.........  Removal of              36.09           NA           NA         17.08        17.67          5.73  090
                                         vertebral body.
63306........  ...........  A.........  Removal of              35.40           NA           NA         16.75        17.12          8.35  090
                                         vertebral body.
63307........  ...........  A.........  Removal of              34.81           NA           NA         14.75        16.30          4.47  090
                                         vertebral body.
63308........  ...........  A.........  Remove vertebral         5.24           NA           NA          1.97         2.28          1.29  ZZZ
                                         body add-on.
63600........  ...........  A.........  Remove spinal           15.02           NA           NA          4.08         4.81          1.52  090
                                         cord lesion.
63610........  ...........  A.........  Stimulation of           8.72        13.66        36.72          1.46         1.87          0.86  000
                                         spinal cord.
63615........  ...........  A.........  Remove lesion of        17.22           NA           NA          8.59         8.50          2.85  090
                                         spinal cord.
63650........  ...........  A.........  Implant                  7.57           NA           NA          2.94         3.05          0.53  090
                                         neuroelectrodes.
63655........  ...........  A.........  Implant                 11.43           NA           NA          7.67         7.32          2.44  090
                                         neuroelectrodes.
63660........  ...........  A.........  Revise/remove            6.87           NA           NA          3.45         3.51          0.78  090
                                         neuroelectrode.
63685........  ...........  A.........  Insrt/redo spine         7.87           NA           NA          3.68         3.91          1.05  090
                                         n generator.
63688........  ...........  A.........  Revise/remove            6.10           NA           NA          3.54         3.55          0.89  090
                                         neuroreceiver.
63700........  ...........  A.........  Repair of spinal        17.32           NA           NA          9.95        10.12          3.53  090
                                         herniation.
63702........  ...........  A.........  Repair of spinal        19.26           NA           NA         10.03        10.70          4.13  090
                                         herniation.
63704........  ...........  A.........  Repair of spinal        22.23           NA           NA         11.72        12.48          4.58  090
                                         herniation.
63706........  ...........  A.........  Repair of spinal        25.15           NA           NA         14.39        14.13          6.25  090
                                         herniation.
63707........  ...........  A.........  Repair spinal           12.52           NA           NA          7.87         7.80          2.52  090
                                         fluid leakage.
63709........  ...........  A.........  Repair spinal           15.52           NA           NA          9.02         9.23          3.10  090
                                         fluid leakage.
63710........  ...........  A.........  Graft repair of         15.27           NA           NA          9.25         9.16          3.41  090
                                         spine defect.
63740........  ...........  A.........  Install spinal          12.50           NA           NA          8.31         7.83          2.94  090
                                         shunt.
63741........  ...........  A.........  Install spinal           9.02           NA           NA          4.96         4.84          1.66  090
                                         shunt.
63744........  ...........  A.........  Revision of              8.86           NA           NA          5.82         5.59          1.90  090
                                         spinal shunt.
63746........  ...........  A.........  Removal of spinal        7.25           NA           NA          5.69         4.58          1.53  090
                                         shunt.
64400........  ...........  A.........  N block inj,             1.11         1.40         1.65          0.44         0.44          0.07  000
                                         trigeminal.
64402........  ...........  A.........  N block inj,             1.25         1.40         1.51          0.50         0.55          0.09  000
                                         facial.
64405........  ...........  A.........  N block inj,             1.32         1.15         1.31          0.50         0.48          0.08  000
                                         occipital.
64408........  ...........  A.........  N block inj,             1.41         1.44         1.51          0.71         0.78          0.10  000
                                         vagus.
64410........  ...........  A.........  N block inj,             1.43         1.91         2.19          0.56         0.51          0.09  000
                                         phrenic.
64412........  ...........  A.........  N block inj,             1.18         2.12         2.37          0.59         0.50          0.08  000
                                         spinal accessor.
64413........  ...........  A.........  N block inj,             1.40         1.30         1.57          0.48         0.49          0.08  000
                                         cervical plexus.
64415........  ...........  A.........  N block inj,             1.48         1.40         2.11          0.31         0.39          0.09  000
                                         brachial plexus.
64416........  ...........  A.........  N block cont             3.85           NA           NA          0.47         0.65          0.31  010
                                         infuse, b plex.
64417........  ...........  A.........  N block inj,             1.44         1.42         2.24          0.32         0.41          0.11  000
                                         axillary.
64418........  ...........  A.........  N block inj,             1.32         1.89         2.25          0.52         0.48          0.07  000
                                         suprascapular.
64420........  ...........  A.........  N block inj,             1.18         2.38         3.13          0.45         0.44          0.08  000
                                         intercost, sng.
64421........  ...........  A.........  N block inj,             1.68         3.53         4.80          0.53         0.52          0.11  000
                                         intercost, mlt.
64425........  ...........  A.........  N block inj, ilio-       1.75         1.29         1.48          0.53         0.54          0.13  000
                                         ing/hypogi.
64430........  ...........  A.........  N block inj,             1.46         2.39         2.45          0.78         0.67          0.10  000
                                         pudendal.
64435........  ...........  A.........  N block inj,             1.45         1.99         2.25          0.56         0.63          0.16  000
                                         paracervical.
64445........  ...........  A.........  N block inj,             1.48         1.62         2.15          0.51         0.51          0.10  000
                                         sciatic, sng.
64446........  ...........  A.........  N blk inj,               3.61           NA           NA          0.49         0.76          0.20  010
                                         sciatic, cont
                                         inf.
64447........  ...........  A.........  N block inj fem,         1.50           NA           NA          0.18         0.31          0.09  000
                                         single.
64448........  ...........  A.........  N block inj fem,         3.36           NA           NA          0.40         0.62          0.18  010
                                         cont inf.
64449........  ...........  A.........  N block inj,             3.24           NA           NA          0.42         0.70          0.15  010
                                         lumbar plexus.
64450........  ...........  A.........  N block, other           1.27         1.25         1.25          0.48         0.49          0.13  000
                                         peripheral.
64470........  ...........  A.........  Inj paravertebral        1.85         3.79         5.51          0.70         0.71          0.11  000
                                         c/t.
64472........  ...........  A.........  Inj paravertebral        1.29         1.21         1.77          0.33         0.34          0.08  ZZZ
                                         c/t add-on.
64475........  ...........  A.........  Inj paravertebral        1.41         3.62         5.25          0.58         0.61          0.10  000
                                         l/s.
64476........  ...........  A.........  Inj paravertebral        0.98         1.10         1.61          0.23         0.24          0.07  ZZZ
                                         l/s add-on.
64479........  ...........  A.........  Inj foramen              2.20         3.73         5.61          0.81         0.85          0.12  000
                                         epidural c/t.

[[Page 38304]]

 
64480........  ...........  A.........  Inj foramen              1.54         1.54         2.18          0.40         0.43          0.10  ZZZ
                                         epidural add-on.
64483........  ...........  A.........  Inj foramen              1.90         3.80         5.84          0.75         0.79          0.11  000
                                         epidural l/s.
64484........  ...........  A.........  Inj foramen              1.33         1.62         2.45          0.33         0.35          0.08  ZZZ
                                         epidural add-on.
64505........  ...........  A.........  N block,                 1.36         1.13         1.18          0.74         0.70          0.10  000
                                         spenopalatine
                                         gangl.
64508........  ...........  A.........  N block, carotid         1.12         2.00         2.64          0.55         0.64          0.07  000
                                         sinus s/p.
64510........  ...........  A.........  N block, stellate        1.22         1.89         2.67          0.43         0.47          0.07  000
                                         ganglion.
64517........  ...........  A.........  N block inj,             2.20         1.72         2.21          0.69         0.77          0.11  000
                                         hypogas plxs.
64520........  ...........  A.........  N block, lumbar/         1.35         2.56         3.85          0.51         0.53          0.08  000
                                         thoracic.
64530........  ...........  A.........  N block inj,             1.58         2.78         3.58          0.66         0.64          0.10  000
                                         celiac pelus.
64550........  ...........  A.........  Apply                    0.18         0.20         0.24          0.05         0.05          0.01  000
                                         neurostimulator.
64553........  ...........  A.........  Implant                  2.33         2.67         2.72          1.46         1.64          0.18  010
                                         neuroelectrodes.
64555........  ...........  A.........  Implant                  2.29         2.77         2.90          1.49         1.32          0.19  010
                                         neuroelectrodes.
64560........  ...........  A.........  Implant                  2.38         2.40         2.53          1.26         1.29          0.22  010
                                         neuroelectrodes.
64561........  ...........  A.........  Implant                  7.07        19.55        24.86          3.80         3.30          0.51  010
                                         neuroelectrodes.
64565........  ...........  A.........  Implant                  1.78         2.44         2.87          1.28         1.27          0.13  010
                                         neuroelectrodes.
64573........  ...........  A.........  Implant                  8.15           NA           NA          5.18         5.27          1.60  090
                                         neuroelectrodes.
64575........  ...........  A.........  Implant                  4.37           NA           NA          2.06         2.35          0.61  090
                                         neuroelectrodes.
64577........  ...........  A.........  Implant                  4.64           NA           NA          4.79         3.71          1.04  090
                                         neuroelectrodes.
64580........  ...........  A.........  Implant                  4.14           NA           NA          2.72         3.13          0.36  090
                                         neuroelectrodes.
64581........  ...........  A.........  Implant                 14.15           NA           NA          6.69         6.05          1.05  090
                                         neuroelectrodes.
64585........  ...........  A.........  Revise/remove            2.08         5.89         8.56          2.29         2.20          0.20  010
                                         neuroelectrode.
64590........  ...........  A.........  Insrt/redo pn/           2.42         6.38         6.76          2.46         2.37          0.19  010
                                         gastr stimul.
64595........  ...........  A.........  Revise/rmv pn/           1.75         6.41         8.41          2.17         2.05          0.19  010
                                         gastr stimul.
64600........  ...........  A.........  Injection                3.46         5.41         7.35          1.65         1.64          0.34  010
                                         treatment of
                                         nerve.
64605........  ...........  A.........  Injection                5.62         7.16         8.41          2.28         2.25          0.79  010
                                         treatment of
                                         nerve.
64610........  ...........  A.........  Injection                7.17         9.24         9.08          3.48         3.61          1.58  010
                                         treatment of
                                         nerve.
64612........  ...........  A.........  Destroy nerve,           1.98         1.59         2.04          1.34         1.34          0.11  010
                                         face muscle.
64613........  ...........  A.........  Destroy nerve,           1.98         1.37         2.15          1.14         1.18          0.11  010
                                         neck muscle.
64614........  ...........  A.........  Destroy nerve,           2.20         1.61         2.42          1.31         1.31          0.10  010
                                         extrem musc.
64620........  ...........  A.........  Injection                2.86         3.29         4.19          1.11         1.22          0.20  010
                                         treatment of
                                         nerve.
64622........  ...........  A.........  Destr                    3.02         4.04         5.89          1.26         1.31          0.18  010
                                         paravertebrl
                                         nerve l/s.
64623........  ...........  A.........  Destr                    0.99         1.67         2.30          0.22         0.22          0.06  ZZZ
                                         paravertebral n
                                         add-on.
64626........  ...........  A.........  Destr                    3.82         4.72         6.23          1.88         1.91          0.20  010
                                         paravertebrl
                                         nerve c/t.
64627........  ...........  A.........  Destr                    1.16         2.36         3.44          0.25         0.26          0.07  ZZZ
                                         paravertebral n
                                         add-on.
64630........  ...........  A.........  Injection                3.02         2.77         2.75          1.85         1.64          0.22  010
                                         treatment of
                                         nerve.
64640........  ...........  A.........  Injection                2.78         2.36         3.29          1.38         1.63          0.29  010
                                         treatment of
                                         nerve.
64650........  ...........  A.........  Chemodenerv              0.70         0.71         0.80          0.16         0.23          0.06  000
                                         eccrine glands.
64653........  ...........  A.........  Chemodenerv              0.88         0.75         0.85          0.19         0.29          0.08  000
                                         eccrine glands.
64680........  ...........  A.........  Injection                2.64         4.22         5.42          1.20         1.29          0.18  010
                                         treatment of
                                         nerve.
64681........  ...........  A.........  Injection                3.78         4.74         7.03          1.26         1.67          0.28  010
                                         treatment of
                                         nerve.
64702........  ...........  A.........  Revise finger/toe        6.10           NA           NA          5.15         4.54          0.61  090
                                         nerve.
64704........  ...........  A.........  Revise hand/foot         4.61           NA           NA          3.05         3.21          0.61  090
                                         nerve.
64708........  ...........  A.........  Revise arm/leg           6.22           NA           NA          4.16         4.54          0.96  090
                                         nerve.
64712........  ...........  A.........  Revision of              7.98           NA           NA          4.34         4.69          0.95  090
                                         sciatic nerve.
64713........  ...........  A.........  Revision of arm         11.29           NA           NA          6.05         6.04          1.83  090
                                         nerve(s).
64714........  ...........  A.........  Revise low back         10.44           NA           NA          4.37         4.38          1.19  090
                                         nerve(s).
64716........  ...........  A.........  Revision of              6.86           NA           NA          5.47         5.68          0.63  090
                                         cranial nerve.
64718........  ...........  A.........  Revise ulnar             7.06           NA           NA          6.18         6.10          1.05  090
                                         nerve at elbow.
64719........  ...........  A.........  Revise ulnar             4.89           NA           NA          4.12         4.33          0.77  090
                                         nerve at wrist.
64721........  ...........  A.........  Carpal tunnel            4.84         4.69         5.04          4.63         5.00          0.73  090
                                         surgery.
64722........  ...........  A.........  Relieve pressure         4.74           NA           NA          2.98         2.99          0.48  090
                                         on nerve(s).
64726........  ...........  A.........  Release foot/toe         4.21           NA           NA          2.59         2.72          0.54  090
                                         nerve.
64727........  ...........  A.........  Internal nerve           3.10           NA           NA          1.19         1.36          0.48  ZZZ
                                         revision.
64732........  ...........  A.........  Incision of brow         4.81           NA           NA          3.67         3.70          0.98  090
                                         nerve.
64734........  ...........  A.........  Incision of cheek        5.45           NA           NA          4.45         4.29          0.89  090
                                         nerve.
64736........  ...........  A.........  Incision of chin         5.13           NA           NA          3.74         3.91          0.52  090
                                         nerve.
64738........  ...........  A.........  Incision of jaw          6.26           NA           NA          4.67         4.58          1.08  090
                                         nerve.
64740........  ...........  A.........  Incision of              6.12           NA           NA          5.02         4.97          0.69  090
                                         tongue nerve.
64742........  ...........  A.........  Incision of              6.75           NA           NA          4.31         4.52          0.73  090
                                         facial nerve.
64744........  ...........  A.........  Incise nerve,            5.64           NA           NA          4.08         4.01          1.16  090
                                         back of head.
64746........  ...........  A.........  Incise diaphragm         6.46           NA           NA          3.86         4.18          0.82  090
                                         nerve.
64752........  ...........  A.........  Incision of vagus        7.59           NA           NA          3.78         4.07          0.93  090
                                         nerve.
64755........  ...........  A.........  Incision of             14.97           NA           NA          5.50         5.61          1.84  090
                                         stomach nerves.
64760........  ...........  A.........  Incision of vagus        7.49           NA           NA          3.76         3.62          0.81  090
                                         nerve.
64761........  ...........  A.........  Incision of              6.94           NA           NA          4.28         3.85          0.53  090
                                         pelvis nerve.
64763........  ...........  A.........  Incise hip/thigh         7.46           NA           NA          3.89         4.75          0.94  090
                                         nerve.
64766........  ...........  A.........  Incise hip/thigh         9.34           NA           NA          4.55         5.02          1.06  090
                                         nerve.
64771........  ...........  A.........  Sever cranial            8.02           NA           NA          5.65         5.55          1.23  090
                                         nerve.
64772........  ...........  A.........  Incision of              7.74           NA           NA          5.09         5.05          1.40  090
                                         spinal nerve.
64774........  ...........  A.........  Remove skin nerve        5.70           NA           NA          4.00         3.91          0.74  090
                                         lesion.
64776........  ...........  A.........  Remove digit             5.52           NA           NA          3.69         3.70          0.76  090
                                         nerve lesion.
64778........  ...........  A.........  Digit nerve              3.11           NA           NA          1.21         1.36          0.46  ZZZ
                                         surgery add-on.

[[Page 38305]]

 
64782........  ...........  A.........  Remove limb nerve        6.76           NA           NA          4.01         3.91          0.86  090
                                         lesion.
64783........  ...........  A.........  Limb nerve               3.71           NA           NA          1.37         1.61          0.51  ZZZ
                                         surgery add-on.
64784........  ...........  A.........  Remove nerve            10.49           NA           NA          6.38         6.47          1.38  090
                                         lesion.
64786........  ...........  A.........  Remove sciatic          16.12           NA           NA          8.46         9.25          2.61  090
                                         nerve lesion.
64787........  ...........  A.........  Implant nerve end        4.29           NA           NA          1.64         1.88          0.58  ZZZ
64788........  ...........  A.........  Remove skin nerve        5.14           NA           NA          4.05         3.73          0.73  090
                                         lesion.
64790........  ...........  A.........  Removal of nerve        11.97           NA           NA          6.97         7.07          2.11  090
                                         lesion.
64792........  ...........  A.........  Removal of nerve        15.71           NA           NA          8.31         8.60          2.49  090
                                         lesion.
64795........  ...........  A.........  Biopsy of nerve..        3.01           NA           NA          1.43         1.50          0.52  000
64802........  ...........  A.........  Remove                  10.24           NA           NA          3.51         4.44          1.29  090
                                         sympathetic
                                         nerves.
64804........  ...........  A.........  Remove                  15.78           NA           NA          6.02         6.59          2.15  090
                                         sympathetic
                                         nerves.
64809........  ...........  A.........  Remove                  14.61           NA           NA          6.90         6.29          1.50  090
                                         sympathetic
                                         nerves.
64818........  ...........  A.........  Remove                  11.24           NA           NA          4.33         4.80          1.33  090
                                         sympathetic
                                         nerves.
64820........  ...........  A.........  Remove                  10.64           NA           NA          6.93         7.06          1.49  090
                                         sympathetic
                                         nerves.
64821........  ...........  A.........  Remove                   9.19           NA           NA          6.50         6.96          1.24  090
                                         sympathetic
                                         nerves.
64822........  ...........  A.........  Remove                   9.19           NA           NA          6.40         6.84          1.30  090
                                         sympathetic
                                         nerves.
64823........  ...........  A.........  Remove                  10.80           NA           NA          6.34         7.38          1.57  090
                                         sympathetic
                                         nerves.
64831........  ...........  A.........  Repair of digit         10.23           NA           NA          6.60         6.87          1.41  090
                                         nerve.
64832........  ...........  A.........  Repair nerve add-        5.65           NA           NA          2.31         2.64          0.85  ZZZ
                                         on.
64834........  ...........  A.........  Repair of hand or       10.71           NA           NA          6.43         6.80          1.54  090
                                         foot nerve.
64835........  ...........  A.........  Repair of hand or       11.60           NA           NA          6.93         7.39          1.74  090
                                         foot nerve.
64836........  ...........  A.........  Repair of hand or       11.60           NA           NA          7.12         7.39          1.68  090
                                         foot nerve.
64837........  ...........  A.........  Repair nerve add-        6.25           NA           NA          2.62         2.95          0.97  ZZZ
                                         on.
64840........  ...........  A.........  Repair of leg           13.87           NA           NA          7.44         7.47          1.37  090
                                         nerve.
64856........  ...........  A.........  Repair/transpose        14.94           NA           NA          8.47         8.87          2.13  090
                                         nerve.
64857........  ...........  A.........  Repair arm/leg          15.69           NA           NA          8.75         9.24          2.22  090
                                         nerve.
64858........  ...........  A.........  Repair sciatic          17.69           NA           NA          9.59        10.32          3.34  090
                                         nerve.
64859........  ...........  A.........  Nerve surgery....        4.25           NA           NA          1.76         2.01          0.67  ZZZ
64861........  ...........  A.........  Repair of arm           20.74           NA           NA         10.02        10.92          4.09  090
                                         nerves.
64862........  ...........  A.........  Repair of low           20.94           NA           NA          9.78        10.35          4.32  090
                                         back nerves.
64864........  ...........  A.........  Repair of facial        13.31           NA           NA          7.50         8.08          1.26  090
                                         nerve.
64865........  ...........  A.........  Repair of facial        15.96           NA           NA         11.55        12.29          1.50  090
                                         nerve.
64866........  ...........  A.........  Fusion of facial/       16.70           NA           NA         11.13        12.36          2.05  090
                                         other nerve.
64868........  ...........  A.........  Fusion of facial/       14.80           NA           NA          9.82        10.52          1.43  090
                                         other nerve.
64870........  ...........  A.........  Fusion of facial/       16.95           NA           NA          8.17         8.51          1.30  090
                                         other nerve.
64872........  ...........  A.........  Subsequent repair        1.99           NA           NA          0.78         0.94          0.29  ZZZ
                                         of nerve.
64874........  ...........  A.........  Repair & revise          2.98           NA           NA          1.27         1.40          0.42  ZZZ
                                         nerve add-on.
64876........  ...........  A.........  Repair nerve/            3.37           NA           NA          1.44         1.48          0.47  ZZZ
                                         shorten bone.
64885........  ...........  A.........  Nerve graft, head       17.50           NA           NA          9.00        10.31          1.63  090
                                         or neck.
64886........  ...........  A.........  Nerve graft, head       20.72           NA           NA         10.45        11.92          2.09  090
                                         or neck.
64890........  ...........  A.........  Nerve graft, hand       16.11           NA           NA          8.96         9.52          2.30  090
                                         or foot.
64891........  ...........  A.........  Nerve graft, hand       17.22           NA           NA          9.53         8.64          1.63  090
                                         or foot.
64892........  ...........  A.........  Nerve graft, arm        15.61           NA           NA          9.14         8.99          2.48  090
                                         or leg.
64893........  ...........  A.........  Nerve graft, arm        16.74           NA           NA          9.60         9.78          2.62  090
                                         or leg.
64895........  ...........  A.........  Nerve graft, hand       20.26           NA           NA         11.09        10.24          2.58  090
                                         or foot.
64896........  ...........  A.........  Nerve graft, hand       21.81           NA           NA         11.67        11.39          3.17  090
                                         or foot.
64897........  ...........  A.........  Nerve graft, arm        19.25           NA           NA         10.51        10.62          2.55  090
                                         or leg.
64898........  ...........  A.........  Nerve graft, arm        20.82           NA           NA         11.50        11.65          2.78  090
                                         or leg.
64901........  ...........  A.........  Nerve graft add-        10.20           NA           NA          3.55         4.47          1.37  ZZZ
                                         on.
64902........  ...........  A.........  Nerve graft add-        11.81           NA           NA          4.68         5.27          1.55  ZZZ
                                         on.
64905........  ...........  A.........  Nerve pedicle           14.98           NA           NA          7.01         7.75          2.01  090
                                         transfer.
64907........  ...........  A.........  Nerve pedicle           19.90           NA           NA          6.34         9.43          3.17  090
                                         transfer.
64910........  ...........  A.........  Nerve repair w/         11.21           NA           NA          4.63         5.02          1.74  090
                                         allograft.
64911........  ...........  A.........  Neurorraphy w/          14.21           NA           NA          5.29         5.74          1.91  090
                                         vein autograft.
64999........  ...........  C.........  Nervous system           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
65091........  ...........  A.........  Revise eye.......        7.13           NA           NA          6.76         7.59          0.32  090
65093........  ...........  A.........  Revise eye with          6.93           NA           NA          6.82         7.80          0.34  090
                                         implant.
65101........  ...........  A.........  Removal of eye...        8.10           NA           NA          7.99         8.79          0.35  090
65103........  ...........  A.........  Remove eye/insert        8.64           NA           NA          8.16         8.99          0.37  090
                                         implant.
65105........  ...........  A.........  Remove eye/attach        9.70           NA           NA          8.81         9.69          0.42  090
                                         implant.
65110........  ...........  A.........  Removal of eye...       15.42           NA           NA         11.50        12.62          0.81  090
65112........  ...........  A.........  Remove eye/revise       18.18           NA           NA         13.29        14.70          1.30  090
                                         socket.
65114........  ...........  A.........  Remove eye/revise       19.32           NA           NA         13.58        15.01          1.02  090
                                         socket.
65125........  ...........  A.........  Revise ocular            3.18         6.69         7.76          3.17         3.39          0.19  090
                                         implant.
65130........  ...........  A.........  Insert ocular            8.22           NA           NA          7.71         8.49          0.35  090
                                         implant.
65135........  ...........  A.........  Insert ocular            8.40           NA           NA          7.78         8.59          0.36  090
                                         implant.
65140........  ...........  A.........  Attach ocular            9.23           NA           NA          8.42         9.19          0.40  090
                                         implant.
65150........  ...........  A.........  Revise ocular            6.32           NA           NA          6.31         7.18          0.31  090
                                         implant.
65155........  ...........  A.........  Reinsert ocular          9.87           NA           NA          8.81         9.66          0.50  090
                                         implant.
65175........  ...........  A.........  Removal of ocular        7.22           NA           NA          7.07         7.82          0.31  090
                                         implant.
65205........  ...........  A.........  Remove foreign           0.71         0.57         0.61          0.32         0.31          0.03  000
                                         body from eye.
65210........  ...........  A.........  Remove foreign           0.84         0.71         0.76          0.39         0.39          0.04  000
                                         body from eye.

[[Page 38306]]

 
65220........  ...........  A.........  Remove foreign           0.71         0.59         0.62          0.28         0.28          0.05  000
                                         body from eye.
65222........  ...........  A.........  Remove foreign           0.93         0.78         0.84          0.42         0.41          0.04  000
                                         body from eye.
65235........  ...........  A.........  Remove foreign           8.78           NA           NA          6.83         6.82          0.37  090
                                         body from eye.
65260........  ...........  A.........  Remove foreign          12.29           NA           NA          8.80         9.28          0.57  090
                                         body from eye.
65265........  ...........  A.........  Remove foreign          14.06           NA           NA          9.67        10.20          0.62  090
                                         body from eye.
65270........  ...........  A.........  Repair of eye            1.92         3.82         4.53          1.21         1.30          0.09  010
                                         wound.
65272........  ...........  A.........  Repair of eye            4.49         6.30         7.04          3.18         3.26          0.19  090
                                         wound.
65273........  ...........  A.........  Repair of eye            5.03           NA           NA          3.34         3.48          0.22  090
                                         wound.
65275........  ...........  A.........  Repair of eye            6.14         6.31         6.34          3.93         3.96          0.26  090
                                         wound.
65280........  ...........  A.........  Repair of eye            8.87           NA           NA          5.88         6.09          0.38  090
                                         wound.
65285........  ...........  A.........  Repair of eye           14.43           NA           NA          8.47         8.90          0.64  090
                                         wound.
65286........  ...........  A.........  Repair of eye            6.45         8.71         9.97          4.42         4.55          0.27  090
                                         wound.
65290........  ...........  A.........  Repair of eye            6.35           NA           NA          4.43         4.62          0.31  090
                                         socket wound.
65400........  ...........  A.........  Removal of eye           7.27         7.47         7.94          5.88         6.03          0.30  090
                                         lesion.
65410........  ...........  A.........  Biopsy of cornea.        1.47         1.67         1.90          0.87         0.92          0.07  000
65420........  ...........  A.........  Removal of eye           4.24         6.85         7.88          3.98         4.23          0.21  090
                                         lesion.
65426........  ...........  A.........  Removal of eye           5.93         8.10         9.19          4.53         4.76          0.25  090
                                         lesion.
65430........  ...........  A.........  Corneal smear....        1.47         1.10         1.20          0.87         0.93          0.07  000
65435........  ...........  A.........  Curette/treat            0.92         0.86         0.93          0.65         0.68          0.04  000
                                         cornea.
65436........  ...........  A.........  Curette/treat            4.72         3.78         3.96          3.45         3.58          0.21  090
                                         cornea.
65450........  ...........  A.........  Treatment of             3.35         3.68         3.89          3.61         3.79          0.16  090
                                         corneal lesion.
65600........  ...........  A.........  Revision of              4.07         4.44         4.75          3.40         3.40          0.17  090
                                         cornea.
65710........  ...........  A.........  Corneal                 14.09           NA           NA         10.22        10.77          0.61  090
                                         transplant.
65730........  ...........  A.........  Corneal                 15.99           NA           NA         11.05        11.60          0.70  090
                                         transplant.
65750........  ...........  A.........  Corneal                 16.60           NA           NA         10.71        11.41          0.74  090
                                         transplant.
65755........  ...........  A.........  Corneal                 16.49           NA           NA         10.68        11.35          0.73  090
                                         transplant.
65770........  ...........  A.........  Revise cornea           19.41           NA           NA         11.77        12.56          0.87  090
                                         with implant.
65772........  ...........  A.........  Correction of            4.96         4.86         5.22          3.94         4.06          0.21  090
                                         astigmatism.
65775........  ...........  A.........  Correction of            6.73           NA           NA          5.33         5.67          0.28  090
                                         astigmatism.
65780........  ...........  A.........  Ocular reconst,         10.43           NA           NA          8.98         9.69          0.44  090
                                         transplant.
65781........  ...........  A.........  Ocular reconst,         17.84           NA           NA         11.68        12.75          0.44  090
                                         transplant.
65782........  ...........  A.........  Ocular reconst,         15.16           NA           NA         10.28        11.20          0.44  090
                                         transplant.
65800........  ...........  A.........  Drainage of eye..        1.91         1.40         1.61          1.03         1.12          0.09  000
65805........  ...........  A.........  Drainage of eye..        1.91         1.70         1.95          1.03         1.12          0.09  000
65810........  ...........  A.........  Drainage of eye..        5.67           NA           NA          4.69         4.72          0.24  090
65815........  ...........  A.........  Drainage of eye..        5.85         7.92         9.00          4.61         4.74          0.25  090
65820........  ...........  A.........  Relieve inner eye        8.72           NA           NA          7.68         8.41          0.40  090
                                         pressure.
65850........  ...........  A.........  Incision of eye..       11.24           NA           NA          7.39         7.96          0.52  090
65855........  ...........  A.........  Laser surgery of         3.90         3.51         3.93          2.65         2.89          0.19  010
                                         eye.
65860........  ...........  A.........  Incise inner eye         3.56         3.27         3.68          2.10         2.31          0.18  090
                                         adhesions.
65865........  ...........  A.........  Incise inner eye         5.66           NA           NA          4.72         5.20          0.28  090
                                         adhesions.
65870........  ...........  A.........  Incise inner eye         7.21           NA           NA          5.74         6.11          0.31  090
                                         adhesions.
65875........  ...........  A.........  Incise inner eye         7.61           NA           NA          6.17         6.52          0.32  090
                                         adhesions.
65880........  ...........  A.........  Incise inner eye         8.16           NA           NA          6.34         6.73          0.35  090
                                         adhesions.
65900........  ...........  A.........  Remove eye lesion       12.26           NA           NA          8.95         9.65          0.54  090
65920........  ...........  A.........  Remove implant of        9.74           NA           NA          7.51         7.89          0.41  090
                                         eye.
65930........  ...........  A.........  Remove blood clot        8.24           NA           NA          5.81         6.36          0.37  090
                                         from eye.
66020........  ...........  A.........  Injection                1.61         2.42         2.78          1.28         1.37          0.08  010
                                         treatment of eye.
66030........  ...........  A.........  Injection                1.27         2.29         2.64          1.15         1.22          0.06  010
                                         treatment of eye.
66130........  ...........  A.........  Remove eye lesion        7.74         7.54         8.62          4.91         5.30          0.38  090
66150........  ...........  A.........  Glaucoma surgery.       10.18           NA           NA          8.85         9.17          0.46  090
66155........  ...........  A.........  Glaucoma surgery.       10.17           NA           NA          8.85         9.14          0.41  090
66160........  ...........  A.........  Glaucoma surgery.       12.04           NA           NA          9.53         9.92          0.50  090
66165........  ...........  A.........  Glaucoma surgery.        9.89           NA           NA          8.81         9.07          0.40  090
66170........  ...........  A.........  Glaucoma surgery.       14.57           NA           NA         11.61        11.98          0.60  090
66172........  ...........  A.........  Incision of eye..       18.26           NA           NA         14.72        15.05          0.74  090
66180........  ...........  A.........  Implant eye shunt       16.02           NA           NA          9.78        10.34          0.71  090
66185........  ...........  A.........  Revise eye shunt.        9.35           NA           NA          7.09         7.28          0.40  090
66220........  ...........  A.........  Repair eye lesion        8.98           NA           NA          7.20         7.17          0.40  090
66225........  ...........  A.........  Repair/graft eye        12.38           NA           NA          8.18         8.51          0.55  090
                                         lesion.
66250........  ...........  A.........  Follow-up surgery        6.92         9.25        10.52          5.28         5.41          0.30  090
                                         of eye.
66500........  ...........  A.........  Incision of iris.        3.75           NA           NA          3.96         4.32          0.18  090
66505........  ...........  A.........  Incision of iris.        4.13           NA           NA          4.32         4.68          0.20  090
66600........  ...........  A.........  Remove iris and          9.89           NA           NA          8.33         8.32          0.43  090
                                         lesion.
66605........  ...........  A.........  Removal of iris..       13.99           NA           NA          9.54         9.77          0.77  090
66625........  ...........  A.........  Removal of iris..        5.19           NA           NA          4.23         4.50          0.26  090
66630........  ...........  A.........  Removal of iris..        7.10           NA           NA          5.38         5.58          0.31  090
66635........  ...........  A.........  Removal of iris..        7.19           NA           NA          5.41         5.61          0.31  090
66680........  ...........  A.........  Repair iris &            6.24           NA           NA          5.09         5.21          0.27  090
                                         ciliary body.
66682........  ...........  A.........  Repair iris &            7.15           NA           NA          6.73         6.71          0.31  090
                                         ciliary body.
66700........  ...........  A.........  Destruction,             5.06         4.80         5.05          3.61         3.80          0.24  090
                                         ciliary body.
66710........  ...........  A.........  Ciliary                  5.06         4.62         4.92          3.62         3.75          0.23  090
                                         transsleral
                                         therapy.

[[Page 38307]]

 
66711........  ...........  A.........  Ciliary                  7.70           NA           NA          6.32         6.43          0.30  090
                                         endoscopic
                                         ablation.
66720........  ...........  A.........  Destruction,             4.86         5.38         5.61          4.33         4.54          0.26  090
                                         ciliary body.
66740........  ...........  A.........  Destruction,             5.06         4.55         4.84          3.63         3.82          0.23  090
                                         ciliary body.
66761........  ...........  A.........  Revision of iris.        4.87         5.03         5.34          4.21         4.28          0.20  090
66762........  ...........  A.........  Revision of iris.        5.25         5.12         5.41          4.09         4.22          0.23  090
66770........  ...........  A.........  Removal of inner         5.98         5.55         5.85          4.61         4.74          0.26  090
                                         eye lesion.
66820........  ...........  A.........  Incision,                3.93           NA           NA          4.63         5.24          0.19  090
                                         secondary
                                         cataract.
66821........  ...........  A.........  After cataract           3.32         3.84         3.98          3.43         3.54          0.11  090
                                         laser surgery.
66825........  ...........  A.........  Reposition               8.82           NA           NA          7.81         8.48          0.40  090
                                         intraocular lens.
66830........  ...........  A.........  Removal of lens          9.27           NA           NA          6.42         6.73          0.36  090
                                         lesion.
66840........  ...........  A.........  Removal of lens          8.98           NA           NA          6.34         6.64          0.39  090
                                         material.
66850........  ...........  A.........  Removal of lens         10.32           NA           NA          7.12         7.43          0.45  090
                                         material.
66852........  ...........  A.........  Removal of lens         11.18           NA           NA          7.45         7.82          0.49  090
                                         material.
66920........  ...........  A.........  Extraction of            9.93           NA           NA          6.70         7.04          0.44  090
                                         lens.
66930........  ...........  A.........  Extraction of           11.38           NA           NA          7.52         7.88          0.49  090
                                         lens.
66940........  ...........  A.........  Extraction of           10.14           NA           NA          7.06         7.38          0.43  090
                                         lens.
66982........  ...........  A.........  Cataract surgery,       14.83           NA           NA          9.04         9.51          0.63  090
                                         complex.
66983........  ...........  A.........  Cataract surg w/        10.20           NA           NA          6.57         6.31          0.14  090
                                         iol, 1 stage.
66984........  ...........  A.........  Cataract surg w/        10.36           NA           NA          6.51         7.00          0.39  090
                                         iol, 1 stage.
66985........  ...........  A.........  Insert lens              9.73           NA           NA          7.18         7.35          0.36  090
                                         prosthesis.
66986........  ...........  A.........  Exchange lens           12.26           NA           NA          8.12         8.70          0.60  090
                                         prosthesis.
66990........  ...........  A.........  Ophthalmic               1.51           NA           NA          0.55         0.62          0.07  ZZZ
                                         endoscope add-on.
66999........  ...........  C.........  Eye surgery              0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
67005........  ...........  A.........  Partial removal          5.77           NA           NA          4.60         4.76          0.28  090
                                         of eye fluid.
67010........  ...........  A.........  Partial removal          6.94           NA           NA          5.03         5.25          0.34  090
                                         of eye fluid.
67015........  ...........  A.........  Release of eye           7.00           NA           NA          5.73         6.12          0.34  090
                                         fluid.
67025........  ...........  A.........  Replace eye fluid        7.91         7.89         8.60          5.95         6.12          0.34  090
67027........  ...........  A.........  Implant eye drug        11.43           NA           NA          7.43         7.76          0.54  090
                                         system.
67028........  ...........  A.........  Injection eye            2.52         2.16         2.45          1.26         1.37          0.12  000
                                         drug.
67030........  ...........  A.........  Incise inner eye         5.91           NA           NA          5.62         5.77          0.24  090
                                         strands.
67031........  ...........  A.........  Laser surgery,           4.34         4.11         4.38          3.45         3.56          0.18  090
                                         eye strands.
67036........  ...........  A.........  Removal of inner        13.09           NA           NA          8.13         8.68          0.58  090
                                         eye fluid.
67038........  ...........  A.........  Strip retinal           23.30           NA           NA         13.59        14.64          1.04  090
                                         membrane.
67039........  ...........  A.........  Laser treatment         16.39           NA           NA         10.80        11.56          0.71  090
                                         of retina.
67040........  ...........  A.........  Laser treatment         19.23           NA           NA         12.11        12.98          0.85  090
                                         of retina.
67101........  ...........  A.........  Repair detached          8.60         8.52         8.87          6.22         6.41          0.37  090
                                         retina.
67105........  ...........  A.........  Repair detached          8.35         7.45         7.81          5.83         6.03          0.37  090
                                         retina.
67107........  ...........  A.........  Repair detached         16.35           NA           NA         10.44        10.94          0.73  090
                                         retina.
67108........  ...........  A.........  Repair detached         22.49           NA           NA         13.08        13.84          1.02  090
                                         retina.
67110........  ...........  A.........  Repair detached         10.02         8.97         9.65          7.02         7.25          0.44  090
                                         retina.
67112........  ...........  A.........  Rerepair detached       18.45           NA           NA         10.97        11.46          0.83  090
                                         retina.
67115........  ...........  A.........  Release                  5.93           NA           NA          4.96         5.05          0.25  090
                                         encircling
                                         material.
67120........  ...........  A.........  Remove eye               6.92         7.37         8.02          5.31         5.45          0.29  090
                                         implant material.
67121........  ...........  A.........  Remove eye              12.00           NA           NA          8.02         8.33          0.53  090
                                         implant material.
67141........  ...........  A.........  Treatment of             6.00         5.44         5.68          4.68         4.80          0.26  090
                                         retina.
67145........  ...........  A.........  Treatment of             6.17         5.37         5.58          4.74         4.87          0.27  090
                                         retina.
67208........  ...........  A.........  Treatment of             7.50         5.69         5.94          5.24         5.41          0.33  090
                                         retinal lesion.
67210........  ...........  A.........  Treatment of             9.35         5.97         6.31          5.49         5.72          0.44  090
                                         retinal lesion.
67218........  ...........  A.........  Treatment of            20.22           NA           NA         10.74        11.53          0.92  090
                                         retinal lesion.
67220........  ...........  A.........  Treatment of            14.19         9.30         9.92          8.25         8.68          0.65  090
                                         choroid lesion.
67221........  ...........  R.........  Ocular                   3.45         2.93         3.65          1.40         1.61          0.20  000
                                         photodynamic
                                         ther.
67225........  ...........  A.........  Eye photodynamic         0.47         0.23         0.24          0.17         0.19          0.02  ZZZ
                                         ther add-on.
67227........  ...........  A.........  Treatment of             7.38         6.03         6.34          5.20         5.39          0.33  090
                                         retinal lesion.
67228........  ...........  A.........  Treatment of            13.67         9.99        10.80          7.76         8.21          0.63  090
                                         retinal lesion.
67250........  ...........  A.........  Reinforce eye            9.46           NA           NA          7.71         8.48          0.47  090
                                         wall.
67255........  ...........  A.........  Reinforce/graft          9.97           NA           NA          8.47         9.23          0.44  090
                                         eye wall.
67299........  ...........  C.........  Eye surgery              0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
67311........  ...........  A.........  Revise eye muscle        7.59           NA           NA          5.54         5.81          0.37  090
67312........  ...........  A.........  Revise two eye           9.48           NA           NA          6.25         6.54          0.43  090
                                         muscles.
67314........  ...........  A.........  Revise eye muscle        8.59           NA           NA          6.20         6.41          0.39  090
67316........  ...........  A.........  Revise two eye          10.73           NA           NA          6.98         7.29          0.49  090
                                         muscles.
67318........  ...........  A.........  Revise eye               8.92           NA           NA          6.56         6.79          0.41  090
                                         muscle(s).
67320........  ...........  A.........  Revise eye               5.40           NA           NA          1.96         1.97          0.22  ZZZ
                                         muscle(s) add-on.
67331........  ...........  A.........  Eye surgery              5.13           NA           NA          1.85         1.86          0.21  ZZZ
                                         follow-up add-on.
67332........  ...........  A.........  Rerevise eye             5.56           NA           NA          2.01         2.04          0.23  ZZZ
                                         muscles add-on.
67334........  ...........  A.........  Revise eye muscle        5.05           NA           NA          1.84         1.83          0.20  ZZZ
                                         w/suture.
67335........  ...........  A.........  Eye suture during        2.49           NA           NA          0.91         1.02          0.13  ZZZ
                                         surgery.
67340........  ...........  A.........  Revise eye muscle        6.00           NA           NA          2.18         2.21          0.25  ZZZ
                                         add-on.
67343........  ...........  A.........  Release eye              8.29           NA           NA          6.11         6.34          0.37  090
                                         tissue.
67345........  ...........  A.........  Destroy nerve of         2.98         2.18         2.40          1.71         1.88          0.17  010
                                         eye muscle.
67346........  ...........  A.........  Biopsy, eye              2.87           NA           NA          1.64         1.80          0.15  000
                                         muscle.
67399........  ...........  C.........  Eye muscle               0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery
                                         procedure.

[[Page 38308]]

 
67400........  ...........  A.........  Explore/biopsy          10.97           NA           NA          9.46        10.41          0.56  090
                                         eye socket.
67405........  ...........  A.........  Explore/drain eye        9.00           NA           NA          8.36         9.09          0.44  090
                                         socket.
67412........  ...........  A.........  Explore/treat eye       10.17           NA           NA          8.58         9.81          0.48  090
                                         socket.
67413........  ...........  A.........  Explore/treat eye       10.09           NA           NA          8.73         9.80          0.50  090
                                         socket.
67414........  ...........  A.........  Explr/decompress        17.78           NA           NA         11.73        11.95          0.65  090
                                         eye socket.
67415........  ...........  A.........  Aspiration,              1.76           NA           NA          0.63         0.70          0.09  000
                                         orbital contents.
67420........  ...........  A.........  Explore/treat eye       21.62           NA           NA         14.36        15.94          1.15  090
                                         socket.
67430........  ...........  A.........  Explore/treat eye       14.99           NA           NA         11.92        13.55          0.86  090
                                         socket.
67440........  ...........  A.........  Explore/drain eye       14.56           NA           NA         11.94        13.15          0.70  090
                                         socket.
67445........  ...........  A.........  Explr/decompress        18.96           NA           NA         12.26        13.16          0.90  090
                                         eye socket.
67450........  ...........  A.........  Explore/biopsy          15.11           NA           NA         12.37        13.59          0.68  090
                                         eye socket.
67500........  ...........  A.........  Inject/treat eye         1.44         0.58         0.63          0.45         0.38          0.05  000
                                         socket.
67505........  ...........  A.........  Inject/treat eye         1.27         0.66         0.65          0.51         0.40          0.05  000
                                         socket.
67515........  ...........  A.........  Inject/treat eye         1.40         0.78         0.69          0.62         0.51          0.03  000
                                         socket.
67550........  ...........  A.........  Insert eye socket       11.52           NA           NA          9.88        10.63          0.72  090
                                         implant.
67560........  ...........  A.........  Revise eye socket       11.93           NA           NA          9.84        10.66          0.60  090
                                         implant.
67570........  ...........  A.........  Decompress optic        14.21           NA           NA         11.10        12.39          0.68  090
                                         nerve.
67599........  ...........  C.........  Orbit surgery            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
67700........  ...........  A.........  Drainage of              1.37         4.29         5.18          1.18         1.23          0.07  010
                                         eyelid abscess.
67710........  ...........  A.........  Incision of              1.04         3.69         4.54          1.08         1.15          0.05  010
                                         eyelid.
67715........  ...........  A.........  Incision of              1.24         3.82         4.61          1.16         1.23          0.06  010
                                         eyelid fold.
67800........  ...........  A.........  Remove eyelid            1.39         1.40         1.52          0.91         0.98          0.07  010
                                         lesion.
67801........  ...........  A.........  Remove eyelid            1.89         1.68         1.83          1.09         1.18          0.09  010
                                         lesions.
67805........  ...........  A.........  Remove eyelid            2.24         2.19         2.37          1.42         1.55          0.11  010
                                         lesions.
67808........  ...........  A.........  Remove eyelid            4.47           NA           NA          3.62         3.71          0.19  090
                                         lesion(s).
67810........  ...........  A.........  Biopsy of eyelid.        1.48         3.93         3.64          0.69         0.69          0.06  000
67820........  ...........  A.........  Revise eyelashes.        0.71         0.44         0.53          0.51         0.53          0.04  000
67825........  ...........  A.........  Revise eyelashes.        1.40         1.40         1.57          1.26         1.35          0.07  010
67830........  ...........  A.........  Revise eyelashes.        1.72         3.99         4.78          1.33         1.42          0.08  010
67835........  ...........  A.........  Revise eyelashes.        5.61           NA           NA          4.15         4.40          0.28  090
67840........  ...........  A.........  Remove eyelid            2.06         3.90         4.70          1.46         1.57          0.10  010
                                         lesion.
67850........  ...........  A.........  Treat eyelid             1.71         3.28         3.33          1.45         1.46          0.07  010
                                         lesion.
67875........  ...........  A.........  Closure of eyelid        1.35         2.38         2.85          0.84         0.89          0.07  000
                                         by suture.
67880........  ...........  A.........  Revision of              4.47         5.44         6.05          3.59         3.72          0.19  090
                                         eyelid.
67882........  ...........  A.........  Revision of              5.87         6.37         7.04          4.49         4.68          0.25  090
                                         eyelid.
67900........  ...........  A.........  Repair brow              6.69         7.38         8.25          4.64         4.97          0.38  090
                                         defect.
67901........  ...........  A.........  Repair eyelid            7.47         9.00         7.25          5.32         5.39          0.54  090
                                         defect.
67902........  ...........  A.........  Repair eyelid            9.68           NA           NA          6.39         5.97          0.60  090
                                         defect.
67903........  ...........  A.........  Repair eyelid            6.42         6.65         8.14          4.37         4.97          0.47  090
                                         defect.
67904........  ...........  A.........  Repair eyelid            7.83         8.19         8.96          5.41         5.36          0.41  090
                                         defect.
67906........  ...........  A.........  Repair eyelid            6.84           NA           NA          4.51         4.80          0.46  090
                                         defect.
67908........  ...........  A.........  Repair eyelid            5.19         5.57         6.13          4.15         4.77          0.28  090
                                         defect.
67909........  ...........  A.........  Revise eyelid            5.46         6.19         7.15          4.19         4.60          0.31  090
                                         defect.
67911........  ...........  A.........  Revise eyelid            7.38           NA           NA          5.09         4.97          0.31  090
                                         defect.
67912........  ...........  A.........  Correction eyelid        6.23        13.10        16.03          4.76         5.15          0.28  090
                                         w/implant.
67914........  ...........  A.........  Repair eyelid            3.70         4.75         5.57          2.69         2.89          0.19  090
                                         defect.
67915........  ...........  A.........  Repair eyelid            3.21         4.32         5.19          2.44         2.65          0.16  090
                                         defect.
67916........  ...........  A.........  Repair eyelid            5.37         6.38         7.25          4.17         4.49          0.28  090
                                         defect.
67917........  ...........  A.........  Repair eyelid            6.08         6.74         7.63          4.44         4.78          0.36  090
                                         defect.
67921........  ...........  A.........  Repair eyelid            3.42         4.63         5.43          2.58         2.75          0.17  090
                                         defect.
67922........  ...........  A.........  Repair eyelid            3.09         4.16         5.09          2.34         2.58          0.15  090
                                         defect.
67923........  ...........  A.........  Repair eyelid            5.94         6.46         7.33          4.36         4.69          0.30  090
                                         defect.
67924........  ...........  A.........  Repair eyelid            5.84         6.93         7.96          4.09         4.41          0.30  090
                                         defect.
67930........  ...........  A.........  Repair eyelid            3.62         4.37         5.06          1.80         2.00          0.19  010
                                         wound.
67935........  ...........  A.........  Repair eyelid            6.27         6.78         7.69          3.62         4.04          0.39  090
                                         wound.
67938........  ...........  A.........  Remove eyelid            1.35         3.81         4.62          1.22         1.25          0.06  010
                                         foreign body.
67950........  ...........  A.........  Revision of              5.88         6.67         7.68          4.40         4.83          0.36  090
                                         eyelid.
67961........  ...........  A.........  Revision of              5.75         6.83         7.79          4.33         4.71          0.33  090
                                         eyelid.
67966........  ...........  A.........  Revision of              8.83         8.08         8.65          5.79         5.71          0.37  090
                                         eyelid.
67971........  ...........  A.........  Reconstruction of        9.87           NA           NA          6.23         6.80          0.53  090
                                         eyelid.
67973........  ...........  A.........  Reconstruction of       12.96           NA           NA          7.79         8.61          0.75  090
                                         eyelid.
67974........  ...........  A.........  Reconstruction of       12.93           NA           NA          7.77         8.56          0.75  090
                                         eyelid.
67975........  ...........  A.........  Reconstruction of        9.21           NA           NA          6.00         6.52          0.50  090
                                         eyelid.
67999........  ...........  C.........  Revision of              0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         eyelid.
68020........  ...........  A.........  Incise/drain             1.39         1.24         1.33          1.06         1.14          0.06  010
                                         eyelid lining.
68040........  ...........  A.........  Treatment of             0.85         0.61         0.66          0.36         0.40          0.04  000
                                         eyelid lesions.
68100........  ...........  A.........  Biopsy of eyelid         1.35         2.36         2.81          0.87         0.92          0.07  000
                                         lining.
68110........  ...........  A.........  Remove eyelid            1.79         3.07         3.60          1.49         1.58          0.09  010
                                         lining lesion.
68115........  ...........  A.........  Remove eyelid            2.38         4.33         5.16          1.70         1.81          0.12  010
                                         lining lesion.
68130........  ...........  A.........  Remove eyelid            4.99         6.65         7.72          4.05         4.35          0.24  090
                                         lining lesion.
68135........  ...........  A.........  Remove eyelid            1.86         1.59         1.71          1.48         1.57          0.09  010
                                         lining lesion.
68200........  ...........  A.........  Treat eyelid by          0.49         0.45         0.50          0.29         0.31          0.02  000
                                         injection.

[[Page 38309]]

 
68320........  ...........  A.........  Revise/graft             6.44         9.17        10.27          5.34         5.46          0.27  090
                                         eyelid lining.
68325........  ...........  A.........  Revise/graft             8.43           NA           NA          6.15         6.36          0.44  090
                                         eyelid lining.
68326........  ...........  A.........  Revise/graft             8.22           NA           NA          5.96         6.22          0.35  090
                                         eyelid lining.
68328........  ...........  A.........  Revise/graft             9.25           NA           NA          6.42         6.91          0.54  090
                                         eyelid lining.
68330........  ...........  A.........  Revise eyelid            5.63         7.42         8.45          4.47         4.62          0.24  090
                                         lining.
68335........  ...........  A.........  Revise/graft             8.26           NA           NA          5.96         6.21          0.36  090
                                         eyelid lining.
68340........  ...........  A.........  Separate eyelid          4.84         6.88         7.91          3.89         4.02          0.21  090
                                         adhesions.
68360........  ...........  A.........  Revise eyelid            5.04         6.44         7.27          3.98         4.10          0.22  090
                                         lining.
68362........  ...........  A.........  Revise eyelid            8.41           NA           NA          6.02         6.25          0.36  090
                                         lining.
68371........  ...........  A.........  Harvest eye              4.97           NA           NA          4.08         4.43          0.44  010
                                         tissue, alograft.
68399........  ...........  C.........  Eyelid lining            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
68400........  ...........  A.........  Incise/drain tear        1.71         4.41         5.16          1.22         1.53          0.08  010
                                         gland.
68420........  ...........  A.........  Incise/drain tear        2.32         4.59         5.41          1.43         1.78          0.11  010
                                         sac.
68440........  ...........  A.........  Incise tear duct         0.96         1.25         1.67          1.19         1.24          0.05  010
                                         opening.
68500........  ...........  A.........  Removal of tear         12.49           NA           NA          9.55         9.56          0.55  090
                                         gland.
68505........  ...........  A.........  Partial removal,        12.41           NA           NA          8.97         9.85          0.55  090
                                         tear gland.
68510........  ...........  A.........  Biopsy of tear           4.60         5.23         6.30          2.06         2.09          0.23  000
                                         gland.
68520........  ...........  A.........  Removal of tear          8.58           NA           NA          6.53         7.01          0.37  090
                                         sac.
68525........  ...........  A.........  Biopsy of tear           4.42           NA           NA          1.60         1.83          0.22  000
                                         sac.
68530........  ...........  A.........  Clearance of tear        3.67         5.60         6.91          2.10         2.38          0.18  010
                                         duct.
68540........  ...........  A.........  Remove tear gland       11.93           NA           NA          8.55         9.02          0.52  090
                                         lesion.
68550........  ...........  A.........  Remove tear gland       14.86           NA           NA          9.74        10.69          0.80  090
                                         lesion.
68700........  ...........  A.........  Repair tear ducts        7.67           NA           NA          5.60         5.83          0.32  090
68705........  ...........  A.........  Revise tear duct         2.08         3.04         3.62          1.59         1.70          0.10  010
                                         opening.
68720........  ...........  A.........  Create tear sac          9.78           NA           NA          6.93         7.44          0.44  090
                                         drain.
68745........  ...........  A.........  Create tear duct         9.70           NA           NA          7.03         7.53          0.52  090
                                         drain.
68750........  ...........  A.........  Create tear duct         9.87           NA           NA          7.48         7.91          0.43  090
                                         drain.
68760........  ...........  A.........  Close tear duct          1.75         2.59         3.08          1.46         1.55          0.09  010
                                         opening.
68761........  ...........  A.........  Close tear duct          1.38         1.83         2.06          1.25         1.29          0.06  010
                                         opening.
68770........  ...........  A.........  Close tear system        8.09           NA           NA          5.79         4.51          0.35  090
                                         fistula.
68801........  ...........  A.........  Dilate tear duct         0.96         1.77         1.86          1.41         1.46          0.05  010
                                         opening.
68810........  ...........  A.........  Probe                    2.63         3.39         3.54          2.69         2.70          0.10  010
                                         nasolacrimal
                                         duct.
68811........  ...........  A.........  Probe                    2.39           NA           NA          2.13         2.28          0.13  010
                                         nasolacrimal
                                         duct.
68815........  ...........  A.........  Probe                    3.24         6.41         7.35          2.45         2.64          0.17  010
                                         nasolacrimal
                                         duct.
68840........  ...........  A.........  Explore/irrigate         1.27         1.51         1.56          1.28         1.21          0.06  010
                                         tear ducts.
68850........  ...........  A.........  Injection for            0.80         0.72         0.79          0.60         0.63          0.04  000
                                         tear sac x-ray.
68899........  ...........  C.........  Tear duct system         0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
69000........  ...........  A.........  Drain external           1.47         2.87         2.85          1.34         1.34          0.12  010
                                         ear lesion.
69005........  ...........  A.........  Drain external           2.13         2.98         2.92          1.61         1.70          0.17  010
                                         ear lesion.
69020........  ...........  A.........  Drain outer ear          1.50         4.07         4.00          1.90         1.96          0.12  010
                                         canal lesion.
69100........  ...........  A.........  Biopsy of                0.81         1.84         1.78          0.40         0.40          0.03  000
                                         external ear.
69105........  ...........  A.........  Biopsy of                0.85         2.62         2.46          0.71         0.73          0.07  000
                                         external ear
                                         canal.
69110........  ...........  A.........  Remove external          3.47         7.80         7.24          4.44         4.43          0.30  090
                                         ear, partial.
69120........  ...........  A.........  Removal of               4.08           NA           NA          5.34         5.72          0.38  090
                                         external ear.
69140........  ...........  A.........  Remove ear canal         8.03           NA           NA         13.17        13.10          0.65  090
                                         lesion(s).
69145........  ...........  A.........  Remove ear canal         2.65         6.99         6.31          3.36         3.29          0.21  090
                                         lesion(s).
69150........  ...........  A.........  Extensive ear           13.49           NA           NA         11.45        12.30          1.22  090
                                         canal surgery.
69155........  ...........  A.........  Extensive ear/          23.06           NA           NA         16.99        17.94          1.93  090
                                         neck surgery.
69200........  ...........  A.........  Clear outer ear          0.77         2.14         2.24          0.61         0.58          0.06  000
                                         canal.
69205........  ...........  A.........  Clear outer ear          1.20           NA           NA          1.24         1.29          0.10  010
                                         canal.
69210........  ...........  A.........  Remove impacted          0.61         0.58         0.60          0.17         0.20          0.05  000
                                         ear wax.
69220........  ...........  A.........  Clean out mastoid        0.83         2.55         2.43          0.68         0.69          0.07  000
                                         cavity.
69222........  ...........  A.........  Clean out mastoid        1.42         3.95         3.86          1.89         1.95          0.12  010
                                         cavity.
69300........  ...........  R.........  Revise external          6.69        10.69         7.30          5.20         4.63          0.72  YYY
                                         ear.
69310........  ...........  A.........  Rebuild outer ear       10.85           NA           NA         15.45        15.68          0.85  090
                                         canal.
69320........  ...........  A.........  Rebuild outer ear       17.03           NA           NA         20.02        20.65          1.37  090
                                         canal.
69399........  ...........  C.........  Outer ear surgery        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
69400........  ...........  A.........  Inflate middle           0.83         2.80         2.45          0.68         0.67          0.07  000
                                         ear canal.
69401........  ...........  A.........  Inflate middle           0.63         1.52         1.37          0.60         0.62          0.05  000
                                         ear canal.
69405........  ...........  A.........  Catheterize              2.65         3.65         3.54          1.97         2.12          0.21  010
                                         middle ear canal.
69420........  ...........  A.........  Incision of              1.35         3.30         3.19          1.55         1.55          0.11  010
                                         eardrum.
69421........  ...........  A.........  Incision of              1.75           NA           NA          1.85         1.98          0.15  010
                                         eardrum.
69424........  ...........  A.........  Remove                   0.85         2.32         2.23          0.68         0.67          0.07  000
                                         ventilating tube.
69433........  ...........  A.........  Create eardrum           1.54         3.30         3.16          1.59         1.60          0.13  010
                                         opening.
69436........  ...........  A.........  Create eardrum           1.98           NA           NA          1.90         2.07          0.19  010
                                         opening.
69440........  ...........  A.........  Exploration of           7.62           NA           NA          9.10         8.82          0.61  090
                                         middle ear.
69450........  ...........  A.........  Eardrum revision.        5.61           NA           NA          7.59         7.22          0.45  090
69501........  ...........  A.........  Mastoidectomy....        9.12           NA           NA          8.65         8.70          0.73  090
69502........  ...........  A.........  Mastoidectomy....       12.44           NA           NA         11.04        11.17          1.00  090
69505........  ...........  A.........  Remove mastoid          13.05           NA           NA         16.10        16.45          1.05  090
                                         structures.
69511........  ...........  A.........  Extensive mastoid       13.58           NA           NA         16.29        16.67          1.09  090
                                         surgery.
69530........  ...........  A.........  Extensive mastoid       20.24           NA           NA         19.65        20.40          1.54  090
                                         surgery.

[[Page 38310]]

 
69535........  ...........  A.........  Remove part of          37.27           NA           NA         26.82        29.01          2.93  090
                                         temporal bone.
69540........  ...........  A.........  Remove ear lesion        1.22         3.88         3.77          1.85         1.89          0.10  010
69550........  ...........  A.........  Remove ear lesion       11.04           NA           NA         14.24        14.37          0.89  090
69552........  ...........  A.........  Remove ear lesion       19.69           NA           NA         18.18        19.19          1.59  090
69554........  ...........  A.........  Remove ear lesion       35.71           NA           NA         24.04        26.97          2.92  090
69601........  ...........  A.........  Mastoid surgery         13.31           NA           NA         11.92        12.14          1.07  090
                                         revision.
69602........  ...........  A.........  Mastoid surgery         13.64           NA           NA         12.80        12.83          1.10  090
                                         revision.
69603........  ...........  A.........  Mastoid surgery         14.08           NA           NA         16.41        17.18          1.14  090
                                         revision.
69604........  ...........  A.........  Mastoid surgery         14.08           NA           NA         12.77        13.07          1.14  090
                                         revision.
69605........  ...........  A.........  Mastoid surgery         18.55           NA           NA         19.27        19.85          1.50  090
                                         revision.
69610........  ...........  A.........  Repair of eardrum        4.44         4.90         5.16          2.59         2.89          0.36  010
69620........  ...........  A.........  Repair of eardrum        5.94        10.87        10.87          5.83         5.98          0.48  090
69631........  ...........  A.........  Repair eardrum           9.93           NA           NA         11.50        11.20          0.80  090
                                         structures.
69632........  ...........  A.........  Rebuild eardrum         12.82           NA           NA         13.30        13.21          1.03  090
                                         structures.
69633........  ...........  A.........  Rebuild eardrum         12.17           NA           NA         13.07        12.89          0.98  090
                                         structures.
69635........  ...........  A.........  Repair eardrum          13.39           NA           NA         16.26        16.29          1.08  090
                                         structures.
69636........  ...........  A.........  Rebuild eardrum         15.29           NA           NA         18.16        18.50          1.23  090
                                         structures.
69637........  ...........  A.........  Rebuild eardrum         15.18           NA           NA         18.07        18.42          1.22  090
                                         structures.
69641........  ...........  A.........  Revise middle ear       12.77           NA           NA         12.47        12.46          1.03  090
                                         & mastoid.
69642........  ...........  A.........  Revise middle ear       16.91           NA           NA         15.53        15.69          1.36  090
                                         & mastoid.
69643........  ...........  A.........  Revise middle ear       15.45           NA           NA         14.16        14.29          1.24  090
                                         & mastoid.
69644........  ...........  A.........  Revise middle ear       17.09           NA           NA         18.71        19.32          1.37  090
                                         & mastoid.
69645........  ...........  A.........  Revise middle ear       16.57           NA           NA         18.57        19.06          1.33  090
                                         & mastoid.
69646........  ...........  A.........  Revise middle ear       18.23           NA           NA         19.09        19.68          1.46  090
                                         & mastoid.
69650........  ...........  A.........  Release middle           9.71           NA           NA          9.52         9.59          0.78  090
                                         ear bone.
69660........  ...........  A.........  Revise middle ear       11.94           NA           NA         10.50        10.70          0.96  090
                                         bone.
69661........  ...........  A.........  Revise middle ear       15.80           NA           NA         13.47        13.90          1.27  090
                                         bone.
69662........  ...........  A.........  Revise middle ear       15.49           NA           NA         12.52        12.96          1.25  090
                                         bone.
69666........  ...........  A.........  Repair middle ear        9.80           NA           NA          9.79         9.75          0.79  090
                                         structures.
69667........  ...........  A.........  Repair middle ear        9.81           NA           NA          9.83         9.76          0.79  090
                                         structures.
69670........  ...........  A.........  Remove mastoid          11.62           NA           NA         11.24        11.31          0.93  090
                                         air cells.
69676........  ...........  A.........  Remove middle ear        9.58           NA           NA         10.60        10.53          0.81  090
                                         nerve.
69700........  ...........  A.........  Close mastoid            8.28           NA           NA          8.67         8.80          0.67  090
                                         fistula.
69711........  ...........  A.........  Remove/repair           10.50           NA           NA         10.40        10.45          0.83  090
                                         hearing aid.
69714........  ...........  A.........  Implant temple          14.31           NA           NA         11.81        12.06          1.13  090
                                         bone w/stimul.
69715........  ...........  A.........  Temple bne implnt       18.80           NA           NA         13.36        13.99          1.48  090
                                         w/stimulat.
69717........  ...........  A.........  Temple bone             15.29           NA           NA         11.98        13.13          0.90  090
                                         implant revision.
69718........  ...........  A.........  Revise temple           19.05           NA           NA         13.44        15.53          3.22  090
                                         bone implant.
69720........  ...........  A.........  Release facial          14.57           NA           NA         14.02        14.09          1.16  090
                                         nerve.
69725........  ...........  A.........  Release facial          27.44           NA           NA         18.08        18.86          2.45  090
                                         nerve.
69740........  ...........  A.........  Repair facial           16.18           NA           NA         11.56        12.45          1.27  090
                                         nerve.
69745........  ...........  A.........  Repair facial           16.91           NA           NA          9.87        12.78          1.14  090
                                         nerve.
69799........  ...........  C.........  Middle ear               0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery
                                         procedure.
69801........  ...........  A.........  Incise inner ear.        8.61           NA           NA          9.60         9.41          0.69  090
69802........  ...........  A.........  Incise inner ear.       13.39           NA           NA         11.86        11.89          1.06  090
69805........  ...........  A.........  Explore inner ear       14.55           NA           NA         10.92        11.24          1.12  090
69806........  ...........  A.........  Explore inner ear       12.52           NA           NA         10.40        10.57          1.00  090
69820........  ...........  A.........  Establish inner         10.40           NA           NA         10.25        10.68          0.90  090
                                         ear window.
69840........  ...........  A.........  Revise inner ear        10.32           NA           NA         11.39        12.34          0.79  090
                                         window.
69905........  ...........  A.........  Remove inner ear.       11.15           NA           NA         11.03        11.05          0.90  090
69910........  ...........  A.........  Remove inner ear        13.80           NA           NA         10.90        11.25          1.07  090
                                         & mastoid.
69915........  ...........  A.........  Incise inner ear        22.65           NA           NA         14.86        15.45          1.70  090
                                         nerve.
69930........  ...........  A.........  Implant cochlear        17.60           NA           NA         13.13        13.75          1.36  090
                                         device.
69949........  ...........  C.........  Inner ear surgery        0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         procedure.
69950........  ...........  A.........  Incise inner ear        27.44           NA           NA         16.94        17.69          2.29  090
                                         nerve.
69955........  ...........  A.........  Release facial          29.22           NA           NA         19.51        20.12          2.49  090
                                         nerve.
69960........  ...........  A.........  Release inner ear       29.22           NA           NA         17.99        18.64          2.18  090
                                         canal.
69970........  ...........  A.........  Remove inner ear        32.21           NA           NA         19.60        21.18          2.42  090
                                         lesion.
69979........  ...........  C.........  Temporal bone            0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         surgery.
69990........  ...........  R.........  Microsurgery add-        3.46           NA           NA          1.29         1.54          0.89  ZZZ
                                         on.
70010........  ...........  A.........  Contrast x-ray of        1.19         2.80         3.73            NA           NA          0.27  XXX
                                         brain.
70010........  26.........  A.........  Contrast x-ray of        1.19         0.42         0.39          0.42         0.39          0.05  XXX
                                         brain.
70010........  TC.........  A.........  Contrast x-ray of        0.00         2.37         3.34            NA           NA          0.22  XXX
                                         brain.
70015........  ...........  A.........  Contrast x-ray of        1.19         2.90         2.29            NA           NA          0.16  XXX
                                         brain.
70015........  26.........  A.........  Contrast x-ray of        1.19         0.43         0.40          0.43         0.40          0.08  XXX
                                         brain.
70015........  TC.........  A.........  Contrast x-ray of        0.00         2.47         1.89            NA           NA          0.08  XXX
                                         brain.
70030........  ...........  A.........  X-ray eye for            0.17         0.60         0.54            NA           NA          0.03  XXX
                                         foreign body.
70030........  26.........  A.........  X-ray eye for            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         foreign body.
70030........  TC.........  A.........  X-ray eye for            0.00         0.54         0.48            NA           NA          0.02  XXX
                                         foreign body.
70100........  ...........  A.........  X-ray exam of jaw        0.18         0.63         0.60            NA           NA          0.03  XXX
70100........  26.........  A.........  X-ray exam of jaw        0.18         0.06         0.06          0.06         0.06          0.01  XXX
70100........  TC.........  A.........  X-ray exam of jaw        0.00         0.58         0.55            NA           NA          0.02  XXX

[[Page 38311]]

 
70110........  ...........  A.........  X-ray exam of jaw        0.25         0.80         0.75            NA           NA          0.05  XXX
70110........  26.........  A.........  X-ray exam of jaw        0.25         0.09         0.08          0.09         0.08          0.01  XXX
70110........  TC.........  A.........  X-ray exam of jaw        0.00         0.71         0.66            NA           NA          0.04  XXX
70120........  ...........  A.........  X-ray exam of            0.18         0.69         0.68            NA           NA          0.05  XXX
                                         mastoids.
70120........  26.........  A.........  X-ray exam of            0.18         0.06         0.06          0.06         0.06          0.01  XXX
                                         mastoids.
70120........  TC.........  A.........  X-ray exam of            0.00         0.63         0.62            NA           NA          0.04  XXX
                                         mastoids.
70130........  ...........  A.........  X-ray exam of            0.34         1.14         1.01            NA           NA          0.07  XXX
                                         mastoids.
70130........  26.........  A.........  X-ray exam of            0.34         0.11         0.11          0.11         0.11          0.02  XXX
                                         mastoids.
70130........  TC.........  A.........  X-ray exam of            0.00         1.03         0.90            NA           NA          0.05  XXX
                                         mastoids.
70134........  ...........  A.........  X-ray exam of            0.34         0.91         0.87            NA           NA          0.07  XXX
                                         middle ear.
70134........  26.........  A.........  X-ray exam of            0.34         0.12         0.11          0.12         0.11          0.02  XXX
                                         middle ear.
70134........  TC.........  A.........  X-ray exam of            0.00         0.79         0.76            NA           NA          0.05  XXX
                                         middle ear.
70140........  ...........  A.........  X-ray exam of            0.19         0.54         0.61            NA           NA          0.05  XXX
                                         facial bones.
70140........  26.........  A.........  X-ray exam of            0.19         0.05         0.06          0.05         0.06          0.01  XXX
                                         facial bones.
70140........  TC.........  A.........  X-ray exam of            0.00         0.49         0.55            NA           NA          0.04  XXX
                                         facial bones.
70150........  ...........  A.........  X-ray exam of            0.26         0.85         0.85            NA           NA          0.06  XXX
                                         facial bones.
70150........  26.........  A.........  X-ray exam of            0.26         0.08         0.08          0.08         0.08          0.01  XXX
                                         facial bones.
70150........  TC.........  A.........  X-ray exam of            0.00         0.76         0.77            NA           NA          0.05  XXX
                                         facial bones.
70160........  ...........  A.........  X-ray exam of            0.17         0.70         0.63            NA           NA          0.03  XXX
                                         nasal bones.
70160........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         nasal bones.
70160........  TC.........  A.........  X-ray exam of            0.00         0.64         0.57            NA           NA          0.02  XXX
                                         nasal bones.
70170........  ...........  C.........  X-ray exam of            0.30           NA           NA            NA           NA          0.07  XXX
                                         tear duct.
70170........  26.........  A.........  X-ray exam of            0.30         0.11         0.10          0.11         0.10          0.01  XXX
                                         tear duct.
70170........  TC.........  C.........  X-ray exam of            0.00           NA           NA            NA           NA          0.06  XXX
                                         tear duct.
70190........  ...........  A.........  X-ray exam of eye        0.21         0.72         0.70            NA           NA          0.05  XXX
                                         sockets.
70190........  26.........  A.........  X-ray exam of eye        0.21         0.07         0.07          0.07         0.07          0.01  XXX
                                         sockets.
70190........  TC.........  A.........  X-ray exam of eye        0.00         0.65         0.63            NA           NA          0.04  XXX
                                         sockets.
70200........  ...........  A.........  X-ray exam of eye        0.28         0.87         0.86            NA           NA          0.06  XXX
                                         sockets.
70200........  26.........  A.........  X-ray exam of eye        0.28         0.10         0.09          0.10         0.09          0.01  XXX
                                         sockets.
70200........  TC.........  A.........  X-ray exam of eye        0.00         0.78         0.77            NA           NA          0.05  XXX
                                         sockets.
70210........  ...........  A.........  X-ray exam of            0.17         0.58         0.63            NA           NA          0.05  XXX
                                         sinuses.
70210........  26.........  A.........  X-ray exam of            0.17         0.05         0.06          0.05         0.06          0.01  XXX
                                         sinuses.
70210........  TC.........  A.........  X-ray exam of            0.00         0.52         0.57            NA           NA          0.04  XXX
                                         sinuses.
70220........  ...........  A.........  X-ray exam of            0.25         0.72         0.79            NA           NA          0.06  XXX
                                         sinuses.
70220........  26.........  A.........  X-ray exam of            0.25         0.08         0.08          0.08         0.08          0.01  XXX
                                         sinuses.
70220........  TC.........  A.........  X-ray exam of            0.00         0.65         0.71            NA           NA          0.05  XXX
                                         sinuses.
70240........  ...........  A.........  X-ray exam,              0.19         0.60         0.54            NA           NA          0.03  XXX
                                         pituitary saddle.
70240........  26.........  A.........  X-ray exam,              0.19         0.06         0.06          0.06         0.06          0.01  XXX
                                         pituitary saddle.
70240........  TC.........  A.........  X-ray exam,              0.00         0.54         0.48            NA           NA          0.02  XXX
                                         pituitary saddle.
70250........  ...........  A.........  X-ray exam of            0.24         0.69         0.70            NA           NA          0.05  XXX
                                         skull.
70250........  26.........  A.........  X-ray exam of            0.24         0.07         0.08          0.07         0.08          0.01  XXX
                                         skull.
70250........  TC.........  A.........  X-ray exam of            0.00         0.62         0.62            NA           NA          0.04  XXX
                                         skull.
70260........  ...........  A.........  X-ray exam of            0.34         0.87         0.93            NA           NA          0.08  XXX
                                         skull.
70260........  26.........  A.........  X-ray exam of            0.34         0.11         0.11          0.11         0.11          0.02  XXX
                                         skull.
70260........  TC.........  A.........  X-ray exam of            0.00         0.77         0.82            NA           NA          0.06  XXX
                                         skull.
70300........  ...........  A.........  X-ray exam of            0.10         0.24         0.28            NA           NA          0.03  XXX
                                         teeth.
70300........  26.........  A.........  X-ray exam of            0.10         0.03         0.04          0.03         0.04          0.01  XXX
                                         teeth.
70300........  TC.........  A.........  X-ray exam of            0.00         0.21         0.24            NA           NA          0.02  XXX
                                         teeth.
70310........  ...........  A.........  X-ray exam of            0.16         0.81         0.66            NA           NA          0.03  XXX
                                         teeth.
70310........  26.........  A.........  X-ray exam of            0.16         0.05         0.06          0.05         0.06          0.01  XXX
                                         teeth.
70310........  TC.........  A.........  X-ray exam of            0.00         0.76         0.59            NA           NA          0.02  XXX
                                         teeth.
70320........  ...........  A.........  Full mouth x-ray         0.22         1.06         0.95            NA           NA          0.06  XXX
                                         of teeth.
70320........  26.........  A.........  Full mouth x-ray         0.22         0.07         0.08          0.07         0.08          0.01  XXX
                                         of teeth.
70320........  TC.........  A.........  Full mouth x-ray         0.00         0.99         0.87            NA           NA          0.05  XXX
                                         of teeth.
70328........  ...........  A.........  X-ray exam of jaw        0.18         0.62         0.58            NA           NA          0.03  XXX
                                         joint.
70328........  26.........  A.........  X-ray exam of jaw        0.18         0.06         0.06          0.06         0.06          0.01  XXX
                                         joint.
70328........  TC.........  A.........  X-ray exam of jaw        0.00         0.56         0.52            NA           NA          0.02  XXX
                                         joint.
70330........  ...........  A.........  X-ray exam of jaw        0.24         1.00         0.95            NA           NA          0.06  XXX
                                         joints.
70330........  26.........  A.........  X-ray exam of jaw        0.24         0.08         0.08          0.08         0.08          0.01  XXX
                                         joints.
70330........  TC.........  A.........  X-ray exam of jaw        0.00         0.92         0.87            NA           NA          0.05  XXX
                                         joints.
70332........  ...........  A.........  X-ray exam of jaw        0.54         1.45         1.87            NA           NA          0.14  XXX
                                         joint.
70332........  26.........  A.........  X-ray exam of jaw        0.54         0.17         0.18          0.17         0.18          0.02  XXX
                                         joint.
70332........  TC.........  A.........  X-ray exam of jaw        0.00         1.28         1.69            NA           NA          0.12  XXX
                                         joint.
70336........  ...........  A.........  Magnetic image,          1.48        12.06        11.80            NA           NA          0.66  XXX
                                         jaw joint.
70336........  26.........  A.........  Magnetic image,          1.48         0.51         0.48          0.51         0.48          0.07  XXX
                                         jaw joint.
70336........  TC.........  A.........  Magnetic image,          0.00        11.55        11.32            NA           NA          0.59  XXX
                                         jaw joint.
70350........  ...........  A.........  X-ray head for           0.17         0.33         0.39            NA           NA          0.03  XXX
                                         orthodontia.
70350........  26.........  A.........  X-ray head for           0.17         0.06         0.07          0.06         0.07          0.01  XXX
                                         orthodontia.
70350........  TC.........  A.........  X-ray head for           0.00         0.27         0.32            NA           NA          0.02  XXX
                                         orthodontia.
70355........  ...........  A.........  Panoramic x-ray          0.20         0.30         0.47            NA           NA          0.05  XXX
                                         of jaws.
70355........  26.........  A.........  Panoramic x-ray          0.20         0.07         0.07          0.07         0.07          0.01  XXX
                                         of jaws.
70355........  TC.........  A.........  Panoramic x-ray          0.00         0.23         0.40            NA           NA          0.04  XXX
                                         of jaws.

[[Page 38312]]

 
70360........  ...........  A.........  X-ray exam of            0.17         0.56         0.52            NA           NA          0.03  XXX
                                         neck.
70360........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         neck.
70360........  TC.........  A.........  X-ray exam of            0.00         0.50         0.46            NA           NA          0.02  XXX
                                         neck.
70370........  ...........  A.........  Throat x-ray &           0.32         1.63         1.52            NA           NA          0.08  XXX
                                         fluoroscopy.
70370........  26.........  A.........  Throat x-ray &           0.32         0.10         0.10          0.10         0.10          0.01  XXX
                                         fluoroscopy.
70370........  TC.........  A.........  Throat x-ray &           0.00         1.53         1.42            NA           NA          0.07  XXX
                                         fluoroscopy.
70371........  ...........  A.........  Speech                   0.84         1.46         1.91            NA           NA          0.16  XXX
                                         evaluation,
                                         complex.
70371........  26.........  A.........  Speech                   0.84         0.26         0.27          0.26         0.27          0.04  XXX
                                         evaluation,
                                         complex.
70371........  TC.........  A.........  Speech                   0.00         1.20         1.65            NA           NA          0.12  XXX
                                         evaluation,
                                         complex.
70373........  ...........  A.........  Contrast x-ray of        0.44         1.56         1.74            NA           NA          0.13  XXX
                                         larynx.
70373........  26.........  A.........  Contrast x-ray of        0.44         0.11         0.12          0.11         0.12          0.02  XXX
                                         larynx.
70373........  TC.........  A.........  Contrast x-ray of        0.00         1.45         1.62            NA           NA          0.11  XXX
                                         larynx.
70380........  ...........  A.........  X-ray exam of            0.17         0.82         0.77            NA           NA          0.05  XXX
                                         salivary gland.
70380........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         salivary gland.
70380........  TC.........  A.........  X-ray exam of            0.00         0.76         0.71            NA           NA          0.04  XXX
                                         salivary gland.
70390........  ...........  A.........  X-ray exam of            0.38         2.32         2.09            NA           NA          0.13  XXX
                                         salivary duct.
70390........  26.........  A.........  X-ray exam of            0.38         0.14         0.13          0.14         0.13          0.02  XXX
                                         salivary duct.
70390........  TC.........  A.........  X-ray exam of            0.00         2.18         1.97            NA           NA          0.11  XXX
                                         salivary duct.
70450........  ...........  A.........  Ct head/brain w/o        0.85         4.88         4.90            NA           NA          0.29  XXX
                                         dye.
70450........  26.........  A.........  Ct head/brain w/o        0.85         0.31         0.28          0.31         0.28          0.04  XXX
                                         dye.
70450........  TC.........  A.........  Ct head/brain w/o        0.00         4.57         4.62            NA           NA          0.25  XXX
                                         dye.
70460........  ...........  A.........  Ct head/brain w/         1.13         6.46         6.19            NA           NA          0.35  XXX
                                         dye.
70460........  26.........  A.........  Ct head/brain w/         1.13         0.41         0.38          0.41         0.38          0.05  XXX
                                         dye.
70460........  TC.........  A.........  Ct head/brain w/         0.00         6.05         5.82            NA           NA          0.30  XXX
                                         dye.
70470........  ...........  A.........  Ct head/brain w/o        1.27         7.86         7.61            NA           NA          0.43  XXX
                                         & w/dye.
70470........  26.........  A.........  Ct head/brain w/o        1.27         0.45         0.42          0.45         0.42          0.06  XXX
                                         & w/dye.
70470........  TC.........  A.........  Ct head/brain w/o        0.00         7.41         7.19            NA           NA          0.37  XXX
                                         & w/dye.
70480........  ...........  A.........  Ct orbit/ear/            1.28         8.41         6.71            NA           NA          0.31  XXX
                                         fossa w/o dye.
70480........  26.........  A.........  Ct orbit/ear/            1.28         0.45         0.42          0.45         0.42          0.06  XXX
                                         fossa w/o dye.
70480........  TC.........  A.........  Ct orbit/ear/            0.00         7.96         6.29            NA           NA          0.25  XXX
                                         fossa w/o dye.
70481........  ...........  A.........  Ct orbit/ear/            1.38         9.88         7.93            NA           NA          0.36  XXX
                                         fossa w/dye.
70481........  26.........  A.........  Ct orbit/ear/            1.38         0.49         0.46          0.49         0.46          0.06  XXX
                                         fossa w/dye.
70481........  TC.........  A.........  Ct orbit/ear/            0.00         9.39         7.47            NA           NA          0.30  XXX
                                         fossa w/dye.
70482........  ...........  A.........  Ct orbit/ear/            1.45        11.30         9.34            NA           NA          0.43  XXX
                                         fossa w/o&w/dye.
70482........  26.........  A.........  Ct orbit/ear/            1.45         0.51         0.48          0.51         0.48          0.06  XXX
                                         fossa w/o&w/dye.
70482........  TC.........  A.........  Ct orbit/ear/            0.00        10.79         8.86            NA           NA          0.37  XXX
                                         fossa w/o&w/dye.
70486........  ...........  A.........  Ct maxillofacial         1.14         6.74         5.86            NA           NA          0.30  XXX
                                         w/o dye.
70486........  26.........  A.........  Ct maxillofacial         1.14         0.40         0.37          0.40         0.37          0.05  XXX
                                         w/o dye.
70486........  TC.........  A.........  Ct maxillofacial         0.00         6.33         5.48            NA           NA          0.25  XXX
                                         w/o dye.
70487........  ...........  A.........  Ct maxillofacial         1.30         8.28         7.13            NA           NA          0.36  XXX
                                         w/dye.
70487........  26.........  A.........  Ct maxillofacial         1.30         0.47         0.44          0.47         0.44          0.06  XXX
                                         w/dye.
70487........  TC.........  A.........  Ct maxillofacial         0.00         7.81         6.69            NA           NA          0.30  XXX
                                         w/dye.
70488........  ...........  A.........  Ct maxillofacial         1.42        10.31         8.84            NA           NA          0.43  XXX
                                         w/o & w/dye.
70488........  26.........  A.........  Ct maxillofacial         1.42         0.50         0.47          0.50         0.47          0.06  XXX
                                         w/o & w/dye.
70488........  TC.........  A.........  Ct maxillofacial         0.00         9.81         8.38            NA           NA          0.37  XXX
                                         w/o & w/dye.
70490........  ...........  A.........  Ct soft tissue           1.28         6.44         5.74            NA           NA          0.31  XXX
                                         neck w/o dye.
70490........  26.........  A.........  Ct soft tissue           1.28         0.46         0.43          0.46         0.43          0.06  XXX
                                         neck w/o dye.
70490........  TC.........  A.........  Ct soft tissue           0.00         5.98         5.31            NA           NA          0.25  XXX
                                         neck w/o dye.
70491........  ...........  A.........  Ct soft tissue           1.38         7.97         6.98            NA           NA          0.36  XXX
                                         neck w/dye.
70491........  26.........  A.........  Ct soft tissue           1.38         0.50         0.46          0.50         0.46          0.06  XXX
                                         neck w/dye.
70491........  TC.........  A.........  Ct soft tissue           0.00         7.48         6.52            NA           NA          0.30  XXX
                                         neck w/dye.
70492........  ...........  A.........  Ct sft tsue nck w/       1.45         9.94         8.67            NA           NA          0.43  XXX
                                         o & w/dye.
70492........  26.........  A.........  Ct sft tsue nck w/       1.45         0.51         0.48          0.51         0.48          0.06  XXX
                                         o & w/dye.
70492........  TC.........  A.........  Ct sft tsue nck w/       0.00         9.43         8.20            NA           NA          0.37  XXX
                                         o & w/dye.
70496........  ...........  A.........  Ct angiography,          1.75        16.92        13.93            NA           NA          0.66  XXX
                                         head.
70496........  26.........  A.........  Ct angiography,          1.75         0.64         0.59          0.64         0.59          0.08  XXX
                                         head.
70496........  TC.........  A.........  Ct angiography,          0.00        16.28        13.34            NA           NA          0.58  XXX
                                         head.
70498........  ...........  A.........  Ct angiography,          1.75        17.03        13.98            NA           NA          0.66  XXX
                                         neck.
70498........  26.........  A.........  Ct angiography,          1.75         0.65         0.59          0.65         0.59          0.08  XXX
                                         neck.
70498........  TC.........  A.........  Ct angiography,          0.00        16.38        13.39            NA           NA          0.58  XXX
                                         neck.
70540........  ...........  A.........  Mri orbit/face/          1.35        14.05        12.76            NA           NA          0.45  XXX
                                         neck w/o dye.
70540........  26.........  A.........  Mri orbit/face/          1.35         0.47         0.44          0.47         0.44          0.06  XXX
                                         neck w/o dye.
70540........  TC.........  A.........  Mri orbit/face/          0.00        13.58        12.31            NA           NA          0.39  XXX
                                         neck w/o dye.
70542........  ...........  A.........  Mri orbit/face/          1.62        15.16        14.45            NA           NA          0.54  XXX
                                         neck w/dye.
70542........  26.........  A.........  Mri orbit/face/          1.62         0.57         0.53          0.57         0.53          0.07  XXX
                                         neck w/dye.
70542........  TC.........  A.........  Mri orbit/face/          0.00        14.59        13.92            NA           NA          0.47  XXX
                                         neck w/dye.
70543........  ...........  A.........  Mri orbt/fac/nck         2.15        18.60        21.97            NA           NA          0.94  XXX
                                         w/o & w/dye.
70543........  26.........  A.........  Mri orbt/fac/nck         2.15         0.75         0.71          0.75         0.71          0.10  XXX
                                         w/o & w/dye.
70543........  TC.........  A.........  Mri orbt/fac/nck         0.00        17.85        21.26            NA           NA          0.84  XXX
                                         w/o & w/dye.
70544........  ...........  A.........  Mr angiography           1.20        15.70        13.54            NA           NA          0.64  XXX
                                         head w/o dye.
70544........  26.........  A.........  Mr angiography           1.20         0.42         0.40          0.42         0.40          0.05  XXX
                                         head w/o dye.
70544........  TC.........  A.........  Mr angiography           0.00        15.28        13.14            NA           NA          0.59  XXX
                                         head w/o dye.

[[Page 38313]]

 
70545........  ...........  A.........  Mr angiography           1.20        15.58        13.49            NA           NA          0.64  XXX
                                         head w/dye.
70545........  26.........  A.........  Mr angiography           1.20         0.42         0.39          0.42         0.39          0.05  XXX
                                         head w/dye.
70545........  TC.........  A.........  Mr angiography           0.00        15.15        13.09            NA           NA          0.59  XXX
                                         head w/dye.
70546........  ...........  A.........  Mr angiograph            1.80        23.80        23.25            NA           NA          0.67  XXX
                                         head w/o&w/dye.
70546........  26.........  A.........  Mr angiograph            1.80         0.63         0.59          0.63         0.59          0.08  XXX
                                         head w/o&w/dye.
70546........  TC.........  A.........  Mr angiograph            0.00        23.17        22.66            NA           NA          0.59  XXX
                                         head w/o&w/dye.
70547........  ...........  A.........  Mr angiography           1.20        15.64        13.51            NA           NA          0.64  XXX
                                         neck w/o dye.
70547........  26.........  A.........  Mr angiography           1.20         0.42         0.39          0.42         0.39          0.05  XXX
                                         neck w/o dye.
70547........  TC.........  A.........  Mr angiography           0.00        15.22        13.12            NA           NA          0.59  XXX
                                         neck w/o dye.
70548........  ...........  A.........  Mr angiography           1.20        16.49        13.93            NA           NA          0.64  XXX
                                         neck w/dye.
70548........  26.........  A.........  Mr angiography           1.20         0.43         0.40          0.43         0.40          0.05  XXX
                                         neck w/dye.
70548........  TC.........  A.........  Mr angiography           0.00        16.06        13.53            NA           NA          0.59  XXX
                                         neck w/dye.
70549........  ...........  A.........  Mr angiograph            1.80        23.81        23.24            NA           NA          0.67  XXX
                                         neck w/o&w/dye.
70549........  26.........  A.........  Mr angiograph            1.80         0.64         0.59          0.64         0.59          0.08  XXX
                                         neck w/o&w/dye.
70549........  TC.........  A.........  Mr angiograph            0.00        23.18        22.65            NA           NA          0.59  XXX
                                         neck w/o&w/dye.
70551........  ...........  A.........  Mri brain w/o dye        1.48        14.30        12.90            NA           NA          0.66  XXX
70551........  26.........  A.........  Mri brain w/o dye        1.48         0.52         0.49          0.52         0.49          0.07  XXX
70551........  TC.........  A.........  Mri brain w/o dye        0.00        13.79        12.42            NA           NA          0.59  XXX
70552........  ...........  A.........  Mri brain w/dye..        1.78        15.45        14.63            NA           NA          0.78  XXX
70552........  26.........  A.........  Mri brain w/dye..        1.78         0.63         0.59          0.63         0.59          0.08  XXX
70552........  TC.........  A.........  Mri brain w/dye..        0.00        14.82        14.04            NA           NA          0.70  XXX
70553........  ...........  A.........  Mri brain w/o & w/       2.36        17.92        21.66            NA           NA          1.41  XXX
                                         dye.
70553........  26.........  A.........  Mri brain w/o & w/       2.36         0.83         0.78          0.83         0.78          0.10  XXX
                                         dye.
70553........  TC.........  A.........  Mri brain w/o & w/       0.00        17.09        20.88            NA           NA          1.31  XXX
                                         dye.
70554........  ...........  A.........  Fmri brain by            2.11        15.22        14.07            NA           NA          0.92  XXX
                                         tech.
70554........  26.........  A.........  Fmri brain by            2.11         0.70         0.63          0.70         0.63          0.10  XXX
                                         tech.
70554........  TC.........  A.........  Fmri brain by            0.00        14.53        13.44            NA           NA          0.82  XXX
                                         tech.
70555........  ...........  C.........  Fmri brain by            0.00           NA           NA            NA           NA          0.11  XXX
                                         phys/psych.
70555........  26.........  A.........  Fmri brain by            2.54         0.89         0.78          0.89         0.78          0.11  XXX
                                         phys/psych.
70555........  TC.........  C.........  Fmri brain by            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         phys/psych.
70557........  ...........  C.........  Mri brain w/o dye        2.90         0.00         0.71          0.00         0.71          0.08  XXX
70557........  26.........  A.........  Mri brain w/o dye        2.90         1.05         1.06          1.05         1.06          0.08  XXX
70557........  TC.........  C.........  Mri brain w/o dye        0.00         0.00         0.00          0.00         0.00          0.00  XXX
70558........  ...........  C.........  Mri brain w/dye..        3.20         0.00         0.79          0.00         0.79          0.10  XXX
70558........  26.........  A.........  Mri brain w/dye..        3.20         1.11         1.16          1.11         1.16          0.10  XXX
70558........  TC.........  C.........  Mri brain w/dye..        0.00         0.00         0.00          0.00         0.00          0.00  XXX
70559........  ...........  C.........  Mri brain w/o & w/       3.20         0.00         0.78          0.00         0.78          0.12  XXX
                                         dye.
70559........  26.........  A.........  Mri brain w/o & w/       3.20         1.15         1.16          1.15         1.16          0.12  XXX
                                         dye.
70559........  TC.........  C.........  Mri brain w/o & w/       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         dye.
71010........  ...........  A.........  Chest x-ray......        0.18         0.43         0.48            NA           NA          0.03  XXX
71010........  26.........  A.........  Chest x-ray......        0.18         0.06         0.06          0.06         0.06          0.01  XXX
71010........  TC.........  A.........  Chest x-ray......        0.00         0.37         0.42            NA           NA          0.02  XXX
71015........  ...........  A.........  Chest x-ray......        0.21         0.57         0.58            NA           NA          0.03  XXX
71015........  26.........  A.........  Chest x-ray......        0.21         0.07         0.07          0.07         0.07          0.01  XXX
71015........  TC.........  A.........  Chest x-ray......        0.00         0.50         0.51            NA           NA          0.02  XXX
71020........  ...........  A.........  Chest x-ray......        0.22         0.57         0.63            NA           NA          0.05  XXX
71020........  26.........  A.........  Chest x-ray......        0.22         0.07         0.07          0.07         0.07          0.01  XXX
71020........  TC.........  A.........  Chest x-ray......        0.00         0.50         0.56            NA           NA          0.04  XXX
71021........  ...........  A.........  Chest x-ray......        0.27         0.70         0.76            NA           NA          0.06  XXX
71021........  26.........  A.........  Chest x-ray......        0.27         0.09         0.09          0.09         0.09          0.01  XXX
71021........  TC.........  A.........  Chest x-ray......        0.00         0.62         0.67            NA           NA          0.05  XXX
71022........  ...........  A.........  Chest x-ray......        0.31         0.89         0.86            NA           NA          0.06  XXX
71022........  26.........  A.........  Chest x-ray......        0.31         0.10         0.10          0.10         0.10          0.01  XXX
71022........  TC.........  A.........  Chest x-ray......        0.00         0.79         0.76            NA           NA          0.05  XXX
71023........  ...........  A.........  Chest x-ray and          0.38         1.52         1.21            NA           NA          0.06  XXX
                                         fluoroscopy.
71023........  26.........  A.........  Chest x-ray and          0.38         0.14         0.13          0.14         0.13          0.01  XXX
                                         fluoroscopy.
71023........  TC.........  A.........  Chest x-ray and          0.00         1.37         1.08            NA           NA          0.05  XXX
                                         fluoroscopy.
71030........  ...........  A.........  Chest x-ray......        0.31         0.92         0.89            NA           NA          0.06  XXX
71030........  26.........  A.........  Chest x-ray......        0.31         0.10         0.10          0.10         0.10          0.01  XXX
71030........  TC.........  A.........  Chest x-ray......        0.00         0.81         0.79            NA           NA          0.05  XXX
71034........  ...........  A.........  Chest x-ray and          0.46         2.07         1.82            NA           NA          0.10  XXX
                                         fluoroscopy.
71034........  26.........  A.........  Chest x-ray and          0.46         0.20         0.17          0.20         0.17          0.02  XXX
                                         fluoroscopy.
71034........  TC.........  A.........  Chest x-ray and          0.00         1.86         1.64            NA           NA          0.08  XXX
                                         fluoroscopy.
71035........  ...........  A.........  Chest x-ray......        0.18         0.78         0.67            NA           NA          0.03  XXX
71035........  26.........  A.........  Chest x-ray......        0.18         0.07         0.06          0.07         0.06          0.01  XXX
71035........  TC.........  A.........  Chest x-ray......        0.00         0.71         0.61            NA           NA          0.02  XXX
71040........  ...........  A.........  Contrast x-ray of        0.58         2.04         1.84            NA           NA          0.11  XXX
                                         bronchi.
71040........  26.........  A.........  Contrast x-ray of        0.58         0.18         0.18          0.18         0.18          0.03  XXX
                                         bronchi.
71040........  TC.........  A.........  Contrast x-ray of        0.00         1.86         1.66            NA           NA          0.08  XXX
                                         bronchi.
71060........  ...........  A.........  Contrast x-ray of        0.74         3.07         2.73            NA           NA          0.16  XXX
                                         bronchi.
71060........  26.........  A.........  Contrast x-ray of        0.74         0.26         0.24          0.26         0.24          0.03  XXX
                                         bronchi.
71060........  TC.........  A.........  Contrast x-ray of        0.00         2.81         2.49            NA           NA          0.13  XXX
                                         bronchi.

[[Page 38314]]

 
71090........  ...........  C.........  X-ray & pacemaker        0.54           NA           NA            NA           NA          0.13  XXX
                                         insertion.
71090........  26.........  A.........  X-ray & pacemaker        0.54         0.27         0.24          0.27         0.24          0.02  XXX
                                         insertion.
71090........  TC.........  C.........  X-ray & pacemaker        0.00           NA           NA            NA           NA          0.11  XXX
                                         insertion.
71100........  ...........  A.........  X-ray exam of            0.22         0.61         0.62            NA           NA          0.05  XXX
                                         ribs.
71100........  26.........  A.........  X-ray exam of            0.22         0.07         0.07          0.07         0.07          0.01  XXX
                                         ribs.
71100........  TC.........  A.........  X-ray exam of            0.00         0.54         0.55            NA           NA          0.04  XXX
                                         ribs.
71101........  ...........  A.........  X-ray exam of            0.27         0.76         0.75            NA           NA          0.05  XXX
                                         ribs/chest.
71101........  26.........  A.........  X-ray exam of            0.27         0.09         0.09          0.09         0.09          0.01  XXX
                                         ribs/chest.
71101........  TC.........  A.........  X-ray exam of            0.00         0.67         0.66            NA           NA          0.04  XXX
                                         ribs/chest.
71110........  ...........  A.........  X-ray exam of            0.27         0.77         0.82            NA           NA          0.06  XXX
                                         ribs.
71110........  26.........  A.........  X-ray exam of            0.27         0.08         0.09          0.08         0.09          0.01  XXX
                                         ribs.
71110........  TC.........  A.........  X-ray exam of            0.00         0.68         0.73            NA           NA          0.05  XXX
                                         ribs.
71111........  ...........  A.........  X-ray exam of            0.32         1.05         1.02            NA           NA          0.07  XXX
                                         ribs/chest.
71111........  26.........  A.........  X-ray exam of            0.32         0.10         0.10          0.10         0.10          0.01  XXX
                                         ribs/chest.
71111........  TC.........  A.........  X-ray exam of            0.00         0.95         0.92            NA           NA          0.06  XXX
                                         ribs/chest.
71120........  ...........  A.........  X-ray exam of            0.20         0.63         0.67            NA           NA          0.05  XXX
                                         breastbone.
71120........  26.........  A.........  X-ray exam of            0.20         0.07         0.07          0.07         0.07          0.01  XXX
                                         breastbone.
71120........  TC.........  A.........  X-ray exam of            0.00         0.56         0.60            NA           NA          0.04  XXX
                                         breastbone.
71130........  ...........  A.........  X-ray exam of            0.22         0.75         0.76            NA           NA          0.05  XXX
                                         breastbone.
71130........  26.........  A.........  X-ray exam of            0.22         0.08         0.07          0.08         0.07          0.01  XXX
                                         breastbone.
71130........  TC.........  A.........  X-ray exam of            0.00         0.67         0.69            NA           NA          0.04  XXX
                                         breastbone.
71250........  ...........  A.........  Ct thorax w/o dye        1.16         6.39         6.29            NA           NA          0.36  XXX
71250........  26.........  A.........  Ct thorax w/o dye        1.16         0.41         0.38          0.41         0.38          0.05  XXX
71250........  TC.........  A.........  Ct thorax w/o dye        0.00         5.98         5.91            NA           NA          0.31  XXX
71260........  ...........  A.........  Ct thorax w/dye..        1.24         7.93         7.64            NA           NA          0.42  XXX
71260........  26.........  A.........  Ct thorax w/dye..        1.24         0.44         0.41          0.44         0.41          0.05  XXX
71260........  TC.........  A.........  Ct thorax w/dye..        0.00         7.48         7.23            NA           NA          0.37  XXX
71270........  ...........  A.........  Ct thorax w/o & w/       1.38         9.95         9.56            NA           NA          0.52  XXX
                                         dye.
71270........  26.........  A.........  Ct thorax w/o & w/       1.38         0.49         0.46          0.49         0.46          0.06  XXX
                                         dye.
71270........  TC.........  A.........  Ct thorax w/o & w/       0.00         9.47         9.10            NA           NA          0.46  XXX
                                         dye.
71275........  ...........  A.........  Ct angiography,          1.92        11.65        12.24            NA           NA          0.48  XXX
                                         chest.
71275........  26.........  A.........  Ct angiography,          1.92         0.70         0.64          0.70         0.64          0.09  XXX
                                         chest.
71275........  TC.........  A.........  Ct angiography,          0.00        10.95        11.60            NA           NA          0.39  XXX
                                         chest.
71550........  ...........  A.........  Mri chest w/o dye        1.46        16.21        13.84            NA           NA          0.51  XXX
71550........  26.........  A.........  Mri chest w/o dye        1.46         0.51         0.48          0.51         0.48          0.06  XXX
71550........  TC.........  A.........  Mri chest w/o dye        0.00        15.70        13.36            NA           NA          0.45  XXX
71551........  ...........  A.........  Mri chest w/dye..        1.73        17.75        15.76            NA           NA          0.60  XXX
71551........  26.........  A.........  Mri chest w/dye..        1.73         0.61         0.57          0.61         0.57          0.08  XXX
71551........  TC.........  A.........  Mri chest w/dye..        0.00        17.15        15.19            NA           NA          0.52  XXX
71552........  ...........  A.........  Mri chest w/o & w/       2.26        22.34        23.82            NA           NA          0.78  XXX
                                         dye.
71552........  26.........  A.........  Mri chest w/o & w/       2.26         0.81         0.75          0.81         0.75          0.10  XXX
                                         dye.
71552........  TC.........  A.........  Mri chest w/o & w/       0.00        21.52        23.07            NA           NA          0.68  XXX
                                         dye.
71555........  ...........  R.........  Mri angio chest w        1.81        15.13        13.39            NA           NA          0.67  XXX
                                         or w/o dye.
71555........  26.........  R.........  Mri angio chest w        1.81         0.66         0.61          0.66         0.61          0.08  XXX
                                         or w/o dye.
71555........  TC.........  R.........  Mri angio chest w        0.00        14.47        12.78            NA           NA          0.59  XXX
                                         or w/o dye.
72010........  ...........  A.........  X-ray exam of            0.45         1.42         1.29            NA           NA          0.08  XXX
                                         spine.
72010........  26.........  A.........  X-ray exam of            0.45         0.13         0.14          0.13         0.14          0.02  XXX
                                         spine.
72010........  TC.........  A.........  X-ray exam of            0.00         1.29         1.16            NA           NA          0.06  XXX
                                         spine.
72020........  ...........  A.........  X-ray exam of            0.15         0.47         0.46            NA           NA          0.03  XXX
                                         spine.
72020........  26.........  A.........  X-ray exam of            0.15         0.05         0.05          0.05         0.05          0.01  XXX
                                         spine.
72020........  TC.........  A.........  X-ray exam of            0.00         0.41         0.41            NA           NA          0.02  XXX
                                         spine.
72040........  ...........  A.........  X-ray exam of            0.22         0.76         0.71            NA           NA          0.05  XXX
                                         neck spine.
72040........  26.........  A.........  X-ray exam of            0.22         0.07         0.07          0.07         0.07          0.01  XXX
                                         neck spine.
72040........  TC.........  A.........  X-ray exam of            0.00         0.69         0.64            NA           NA          0.04  XXX
                                         neck spine.
72050........  ...........  A.........  X-ray exam of            0.31         1.07         1.02            NA           NA          0.07  XXX
                                         neck spine.
72050........  26.........  A.........  X-ray exam of            0.31         0.11         0.10          0.11         0.10          0.01  XXX
                                         neck spine.
72050........  TC.........  A.........  X-ray exam of            0.00         0.96         0.92            NA           NA          0.06  XXX
                                         neck spine.
72052........  ...........  A.........  X-ray exam of            0.36         1.38         1.31            NA           NA          0.08  XXX
                                         neck spine.
72052........  26.........  A.........  X-ray exam of            0.36         0.12         0.12          0.12         0.12          0.02  XXX
                                         neck spine.
72052........  TC.........  A.........  X-ray exam of            0.00         1.26         1.19            NA           NA          0.06  XXX
                                         neck spine.
72069........  ...........  A.........  X-ray exam of            0.22         0.75         0.66            NA           NA          0.03  XXX
                                         trunk spine.
72069........  26.........  A.........  X-ray exam of            0.22         0.08         0.08          0.08         0.08          0.01  XXX
                                         trunk spine.
72069........  TC.........  A.........  X-ray exam of            0.00         0.67         0.58            NA           NA          0.02  XXX
                                         trunk spine.
72070........  ...........  A.........  X-ray exam of            0.22         0.63         0.67            NA           NA          0.05  XXX
                                         thoracic spine.
72070........  26.........  A.........  X-ray exam of            0.22         0.07         0.07          0.07         0.07          0.01  XXX
                                         thoracic spine.
72070........  TC.........  A.........  X-ray exam of            0.00         0.56         0.60            NA           NA          0.04  XXX
                                         thoracic spine.
72072........  ...........  A.........  X-ray exam of            0.22         0.77         0.78            NA           NA          0.06  XXX
                                         thoracic spine.
72072........  26.........  A.........  X-ray exam of            0.22         0.08         0.07          0.08         0.07          0.01  XXX
                                         thoracic spine.
72072........  TC.........  A.........  X-ray exam of            0.00         0.69         0.70            NA           NA          0.05  XXX
                                         thoracic spine.
72074........  ...........  A.........  X-ray exam of            0.22         0.94         0.95            NA           NA          0.07  XXX
                                         thoracic spine.
72074........  26.........  A.........  X-ray exam of            0.22         0.07         0.07          0.07         0.07          0.01  XXX
                                         thoracic spine.
72074........  TC.........  A.........  X-ray exam of            0.00         0.87         0.88            NA           NA          0.06  XXX
                                         thoracic spine.

[[Page 38315]]

 
72080........  ...........  A.........  X-ray exam of            0.22         0.69         0.71            NA           NA          0.05  XXX
                                         trunk spine.
72080........  26.........  A.........  X-ray exam of            0.22         0.08         0.07          0.08         0.07          0.01  XXX
                                         trunk spine.
72080........  TC.........  A.........  X-ray exam of            0.00         0.61         0.64            NA           NA          0.04  XXX
                                         trunk spine.
72090........  ...........  A.........  X-ray exam of            0.28         1.00         0.87            NA           NA          0.05  XXX
                                         trunk spine.
72090........  26.........  A.........  X-ray exam of            0.28         0.10         0.09          0.10         0.09          0.01  XXX
                                         trunk spine.
72090........  TC.........  A.........  X-ray exam of            0.00         0.89         0.78            NA           NA          0.04  XXX
                                         trunk spine.
72100........  ...........  A.........  X-ray exam of            0.22         0.80         0.77            NA           NA          0.05  XXX
                                         lower spine.
72100........  26.........  A.........  X-ray exam of            0.22         0.07         0.07          0.07         0.07          0.01  XXX
                                         lower spine.
72100........  TC.........  A.........  X-ray exam of            0.00         0.73         0.70            NA           NA          0.04  XXX
                                         lower spine.
72110........  ...........  A.........  X-ray exam of            0.31         1.13         1.06            NA           NA          0.07  XXX
                                         lower spine.
72110........  26.........  A.........  X-ray exam of            0.31         0.11         0.10          0.11         0.10          0.01  XXX
                                         lower spine.
72110........  TC.........  A.........  X-ray exam of            0.00         1.03         0.96            NA           NA          0.06  XXX
                                         lower spine.
72114........  ...........  A.........  X-ray exam of            0.36         1.55         1.42            NA           NA          0.08  XXX
                                         lower spine.
72114........  26.........  A.........  X-ray exam of            0.36         0.13         0.12          0.13         0.12          0.02  XXX
                                         lower spine.
72114........  TC.........  A.........  X-ray exam of            0.00         1.42         1.30            NA           NA          0.06  XXX
                                         lower spine.
72120........  ...........  A.........  X-ray exam of            0.22         1.06         1.01            NA           NA          0.07  XXX
                                         lower spine.
72120........  26.........  A.........  X-ray exam of            0.22         0.08         0.07          0.08         0.07          0.01  XXX
                                         lower spine.
72120........  TC.........  A.........  X-ray exam of            0.00         0.99         0.94            NA           NA          0.06  XXX
                                         lower spine.
72125........  ...........  A.........  Ct neck spine w/o        1.16         6.41         6.30            NA           NA          0.36  XXX
                                         dye.
72125........  26.........  A.........  Ct neck spine w/o        1.16         0.41         0.38          0.41         0.38          0.05  XXX
                                         dye.
72125........  TC.........  A.........  Ct neck spine w/o        0.00         6.00         5.91            NA           NA          0.31  XXX
                                         dye.
72126........  ...........  A.........  Ct neck spine w/         1.22         7.93         7.64            NA           NA          0.42  XXX
                                         dye.
72126........  26.........  A.........  Ct neck spine w/         1.22         0.44         0.41          0.44         0.41          0.05  XXX
                                         dye.
72126........  TC.........  A.........  Ct neck spine w/         0.00         7.49         7.23            NA           NA          0.37  XXX
                                         dye.
72127........  ...........  A.........  Ct neck spine w/o        1.27         9.95         9.52            NA           NA          0.52  XXX
                                         & w/dye.
72127........  26.........  A.........  Ct neck spine w/o        1.27         0.44         0.42          0.44         0.42          0.06  XXX
                                         & w/dye.
72127........  TC.........  A.........  Ct neck spine w/o        0.00         9.51         9.10            NA           NA          0.46  XXX
                                         & w/dye.
72128........  ...........  A.........  Ct chest spine w/        1.16         6.40         6.29            NA           NA          0.36  XXX
                                         o dye.
72128........  26.........  A.........  Ct chest spine w/        1.16         0.41         0.38          0.41         0.38          0.05  XXX
                                         o dye.
72128........  TC.........  A.........  Ct chest spine w/        0.00         5.98         5.91            NA           NA          0.31  XXX
                                         o dye.
72129........  ...........  A.........  Ct chest spine w/        1.22         7.94         7.64            NA           NA          0.42  XXX
                                         dye.
72129........  26.........  A.........  Ct chest spine w/        1.22         0.44         0.41          0.44         0.41          0.05  XXX
                                         dye.
72129........  TC.........  A.........  Ct chest spine w/        0.00         7.50         7.23            NA           NA          0.37  XXX
                                         dye.
72130........  ...........  A.........  Ct chest spine w/        1.27         9.89         9.49            NA           NA          0.52  XXX
                                         o & w/dye.
72130........  26.........  A.........  Ct chest spine w/        1.27         0.45         0.42          0.45         0.42          0.06  XXX
                                         o & w/dye.
72130........  TC.........  A.........  Ct chest spine w/        0.00         9.44         9.07            NA           NA          0.46  XXX
                                         o & w/dye.
72131........  ...........  A.........  Ct lumbar spine w/       1.16         6.38         6.29            NA           NA          0.36  XXX
                                         o dye.
72131........  26.........  A.........  Ct lumbar spine w/       1.16         0.41         0.38          0.41         0.38          0.05  XXX
                                         o dye.
72131........  TC.........  A.........  Ct lumbar spine w/       0.00         5.97         5.90            NA           NA          0.31  XXX
                                         o dye.
72132........  ...........  A.........  Ct lumbar spine w/       1.22         7.91         7.63            NA           NA          0.42  XXX
                                         dye.
72132........  26.........  A.........  Ct lumbar spine w/       1.22         0.44         0.41          0.44         0.41          0.05  XXX
                                         dye.
72132........  TC.........  A.........  Ct lumbar spine w/       0.00         7.47         7.22            NA           NA          0.37  XXX
                                         dye.
72133........  ...........  A.........  Ct lumbar spine w/       1.27         9.93         9.54            NA           NA          0.52  XXX
                                         o & w/dye.
72133........  26.........  A.........  Ct lumbar spine w/       1.27         0.45         0.42          0.45         0.42          0.06  XXX
                                         o & w/dye.
72133........  TC.........  A.........  Ct lumbar spine w/       0.00         9.48         9.11            NA           NA          0.46  XXX
                                         o & w/dye.
72141........  ...........  A.........  Mri neck spine w/        1.60        12.35        11.96            NA           NA          0.66  XXX
                                         o dye.
72141........  26.........  A.........  Mri neck spine w/        1.60         0.56         0.53          0.56         0.53          0.07  XXX
                                         o dye.
72141........  TC.........  A.........  Mri neck spine w/        0.00        11.79        11.43            NA           NA          0.59  XXX
                                         o dye.
72142........  ...........  A.........  Mri neck spine w/        1.92        15.48        14.67            NA           NA          0.79  XXX
                                         dye.
72142........  26.........  A.........  Mri neck spine w/        1.92         0.67         0.64          0.67         0.64          0.09  XXX
                                         dye.
72142........  TC.........  A.........  Mri neck spine w/        0.00        14.81        14.03            NA           NA          0.70  XXX
                                         dye.
72146........  ...........  A.........  Mri chest spine w/       1.60        12.37        12.58            NA           NA          0.71  XXX
                                         o dye.
72146........  26.........  A.........  Mri chest spine w/       1.60         0.56         0.53          0.56         0.53          0.07  XXX
                                         o dye.
72146........  TC.........  A.........  Mri chest spine w/       0.00        11.81        12.06            NA           NA          0.64  XXX
                                         o dye.
72147........  ...........  A.........  Mri chest spine w/       1.92        13.46        13.66            NA           NA          0.79  XXX
                                         dye.
72147........  26.........  A.........  Mri chest spine w/       1.92         0.68         0.63          0.68         0.63          0.09  XXX
                                         dye.
72147........  TC.........  A.........  Mri chest spine w/       0.00        12.78        13.03            NA           NA          0.70  XXX
                                         dye.
72148........  ...........  A.........  Mri lumbar spine         1.48        12.30        12.54            NA           NA          0.71  XXX
                                         w/o dye.
72148........  26.........  A.........  Mri lumbar spine         1.48         0.51         0.49          0.51         0.49          0.07  XXX
                                         w/o dye.
72148........  TC.........  A.........  Mri lumbar spine         0.00        11.79        12.05            NA           NA          0.64  XXX
                                         w/o dye.
72149........  ...........  A.........  Mri lumbar spine         1.78        15.38        14.61            NA           NA          0.78  XXX
                                         w/dye.
72149........  26.........  A.........  Mri lumbar spine         1.78         0.63         0.60          0.63         0.60          0.08  XXX
                                         w/dye.
72149........  TC.........  A.........  Mri lumbar spine         0.00        14.75        14.02            NA           NA          0.70  XXX
                                         w/dye.
72156........  ...........  A.........  Mri neck spine w/        2.57        17.62        21.55            NA           NA          1.42  XXX
                                         o & w/dye.
72156........  26.........  A.........  Mri neck spine w/        2.57         0.90         0.85          0.90         0.85          0.11  XXX
                                         o & w/dye.
72156........  TC.........  A.........  Mri neck spine w/        0.00        16.72        20.71            NA           NA          1.31  XXX
                                         o & w/dye.
72157........  ...........  A.........  Mri chest spine w/       2.57        16.07        20.77            NA           NA          1.42  XXX
                                         o & w/dye.
72157........  26.........  A.........  Mri chest spine w/       2.57         0.91         0.84          0.91         0.84          0.11  XXX
                                         o & w/dye.
72157........  TC.........  A.........  Mri chest spine w/       0.00        15.16        19.93            NA           NA          1.31  XXX
                                         o & w/dye.
72158........  ...........  A.........  Mri lumbar spine         2.36        17.54        21.48            NA           NA          1.41  XXX
                                         w/o & w/dye.
72158........  26.........  A.........  Mri lumbar spine         2.36         0.83         0.78          0.83         0.78          0.10  XXX
                                         w/o & w/dye.
72158........  TC.........  A.........  Mri lumbar spine         0.00        16.71        20.70            NA           NA          1.31  XXX
                                         w/o & w/dye.

[[Page 38316]]

 
72159........  ...........  N.........  Mr angio spine w/        1.80        14.47        13.70            NA           NA          0.74  XXX
                                         o&w/dye.
72159........  26.........  N.........  Mr angio spine w/        1.80         0.42         0.55          0.42         0.55          0.10  XXX
                                         o&w/dye.
72159........  TC.........  N.........  Mr angio spine w/        0.00        14.06        13.15            NA           NA          0.64  XXX
                                         o&w/dye.
72170........  ...........  A.........  X-ray exam of            0.17         0.49         0.54            NA           NA          0.03  XXX
                                         pelvis.
72170........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         pelvis.
72170........  TC.........  A.........  X-ray exam of            0.00         0.43         0.48            NA           NA          0.02  XXX
                                         pelvis.
72190........  ...........  A.........  X-ray exam of            0.21         0.84         0.79            NA           NA          0.05  XXX
                                         pelvis.
72190........  26.........  A.........  X-ray exam of            0.21         0.08         0.07          0.08         0.07          0.01  XXX
                                         pelvis.
72190........  TC.........  A.........  X-ray exam of            0.00         0.77         0.72            NA           NA          0.04  XXX
                                         pelvis.
72191........  ...........  A.........  Ct angiograph            1.81        11.23        11.84            NA           NA          0.47  XXX
                                         pelv w/o&w/dye.
72191........  26.........  A.........  Ct angiograph            1.81         0.66         0.61          0.66         0.61          0.08  XXX
                                         pelv w/o&w/dye.
72191........  TC.........  A.........  Ct angiograph            0.00        10.57        11.24            NA           NA          0.39  XXX
                                         pelv w/o&w/dye.
72192........  ...........  A.........  Ct pelvis w/o dye        1.09         5.98         6.07            NA           NA          0.36  XXX
72192........  26.........  A.........  Ct pelvis w/o dye        1.09         0.39         0.36          0.39         0.36          0.05  XXX
72192........  TC.........  A.........  Ct pelvis w/o dye        0.00         5.59         5.71            NA           NA          0.31  XXX
72193........  ...........  A.........  Ct pelvis w/dye..        1.16         7.49         7.30            NA           NA          0.41  XXX
72193........  26.........  A.........  Ct pelvis w/dye..        1.16         0.42         0.39          0.42         0.39          0.05  XXX
72193........  TC.........  A.........  Ct pelvis w/dye..        0.00         7.07         6.91            NA           NA          0.36  XXX
72194........  ...........  A.........  Ct pelvis w/o & w/       1.22        10.04         9.39            NA           NA          0.48  XXX
                                         dye.
72194........  26.........  A.........  Ct pelvis w/o & w/       1.22         0.44         0.41          0.44         0.41          0.05  XXX
                                         dye.
72194........  TC.........  A.........  Ct pelvis w/o & w/       0.00         9.60         8.98            NA           NA          0.43  XXX
                                         dye.
72195........  ...........  A.........  Mri pelvis w/o           1.46        14.30        12.89            NA           NA          0.51  XXX
                                         dye.
72195........  26.........  A.........  Mri pelvis w/o           1.46         0.51         0.48          0.51         0.48          0.06  XXX
                                         dye.
72195........  TC.........  A.........  Mri pelvis w/o           0.00        13.79        12.41            NA           NA          0.45  XXX
                                         dye.
72196........  ...........  A.........  Mri pelvis w/dye.        1.73        15.39        14.58            NA           NA          0.60  XXX
72196........  26.........  A.........  Mri pelvis w/dye.        1.73         0.62         0.57          0.62         0.57          0.08  XXX
72196........  TC.........  A.........  Mri pelvis w/dye.        0.00        14.77        14.01            NA           NA          0.52  XXX
72197........  ...........  A.........  Mri pelvis w/o &         2.26        18.79        22.07            NA           NA          1.02  XXX
                                         w/dye.
72197........  26.........  A.........  Mri pelvis w/o &         2.26         0.80         0.75          0.80         0.75          0.10  XXX
                                         w/dye.
72197........  TC.........  A.........  Mri pelvis w/o &         0.00        18.00        21.33            NA           NA          0.92  XXX
                                         w/dye.
72198........  ...........  A.........  Mr angio pelvis w/       1.80        14.94        13.25            NA           NA          0.67  XXX
                                         o & w/dye.
72198........  26.........  A.........  Mr angio pelvis w/       1.80         0.65         0.60          0.65         0.60          0.08  XXX
                                         o & w/dye.
72198........  TC.........  A.........  Mr angio pelvis w/       0.00        14.30        12.66            NA           NA          0.59  XXX
                                         o & w/dye.
72200........  ...........  A.........  X-ray exam               0.17         0.59         0.58            NA           NA          0.03  XXX
                                         sacroiliac
                                         joints.
72200........  26.........  A.........  X-ray exam               0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         sacroiliac
                                         joints.
72200........  TC.........  A.........  X-ray exam               0.00         0.54         0.53            NA           NA          0.02  XXX
                                         sacroiliac
                                         joints.
72202........  ...........  A.........  X-ray exam               0.19         0.73         0.70            NA           NA          0.05  XXX
                                         sacroiliac
                                         joints.
72202........  26.........  A.........  X-ray exam               0.19         0.07         0.06          0.07         0.06          0.01  XXX
                                         sacroiliac
                                         joints.
72202........  TC.........  A.........  X-ray exam               0.00         0.67         0.64            NA           NA          0.04  XXX
                                         sacroiliac
                                         joints.
72220........  ...........  A.........  X-ray exam of            0.17         0.57         0.60            NA           NA          0.05  XXX
                                         tailbone.
72220........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         tailbone.
72220........  TC.........  A.........  X-ray exam of            0.00         0.52         0.54            NA           NA          0.04  XXX
                                         tailbone.
72240........  ...........  A.........  Contrast x-ray of        0.91         2.55         3.76            NA           NA          0.29  XXX
                                         neck spine.
72240........  26.........  A.........  Contrast x-ray of        0.91         0.32         0.29          0.32         0.29          0.04  XXX
                                         neck spine.
72240........  TC.........  A.........  Contrast x-ray of        0.00         2.24         3.47            NA           NA          0.25  XXX
                                         neck spine.
72255........  ...........  A.........  Contrast x-ray,          0.91         2.23         3.40            NA           NA          0.26  XXX
                                         thorax spine.
72255........  26.........  A.........  Contrast x-ray,          0.91         0.29         0.27          0.29         0.27          0.04  XXX
                                         thorax spine.
72255........  TC.........  A.........  Contrast x-ray,          0.00         1.94         3.13            NA           NA          0.22  XXX
                                         thorax spine.
72265........  ...........  A.........  Contrast x-ray,          0.83         2.51         3.39            NA           NA          0.26  XXX
                                         lower spine.
72265........  26.........  A.........  Contrast x-ray,          0.83         0.29         0.26          0.29         0.26          0.04  XXX
                                         lower spine.
72265........  TC.........  A.........  Contrast x-ray,          0.00         2.22         3.13            NA           NA          0.22  XXX
                                         lower spine.
72270........  ...........  A.........  Contrast x-ray,          1.33         3.97         5.20            NA           NA          0.39  XXX
                                         spine.
72270........  26.........  A.........  Contrast x-ray,          1.33         0.48         0.43          0.48         0.43          0.06  XXX
                                         spine.
72270........  TC.........  A.........  Contrast x-ray,          0.00         3.49         4.76            NA           NA          0.33  XXX
                                         spine.
72275........  ...........  A.........  Epidurography....        0.76         1.71         2.00            NA           NA          0.26  XXX
72275........  26.........  A.........  Epidurography....        0.76         0.20         0.20          0.20         0.20          0.04  XXX
72275........  TC.........  A.........  Epidurography....        0.00         1.51         1.80            NA           NA          0.22  XXX
72285........  ...........  A.........  X-ray c/t spine          1.16         1.43         5.08            NA           NA          0.50  XXX
                                         disk.
72285........  26.........  A.........  X-ray c/t spine          1.16         0.30         0.33          0.30         0.33          0.07  XXX
                                         disk.
72285........  TC.........  A.........  X-ray c/t spine          0.00         1.13         4.75            NA           NA          0.43  XXX
                                         disk.
72291........  ...........  C.........  Perq                     1.31         0.00         0.00          0.00         0.00          0.10  XXX
                                         vertebroplasty,
                                         fluor.
72291........  26.........  A.........  Perq                     1.31         0.48         0.47          0.48         0.47          0.10  XXX
                                         vertebroplasty,
                                         fluor.
72291........  TC.........  C.........  Perq                     0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vertebroplasty,
                                         fluor.
72292........  ...........  C.........  Perq                     1.38         0.00         0.00          0.00         0.00          0.07  XXX
                                         vertebroplasty,
                                         ct.
72292........  26.........  A.........  Perq                     1.38         0.51         0.49          0.51         0.49          0.07  XXX
                                         vertebroplasty,
                                         ct.
72292........  TC.........  C.........  Perq                     0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         vertebroplasty,
                                         ct.
72295........  ...........  A.........  X-ray of lower           0.83         1.45         4.78            NA           NA          0.46  XXX
                                         spine disk.
72295........  26.........  A.........  X-ray of lower           0.83         0.25         0.26          0.25         0.26          0.06  XXX
                                         spine disk.
72295........  TC.........  A.........  X-ray of lower           0.00         1.20         4.52            NA           NA          0.40  XXX
                                         spine disk.
73000........  ...........  A.........  X-ray exam of            0.16         0.55         0.56            NA           NA          0.03  XXX
                                         collar bone.
73000........  26.........  A.........  X-ray exam of            0.16         0.05         0.05          0.05         0.05          0.01  XXX
                                         collar bone.
73000........  TC.........  A.........  X-ray exam of            0.00         0.50         0.51            NA           NA          0.02  XXX
                                         collar bone.

[[Page 38317]]

 
73010........  ...........  A.........  X-ray exam of            0.17         0.58         0.58            NA           NA          0.03  XXX
                                         shoulder blade.
73010........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         shoulder blade.
73010........  TC.........  A.........  X-ray exam of            0.00         0.52         0.52            NA           NA          0.02  XXX
                                         shoulder blade.
73020........  ...........  A.........  X-ray exam of            0.15         0.44         0.48            NA           NA          0.03  XXX
                                         shoulder.
73020........  26.........  A.........  X-ray exam of            0.15         0.05         0.05          0.05         0.05          0.01  XXX
                                         shoulder.
73020........  TC.........  A.........  X-ray exam of            0.00         0.39         0.43            NA           NA          0.02  XXX
                                         shoulder.
73030........  ...........  A.........  X-ray exam of            0.18         0.57         0.60            NA           NA          0.05  XXX
                                         shoulder.
73030........  26.........  A.........  X-ray exam of            0.18         0.06         0.06          0.06         0.06          0.01  XXX
                                         shoulder.
73030........  TC.........  A.........  X-ray exam of            0.00         0.50         0.53            NA           NA          0.04  XXX
                                         shoulder.
73040........  ...........  A.........  Contrast x-ray of        0.54         2.23         2.24            NA           NA          0.14  XXX
                                         shoulder.
73040........  26.........  A.........  Contrast x-ray of        0.54         0.19         0.18          0.19         0.18          0.02  XXX
                                         shoulder.
73040........  TC.........  A.........  Contrast x-ray of        0.00         2.04         2.05            NA           NA          0.12  XXX
                                         shoulder.
73050........  ...........  A.........  X-ray exam of            0.20         0.73         0.73            NA           NA          0.05  XXX
                                         shoulders.
73050........  26.........  A.........  X-ray exam of            0.20         0.08         0.07          0.08         0.07          0.01  XXX
                                         shoulders.
73050........  TC.........  A.........  X-ray exam of            0.00         0.65         0.66            NA           NA          0.04  XXX
                                         shoulders.
73060........  ...........  A.........  X-ray exam of            0.17         0.57         0.60            NA           NA          0.05  XXX
                                         humerus.
73060........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         humerus.
73060........  TC.........  A.........  X-ray exam of            0.00         0.51         0.54            NA           NA          0.04  XXX
                                         humerus.
73070........  ...........  A.........  X-ray exam of            0.15         0.55         0.56            NA           NA          0.03  XXX
                                         elbow.
73070........  26.........  A.........  X-ray exam of            0.15         0.05         0.05          0.05         0.05          0.01  XXX
                                         elbow.
73070........  TC.........  A.........  X-ray exam of            0.00         0.50         0.51            NA           NA          0.02  XXX
                                         elbow.
73080........  ...........  A.........  X-ray exam of            0.17         0.75         0.69            NA           NA          0.05  XXX
                                         elbow.
73080........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         elbow.
73080........  TC.........  A.........  X-ray exam of            0.00         0.69         0.63            NA           NA          0.04  XXX
                                         elbow.
73085........  ...........  A.........  Contrast x-ray of        0.54         1.82         2.04            NA           NA          0.14  XXX
                                         elbow.
73085........  26.........  A.........  Contrast x-ray of        0.54         0.18         0.18          0.18         0.18          0.02  XXX
                                         elbow.
73085........  TC.........  A.........  Contrast x-ray of        0.00         1.64         1.86            NA           NA          0.12  XXX
                                         elbow.
73090........  ...........  A.........  X-ray exam of            0.16         0.55         0.56            NA           NA          0.03  XXX
                                         forearm.
73090........  26.........  A.........  X-ray exam of            0.16         0.05         0.05          0.05         0.05          0.01  XXX
                                         forearm.
73090........  TC.........  A.........  X-ray exam of            0.00         0.50         0.51            NA           NA          0.02  XXX
                                         forearm.
73092........  ...........  A.........  X-ray exam of            0.16         0.57         0.56            NA           NA          0.03  XXX
                                         arm, infant.
73092........  26.........  A.........  X-ray exam of            0.16         0.05         0.05          0.05         0.05          0.01  XXX
                                         arm, infant.
73092........  TC.........  A.........  X-ray exam of            0.00         0.52         0.51            NA           NA          0.02  XXX
                                         arm, infant.
73100........  ...........  A.........  X-ray exam of            0.16         0.60         0.57            NA           NA          0.03  XXX
                                         wrist.
73100........  26.........  A.........  X-ray exam of            0.16         0.06         0.05          0.06         0.05          0.01  XXX
                                         wrist.
73100........  TC.........  A.........  X-ray exam of            0.00         0.54         0.51            NA           NA          0.02  XXX
                                         wrist.
73110........  ...........  A.........  X-ray exam of            0.17         0.77         0.68            NA           NA          0.03  XXX
                                         wrist.
73110........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         wrist.
73110........  TC.........  A.........  X-ray exam of            0.00         0.71         0.62            NA           NA          0.02  XXX
                                         wrist.
73115........  ...........  A.........  Contrast x-ray of        0.54         2.31         2.03            NA           NA          0.12  XXX
                                         wrist.
73115........  26.........  A.........  Contrast x-ray of        0.54         0.19         0.18          0.19         0.18          0.02  XXX
                                         wrist.
73115........  TC.........  A.........  Contrast x-ray of        0.00         2.12         1.85            NA           NA          0.10  XXX
                                         wrist.
73120........  ...........  A.........  X-ray exam of            0.16         0.55         0.54            NA           NA          0.03  XXX
                                         hand.
73120........  26.........  A.........  X-ray exam of            0.16         0.05         0.05          0.05         0.05          0.01  XXX
                                         hand.
73120........  TC.........  A.........  X-ray exam of            0.00         0.50         0.49            NA           NA          0.02  XXX
                                         hand.
73130........  ...........  A.........  X-ray exam of            0.17         0.65         0.62            NA           NA          0.03  XXX
                                         hand.
73130........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         hand.
73130........  TC.........  A.........  X-ray exam of            0.00         0.60         0.56            NA           NA          0.02  XXX
                                         hand.
73140........  ...........  A.........  X-ray exam of            0.13         0.67         0.56            NA           NA          0.03  XXX
                                         finger(s).
73140........  26.........  A.........  X-ray exam of            0.13         0.04         0.04          0.04         0.04          0.01  XXX
                                         finger(s).
73140........  TC.........  A.........  X-ray exam of            0.00         0.63         0.52            NA           NA          0.02  XXX
                                         finger(s).
73200........  ...........  A.........  Ct upper                 1.09         6.34         5.78            NA           NA          0.30  XXX
                                         extremity w/o
                                         dye.
73200........  26.........  A.........  Ct upper                 1.09         0.39         0.36          0.39         0.36          0.05  XXX
                                         extremity w/o
                                         dye.
73200........  TC.........  A.........  Ct upper                 0.00         5.96         5.42            NA           NA          0.25  XXX
                                         extremity w/o
                                         dye.
73201........  ...........  A.........  Ct upper                 1.16         7.84         7.00            NA           NA          0.36  XXX
                                         extremity w/dye.
73201........  26.........  A.........  Ct upper                 1.16         0.41         0.38          0.41         0.38          0.05  XXX
                                         extremity w/dye.
73201........  TC.........  A.........  Ct upper                 0.00         7.43         6.62            NA           NA          0.31  XXX
                                         extremity w/dye.
73202........  ...........  A.........  Ct uppr extremity        1.22        10.46         9.07            NA           NA          0.44  XXX
                                         w/o&w/dye.
73202........  26.........  A.........  Ct uppr extremity        1.22         0.43         0.40          0.43         0.40          0.05  XXX
                                         w/o&w/dye.
73202........  TC.........  A.........  Ct uppr extremity        0.00        10.03         8.67            NA           NA          0.39  XXX
                                         w/o&w/dye.
73206........  ...........  A.........  Ct angio upr             1.81        10.81        11.08            NA           NA          0.47  XXX
                                         extrm w/o&w/dye.
73206........  26.........  A.........  Ct angio upr             1.81         0.68         0.61          0.68         0.61          0.08  XXX
                                         extrm w/o&w/dye.
73206........  TC.........  A.........  Ct angio upr             0.00        10.13        10.47            NA           NA          0.39  XXX
                                         extrm w/o&w/dye.
73218........  ...........  A.........  Mri upper                1.35        14.51        13.00            NA           NA          0.45  XXX
                                         extremity w/o
                                         dye.
73218........  26.........  A.........  Mri upper                1.35         0.46         0.44          0.46         0.44          0.06  XXX
                                         extremity w/o
                                         dye.
73218........  TC.........  A.........  Mri upper                0.00        14.05        12.56            NA           NA          0.39  XXX
                                         extremity w/o
                                         dye.
73219........  ...........  A.........  Mri upper                1.62        15.26        14.52            NA           NA          0.54  XXX
                                         extremity w/dye.
73219........  26.........  A.........  Mri upper                1.62         0.57         0.54          0.57         0.54          0.07  XXX
                                         extremity w/dye.
73219........  TC.........  A.........  Mri upper                0.00        14.69        13.98            NA           NA          0.47  XXX
                                         extremity w/dye.
73220........  ...........  A.........  Mri uppr                 2.15        18.88        22.11            NA           NA          0.94  XXX
                                         extremity w/o&w/
                                         dye.
73220........  26.........  A.........  Mri uppr                 2.15         0.76         0.71          0.76         0.71          0.10  XXX
                                         extremity w/o&w/
                                         dye.
73220........  TC.........  A.........  Mri uppr                 0.00        18.13        21.40            NA           NA          0.84  XXX
                                         extremity w/o&w/
                                         dye.

[[Page 38318]]

 
73221........  ...........  A.........  Mri joint upr            1.35        13.43        12.46            NA           NA          0.45  XXX
                                         extrem w/o dye.
73221........  26.........  A.........  Mri joint upr            1.35         0.47         0.44          0.47         0.44          0.06  XXX
                                         extrem w/o dye.
73221........  TC.........  A.........  Mri joint upr            0.00        12.96        12.02            NA           NA          0.39  XXX
                                         extrem w/o dye.
73222........  ...........  A.........  Mri joint upr            1.62        14.17        13.98            NA           NA          0.54  XXX
                                         extrem w/dye.
73222........  26.........  A.........  Mri joint upr            1.62         0.57         0.54          0.57         0.54          0.07  XXX
                                         extrem w/dye.
73222........  TC.........  A.........  Mri joint upr            0.00        13.61        13.45            NA           NA          0.47  XXX
                                         extrem w/dye.
73223........  ...........  A.........  Mri joint upr            2.15        17.42        21.39            NA           NA          0.94  XXX
                                         extr w/o&w/dye.
73223........  26.........  A.........  Mri joint upr            2.15         0.75         0.71          0.75         0.71          0.10  XXX
                                         extr w/o&w/dye.
73223........  TC.........  A.........  Mri joint upr            0.00        16.67        20.68            NA           NA          0.84  XXX
                                         extr w/o&w/dye.
73225........  ...........  N.........  Mr angio upr extr        1.73        14.46        13.07            NA           NA          0.69  XXX
                                         w/o&w/dye.
73225........  26.........  N.........  Mr angio upr extr        1.73         0.40         0.53          0.40         0.53          0.10  XXX
                                         w/o&w/dye.
73225........  TC.........  N.........  Mr angio upr extr        0.00        14.06        12.54            NA           NA          0.59  XXX
                                         w/o&w/dye.
73500........  ...........  A.........  X-ray exam of hip        0.17         0.49         0.51            NA           NA          0.03  XXX
73500........  26.........  A.........  X-ray exam of hip        0.17         0.06         0.06          0.06         0.06          0.01  XXX
73500........  TC.........  A.........  X-ray exam of hip        0.00         0.42         0.45            NA           NA          0.02  XXX
73510........  ...........  A.........  X-ray exam of hip        0.21         0.77         0.70            NA           NA          0.05  XXX
73510........  26.........  A.........  X-ray exam of hip        0.21         0.07         0.07          0.07         0.07          0.01  XXX
73510........  TC.........  A.........  X-ray exam of hip        0.00         0.70         0.63            NA           NA          0.04  XXX
73520........  ...........  A.........  X-ray exam of            0.26         0.78         0.77            NA           NA          0.05  XXX
                                         hips.
73520........  26.........  A.........  X-ray exam of            0.26         0.09         0.09          0.09         0.09          0.01  XXX
                                         hips.
73520........  TC.........  A.........  X-ray exam of            0.00         0.69         0.68            NA           NA          0.04  XXX
                                         hips.
73525........  ...........  A.........  Contrast x-ray of        0.54         1.81         2.04            NA           NA          0.15  XXX
                                         hip.
73525........  26.........  A.........  Contrast x-ray of        0.54         0.18         0.18          0.18         0.18          0.03  XXX
                                         hip.
73525........  TC.........  A.........  Contrast x-ray of        0.00         1.63         1.86            NA           NA          0.12  XXX
                                         hip.
73530........  ...........  C.........  X-ray exam of hip        0.29           NA           NA            NA           NA          0.03  XXX
73530........  26.........  A.........  X-ray exam of hip        0.29         0.11         0.10          0.11         0.10          0.01  XXX
73530........  TC.........  C.........  X-ray exam of hip        0.00           NA           NA            NA           NA          0.02  XXX
73540........  ...........  A.........  X-ray exam of            0.20         0.81         0.72            NA           NA          0.05  XXX
                                         pelvis & hips.
73540........  26.........  A.........  X-ray exam of            0.20         0.07         0.07          0.07         0.07          0.01  XXX
                                         pelvis & hips.
73540........  TC.........  A.........  X-ray exam of            0.00         0.73         0.65            NA           NA          0.04  XXX
                                         pelvis & hips.
73542........  ...........  A.........  X-ray exam,              0.59         1.12         1.69            NA           NA          0.15  XXX
                                         sacroiliac joint.
73542........  26.........  A.........  X-ray exam,              0.59         0.14         0.15          0.14         0.15          0.03  XXX
                                         sacroiliac joint.
73542........  TC.........  A.........  X-ray exam,              0.00         0.98         1.54            NA           NA          0.12  XXX
                                         sacroiliac joint.
73550........  ...........  A.........  X-ray exam of            0.17         0.54         0.59            NA           NA          0.05  XXX
                                         thigh.
73550........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         thigh.
73550........  TC.........  A.........  X-ray exam of            0.00         0.48         0.53            NA           NA          0.04  XXX
                                         thigh.
73560........  ...........  A.........  X-ray exam of            0.17         0.58         0.58            NA           NA          0.03  XXX
                                         knee, 1 or 2.
73560........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         knee, 1 or 2.
73560........  TC.........  A.........  X-ray exam of            0.00         0.52         0.52            NA           NA          0.02  XXX
                                         knee, 1 or 2.
73562........  ...........  A.........  X-ray exam of            0.18         0.72         0.67            NA           NA          0.05  XXX
                                         knee, 3.
73562........  26.........  A.........  X-ray exam of            0.18         0.07         0.06          0.07         0.06          0.01  XXX
                                         knee, 3.
73562........  TC.........  A.........  X-ray exam of            0.00         0.66         0.61            NA           NA          0.04  XXX
                                         knee, 3.
73564........  ...........  A.........  X-ray exam, knee,        0.22         0.86         0.77            NA           NA          0.05  XXX
                                         4 or more.
73564........  26.........  A.........  X-ray exam, knee,        0.22         0.08         0.07          0.08         0.07          0.01  XXX
                                         4 or more.
73564........  TC.........  A.........  X-ray exam, knee,        0.00         0.78         0.70            NA           NA          0.04  XXX
                                         4 or more.
73565........  ...........  A.........  X-ray exam of            0.17         0.65         0.60            NA           NA          0.03  XXX
                                         knees.
73565........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         knees.
73565........  TC.........  A.........  X-ray exam of            0.00         0.58         0.53            NA           NA          0.02  XXX
                                         knees.
73580........  ...........  A.........  Contrast x-ray of        0.54         2.54         2.63            NA           NA          0.17  XXX
                                         knee joint.
73580........  26.........  A.........  Contrast x-ray of        0.54         0.20         0.18          0.20         0.18          0.03  XXX
                                         knee joint.
73580........  TC.........  A.........  Contrast x-ray of        0.00         2.35         2.45            NA           NA          0.14  XXX
                                         knee joint.
73590........  ...........  A.........  X-ray exam of            0.17         0.53         0.56            NA           NA          0.03  XXX
                                         lower leg.
73590........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         lower leg.
73590........  TC.........  A.........  X-ray exam of            0.00         0.48         0.50            NA           NA          0.02  XXX
                                         lower leg.
73592........  ...........  A.........  X-ray exam of            0.16         0.57         0.56            NA           NA          0.03  XXX
                                         leg, infant.
73592........  26.........  A.........  X-ray exam of            0.16         0.05         0.05          0.05         0.05          0.01  XXX
                                         leg, infant.
73592........  TC.........  A.........  X-ray exam of            0.00         0.52         0.51            NA           NA          0.02  XXX
                                         leg, infant.
73600........  ...........  A.........  X-ray exam of            0.16         0.55         0.54            NA           NA          0.03  XXX
                                         ankle.
73600........  26.........  A.........  X-ray exam of            0.16         0.05         0.05          0.05         0.05          0.01  XXX
                                         ankle.
73600........  TC.........  A.........  X-ray exam of            0.00         0.50         0.49            NA           NA          0.02  XXX
                                         ankle.
73610........  ...........  A.........  X-ray exam of            0.17         0.67         0.63            NA           NA          0.03  XXX
                                         ankle.
73610........  26.........  A.........  X-ray exam of            0.17         0.06         0.06          0.06         0.06          0.01  XXX
                                         ankle.
73610........  TC.........  A.........  X-ray exam of            0.00         0.61         0.57            NA           NA          0.02  XXX
                                         ankle.
73615........  ...........  A.........  Contrast x-ray of        0.54         1.98         2.11            NA           NA          0.15  XXX
                                         ankle.
73615........  26.........  A.........  Contrast x-ray of        0.54         0.18         0.18          0.18         0.18          0.03  XXX
                                         ankle.
73615........  TC.........  A.........  Contrast x-ray of        0.00         1.80         1.93            NA           NA          0.12  XXX
                                         ankle.
73620........  ...........  A.........  X-ray exam of            0.16         0.52         0.53            NA           NA          0.03  XXX
                                         foot.
73620........  26.........  A.........  X-ray exam of            0.16         0.04         0.05          0.04         0.05          0.01  XXX
                                         foot.
73620........  TC.........  A.........  X-ray exam of            0.00         0.47         0.48            NA           NA          0.02  XXX
                                         foot.
73630........  ...........  A.........  X-ray exam of            0.17         0.65         0.62            NA           NA          0.03  XXX
                                         foot.
73630........  26.........  A.........  X-ray exam of            0.17         0.05         0.06          0.05         0.06          0.01  XXX
                                         foot.
73630........  TC.........  A.........  X-ray exam of            0.00         0.59         0.56            NA           NA          0.02  XXX
                                         foot.

[[Page 38319]]

 
73650........  ...........  A.........  X-ray exam of            0.16         0.54         0.53            NA           NA          0.03  XXX
                                         heel.
73650........  26.........  A.........  X-ray exam of            0.16         0.05         0.05          0.05         0.05          0.01  XXX
                                         heel.
73650........  TC.........  A.........  X-ray exam of            0.00         0.49         0.48            NA           NA          0.02  XXX
                                         heel.
73660........  ...........  A.........  X-ray exam of            0.13         0.63         0.54            NA           NA          0.03  XXX
                                         toe(s).
73660........  26.........  A.........  X-ray exam of            0.13         0.04         0.04          0.04         0.04          0.01  XXX
                                         toe(s).
73660........  TC.........  A.........  X-ray exam of            0.00         0.59         0.50            NA           NA          0.02  XXX
                                         toe(s).
73700........  ...........  A.........  Ct lower                 1.09         6.35         5.78            NA           NA          0.30  XXX
                                         extremity w/o
                                         dye.
73700........  26.........  A.........  Ct lower                 1.09         0.39         0.36          0.39         0.36          0.05  XXX
                                         extremity w/o
                                         dye.
73700........  TC.........  A.........  Ct lower                 0.00         5.97         5.42            NA           NA          0.25  XXX
                                         extremity w/o
                                         dye.
73701........  ...........  A.........  Ct lower                 1.16         7.90         7.03            NA           NA          0.36  XXX
                                         extremity w/dye.
73701........  26.........  A.........  Ct lower                 1.16         0.42         0.39          0.42         0.39          0.05  XXX
                                         extremity w/dye.
73701........  TC.........  A.........  Ct lower                 0.00         7.49         6.65            NA           NA          0.31  XXX
                                         extremity w/dye.
73702........  ...........  A.........  Ct lwr extremity         1.22        10.62         9.14            NA           NA          0.44  XXX
                                         w/o&w/dye.
73702........  26.........  A.........  Ct lwr extremity         1.22         0.45         0.41          0.45         0.41          0.05  XXX
                                         w/o&w/dye.
73702........  TC.........  A.........  Ct lwr extremity         0.00        10.17         8.73            NA           NA          0.39  XXX
                                         w/o&w/dye.
73706........  ...........  A.........  Ct angio lwr extr        1.90        12.19        11.80            NA           NA          0.47  XXX
                                         w/o&w/dye.
73706........  26.........  A.........  Ct angio lwr extr        1.90         0.72         0.65          0.72         0.65          0.08  XXX
                                         w/o&w/dye.
73706........  TC.........  A.........  Ct angio lwr extr        0.00        11.47        11.15            NA           NA          0.39  XXX
                                         w/o&w/dye.
73718........  ...........  A.........  Mri lower                1.35        14.13        12.80            NA           NA          0.45  XXX
                                         extremity w/o
                                         dye.
73718........  26.........  A.........  Mri lower                1.35         0.47         0.44          0.47         0.44          0.06  XXX
                                         extremity w/o
                                         dye.
73718........  TC.........  A.........  Mri lower                0.00        13.66        12.36            NA           NA          0.39  XXX
                                         extremity w/o
                                         dye.
73719........  ...........  A.........  Mri lower                1.62        15.26        14.50            NA           NA          0.54  XXX
                                         extremity w/dye.
73719........  26.........  A.........  Mri lower                1.62         0.57         0.53          0.57         0.53          0.07  XXX
                                         extremity w/dye.
73719........  TC.........  A.........  Mri lower                0.00        14.69        13.97            NA           NA          0.47  XXX
                                         extremity w/dye.
73720........  ...........  A.........  Mri lwr extremity        2.15        18.82        22.07            NA           NA          0.94  XXX
                                         w/o&w/dye.
73720........  26.........  A.........  Mri lwr extremity        2.15         0.76         0.71          0.76         0.71          0.10  XXX
                                         w/o&w/dye.
73720........  TC.........  A.........  Mri lwr extremity        0.00        18.06        21.37            NA           NA          0.84  XXX
                                         w/o&w/dye.
73721........  ...........  A.........  Mri jnt of lwr           1.35        13.74        12.61            NA           NA          0.45  XXX
                                         extre w/o dye.
73721........  26.........  A.........  Mri jnt of lwr           1.35         0.47         0.44          0.47         0.44          0.06  XXX
                                         extre w/o dye.
73721........  TC.........  A.........  Mri jnt of lwr           0.00        13.27        12.17            NA           NA          0.39  XXX
                                         extre w/o dye.
73722........  ...........  A.........  Mri joint of lwr         1.62        14.36        14.09            NA           NA          0.54  XXX
                                         extr w/dye.
73722........  26.........  A.........  Mri joint of lwr         1.62         0.57         0.54          0.57         0.54          0.07  XXX
                                         extr w/dye.
73722........  TC.........  A.........  Mri joint of lwr         0.00        13.79        13.55            NA           NA          0.47  XXX
                                         extr w/dye.
73723........  ...........  A.........  Mri joint lwr            2.15        17.40        21.38            NA           NA          0.94  XXX
                                         extr w/o&w/dye.
73723........  26.........  A.........  Mri joint lwr            2.15         0.75         0.71          0.75         0.71          0.10  XXX
                                         extr w/o&w/dye.
73723........  TC.........  A.........  Mri joint lwr            0.00        16.64        20.67            NA           NA          0.84  XXX
                                         extr w/o&w/dye.
73725........  ...........  R.........  Mr ang lwr ext w         1.82        14.98        13.29            NA           NA          0.67  XXX
                                         or w/o dye.
73725........  26.........  R.........  Mr ang lwr ext w         1.82         0.65         0.60          0.65         0.60          0.08  XXX
                                         or w/o dye.
73725........  TC.........  R.........  Mr ang lwr ext w         0.00        14.33        12.68            NA           NA          0.59  XXX
                                         or w/o dye.
74000........  ...........  A.........  X-ray exam of            0.18         0.46         0.52            NA           NA          0.03  XXX
                                         abdomen.
74000........  26.........  A.........  X-ray exam of            0.18         0.06         0.06          0.06         0.06          0.01  XXX
                                         abdomen.
74000........  TC.........  A.........  X-ray exam of            0.00         0.40         0.46            NA           NA          0.02  XXX
                                         abdomen.
74010........  ...........  A.........  X-ray exam of            0.23         0.78         0.71            NA           NA          0.05  XXX
                                         abdomen.
74010........  26.........  A.........  X-ray exam of            0.23         0.08         0.08          0.08         0.08          0.01  XXX
                                         abdomen.
74010........  TC.........  A.........  X-ray exam of            0.00         0.71         0.64            NA           NA          0.04  XXX
                                         abdomen.
74020........  ...........  A.........  X-ray exam of            0.27         0.81         0.75            NA           NA          0.05  XXX
                                         abdomen.
74020........  26.........  A.........  X-ray exam of            0.27         0.10         0.09          0.10         0.09          0.01  XXX
                                         abdomen.
74020........  TC.........  A.........  X-ray exam of            0.00         0.71         0.66            NA           NA          0.04  XXX
                                         abdomen.
74022........  ...........  A.........  X-ray exam               0.32         0.98         0.89            NA           NA          0.06  XXX
                                         series, abdomen.
74022........  26.........  A.........  X-ray exam               0.32         0.11         0.10          0.11         0.10          0.01  XXX
                                         series, abdomen.
74022........  TC.........  A.........  X-ray exam               0.00         0.87         0.79            NA           NA          0.05  XXX
                                         series, abdomen.
74150........  ...........  A.........  Ct abdomen w/o           1.19         6.02         5.99            NA           NA          0.35  XXX
                                         dye.
74150........  26.........  A.........  Ct abdomen w/o           1.19         0.43         0.40          0.43         0.40          0.05  XXX
                                         dye.
74150........  TC.........  A.........  Ct abdomen w/o           0.00         5.59         5.59            NA           NA          0.30  XXX
                                         dye.
74160........  ...........  A.........  Ct abdomen w/dye.        1.27         8.75         7.94            NA           NA          0.42  XXX
74160........  26.........  A.........  Ct abdomen w/dye.        1.27         0.46         0.43          0.46         0.43          0.06  XXX
74160........  TC.........  A.........  Ct abdomen w/dye.        0.00         8.29         7.51            NA           NA          0.36  XXX
74170........  ...........  A.........  Ct abdomen w/o &         1.40        12.08        10.43            NA           NA          0.49  XXX
                                         w/dye.
74170........  26.........  A.........  Ct abdomen w/o &         1.40         0.50         0.47          0.50         0.47          0.06  XXX
                                         w/dye.
74170........  TC.........  A.........  Ct abdomen w/o &         0.00        11.58         9.96            NA           NA          0.43  XXX
                                         w/dye.
74175........  ...........  A.........  Ct angio abdom w/        1.90        12.15        12.31            NA           NA          0.47  XXX
                                         o & w/dye.
74175........  26.........  A.........  Ct angio abdom w/        1.90         0.70         0.64          0.70         0.64          0.08  XXX
                                         o & w/dye.
74175........  TC.........  A.........  Ct angio abdom w/        0.00        11.46        11.67            NA           NA          0.39  XXX
                                         o & w/dye.
74181........  ...........  A.........  Mri abdomen w/o          1.46        12.34        11.92            NA           NA          0.51  XXX
                                         dye.
74181........  26.........  A.........  Mri abdomen w/o          1.46         0.52         0.48          0.52         0.48          0.06  XXX
                                         dye.
74181........  TC.........  A.........  Mri abdomen w/o          0.00        11.82        11.44            NA           NA          0.45  XXX
                                         dye.
74182........  ...........  A.........  Mri abdomen w/dye        1.73        17.28        15.51            NA           NA          0.60  XXX
74182........  26.........  A.........  Mri abdomen w/dye        1.73         0.62         0.57          0.62         0.57          0.08  XXX
74182........  TC.........  A.........  Mri abdomen w/dye        0.00        16.67        14.94            NA           NA          0.52  XXX
74183........  ...........  A.........  Mri abdomen w/o &        2.26        18.82        22.09            NA           NA          1.02  XXX
                                         w/dye.
74183........  26.........  A.........  Mri abdomen w/o &        2.26         0.80         0.75          0.80         0.75          0.10  XXX
                                         w/dye.
74183........  TC.........  A.........  Mri abdomen w/o &        0.00        18.02        21.34            NA           NA          0.92  XXX
                                         w/dye.

[[Page 38320]]

 
74185........  ...........  R.........  Mri angio, abdom         1.80        14.94        13.26            NA           NA          0.67  XXX
                                         w orw/o dye.
74185........  26.........  R.........  Mri angio, abdom         1.80         0.64         0.59          0.64         0.59          0.08  XXX
                                         w orw/o dye.
74185........  TC.........  R.........  Mri angio, abdom         0.00        14.30        12.67            NA           NA          0.59  XXX
                                         w orw/o dye.
74190........  ...........  C.........  X-ray exam of            0.48           NA           NA            NA           NA          0.09  XXX
                                         peritoneum.
74190........  26.........  A.........  X-ray exam of            0.48         0.17         0.16          0.17         0.16          0.02  XXX
                                         peritoneum.
74190........  TC.........  C.........  X-ray exam of            0.00           NA           NA            NA           NA          0.07  XXX
                                         peritoneum.
74210........  ...........  A.........  Contrst x-ray            0.36         1.76         1.52            NA           NA          0.08  XXX
                                         exam of throat.
74210........  26.........  A.........  Contrst x-ray            0.36         0.13         0.12          0.13         0.12          0.02  XXX
                                         exam of throat.
74210........  TC.........  A.........  Contrst x-ray            0.00         1.63         1.40            NA           NA          0.06  XXX
                                         exam of throat.
74220........  ...........  A.........  Contrast x-ray,          0.46         2.00         1.65            NA           NA          0.08  XXX
                                         esophagus.
74220........  26.........  A.........  Contrast x-ray,          0.46         0.16         0.15          0.16         0.15          0.02  XXX
                                         esophagus.
74220........  TC.........  A.........  Contrast x-ray,          0.00         1.83         1.50            NA           NA          0.06  XXX
                                         esophagus.
74230........  ...........  A.........  Cine/vid x-ray,          0.53         1.94         1.69            NA           NA          0.09  XXX
                                         throat/esoph.
74230........  26.........  A.........  Cine/vid x-ray,          0.53         0.19         0.18          0.19         0.18          0.02  XXX
                                         throat/esoph.
74230........  TC.........  A.........  Cine/vid x-ray,          0.00         1.75         1.52            NA           NA          0.07  XXX
                                         throat/esoph.
74235........  ...........  C.........  Remove esophagus         1.19         0.00         0.26          0.00         0.26          0.05  XXX
                                         obstruction.
74235........  26.........  A.........  Remove esophagus         1.19         0.46         0.41          0.46         0.41          0.05  XXX
                                         obstruction.
74235........  TC.........  C.........  Remove esophagus         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         obstruction.
74240........  ...........  A.........  X-ray exam, upper        0.69         2.29         1.96            NA           NA          0.11  XXX
                                         gi tract.
74240........  26.........  A.........  X-ray exam, upper        0.69         0.25         0.23          0.25         0.23          0.03  XXX
                                         gi tract.
74240........  TC.........  A.........  X-ray exam, upper        0.00         2.04         1.73            NA           NA          0.08  XXX
                                         gi tract.
74241........  ...........  A.........  X-ray exam, upper        0.69         2.54         2.11            NA           NA          0.11  XXX
                                         gi tract.
74241........  26.........  A.........  X-ray exam, upper        0.69         0.24         0.23          0.24         0.23          0.03  XXX
                                         gi tract.
74241........  TC.........  A.........  X-ray exam, upper        0.00         2.30         1.88            NA           NA          0.08  XXX
                                         gi tract.
74245........  ...........  A.........  X-ray exam, upper        0.91         3.93         3.27            NA           NA          0.17  XXX
                                         gi tract.
74245........  26.........  A.........  X-ray exam, upper        0.91         0.32         0.30          0.32         0.30          0.04  XXX
                                         gi tract.
74245........  TC.........  A.........  X-ray exam, upper        0.00         3.60         2.97            NA           NA          0.13  XXX
                                         gi tract.
74246........  ...........  A.........  Contrst x-ray            0.69         2.78         2.30            NA           NA          0.13  XXX
                                         uppr gi tract.
74246........  26.........  A.........  Contrst x-ray            0.69         0.25         0.23          0.25         0.23          0.03  XXX
                                         uppr gi tract.
74246........  TC.........  A.........  Contrst x-ray            0.00         2.53         2.07            NA           NA          0.10  XXX
                                         uppr gi tract.
74247........  ...........  A.........  Contrst x-ray            0.69         3.19         2.52            NA           NA          0.14  XXX
                                         uppr gi tract.
74247........  26.........  A.........  Contrst x-ray            0.69         0.25         0.23          0.25         0.23          0.03  XXX
                                         uppr gi tract.
74247........  TC.........  A.........  Contrst x-ray            0.00         2.95         2.29            NA           NA          0.11  XXX
                                         uppr gi tract.
74249........  ...........  A.........  Contrst x-ray            0.91         4.32         3.55            NA           NA          0.18  XXX
                                         uppr gi tract.
74249........  26.........  A.........  Contrst x-ray            0.91         0.32         0.30          0.32         0.30          0.04  XXX
                                         uppr gi tract.
74249........  TC.........  A.........  Contrst x-ray            0.00         3.99         3.25            NA           NA          0.14  XXX
                                         uppr gi tract.
74250........  ...........  A.........  X-ray exam of            0.47         2.46         1.94            NA           NA          0.09  XXX
                                         small bowel.
74250........  26.........  A.........  X-ray exam of            0.47         0.17         0.16          0.17         0.16          0.02  XXX
                                         small bowel.
74250........  TC.........  A.........  X-ray exam of            0.00         2.30         1.79            NA           NA          0.07  XXX
                                         small bowel.
74251........  ...........  A.........  X-ray exam of            0.69         9.92         5.65            NA           NA          0.10  XXX
                                         small bowel.
74251........  26.........  A.........  X-ray exam of            0.69         0.25         0.23          0.25         0.23          0.03  XXX
                                         small bowel.
74251........  TC.........  A.........  X-ray exam of            0.00         9.67         5.42            NA           NA          0.07  XXX
                                         small bowel.
74260........  ...........  A.........  X-ray exam of            0.50         8.23         4.88            NA           NA          0.10  XXX
                                         small bowel.
74260........  26.........  A.........  X-ray exam of            0.50         0.18         0.17          0.18         0.17          0.02  XXX
                                         small bowel.
74260........  TC.........  A.........  X-ray exam of            0.00         8.05         4.72            NA           NA          0.08  XXX
                                         small bowel.
74270........  ...........  A.........  Contrast x-ray           0.69         3.56         2.71            NA           NA          0.14  XXX
                                         exam of colon.
74270........  26.........  A.........  Contrast x-ray           0.69         0.25         0.23          0.25         0.23          0.03  XXX
                                         exam of colon.
74270........  TC.........  A.........  Contrast x-ray           0.00         3.31         2.48            NA           NA          0.11  XXX
                                         exam of colon.
74280........  ...........  A.........  Contrast x-ray           0.99         4.91         3.68            NA           NA          0.17  XXX
                                         exam of colon.
74280........  26.........  A.........  Contrast x-ray           0.99         0.35         0.32          0.35         0.32          0.04  XXX
                                         exam of colon.
74280........  TC.........  A.........  Contrast x-ray           0.00         4.55         3.36            NA           NA          0.13  XXX
                                         exam of colon.
74283........  ...........  A.........  Contrast x-ray           2.02         3.47         3.31            NA           NA          0.23  XXX
                                         exam of colon.
74283........  26.........  A.........  Contrast x-ray           2.02         0.70         0.66          0.70         0.66          0.09  XXX
                                         exam of colon.
74283........  TC.........  A.........  Contrast x-ray           0.00         2.77         2.65            NA           NA          0.14  XXX
                                         exam of colon.
74290........  ...........  A.........  Contrast x-ray,          0.32         1.57         1.18            NA           NA          0.06  XXX
                                         gallbladder.
74290........  26.........  A.........  Contrast x-ray,          0.32         0.11         0.10          0.11         0.10          0.01  XXX
                                         gallbladder.
74290........  TC.........  A.........  Contrast x-ray,          0.00         1.46         1.08            NA           NA          0.05  XXX
                                         gallbladder.
74291........  ...........  A.........  Contrast x-rays,         0.20         1.54         1.02            NA           NA          0.03  XXX
                                         gallbladder.
74291........  26.........  A.........  Contrast x-rays,         0.20         0.07         0.07          0.07         0.07          0.01  XXX
                                         gallbladder.
74291........  TC.........  A.........  Contrast x-rays,         0.00         1.47         0.95            NA           NA          0.02  XXX
                                         gallbladder.
74300........  ...........  C.........  X-ray bile ducts/        0.36         0.00         0.08          0.00         0.08          0.02  XXX
                                         pancreas.
74300........  26.........  A.........  X-ray bile ducts/        0.36         0.13         0.12          0.13         0.12          0.02  XXX
                                         pancreas.
74300........  TC.........  C.........  X-ray bile ducts/        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         pancreas.
74301........  ...........  C.........  X-rays at surgery        0.21         0.00         0.05          0.00         0.05          0.01  ZZZ
                                         add-on.
74301........  26.........  A.........  X-rays at surgery        0.21         0.08         0.07          0.08         0.07          0.01  ZZZ
                                         add-on.
74301........  TC.........  C.........  X-rays at surgery        0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         add-on.
74305........  ...........  C.........  X-ray bile ducts/        0.42           NA           NA            NA           NA          0.07  XXX
                                         pancreas.
74305........  26.........  A.........  X-ray bile ducts/        0.42         0.15         0.14          0.15         0.14          0.02  XXX
                                         pancreas.
74305........  TC.........  C.........  X-ray bile ducts/        0.00           NA           NA            NA           NA          0.05  XXX
                                         pancreas.
74320........  ...........  A.........  Contrast x-ray of        0.54         2.12         2.71            NA           NA          0.19  XXX
                                         bile ducts.
74320........  26.........  A.........  Contrast x-ray of        0.54         0.20         0.19          0.20         0.19          0.02  XXX
                                         bile ducts.
74320........  TC.........  A.........  Contrast x-ray of        0.00         1.92         2.52            NA           NA          0.17  XXX
                                         bile ducts.

[[Page 38321]]

 
74327........  ...........  A.........  X-ray bile stone         0.70         2.95         2.44            NA           NA          0.14  XXX
                                         removal.
74327........  26.........  A.........  X-ray bile stone         0.70         0.26         0.23          0.26         0.23          0.03  XXX
                                         removal.
74327........  TC.........  A.........  X-ray bile stone         0.00         2.69         2.21            NA           NA          0.11  XXX
                                         removal.
74328........  ...........  C.........  X-ray bile duct          0.70           NA           NA            NA           NA          0.20  XXX
                                         endoscopy.
74328........  26.........  A.........  X-ray bile duct          0.70         0.26         0.24          0.26         0.24          0.03  XXX
                                         endoscopy.
74328........  TC.........  C.........  X-ray bile duct          0.00           NA           NA            NA           NA          0.17  XXX
                                         endoscopy.
74329........  ...........  C.........  X-ray for                0.70         0.00         1.73          0.00         1.73          0.03  XXX
                                         pancreas
                                         endoscopy.
74329........  26.........  A.........  X-ray for                0.70         0.27         0.24          0.27         0.24          0.03  XXX
                                         pancreas
                                         endoscopy.
74329........  TC.........  C.........  X-ray for                0.00         0.00         1.58          0.00         1.58          0.00  XXX
                                         pancreas
                                         endoscopy.
74330........  ...........  C.........  X-ray bile/panc          0.90           NA           NA            NA           NA          0.21  XXX
                                         endoscopy.
74330........  26.........  A.........  X-ray bile/panc          0.90         0.33         0.30          0.33         0.30          0.04  XXX
                                         endoscopy.
74330........  TC.........  C.........  X-ray bile/panc          0.00           NA           NA            NA           NA          0.17  XXX
                                         endoscopy.
74340........  ...........  C.........  X-ray guide for          0.54           NA           NA            NA           NA          0.16  XXX
                                         GI tube.
74340........  26.........  A.........  X-ray guide for          0.54         0.20         0.19          0.20         0.19          0.02  XXX
                                         GI tube.
74340........  TC.........  C.........  X-ray guide for          0.00         0.00         1.75          0.00         1.75          0.14  XXX
                                         GI tube.
74350........  ...........  A.........  X-ray guide,             0.76         2.21         2.78            NA           NA          0.20  XXX
                                         stomach tube.
74350........  26.........  A.........  X-ray guide,             0.76         0.28         0.25          0.28         0.25          0.03  XXX
                                         stomach tube.
74350........  TC.........  A.........  X-ray guide,             0.00         1.93         2.53            NA           NA          0.17  XXX
                                         stomach tube.
74355........  ...........  C.........  X-ray guide,             0.76           NA           NA            NA           NA          0.17  XXX
                                         intestinal tube.
74355........  26.........  A.........  X-ray guide,             0.76         0.28         0.25          0.28         0.25          0.03  XXX
                                         intestinal tube.
74355........  TC.........  C.........  X-ray guide,             0.00         0.00         1.75          0.00         1.75          0.14  XXX
                                         intestinal tube.
74360........  ...........  C.........  X-ray guide, GI          0.54           NA           NA            NA           NA          0.19  XXX
                                         dilation.
74360........  26.........  A.........  X-ray guide, GI          0.54         0.24         0.21          0.24         0.21          0.02  XXX
                                         dilation.
74360........  TC.........  C.........  X-ray guide, GI          0.00           NA           NA            NA           NA          0.17  XXX
                                         dilation.
74363........  ...........  C.........  X-ray, bile duct         0.88         0.00         0.19          0.00         0.19          0.04  XXX
                                         dilation.
74363........  26.........  A.........  X-ray, bile duct         0.88         0.32         0.29          0.32         0.29          0.04  XXX
                                         dilation.
74363........  TC.........  C.........  X-ray, bile duct         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         dilation.
74400........  ...........  A.........  Contrst x-ray,           0.49         2.59         2.20            NA           NA          0.13  XXX
                                         urinary tract.
74400........  26.........  A.........  Contrst x-ray,           0.49         0.18         0.17          0.18         0.17          0.02  XXX
                                         urinary tract.
74400........  TC.........  A.........  Contrst x-ray,           0.00         2.41         2.03            NA           NA          0.11  XXX
                                         urinary tract.
74410........  ...........  A.........  Contrst x-ray,           0.49         2.67         2.38            NA           NA          0.13  XXX
                                         urinary tract.
74410........  26.........  A.........  Contrst x-ray,           0.49         0.18         0.17          0.18         0.17          0.02  XXX
                                         urinary tract.
74410........  TC.........  A.........  Contrst x-ray,           0.00         2.49         2.21            NA           NA          0.11  XXX
                                         urinary tract.
74415........  ...........  A.........  Contrst x-ray,           0.49         3.25         2.74            NA           NA          0.14  XXX
                                         urinary tract.
74415........  26.........  A.........  Contrst x-ray,           0.49         0.18         0.17          0.18         0.17          0.02  XXX
                                         urinary tract.
74415........  TC.........  A.........  Contrst x-ray,           0.00         3.07         2.58            NA           NA          0.12  XXX
                                         urinary tract.
74420........  ...........  C.........  Contrst x-ray,           0.36           NA           NA            NA           NA          0.16  XXX
                                         urinary tract.
74420........  26.........  A.........  Contrst x-ray,           0.36         0.14         0.13          0.14         0.13          0.02  XXX
                                         urinary tract.
74420........  TC.........  C.........  Contrst x-ray,           0.00           NA           NA            NA           NA          0.14  XXX
                                         urinary tract.
74425........  ...........  C.........  Contrst x-ray,           0.36           NA           NA            NA           NA          0.09  XXX
                                         urinary tract.
74425........  26.........  A.........  Contrst x-ray,           0.36         0.13         0.12          0.13         0.12          0.02  XXX
                                         urinary tract.
74425........  TC.........  C.........  Contrst x-ray,           0.00           NA           NA            NA           NA          0.07  XXX
                                         urinary tract.
74430........  ...........  A.........  Contrast x-ray,          0.32         1.94         1.53            NA           NA          0.08  XXX
                                         bladder.
74430........  26.........  A.........  Contrast x-ray,          0.32         0.12         0.11          0.12         0.11          0.02  XXX
                                         bladder.
74430........  TC.........  A.........  Contrast x-ray,          0.00         1.83         1.43            NA           NA          0.06  XXX
                                         bladder.
74440........  ...........  A.........  X-ray, male              0.38         2.11         1.69            NA           NA          0.08  XXX
                                         genital tract.
74440........  26.........  A.........  X-ray, male              0.38         0.15         0.14          0.15         0.14          0.02  XXX
                                         genital tract.
74440........  TC.........  A.........  X-ray, male              0.00         1.96         1.55            NA           NA          0.06  XXX
                                         genital tract.
74445........  ...........  C.........  X-ray exam of            1.14           NA           NA            NA           NA          0.13  XXX
                                         penis.
74445........  26.........  A.........  X-ray exam of            1.14         0.46         0.41          0.46         0.41          0.07  XXX
                                         penis.
74445........  TC.........  C.........  X-ray exam of            0.00           NA           NA            NA           NA          0.06  XXX
                                         penis.
74450........  ...........  C.........  X-ray, urethra/          0.33           NA           NA            NA           NA          0.10  XXX
                                         bladder.
74450........  26.........  A.........  X-ray, urethra/          0.33         0.12         0.11          0.12         0.11          0.02  XXX
                                         bladder.
74450........  TC.........  C.........  X-ray, urethra/          0.00           NA           NA            NA           NA          0.08  XXX
                                         bladder.
74455........  ...........  A.........  X-ray, urethra/          0.33         2.17         1.92            NA           NA          0.12  XXX
                                         bladder.
74455........  26.........  A.........  X-ray, urethra/          0.33         0.13         0.12          0.13         0.12          0.02  XXX
                                         bladder.
74455........  TC.........  A.........  X-ray, urethra/          0.00         2.04         1.80            NA           NA          0.10  XXX
                                         bladder.
74470........  ...........  C.........  X-ray exam of            0.54           NA           NA            NA           NA          0.09  XXX
                                         kidney lesion.
74470........  26.........  A.........  X-ray exam of            0.54         0.17         0.17          0.17         0.17          0.02  XXX
                                         kidney lesion.
74470........  TC.........  C.........  X-ray exam of            0.00           NA           NA            NA           NA          0.07  XXX
                                         kidney lesion.
74475........  ...........  A.........  X-ray control,           0.54         2.10         3.16            NA           NA          0.24  XXX
                                         cath insert.
74475........  26.........  A.........  X-ray control,           0.54         0.20         0.19          0.20         0.19          0.02  XXX
                                         cath insert.
74475........  TC.........  A.........  X-ray control,           0.00         1.90         2.97            NA           NA          0.22  XXX
                                         cath insert.
74480........  ...........  A.........  X-ray control,           0.54         2.11         3.16            NA           NA          0.24  XXX
                                         cath insert.
74480........  26.........  A.........  X-ray control,           0.54         0.20         0.19          0.20         0.19          0.02  XXX
                                         cath insert.
74480........  TC.........  A.........  X-ray control,           0.00         1.91         2.98            NA           NA          0.22  XXX
                                         cath insert.
74485........  ...........  A.........  X-ray guide, GU          0.54         2.26         2.77            NA           NA          0.20  XXX
                                         dilation.
74485........  26.........  A.........  X-ray guide, GU          0.54         0.21         0.18          0.21         0.18          0.03  XXX
                                         dilation.
74485........  TC.........  A.........  X-ray guide, GU          0.00         2.06         2.59            NA           NA          0.17  XXX
                                         dilation.
74710........  ...........  A.........  X-ray measurement        0.34         0.64         0.90            NA           NA          0.08  XXX
                                         of pelvis.
74710........  26.........  A.........  X-ray measurement        0.34         0.12         0.11          0.12         0.11          0.02  XXX
                                         of pelvis.
74710........  TC.........  A.........  X-ray measurement        0.00         0.52         0.79            NA           NA          0.06  XXX
                                         of pelvis.

[[Page 38322]]

 
74740........  ...........  A.........  X-ray, female            0.38         1.75         1.58            NA           NA          0.09  XXX
                                         genital tract.
74740........  26.........  A.........  X-ray, female            0.38         0.13         0.13          0.13         0.13          0.02  XXX
                                         genital tract.
74740........  TC.........  A.........  X-ray, female            0.00         1.62         1.45            NA           NA          0.07  XXX
                                         genital tract.
74742........  ...........  C.........  X-ray, fallopian         0.61         0.00         0.13          0.00         0.13          0.03  XXX
                                         tube.
74742........  26.........  A.........  X-ray, fallopian         0.61         0.19         0.19          0.19         0.19          0.03  XXX
                                         tube.
74742........  TC.........  C.........  X-ray, fallopian         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         tube.
74775........  ...........  C.........  X-ray exam of            0.62           NA           NA            NA           NA          0.11  XXX
                                         perineum.
74775........  26.........  A.........  X-ray exam of            0.62         0.23         0.21          0.23         0.21          0.03  XXX
                                         perineum.
74775........  TC.........  C.........  X-ray exam of            0.00         0.00         0.97          0.00         0.97          0.08  XXX
                                         perineum.
75552........  ...........  A.........  Heart mri for            1.60        18.93        15.23            NA           NA          0.66  XXX
                                         morph w/o dye.
75552........  26.........  A.........  Heart mri for            1.60         0.62         0.56          0.62         0.56          0.07  XXX
                                         morph w/o dye.
75552........  TC.........  A.........  Heart mri for            0.00        18.31        14.67            NA           NA          0.59  XXX
                                         morph w/o dye.
75553........  ...........  A.........  Heart mri for            2.00        23.11        17.57            NA           NA          0.66  XXX
                                         morph w/dye.
75553........  26.........  A.........  Heart mri for            2.00         0.84         0.76          0.84         0.76          0.07  XXX
                                         morph w/dye.
75553........  TC.........  A.........  Heart mri for            0.00        22.27        16.81            NA           NA          0.59  XXX
                                         morph w/dye.
75554........  ...........  A.........  Cardiac MRI/             1.83        26.43        19.14            NA           NA          0.66  XXX
                                         function.
75554........  26.........  A.........  Cardiac MRI/             1.83         0.82         0.73          0.82         0.73          0.07  XXX
                                         function.
75554........  TC.........  A.........  Cardiac MRI/             0.00        25.61        18.42            NA           NA          0.59  XXX
                                         function.
75555........  ...........  A.........  Cardiac MRI/             1.74        25.66        18.98            NA           NA          0.66  XXX
                                         limited study.
75555........  26.........  A.........  Cardiac MRI/             1.74         0.76         0.71          0.76         0.71          0.07  XXX
                                         limited study.
75555........  TC.........  A.........  Cardiac MRI/             0.00        24.90        18.27            NA           NA          0.59  XXX
                                         limited study.
75600........  ...........  A.........  Contrast x-ray           0.49         6.22         9.54            NA           NA          0.67  XXX
                                         exam of aorta.
75600........  26.........  A.........  Contrast x-ray           0.49         0.23         0.22          0.23         0.22          0.02  XXX
                                         exam of aorta.
75600........  TC.........  A.........  Contrast x-ray           0.00         5.99         9.32            NA           NA          0.65  XXX
                                         exam of aorta.
75605........  ...........  A.........  Contrast x-ray           1.14         3.47         8.24            NA           NA          0.70  XXX
                                         exam of aorta.
75605........  26.........  A.........  Contrast x-ray           1.14         0.48         0.44          0.48         0.44          0.05  XXX
                                         exam of aorta.
75605........  TC.........  A.........  Contrast x-ray           0.00         2.98         7.80            NA           NA          0.65  XXX
                                         exam of aorta.
75625........  ...........  A.........  Contrast x-ray           1.14         3.30         8.13            NA           NA          0.71  XXX
                                         exam of aorta.
75625........  26.........  A.........  Contrast x-ray           1.14         0.42         0.40          0.42         0.40          0.06  XXX
                                         exam of aorta.
75625........  TC.........  A.........  Contrast x-ray           0.00         2.87         7.73            NA           NA          0.65  XXX
                                         exam of aorta.
75630........  ...........  A.........  X-ray aorta, leg         1.79         3.67         8.72            NA           NA          0.80  XXX
                                         arteries.
75630........  26.........  A.........  X-ray aorta, leg         1.79         0.70         0.66          0.70         0.66          0.11  XXX
                                         arteries.
75630........  TC.........  A.........  X-ray aorta, leg         0.00         2.98         8.06            NA           NA          0.69  XXX
                                         arteries.
75635........  ...........  A.........  Ct angio                 2.40        12.76        14.63            NA           NA          0.50  XXX
                                         abdominal
                                         arteries.
75635........  26.........  A.........  Ct angio                 2.40         0.92         0.83          0.92         0.83          0.11  XXX
                                         abdominal
                                         arteries.
75635........  TC.........  A.........  Ct angio                 0.00        11.84        13.80            NA           NA          0.39  XXX
                                         abdominal
                                         arteries.
75650........  ...........  A.........  Artery x-rays,           1.49         3.46         8.26            NA           NA          0.72  XXX
                                         head & neck.
75650........  26.........  A.........  Artery x-rays,           1.49         0.57         0.52          0.57         0.52          0.07  XXX
                                         head & neck.
75650........  TC.........  A.........  Artery x-rays,           0.00         2.90         7.74            NA           NA          0.65  XXX
                                         head & neck.
75658........  ...........  A.........  Artery x-rays,           1.31         3.67         8.38            NA           NA          0.72  XXX
                                         arm.
75658........  26.........  A.........  Artery x-rays,           1.31         0.44         0.46          0.44         0.46          0.07  XXX
                                         arm.
75658........  TC.........  A.........  Artery x-rays,           0.00         3.23         7.92            NA           NA          0.65  XXX
                                         arm.
75660........  ...........  A.........  Artery x-rays,           1.31         3.83         8.43            NA           NA          0.71  XXX
                                         head & neck.
75660........  26.........  A.........  Artery x-rays,           1.31         0.49         0.46          0.49         0.46          0.06  XXX
                                         head & neck.
75660........  TC.........  A.........  Artery x-rays,           0.00         3.33         7.96            NA           NA          0.65  XXX
                                         head & neck.
75662........  ...........  A.........  Artery x-rays,           1.66         4.91         9.06            NA           NA          0.71  XXX
                                         head & neck.
75662........  26.........  A.........  Artery x-rays,           1.66         0.69         0.64          0.69         0.64          0.06  XXX
                                         head & neck.
75662........  TC.........  A.........  Artery x-rays,           0.00         4.22         8.42            NA           NA          0.65  XXX
                                         head & neck.
75665........  ...........  A.........  Artery x-rays,           1.31         4.04         8.52            NA           NA          0.74  XXX
                                         head & neck.
75665........  26.........  A.........  Artery x-rays,           1.31         0.48         0.45          0.48         0.45          0.09  XXX
                                         head & neck.
75665........  TC.........  A.........  Artery x-rays,           0.00         3.56         8.07            NA           NA          0.65  XXX
                                         head & neck.
75671........  ...........  A.........  Artery x-rays,           1.66         5.02         9.06            NA           NA          0.72  XXX
                                         head & neck.
75671........  26.........  A.........  Artery x-rays,           1.66         0.63         0.58          0.63         0.58          0.07  XXX
                                         head & neck.
75671........  TC.........  A.........  Artery x-rays,           0.00         4.38         8.47            NA           NA          0.65  XXX
                                         head & neck.
75676........  ...........  A.........  Artery x-rays,           1.31         3.81         8.41            NA           NA          0.72  XXX
                                         neck.
75676........  26.........  A.........  Artery x-rays,           1.31         0.48         0.45          0.48         0.45          0.07  XXX
                                         neck.
75676........  TC.........  A.........  Artery x-rays,           0.00         3.32         7.95            NA           NA          0.65  XXX
                                         neck.
75680........  ...........  A.........  Artery x-rays,           1.66         4.53         8.82            NA           NA          0.72  XXX
                                         neck.
75680........  26.........  A.........  Artery x-rays,           1.66         0.65         0.59          0.65         0.59          0.07  XXX
                                         neck.
75680........  TC.........  A.........  Artery x-rays,           0.00         3.88         8.23            NA           NA          0.65  XXX
                                         neck.
75685........  ...........  A.........  Artery x-rays,           1.31         3.83         8.41            NA           NA          0.71  XXX
                                         spine.
75685........  26.........  A.........  Artery x-rays,           1.31         0.50         0.46          0.50         0.46          0.06  XXX
                                         spine.
75685........  TC.........  A.........  Artery x-rays,           0.00         3.33         7.95            NA           NA          0.65  XXX
                                         spine.
75705........  ...........  A.........  Artery x-rays,           2.18         4.15         8.68            NA           NA          0.78  XXX
                                         spine.
75705........  26.........  A.........  Artery x-rays,           2.18         0.81         0.74          0.81         0.74          0.13  XXX
                                         spine.
75705........  TC.........  A.........  Artery x-rays,           0.00         3.35         7.94            NA           NA          0.65  XXX
                                         spine.
75710........  ...........  A.........  Artery x-rays,           1.14         3.88         8.44            NA           NA          0.72  XXX
                                         arm/leg.
75710........  26.........  A.........  Artery x-rays,           1.14         0.42         0.41          0.42         0.41          0.07  XXX
                                         arm/leg.
75710........  TC.........  A.........  Artery x-rays,           0.00         3.45         8.03            NA           NA          0.65  XXX
                                         arm/leg.
75716........  ...........  A.........  Artery x-rays,           1.31         4.82         8.91            NA           NA          0.72  XXX
                                         arms/legs.
75716........  26.........  A.........  Artery x-rays,           1.31         0.49         0.46          0.49         0.46          0.07  XXX
                                         arms/legs.
75716........  TC.........  A.........  Artery x-rays,           0.00         4.33         8.46            NA           NA          0.65  XXX
                                         arms/legs.

[[Page 38323]]

 
75722........  ...........  A.........  Artery x-rays,           1.14         3.76         8.39            NA           NA          0.70  XXX
                                         kidney.
75722........  26.........  A.........  Artery x-rays,           1.14         0.47         0.44          0.47         0.44          0.05  XXX
                                         kidney.
75722........  TC.........  A.........  Artery x-rays,           0.00         3.29         7.95            NA           NA          0.65  XXX
                                         kidney.
75724........  ...........  A.........  Artery x-rays,           1.49         4.96         9.09            NA           NA          0.70  XXX
                                         kidneys.
75724........  26.........  A.........  Artery x-rays,           1.49         0.71         0.64          0.71         0.64          0.05  XXX
                                         kidneys.
75724........  TC.........  A.........  Artery x-rays,           0.00         4.25         8.44            NA           NA          0.65  XXX
                                         kidneys.
75726........  ...........  A.........  Artery x-rays,           1.14         3.73         8.32            NA           NA          0.70  XXX
                                         abdomen.
75726........  26.........  A.........  Artery x-rays,           1.14         0.43         0.39          0.43         0.39          0.05  XXX
                                         abdomen.
75726........  TC.........  A.........  Artery x-rays,           0.00         3.31         7.93            NA           NA          0.65  XXX
                                         abdomen.
75731........  ...........  A.........  Artery x-rays,           1.14         4.00         8.44            NA           NA          0.71  XXX
                                         adrenal gland.
75731........  26.........  A.........  Artery x-rays,           1.14         0.50         0.42          0.50         0.42          0.06  XXX
                                         adrenal gland.
75731........  TC.........  A.........  Artery x-rays,           0.00         3.51         8.02            NA           NA          0.65  XXX
                                         adrenal gland.
75733........  ...........  A.........  Artery x-rays,           1.31         5.30         9.14            NA           NA          0.71  XXX
                                         adrenals.
75733........  26.........  A.........  Artery x-rays,           1.31         0.63         0.53          0.63         0.53          0.06  XXX
                                         adrenals.
75733........  TC.........  A.........  Artery x-rays,           0.00         4.66         8.61            NA           NA          0.65  XXX
                                         adrenals.
75736........  ...........  A.........  Artery x-rays,           1.14         3.81         8.38            NA           NA          0.71  XXX
                                         pelvis.
75736........  26.........  A.........  Artery x-rays,           1.14         0.43         0.40          0.43         0.40          0.06  XXX
                                         pelvis.
75736........  TC.........  A.........  Artery x-rays,           0.00         3.38         7.98            NA           NA          0.65  XXX
                                         pelvis.
75741........  ...........  A.........  Artery x-rays,           1.31         3.14         8.06            NA           NA          0.71  XXX
                                         lung.
75741........  26.........  A.........  Artery x-rays,           1.31         0.49         0.45          0.49         0.45          0.06  XXX
                                         lung.
75741........  TC.........  A.........  Artery x-rays,           0.00         2.65         7.61            NA           NA          0.65  XXX
                                         lung.
75743........  ...........  A.........  Artery x-rays,           1.66         3.53         8.30            NA           NA          0.72  XXX
                                         lungs.
75743........  26.........  A.........  Artery x-rays,           1.66         0.62         0.56          0.62         0.56          0.07  XXX
                                         lungs.
75743........  TC.........  A.........  Artery x-rays,           0.00         2.90         7.73            NA           NA          0.65  XXX
                                         lungs.
75746........  ...........  A.........  Artery x-rays,           1.14         3.49         8.20            NA           NA          0.70  XXX
                                         lung.
75746........  26.........  A.........  Artery x-rays,           1.14         0.40         0.38          0.40         0.38          0.05  XXX
                                         lung.
75746........  TC.........  A.........  Artery x-rays,           0.00         3.08         7.82            NA           NA          0.65  XXX
                                         lung.
75756........  ...........  A.........  Artery x-rays,           1.14         4.21         8.66            NA           NA          0.69  XXX
                                         chest.
75756........  26.........  A.........  Artery x-rays,           1.14         0.56         0.51          0.56         0.51          0.04  XXX
                                         chest.
75756........  TC.........  A.........  Artery x-rays,           0.00         3.65         8.14            NA           NA          0.65  XXX
                                         chest.
75774........  ...........  A.........  Artery x-ray,            0.36         2.46         7.59          2.46         7.59          0.67  ZZZ
                                         each vessel.
75774........  26.........  A.........  Artery x-ray,            0.36         0.14         0.13          0.14         0.13          0.02  ZZZ
                                         each vessel.
75774........  TC.........  A.........  Artery x-ray,            0.00         2.32         7.46          2.32         7.46          0.65  ZZZ
                                         each vessel.
75790........  ...........  A.........  Visualize A-V            1.84         3.10         2.50            NA           NA          0.17  XXX
                                         shunt.
75790........  26.........  A.........  Visualize A-V            1.84         0.60         0.59          0.60         0.59          0.09  XXX
                                         shunt.
75790........  TC.........  A.........  Visualize A-V            0.00         2.50         1.91            NA           NA          0.08  XXX
                                         shunt.
75801........  ...........  C.........  Lymph vessel x-          0.81         0.00         0.17          0.00         0.17          0.37  XXX
                                         ray, arm/leg.
75801........  26.........  A.........  Lymph vessel x-          0.81         0.22         0.25          0.22         0.25          0.08  XXX
                                         ray, arm/leg.
75801........  TC.........  C.........  Lymph vessel x-          0.00         0.00         3.62          0.00         3.62          0.29  XXX
                                         ray, arm/leg.
75803........  ...........  C.........  Lymph vessel x-          1.17           NA           NA            NA           NA          0.34  XXX
                                         ray,arms/legs.
75803........  26.........  A.........  Lymph vessel x-          1.17         0.42         0.38          0.42         0.38          0.05  XXX
                                         ray,arms/legs.
75803........  TC.........  C.........  Lymph vessel x-          0.00         0.00         3.62          0.00         3.62          0.29  XXX
                                         ray,arms/legs.
75805........  ...........  C.........  Lymph vessel x-          0.81         0.00         0.17          0.00         0.17          0.38  XXX
                                         ray, trunk.
75805........  26.........  A.........  Lymph vessel x-          0.81         0.28         0.27          0.28         0.27          0.05  XXX
                                         ray, trunk.
75805........  TC.........  C.........  Lymph vessel x-          0.00         0.00         4.08          0.00         4.08          0.33  XXX
                                         ray, trunk.
75807........  ...........  C.........  Lymph vessel x-          1.17         0.00         0.25          0.00         0.25          0.05  XXX
                                         ray, trunk.
75807........  26.........  A.........  Lymph vessel x-          1.17         0.40         0.38          0.40         0.38          0.05  XXX
                                         ray, trunk.
75807........  TC.........  C.........  Lymph vessel x-          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ray, trunk.
75809........  ...........  A.........  Nonvascular              0.47         2.15         1.53            NA           NA          0.07  XXX
                                         shunt, x-ray.
75809........  26.........  A.........  Nonvascular              0.47         0.16         0.15          0.16         0.15          0.02  XXX
                                         shunt, x-ray.
75809........  TC.........  A.........  Nonvascular              0.00         1.99         1.38            NA           NA          0.05  XXX
                                         shunt, x-ray.
75810........  ...........  C.........  Vein x-ray,              1.14           NA           NA            NA           NA          0.70  XXX
                                         spleen/liver.
75810........  26.........  A.........  Vein x-ray,              1.14         0.41         0.38          0.41         0.38          0.05  XXX
                                         spleen/liver.
75810........  TC.........  C.........  Vein x-ray,              0.00         0.00         8.43          0.00         8.43          0.65  XXX
                                         spleen/liver.
75820........  ...........  A.........  Vein x-ray, arm/         0.70         2.95         2.06            NA           NA          0.09  XXX
                                         leg.
75820........  26.........  A.........  Vein x-ray, arm/         0.70         0.28         0.25          0.28         0.25          0.03  XXX
                                         leg.
75820........  TC.........  A.........  Vein x-ray, arm/         0.00         2.66         1.81            NA           NA          0.06  XXX
                                         leg.
75822........  ...........  A.........  Vein x-ray, arms/        1.06         3.15         2.46            NA           NA          0.13  XXX
                                         legs.
75822........  26.........  A.........  Vein x-ray, arms/        1.06         0.38         0.35          0.38         0.35          0.05  XXX
                                         legs.
75822........  TC.........  A.........  Vein x-ray, arms/        0.00         2.77         2.11            NA           NA          0.08  XXX
                                         legs.
75825........  ...........  A.........  Vein x-ray, trunk        1.14         2.91         7.92            NA           NA          0.72  XXX
75825........  26.........  A.........  Vein x-ray, trunk        1.14         0.39         0.37          0.39         0.37          0.07  XXX
75825........  TC.........  A.........  Vein x-ray, trunk        0.00         2.52         7.55            NA           NA          0.65  XXX
75827........  ...........  A.........  Vein x-ray, chest        1.14         2.93         7.93            NA           NA          0.70  XXX
75827........  26.........  A.........  Vein x-ray, chest        1.14         0.38         0.37          0.38         0.37          0.05  XXX
75827........  TC.........  A.........  Vein x-ray, chest        0.00         2.56         7.57            NA           NA          0.65  XXX
75831........  ...........  A.........  Vein x-ray,              1.14         3.03         7.98            NA           NA          0.71  XXX
                                         kidney.
75831........  26.........  A.........  Vein x-ray,              1.14         0.38         0.37          0.38         0.37          0.06  XXX
                                         kidney.
75831........  TC.........  A.........  Vein x-ray,              0.00         2.64         7.61            NA           NA          0.65  XXX
                                         kidney.
75833........  ...........  A.........  Vein x-ray,              1.49         3.65         8.35            NA           NA          0.74  XXX
                                         kidneys.
75833........  26.........  A.........  Vein x-ray,              1.49         0.51         0.49          0.51         0.49          0.09  XXX
                                         kidneys.
75833........  TC.........  A.........  Vein x-ray,              0.00         3.14         7.86            NA           NA          0.65  XXX
                                         kidneys.

[[Page 38324]]

 
75840........  ...........  A.........  Vein x-ray,              1.14         2.92         7.99            NA           NA          0.72  XXX
                                         adrenal gland.
75840........  26.........  A.........  Vein x-ray,              1.14         0.36         0.38          0.36         0.38          0.07  XXX
                                         adrenal gland.
75840........  TC.........  A.........  Vein x-ray,              0.00         2.56         7.61            NA           NA          0.65  XXX
                                         adrenal gland.
75842........  ...........  A.........  Vein x-ray,              1.49         3.73         8.36            NA           NA          0.72  XXX
                                         adrenal glands.
75842........  26.........  A.........  Vein x-ray,              1.49         0.56         0.50          0.56         0.50          0.07  XXX
                                         adrenal glands.
75842........  TC.........  A.........  Vein x-ray,              0.00         3.17         7.86            NA           NA          0.65  XXX
                                         adrenal glands.
75860........  ...........  A.........  Vein x-ray, neck.        1.14         3.32         8.17            NA           NA          0.69  XXX
75860........  26.........  A.........  Vein x-ray, neck.        1.14         0.48         0.44          0.48         0.44          0.04  XXX
75860........  TC.........  A.........  Vein x-ray, neck.        0.00         2.84         7.73            NA           NA          0.65  XXX
75870........  ...........  A.........  Vein x-ray, skull        1.14         3.27         8.10            NA           NA          0.70  XXX
75870........  26.........  A.........  Vein x-ray, skull        1.14         0.41         0.40          0.41         0.40          0.05  XXX
75870........  TC.........  A.........  Vein x-ray, skull        0.00         2.86         7.71            NA           NA          0.65  XXX
75872........  ...........  A.........  Vein x-ray, skull        1.14         4.02         8.47            NA           NA          0.79  XXX
75872........  26.........  A.........  Vein x-ray, skull        1.14         0.45         0.41          0.45         0.41          0.14  XXX
75872........  TC.........  A.........  Vein x-ray, skull        0.00         3.57         8.06            NA           NA          0.65  XXX
75880........  ...........  A.........  Vein x-ray, eye          0.70         3.16         2.13            NA           NA          0.09  XXX
                                         socket.
75880........  26.........  A.........  Vein x-ray, eye          0.70         0.27         0.24          0.27         0.24          0.03  XXX
                                         socket.
75880........  TC.........  A.........  Vein x-ray, eye          0.00         2.89         1.88            NA           NA          0.06  XXX
                                         socket.
75885........  ...........  A.........  Vein x-ray, liver        1.44         3.16         8.08            NA           NA          0.71  XXX
75885........  26.........  A.........  Vein x-ray, liver        1.44         0.52         0.48          0.52         0.48          0.06  XXX
75885........  TC.........  A.........  Vein x-ray, liver        0.00         2.63         7.60            NA           NA          0.65  XXX
75887........  ...........  A.........  Vein x-ray, liver        1.44         3.40         8.20            NA           NA          0.71  XXX
75887........  26.........  A.........  Vein x-ray, liver        1.44         0.57         0.50          0.57         0.50          0.06  XXX
75887........  TC.........  A.........  Vein x-ray, liver        0.00         2.83         7.70            NA           NA          0.65  XXX
75889........  ...........  A.........  Vein x-ray, liver        1.14         3.06         7.98            NA           NA          0.70  XXX
75889........  26.........  A.........  Vein x-ray, liver        1.14         0.42         0.38          0.42         0.38          0.05  XXX
75889........  TC.........  A.........  Vein x-ray, liver        0.00         2.64         7.60            NA           NA          0.65  XXX
75891........  ...........  A.........  Vein x-ray, liver        1.14         3.05         7.98            NA           NA          0.70  XXX
75891........  26.........  A.........  Vein x-ray, liver        1.14         0.42         0.38          0.42         0.38          0.05  XXX
75891........  TC.........  A.........  Vein x-ray, liver        0.00         2.63         7.60            NA           NA          0.65  XXX
75893........  ...........  A.........  Venous sampling          0.54         2.83         7.79            NA           NA          0.67  XXX
                                         by catheter.
75893........  26.........  A.........  Venous sampling          0.54         0.20         0.19          0.20         0.19          0.02  XXX
                                         by catheter.
75893........  TC.........  A.........  Venous sampling          0.00         2.64         7.61            NA           NA          0.65  XXX
                                         by catheter.
75894........  ...........  C.........  X-rays, transcath        1.31           NA           NA            NA           NA          1.35  XXX
                                         therapy.
75894........  26.........  A.........  X-rays, transcath        1.31         0.46         0.43          0.46         0.43          0.08  XXX
                                         therapy.
75894........  TC.........  C.........  X-rays, transcath        0.00           NA           NA            NA           NA          1.27  XXX
                                         therapy.
75896........  ...........  C.........  X-rays, transcath        1.31           NA           NA            NA           NA          1.15  XXX
                                         therapy.
75896........  26.........  A.........  X-rays, transcath        1.31         0.51         0.48          0.51         0.48          0.05  XXX
                                         therapy.
75896........  TC.........  C.........  X-rays, transcath        0.00           NA           NA            NA           NA          1.10  XXX
                                         therapy.
75898........  ...........  C.........  Follow-up                1.65           NA           NA            NA           NA          0.13  XXX
                                         angiography.
75898........  26.........  A.........  Follow-up                1.65         0.63         0.58          0.63         0.58          0.07  XXX
                                         angiography.
75898........  TC.........  C.........  Follow-up                0.00           NA           NA            NA           NA          0.06  XXX
                                         angiography.
75900........  ...........  C.........  Intravascular            0.49         0.00        10.60          0.00        10.60          0.03  XXX
                                         cath exchange.
75900........  26.........  A.........  Intravascular            0.49         0.17         0.16          0.17         0.16          0.03  XXX
                                         cath exchange.
75900........  TC.........  C.........  Intravascular            0.00         0.00        10.49          0.00        10.49          0.00  XXX
                                         cath exchange.
75901........  ...........  A.........  Remove cva device        0.49         4.11         2.76            NA           NA          0.85  XXX
                                         obstruct.
75901........  26.........  A.........  Remove cva device        0.49         0.17         0.16          0.17         0.16          0.02  XXX
                                         obstruct.
75901........  TC.........  A.........  Remove cva device        0.00         3.94         2.60            NA           NA          0.83  XXX
                                         obstruct.
75902........  ...........  A.........  Remove cva lumen         0.39         1.62         1.52            NA           NA          0.85  XXX
                                         obstruct.
75902........  26.........  A.........  Remove cva lumen         0.39         0.14         0.13          0.14         0.13          0.02  XXX
                                         obstruct.
75902........  TC.........  A.........  Remove cva lumen         0.00         1.49         1.39            NA           NA          0.83  XXX
                                         obstruct.
75940........  ...........  C.........  X-ray placement,         0.54           NA           NA            NA           NA          0.69  XXX
                                         vein filter.
75940........  26.........  A.........  X-ray placement,         0.54         0.19         0.18          0.19         0.18          0.04  XXX
                                         vein filter.
75940........  TC.........  C.........  X-ray placement,         0.00           NA           NA            NA           NA          0.65  XXX
                                         vein filter.
75945........  ...........  C.........  Intravascular us.        0.40           NA           NA            NA           NA          0.28  XXX
75945........  26.........  A.........  Intravascular us.        0.40         0.14         0.14          0.14         0.14          0.04  XXX
75945........  TC.........  C.........  Intravascular us.        0.00           NA           NA            NA           NA          0.24  XXX
75946........  ...........  C.........  Intravascular us         0.40         0.00         0.09          0.00         0.09          0.05  ZZZ
                                         add-on.
75946........  26.........  A.........  Intravascular us         0.40         0.12         0.13          0.12         0.13          0.05  ZZZ
                                         add-on.
75946........  TC.........  C.........  Intravascular us         0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         add-on.
75952........  ...........  C.........  Endovasc repair          4.49         0.00         0.96          0.00         0.96          0.43  XXX
                                         abdom aorta.
75952........  26.........  A.........  Endovasc repair          4.49         1.30         1.39          1.30         1.39          0.43  XXX
                                         abdom aorta.
75952........  TC.........  C.........  Endovasc repair          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         abdom aorta.
75953........  ...........  C.........  Abdom aneurysm           1.36         0.00         0.29          0.00         0.29          0.13  XXX
                                         endovas rpr.
75953........  26.........  A.........  Abdom aneurysm           1.36         0.40         0.43          0.40         0.43          0.13  XXX
                                         endovas rpr.
75953........  TC.........  C.........  Abdom aneurysm           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         endovas rpr.
75954........  ...........  C.........  Iliac aneurysm           2.25         0.00         0.50          0.00         0.50          0.15  XXX
                                         endovas rpr.
75954........  26.........  A.........  Iliac aneurysm           2.25         0.63         0.71          0.63         0.71          0.15  XXX
                                         endovas rpr.
75954........  TC.........  C.........  Iliac aneurysm           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         endovas rpr.
75956........  ...........  C.........  Xray, endovasc           7.00         0.00         1.65          0.00         1.65          0.69  XXX
                                         thor ao repr.
75956........  26.........  A.........  Xray, endovasc           7.00         1.87         2.27          1.87         2.27          0.69  XXX
                                         thor ao repr.
75956........  TC.........  C.........  Xray, endovasc           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         thor ao repr.

[[Page 38325]]

 
75957........  ...........  C.........  Xray, endovasc           6.00         0.00         1.41          0.00         1.41          0.59  XXX
                                         thor ao repr.
75957........  26.........  A.........  Xray, endovasc           6.00         1.64         1.96          1.64         1.96          0.59  XXX
                                         thor ao repr.
75957........  TC.........  C.........  Xray, endovasc           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         thor ao repr.
75958........  ...........  C.........  Xray, place prox         4.00         0.00         0.94          0.00         0.94          0.39  XXX
                                         ext thor ao.
75958........  26.........  A.........  Xray, place prox         4.00         1.05         1.29          1.05         1.29          0.39  XXX
                                         ext thor ao.
75958........  TC.........  C.........  Xray, place prox         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ext thor ao.
75959........  ...........  C.........  Xray, place dist         3.50         0.00         0.83          0.00         0.83          0.34  XXX
                                         ext thor ao.
75959........  26.........  A.........  Xray, place dist         3.50         0.91         1.13          0.91         1.13          0.34  XXX
                                         ext thor ao.
75959........  TC.........  C.........  Xray, place dist         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ext thor ao.
75960........  ...........  C.........  Transcath iv             0.82         0.00         0.19          0.00         0.19          0.82  XXX
                                         stent rs&i.
75960........  26.........  A.........  Transcath iv             0.82         0.31         0.30          0.31         0.30          0.05  XXX
                                         stent rs&i.
75960........  TC.........  C.........  Transcath iv             0.00         0.00         9.96          0.00         9.96          0.77  XXX
                                         stent rs&i.
75961........  ...........  A.........  Retrieval, broken        4.24         4.64         8.21            NA           NA          0.73  XXX
                                         catheter.
75961........  26.........  A.........  Retrieval, broken        4.24         1.50         1.41          1.50         1.41          0.18  XXX
                                         catheter.
75961........  TC.........  A.........  Retrieval, broken        0.00         3.15         6.80            NA           NA          0.55  XXX
                                         catheter.
75962........  ...........  A.........  Repair arterial          0.54         3.43         9.68            NA           NA          0.86  XXX
                                         blockage.
75962........  26.........  A.........  Repair arterial          0.54         0.20         0.19          0.20         0.19          0.03  XXX
                                         blockage.
75962........  TC.........  A.........  Repair arterial          0.00         3.23         9.49            NA           NA          0.83  XXX
                                         blockage.
75964........  ...........  A.........  Repair artery            0.36         2.31         5.41          2.31         5.41          0.46  ZZZ
                                         blockage, each.
75964........  26.........  A.........  Repair artery            0.36         0.13         0.12          0.13         0.12          0.03  ZZZ
                                         blockage, each.
75964........  TC.........  A.........  Repair artery            0.00         2.18         5.29          2.18         5.29          0.43  ZZZ
                                         blockage, each.
75966........  ...........  A.........  Repair arterial          1.31         4.06        10.14            NA           NA          0.89  XXX
                                         blockage.
75966........  26.........  A.........  Repair arterial          1.31         0.55         0.51          0.55         0.51          0.06  XXX
                                         blockage.
75966........  TC.........  A.........  Repair arterial          0.00         3.50         9.63            NA           NA          0.83  XXX
                                         blockage.
75968........  ...........  A.........  Repair artery            0.36         2.35         5.44          2.35         5.44          0.45  ZZZ
                                         blockage, each.
75968........  26.........  A.........  Repair artery            0.36         0.15         0.14          0.15         0.14          0.02  ZZZ
                                         blockage, each.
75968........  TC.........  A.........  Repair artery            0.00         2.19         5.30          2.19         5.30          0.43  ZZZ
                                         blockage, each.
75970........  ...........  C.........  Vascular biopsy..        0.83           NA           NA            NA           NA          0.64  XXX
75970........  26.........  A.........  Vascular biopsy..        0.83         0.31         0.29          0.31         0.29          0.04  XXX
75970........  TC.........  C.........  Vascular biopsy..        0.00           NA           NA            NA           NA          0.60  XXX
75978........  ...........  A.........  Repair venous            0.54         3.23         9.56            NA           NA          0.85  XXX
                                         blockage.
75978........  26.........  A.........  Repair venous            0.54         0.18         0.18          0.18         0.18          0.02  XXX
                                         blockage.
75978........  TC.........  A.........  Repair venous            0.00         3.05         9.38            NA           NA          0.83  XXX
                                         blockage.
75980........  ...........  C.........  Contrast xray            1.44           NA           NA            NA           NA          0.35  XXX
                                         exam bile duct.
75980........  26.........  A.........  Contrast xray            1.44         0.53         0.48          0.53         0.48          0.06  XXX
                                         exam bile duct.
75980........  TC.........  C.........  Contrast xray            0.00         0.00         3.62          0.00         3.62          0.29  XXX
                                         exam bile duct.
75982........  ...........  C.........  Contrast xray            1.44         0.00         0.31          0.00         0.31          0.06  XXX
                                         exam bile duct.
75982........  26.........  A.........  Contrast xray            1.44         0.53         0.48          0.53         0.48          0.06  XXX
                                         exam bile duct.
75982........  TC.........  C.........  Contrast xray            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         exam bile duct.
75984........  ...........  A.........  Xray control             0.72         2.30         2.22            NA           NA          0.14  XXX
                                         catheter change.
75984........  26.........  A.........  Xray control             0.72         0.26         0.24          0.26         0.24          0.03  XXX
                                         catheter change.
75984........  TC.........  A.........  Xray control             0.00         2.03         1.98            NA           NA          0.11  XXX
                                         catheter change.
75989........  ...........  A.........  Abscess drainage         1.19         2.23         2.86            NA           NA          0.22  XXX
                                         under x-ray.
75989........  26.........  A.........  Abscess drainage         1.19         0.43         0.40          0.43         0.40          0.05  XXX
                                         under x-ray.
75989........  TC.........  A.........  Abscess drainage         0.00         1.80         2.47            NA           NA          0.17  XXX
                                         under x-ray.
75992........  ...........  C.........  Atherectomy, x-          0.54           NA           NA            NA           NA          0.86  XXX
                                         ray exam.
75992........  26.........  A.........  Atherectomy, x-          0.54         0.22         0.21          0.22         0.21          0.03  XXX
                                         ray exam.
75992........  TC.........  C.........  Atherectomy, x-          0.00         0.00        10.53          0.00        10.53          0.83  XXX
                                         ray exam.
75993........  ...........  C.........  Atherectomy, x-          0.36         0.00         4.29          0.00         4.29          0.02  ZZZ
                                         ray exam.
75993........  26.........  A.........  Atherectomy, x-          0.36         0.14         0.14          0.14         0.14          0.02  ZZZ
                                         ray exam.
75993........  TC.........  C.........  Atherectomy, x-          0.00         0.00         4.20          0.00         4.20          0.00  ZZZ
                                         ray exam.
75994........  ...........  C.........  Atherectomy, x-          1.31         0.00         8.21          0.00         8.21          0.07  XXX
                                         ray exam.
75994........  26.........  A.........  Atherectomy, x-          1.31         0.52         0.51          0.52         0.51          0.07  XXX
                                         ray exam.
75994........  TC.........  C.........  Atherectomy, x-          0.00         0.00         7.87          0.00         7.87          0.00  XXX
                                         ray exam.
75995........  ...........  C.........  Atherectomy, x-          1.31         0.00         8.19          0.00         8.19          0.05  XXX
                                         ray exam.
75995........  26.........  A.........  Atherectomy, x-          1.31         0.47         0.48          0.47         0.48          0.05  XXX
                                         ray exam.
75995........  TC.........  C.........  Atherectomy, x-          0.00         0.00         7.87          0.00         7.87          0.00  XXX
                                         ray exam.
75996........  ...........  C.........  Atherectomy, x-          0.36         0.00         4.29          0.00         4.29          0.02  ZZZ
                                         ray exam.
75996........  26.........  A.........  Atherectomy, x-          0.36         0.12         0.13          0.12         0.13          0.02  ZZZ
                                         ray exam.
75996........  TC.........  C.........  Atherectomy, x-          0.00         0.00         4.20          0.00         4.20          0.00  ZZZ
                                         ray exam.
76000........  ...........  A.........  Fluoroscope              0.17         2.74         2.03            NA           NA          0.08  XXX
                                         examination.
76000........  26.........  A.........  Fluoroscope              0.17         0.06         0.05          0.06         0.05          0.01  XXX
                                         examination.
76000........  TC.........  A.........  Fluoroscope              0.00         2.68         1.98            NA           NA          0.07  XXX
                                         examination.
76001........  ...........  C.........  Fluoroscope exam,        0.67           NA           NA            NA           NA          0.19  XXX
                                         extensive.
76001........  26.........  A.........  Fluoroscope exam,        0.67         0.24         0.23          0.24         0.23          0.05  XXX
                                         extensive.
76001........  TC.........  C.........  Fluoroscope exam,        0.00           NA           NA            NA           NA          0.14  XXX
                                         extensive.
76010........  ...........  A.........  X-ray, nose to           0.18         0.54         0.56            NA           NA          0.03  XXX
                                         rectum.
76010........  26.........  A.........  X-ray, nose to           0.18         0.06         0.06          0.06         0.06          0.01  XXX
                                         rectum.
76010........  TC.........  A.........  X-ray, nose to           0.00         0.47         0.50            NA           NA          0.02  XXX
                                         rectum.
76080........  ...........  A.........  X-ray exam of            0.54         1.09         1.15            NA           NA          0.08  XXX
                                         fistula.
76080........  26.........  A.........  X-ray exam of            0.54         0.20         0.19          0.20         0.19          0.02  XXX
                                         fistula.
76080........  TC.........  A.........  X-ray exam of            0.00         0.89         0.96            NA           NA          0.06  XXX
                                         fistula.

[[Page 38326]]

 
76098........  ...........  A.........  X-ray exam,              0.16         0.32         0.39            NA           NA          0.03  XXX
                                         breast specimen.
76098........  26.........  A.........  X-ray exam,              0.16         0.06         0.05          0.06         0.05          0.01  XXX
                                         breast specimen.
76098........  TC.........  A.........  X-ray exam,              0.00         0.27         0.34            NA           NA          0.02  XXX
                                         breast specimen.
76100........  ...........  A.........  X-ray exam of            0.58         3.53         2.46            NA           NA          0.10  XXX
                                         body section.
76100........  26.........  A.........  X-ray exam of            0.58         0.21         0.20          0.21         0.20          0.03  XXX
                                         body section.
76100........  TC.........  A.........  X-ray exam of            0.00         3.33         2.27            NA           NA          0.07  XXX
                                         body section.
76101........  ...........  A.........  Complex body             0.58         5.44         3.48            NA           NA          0.11  XXX
                                         section x-ray.
76101........  26.........  A.........  Complex body             0.58         0.19         0.19          0.19         0.19          0.03  XXX
                                         section x-ray.
76101........  TC.........  A.........  Complex body             0.00         5.25         3.29            NA           NA          0.08  XXX
                                         section x-ray.
76102........  ...........  A.........  Complex body             0.58         7.60         4.77            NA           NA          0.14  XXX
                                         section x-rays.
76102........  26.........  A.........  Complex body             0.58         0.18         0.19          0.18         0.19          0.03  XXX
                                         section x-rays.
76102........  TC.........  A.........  Complex body             0.00         7.41         4.58            NA           NA          0.11  XXX
                                         section x-rays.
76120........  ...........  A.........  Cine/video x-rays        0.38         1.84         1.51            NA           NA          0.08  XXX
76120........  26.........  A.........  Cine/video x-rays        0.38         0.13         0.13          0.13         0.13          0.02  XXX
76120........  TC.........  A.........  Cine/video x-rays        0.00         1.71         1.38            NA           NA          0.06  XXX
76125........  ...........  C.........  Cine/video x-rays        0.27           NA           NA            NA           NA          0.06  ZZZ
                                         add-on.
76125........  26.........  A.........  Cine/video x-rays        0.27         0.11         0.10          0.11         0.10          0.01  ZZZ
                                         add-on.
76125........  TC.........  C.........  Cine/video x-rays        0.00         0.00         0.52          0.00         0.52          0.05  ZZZ
                                         add-on.
76150........  ...........  A.........  X-ray exam, dry          0.00         0.67         0.54            NA           NA          0.02  XXX
                                         process.
76350........  ...........  C.........  Special x-ray            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         contrast study.
76376........  ...........  A.........  3d render w/o            0.20         1.39         2.43            NA           NA          0.10  XXX
                                         postprocess.
76376........  26.........  A.........  3d render w/o            0.20         0.07         0.07          0.07         0.07          0.02  XXX
                                         postprocess.
76376........  TC.........  A.........  3d render w/o            0.00         1.32         2.36            NA           NA          0.08  XXX
                                         postprocess.
76377........  ...........  A.........  3d rendering w/          0.79         1.40         2.53            NA           NA          0.39  XXX
                                         postprocess.
76377........  26.........  A.........  3d rendering w/          0.79         0.28         0.27          0.28         0.27          0.08  XXX
                                         postprocess.
76377........  TC.........  A.........  3d rendering w/          0.00         1.11         2.26            NA           NA          0.31  XXX
                                         postprocess.
76380........  ...........  A.........  CAT scan follow-         0.98         4.68         4.21            NA           NA          0.22  XXX
                                         up study.
76380........  26.........  A.........  CAT scan follow-         0.98         0.34         0.32          0.34         0.32          0.04  XXX
                                         up study.
76380........  TC.........  A.........  CAT scan follow-         0.00         4.33         3.89            NA           NA          0.18  XXX
                                         up study.
76390........  ...........  N.........  Mr spectroscopy..        1.40         9.31        10.40            NA           NA          0.66  XXX
76390........  26.........  N.........  Mr spectroscopy..        1.40         0.32         0.39          0.32         0.39          0.07  XXX
76390........  TC.........  N.........  Mr spectroscopy..        0.00         8.99        10.00            NA           NA          0.59  XXX
76496........  ...........  C.........  Fluoroscopic             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
76496........  26.........  C.........  Fluoroscopic             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
76496........  TC.........  C.........  Fluoroscopic             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
76497........  ...........  C.........  Ct procedure.....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
76497........  26.........  C.........  Ct procedure.....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
76497........  TC.........  C.........  Ct procedure.....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
76498........  ...........  C.........  Mri procedure....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
76498........  26.........  C.........  Mri procedure....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
76498........  TC.........  C.........  Mri procedure....        0.00         0.00         0.00          0.00         0.00          0.00  XXX
76499........  ...........  C.........  Radiographic             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
76499........  26.........  C.........  Radiographic             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
76499........  TC.........  C.........  Radiographic             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
76506........  ...........  A.........  Echo exam of head        0.63         2.75         2.20            NA           NA          0.14  XXX
76506........  26.........  A.........  Echo exam of head        0.63         0.21         0.22          0.21         0.22          0.06  XXX
76506........  TC.........  A.........  Echo exam of head        0.00         2.54         1.97            NA           NA          0.08  XXX
76510........  ...........  A.........  Ophth us, b &            1.55         2.25         2.57            NA           NA          0.10  XXX
                                         quant a.
76510........  26.........  A.........  Ophth us, b &            1.55         0.56         0.63          0.56         0.63          0.03  XXX
                                         quant a.
76510........  TC.........  A.........  Ophth us, b &            0.00         1.69         1.94            NA           NA          0.07  XXX
                                         quant a.
76511........  ...........  A.........  Ophth us, quant a        0.94         1.35         1.90            NA           NA          0.10  XXX
                                         only.
76511........  26.........  A.........  Ophth us, quant a        0.94         0.33         0.37          0.33         0.37          0.03  XXX
                                         only.
76511........  TC.........  A.........  Ophth us, quant a        0.00         1.01         1.52            NA           NA          0.07  XXX
                                         only.
76512........  ...........  A.........  Ophth us, b w/non-       0.94         1.16         1.70            NA           NA          0.12  XXX
                                         quant a.
76512........  26.........  A.........  Ophth us, b w/non-       0.94         0.33         0.38          0.33         0.38          0.02  XXX
                                         quant a.
76512........  TC.........  A.........  Ophth us, b w/non-       0.00         0.82         1.32            NA           NA          0.10  XXX
                                         quant a.
76513........  ...........  A.........  Echo exam of eye,        0.66         1.52         1.67            NA           NA          0.12  XXX
                                         water bath.
76513........  26.........  A.........  Echo exam of eye,        0.66         0.24         0.27          0.24         0.27          0.02  XXX
                                         water bath.
76513........  TC.........  A.........  Echo exam of eye,        0.00         1.29         1.41            NA           NA          0.10  XXX
                                         water bath.
76514........  ...........  A.........  Echo exam of eye,        0.17         0.16         0.15            NA           NA          0.02  XXX
                                         thickness.
76514........  26.........  A.........  Echo exam of eye,        0.17         0.06         0.07          0.06         0.07          0.01  XXX
                                         thickness.
76514........  TC.........  A.........  Echo exam of eye,        0.00         0.10         0.08            NA           NA          0.01  XXX
                                         thickness.
76516........  ...........  A.........  Echo exam of eye.        0.54         1.16         1.31            NA           NA          0.08  XXX
76516........  26.........  A.........  Echo exam of eye.        0.54         0.19         0.22          0.19         0.22          0.01  XXX
76516........  TC.........  A.........  Echo exam of eye.        0.00         0.97         1.10            NA           NA          0.07  XXX
76519........  ...........  A.........  Echo exam of eye.        0.54         1.29         1.42            NA           NA          0.08  XXX
76519........  26.........  A.........  Echo exam of eye.        0.54         0.20         0.22          0.20         0.22          0.01  XXX
76519........  TC.........  A.........  Echo exam of eye.        0.00         1.09         1.20            NA           NA          0.07  XXX
76529........  ...........  A.........  Echo exam of eye.        0.57         1.16         1.27            NA           NA          0.10  XXX
76529........  26.........  A.........  Echo exam of eye.        0.57         0.20         0.22          0.20         0.22          0.02  XXX
76529........  TC.........  A.........  Echo exam of eye.        0.00         0.95         1.04            NA           NA          0.08  XXX
76536........  ...........  A.........  Us exam of head          0.56         2.65         2.10            NA           NA          0.10  XXX
                                         and neck.

[[Page 38327]]

 
76536........  26.........  A.........  Us exam of head          0.56         0.18         0.17          0.18         0.17          0.02  XXX
                                         and neck.
76536........  TC.........  A.........  Us exam of head          0.00         2.47         1.93            NA           NA          0.08  XXX
                                         and neck.
76604........  ...........  A.........  Us exam, chest...        0.55         1.82         1.63            NA           NA          0.09  XXX
76604........  26.........  A.........  Us exam, chest...        0.55         0.19         0.18          0.19         0.18          0.02  XXX
76604........  TC.........  A.........  Us exam, chest...        0.00         1.63         1.46            NA           NA          0.07  XXX
76645........  ...........  A.........  Us exam,                 0.54         2.10         1.64            NA           NA          0.08  XXX
                                         breast(s).
76645........  26.........  A.........  Us exam,                 0.54         0.19         0.18          0.19         0.18          0.02  XXX
                                         breast(s).
76645........  TC.........  A.........  Us exam,                 0.00         1.91         1.46            NA           NA          0.06  XXX
                                         breast(s).
76700........  ...........  A.........  Us exam, abdom,          0.81         3.00         2.59            NA           NA          0.15  XXX
                                         complete.
76700........  26.........  A.........  Us exam, abdom,          0.81         0.28         0.27          0.28         0.27          0.04  XXX
                                         complete.
76700........  TC.........  A.........  Us exam, abdom,          0.00         2.72         2.33            NA           NA          0.11  XXX
                                         complete.
76705........  ...........  A.........  Echo exam of             0.59         2.33         1.96            NA           NA          0.11  XXX
                                         abdomen.
76705........  26.........  A.........  Echo exam of             0.59         0.21         0.20          0.21         0.20          0.03  XXX
                                         abdomen.
76705........  TC.........  A.........  Echo exam of             0.00         2.13         1.76            NA           NA          0.08  XXX
                                         abdomen.
76770........  ...........  A.........  Us exam abdo back        0.74         2.91         2.54            NA           NA          0.14  XXX
                                         wall, comp.
76770........  26.........  A.........  Us exam abdo back        0.74         0.26         0.25          0.26         0.25          0.03  XXX
                                         wall, comp.
76770........  TC.........  A.........  Us exam abdo back        0.00         2.65         2.30            NA           NA          0.11  XXX
                                         wall, comp.
76775........  ...........  A.........  Us exam abdo back        0.58         2.40         1.98            NA           NA          0.11  XXX
                                         wall, lim.
76775........  26.........  A.........  Us exam abdo back        0.58         0.21         0.20          0.21         0.20          0.03  XXX
                                         wall, lim.
76775........  TC.........  A.........  Us exam abdo back        0.00         2.19         1.78            NA           NA          0.08  XXX
                                         wall, lim.
76776........  ...........  A.........  Us exam k transpl        0.76         3.41         2.62            NA           NA          0.14  XXX
                                         w/doppler.
76776........  26.........  A.........  Us exam k transpl        0.76         0.27         0.25          0.27         0.25          0.03  XXX
                                         w/doppler.
76776........  TC.........  A.........  Us exam k transpl        0.00         3.13         2.36            NA           NA          0.11  XXX
                                         w/doppler.
76800........  ...........  A.........  Us exam, spinal          1.13         2.30         2.03            NA           NA          0.13  XXX
                                         canal.
76800........  26.........  A.........  Us exam, spinal          1.13         0.29         0.32          0.29         0.32          0.05  XXX
                                         canal.
76800........  TC.........  A.........  Us exam, spinal          0.00         2.01         1.71            NA           NA          0.08  XXX
                                         canal.
76801........  ...........  A.........  Ob us < 14 wks,          0.99         2.45         2.44            NA           NA          0.16  XXX
                                         single fetus.
76801........  26.........  A.........  Ob us < 14 wks,          0.99         0.31         0.32          0.31         0.32          0.04  XXX
                                         single fetus.
76801........  TC.........  A.........  Ob us < 14 wks,          0.00         2.14         2.11            NA           NA          0.12  XXX
                                         single fetus.
76802........  ...........  A.........  Ob us < 14 wks,          0.83         0.97         1.15          0.97         1.15          0.16  ZZZ
                                         add[boxHu]l
                                         fetus.
76802........  26.........  A.........  Ob us < 14 wks,          0.83         0.27         0.28          0.27         0.28          0.04  ZZZ
                                         add[boxHu]l
                                         fetus.
76802........  TC.........  A.........  Ob us < 14 wks,          0.00         0.70         0.87          0.70         0.87          0.12  ZZZ
                                         add[boxHu]l
                                         fetus.
76805........  ...........  A.........  Ob us >/= 14 wks,        0.99         3.02         2.71            NA           NA          0.16  XXX
                                         sngl fetus.
76805........  26.........  A.........  Ob us >/= 14 wks,        0.99         0.31         0.32          0.31         0.32          0.04  XXX
                                         sngl fetus.
76805........  TC.........  A.........  Ob us >/= 14 wks,        0.00         2.71         2.39            NA           NA          0.12  XXX
                                         sngl fetus.
76810........  ...........  A.........  Ob us >/= 14 wks,        0.98         1.64         1.51          1.64         1.51          0.26  ZZZ
                                         addl fetus.
76810........  26.........  A.........  Ob us >/= 14 wks,        0.98         0.30         0.31          0.30         0.31          0.04  ZZZ
                                         addl fetus.
76810........  TC.........  A.........  Ob us >/= 14 wks,        0.00         1.34         1.19          1.34         1.19          0.22  ZZZ
                                         addl fetus.
76811........  ...........  A.........  Ob us, detailed,         1.90         3.04         3.63            NA           NA          0.52  XXX
                                         sngl fetus.
76811........  26.........  A.........  Ob us, detailed,         1.90         0.55         0.63          0.55         0.63          0.09  XXX
                                         sngl fetus.
76811........  TC.........  A.........  Ob us, detailed,         0.00         2.49         3.00            NA           NA          0.43  XXX
                                         sngl fetus.
76812........  ...........  A.........  Ob us, detailed,         1.78         3.96         2.82          3.96         2.82          0.49  ZZZ
                                         addl fetus.
76812........  26.........  A.........  Ob us, detailed,         1.78         0.51         0.58          0.51         0.58          0.08  ZZZ
                                         addl fetus.
76812........  TC.........  A.........  Ob us, detailed,         0.00         3.45         2.24          3.45         2.24          0.41  ZZZ
                                         addl fetus.
76813........  ...........  A.........  Ob us nuchal             1.18         2.20         2.11            NA           NA          0.19  XXX
                                         meas, 1 gest.
76813........  26.........  A.........  Ob us nuchal             1.18         0.40         0.35          0.40         0.35          0.05  XXX
                                         meas, 1 gest.
76813........  TC.........  A.........  Ob us nuchal             0.00         1.80         1.75            NA           NA          0.14  XXX
                                         meas, 1 gest.
76814........  ...........  A.........  Ob us nuchal             0.99         1.15         1.12            NA           NA          0.19  XXX
                                         meas, add-on.
76814........  26.........  A.........  Ob us nuchal             0.99         0.29         0.28          0.29         0.28          0.05  XXX
                                         meas, add-on.
76814........  TC.........  A.........  Ob us nuchal             0.00         0.85         0.84            NA           NA          0.14  XXX
                                         meas, add-on.
76815........  ...........  A.........  Ob us, limited,          0.65         1.79         1.71            NA           NA          0.11  XXX
                                         fetus(s).
76815........  26.........  A.........  Ob us, limited,          0.65         0.20         0.21          0.20         0.21          0.03  XXX
                                         fetus(s).
76815........  TC.........  A.........  Ob us, limited,          0.00         1.59         1.50            NA           NA          0.08  XXX
                                         fetus(s).
76816........  ...........  A.........  Ob us, follow-up,        0.85         2.36         1.89            NA           NA          0.10  XXX
                                         per fetus.
76816........  26.........  A.........  Ob us, follow-up,        0.85         0.25         0.28          0.25         0.28          0.04  XXX
                                         per fetus.
76816........  TC.........  A.........  Ob us, follow-up,        0.00         2.11         1.61            NA           NA          0.06  XXX
                                         per fetus.
76817........  ...........  A.........  Transvaginal us,         0.75         2.01         1.88            NA           NA          0.09  XXX
                                         obstetric.
76817........  26.........  A.........  Transvaginal us,         0.75         0.23         0.24          0.23         0.24          0.03  XXX
                                         obstetric.
76817........  TC.........  A.........  Transvaginal us,         0.00         1.78         1.64            NA           NA          0.06  XXX
                                         obstetric.
76818........  ...........  A.........  Fetal biophys            1.05         2.21         2.10            NA           NA          0.15  XXX
                                         profile w/nst.
76818........  26.........  A.........  Fetal biophys            1.05         0.31         0.35          0.31         0.35          0.05  XXX
                                         profile w/nst.
76818........  TC.........  A.........  Fetal biophys            0.00         1.90         1.75            NA           NA          0.10  XXX
                                         profile w/nst.
76819........  ...........  A.........  Fetal biophys            0.77         1.62         1.75            NA           NA          0.13  XXX
                                         profil w/o nst.
76819........  26.........  A.........  Fetal biophys            0.77         0.23         0.25          0.23         0.25          0.03  XXX
                                         profil w/o nst.
76819........  TC.........  A.........  Fetal biophys            0.00         1.39         1.50            NA           NA          0.10  XXX
                                         profil w/o nst.
76820........  ...........  A.........  Umbilical artery         0.50         0.56         1.18            NA           NA          0.15  XXX
                                         echo.
76820........  26.........  A.........  Umbilical artery         0.50         0.14         0.17          0.14         0.17          0.03  XXX
                                         echo.
76820........  TC.........  A.........  Umbilical artery         0.00         0.42         1.01            NA           NA          0.12  XXX
                                         echo.
76821........  ...........  A.........  Middle cerebral          0.70         1.86         1.87            NA           NA          0.15  XXX
                                         artery echo.
76821........  26.........  A.........  Middle cerebral          0.70         0.21         0.24          0.21         0.24          0.03  XXX
                                         artery echo.
76821........  TC.........  A.........  Middle cerebral          0.00         1.65         1.63            NA           NA          0.12  XXX
                                         artery echo.
76825........  ...........  A.........  Echo exam of             1.67         4.31         3.44            NA           NA          0.18  XXX
                                         fetal heart.

[[Page 38328]]

 
76825........  26.........  A.........  Echo exam of             1.67         0.50         0.55          0.50         0.55          0.07  XXX
                                         fetal heart.
76825........  TC.........  A.........  Echo exam of             0.00         3.82         2.89            NA           NA          0.11  XXX
                                         fetal heart.
76826........  ...........  A.........  Echo exam of             0.83         2.73         1.86            NA           NA          0.08  XXX
                                         fetal heart.
76826........  26.........  A.........  Echo exam of             0.83         0.24         0.27          0.24         0.27          0.03  XXX
                                         fetal heart.
76826........  TC.........  A.........  Echo exam of             0.00         2.48         1.59            NA           NA          0.05  XXX
                                         fetal heart.
76827........  ...........  A.........  Echo exam of             0.58         1.06         1.49            NA           NA          0.14  XXX
                                         fetal heart.
76827........  26.........  A.........  Echo exam of             0.58         0.17         0.19          0.17         0.19          0.02  XXX
                                         fetal heart.
76827........  TC.........  A.........  Echo exam of             0.00         0.89         1.30            NA           NA          0.12  XXX
                                         fetal heart.
76828........  ...........  A.........  Echo exam of             0.56         0.63         0.98            NA           NA          0.11  XXX
                                         fetal heart.
76828........  26.........  A.........  Echo exam of             0.56         0.16         0.19          0.16         0.19          0.03  XXX
                                         fetal heart.
76828........  TC.........  A.........  Echo exam of             0.00         0.47         0.79            NA           NA          0.08  XXX
                                         fetal heart.
76830........  ...........  A.........  Transvaginal us,         0.69         2.74         2.23            NA           NA          0.13  XXX
                                         non-ob.
76830........  26.........  A.........  Transvaginal us,         0.69         0.23         0.22          0.23         0.22          0.03  XXX
                                         non-ob.
76830........  TC.........  A.........  Transvaginal us,         0.00         2.52         2.01            NA           NA          0.10  XXX
                                         non-ob.
76831........  ...........  A.........  Echo exam, uterus        0.72         2.71         2.24            NA           NA          0.13  XXX
76831........  26.........  A.........  Echo exam, uterus        0.72         0.21         0.23          0.21         0.23          0.03  XXX
76831........  TC.........  A.........  Echo exam, uterus        0.00         2.50         2.01            NA           NA          0.10  XXX
76856........  ...........  A.........  Us exam, pelvic,         0.69         2.77         2.25            NA           NA          0.13  XXX
                                         complete.
76856........  26.........  A.........  Us exam, pelvic,         0.69         0.24         0.23          0.24         0.23          0.03  XXX
                                         complete.
76856........  TC.........  A.........  Us exam, pelvic,         0.00         2.53         2.02            NA           NA          0.10  XXX
                                         complete.
76857........  ...........  A.........  Us exam, pelvic,         0.38         2.48         2.15            NA           NA          0.08  XXX
                                         limited.
76857........  26.........  A.........  Us exam, pelvic,         0.38         0.15         0.14          0.15         0.14          0.02  XXX
                                         limited.
76857........  TC.........  A.........  Us exam, pelvic,         0.00         2.33         2.02            NA           NA          0.06  XXX
                                         limited.
76870........  ...........  A.........  Us exam, scrotum.        0.64         2.80         2.25            NA           NA          0.13  XXX
76870........  26.........  A.........  Us exam, scrotum.        0.64         0.23         0.22          0.23         0.22          0.03  XXX
76870........  TC.........  A.........  Us exam, scrotum.        0.00         2.57         2.03            NA           NA          0.10  XXX
76872........  ...........  A.........  Us, transrectal..        0.69         3.39         2.81            NA           NA          0.14  XXX
76872........  26.........  A.........  Us, transrectal..        0.69         0.27         0.24          0.27         0.24          0.04  XXX
76872........  TC.........  A.........  Us, transrectal..        0.00         3.12         2.57            NA           NA          0.10  XXX
76873........  ...........  A.........  Echograp trans r,        1.55         3.39         3.00            NA           NA          0.25  XXX
                                         pros study.
76873........  26.........  A.........  Echograp trans r,        1.55         0.56         0.53          0.56         0.53          0.09  XXX
                                         pros study.
76873........  TC.........  A.........  Echograp trans r,        0.00         2.83         2.47            NA           NA          0.16  XXX
                                         pros study.
76880........  ...........  A.........  Us exam,                 0.59         3.14         2.36            NA           NA          0.11  XXX
                                         extremity.
76880........  26.........  A.........  Us exam,                 0.59         0.18         0.18          0.18         0.18          0.03  XXX
                                         extremity.
76880........  TC.........  A.........  Us exam,                 0.00         2.96         2.18            NA           NA          0.08  XXX
                                         extremity.
76885........  ...........  A.........  Us exam infant           0.74         3.23         2.46            NA           NA          0.13  XXX
                                         hips, dynamic.
76885........  26.........  A.........  Us exam infant           0.74         0.25         0.24          0.25         0.24          0.03  XXX
                                         hips, dynamic.
76885........  TC.........  A.........  Us exam infant           0.00         2.98         2.23            NA           NA          0.10  XXX
                                         hips, dynamic.
76886........  ...........  A.........  Us exam infant           0.62         2.24         1.92            NA           NA          0.11  XXX
                                         hips, static.
76886........  26.........  A.........  Us exam infant           0.62         0.22         0.20          0.22         0.20          0.03  XXX
                                         hips, static.
76886........  TC.........  A.........  Us exam infant           0.00         2.02         1.72            NA           NA          0.08  XXX
                                         hips, static.
76930........  ...........  A.........  Echo guide,              0.67         2.01         1.90            NA           NA          0.12  XXX
                                         cardiocentesis.
76930........  26.........  A.........  Echo guide,              0.67         0.33         0.29          0.33         0.29          0.02  XXX
                                         cardiocentesis.
76930........  TC.........  A.........  Echo guide,              0.00         1.68         1.61            NA           NA          0.10  XXX
                                         cardiocentesis.
76932........  ...........  C.........  Echo guide for           0.67           NA           NA            NA           NA          0.12  XXX
                                         heart biopsy.
76932........  26.........  A.........  Echo guide for           0.67         0.33         0.30          0.33         0.30          0.02  XXX
                                         heart biopsy.
76932........  TC.........  C.........  Echo guide for           0.00           NA           NA            NA           NA          0.10  XXX
                                         heart biopsy.
76936........  ...........  A.........  Echo guide for           1.99         6.03         6.46            NA           NA          0.47  XXX
                                         artery repair.
76936........  26.........  A.........  Echo guide for           1.99         0.71         0.68          0.71         0.68          0.13  XXX
                                         artery repair.
76936........  TC.........  A.........  Echo guide for           0.00         5.33         5.78            NA           NA          0.34  XXX
                                         artery repair.
76937........  ...........  A.........  Us guide,                0.30         0.61         0.54          0.61         0.54          0.13  ZZZ
                                         vascular access.
76937........  26.........  A.........  Us guide,                0.30         0.10         0.10          0.10         0.10          0.03  ZZZ
                                         vascular access.
76937........  TC.........  A.........  Us guide,                0.00         0.51         0.44          0.51         0.44          0.10  ZZZ
                                         vascular access.
76940........  ...........  C.........  Us guide, tissue         2.00           NA           NA            NA           NA          0.60  XXX
                                         ablation.
76940........  26.........  A.........  Us guide, tissue         2.00         0.65         0.64          0.65         0.64          0.31  XXX
                                         ablation.
76940........  TC.........  C.........  Us guide, tissue         0.00           NA           NA            NA           NA          0.29  XXX
                                         ablation.
76941........  ...........  C.........  Echo guide for           1.34           NA           NA            NA           NA          0.15  XXX
                                         transfusion.
76941........  26.........  A.........  Echo guide for           1.34         0.39         0.44          0.39         0.44          0.07  XXX
                                         transfusion.
76941........  TC.........  C.........  Echo guide for           0.00         0.00         1.02          0.00         1.02          0.08  XXX
                                         transfusion.
76942........  ...........  A.........  Echo guide for           0.67         4.76         3.87            NA           NA          0.13  XXX
                                         biopsy.
76942........  26.........  A.........  Echo guide for           0.67         0.24         0.23          0.24         0.23          0.03  XXX
                                         biopsy.
76942........  TC.........  A.........  Echo guide for           0.00         4.52         3.65            NA           NA          0.10  XXX
                                         biopsy.
76945........  ...........  C.........  Echo guide,              0.67           NA           NA            NA           NA          0.11  XXX
                                         villus sampling.
76945........  26.........  A.........  Echo guide,              0.67         0.20         0.21          0.20         0.21          0.03  XXX
                                         villus sampling.
76945........  TC.........  C.........  Echo guide,              0.00         0.00         1.02          0.00         1.02          0.08  XXX
                                         villus sampling.
76946........  ...........  A.........  Echo guide for           0.38         0.45         1.05            NA           NA          0.12  XXX
                                         amniocentesis.
76946........  26.........  A.........  Echo guide for           0.38         0.11         0.12          0.11         0.12          0.02  XXX
                                         amniocentesis.
76946........  TC.........  A.........  Echo guide for           0.00         0.34         0.93            NA           NA          0.10  XXX
                                         amniocentesis.
76948........  ...........  A.........  Echo guide, ova          0.38         0.44         1.04            NA           NA          0.12  XXX
                                         aspiration.
76948........  26.........  A.........  Echo guide, ova          0.38         0.10         0.11          0.10         0.11          0.02  XXX
                                         aspiration.
76948........  TC.........  A.........  Echo guide, ova          0.00         0.34         0.93            NA           NA          0.10  XXX
                                         aspiration.
76950........  ...........  A.........  Echo guidance            0.58         1.21         1.36            NA           NA          0.10  XXX
                                         radiotherapy.

[[Page 38329]]

 
76950........  26.........  A.........  Echo guidance            0.58         0.19         0.19          0.19         0.19          0.03  XXX
                                         radiotherapy.
76950........  TC.........  A.........  Echo guidance            0.00         1.01         1.16            NA           NA          0.07  XXX
                                         radiotherapy.
76965........  ...........  A.........  Echo guidance            1.34         1.20         3.60            NA           NA          0.37  XXX
                                         radiotherapy.
76965........  26.........  A.........  Echo guidance            1.34         0.50         0.47          0.50         0.47          0.08  XXX
                                         radiotherapy.
76965........  TC.........  A.........  Echo guidance            0.00         0.70         3.13            NA           NA          0.29  XXX
                                         radiotherapy.
76970........  ...........  A.........  Ultrasound exam          0.40         1.96         1.59            NA           NA          0.08  XXX
                                         follow-up.
76970........  26.........  A.........  Ultrasound exam          0.40         0.11         0.12          0.11         0.12          0.02  XXX
                                         follow-up.
76970........  TC.........  A.........  Ultrasound exam          0.00         1.85         1.47            NA           NA          0.06  XXX
                                         follow-up.
76975........  ...........  C.........  GI endoscopic            0.81           NA           NA            NA           NA          0.14  XXX
                                         ultrasound.
76975........  26.........  A.........  GI endoscopic            0.81         0.31         0.29          0.31         0.29          0.04  XXX
                                         ultrasound.
76975........  TC.........  C.........  GI endoscopic            0.00           NA           NA            NA           NA          0.10  XXX
                                         ultrasound.
76977........  ...........  A.........  Us bone density          0.05         0.10         0.47            NA           NA          0.06  XXX
                                         measure.
76977........  26.........  A.........  Us bone density          0.05         0.01         0.02          0.01         0.02          0.01  XXX
                                         measure.
76977........  TC.........  A.........  Us bone density          0.00         0.09         0.46            NA           NA          0.05  XXX
                                         measure.
76998........  ...........  C.........  Us guide, intraop        0.00           NA           NA            NA           NA          0.13  XXX
76998........  26.........  A.........  Us guide, intraop        1.20         0.35         0.38          0.35         0.38          0.13  XXX
76998........  TC.........  C.........  Us guide, intraop        0.00         0.00         1.75          0.00         1.75          0.00  XXX
76999........  ...........  C.........  Echo examination         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
76999........  26.........  C.........  Echo examination         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
76999........  TC.........  C.........  Echo examination         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
77001........  ...........  A.........  Fluoroguide for          0.38         2.70         1.86            NA           NA          0.11  ZZZ
                                         vein device.
77001........  26.........  A.........  Fluoroguide for          0.38         0.13         0.13          0.13         0.13          0.01  ZZZ
                                         vein device.
77001........  TC.........  A.........  Fluoroguide for          0.00         2.57         1.73            NA           NA          0.10  ZZZ
                                         vein device.
77002........  ...........  A.........  Needle                   0.54         1.21         1.39            NA           NA          0.09  XXX
                                         localization by
                                         xray.
77002........  26.........  A.........  Needle                   0.54         0.16         0.17          0.16         0.17          0.02  XXX
                                         localization by
                                         xray.
77002........  TC.........  A.........  Needle                   0.00         1.06         1.23            NA           NA          0.07  XXX
                                         localization by
                                         xray.
77003........  ...........  A.........  Fluoroguide for          0.60         0.75         1.22            NA           NA          0.10  XXX
                                         spine inject.
77003........  26.........  A.........  Fluoroguide for          0.60         0.14         0.15          0.14         0.15          0.03  XXX
                                         spine inject.
77003........  TC.........  A.........  Fluoroguide for          0.00         0.61         1.08            NA           NA          0.07  XXX
                                         spine inject.
77011........  ...........  A.........  Ct scan for              1.21        20.09        12.48            NA           NA          0.47  XXX
                                         localization.
77011........  26.........  A.........  Ct scan for              1.21         0.40         0.40          0.40         0.40          0.05  XXX
                                         localization.
77011........  TC.........  A.........  Ct scan for              0.00        19.68        12.08            NA           NA          0.42  XXX
                                         localization.
77012........  ...........  A.........  Ct scan for              1.16         2.31         6.54            NA           NA          0.47  XXX
                                         needle biopsy.
77012........  26.........  A.........  Ct scan for              1.16         0.42         0.39          0.42         0.39          0.05  XXX
                                         needle biopsy.
77012........  TC.........  A.........  Ct scan for              0.00         1.90         6.15            NA           NA          0.42  XXX
                                         needle biopsy.
77013........  ...........  C.........  Ct guide for             0.00           NA           NA            NA           NA          0.18  XXX
                                         tissue ablation.
77013........  26.........  A.........  Ct guide for             3.99         1.43         1.34          1.43         1.34          0.18  XXX
                                         tissue ablation.
77013........  TC.........  C.........  Ct guide for             0.00         0.00         5.52          0.00         5.52          0.00  XXX
                                         tissue ablation.
77014........  ...........  A.........  Ct scan for              0.85         4.44         3.64            NA           NA          0.20  XXX
                                         therapy guide.
77014........  26.........  A.........  Ct scan for              0.85         0.29         0.28          0.29         0.28          0.04  XXX
                                         therapy guide.
77014........  TC.........  A.........  Ct scan for              0.00         4.16         3.36            NA           NA          0.16  XXX
                                         therapy guide.
77021........  ...........  A.........  Mr guidance for          1.50         9.63        11.03            NA           NA          0.64  XXX
                                         needle place.
77021........  26.........  A.........  Mr guidance for          1.50         0.53         0.51          0.53         0.51          0.09  XXX
                                         needle place.
77021........  TC.........  A.........  Mr guidance for          0.00         9.10        10.52            NA           NA          0.55  XXX
                                         needle place.
77022........  ...........  C.........  Mri for tissue           0.00           NA           NA            NA           NA          0.24  XXX
                                         ablation.
77022........  26.........  A.........  Mri for tissue           4.24         1.61         1.46          1.61         1.46          0.24  XXX
                                         ablation.
77022........  TC.........  C.........  Mri for tissue           0.00         0.00         7.49          0.00         7.49          0.00  XXX
                                         ablation.
77031........  ...........  A.........  Stereotact guide         1.59         1.86         5.75            NA           NA          0.46  XXX
                                         for brst bx.
77031........  26.........  A.........  Stereotact guide         1.59         0.54         0.53          0.54         0.53          0.09  XXX
                                         for brst bx.
77031........  TC.........  A.........  Stereotact guide         0.00         1.32         5.23            NA           NA          0.37  XXX
                                         for brst bx.
77032........  ...........  A.........  Guidance for             0.56         0.62         1.20            NA           NA          0.09  XXX
                                         needle, breast.
77032........  26.........  A.........  Guidance for             0.56         0.20         0.19          0.20         0.19          0.02  XXX
                                         needle, breast.
77032........  TC.........  A.........  Guidance for             0.00         0.42         1.01            NA           NA          0.07  XXX
                                         needle, breast.
77051........  ...........  A.........  Computer dx              0.06         0.20         0.36          0.20         0.36          0.02  ZZZ
                                         mammogram add-on.
77051........  26.........  A.........  Computer dx              0.06         0.02         0.02          0.02         0.02          0.01  ZZZ
                                         mammogram add-on.
77051........  TC.........  A.........  Computer dx              0.00         0.18         0.34          0.18         0.34          0.01  ZZZ
                                         mammogram add-on.
77052........  ...........  A.........  Comp screen              0.06         0.20         0.36          0.20         0.36          0.02  ZZZ
                                         mammogram add-on.
77052........  26.........  A.........  Comp screen              0.06         0.02         0.02          0.02         0.02          0.01  ZZZ
                                         mammogram add-on.
77052........  TC.........  A.........  Comp screen              0.00         0.18         0.34          0.18         0.34          0.01  ZZZ
                                         mammogram add-on.
77053........  ...........  A.........  X-ray of mammary         0.36         0.65         2.05            NA           NA          0.16  XXX
                                         duct.
77053........  26.........  A.........  X-ray of mammary         0.36         0.13         0.12          0.13         0.12          0.02  XXX
                                         duct.
77053........  TC.........  A.........  X-ray of mammary         0.00         0.52         1.93            NA           NA          0.14  XXX
                                         duct.
77054........  ...........  A.........  X-ray of mammary         0.45         1.66         3.10            NA           NA          0.21  XXX
                                         ducts.
77054........  26.........  A.........  X-ray of mammary         0.45         0.16         0.15          0.16         0.15          0.02  XXX
                                         ducts.
77054........  TC.........  A.........  X-ray of mammary         0.00         1.50         2.95            NA           NA          0.19  XXX
                                         ducts.
77055........  ...........  A.........  Mammogram, one           0.70         1.64         1.40            NA           NA          0.09  XXX
                                         breast.
77055........  26.........  A.........  Mammogram, one           0.70         0.25         0.24          0.25         0.24          0.03  XXX
                                         breast.
77055........  TC.........  A.........  Mammogram, one           0.00         1.39         1.16            NA           NA          0.06  XXX
                                         breast.
77056........  ...........  A.........  Mammogram, both          0.87         2.13         1.77            NA           NA          0.11  XXX
                                         breasts.
77056........  26.........  A.........  Mammogram, both          0.87         0.31         0.29          0.31         0.29          0.04  XXX
                                         breasts.
77056........  TC.........  A.........  Mammogram, both          0.00         1.82         1.48            NA           NA          0.07  XXX
                                         breasts.
77057........  ...........  A.........  Mammogram,               0.70         1.44         1.45            NA           NA          0.10  XXX
                                         screening.

[[Page 38330]]

 
77057........  26.........  A.........  Mammogram,               0.70         0.25         0.24          0.25         0.24          0.03  XXX
                                         screening.
77057........  TC.........  A.........  Mammogram,               0.00         1.19         1.22            NA           NA          0.07  XXX
                                         screening.
77058........  ...........  A.........  Mri, one breast..        1.63        21.44        19.28            NA           NA          0.99  XXX
77058........  26.........  A.........  Mri, one breast..        1.63         0.57         0.54          0.57         0.54          0.07  XXX
77058........  TC.........  A.........  Mri, one breast..        0.00        20.87        18.74            NA           NA          0.92  XXX
77059........  ...........  A.........  Mri, both breasts        1.63        21.37        23.46            NA           NA          1.31  XXX
77059........  26.........  A.........  Mri, both breasts        1.63         0.57         0.54          0.57         0.54          0.07  XXX
77059........  TC.........  A.........  Mri, both breasts        0.00        20.80        22.92            NA           NA          1.24  XXX
77071........  ...........  A.........  X-ray stress view        0.41         0.76         0.37          0.76         0.37          0.06  XXX
77072........  ...........  A.........  X-rays for bone          0.19         0.42         0.18            NA           NA          0.03  XXX
                                         age.
77072........  26.........  A.........  X-rays for bone          0.19         0.07         0.06          0.07         0.06          0.01  XXX
                                         age.
77072........  TC.........  A.........  X-rays for bone          0.00         0.36         0.35            NA           NA          0.02  XXX
                                         age.
77073........  ...........  A.........  X-rays, bone             0.27         0.67         0.80            NA           NA          0.06  XXX
                                         length studies.
77073........  26.........  A.........  X-rays, bone             0.27         0.10         0.09          0.10         0.09          0.01  XXX
                                         length studies.
77073........  TC.........  A.........  X-rays, bone             0.00         0.57         0.71            NA           NA          0.05  XXX
                                         length studies.
77074........  ...........  A.........  X-rays, bone             0.45         1.44         1.25            NA           NA          0.08  XXX
                                         survey, limited.
77074........  26.........  A.........  X-rays, bone             0.45         0.16         0.15          0.16         0.15          0.02  XXX
                                         survey, limited.
77074........  TC.........  A.........  X-rays, bone             0.00         1.27         1.09            NA           NA          0.06  XXX
                                         survey, limited.
77075........  ...........  A.........  X-rays, bone             0.54         2.28         1.84            NA           NA          0.10  XXX
                                         survey complete.
77075........  26.........  A.........  X-rays, bone             0.54         0.20         0.19          0.20         0.19          0.02  XXX
                                         survey complete.
77075........  TC.........  A.........  X-rays, bone             0.00         2.08         1.65            NA           NA          0.08  XXX
                                         survey complete.
77076........  ...........  A.........  X-rays, bone             0.70         2.12         1.35            NA           NA          0.08  XXX
                                         survey, infant.
77076........  26.........  A.........  X-rays, bone             0.70         0.23         0.23          0.23         0.23          0.03  XXX
                                         survey, infant.
77076........  TC.........  A.........  X-rays, bone             0.00         1.89         1.12            NA           NA          0.05  XXX
                                         survey, infant.
77077........  ...........  A.........  Joint survey,            0.31         0.65         1.02            NA           NA          0.08  XXX
                                         single view.
77077........  26.........  A.........  Joint survey,            0.31         0.11         0.10          0.11         0.10          0.02  XXX
                                         single view.
77077........  TC.........  A.........  Joint survey,            0.00         0.54         0.92            NA           NA          0.06  XXX
                                         single view.
77078........  ...........  A.........  Ct bone density,         0.25         4.69         3.59            NA           NA          0.17  XXX
                                         axial.
77078........  26.........  A.........  Ct bone density,         0.25         0.09         0.08          0.09         0.08          0.01  XXX
                                         axial.
77078........  TC.........  A.........  Ct bone density,         0.00         4.61         3.51            NA           NA          0.16  XXX
                                         axial.
77079........  ...........  A.........  Ct bone density,         0.22         0.81         2.29            NA           NA          0.06  XXX
                                         peripheral.
77079........  26.........  A.........  Ct bone density,         0.22         0.08         0.07          0.08         0.07          0.01  XXX
                                         peripheral.
77079........  TC.........  A.........  Ct bone density,         0.00         0.73         2.22            NA           NA          0.05  XXX
                                         peripheral.
77080........  ...........  A.........  Dxa bone density,        0.20         0.87         2.42            NA           NA          0.18  XXX
                                         axial.
77080........  26.........  A.........  Dxa bone density,        0.20         0.06         0.09          0.06         0.09          0.01  XXX
                                         axial.
77080........  TC.........  A.........  Dxa bone density,        0.00         0.81         2.34            NA           NA          0.17  XXX
                                         axial.
77081........  ...........  A.........  Dxa bone density/        0.22         0.47         0.71            NA           NA          0.06  XXX
                                         peripheral.
77081........  26.........  A.........  Dxa bone density/        0.22         0.06         0.07          0.06         0.07          0.01  XXX
                                         peripheral.
77081........  TC.........  A.........  Dxa bone density/        0.00         0.40         0.63            NA           NA          0.05  XXX
                                         peripheral.
77082........  ...........  A.........  Dxa bone density,        0.17         0.52         0.71            NA           NA          0.06  XXX
                                         vert fx.
77082........  26.........  A.........  Dxa bone density,        0.17         0.05         0.06          0.05         0.06          0.01  XXX
                                         vert fx.
77082........  TC.........  A.........  Dxa bone density,        0.00         0.47         0.66            NA           NA          0.05  XXX
                                         vert fx.
77083........  ...........  A.........  Radiographic             0.20         0.36         0.67            NA           NA          0.06  XXX
                                         absorptiometry.
77083........  26.........  A.........  Radiographic             0.20         0.05         0.06          0.05         0.06          0.01  XXX
                                         absorptiometry.
77083........  TC.........  A.........  Radiographic             0.00         0.31         0.60            NA           NA          0.05  XXX
                                         absorptiometry.
77084........  ...........  A.........  Magnetic image,          1.60        13.43        12.31            NA           NA          0.66  XXX
                                         bone marrow.
77084........  26.........  A.........  Magnetic image,          1.60         0.53         0.52          0.53         0.52          0.07  XXX
                                         bone marrow.
77084........  TC.........  A.........  Magnetic image,          0.00        12.90        11.79            NA           NA          0.59  XXX
                                         bone marrow.
77261........  ...........  A.........  Radiation therapy        1.39         0.49         0.50          0.49         0.50          0.07  XXX
                                         planning.
77262........  ...........  A.........  Radiation therapy        2.11         0.70         0.73          0.70         0.73          0.11  XXX
                                         planning.
77263........  ...........  A.........  Radiation therapy        3.14         1.05         1.08          1.05         1.08          0.16  XXX
                                         planning.
77280........  ...........  A.........  Set radiation            0.70         4.40         4.06            NA           NA          0.22  XXX
                                         therapy field.
77280........  26.........  A.........  Set radiation            0.70         0.23         0.23          0.23         0.23          0.04  XXX
                                         therapy field.
77280........  TC.........  A.........  Set radiation            0.00         4.16         3.83            NA           NA          0.18  XXX
                                         therapy field.
77285........  ...........  A.........  Set radiation            1.05         7.96         6.95            NA           NA          0.35  XXX
                                         therapy field.
77285........  26.........  A.........  Set radiation            1.05         0.35         0.34          0.35         0.34          0.05  XXX
                                         therapy field.
77285........  TC.........  A.........  Set radiation            0.00         7.61         6.61            NA           NA          0.30  XXX
                                         therapy field.
77290........  ...........  A.........  Set radiation            1.56        13.31        10.19            NA           NA          0.43  XXX
                                         therapy field.
77290........  26.........  A.........  Set radiation            1.56         0.52         0.51          0.52         0.51          0.08  XXX
                                         therapy field.
77290........  TC.........  A.........  Set radiation            0.00        12.79         9.68            NA           NA          0.35  XXX
                                         therapy field.
77295........  ...........  A.........  Set radiation            4.56         7.42        18.42            NA           NA          1.71  XXX
                                         therapy field.
77295........  26.........  A.........  Set radiation            4.56         1.52         1.49          1.52         1.49          0.23  XXX
                                         therapy field.
77295........  TC.........  A.........  Set radiation            0.00         5.90        16.93            NA           NA          1.48  XXX
                                         therapy field.
77299........  ...........  C.........  Radiation therapy        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         planning.
77299........  26.........  C.........  Radiation therapy        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         planning.
77299........  TC.........  C.........  Radiation therapy        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         planning.
77300........  ...........  A.........  Radiation therapy        0.62         1.18         1.36            NA           NA          0.10  XXX
                                         dose plan.
77300........  26.........  A.........  Radiation therapy        0.62         0.21         0.20          0.21         0.20          0.03  XXX
                                         dose plan.
77300........  TC.........  A.........  Radiation therapy        0.00         0.97         1.16            NA           NA          0.07  XXX
                                         dose plan.
77301........  ...........  A.........  Radiotherapy dose        7.99        57.00        43.83            NA           NA          1.88  XXX
                                         plan, imrt.
77301........  26.........  A.........  Radiotherapy dose        7.99         2.66         2.61          2.66         2.61          0.40  XXX
                                         plan, imrt.
77301........  TC.........  A.........  Radiotherapy dose        0.00        54.35        41.22            NA           NA          1.48  XXX
                                         plan, imrt.

[[Page 38331]]

 
77305........  ...........  A.........  Teletx isodose           0.70         0.90         1.49            NA           NA          0.15  XXX
                                         plan simple.
77305........  26.........  A.........  Teletx isodose           0.70         0.23         0.23          0.23         0.23          0.04  XXX
                                         plan simple.
77305........  TC.........  A.........  Teletx isodose           0.00         0.66         1.26            NA           NA          0.11  XXX
                                         plan simple.
77310........  ...........  A.........  Teletx isodose           1.05         1.25         1.96            NA           NA          0.18  XXX
                                         plan intermed.
77310........  26.........  A.........  Teletx isodose           1.05         0.35         0.34          0.35         0.34          0.05  XXX
                                         plan intermed.
77310........  TC.........  A.........  Teletx isodose           0.00         0.90         1.62            NA           NA          0.13  XXX
                                         plan intermed.
77315........  ...........  A.........  Teletx isodose           1.56         2.08         2.63            NA           NA          0.22  XXX
                                         plan complex.
77315........  26.........  A.........  Teletx isodose           1.56         0.52         0.51          0.52         0.51          0.08  XXX
                                         plan complex.
77315........  TC.........  A.........  Teletx isodose           0.00         1.56         2.11            NA           NA          0.14  XXX
                                         plan complex.
77321........  ...........  A.........  Special teletx           0.95         1.50         2.93            NA           NA          0.26  XXX
                                         port plan.
77321........  26.........  A.........  Special teletx           0.95         0.32         0.31          0.32         0.31          0.05  XXX
                                         port plan.
77321........  TC.........  A.........  Special teletx           0.00         1.19         2.62            NA           NA          0.21  XXX
                                         port plan.
77326........  ...........  A.........  Brachytx isodose         0.93         2.97         2.82            NA           NA          0.18  XXX
                                         calc simp.
77326........  26.........  A.........  Brachytx isodose         0.93         0.31         0.31          0.31         0.31          0.05  XXX
                                         calc simp.
77326........  TC.........  A.........  Brachytx isodose         0.00         2.66         2.51            NA           NA          0.13  XXX
                                         calc simp.
77327........  ...........  A.........  Brachytx isodose         1.39         4.07         4.00            NA           NA          0.25  XXX
                                         calc interm.
77327........  26.........  A.........  Brachytx isodose         1.39         0.46         0.45          0.46         0.45          0.07  XXX
                                         calc interm.
77327........  TC.........  A.........  Brachytx isodose         0.00         3.61         3.55            NA           NA          0.18  XXX
                                         calc interm.
77328........  ...........  A.........  Brachytx isodose         2.09         5.22         5.43            NA           NA          0.36  XXX
                                         plan compl.
77328........  26.........  A.........  Brachytx isodose         2.09         0.70         0.69          0.70         0.69          0.11  XXX
                                         plan compl.
77328........  TC.........  A.........  Brachytx isodose         0.00         4.53         4.75            NA           NA          0.25  XXX
                                         plan compl.
77331........  ...........  A.........  Special radiation        0.87         0.80         0.79            NA           NA          0.06  XXX
                                         dosimetry.
77331........  26.........  A.........  Special radiation        0.87         0.29         0.28          0.29         0.28          0.04  XXX
                                         dosimetry.
77331........  TC.........  A.........  Special radiation        0.00         0.51         0.51            NA           NA          0.02  XXX
                                         dosimetry.
77332........  ...........  A.........  Radiation                0.54         1.54         1.53            NA           NA          0.10  XXX
                                         treatment aid(s).
77332........  26.........  A.........  Radiation                0.54         0.18         0.18          0.18         0.18          0.03  XXX
                                         treatment aid(s).
77332........  TC.........  A.........  Radiation                0.00         1.36         1.35            NA           NA          0.07  XXX
                                         treatment aid(s).
77333........  ...........  A.........  Radiation                0.84         0.52         1.34            NA           NA          0.15  XXX
                                         treatment aid(s).
77333........  26.........  A.........  Radiation                0.84         0.28         0.27          0.28         0.27          0.04  XXX
                                         treatment aid(s).
77333........  TC.........  A.........  Radiation                0.00         0.24         1.07            NA           NA          0.11  XXX
                                         treatment aid(s).
77334........  ...........  A.........  Radiation                1.24         2.70         3.19            NA           NA          0.23  XXX
                                         treatment aid(s).
77334........  26.........  A.........  Radiation                1.24         0.41         0.41          0.41         0.41          0.06  XXX
                                         treatment aid(s).
77334........  TC.........  A.........  Radiation                0.00         2.29         2.78            NA           NA          0.17  XXX
                                         treatment aid(s).
77336........  ...........  A.........  Radiation physics        0.00         1.13         2.06            NA           NA          0.16  XXX
                                         consult.
77370........  ...........  A.........  Radiation physics        0.00         3.02         3.26            NA           NA          0.18  XXX
                                         consult.
77371........  ...........  A.........  Srs, multisource.        0.00        29.82        30.11            NA           NA          0.13  XXX
77372........  ...........  A.........  Srs, linear based        0.00        22.61        22.82            NA           NA          0.13  XXX
77373........  ...........  A.........  Sbrt delivery....        0.00        42.26        42.67            NA           NA          0.13  XXX
77399........  ...........  C.........  External                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         radiation
                                         dosimetry.
77399........  26.........  C.........  External                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         radiation
                                         dosimetry.
77399........  TC.........  C.........  External                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         radiation
                                         dosimetry.
77401........  ...........  A.........  Radiation                0.00         0.47         1.12            NA           NA          0.11  XXX
                                         treatment
                                         delivery.
77402........  ...........  A.........  Radiation                0.00         4.30         3.01            NA           NA          0.11  XXX
                                         treatment
                                         delivery.
77403........  ...........  A.........  Radiation                0.00         3.72         2.75            NA           NA          0.11  XXX
                                         treatment
                                         delivery.
77404........  ...........  A.........  Radiation                0.00         4.17         2.98            NA           NA          0.11  XXX
                                         treatment
                                         delivery.
77406........  ...........  A.........  Radiation                0.00         4.20         2.99            NA           NA          0.11  XXX
                                         treatment
                                         delivery.
77407........  ...........  A.........  Radiation                0.00         5.75         3.87            NA           NA          0.12  XXX
                                         treatment
                                         delivery.
77408........  ...........  A.........  Radiation                0.00         5.14         3.63            NA           NA          0.12  XXX
                                         treatment
                                         delivery.
77409........  ...........  A.........  Radiation                0.00         5.71         3.92            NA           NA          0.12  XXX
                                         treatment
                                         delivery.
77411........  ...........  A.........  Radiation                0.00         5.68         3.90            NA           NA          0.12  XXX
                                         treatment
                                         delivery.
77412........  ...........  A.........  Radiation                0.00         6.72         4.55            NA           NA          0.13  XXX
                                         treatment
                                         delivery.
77413........  ...........  A.........  Radiation                0.00         6.79         4.57            NA           NA          0.13  XXX
                                         treatment
                                         delivery.
77414........  ...........  A.........  Radiation                0.00         7.64         5.00            NA           NA          0.13  XXX
                                         treatment
                                         delivery.
77416........  ...........  A.........  Radiation                0.00         7.65         5.00            NA           NA          0.13  XXX
                                         treatment
                                         delivery.
77417........  ...........  A.........  Radiology port           0.00         0.36         0.47            NA           NA          0.04  XXX
                                         film(s).
77418........  ...........  A.........  Radiation tx             0.00        13.04        15.55            NA           NA          0.13  XXX
                                         delivery, imrt.
77421........  ...........  A.........  Stereoscopic x-          0.39         1.98         2.73            NA           NA          0.12  XXX
                                         ray guidance.
77421........  26.........  A.........  Stereoscopic x-          0.39         0.13         0.13          0.13         0.13          0.02  XXX
                                         ray guidance.
77421........  TC.........  A.........  Stereoscopic x-          0.00         1.85         2.60            NA           NA          0.10  XXX
                                         ray guidance.
77422........  ...........  A.........  Neutron beam tx,         0.00         5.37         4.84            NA           NA          0.13  XXX
                                         simple.
77423........  ...........  A.........  Neutron beam tx,         0.00         7.41         5.03            NA           NA          0.13  XXX
                                         complex.
77427........  ...........  A.........  Radiation tx             3.70         1.40         1.23          1.40         1.23          0.17  XXX
                                         management, x5.
77431........  ...........  A.........  Radiation therapy        1.81         0.79         0.74          0.79         0.74          0.09  XXX
                                         management.
77432........  ...........  A.........  Stereotactic             7.92         2.64         2.78          2.64         2.78          0.41  XXX
                                         radiation trmt.
77435........  ...........  A.........  Sbrt management..       13.00         4.75         4.75            NA           NA          0.67  XXX
77470........  ...........  A.........  Special radiation        2.09         1.93         6.88            NA           NA          0.70  XXX
                                         treatment.
77470........  26.........  A.........  Special radiation        2.09         0.69         0.68          0.69         0.68          0.11  XXX
                                         treatment.
77470........  TC.........  A.........  Special radiation        0.00         1.23         6.19            NA           NA          0.59  XXX
                                         treatment.
77499........  ...........  C.........  Radiation therapy        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         management.
77499........  26.........  C.........  Radiation therapy        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         management.
77499........  TC.........  C.........  Radiation therapy        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         management.
77520........  ...........  C.........  Proton trmt,             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         simple w/o comp.

[[Page 38332]]

 
77522........  ...........  C.........  Proton trmt,             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         simple w/comp.
77523........  ...........  C.........  Proton trmt,             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         intermediate.
77525........  ...........  C.........  Proton treatment,        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         complex.
77600........  ...........  R.........  Hyperthermia             1.56        10.16         6.78            NA           NA          0.24  XXX
                                         treatment.
77600........  26.........  R.........  Hyperthermia             1.56         0.51         0.49          0.51         0.49          0.08  XXX
                                         treatment.
77600........  TC.........  R.........  Hyperthermia             0.00         9.65         6.29            NA           NA          0.16  XXX
                                         treatment.
77605........  ...........  R.........  Hyperthermia             2.09        18.23        11.32            NA           NA          0.38  XXX
                                         treatment.
77605........  26.........  R.........  Hyperthermia             2.09         0.55         0.62          0.55         0.62          0.16  XXX
                                         treatment.
77605........  TC.........  R.........  Hyperthermia             0.00        17.68        10.71            NA           NA          0.22  XXX
                                         treatment.
77610........  ...........  R.........  Hyperthermia             1.56        17.70        10.52            NA           NA          0.24  XXX
                                         treatment.
77610........  26.........  R.........  Hyperthermia             1.56         0.36         0.46          0.36         0.46          0.08  XXX
                                         treatment.
77610........  TC.........  R.........  Hyperthermia             0.00        17.34        10.06            NA           NA          0.16  XXX
                                         treatment.
77615........  ...........  R.........  Hyperthermia             2.09        25.69        15.24            NA           NA          0.33  XXX
                                         treatment.
77615........  26.........  R.........  Hyperthermia             2.09         0.65         0.66          0.65         0.66          0.11  XXX
                                         treatment.
77615........  TC.........  R.........  Hyperthermia             0.00        25.04        14.58            NA           NA          0.22  XXX
                                         treatment.
77620........  ...........  R.........  Hyperthermia             1.56        10.38         6.83            NA           NA          0.36  XXX
                                         treatment.
77620........  26.........  R.........  Hyperthermia             1.56         0.40         0.46          0.40         0.46          0.20  XXX
                                         treatment.
77620........  TC.........  R.........  Hyperthermia             0.00         9.97         6.36            NA           NA          0.16  XXX
                                         treatment.
77750........  ...........  A.........  Infuse                   4.94         4.56         3.74          4.56         3.74          0.32  090
                                         radioactive
                                         materials.
77750........  26.........  A.........  Infuse                   4.94         1.65         1.62          1.65         1.62          0.25  090
                                         radioactive
                                         materials.
77750........  TC.........  A.........  Infuse                   0.00         2.91         2.12          2.91         2.12          0.07  090
                                         radioactive
                                         materials.
77761........  ...........  A.........  Apply intrcav            3.82         6.33         4.96          6.33         4.96          0.33  090
                                         radiat simple.
77761........  26.........  A.........  Apply intrcav            3.82         1.27         1.18          1.27         1.18          0.19  090
                                         radiat simple.
77761........  TC.........  A.........  Apply intrcav            0.00         5.06         3.78          5.06         3.78          0.14  090
                                         radiat simple.
77762........  ...........  A.........  Apply intrcav            5.73         7.60         6.54          7.60         6.54          0.48  090
                                         radiat interm.
77762........  26.........  A.........  Apply intrcav            5.73         1.90         1.87          1.90         1.87          0.29  090
                                         radiat interm.
77762........  TC.........  A.........  Apply intrcav            0.00         5.70         4.67          5.70         4.67          0.19  090
                                         radiat interm.
77763........  ...........  A.........  Apply intrcav            8.60        10.33         8.80         10.33         8.80          0.66  090
                                         radiat compl.
77763........  26.........  A.........  Apply intrcav            8.60         2.86         2.81          2.86         2.81          0.43  090
                                         radiat compl.
77763........  TC.........  A.........  Apply intrcav            0.00         7.46         5.99          7.46         5.99          0.23  090
                                         radiat compl.
77776........  ...........  A.........  Apply interstit          4.67         7.45         5.30          7.45         5.30          0.57  090
                                         radiat simpl.
77776........  26.........  A.........  Apply interstit          4.67         1.70         1.33          1.70         1.33          0.44  090
                                         radiat simpl.
77776........  TC.........  A.........  Apply interstit          0.00         5.75         3.98          5.75         3.98          0.13  090
                                         radiat simpl.
77777........  ...........  A.........  Apply interstit          7.49         7.91         7.25          7.91         7.25          0.61  090
                                         radiat inter.
77777........  26.........  A.........  Apply interstit          7.49         2.48         2.43          2.48         2.43          0.39  090
                                         radiat inter.
77777........  TC.........  A.........  Apply interstit          0.00         5.43         4.82          5.43         4.82          0.22  090
                                         radiat inter.
77778........  ...........  A.........  Apply interstit         11.23        11.32        10.03         11.32        10.03          0.84  090
                                         radiat compl.
77778........  26.........  A.........  Apply interstit         11.23         3.75         3.67          3.75         3.67          0.57  090
                                         radiat compl.
77778........  TC.........  A.........  Apply interstit          0.00         7.57         6.36          7.57         6.36          0.27  090
                                         radiat compl.
77781........  ...........  A.........  High intensity           1.21         4.37        12.61            NA           NA          1.14  XXX
                                         brachytherapy.
77781........  26.........  A.........  High intensity           1.21         0.40         0.47          0.40         0.47          0.08  XXX
                                         brachytherapy.
77781........  TC.........  A.........  High intensity           0.00         3.97        12.14            NA           NA          1.06  XXX
                                         brachytherapy.
77782........  ...........  A.........  High intensity           2.04        12.31        16.73            NA           NA          1.19  XXX
                                         brachytherapy.
77782........  26.........  A.........  High intensity           2.04         0.68         0.74          0.68         0.74          0.13  XXX
                                         brachytherapy.
77782........  TC.........  A.........  High intensity           0.00        11.64        15.99            NA           NA          1.06  XXX
                                         brachytherapy.
77783........  ...........  A.........  High intensity           3.27        24.00        22.80            NA           NA          1.25  XXX
                                         brachytherapy.
77783........  26.........  A.........  High intensity           3.27         1.08         1.14          1.08         1.14          0.19  XXX
                                         brachytherapy.
77783........  TC.........  A.........  High intensity           0.00        22.92        21.66            NA           NA          1.06  XXX
                                         brachytherapy.
77784........  ...........  A.........  High intensity           5.15        45.31        33.80            NA           NA          1.35  XXX
                                         brachytherapy.
77784........  26.........  A.........  High intensity           5.15         1.71         1.76          1.71         1.76          0.29  XXX
                                         brachytherapy.
77784........  TC.........  A.........  High intensity           0.00        43.60        32.04            NA           NA          1.06  XXX
                                         brachytherapy.
77789........  ...........  A.........  Apply surface            1.14         2.02         1.43          2.02         1.43          0.08  000
                                         radiation.
77789........  26.........  A.........  Apply surface            1.14         0.39         0.38          0.39         0.38          0.06  000
                                         radiation.
77789........  TC.........  A.........  Apply surface            0.00         1.63         1.05          1.63         1.05          0.02  000
                                         radiation.
77790........  ...........  A.........  Radiation                1.05         1.47         1.16            NA           NA          0.07  XXX
                                         handling.
77790........  26.........  A.........  Radiation                1.05         0.35         0.34          0.35         0.34          0.05  XXX
                                         handling.
77790........  TC.........  A.........  Radiation                0.00         1.11         0.81            NA           NA          0.02  XXX
                                         handling.
77799........  ...........  C.........  Radium/                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         radioisotope
                                         therapy.
77799........  26.........  C.........  Radium/                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         radioisotope
                                         therapy.
77799........  TC.........  C.........  Radium/                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         radioisotope
                                         therapy.
78000........  ...........  A.........  Thyroid, single          0.19         1.83         1.42            NA           NA          0.07  XXX
                                         uptake.
78000........  26.........  A.........  Thyroid, single          0.19         0.06         0.06          0.06         0.06          0.01  XXX
                                         uptake.
78000........  TC.........  A.........  Thyroid, single          0.00         1.77         1.36            NA           NA          0.06  XXX
                                         uptake.
78001........  ...........  A.........  Thyroid, multiple        0.26         2.28         1.82            NA           NA          0.08  XXX
                                         uptakes.
78001........  26.........  A.........  Thyroid, multiple        0.26         0.09         0.09          0.09         0.09          0.01  XXX
                                         uptakes.
78001........  TC.........  A.........  Thyroid, multiple        0.00         2.19         1.73            NA           NA          0.07  XXX
                                         uptakes.
78003........  ...........  A.........  Thyroid suppress/        0.33         1.92         1.48            NA           NA          0.07  XXX
                                         stimul.
78003........  26.........  A.........  Thyroid suppress/        0.33         0.12         0.11          0.12         0.11          0.01  XXX
                                         stimul.
78003........  TC.........  A.........  Thyroid suppress/        0.00         1.81         1.37            NA           NA          0.06  XXX
                                         stimul.
78006........  ...........  A.........  Thyroid imaging          0.49         6.16         4.31            NA           NA          0.15  XXX
                                         with uptake.
78006........  26.........  A.........  Thyroid imaging          0.49         0.17         0.16          0.17         0.16          0.02  XXX
                                         with uptake.
78006........  TC.........  A.........  Thyroid imaging          0.00         5.99         4.14            NA           NA          0.13  XXX
                                         with uptake.

[[Page 38333]]

 
78007........  ...........  A.........  Thyroid image,           0.50         3.03         2.85            NA           NA          0.16  XXX
                                         mult uptakes.
78007........  26.........  A.........  Thyroid image,           0.50         0.17         0.16          0.17         0.16          0.02  XXX
                                         mult uptakes.
78007........  TC.........  A.........  Thyroid image,           0.00         2.86         2.69            NA           NA          0.14  XXX
                                         mult uptakes.
78010........  ...........  A.........  Thyroid imaging..        0.39         4.14         3.01            NA           NA          0.13  XXX
78010........  26.........  A.........  Thyroid imaging..        0.39         0.13         0.13          0.13         0.13          0.02  XXX
78010........  TC.........  A.........  Thyroid imaging..        0.00         4.01         2.88            NA           NA          0.11  XXX
78011........  ...........  A.........  Thyroid imaging          0.45         4.48         3.49            NA           NA          0.15  XXX
                                         with flow.
78011........  26.........  A.........  Thyroid imaging          0.45         0.16         0.15          0.16         0.15          0.02  XXX
                                         with flow.
78011........  TC.........  A.........  Thyroid imaging          0.00         4.32         3.33            NA           NA          0.13  XXX
                                         with flow.
78015........  ...........  A.........  Thyroid met              0.67         5.28         4.01            NA           NA          0.17  XXX
                                         imaging.
78015........  26.........  A.........  Thyroid met              0.67         0.23         0.22          0.23         0.22          0.03  XXX
                                         imaging.
78015........  TC.........  A.........  Thyroid met              0.00         5.06         3.79            NA           NA          0.14  XXX
                                         imaging.
78016........  ...........  A.........  Thyroid met              0.82         8.42         6.04            NA           NA          0.21  XXX
                                         imaging/studies.
78016........  26.........  A.........  Thyroid met              0.82         0.28         0.27          0.28         0.27          0.03  XXX
                                         imaging/studies.
78016........  TC.........  A.........  Thyroid met              0.00         8.14         5.77            NA           NA          0.18  XXX
                                         imaging/studies.
78018........  ...........  A.........  Thyroid met              0.86         7.84         6.72            NA           NA          0.33  XXX
                                         imaging, body.
78018........  26.........  A.........  Thyroid met              0.86         0.30         0.29          0.30         0.29          0.04  XXX
                                         imaging, body.
78018........  TC.........  A.........  Thyroid met              0.00         7.54         6.43            NA           NA          0.29  XXX
                                         imaging, body.
78020........  ...........  A.........  Thyroid met              0.60         1.78         1.63          1.78         1.63          0.16  ZZZ
                                         uptake.
78020........  26.........  A.........  Thyroid met              0.60         0.20         0.20          0.20         0.20          0.02  ZZZ
                                         uptake.
78020........  TC.........  A.........  Thyroid met              0.00         1.57         1.43          1.57         1.43          0.14  ZZZ
                                         uptake.
78070........  ...........  A.........  Parathyroid              0.82         3.45         3.96            NA           NA          0.15  XXX
                                         nuclear imaging.
78070........  26.........  A.........  Parathyroid              0.82         0.28         0.27          0.28         0.27          0.04  XXX
                                         nuclear imaging.
78070........  TC.........  A.........  Parathyroid              0.00         3.17         3.68            NA           NA          0.11  XXX
                                         nuclear imaging.
78075........  ...........  A.........  Adrenal nuclear          0.74        11.47         8.50            NA           NA          0.32  XXX
                                         imaging.
78075........  26.........  A.........  Adrenal nuclear          0.74         0.25         0.25          0.25         0.25          0.03  XXX
                                         imaging.
78075........  TC.........  A.........  Adrenal nuclear          0.00        11.22         8.25            NA           NA          0.29  XXX
                                         imaging.
78099........  ...........  C.........  Endocrine nuclear        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
78099........  26.........  C.........  Endocrine nuclear        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
78099........  TC.........  C.........  Endocrine nuclear        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
78102........  ...........  A.........  Bone marrow              0.55         4.13         3.14            NA           NA          0.14  XXX
                                         imaging, ltd.
78102........  26.........  A.........  Bone marrow              0.55         0.19         0.18          0.19         0.18          0.02  XXX
                                         imaging, ltd.
78102........  TC.........  A.........  Bone marrow              0.00         3.94         2.96            NA           NA          0.12  XXX
                                         imaging, ltd.
78103........  ...........  A.........  Bone marrow              0.75         5.37         4.36            NA           NA          0.20  XXX
                                         imaging, mult.
78103........  26.........  A.........  Bone marrow              0.75         0.26         0.25          0.26         0.25          0.03  XXX
                                         imaging, mult.
78103........  TC.........  A.........  Bone marrow              0.00         5.11         4.10            NA           NA          0.17  XXX
                                         imaging, mult.
78104........  ...........  A.........  Bone marrow              0.80         6.15         5.22            NA           NA          0.25  XXX
                                         imaging, body.
78104........  26.........  A.........  Bone marrow              0.80         0.30         0.28          0.30         0.28          0.03  XXX
                                         imaging, body.
78104........  TC.........  A.........  Bone marrow              0.00         5.86         4.94            NA           NA          0.22  XXX
                                         imaging, body.
78110........  ...........  A.........  Plasma volume,           0.19         2.10         1.55            NA           NA          0.07  XXX
                                         single.
78110........  26.........  A.........  Plasma volume,           0.19         0.07         0.07          0.07         0.07          0.01  XXX
                                         single.
78110........  TC.........  A.........  Plasma volume,           0.00         2.04         1.49            NA           NA          0.06  XXX
                                         single.
78111........  ...........  A.........  Plasma volume,           0.22         2.11         2.37            NA           NA          0.15  XXX
                                         multiple.
78111........  26.........  A.........  Plasma volume,           0.22         0.07         0.08          0.07         0.08          0.01  XXX
                                         multiple.
78111........  TC.........  A.........  Plasma volume,           0.00         2.04         2.29            NA           NA          0.14  XXX
                                         multiple.
78120........  ...........  A.........  Red cell mass,           0.23         2.07         1.92            NA           NA          0.12  XXX
                                         single.
78120........  26.........  A.........  Red cell mass,           0.23         0.08         0.08          0.08         0.08          0.01  XXX
                                         single.
78120........  TC.........  A.........  Red cell mass,           0.00         1.99         1.84            NA           NA          0.11  XXX
                                         single.
78121........  ...........  A.........  Red cell mass,           0.32         2.17         2.58            NA           NA          0.15  XXX
                                         multiple.
78121........  26.........  A.........  Red cell mass,           0.32         0.10         0.11          0.10         0.11          0.01  XXX
                                         multiple.
78121........  TC.........  A.........  Red cell mass,           0.00         2.07         2.48            NA           NA          0.14  XXX
                                         multiple.
78122........  ...........  A.........  Blood volume.....        0.45         2.22         3.47            NA           NA          0.26  XXX
78122........  26.........  A.........  Blood volume.....        0.45         0.15         0.15          0.15         0.15          0.02  XXX
78122........  TC.........  A.........  Blood volume.....        0.00         2.07         3.32            NA           NA          0.24  XXX
78130........  ...........  A.........  Red cell survival        0.61         3.47         3.24            NA           NA          0.17  XXX
                                         study.
78130........  26.........  A.........  Red cell survival        0.61         0.21         0.20          0.21         0.20          0.03  XXX
                                         study.
78130........  TC.........  A.........  Red cell survival        0.00         3.26         3.03            NA           NA          0.14  XXX
                                         study.
78135........  ...........  A.........  Red cell survival        0.64         8.59         6.76            NA           NA          0.28  XXX
                                         kinetics.
78135........  26.........  A.........  Red cell survival        0.64         0.22         0.21          0.22         0.21          0.03  XXX
                                         kinetics.
78135........  TC.........  A.........  Red cell survival        0.00         8.37         6.54            NA           NA          0.25  XXX
                                         kinetics.
78140........  ...........  A.........  Red cell                 0.61         2.92         3.49            NA           NA          0.24  XXX
                                         sequestration.
78140........  26.........  A.........  Red cell                 0.61         0.22         0.20          0.22         0.20          0.03  XXX
                                         sequestration.
78140........  TC.........  A.........  Red cell                 0.00         2.70         3.29            NA           NA          0.21  XXX
                                         sequestration.
78185........  ...........  A.........  Spleen imaging...        0.40         5.13         3.78            NA           NA          0.15  XXX
78185........  26.........  A.........  Spleen imaging...        0.40         0.14         0.13          0.14         0.13          0.02  XXX
78185........  TC.........  A.........  Spleen imaging...        0.00         4.99         3.64            NA           NA          0.13  XXX
78190........  ...........  A.........  Platelet                 1.09         8.27         7.27            NA           NA          0.38  XXX
                                         survival,
                                         kinetics.
78190........  26.........  A.........  Platelet                 1.09         0.25         0.34          0.25         0.34          0.08  XXX
                                         survival,
                                         kinetics.
78190........  TC.........  A.........  Platelet                 0.00         8.02         6.93            NA           NA          0.30  XXX
                                         survival,
                                         kinetics.
78191........  ...........  A.........  Platelet survival        0.61         3.49         5.47            NA           NA          0.40  XXX
78191........  26.........  A.........  Platelet survival        0.61         0.22         0.20          0.22         0.20          0.03  XXX
78191........  TC.........  A.........  Platelet survival        0.00         3.27         5.27            NA           NA          0.37  XXX

[[Page 38334]]

 
78195........  ...........  A.........  Lymph system             1.20         8.60         6.47            NA           NA          0.28  XXX
                                         imaging.
78195........  26.........  A.........  Lymph system             1.20         0.42         0.40          0.42         0.40          0.06  XXX
                                         imaging.
78195........  TC.........  A.........  Lymph system             0.00         8.18         6.07            NA           NA          0.22  XXX
                                         imaging.
78199........  ...........  C.........  Blood/lymph              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78199........  26.........  C.........  Blood/lymph              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78199........  TC.........  C.........  Blood/lymph              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78201........  ...........  A.........  Liver imaging....        0.44         4.55         3.52            NA           NA          0.15  XXX
78201........  26.........  A.........  Liver imaging....        0.44         0.13         0.14          0.13         0.14          0.02  XXX
78201........  TC.........  A.........  Liver imaging....        0.00         4.42         3.38            NA           NA          0.13  XXX
78202........  ...........  A.........  Liver imaging            0.51         5.28         4.13            NA           NA          0.16  XXX
                                         with flow.
78202........  26.........  A.........  Liver imaging            0.51         0.17         0.16          0.17         0.16          0.02  XXX
                                         with flow.
78202........  TC.........  A.........  Liver imaging            0.00         5.10         3.96            NA           NA          0.14  XXX
                                         with flow.
78205........  ...........  A.........  Liver imaging            0.71         5.21         5.64            NA           NA          0.34  XXX
                                         (3D).
78205........  26.........  A.........  Liver imaging            0.71         0.25         0.24          0.25         0.24          0.03  XXX
                                         (3D).
78205........  TC.........  A.........  Liver imaging            0.00         4.96         5.40            NA           NA          0.31  XXX
                                         (3D).
78206........  ...........  A.........  Liver image (3d)         0.96         8.52         8.25            NA           NA          0.15  XXX
                                         with flow.
78206........  26.........  A.........  Liver image (3d)         0.96         0.34         0.33          0.34         0.33          0.04  XXX
                                         with flow.
78206........  TC.........  A.........  Liver image (3d)         0.00         8.18         7.93            NA           NA          0.11  XXX
                                         with flow.
78215........  ...........  A.........  Liver and spleen         0.49         4.78         3.90            NA           NA          0.16  XXX
                                         imaging.
78215........  26.........  A.........  Liver and spleen         0.49         0.17         0.16          0.17         0.16          0.02  XXX
                                         imaging.
78215........  TC.........  A.........  Liver and spleen         0.00         4.60         3.73            NA           NA          0.14  XXX
                                         imaging.
78216........  ...........  A.........  Liver & spleen           0.57         2.82         3.21            NA           NA          0.20  XXX
                                         image/flow.
78216........  26.........  A.........  Liver & spleen           0.57         0.20         0.19          0.20         0.19          0.02  XXX
                                         image/flow.
78216........  TC.........  A.........  Liver & spleen           0.00         2.62         3.03            NA           NA          0.18  XXX
                                         image/flow.
78220........  ...........  A.........  Liver function           0.49         3.05         3.44            NA           NA          0.21  XXX
                                         study.
78220........  26.........  A.........  Liver function           0.49         0.17         0.16          0.17         0.16          0.02  XXX
                                         study.
78220........  TC.........  A.........  Liver function           0.00         2.88         3.27            NA           NA          0.19  XXX
                                         study.
78223........  ...........  A.........  Hepatobiliary            0.84         8.43         6.11            NA           NA          0.23  XXX
                                         imaging.
78223........  26.........  A.........  Hepatobiliary            0.84         0.30         0.28          0.30         0.28          0.04  XXX
                                         imaging.
78223........  TC.........  A.........  Hepatobiliary            0.00         8.13         5.83            NA           NA          0.19  XXX
                                         imaging.
78230........  ...........  A.........  Salivary gland           0.45         4.13         3.19            NA           NA          0.15  XXX
                                         imaging.
78230........  26.........  A.........  Salivary gland           0.45         0.16         0.15          0.16         0.15          0.02  XXX
                                         imaging.
78230........  TC.........  A.........  Salivary gland           0.00         3.97         3.04            NA           NA          0.13  XXX
                                         imaging.
78231........  ...........  A.........  Serial salivary          0.52         2.75         3.03            NA           NA          0.19  XXX
                                         imaging.
78231........  26.........  A.........  Serial salivary          0.52         0.16         0.17          0.16         0.17          0.02  XXX
                                         imaging.
78231........  TC.........  A.........  Serial salivary          0.00         2.58         2.86            NA           NA          0.17  XXX
                                         imaging.
78232........  ...........  A.........  Salivary gland           0.47         2.74         3.19            NA           NA          0.20  XXX
                                         function exam.
78232........  26.........  A.........  Salivary gland           0.47         0.15         0.15          0.15         0.15          0.02  XXX
                                         function exam.
78232........  TC.........  A.........  Salivary gland           0.00         2.59         3.04            NA           NA          0.18  XXX
                                         function exam.
78258........  ...........  A.........  Esophageal               0.74         5.48         4.32            NA           NA          0.17  XXX
                                         motility study.
78258........  26.........  A.........  Esophageal               0.74         0.27         0.26          0.27         0.26          0.03  XXX
                                         motility study.
78258........  TC.........  A.........  Esophageal               0.00         5.21         4.06            NA           NA          0.14  XXX
                                         motility study.
78261........  ...........  A.........  Gastric mucosa           0.69         5.94         5.10            NA           NA          0.25  XXX
                                         imaging.
78261........  26.........  A.........  Gastric mucosa           0.69         0.24         0.23          0.24         0.23          0.03  XXX
                                         imaging.
78261........  TC.........  A.........  Gastric mucosa           0.00         5.70         4.87            NA           NA          0.22  XXX
                                         imaging.
78262........  ...........  A.........  Gastroesophageal         0.68         5.89         5.14            NA           NA          0.25  XXX
                                         reflux exam.
78262........  26.........  A.........  Gastroesophageal         0.68         0.22         0.22          0.22         0.22          0.03  XXX
                                         reflux exam.
78262........  TC.........  A.........  Gastroesophageal         0.00         5.67         4.92            NA           NA          0.22  XXX
                                         reflux exam.
78264........  ...........  A.........  Gastric emptying         0.78         7.10         5.69            NA           NA          0.25  XXX
                                         study.
78264........  26.........  A.........  Gastric emptying         0.78         0.28         0.26          0.28         0.26          0.03  XXX
                                         study.
78264........  TC.........  A.........  Gastric emptying         0.00         6.82         5.43            NA           NA          0.22  XXX
                                         study.
78270........  ...........  A.........  Vit B-12                 0.20         1.92         1.75            NA           NA          0.11  XXX
                                         absorption exam.
78270........  26.........  A.........  Vit B-12                 0.20         0.07         0.07          0.07         0.07          0.01  XXX
                                         absorption exam.
78270........  TC.........  A.........  Vit B-12                 0.00         1.85         1.68            NA           NA          0.10  XXX
                                         absorption exam.
78271........  ...........  A.........  Vit b-12 absrp           0.20         1.87         1.79            NA           NA          0.11  XXX
                                         exam, int fac.
78271........  26.........  A.........  Vit b-12 absrp           0.20         0.05         0.06          0.05         0.06          0.01  XXX
                                         exam, int fac.
78271........  TC.........  A.........  Vit b-12 absrp           0.00         1.81         1.72            NA           NA          0.10  XXX
                                         exam, int fac.
78272........  ...........  A.........  Vit B-12 absorp,         0.27         2.04         2.21            NA           NA          0.14  XXX
                                         combined.
78272........  26.........  A.........  Vit B-12 absorp,         0.27         0.07         0.08          0.07         0.08          0.01  XXX
                                         combined.
78272........  TC.........  A.........  Vit B-12 absorp,         0.00         1.96         2.13            NA           NA          0.13  XXX
                                         combined.
78278........  ...........  A.........  Acute GI blood           0.99         8.52         6.79            NA           NA          0.29  XXX
                                         loss imaging.
78278........  26.........  A.........  Acute GI blood           0.99         0.35         0.33          0.35         0.33          0.04  XXX
                                         loss imaging.
78278........  TC.........  A.........  Acute GI blood           0.00         8.17         6.46            NA           NA          0.25  XXX
                                         loss imaging.
78282........  ...........  C.........  GI protein loss          0.38         0.00         0.08            NA           NA          0.02  XXX
                                         exam.
78282........  26.........  A.........  GI protein loss          0.38         0.13         0.12          0.13         0.12          0.02  XXX
                                         exam.
78282........  TC.........  C.........  GI protein loss          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         exam.
78290........  ...........  A.........  Meckel[boxHu]s           0.68         8.44         5.78            NA           NA          0.19  XXX
                                         divert exam.
78290........  26.........  A.........  Meckel[boxHu]s           0.68         0.24         0.23          0.24         0.23          0.03  XXX
                                         divert exam.
78290........  TC.........  A.........  Meckel[boxHu]s           0.00         8.19         5.55            NA           NA          0.16  XXX
                                         divert exam.
78291........  ...........  A.........  Leveen/shunt             0.88         6.09         4.68            NA           NA          0.20  XXX
                                         patency exam.
78291........  26.........  A.........  Leveen/shunt             0.88         0.31         0.30          0.31         0.30          0.04  XXX
                                         patency exam.
78291........  TC.........  A.........  Leveen/shunt             0.00         5.78         4.39            NA           NA          0.16  XXX
                                         patency exam.

[[Page 38335]]

 
78299........  ...........  C.........  GI nuclear               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
78299........  26.........  C.........  GI nuclear               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
78299........  TC.........  C.........  GI nuclear               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
78300........  ...........  A.........  Bone imaging,            0.62         4.19         3.40            NA           NA          0.17  XXX
                                         limited area.
78300........  26.........  A.........  Bone imaging,            0.62         0.22         0.21          0.22         0.21          0.03  XXX
                                         limited area.
78300........  TC.........  A.........  Bone imaging,            0.00         3.97         3.19            NA           NA          0.14  XXX
                                         limited area.
78305........  ...........  A.........  Bone imaging,            0.83         5.42         4.63            NA           NA          0.23  XXX
                                         multiple areas.
78305........  26.........  A.........  Bone imaging,            0.83         0.28         0.27          0.28         0.27          0.04  XXX
                                         multiple areas.
78305........  TC.........  A.........  Bone imaging,            0.00         5.14         4.36            NA           NA          0.19  XXX
                                         multiple areas.
78306........  ...........  A.........  Bone imaging,            0.86         6.01         5.23            NA           NA          0.26  XXX
                                         whole body.
78306........  26.........  A.........  Bone imaging,            0.86         0.30         0.29          0.30         0.29          0.04  XXX
                                         whole body.
78306........  TC.........  A.........  Bone imaging,            0.00         5.71         4.94            NA           NA          0.22  XXX
                                         whole body.
78315........  ...........  A.........  Bone imaging, 3          1.02         8.51         6.74            NA           NA          0.29  XXX
                                         phase.
78315........  26.........  A.........  Bone imaging, 3          1.02         0.36         0.34          0.36         0.34          0.04  XXX
                                         phase.
78315........  TC.........  A.........  Bone imaging, 3          0.00         8.15         6.40            NA           NA          0.25  XXX
                                         phase.
78320........  ...........  A.........  Bone imaging (3D)        1.04         5.29         5.73            NA           NA          0.35  XXX
78320........  26.........  A.........  Bone imaging (3D)        1.04         0.36         0.35          0.36         0.35          0.04  XXX
78320........  TC.........  A.........  Bone imaging (3D)        0.00         4.93         5.38            NA           NA          0.31  XXX
78350........  ...........  N.........  Bone mineral,            0.22         0.51         0.72            NA           NA          0.06  XXX
                                         single photon.
78350........  26.........  N.........  Bone mineral,            0.22         0.05         0.06          0.05         0.06          0.01  XXX
                                         single photon.
78350........  TC.........  N.........  Bone mineral,            0.00         0.46         0.65            NA           NA          0.05  XXX
                                         single photon.
78351........  ...........  N.........  Bone mineral,            0.30         0.07         0.96          0.07         0.10          0.01  XXX
                                         dual photon.
78399........  ...........  C.........  Musculoskeletal          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78399........  26.........  C.........  Musculoskeletal          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78399........  TC.........  C.........  Musculoskeletal          0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78414........  ...........  C.........  Non-imaging heart        0.45         0.00         0.11            NA           NA          0.02  XXX
                                         function.
78414........  26.........  A.........  Non-imaging heart        0.45         0.16         0.16          0.16         0.16          0.02  XXX
                                         function.
78414........  TC.........  C.........  Non-imaging heart        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         function.
78428........  ...........  A.........  Cardiac shunt            0.78         5.11         3.85            NA           NA          0.16  XXX
                                         imaging.
78428........  26.........  A.........  Cardiac shunt            0.78         0.35         0.32          0.35         0.32          0.03  XXX
                                         imaging.
78428........  TC.........  A.........  Cardiac shunt            0.00         4.76         3.53            NA           NA          0.13  XXX
                                         imaging.
78445........  ...........  A.........  Vascular flow            0.49         4.42         3.21            NA           NA          0.13  XXX
                                         imaging.
78445........  26.........  A.........  Vascular flow            0.49         0.17         0.17          0.17         0.17          0.02  XXX
                                         imaging.
78445........  TC.........  A.........  Vascular flow            0.00         4.25         3.04            NA           NA          0.11  XXX
                                         imaging.
78456........  ...........  A.........  Acute venous             1.00         9.10         6.84            NA           NA          0.33  XXX
                                         thrombus image.
78456........  26.........  A.........  Acute venous             1.00         0.42         0.39          0.42         0.39          0.04  XXX
                                         thrombus image.
78456........  TC.........  A.........  Acute venous             0.00         8.68         6.45            NA           NA          0.29  XXX
                                         thrombus image.
78457........  ...........  A.........  Venous thrombosis        0.77         4.60         3.75            NA           NA          0.17  XXX
                                         imaging.
78457........  26.........  A.........  Venous thrombosis        0.77         0.25         0.25          0.25         0.25          0.03  XXX
                                         imaging.
78457........  TC.........  A.........  Venous thrombosis        0.00         4.35         3.50            NA           NA          0.14  XXX
                                         imaging.
78458........  ...........  A.........  Ven thrombosis           0.90         4.44         4.37            NA           NA          0.25  XXX
                                         images, bilat.
78458........  26.........  A.........  Ven thrombosis           0.90         0.29         0.30          0.29         0.30          0.04  XXX
                                         images, bilat.
78458........  TC.........  A.........  Ven thrombosis           0.00         4.15         4.07            NA           NA          0.21  XXX
                                         images, bilat.
78459........  ...........  C.........  Heart muscle             1.50         0.00         0.37          0.00         0.37          0.05  XXX
                                         imaging (PET).
78459........  26.........  A.........  Heart muscle             1.50         0.59         0.57          0.59         0.57          0.05  XXX
                                         imaging (PET).
78459........  TC.........  C.........  Heart muscle             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         imaging (PET).
78460........  ...........  A.........  Heart muscle             0.86         4.60         3.60            NA           NA          0.17  XXX
                                         blood, single.
78460........  26.........  A.........  Heart muscle             0.86         0.32         0.30          0.32         0.30          0.04  XXX
                                         blood, single.
78460........  TC.........  A.........  Heart muscle             0.00         4.29         3.30            NA           NA          0.13  XXX
                                         blood, single.
78461........  ...........  A.........  Heart muscle             1.23         4.02         4.55            NA           NA          0.30  XXX
                                         blood, multiple.
78461........  26.........  A.........  Heart muscle             1.23         0.46         0.43          0.46         0.43          0.05  XXX
                                         blood, multiple.
78461........  TC.........  A.........  Heart muscle             0.00         3.56         4.11            NA           NA          0.25  XXX
                                         blood, multiple.
78464........  ...........  A.........  Heart image (3d),        1.09         5.71         6.59            NA           NA          0.41  XXX
                                         single.
78464........  26.........  A.........  Heart image (3d),        1.09         0.49         0.44          0.49         0.44          0.04  XXX
                                         single.
78464........  TC.........  A.........  Heart image (3d),        0.00         5.22         6.15            NA           NA          0.37  XXX
                                         single.
78465........  ...........  A.........  Heart image (3d),        1.46        11.11        11.76            NA           NA          0.67  XXX
                                         multiple.
78465........  26.........  A.........  Heart image (3d),        1.46         0.69         0.61          0.69         0.61          0.05  XXX
                                         multiple.
78465........  TC.........  A.........  Heart image (3d),        0.00        10.42        11.15            NA           NA          0.62  XXX
                                         multiple.
78466........  ...........  A.........  Heart infarct            0.69         4.47         3.64            NA           NA          0.17  XXX
                                         image.
78466........  26.........  A.........  Heart infarct            0.69         0.28         0.25          0.28         0.25          0.03  XXX
                                         image.
78466........  TC.........  A.........  Heart infarct            0.00         4.19         3.39            NA           NA          0.14  XXX
                                         image.
78468........  ...........  A.........  Heart infarct            0.80         5.70         4.87            NA           NA          0.22  XXX
                                         image (ef).
78468........  26.........  A.........  Heart infarct            0.80         0.39         0.34          0.39         0.34          0.03  XXX
                                         image (ef).
78468........  TC.........  A.........  Heart infarct            0.00         5.31         4.53            NA           NA          0.19  XXX
                                         image (ef).
78469........  ...........  A.........  Heart infarct            0.92         6.09         5.83            NA           NA          0.31  XXX
                                         image (3D).
78469........  26.........  A.........  Heart infarct            0.92         0.43         0.37          0.43         0.37          0.03  XXX
                                         image (3D).
78469........  TC.........  A.........  Heart infarct            0.00         5.66         5.46            NA           NA          0.28  XXX
                                         image (3D).
78472........  ...........  A.........  Gated heart,             0.98         5.90         5.88            NA           NA          0.34  XXX
                                         planar, single.
78472........  26.........  A.........  Gated heart,             0.98         0.40         0.37          0.40         0.37          0.04  XXX
                                         planar, single.
78472........  TC.........  A.........  Gated heart,             0.00         5.50         5.51            NA           NA          0.30  XXX
                                         planar, single.
78473........  ...........  A.........  Gated heart,             1.47         7.56         8.16            NA           NA          0.48  XXX
                                         multiple.
78473........  26.........  A.........  Gated heart,             1.47         0.63         0.56          0.63         0.56          0.06  XXX
                                         multiple.

[[Page 38336]]

 
78473........  TC.........  A.........  Gated heart,             0.00         6.93         7.60            NA           NA          0.42  XXX
                                         multiple.
78478........  ...........  A.........  Heart wall motion        0.50         0.78         1.29            NA           NA          0.12  XXX
                                         add-on.
78478........  26.........  A.........  Heart wall motion        0.50         0.23         0.23          0.23         0.23          0.02  XXX
                                         add-on.
78478........  TC.........  A.........  Heart wall motion        0.00         0.54         1.05            NA           NA          0.10  XXX
                                         add-on.
78480........  ...........  A.........  Heart function           0.30         0.68         1.23            NA           NA          0.12  XXX
                                         add-on.
78480........  26.........  A.........  Heart function           0.30         0.14         0.18          0.14         0.18          0.02  XXX
                                         add-on.
78480........  TC.........  A.........  Heart function           0.00         0.54         1.05            NA           NA          0.10  XXX
                                         add-on.
78481........  ...........  A.........  Heart first pass,        0.98         4.90         5.27            NA           NA          0.31  XXX
                                         single.
78481........  26.........  A.........  Heart first pass,        0.98         0.47         0.42          0.47         0.42          0.03  XXX
                                         single.
78481........  TC.........  A.........  Heart first pass,        0.00         4.43         4.85            NA           NA          0.28  XXX
                                         single.
78483........  ...........  A.........  Heart first pass,        1.47         6.64         7.56            NA           NA          0.46  XXX
                                         multiple.
78483........  26.........  A.........  Heart first pass,        1.47         0.75         0.65          0.75         0.65          0.05  XXX
                                         multiple.
78483........  TC.........  A.........  Heart first pass,        0.00         5.89         6.91            NA           NA          0.41  XXX
                                         multiple.
78491........  ...........  C.........  Heart image              1.50         0.00         0.39          0.00         0.39          0.06  XXX
                                         (pet), single.
78491........  26.........  A.........  Heart image              1.50         0.62         0.60          0.62         0.60          0.06  XXX
                                         (pet), single.
78491........  TC.........  C.........  Heart image              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         (pet), single.
78492........  ...........  C.........  Heart image              1.87         0.00         0.52          0.00         0.52          0.07  XXX
                                         (pet), multiple.
78492........  26.........  A.........  Heart image              1.87         0.88         0.81          0.88         0.81          0.07  XXX
                                         (pet), multiple.
78492........  TC.........  C.........  Heart image              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         (pet), multiple.
78494........  ...........  A.........  Heart image,             1.19         6.05         6.80            NA           NA          0.35  XXX
                                         spect.
78494........  26.........  A.........  Heart image,             1.19         0.53         0.48          0.53         0.48          0.05  XXX
                                         spect.
78494........  TC.........  A.........  Heart image,             0.00         5.52         6.32            NA           NA          0.30  XXX
                                         spect.
78496........  ...........  A.........  Heart first pass         0.50         0.86         4.07          0.86         4.07          0.32  ZZZ
                                         add-on.
78496........  26.........  A.........  Heart first pass         0.50         0.22         0.21          0.22         0.21          0.02  ZZZ
                                         add-on.
78496........  TC.........  A.........  Heart first pass         0.00         0.63         3.86          0.63         3.86          0.30  ZZZ
                                         add-on.
78499........  ...........  C.........  Cardiovascular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78499........  26.........  C.........  Cardiovascular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78499........  TC.........  C.........  Cardiovascular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78580........  ...........  A.........  Lung perfusion           0.74         5.08         4.34            NA           NA          0.21  XXX
                                         imaging.
78580........  26.........  A.........  Lung perfusion           0.74         0.26         0.25          0.26         0.25          0.03  XXX
                                         imaging.
78580........  TC.........  A.........  Lung perfusion           0.00         4.81         4.09            NA           NA          0.18  XXX
                                         imaging.
78584........  ...........  A.........  Lung V/Q image           0.99         3.00         3.23            NA           NA          0.21  XXX
                                         single breath.
78584........  26.........  A.........  Lung V/Q image           0.99         0.35         0.33          0.35         0.33          0.04  XXX
                                         single breath.
78584........  TC.........  A.........  Lung V/Q image           0.00         2.65         2.90            NA           NA          0.17  XXX
                                         single breath.
78585........  ...........  A.........  Lung V/Q imaging.        1.09         8.55         7.20            NA           NA          0.35  XXX
78585........  26.........  A.........  Lung V/Q imaging.        1.09         0.39         0.36          0.39         0.36          0.05  XXX
78585........  TC.........  A.........  Lung V/Q imaging.        0.00         8.16         6.84            NA           NA          0.30  XXX
78586........  ...........  A.........  Aerosol lung             0.40         4.13         3.39            NA           NA          0.16  XXX
                                         image, single.
78586........  26.........  A.........  Aerosol lung             0.40         0.14         0.13          0.14         0.13          0.02  XXX
                                         image, single.
78586........  TC.........  A.........  Aerosol lung             0.00         3.99         3.26            NA           NA          0.14  XXX
                                         image, single.
78587........  ...........  A.........  Aerosol lung             0.49         5.37         4.13            NA           NA          0.16  XXX
                                         image, multiple.
78587........  26.........  A.........  Aerosol lung             0.49         0.17         0.16          0.17         0.16          0.02  XXX
                                         image, multiple.
78587........  TC.........  A.........  Aerosol lung             0.00         5.20         3.97            NA           NA          0.14  XXX
                                         image, multiple.
78588........  ...........  A.........  Perfusion lung           1.09         8.58         5.99            NA           NA          0.23  XXX
                                         image.
78588........  26.........  A.........  Perfusion lung           1.09         0.38         0.36          0.38         0.36          0.05  XXX
                                         image.
78588........  TC.........  A.........  Perfusion lung           0.00         8.19         5.63            NA           NA          0.18  XXX
                                         image.
78591........  ...........  A.........  Vent image, 1            0.40         4.13         3.52            NA           NA          0.16  XXX
                                         breath, 1 proj.
78591........  26.........  A.........  Vent image, 1            0.40         0.14         0.13          0.14         0.13          0.02  XXX
                                         breath, 1 proj.
78591........  TC.........  A.........  Vent image, 1            0.00         3.99         3.38            NA           NA          0.14  XXX
                                         breath, 1 proj.
78593........  ...........  A.........  Vent image, 1            0.49         4.77         4.15            NA           NA          0.20  XXX
                                         proj, gas.
78593........  26.........  A.........  Vent image, 1            0.49         0.17         0.16          0.17         0.16          0.02  XXX
                                         proj, gas.
78593........  TC.........  A.........  Vent image, 1            0.00         4.60         3.99            NA           NA          0.18  XXX
                                         proj, gas.
78594........  ...........  A.........  Vent image, mult         0.53         5.22         5.15            NA           NA          0.27  XXX
                                         proj, gas.
78594........  26.........  A.........  Vent image, mult         0.53         0.18         0.17          0.18         0.17          0.02  XXX
                                         proj, gas.
78594........  TC.........  A.........  Vent image, mult         0.00         5.05         4.98            NA           NA          0.25  XXX
                                         proj, gas.
78596........  ...........  A.........  Lung differential        1.27         8.59         8.00            NA           NA          0.42  XXX
                                         function.
78596........  26.........  A.........  Lung differential        1.27         0.39         0.40          0.39         0.40          0.05  XXX
                                         function.
78596........  TC.........  A.........  Lung differential        0.00         8.19         7.60            NA           NA          0.37  XXX
                                         function.
78599........  ...........  C.........  Respiratory              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78599........  26.........  C.........  Respiratory              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78599........  TC.........  C.........  Respiratory              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78600........  ...........  A.........  Brain imaging,           0.44         4.33         4.10            NA           NA          0.16  XXX
                                         ltd static.
78600........  26.........  A.........  Brain imaging,           0.44         0.15         0.14          0.15         0.14          0.02  XXX
                                         ltd static.
78600........  TC.........  A.........  Brain imaging,           0.00         4.18         3.95            NA           NA          0.14  XXX
                                         ltd static.
78601........  ...........  A.........  Brain imaging,           0.51         5.33         4.40            NA           NA          0.20  XXX
                                         ltd w/flow.
78601........  26.........  A.........  Brain imaging,           0.51         0.18         0.17          0.18         0.17          0.02  XXX
                                         ltd w/flow.
78601........  TC.........  A.........  Brain imaging,           0.00         5.15         4.23            NA           NA          0.18  XXX
                                         ltd w/flow.
78605........  ...........  A.........  Brain imaging,           0.53         4.79         4.13            NA           NA          0.20  XXX
                                         complete.
78605........  26.........  A.........  Brain imaging,           0.53         0.19         0.18          0.19         0.18          0.02  XXX
                                         complete.
78605........  TC.........  A.........  Brain imaging,           0.00         4.60         3.95            NA           NA          0.18  XXX
                                         complete.
78606........  ...........  A.........  Brain imaging,           0.64         8.44         6.20            NA           NA          0.24  XXX
                                         compl w/flow.
78606........  26.........  A.........  Brain imaging,           0.64         0.22         0.21          0.22         0.21          0.03  XXX
                                         compl w/flow.

[[Page 38337]]

 
78606........  TC.........  A.........  Brain imaging,           0.00         8.22         5.99            NA           NA          0.21  XXX
                                         compl w/flow.
78607........  ...........  A.........  Brain imaging            1.23         8.53         8.73            NA           NA          0.40  XXX
                                         (3D).
78607........  26.........  A.........  Brain imaging            1.23         0.41         0.41          0.41         0.41          0.05  XXX
                                         (3D).
78607........  TC.........  A.........  Brain imaging            0.00         8.12         8.32            NA           NA          0.35  XXX
                                         (3D).
78608........  ...........  C.........  Brain imaging            1.50         0.00         0.33          0.00         0.33          0.06  XXX
                                         (PET).
78608........  26.........  A.........  Brain imaging            1.50         0.50         0.49          0.50         0.49          0.06  XXX
                                         (PET).
78608........  TC.........  C.........  Brain imaging            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         (PET).
78609........  ...........  C.........  Brain imaging            1.50         0.00         0.33          0.00         0.33          0.06  XXX
                                         (PET).
78609........  26.........  A.........  Brain imaging            1.50         0.52         0.50          0.52         0.50          0.06  XXX
                                         (PET).
78609........  TC.........  C.........  Brain imaging            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         (PET).
78610........  ...........  A.........  Brain flow               0.30         4.36         3.00            NA           NA          0.11  XXX
                                         imaging only.
78610........  26.........  A.........  Brain flow               0.30         0.10         0.11          0.10         0.11          0.01  XXX
                                         imaging only.
78610........  TC.........  A.........  Brain flow               0.00         4.25         2.89            NA           NA          0.10  XXX
                                         imaging only.
78615........  ...........  A.........  Cerebral vascular        0.42         5.44         4.65            NA           NA          0.23  XXX
                                         flow image.
78615........  26.........  A.........  Cerebral vascular        0.42         0.15         0.14          0.15         0.14          0.02  XXX
                                         flow image.
78615........  TC.........  A.........  Cerebral vascular        0.00         5.29         4.51            NA           NA          0.21  XXX
                                         flow image.
78630........  ...........  A.........  Cerebrospinal            0.68         8.57         6.84            NA           NA          0.30  XXX
                                         fluid scan.
78630........  26.........  A.........  Cerebrospinal            0.68         0.24         0.23          0.24         0.23          0.03  XXX
                                         fluid scan.
78630........  TC.........  A.........  Cerebrospinal            0.00         8.33         6.62            NA           NA          0.27  XXX
                                         fluid scan.
78635........  ...........  A.........  CSF                      0.61         8.70         5.63            NA           NA          0.16  XXX
                                         ventriculography.
78635........  26.........  A.........  CSF                      0.61         0.21         0.22          0.21         0.22          0.02  XXX
                                         ventriculography.
78635........  TC.........  A.........  CSF                      0.00         8.49         5.42            NA           NA          0.14  XXX
                                         ventriculography.
78645........  ...........  A.........  CSF shunt                0.57         8.38         5.93            NA           NA          0.20  XXX
                                         evaluation.
78645........  26.........  A.........  CSF shunt                0.57         0.20         0.19          0.20         0.19          0.02  XXX
                                         evaluation.
78645........  TC.........  A.........  CSF shunt                0.00         8.18         5.75            NA           NA          0.18  XXX
                                         evaluation.
78647........  ...........  A.........  Cerebrospinal            0.90         8.41         8.18            NA           NA          0.35  XXX
                                         fluid scan.
78647........  26.........  A.........  Cerebrospinal            0.90         0.29         0.29          0.29         0.29          0.04  XXX
                                         fluid scan.
78647........  TC.........  A.........  Cerebrospinal            0.00         8.12         7.89            NA           NA          0.31  XXX
                                         fluid scan.
78650........  ...........  A.........  CSF leakage              0.61         8.47         6.61            NA           NA          0.27  XXX
                                         imaging.
78650........  26.........  A.........  CSF leakage              0.61         0.21         0.20          0.21         0.20          0.03  XXX
                                         imaging.
78650........  TC.........  A.........  CSF leakage              0.00         8.26         6.41            NA           NA          0.24  XXX
                                         imaging.
78660........  ...........  A.........  Nuclear exam of          0.53         4.22         3.23            NA           NA          0.14  XXX
                                         tear flow.
78660........  26.........  A.........  Nuclear exam of          0.53         0.19         0.18          0.19         0.18          0.02  XXX
                                         tear flow.
78660........  TC.........  A.........  Nuclear exam of          0.00         4.03         3.05            NA           NA          0.12  XXX
                                         tear flow.
78699........  ...........  C.........  Nervous system           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78699........  26.........  C.........  Nervous system           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78699........  TC.........  C.........  Nervous system           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78700........  ...........  A.........  Kidney imaging,          0.45         4.35         3.76            NA           NA          0.18  XXX
                                         morphol.
78700........  26.........  A.........  Kidney imaging,          0.45         0.16         0.15          0.16         0.15          0.02  XXX
                                         morphol.
78700........  TC.........  A.........  Kidney imaging,          0.00         4.19         3.61            NA           NA          0.16  XXX
                                         morphol.
78701........  ...........  A.........  Kidney imaging           0.49         5.33         4.48            NA           NA          0.20  XXX
                                         with flow.
78701........  26.........  A.........  Kidney imaging           0.49         0.17         0.16          0.17         0.16          0.02  XXX
                                         with flow.
78701........  TC.........  A.........  Kidney imaging           0.00         5.16         4.32            NA           NA          0.18  XXX
                                         with flow.
78707........  ...........  A.........  K flow/funct             0.96         5.43         5.06            NA           NA          0.27  XXX
                                         image w/o drug.
78707........  26.........  A.........  K flow/funct             0.96         0.34         0.32          0.34         0.32          0.04  XXX
                                         image w/o drug.
78707........  TC.........  A.........  K flow/funct             0.00         5.09         4.74            NA           NA          0.23  XXX
                                         image w/o drug.
78708........  ...........  A.........  K flow/funct             1.21         3.45         4.12            NA           NA          0.28  XXX
                                         image w/drug.
78708........  26.........  A.........  K flow/funct             1.21         0.43         0.40          0.43         0.40          0.05  XXX
                                         image w/drug.
78708........  TC.........  A.........  K flow/funct             0.00         3.02         3.71            NA           NA          0.23  XXX
                                         image w/drug.
78709........  ...........  A.........  K flow/funct             1.41         8.80         6.79            NA           NA          0.29  XXX
                                         image, multiple.
78709........  26.........  A.........  K flow/funct             1.41         0.50         0.47          0.50         0.47          0.06  XXX
                                         image, multiple.
78709........  TC.........  A.........  K flow/funct             0.00         8.30         6.33            NA           NA          0.23  XXX
                                         image, multiple.
78710........  ...........  A.........  Kidney imaging           0.66         5.22         5.64            NA           NA          0.34  XXX
                                         (3D).
78710........  26.........  A.........  Kidney imaging           0.66         0.22         0.21          0.22         0.21          0.03  XXX
                                         (3D).
78710........  TC.........  A.........  Kidney imaging           0.00         5.00         5.43            NA           NA          0.31  XXX
                                         (3D).
78725........  ...........  A.........  Kidney function          0.38         2.33         2.11            NA           NA          0.13  XXX
                                         study.
78725........  26.........  A.........  Kidney function          0.38         0.13         0.13          0.13         0.13          0.02  XXX
                                         study.
78725........  TC.........  A.........  Kidney function          0.00         2.20         1.98            NA           NA          0.11  XXX
                                         study.
78730........  ...........  A.........  Urinary bladder          0.15         1.97         1.78            NA           NA          0.10  ZZZ
                                         retention.
78730........  26.........  A.........  Urinary bladder          0.15         0.06         0.09          0.06         0.09          0.02  ZZZ
                                         retention.
78730........  TC.........  A.........  Urinary bladder          0.00         1.92         1.69            NA           NA          0.08  ZZZ
                                         retention.
78740........  ...........  A.........  Ureteral reflux          0.57         5.61         3.88            NA           NA          0.15  XXX
                                         study.
78740........  26.........  A.........  Ureteral reflux          0.57         0.20         0.19          0.20         0.19          0.03  XXX
                                         study.
78740........  TC.........  A.........  Ureteral reflux          0.00         5.42         3.70            NA           NA          0.12  XXX
                                         study.
78761........  ...........  A.........  Testicular               0.71         5.01         4.16            NA           NA          0.20  XXX
                                         imaging w/flow.
78761........  26.........  A.........  Testicular               0.71         0.25         0.24          0.25         0.24          0.03  XXX
                                         imaging w/flow.
78761........  TC.........  A.........  Testicular               0.00         4.76         3.92            NA           NA          0.17  XXX
                                         imaging w/flow.
78799........  ...........  C.........  Genitourinary            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78799........  26.........  C.........  Genitourinary            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78799........  TC.........  C.........  Genitourinary            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         nuclear exam.
78800........  ...........  A.........  Tumor imaging,           0.66         4.29         3.92            NA           NA          0.22  XXX
                                         limited area.
78800........  26.........  A.........  Tumor imaging,           0.66         0.21         0.21          0.21         0.21          0.04  XXX
                                         limited area.

[[Page 38338]]

 
78800........  TC.........  A.........  Tumor imaging,           0.00         4.08         3.71            NA           NA          0.18  XXX
                                         limited area.
78801........  ...........  A.........  Tumor imaging,           0.79         5.99         5.20            NA           NA          0.27  XXX
                                         mult areas.
78801........  26.........  A.........  Tumor imaging,           0.79         0.27         0.26          0.27         0.26          0.05  XXX
                                         mult areas.
78801........  TC.........  A.........  Tumor imaging,           0.00         5.72         4.94            NA           NA          0.22  XXX
                                         mult areas.
78802........  ...........  A.........  Tumor imaging,           0.86         8.05         6.88            NA           NA          0.34  XXX
                                         whole body.
78802........  26.........  A.........  Tumor imaging,           0.86         0.30         0.29          0.30         0.29          0.04  XXX
                                         whole body.
78802........  TC.........  A.........  Tumor imaging,           0.00         7.75         6.59            NA           NA          0.30  XXX
                                         whole body.
78803........  ...........  A.........  Tumor imaging            1.09         8.44         8.63            NA           NA          0.40  XXX
                                         (3D).
78803........  26.........  A.........  Tumor imaging            1.09         0.38         0.37          0.38         0.37          0.05  XXX
                                         (3D).
78803........  TC.........  A.........  Tumor imaging            0.00         8.06         8.27            NA           NA          0.35  XXX
                                         (3D).
78804........  ...........  A.........  Tumor imaging,           1.07        14.68        12.95            NA           NA          0.34  XXX
                                         whole body.
78804........  26.........  A.........  Tumor imaging,           1.07         0.37         0.36          0.37         0.36          0.04  XXX
                                         whole body.
78804........  TC.........  A.........  Tumor imaging,           0.00        14.31        12.59            NA           NA          0.30  XXX
                                         whole body.
78805........  ...........  A.........  Abscess imaging,         0.73         4.18         3.88            NA           NA          0.21  XXX
                                         ltd area.
78805........  26.........  A.........  Abscess imaging,         0.73         0.25         0.24          0.25         0.24          0.03  XXX
                                         ltd area.
78805........  TC.........  A.........  Abscess imaging,         0.00         3.93         3.64            NA           NA          0.18  XXX
                                         ltd area.
78806........  ...........  A.........  Abscess imaging,         0.86         8.27         7.43            NA           NA          0.39  XXX
                                         whole body.
78806........  26.........  A.........  Abscess imaging,         0.86         0.30         0.29          0.30         0.29          0.04  XXX
                                         whole body.
78806........  TC.........  A.........  Abscess imaging,         0.00         7.97         7.14            NA           NA          0.35  XXX
                                         whole body.
78807........  ...........  A.........  Nuclear                  1.09         8.40         8.51            NA           NA          0.39  XXX
                                         localization/
                                         abscess.
78807........  26.........  A.........  Nuclear                  1.09         0.37         0.37          0.37         0.37          0.04  XXX
                                         localization/
                                         abscess.
78807........  TC.........  A.........  Nuclear                  0.00         8.03         8.14            NA           NA          0.35  XXX
                                         localization/
                                         abscess.
78811........  ...........  C.........  Tumor imaging            1.54         0.00         0.34            NA           NA          0.11  XXX
                                         (pet), limited.
78811........  26.........  A.........  Tumor imaging            1.54         0.54         0.52          0.54         0.52          0.11  XXX
                                         (pet), limited.
78811........  TC.........  C.........  Tumor imaging            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         (pet), limited.
78812........  ...........  C.........  Tumor image (pet)/       1.93         0.00         0.43            NA           NA          0.11  XXX
                                         skul-thigh.
78812........  26.........  A.........  Tumor image (pet)/       1.93         0.67         0.65          0.67         0.65          0.11  XXX
                                         skul-thigh.
78812........  TC.........  C.........  Tumor image (pet)/       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         skul-thigh.
78813........  ...........  C.........  Tumor image (pet)        2.00         0.00         0.44            NA           NA          0.11  XXX
                                         full body.
78813........  26.........  A.........  Tumor image (pet)        2.00         0.69         0.67          0.69         0.67          0.11  XXX
                                         full body.
78813........  TC.........  C.........  Tumor image (pet)        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         full body.
78814........  ...........  C.........  Tumor image pet/         2.20         0.00         0.49            NA           NA          0.11  XXX
                                         ct, limited.
78814........  26.........  A.........  Tumor image pet/         2.20         0.74         0.73          0.74         0.73          0.11  XXX
                                         ct, limited.
78814........  TC.........  C.........  Tumor image pet/         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ct, limited.
78815........  ...........  C.........  Tumorimage pet/ct        2.44         0.00         0.54            NA           NA          0.11  XXX
                                         skul-thigh.
78815........  26.........  A.........  Tumorimage pet/ct        2.44         0.84         0.82          0.84         0.82          0.11  XXX
                                         skul-thigh.
78815........  TC.........  C.........  Tumorimage pet/ct        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         skul-thigh.
78816........  ...........  C.........  Tumor image pet/         2.50         0.00         0.55            NA           NA          0.11  XXX
                                         ct full body.
78816........  26.........  A.........  Tumor image pet/         2.50         0.86         0.84          0.86         0.84          0.11  XXX
                                         ct full body.
78816........  TC.........  C.........  Tumor image pet/         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ct full body.
78890........  ...........  B.........  Nuclear medicine         0.05         0.38         0.86            NA           NA          0.07  XXX
                                         data proc.
78890........  26.........  B.........  Nuclear medicine         0.05         0.01         0.02          0.01         0.02          0.01  XXX
                                         data proc.
78890........  TC.........  B.........  Nuclear medicine         0.00         0.37         0.84            NA           NA          0.06  XXX
                                         data proc.
78891........  ...........  B.........  Nuclear med data         0.10         0.87         1.77            NA           NA          0.14  XXX
                                         proc.
78891........  26.........  B.........  Nuclear med data         0.10         0.02         0.03          0.02         0.03          0.01  XXX
                                         proc.
78891........  TC.........  B.........  Nuclear med data         0.00         0.85         1.74            NA           NA          0.13  XXX
                                         proc.
78999........  ...........  C.........  Nuclear                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         diagnostic exam.
78999........  26.........  C.........  Nuclear                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         diagnostic exam.
78999........  TC.........  C.........  Nuclear                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         diagnostic exam.
79005........  ...........  A.........  Nuclear rx, oral         1.80         1.84         2.51            NA           NA          0.22  XXX
                                         admin.
79005........  26.........  A.........  Nuclear rx, oral         1.80         0.59         0.58          0.59         0.58          0.08  XXX
                                         admin.
79005........  TC.........  A.........  Nuclear rx, oral         0.00         1.25         1.93            NA           NA          0.14  XXX
                                         admin.
79101........  ...........  A.........  Nuclear rx, iv           1.96         2.14         2.70            NA           NA          0.22  XXX
                                         admin.
79101........  26.........  A.........  Nuclear rx, iv           1.96         0.74         0.69          0.74         0.69          0.08  XXX
                                         admin.
79101........  TC.........  A.........  Nuclear rx, iv           0.00         1.41         2.01            NA           NA          0.14  XXX
                                         admin.
79200........  ...........  A.........  Nuclear rx,              1.99         2.21         2.74            NA           NA          0.23  XXX
                                         intracav admin.
79200........  26.........  A.........  Nuclear rx,              1.99         0.66         0.66          0.66         0.66          0.09  XXX
                                         intracav admin.
79200........  TC.........  A.........  Nuclear rx,              0.00         1.55         2.08            NA           NA          0.14  XXX
                                         intracav admin.
79300........  ...........  C.........  Nuclr rx,                1.60         0.00         0.37            NA           NA          0.13  XXX
                                         interstit
                                         colloid.
79300........  26.........  A.........  Nuclr rx,                1.60         0.52         0.55          0.52         0.55          0.13  XXX
                                         interstit
                                         colloid.
79300........  TC.........  C.........  Nuclr rx,                0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         interstit
                                         colloid.
79403........  ...........  A.........  Hematopoietic            2.25         2.90         4.01            NA           NA          0.24  XXX
                                         nuclear tx.
79403........  26.........  A.........  Hematopoietic            2.25         0.76         0.81          0.76         0.81          0.10  XXX
                                         nuclear tx.
79403........  TC.........  A.........  Hematopoietic            0.00         2.14         3.20            NA           NA          0.14  XXX
                                         nuclear tx.
79440........  ...........  A.........  Nuclear rx, intra-       1.99         1.82         2.55            NA           NA          0.22  XXX
                                         articular.
79440........  26.........  A.........  Nuclear rx, intra-       1.99         0.68         0.68          0.68         0.68          0.08  XXX
                                         articular.
79440........  TC.........  A.........  Nuclear rx, intra-       0.00         1.14         1.87            NA           NA          0.14  XXX
                                         articular.
79445........  ...........  C.........  Nuclear rx, intra-       2.40         0.00         0.53          0.00         0.53          0.12  XXX
                                         arterial.
79445........  26.........  A.........  Nuclear rx, intra-       2.40         0.87         0.82          0.87         0.82          0.12  XXX
                                         arterial.
79445........  TC.........  C.........  Nuclear rx, intra-       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         arterial.
79999........  ...........  C.........  Nuclear medicine         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         therapy.
79999........  26.........  C.........  Nuclear medicine         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         therapy.

[[Page 38339]]

 
79999........  TC.........  C.........  Nuclear medicine         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         therapy.
80500........  ...........  A.........  Lab pathology            0.37         0.20         0.21          0.12         0.14          0.01  XXX
                                         consultation.
80502........  ...........  A.........  Lab pathology            1.33         0.31         0.42          0.25         0.40          0.04  XXX
                                         consultation.
83020........  26.........  A.........  Hemoglobin               0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         electrophoresis.
83912........  26.........  A.........  Genetic                  0.37         0.11         0.12          0.11         0.12          0.01  XXX
                                         examination.
84165........  26.........  A.........  Protein e-               0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         phoresis, serum.
84166........  26.........  A.........  Protein e-               0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         phoresis/urine/
                                         csf.
84181........  26.........  A.........  Western blot test        0.37         0.12         0.13          0.12         0.13          0.01  XXX
84182........  26.........  A.........  Protein, western         0.37         0.12         0.14          0.12         0.14          0.02  XXX
                                         blot test.
85060........  ...........  A.........  Blood smear              0.45         0.14         0.16          0.14         0.16          0.02  XXX
                                         interpretation.
85097........  ...........  A.........  Bone marrow              0.94         1.24         1.59          0.27         0.34          0.04  XXX
                                         interpretation.
85390........  26.........  A.........  Fibrinolysins            0.37         0.13         0.13          0.13         0.13          0.01  XXX
                                         screen.
85396........  ...........  A.........  Clotting assay,          0.37           NA           NA          0.10         0.12          0.04  XXX
                                         whole blood.
85576........  26.........  A.........  Blood platelet           0.37         0.12         0.14          0.12         0.14          0.01  XXX
                                         aggregation.
86077........  ...........  A.........  Physician blood          0.94         0.39         0.39          0.30         0.35          0.03  XXX
                                         bank service.
86078........  ...........  A.........  Physician blood          0.94         0.39         0.42          0.30         0.35          0.03  XXX
                                         bank service.
86079........  ...........  A.........  Physician blood          0.94         0.39         0.42          0.31         0.36          0.03  XXX
                                         bank service.
86255........  26.........  A.........  Fluorescent              0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         antibody, screen.
86256........  26.........  A.........  Fluorescent              0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         antibody, titer.
86320........  26.........  A.........  Serum                    0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         immunoelectropho
                                         resis.
86325........  26.........  A.........  Other                    0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         immunoelectropho
                                         resis.
86327........  26.........  A.........  Immunoelectrophor        0.42         0.13         0.16          0.13         0.16          0.02  XXX
                                         esis assay.
86334........  26.........  A.........  Immunofix e-             0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         phoresis, serum.
86335........  26.........  A.........  Immunfix e-              0.37         0.12         0.13          0.12         0.13          0.01  XXX
                                         phorsis/urine/
                                         csf.
86485........  ...........  C.........  Skin test,               0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         candida.
86490........  ...........  A.........  Coccidioidomycosi        0.00         0.13         0.21            NA           NA          0.02  XXX
                                         s skin test.
86510........  ...........  A.........  Histoplasmosis           0.00         0.12         0.23            NA           NA          0.02  XXX
                                         skin test.
86580........  ...........  A.........  TB intradermal           0.00         0.16         0.21            NA           NA          0.02  XXX
                                         test.
87164........  26.........  A.........  Dark field               0.37         0.12         0.12          0.12         0.12          0.01  XXX
                                         examination.
87207........  26.........  A.........  Smear, special           0.37         0.12         0.14          0.12         0.14          0.01  XXX
                                         stain.
88104........  ...........  A.........  Cytopath fl              0.56         1.18         1.01            NA           NA          0.04  XXX
                                         nongyn, smears.
88104........  26.........  A.........  Cytopath fl              0.56         0.16         0.20          0.16         0.20          0.02  XXX
                                         nongyn, smears.
88104........  TC.........  A.........  Cytopath fl              0.00         1.02         0.81            NA           NA          0.02  XXX
                                         nongyn, smears.
88106........  ...........  A.........  Cytopath fl              0.56         1.52         1.43            NA           NA          0.04  XXX
                                         nongyn, filter.
88106........  26.........  A.........  Cytopath fl              0.56         0.15         0.20          0.15         0.20          0.02  XXX
                                         nongyn, filter.
88106........  TC.........  A.........  Cytopath fl              0.00         1.36         1.23            NA           NA          0.02  XXX
                                         nongyn, filter.
88107........  ...........  A.........  Cytopath fl              0.76         1.98         1.77            NA           NA          0.05  XXX
                                         nongyn, sm/fltr.
88107........  26.........  A.........  Cytopath fl              0.76         0.23         0.28          0.23         0.28          0.03  XXX
                                         nongyn, sm/fltr.
88107........  TC.........  A.........  Cytopath fl              0.00         1.75         1.48            NA           NA          0.02  XXX
                                         nongyn, sm/fltr.
88108........  ...........  A.........  Cytopath,                0.56         1.46         1.33            NA           NA          0.04  XXX
                                         concentrate tech.
88108........  26.........  A.........  Cytopath,                0.56         0.16         0.20          0.16         0.20          0.02  XXX
                                         concentrate tech.
88108........  TC.........  A.........  Cytopath,                0.00         1.31         1.14            NA           NA          0.02  XXX
                                         concentrate tech.
88112........  ...........  A.........  Cytopath, cell           1.18         1.47         1.72            NA           NA          0.04  XXX
                                         enhance tech.
88112........  26.........  A.........  Cytopath, cell           1.18         0.30         0.41          0.30         0.41          0.02  XXX
                                         enhance tech.
88112........  TC.........  A.........  Cytopath, cell           0.00         1.17         1.32            NA           NA          0.02  XXX
                                         enhance tech.
88125........  ...........  A.........  Forensic                 0.26         0.29         0.28            NA           NA          0.02  XXX
                                         cytopathology.
88125........  26.........  A.........  Forensic                 0.26         0.07         0.09          0.07         0.09          0.01  XXX
                                         cytopathology.
88125........  TC.........  A.........  Forensic                 0.00         0.22         0.19            NA           NA          0.01  XXX
                                         cytopathology.
88141........  ...........  A.........  Cytopath, c/v,           0.42         0.37         0.26          0.37         0.26          0.02  XXX
                                         interpret.
88160........  ...........  A.........  Cytopath smear,          0.50         0.90         0.87            NA           NA          0.04  XXX
                                         other source.
88160........  26.........  A.........  Cytopath smear,          0.50         0.13         0.17          0.13         0.17          0.02  XXX
                                         other source.
88160........  TC.........  A.........  Cytopath smear,          0.00         0.77         0.70            NA           NA          0.02  XXX
                                         other source.
88161........  ...........  A.........  Cytopath smear,          0.50         1.07         1.02            NA           NA          0.04  XXX
                                         other source.
88161........  26.........  A.........  Cytopath smear,          0.50         0.15         0.18          0.15         0.18          0.02  XXX
                                         other source.
88161........  TC.........  A.........  Cytopath smear,          0.00         0.92         0.83            NA           NA          0.02  XXX
                                         other source.
88162........  ...........  A.........  Cytopath smear,          0.76         1.58         1.23            NA           NA          0.05  XXX
                                         other source.
88162........  26.........  A.........  Cytopath smear,          0.76         0.24         0.27          0.24         0.27          0.03  XXX
                                         other source.
88162........  TC.........  A.........  Cytopath smear,          0.00         1.34         0.95            NA           NA          0.02  XXX
                                         other source.
88172........  ...........  A.........  Cytopathology            0.60         0.81         0.78            NA           NA          0.04  XXX
                                         eval of fna.
88172........  26.........  A.........  Cytopathology            0.60         0.17         0.22          0.17         0.22          0.02  XXX
                                         eval of fna.
88172........  TC.........  A.........  Cytopathology            0.00         0.63         0.56            NA           NA          0.02  XXX
                                         eval of fna.
88173........  ...........  A.........  Cytopath eval,           1.39         2.19         2.18            NA           NA          0.07  XXX
                                         fna, report.
88173........  26.........  A.........  Cytopath eval,           1.39         0.39         0.49          0.39         0.49          0.05  XXX
                                         fna, report.
88173........  TC.........  A.........  Cytopath eval,           0.00         1.80         1.69            NA           NA          0.02  XXX
                                         fna, report.
88182........  ...........  A.........  Cell marker study        0.77         1.99         1.98            NA           NA          0.07  XXX
88182........  26.........  A.........  Cell marker study        0.77         0.14         0.23          0.14         0.23          0.03  XXX
88182........  TC.........  A.........  Cell marker study        0.00         1.85         1.74            NA           NA          0.04  XXX
88184........  ...........  A.........  Flowcytometry/           0.00         2.44         1.88            NA           NA          0.02  XXX
                                         tc, 1 marker.
88185........  ...........  A.........  Flowcytometry/tc,        0.00         1.48         1.06            NA           NA          0.02  ZZZ
                                         add-on.
88187........  ...........  A.........  Flowcytometry/           1.36         0.40         0.43          0.40         0.43          0.01  XXX
                                         read, 2-8.
88188........  ...........  A.........  Flowcytometry/           1.69         0.45         0.51          0.45         0.51          0.01  XXX
                                         read, 9-15.
88189........  ...........  A.........  Flowcytometry/           2.23         0.48         0.61          0.48         0.61          0.01  XXX
                                         read, 16 & >.

[[Page 38340]]

 
88199........  ...........  C.........  Cytopathology            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
88199........  26.........  C.........  Cytopathology            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
88199........  TC.........  C.........  Cytopathology            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
88291........  ...........  A.........  Cyto/molecular           0.52         0.27         0.22          0.27         0.22          0.02  XXX
                                         report.
88299........  ...........  C.........  Cytogenetic study        0.00         0.00         0.00          0.00         0.00          0.00  XXX
88300........  ...........  A.........  Surgical path,           0.08         0.56         0.51            NA           NA          0.02  XXX
                                         gross.
88300........  26.........  A.........  Surgical path,           0.08         0.02         0.03          0.02         0.03          0.01  XXX
                                         gross.
88300........  TC.........  A.........  Surgical path,           0.00         0.53         0.48            NA           NA          0.01  XXX
                                         gross.
88302........  ...........  A.........  Tissue exam by           0.13         1.28         1.16            NA           NA          0.03  XXX
                                         pathologist.
88302........  26.........  A.........  Tissue exam by           0.13         0.04         0.05          0.04         0.05          0.01  XXX
                                         pathologist.
88302........  TC.........  A.........  Tissue exam by           0.00         1.24         1.11            NA           NA          0.02  XXX
                                         pathologist.
88304........  ...........  A.........  Tissue exam by           0.22         1.45         1.40            NA           NA          0.03  XXX
                                         pathologist.
88304........  26.........  A.........  Tissue exam by           0.22         0.06         0.07          0.06         0.07          0.01  XXX
                                         pathologist.
88304........  TC.........  A.........  Tissue exam by           0.00         1.39         1.32            NA           NA          0.02  XXX
                                         pathologist.
88305........  ...........  A.........  Tissue exam by           0.75         2.03         1.99            NA           NA          0.07  XXX
                                         pathologist.
88305........  26.........  A.........  Tissue exam by           0.75         0.20         0.27          0.20         0.27          0.03  XXX
                                         pathologist.
88305........  TC.........  A.........  Tissue exam by           0.00         1.83         1.72            NA           NA          0.04  XXX
                                         pathologist.
88307........  ...........  A.........  Tissue exam by           1.59         4.38         3.78            NA           NA          0.12  XXX
                                         pathologist.
88307........  26.........  A.........  Tissue exam by           1.59         0.48         0.58          0.48         0.58          0.06  XXX
                                         pathologist.
88307........  TC.........  A.........  Tissue exam by           0.00         3.90         3.20            NA           NA          0.06  XXX
                                         pathologist.
88309........  ...........  A.........  Tissue exam by           2.80         6.13         5.28            NA           NA          0.14  XXX
                                         pathologist.
88309........  26.........  A.........  Tissue exam by           2.80         0.83         0.90          0.83         0.90          0.08  XXX
                                         pathologist.
88309........  TC.........  A.........  Tissue exam by           0.00         5.29         4.38            NA           NA          0.06  XXX
                                         pathologist.
88311........  ...........  A.........  Decalcify tissue.        0.24         0.24         0.23            NA           NA          0.02  XXX
88311........  26.........  A.........  Decalcify tissue.        0.24         0.07         0.08          0.07         0.08          0.01  XXX
88311........  TC.........  A.........  Decalcify tissue.        0.00         0.17         0.15            NA           NA          0.01  XXX
88312........  ...........  A.........  Special stains...        0.54         2.27         1.93            NA           NA          0.03  XXX
88312........  26.........  A.........  Special stains...        0.54         0.14         0.19          0.14         0.19          0.02  XXX
88312........  TC.........  A.........  Special stains...        0.00         2.13         1.74            NA           NA          0.01  XXX
88313........  ...........  A.........  Special stains...        0.24         1.93         1.59            NA           NA          0.02  XXX
88313........  26.........  A.........  Special stains...        0.24         0.06         0.08          0.06         0.08          0.01  XXX
88313........  TC.........  A.........  Special stains...        0.00         1.87         1.51            NA           NA          0.01  XXX
88314........  ...........  A.........  Histochemical            0.45         1.94         2.01            NA           NA          0.04  XXX
                                         stain.
88314........  26.........  A.........  Histochemical            0.45         0.14         0.17          0.14         0.17          0.02  XXX
                                         stain.
88314........  TC.........  A.........  Histochemical            0.00         1.80         1.84            NA           NA          0.02  XXX
                                         stain.
88318........  ...........  A.........  Chemical                 0.42         2.93         2.30            NA           NA          0.03  XXX
                                         histochemistry.
88318........  26.........  A.........  Chemical                 0.42         0.12         0.15          0.12         0.15          0.02  XXX
                                         histochemistry.
88318........  TC.........  A.........  Chemical                 0.00         2.80         2.14            NA           NA          0.01  XXX
                                         histochemistry.
88319........  ...........  A.........  Enzyme                   0.53         3.20         3.31            NA           NA          0.04  XXX
                                         histochemistry.
88319........  26.........  A.........  Enzyme                   0.53         0.15         0.18          0.15         0.18          0.02  XXX
                                         histochemistry.
88319........  TC.........  A.........  Enzyme                   0.00         3.04         3.12            NA           NA          0.02  XXX
                                         histochemistry.
88321........  ...........  A.........  Microslide               1.63         0.72         0.76          0.47         0.52          0.05  XXX
                                         consultation.
88323........  ...........  A.........  Microslide               1.83         2.20         1.99            NA           NA          0.07  XXX
                                         consultation.
88323........  26.........  A.........  Microslide               1.83         0.47         0.52          0.47         0.52          0.05  XXX
                                         consultation.
88323........  TC.........  A.........  Microslide               0.00         1.73         1.47            NA           NA          0.02  XXX
                                         consultation.
88325........  ...........  A.........  Comprehensive            2.50         2.39         2.64          0.70         0.81          0.07  XXX
                                         review of data.
88329........  ...........  A.........  Path consult             0.67         0.66         0.66          0.20         0.25          0.02  XXX
                                         introp.
88331........  ...........  A.........  Path consult             1.19         1.20         1.16            NA           NA          0.08  XXX
                                         intraop, 1 bloc.
88331........  26.........  A.........  Path consult             1.19         0.37         0.44          0.37         0.44          0.04  XXX
                                         intraop, 1 bloc.
88331........  TC.........  A.........  Path consult             0.00         0.83         0.72            NA           NA          0.04  XXX
                                         intraop, 1 bloc.
88332........  ...........  A.........  Path consult             0.59         0.48         0.47            NA           NA          0.04  XXX
                                         intraop,
                                         add[boxHu]l.
88332........  26.........  A.........  Path consult             0.59         0.18         0.21          0.18         0.21          0.02  XXX
                                         intraop,
                                         add[boxHu]l.
88332........  TC.........  A.........  Path consult             0.00         0.29         0.25            NA           NA          0.02  XXX
                                         intraop,
                                         add[boxHu]l.
88333........  ...........  A.........  Intraop cyto path        1.20         1.31         1.20            NA           NA          0.08  XXX
                                         consult, 1.
88333........  26.........  A.........  Intraop cyto path        1.20         0.37         0.45          0.37         0.45          0.04  XXX
                                         consult, 1.
88333........  TC.........  A.........  Intraop cyto path        0.00         0.94         0.75            NA           NA          0.04  XXX
                                         consult, 1.
88334........  ...........  A.........  Intraop cyto path        0.73         0.78         0.69            NA           NA          0.04  XXX
                                         consult, 2.
88334........  26.........  A.........  Intraop cyto path        0.73         0.22         0.24          0.22         0.24          0.02  XXX
                                         consult, 2.
88334........  TC.........  A.........  Intraop cyto path        0.00         0.56         0.45            NA           NA          0.02  XXX
                                         consult, 2.
88342........  ...........  A.........  Immunohistochemis        0.85         1.98         1.73            NA           NA          0.05  XXX
                                         try.
88342........  26.........  A.........  Immunohistochemis        0.85         0.23         0.30          0.23         0.30          0.03  XXX
                                         try.
88342........  TC.........  A.........  Immunohistochemis        0.00         1.75         1.43            NA           NA          0.02  XXX
                                         try.
88346........  ...........  A.........  Immunofluorescent        0.86         1.89         1.74            NA           NA          0.05  XXX
                                         study.
88346........  26.........  A.........  Immunofluorescent        0.86         0.23         0.30          0.23         0.30          0.03  XXX
                                         study.
88346........  TC.........  A.........  Immunofluorescent        0.00         1.66         1.45            NA           NA          0.02  XXX
                                         study.
88347........  ...........  A.........  Immunofluorescent        0.86         1.31         1.29            NA           NA          0.05  XXX
                                         study.
88347........  26.........  A.........  Immunofluorescent        0.86         0.19         0.27          0.19         0.27          0.03  XXX
                                         study.
88347........  TC.........  A.........  Immunofluorescent        0.00         1.12         1.02            NA           NA          0.02  XXX
                                         study.
88348........  ...........  A.........  Electron                 1.51        18.10        13.69            NA           NA          0.13  XXX
                                         microscopy.
88348........  26.........  A.........  Electron                 1.51         0.42         0.53          0.42         0.53          0.06  XXX
                                         microscopy.
88348........  TC.........  A.........  Electron                 0.00        17.68        13.16            NA           NA          0.07  XXX
                                         microscopy.
88349........  ...........  A.........  Scanning electron        0.76         9.38         6.38            NA           NA          0.09  XXX
                                         microscopy.

[[Page 38341]]

 
88349........  26.........  A.........  Scanning electron        0.76         0.23         0.28          0.23         0.28          0.03  XXX
                                         microscopy.
88349........  TC.........  A.........  Scanning electron        0.00         9.15         6.10            NA           NA          0.06  XXX
                                         microscopy.
88355........  ...........  A.........  Analysis,                1.85         3.19         6.00            NA           NA          0.13  XXX
                                         skeletal muscle.
88355........  26.........  A.........  Analysis,                1.85         0.37         0.58          0.37         0.58          0.07  XXX
                                         skeletal muscle.
88355........  TC.........  A.........  Analysis,                0.00         2.82         5.42            NA           NA          0.06  XXX
                                         skeletal muscle.
88356........  ...........  A.........  Analysis, nerve..        3.02         5.33         4.97            NA           NA          0.19  XXX
88356........  26.........  A.........  Analysis, nerve..        3.02         0.59         0.96          0.59         0.96          0.12  XXX
88356........  TC.........  A.........  Analysis, nerve..        0.00         4.74         4.01            NA           NA          0.07  XXX
88358........  ...........  A.........  Analysis, tumor..        0.95         1.09         0.97            NA           NA          0.17  XXX
88358........  26.........  A.........  Analysis, tumor..        0.95         0.16         0.28          0.16         0.28          0.10  XXX
88358........  TC.........  A.........  Analysis, tumor..        0.00         0.93         0.69            NA           NA          0.07  XXX
88360........  ...........  A.........  Tumor                    1.10         2.21         1.98            NA           NA          0.08  XXX
                                         immunohistochem/
                                         manual.
88360........  26.........  A.........  Tumor                    1.10         0.27         0.37          0.27         0.37          0.06  XXX
                                         immunohistochem/
                                         manual.
88360........  TC.........  A.........  Tumor                    0.00         1.93         1.61            NA           NA          0.02  XXX
                                         immunohistochem/
                                         manual.
88361........  ...........  A.........  Tumor                    1.18         2.77         2.88            NA           NA          0.17  XXX
                                         immunohistochem/
                                         comput.
88361........  26.........  A.........  Tumor                    1.18         0.27         0.38          0.27         0.38          0.10  XXX
                                         immunohistochem/
                                         comput.
88361........  TC.........  A.........  Tumor                    0.00         2.50         2.51            NA           NA          0.07  XXX
                                         immunohistochem/
                                         comput.
88362........  ...........  A.........  Nerve teasing            2.17         4.95         4.87            NA           NA          0.15  XXX
                                         preparations.
88362........  26.........  A.........  Nerve teasing            2.17         0.58         0.75          0.58         0.75          0.09  XXX
                                         preparations.
88362........  TC.........  A.........  Nerve teasing            0.00         4.37         4.12            NA           NA          0.06  XXX
                                         preparations.
88365........  ...........  A.........  Insitu                   1.20         3.30         2.65            NA           NA          0.05  XXX
                                         hybridization
                                         (fish).
88365........  26.........  A.........  Insitu                   1.20         0.30         0.39          0.30         0.39          0.03  XXX
                                         hybridization
                                         (fish).
88365........  TC.........  A.........  Insitu                   0.00         3.00         2.25            NA           NA          0.02  XXX
                                         hybridization
                                         (fish).
88367........  ...........  A.........  Insitu                   1.30         5.11         4.58            NA           NA          0.12  XXX
                                         hybridization,
                                         auto.
88367........  26.........  A.........  Insitu                   1.30         0.23         0.38          0.23         0.38          0.06  XXX
                                         hybridization,
                                         auto.
88367........  TC.........  A.........  Insitu                   0.00         4.88         4.19            NA           NA          0.06  XXX
                                         hybridization,
                                         auto.
88368........  ...........  A.........  Insitu                   1.40         4.93         3.62            NA           NA          0.12  XXX
                                         hybridization,
                                         manual.
88368........  26.........  A.........  Insitu                   1.40         0.26         0.42          0.26         0.42          0.06  XXX
                                         hybridization,
                                         manual.
88368........  TC.........  A.........  Insitu                   0.00         4.67         3.20            NA           NA          0.06  XXX
                                         hybridization,
                                         manual.
88371........  26.........  A.........  Protein, western         0.37         0.10         0.11          0.10         0.11          0.01  XXX
                                         blot tissue.
88372........  26.........  A.........  Protein analysis         0.37         0.12         0.14          0.12         0.14          0.01  XXX
                                         w/probe.
88380........  ...........  C.........  Microdissection..        0.00         0.00         0.00          0.00         0.00          0.00  XXX
88380........  26.........  C.........  Microdissection..        0.00         0.00         0.00          0.00         0.00          0.00  XXX
88380........  TC.........  C.........  Microdissection..        0.00         0.00         0.00          0.00         0.00          0.00  XXX
88384........  ...........  C.........  Eval molecular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         probes, 11-50.
88384........  26.........  C.........  Eval molecular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         probes, 11-50.
88384........  TC.........  C.........  Eval molecular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         probes, 11-50.
88385........  ...........  A.........  Eval molecul             1.50        15.07        10.96            NA           NA          0.12  XXX
                                         probes, 51-250.
88385........  26.........  A.........  Eval molecul             1.50         0.27         0.45          0.27         0.45          0.06  XXX
                                         probes, 51-250.
88385........  TC.........  A.........  Eval molecul             0.00        14.79        10.50            NA           NA          0.06  XXX
                                         probes, 51-250.
88386........  ...........  A.........  Eval molecul             1.88        14.98        10.89            NA           NA          0.16  XXX
                                         probes, 251-500.
88386........  26.........  A.........  Eval molecul             1.88         0.35         0.58          0.35         0.58          0.08  XXX
                                         probes, 251-500.
88386........  TC.........  A.........  Eval molecul             0.00        14.63        10.31            NA           NA          0.08  XXX
                                         probes, 251-500.
88399........  ...........  C.........  Surgical                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         pathology
                                         procedure.
88399........  26.........  C.........  Surgical                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         pathology
                                         procedure.
88399........  TC.........  C.........  Surgical                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         pathology
                                         procedure.
89049........  ...........  A.........  Chct for mal             1.40         3.53         3.57          0.20         0.24          0.06  XXX
                                         hyperthermia.
89060........  26.........  A.........  Exam,synovial            0.37         0.12         0.14          0.12         0.14          0.01  XXX
                                         fluid crystals.
89100........  ...........  A.........  Sample intestinal        0.60         7.87         5.01          0.54         0.39          0.03  XXX
                                         contents.
89105........  ...........  A.........  Sample intestinal        0.50         7.78         4.97          0.46         0.31          0.02  XXX
                                         contents.
89130........  ...........  A.........  Sample stomach           0.45         6.47         4.17          0.37         0.26          0.02  XXX
                                         contents.
89132........  ...........  A.........  Sample stomach           0.19         8.30         4.62          0.38         0.21          0.01  XXX
                                         contents.
89135........  ...........  A.........  Sample stomach           0.79         8.74         5.33          0.67         0.46          0.04  XXX
                                         contents.
89136........  ...........  A.........  Sample stomach           0.21         5.87         3.99          0.26         0.19          0.01  XXX
                                         contents.
89140........  ...........  A.........  Sample stomach           0.94         6.14         4.21          0.43         0.36          0.04  XXX
                                         contents.
89141........  ...........  A.........  Sample stomach           0.85         6.30         4.39          0.49         0.39          0.03  XXX
                                         contents.
89220........  ...........  A.........  Sputum specimen          0.00         0.37         0.40            NA           NA          0.02  XXX
                                         collection.
89230........  ...........  A.........  Collect sweat for        0.00         0.07         0.09            NA           NA          0.02  XXX
                                         test.
89240........  ...........  C.........  Pathology lab            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
90465........  ...........  A.........  Immune admin 1           0.17         0.44         0.38            NA           NA          0.01  XXX
                                         inj, < 8 yrs.
90466........  ...........  A.........  Immune admin addl        0.15         0.11         0.12          0.04         0.09          0.01  ZZZ
                                         inj, < 8 y.
90467........  ...........  R.........  Immune admin o or        0.17         0.17         0.17          0.07         0.08          0.01  XXX
                                         n, < 8 yrs.
90468........  ...........  R.........  Immune admin o/n,        0.15         0.11         0.11          0.04         0.05          0.01  ZZZ
                                         addl < 8 y.
90471........  ...........  A.........  Immunization             0.17         0.44         0.38            NA           NA          0.01  XXX
                                         admin.
90472........  ...........  A.........  Immunization             0.15         0.12         0.13          0.04         0.09          0.01  ZZZ
                                         admin, each add.
90473........  ...........  R.........  Immune admin oral/       0.17         0.17         0.18          0.04         0.05          0.01  XXX
                                         nasal.
90474........  ...........  R.........  Immune admin oral/       0.15         0.08         0.09          0.04         0.05          0.01  ZZZ
                                         nasal addl.
90760........  ...........  A.........  Hydration iv             0.17         1.31         1.37            NA           NA          0.07  XXX
                                         infusion, init.
90761........  ...........  A.........  Hydrate iv               0.09         0.31         0.36            NA           NA          0.04  ZZZ
                                         infusion, add-on.
90765........  ...........  A.........  Ther/proph/diag          0.21         1.60         1.68            NA           NA          0.07  XXX
                                         iv inf, init.
90766........  ...........  A.........  Ther/proph/dg iv         0.18         0.37         0.42            NA           NA          0.04  ZZZ
                                         inf, add-on.
90767........  ...........  A.........  Tx/proph/dg addl         0.19         0.68         0.79            NA           NA          0.04  ZZZ
                                         seq iv inf.

[[Page 38342]]

 
90768........  ...........  A.........  Ther/diag                0.17         0.33         0.38            NA           NA          0.04  ZZZ
                                         concurrent inf.
90772........  ...........  A.........  Ther/proph/diag          0.17         0.44         0.38            NA           NA          0.01  XXX
                                         inj, sc/im.
90773........  ...........  A.........  Ther/proph/diag          0.17         0.30         0.31            NA           NA          0.02  XXX
                                         inj, ia.
90774........  ...........  A.........  Ther/proph/diag          0.18         1.32         1.31            NA           NA          0.04  XXX
                                         inj, iv push.
90775........  ...........  A.........  Ther/proph/diag          0.10         0.51         0.54            NA           NA          0.04  ZZZ
                                         inj add-on.
90779........  ...........  C.........  Ther/prop/diag           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         inj/inf proc.
90801........  ...........  A.........  Psy dx interview.        2.80         1.49         1.33          0.60         0.77          0.06  XXX
90802........  ...........  A.........  Intac psy dx             3.01         1.53         1.36          0.68         0.83          0.07  XXX
                                         interview.
90804........  ...........  A.........  Psytx, office, 20-       1.21         0.56         0.53          0.22         0.30          0.03  XXX
                                         30 min.
90805........  ...........  A.........  Psytx, off, 20-30        1.37         0.60         0.55          0.24         0.33          0.03  XXX
                                         min w/e&m.
90806........  ...........  A.........  Psytx, off, 45-50        1.86         0.53         0.62          0.33         0.46          0.04  XXX
                                         min.
90807........  ...........  A.........  Psytx, off, 45-50        2.02         0.70         0.70          0.36         0.49          0.05  XXX
                                         min w/e&m.
90808........  ...........  A.........  Psytx, office, 75-       2.79         0.69         0.86          0.50         0.70          0.06  XXX
                                         80 min.
90809........  ...........  A.........  Psytx, off, 75-          2.95         0.86         0.93          0.53         0.72          0.07  XXX
                                         80, w/e&m.
90810........  ...........  A.........  Intac psytx, off,        1.32         0.53         0.52          0.23         0.33          0.04  XXX
                                         20-30 min.
90811........  ...........  A.........  Intac psytx, 20-         1.48         0.72         0.65          0.26         0.36          0.04  XXX
                                         30, w/e&m.
90812........  ...........  A.........  Intac psytx, off,        1.97         0.65         0.72          0.35         0.50          0.04  XXX
                                         45-50 min.
90813........  ...........  A.........  Intac psytx, 45-         2.13         0.83         0.80          0.37         0.52          0.05  XXX
                                         50 min w/e&m.
90814........  ...........  A.........  Intac psytx, off,        2.90         0.82         0.95          0.54         0.76          0.06  XXX
                                         75-80 min.
90815........  ...........  A.........  Intac psytx, 75-         3.06         1.00         1.03          0.54         0.75          0.07  XXX
                                         80 w/e&m.
90816........  ...........  A.........  Psytx, hosp, 20-         1.25           NA           NA          0.33         0.40          0.03  XXX
                                         30 min.
90817........  ...........  A.........  Psytx, hosp, 20-         1.41           NA           NA          0.35         0.41          0.03  XXX
                                         30 min w/e&m.
90818........  ...........  A.........  Psytx, hosp, 45-         1.89           NA           NA          0.44         0.57          0.04  XXX
                                         50 min.
90819........  ...........  A.........  Psytx, hosp, 45-         2.05           NA           NA          0.46         0.56          0.05  XXX
                                         50 min w/e&m.
90821........  ...........  A.........  Psytx, hosp, 75-         2.83           NA           NA          0.60         0.81          0.06  XXX
                                         80 min.
90822........  ...........  A.........  Psytx, hosp, 75-         2.99           NA           NA          0.63         0.79          0.08  XXX
                                         80 min w/e&m.
90823........  ...........  A.........  Intac psytx,             1.36           NA           NA          0.35         0.42          0.03  XXX
                                         hosp, 20-30 min.
90824........  ...........  A.........  Intac psytx, hsp         1.52           NA           NA          0.37         0.43          0.04  XXX
                                         20-30 w/e&m.
90826........  ...........  A.........  Intac psytx,             2.01           NA           NA          0.46         0.59          0.05  XXX
                                         hosp, 45-50 min.
90827........  ...........  A.........  Intac psytx, hsp         2.16           NA           NA          0.48         0.58          0.05  XXX
                                         45-50 w/e&m.
90828........  ...........  A.........  Intac psytx,             2.94           NA           NA          0.63         0.84          0.06  XXX
                                         hosp, 75-80 min.
90829........  ...........  A.........  Intac psytx, hsp         3.10           NA           NA          0.65         0.82          0.07  XXX
                                         75-80 w/e&m.
90845........  ...........  A.........  Psychoanalysis...        1.79         0.39         0.48          0.32         0.43          0.04  XXX
90846........  ...........  R.........  Family psytx w/o         1.83         0.51         0.58          0.43         0.54          0.04  XXX
                                         patient.
90847........  ...........  R.........  Family psytx w/          2.21         0.74         0.78          0.50         0.63          0.05  XXX
                                         patient.
90849........  ...........  R.........  Multiple family          0.59         0.33         0.30          0.21         0.22          0.02  XXX
                                         group psytx.
90853........  ...........  A.........  Group                    0.59         0.26         0.26          0.20         0.21          0.01  XXX
                                         psychotherapy.
90857........  ...........  A.........  Intac group psytx        0.63         0.38         0.33          0.21         0.23          0.01  XXX
90862........  ...........  A.........  Medication               0.95         0.62         0.51          0.27         0.30          0.02  XXX
                                         management.
90865........  ...........  A.........  Narcosynthesis...        2.84         1.17         1.27          0.63         0.78          0.12  XXX
90870........  ...........  A.........  Electroconvulsive        1.88         1.91         1.92          0.38         0.49          0.04  000
                                         therapy.
90875........  ...........  N.........  Psychophysiologic        1.20         0.52         0.71          0.28         0.37          0.04  XXX
                                         al therapy.
90876........  ...........  N.........  Psychophysiologic        1.90         0.67         0.92          0.44         0.59          0.05  XXX
                                         al therapy.
90880........  ...........  A.........  Hypnotherapy.....        2.19         0.58         0.81          0.39         0.54          0.05  XXX
90885........  ...........  B.........  Psy evaluation of        0.97         0.22         0.29          0.22         0.29          0.02  XXX
                                         records.
90887........  ...........  B.........  Consultation with        1.48         0.61         0.72          0.34         0.45          0.04  XXX
                                         family.
90899........  ...........  C.........  Psychiatric              0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         service/therapy.
90901........  ...........  A.........  Biofeedback              0.41         0.46         0.56          0.10         0.12          0.02  000
                                         train, any meth.
90911........  ...........  A.........  Biofeedback peri/        0.89         1.37         1.46          0.30         0.31          0.06  000
                                         uro/rectal.
90918........  ...........  I.........  ESRD related            11.16         4.68         5.39          3.73         4.92          0.36  XXX
                                         services, month.
90919........  ...........  I.........  ESRD related             8.53         3.02         3.51          2.55         3.28          0.29  XXX
                                         services, month.
90920........  ...........  I.........  ESRD related             7.26         2.73         3.24          2.26         3.01          0.23  XXX
                                         services, month.
90921........  ...........  I.........  ESRD related             4.46         1.70         2.07          1.61         2.02          0.14  XXX
                                         services, month.
90922........  ...........  I.........  ESRD related             0.37         0.16         0.19          0.12         0.17          0.01  XXX
                                         services, day.
90923........  ...........  I.........  Esrd related             0.28         0.10         0.11          0.08         0.11          0.01  XXX
                                         services, day.
90924........  ...........  I.........  Esrd related             0.24         0.09         0.10          0.07         0.10          0.01  XXX
                                         services, day.
90925........  ...........  I.........  Esrd related             0.15         0.05         0.06          0.05         0.06          0.01  XXX
                                         services, day.
90935........  ...........  A.........  Hemodialysis, one        1.22           NA           NA          0.54         0.61          0.04  000
                                         evaluation.
90937........  ...........  A.........  Hemodialysis,            2.11           NA           NA          0.77         0.88          0.07  000
                                         repeated eval.
90945........  ...........  A.........  Dialysis, one            1.28           NA           NA          0.55         0.62          0.04  000
                                         evaluation.
90947........  ...........  A.........  Dialysis,                2.16           NA           NA          0.79         0.89          0.07  000
                                         repeated eval.
90997........  ...........  A.........  Hemoperfusion....        1.84           NA           NA          0.50         0.58          0.06  000
90999........  ...........  C.........  Dialysis                 0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
91000........  ...........  A.........  Esophageal               0.73         2.11         1.24          2.11         1.24          0.04  000
                                         intubation.
91000........  26.........  A.........  Esophageal               0.73         0.22         0.24          0.22         0.24          0.03  000
                                         intubation.
91000........  TC.........  A.........  Esophageal               0.00         1.88         0.99          1.88         0.99          0.01  000
                                         intubation.
91010........  ...........  A.........  Esophagus                1.25         3.64         4.03          3.64         4.03          0.12  000
                                         motility study.
91010........  26.........  A.........  Esophagus                1.25         0.55         0.50          0.55         0.50          0.06  000
                                         motility study.
91010........  TC.........  A.........  Esophagus                0.00         3.09         3.53          3.09         3.53          0.06  000
                                         motility study.
91011........  ...........  A.........  Esophagus                1.50         5.33         5.28          5.33         5.28          0.13  000
                                         motility study.
91011........  26.........  A.........  Esophagus                1.50         0.72         0.63          0.72         0.63          0.07  000
                                         motility study.
91011........  TC.........  A.........  Esophagus                0.00         4.60         4.65          4.60         4.65          0.06  000
                                         motility study.

[[Page 38343]]

 
91012........  ...........  A.........  Esophagus                1.46         5.41         5.60          5.41         5.60          0.13  000
                                         motility study.
91012........  26.........  A.........  Esophagus                1.46         0.69         0.60          0.69         0.60          0.06  000
                                         motility study.
91012........  TC.........  A.........  Esophagus                0.00         4.72         4.99          4.72         4.99          0.07  000
                                         motility study.
91020........  ...........  A.........  Gastric motility         1.44         4.77         4.64          4.77         4.64          0.13  000
                                         studies.
91020........  26.........  A.........  Gastric motility         1.44         0.61         0.55          0.61         0.55          0.07  000
                                         studies.
91020........  TC.........  A.........  Gastric motility         0.00         4.16         4.09          4.16         4.09          0.06  000
                                         studies.
91022........  ...........  A.........  Duodenal motility        1.44         3.11         3.76          3.11         3.76          0.13  000
                                         study.
91022........  26.........  A.........  Duodenal motility        1.44         0.62         0.57          0.62         0.57          0.07  000
                                         study.
91022........  TC.........  A.........  Duodenal motility        0.00         2.49         3.19          2.49         3.19          0.06  000
                                         study.
91030........  ...........  A.........  Acid perfusion of        0.91         2.87         2.66          2.87         2.66          0.06  000
                                         esophagus.
91030........  26.........  A.........  Acid perfusion of        0.91         0.42         0.37          0.42         0.37          0.04  000
                                         esophagus.
91030........  TC.........  A.........  Acid perfusion of        0.00         2.45         2.28          2.45         2.28          0.02  000
                                         esophagus.
91034........  ...........  A.........  Gastroesophageal         0.97         4.12         4.68          4.12         4.68          0.12  000
                                         reflux test.
91034........  26.........  A.........  Gastroesophageal         0.97         0.43         0.38          0.43         0.38          0.06  000
                                         reflux test.
91034........  TC.........  A.........  Gastroesophageal         0.00         3.69         4.30          3.69         4.30          0.06  000
                                         reflux test.
91035........  ...........  A.........  G-esoph reflx tst        1.59        11.28        11.04         11.28        11.04          0.12  000
                                         w/electrod.
91035........  26.........  A.........  G-esoph reflx tst        1.59         0.71         0.64          0.71         0.64          0.06  000
                                         w/electrod.
91035........  TC.........  A.........  G-esoph reflx tst        0.00        10.57        10.40         10.57        10.40          0.06  000
                                         w/electrod.
91037........  ...........  A.........  Esoph imped              0.97         3.45         3.18          3.45         3.18          0.12  000
                                         function test.
91037........  26.........  A.........  Esoph imped              0.97         0.45         0.39          0.45         0.39          0.06  000
                                         function test.
91037........  TC.........  A.........  Esoph imped              0.00         3.00         2.79          3.00         2.79          0.06  000
                                         function test.
91038........  ...........  A.........  Esoph imped funct        1.10         2.79         2.50          2.79         2.50          0.12  000
                                         test > 1h.
91038........  26.........  A.........  Esoph imped funct        1.10         0.51         0.45          0.51         0.45          0.06  000
                                         test > 1h.
91038........  TC.........  A.........  Esoph imped funct        0.00         2.28         2.05          2.28         2.05          0.06  000
                                         test > 1h.
91040........  ...........  A.........  Esoph balloon            0.97         7.63         9.66          7.63         9.66          0.12  000
                                         distension tst.
91040........  26.........  A.........  Esoph balloon            0.97         0.28         0.33          0.28         0.33          0.06  000
                                         distension tst.
91040........  TC.........  A.........  Esoph balloon            0.00         7.35         9.33          7.35         9.33          0.06  000
                                         distension tst.
91052........  ...........  A.........  Gastric analysis         0.79         2.93         2.70          2.93         2.70          0.05  000
                                         test.
91052........  26.........  A.........  Gastric analysis         0.79         0.37         0.33          0.37         0.33          0.03  000
                                         test.
91052........  TC.........  A.........  Gastric analysis         0.00         2.56         2.37          2.56         2.37          0.02  000
                                         test.
91055........  ...........  A.........  Gastric                  0.94         2.56         2.73          2.56         2.73          0.07  000
                                         intubation for
                                         smear.
91055........  26.........  A.........  Gastric                  0.94         0.29         0.28          0.29         0.28          0.05  000
                                         intubation for
                                         smear.
91055........  TC.........  A.........  Gastric                  0.00         2.27         2.45          2.27         2.45          0.02  000
                                         intubation for
                                         smear.
91065........  ...........  A.........  Breath hydrogen          0.20         1.33         1.39          1.33         1.39          0.03  000
                                         test.
91065........  26.........  A.........  Breath hydrogen          0.20         0.06         0.07          0.06         0.07          0.01  000
                                         test.
91065........  TC.........  A.........  Breath hydrogen          0.00         1.26         1.32          1.26         1.32          0.02  000
                                         test.
91100........  ...........  A.........  Pass intestine           1.08         2.12         2.46          0.32         0.31          0.07  000
                                         bleeding tube.
91105........  ...........  A.........  Gastric                  0.37         1.65         1.89          0.07         0.08          0.03  000
                                         intubation
                                         treatment.
91110........  ...........  A.........  Gi tract capsule         3.64        20.46        21.33            NA           NA          0.16  XXX
                                         endoscopy.
91110........  26.........  A.........  Gi tract capsule         3.64         1.68         1.49          1.68         1.49          0.09  XXX
                                         endoscopy.
91110........  TC.........  A.........  Gi tract capsule         0.00        18.78        19.85            NA           NA          0.07  XXX
                                         endoscopy.
91111........  ...........  A.........  Esophageal               1.00        18.64        18.65            NA           NA          0.05  XXX
                                         capsule
                                         endoscopy.
91111........  26.........  A.........  Esophageal               1.00         0.45         0.46          0.45         0.46          0.03  XXX
                                         capsule
                                         endoscopy.
91111........  TC.........  A.........  Esophageal               0.00        18.19        18.19            NA           NA          0.02  XXX
                                         capsule
                                         endoscopy.
91120........  ...........  A.........  Rectal sensation         0.97         8.81         9.93          8.81         9.93          0.11  XXX
                                         test.
91120........  26.........  A.........  Rectal sensation         0.97         0.28         0.31          0.28         0.31          0.07  XXX
                                         test.
91120........  TC.........  A.........  Rectal sensation         0.00         8.53         9.62          8.53         9.62          0.04  XXX
                                         test.
91122........  ...........  A.........  Anal pressure            1.77         4.29         4.60          4.29         4.60          0.21  000
                                         record.
91122........  26.........  A.........  Anal pressure            1.77         0.63         0.60          0.63         0.60          0.13  000
                                         record.
91122........  TC.........  A.........  Anal pressure            0.00         3.66         4.01          3.66         4.01          0.08  000
                                         record.
91132........  ...........  C.........  Electrogastrograp        0.52         0.00         0.13            NA           NA          0.02  XXX
                                         hy.
91132........  26.........  A.........  Electrogastrograp        0.52         0.26         0.22          0.26         0.22          0.02  XXX
                                         hy.
91132........  TC.........  C.........  Electrogastrograp        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         hy.
91133........  ...........  C.........  Electrogastrograp        0.66         0.00         0.17            NA           NA          0.03  XXX
                                         hy w/test.
91133........  26.........  A.........  Electrogastrograp        0.66         0.32         0.27          0.32         0.27          0.03  XXX
                                         hy w/test.
91133........  TC.........  C.........  Electrogastrograp        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         hy w/test.
91299........  ...........  C.........  Gastroenterology         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
91299........  26.........  C.........  Gastroenterology         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
91299........  TC.........  C.........  Gastroenterology         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
92002........  ...........  A.........  Eye exam, new            0.88         0.94         0.96          0.26         0.31          0.02  XXX
                                         patient.
92004........  ...........  A.........  Eye exam, new            1.82         1.58         1.64          0.56         0.62          0.04  XXX
                                         patient.
92012........  ...........  A.........  Eye exam                 0.92         0.99         1.00          0.32         0.29          0.02  XXX
                                         established pat.
92014........  ...........  A.........  Eye exam &               1.42         1.38         1.39          0.47         0.46          0.03  XXX
                                         treatment.
92015........  ...........  N.........  Refraction.......        0.38         0.10         0.79          0.09         0.12          0.01  XXX
92018........  ...........  A.........  New eye exam &           2.50           NA           NA          0.87         0.98          0.07  XXX
                                         treatment.
92019........  ...........  A.........  Eye exam &               1.31           NA           NA          0.36         0.47          0.03  XXX
                                         treatment.
92020........  ...........  A.........  Special eye              0.37         0.25         0.30          0.13         0.14          0.01  XXX
                                         evaluation.
92025........  ...........  A.........  Corneal                  0.35         0.43         0.44          0.43         0.44          0.02  XXX
                                         topography.
92025........  26.........  A.........  Corneal                  0.35         0.12         0.12          0.12         0.12          0.01  XXX
                                         topography.
92025........  TC.........  A.........  Corneal                  0.00         0.31         0.32          0.31         0.32          0.01  XXX
                                         topography.
92060........  ...........  A.........  Special eye              0.69         0.77         0.76            NA           NA          0.03  XXX
                                         evaluation.
92060........  26.........  A.........  Special eye              0.69         0.23         0.26          0.23         0.26          0.02  XXX
                                         evaluation.

[[Page 38344]]

 
92060........  TC.........  A.........  Special eye              0.00         0.54         0.49            NA           NA          0.01  XXX
                                         evaluation.
92065........  ...........  A.........  Orthoptic/               0.37         0.85         0.70            NA           NA          0.02  XXX
                                         pleoptic
                                         training.
92065........  26.........  A.........  Orthoptic/               0.37         0.09         0.12          0.09         0.12          0.01  XXX
                                         pleoptic
                                         training.
92065........  TC.........  A.........  Orthoptic/               0.00         0.76         0.57            NA           NA          0.01  XXX
                                         pleoptic
                                         training.
92070........  ...........  A.........  Fitting of               0.70         0.90         0.99          0.23         0.28          0.02  XXX
                                         contact lens.
92081........  ...........  A.........  Visual field             0.36         0.95         0.95            NA           NA          0.02  XXX
                                         examination(s).
92081........  26.........  A.........  Visual field             0.36         0.11         0.13          0.11         0.13          0.01  XXX
                                         examination(s).
92081........  TC.........  A.........  Visual field             0.00         0.84         0.82            NA           NA          0.01  XXX
                                         examination(s).
92082........  ...........  A.........  Visual field             0.44         1.31         1.28            NA           NA          0.02  XXX
                                         examination(s).
92082........  26.........  A.........  Visual field             0.44         0.14         0.17          0.14         0.17          0.01  XXX
                                         examination(s).
92082........  TC.........  A.........  Visual field             0.00         1.18         1.11            NA           NA          0.01  XXX
                                         examination(s).
92083........  ...........  A.........  Visual field             0.50         1.51         1.48            NA           NA          0.02  XXX
                                         examination(s).
92083........  26.........  A.........  Visual field             0.50         0.17         0.20          0.17         0.20          0.01  XXX
                                         examination(s).
92083........  TC.........  A.........  Visual field             0.00         1.34         1.28            NA           NA          0.01  XXX
                                         examination(s).
92100........  ...........  A.........  Serial tonometry         0.92         1.24         1.30          0.28         0.33          0.02  XXX
                                         exam(s).
92120........  ...........  A.........  Tonography & eye         0.81         0.97         1.02          0.25         0.29          0.02  XXX
                                         evaluation.
92130........  ...........  A.........  Water provocation        0.81         1.18         1.23          0.28         0.33          0.02  XXX
                                         tonography.
92135........  ...........  A.........  Opthalmic dx             0.35         0.79         0.79            NA           NA          0.02  XXX
                                         imaging.
92135........  26.........  A.........  Opthalmic dx             0.35         0.12         0.13          0.12         0.13          0.01  XXX
                                         imaging.
92135........  TC.........  A.........  Opthalmic dx             0.00         0.67         0.66            NA           NA          0.01  XXX
                                         imaging.
92136........  ...........  A.........  Ophthalmic               0.54         1.42         1.54            NA           NA          0.08  XXX
                                         biometry.
92136........  26.........  A.........  Ophthalmic               0.54         0.20         0.22          0.20         0.22          0.01  XXX
                                         biometry.
92136........  TC.........  A.........  Ophthalmic               0.00         1.22         1.32            NA           NA          0.07  XXX
                                         biometry.
92140........  ...........  A.........  Glaucoma                 0.50         0.88         0.94          0.14         0.18          0.01  XXX
                                         provocative
                                         tests.
92225........  ...........  A.........  Special eye exam,        0.38         0.24         0.23          0.13         0.14          0.01  XXX
                                         initial.
92226........  ...........  A.........  Special eye exam,        0.33         0.23         0.22          0.12         0.13          0.01  XXX
                                         subsequent.
92230........  ...........  A.........  Eye exam with            0.60         0.68         1.11          0.19         0.20          0.02  XXX
                                         photos.
92235........  ...........  A.........  Eye exam with            0.81         2.25         2.44            NA           NA          0.08  XXX
                                         photos.
92235........  26.........  A.........  Eye exam with            0.81         0.29         0.34          0.29         0.34          0.02  XXX
                                         photos.
92235........  TC.........  A.........  Eye exam with            0.00         1.96         2.11            NA           NA          0.06  XXX
                                         photos.
92240........  ...........  A.........  Icg angiography..        1.10         4.37         5.26            NA           NA          0.09  XXX
92240........  26.........  A.........  Icg angiography..        1.10         0.40         0.45          0.40         0.45          0.03  XXX
92240........  TC.........  A.........  Icg angiography..        0.00         3.97         4.80            NA           NA          0.06  XXX
92250........  ...........  A.........  Eye exam with            0.44         1.29         1.42            NA           NA          0.02  XXX
                                         photos.
92250........  26.........  A.........  Eye exam with            0.44         0.14         0.17          0.14         0.17          0.01  XXX
                                         photos.
92250........  TC.........  A.........  Eye exam with            0.00         1.15         1.25            NA           NA          0.01  XXX
                                         photos.
92260........  ...........  A.........  Ophthalmoscopy/          0.20         0.23         0.24          0.07         0.08          0.01  XXX
                                         dynamometry.
92265........  ...........  A.........  Eye muscle               0.81         0.99         1.24            NA           NA          0.06  XXX
                                         evaluation.
92265........  26.........  A.........  Eye muscle               0.81         0.24         0.26          0.24         0.26          0.04  XXX
                                         evaluation.
92265........  TC.........  A.........  Eye muscle               0.00         0.75         0.98            NA           NA          0.02  XXX
                                         evaluation.
92270........  ...........  A.........  Electro-                 0.81         1.31         1.44            NA           NA          0.05  XXX
                                         oculography.
92270........  26.........  A.........  Electro-                 0.81         0.23         0.28          0.23         0.28          0.03  XXX
                                         oculography.
92270........  TC.........  A.........  Electro-                 0.00         1.08         1.15            NA           NA          0.02  XXX
                                         oculography.
92275........  ...........  A.........  Electroretinograp        1.01         2.41         2.19            NA           NA          0.05  XXX
                                         hy.
92275........  26.........  A.........  Electroretinograp        1.01         0.35         0.40          0.35         0.40          0.03  XXX
                                         hy.
92275........  TC.........  A.........  Electroretinograp        0.00         2.06         1.79            NA           NA          0.02  XXX
                                         hy.
92283........  ...........  A.........  Color vision             0.17         0.98         0.92            NA           NA          0.02  XXX
                                         examination.
92283........  26.........  A.........  Color vision             0.17         0.05         0.06          0.05         0.06          0.01  XXX
                                         examination.
92283........  TC.........  A.........  Color vision             0.00         0.93         0.86            NA           NA          0.01  XXX
                                         examination.
92284........  ...........  A.........  Dark adaptation          0.24         1.12         1.52            NA           NA          0.02  XXX
                                         eye exam.
92284........  26.........  A.........  Dark adaptation          0.24         0.07         0.08          0.07         0.08          0.01  XXX
                                         eye exam.
92284........  TC.........  A.........  Dark adaptation          0.00         1.05         1.44            NA           NA          0.01  XXX
                                         eye exam.
92285........  ...........  A.........  Eye photography..        0.20         0.79         0.90            NA           NA          0.02  XXX
92285........  26.........  A.........  Eye photography..        0.20         0.07         0.08          0.07         0.08          0.01  XXX
92285........  TC.........  A.........  Eye photography..        0.00         0.72         0.81            NA           NA          0.01  XXX
92286........  ...........  A.........  Internal eye             0.66         2.08         2.58            NA           NA          0.04  XXX
                                         photography.
92286........  26.........  A.........  Internal eye             0.66         0.22         0.26          0.22         0.26          0.02  XXX
                                         photography.
92286........  TC.........  A.........  Internal eye             0.00         1.85         2.32            NA           NA          0.02  XXX
                                         photography.
92287........  ...........  A.........  Internal eye             0.81         1.90         2.15          0.28         0.30          0.02  XXX
                                         photography.
92310........  ...........  N.........  Contact lens             1.17         1.05         1.08          0.27         0.36          0.04  XXX
                                         fitting.
92311........  ...........  A.........  Contact lens             1.08         1.27         1.18          0.31         0.34          0.03  XXX
                                         fitting.
92312........  ...........  A.........  Contact lens             1.26         1.45         1.28          0.34         0.43          0.03  XXX
                                         fitting.
92313........  ...........  A.........  Contact lens             0.92         1.42         1.25          0.31         0.30          0.02  XXX
                                         fitting.
92314........  ...........  N.........  Prescription of          0.69         1.12         1.03          0.16         0.21          0.01  XXX
                                         contact lens.
92315........  ...........  A.........  Prescription of          0.45         1.30         1.08          0.13         0.15          0.01  XXX
                                         contact lens.
92316........  ...........  A.........  Prescription of          0.68         1.63         1.28          0.23         0.26          0.02  XXX
                                         contact lens.
92317........  ...........  A.........  Prescription of          0.45         1.30         1.15          0.11         0.14          0.01  XXX
                                         contact lens.
92325........  ...........  A.........  Modification of          0.00         0.83         0.62            NA           NA          0.01  XXX
                                         contact lens.
92326........  ...........  A.........  Replacement of           0.00         0.72         1.18            NA           NA          0.06  XXX
                                         contact lens.
92340........  ...........  N.........  Fitting of               0.37         0.44         0.57          0.09         0.12          0.01  XXX
                                         spectacles.
92341........  ...........  N.........  Fitting of               0.47         0.46         0.60          0.11         0.14          0.01  XXX
                                         spectacles.
92342........  ...........  N.........  Fitting of               0.53         0.47         0.62          0.12         0.17          0.01  XXX
                                         spectacles.

[[Page 38345]]

 
92352........  ...........  B.........  Special                  0.37         0.56         0.62          0.09         0.12          0.01  XXX
                                         spectacles
                                         fitting.
92353........  ...........  B.........  Special                  0.50         0.59         0.66          0.12         0.15          0.02  XXX
                                         spectacles
                                         fitting.
92354........  ...........  B.........  Special                  0.00         0.28         4.57            NA           NA          0.10  XXX
                                         spectacles
                                         fitting.
92355........  ...........  B.........  Special                  0.00         0.44         2.39            NA           NA          0.01  XXX
                                         spectacles
                                         fitting.
92358........  ...........  B.........  Eye prosthesis           0.00         0.23         0.60            NA           NA          0.05  XXX
                                         service.
92370........  ...........  N.........  Repair & adjust          0.32         0.39         0.47          0.07         0.10          0.02  XXX
                                         spectacles.
92371........  ...........  B.........  Repair & adjust          0.00         0.24         0.43            NA           NA          0.02  XXX
                                         spectacles.
92499........  ...........  C.........  Eye service or           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
92499........  26.........  C.........  Eye service or           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
92499........  TC.........  C.........  Eye service or           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
92502........  ...........  A.........  Ear and throat           1.51           NA           NA          0.91         0.99          0.05  000
                                         examination.
92504........  ...........  A.........  Ear microscopy           0.18         0.59         0.54          0.06         0.07          0.01  XXX
                                         examination.
92506........  ...........  A.........  Speech/hearing           0.86         3.47         3.00          0.28         0.33          0.03  XXX
                                         evaluation.
92507........  ...........  A.........  Speech/hearing           0.52         1.22         1.16          0.16         0.19          0.02  XXX
                                         therapy.
92508........  ...........  A.........  Speech/hearing           0.26         0.55         0.52          0.09         0.10          0.01  XXX
                                         therapy.
92511........  ...........  A.........  Nasopharyngoscopy        0.84         3.10         3.17          0.67         0.72          0.03  000
92512........  ...........  A.........  Nasal function           0.55         0.99         1.06          0.18         0.18          0.02  XXX
                                         studies.
92516........  ...........  A.........  Facial nerve             0.43         1.23         1.20          0.14         0.18          0.01  XXX
                                         function test.
92520........  ...........  A.........  Laryngeal                0.75         0.93         0.71          0.24         0.31          0.03  XXX
                                         function studies.
92526........  ...........  A.........  Oral function            0.55         1.69         1.66          0.17         0.18          0.02  XXX
                                         therapy.
92541........  ...........  A.........  Spontaneous              0.40         1.14         1.08            NA           NA          0.04  XXX
                                         nystagmus test.
92541........  26.........  A.........  Spontaneous              0.40         0.11         0.15          0.11         0.15          0.02  XXX
                                         nystagmus test.
92541........  TC.........  A.........  Spontaneous              0.00         1.03         0.93            NA           NA          0.02  XXX
                                         nystagmus test.
92542........  ...........  A.........  Positional               0.33         1.28         1.20            NA           NA          0.03  XXX
                                         nystagmus test.
92542........  26.........  A.........  Positional               0.33         0.09         0.12          0.09         0.12          0.01  XXX
                                         nystagmus test.
92542........  TC.........  A.........  Positional               0.00         1.19         1.08            NA           NA          0.02  XXX
                                         nystagmus test.
92543........  ...........  A.........  Caloric                  0.10         0.64         0.61            NA           NA          0.02  XXX
                                         vestibular test.
92543........  26.........  A.........  Caloric                  0.10         0.03         0.04          0.03         0.04          0.01  XXX
                                         vestibular test.
92543........  TC.........  A.........  Caloric                  0.00         0.62         0.57            NA           NA          0.01  XXX
                                         vestibular test.
92544........  ...........  A.........  Optokinetic              0.26         1.02         0.96            NA           NA          0.03  XXX
                                         nystagmus test.
92544........  26.........  A.........  Optokinetic              0.26         0.07         0.10          0.07         0.10          0.01  XXX
                                         nystagmus test.
92544........  TC.........  A.........  Optokinetic              0.00         0.95         0.86            NA           NA          0.02  XXX
                                         nystagmus test.
92545........  ...........  A.........  Oscillating              0.23         0.99         0.90            NA           NA          0.03  XXX
                                         tracking test.
92545........  26.........  A.........  Oscillating              0.23         0.06         0.09          0.06         0.09          0.01  XXX
                                         tracking test.
92545........  TC.........  A.........  Oscillating              0.00         0.93         0.81            NA           NA          0.02  XXX
                                         tracking test.
92546........  ...........  A.........  Sinusoidal               0.29         1.79         1.89            NA           NA          0.03  XXX
                                         rotational test.
92546........  26.........  A.........  Sinusoidal               0.29         0.08         0.11          0.08         0.11          0.01  XXX
                                         rotational test.
92546........  TC.........  A.........  Sinusoidal               0.00         1.72         1.79            NA           NA          0.02  XXX
                                         rotational test.
92547........  ...........  A.........  Supplemental             0.00         0.11         0.10          0.11         0.10          0.06  ZZZ
                                         electrical test.
92548........  ...........  A.........  Posturography....        0.50         1.68         1.96            NA           NA          0.15  XXX
92548........  26.........  A.........  Posturography....        0.50         0.14         0.20          0.14         0.20          0.02  XXX
92548........  TC.........  A.........  Posturography....        0.00         1.55         1.76            NA           NA          0.13  XXX
92551........  ...........  N.........  Pure tone hearing        0.00         0.25         0.25            NA           NA          0.01  XXX
                                         test, air.
92552........  ...........  A.........  Pure tone                0.00         0.60         0.51            NA           NA          0.04  XXX
                                         audiometry, air.
92553........  ...........  A.........  Audiometry, air &        0.00         0.76         0.70            NA           NA          0.06  XXX
                                         bone.
92555........  ...........  A.........  Speech threshold         0.00         0.41         0.39            NA           NA          0.04  XXX
                                         audiometry.
92556........  ...........  A.........  Speech                   0.00         0.51         0.54            NA           NA          0.06  XXX
                                         audiometry,
                                         complete.
92557........  ...........  A.........  Comprehensive            0.60         0.30         0.91          0.30         0.91          0.12  XXX
                                         hearing test.
92561........  ...........  A.........  Bekesy                   0.00         0.69         0.70            NA           NA          0.06  XXX
                                         audiometry,
                                         diagnosis.
92562........  ...........  A.........  Loudness balance         0.00         0.61         0.52            NA           NA          0.04  XXX
                                         test.
92563........  ...........  A.........  Tone decay               0.00         0.54         0.45            NA           NA          0.04  XXX
                                         hearing test.
92564........  ...........  A.........  Sisi hearing test        0.00         0.48         0.47            NA           NA          0.05  XXX
92565........  ...........  A.........  Stenger test,            0.00         0.25         0.32            NA           NA          0.04  XXX
                                         pure tone.
92567........  ...........  A.........  Tympanometry.....        0.20         0.13         0.38          0.13         0.38          0.06  XXX
92568........  ...........  A.........  Acoustic refl            0.29         0.10         0.25          0.10         0.25          0.04  XXX
                                         threshold tst.
92569........  ...........  A.........  Acoustic reflex          0.20         0.07         0.26          0.07         0.26          0.04  XXX
                                         decay test.
92571........  ...........  A.........  Filtered speech          0.00         0.44         0.41            NA           NA          0.04  XXX
                                         hearing test.
92572........  ...........  A.........  Staggered                0.00         0.58         0.34            NA           NA          0.01  XXX
                                         spondaic word
                                         test.
92575........  ...........  A.........  Sensorineural            0.00         1.14         0.71            NA           NA          0.02  XXX
                                         acuity test.
92576........  ...........  A.........  Synthetic                0.00         0.58         0.51            NA           NA          0.05  XXX
                                         sentence test.
92577........  ...........  A.........  Stenger test,            0.00         0.26         0.49            NA           NA          0.07  XXX
                                         speech.
92579........  ...........  A.........  Visual audiometry        0.70         0.35         0.62          0.35         0.62          0.06  XXX
                                         (vra).
92582........  ...........  A.........  Conditioning play        0.00         1.16         0.93            NA           NA          0.06  XXX
                                         audiometry.
92583........  ...........  A.........  Select picture           0.00         0.73         0.80            NA           NA          0.08  XXX
                                         audiometry.
92584........  ...........  A.........  Electrocochleogra        0.00         1.35         1.88            NA           NA          0.21  XXX
                                         phy.
92585........  ...........  A.........  Auditor evoke            0.50         2.09         2.04            NA           NA          0.17  XXX
                                         potent, compre.
92585........  26.........  A.........  Auditor evoke            0.50         0.15         0.18          0.15         0.18          0.03  XXX
                                         potent, compre.
92585........  TC.........  A.........  Auditor evoke            0.00         1.93         1.86            NA           NA          0.14  XXX
                                         potent, compre.
92586........  ...........  A.........  Auditor evoke            0.00         1.40         1.63            NA           NA          0.14  XXX
                                         potent, limit.
92587........  ...........  A.........  Evoked auditory          0.13         0.65         1.01            NA           NA          0.12  XXX
                                         test.
92587........  26.........  A.........  Evoked auditory          0.13         0.04         0.05          0.04         0.05          0.01  XXX
                                         test.
92587........  TC.........  A.........  Evoked auditory          0.00         0.61         0.96            NA           NA          0.11  XXX
                                         test.

[[Page 38346]]

 
92588........  ...........  A.........  Evoked auditory          0.36         1.11         1.36            NA           NA          0.14  XXX
                                         test.
92588........  26.........  A.........  Evoked auditory          0.36         0.11         0.14          0.11         0.14          0.01  XXX
                                         test.
92588........  TC.........  A.........  Evoked auditory          0.00         1.00         1.22            NA           NA          0.13  XXX
                                         test.
92596........  ...........  A.........  Ear protector            0.00         1.01         0.79            NA           NA          0.06  XXX
                                         evaluation.
92597........  ...........  A.........  Oral speech              0.86         1.81         1.73          0.29         0.36          0.03  XXX
                                         device eval.
92601........  ...........  A.........  Cochlear implt f/        2.30         4.87         3.84            NA           NA          0.07  XXX
                                         up exam < 7.
92602........  ...........  A.........  Reprogram                1.30         0.89         2.04            NA           NA          0.07  XXX
                                         cochlear implt <
                                         7.
92603........  ...........  A.........  Cochlear implt f/        2.25         1.19         2.00          0.74         1.85          0.07  XXX
                                         up exam 7 >.
92604........  ...........  A.........  Reprogram                1.25         0.78         1.29          0.41         1.16          0.07  XXX
                                         cochlear implt 7
                                         >.
92607........  ...........  A.........  Ex for speech            0.00         4.59         3.78            NA           NA          0.05  XXX
                                         device rx, 1hr.
92608........  ...........  A.........  Ex for speech            0.00         0.87         0.71            NA           NA          0.05  XXX
                                         device rx addl.
92609........  ...........  A.........  Use of speech            0.00         2.43         1.99            NA           NA          0.04  XXX
                                         device service.
92610........  ...........  A.........  Evaluate                 0.00         1.69         2.55            NA           NA          0.08  XXX
                                         swallowing
                                         function.
92611........  ...........  A.........  Motion                   0.00         1.93         2.67            NA           NA          0.08  XXX
                                         fluoroscopy/
                                         swallow.
92612........  ...........  A.........  Endoscopy swallow        1.27         2.95         2.81          0.42         0.53          0.04  XXX
                                         tst (fees).
92613........  ...........  A.........  Endoscopy swallow        0.71         0.24         0.32          0.24         0.31          0.05  XXX
                                         tst (fees).
92614........  ...........  A.........  Laryngoscopic            1.27         2.41         2.43          0.42         0.53          0.04  XXX
                                         sensory test.
92615........  ...........  A.........  Eval laryngoscopy        0.63         0.21         0.28          0.21         0.28          0.05  XXX
                                         sense tst.
92616........  ...........  A.........  Fees w/laryngeal         1.88         3.15         3.23          0.62         0.79          0.06  XXX
                                         sense test.
92617........  ...........  A.........  Interprt fees/           0.79         0.27         0.35          0.26         0.35          0.05  XXX
                                         laryngeal test.
92620........  ...........  A.........  Auditory                 0.00         1.92         1.52            NA           NA          0.06  XXX
                                         function, 60 min.
92621........  ...........  A.........  Auditory                 0.00         0.43         0.34            NA           NA          0.06  ZZZ
                                         function, + 15
                                         min.
92625........  ...........  A.........  Tinnitus                 0.00         1.92         1.51          1.92         1.51          0.06  XXX
                                         assessment.
92626........  ...........  A.........  Eval aud rehab           0.00         1.99         2.07            NA           NA          0.06  XXX
                                         status.
92627........  ...........  A.........  Eval aud status          0.00         0.45         0.50          0.45         0.50          0.02  ZZZ
                                         rehab add-on.
92640........  ...........  A.........  Aud brainstem            0.00         1.32         1.37          1.32         1.37          0.01  XXX
                                         implt programg.
92700........  ...........  C.........  Ent procedure/           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         service.
92950........  ...........  A.........  Heart/lung               3.79         3.21         3.71          0.77         0.88          0.28  000
                                         resuscitation
                                         cpr.
92953........  ...........  A.........  Temporary                0.23           NA           NA          0.07         0.07          0.02  000
                                         external pacing.
92960........  ...........  A.........  Cardioversion            2.25         4.22         5.29          1.39         1.30          0.07  000
                                         electric, ext.
92961........  ...........  A.........  Cardioversion,           4.59           NA           NA          2.35         2.24          0.29  000
                                         electric, int.
92970........  ...........  A.........  Cardioassist,            3.51           NA           NA          1.44         1.28          0.16  000
                                         internal.
92971........  ...........  A.........  Cardioassist,            1.77           NA           NA          1.06         0.96          0.06  000
                                         external.
92973........  ...........  A.........  Percut coronary          3.28           NA           NA          1.69         1.51          0.23  ZZZ
                                         thrombectomy.
92974........  ...........  A.........  Cath place,              3.00           NA           NA          1.55         1.39          0.21  ZZZ
                                         cardio brachytx.
92975........  ...........  A.........  Dissolve clot,           7.24           NA           NA          3.68         3.29          0.50  000
                                         heart vessel.
92977........  ...........  A.........  Dissolve clot,           0.00         1.68         4.87            NA           NA          0.46  XXX
                                         heart vessel.
92978........  ...........  C.........  Intravasc us,            1.80           NA           NA            NA           NA          0.30  ZZZ
                                         heart add-on.
92978........  26.........  A.........  Intravasc us,            1.80         0.92         0.83          0.92         0.83          0.06  ZZZ
                                         heart add-on.
92978........  TC.........  C.........  Intravasc us,            0.00           NA           NA            NA           NA          0.24  ZZZ
                                         heart add-on.
92979........  ...........  C.........  Intravasc us,            1.44           NA           NA            NA           NA          0.19  ZZZ
                                         heart add-on.
92979........  26.........  A.........  Intravasc us,            1.44         0.74         0.66          0.74         0.66          0.06  ZZZ
                                         heart add-on.
92979........  TC.........  C.........  Intravasc us,            0.00           NA           NA            NA           NA          0.13  ZZZ
                                         heart add-on.
92980........  ...........  A.........  Insert                  14.82           NA           NA          7.80         7.03          1.03  000
                                         intracoronary
                                         stent.
92981........  ...........  A.........  Insert                   4.16           NA           NA          2.14         1.91          0.29  ZZZ
                                         intracoronary
                                         stent.
92982........  ...........  A.........  Coronary artery         10.96           NA           NA          5.82         5.25          0.76  000
                                         dilation.
92984........  ...........  A.........  Coronary artery          2.97           NA           NA          1.52         1.36          0.21  ZZZ
                                         dilation.
92986........  ...........  A.........  Revision of             22.70           NA           NA         14.75        13.48          1.51  090
                                         aortic valve.
92987........  ...........  A.........  Revision of             23.48           NA           NA         15.33        13.94          1.59  090
                                         mitral valve.
92990........  ...........  A.........  Revision of             18.12           NA           NA         10.98        10.44          1.20  090
                                         pulmonary valve.
92992........  ...........  C.........  Revision of heart        0.00         0.00         0.00          0.00         0.00          0.00  090
                                         chamber.
92993........  ...........  C.........  Revision of heart        0.00         0.00         0.00          0.00         0.00          0.00  090
                                         chamber.
92995........  ...........  A.........  Coronary                12.07           NA           NA          6.38         5.76          0.84  000
                                         atherectomy.
92996........  ...........  A.........  Coronary                 3.26           NA           NA          1.68         1.50          0.10  ZZZ
                                         atherectomy add-
                                         on.
92997........  ...........  A.........  Pul art balloon         11.98           NA           NA          5.52         5.13          0.40  000
                                         repr, percut.
92998........  ...........  A.........  Pul art balloon          5.99           NA           NA          2.91         2.54          0.28  ZZZ
                                         repr, percut.
93000........  ...........  A.........  Electrocardiogram        0.17         0.33         0.42          0.33         0.42          0.03  XXX
                                         , complete.
93005........  ...........  A.........  Electrocardiogram        0.00         0.27         0.36            NA           NA          0.02  XXX
                                         , tracing.
93010........  ...........  A.........  Electrocardiogram        0.17         0.07         0.06          0.07         0.06          0.01  XXX
                                         report.
93012........  ...........  A.........  Transmission of          0.00         4.10         5.07            NA           NA          0.18  XXX
                                         ecg.
93014........  ...........  A.........  Report on                0.52         0.22         0.21          0.22         0.21          0.02  XXX
                                         transmitted ecg.
93015........  ...........  A.........  Cardiovascular           0.75         1.84         1.91          1.84         1.91          0.14  XXX
                                         stress test.
93016........  ...........  A.........  Cardiovascular           0.45         0.22         0.20          0.22         0.20          0.02  XXX
                                         stress test.
93017........  ...........  A.........  Cardiovascular           0.00         1.48         1.59            NA           NA          0.11  XXX
                                         stress test.
93018........  ...........  A.........  Cardiovascular           0.30         0.14         0.13          0.14         0.13          0.01  XXX
                                         stress test.
93024........  ...........  A.........  Cardiac drug             1.17         2.31         1.96            NA           NA          0.12  XXX
                                         stress test.
93024........  26.........  A.........  Cardiac drug             1.17         0.55         0.51          0.55         0.51          0.04  XXX
                                         stress test.
93024........  TC.........  A.........  Cardiac drug             0.00         1.75         1.45            NA           NA          0.08  XXX
                                         stress test.
93025........  ...........  A.........  Microvolt t-wave         0.75         3.81         5.72            NA           NA          0.14  XXX
                                         assess.
93025........  26.........  A.........  Microvolt t-wave         0.75         0.37         0.33          0.37         0.33          0.03  XXX
                                         assess.
93025........  TC.........  A.........  Microvolt t-wave         0.00         3.44         5.39            NA           NA          0.11  XXX
                                         assess.
93040........  ...........  A.........  Rhythm ECG with          0.16         0.19         0.20          0.19         0.20          0.02  XXX
                                         report.

[[Page 38347]]

 
93041........  ...........  A.........  Rhythm ECG,              0.00         0.14         0.15            NA           NA          0.01  XXX
                                         tracing.
93042........  ...........  A.........  Rhythm ECG,              0.16         0.05         0.05          0.05         0.05          0.01  XXX
                                         report.
93224........  ...........  A.........  ECG monitor/             0.52         1.88         2.82          1.88         2.82          0.24  XXX
                                         report, 24 hrs.
93225........  ...........  A.........  ECG monitor/             0.00         0.83         1.04            NA           NA          0.08  XXX
                                         record, 24 hrs.
93226........  ...........  A.........  ECG monitor/             0.00         1.15         1.67            NA           NA          0.14  XXX
                                         report, 24 hrs.
93227........  ...........  A.........  ECG monitor/             0.52         0.26         0.23          0.26         0.23          0.02  XXX
                                         review, 24 hrs.
93230........  ...........  A.........  ECG monitor/             0.52         1.70         2.89          1.70         2.89          0.26  XXX
                                         report, 24 hrs.
93231........  ...........  A.........  Ecg monitor/             0.00         0.70         1.11            NA           NA          0.11  XXX
                                         record, 24 hrs.
93232........  ...........  A.........  ECG monitor/             0.00         1.31         1.75            NA           NA          0.13  XXX
                                         report, 24 hrs.
93233........  ...........  A.........  ECG monitor/             0.52         0.22         0.21          0.22         0.21          0.02  XXX
                                         review, 24 hrs.
93235........  ...........  C.........  ECG monitor/             0.45         0.00         1.43            NA           NA          0.16  XXX
                                         report, 24 hrs.
93236........  ...........  C.........  ECG monitor/             0.00         0.00         1.31            NA           NA          0.14  XXX
                                         report, 24 hrs.
93237........  ...........  A.........  ECG monitor/             0.45         0.21         0.19          0.21         0.19          0.02  XXX
                                         review, 24 hrs.
93268........  ...........  A.........  ECG record/review        0.52         0.75         4.93          0.75         4.93          0.28  XXX
93270........  ...........  A.........  ECG recording....        0.00         0.28         0.76            NA           NA          0.08  XXX
93271........  ...........  A.........  Ecg/monitoring           0.00         5.15         5.60            NA           NA          0.18  XXX
                                         and analysis.
93272........  ...........  A.........  Ecg/review,              0.52         0.21         0.20          0.21         0.20          0.02  XXX
                                         interpret only.
93278........  ...........  A.........  ECG/signal-              0.25         0.61         0.93            NA           NA          0.12  XXX
                                         averaged.
93278........  26.........  A.........  ECG/signal-              0.25         0.10         0.10          0.10         0.10          0.01  XXX
                                         averaged.
93278........  TC.........  A.........  ECG/signal-              0.00         0.51         0.83            NA           NA          0.11  XXX
                                         averaged.
93303........  ...........  A.........  Echo                     1.30         4.37         4.40            NA           NA          0.27  XXX
                                         transthoracic.
93303........  26.........  A.........  Echo                     1.30         0.52         0.51          0.52         0.51          0.04  XXX
                                         transthoracic.
93303........  TC.........  A.........  Echo                     0.00         3.86         3.89            NA           NA          0.23  XXX
                                         transthoracic.
93304........  ...........  A.........  Echo                     0.75         3.02         2.65            NA           NA          0.15  XXX
                                         transthoracic.
93304........  26.........  A.........  Echo                     0.75         0.29         0.29          0.29         0.29          0.02  XXX
                                         transthoracic.
93304........  TC.........  A.........  Echo                     0.00         2.73         2.36            NA           NA          0.13  XXX
                                         transthoracic.
93307........  ...........  A.........  Echo exam of             0.92         3.61         3.94            NA           NA          0.26  XXX
                                         heart.
93307........  26.........  A.........  Echo exam of             0.92         0.44         0.40          0.44         0.40          0.03  XXX
                                         heart.
93307........  TC.........  A.........  Echo exam of             0.00         3.18         3.54            NA           NA          0.23  XXX
                                         heart.
93308........  ...........  A.........  Echo exam of             0.53         2.53         2.35            NA           NA          0.15  XXX
                                         heart.
93308........  26.........  A.........  Echo exam of             0.53         0.26         0.23          0.26         0.23          0.02  XXX
                                         heart.
93308........  TC.........  A.........  Echo exam of             0.00         2.28         2.12            NA           NA          0.13  XXX
                                         heart.
93312........  ...........  A.........  Echo                     2.20         7.17         5.93            NA           NA          0.37  XXX
                                         transesophageal.
93312........  26.........  A.........  Echo                     2.20         0.94         0.88          0.94         0.88          0.08  XXX
                                         transesophageal.
93312........  TC.........  A.........  Echo                     0.00         6.23         5.05            NA           NA          0.29  XXX
                                         transesophageal.
93313........  ...........  A.........  Echo                     0.95           NA           NA          0.13         0.17          0.06  XXX
                                         transesophageal.
93314........  ...........  A.........  Echo                     1.25         7.00         5.66            NA           NA          0.33  XXX
                                         transesophageal.
93314........  26.........  A.........  Echo                     1.25         0.54         0.51          0.54         0.51          0.04  XXX
                                         transesophageal.
93314........  TC.........  A.........  Echo                     0.00         6.46         5.15            NA           NA          0.29  XXX
                                         transesophageal.
93315........  ...........  C.........  Echo                     2.78           NA           NA            NA           NA          0.09  XXX
                                         transesophageal.
93315........  26.........  A.........  Echo                     2.78         1.26         1.15          1.26         1.15          0.09  XXX
                                         transesophageal.
93315........  TC.........  C.........  Echo                     0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         transesophageal.
93316........  ...........  A.........  Echo                     0.95           NA           NA          0.25         0.25          0.05  XXX
                                         transesophageal.
93317........  ...........  C.........  Echo                     1.83           NA           NA            NA           NA          0.08  XXX
                                         transesophageal.
93317........  26.........  A.........  Echo                     1.83         0.60         0.66          0.60         0.66          0.08  XXX
                                         transesophageal.
93317........  TC.........  C.........  Echo                     0.00         0.00         1.79          0.00         1.79          0.00  XXX
                                         transesophageal.
93318........  ...........  C.........  Echo                     2.20         0.00         0.39          0.00         0.39          0.14  XXX
                                         transesophageal
                                         intraop.
93318........  26.........  A.........  Echo                     2.20         0.83         0.67          0.83         0.67          0.14  XXX
                                         transesophageal
                                         intraop.
93318........  TC.........  C.........  Echo                     0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         transesophageal
                                         intraop.
93320........  ...........  A.........  Doppler echo             0.38         1.62         1.75          1.62         1.75          0.13  ZZZ
                                         exam, heart.
93320........  26.........  A.........  Doppler echo             0.38         0.18         0.17          0.18         0.17          0.01  ZZZ
                                         exam, heart.
93320........  TC.........  A.........  Doppler echo             0.00         1.44         1.59          1.44         1.59          0.12  ZZZ
                                         exam, heart.
93321........  ...........  A.........  Doppler echo             0.15         0.59         0.89          0.59         0.89          0.09  ZZZ
                                         exam, heart.
93321........  26.........  A.........  Doppler echo             0.15         0.07         0.07          0.07         0.07          0.01  ZZZ
                                         exam, heart.
93321........  TC.........  A.........  Doppler echo             0.00         0.52         0.82          0.52         0.82          0.08  ZZZ
                                         exam, heart.
93325........  ...........  B.........  Doppler color            0.07         0.64         1.79          0.64         1.79          0.22  ZZZ
                                         flow add-on.
93325........  26.........  B.........  Doppler color            0.07         0.03         0.03          0.03         0.03          0.01  ZZZ
                                         flow add-on.
93325........  TC.........  B.........  Doppler color            0.00         0.61         1.76          0.61         1.76          0.21  ZZZ
                                         flow add-on.
93350........  ...........  A.........  Echo                     1.48         4.92         3.66            NA           NA          0.18  XXX
                                         transthoracic.
93350........  26.........  A.........  Echo                     1.48         0.73         0.66          0.73         0.66          0.05  XXX
                                         transthoracic.
93350........  TC.........  A.........  Echo                     0.00         4.19         3.00            NA           NA          0.13  XXX
                                         transthoracic.
93501........  ...........  A.........  Right heart              3.02        18.09        15.33            NA           NA          1.26  000
                                         catheterization.
93501........  26.........  A.........  Right heart              3.02         1.51         1.35          1.51         1.35          0.21  000
                                         catheterization.
93501........  TC.........  A.........  Right heart              0.00        16.58        13.98            NA           NA          1.05  000
                                         catheterization.
93503........  ...........  A.........  Insert/place             2.91           NA           NA          0.43         0.56          0.20  000
                                         heart catheter.
93505........  ...........  A.........  Biopsy of heart          4.37        20.23         8.97            NA           NA          0.46  000
                                         lining.
93505........  26.........  A.........  Biopsy of heart          4.37         2.19         1.96          2.19         1.96          0.30  000
                                         lining.
93505........  TC.........  A.........  Biopsy of heart          0.00        18.03         7.00            NA           NA          0.16  000
                                         lining.
93508........  ...........  A.........  Cath placement,          4.09        27.89        17.02            NA           NA          0.93  000
                                         angiography.
93508........  26.........  A.........  Cath placement,          4.09         2.09         2.12          2.09         2.12          0.28  000
                                         angiography.
93508........  TC.........  A.........  Cath placement,          0.00        25.80        14.90            NA           NA          0.65  000
                                         angiography.
93510........  ...........  A.........  Left heart               4.32        27.22        29.03            NA           NA          2.62  000
                                         catheterization.

[[Page 38348]]

 
93510........  26.........  A.........  Left heart               4.32         2.19         2.21          2.19         2.21          0.30  000
                                         catheterization.
93510........  TC.........  A.........  Left heart               0.00        25.03        26.82            NA           NA          2.32  000
                                         catheterization.
93511........  ...........  A.........  Left heart               5.02           NA           NA            NA           NA          2.60  000
                                         catheterization.
93511........  26.........  A.........  Left heart               5.02         2.53         2.51          2.53         2.51          0.35  000
                                         catheterization.
93511........  TC.........  A.........  Left heart               0.00           NA           NA            NA           NA          2.25  000
                                         catheterization.
93514........  ...........  A.........  Left heart               7.04           NA           NA            NA           NA          0.49  000
                                         catheterization.
93514........  26.........  A.........  Left heart               7.04         2.72         3.00          2.72         3.00          0.49  000
                                         catheterization.
93524........  ...........  A.........  Left heart               6.94           NA           NA            NA           NA          3.44  000
                                         catheterization.
93524........  26.........  A.........  Left heart               6.94         3.60         3.42          3.60         3.42          0.48  000
                                         catheterization.
93524........  TC.........  A.........  Left heart               0.00           NA           NA            NA           NA          2.96  000
                                         catheterization.
93526........  ...........  A.........  Rt & Lt heart            5.98        33.97        37.42            NA           NA          3.47  000
                                         catheters.
93526........  26.........  A.........  Rt & Lt heart            5.98         3.04         2.97          3.04         2.97          0.42  000
                                         catheters.
93526........  TC.........  A.........  Rt & Lt heart            0.00        30.93        34.46            NA           NA          3.05  000
                                         catheters.
93527........  ...........  A.........  Rt & Lt heart            7.27           NA           NA            NA           NA          3.47  000
                                         catheters.
93527........  26.........  A.........  Rt & Lt heart            7.27         3.70         3.56          3.70         3.56          0.51  000
                                         catheters.
93527........  TC.........  A.........  Rt & Lt heart            0.00           NA           NA            NA           NA          2.96  000
                                         catheters.
93528........  ...........  A.........  Rt & Lt heart            8.99           NA           NA            NA           NA          3.58  000
                                         catheters.
93528........  26.........  A.........  Rt & Lt heart            8.99         4.26         4.21          4.26         4.21          0.62  000
                                         catheters.
93528........  TC.........  A.........  Rt & Lt heart            0.00           NA           NA            NA           NA          2.96  000
                                         catheters.
93529........  ...........  A.........  Rt, lt heart             4.79           NA           NA            NA           NA          3.29  000
                                         catheterization.
93529........  26.........  A.........  Rt, lt heart             4.79         2.44         2.39          2.44         2.39          0.33  000
                                         catheterization.
93529........  TC.........  A.........  Rt, lt heart             0.00           NA           NA            NA           NA          2.96  000
                                         catheterization.
93530........  ...........  A.........  Rt heart cath,           4.22           NA           NA            NA           NA          1.34  000
                                         congenital.
93530........  26.........  A.........  Rt heart cath,           4.22         1.77         1.87          1.77         1.87          0.29  000
                                         congenital.
93530........  TC.........  A.........  Rt heart cath,           0.00           NA           NA            NA           NA          1.05  000
                                         congenital.
93531........  ...........  A.........  R & l heart cath,        8.34           NA           NA            NA           NA          3.63  000
                                         congenital.
93531........  26.........  A.........  R & l heart cath,        8.34         2.76         3.34          2.76         3.34          0.58  000
                                         congenital.
93531........  TC.........  A.........  R & l heart cath,        0.00           NA           NA            NA           NA          3.05  000
                                         congenital.
93532........  ...........  A.........  R & l heart cath,        9.99           NA           NA            NA           NA          0.69  000
                                         congenital.
93532........  26.........  A.........  R & l heart cath,        9.99         3.41         3.94          3.41         3.94          0.69  000
                                         congenital.
93533........  ...........  A.........  R & l heart cath,        6.69           NA           NA            NA           NA          0.47  000
                                         congenital.
93533........  26.........  A.........  R & l heart cath,        6.69         2.96         2.90          2.96         2.90          0.47  000
                                         congenital.
93539........  ...........  A.........  Injection,               0.40         2.39         0.92            NA           NA          0.01  000
                                         cardiac cath.
93540........  ...........  A.........  Injection,               0.43         0.67         0.35            NA           NA          0.01  000
                                         cardiac cath.
93541........  ...........  A.........  Injection for            0.29           NA           NA          0.15         0.13          0.01  000
                                         lung angiogram.
93542........  ...........  A.........  Injection for            0.29         0.46         0.23            NA           NA          0.01  000
                                         heart x-rays.
93543........  ...........  A.........  Injection for            0.29         2.54         0.93            NA           NA          0.01  000
                                         heart x-rays.
93544........  ...........  A.........  Injection for            0.25         1.78         0.67            NA           NA          0.01  000
                                         aortography.
93545........  ...........  A.........  Inject for               0.40         5.67         2.01            NA           NA          0.01  000
                                         coronary x-rays.
93555........  ...........  A.........  Imaging, cardiac         0.81         0.57         3.56            NA           NA          0.37  XXX
                                         cath.
93555........  26.........  A.........  Imaging, cardiac         0.81         0.41         0.37          0.41         0.37          0.03  XXX
                                         cath.
93555........  TC.........  A.........  Imaging, cardiac         0.00         0.16         3.19            NA           NA          0.34  XXX
                                         cath.
93556........  ...........  A.........  Imaging, cardiac         0.83         0.84         5.47            NA           NA          0.54  XXX
                                         cath.
93556........  26.........  A.........  Imaging, cardiac         0.83         0.42         0.38          0.42         0.38          0.03  XXX
                                         cath.
93556........  TC.........  A.........  Imaging, cardiac         0.00         0.42         5.09            NA           NA          0.51  XXX
                                         cath.
93561........  ...........  A.........  Cardiac output           0.50           NA           NA            NA           NA          0.08  000
                                         measurement.
93561........  26.........  A.........  Cardiac output           0.50         0.14         0.15          0.14         0.15          0.02  000
                                         measurement.
93561........  TC.........  A.........  Cardiac output           0.00           NA           NA            NA           NA          0.06  000
                                         measurement.
93562........  ...........  A.........  Cardiac output           0.16           NA           NA            NA           NA          0.05  000
                                         measurement.
93562........  26.........  A.........  Cardiac output           0.16         0.03         0.04          0.03         0.04          0.01  000
                                         measurement.
93562........  TC.........  A.........  Cardiac output           0.00           NA           NA            NA           NA          0.04  000
                                         measurement.
93571........  ...........  A.........  Heart flow               1.80           NA           NA            NA           NA          0.30  ZZZ
                                         reserve measure.
93571........  26.........  A.........  Heart flow               1.80         0.92         0.81          0.92         0.81          0.06  ZZZ
                                         reserve measure.
93571........  TC.........  A.........  Heart flow               0.00            .         4.57             .         4.57          0.24  ZZZ
                                         reserve measure.
93572........  ...........  A.........  Heart flow               1.44         0.71         0.61          0.71         0.61          0.04  ZZZ
                                         reserve measure.
93572........  26.........  A.........  Heart flow               1.44         0.71         0.61          0.71         0.61          0.04  ZZZ
                                         reserve measure.
93580........  ...........  A.........  Transcath closure       17.97           NA           NA          9.05         8.33          1.25  000
                                         of asd.
93581........  ...........  A.........  Transcath closure       24.39           NA           NA         10.89        10.56          1.72  000
                                         of vsd.
93600........  ...........  C.........  Bundle of His            2.12           NA           NA            NA           NA          0.29  000
                                         recording.
93600........  26.........  A.........  Bundle of His            2.12         1.04         0.95          1.04         0.95          0.16  000
                                         recording.
93600........  TC.........  C.........  Bundle of His            0.00         0.00         1.31          0.00         1.31          0.13  000
                                         recording.
93602........  ...........  C.........  Intra-atrial             2.12           NA           NA            NA           NA          0.24  000
                                         recording.
93602........  26.........  A.........  Intra-atrial             2.12         1.01         0.93          1.01         0.93          0.17  000
                                         recording.
93602........  TC.........  C.........  Intra-atrial             0.00         0.00         0.74          0.00         0.74          0.07  000
                                         recording.
93603........  ...........  C.........  Right ventricular        2.12           NA           NA            NA           NA          0.29  000
                                         recording.
93603........  26.........  A.........  Right ventricular        2.12         1.00         0.92          1.00         0.92          0.18  000
                                         recording.
93603........  TC.........  C.........  Right ventricular        0.00         0.00         1.12          0.00         1.12          0.11  000
                                         recording.
93609........  ...........  C.........  Map tachycardia,         4.99           NA           NA            NA           NA          0.52  ZZZ
                                         add-on.
93609........  26.........  A.........  Map tachycardia,         4.99         2.51         2.27          2.51         2.27          0.35  ZZZ
                                         add-on.
93609........  TC.........  C.........  Map tachycardia,         0.00         0.00         1.82          0.00         1.82          0.17  ZZZ
                                         add-on.
93610........  ...........  C.........  Intra-atrial             3.02           NA           NA            NA           NA          0.34  000
                                         pacing.
93610........  26.........  A.........  Intra-atrial             3.02         1.41         1.30          1.41         1.30          0.24  000
                                         pacing.

[[Page 38349]]

 
93610........  TC.........  C.........  Intra-atrial             0.00           NA           NA            NA           NA          0.10  000
                                         pacing.
93612........  ...........  C.........  Intraventricular         3.02           NA           NA            NA           NA          0.36  000
                                         pacing.
93612........  26.........  A.........  Intraventricular         3.02         1.37         1.28          1.37         1.28          0.25  000
                                         pacing.
93612........  TC.........  C.........  Intraventricular         0.00         0.00         1.07          0.00         1.07          0.11  000
                                         pacing.
93613........  ...........  A.........  Electrophys map          6.99           NA           NA          3.54         3.20          0.49  ZZZ
                                         3d, add-on.
93615........  ...........  C.........  Esophageal               0.99           NA           NA            NA           NA          0.05  000
                                         recording.
93615........  26.........  A.........  Esophageal               0.99         0.51         0.39          0.51         0.39          0.03  000
                                         recording.
93615........  TC.........  C.........  Esophageal               0.00         0.00         0.21          0.00         0.21          0.02  000
                                         recording.
93616........  ...........  C.........  Esophageal               1.49         0.00         0.45          0.00         0.45          0.09  000
                                         recording.
93616........  26.........  A.........  Esophageal               1.49         0.26         0.37          0.26         0.37          0.09  000
                                         recording.
93616........  TC.........  C.........  Esophageal               0.00         0.00         0.16          0.00         0.16          0.00  000
                                         recording.
93618........  ...........  C.........  Heart rhythm             4.25           NA           NA            NA           NA          0.54  000
                                         pacing.
93618........  26.........  A.........  Heart rhythm             4.25         2.19         1.96          2.19         1.96          0.30  000
                                         pacing.
93618........  TC.........  C.........  Heart rhythm             0.00         0.00         2.65          0.00         2.65          0.24  000
                                         pacing.
93619........  ...........  C.........  Electrophysiology        7.31           NA           NA            NA           NA          0.98  000
                                         evaluation.
93619........  26.........  A.........  Electrophysiology        7.31         3.71         3.48          3.71         3.48          0.51  000
                                         evaluation.
93619........  TC.........  C.........  Electrophysiology        0.00         0.00         5.15          0.00         5.15          0.47  000
                                         evaluation.
93620........  ...........  C.........  Electrophysiology       11.57           NA           NA          0.00         7.91          0.80  000
                                         evaluation.
93620........  26.........  A.........  Electrophysiology       11.57         5.84         5.43          5.84         5.43          0.80  000
                                         evaluation.
93620........  TC.........  C.........  Electrophysiology        0.00         0.00         4.43          0.00         4.43          0.00  000
                                         evaluation.
93621........  ...........  C.........  Electrophysiology        2.10         0.00         0.60          0.00         0.60          0.15  ZZZ
                                         evaluation.
93621........  26.........  A.........  Electrophysiology        2.10         1.06         0.95          1.06         0.95          0.15  ZZZ
                                         evaluation.
93621........  TC.........  C.........  Electrophysiology        0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         evaluation.
93622........  ...........  C.........  Electrophysiology        3.10         0.00         0.89          0.00         0.89          0.22  ZZZ
                                         evaluation.
93622........  26.........  A.........  Electrophysiology        3.10         1.50         1.39          1.50         1.39          0.22  ZZZ
                                         evaluation.
93622........  TC.........  C.........  Electrophysiology        0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         evaluation.
93623........  ...........  C.........  Stimulation,             2.85         0.00         0.81          0.00         0.81          0.20  ZZZ
                                         pacing heart.
93623........  26.........  A.........  Stimulation,             2.85         1.43         1.29          1.43         1.29          0.20  ZZZ
                                         pacing heart.
93623........  TC.........  C.........  Stimulation,             0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         pacing heart.
93624........  ...........  C.........  Electrophysiologi        4.80           NA           NA          0.00         1.54          0.46  000
                                         c study.
93624........  26.........  A.........  Electrophysiologi        4.80         2.49         2.37          2.49         2.37          0.33  000
                                         c study.
93624........  TC.........  C.........  Electrophysiologi        0.00         0.00         1.33          0.00         1.33          0.13  000
                                         c study.
93631........  ...........  C.........  Heart pacing,            7.59         0.00         4.92          0.00         4.92          0.97  000
                                         mapping.
93631........  26.........  A.........  Heart pacing,            7.59         2.75         2.76          2.75         2.76          0.97  000
                                         mapping.
93631........  TC.........  C.........  Heart pacing,            0.00         0.00         3.07          0.00         3.07          0.00  000
                                         mapping.
93640........  ...........  C.........  Evaluation heart         3.51           NA           NA            NA           NA          0.66  000
                                         device.
93640........  26.........  A.........  Evaluation heart         3.51         1.74         1.58          1.74         1.58          0.24  000
                                         device.
93640........  TC.........  C.........  Evaluation heart         0.00         0.00         4.79          0.00         4.79          0.42  000
                                         device.
93641........  ...........  C.........  Electrophysiology        5.92           NA           NA            NA           NA          0.83  000
                                         evaluation.
93641........  26.........  A.........  Electrophysiology        5.92         2.99         2.69          2.99         2.69          0.41  000
                                         evaluation.
93641........  TC.........  C.........  Electrophysiology        0.00         0.00         4.79          0.00         4.79          0.42  000
                                         evaluation.
93642........  ...........  A.........  Electrophysiology        4.88         7.08         8.29          7.08         8.29          0.57  000
                                         evaluation.
93642........  26.........  A.........  Electrophysiology        4.88         2.48         2.38          2.48         2.38          0.15  000
                                         evaluation.
93642........  TC.........  A.........  Electrophysiology        0.00         4.60         5.91          4.60         5.91          0.42  000
                                         evaluation.
93650........  ...........  A.........  Ablate heart            10.49           NA           NA          5.58         5.09          0.73  000
                                         dysrhythm focus.
93651........  ...........  A.........  Ablate heart            16.23           NA           NA          8.19         7.37          1.13  000
                                         dysrhythm focus.
93652........  ...........  A.........  Ablate heart            17.65           NA           NA          8.47         7.88          1.23  000
                                         dysrhythm focus.
93660........  ...........  A.........  Tilt table               1.89         2.90         2.69          2.90         2.69          0.08  000
                                         evaluation.
93660........  26.........  A.........  Tilt table               1.89         0.94         0.85          0.94         0.85          0.06  000
                                         evaluation.
93660........  TC.........  A.........  Tilt table               0.00         1.97         1.84          1.97         1.84          0.02  000
                                         evaluation.
93662........  ...........  C.........  Intracardiac ecg         2.80         0.00         0.81          0.00         0.81          0.09  ZZZ
                                         (ice).
93662........  26.........  A.........  Intracardiac ecg         2.80         1.41         1.28          1.41         1.28          0.09  ZZZ
                                         (ice).
93662........  TC.........  C.........  Intracardiac ecg         0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         (ice).
93668........  ...........  N.........  Peripheral               0.00         0.40         0.40            NA           NA          0.01  XXX
                                         vascular rehab.
93701........  ...........  A.........  Bioimpedance,            0.17         0.68         0.83            NA           NA          0.02  XXX
                                         thoracic.
93701........  26.........  A.........  Bioimpedance,            0.17         0.06         0.07          0.06         0.07          0.01  XXX
                                         thoracic.
93701........  TC.........  A.........  Bioimpedance,            0.00         0.62         0.77            NA           NA          0.01  XXX
                                         thoracic.
93720........  ...........  A.........  Total body               0.17         1.26         1.00          1.26         1.00          0.07  XXX
                                         plethysmography.
93721........  ...........  A.........  Plethysmography          0.00         1.12         0.92            NA           NA          0.06  XXX
                                         tracing.
93722........  ...........  A.........  Plethysmography          0.17         0.04         0.05          0.04         0.05          0.01  XXX
                                         report.
93724........  ...........  A.........  Analyze pacemaker        4.88         3.04         4.54          3.04         4.54          0.39  000
                                         system.
93724........  26.........  A.........  Analyze pacemaker        4.88         2.21         2.13          2.21         2.13          0.15  000
                                         system.
93724........  TC.........  A.........  Analyze pacemaker        0.00         0.84         2.41          0.84         2.41          0.24  000
                                         system.
93727........  ...........  A.........  Analyze ilr              0.52         0.61         0.41          0.61         0.41          0.02  XXX
                                         system.
93731........  ...........  A.........  Analyze pacemaker        0.45         0.76         0.72            NA           NA          0.05  XXX
                                         system.
93731........  26.........  A.........  Analyze pacemaker        0.45         0.23         0.20          0.23         0.20          0.01  XXX
                                         system.
93731........  TC.........  A.........  Analyze pacemaker        0.00         0.53         0.52            NA           NA          0.04  XXX
                                         system.
93732........  ...........  A.........  Analyze pacemaker        0.92         1.11         1.00            NA           NA          0.07  XXX
                                         system.
93732........  26.........  A.........  Analyze pacemaker        0.92         0.46         0.41          0.46         0.41          0.03  XXX
                                         system.
93732........  TC.........  A.........  Analyze pacemaker        0.00         0.64         0.58            NA           NA          0.04  XXX
                                         system.
93733........  ...........  A.........  Telephone analy,         0.17         0.90         0.85            NA           NA          0.07  XXX
                                         pacemaker.
93733........  26.........  A.........  Telephone analy,         0.17         0.08         0.07          0.08         0.07          0.01  XXX
                                         pacemaker.

[[Page 38350]]

 
93733........  TC.........  A.........  Telephone analy,         0.00         0.82         0.78            NA           NA          0.06  XXX
                                         pacemaker.
93734........  ...........  A.........  Analyze pacemaker        0.38         0.68         0.59            NA           NA          0.03  XXX
                                         system.
93734........  26.........  A.........  Analyze pacemaker        0.38         0.19         0.17          0.19         0.17          0.01  XXX
                                         system.
93734........  TC.........  A.........  Analyze pacemaker        0.00         0.48         0.42            NA           NA          0.02  XXX
                                         system.
93735........  ...........  A.........  Analyze pacemaker        0.74         0.92         0.83            NA           NA          0.06  XXX
                                         system.
93735........  26.........  A.........  Analyze pacemaker        0.74         0.37         0.33          0.37         0.33          0.02  XXX
                                         system.
93735........  TC.........  A.........  Analyze pacemaker        0.00         0.55         0.50            NA           NA          0.04  XXX
                                         system.
93736........  ...........  A.........  Telephonic analy,        0.15         0.88         0.79            NA           NA          0.07  XXX
                                         pacemaker.
93736........  26.........  A.........  Telephonic analy,        0.15         0.07         0.06          0.07         0.06          0.01  XXX
                                         pacemaker.
93736........  TC.........  A.........  Telephonic analy,        0.00         0.82         0.73            NA           NA          0.06  XXX
                                         pacemaker.
93740........  ...........  B.........  Temperature              0.16         0.04         0.11            NA           NA          0.02  XXX
                                         gradient studies.
93740........  26.........  B.........  Temperature              0.16         0.04         0.04          0.04         0.04          0.01  XXX
                                         gradient studies.
93740........  TC.........  B.........  Temperature              0.00         0.00         0.07            NA           NA          0.01  XXX
                                         gradient studies.
93741........  ...........  A.........  Analyze ht pace          0.80         0.98         0.99            NA           NA          0.07  XXX
                                         device sngl.
93741........  26.........  A.........  Analyze ht pace          0.80         0.41         0.36          0.41         0.36          0.03  XXX
                                         device sngl.
93741........  TC.........  A.........  Analyze ht pace          0.00         0.57         0.62            NA           NA          0.04  XXX
                                         device sngl.
93742........  ...........  A.........  Analyze ht pace          0.91         1.11         1.08            NA           NA          0.07  XXX
                                         device sngl.
93742........  26.........  A.........  Analyze ht pace          0.91         0.46         0.42          0.46         0.42          0.03  XXX
                                         device sngl.
93742........  TC.........  A.........  Analyze ht pace          0.00         0.65         0.66            NA           NA          0.04  XXX
                                         device sngl.
93743........  ...........  A.........  Analyze ht pace          1.03         1.15         1.15            NA           NA          0.07  XXX
                                         device dual.
93743........  26.........  A.........  Analyze ht pace          1.03         0.52         0.47          0.52         0.47          0.03  XXX
                                         device dual.
93743........  TC.........  A.........  Analyze ht pace          0.00         0.62         0.68            NA           NA          0.04  XXX
                                         device dual.
93744........  ...........  A.........  Analyze ht pace          1.18         1.29         1.22            NA           NA          0.08  XXX
                                         device dual.
93744........  26.........  A.........  Analyze ht pace          1.18         0.60         0.54          0.60         0.54          0.04  XXX
                                         device dual.
93744........  TC.........  A.........  Analyze ht pace          0.00         0.69         0.68            NA           NA          0.04  XXX
                                         device dual.
93745........  ...........  C.........  Set-up cardiovert-       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         defibrill.
93745........  26.........  C.........  Set-up cardiovert-       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         defibrill.
93745........  TC.........  C.........  Set-up cardiovert-       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         defibrill.
93770........  ...........  B.........  Measure venous           0.16         0.04         0.06            NA           NA          0.02  XXX
                                         pressure.
93770........  26.........  B.........  Measure venous           0.16         0.04         0.05          0.04         0.05          0.01  XXX
                                         pressure.
93770........  TC.........  B.........  Measure venous           0.00         0.00         0.01            NA           NA          0.01  XXX
                                         pressure.
93784........  ...........  A.........  Ambulatory BP            0.38         1.13         1.40          1.13         1.40          0.03  XXX
                                         monitoring.
93786........  ...........  A.........  Ambulatory BP            0.00         0.86         0.89            NA           NA          0.01  XXX
                                         recording.
93788........  ...........  A.........  Ambulatory BP            0.00         0.51         0.51            NA           NA          0.01  XXX
                                         analysis.
93790........  ...........  A.........  Review/report BP         0.38         0.14         0.13          0.14         0.13          0.01  XXX
                                         recording.
93797........  ...........  I.........  Cardiac rehab....        0.00         0.00         0.00          0.00         0.00          0.00  000
93798........  ...........  I.........  Cardiac rehab/           0.00         0.00         0.00          0.00         0.00          0.00  000
                                         monitor.
93799........  ...........  C.........  Cardiovascular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
93799........  26.........  C.........  Cardiovascular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
93799........  TC.........  C.........  Cardiovascular           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
93875........  ...........  A.........  Extracranial             0.22         2.50         2.42            NA           NA          0.12  XXX
                                         study.
93875........  26.........  A.........  Extracranial             0.22         0.07         0.08          0.07         0.08          0.01  XXX
                                         study.
93875........  TC.........  A.........  Extracranial             0.00         2.44         2.35            NA           NA          0.11  XXX
                                         study.
93880........  ...........  A.........  Extracranial             0.60         6.05         5.80            NA           NA          0.39  XXX
                                         study.
93880........  26.........  A.........  Extracranial             0.60         0.21         0.20          0.21         0.20          0.04  XXX
                                         study.
93880........  TC.........  A.........  Extracranial             0.00         5.84         5.59            NA           NA          0.35  XXX
                                         study.
93882........  ...........  A.........  Extracranial             0.40         4.06         3.77            NA           NA          0.26  XXX
                                         study.
93882........  26.........  A.........  Extracranial             0.40         0.11         0.12          0.11         0.12          0.04  XXX
                                         study.
93882........  TC.........  A.........  Extracranial             0.00         3.94         3.65            NA           NA          0.22  XXX
                                         study.
93886........  ...........  A.........  Intracranial             0.94         6.94         6.83            NA           NA          0.45  XXX
                                         study.
93886........  26.........  A.........  Intracranial             0.94         0.28         0.33          0.28         0.33          0.06  XXX
                                         study.
93886........  TC.........  A.........  Intracranial             0.00         6.66         6.50            NA           NA          0.39  XXX
                                         study.
93888........  ...........  A.........  Intracranial             0.62         4.83         4.52            NA           NA          0.32  XXX
                                         study.
93888........  26.........  A.........  Intracranial             0.62         0.20         0.21          0.20         0.21          0.05  XXX
                                         study.
93888........  TC.........  A.........  Intracranial             0.00         4.63         4.30            NA           NA          0.27  XXX
                                         study.
93890........  ...........  A.........  Tcd,                     1.00         6.35         5.58            NA           NA          0.45  XXX
                                         vasoreactivity
                                         study.
93890........  26.........  A.........  Tcd,                     1.00         0.31         0.36          0.31         0.36          0.06  XXX
                                         vasoreactivity
                                         study.
93890........  TC.........  A.........  Tcd,                     0.00         6.04         5.23            NA           NA          0.39  XXX
                                         vasoreactivity
                                         study.
93892........  ...........  A.........  Tcd, emboli              1.15         6.77         5.94            NA           NA          0.45  XXX
                                         detect w/o inj.
93892........  26.........  A.........  Tcd, emboli              1.15         0.32         0.39          0.32         0.39          0.06  XXX
                                         detect w/o inj.
93892........  TC.........  A.........  Tcd, emboli              0.00         6.44         5.54            NA           NA          0.39  XXX
                                         detect w/o inj.
93893........  ...........  A.........  Tcd, emboli              1.15         6.92         5.87            NA           NA          0.45  XXX
                                         detect w/inj.
93893........  26.........  A.........  Tcd, emboli              1.15         0.33         0.40          0.33         0.40          0.06  XXX
                                         detect w/inj.
93893........  TC.........  A.........  Tcd, emboli              0.00         6.59         5.47            NA           NA          0.39  XXX
                                         detect w/inj.
93922........  ...........  A.........  Extremity study..        0.25         3.05         2.87            NA           NA          0.15  XXX
93922........  26.........  A.........  Extremity study..        0.25         0.08         0.08          0.08         0.08          0.02  XXX
93922........  TC.........  A.........  Extremity study..        0.00         2.97         2.79            NA           NA          0.13  XXX
93923........  ...........  A.........  Extremity study..        0.45         4.60         4.32            NA           NA          0.26  XXX
93923........  26.........  A.........  Extremity study..        0.45         0.14         0.15          0.14         0.15          0.04  XXX
93923........  TC.........  A.........  Extremity study..        0.00         4.46         4.17            NA           NA          0.22  XXX
93924........  ...........  A.........  Extremity study..        0.50         5.82         5.31            NA           NA          0.30  XXX
93924........  26.........  A.........  Extremity study..        0.50         0.16         0.17          0.16         0.17          0.05  XXX

[[Page 38351]]

 
93924........  TC.........  A.........  Extremity study..        0.00         5.66         5.14            NA           NA          0.25  XXX
93925........  ...........  A.........  Lower extremity          0.58         7.88         7.33            NA           NA          0.39  XXX
                                         study.
93925........  26.........  A.........  Lower extremity          0.58         0.19         0.20          0.19         0.20          0.04  XXX
                                         study.
93925........  TC.........  A.........  Lower extremity          0.00         7.70         7.13            NA           NA          0.35  XXX
                                         study.
93926........  ...........  A.........  Lower extremity          0.39         5.07         4.56            NA           NA          0.27  XXX
                                         study.
93926........  26.........  A.........  Lower extremity          0.39         0.11         0.12          0.11         0.12          0.04  XXX
                                         study.
93926........  TC.........  A.........  Lower extremity          0.00         4.96         4.44            NA           NA          0.23  XXX
                                         study.
93930........  ...........  A.........  Upper extremity          0.46         6.16         5.75            NA           NA          0.41  XXX
                                         study.
93930........  26.........  A.........  Upper extremity          0.46         0.15         0.16          0.15         0.16          0.04  XXX
                                         study.
93930........  TC.........  A.........  Upper extremity          0.00         6.01         5.59            NA           NA          0.37  XXX
                                         study.
93931........  ...........  A.........  Upper extremity          0.31         4.11         3.80            NA           NA          0.27  XXX
                                         study.
93931........  26.........  A.........  Upper extremity          0.31         0.10         0.10          0.10         0.10          0.03  XXX
                                         study.
93931........  TC.........  A.........  Upper extremity          0.00         4.02         3.70            NA           NA          0.24  XXX
                                         study.
93965........  ...........  A.........  Extremity study..        0.35         2.96         2.87            NA           NA          0.14  XXX
93965........  26.........  A.........  Extremity study..        0.35         0.11         0.12          0.11         0.12          0.02  XXX
93965........  TC.........  A.........  Extremity study..        0.00         2.86         2.76            NA           NA          0.12  XXX
93970........  ...........  A.........  Extremity study..        0.68         6.13         5.67            NA           NA          0.46  XXX
93970........  26.........  A.........  Extremity study..        0.68         0.21         0.22          0.21         0.22          0.06  XXX
93970........  TC.........  A.........  Extremity study..        0.00         5.92         5.45            NA           NA          0.40  XXX
93971........  ...........  A.........  Extremity study..        0.45         4.02         3.79            NA           NA          0.30  XXX
93971........  26.........  A.........  Extremity study..        0.45         0.15         0.15          0.15         0.15          0.03  XXX
93971........  TC.........  A.........  Extremity study..        0.00         3.88         3.64            NA           NA          0.27  XXX
93975........  ...........  A.........  Vascular study...        1.80         8.32         7.96            NA           NA          0.56  XXX
93975........  26.........  A.........  Vascular study...        1.80         0.62         0.61          0.62         0.61          0.13  XXX
93975........  TC.........  A.........  Vascular study...        0.00         7.69         7.35            NA           NA          0.43  XXX
93976........  ...........  A.........  Vascular study...        1.21         4.53         4.40            NA           NA          0.35  XXX
93976........  26.........  A.........  Vascular study...        1.21         0.43         0.40          0.43         0.40          0.05  XXX
93976........  TC.........  A.........  Vascular study...        0.00         4.11         4.00            NA           NA          0.30  XXX
93978........  ...........  A.........  Vascular study...        0.65         5.92         5.21            NA           NA          0.43  XXX
93978........  26.........  A.........  Vascular study...        0.65         0.21         0.22          0.21         0.22          0.06  XXX
93978........  TC.........  A.........  Vascular study...        0.00         5.71         4.99            NA           NA          0.37  XXX
93979........  ...........  A.........  Vascular study...        0.44         4.09         3.67            NA           NA          0.27  XXX
93979........  26.........  A.........  Vascular study...        0.44         0.14         0.15          0.14         0.15          0.03  XXX
93979........  TC.........  A.........  Vascular study...        0.00         3.95         3.52            NA           NA          0.24  XXX
93980........  ...........  A.........  Penile vascular          1.25         3.45         3.16            NA           NA          0.42  XXX
                                         study.
93980........  26.........  A.........  Penile vascular          1.25         0.47         0.44          0.47         0.44          0.08  XXX
                                         study.
93980........  TC.........  A.........  Penile vascular          0.00         2.99         2.72            NA           NA          0.34  XXX
                                         study.
93981........  ...........  A.........  Penile vascular          0.44         2.82         2.84            NA           NA          0.33  XXX
                                         study.
93981........  26.........  A.........  Penile vascular          0.44         0.16         0.15          0.16         0.15          0.02  XXX
                                         study.
93981........  TC.........  A.........  Penile vascular          0.00         2.66         2.69            NA           NA          0.31  XXX
                                         study.
93990........  ...........  A.........  Doppler flow             0.25         5.16         4.57            NA           NA          0.26  XXX
                                         testing.
93990........  26.........  A.........  Doppler flow             0.25         0.06         0.07          0.06         0.07          0.03  XXX
                                         testing.
93990........  TC.........  A.........  Doppler flow             0.00         5.09         4.50            NA           NA          0.23  XXX
                                         testing.
94002........  ...........  A.........  Vent mgmt inpat,         1.99           NA           NA          0.36         0.33          0.09  XXX
                                         init day.
94003........  ...........  A.........  Vent mgmt inpat,         1.37           NA           NA          0.32         0.33          0.06  XXX
                                         subq day.
94004........  ...........  A.........  Vent mgmt nf per         1.00           NA           NA          0.23         0.24          0.04  XXX
                                         day.
94005........  ...........  B.........  Home vent mgmt           1.50         0.69         0.69            NA           NA          0.06  XXX
                                         supervision.
94010........  ...........  A.........  Breathing                0.17         0.73         0.70            NA           NA          0.03  XXX
                                         capacity test.
94010........  26.........  A.........  Breathing                0.17         0.04         0.05          0.04         0.05          0.01  XXX
                                         capacity test.
94010........  TC.........  A.........  Breathing                0.00         0.69         0.66            NA           NA          0.02  XXX
                                         capacity test.
94014........  ...........  A.........  Patient recorded         0.52         0.80         0.78          0.80         0.78          0.03  XXX
                                         spirometry.
94015........  ...........  A.........  Patient recorded         0.00         0.66         0.63            NA           NA          0.01  XXX
                                         spirometry.
94016........  ...........  A.........  Review patient           0.52         0.14         0.15          0.14         0.15          0.02  XXX
                                         spirometry.
94060........  ...........  A.........  Evaluation of            0.31         1.30         1.19          1.30         1.19          0.07  XXX
                                         wheezing.
94060........  26.........  A.........  Evaluation of            0.31         0.08         0.09          0.08         0.09          0.01  XXX
                                         wheezing.
94060........  TC.........  A.........  Evaluation of            0.00         1.22         1.10          1.22         1.10          0.06  XXX
                                         wheezing.
94070........  ...........  A.........  Evaluation of            0.60         0.99         0.90            NA           NA          0.13  XXX
                                         wheezing.
94070........  26.........  A.........  Evaluation of            0.60         0.15         0.16          0.15         0.16          0.03  XXX
                                         wheezing.
94070........  TC.........  A.........  Evaluation of            0.00         0.84         0.74            NA           NA          0.10  XXX
                                         wheezing.
94150........  ...........  B.........  Vital capacity           0.07         0.47         0.48            NA           NA          0.02  XXX
                                         test.
94150........  26.........  B.........  Vital capacity           0.07         0.02         0.03          0.02         0.03          0.01  XXX
                                         test.
94150........  TC.........  B.........  Vital capacity           0.00         0.46         0.45            NA           NA          0.01  XXX
                                         test.
94200........  ...........  A.........  Lung function            0.11         0.50         0.47            NA           NA          0.03  XXX
                                         test (MBC/MVV).
94200........  26.........  A.........  Lung function            0.11         0.03         0.03          0.03         0.03          0.01  XXX
                                         test (MBC/MVV).
94200........  TC.........  A.........  Lung function            0.00         0.47         0.44            NA           NA          0.02  XXX
                                         test (MBC/MVV).
94240........  ...........  A.........  Residual lung            0.26         0.81         0.74            NA           NA          0.06  XXX
                                         capacity.
94240........  26.........  A.........  Residual lung            0.26         0.06         0.07          0.06         0.07          0.01  XXX
                                         capacity.
94240........  TC.........  A.........  Residual lung            0.00         0.75         0.66            NA           NA          0.05  XXX
                                         capacity.
94250........  ...........  A.........  Expired gas              0.11         0.51         0.58            NA           NA          0.02  XXX
                                         collection.
94250........  26.........  A.........  Expired gas              0.11         0.03         0.03          0.03         0.03          0.01  XXX
                                         collection.
94250........  TC.........  A.........  Expired gas              0.00         0.48         0.55            NA           NA          0.01  XXX
                                         collection.
94260........  ...........  A.........  Thoracic gas             0.13         0.75         0.67            NA           NA          0.05  XXX
                                         volume.

[[Page 38352]]

 
94260........  26.........  A.........  Thoracic gas             0.13         0.03         0.04          0.03         0.04          0.01  XXX
                                         volume.
94260........  TC.........  A.........  Thoracic gas             0.00         0.72         0.63            NA           NA          0.04  XXX
                                         volume.
94350........  ...........  A.........  Lung nitrogen            0.26         0.61         0.69            NA           NA          0.05  XXX
                                         washout curve.
94350........  26.........  A.........  Lung nitrogen            0.26         0.06         0.07          0.06         0.07          0.01  XXX
                                         washout curve.
94350........  TC.........  A.........  Lung nitrogen            0.00         0.55         0.62            NA           NA          0.04  XXX
                                         washout curve.
94360........  ...........  A.........  Measure airflow          0.26         0.94         0.83            NA           NA          0.07  XXX
                                         resistance.
94360........  26.........  A.........  Measure airflow          0.26         0.06         0.07          0.06         0.07          0.01  XXX
                                         resistance.
94360........  TC.........  A.........  Measure airflow          0.00         0.88         0.75            NA           NA          0.06  XXX
                                         resistance.
94370........  ...........  A.........  Breath airway            0.26         0.60         0.66            NA           NA          0.03  XXX
                                         closing volume.
94370........  26.........  A.........  Breath airway            0.26         0.07         0.08          0.07         0.08          0.01  XXX
                                         closing volume.
94370........  TC.........  A.........  Breath airway            0.00         0.53         0.58            NA           NA          0.02  XXX
                                         closing volume.
94375........  ...........  A.........  Respiratory flow         0.31         0.71         0.66            NA           NA          0.03  XXX
                                         volume loop.
94375........  26.........  A.........  Respiratory flow         0.31         0.08         0.09          0.08         0.09          0.01  XXX
                                         volume loop.
94375........  TC.........  A.........  Respiratory flow         0.00         0.64         0.57            NA           NA          0.02  XXX
                                         volume loop.
94400........  ...........  A.........  CO2 breathing            0.40         1.02         0.93            NA           NA          0.09  XXX
                                         response curve.
94400........  26.........  A.........  CO2 breathing            0.40         0.10         0.11          0.10         0.11          0.03  XXX
                                         response curve.
94400........  TC.........  A.........  CO2 breathing            0.00         0.92         0.82            NA           NA          0.06  XXX
                                         response curve.
94450........  ...........  A.........  Hypoxia response         0.40         1.00         0.93            NA           NA          0.04  XXX
                                         curve.
94450........  26.........  A.........  Hypoxia response         0.40         0.09         0.10          0.09         0.10          0.02  XXX
                                         curve.
94450........  TC.........  A.........  Hypoxia response         0.00         0.91         0.82            NA           NA          0.02  XXX
                                         curve.
94452........  ...........  A.........  Hast w/report....        0.31         1.26         1.12            NA           NA          0.04  XXX
94452........  26.........  A.........  Hast w/report....        0.31         0.07         0.08          0.07         0.08          0.02  XXX
94452........  TC.........  A.........  Hast w/report....        0.00         1.18         1.03            NA           NA          0.02  XXX
94453........  ...........  A.........  Hast w/oxygen            0.40         1.67         1.58            NA           NA          0.04  XXX
                                         titrate.
94453........  26.........  A.........  Hast w/oxygen            0.40         0.10         0.11          0.10         0.11          0.02  XXX
                                         titrate.
94453........  TC.........  A.........  Hast w/oxygen            0.00         1.57         1.46            NA           NA          0.02  XXX
                                         titrate.
94610........  ...........  A.........  Surfactant admin         1.16         0.34         0.35          0.34         0.35          0.26  XXX
                                         thru tube.
94620........  ...........  A.........  Pulmonary stress         0.64         0.79         1.64            NA           NA          0.13  XXX
                                         test/simple.
94620........  26.........  A.........  Pulmonary stress         0.64         0.17         0.18          0.17         0.18          0.03  XXX
                                         test/simple.
94620........  TC.........  A.........  Pulmonary stress         0.00         0.62         1.45            NA           NA          0.10  XXX
                                         test/simple.
94621........  ...........  A.........  Pulm stress test/        1.42         3.11         2.67            NA           NA          0.16  XXX
                                         complex.
94621........  26.........  A.........  Pulm stress test/        1.42         0.44         0.45          0.44         0.45          0.06  XXX
                                         complex.
94621........  TC.........  A.........  Pulm stress test/        0.00         2.67         2.22            NA           NA          0.10  XXX
                                         complex.
94640........  ...........  A.........  Airway inhalation        0.00         0.37         0.34            NA           NA          0.02  XXX
                                         treatment.
94642........  ...........  C.........  Aerosol                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         inhalation
                                         treatment.
94644........  ...........  A.........  Cbt, 1st hour....        0.00         0.95         0.93            NA           NA          0.02  XXX
94645........  ...........  A.........  Cbt, each addl           0.00         0.34         0.34            NA           NA          0.02  XXX
                                         hour.
94660........  ...........  A.........  Pos airway               0.76         0.80         0.73          0.19         0.21          0.04  XXX
                                         pressure, CPAP.
94662........  ...........  A.........  Neg press                0.76           NA           NA          0.20         0.21          0.03  XXX
                                         ventilation, cnp.
94664........  ...........  A.........  Evaluate pt use          0.00         0.40         0.35            NA           NA          0.04  XXX
                                         of inhaler.
94667........  ...........  A.........  Chest wall               0.00         0.53         0.53            NA           NA          0.05  XXX
                                         manipulation.
94668........  ...........  A.........  Chest wall               0.00         0.50         0.47            NA           NA          0.02  XXX
                                         manipulation.
94680........  ...........  A.........  Exhaled air              0.26         1.05         1.46          1.05         1.46          0.07  XXX
                                         analysis, o2.
94680........  26.........  A.........  Exhaled air              0.26         0.07         0.08          0.07         0.08          0.01  XXX
                                         analysis, o2.
94680........  TC.........  A.........  Exhaled air              0.00         0.98         1.39          0.98         1.39          0.06  XXX
                                         analysis, o2.
94681........  ...........  A.........  Exhaled air              0.20         1.06         1.79            NA           NA          0.13  XXX
                                         analysis, o2/co2.
94681........  26.........  A.........  Exhaled air              0.20         0.05         0.06          0.05         0.06          0.01  XXX
                                         analysis, o2/co2.
94681........  TC.........  A.........  Exhaled air              0.00         1.01         1.74            NA           NA          0.12  XXX
                                         analysis, o2/co2.
94690........  ...........  A.........  Exhaled air              0.07         1.03         1.51            NA           NA          0.05  XXX
                                         analysis.
94690........  26.........  A.........  Exhaled air              0.07         0.02         0.02          0.02         0.02          0.01  XXX
                                         analysis.
94690........  TC.........  A.........  Exhaled air              0.00         1.01         1.49            NA           NA          0.04  XXX
                                         analysis.
94720........  ...........  A.........  Monoxide                 0.26         1.14         1.07            NA           NA          0.07  XXX
                                         diffusing
                                         capacity.
94720........  26.........  A.........  Monoxide                 0.26         0.06         0.07          0.06         0.07          0.01  XXX
                                         diffusing
                                         capacity.
94720........  TC.........  A.........  Monoxide                 0.00         1.08         1.00            NA           NA          0.06  XXX
                                         diffusing
                                         capacity.
94725........  ...........  A.........  Membrane                 0.26         0.97         1.94            NA           NA          0.13  XXX
                                         diffusion
                                         capacity.
94725........  26.........  A.........  Membrane                 0.26         0.07         0.08          0.07         0.08          0.01  XXX
                                         diffusion
                                         capacity.
94725........  TC.........  A.........  Membrane                 0.00         0.90         1.87            NA           NA          0.12  XXX
                                         diffusion
                                         capacity.
94750........  ...........  A.........  Pulmonary                0.23         1.75         1.54            NA           NA          0.05  XXX
                                         compliance study.
94750........  26.........  A.........  Pulmonary                0.23         0.06         0.07          0.06         0.07          0.01  XXX
                                         compliance study.
94750........  TC.........  A.........  Pulmonary                0.00         1.69         1.47            NA           NA          0.04  XXX
                                         compliance study.
94760........  ...........  T.........  Measure blood            0.00         0.06         0.05            NA           NA          0.02  XXX
                                         oxygen level.
94761........  ...........  T.........  Measure blood            0.00         0.11         0.09            NA           NA          0.06  XXX
                                         oxygen level.
94762........  ...........  A.........  Measure blood            0.00         0.84         0.65            NA           NA          0.10  XXX
                                         oxygen level.
94770........  ...........  A.........  Exhaled carbon           0.15         0.80         0.77            NA           NA          0.08  XXX
                                         dioxide test.
94770........  26.........  A.........  Exhaled carbon           0.15         0.04         0.04          0.04         0.04          0.01  XXX
                                         dioxide test.
94770........  TC.........  A.........  Exhaled carbon           0.00         0.76         0.73            NA           NA          0.07  XXX
                                         dioxide test.
94772........  ...........  C.........  Breath recording,        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         infant.
94772........  26.........  C.........  Breath recording,        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         infant.
94772........  TC.........  C.........  Breath recording,        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         infant.
94774........  ...........  C.........  Ped home apnea           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         rec, compl.
94775........  ...........  C.........  Ped home apnea           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         rec, hk-up.
94776........  ...........  C.........  Ped home apnea           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         rec, downld.

[[Page 38353]]

 
94777........  ...........  C.........  Ped home apnea           0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         rec, report.
94799........  ...........  C.........  Pulmonary service/       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
94799........  26.........  C.........  Pulmonary service/       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
94799........  TC.........  C.........  Pulmonary service/       0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
95004........  ...........  A.........  Percut allergy           0.00         0.15         0.13            NA           NA          0.01  XXX
                                         skin tests.
95010........  ...........  A.........  Percut allergy           0.15         0.31         0.31          0.05         0.06          0.01  XXX
                                         titrate test.
95012........  ...........  A.........  Exhaled nitric           0.00         0.48         0.48            NA           NA          0.01  XXX
                                         oxide meas.
95015........  ...........  A.........  Id allergy               0.15         0.21         0.18          0.05         0.06          0.01  XXX
                                         titrate-drug/bug.
95024........  ...........  A.........  Id allergy test,         0.00         0.17         0.17            NA           NA          0.01  XXX
                                         drug/bug.
95027........  ...........  A.........  Id allergy               0.00         0.10         0.15            NA           NA          0.01  XXX
                                         titrate-airborne.
95028........  ...........  A.........  Id allergy test-         0.00         0.31         0.27            NA           NA          0.01  XXX
                                         delayed type.
95044........  ...........  A.........  Allergy patch            0.00         0.15         0.18            NA           NA          0.01  XXX
                                         tests.
95052........  ...........  A.........  Photo patch test.        0.00         0.15         0.20            NA           NA          0.01  XXX
95056........  ...........  A.........  Photosensitivity         0.00         1.24         0.70            NA           NA          0.01  XXX
                                         tests.
95060........  ...........  A.........  Eye allergy tests        0.00         0.72         0.53          0.72         0.53          0.02  XXX
95065........  ...........  A.........  Nose allergy test        0.00         0.68         0.43          0.68         0.43          0.01  XXX
95070........  ...........  A.........  Bronchial allergy        0.00         0.80         1.54            NA           NA          0.02  XXX
                                         tests.
95071........  ...........  A.........  Bronchial allergy        0.00         0.96         1.93            NA           NA          0.02  XXX
                                         tests.
95075........  ...........  A.........  Ingestion                0.95         0.66         0.74          0.26         0.32          0.03  XXX
                                         challenge test.
95115........  ...........  A.........  Immunotherapy,           0.00         0.22         0.31          0.00         0.19          0.02  XXX
                                         one injection.
95117........  ...........  A.........  Immunotherapy            0.00         0.28         0.39          0.00         0.25          0.02  XXX
                                         injections.
95144........  ...........  A.........  Antigen therapy          0.06         0.26         0.23          0.02         0.02          0.01  XXX
                                         services.
95145........  ...........  A.........  Antigen therapy          0.06         0.35         0.34          0.02         0.02          0.01  XXX
                                         services.
95146........  ...........  A.........  Antigen therapy          0.06         0.66         0.55          0.02         0.03          0.01  XXX
                                         services.
95147........  ...........  A.........  Antigen therapy          0.06         0.64         0.53          0.02         0.02          0.01  XXX
                                         services.
95148........  ...........  A.........  Antigen therapy          0.06         0.95         0.76          0.02         0.03          0.01  XXX
                                         services.
95149........  ...........  A.........  Antigen therapy          0.06         1.26         1.03          0.02         0.03          0.01  XXX
                                         services.
95165........  ...........  A.........  Antigen therapy          0.06         0.26         0.23          0.02         0.02          0.01  XXX
                                         services.
95170........  ...........  A.........  Antigen therapy          0.06         0.20         0.17          0.02         0.03          0.01  XXX
                                         services.
95180........  ...........  A.........  Rapid                    2.01         1.61         1.82          0.74         0.83          0.04  XXX
                                         desensitization.
95199........  ...........  C.........  Allergy                  0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         immunology
                                         services.
95250........  ...........  A.........  Glucose                  0.00         3.46         3.79            NA           NA          0.01  XXX
                                         monitoring, cont.
95251........  ...........  A.........  Gluc monitor,            0.85         0.26         0.23          0.26         0.23          0.02  XXX
                                         cont, phys i&r.
95805........  ...........  A.........  Multiple sleep           1.88         6.93        12.11            NA           NA          0.43  XXX
                                         latency test.
95805........  26.........  A.........  Multiple sleep           1.88         0.51         0.58          0.51         0.58          0.09  XXX
                                         latency test.
95805........  TC.........  A.........  Multiple sleep           0.00         6.42        11.53            NA           NA          0.34  XXX
                                         latency test.
95806........  ...........  A.........  Sleep study,             1.66         3.87         3.60            NA           NA          0.39  XXX
                                         unattended.
95806........  26.........  A.........  Sleep study,             1.66         0.47         0.51          0.47         0.51          0.08  XXX
                                         unattended.
95806........  TC.........  A.........  Sleep study,             0.00         3.40         3.09            NA           NA          0.31  XXX
                                         unattended.
95807........  ...........  A.........  Sleep study,             1.66        12.21        11.95            NA           NA          0.50  XXX
                                         attended.
95807........  26.........  A.........  Sleep study,             1.66         0.41         0.48          0.41         0.48          0.08  XXX
                                         attended.
95807........  TC.........  A.........  Sleep study,             0.00        11.80        11.47            NA           NA          0.42  XXX
                                         attended.
95808........  ...........  A.........  Polysomnography,         2.65        15.60        14.39            NA           NA          0.55  XXX
                                         1-3.
95808........  26.........  A.........  Polysomnography,         2.65         0.71         0.82          0.71         0.82          0.13  XXX
                                         1-3.
95808........  TC.........  A.........  Polysomnography,         0.00        14.89        13.58            NA           NA          0.42  XXX
                                         1-3.
95810........  ...........  A.........  Polysomnography,         3.52        17.52        17.53            NA           NA          0.59  XXX
                                         4 or more.
95810........  26.........  A.........  Polysomnography,         3.52         0.90         1.05          0.90         1.05          0.17  XXX
                                         4 or more.
95810........  TC.........  A.........  Polysomnography,         0.00        16.62        16.49            NA           NA          0.42  XXX
                                         4 or more.
95811........  ...........  A.........  Polysomnography w/       3.79        19.51        19.38            NA           NA          0.61  XXX
                                         cpap.
95811........  26.........  A.........  Polysomnography w/       3.79         0.96         1.12          0.96         1.12          0.18  XXX
                                         cpap.
95811........  TC.........  A.........  Polysomnography w/       0.00        18.54        18.26            NA           NA          0.43  XXX
                                         cpap.
95812........  ...........  A.........  Eeg, 41-60               1.08         5.84         4.94            NA           NA          0.17  XXX
                                         minutes.
95812........  26.........  A.........  Eeg, 41-60               1.08         0.30         0.38          0.30         0.38          0.06  XXX
                                         minutes.
95812........  TC.........  A.........  Eeg, 41-60               0.00         5.54         4.56            NA           NA          0.11  XXX
                                         minutes.
95813........  ...........  A.........  Eeg, over 1 hour.        1.73         6.46         5.75            NA           NA          0.20  XXX
95813........  26.........  A.........  Eeg, over 1 hour.        1.73         0.49         0.60          0.49         0.60          0.09  XXX
95813........  TC.........  A.........  Eeg, over 1 hour.        0.00         5.97         5.16            NA           NA          0.11  XXX
95816........  ...........  A.........  Eeg, awake and           1.08         5.23         4.48            NA           NA          0.16  XXX
                                         drowsy.
95816........  26.........  A.........  Eeg, awake and           1.08         0.30         0.38          0.30         0.38          0.06  XXX
                                         drowsy.
95816........  TC.........  A.........  Eeg, awake and           0.00         4.92         4.09            NA           NA          0.10  XXX
                                         drowsy.
95819........  ...........  A.........  Eeg, awake and           1.08         6.07         4.53            NA           NA          0.16  XXX
                                         asleep.
95819........  26.........  A.........  Eeg, awake and           1.08         0.30         0.38          0.30         0.38          0.06  XXX
                                         asleep.
95819........  TC.........  A.........  Eeg, awake and           0.00         5.77         4.15            NA           NA          0.10  XXX
                                         asleep.
95822........  ...........  A.........  Eeg, coma or             1.08         5.47         5.04            NA           NA          0.19  XXX
                                         sleep only.
95822........  26.........  A.........  Eeg, coma or             1.08         0.30         0.38          0.30         0.38          0.06  XXX
                                         sleep only.
95822........  TC.........  A.........  Eeg, coma or             0.00         5.16         4.65            NA           NA          0.13  XXX
                                         sleep only.
95824........  ...........  C.........  Eeg, cerebral            0.74         0.00         0.23          0.00         0.23          0.04  XXX
                                         death only.
95824........  26.........  A.........  Eeg, cerebral            0.74         0.21         0.26          0.21         0.26          0.04  XXX
                                         death only.
95824........  TC.........  C.........  Eeg, cerebral            0.00         0.00         0.03          0.00         0.03          0.00  XXX
                                         death only.
95827........  ...........  A.........  Eeg, all night           1.08        11.40         7.06            NA           NA          0.19  XXX
                                         recording.
95827........  26.........  A.........  Eeg, all night           1.08         0.30         0.35          0.30         0.35          0.05  XXX
                                         recording.
95827........  TC.........  A.........  Eeg, all night           0.00        11.10         6.71            NA           NA          0.14  XXX
                                         recording.

[[Page 38354]]

 
95829........  ...........  A.........  Surgery                  6.20        20.92        26.68            NA           NA          0.50  XXX
                                         electrocorticogr
                                         am.
95829........  26.........  A.........  Surgery                  6.20         1.59         1.99          1.59         1.99          0.48  XXX
                                         electrocorticogr
                                         am.
95829........  TC.........  A.........  Surgery                  0.00        19.32        24.69            NA           NA          0.02  XXX
                                         electrocorticogr
                                         am.
95830........  ...........  A.........  Insert electrodes        1.70         2.94         3.12          0.42         0.58          0.11  XXX
                                         for EEG.
95831........  ...........  A.........  Limb muscle              0.28         0.40         0.43          0.09         0.11          0.01  XXX
                                         testing, manual.
95832........  ...........  A.........  Hand muscle              0.29         0.37         0.35          0.10         0.11          0.02  XXX
                                         testing, manual.
95833........  ...........  A.........  Body muscle              0.47         0.49         0.53          0.14         0.19          0.02  XXX
                                         testing, manual.
95834........  ...........  A.........  Body muscle              0.60         0.54         0.59          0.17         0.23          0.03  XXX
                                         testing, manual.
95851........  ...........  A.........  Range of motion          0.16         0.26         0.31          0.04         0.06          0.01  XXX
                                         measurements.
95852........  ...........  A.........  Range of motion          0.11         0.23         0.24          0.04         0.05          0.01  XXX
                                         measurements.
95857........  ...........  A.........  Tensilon test....        0.53         0.58         0.59          0.16         0.20          0.02  XXX
95860........  ...........  A.........  Muscle test, one         0.96         1.15         1.29            NA           NA          0.07  XXX
                                         limb.
95860........  26.........  A.........  Muscle test, one         0.96         0.32         0.37          0.32         0.37          0.05  XXX
                                         limb.
95860........  TC.........  A.........  Muscle test, one         0.00         0.83         0.92            NA           NA          0.02  XXX
                                         limb.
95861........  ...........  A.........  Muscle test, 2           1.54         1.65         1.54            NA           NA          0.13  XXX
                                         limbs.
95861........  26.........  A.........  Muscle test, 2           1.54         0.51         0.60          0.51         0.60          0.07  XXX
                                         limbs.
95861........  TC.........  A.........  Muscle test, 2           0.00         1.14         0.94            NA           NA          0.06  XXX
                                         limbs.
95863........  ...........  A.........  Muscle test, 3           1.87         1.91         1.83            NA           NA          0.15  XXX
                                         limbs.
95863........  26.........  A.........  Muscle test, 3           1.87         0.57         0.69          0.57         0.69          0.09  XXX
                                         limbs.
95863........  TC.........  A.........  Muscle test, 3           0.00         1.34         1.14            NA           NA          0.06  XXX
                                         limbs.
95864........  ...........  A.........  Muscle test, 4           1.99         2.14         2.40            NA           NA          0.21  XXX
                                         limbs.
95864........  26.........  A.........  Muscle test, 4           1.99         0.62         0.75          0.62         0.75          0.09  XXX
                                         limbs.
95864........  TC.........  A.........  Muscle test, 4           0.00         1.52         1.65            NA           NA          0.12  XXX
                                         limbs.
95865........  ...........  A.........  Muscle test,             1.57         1.40         1.42            NA           NA          0.11  XXX
                                         larynx.
95865........  26.........  A.........  Muscle test,             1.57         0.50         0.63          0.50         0.63          0.08  XXX
                                         larynx.
95865........  TC.........  A.........  Muscle test,             0.00         0.90         0.79            NA           NA          0.03  XXX
                                         larynx.
95866........  ...........  A.........  Muscle test,             1.25         1.31         1.04            NA           NA          0.10  XXX
                                         hemidiaphragm.
95866........  26.........  A.........  Muscle test,             1.25         0.39         0.48          0.39         0.48          0.07  XXX
                                         hemidiaphragm.
95866........  TC.........  A.........  Muscle test,             0.00         0.92         0.56            NA           NA          0.03  XXX
                                         hemidiaphragm.
95867........  ...........  A.........  Muscle test cran         0.79         1.15         1.04            NA           NA          0.07  XXX
                                         nerv unilat.
95867........  26.........  A.........  Muscle test cran         0.79         0.24         0.29          0.24         0.29          0.03  XXX
                                         nerv unilat.
95867........  TC.........  A.........  Muscle test cran         0.00         0.90         0.74            NA           NA          0.04  XXX
                                         nerv unilat.
95868........  ...........  A.........  Muscle test cran         1.18         1.47         1.33            NA           NA          0.10  XXX
                                         nerve bilat.
95868........  26.........  A.........  Muscle test cran         1.18         0.37         0.44          0.37         0.44          0.05  XXX
                                         nerve bilat.
95868........  TC.........  A.........  Muscle test cran         0.00         1.10         0.89            NA           NA          0.05  XXX
                                         nerve bilat.
95869........  ...........  A.........  Muscle test, thor        0.37         1.02         0.69            NA           NA          0.04  XXX
                                         paraspinal.
95869........  26.........  A.........  Muscle test, thor        0.37         0.12         0.14          0.12         0.14          0.02  XXX
                                         paraspinal.
95869........  TC.........  A.........  Muscle test, thor        0.00         0.90         0.55            NA           NA          0.02  XXX
                                         paraspinal.
95870........  ...........  A.........  Muscle test,             0.37         0.98         0.68            NA           NA          0.04  XXX
                                         nonparaspinal.
95870........  26.........  A.........  Muscle test,             0.37         0.12         0.14          0.12         0.14          0.02  XXX
                                         nonparaspinal.
95870........  TC.........  A.........  Muscle test,             0.00         0.86         0.54            NA           NA          0.02  XXX
                                         nonparaspinal.
95872........  ...........  A.........  Muscle test, one         2.88         1.63         1.44            NA           NA          0.13  XXX
                                         fiber.
95872........  26.........  A.........  Muscle test, one         2.88         0.88         0.77          0.88         0.77          0.08  XXX
                                         fiber.
95872........  TC.........  A.........  Muscle test, one         0.00         0.75         0.68            NA           NA          0.05  XXX
                                         fiber.
95873........  ...........  A.........  Guide nerv destr,        0.37         1.01         0.68          1.01         0.68          0.04  ZZZ
                                         elec stim.
95873........  26.........  A.........  Guide nerv destr,        0.37         0.14         0.15          0.14         0.15          0.02  ZZZ
                                         elec stim.
95873........  TC.........  A.........  Guide nerv destr,        0.00         0.87         0.53          0.87         0.53          0.02  ZZZ
                                         elec stim.
95874........  ...........  A.........  Guide nerv destr,        0.37         0.95         0.66          0.95         0.66          0.04  ZZZ
                                         needle emg.
95874........  26.........  A.........  Guide nerv destr,        0.37         0.12         0.15          0.12         0.15          0.02  ZZZ
                                         needle emg.
95874........  TC.........  A.........  Guide nerv destr,        0.00         0.83         0.52          0.83         0.52          0.02  ZZZ
                                         needle emg.
95875........  ...........  A.........  Limb exercise            1.10         1.46         1.43            NA           NA          0.11  XXX
                                         test.
95875........  26.........  A.........  Limb exercise            1.10         0.39         0.42          0.39         0.42          0.05  XXX
                                         test.
95875........  TC.........  A.........  Limb exercise            0.00         1.07         1.01            NA           NA          0.06  XXX
                                         test.
95900........  ...........  A.........  Motor nerve              0.42         0.91         1.09            NA           NA          0.04  XXX
                                         conduction test.
95900........  26.........  A.........  Motor nerve              0.42         0.14         0.16          0.14         0.16          0.02  XXX
                                         conduction test.
95900........  TC.........  A.........  Motor nerve              0.00         0.77         0.93            NA           NA          0.02  XXX
                                         conduction test.
95903........  ...........  A.........  Motor nerve              0.60         0.99         1.10            NA           NA          0.05  XXX
                                         conduction test.
95903........  26.........  A.........  Motor nerve              0.60         0.17         0.22          0.17         0.22          0.03  XXX
                                         conduction test.
95903........  TC.........  A.........  Motor nerve              0.00         0.82         0.88            NA           NA          0.02  XXX
                                         conduction test.
95904........  ...........  A.........  Sense nerve              0.34         0.84         0.97            NA           NA          0.04  XXX
                                         conduction test.
95904........  26.........  A.........  Sense nerve              0.34         0.10         0.13          0.10         0.13          0.02  XXX
                                         conduction test.
95904........  TC.........  A.........  Sense nerve              0.00         0.74         0.84            NA           NA          0.02  XXX
                                         conduction test.
95920........  ...........  A.........  Intraop nerve            2.11         1.72         1.99          1.72         1.99          0.23  ZZZ
                                         test add-on.
95920........  26.........  A.........  Intraop nerve            2.11         0.63         0.79          0.63         0.79          0.16  ZZZ
                                         test add-on.
95920........  TC.........  A.........  Intraop nerve            0.00         1.09         1.20          1.09         1.20          0.07  ZZZ
                                         test add-on.
95921........  ...........  A.........  Autonomic nerv           0.90         1.14         0.93            NA           NA          0.06  XXX
                                         function test.
95921........  26.........  A.........  Autonomic nerv           0.90         0.24         0.29          0.24         0.29          0.04  XXX
                                         function test.
95921........  TC.........  A.........  Autonomic nerv           0.00         0.90         0.64            NA           NA          0.02  XXX
                                         function test.
95922........  ...........  A.........  Autonomic nerv           0.96         1.59         1.20            NA           NA          0.07  XXX
                                         function test.
95922........  26.........  A.........  Autonomic nerv           0.96         0.26         0.33          0.26         0.33          0.05  XXX
                                         function test.
95922........  TC.........  A.........  Autonomic nerv           0.00         1.33         0.86            NA           NA          0.02  XXX
                                         function test.
95923........  ...........  A.........  Autonomic nerv           0.90         2.31         2.10            NA           NA          0.07  XXX
                                         function test.

[[Page 38355]]

 
95923........  26.........  A.........  Autonomic nerv           0.90         0.26         0.32          0.26         0.32          0.05  XXX
                                         function test.
95923........  TC.........  A.........  Autonomic nerv           0.00         2.06         1.78            NA           NA          0.02  XXX
                                         function test.
95925........  ...........  A.........  Somatosensory            0.54         3.04         2.10            NA           NA          0.10  XXX
                                         testing.
95925........  26.........  A.........  Somatosensory            0.54         0.15         0.19          0.15         0.19          0.04  XXX
                                         testing.
95925........  TC.........  A.........  Somatosensory            0.00         2.88         1.91            NA           NA          0.06  XXX
                                         testing.
95926........  ...........  A.........  Somatosensory            0.54         2.96         2.05            NA           NA          0.09  XXX
                                         testing.
95926........  26.........  A.........  Somatosensory            0.54         0.15         0.19          0.15         0.19          0.03  XXX
                                         testing.
95926........  TC.........  A.........  Somatosensory            0.00         2.81         1.86            NA           NA          0.06  XXX
                                         testing.
95927........  ...........  A.........  Somatosensory            0.54         3.10         2.12            NA           NA          0.10  XXX
                                         testing.
95927........  26.........  A.........  Somatosensory            0.54         0.17         0.21          0.17         0.21          0.04  XXX
                                         testing.
95927........  TC.........  A.........  Somatosensory            0.00         2.93         1.91            NA           NA          0.06  XXX
                                         testing.
95928........  ...........  A.........  C motor evoked,          1.50         3.90         3.47            NA           NA          0.09  XXX
                                         uppr limbs.
95928........  26.........  A.........  C motor evoked,          1.50         0.44         0.55          0.44         0.55          0.06  XXX
                                         uppr limbs.
95928........  TC.........  A.........  C motor evoked,          0.00         3.46         2.92            NA           NA          0.03  XXX
                                         uppr limbs.
95929........  ...........  A.........  C motor evoked,          1.50         4.22         3.73            NA           NA          0.09  XXX
                                         lwr limbs.
95929........  26.........  A.........  C motor evoked,          1.50         0.45         0.56          0.45         0.56          0.06  XXX
                                         lwr limbs.
95929........  TC.........  A.........  C motor evoked,          0.00         3.78         3.17            NA           NA          0.03  XXX
                                         lwr limbs.
95930........  ...........  A.........  Visual evoked            0.35         2.62         2.43            NA           NA          0.03  XXX
                                         potential test.
95930........  26.........  A.........  Visual evoked            0.35         0.10         0.13          0.10         0.13          0.02  XXX
                                         potential test.
95930........  TC.........  A.........  Visual evoked            0.00         2.52         2.31            NA           NA          0.01  XXX
                                         potential test.
95933........  ...........  A.........  Blink reflex test        0.59         1.10         1.06            NA           NA          0.10  XXX
95933........  26.........  A.........  Blink reflex test        0.59         0.17         0.20          0.17         0.20          0.04  XXX
95933........  TC.........  A.........  Blink reflex test        0.00         0.93         0.86            NA           NA          0.06  XXX
95934........  ...........  A.........  H-reflex test....        0.51         0.85         0.65            NA           NA          0.04  XXX
95934........  26.........  A.........  H-reflex test....        0.51         0.16         0.19          0.16         0.19          0.02  XXX
95934........  TC.........  A.........  H-reflex test....        0.00         0.70         0.46            NA           NA          0.02  XXX
95936........  ...........  A.........  H-reflex test....        0.55         0.59         0.52            NA           NA          0.05  XXX
95936........  26.........  A.........  H-reflex test....        0.55         0.16         0.20          0.16         0.20          0.03  XXX
95936........  TC.........  A.........  H-reflex test....        0.00         0.42         0.32            NA           NA          0.02  XXX
95937........  ...........  A.........  Neuromuscular            0.65         0.91         0.76            NA           NA          0.10  XXX
                                         junction test.
95937........  26.........  A.........  Neuromuscular            0.65         0.20         0.23          0.20         0.23          0.08  XXX
                                         junction test.
95937........  TC.........  A.........  Neuromuscular            0.00         0.71         0.52            NA           NA          0.02  XXX
                                         junction test.
95950........  ...........  A.........  Ambulatory eeg           1.51         4.88         4.41            NA           NA          0.51  XXX
                                         monitoring.
95950........  26.........  A.........  Ambulatory eeg           1.51         0.43         0.54          0.43         0.54          0.08  XXX
                                         monitoring.
95950........  TC.........  A.........  Ambulatory eeg           0.00         4.45         3.88            NA           NA          0.43  XXX
                                         monitoring.
95951........  ...........  C.........  EEG monitoring/          5.99         0.00        20.01          0.00        20.01          0.32  XXX
                                         videorecord.
95951........  26.........  A.........  EEG monitoring/          5.99         1.69         2.12          1.69         2.12          0.32  XXX
                                         videorecord.
95951........  TC.........  C.........  EEG monitoring/          0.00         0.00        18.45          0.00        18.45          0.00  XXX
                                         videorecord.
95953........  ...........  A.........  EEG monitoring/          3.30         7.16         7.40            NA           NA          0.60  XXX
                                         computer.
95953........  26.........  A.........  EEG monitoring/          3.30         0.93         1.12          0.93         1.12          0.17  XXX
                                         computer.
95953........  TC.........  A.........  EEG monitoring/          0.00         6.23         6.28            NA           NA          0.43  XXX
                                         computer.
95954........  ...........  A.........  EEG monitoring/          2.45         4.34         4.37            NA           NA          0.19  XXX
                                         giving drugs.
95954........  26.........  A.........  EEG monitoring/          2.45         0.43         0.75          0.43         0.75          0.13  XXX
                                         giving drugs.
95954........  TC.........  A.........  EEG monitoring/          0.00         3.91         3.62            NA           NA          0.06  XXX
                                         giving drugs.
95955........  ...........  A.........  EEG during               1.01         2.73         2.53          2.73         2.53          0.22  XXX
                                         surgery.
95955........  26.........  A.........  EEG during               1.01         0.28         0.32          0.28         0.32          0.05  XXX
                                         surgery.
95955........  TC.........  A.........  EEG during               0.00         2.45         2.21          2.45         2.21          0.17  XXX
                                         surgery.
95956........  ...........  A.........  Eeg monitoring,          3.08        16.14        15.69            NA           NA          0.59  XXX
                                         cable/radio.
95956........  26.........  A.........  Eeg monitoring,          3.08         0.87         1.09          0.87         1.09          0.16  XXX
                                         cable/radio.
95956........  TC.........  A.........  Eeg monitoring,          0.00        15.27        14.60            NA           NA          0.43  XXX
                                         cable/radio.
95957........  ...........  A.........  EEG digital              1.98         5.80         4.18            NA           NA          0.23  XXX
                                         analysis.
95957........  26.........  A.........  EEG digital              1.98         0.56         0.71          0.56         0.71          0.11  XXX
                                         analysis.
95957........  TC.........  A.........  EEG digital              0.00         5.24         3.47            NA           NA          0.12  XXX
                                         analysis.
95958........  ...........  A.........  EEG monitoring/          4.24         6.66         5.05            NA           NA          0.34  XXX
                                         function test.
95958........  26.........  A.........  EEG monitoring/          4.24         1.24         1.49          1.24         1.49          0.21  XXX
                                         function test.
95958........  TC.........  A.........  EEG monitoring/          0.00         5.42         3.57            NA           NA          0.13  XXX
                                         function test.
95961........  ...........  A.........  Electrode                2.97         3.04         2.85            NA           NA          0.55  XXX
                                         stimulation,
                                         brain.
95961........  26.........  A.........  Electrode                2.97         0.88         1.11          0.88         1.11          0.48  XXX
                                         stimulation,
                                         brain.
95961........  TC.........  A.........  Electrode                0.00         2.16         1.74            NA           NA          0.07  XXX
                                         stimulation,
                                         brain.
95962........  ...........  A.........  Electrode stim,          3.21         2.20         2.46          2.20         2.46          0.39  ZZZ
                                         brain add-on.
95962........  26.........  A.........  Electrode stim,          3.21         0.91         1.16          0.91         1.16          0.32  ZZZ
                                         brain add-on.
95962........  TC.........  A.........  Electrode stim,          0.00         1.28         1.30          1.28         1.30          0.07  ZZZ
                                         brain add-on.
95965........  ...........  C.........  Meg, spontaneous.        7.99         0.00         2.09          0.00         2.09          0.46  XXX
95965........  26.........  A.........  Meg, spontaneous.        7.99         2.31         2.86          2.31         2.86          0.46  XXX
95965........  TC.........  C.........  Meg, spontaneous.        0.00         0.00         0.00          0.00         0.00          0.00  XXX
95966........  ...........  C.........  Meg, evoked,             3.99         0.00         1.05          0.00         1.05          0.19  XXX
                                         single.
95966........  26.........  A.........  Meg, evoked,             3.99         1.17         1.44          1.17         1.44          0.19  XXX
                                         single.
95966........  TC.........  C.........  Meg, evoked,             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         single.
95967........  ...........  C.........  Meg, evoked, each        3.49         0.00         0.75          0.00         0.75          0.16  ZZZ
                                         add[boxHu]l.
95967........  26.........  A.........  Meg, evoked, each        3.49         1.01         1.09          1.01         1.09          0.16  ZZZ
                                         add[boxHu]l.
95967........  TC.........  C.........  Meg, evoked, each        0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         add[boxHu]l.
95970........  ...........  A.........  Analyze                  0.45         0.89         0.87          0.13         0.14          0.03  XXX
                                         neurostim, no
                                         prog.

[[Page 38356]]

 
95971........  ...........  A.........  Analyze                  0.78         0.58         0.63          0.19         0.21          0.07  XXX
                                         neurostim,
                                         simple.
95972........  ...........  A.........  Analyze                  1.50         1.15         1.19          0.45         0.47          0.14  XXX
                                         neurostim,
                                         complex.
95973........  ...........  A.........  Analyze                  0.92         0.49         0.57          0.22         0.29          0.07  ZZZ
                                         neurostim,
                                         complex.
95974........  ...........  A.........  Cranial                  3.00         1.44         1.58          0.79         1.06          0.16  XXX
                                         neurostim,
                                         complex.
95975........  ...........  A.........  Cranial                  1.70         0.73         0.82          0.47         0.60          0.12  ZZZ
                                         neurostim,
                                         complex.
95978........  ...........  A.........  Analyze neurostim        3.50         1.86         1.89          1.04         1.17          0.18  XXX
                                         brain/1h.
95979........  ...........  A.........  Analyz neurostim         1.64         0.73         0.80          0.47         0.58          0.08  ZZZ
                                         brain add-on.
95990........  ...........  A.........  Spin/brain pump          0.00         1.61         1.56            NA           NA          0.06  XXX
                                         refil & main.
95991........  ...........  A.........  Spin/brain pump          0.77         1.60         1.55          0.18         0.17          0.06  XXX
                                         refil & main.
95999........  ...........  C.........  Neurological             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
96000........  ...........  A.........  Motion analysis,         1.80           NA           NA          0.44         0.51          0.11  XXX
                                         video/3d.
96001........  ...........  A.........  Motion test w/ft         2.15           NA           NA          0.55         0.60          0.10  XXX
                                         press meas.
96002........  ...........  A.........  Dynamic surface          0.41           NA           NA          0.10         0.13          0.02  XXX
                                         emg.
96003........  ...........  A.........  Dynamic fine wire        0.37           NA           NA          0.09         0.12          0.02  XXX
                                         emg.
96004........  ...........  A.........  Phys review of           2.14         0.65         0.78          0.65         0.78          0.11  XXX
                                         motion tests.
96020........  ...........  C.........  Functional brain         0.00           NA           NA            NA           NA          0.17  XXX
                                         mapping.
96020........  26.........  A.........  Functional brain         3.43         1.05         0.92          1.05         0.92          0.17  XXX
                                         mapping.
96020........  TC.........  C.........  Functional brain         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         mapping.
96040........  ...........  B.........  Genetic                  0.00         0.97         0.97            NA           NA          0.01  XXX
                                         counseling, 30
                                         min.
96101........  ...........  A.........  Psycho testing by        1.86         0.35         0.50          0.33         0.48          0.05  XXX
                                         psych/phys.
96102........  ...........  A.........  Psycho testing by        0.50         1.09         0.90          0.10         0.13          0.01  XXX
                                         technician.
96103........  ...........  A.........  Psycho testing           0.51         0.91         0.63          0.10         0.13          0.02  XXX
                                         admin by comp.
96105........  ...........  A.........  Assessment of            0.00         1.64         1.77            NA           NA          0.18  XXX
                                         aphasia.
96110........  ...........  A.........  Developmental            0.00         0.18         0.18            NA           NA          0.18  XXX
                                         test, lim.
96111........  ...........  A.........  Developmental            2.60         0.69         0.87          0.58         0.81          0.18  XXX
                                         test, extend.
96116........  ...........  A.........  Neurobehavioral          1.86         0.53         0.68          0.41         0.53          0.18  XXX
                                         status exam.
96118........  ...........  A.........  Neuropsych tst by        1.86         0.83         1.11          0.33         0.48          0.18  XXX
                                         psych/phys.
96119........  ...........  A.........  Neuropsych               0.55         1.51         1.27          0.10         0.15          0.18  XXX
                                         testing by tec.
96120........  ...........  A.........  Neuropsych tst           0.51         1.67         1.25          0.10         0.13          0.02  XXX
                                         admin w/comp.
96150........  ...........  A.........  Assess hlth/             0.50         0.10         0.14          0.09         0.14          0.01  XXX
                                         behave, init.
96151........  ...........  A.........  Assess hlth/             0.48         0.10         0.14          0.09         0.13          0.01  XXX
                                         behave, subseq.
96152........  ...........  A.........  Intervene hlth/          0.46         0.09         0.13          0.08         0.12          0.01  XXX
                                         behave, indiv.
96153........  ...........  A.........  Intervene hlth/          0.10         0.02         0.03          0.02         0.03          0.01  XXX
                                         behave, group.
96154........  ...........  A.........  Interv hlth/             0.45         0.09         0.13          0.08         0.12          0.01  XXX
                                         behav, fam w/pt.
96155........  ...........  N.........  Interv hlth/behav        0.44         0.10         0.14          0.10         0.13          0.02  XXX
                                         fam no pt.
96401........  ...........  A.........  Chemo, anti-             0.21         1.84         1.51            NA           NA          0.01  XXX
                                         neopl, sq/im.
96402........  ...........  A.........  Chemo hormon             0.19         0.77         0.88            NA           NA          0.01  XXX
                                         antineopl sq/im.
96405........  ...........  A.........  Chemo                    0.52         3.67         3.03          0.24         0.24          0.03  000
                                         intralesional,
                                         up to 7.
96406........  ...........  A.........  Chemo                    0.80         3.58         3.25          0.33         0.30          0.03  000
                                         intralesional
                                         over 7.
96409........  ...........  A.........  Chemo, iv push,          0.24         2.77         2.84            NA           NA          0.06  XXX
                                         sngl drug.
96411........  ...........  A.........  Chemo, iv push,          0.20         1.49         1.55            NA           NA          0.06  ZZZ
                                         addl drug.
96413........  ...........  A.........  Chemo, iv                0.28         3.61         3.90            NA           NA          0.08  XXX
                                         infusion, 1 hr.
96415........  ...........  A.........  Chemo, iv                0.19         0.65         0.71            NA           NA          0.07  ZZZ
                                         infusion, addl
                                         hr.
96416........  ...........  A.........  Chemo prolong            0.21         4.05         4.33            NA           NA          0.08  XXX
                                         infuse w/pump.
96417........  ...........  A.........  Chemo iv infus           0.21         1.71         1.83            NA           NA          0.07  ZZZ
                                         each addl seq.
96420........  ...........  A.........  Chemo, ia, push          0.17         2.77         2.70            NA           NA          0.08  XXX
                                         tecnique.
96422........  ...........  A.........  Chemo ia infusion        0.17         4.46         4.53            NA           NA          0.08  XXX
                                         up to 1 hr.
96423........  ...........  A.........  Chemo ia infuse          0.17         1.98         1.92            NA           NA          0.02  ZZZ
                                         each addl hr.
96425........  ...........  A.........  Chemotherapy,            0.17         4.64         4.53            NA           NA          0.08  XXX
                                         infusion method.
96440........  ...........  A.........  Chemotherapy,            2.37         5.46         6.81          0.97         1.10          0.17  000
                                         intracavitary.
96445........  ...........  A.........  Chemotherapy,            2.20         5.39         6.72          0.97         1.07          0.14  000
                                         intracavitary.
96450........  ...........  A.........  Chemotherapy,            1.53         4.95         5.95          0.84         1.07          0.09  000
                                         into CNS.
96521........  ...........  A.........  Refill/maint,            0.21         3.13         3.44            NA           NA          0.06  XXX
                                         portable pump.
96522........  ...........  A.........  Refill/maint pump/       0.21         2.76         2.69            NA           NA          0.06  XXX
                                         resvr syst.
96523........  ...........  T.........  Irrig drug               0.04         0.64         0.67            NA           NA          0.01  XXX
                                         delivery device.
96542........  ...........  A.........  Chemotherapy             0.75         3.53         3.89          0.33         0.50          0.07  XXX
                                         injection.
96549........  ...........  C.........  Chemotherapy,            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         unspecified.
96567........  ...........  A.........  Photodynamic tx,         0.00         3.72         2.84            NA           NA          0.04  XXX
                                         skin.
96570........  ...........  A.........  Photodynamic tx,         1.10         0.40         0.39          0.40         0.39          0.11  ZZZ
                                         30 min.
96571........  ...........  A.........  Photodynamic tx,         0.55         0.20         0.19          0.20         0.19          0.03  ZZZ
                                         addl 15 min.
96900........  ...........  A.........  Ultraviolet light        0.00         0.56         0.50            NA           NA          0.02  XXX
                                         therapy.
96902........  ...........  B.........  Trichogram.......        0.41         0.11         0.14          0.09         0.13          0.01  XXX
96904........  ...........  R.........  Whole body               0.00         1.89         1.89            NA           NA          0.01  XXX
                                         photography.
96910........  ...........  A.........  Photochemotherapy        0.00         2.00         1.49            NA           NA          0.04  XXX
                                         with UV-B.
96912........  ...........  A.........  Photochemotherapy        0.00         2.57         1.92            NA           NA          0.05  XXX
                                         with UV-A.
96913........  ...........  A.........  Photochemotherapy        0.00         3.45         2.60            NA           NA          0.10  XXX
                                         , UV-A or B.
96920........  ...........  A.........  Laser tx, skin <         1.15         3.57         3.06          0.57         0.57          0.02  000
                                         250 sq cm.
96921........  ...........  A.........  Laser tx, skin           1.17         3.32         2.99          0.52         0.55          0.03  000
                                         250-500 sq cm.
96922........  ...........  A.........  Laser tx, skin >         2.10         4.63         4.06          1.05         0.84          0.04  000
                                         500 sq cm.
96999........  ...........  C.........  Dermatological           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
97001........  ...........  A.........  Pt evaluation....        1.20         0.66         0.71            NA           NA          0.05  XXX
97002........  ...........  A.........  Pt re-evaluation.        0.60         0.41         0.42            NA           NA          0.02  XXX

[[Page 38357]]

 
97003........  ...........  A.........  Ot evaluation....        1.20         0.76         0.83            NA           NA          0.06  XXX
97004........  ...........  A.........  Ot re-evaluation.        0.60         0.54         0.61            NA           NA          0.02  XXX
97010........  ...........  B.........  Hot or cold packs        0.06         0.07         0.06            NA           NA          0.01  XXX
                                         therapy.
97012........  ...........  A.........  Mechanical               0.25         0.14         0.13            NA           NA          0.01  XXX
                                         traction therapy.
97014........  ...........  I.........  Electric                 0.18         0.18         0.19            NA           NA          0.01  XXX
                                         stimulation
                                         therapy.
97016........  ...........  A.........  Vasopneumatic            0.18         0.24         0.21            NA           NA          0.01  XXX
                                         device therapy.
97018........  ...........  A.........  Paraffin bath            0.06         0.16         0.13            NA           NA          0.01  XXX
                                         therapy.
97022........  ...........  A.........  Whirlpool therapy        0.17         0.33         0.27            NA           NA          0.01  XXX
97024........  ...........  A.........  Diathermy eg,            0.06         0.08         0.07            NA           NA          0.01  XXX
                                         microwave.
97026........  ...........  A.........  Infrared therapy.        0.06         0.07         0.06            NA           NA          0.01  XXX
97028........  ...........  A.........  Ultraviolet              0.08         0.08         0.07            NA           NA          0.01  XXX
                                         therapy.
97032........  ...........  A.........  Electrical               0.25         0.20         0.18            NA           NA          0.01  XXX
                                         stimulation.
97033........  ...........  A.........  Electric current         0.26         0.44         0.35            NA           NA          0.01  XXX
                                         therapy.
97034........  ...........  A.........  Contrast bath            0.21         0.20         0.17            NA           NA          0.01  XXX
                                         therapy.
97035........  ...........  A.........  Ultrasound               0.21         0.10         0.10            NA           NA          0.01  XXX
                                         therapy.
97036........  ...........  A.........  Hydrotherapy.....        0.28         0.44         0.38            NA           NA          0.01  XXX
97039........  ...........  C.........  Physical therapy         0.00         0.00         0.05            NA           NA          0.00  XXX
                                         treatment.
97110........  ...........  A.........  Therapeutic              0.45         0.32         0.29            NA           NA          0.02  XXX
                                         exercises.
97112........  ...........  A.........  Neuromuscular            0.45         0.34         0.33            NA           NA          0.01  XXX
                                         reeducation.
97113........  ...........  A.........  Aquatic therapy/         0.44         0.53         0.46            NA           NA          0.01  XXX
                                         exercises.
97116........  ...........  A.........  Gait training            0.40         0.28         0.26            NA           NA          0.01  XXX
                                         therapy.
97124........  ...........  A.........  Massage therapy..        0.35         0.27         0.25            NA           NA          0.01  XXX
97139........  ...........  C.........  Physical medicine        0.00         0.00         0.10            NA           NA          0.00  XXX
                                         procedure.
97140........  ...........  A.........  Manual therapy...        0.43         0.29         0.27            NA           NA          0.01  XXX
97150........  ...........  A.........  Group therapeutic        0.27         0.22         0.20            NA           NA          0.01  XXX
                                         procedures.
97530........  ...........  A.........  Therapeutic              0.44         0.38         0.35            NA           NA          0.01  XXX
                                         activities.
97532........  ...........  A.........  Cognitive skills         0.44         0.22         0.21            NA           NA          0.01  XXX
                                         development.
97533........  ...........  A.........  Sensory                  0.44         0.27         0.26            NA           NA          0.01  XXX
                                         integration.
97535........  ...........  A.........  Self care mngment        0.45         0.37         0.35            NA           NA          0.01  XXX
                                         training.
97537........  ...........  A.........  Community/work           0.45         0.28         0.27            NA           NA          0.01  XXX
                                         reintegration.
97542........  ...........  A.........  Wheelchair               0.45         0.29         0.28            NA           NA          0.01  XXX
                                         mngment training.
97597........  ...........  A.........  Active wound care/       0.58         1.09         0.88          0.12         0.39          0.05  XXX
                                         20 cm or <.
97598........  ...........  A.........  Active wound care        0.80         1.27         1.03          0.17         0.48          0.05  XXX
                                         > 20 cm.
97605........  ...........  A.........  Neg press wound          0.55         0.40         0.37          0.12         0.17          0.02  XXX
                                         tx, < 50 cm.
97606........  ...........  A.........  Neg press wound          0.60         0.42         0.39          0.13         0.18          0.03  XXX
                                         tx, > 50 cm.
97750........  ...........  A.........  Physical                 0.45         0.33         0.32            NA           NA          0.02  XXX
                                         performance test.
97755........  ...........  A.........  Assistive                0.62         0.28         0.28            NA           NA          0.02  XXX
                                         technology
                                         assess.
97760........  ...........  A.........  Orthotic mgmt and        0.45         0.42         0.38            NA           NA          0.03  XXX
                                         training.
97761........  ...........  A.........  Prosthetic               0.45         0.33         0.30            NA           NA          0.02  XXX
                                         training.
97762........  ...........  A.........  C/o for orthotic/        0.25         0.73         0.58            NA           NA          0.02  XXX
                                         prosth use.
97799........  ...........  C.........  Physical medicine        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         procedure.
97802........  ...........  A.........  Medical                  0.45         0.14         0.31          0.11         0.29          0.01  XXX
                                         nutrition,
                                         indiv, in.
97803........  ...........  A.........  Med nutrition,           0.37         0.12         0.29          0.09         0.28          0.01  XXX
                                         indiv, subseq.
97804........  ...........  A.........  Medical                  0.25         0.08         0.13          0.07         0.12          0.01  XXX
                                         nutrition, group.
97810........  ...........  N.........  Acupunct w/o             0.60         0.26         0.32          0.14         0.19          0.03  XXX
                                         stimul 15 min.
97811........  ...........  N.........  Acupunct w/o             0.50         0.15         0.20          0.12         0.15          0.03  ZZZ
                                         stimul addl 15m.
97813........  ...........  N.........  Acupunct w/stimul        0.65         0.27         0.34          0.15         0.20          0.03  XXX
                                         15 min.
97814........  ...........  N.........  Acupunct w/stimul        0.55         0.19         0.24          0.13         0.17          0.03  ZZZ
                                         addl 15m.
98925........  ...........  A.........  Osteopathic              0.45         0.29         0.30          0.12         0.13          0.02  000
                                         manipulation.
98926........  ...........  A.........  Osteopathic              0.65         0.37         0.39          0.17         0.21          0.03  000
                                         manipulation.
98927........  ...........  A.........  Osteopathic              0.87         0.45         0.48          0.22         0.26          0.03  000
                                         manipulation.
98928........  ...........  A.........  Osteopathic              1.03         0.51         0.55          0.26         0.30          0.04  000
                                         manipulation.
98929........  ...........  A.........  Osteopathic              1.19         0.57         0.62          0.30         0.33          0.05  000
                                         manipulation.
98940........  ...........  A.........  Chiropractic             0.45         0.21         0.22          0.12         0.12          0.01  000
                                         manipulation.
98941........  ...........  A.........  Chiropractic             0.65         0.27         0.28          0.18         0.17          0.01  000
                                         manipulation.
98942........  ...........  A.........  Chiropractic             0.87         0.34         0.35          0.24         0.23          0.02  000
                                         manipulation.
98943........  ...........  N.........  Chiropractic             0.40         0.17         0.20          0.09         0.12          0.01  XXX
                                         manipulation.
98960........  ...........  B.........  Self-mgmt educ &         0.00         0.58         0.57            NA           NA          0.01  XXX
                                         train, 1 pt.
98961........  ...........  B.........  Self-mgmt educ/          0.00         0.28         0.27            NA           NA          0.01  XXX
                                         train, 2-4 pt.
98962........  ...........  B.........  Self-mgmt educ/          0.00         0.20         0.20            NA           NA          0.01  XXX
                                         train, 5-8 pt.
99082........  ...........  C.........  Unusual physician        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         travel.
99091........  ...........  B.........  Collect/review           1.10         0.25         0.25            NA           NA          0.04  XXX
                                         data from pt.
99143........  ...........  C.........  Mod cs by same           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         phys, < 5 yrs.
99144........  ...........  C.........  Mod cs by same           0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         phys, 5 yrs +.
99145........  ...........  C.........  Mod cs by same           0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         phys add-on.
99148........  ...........  C.........  Mod cs diff phys         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         < 5 yrs.
99149........  ...........  C.........  Mod cs diff phys         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         5 yrs +.
99150........  ...........  C.........  Mod cs diff phys         0.00         0.00         0.00          0.00         0.00          0.00  ZZZ
                                         add-on.
99170........  ...........  A.........  Anogenital exam,         1.75         1.82         1.74          0.61         0.56          0.08  000
                                         child.
99173........  ...........  N.........  Visual acuity            0.00         0.06         0.06            NA           NA          0.01  XXX
                                         screen.
99175........  ...........  A.........  Induction of             0.00         0.37         0.88            NA           NA          0.10  XXX
                                         vomiting.
99183........  ...........  A.........  Hyperbaric oxygen        2.34         2.58         2.91          0.58         0.65          0.16  XXX
                                         therapy.

[[Page 38358]]

 
99185........  ...........  A.........  Regional                 0.00         1.63         1.14            NA           NA          0.04  XXX
                                         hypothermia.
99186........  ...........  A.........  Total body               0.00         1.61         1.66            NA           NA          0.45  XXX
                                         hypothermia.
99195........  ...........  A.........  Phlebotomy.......        0.00         2.54         1.50            NA           NA          0.02  XXX
99199........  ...........  C.........  Special service/         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         proc/report.
99201........  ...........  A.........  Office/outpatient        0.45         0.55         0.52          0.16         0.15          0.03  XXX
                                         visit, new.
99202........  ...........  A.........  Office/outpatient        0.88         0.84         0.81          0.30         0.31          0.05  XXX
                                         visit, new.
99203........  ...........  A.........  Office/outpatient        1.34         1.10         1.12          0.43         0.46          0.09  XXX
                                         visit, new.
99204........  ...........  A.........  Office/outpatient        2.30         1.48         1.49          0.71         0.71          0.12  XXX
                                         visit, new.
99205........  ...........  A.........  Office/outpatient        3.00         1.77         1.78          0.91         0.94          0.15  XXX
                                         visit, new.
99211........  ...........  A.........  Office/outpatient        0.17         0.32         0.35          0.06         0.06          0.01  XXX
                                         visit, est.
99212........  ...........  A.........  Office/outpatient        0.45         0.55         0.54          0.15         0.16          0.03  XXX
                                         visit, est.
99213........  ...........  A.........  Office/outpatient        0.92         0.76         0.73          0.28         0.26          0.03  XXX
                                         visit, est.
99214........  ...........  A.........  Office/outpatient        1.42         1.09         1.06          0.44         0.43          0.05  XXX
                                         visit, est.
99215........  ...........  A.........  Office/outpatient        2.00         1.37         1.35          0.61         0.63          0.08  XXX
                                         visit, est.
99217........  ...........  A.........  Observation care         1.28           NA           NA          0.49         0.52          0.06  XXX
                                         discharge.
99218........  ...........  A.........  Observation care.        1.28           NA           NA          0.38         0.41          0.06  XXX
99219........  ...........  A.........  Observation care.        2.14           NA           NA          0.59         0.66          0.10  XXX
99220........  ...........  A.........  Observation care.        2.99           NA           NA          0.84         0.94          0.14  XXX
99221........  ...........  A.........  Initial hospital         1.88           NA           NA          0.54         0.50          0.07  XXX
                                         care.
99222........  ...........  A.........  Initial hospital         2.56           NA           NA          0.71         0.73          0.10  XXX
                                         care.
99223........  ...........  A.........  Initial hospital         3.78           NA           NA          1.07         1.06          0.13  XXX
                                         care.
99231........  ...........  A.........  Subsequent               0.76           NA           NA          0.24         0.23          0.03  XXX
                                         hospital care.
99232........  ...........  A.........  Subsequent               1.39           NA           NA          0.43         0.40          0.04  XXX
                                         hospital care.
99233........  ...........  A.........  Subsequent               2.00           NA           NA          0.59         0.56          0.06  XXX
                                         hospital care.
99234........  ...........  A.........  Observ/hosp same         2.56           NA           NA          0.78         0.84          0.13  XXX
                                         date.
99235........  ...........  A.........  Observ/hosp same         3.41           NA           NA          0.98         1.07          0.16  XXX
                                         date.
99236........  ...........  A.........  Observ/hosp same         4.26           NA           NA          1.21         1.34          0.19  XXX
                                         date.
99238........  ...........  A.........  Hospital                 1.28           NA           NA          0.49         0.52          0.05  XXX
                                         discharge day.
99239........  ...........  A.........  Hospital                 1.90           NA           NA          0.67         0.70          0.07  XXX
                                         discharge day.
99241........  ...........  A.........  Office                   0.64         0.66         0.65          0.22         0.22          0.05  XXX
                                         consultation.
99242........  ...........  A.........  Office                   1.34         1.08         1.06          0.48         0.47          0.10  XXX
                                         consultation.
99243........  ...........  A.........  Office                   1.88         1.45         1.42          0.67         0.65          0.13  XXX
                                         consultation.
99244........  ...........  A.........  Office                   3.02         1.92         1.88          1.08         1.01          0.16  XXX
                                         consultation.
99245........  ...........  A.........  Office                   3.77         2.24         2.27          1.31         1.28          0.21  XXX
                                         consultation.
99251........  ...........  A.........  Inpatient                1.00           NA           NA          0.31         0.28          0.05  XXX
                                         consultation.
99252........  ...........  A.........  Inpatient                1.50           NA           NA          0.49         0.50          0.09  XXX
                                         consultation.
99253........  ...........  A.........  Inpatient                2.27           NA           NA          0.80         0.75          0.11  XXX
                                         consultation.
99254........  ...........  A.........  Inpatient                3.29           NA           NA          1.18         1.09          0.13  XXX
                                         consultation.
99255........  ...........  A.........  Inpatient                4.00           NA           NA          1.38         1.37          0.18  XXX
                                         consultation.
99281........  ...........  A.........  Emergency dept           0.45           NA           NA          0.09         0.09          0.02  XXX
                                         visit.
99282........  ...........  A.........  Emergency dept           0.88           NA           NA          0.17         0.16          0.04  XXX
                                         visit.
99283........  ...........  A.........  Emergency dept           1.34           NA           NA          0.25         0.28          0.09  XXX
                                         visit.
99284........  ...........  A.........  Emergency dept           2.56           NA           NA          0.47         0.47          0.14  XXX
                                         visit.
99285........  ...........  A.........  Emergency dept           3.80           NA           NA          0.67         0.70          0.23  XXX
                                         visit.
99289........  ...........  A.........  Ped crit care            4.79           NA           NA          1.08         1.27          0.24  XXX
                                         transport.
99290........  ...........  A.........  Ped crit care            2.40           NA           NA          0.87         0.80          0.12  ZZZ
                                         transport addl.
99291........  ...........  A.........  Critical care,           4.50         2.24         2.41          1.10         1.20          0.21  XXX
                                         first hour.
99292........  ...........  A.........  Critical care,           2.25         0.79         0.86          0.56         0.61          0.11  ZZZ
                                         add[boxHu]l 30
                                         min.
99293........  ...........  A.........  Ped critical            15.98           NA           NA          3.78         4.25          1.12  XXX
                                         care, initial.
99294........  ...........  A.........  Ped critical             7.99           NA           NA          1.66         2.05          0.45  XXX
                                         care, subseq.
99295........  ...........  A.........  Neonate crit            18.46           NA           NA          4.61         4.96          1.16  XXX
                                         care, initial.
99296........  ...........  A.........  Neonate critical         7.99           NA           NA          2.07         2.26          0.32  XXX
                                         care subseq.
99298........  ...........  A.........  Ic for lbw infant        2.75           NA           NA          0.68         0.81          0.17  XXX
                                         < 1500 gm.
99299........  ...........  A.........  Ic, lbw infant           2.50           NA           NA          0.59         0.76          0.16  XXX
                                         1500-2500 gm.
99300........  ...........  A.........  Ic, infant pbw           2.40           NA           NA          0.71         0.78          0.15  XXX
                                         2501-5000 gm.
99304........  ...........  A.........  Nursing facility         1.61         0.57         0.51          0.57         0.51          0.05  XXX
                                         care, init.
99305........  ...........  A.........  Nursing facility         2.30         0.74         0.66          0.74         0.66          0.07  XXX
                                         care, init.
99306........  ...........  A.........  Nursing facility         3.00         0.91         0.79          0.91         0.79          0.09  XXX
                                         care, init.
99307........  ...........  A.........  Nursing fac care,        0.76         0.31         0.28          0.31         0.28          0.03  XXX
                                         subseq.
99308........  ...........  A.........  Nursing fac care,        1.16         0.47         0.46          0.47         0.46          0.04  XXX
                                         subseq.
99309........  ...........  A.........  Nursing fac care,        1.55         0.61         0.61          0.61         0.61          0.06  XXX
                                         subseq.
99310........  ...........  A.........  Nursing fac care,        2.35         0.87         0.80          0.87         0.80          0.08  XXX
                                         subseq.
99315........  ...........  A.........  Nursing fac              1.13         0.41         0.43          0.41         0.43          0.05  XXX
                                         discharge day.
99316........  ...........  A.........  Nursing fac              1.50         0.51         0.55          0.51         0.55          0.06  XXX
                                         discharge day.
99318........  ...........  A.........  Annual nursing           1.71         0.56         0.51          0.56         0.51          0.05  XXX
                                         fac assessmnt.
99324........  ...........  A.........  Domicil/r-home           1.01         0.42         0.46            NA           NA          0.05  XXX
                                         visit new pat.
99325........  ...........  A.........  Domicil/r-home           1.52         0.54         0.62            NA           NA          0.07  XXX
                                         visit new pat.
99326........  ...........  A.........  Domicil/r-home           2.27         0.73         0.83            NA           NA          0.10  XXX
                                         visit new pat.
99327........  ...........  A.........  Domicil/r-home           3.03         0.92         1.05            NA           NA          0.13  XXX
                                         visit new pat.
99328........  ...........  A.........  Domicil/r-home           3.78         1.09         1.26            NA           NA          0.16  XXX
                                         visit new pat.
99334........  ...........  A.........  Domicil/r-home           0.76         0.35         0.38            NA           NA          0.04  XXX
                                         visit est pat.
99335........  ...........  A.........  Domicil/r-home           1.26         0.47         0.53            NA           NA          0.06  XXX
                                         visit est pat.

[[Page 38359]]

 
99336........  ...........  A.........  Domicil/r-home           2.02         0.66         0.74            NA           NA          0.09  XXX
                                         visit est pat.
99337........  ...........  A.........  Domicil/r-home           3.03         0.90         1.03            NA           NA          0.13  XXX
                                         visit est pat.
99339........  ...........  B.........  Domicil/r-home           1.25         0.58         0.58            NA           NA          0.06  XXX
                                         care supervis.
99340........  ...........  B.........  Domicil/r-home           1.80         0.76         0.76            NA           NA          0.07  XXX
                                         care supervis.
99341........  ...........  A.........  Home visit, new          1.01         0.42         0.45            NA           NA          0.05  XXX
                                         patient.
99342........  ...........  A.........  Home visit, new          1.52         0.54         0.62            NA           NA          0.07  XXX
                                         patient.
99343........  ...........  A.........  Home visit, new          2.27         0.74         0.85            NA           NA          0.10  XXX
                                         patient.
99344........  ...........  A.........  Home visit, new          3.03         0.91         1.05            NA           NA          0.13  XXX
                                         patient.
99345........  ...........  A.........  Home visit, new          3.78         1.08         1.26            NA           NA          0.16  XXX
                                         patient.
99347........  ...........  A.........  Home visit, est          0.76         0.35         0.38            NA           NA          0.04  XXX
                                         patient.
99348........  ...........  A.........  Home visit, est          1.26         0.48         0.53            NA           NA          0.06  XXX
                                         patient.
99349........  ...........  A.........  Home visit, est          2.02         0.66         0.75            NA           NA          0.09  XXX
                                         patient.
99350........  ...........  A.........  Home visit, est          3.03         0.90         1.05            NA           NA          0.13  XXX
                                         patient.
99354........  ...........  A.........  Prolonged                1.77         0.65         0.71          0.50         0.58          0.08  ZZZ
                                         service, office.
99355........  ...........  A.........  Prolonged                1.77         0.62         0.69          0.47         0.56          0.07  ZZZ
                                         service, office.
99356........  ...........  A.........  Prolonged                1.71           NA           NA          0.50         0.57          0.07  ZZZ
                                         service,
                                         inpatient.
99357........  ...........  A.........  Prolonged                1.71           NA           NA          0.50         0.57          0.08  ZZZ
                                         service,
                                         inpatient.
99358........  ...........  B.........  Prolonged serv, w/       2.10         0.51         0.51          0.51         0.51          0.09  ZZZ
                                         o contact.
99359........  ...........  B.........  Prolonged serv, w/       1.00         0.26         0.26          0.26         0.26          0.04  ZZZ
                                         o contact.
99360........  ...........  X.........  Physician standby        1.20         0.28         0.28          0.28         0.28          0.05  XXX
                                         services.
99363........  ...........  B.........  Anticoag mgmt,           1.65         1.29         1.29          0.38         0.38          0.07  XXX
                                         init.
99364........  ...........  B.........  Anticoag mgmt,           0.63         0.38         0.38          0.15         0.15          0.04  XXX
                                         subseq.
99374........  ...........  B.........  Home health care         1.10         0.54         0.62          0.25         0.34          0.05  XXX
                                         supervision.
99375........  ...........  I.........  Home health care         1.73         0.75         1.15          0.40         0.97          0.07  XXX
                                         supervision.
99377........  ...........  B.........  Hospice care             1.10         0.54         0.62          0.25         0.34          0.05  XXX
                                         supervision.
99378........  ...........  I.........  Hospice care             1.73         0.75         1.34          0.40         1.17          0.07  XXX
                                         supervision.
99379........  ...........  B.........  Nursing fac care         1.10         0.54         0.62          0.25         0.34          0.04  XXX
                                         supervision.
99380........  ...........  B.........  Nursing fac care         1.73         0.75         0.87          0.40         0.53          0.06  XXX
                                         supervision.
99381........  ...........  N.........  Init pm e/m, new         1.19         0.99         1.24          0.27         0.36          0.05  XXX
                                         pat, inf.
99382........  ...........  N.........  Init pm e/m, new         1.36         1.03         1.28          0.31         0.42          0.05  XXX
                                         pat 1-4 yrs.
99383........  ...........  N.........  Prev visit, new,         1.36         1.02         1.25          0.31         0.42          0.05  XXX
                                         age 5-11.
99384........  ...........  N.........  Prev visit, new,         1.53         1.06         1.31          0.35         0.47          0.06  XXX
                                         age 12-17.
99385........  ...........  N.........  Prev visit, new,         1.53         1.06         1.31          0.35         0.47          0.06  XXX
                                         age 18-39.
99386........  ...........  N.........  Prev visit, new,         1.88         1.14         1.44          0.43         0.58          0.07  XXX
                                         age 40-64.
99387........  ...........  N.........  Init pm e/m, new         2.06         1.27         1.57          0.48         0.63          0.07  XXX
                                         pat 65+ yrs.
99391........  ...........  N.........  Per pm reeval,           1.02         0.85         0.94          0.24         0.31          0.04  XXX
                                         est pat, inf.
99392........  ...........  N.........  Prev visit, est,         1.19         0.89         0.99          0.27         0.36          0.05  XXX
                                         age 1-4.
99393........  ...........  N.........  Prev visit, est,         1.19         0.89         0.98          0.27         0.36          0.05  XXX
                                         age 5-11.
99394........  ...........  N.........  Prev visit, est,         1.36         0.93         1.03          0.31         0.42          0.05  XXX
                                         age 12-17.
99395........  ...........  N.........  Prev visit, est,         1.36         0.93         1.04          0.31         0.42          0.05  XXX
                                         age 18-39.
99396........  ...........  N.........  Prev visit, est,         1.53         0.97         1.11          0.35         0.47          0.06  XXX
                                         age 40-64.
99397........  ...........  N.........  Per pm reeval est        1.71         1.11         1.24          0.39         0.53          0.06  XXX
                                         pat 65+ yr.
99401........  ...........  N.........  Preventive               0.48         0.36         0.49          0.11         0.15          0.01  XXX
                                         counseling,
                                         indiv.
99402........  ...........  N.........  Preventive               0.98         0.47         0.67          0.22         0.30          0.02  XXX
                                         counseling,
                                         indiv.
99403........  ...........  N.........  Preventive               1.46         0.58         0.83          0.34         0.45          0.04  XXX
                                         counseling,
                                         indiv.
99404........  ...........  N.........  Preventive               1.95         0.70         1.01          0.45         0.60          0.05  XXX
                                         counseling,
                                         indiv.
99411........  ...........  N.........  Preventive               0.15         0.22         0.20          0.03         0.04          0.01  XXX
                                         counseling,
                                         group.
99412........  ...........  N.........  Preventive               0.25         0.24         0.25          0.06         0.08          0.01  XXX
                                         counseling,
                                         group.
99420........  ...........  N.........  Health risk              0.00         0.22         0.22            NA           NA          0.01  XXX
                                         assessment test.
99431........  ...........  A.........  Initial care,            1.17           NA           NA          0.27         0.32          0.05  XXX
                                         normal newborn.
99432........  ...........  A.........  Newborn care, not        1.26         1.00         0.97          0.29         0.34          0.07  XXX
                                         in hosp.
99433........  ...........  A.........  Normal newborn           0.62           NA           NA          0.17         0.18          0.02  XXX
                                         care/hospital.
99435........  ...........  A.........  Newborn discharge        1.50           NA           NA          0.50         0.54          0.06  XXX
                                         day hosp.
99436........  ...........  A.........  Attendance, birth        1.50           NA           NA          0.33         0.40          0.06  XXX
99440........  ...........  A.........  Newborn                  2.93           NA           NA          0.67         0.80          0.12  XXX
                                         resuscitation.
99499........  ...........  C.........  Unlisted e&m             0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         service.
G0101........  ...........  A.........  CA screen;pelvic/        0.45         0.48         0.50            NA           NA          0.02  XXX
                                         breast exam.
G0102........  ...........  A.........  Prostate ca              0.17         0.32         0.35          0.06         0.06          0.01  XXX
                                         screening; dre.
G0104........  ...........  A.........  CA screen;flexi          0.96         2.50         2.39          0.62         0.56          0.08  000
                                         sigmoidscope.
G0105........  ...........  A.........  Colorectal scrn;         3.69         6.35         6.25          1.83         1.66          0.30  000
                                         hi risk ind.
G0105........  53.........  A.........  Colorectal scrn;         0.96         2.50         2.39          0.62         0.56          0.08  000
                                         hi risk ind.
G0106........  ...........  A.........  Colon CA                 0.99         4.91         3.68            NA           NA          0.17  XXX
                                         screen;barium
                                         enema.
G0106........  26.........  A.........  Colon CA                 0.99         0.35         0.32          0.35         0.32          0.04  XXX
                                         screen;barium
                                         enema.
G0106........  TC.........  A.........  Colon CA                 0.00         4.55         3.36            NA           NA          0.13  XXX
                                         screen;barium
                                         enema.
G0108........  ...........  A.........  Diab manage trn          0.00         0.58         0.71            NA           NA          0.01  XXX
                                         per indiv.
G0109........  ...........  A.........  Diab manage trn          0.00         0.31         0.40            NA           NA          0.01  XXX
                                         ind/group.
G0117........  ...........  T.........  Glaucoma scrn hgh        0.45         0.76         0.75            NA           NA          0.01  XXX
                                         risk direc.
G0118........  ...........  T.........  Glaucoma scrn hgh        0.17         0.71         0.64            NA           NA          0.01  XXX
                                         risk direc.
G0120........  ...........  A.........  Colon ca scrn;           0.99         4.91         3.68            NA           NA          0.17  XXX
                                         barium enema.
G0120........  26.........  A.........  Colon ca scrn;           0.99         0.35         0.32          0.35         0.32          0.04  XXX
                                         barium enema.
G0120........  TC.........  A.........  Colon ca scrn;           0.00         4.55         3.36            NA           NA          0.13  XXX
                                         barium enema.
G0121........  ...........  A.........  Colon ca scrn not        3.69         6.35         6.25          1.83         1.66          0.30  000
                                         hi rsk ind.

[[Page 38360]]

 
G0121........  53.........  A.........  Colon ca scrn not        0.96         2.50         2.39          0.62         0.56          0.08  000
                                         hi rsk ind.
G0122........  ...........  N.........  Colon ca scrn;           0.99         5.57         4.07            NA           NA          0.18  XXX
                                         barium enema.
G0122........  26.........  N.........  Colon ca scrn;           0.99         0.23         0.30          0.23         0.30          0.05  XXX
                                         barium enema.
G0122........  TC.........  N.........  Colon ca scrn;           0.00         5.34         3.77            NA           NA          0.13  XXX
                                         barium enema.
G0124........  ...........  A.........  Screen c/v thin          0.42         0.37         0.26          0.37         0.26          0.02  XXX
                                         layer by MD.
G0127........  ...........  R.........  Trim nail(s).....        0.17         0.37         0.31          0.04         0.06          0.01  000
G0128........  ...........  R.........  CORF skilled             0.08         0.02         0.03          0.02         0.03          0.01  XXX
                                         nursing service.
G0130........  ...........  A.........  Single energy x-         0.22         0.55         0.71            NA           NA          0.06  XXX
                                         ray study.
G0130........  26.........  A.........  Single energy x-         0.22         0.06         0.07          0.06         0.07          0.01  XXX
                                         ray study.
G0130........  TC.........  A.........  Single energy x-         0.00         0.49         0.64            NA           NA          0.05  XXX
                                         ray study.
G0141........  ...........  A.........  Scr c/v                  0.42         0.37         0.26          0.37         0.26          0.02  XXX
                                         cyto,autosys and
                                         md.
G0166........  ...........  A.........  Extrnl                   0.07         4.35         3.99            NA           NA          0.01  XXX
                                         counterpulse,
                                         per tx.
G0168........  ...........  A.........  Wound closure by         0.45         1.56         1.75          0.21         0.22          0.03  000
                                         adhesive.
G0179........  ...........  A.........  MD                       0.45         0.47         0.75            NA           NA          0.02  XXX
                                         recertification
                                         HHA PT.
G0180........  ...........  A.........  MD certification         0.67         0.55         0.91            NA           NA          0.03  XXX
                                         HHA patient.
G0181........  ...........  A.........  Home health care         1.73         0.80         1.15            NA           NA          0.07  XXX
                                         supervision.
G0182........  ...........  A.........  Hospice care             1.73         0.82         1.25            NA           NA          0.07  XXX
                                         supervision.
G0186........  ...........  C.........  Dstry eye                0.00         0.00         0.00          0.00         0.00          0.00  YYY
                                         lesn,fdr vssl
                                         tech.
G0202........  ...........  A.........  Screeningmammogra        0.70         2.81         2.76            NA           NA          0.10  XXX
                                         phydigital.
G0202........  26.........  A.........  Screeningmammogra        0.70         0.24         0.23          0.24         0.23          0.03  XXX
                                         phydigital.
G0202........  TC.........  A.........  Screeningmammogra        0.00         2.57         2.54            NA           NA          0.07  XXX
                                         phydigital.
G0204........  ...........  A.........  Diagnosticmammogr        0.87         3.41         3.05            NA           NA          0.11  XXX
                                         aphydigital.
G0204........  26.........  A.........  Diagnosticmammogr        0.87         0.30         0.28          0.30         0.28          0.04  XXX
                                         aphydigital.
G0204........  TC.........  A.........  Diagnosticmammogr        0.00         3.11         2.77            NA           NA          0.07  XXX
                                         aphydigital.
G0206........  ...........  A.........  Diagnosticmammogr        0.70         2.67         2.43            NA           NA          0.09  XXX
                                         aphydigital.
G0206........  26.........  A.........  Diagnosticmammogr        0.70         0.24         0.23          0.24         0.23          0.03  XXX
                                         aphydigital.
G0206........  TC.........  A.........  Diagnosticmammogr        0.00         2.43         2.20            NA           NA          0.06  XXX
                                         aphydigital.
G0237........  ...........  A.........  Therapeutic procd        0.00         0.21         0.34            NA           NA          0.02  XXX
                                         strg endur.
G0238........  ...........  A.........  Oth resp proc,           0.00         0.23         0.36            NA           NA          0.02  XXX
                                         indiv.
G0239........  ...........  A.........  Oth resp proc,           0.00         0.31         0.32            NA           NA          0.02  XXX
                                         group.
G0245........  ...........  R.........  Initial foot exam        0.88         0.84         0.81          0.30         0.31          0.04  XXX
                                         pt lops.
G0246........  ...........  R.........  Followup eval of         0.45         0.55         0.54          0.15         0.16          0.02  XXX
                                         foot pt lop.
G0247........  ...........  R.........  Routine footcare         0.50         0.66         0.59          0.16         0.19          0.02  ZZZ
                                         pt w lops.
G0248........  ...........  R.........  Demonstrate use          0.00         3.37         4.99            NA           NA          0.01  XXX
                                         home inr mon.
G0249........  ...........  R.........  Provide test             0.00         2.72         3.29            NA           NA          0.01  XXX
                                         material,equipm.
G0250........  ...........  R.........  MD review                0.18         0.08         0.07            NA           NA          0.01  XXX
                                         interpret of
                                         test.
G0252........  26.........  N.........  PET imaging              1.50         0.35         0.52          0.35         0.52          0.04  XXX
                                         initial dx.
G0268........  ...........  A.........  Removal of               0.61         0.66         0.64          0.20         0.22          0.02  000
                                         impacted wax md.
G0270........  ...........  A.........  MNT subs tx for          0.37         0.12         0.29          0.09         0.28          0.01  XXX
                                         change dx.
G0271........  ...........  A.........  Group MNT 2 or           0.25         0.08         0.13          0.07         0.12          0.01  XXX
                                         more 30 mins.
G0275........  ...........  A.........  Renal angio,             0.25           NA           NA          0.13         0.12          0.01  ZZZ
                                         cardiac cath.
G0278........  ...........  A.........  Iliac art                0.25           NA           NA          0.13         0.12          0.01  ZZZ
                                         angio,cardiac
                                         cath.
G0281........  ...........  A.........  Elec stim                0.18         0.14         0.13            NA           NA          0.01  XXX
                                         unattend for
                                         press.
G0283........  ...........  A.........  Elec stim other          0.18         0.14         0.13            NA           NA          0.01  XXX
                                         than wound.
G0288........  ...........  A.........  Recon, CTA for           0.00         1.02         5.81            NA           NA          0.18  XXX
                                         surg plan.
G0289........  ...........  A.........  Arthro, loose            1.48           NA           NA          0.59         0.70          0.26  ZZZ
                                         body + chondro.
G0308........  ...........  A.........  ESRD related svc        12.74         5.62         7.07          5.62         7.07          0.42  XXX
                                         4+mo < 2yrs.
G0309........  ...........  A.........  ESRD related svc        10.61         4.16         5.75          4.16         5.75          0.36  XXX
                                         2-3mo <2yrs.
G0310........  ...........  A.........  ESRD related svc         8.49         2.78         4.25          2.78         4.25          0.28  XXX
                                         1 vst <2yrs.
G0311........  ...........  A.........  ESRD related svs         9.73         3.55         4.15          3.55         4.15          0.34  XXX
                                         4+mo 2-11yr.
G0312........  ...........  A.........  ESRD relate svs 2-       8.11         2.71         3.32          2.71         3.32          0.29  XXX
                                         3 mo 2-11y.
G0313........  ...........  A.........  ESRD related svs         6.49         1.84         2.50          1.84         2.50          0.22  XXX
                                         1 mon 2-11y.
G0314........  ...........  A.........  ESRD related svs         8.28         3.39         3.92          3.39         3.92          0.27  XXX
                                         4+ mo 12-19.
G0315........  ...........  A.........  ESRD related svs         6.90         2.56         3.13          2.56         3.13          0.23  XXX
                                         2-3mo/12-19.
G0316........  ...........  A.........  ESRD related svs         5.52         1.67         2.31          1.67         2.31          0.17  XXX
                                         1vis/12-19y.
G0317........  ...........  A.........  ESRD related svs         5.09         2.25         2.56          2.25         2.56          0.17  XXX
                                         4+mo 20+yrs.
G0318........  ...........  A.........  ESRD related svs         4.24         1.70         2.05          1.70         2.05          0.14  XXX
                                         2-3 mo 20+y.
G0319........  ...........  A.........  ESRD related svs         3.39         1.14         1.53          1.14         1.53          0.11  XXX
                                         1visit 20+y.
G0320........  ...........  A.........  ESD related svs         10.61         2.71         4.91          2.71         4.91          0.36  XXX
                                         home undr 2.
G0321........  ...........  A.........  ESRDrelatedsvs           8.11         2.00         2.97          2.00         2.97          0.29  XXX
                                         home mo 2-11y.
G0322........  ...........  A.........  ESRD related svs         6.90         1.72         2.70          1.72         2.70          0.23  XXX
                                         hom mo12-19.
G0323........  ...........  A.........  ESRD related svs         4.24         1.15         1.77          1.15         1.77          0.14  XXX
                                         home mo 20+.
G0324........  ...........  A.........  ESRD relate svs          0.35         0.16         0.20          0.16         0.20          0.01  XXX
                                         home/dy <2yr.
G0325........  ...........  A.........  ESRD relate home/        0.23         0.09         0.10          0.09         0.10          0.01  XXX
                                         day/ 2-11yr.
G0326........  ...........  A.........  ESRD relate home/        0.27         0.10         0.11          0.10         0.11          0.01  XXX
                                         dy 12-19yr.
G0327........  ...........  A.........  ESRD relate home/        0.14         0.06         0.07          0.06         0.07          0.01  XXX
                                         dy 20+yrs.
G0329........  ...........  A.........  Electromagntic tx        0.06         0.15         0.14            NA           NA          0.01  XXX
                                         for ulcers.
G0337........  ...........  X.........  Hospice                  1.34         0.31         0.41          0.31         0.41          0.09  XXX
                                         evaluation
                                         preelecti.
G0339........  ...........  C.........  Robot lin-radsurg        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         com, first.
G0340........  ...........  C.........  Robt lin-radsurg         0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         fractx 2-5.
G0341........  ...........  A.........  Percutaneous             6.98           NA           NA          2.35         2.42          0.48  000
                                         islet celltrans.
G0342........  ...........  A.........  Laparoscopy islet       11.92           NA           NA          5.05         5.18          1.46  090
                                         cell trans.

[[Page 38361]]

 
G0343........  ...........  A.........  Laparotomy islet        19.85           NA           NA          8.53         8.66          2.07  090
                                         cell transp.
G0344........  ...........  A.........  Initial                  1.34         1.10         1.12          0.43         0.46          0.10  XXX
                                         preventive exam.
G0364........  ...........  A.........  Bone marrow              0.16         0.16         0.15          0.07         0.06          0.04  ZZZ
                                         aspirate &biopsy.
G0365........  ...........  A.........  Vessel mapping           0.25         5.16         4.57            NA           NA          0.25  XXX
                                         hemo access.
G0365........  26.........  A.........  Vessel mapping           0.25         0.06         0.07          0.06         0.07          0.02  XXX
                                         hemo access.
G0365........  TC.........  A.........  Vessel mapping           0.00         5.09         4.50            NA           NA          0.23  XXX
                                         hemo access.
G0366........  ...........  A.........  EKG for initial          0.17         0.33         0.42          0.33         0.42          0.03  XXX
                                         prevent exam.
G0367........  ...........  A.........  EKG tracing for          0.00         0.27         0.36            NA           NA          0.02  XXX
                                         initial prev.
G0368........  ...........  A.........  EKG interpret &          0.17         0.07         0.06          0.07         0.06          0.01  XXX
                                         report preve.
G0372........  ...........  A.........  MD service               0.17         0.05         0.22          0.05         0.06          0.01  XXX
                                         required for PMD.
G0375........  ...........  A.........  Smoke/tobacco            0.24         0.07         0.08          0.07         0.08          0.01  XXX
                                         counselng 3-10.
G0376........  ...........  A.........  Smoke/tobacco            0.48         0.13         0.16          0.13         0.15          0.01  XXX
                                         counseling >10.
G0389........  ...........  A.........  Ultrasound exam          0.58         2.40         1.98            NA           NA          0.11  XXX
                                         AAA screen.
G0389........  26.........  A.........  Ultrasound exam          0.58         0.21         0.20          0.21         0.20          0.03  XXX
                                         AAA screen.
G0389........  TC.........  A.........  Ultrasound exam          0.00         2.19         1.78            NA           NA          0.08  XXX
                                         AAA screen.
G0392........  ...........  A.........  AV fistula or            9.48        48.02        51.97            NA           NA          0.62  000
                                         graft arterial.
G0393........  ...........  A.........  AV fistula or            6.03        36.79        40.56            NA           NA          0.34  000
                                         graft venous.
G9041........  ...........  A.........  Low vision rehab         0.44         0.10         0.19          0.10         0.19          0.01  XXX
                                         occupationa.
G9042........  ...........  A.........  Low vision rehab         0.10         0.02         0.15          0.02         0.15          0.01  XXX
                                         orient/mobi.
G9043........  ...........  A.........  Low vision               0.10         0.02         0.15          0.02         0.15          0.01  XXX
                                         lowvision
                                         therapi.
G9044........  ...........  A.........  Low vision               0.10         0.02         0.13          0.02         0.13          0.01  XXX
                                         rehabilate
                                         teache.
Gxxx1........  ...........  A.........  MD serv cardiac          0.18         0.31         0.31          0.09         0.08          0.01  000
                                         rehab wo ECG.
Gxxx2........  ...........  A.........  MD serv cardiac          0.28         0.43         0.45          0.13         0.12          0.01  000
                                         rehab w ECG.
M0064........  ...........  A.........  Visit for drug           0.37         0.90         0.62          0.07         0.10          0.01  XXX
                                         monitoring.
P3001........  ...........  A.........  Screening pap            0.42         0.37         0.26          0.37         0.26          0.02  XXX
                                         smear by phys.
Q0035........  ...........  A.........  Cardiokymography.        0.17         0.30         0.38            NA           NA          0.03  XXX
Q0035........  26.........  A.........  Cardiokymography.        0.17         0.05         0.06          0.05         0.06          0.01  XXX
Q0035........  TC.........  A.........  Cardiokymography.        0.00         0.25         0.32            NA           NA          0.02  XXX
Q0091........  ...........  A.........  Obtaining screen         0.37         0.75         0.71          0.10         0.12          0.02  XXX
                                         pap smear.
Q0092........  ...........  A.........  Set up port xray         0.00         0.47         0.39          0.47         0.39          0.01  XXX
                                         equipment.
Q3001........  ...........  C.........  Brachytherapy            0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         Radioelements.
R0070........  ...........  C.........  Transport                0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         portable x-ray.
R0075........  ...........  C.........  Transport port x-        0.00         0.00         0.00          0.00         0.00          0.00  XXX
                                         ray multipl.
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
\2\ Copyright 2007 American Dental Association. All rights reserved.
\3\ If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public
  and are not used for Medicare payment.








  Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / 
Proposed Rules  

[[Page 38361]]




[[Page 38362]]



                                    Addendum C.--Codes for Which We Received PERC Recommendations on PE Direct Inputs
--------------------------------------------------------------------------------------------------------------------------------------------------------
          CPT \1\ code                              Description                        CPT \1\ code                        Description
--------------------------------------------------------------------------------------------------------------------------------------------------------
37205..........................  Transcath iv stent, percut.......................  58542.............  Lsh w/t/o ut 250 g or less.
37206..........................  Transcath iv stent/perc addl.....................  58543.............  Lsh uterus above 250 g.
38570..........................  Laparoscopy, lymph node biop.....................  58544.............  Lsh w/t/o uterus above 250 g.
38571..........................  Laparoscopy, lymphadenectomy.....................  58545.............  Laparoscopic myomectomy.
38572..........................  Laparoscopy, lymphadenectomy.....................  58546.............  Laparo-myomectomy, complex.
51840..........................  Attach bladder/urethra...........................  58548.............  Lap radical hyst.
51841..........................  Attach bladder/urethra...........................  58550.............  Laparo-asst vag hysterectomy.
51925..........................  Hysterectomy/bladder repair......................  58552.............  Laparo-vag hyst incl t/o.
56405..........................  I & D of vulva/perineum..........................  58553.............  Laparo-vag hyst, complex.
56420..........................  Drainage of gland abscess........................  58554.............  Laparo-vag hyst w/t/o, compl.
56441..........................  Lysis of labial lesion(s)........................  58555.............  Hysteroscopy, dx, sep proc.
56501..........................  Destroy, vulva lesions, sim......................  58558.............  Hysteroscopy, biopsy.
56515..........................  Destroy vulva lesion/s compl.....................  58562.............  Hysteroscopy, remove fb.
56605..........................  Biopsy of vulva/perineum.........................  58563.............  Hysteroscopy, ablation.
56606..........................  Biopsy of vulva/perineum.........................  58565.............  Hysteroscopy, sterilization.
56620..........................  Partial removal of vulva.........................  58600.............  Division of fallopian tube.
56625..........................  Complete removal of vulva........................  58605.............  Division of fallopian tube.
56630..........................  Extensive vulva surgery..........................  58615.............  Occlude fallopian tube(s).
56631..........................  Extensive vulva surgery..........................  58660.............  Laparoscopy, lysis.
56632..........................  Extensive vulva surgery..........................  58661.............  Laparoscopy, remove adnexa.
56633..........................  Extensive vulva surgery..........................  58662.............  Laparoscopy, excise lesions.
56634..........................  Extensive vulva surgery..........................  58670.............  Laparoscopy, tubal cautery.
56637..........................  Extensive vulva surgery..........................  58671.............  Laparoscopy, tubal block.
56640..........................  Extensive vulva surgery..........................  58672.............  Laparoscopy, fimbrioplasty.
56700..........................  Partial removal of hymen.........................  58673.............  Laparoscopy, salpingostomy.
56740..........................  Remove vagina gland lesion.......................  58700.............  Removal of fallopian tube.
56800..........................  Repair of vagina.................................  58720.............  Removal of ovary/tube(s).
56805..........................  Repair clitoris..................................  58740.............  Revise fallopian tube(s).
56810..........................  Repair of perineum...............................  58750.............  Repair oviduct.
56820..........................  Exam of vulva w/scope............................  58752.............  Revise ovarian tube(s).
56821..........................  Exam/biopsy of vulva w/scope.....................  58760.............  Remove tubal obstruction.
57000..........................  Exploration of vagina............................  58770.............  Create new tubal opening.
57010..........................  Drainage of pelvic abscess.......................  58800.............  Drainage of ovarian cyst(s).
57020..........................  Drainage of pelvic fluid.........................  58805.............  Drainage of ovarian cyst(s).
57022..........................  I & vaginal hematoma, pp.........................  58820.............  Drain ovary abscess, open.
57023..........................  I & vag hematoma, non-ob.........................  58822.............  Drain ovary abscess, percut.
57061..........................  Destroy vag lesions, simple......................  58825.............  Transposition, ovary(s).
57065..........................  Destroy vag lesions, complex.....................  58900.............  Biopsy of ovary(s).
57100..........................  Biopsy of vagina.................................  58920.............  Partial removal of ovary(s).
57105..........................  Biopsy of vagina.................................  58925.............  Removal of ovarian cyst(s).
57106..........................  Remove vagina wall, partial......................  58940.............  Removal of ovary(s).
57107..........................  Remove vagina tissue, part.......................  58943.............  Removal of ovary(s).
57109..........................  Vaginectomy partial w/nodes......................  58950.............  Resect ovarian malignancy.
57110..........................  Remove vagina wall, complete.....................  58951.............  Resect ovarian malignancy.
57111..........................  Remove vagina tissue, compl......................  58952.............  Resect ovarian malignancy.
57112..........................  Vaginectomy w/nodes, compl.......................  58953.............  Tah, rad dissect for debulk.
57120..........................  Closure of vagina................................  58954.............  Tah rad debulk/lymph remove.
57130..........................  Remove vagina lesion.............................  58956.............  Bso, omentectomy w/tah.
57135..........................  Remove vagina lesion.............................  58957.............  Resect recurrent gyn mal.
57150..........................  Treat vagina infection...........................  58958.............  Resect recur gyn mal w/lym.
57155..........................  Insert uteri tandems/ovoids......................  58960.............  Exploration of abdomen.
57160..........................  Insert pessary/other device......................  58970.............  Retrieval of oocyte.
57170..........................  Fitting of diaphragm/cap.........................  58974.............  Transfer of embryo.
57180..........................  Treat vaginal bleeding...........................  58976.............  Transfer of embryo.
57200..........................  Repair of vagina.................................  59000.............  Amniocentesis, diagnostic.
57210..........................  Repair vagina/perineum...........................  59015.............  Chorion biopsy.
57220..........................  Revision of urethra..............................  59100.............  Remove uterus lesion.
57230..........................  Repair of urethral lesion........................  59120.............  Treat ectopic pregnancy.
57240..........................  Repair bladder & vagina..........................  59121.............  Treat ectopic pregnancy.
57250..........................  Repair rectum & vagina...........................  59130.............  Treat ectopic pregnancy.
57260..........................  Repair of vagina.................................  59135.............  Treat ectopic pregnancy.
57265..........................  Extensive repair of vagina.......................  59136.............  Treat ectopic pregnancy.
57268..........................  Repair of bowel bulge............................  59140.............  Treat ectopic pregnancy.
57270..........................  Repair of bowel pouch............................  59150.............  Treat ectopic pregnancy.
57280..........................  Suspension of vagina.............................  59151.............  Treat ectopic pregnancy.
57282..........................  Colpopexy, extraperitoneal.......................  59160.............  D & c after delivery.
57283..........................  Colpopexy, intraperitoneal.......................  59200.............  Insert cervical dilator.
57284..........................  Repair paravaginal defect........................  59300.............  Episiotomy or vaginal repair.
57287..........................  Revise/remove sling repair.......................  59400.............  Obstetrical care.
57288..........................  Repair bladder defect............................  59410.............  Obstetrical care.
57289..........................  Repair bladder & vagina..........................  59425.............  Antepartum care only.
57291..........................  Construction of vagina...........................  59426.............  Antepartum care only.

[[Page 38363]]

 
57292..........................  Construct vagina with graft......................  59430.............  Care after delivery.
57295..........................  Revise vag graft via vagina......................  59510.............  Cesarean delivery.
57296..........................  Revise vag graft, open abd.......................  59515.............  Cesarean delivery.
57300..........................  Repair rectum-vagina fistula.....................  59610.............  Vbac delivery.
57305..........................  Repair rectum-vagina fistula.....................  59614.............  Vbac care after delivery.
57307..........................  Fistula repair & colostomy.......................  59618.............  Attempted vbac delivery.
57310..........................  Repair urethrovaginal lesion.....................  59622.............  Attempted vbac after care.
57311..........................  Repair urethrovaginal lesion.....................  59812.............  Vbac delivery only.
57320..........................  Repair bladder-vagina lesion.....................  59820.............  Care of miscarriage.
57330..........................  Repair bladder-vagina lesion.....................  59821.............  Treatment of miscarriage.
57335..........................  Repair vagina....................................  59830.............  Treat uterus infection.
57415..........................  Remove vaginal foreign body......................  59840.............  Abortion.
57420..........................  Exam of vagina w/scope...........................  59841.............  Abortion.
57421..........................  Exam/biopsy of vag w/scope.......................  59850.............  Abortion.
57425..........................  Laparoscopy, surg, colpopexy.....................  59851.............  Abortion.
57452..........................  Exam of cervix w/scope...........................  59852.............  Abortion.
57454..........................  Bx/curett of cervix w/scope......................  59855.............  Abortion.
57455..........................  Biopsy of cervix w/scope.........................  59856.............  Abortion.
57456..........................  Endocerv curettage w/scope.......................  59857.............  Abortion.
57460..........................  Bx of cervix w/scope, leep.......................  59870.............  Evacuate mole of uterus.
57461..........................  Conz of cervix w/scope, leep.....................  64430.............  N block inj, pudendal.
57500..........................  Biopsy of cervix.................................  64435.............  N block inj, paracervical.
57505..........................  Endocervical curettage...........................  64360.............  Injection treatment of nerve.
57510..........................  Cauterization of cervix..........................  75960.............  Transcath iv stent rs&i.
57511..........................  Cryocautery of cervix............................  77051.............  Computer dx mammogram add-on.
57513..........................  Laser surgery of cervix..........................  77052.............  Comp screen mammogram add-on.
57520..........................  Conization of cervix.............................  77080.............  Dxa bone density, axial.
57522..........................  Conization of cervix.............................  77081.............  Dxa bone density/peripheral.
57530..........................  Removal of cervix................................  77082.............  Dxa bone density, vert fx.
57531..........................  Removal of cervix, radical.......................  78206.............  Liver image (3d) with flow.
57540..........................  Removal of residual cervix.......................  78600.............  Brain imaging, ltd static.
57545..........................  Remove cervix/repair pelvis......................  78601.............  Brain imaging, ltd w/flow.
57550..........................  Removal of residual cervix.......................  78605.............  Brain imaging, complete.
57555..........................  Remove cervix/repair vagina......................  78606.............  Brain imaging, compl w/flow.
57556..........................  Remove cervix, repair bowel......................  78607.............  Brain imaging (3D).
57558..........................  D&c of cervical stump............................  78610.............  Brain flow imaging only.
57700..........................  Revision of cervix...............................  78615.............  Cerebral vascular flow image.
57720..........................  Revision of cervix...............................  78647.............  Cerebrospinal fluid scan.
57800..........................  Dilation of cervical canal.......................  78803.............  Tumor imaging (3D).
58100..........................  Biopsy of uterus lining..........................  78807.............  Nuclear localization/abscess.
58110..........................  Bx done w/colposcopy add-on......................  93501.............  Right heart catheterization.
58120..........................  Dilation and curettage...........................  93503.............  Insert/place heart catheter.
58140..........................  Myomectomy abdom method..........................  93505.............  Biopsy of heart lining.
58145..........................  Myomectomy vag method............................  93508.............  Cath placement, angiography.
58146..........................  Myomectomy abdom complex.........................  93510.............  Left heart catheterization.
58150..........................  Total hysterectomy...............................  93511.............  Left heart catheterization.
58152..........................  Total hysterectomy...............................  93514.............  Left heart catheterization.
58180..........................  Partial hysterectomy.............................  93524.............  Left heart catheterization.
58200..........................  Extensive hysterectomy...........................  93526.............  Rt & Lt heart catheters.
58210..........................  Extensive hysterectomy...........................  93527.............  Rt & Lt heart catheters.
58240..........................  Removal of pelvis contents.......................  93528.............  Rt & Lt heart catheters.
58260..........................  Vaginal hysterectomy.............................  93529.............  Rt, lt heart catheterization.
58262..........................  Vag hyst including t/o...........................  93530.............  Rt heart cath, congenital.
58263..........................  Vag hyst w/t/o & vag repair......................  93531.............  R & l heart cath, congenital.
58267..........................  Vag hyst w/urinary repair........................  93532.............  R & l heart cath, congenital.
58270..........................  Vag hyst w/enterocele repair.....................  93533.............  R & l heart cath, congenital.
58275..........................  Hysterectomy/revise vagina.......................  93539.............  Injection, cardiac cath.
58280..........................  Hysterectomy/revise vagina.......................  93540.............  Injection, cardiac cath.
58285..........................  Extensive hysterectomy...........................  93541.............  Injection for lung angiogram.
58290..........................  Vag hyst complex.................................  93542.............  Injection for heart x-rays.
58291..........................  Vag hyst incl t/o, complex.......................  93543.............  Injection for heart x-rays.
58292..........................  Vag hyst t/o & repair, compl.....................  93544.............  Injection for aortography.
58293..........................  Vag hyst w/uro repair, compl.....................  93545.............  Inject for coronary x-rays.
58294..........................  Vag hyst w/enterocele, compl.....................  93555.............  Imaging, cardiac cath.
58340..........................  Catheter for hysterography.......................  93556.............  Imaging, cardiac cath.
58345..........................  Reopen fallopian tube............................  93561.............  Cardiac output measurement.
58346..........................  Insert heyman uteri capsule......................  93562.............  Cardiac output measurement.
58350..........................  Reopen fallopian tube............................  93571.............  Heart flow reserve measure.
58353..........................  Endometr ablate, thermal.........................  93572.............  Heart flow reserve measure.
58555..........................  Hysteroscopy, dx, sep proc.......................
58356..........................  Endometrial cryoablation.........................
58400..........................  Suspension of uterus.............................

[[Page 38364]]

 
58410..........................  Suspension of uterus.............................
58520..........................  Repair of ruptured uterus........................
58540..........................  Revision of uterus...............................
58541..........................  Lsh, uterus 250 g or less........................
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 38365]]


                         Addendum D.--Proposed 2008 Geographic Adjustment Factors (GAFs)
----------------------------------------------------------------------------------------------------------------
             Carrier               Locality             Locality name             2008 GAF   2007 GAF   % change
----------------------------------------------------------------------------------------------------------------
31140...........................         06  San Mateo, CA.....................      1.231      1.259     -2.19%
31140...........................         05  San Francisco, CA.................      1.228      1.256     -2.19%
31140...........................         09  Santa Clara, CA...................      1.206      1.265     -4.63%
00803...........................         01  Manhattan, NY.....................      1.174      1.184     -0.84%
00803...........................         02  NYC Suburbs/Long I., NY...........      1.171       1.18     -0.73%
31140...........................         07  Oakland/Berkley, CA...............      1.154      1.177     -1.94%
31143...........................         01  Metropolitan Boston...............      1.143      1.153     -0.85%
14330...........................         04  Queens, NY........................      1.137      1.144     -0.62%
31140...........................         03  Marin/Napa/Solano, CA.............      1.133      1.154     -1.84%
00805...........................         01  Northern NJ.......................      1.130      1.126      0.39%
00903...........................         01  DC + MD/VA Suburbs................      1.127      1.132     -0.47%
31146...........................         26  Anaheim/Santa Ana, CA.............      1.124       1.12      0.35%
31146...........................         17  Ventura, CA.......................      1.102      1.084      1.69%
31146...........................         18  Los Angeles, CA...................      1.100      1.088      1.14%
00591...........................         00  Connecticut.......................      1.096      1.091      0.42%
00952...........................         12  Chicago, IL.......................      1.093      1.102     -0.78%
00590...........................         04  Miami, FL.........................      1.092      1.069      2.17%
00953...........................         01  Detroit, MI.......................      1.091       1.11     -1.71%
00805...........................         99  Rest of New Jersey................      1.078      1.074      0.37%
00952...........................         16  Suburban Chicago, IL..............      1.074      1.085     -0.99%
00865...........................         01  Metropolitan Philadelphia, PA.....      1.072      1.069      0.30%
00836...........................         02  Seattle (King Cnty), WA...........      1.046      1.058     -1.17%
00831...........................         01  Alaska............................      1.045      1.055     -0.94%
00833...........................         01  Hawaii/Guam.......................      1.044      1.044     -0.03%
31143...........................         99  Rest of Massachusetts.............      1.042      1.042     -0.03%
00803...........................         03  Poughkpsie/N NYC Suburbs, NY......      1.040      1.046     -0.54%
00901...........................         01  Baltimore/Surr. Cntys, MD.........      1.037      1.039     -0.21%
00590...........................         03  Fort Lauderdale, FL...............      1.033      1.015      1.79%
00524...........................         01  Rhode Island......................      1.031      1.016      1.44%
00511...........................         01  Atlanta, GA.......................      1.024      1.043     -1.82%
00900...........................         11  Dallas, TX........................      1.022      1.035     -1.24%
00900...........................         18  Houston, TX.......................      1.021      1.026     -0.49%
00834...........................         00  Nevada............................      1.020      1.023     -0.32%
31140...........................         99  Rest of California*...............      1.014      1.017     -0.28%
31146...........................         99  Rest of California*...............      1.014      1.017     -0.28%
00902...........................         01  Delaware..........................      1.012      1.011      0.10%
00900...........................         31  Austin, TX........................      1.001      1.015     -1.40%
00835...........................         01  Portland, OR......................      0.996      1.005     -0.88%
00900...........................         09  Brazoria, TX......................      0.995      1.005     -0.98%
00528...........................         01  New Orleans, LA...................      0.993      0.976      1.76%
31144...........................         40  New Hampshire.....................      0.993          1     -0.69%
00952...........................         15  East St. Louis, IL................      0.993      0.995     -0.24%
00900...........................         28  Fort Worth, TX....................      0.989      0.996     -0.65%
00973...........................         50  Virgin Islands....................      0.989      0.989     -0.03%
00900...........................         15  Galveston, TX.....................      0.986      0.985      0.07%
00824...........................         01  Colorado..........................      0.983      0.991     -0.81%
00901...........................         99  Rest of Maryland..................      0.981      0.978      0.31%
31142...........................         03  Southern Maine....................      0.981      0.981     -0.03%
03102...........................         00  Arizona...........................      0.980      0.993     -1.29%
00523...........................         01  Metropolitan Kansas City, MO......      0.980      0.982     -0.23%
00590...........................         99  Rest of Florida...................      0.978      0.968      0.98%
00953...........................         99  Rest of Michigan..................      0.976      0.984     -0.81%
00836...........................         99  Rest of Washington................      0.973      0.977     -0.37%
00740...........................         02  Metropolitan St. Louis, MO........      0.971      0.974     -0.27%
00883...........................         00  Ohio..............................      0.969      0.965      0.46%
00954...........................         00  Minnesota.........................      0.967      0.975     -0.85%
00865...........................         99  Rest of Pennsylvania..............      0.956      0.946      1.08%
31145...........................         50  Vermont...........................      0.953      0.951      0.22%
00904...........................         00  Virginia..........................      0.950      0.948      0.19%
03502...........................         09  Utah..............................      0.948      0.947      0.08%
00900...........................         20  Beaumont, TX......................      0.946      0.942      0.44%
00801...........................         99  Rest of New York..................      0.946       0.95     -0.45%
00884...........................         16  Wisconsin.........................      0.943       0.95     -0.77%
00952...........................         99  Rest of Illinois..................      0.941      0.938      0.29%
05535...........................         00  North Carolina....................      0.937      0.936      0.13%
00521...........................         05  New Mexico........................      0.937      0.932      0.49%
00630...........................         00  Indiana...........................      0.935       0.93      0.58%
00511...........................         99  Rest of Georgia...................      0.932      0.932     -0.03%
00900...........................         99  Rest of Texas.....................      0.931      0.929      0.23%
00835...........................         99  Rest of Oregon....................      0.930      0.929      0.09%
00951...........................         00  West Virginia.....................      0.926      0.927     -0.09%

[[Page 38366]]

 
00528...........................         99  Rest of Louisiana.................      0.923      0.919      0.45%
05440...........................         35  Tennessee.........................      0.923      0.921      0.20%
00880...........................         01  South Carolina....................      0.920      0.917      0.37%
00650...........................         00  Kansas*...........................      0.917      0.919     -0.20%
00740...........................         04  Kansas*...........................      0.917      0.919     -0.20%
31142...........................         99  Rest of Maine.....................      0.915      0.916     -0.15%
00660...........................         00  Kentucky..........................      0.912      0.915     -0.31%
00510...........................         00  Alabama...........................      0.910      0.914     -0.41%
05130...........................         00  Idaho.............................      0.909      0.905      0.47%
03602...........................         21  Wyoming...........................      0.907       0.91     -0.32%
00826...........................         00  Iowa..............................      0.906      0.905      0.10%
00512...........................         00  Mississippi.......................      0.903      0.898      0.54%
00655...........................         00  Nebraska..........................      0.902      0.903     -0.15%
03202...........................         01  Montana...........................      0.898      0.902     -0.45%
00522...........................         00  Oklahoma..........................      0.898      0.894      0.40%
00740...........................         99  Rest of Missouri*.................      0.890      0.883      0.78%
03402...........................         02  South Dakota......................      0.890      0.891     -0.17%
00523...........................         99  Rest of Missouri*.................      0.889      0.883      0.71%
03302...........................         01  North Dakota......................      0.888      0.895     -0.82%
00520...........................         13  Arkansas..........................      0.887      0.884      0.39%
00973...........................         20  Puerto Rico.......................      0.789       0.79     -0.18%
----------------------------------------------------------------------------------------------------------------
 GAF equation: (0.52466*work GPCI)+(0.43669*pe GPCI)+(0.03865*mp GPCI)
* designates multiple carriers
 GAF values do not contain a 1.000 floor on physician work GPCI.


[[Page 38367]]


                         Addendum E.--Proposed 2008 *** Geographic Practice Cost Indices (GPCIs) by State and Medicare Locality
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                           2007     2008     2009
       Carrier                Locality              Locality name          Work     Work     Work   2007 PE  2008 PE  2009 PE  2007 MP  2008 MP  2009 MP
                                                                         GPCI **    GPCI     GPCI     GPCI     GPCI     GPCI     GPCI     GPCI     GPCI
--------------------------------------------------------------------------------------------------------------------------------------------------------
00510................  00...................  Alabama..................    0.982    0.982    0.982    0.847    0.850    0.852    0.740    0.622    0.504
00831................  01...................  Alaska...................    1.017    1.018    1.018    1.105    1.097    1.088    1.013    0.835    0.657
03102................  00...................  Arizona..................    0.987    0.988    0.988    0.994    0.975    0.955    1.052    0.944    0.836
00520................  13...................  Arkansas.................    0.961    0.961    0.961    0.832    0.839    0.845    0.431    0.443    0.454
31146................  26...................  Anaheim/Santa Ana, CA....    1.034    1.035    1.035    1.238    1.253    1.267    0.939    0.882    0.825
31146................  18...................  Los Angeles, CA..........    1.041    1.042    1.042    1.158    1.191    1.223    0.939    0.879    0.818
31140................  03...................  Marin/Napa/Solano, CA....    1.035    1.035    1.035    1.342    1.303    1.263    0.640    0.540    0.439
31140................  07...................  Oakland/Berkley, CA......    1.054    1.055    1.055    1.373    1.329    1.284    0.640    0.536    0.432
31140................  05...................  San Francisco, CA........    1.060    1.060    1.060    1.546    1.493    1.439    0.640    0.531    0.421
31140................  06...................  San Mateo, CA............    1.073    1.073    1.073    1.539    1.485    1.431    0.629    0.515    0.401
31140................  09...................  Santa Clara, CA..........    1.083    1.084    1.084    1.543    1.418    1.292    0.595    0.489    0.383
31146................  17...................  Ventura, CA..............    1.028    1.028    1.028    1.181    1.222    1.263    0.732    0.756    0.779
31140................  99...................  Rest of California *.....    1.007    1.008    1.008    1.054    1.055    1.056    0.721    0.640    0.558
31146................  99...................  Rest of California *.....    1.007    1.008    1.008    1.054    1.055    1.056    0.721    0.640    0.558
00824................  01...................  Colorado.................    0.986    0.986    0.986    1.015    1.003    0.990    0.790    0.721    0.652
00591................  00...................  Connecticut..............    1.038    1.039    1.039    1.172    1.178    1.183    0.886    0.942    0.997
00903................  01...................  DC + MD/VA Suburbs.......    1.048    1.048    1.048    1.252    1.234    1.216    0.911    0.981    1.050
00902................  01...................  Delaware.................    1.012    1.012    1.012    1.020    1.032    1.044    0.877    0.784    0.690
00590................  03...................  Fort Lauderdale, FL......    0.988    0.989    0.989    0.990    1.003    1.016    1.675    1.982    2.288
00590................  04...................  Miami, FL................    1.000    1.001    1.001    1.048    1.058    1.067    2.233    2.727    3.221
00590................  99...................  Rest of Florida..........    0.973    0.973    0.973    0.936    0.937    0.937    1.251    1.502    1.753
00511................  01...................  Atlanta, GA..............    1.010    1.010    1.010    1.091    1.052    1.012    0.950    0.900    0.850
00511................  99...................  Rest of Georgia..........    0.979    0.979    0.979    0.874    0.878    0.882    0.950    0.897    0.843
00833................  01...................  Hawaii/Guam..............    1.005    0.990    0.975    1.113    1.136    1.158    0.787    0.732    0.676
05130................  00...................  Idaho....................    0.968    0.967    0.967    0.869    0.876    0.882    0.452    0.504    0.555
00952................  12...................  Chicago, IL..............    1.025    1.026    1.026    1.128    1.103    1.078    1.837    1.905    1.973
00952................  15...................  East St. Louis, IL.......    0.988    0.989    0.989    0.940    0.929    0.917    1.722    1.773    1.824
00952................  16...................  Suburban Chicago, IL.....    1.018    1.018    1.018    1.117    1.092    1.066    1.626    1.642    1.657
00952................  99...................  Rest of Illinois.........    0.974    0.975    0.975    0.874    0.877    0.879    1.174    1.207    1.240
00630................  00...................  Indiana..................    0.985    0.986    0.986    0.908    0.912    0.916    0.429    0.519    0.609
00826................  00...................  Iowa.....................    0.967    0.966    0.965    0.869    0.869    0.869    0.579    0.510    0.441
00650................  00...................  Kansas *.................    0.968    0.968    0.969    0.880    0.881    0.881    0.709    0.638    0.567
00740................  04...................  Kansas *.................    0.968    0.968    0.969    0.880    0.881    0.881    0.709    0.638    0.567
00660................  00...................  Kentucky.................    0.970    0.969    0.969    0.855    0.857    0.859    0.859    0.761    0.663
00528................  01...................  New Orleans, LA..........    0.986    0.986    0.986    0.947    0.995    1.042    1.178    1.075    0.972
00528................  99...................  Rest of Louisiana........    0.970    0.970    0.970    0.848    0.863    0.877    1.041    0.974    0.907
31142................  03...................  Southern Maine...........    0.980    0.980    0.980    1.014    1.019    1.023    0.626    0.563    0.500
31142................  99...................  Rest of Maine............    0.962    0.962    0.962    0.887    0.889    0.891    0.626    0.563    0.500
00901................  01...................  Baltimore/Surr. Cntys, MD    1.012    1.013    1.013    1.080    1.068    1.055    0.932    1.019    1.105
00901................  99...................  Rest of Maryland.........    0.993    0.994    0.994    0.981    0.981    0.980    0.748    0.819    0.889
31143................  01...................  Metropolitan Boston......    1.030    1.030    1.030    1.331    1.310    1.289    0.810    0.794    0.777
31143................  99...................  Rest of Massachusetts....    1.007    1.008    1.008    1.105    1.105    1.104    0.810    0.794    0.777
00953................  01...................  Detroit, MI..............    1.037    1.037    1.037    1.056    1.047    1.038    2.700    2.320    1.939
00953................  99...................  Rest of Michigan.........    0.997    0.998    0.998    0.922    0.922    0.921    1.494    1.298    1.101
00954................  00...................  Minnesota................    0.991    0.992    0.992    1.006    0.994    0.981    0.404    0.327    0.249
00512................  00...................  Mississippi..............    0.960    0.959    0.959    0.841    0.847    0.853    0.711    0.767    0.822
00523................  01...................  Metropolitan Kansas City,    0.989    0.990    0.990    0.977    0.960    0.943    0.931    1.070    1.208
                                               MO.
00740................  02...................  Metropolitan St. Louis,      0.992    0.993    0.993    0.956    0.943    0.929    0.926    1.010    1.093
                                               MO.
00523................  99...................  Rest of Missouri *.......    0.950    0.950    0.950    0.803    0.812    0.820    0.878    0.946    1.014
00740................  99...................  Rest of Missouri *.......    0.950    0.951    0.952    0.803    0.812    0.820    0.878    0.946    1.014
03202................  01...................  Montana..................    0.950    0.950    0.950    0.845    0.846    0.846    0.889    0.787    0.685
00655................  00...................  Nebraska.................    0.959    0.959    0.959    0.876    0.882    0.888    0.447    0.348    0.249
00834................  00...................  Nevada...................    1.003    1.003    1.003    1.045    1.035    1.024    1.050    1.076    1.102
31144................  40...................  New Hampshire............    0.981    0.982    0.982    1.029    1.033    1.037    0.927    0.699    0.470
00805................  01...................  Northern NJ..............    1.058    1.059    1.059    1.222    1.224    1.226    0.958    1.047    1.135
00805................  99...................  Rest of New Jersey.......    1.043    1.043    1.043    1.121    1.123    1.124    0.958    1.047    1.135
00521................  05...................  New Mexico...............    0.972    0.973    0.973    0.888    0.888    0.888    0.880    0.998    1.115
00803................  01...................  Manhattan, NY............    1.065    1.065    1.065    1.300    1.298    1.296    1.480    1.254    1.027
00803................  02...................  NYC Suburbs/Long I., NY..    1.052    1.052    1.052    1.283    1.285    1.287    1.756    1.506    1.256
00803................  03...................  Poughkpsie/N NYC Suburbs,    1.014    1.015    1.015    1.076    1.076    1.075    1.148    0.992    0.836
                                               NY.
14330................  04...................  Queens, NY...............    1.032    1.033    1.033    1.230    1.234    1.237    1.682    1.462    1.241
00801................  99...................  Rest of New York.........    0.997    0.997    0.997    0.919    0.919    0.919    0.666    0.549    0.432
05535................  00...................  North Carolina...........    0.971    0.972    0.972    0.922    0.923    0.923    0.630    0.638    0.645
03302................  01...................  North Dakota.............    0.946    0.946    0.947    0.861    0.852    0.843    0.593    0.494    0.394
00883................  00...................  Ohio.....................    0.992    0.993    0.993    0.934    0.930    0.925    0.960    1.107    1.253
00522................  00...................  Oklahoma.................    0.964    0.964    0.964    0.856    0.853    0.849    0.376    0.507    0.638
00835................  01...................  Portland, OR.............    1.002    1.003    1.003    1.059    1.036    1.013    0.434    0.457    0.480
00835................  99...................  Rest of Oregon...........    0.968    0.968    0.968    0.927    0.926    0.925    0.434    0.457    0.480
00865................  01...................  Metropolitan                 1.016    1.017    1.017    1.106    1.101    1.095    1.364    1.505    1.645
                                               Philadelphia, PA.
00865................  99...................  Rest of Pennsylvania.....    0.992    0.993    0.993    0.904    0.914    0.923    0.793    0.946    1.099
00973................  20...................  Puerto Rico..............    0.906    0.905    0.904    0.699    0.696    0.693    0.257    0.256    0.254
00524................  01...................  Rhode Island.............    1.045    1.030    1.014    0.991    1.039    1.086    0.895    0.954    1.013
00880................  01...................  South Carolina...........    0.975    0.975    0.975    0.894    0.899    0.904    0.388    0.421    0.454
03402................  02...................  South Dakota.............    0.943    0.942    0.942    0.877    0.870    0.863    0.359    0.393    0.427
05440................  35...................  Tennessee................    0.977    0.978    0.978    0.881    0.884    0.887    0.621    0.620    0.618
00900................  31...................  Austin, TX...............    0.991    0.991    0.991    1.048    1.015    0.981    0.970    0.978    0.986
00900................  20...................  Beaumont, TX.............    0.983    0.984    0.984    0.862    0.868    0.874    1.277    1.323    1.369
00900................  09...................  Brazoria, TX.............    1.020    1.020    1.020    0.963    0.942    0.920    1.277    1.261    1.244
00900................  11...................  Dallas, TX...............    1.009    1.010    1.010    1.064    1.032    0.999    1.044    1.087    1.129
00900................  28...................  Fort Worth, TX...........    0.997    0.998    0.998    0.991    0.971    0.951    1.044    1.087    1.129

[[Page 38368]]

 
00900................  15...................  Galveston, TX............    0.990    0.991    0.991    0.954    0.956    0.957    1.277    1.261    1.244
00900................  18...................  Houston, TX..............    1.016    1.017    1.017    1.016    1.000    0.983    1.276    1.322    1.368
00900................  99...................  Rest of Texas............    0.968    0.968    0.968    0.866    0.872    0.878    1.120    1.102    1.083
03502................  09...................  Utah.....................    0.977    0.977    0.977    0.938    0.922    0.905    0.651    0.848    1.044
31145................  50...................  Vermont..................    0.968    0.968    0.968    0.970    0.976    0.981    0.505    0.501    0.497
00904................  00...................  Virginia.................    0.981    0.982    0.982    0.942    0.941    0.940    0.569    0.619    0.668
00973................  50...................  Virgin Islands...........    0.967    0.982    0.997    1.015    0.996    0.976    0.987    1.007    1.026
00836................  02...................  Seattle (King Cnty), WA..    1.014    1.015    1.015    1.133    1.108    1.083    0.805    0.762    0.718
00836................  99...................  Rest of Washington.......    0.987    0.987    0.988    0.980    0.976    0.972    0.805    0.755    0.705
00951................  00...................  West Virginia............    0.973    0.974    0.974    0.820    0.823    0.826    1.522    1.449    1.376
00884................  16...................  Wisconsin................    0.987    0.988    0.988    0.920    0.920    0.919    0.777    0.597    0.416
03602................  21...................  Wyoming..................    0.956    0.956    0.956    0.855    0.848    0.841    0.920    0.912    0.904
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Indicates multiple carriers.
** 2007 work GPCI does not reflect the 1.000 floor.
*** 2008 GPCIs are the first year of the update transition, 2009 GPCIs are the fully implemented updated GPCI.
2008 GPCIs: \1/2\ the difference between 2007 and 2009 GPCIs.


[[Page 38369]]


  ADDENDUM F--CPT/HCPCS Imaging Codes Defined by Section 5102(b) of the
                                   DRA
------------------------------------------------------------------------
                HCPCS/CPT*                        Short Descriptor
------------------------------------------------------------------------
31620.....................................  Endobronchial us add-on.
37250.....................................  Iv us first vessel add-on.
37251.....................................  Iv us each add vessel add-
                                             on.
51798.....................................  Us urine capacity measure.
70010.....................................  Contrast x-ray of brain.
70015.....................................  Contrast x-ray of brain.
70030.....................................  X-ray eye for foreign body.
70100.....................................  X-ray exam of jaw.
70110.....................................  X-ray exam of jaw.
70120.....................................  X-ray exam of mastoids.
70130.....................................  X-ray exam of mastoids.
70134.....................................  X-ray exam of middle ear.
70140.....................................  X-ray exam of facial bones.
70150.....................................  X-ray exam of facial bones.
70160.....................................  X-ray exam of nasal bones.
70170.....................................  X-ray exam of tear duct.
70190.....................................  X-ray exam of eye sockets.
70200.....................................  X-ray exam of eye sockets.
70210.....................................  X-ray exam of sinuses.
70220.....................................  X-ray exam of sinuses.
70240.....................................  X-ray exam, pituitary
                                             saddle.
70250.....................................  X-ray exam of skull.
70260.....................................  X-ray exam of skull.
70300.....................................  X-ray exam of teeth.
70310.....................................  X-ray exam of teeth.
70320.....................................  Full mouth x-ray of teeth.
70328.....................................  X-ray exam of jaw joint.
70330.....................................  X-ray exam of jaw joints.
70332.....................................  X-ray exam of jaw joint.
70336.....................................  Magnetic image, jaw joint.
70350.....................................  X-ray head for orthodontia.
70355.....................................  Panoramic x-ray of jaws.
70360.....................................  X-ray exam of neck.
70370.....................................  Throat x-ray & fluoroscopy.
70371.....................................  Speech evaluation, complex.
70373.....................................  Contrast x-ray of larynx.
70380.....................................  X-ray exam of salivary
                                             gland.
70390.....................................  X-ray exam of salivary duct.
70450.....................................  Ct head/brain w/o dye.
70460.....................................  Ct head/brain w/dye.
70470.....................................  Ct head/brain w/o & w/dye.
70480.....................................  Ct orbit/ear/fossa w/o dye.
70481.....................................  Ct orbit/ear/fossa w/dye.
70482.....................................  Ct orbit/ear/fossa w/o&w/
                                             dye.
70486.....................................  Ct maxillofacial w/o dye.
70487.....................................  Ct maxillofacial w/dye.
70488.....................................  Ct maxillofacial w/o & w/
                                             dye.
70490.....................................  Ct soft tissue neck w/o dye.
70491.....................................  Ct soft tissue neck w/dye.
70492.....................................  Ct sft tsue nck w/o & w/dye.
70496.....................................  Ct angiography, head.
70498.....................................  Ct angiography, neck.
70540.....................................  Mri orbit/face/neck w/o dye.
70542.....................................  Mri orbit/face/neck w/dye.
70543.....................................  Mri orbt/fac/nck w/o & w/
                                             dye.
70544.....................................  Mr angiography head w/o dye.
70545.....................................  Mr angiography head w/dye.
70546.....................................  Mr angiograph head w/o&w/
                                             dye.
70547.....................................  Mr angiography neck w/o dye.
70548.....................................  Mr angiography neck w/dye.
70549.....................................  Mr angiograph neck w/o&w/
                                             dye.
70551.....................................  Mri brain w/o dye.
70552.....................................  Mri brain w/dye.
70553.....................................  Mri brain w/o & w/dye.
70557.....................................  Mri brain w/o dye.
70558.....................................  Mri brain w/dye.
70559.....................................  Mri brain w/o & w/dye.
71010.....................................  Chest x-ray.
71015.....................................  Chest x-ray.
71020.....................................  Chest x-ray.
71021.....................................  Chest x-ray.
71022.....................................  Chest x-ray.
71023.....................................  Chest x-ray and fluoroscopy.
71030.....................................  Chest x-ray.
71034.....................................  Chest x-ray and fluoroscopy.
71035.....................................  Chest x-ray.
71040.....................................  Contrast x-ray of bronchi.
71060.....................................  Contrast x-ray of bronchi.
71090.....................................  X-ray & pacemaker insertion.
71100.....................................  X-ray exam of ribs.
71101.....................................  X-ray exam of ribs/chest.
71110.....................................  X-ray exam of ribs.
71111.....................................  X-ray exam of ribs/chest.
71120.....................................  X-ray exam of breastbone.
71130.....................................  X-ray exam of breastbone.
71250.....................................  Ct thorax w/o dye.
71260.....................................  Ct thorax w/dye.
71270.....................................  Ct thorax w/o & w/dye.
71275.....................................  Ct angiography, chest.
71550.....................................  Mri chest w/o dye.
71551.....................................  Mri chest w/dye.
71552.....................................  Mri chest w/o & w/dye.
71555.....................................  Mri angio chest w or w/o
                                             dye.
72010.....................................  X-ray exam of spine.
72020.....................................  X-ray exam of spine.
72040.....................................  X-ray exam of neck spine.
72050.....................................  X-ray exam of neck spine.
72052.....................................  X-ray exam of neck spine.
72069.....................................  X-ray exam of trunk spine.
72070.....................................  X-ray exam of thoracic
                                             spine.
72072.....................................  X-ray exam of thoracic
                                             spine.
72074.....................................  X-ray exam of thoracic
                                             spine.
72080.....................................  X-ray exam of trunk spine.
72090.....................................  X-ray exam of trunk spine.
72100.....................................  X-ray exam of lower spine.
72110.....................................  X-ray exam of lower spine.
72114.....................................  X-ray exam of lower spine.
72120.....................................  X-ray exam of lower spine.
72125.....................................  Ct neck spine w/o dye.
72126.....................................  Ct neck spine w/dye.
72127.....................................  Ct neck spine w/o & w/dye.
72128.....................................  Ct chest spine w/o dye.
72129.....................................  Ct chest spine w/dye.
72130.....................................  Ct chest spine w/o & w/dye.
72131.....................................  Ct lumbar spine w/o dye.
72132.....................................  Ct lumbar spine w/dye.
72133.....................................  Ct lumbar spine w/o & w/dye.
72141.....................................  Mri neck spine w/o dye.
72142.....................................  Mri neck spine w/dye.
72146.....................................  Mri chest spine w/o dye.
72147.....................................  Mri chest spine w/dye.
72148.....................................  Mri lumbar spine w/o dye.
72149.....................................  Mri lumbar spine w/dye.
72156.....................................  Mri neck spine w/o & w/dye.
72157.....................................  Mri chest spine w/o & w/dye.
72158.....................................  Mri lumbar spine w/o & w/
                                             dye.
72159.....................................  Mr angio spine w/o&w/dye.
72170.....................................  X-ray exam of pelvis.
72190.....................................  X-ray exam of pelvis.
72191.....................................  Ct angiograph pelv w/o&w/
                                             dye.
72192.....................................  Ct pelvis w/o dye.
72193.....................................  Ct pelvis w/dye.
72194.....................................  Ct pelvis w/o & w/dye.
72195.....................................  Mri pelvis w/o dye.
72196.....................................  Mri pelvis w/dye.
72197.....................................  Mri pelvis w/o & w/dye.
72198.....................................  Mr angio pelvis w/o & w/dye.
72200.....................................  X-ray exam sacroiliac
                                             joints.
72202.....................................  X-ray exam sacroiliac
                                             joints.
72220.....................................  X-ray exam of tailbone.
72240.....................................  Contrast x-ray of neck
                                             spine.
72255.....................................  Contrast x-ray, thorax
                                             spine.
72265.....................................  Contrast x-ray, lower spine.
72270.....................................  Contrast x-ray, spine.
72275.....................................  Epidurography.
72285.....................................  X-ray c/t spine disk.
72291.....................................  Percut vertebroplasty fluor.
72293.....................................  Percut vertebroplasty, ct.
72295.....................................  X-ray of lower spine disk.
73000.....................................  X-ray exam of collar bone.
73010.....................................  X-ray exam of shoulder
                                             blade.
73020.....................................  X-ray exam of shoulder.
73030.....................................  X-ray exam of shoulder.
73040.....................................  Contrast x-ray of shoulder.
73050.....................................  X-ray exam of shoulders.
73060.....................................  X-ray exam of humerus.
73070.....................................  X-ray exam of elbow.
73080.....................................  X-ray exam of elbow.
73085.....................................  Contrast x-ray of elbow.
73090.....................................  X-ray exam of forearm.
73092.....................................  X-ray exam of arm, infant.
73100.....................................  X-ray exam of wrist.
73110.....................................  X-ray exam of wrist.
73115.....................................  Contrast x-ray of wrist.
73120.....................................  X-ray exam of hand.
73130.....................................  X-ray exam of hand.
73140.....................................  X-ray exam of finger(s).
73200.....................................  Ct upper extremity w/o dye.
73201.....................................  Ct upper extremity w/dye.
73202.....................................  Ct uppr extremity w/o&w/dye.
73206.....................................  Ct angio upr extrm w/o&w/
                                             dye.
73218.....................................  Mri upper extremity w/o dye.
73219.....................................  Mri upper extremity w/dye.
73220.....................................  Mri uppr extremity w/o&w/
                                             dye.
73221.....................................  Mri joint upr extrem w/o
                                             dye.
73222.....................................  Mri joint upr extrem w/dye.
73223.....................................  Mri joint upr extr w/o&w/
                                             dye.
73225.....................................  Mr angio upr extr w/o&w/dye.
73500.....................................  X-ray exam of hip.
73510.....................................  X-ray exam of hip.
73520.....................................  X-ray exam of hips.
73525.....................................  Contrast x-ray of hip.
73530.....................................  X-ray exam of hip.
73540.....................................  X-ray exam of pelvis & hips.
73542.....................................  X-ray exam, sacroiliac
                                             joint.
73550.....................................  X-ray exam of thigh.
73560.....................................  X-ray exam of knee, 1 or 2.
73562.....................................  X-ray exam of knee, 3.
73564.....................................  X-ray exam, knee, 4 or more.
73565.....................................  X-ray exam of knees.
73580.....................................  Contrast x-ray of knee
                                             joint.
73590.....................................  X-ray exam of lower leg.
73592.....................................  X-ray exam of leg, infant.
73600.....................................  X-ray exam of ankle.
73610.....................................  X-ray exam of ankle.
73615.....................................  Contrast x-ray of ankle.
73620.....................................  X-ray exam of foot.
73630.....................................  X-ray exam of foot.
73650.....................................  X-ray exam of heel.
73660.....................................  X-ray exam of toe(s).
73700.....................................  Ct lower extremity w/o dye.
73701.....................................  Ct lower extremity w/dye.
73702.....................................  Ct lwr extremity w/o&w/dye.
73706.....................................  Ct angio lwr extr w/o&w/dye.
73718.....................................  Mri lower extremity w/o dye.

[[Page 38370]]

 
73719.....................................  Mri lower extremity w/dye.
73720.....................................  Mri lwr extremity w/o&w/dye.
73721.....................................  Mri jnt of lwr extre w/o
                                             dye.
73722.....................................  Mri joint of lwr extr w/dye.
73723.....................................  Mri joint lwr extr w/o&w/
                                             dye.
73725.....................................  Mr ang lwr ext w or w/o dye.
74000.....................................  X-ray exam of abdomen.
74010.....................................  X-ray exam of abdomen.
74020.....................................  X-ray exam of abdomen.
74022.....................................  X-ray exam series, abdomen.
74150.....................................  Ct abdomen w/o dye.
74160.....................................  Ct abdomen w/dye.
74170.....................................  Ct abdomen w/o & w/dye.
74175.....................................  Ct angio abdom w/o & w/dye.
74181.....................................  Mri abdomen w/o dye.
74182.....................................  Mri abdomen w/dye.
74183.....................................  Mri abdomen w/o & w/dye.
74185.....................................  Mri angio, abdom w orw/o
                                             dye.
74190.....................................  X-ray exam of peritoneum.
74210.....................................  Contrst x-ray exam of
                                             throat.
74220.....................................  Contrast x-ray, esophagus.
74230.....................................  Cine/vid x-ray, throat/
                                             esoph.
74235.....................................  Remove esophagus
                                             obstruction.
74240.....................................  X-ray exam, upper gi tract.
74241.....................................  X-ray exam, upper gi tract.
74245.....................................  X-ray exam, upper gi tract.
74246.....................................  Contrst x-ray uppr gi tract.
74247.....................................  Contrst x-ray uppr gi tract.
74249.....................................  Contrst x-ray uppr gi tract.
74250.....................................  X-ray exam of small bowel.
74251.....................................  X-ray exam of small bowel.
74260.....................................  X-ray exam of small bowel.
74270.....................................  Contrast x-ray exam of
                                             colon.
74280.....................................  Contrast x-ray exam of
                                             colon.
74283.....................................  Contrast x-ray exam of
                                             colon.
74290.....................................  Contrast x-ray, gallbladder.
74291.....................................  Contrast x-rays,
                                             gallbladder.
74300.....................................  X-ray bile ducts/pancreas.
74301.....................................  X-rays at surgery add-on.
74305.....................................  X-ray bile ducts/pancreas.
74320.....................................  Contrast x-ray of bile
                                             ducts.
74327.....................................  X-ray bile stone removal.
74328.....................................  X-ray bile duct endoscopy.
74329.....................................  X-ray for pancreas
                                             endoscopy.
74330.....................................  X-ray bile/panc endoscopy.
74340.....................................  X-ray guide for GI tube.
74350.....................................  X-ray guide, stomach tube.
74355.....................................  X-ray guide, intestinal
                                             tube.
74360.....................................  X-ray guide, GI dilation.
74363.....................................  X-ray, bile duct dilation.
74400.....................................  Contrst x-ray, urinary
                                             tract.
74410.....................................  Contrst x-ray, urinary
                                             tract.
74415.....................................  Contrst x-ray, urinary
                                             tract.
74420.....................................  Contrst x-ray, urinary
                                             tract.
74425.....................................  Contrst x-ray, urinary
                                             tract.
74430.....................................  Contrast x-ray, bladder.
74440.....................................  X-ray, male genital tract.
74445.....................................  X-ray exam of penis.
74450.....................................  X-ray, urethra/bladder.
74455.....................................  X-ray, urethra/bladder.
74470.....................................  X-ray exam of kidney lesion.
74475.....................................  X-ray control, cath insert.
74480.....................................  X-ray control, cath insert.
74485.....................................  X-ray guide, GU dilation.
74710.....................................  X-ray measurement of pelvis.
74740.....................................  X-ray, female genital tract.
74742.....................................  X-ray, fallopian tube.
74775.....................................  X-ray exam of perineum.
75552.....................................  Heart mri for morph w/o dye.
75553.....................................  Heart mri for morph w/dye.
75554.....................................  Cardiac MRI/function.
75555.....................................  Cardiac MRI/limited study.
75556.....................................  Cardiac MRI/flow mapping.
75600.....................................  Contrast x-ray exam of
                                             aorta.
75605.....................................  Contrast x-ray exam of
                                             aorta.
75625.....................................  Contrast x-ray exam of
                                             aorta.
75630.....................................  X-ray aorta, leg arteries.
75635.....................................  Ct angio abdominal arteries.
75650.....................................  Artery x-rays, head & neck.
75658.....................................  Artery x-rays, arm.
75660.....................................  Artery x-rays, head & neck.
75662.....................................  Artery x-rays, head & neck.
75665.....................................  Artery x-rays, head & neck.
75671.....................................  Artery x-rays, head & neck.
75676.....................................  Artery x-rays, neck.
75680.....................................  Artery x-rays, neck.
75685.....................................  Artery x-rays, spine.
75705.....................................  Artery x-rays, spine.
75710.....................................  Artery x-rays, arm/leg.
75716.....................................  Artery x-rays, arms/legs.
75722.....................................  Artery x-rays, kidney.
75724.....................................  Artery x-rays, kidneys.
75726.....................................  Artery x-rays, abdomen.
75731.....................................  Artery x-rays, adrenal
                                             gland.
75733.....................................  Artery x-rays, adrenals.
75736.....................................  Artery x-rays, pelvis.
75741.....................................  Artery x-rays, lung.
75743.....................................  Artery x-rays, lungs.
75746.....................................  Artery x-rays, lung.
75756.....................................  Artery x-rays, chest.
75774.....................................  Artery x-ray, each vessel.
75790.....................................  Visualize A-V shunt.
75801.....................................  Lymph vessel x-ray, arm/leg.
75803.....................................  Lymph vessel x-ray,arms/
                                             legs.
75805.....................................  Lymph vessel x-ray, trunk.
75807.....................................  Lymph vessel x-ray, trunk.
75809.....................................  Nonvascular shunt, x-ray.
75810.....................................  Vein x-ray, spleen/liver.
75820.....................................  Vein x-ray, arm/leg.
75822.....................................  Vein x-ray, arms/legs.
75825.....................................  Vein x-ray, trunk.
75827.....................................  Vein x-ray, chest.
75831.....................................  Vein x-ray, kidney.
75833.....................................  Vein x-ray, kidneys.
75840.....................................  Vein x-ray, adrenal gland.
75842.....................................  Vein x-ray, adrenal glands.
75860.....................................  Vein x-ray, neck.
75870.....................................  Vein x-ray, skull.
75872.....................................  Vein x-ray, skull.
75880.....................................  Vein x-ray, eye socket.
75885.....................................  Vein x-ray, liver.
75887.....................................  Vein x-ray, liver.
75889.....................................  Vein x-ray, liver.
75891.....................................  Vein x-ray, liver.
75893.....................................  Venous sampling by catheter.
75894.....................................  X-rays, transcath therapy.
75896.....................................  X-rays, transcath therapy.
75898.....................................  Follow-up angiography.
75900.....................................  Intravascular cath exchange.
75901.....................................  Remove cva device obstruct.
75902.....................................  Remove cva lumen obstruct.
75940.....................................  X-ray placement, vein
                                             filter.
75945.....................................  Intravascular us.
75946.....................................  Intravascular us add-on.
75953.....................................  Abdom aneurysm endovas rpr.
75956.....................................  Xray, endovasc thor ao repr.
75957.....................................  Xray, endovasc thor ao repr.
75958.....................................  Xray, place prox ext thor
                                             ao.
75959.....................................  Xray, place dist ext thor
                                             ao.
75960.....................................  Transcath iv stent rs&i.
75961.....................................  Retrieval, broken catheter.
75962.....................................  Repair arterial blockage.
75964.....................................  Repair artery blockage,
                                             each.
75966.....................................  Repair arterial blockage.
75968.....................................  Repair artery blockage,
                                             each.
75970.....................................  Vascular biopsy.
75978.....................................  Repair venous blockage.
75980.....................................  Contrast xray exam bile
                                             duct.
75982.....................................  Contrast xray exam bile
                                             duct.
75984.....................................  Xray control catheter
                                             change.
75989.....................................  Abscess drainage under x-
                                             ray.
75992.....................................  Atherectomy, x-ray exam.
76000.....................................  Fluoroscope examination.
76001.....................................  Fluoroscope exam, extensive.
76010.....................................  X-ray, nose to rectum.
76080.....................................  X-ray exam of fistula.
76098.....................................  X-ray exam, breast specimen.
76100.....................................  X-ray exam of body section.
76101.....................................  Complex body section x-ray.
76102.....................................  Complex body section x-rays.
76120.....................................  Cine/video x-rays.
76125.....................................  Cine/video x-rays add-on.
76140.....................................  X-ray consultation.
76150.....................................  X-ray exam, dry process.
76350.....................................  Special x-ray contrast
                                             study.
76376.....................................  3d render w/o postprocess.
76377.....................................  3d rendering w/postprocess.
76380.....................................  CAT scan follow-up study.
76390.....................................  Mr spectroscopy.
76496.....................................  Fluoroscopic procedure.
76497.....................................  Ct procedure.
76498.....................................  Mri procedure.
76506.....................................  Echo exam of head.
76510.....................................  Ophth us, b & quant a.
76511.....................................  Ophth us, quant a only.
76512.....................................  Ophth us, b w/non-quant a.
76513.....................................  Echo exam of eye, water
                                             bath.
76514.....................................  Echo exam of eye, thickness.
76516.....................................  Echo exam of eye.
76519.....................................  Echo exam of eye.
76529.....................................  Echo exam of eye.
76536.....................................  Us exam of head and neck.
76604.....................................  Us exam, chest, b-scan.
76645.....................................  Us exam, breast(s).
76700.....................................  Us exam, abdom, complete.
76705.....................................  Echo exam of abdomen.
76770.....................................  Us exam abdo back wall,
                                             comp.
76775.....................................  Us exam abdo back wall, lim.
76778.....................................  Us exam kidney transplant.
76800.....................................  Us exam, spinal canal.
76801.....................................  Ob us < 14 wks, single
                                             fetus.
76802.....................................  Ob us < 14 wks, add?l fetus.
76805.....................................  Ob us >= 14 wks, sngl fetus.
76810.....................................  Ob us >= 14 wks, addl fetus.
76811.....................................  Ob us, detailed, sngl fetus.
76812.....................................  Ob us, detailed, addl fetus.
76815.....................................  Ob us, limited, fetus(s).
76816.....................................  Ob us, follow-up, per fetus.
76817.....................................  Transvaginal us, obstetric.
76818.....................................  Fetal biophys profile w/nst.
76819.....................................  Fetal biophys profil w/o
                                             nst.
76820.....................................  Umbilical artery echo.
76821.....................................  Middle cerebral artery echo.
76825.....................................  Echo exam of fetal heart.
76826.....................................  Echo exam of fetal heart.

[[Page 38371]]

 
76827.....................................  Echo exam of fetal heart.
76828.....................................  Echo exam of fetal heart.
76830.....................................  Transvaginal us, non-ob.
76831.....................................  Echo exam, uterus.
76856.....................................  Us exam, pelvic, complete.
76857.....................................  Us exam, pelvic, limited.
76870.....................................  Us exam, scrotum.
76872.....................................  Us, transrectal.
76873.....................................  Echograp trans r, pros
                                             study.
76880.....................................  Us exam, extremity.
76885.....................................  Us exam infant hips,
                                             dynamic.
76886.....................................  Us exam infant hips, static.
76930.....................................  Echo guide, cardiocentesis.
76932.....................................  Echo guide for heart biopsy.
76936.....................................  Echo guide for artery
                                             repair.
76937.....................................  Us guide, vascular access.
76940.....................................  Us guide, tissue ablation.
76941.....................................  Echo guide for transfusion.
76942.....................................  Echo guide for biopsy.
76945.....................................  Echo guide, villus sampling.
76946.....................................  Echo guide for
                                             amniocentesis.
76948.....................................  Echo guide, ova aspiration.
76950.....................................  Echo guidance radiotherapy.
76965.....................................  Echo guidance radiotherapy.
76970.....................................  Ultrasound exam follow-up.
76975.....................................  GI endoscopic ultrasound.
76977.....................................  Us bone density measure.
76998.....................................  Ultrasound guide intraoper.
77001.....................................  Fluoroguide for vein device.
77002.....................................  Needle localization by x-
                                             ray.
77003.....................................  Fluoroguide for spine
                                             inject.
77011.....................................  Ct scan for localization.
77012.....................................  Ct scan for needle biopsy.
77013.....................................  Ct guide for tissue
                                             ablation.
77014.....................................  Ct scan for therapy guide.
77021.....................................  Mr guidance for needle
                                             place.
77022.....................................  Mri for tissue ablation.
77031.....................................  Stereotactic breast biopsy.
77032.....................................  X-ray of needle wire,
                                             breast.
77053.....................................  X-ray of mammary duct.
77054.....................................  X-ray of mammary ducts.
77058.....................................  Magnetic image, breast.
77059.....................................  Magnetic image, both
                                             breasts.
77071.....................................  X-ray stress view.
77072.....................................  X-rays for bone age.
77073.....................................  X-rays, bone evaluation.
77074.....................................  X-rays, bone survey.
77075.....................................  X-rays, bone survey.
77076.....................................  X-rays, bone evaluation.
77077.....................................  Joint survey, single view.
77078.....................................  Ct bone density, axial.
77079.....................................  Ct bone density, peripheral.
77080.....................................  Dxa bone density, axial.
77081.....................................  Dxa bone density/peripheral.
77082.....................................  Dxa bone density/v-fracture.
77083.....................................  Radiographic absorptiometry.
77084.....................................  Magnetic image, bone marrow.
77417.....................................  Radiology port film(s).
77421.....................................  Stereoscopic x-ray guidance.
78006.....................................  Thyroid imaging with uptake.
78007.....................................  Thyroid image, mult uptakes.
78010.....................................  Thyroid imaging.
78011.....................................  Thyroid imaging with flow.
78015.....................................  Thyroid met imaging.
78016.....................................  Thyroid met imaging/studies.
78018.....................................  Thyroid met imaging, body.
78020.....................................  Thyroid met uptake.
78070.....................................  Parathyroid nuclear imaging.
78075.....................................  Adrenal nuclear imaging.
78102.....................................  Bone marrow imaging, ltd.
78103.....................................  Bone marrow imaging, mult.
78104.....................................  Bone marrow imaging, body.
78135.....................................  Red cell survival kinetics.
78140.....................................  Red cell sequestration.
78185.....................................  Spleen imaging.
78190.....................................  Platelet survival, kinetics.
78195.....................................  Lymph system imaging.
78201.....................................  Liver imaging.
78202.....................................  Liver imaging with flow.
78205.....................................  Liver imaging (3D).
78206.....................................  Liver image (3d) with flow.
78215.....................................  Liver and spleen imaging.
78216.....................................  Liver & spleen image/flow.
78220.....................................  Liver function study.
78223.....................................  Hepatobiliary imaging.
78230.....................................  Salivary gland imaging.
78231.....................................  Serial salivary imaging.
78232.....................................  Salivary gland function
                                             exam.
78258.....................................  Esophageal motility study.
78261.....................................  Gastric mucosa imaging.
78262.....................................  Gastroesophageal reflux
                                             exam.
78264.....................................  Gastric emptying study.
78278.....................................  Acute GI blood loss imaging.
78282.....................................  GI protein loss exam.
78290.....................................  Meckel?s divert exam.
78291.....................................  Leveen/shunt patency exam.
78300.....................................  Bone imaging, limited area.
78305.....................................  Bone imaging, multiple
                                             areas.
78306.....................................  Bone imaging, whole body.
78315.....................................  Bone imaging, 3 phase.
78320.....................................  Bone imaging (3D).
78350.....................................  Bone mineral, single photon.
78351.....................................  Bone mineral, dual photon.
78428.....................................  Cardiac shunt imaging.
78445.....................................  Vascular flow imaging.
78456.....................................  Acute venous thrombus image.
78457.....................................  Venous thrombosis imaging.
78458.....................................  Ven thrombosis images,
                                             bilat.
78459.....................................  Heart muscle imaging (PET).
78460.....................................  Heart muscle blood, single.
78461.....................................  Heart muscle blood,
                                             multiple.
78464.....................................  Heart image (3d), single.
78465.....................................  Heart image (3d), multiple.
78466.....................................  Heart infarct image.
78468.....................................  Heart infarct image (ef).
78469.....................................  Heart infarct image (3D).
78472.....................................  Gated heart, planar, single.
78473.....................................  Gated heart, multiple.
78478.....................................  Heart wall motion add-on.
78480.....................................  Heart function add-on.
78481.....................................  Heart first pass, single.
78483.....................................  Heart first pass, multiple.
78491.....................................  Heart image (pet), single.
78492.....................................  Heart image (pet), multiple.
78494.....................................  Heart image, spect.
78496.....................................  Heart first pass add-on.
78580.....................................  Lung perfusion imaging.
78584.....................................  Lung V/Q image single
                                             breath.
78585.....................................  Lung V/Q imaging.
78586.....................................  Aerosol lung image, single.
78587.....................................  Aerosol lung image,
                                             multiple.
78588.....................................  Perfusion lung image.
78591.....................................  Vent image, 1 breath, 1
                                             proj.
78593.....................................  Vent image, 1 proj, gas.
78594.....................................  Vent image, mult proj, gas.
78596.....................................  Lung differential function.
78600.....................................  Brain imaging, ltd static.
78601.....................................  Brain imaging, ltd w/flow.
78605.....................................  Brain imaging, complete.
78606.....................................  Brain imaging, compl w/flow.
78607.....................................  Brain imaging (3D).
78608.....................................  Brain imaging (PET).
78609.....................................  Brain imaging (PET).
78610.....................................  Brain flow imaging only.
78615.....................................  Cerebral vascular flow
                                             image.
78630.....................................  Cerebrospinal fluid scan.
78635.....................................  CSF ventriculography.
78645.....................................  CSF shunt evaluation.
78647.....................................  Cerebrospinal fluid scan.
78650.....................................  CSF leakage imaging.
78660.....................................  Nuclear exam of tear flow.
78700.....................................  Kidney imaging, static.
78701.....................................  Kidney imaging with flow.
78704.....................................  Imaging renogram.
78707.....................................  Kidney flow/function image.
78708.....................................  Kidney flow/function image.
78709.....................................  Kidney flow/function image.
78710.....................................  Kidney imaging (3D).
78715.....................................  Renal vascular flow exam.
78730.....................................  Urinary bladder retention.
78740.....................................  Ureteral reflux study.
78760.....................................  Testicular imaging.
78761.....................................  Testicular imaging/flow.
78800.....................................  Tumor imaging, limited area.
78801.....................................  Tumor imaging, mult areas.
78802.....................................  Tumor imaging, whole body.
78803.....................................  Tumor imaging (3D).
78804.....................................  Tumor imaging, whole body.
78805.....................................  Abscess imaging, ltd area.
78806.....................................  Abscess imaging, whole body.
78807.....................................  Nuclear localization/
                                             abscess.
78811.....................................  Tumor imaging (pet),
                                             limited.
78812.....................................  Tumor image (pet)/skul-
                                             thigh.
78813.....................................  Tumor image (pet) full body.
78814.....................................  Tumor image pet/ct, limited.
78815.....................................  Tumorimage pet/ct skul-
                                             thigh.
78816.....................................  Tumor image pet/ct full
                                             body.
78890.....................................  Nuclear medicine data proc.
78891.....................................  Nuclear med data proc.
92135.....................................  Opthalmic dx imagingt.
92235.....................................  Eye exam with photos.
92240.....................................  Icg angiography.
92250.....................................  Eye exam with photos.
92285.....................................  Eye photography.
92286.....................................  Internal eye photography.
93303.....................................  Echo transthoracic.
93304.....................................  Echo transthoracic.
93307.....................................  Echo exam of heart.
93308.....................................  Echo exam of heart.
93312.....................................  Echo transesophageal.
93313.....................................  Echo transesophageal.
93314.....................................  Echo transesophageal.
93315.....................................  Echo transesophageal.
93316.....................................  Echo transesophageal.
93317.....................................  Echo transesophageal.
93318.....................................  Echo transesophageal
                                             intraop.
93320.....................................  Doppler echo exam, heart.
93321.....................................  Doppler echo exam, heart.
93325.....................................  Doppler color flow add-on.
93350.....................................  Echo transthoracic.
93555.....................................  Imaging, cardiac cath.
93556.....................................  Imaging, cardiac cath.
93571.....................................  Heart flow reserve measure.
93572.....................................  Heart flow reserve measure.
93880.....................................  Extracranial study.
93882.....................................  Extracranial study.
93886.....................................  Intracranial study.

[[Page 38372]]

 
93888.....................................  Intracranial study.
93890.....................................  Tcd, vasoreactivity study.
93892.....................................  Tcd, emboli detect w/o inj.
93893.....................................  Tcd, emboli detect w/inj.
93925.....................................  Lower extremity study.
93926.....................................  Lower extremity study.
93930.....................................  Upper extremity study.
93931.....................................  Upper extremity study.
93970.....................................  Extremity study.
93971.....................................  Extremity study.
93975.....................................  Vascular study.
93976.....................................  Vascular study.
93978.....................................  Vascular study.
93979.....................................  Vascular study.
93980.....................................  Penile vascular study.
93981.....................................  Penile vascular study.
93990.....................................  Doppler flow testing.
0028T.....................................  Dexa body composition study.
0042T.....................................  Ct perfusion w/contrast,
                                             cbf.
0066T.....................................  Ct colonography;screen.
0067T.....................................  Ct colonography;dx.
0080T.....................................  Endovasc aort repr rad s&i.
0081T.....................................  Endovasc visc extnsn s&i.
0144T.....................................  CT heart wo dye; qual calc.
0145T.....................................  CT heart w/wo dye funct.
0146T.....................................  CCTA w/wo dye.
0147T.....................................  CCTA w/wo, quan calcium.
0148T.....................................  CCTA w/wo, strxr.
0149T.....................................  CCTA w/wo, strxr quan calc.
0150T.....................................  CCTA w/wo, disease strxr.
0151T.....................................  CT heart funct add-on.
0152T.....................................  Computer chest add-on.
G0120.....................................  Colon ca scrn; barium enema.
G0122.....................................  Colon ca scrn; barium enema.
G0130.....................................  Single energy x-ray study.
G0219.....................................  PET img wholbod melano
                                             nonco.
G0235.....................................  PET not otherwise specified.
G0275.....................................  Renal angio, cardiac cath.
G0278.....................................  Iliac art angio,cardiac
                                             cath.
G0288.....................................  Recon, CTA for surg plan.
G0365.....................................  Vessel mapping hemo access.
------------------------------------------------------------------------
*CPT codes and descriptions only are copyright 2006 American Medical
  Association. All rights reserved. Applicable FARS/DFARS apply.


[[Page 38373]]


   Addendum G.--FY 2008 Wage Index for Urban Areas Based on CBSA Labor
                              Market Areas
------------------------------------------------------------------------
                                                                   Wage
    CBSA code           Urban area  (constituent counties)        index
------------------------------------------------------------------------
10180............  Abilene, TX.................................   0.8395
                    Callahan County, TX........................
                    Jones County, TX...........................
                    Taylor County, TX..........................
10380............  Aguadilla-Isabela-San Sebasti[aacute]n, PR..   0.7912
                    Aguada Municipio, PR.......................
                    Aguadilla Municipio, PR....................
                    A[ntilde]asco Municipio, PR................
                    Isabela Municipio, PR......................
                    Lares Municipio, PR........................
                    Moca Municipio, PR.........................
                    Rinc[oacute]n Municipio, PR................
                    San Sebasti[aacute]n Municipio, PR.........
10420............  Akron, OH...................................   0.9278
                    Portage County, OH.........................
                    Summit County, OH..........................
10500............  Albany, GA..................................   0.8983
                    Baker County, GA...........................
                    Dougherty County, GA.......................
                    Lee County, GA.............................
                    Terrell County, GA.........................
                    Worth County, GA...........................
10580............  Albany-Schenectady-Troy, NY.................   0.9061
                    Albany County, NY..........................
                    Rensselaer County, NY......................
                    Saratoga County, NY........................
                    Schenectady County, NY.....................
                    Schoharie County, NY.......................
10740............  Albuquerque, NM.............................   1.0095
                    Bernalillo County, NM......................
                    Sandoval County, NM........................
                    Torrance County, NM........................
                    Valencia County, NM........................
10780............  Alexandria, LA..............................   0.8420
                    Grant Parish, LA...........................
                    Rapides Parish, LA.........................
10900............  Allentown-Bethlehem-Easton, PA-NJ...........   1.0410
                    Warren County, NJ..........................
                    Carbon County, PA..........................
                    Lehigh County, PA..........................
                    Northampton County, PA.....................
11020............  Altoona, PA.................................   0.9094
                    Blair County, PA...........................
11100............  Amarillo, TX................................   0.9601
                    Armstrong County, TX.......................
                    Carson County, TX..........................
                    Potter County, TX..........................
                    Randall County, TX.........................
11180............  Ames, IA....................................   1.0600
                    Story County, IA...........................
11260............  Anchorage, AK...............................   1.2570
                    Anchorage Municipality, AK.................
                    Matanuska-Susitna Borough, AK..............
11300............  Anderson, IN................................   0.9313
                    Madison County, IN.........................
11340............  Anderson, SC................................   0.9587
                    Anderson County, SC........................
11460............  Ann Arbor, MI...............................   1.1120
                    Washtenaw County, MI.......................
11500............  Anniston-Oxford, AL.........................   0.8363
                    Calhoun County, AL.........................
11540............  Appleton, WI................................   1.0161
                    Calumet County, WI.........................
                    Outagamie County, WI.......................
11700............  Asheville, NC...............................   0.9695
                    Buncombe County, NC........................
                    Haywood County, NC.........................
                    Henderson County, NC.......................
                    Madison County, NC.........................
12020............  Athens-Clarke County, GA....................   1.1695
                    Clarke County, GA..........................

[[Page 38374]]

 
                    Madison County, GA.........................
                    Oconee County, GA..........................
                    Oglethorpe County, GA......................
12060............  Atlanta-Sandy Springs-Marietta, GA..........   1.0401
                    Barrow County, GA..........................
                    Bartow County, GA..........................
                    Butts County, GA...........................
                    Carroll County, GA.........................
                    Cherokee County, GA........................
                    Clayton County, GA.........................
                    Cobb County, GA............................
                    Coweta County, GA..........................
                    Dawson County, GA..........................
                    DeKalb County, GA..........................
                    Douglas County, GA.........................
                    Fayette County, GA.........................
                    Forsyth County, GA.........................
                    Fulton County, GA..........................
                    Gwinnett County, GA........................
                    Haralson County, GA........................
                    Heard County, GA...........................
                    Henry County, GA...........................
                    Jasper County, GA..........................
                    Lamar County, GA...........................
                    Meriwether County, GA......................
                    Newton County, GA..........................
                    Paulding County, GA........................
                    Pickens County, GA.........................
                    Pike County, GA............................
                    Rockdale County, GA........................
                    Spalding County, GA........................
                    Walton County, GA..........................
12100............  Atlantic City, NJ...........................   1.2870
                    Atlantic County, NJ........................
12220............  Auburn-Opelika, AL..........................   0.8544
                    Lee County, AL.............................
12260............  Augusta-Richmond County, GA-SC..............   1.0173
                    Burke County, GA...........................
                    Columbia County, GA........................
                    McDuffie County, GA........................
                    Richmond County, GA........................
                    Aiken County, SC...........................
                    Edgefield County, SC.......................
12420............  Austin-Round Rock, TX.......................   1.0082
                    Bastrop County, TX.........................
                    Caldwell County, TX........................
                    Hays County, TX............................
                    Travis County, TX..........................
                    Williamson County, TX......................
12540............  Bakersfield, CA.............................   1.1840
                    Kern County, CA............................
12580............  Baltimore-Towson, MD........................   1.0770
                    Anne Arundel County, MD....................
                    Baltimore County, MD.......................
                    Carroll County, MD.........................
                    Harford County, MD.........................
                    Howard County, MD..........................
                    Queen Anne's County, MD....................
                    Baltimore City, MD.........................
12620............  Bangor, ME..................................   1.0499
                    Penobscot County, ME.......................
12700............  Barnstable Town, MA.........................   1.3298
                    Barnstable County, MA......................
12940............  Baton Rouge, LA.............................   0.8478
                    Ascension Parish, LA.......................
                    East Baton Rouge Parish, LA................
                    East Feliciana Parish, LA..................
                    Iberville Parish, LA.......................
                    Livingston Parish, LA......................
                    Pointe Coupee Parish, LA...................
                    St. Helena Parish, LA......................

[[Page 38375]]

 
                    West Baton Rouge Parish, LA................
                    West Feliciana Parish, LA..................
12980............  Battle Creek, MI............................   1.0723
                    Calhoun County, MI.........................
13020............  Bay City, MI................................   0.9388
                    Bay County, MI.............................
13140............  Beaumont-Port Arthur, TX....................   0.8966
                    Hardin County, TX..........................
                    Jefferson County, TX.......................
                    Orange County, TX..........................
13380............  Bellingham, WA..............................   1.2107
                    Whatcom County, WA.........................
13460............  Bend, OR....................................   1.1545
                    Deschutes County, OR.......................
13644............  Bethesda-Frederick-Gaithersburg, MD.........   1.1091
                    Frederick County, MD.......................
                    Montgomery County, MD......................
13740............  Billings, MT................................   0.9146
                    Carbon County, MT..........................
                    Yellowstone County, MT.....................
13780............  Binghamton, NY..............................   0.9443
                    Broome County, NY..........................
                    Tioga County, NY...........................
13820............  Birmingham-Hoover, AL.......................   0.9401
                    Bibb County, AL............................
                    Blount County, AL..........................
                    Chilton County, AL.........................
                    Jefferson County, AL.......................
                    St. Clair County, AL.......................
                    Shelby County, AL..........................
                    Walker County, AL..........................
13900............  Bismarck, ND................................   0.7912
                    Burleigh County, ND........................
                    Morton County, ND..........................
13980............  Blacksburg-Christiansburg-Radford, VA.......   0.8583
                    Giles County, VA...........................
                    Montgomery County, VA......................
                    Pulaski County, VA.........................
                    Radford City, VA...........................
14020............  Bloomington, IN.............................   0.9406
                    Greene County, IN..........................
                    Monroe County, IN..........................
                    Owen County, IN............................
14060............  Bloomington-Normal, IL......................   0.9839
                    McLean County, IL..........................
14260............  Boise City-Nampa, ID........................   0.9987
                    Ada County, ID.............................
                    Boise County, ID...........................
                    Canyon County, ID..........................
                    Gem County, ID.............................
                    Owyhee County, ID..........................
14484............  Boston-Quincy, MA...........................   1.2289
                    Norfolk County, MA.........................
                    Plymouth County, MA........................
                    Suffolk County, MA.........................
14500............  Boulder, CO.................................   1.1004
                    Boulder County, CO.........................
14540............  Bowling Green, KY...........................   0.8608
                    Edmonson County, KY........................
                    Warren County, KY..........................
14740............  Bremerton-Silverdale, WA....................   1.1505
                    Kitsap County, WA..........................
14860............  Bridgeport-Stamford-Norwalk, CT.............   1.3544
                    Fairfield County, CT.......................
15180............  Brownsville-Harlingen, TX...................   0.9794
                    Cameron County, TX.........................
15260............  Brunswick, GA...............................   0.9997
                    Brantley County, GA........................
                    Glynn County, GA...........................
                    McIntosh County, GA........................
15380............  Buffalo-Niagara Falls, NY...................   1.0089

[[Page 38376]]

 
                    Erie County, NY............................
                    Niagara County, NY.........................
15500............  Burlington, NC..............................   0.9229
                    Alamance County, NC........................
15540............  Burlington-South Burlington, VT.............   1.0193
                    Chittenden County, VT......................
                    Franklin County, VT........................
                    Grand Isle County, VT......................
15764............  Cambridge-Newton-Framingham, MA.............   1.1783
                    Middlesex County, MA.......................
15804............  Camden, NJ..................................   1.0967
                    Burlington County, NJ......................
                    Camden County, NJ..........................
                    Gloucester County, NJ......................
15940............  Canton-Massillon, OH........................   0.9426
                    Carroll County, OH.........................
                    Stark County, OH...........................
15980............  Cape Coral-Fort Myers, FL...................   0.9913
                    Lee County, FL.............................
16180............  Carson City, NV.............................   0.9868
                    Carson City, NV............................
16220............  Casper, WY..................................   0.9902
                    Natrona County, WY.........................
16300............  Cedar Rapids, IA............................   0.9340
                    Benton County, IA..........................
                    Jones County, IA...........................
                    Linn County, IA............................
16580............  Champaign-Urbana, IL........................   0.9908
                    Champaign County, IL.......................
                    Ford County, IL............................
                    Piatt County, IL...........................
16620............  Charleston, WV..............................   0.8746
                    Boone County, WV...........................
                    Clay County, WV............................
                    Kanawha County, WV.........................
                    Lincoln County, WV.........................
                    Putnam County, WV..........................
16700............  Charleston-North Charleston, SC.............   0.9662
                    Berkeley County, SC........................
                    Charleston County, SC......................
                    Dorchester County, SC......................
16740............  Charlotte-Gastonia-Concord, NC-SC...........   1.0046
                    Anson County, NC...........................
                    Cabarrus County, NC........................
                    Gaston County, NC..........................
                    Mecklenburg County, NC.....................
                    Union County, NC...........................
                    York County, SC............................
16820............  Charlottesville, VA.........................   1.0206
                    Albemarle County, VA.......................
                    Fluvanna County, VA........................
                    Greene County, VA..........................
                    Nelson County, VA..........................
                    Charlottesville City, VA...................
16860............  Chattanooga, TN-GA..........................   0.9489
                    Catoosa County, GA.........................
                    Dade County, GA............................
                    Walker County, GA..........................
                    Hamilton County, TN........................
                    Marion County, TN..........................
                    Sequatchie County, TN......................
16940............  Cheyenne, WY................................   0.9821
                    Laramie County, WY.........................
16974............  Chicago-Naperville-Joliet, IL...............   1.1156
                    Cook County, IL............................
                    DeKalb County, IL..........................
                    DuPage County, IL..........................
                    Grundy County, IL..........................
                    Kane County, IL............................
                    Kendall County, IL.........................
                    McHenry County, IL.........................

[[Page 38377]]

 
                    Will County, IL............................
17020............  Chico, CA...................................   1.1911
                    Butte County, CA...........................
17140............  Cincinnati-Middletown, OH-KY-IN.............   1.0310
                    Dearborn County, IN........................
                    Franklin County, IN........................
                    Ohio County, IN............................
                    Boone County, KY...........................
                    Bracken County, KY.........................
                    Campbell County, KY........................
                    Gallatin County, KY........................
                    Grant County, KY...........................
                    Kenton County, KY..........................
                    Pendleton County, KY.......................
                    Brown County, OH...........................
                    Butler County, OH..........................
                    Clermont County, OH........................
                    Hamilton County, OH........................
                    Warren County, OH..........................
17300............  Clarksville, TN-KY..........................   0.8705
                    Christian County, KY.......................
                    Trigg County, KY...........................
                    Montgomery County, TN......................
                    Stewart County, TN.........................
17420............  Cleveland, TN...............................   0.8497
                    Bradley County, TN.........................
                    Polk County, TN............................
17460............  Cleveland-Elyria-Mentor, OH.................   0.9869
                    Cuyahoga County, OH........................
                    Geauga County, OH..........................
                    Lake County, OH............................
                    Lorain County, OH..........................
                    Medina County, OH..........................
17660............  Coeur d'Alene, ID...........................   1.0057
                    Kootenai County, ID........................
17780............  College Station-Bryan, TX...................   0.9873
                    Brazos County, TX..........................
                    Burleson County, TX........................
                    Robertson County, TX.......................
17820............  Colorado Springs, CO........................   1.0255
                    El Paso County, CO.........................
                    Teller County, CO..........................
17860............  Columbia, MO................................   0.9138
                    Boone County, MO...........................
                    Howard County, MO..........................
17900............  Columbia, SC................................   0.9239
                    Calhoun County, SC.........................
                    Fairfield County, SC.......................
                    Kershaw County, SC.........................
                    Lexington County, SC.......................
                    Richland County, SC........................
                    Saluda County, SC..........................
17980............  Columbus, GA-AL.............................   0.9211
                    Russell County, AL.........................
                    Chattahoochee County, GA...................
                    Harris County, GA..........................
                    Marion County, GA..........................
                    Muscogee County, GA........................
18020............  Columbus, IN................................   1.0063
                    Bartholomew County, IN.....................
18140............  Columbus, OH................................   1.0660
                    Delaware County, OH........................
                    Fairfield County, OH.......................
                    Franklin County, OH........................
                    Licking County, OH.........................
                    Madison County, OH.........................
                    Morrow County, OH..........................
                    Pickaway County, OH........................
                    Union County, OH...........................
18580............  Corpus Christi, TX..........................   0.9061
                    Aransas County, TX.........................

[[Page 38378]]

 
                    Nueces County, TX..........................
                    San Patricio County, TX....................
18700............  Corvallis, OR...............................   1.1563
                    Benton County, OR..........................
19060............  Cumberland, MD-WV...........................   0.8752
                    Allegany County, MD........................
                    Mineral County, WV.........................
19124............  Dallas-Plano-Irving, TX.....................   1.0467
                    Collin County, TX..........................
                    Dallas County, TX..........................
                    Delta County, TX...........................
                    Denton County, TX..........................
                    Ellis County, TX...........................
                    Hunt County, TX............................
                    Kaufman County, TX.........................
                    Rockwall County, TX........................
19140............  Dalton, GA..................................   0.9242
                    Murray County, GA..........................
                    Whitfield County, GA.......................
19180............  Danville, IL................................   0.9452
                    Vermilion County, IL.......................
19260............  Danville, VA................................   0.8889
                    Pittsylvania County, VA....................
                    Danville City, VA..........................
19340............  Davenport-Moline-Rock Island, IA-IL.........   0.9316
                    Henry County, IL...........................
                    Mercer County, IL..........................
                    Rock Island County, IL.....................
                    Scott County, IA...........................
19380............  Dayton, OH..................................   0.9697
                    Greene County, OH..........................
                    Miami County, OH...........................
                    Montgomery County, OH......................
                    Preble County, OH..........................
19460............  Decatur, AL.................................   0.8431
                    Lawrence County, AL........................
                    Morgan County, AL..........................
19500............  Decatur, IL.................................   0.8519
                    Macon County, IL...........................
19660............  Deltona-Daytona Beach-Ormond Beach, FL......   0.9529
                    Volusia County, FL.........................
19740............  Denver-Aurora, CO...........................   1.1340
                    Adams County, CO...........................
                    Arapahoe County, CO........................
                    Broomfield County, CO......................
                    Clear Creek County, CO.....................
                    Denver County, CO..........................
                    Douglas County, CO.........................
                    Elbert County, CO..........................
                    Gilpin County, CO..........................
                    Jefferson County, CO.......................
                    Park County, CO............................
19780............  Des Moines-West Des Moines, IA..............   0.9735
                    Dallas County, IA..........................
                    Guthrie County, IA.........................
                    Madison County, IA.........................
                    Polk County, IA............................
                    Warren County, IA..........................
19804............  Detroit-Livonia-Dearborn, MI................   1.0539
                    Wayne County, MI...........................
20020............  Dothan, AL..................................   0.7912
                    Geneva County, AL..........................
                    Henry County, AL...........................
                    Houston County, AL.........................
20100............  Dover, DE...................................   1.0656
                    Kent County, DE............................
20220............  Dubuque, IA.................................   0.9551
                    Dubuque County, IA.........................
20260............  Duluth, MN-WI...............................   1.0592
                    Carlton County, MN.........................
                    St. Louis County, MN.......................

[[Page 38379]]

 
                    Douglas County, WI.........................
20500............  Durham, NC..................................   1.0432
                    Chatham County, NC.........................
                    Durham County, NC..........................
                    Orange County, NC..........................
                    Person County, NC..........................
20740............  Eau Claire, WI..............................   0.9982
                    Chippewa County, WI........................
                    Eau Claire County, WI......................
20764............  Edison, NJ..................................   1.1789
                    Middlesex County, NJ.......................
                    Monmouth County, NJ........................
                    Ocean County, NJ...........................
                    Somerset County, NJ........................
20940............  El Centro, CA...............................   0.9405
                    Imperial County, CA........................
21060............  Elizabethtown, KY...........................   0.9191
                    Hardin County, KY..........................
                    Larue County, KY...........................
21140............  Elkhart-Goshen, IN..........................   1.0026
                    Elkhart County, IN.........................
21300............  Elmira, NY..................................   0.8719
                    Chemung County, NY.........................
21340............  El Paso, TX.................................   0.9485
                    El Paso County, TX.........................
21500............  Erie, PA....................................   0.8964
                    Erie County, PA............................
21660............  Eugene-Springfield, OR......................   1.1535
                    Lane County, OR............................
21780............  Evansville, IN-KY...........................   0.9139
                    Gibson County, IN..........................
                    Posey County, IN...........................
                    Vanderburgh County, IN.....................
                    Warrick County, IN.........................
                    Henderson County, KY.......................
                    Webster County, KY.........................
21820............  Fairbanks, AK...............................   1.1659
                    Fairbanks North Star Borough, AK...........
21940............  Fajardo, PR.................................   0.7912
                    Ceiba Municipio, PR........................
                    Fajardo Municipio, PR......................
                    Luquillo Municipio, PR.....................
22020............  Fargo, ND-MN................................   0.8485
                    Cass County, ND............................
                    Clay County, MN............................
22140............  Farmington, NM..............................   1.0118
                    San Juan County, NM........................
22180............  Fayetteville, NC............................   0.9889
                    Cumberland County, NC......................
                    Hoke County, NC............................
22220............  Fayetteville-Springdale-Rogers, AR-MO.......   0.9225
                    Benton County, AR..........................
                    Madison County, AR.........................
                    Washington County, AR......................
                    McDonald County, MO........................
22380............  Flagstaff, AZ...............................   1.2330
                    Coconino County, AZ........................
22420............  Flint, MI...................................   1.1903
                    Genesee County, MI.........................
22500............  Florence, SC................................   0.8689
                    Darlington County, SC......................
                    Florence County, SC........................
22520............  Florence-Muscle Shoals, AL..................   0.8433
                    Colbert County, AL.........................
                    Lauderdale County, AL......................
22540............  Fond du Lac, WI.............................   1.0200
                    Fond du Lac County, WI.....................
22660............  Fort Collins-Loveland, CO...................   1.0442
                    Larimer County, CO.........................
22744............  Fort Lauderdale-Pompano Beach-Deerfield        1.0793
                    Beach, FL.
                    Broward County, FL.........................

[[Page 38380]]

 
22900............  Fort Smith, AR-OK...........................   0.8370
                    Crawford County, AR........................
                    Franklin County, AR........................
                    Sebastian County, AR.......................
                    Le Flore County, OK........................
                    Sequoyah County, OK........................
23020............  Fort Walton Beach-Crestview-Destin, FL......   0.9222
                    Okaloosa County, FL........................
23060............  Fort Wayne, IN..............................   0.9795
                    Allen County, IN...........................
                    Wells County, IN...........................
                    Whitley County, IN.........................
23104............  Fort Worth-Arlington, TX....................   1.0232
                    Johnson County, TX.........................
                    Parker County, TX..........................
                    Tarrant County, TX.........................
                    Wise County, TX............................
23420............  Fresno, CA..................................   1.1597
                    Fresno County, CA..........................
23460............  Gadsden, AL.................................   0.8590
                    Etowah County, AL..........................
23540............  Gainesville, FL.............................   0.9702
                    Alachua County, FL.........................
                    Gilchrist County, FL.......................
23580............  Gainesville, GA.............................   0.9725
                    Hall County, GA............................
23844............  Gary, IN....................................   0.9732
                    Jasper County, IN..........................
                    Lake County, IN............................
                    Newton County, IN..........................
                    Porter County, IN..........................
24020............  Glens Falls, NY.............................   0.8711
                    Warren County, NY..........................
                    Washington County, NY......................
24140............  Goldsboro, NC...............................   0.9801
                    Wayne County, NC...........................
24220............  Grand Forks, ND-MN..........................   0.8316
                    Polk County, MN............................
                    Grand Forks County, ND.....................
24300............  Grand Junction, CO..........................   1.0407
                    Mesa County, CO............................
24340............  Grand Rapids-Wyoming, MI....................   0.9828
                    Barry County, MI...........................
                    Ionia County, MI...........................
                    Kent County, MI............................
                    Newaygo County, MI.........................
24500............  Great Falls, MT.............................   0.9151
                    Cascade County, MT.........................
24540............  Greeley, CO.................................   1.0191
                    Weld County, CO............................
24580............  Green Bay, WI...............................   1.0263
                    Brown County, WI...........................
                    Kewaunee County, WI........................
                    Oconto County, WI..........................
24660............  Greensboro-High Point, NC...................   0.9507
                    Guilford County, NC........................
                    Randolph County, NC........................
                    Rockingham County, NC......................
24780............  Greenville, NC..............................   0.9920
                    Greene County, NC..........................
                    Pitt County, NC............................
24860............  Greenville, SC..............................   1.0456
                    Greenville County, SC......................
                    Laurens County, SC.........................
                    Pickens County, SC.........................
25020............  Guayama, PR.................................   0.7912
                    Arroyo Municipio, PR.......................
                    Guayama Municipio, PR......................
                    Patillas Municipio, PR.....................
25060............  Gulfport-Biloxi, MS.........................   0.9263
                    Hancock County, MS.........................

[[Page 38381]]

 
                    Harrison County, MS........................
                    Stone County, MS...........................
25180............  Hagerstown-Martinsburg, MD-WV...............   0.9510
                    Washington County, MD......................
                    Berkeley County, WV........................
                    Morgan County, WV..........................
25260............  Hanford-Corcoran, CA........................   1.1074
                    Kings County, CA...........................
25420............  Harrisburg-Carlisle, PA.....................   0.9797
                    Cumberland County, PA......................
                    Dauphin County, PA.........................
                    Perry County, PA...........................
25500............  Harrisonburg, VA............................   0.9436
                    Rockingham County, VA......................
                    Harrisonburg City, VA......................
25540............  Hartford-West Hartford-East Hartford, CT....   1.1487
                    Hartford County, CT........................
                    Litchfield County, CT......................
                    Middlesex County, CT.......................
                    Tolland County, CT.........................
25620............  Hattiesburg, MS.............................   0.7912
                    Forrest County, MS.........................
                    Lamar County, MS...........................
                    Perry County, MS...........................
25860............  Hickory-Lenoir-Morganton, NC................   0.9526
                    Alexander County, NC.......................
                    Burke County, NC...........................
                    Caldwell County, NC........................
                    Catawba County, NC.........................
25980............  Hinesville-Fort Stewart, GA \1\.............   0.9745
                    Liberty County, GA.........................
                    Long County, GA............................
26100............  Holland-Grand Haven, MI.....................   0.9501
                    Ottawa County, MI..........................
26180............  Honolulu, HI................................   1.2169
                    Honolulu County, HI........................
26300............  Hot Springs, AR.............................   0.9611
                    Garland County, AR.........................
26380............  Houma-Bayou Cane-Thibodaux, LA..............   0.8327
                    Lafourche Parish, LA.......................
                    Terrebonne Parish, LA......................
26420............  Houston-Sugar Land-Baytown, TX..............   1.0536
                    Austin County, TX..........................
                    Brazoria County, TX........................
                    Chambers County, TX........................
                    Fort Bend County, TX.......................
                    Galveston County, TX.......................
                    Harris County, TX..........................
                    Liberty County, TX.........................
                    Montgomery County, TX......................
                    San Jacinto County, TX.....................
                    Waller County, TX..........................
26580............  Huntington-Ashland, WV-KY-OH................   0.9499
                    Boyd County, KY............................
                    Greenup County, KY.........................
                    Lawrence County, OH........................
                    Cabell County, WV..........................
                    Wayne County, WV...........................
26620............  Huntsville, AL..............................   0.9814
                    Limestone County, AL.......................
                    Madison County, AL.........................
26820............  Idaho Falls, ID.............................   0.9774
                    Bonneville County, ID......................
                    Jefferson County, ID.......................
26900............  Indianapolis-Carmel, IN.....................   1.0387
                    Boone County, IN...........................
                    Brown County, IN...........................
                    Hamilton County, IN........................
                    Hancock County, IN.........................
                    Hendricks County, IN.......................
                    Johnson County, IN.........................

[[Page 38382]]

 
                    Marion County, IN..........................
                    Morgan County, IN..........................
                    Putnam County, IN..........................
                    Shelby County, IN..........................
26980............  Iowa City, IA...............................   1.0095
                    Johnson County, IA.........................
                    Washington County, IA......................
27060............  Ithaca, NY..................................   1.0149
                    Tompkins County, NY........................
27100............  Jackson, MI.................................   0.9844
                    Jackson County, MI.........................
27140............  Jackson, MS.................................   0.8546
                    Copiah County, MS..........................
                    Hinds County, MS...........................
                    Madison County, MS.........................
                    Rankin County, MS..........................
                    Simpson County, MS.........................
27180............  Jackson, TN.................................   0.9149
                    Chester County, TN.........................
                    Madison County, TN.........................
27260............  Jacksonville, FL............................   0.9535
                    Baker County, FL...........................
                    Clay County, FL............................
                    Duval County, FL...........................
                    Nassau County, FL..........................
                    St. Johns County, FL.......................
27340............  Jacksonville, NC............................   0.8525
                    Onslow County, NC..........................
27500............  Janesville, WI..............................   1.0190
                    Rock County, WI............................
27620............  Jefferson City, MO..........................   0.8945
                    Callaway County, MO........................
                    Cole County, MO............................
                    Moniteau County, MO........................
                    Osage County, MO...........................
27740............  Johnson City, TN............................   0.8152
                    Carter County, TN..........................
                    Unicoi County, TN..........................
                    Washington County, TN......................
27780............  Johnstown, PA...............................   0.7959
                    Cambria County, PA.........................
27860............  Jonesboro, AR...............................   0.8219
                    Craighead County, AR.......................
                    Poinsett County, AR........................
27900............  Joplin, MO..................................   0.9547
                    Jasper County, MO..........................
                    Newton County, MO..........................
28020............  Kalamazoo-Portage, MI.......................   1.1008
                    Kalamazoo County, MI.......................
                    Van Buren County, MI.......................
28100............  Kankakee-Bradley, IL........................   1.2428
                    Kankakee County, IL........................
28140............  Kansas City, MO-KS..........................   1.0025
                    Franklin County, KS........................
                    Johnson County, KS.........................
                    Leavenworth County, KS.....................
                    Linn County, KS............................
                    Miami County, KS...........................
                    Wyandotte County, KS.......................
                    Bates County, MO...........................
                    Caldwell County, MO........................
                    Cass County, MO............................
                    Clay County, MO............................
                    Clinton County, MO.........................
                    Jackson County, MO.........................
                    Lafayette County, MO.......................
                    Platte County, MO..........................
                    Ray County, MO.............................
28420............  Kennewick-Richland-Pasco, WA................   1.0630
                    Benton County, WA..........................
                    Franklin County, WA........................

[[Page 38383]]

 
28660............  Killeen-Temple-Fort Hood, TX................   0.8703
                    Bell County, TX............................
                    Coryell County, TX.........................
                    Lampasas County, TX........................
28700............  Kingsport-Bristol-Bristol, TN-VA............   0.8099
                    Hawkins County, TN.........................
                    Sullivan County, TN........................
                    Bristol City, VA...........................
                    Scott County, VA...........................
                    Washington County, VA......................
28740............  Kingston, NY................................   1.0014
                    Ulster County, NY..........................
28940............  Knoxville, TN...............................   0.8508
                    Anderson County, TN........................
                    Blount County, TN..........................
                    Knox County, TN............................
                    Loudon County, TN..........................
                    Union County, TN...........................
29020............  Kokomo, IN..................................   1.0119
                    Howard County, IN..........................
                    Tipton County, IN..........................
29100............  La Crosse, WI-MN............................   1.0218
                    Houston County, MN.........................
                    La Crosse County, WI.......................
29140............  Lafayette, IN...............................   0.9357
                    Benton County, IN..........................
                    Carroll County, IN.........................
                    Tippecanoe County, IN......................
29180............  Lafayette, LA...............................   0.8698
                    Lafayette Parish, LA.......................
                    St. Martin Parish, LA......................
29340............  Lake Charles, LA............................   0.8205
                    Calcasieu Parish, LA.......................
                    Cameron Parish, LA.........................
29404............  Lake County-Kenosha County, IL-WI...........   1.0857
                    Lake County, IL............................
                    Kenosha County, WI.........................
29420............  Lake Havasu City--Kingman, AZ...............   0.9847
                    Mohave, County, AZ.........................
29460............  Lakeland, FL................................   0.9139
                    Polk County, FL............................
29540............  Lancaster, PA...............................   0.9768
                    Lancaster County, PA.......................
29620............  Lansing-East Lansing, MI....................   1.0676
                    Clinton County, MI.........................
                    Eaton County, MI...........................
                    Ingham County, MI..........................
29700............  Laredo, TX..................................   0.8520
                    Webb County, TX............................
29740............  Las Cruces, NM..............................   0.9154
                    Dona Ana County, NM........................
29820............  Las Vegas-Paradise, NV......................   1.2426
                    Clark County, NV...........................
29940............  Lawrence, KS................................   0.8716
                    Douglas County, KS.........................
30020............  Lawton, OK..................................   0.8465
                    Comanche County, OK........................
30140............  Lebanon, PA.................................   0.8644
                    Lebanon County, PA.........................
30300............  Lewiston, ID-WA.............................   0.9976
                    Nez Perce County, ID.......................
                    Asotin County, WA..........................
30340............  Lewiston-Auburn, ME.........................   0.9700
                    Androscoggin County, ME....................
30460............  Lexington-Fayette, KY.......................   0.9719
                    Bourbon County, KY.........................
                    Clark County, KY...........................
                    Fayette County, KY.........................
                    Jessamine County, KY.......................
                    Scott County, KY...........................
                    Woodford County, KY........................

[[Page 38384]]

 
30620............  Lima, OH....................................   0.9944
                    Allen County, OH...........................
30700............  Lincoln, NE.................................   1.0560
                    Lancaster County, NE.......................
                    Seward County, NE..........................
30780............  Little Rock-North Little Rock, AR...........   0.9351
                    Faulkner County, AR........................
                    Grant County, AR...........................
                    Lonoke County, AR..........................
                    Perry County, AR...........................
                    Pulaski County, AR.........................
                    Saline County, AR..........................
30860............  Logan, UT-ID................................   0.9689
                    Franklin County, ID........................
                    Cache County, UT...........................
30980............  Longview, TX................................   0.9196
                    Gregg County, TX...........................
                    Rusk County, TX............................
                    Upshur County, TX..........................
31020............  Longview, WA................................   1.1424
                    Cowlitz County, WA.........................
31084............  Los Angeles-Long Beach-Glendale, CA.........   1.2399
                    Los Angeles County, CA.....................
31140............  Louisville, KY-IN...........................   0.9576
                    Clark County, IN...........................
                    Floyd County, IN...........................
                    Harrison County, IN........................
                    Washington County, IN......................
                    Bullitt County, KY.........................
                    Henry County, KY...........................
                    Jefferson County, KY.......................
                    Meade County, KY...........................
                    Nelson County, KY..........................
                    Oldham County, KY..........................
                    Shelby County, KY..........................
                    Spencer County, KY.........................
                    Trimble County, KY.........................
31180............  Lubbock, TX.................................   0.9193
                    Crosby County, TX..........................
                    Lubbock County, TX.........................
31340............  Lynchburg, VA...............................   0.9065
                    Amherst County, VA.........................
                    Appomattox County, VA......................
                    Bedford County, VA.........................
                    Campbell County, VA........................
                    Bedford City, VA...........................
                    Lynchburg City, VA.........................
31420............  Macon, GA...................................   1.0064
                    Bibb County, GA............................
                    Crawford County, GA........................
                    Jones County, GA...........................
                    Monroe County, GA..........................
                    Twiggs County, GA..........................
31460............  Madera, CA..................................   0.8515
                    Madera County, CA..........................
31540............  Madison, WI.................................   1.1538
                    Columbia County, WI........................
                    Dane County, WI............................
                    Iowa County, WI............................
31700............  Manchester-Nashua, NH.......................   1.0622
                    Hillsborough County, NH....................
                    Merrimack County, NH.......................
31900............  Mansfield, OH \1\...........................   0.9783
                    Richland County, OH........................
32420............  Mayagu[aacute]ez, PR........................   0.7912
                    Hormigueros Municipio, PR..................
                    Mayag[uuml]ez Municipio, PR................
32580............  McAllen-Edinburg-Pharr, TX..................   0.9625
                    Hidalgo County, TX.........................
32780............  Medford, OR.................................   1.0887
                    Jackson County, OR.........................

[[Page 38385]]

 
32820............  Memphis, TN-MS-AR...........................   0.9731
                    Crittenden County, AR......................
                    DeSoto County, MS..........................
                    Marshall County, MS........................
                    Tate County, MS............................
                    Tunica County, MS..........................
                    Fayette County, TN.........................
                    Shelby County, TN..........................
                    Tipton County, TN..........................
32900............  Merced, CA..................................   1.2766
                    Merced County, CA..........................
33124............  Miami-Miami Beach-Kendall, FL...............   1.0553
                    Miami-Dade County, FL......................
33140............  Michigan City-La Porte, IN..................   0.9406
                    LaPorte County, IN.........................
33260............  Midland, TX.................................   1.0893
                    Midland County, TX.........................
33340............  Milwaukee-Waukesha-West Allis, WI...........   1.0772
                    Milwaukee County, WI.......................
                    Ozaukee County, WI.........................
                    Washington County, WI......................
                    Waukesha County, WI........................
33460............  Minneapolis-St. Paul-Bloomington, MN-WI.....   1.1767
                    Anoka County, MN...........................
                    Carver County, MN..........................
                    Chisago County, MN.........................
                    Dakota County, MN..........................
                    Hennepin County, MN........................
                    Isanti County, MN..........................
                    Ramsey County, MN..........................
                    Scott County, MN...........................
                    Sherburne County, MN.......................
                    Washington County, MN......................
                    Wright County, MN..........................
                    Pierce County, WI..........................
                    St. Croix County, WI.......................
33540............  Missoula, MT................................   0.9439
                    Missoula County, MT........................
33660............  Mobile, AL..................................   0.8473
                    Mobile County, AL..........................
33700............  Modesto, CA.................................   1.2581
                    Stanislaus County, CA......................
33740............  Monroe, LA..................................   0.8263
                    Ouachita Parish, LA........................
                    Union Parish, LA...........................
33780............  Monroe, MI..................................   0.9932
                    Monroe County, MI..........................
33860............  Montgomery, AL..............................   0.8793
                    Autauga County, AL.........................
                    Elmore County, AL..........................
                    Lowndes County, AL.........................
                    Montgomery County, AL......................
34060............  Morgantown, WV..............................   0.8779
                    Monongalia County, WV......................
                    Preston County, WV.........................
34100............  Morristown, TN..............................   0.7912
                    Grainger County, TN........................
                    Hamblen County, TN.........................
                    Jefferson County, TN.......................
34580............  Mount Vernon-Anacortes, WA..................   1.1110
                    Skagit County, WA..........................
34620............  Muncie, IN..................................   0.8666
                    Delaware County, IN........................
34740............  Muskegon-Norton Shores, MI..................   1.0338
                    Muskegon County, MI........................
34820............  Myrtle Beach-Conway-North Myrtle Beach, SC..   0.9112
                    Horry County, SC...........................
34900............  Napa, CA....................................   1.5120
                    Napa County, CA............................
34940............  Naples-Marco Island, FL.....................   1.0148
                    Collier County, FL.........................

[[Page 38386]]

 
34980............  Nashville-Davidson-Murfreesboro, TN.........   1.0278
                    Cannon County, TN..........................
                    Cheatham County, TN........................
                    Davidson County, TN........................
                    Dickson County, TN.........................
                    Hickman County, TN.........................
                    Macon County, TN...........................
                    Robertson County, TN.......................
                    Rutherford County, TN......................
                    Smith County, TN...........................
                    Sumner County, TN..........................
                    Trousdale County, TN.......................
                    Williamson County, TN......................
                    Wilson County, TN..........................
35004............  Nassau-Suffolk, NY..........................   1.3260
                    Nassau County, NY..........................
                    Suffolk County, NY.........................
35084............  Newark-Union, NJ-PA.........................   1.2516
                    Essex County, NJ...........................
                    Hunterdon County, NJ.......................
                    Morris County, NJ..........................
                    Sussex County, NJ..........................
                    Union County, NJ...........................
                    Pike County, PA............................
35300............  New Haven-Milford, CT.......................   1.2530
                    New Haven County, CT.......................
35380............  New Orleans-Metairie-Kenner, LA.............   0.9405
                    Jefferson Parish, LA.......................
                    Orleans Parish, LA.........................
                    Plaquemines Parish, LA.....................
                    St. Bernard Parish, LA.....................
                    St. Charles Parish, LA.....................
                    St. John the Baptist Parish, LA............
                    St. Tammany Parish, LA.....................
35644............  New York-Wayne-White Plains, NY-NJ..........   1.3817
                    Bergen County, NJ..........................
                    Hudson County, NJ..........................
                    Passaic County, NJ.........................
                    Bronx County, NY...........................
                    Kings County, NY...........................
                    New York County, NY........................
                    Putnam County, NY..........................
                    Queens County, NY..........................
                    Richmond County, NY........................
                    Rockland County, NY........................
                    Westchester County, NY.....................
35660............  Niles-Benton Harbor, MI.....................   0.9645
                    Berrien County, MI.........................
35980............  Norwich-New London, CT......................   1.2125
                    New London County, CT......................
36084............  Oakland-Fremont-Hayward, CA.................   1.6478
                    Alameda County, CA.........................
                    Contra Costa County, CA....................
36100............  Ocala, FL...................................   0.9102
                    Marion County, FL..........................
36140............  Ocean City, NJ..............................   1.1246
                    Cape May County, NJ........................
36220............  Odessa, TX..................................   1.0596
                    Ector County, TX...........................
36260............  Ogden-Clearfield, UT........................   0.9501
                    Davis County, UT...........................
                    Morgan County, UT..........................
                    Weber County, UT...........................
36420............  Oklahoma City, OK...........................   0.9307
                    Canadian County, OK........................
                    Cleveland County, OK.......................
                    Grady County, OK...........................
                    Lincoln County, OK.........................
                    Logan County, OK...........................
                    McClain County, OK.........................
                    Oklahoma County, OK........................

[[Page 38387]]

 
36500............  Olympia, WA.................................   1.2187
                    Thurston County, WA........................
36540............  Omaha-Council Bluffs, NE-IA.................   1.0025
                    Harrison County, IA........................
                    Mills County, IA...........................
                    Pottawattamie County, IA...................
                    Cass County, NE............................
                    Douglas County, NE.........................
                    Sarpy County, NE...........................
                    Saunders County, NE........................
                    Washington County, NE......................
36740............  Orlando, FL.................................   0.9832
                    Lake County, FL............................
                    Orange County, FL..........................
                    Osceola County, FL.........................
                    Seminole County, FL........................
36780............  Oshkosh-Neenah, WI..........................   1.0094
                    Winnebago County, WI.......................
36980............  Owensboro, KY...............................   0.9233
                    Daviess County, KY.........................
                    Hancock County, KY.........................
                    McLean County, KY..........................
37100............  Oxnard-Thousand Oaks-Ventura, CA............   1.2478
                    Ventura County, CA.........................
37340............  Palm Bay-Melbourne-Titusville, FL...........   0.9839
                    Brevard County, FL.........................
37380............  Palm Coast, FL..............................   0.9438
                    Flagler County, FL.........................
37460............  Panama City-Lynn Haven, FL..................   0.8620
                    Bay County, FL.............................
37620............  Parkersburg-Marietta, WV-OH.................   0.8548
                    Washington County, OH......................
                    Pleasants County, WV.......................
                    Wirt County, WV............................
                    Wood County, WV............................
37700............  Pascagoula, MS..............................   0.9124
                    George County, MS..........................
                    Jackson County, MS.........................
37764............  Peabody, MA.................................   1.0822
                    Essex County, MA...........................
37860............  Pensacola-Ferry Pass-Brent, FL..............   0.8738
                    Escambia County, FL........................
                    Santa Rosa County, FL......................
37900............  Peoria, IL..................................   0.9795
                    Marshall County, IL........................
                    Peoria County, IL..........................
                    Stark County, IL...........................
                    Tazewell County, IL........................
                    Woodford County, IL........................
37964............  Philadelphia, PA............................   1.1536
                    Bucks County, PA...........................
                    Chester County, PA.........................
                    Delaware County, PA........................
                    Montgomery County, PA......................
                    Philadelphia County, PA....................
38060............  Phoenix-Mesa-Scottsdale, AZ.................   1.0832
                    Maricopa County, AZ........................
                    Pinal County, AZ...........................
38220............  Pine Bluff, AR..............................   0.8271
                    Cleveland County, AR.......................
                    Jefferson County, AR.......................
                    Lincoln County, AR.........................
38300............  Pittsburgh, PA..............................   0.8988
                    Allegheny County, PA.......................
                    Armstrong County, PA.......................
                    Beaver County, PA..........................
                    Butler County, PA..........................
                    Fayette County, PA.........................
                    Washington County, PA......................
                    Westmoreland County, PA....................
38340............  Pittsfield, MA..............................   1.0661

[[Page 38388]]

 
                    Berkshire County, MA.......................
38540............  Pocatello, ID...............................   0.9946
                    Bannock County, ID.........................
                    Power County, ID...........................
38660............  Ponce, PR...................................   0.7912
                    Juana D[iacute]az Municipio, PR............
                    Ponce Municipio, PR........................
                    Villalba Municipio, PR.....................
38860............  Portland-South Portland-Biddeford, ME.......   1.0596
                    Cumberland County, ME......................
                    Sagadahoc County, ME.......................
                    York County, ME............................
38900............  Portland-Vancouver-Beaverton, OR-WA.........   1.2132
                    Clackamas County, OR.......................
                    Columbia County, OR........................
                    Multnomah County, OR.......................
                    Washington County, OR......................
                    Yamhill County, OR.........................
                    Clark County, WA...........................
                    Skamania County, WA........................
38940............  Port St. Lucie-Fort Pierce, FL..............   1.0569
                    Martin County, FL..........................
                    St. Lucie County, FL.......................
39100............  Poughkeepsie-Newburgh-Middletown, NY........   1.1445
                    Dutchess County, NY........................
                    Orange County, NY..........................
39140............  Prescott, AZ................................   1.0572
                    Yavapai County, AZ.........................
39300............  Providence-New Bedford-Fall River, RI-MA....   1.1314
                    Bristol County, MA.........................
                    Bristol County, RI.........................
                    Kent County, RI............................
                    Newport County, RI.........................
                    Providence County, RI......................
                    Washington County, RI......................
39340............  Provo-Orem, UT..............................   1.0083
                    Juab County, UT............................
                    Utah County, UT............................
39380............  Pueblo, CO..................................   0.9338
                    Pueblo County, CO..........................
39460............  Punta Gorda, FL.............................   0.9764
                    Charlotte County, FL.......................
39540............  Racine, WI..................................   1.0022
                    Racine County, WI..........................
39580............  Raleigh-Cary, NC............................   1.0060
                    Franklin County, NC........................
                    Johnston County, NC........................
                    Wake County, NC............................
39660............  Rapid City, SD..............................   0.9296
                    Meade County, SD...........................
                    Pennington County, SD......................
39740............  Reading, PA.................................   0.9871
                    Berks County, PA...........................
39820............  Redding, CA.................................   1.4298
                    Shasta County, CA..........................
39900............  Reno-Sparks, NV.............................   1.1556
                    Storey County, NV..........................
                    Washoe County, NV..........................
40060............  Richmond, VA................................   0.9945
                    Amelia County, VA..........................
                    Caroline County, VA........................
                    Charles City County, VA....................
                    Chesterfield County, VA....................
                    Cumberland County, VA......................
                    Dinwiddie County, VA.......................
                    Goochland County, VA.......................
                    Hanover County, VA.........................
                    Henrico County, VA.........................
                    King and Queen County, VA..................
                    King William County, VA....................
                    Louisa County, VA..........................

[[Page 38389]]

 
                    New Kent County, VA........................
                    Powhatan County, VA........................
                    Prince George County, VA...................
                    Sussex County, VA..........................
                    Colonial Heights City, VA..................
                    Hopewell City, VA..........................
                    Petersburg City, VA........................
                    Richmond City, VA..........................
40140............  Riverside-San Bernardino-Ontario, CA........   1.1532
                    Riverside County, CA.......................
                    San Bernardino County, CA..................
40220............  Roanoke, VA.................................   0.9092
                    Botetourt County, VA.......................
                    Craig County, VA...........................
                    Franklin County, VA........................
                    Roanoke County, VA.........................
                    Roanoke City, VA...........................
                    Salem City, VA.............................
40340............  Rochester, MN...............................   1.1639
                    Dodge County, MN...........................
                    Olmsted County, MN.........................
                    Wabasha County, MN.........................
40380............  Rochester, NY...............................   0.9322
                    Livingston County, NY......................
                    Monroe County, NY..........................
                    Ontario County, NY.........................
                    Orleans County, NY.........................
                    Wayne County, NY...........................
40420............  Rockford, IL................................   1.0191
                    Boone County, IL...........................
                    Winnebago County, IL.......................
40484............  Rockingham County-Strafford County, NH......   1.0669
                    Rockingham County, NH......................
                    Strafford County, NH.......................
40580............  Rocky Mount, NC.............................   0.9503
                    Edgecombe County, NC.......................
                    Nash County, NC............................
40660............  Rome, GA....................................   0.9537
                    Floyd County, GA...........................
40900............  Sacramento-Arden-Arcade-Roseville, CA.......   1.4166
                    El Dorado County, CA.......................
                    Placer County, CA..........................
                    Sacramento County, CA......................
                    Yolo County, CA............................
40980............  Saginaw-Saginaw Township North, MI..........   0.9297
                    Saginaw County, MI.........................
41060............  St. Cloud, MN...............................   1.1131
                    Benton County, MN..........................
                    Stearns County, MN.........................
41100............  St. George, UT..............................   0.9880
                    Washington County, UT......................
41140............  St. Joseph, MO-KS...........................   0.9246
                    Doniphan County, KS........................
                    Andrew County, MO..........................
                    Buchanan County, MO........................
                    DeKalb County, MO..........................
41180............  St. Louis, MO-IL............................   0.9413
                    Bond County, IL............................
                    Calhoun County, IL.........................
                    Clinton County, IL.........................
                    Jersey County, IL..........................
                    Macoupin County, IL........................
                    Madison County, IL.........................
                    Monroe County, IL..........................
                    St. Clair County, IL.......................
                    Crawford County, MO........................
                    Franklin County, MO........................
                    Jefferson County, MO.......................
                    Lincoln County, MO.........................
                    St. Charles County, MO.....................
                    St. Louis County, MO.......................

[[Page 38390]]

 
                    Warren County, MO..........................
                    Washington County, MO......................
                    St. Louis City, MO.........................
41420............  Salem, OR...................................   1.1154
                    Marion County, OR..........................
                    Polk County, OR............................
41500............  Salinas, CA.................................   1.5382
                    Monterey County, CA........................
41540............  Salisbury, MD...............................   0.9489
                    Somerset County, MD........................
                    Wicomico County, MD........................
41620............  Salt Lake City, UT..........................   0.9921
                    Salt Lake County, UT.......................
                    Summit County, UT..........................
                    Tooele County, UT..........................
41660............  San Angelo, TX..............................   0.9053
                    Irion County, TX...........................
                    Tom Green County, TX.......................
41700............  San Antonio, TX.............................   0.9337
                    Atascosa County, TX........................
                    Bandera County, TX.........................
                    Bexar County, TX...........................
                    Comal County, TX...........................
                    Guadalupe County, TX.......................
                    Kendall County, TX.........................
                    Medina County, TX..........................
                    Wilson County, TX..........................
41740............  San Diego-Carlsbad-San Marcos, CA...........   1.2045
                    San Diego County, CA.......................
41780............  Sandusky, OH................................   0.9309
                    Erie County, OH............................
41884............  San Francisco-San Mateo-Redwood City, CA....   1.5987
                    Marin County, CA...........................
                    San Francisco County, CA...................
                    San Mateo County, CA.......................
41900............  San Germa[aacute]n-Cabo Rojo, PR............   0.7912
                    Cabo Rojo Municipio, PR....................
                    Lajas Municipio, PR........................
                    Sabana Grande Municipio, PR................
                    San Germ[iacute]n Municipio, PR............
41940............  San Jose-Sunnyvale-Santa Clara, CA..........   1.6498
                    San Benito County, CA......................
                    Santa Clara County, CA.....................
41980............  San Juan-Caguas-Guaynabo, PR................   0.7912
                    Aguas Buenas Municipio, PR.................
                    Aibonito Municipio, PR.....................
                    Arecibo Municipio, PR......................
                    Barceloneta Municipio, PR..................
                    Barranquitas Municipio, PR.................
                    Bayam[oacute]n Municipio, PR...............
                    Caguas Municipio, PR.......................
                    Camuy Municipio, PR........................
                    Can[oacute]vanas Municipio, PR.............
                    Carolina Municipio, PR.....................
                    Cata[ntilde]o Municipio, PR................
                    Cayey Municipio, PR........................
                    Ciales Municipio, PR.......................
                    Cidra Municipio, PR........................
                    Comer[iacute]o Municipio, PR...............
                    Corozal Municipio, PR......................
                    Dorado Municipio, PR.......................
                    Florida Municipio, PR......................
                    Guaynabo Municipio, PR.....................
                    Gurabo Municipio, PR.......................
                    Hatillo Municipio, PR......................
                    Humacao Municipio, PR......................
                    Juncos Municipio, PR.......................
                    Las Piedras Municipio, PR..................
                    Lo[iacute]za Municipio, PR.................
                    Manat[iacute] Municipio, PR................
                    Maunabo Municipio, PR......................

[[Page 38391]]

 
                    Morovis Municipio, PR......................
                    Naguabo Municipio, PR......................
                    Naranjito Municipio, PR....................
                    Orocovis Municipio, PR.....................
                    Quebradillas Municipio, PR.................
                    R[iacute]o Grande Municipio, PR............
                    San Juan Municipio, PR.....................
                    San Lorenzo Municipio, PR..................
                    Toa Alta Municipio, PR.....................
                    Toa Baja Municipio, PR.....................
                    Trujillo Alto Municipio, PR................
                    Vega Alta Municipio, PR....................
                    Vega Baja Municipio, PR....................
                    Yabucoa Municipio, PR......................
42020............  San Luis Obispo-Paso Robles, CA.............   1.3126
                    San Luis Obispo County, CA.................
42044............  Santa Ana-Anaheim-Irvine, CA................   1.2390
                    Orange County, CA..........................
42060............  Santa Barbara-Santa Maria-Goleta, CA........   1.2340
                    Santa Barbara County, CA...................
42100............  Santa Cruz-Watsonville, CA..................   1.7003
                    Santa Cruz County, CA......................
42140............  Santa Fe, NM................................   1.1325
                    Santa Fe County, NM........................
42220............  Santa Rosa-Petaluma, CA.....................   1.5278
                    Sonoma County, CA..........................
42260............  Sarasota-Bradenton-Venice, FL...............   1.0462
                    Manatee County, FL.........................
                    Sarasota County, FL........................
42340............  Savannah, GA................................   0.9733
                    Bryan County, GA...........................
                    Chatham County, GA.........................
                    Effingham County, GA.......................
42540............  Scranton-Wilkes-Barre, PA...................   0.8924
                    Lackawanna County, PA......................
                    Luzerne County, PA.........................
                    Wyoming County, PA.........................
42644............  Seattle-Bellevue-Everett, WA................   1.2191
                    King County, WA............................
                    Snohomish County, WA.......................
42680............  Sebastian-Vero Beach, FL....................   0.9931
                    Indian River County, FL....................
43100............  Sheboygan, WI...............................   0.9470
                    Sheboygan County, WI.......................
43300............  Sherman-Denison, TX.........................   0.8778
                    Grayson County, TX.........................
43340............  Shreveport-Bossier City, LA.................   0.9004
                    Bossier Parish, LA.........................
                    Caddo Parish, LA...........................
                    De Soto Parish, LA.........................
43580............  Sioux City, IA-NE-SD........................   0.9899
                    Woodbury County, IA........................
                    Dakota County, NE..........................
                    Dixon County, NE...........................
                    Union County, SD...........................
43620............  Sioux Falls, SD.............................   1.0091
                    Lincoln County, SD.........................
                    McCook County, SD..........................
                    Minnehaha County, SD.......................
                    Turner County, SD..........................
43780............  South Bend-Mishawaka, IN-MI.................   1.0147
                    St. Joseph County, IN......................
                    Cass County, MI............................
43900............  Spartanburg, SC.............................   0.9942
                    Spartanburg County, SC.....................
44060............  Spokane, WA.................................   1.1018
                    Spokane County, WA.........................
44100............  Springfield, IL.............................   0.9437
                    Menard County, IL..........................
                    Sangamon County, IL........................
44140............  Springfield, MA.............................   1.0709

[[Page 38392]]

 
                    Franklin County, MA........................
                    Hampden County, MA.........................
                    Hampshire County, MA.......................
44180............  Springfield, MO.............................   0.9595
                    Christian County, MO.......................
                    Dallas County, MO..........................
                    Greene County, MO..........................
                    Polk County, MO............................
                    Webster County, MO.........................
44220............  Springfield, OH.............................   0.9141
                    Clark County, OH...........................
44300............  State College, PA...........................   0.9252
                    Centre County, PA..........................
44700............  Stockton, CA................................   1.2422
                    San Joaquin County, CA.....................
44940............  Sumter, SC..................................   0.9073
                    Sumter County, SC..........................
45060............  Syracuse, NY................................   1.0410
                    Madison County, NY.........................
                    Onondaga County, NY........................
                    Oswego County, NY..........................
45104............  Tacoma, WA..................................   1.1664
                    Pierce County, WA..........................
45220............  Tallahassee, FL.............................   0.9522
                    Gadsden County, FL.........................
                    Jefferson County, FL.......................
                    Leon County, FL............................
                    Wakulla County, FL.........................
45300............  Tampa-St. Petersburg-Clearwater, FL.........   0.9516
                    Hernando County, FL........................
                    Hillsborough County, FL....................
                    Pasco County, FL...........................
                    Pinellas County, FL........................
45460............  Terre Haute, IN.............................   0.9290
                    Clay County, IN............................
                    Sullivan County, IN........................
                    Vermillion County, IN......................
                    Vigo County, IN............................
45500............  Texarkana, TX-Texarkana, AR.................   0.8574
                    Miller County, AR..........................
                    Bowie County, TX...........................
45780............  Toledo, OH..................................   0.9954
                    Fulton County, OH..........................
                    Lucas County, OH...........................
                    Ottawa County, OH..........................
                    Wood County, OH............................
45820............  Topeka, KS..................................   0.9009
                    Jackson County, KS.........................
                    Jefferson County, KS.......................
                    Osage County, KS...........................
                    Shawnee County, KS.........................
                    Wabaunsee County, KS.......................
45940............  Trenton-Ewing, NJ...........................   1.1288
                    Mercer County, NJ..........................
46060............  Tucson, AZ..................................   0.9824
                    Pima County, AZ............................
46140............  Tulsa, OK...................................   0.8801
                    Creek County, OK...........................
                    Okmulgee County, OK........................
                    Osage County, OK...........................
                    Pawnee County, OK..........................
                    Rogers County, OK..........................
                    Tulsa County, OK...........................
                    Wagoner County, OK.........................
46220............  Tuscaloosa, AL..............................   0.8760
                    Greene County, AL..........................
                    Hale County, AL............................
                    Tuscaloosa County, AL......................
46340............  Tyler, TX...................................   0.9261
                    Smith County, TX...........................
46540............  Utica-Rome, NY..............................   0.8949

[[Page 38393]]

 
                    Herkimer County, NY........................
                    Oneida County, NY..........................
46660............  Valdosta, GA................................   0.8544
                    Brooks County, GA..........................
                    Echols County, GA..........................
                    Lanier County, GA..........................
                    Lowndes County, GA.........................
46700............  Vallejo-Fairfield, CA.......................   1.5432
                    Solano County, CA..........................
47020............  Victoria, TX................................   0.8762
                    Calhoun County, TX.........................
                    Goliad County, TX..........................
                    Victoria County, TX........................
47220............  Vineland-Millville-Bridgeton, NJ............   1.0691
                    Cumberland County, NJ......................
47260............  Virginia Beach-Norfolk-Newport News, VA-NC..   0.9308
                    Currituck County, NC.......................
                    Gloucester County, VA......................
                    Isle of Wight County, VA...................
                    James City County, VA......................
                    Mathews County, VA.........................
                    Surry County, VA...........................
                    York County, VA............................
                    Chesapeake City, VA........................
                    Hampton City, VA...........................
                    Newport News City, VA......................
                    Norfolk City, VA...........................
                    Poquoson City, VA..........................
                    Portsmouth City, VA........................
                    Suffolk City, VA...........................
                    Virginia Beach City, VA....................
                    Williamsburg City, VA......................
47300............  Visalia-Porterville, CA.....................   1.0647
                    Tulare County, CA..........................
47380............  Waco, TX....................................   0.8988
                    McLennan County, TX........................
47580............  Warner Robins, GA...........................   0.9632
                    Houston County, GA.........................
47644............  Warren-Troy-Farmington Hills, MI............   1.0554
                    Lapeer County, MI..........................
                    Livingston County, MI......................
                    Macomb County, MI..........................
                    Oakland County, MI.........................
                    St. Clair County, MI.......................
47894............  Washington-Arlington-Alexandria, DC-VA-MD-WV   1.1441
                    District of Columbia, DC...................
                    Calvert County, MD.........................
                    Charles County, MD.........................
                    Prince George's County, MD.................
                    Arlington County, VA.......................
                    Clarke County, VA..........................
                    Fairfax County, VA.........................
                    Fauquier County, VA........................
                    Loudoun County, VA.........................
                    Prince William County, VA..................
                    Spotsylvania County, VA....................
                    Stafford County, VA........................
                    Warren County, VA..........................
                    Alexandria City, VA........................
                    Fairfax City, VA...........................
                    Falls Church City, VA......................
                    Fredericksburg City, VA....................
                    Manassas City, VA..........................
                    Manassas Park City, VA.....................
                    Jefferson County, WV.......................
47940............  Waterloo-Cedar Falls, IA....................   0.8988
                    Black Hawk County, IA......................
                    Bremer County, IA..........................
                    Grundy County, IA..........................
48140............  Wausau, WI..................................   1.0212
                    Marathon County, WI........................

[[Page 38394]]

 
48260............  Weirton-Steubenville, WV-OH.................   0.8361
                    Jefferson County, OH.......................
                    Brooke County, WV..........................
                    Hancock County, WV.........................
48300............  Wenatchee, WA...............................   1.2101
                    Chelan County, WA..........................
                    Douglas County, WA.........................
48424............  West Palm Beach-Boca Raton-Boynton Beach, FL   1.0270
                    Palm Beach County, FL......................
48540............  Wheeling, WV-OH.............................   0.7912
                    Belmont County, OH.........................
                    Marshall County, WV........................
                    Ohio County, WV............................
48620............  Wichita, KS.................................   0.9631
                    Butler County, KS..........................
                    Harvey County, KS..........................
                    Sedgwick County, KS........................
                    Sumner County, KS..........................
48660............  Wichita Falls, TX...........................   0.8642
                    Archer County, TX..........................
                    Clay County, TX............................
                    Wichita County, TX.........................
48700............  Williamsport, PA............................   0.8486
                    Lycoming County, PA........................
48864............  Wilmington, DE-MD-NJ........................   1.1419
                    New Castle County, DE......................
                    Cecil County, MD...........................
                    Salem County, NJ...........................
48900............  Wilmington, NC..............................   0.9937
                    Brunswick County, NC.......................
                    New Hanover County, NC.....................
                    Pender County, NC..........................
49020............  Winchester, VA-WV...........................   1.0459
                    Frederick County, VA.......................
                    Winchester City, VA........................
                    Hampshire County, WV.......................
49180............  Winston-Salem, NC...........................   0.9621
                    Davie County, NC...........................
                    Forsyth County, NC.........................
                    Stokes County, NC..........................
                    Yadkin County, NC..........................
49340............  Worcester, MA...............................   1.1887
                    Worcester County, MA.......................
49420............  Yakima, WA..................................   1.0832
                    Yakima County, WA..........................
49500............  Yauco, PR...................................   0.7912
                    Gu[iacute]nica Municipio, PR...............
                    Guayanilla Municipio, PR...................
                    Pe[ntilde]uelas Municipio, PR..............
                    Yauco Municipio, PR........................
49620............  York-Hanover, PA............................   0.9499
                    York County, PA............................
                   0.9745......................................
49660............  Youngstown-Warren-Boardman, OH-PA...........   0.9499
                    Mahoning County, OH........................
                    Trumbull County, OH........................
                    Mercer County, PA..........................
49700............  Yuba City, CA...............................   1.1349
                    Sutter County, CA..........................
                    Yuba County, CA............................
49740............  Yuma, AZ....................................   1.0010
                    Yuma County, AZ............................
------------------------------------------------------------------------
\1\At this time, there are no hospitals located in this urban area on
  which to base a wage index.


[[Page 38395]]


  ADDENDUM H.-- FY 2008 Wage Index Based on CBSA Labor Market Areas for
                               Rural Areas
------------------------------------------------------------------------
                                                                  Wage
              CBSA code                    Nonurban area         index
------------------------------------------------------------------------
1...................................  Alabama................     0.7975
2...................................  Alaska.................     1.2476
3...................................  Arizona................     0.9131
4...................................  Arkansas...............     0.7912
5...................................  California.............     1.2540
6...................................  Colorado...............     1.0236
7...................................  Connecticut............     1.2106
8...................................  Delaware...............     1.0190
10..................................  Florida................     0.8935
11..................................  Georgia................     0.8080
12..................................  Hawaii.................     1.1202
13..................................  Idaho..................     0.8420
14..................................  Illinois...............     0.8800
15..................................  Indiana................     0.9077
16..................................  Iowa...................     0.9039
17..................................  Kansas.................     0.8423
18..................................  Kentucky...............     0.8220
19..................................  Louisiana..............     0.7912
20..................................  Maine..................     0.8942
21..................................  Maryland...............     0.9532
22..................................  Massachusetts\1\.......     1.2306
23..................................  Michigan...............     0.9432
24..................................  Minnesota..............     0.9690
25..................................  Mississippi............     0.8305
26..................................  Missouri...............     0.8319
27..................................  Montana................     0.8838
28..................................  Nebraska...............     0.9334
29..................................  Nevada.................     0.9763
30..................................  New Hampshire..........     1.1462
31..................................  New Jersey\1\..........     ------
32..................................  New Mexico.............     0.9428
33..................................  New York...............     0.8715
34..................................  North Carolina.........     0.9077
35..................................  North Dakota...........     0.7912
36..................................  Ohio...................     0.9194
37..................................  Oklahoma...............     0.7912
38..................................  Oregon.................     1.0439
39..................................  Pennsylvania...........     0.8852
40..................................  Puerto Rico\1\.........     0.7912
41..................................  Rhode Island \1\.......     ------
42..................................  South Carolina.........     0.9225
43..................................  South Dakota...........     0.9007
44..................................  Tennessee..............     0.8142
45..................................  Texas..................     0.8408
46..................................  Utah...................     0.8635
47..................................  Vermont................     1.0463
48..................................  Virgin Islands.........     0.7912
49..................................  Virginia...............     0.8350
50..................................  Washington.............     1.0826
51..................................  West Virginia..........     0.7912
52..................................  Wisconsin..............     1.0142
53..................................  Wyoming................     0.9798
65..................................  Guam...................     0.9611
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban, with the
  exception of Massachusetts and Puerto Rico. Massachusetts and Puerto
  Rico have areas designated as rural; however, no short-term, acute
  care hospitals are located in the area(s) for FY 2008. The rural
  Massachusetts wage index is calculated as the average of all
  contiguous CBSAs. The Puerto Rico wage index is the same as FY 2007.

[FR Doc. 07-3274 Filed 7-2-07; 8:55 am]
BILLING CODE 4120-01-P