[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]
[[Page 38121]]
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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
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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&mid=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
�������������������������������������������������
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
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\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